Search PubMed⌕ Search

Biomedical subjects

B J Grube

Publications and source records attributed to B J Grube.

25 records · Page 2Linked to original sources
PubMedDate not supplied

Use of 5% sulfamylon (mafenide) solution after excision and grafting of burns.

In previous reports, 5% sulfamylon solution has been utilized on unexcised burns and granulation tissue. We prospectively evaluated 67 burn patients to determine graft take and the incidence of side effects with use of sulfamylon solution dressings after excision and grafting. Of patients excised and grafted, the mean graft take for a total of 100 procedures was 86%. Rash occurred in 18% of patients and sulfamylon was discontinued with no sequelae. Twenty-five percent had at least one positive fungal wound culture, yet only 3% required treatment for candidemia. Those patients who developed a rash and fungal colonization had a significantly larger percent burn and were treated with sulfamylon for a longer period of time. Pain intensity was rated on a Visual Analog Scale with a mean score of 2.4; in no case was the pain considered severe enough by the patient to terminate treatment. Acidosis was present in 3% of patients but felt to be unrelated to the sulfamylon treatment. As an antimicrobial agent, 5% sulfamylon solution is a viable alternative for fresh autografts with excellent graft take and acceptable side effects.

Administration, Topical↗
PubMedDate not supplied

Determinants of donor site infections in small burn grafts.

Studies indicate no advantage to the early use of systemic antibiotics in patients with burns, but the use of prophylactic antibiotics during excision is still being questioned. The records of 213 patients who required excision and who had less than 20% total body surface area burned were reviewed. We investigated risk factors associated with donor- and graft-site infections and whether or not perioperative antibiotics influenced the incidence of infections. Statistically significant increases in donor-site infections occurred when patients did not receive perioperative antibiotics, when the excision was large, and when the time between injury and excision was prolonged. Age, burn size, or type of dressing did not influence the development of infections. A risk of graft infections in those patients who were not receiving perioperative antibiotics existed, but it was not significant. The time between injury and excision and the actual size of the excision influence the development of donor-site infections. However, perioperative antibiotics seem to decrease the risk of these infections.

Adult↗
PubMedDate not supplied

The management of burns to the perineum and genitals.

A review of 1987 patients treated during the years 1981 to 1986 was conducted to answer the following questions about perineal burns: (1) Are Foley catheters necessary for all patients? (2) Is there any advantage to early excision of the perineal burn wound? (3) What are the complications of perineal wounds? One hundred three patients with perineal burns were identified; mean burn size was 36% of total body surface area. There were 29 deaths in this group but none were related to the perineal burns. Of the 74 survivors 36 (49%) needed Foley catheters. However, the catheters were in place for the period of resuscitation only. There were no urethral complications associated with catheterization. Only three patients required surgery: one had a urethral meatotomy and two had split-thickness skin grafts. In conclusion, we found no genitourinary complications associated with perineal burns. Almost all perineal and genital burns were managed without indwelling catheters. Early excision of the perineal burn wound is not necessary, and most of these wounds will heal satisfactorily without grafting.

Burns↗
PubMedDate not supplied

Infection control in a burn center.

No consensus has been reached on the ideal isolation technique to prevent hospital-acquired infection in the patient with burns. This study reports four 2-month consecutive periods of microbial surveillance in a burn center intensive care unit. Phase I, the first period of surveillance, demonstrated a unit-acquired colonization rate of 63%, with the marker organisms appearing at 4 to 8 days. Direct observation of isolation technique showed a 51% error rate. A mandatory educational session reviewing the high colonization rates, observed breaks in isolation technique, and principles of infection control failed to decrease the colonization rates as measured in phase II. A simplified isolation technique was adopted, which led to a decrease in unit-acquired colonization, from 63% to 33% in phase III from phase I values (p = 0.0514); and to a significant delay in inception, from 7.8 to 21 days, in those colonized with Pseudomonas aeruginosa (p less than 0.05). The simplified isolation technique decreased isolation costs over a 6-month period from $53,000 to $30,000. To confirm the decrease colonization rates from phase I to phase III, a fourth 2-month surveillance period was undertaken 6 months later. Phase IV demonstrated similar results to those of phase III.

Burn Units↗
PubMedDate not supplied

Therapeutic hyperbaric oxygen: help or hindrance in burn patients with carbon monoxide poisoning?

Although its efficacy is unproved, administration of hyperbaric oxygen (HBO) for the treatment of carbon monoxide poisoning is often carried out to prevent the development of acute and delayed neurologic sequelae. In burn patients with carbon monoxide poisoning the value of HBO also is unproved. This review of the clinical course of ten such patients showed major complications during the course of treatment: two patients suffered from eustachian tube occlusion, two patients had episodes of aspiration, one patient had seizure activity, and severe hypocalcemia developed in another. Progressive hypovolemia was seen in three patients; respiratory acidosis was evident in four. There were three episodes of cardiac dysrhythmia. Seven of the ten patients survived. The authors state that the efficacy of HBO in carbon monoxide poisoning must be studied further. Based on their experience and a review of the literature, they contend that important delayed neurologic sequelae are rare, and further, that they occur and resolve with or without HBO. Multicenter randomized clinical trials with controlled follow-up are needed to assess the actual incidence of neuropsychiatric sequelae and to evaluate the efficacy of HBO.

Adult↗
PubMedDate not supplied

The Unna 'sleeve': an effective postoperative dressing for pediatric arm burns.

The goal of this study was to develop a postoperative plan for sheet grafts that would protect the graft, yet would also eliminate the need for daily wound care. Eleven pediatric patients (13 arms burns) who underwent excision and grafting were included in our study. The total area on the arm ranged from 1% to 5% total body surface area. All grafts were sheet grafts held in place with steri-strips or sutures. The grafts were covered with a layer of greasy gauze, followed by an Unna done paste dressing, and then an elastic bandage. The Unna "sleeve" remained in place for an average of 6 days (range, 3 to 10 days). In eight cases, a second Unna sleeve was applied and removed 6 to 7 days later. In all 13 cases, additional wound care for grafts was unnecessary, and patients did not require extended inpatient hospitalization. Graft take was 100% in all cases, and no reconstruction was required.

Arm Injuries↗