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Biomedical subjects

C F Snelling

Publications and source records attributed to C F Snelling.

At least 19 recordsLinked to original sources
PubMed1995

Cultured epithelial autograft: five years of clinical experience with twenty-eight patients.

Cultured epithelial autograft (CEA) has been used as an adjunct in burn wound coverage at the Vancouver Hospital and Health Sciences Centre since 1988, and has been available to all patients admitted with significant burn injuries. During the 5-year period from 1988 to 1992 inclusive, 28 patients treated with CEA survived long enough for assessment. The mean age was 35.3 years with a mean total body surface area burn of 52.2% and a mean total full thickness injury of 42.4%. CEA was applied to wounds covering between 2% and 35% body surface area (BSA; mean 10.4%) after excision to fat or fascia. Most wounds had interim homograft coverage. Preservation of homograft dermis was attempted in three patients at the time of removal without effect. The mean CEA "take" was 26.9% of the grafted area. Eight patients had 50% or greater take and were discharged with between 1 and 19% BSA covered with CEA. Thirteen patients had no take on wounds between 2 and 16% BSA. Overall mortality in burn patients treated at the Vancouver Hospital and Health Sciences Centre from 1988 to 1992 was not significantly different from 1983 to 1987 with the populations being similar in terms of total BSA burns, age, inhalation injury, and homograft availability. When compared to a matched control population from the preceding 5 years, when CEA was not available, there was no significant difference in duration of hospital stay or number of autograft harvests. However, approximately one more debridement without autograft harvest per CEA patient occurred. Timing and depth of wound excision, interim coverage, type of dressing, and wound microbiology were not found to influence good versus poor take. The anterior trunk and thighs were the best recipient sites. Subjective differences between CEA and meshed autograft were noted. The results show that after 5 years of use, CEA engraftment continues to be unpredictable and inconsistent, and hence, it should be used as only a biologic dressing and experimental adjunct to conventional burn wound coverage with split thickness autograft.

Adolescent↗
PubMed1995

Lower extremity burns and Unna paste: can we decrease health care costs without compromising patient care?

OBJECTIVE: To compare an alternative treatment for lower extremity burns with the standard in-hospital treatment, in an attempt to shorten hospital stay. DESIGN: A case-control series. SETTING: A university-affiliated hospital. PATIENTS: All patients with a burn isolated to a lower extremity were treated over an 8-month period with split-thickness skin grafting (STSG), Unna paste dressing, immediate mobilization and early discharge. This group was compared with matched controls from the preceding 8 years treated with STSG, occlusive burn gauze dressing, bed rest and hospitalization. MAIN OUTCOME MEASURES: Duration of hospital stay and graft viability. RESULTS: Thirteen patients with an average wound size of 131 cm2 were treated with Unna paste and had a graft viability of greater than 95% and a burn-scar rating equivalent to that of patients treated with the earlier regimen. The duration of hospital stay decreased from a mean of 12.9 days to 1.4 days, with no complications. This translated into a saving of $10,350 per patient. CONCLUSIONS: This alternative treatment is safe, inexpensive and effective and is recommended as the treatment of choice for uncomplicated, noncircumferential lower extremity burns.

Adolescent↗
PubMed1992

Trends in hospital care of burns in Canada.

A review of burn admission patterns to Canadian hospitals from 1966 to 1991 from Statistics Canada data was prompted by a decrease to 125 burn patients admitted to Vancouver General Hospital in 1990 after a plateau at 180-195 per year for 6 years. The total number of fires from Fire Commissioner's data and data from 20 of the 27 Canadian burn units was analyzed. Canadian burn admissions decreased from 57 per 100,000 in 1966 to 23 per 100,000 in 1989. The admission rate is three times greater for children 0-4 years of age but has decreased parallel with the total. The number of fires decreased from 370 to 270 per 100,000 in the last decade. In 1981, 1986, and 1989 15 Canadian units treated a constant 15% share of hospitalized burns, while nine units reported a constant 7% of burn patients who also required ventilation for associated smoke inhalation injury. These trends forecast a 2%-4% decrease in hospitalized burns per capita per year.

Adolescent↗
PubMed1991

Comparison of silver sulphadiazine 1 per cent, silver sulphadiazine 1 per cent plus chlorhexidine digluconate 0.2 per cent and mafenide acetate 8.5 per cent for topical antibacterial effect in infected full skin thickness rat burn wounds.

