Journal of burn care & research : official publication of the American Burn Association
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Although the management of the severely burnt extremity poses a significant therapeutic dilemma, burn injuries resulting in amputation are uncommon, In such cases, however, amputation can reduce the rate of mortality. In a total of 1858 patients from January 1980 to January 2004, there were 34 amputations in 27 patients. There were 23 men (age range, 14-64 years) and 4 women (age range, 34-85 years). ⋯ The majority of single lower-limb amputees and only one of seven bilateral amputees were independently mobile. The presence of pre-existing psychiatric disease significantly impaired rehabilitation. Free tissue transfer and the usage of bioengineered materials may help reduce the incidence of amputations.
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Using Acticoat (Smith & Nephew, London, UK), a dressing that requires changing only twice per week, we are able to discharge children with medium-sized burns for the majority of their acute care. In sizeable wounds, early burn care is often too painful to do at home and, therefore, sedative analgesia or anesthesia can be provided by the burn unity as necessary. In the interval between dressings, the patients remain at home. ⋯ Children treated with Acticoat spent, on average, 0.83 days admitted in hospital whereas those treated with silver sulfadiazine averaged 13.85 days (P < .001). There was a reduction in complications in patients treated with Acticoat and the need for skin grafting was not increased. We have been able to facilitate earlier discharges while continuing to provide safe and effective comprehensive burn care.
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Neuroleptic malignant syndrome (NMS) is an uncommon, potentially fatal syndrome that occurs with the use of neuroleptic medications. In view of the rarity of this syndrome and the overlap with the pathophysiologic manifestations of a burn, the burn surgeon may not readily recognize NMS on presentation. We describe the case of a 27-year-old man with 15% TBSA burns who developed NMS as a result of metoclopramide use. ⋯ Initial treatment should include immediate withdrawal of all neuroleptic agents, measures aimed at decreasing body temperature, supportive care, and restoration of dopamine balance. Various authors have advocated treatment with various medications, including benzodiazepines, dantrolene, and dopaminergic agents. It is important for burn unit personnel to be aware of this syndrome because the early institution of therapy can be life saving.