During the past decade, morbidity and mortality have been shown to be decreased by early excision and grafting in treatment of moderate and large burns. Because of the lack of data on the efficacy of such treatment in scald burns, a retrospective study was done of children under age 4 who were admitted to a burn unit within three days of scald injury. Four groups were examined according to day of first surgical procedure: (1) sooner than five days; (2) 6-10 days; (3) 11-20 days; and (4) later than 20 days. The four groups (similar in age, weight, and percent of TBSA burn) were also analyzed for differences in percent of excised area, blood loss, and length of hospital stay. The amount of excised area in group 1 was significantly larger than in groups 2 and 3, and group 1 also had a significantly greater blood loss. Only in group 4 was the length of stay significantly increased. If excision could be delayed until after day 5, the area excised and the blood loss might be decreased without prolonging hospital stay.

Burns↗

PubMedDate not supplied

Comparison of complications during rehabilitation between conservative and early surgical management in thermal burns involving the feet of children and adolescents.

To evaluate the long-term sequelae of early surgical management compared with conservative therapy, a retrospective review from January 1976 to December 1984 was undertaken. Through inspection of burn diagrams, 395 patients were identified with burns involving the foot. From 1976 through 1980, 109 patients were managed in a conservative fashion with topical antimicrobial therapy and delayed debridement and grafting; 36 of these patients with severe burns were managed with skeletal suspension. Between 1981 and 1984, 136 patients were treated with earlier surgical debridement and grafting; during this period, skeletal suspension was rarely used. No statistical difference was found in mortality, amputations, incidence of open wounds, development of contractures, or number of patients requiring reconstructive procedures between conservative and early excision therapy except in those children treated with skeletal suspension. Thus in burns involving the feet in children, early excision and grafting does not alter the resultant morbidity compared with conservative burn management.

Adolescent↗

PubMedDate not supplied

Increased mortality with intravenous supplemental feeding in severely burned patients.

Patients with large cutaneous burns are characterized by an elevated metabolic rate and lose up to 25% of their body weight within 3 weeks. A previous study suggested that intravenous supplementation to attain nutritional requirements was of no benefit in patients with cutaneous burns covering greater than 50% of their total body surface area. In this study 39 patients with burns greater than 50% of their total body surface area were randomly assigned to receive intravenous supplementation of enteral calories (n = 16) or enteral calories alone (n = 23). Intravenous supplementation decreased the amount of enteral calories that patients with burns could tolerate. The mortality rate was significantly higher (p less than 0.05) in the intravenously supplemented group at 63% as compared with 26% in the group receiving enteral calories alone. Both groups showed significant decrease in natural killer cell activity when compared with controls at both 0 to 7 and 7 to 14 days after injury. T cell helper/suppressor ratios were depressed in both groups when compared with controls; however, the intravenously supplemented group was significantly depressed at 7 to 14 days after burn. Both groups demonstrated hepatomegaly, moderate fatty infiltration, and cholestasis. It is suggested that intravenous supplementation should be carefully evaluated and used only in patients with total enteral failure.

Adult↗

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Fungal sepsis: an increasing problem in major thermal injuries.

In major thermal burns there has been an alarming emergence of fungal sepsis as defined by involvement of three or more organs and/or repeated positive blood cultures. During an 18-month period, we treated 72 patients (aged 18 +/- 2 years; TBSA burn, 57 +/- 3%; percent of third-degree burn, 45 +/- 3) with fungal sepsis. In all patients with documented three-organ involvement, treatment was with intravenous amphotericin (0.5 mg/kg body weight/day), immediate wound debridement, and early wound closure. The mortality was 32% (23 patients); 49 (68%) survived infection. Sixty-two variables were reviewed retrospectively using multiple regression analysis to ascertain specific factors associated with fungal sepsis and their relationship to survival. In burn patients, fungal sepsis is a strong determinant of survival, and its occurrence overshadows traditional factors presently utilized to predict clinical outcome.

Adolescent↗

PubMedDate not supplied

Gasoline explosions, gasoline sniffing: an epidemic in young adolescents.

One hundred twenty-two patients between the ages of 10 and 15 were admitted to the Shriners Burns Institute between July 1981 and November 1984. Seventy-five of the 122 patients sustained burns as a direct result of liquid gasoline explosions. Thirty patients had thrown gasoline on a fire and 17 others admitted to having ignited gasoline with a match. During admission interviews, none of the patients admitted to gasoline sniffing; however, 19 patients were subsequently found to have been sniffing gasoline at the time of the accident. All of the patients with gasoline burns sustained much larger burns, had longer hospitalizations, and required more surgery than did patients burned by other means. Similarly, the 19 patients who had been sniffing gasoline had larger burns, had longer hospital stays, and required more surgery than did those injured by gasoline in other accidents. The most common cause of thermal injury in the ten-to-15 year age group is a gasoline-related accident. The histories of a large number of these adolescents may be compatible with explosions related to gasoline sniffing. Educational efforts relating to the explosive nature of the substance and the dangers of gasoline sniffing are warranted.

Adolescent↗

PubMedDate not supplied

Positioning and splinting the burned patient.

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Bandages↗

PubMedDate not supplied

The use of intravenous aortography in the diagnosis and management of aneurysms of the aorta.

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Adolescent↗