This study defines the normal anatomical relationships among the coracoacromial ligament, the deltoid, and the acromion in cadavers. The effect of arthroscopic acromioplasty on the acromial attachments of the coracoacromial ligament and the anterior fibers of the deltoid was also studied. After arthroscopic acromioplasty, the fibers of coracoacromial ligament and overlying deltoid inserting into the anterior part of the acromion remained attached to the acromion by a bridge of tissue composed of periosteum and collagen fibers of the coracoacromial ligament and deltoid tendon. We have called this the coracoacromial-deltoid-periosteal complex; it has not previously been described. This study demonstrates that arthroscopic acromioplasty preserves the acromial attachment of the coracoacromial ligament and the anterior fibers of the deltoid.

Acromion↗

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Effect of plasma exchange therapy on circulating fibronectin in burned patients.

Explore the source record for details and available documents.

Adult↗

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Do changes in burn size affect measured energy expenditures?

Explore the source record for details and available documents.

Body Surface Area↗

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Cold injury: a collective review.

Cold injury remains a crippling problem. Although research is opening new avenues of accurate diagnosis and expeditious treatment, the gold standard against which these methods must be measured continues to be conservative treatment.

Adolescent↗

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Is tracheostomy warranted in the burn patient? Indications and complications.

Considerable controversy exists as to whether a tracheostomy (TT) is ever indicated in burn patients. Eighty-eight tracheostomies were performed over a 48-month period. An inhalation injury was present in 59.6% of the patients, and 96% had preceding endotracheal intubation (ET). The mean duration of ET was 14 days. Seven percent, 17% and 58% of the TTs were performed within the 1st, 8th, and 14th postburn day, respectively. The indications for TT were: emergency airway access, 7%; complications secondary to ET, 8%; pulmonary sepsis, 75%; pulmonary failure, 10%. The mean duration of TT was 33 days (range: 1-209). Major complications associated with TT included: tracheomalacia, tracheostenosis, tracheoinnominate artery and tracheoesophageal fistulae, and posttracheostomy dysphagia. The decision to perform a TT or to continue with ET should not be predicated on an arbitrary number of days, but must be individualized and based on the clinical condition of the patient. The complications associated with a TT are related to previous ET and to the underlying pulmonary pathology necessitating ventilatory support.

Adult↗

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Vascular access through the femoral vessels: indications and complications.

A prospective study was performed to assess the indications for and complications of femoral vascular access in burn patients. In the study, 1655 femoral catheters (one-third arterial) were inserted in 232 patients; 136 of the catheters were inserted in 29 children (18 were younger than five years of age; the youngest was four months old). Insertion was "easy" in 83.9% of the insertions and "difficult" in 7.6%, with no difference noted between arterial and venous insertions. There were six significant complications: local abscess requiring drainage (2), arterial occlusion (3), and extravasation (1). No septic arthritis, deep infections, catheter erosions, venous thrombosis, embolisms, or late complications were noted. Venous and arterial access through the femoral vessels is an appropriate route for vascular access in burn patients when care is taken to minimize complications. This area is usually free of burn, provides ready access to central vessels, is technically easy, and has few complications.

Abscess↗

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Range of motion of the shoulder performed while patient is anesthetized.

Significant loss of shoulder range of motion (ROM) in the early stages of burn recovery is a common and frustrating complication of burn injury. Pain is a primary reason for decreased motion: it prevents the patient from cooperating in an aggressive therapy program that could minimize contracture formation. To combat loss of movement without inflicting severe pain, the performance of ROM exercises and gentle passive stretching while patients were anesthetized was used as a treatment. A total of 59 treatments were performed on 14 patients who had limited unilateral or bilateral shoulder motion. A significant gain in shoulder ROM was attained when this treatment was performed and resulted in an increase in shoulder ROM when the patient was alert after anesthesia compared with preanesthesia measurements.

Adult↗

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Obesity: a risk factor in the burn patient.