Silver sulphadiazine 1 per cent (SS), silver sulphadiazine 1 per cent plus chlorhexidine digluconate 0.2 per cent (SS + CD 0.2 per cent) and mafenide acetate 8.5 per cent (MA) were compared to assess the antibacterial effect of once daily application on experimental rat 20 per cent full skin thickness burn wounds seeded 24 h earlier with 10(8) microorganisms originally isolated from infected wounds of burned patients. Separate series evaluated Staph. aureus, Enterococcus faecalis, Enterobacter cloacae and Ps. aeruginosa. The mean concentration of all four organisms recovered after 1 week from full thickness biopsies of eschar and from separate biopsies of subjacent muscle was less in MA and SS + CD 0.2 per cent treated animals compared with those treated with SS alone. The mean concentration in muscle and eschar following treatment with MA was less for wounds seeded with Staph. aureus and Ps. aeruginosa than with SS + CD 0.2 per cent treatment, while the mean concentration in eschar application of SS + CD 0.2 per cent was less than with MA for E. faecalis seeded wounds.

Administration, Topical↗
PubMed1988

Comparison of standard and chlorhexidine-derivative topical antibacterial agents on the infected burned rat wound.

The effect of daily treatment with three current topical antibacterial agents and four experimental formulations of chlorhexidine was evaluated after 1 week in rats with full thickness burns. The burn was seeded with 1 x 10(8) colony forming units (CFU) of a strain of P. aeruginosa isolated from the infected wound of a burn patient. Mafenide acetate resulted in the lowest incidence of muscle invasion and yielded the lowest mean eschar and muscle concentrations. Mafenide acetate, gentamicin, and chlorhexidine diphosphanilate (0.5 per cent) had lower mean eschar and muscle concentrations than silver sulphadiazine 1 per cent alone. Addition of chlorhexidine digluconate (0.5 per cent or 1.0 per cent) to silver sulphadiazine reduced mean eschar concentrations but not muscle concentrations compared to silver sulphadiazine alone. All treatments effectively suppressed systemic invasion of lung and blood and prevented death compared with controls. Mafenide acetate, gentamicin sulphate and chlorhexidine disphosphanilate 0.5 per cent were most effective against this patient strain of P. aeruginosa.

Administration, Topical↗
PubMed1988

Tetanus--a continuing problem in minor injuries.

Tetanus is rare in North America because of highly effective specific immunization programs. Nevertheless, 15 patients with generalized tetanus were treated at the Vancouver General Hospital over a 20-year period; 10 of them were over 50 years of age. Two patients had no injury and 12 had suffered only minor wounds. None had received previous immunization and, even after wounding, prophylaxis was unsatisfactory in all cases. Nine patients required intensive care and two died. Positive cultures were obtained in only two cases. Four recommendations are made to prevent tetanus: (a) all wounds should be considered "tetanus-prone", (b) an accurate history of immunization should be obtained, (c) more attention should be given to prophylaxis at the time of injury and (d) patients should record vaccinations.

Adult↗
PubMed1985

Acalculous cholecystitis: its role as a complication of major burn injury.

The authors present four cases of acute acalculous cholecystitis complicating major burn injury and review the recent literature on acalculous cholecystitis. All patients were men and ranged in age from 22 to 40 years. The mean extent of the burn was 50% of the total body surface area, with an average 29% third-degree component. All four patients survived. Because of their severity, major burn injuries expose patients to many risks, including acute acalculous cholecystitis. Recent experimental evidence supports a vascular insult through the activation of Factor XII pathways as the initial event. A diagnosis is made on clinical grounds, supported by laboratory and ultrasonographic findings, in a patient with a burn covering more than 30% of the total body surface area and who has signs of acute cholecystitis. Cholecystectomy is the treatment of choice; tube cholecystostomy is reserved for critically ill patients.

Acute Disease↗
PubMed1985

Fingertip amputation: review of 100 digits.

Evaluation of the functional results and complications of 100 fingertip amputations revealed no difference between the two most commonly used repairs; 52 injuries were treated by primary closure with residual viable skin flaps and 27 by split-thickness skin grafting. No decline in unfavourable functional results was found when patients evaluated 6 weeks after injury were compared to patients evaluated 42 weeks after injury, suggesting that delaying the patient's return to full activity by prolonging rehabilitation is unlikely to yield much improvement. Shortening the nerves in proximal amputations closed by residual flaps did not decrease nerve irritation. Resection of bone produced a mobile amputation-stump tip. While the mean time off work or return to full activity following skin grafting was 6 days less than it was after primary closure, the difference was not significant.

Absenteeism↗
PubMed1985

The comprehensive burn unit.

A burn unit is only as good as its staff. Trained, experienced nurses, therapists and surgeons accustomed to dealing with large open wounds are a major requisite for the care of burned patients, who have a multisystem disease. Equipment needs include monitors, hydrotherapy tank, ready access to the operating room and comprehensive rehabilitation facilities. Skilled anesthesia, consultative support in nephrology, respirology, pediatrics and infectious diseases, a blood bank, access to human allograft and good microbiology support are necessary. Ventilatory support for associated smoke inhalation injury may be provided on the unit or in a separate ventilatory intensive care unit with isolation capability. In 1982, 29.9 Canadians per 100 000 were hospitalized for burn care (approximately 20% to 25% in burn units). Burn care requires a high staff-to-patient ratio and a hospital budget to support this is mandatory.

Burn Units↗
PubMed1984

Prospective comparison of silver sulfadiazine 1 per cent plus chlorhexidine digluconate 0.2 per cent (Silvazine) and silver sulfadiazine 1 per cent (Flamazine) as prophylaxis against burn wound infection.

Patients with fresh full-thickness burn wounds were randomly assigned to receive wound treatment with daily applications of either 1 per cent silver sulfadiazine plus 0.2 per cent chlorhexidine digluconate cream (Silvazine) or 1 per cent silver sulfadiazine (Flamazine). Fifty-four patients treated with Silvazine were comparable to 67 treated with Flamazine with respect to extent and distribution of burn, age and all aspects of wound and associated treatment. Overall incidence of wound bacterial colonization was less in the Silvazine treated patients (65 per cent versus 88 per cent; P = 0.002). With Silvazine, wound colonization by Staphylococcus aureus was less (41 per cent versus 64 per cent; P = 0.01). Clinical wound infection with Staph, aureus developed in one Silvazine treated patient and five Flamazine treated patients (P = 0.16). Colonization by and infection due to all other organisms did not differ in the two groups. The incidence of graft failure was similar with both agents. In future increasing the concentration of chlorhexidine digluconate above 0.2 per cent might produce an improved prophylactic effect against Gram negative bacteria reported by other authors using the combined agent in in vitro and clinical trials. Silvazine was effective in reducing the incidence of Staph. aureus burn wound colonization without fostering supervening opportunistic infection.

Adolescent↗
PubMed1983

Delayed skin graft application following burn scar release of the face and hand.

Hypertrophic scars and contractures involving the face and hand secondary to burns were excised and the defects covered with saline compresses changed every 4 hours. Banked split-thickness skin grafts were applied 24 to 48 hours later. Upper and lower lip, cheek, forehead, scalp, neck, the first web space of the hand, and the flexor surfaces of the fingers were treated. Head and neck defects were grafted open. Hand defects created by release were maintained with dynamic splints and grafted open or covered with bolus dressings kept in place with sutures inserted at the time of creation of the defect. Jobst compression with elastomer inserts for added pressure was started postoperatively. It is believed that delay permitted natural hemostasis to occur without extensive electrocoagulation, which produces additional necrotic tissue. Anesthetic time was shortened. Delay also permitted capillary proliferation to start in the defect, hastening revascularization of the grafts.

Adult↗
PubMed1983

The effect of topical epinephrine hydrochloride in saline on blood loss following tangential excision of burn wounds.

Burn wounds that were excised tangentially in the first 21 days after the burn were dressed immediately following excision with either saline or epinephrine hydrochloride-saline compresses (30 mg in 1030 ml normal saline) that were then left for 30 minutes while skin was harvested and banked. Thereafter, saline compresses were applied to all patients' wounds and changed every 4 hours. Banked skin grafts were applied without the need of a second general anesthetic on the first postoperative day. In both groups of patients, blood loss exceeded 9 percent of the calculated blood volume for each 1 percent of the body surface excised (this included blood loss due to harvest of skin graft necessary to cover the excised wounds) when the excision was performed in the first 14 days after the burn. Addition of epinephrine did not reduce net blood loss. Premature ventricular contractions were not observed, although 2 of 29 patients had an elevation in pulse rate of 25 beats per minute or more. No factors were identified that would reduce the blood loss following early tangential burn excision. Before embarking on tangential excision in the early postburn period, one must be prepared to replace 10 percent of the circulating blood volume for each 1 percent of the body surface to be excised.