Obesity is seldom recognized as a risk factor for the patient with burns. However, the overweight patient with burns presents major problems for the burn team, especially in the areas of wound care, pulmonary care, and general nursing care. One-hundred eighty adults (9.1% weighed more than 45 kg above ideal body weight or more than 100 kg in total weight. Mean weight was 110 kg, with 155 patients heavier than 100 kg. Mean age was 38 years with a mean burn size of 26% (11% full-thickness). The mortality rate was 21%, and respiratory and cardiovascular complications occurred in 33% of these patients. The obese patient presents problems disproportionate to burn size, burn location, and age. The obese patient's problems are related to weight. Care is often compromised by the physical constraints of a patient's size.

Adult↗

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A modified technique for securing oro-nasal tubes.

Secure positioning of orally or nasally placed endotracheal and gastric tubes is a necessity for the patient with burns. This article describes a technique for securing these tubes with a simple modification to avoid compression on the ear that may lead to subsequent necrosis and infection.

Burns↗

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Crawl on your belly like GI Joe.

Many pediatric burns can be prevented. However, education must be presented in an informative and interesting manner to be effective. Is it possible to teach burn safety to elementary school children in four sessions? Sixty-six fourth-grade children were involved in age-appropriate activities, experiments, and discussion that were spaced evenly throughout the school year. Content was based on material furnished by the local fire department with added videos and exercises. By having children crawl blindfolded on their bellies through halls like GI Joe TV characters and by having them watch dry vapors swirl around their faces, boring burn lectures can be turned into challenging and entertaining games. In a game-type testing session, 40 of 49 questions were answered correctly the first time. A community teaching project for interested burn team members is easily planned and implemented. The enthusiastic response of the children and the satisfaction of preventing a possible burn injury promotes continued involvement.

Burns↗

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Cardiac disease and the patient with burns.

Cardiac disease has many manifestations that may complicate burn care. A review of 2477 consecutive acute burn admissions was conducted to determine the types and incidence of cardiac complications in this patient population. Nearly one half of patients with a prior cardiac history manifested some form of cardiac dysfunction, most frequently arrhythmias. Eight percent had an in-hospital myocardial infarction. Only 6% of patients without a prior cardiac history manifested cardiac dysfunction. The in-hospital mortality rate after myocardial infarction for both groups was 3.5 to 4 times that of patients without burns. Except for patients with prosthetic valves, for whom anticoagulation and infection prophylaxis are required, burn care of the cardiac patient is expectant with selective use of invasive monitoring and therapy as determined by the patient's clinical course.

Adult↗

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Tap-water scald burns. Awareness is not the problem.

Review of admissions to a regional burn center showed that tap-water burns were an injury of pediatric, elderly, and neurologically impaired patients. A study was designed to measure general knowledge of tap-water injury and awareness of tap-water temperatures in homes. All those surveyed realized the potential for tap-water scald burns in their homes, and few believed that they could tolerate hot-only tap water at home for as long as 30 seconds. Respondents who had previous experience with tap-water burns had not lowered the settings of their water-heater thermostats. Economical but effective programs must be developed to encourage burn-reduction behaviors in high-risk groups.

Adolescent↗

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Ocular changes from electrical burn injuries. A literature review and report of cases.

One hundred fifty-nine consecutive patients with high-voltage burns were retrospectively reviewed to determine the ocular sequelae of these injuries. Five patients had ophthalmic changes (two had recurrent iritis, eight had cataracts, two had macular holes, and one had central retinal artery occlusion). All four patients with cataractous changes had characteristic anterior subcapsular opacifications, except for one patient who presented with a dense white opacified lens. All had bilateral lenticular changes in which the denser cataract developed earlier than the contact wound and ipsilateral to it. Central retinal artery occlusion has not been previously reported as a complication of electrical burns. Macular holes, formerly believed to be rare in these injuries, were found in two of the five patients. Ocular complications from electrical burn injuries are uncommon. Although a number of these ocular changes occur immediately after injury, many of the visually impairing changes develop days and even years after a severe electrical burn injury; thus, careful follow-up is mandated.

Adult↗