Administration, Topical↗
PubMed1982

Amino acid metabolism in patients with severe burns.

In this study we set out to determine, if relative to net catabolism of skeletal muscle protein as measured by phenylalanine release, the transamination of branched-chain amino acids (valine, isoleucine, and leucine) was greater in nonseptic burn patients than in controls. Arterial and femoral venous amino acid concentrations and circulating liver enzyme levels were measured. When the ratio of the arterial-femoral venous difference in concentration of each branched-chain amino acid to that of phenylalanine was determined, transamination of the branched chain amino acids, relative to net proteolysis, was not occurring at a greater rate in the burn patients. The net release of alanine relative to that of phenylalanine was not significantly greater in the burn patients, consistent with the conclusion that relative to the net rat of proteolysis, transamination of branched-chain amino acids in skeletal muscle is not increased in burn patients. This finding differs from that in septic dogs and septic humans. The mean arterial-femoral venous differences in concentration of alanine, valine, isoleucine, leucine, and phenylalanine were greater in the burn patients (P less than 0.03), indicating increased proteolysis in this group.

Adult↗
PubMed1980

Timing of distant flap pedicle division using xenon 133 clearance.

Clearance of intradermally injected xenon 133 was used to measure blood flow in distant flaps in humans with the donor pedicle temporarily clamped just prior to division. All 18 flaps with a blood flow of 0.5 ml per 100 gm of tissue per minute or more survived completely after separation. Of 7 with lesser flow, 3 underwent marginal necrosis adjacent to the line of division and 4 survived entirely. The false-negative result (complete flap survival in 4 patients) was artifactual due to isotope injection too close to the clamp, reflecting increased local tissue tension caused by the clamp rather than low blood flow in the flap. Xenon 133 washout does permit quantitative evaluation of blood flow, and since it is a clean isotope, it appears superior to sodium 24 and technetium 99m, which have been used in a similar manner. The test is proposed as an adjunct to clinical judgment in timing pedicle division.

Humans↗
PubMed1980

Comparison of donor site dressings.

A comparison study of donor site care using 5 common modalities was undertaken. A total of 210 treated donor areas were examined for healing differences, comfort, complications, and cost. At the conclusion of the study we were able to recommend certain treatment methods depending on the nature of the donor wound.

Animals↗
PubMed1980

Clinical evaluation of the Hydron burn dressing.

Hydron, a synthetic barrier dressing composed of polyhydroxyethyl methacrylate (PHEMA) and polyethylene glycol (PEG), was applied to the burn wounds of 15 hospitalized patients. Application of the dressing was found to be time-consuming to the doctor and tedious for the patient. Dressing integrity was frequently broken by cracking, peeling, or ineffectual drying. Burn-wound colonization occurred beneath Hydron no more frequently than observed in other patients whose wounds had been treated with topical antibacterial agents. In general, the application of Hydron caused a reduction in burn-wound pain. In its present form, Hydron did not produce results superior to those observed in our other hospitalized burn patients. Due to technical difficulties, it is no longer being used in our unit.

Adolescent↗
PubMed1979

Avascular necrosis of bone following revascularization of the thumb.

A 35-year-old man underwent revascularization of a thumb transected through the base of the proximal phalanx after sharp division of all structures except a bridge of dorsal skin 1 cm wide. The digit survived. Avascular necrosis of the bone of the distal segment of the proximal phalanx was evident at 4 weeks and maximal at 9. Avascular necrosis did not occur in the distal phalanx. Roentgenographic changes indicated revascularization initially at the distal end of the phalanx, progressing proximally. Revascularization was first evident subperiosteally and progressed centrally; it was complete at 31 weeks. Fracture healing was delayed-evident at 17 weeks and complete at 27 weeks after injury. Avascular necrosis of bone may be the cause of delayed union or nonunion of bone cited in recent long-term reviews of successfully replanted digits. Measures should be taken to monitor, minimize, and compensate for this complication.

Adult↗