Journal of burn care & research : official publication of the American Burn Association
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Early tangential excision of nonviable burn tissue, followed by immediate skin grafting with autograft or allograft, has resulted in the improvement of burn patient survival. The aim of this study was to add split-thickness dermal grafts (STDGs) as a new source of auto-skin grafting tool to our reconstructive armamentarium in deep partial- and full-thickness burns and soft tissue defects. The authors successfully applied STDGs along with split-thickness skin grafts as a new source of auto-skin grafting in 11 deep partial- and full-thickness burns over a period of 1 year without any significant donor site morbidity. ⋯ There was no donor site healing problem, and donor site epithelization was completed generally 1 week later than split-thickness skin graft by semi-open technique. Autologous split-thickness skin grafting still remains the standard therapy for burn wound closure but may be in limited availability in severe burns. The authors conclude that STDGs may be a new source of auto-skin grafting tool in extensive deep partial- and full-thickness burns.
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Comparative Study
Identification of risk factors associated with critical illness related corticosteroid insufficiency in burn patients.
The goal of this analysis was to characterize risk factors of patients who develop critical illness-related corticosteroid insufficiency (CIRCI) after acute burn injury. This is a retrospective, single-center case-control descriptive study performed at a regional burn unit at an academic medical center. Patients are adults with acute burn injury who developed CIRCI (cases) and sex-, age-, and burn size-matched controls. ⋯ Multivariate conditional logistic regression analysis including Charlson Comorbidity Index and inhalation injury showed significant association of both dependent variables with CIRCI (pseudo-R2 = .32, P ≤ .001). Preexisting comorbidities and inhalation injury provide significant risks for development of CIRCI after acute burn injury. Acute burn patients who develop CIRCI have higher mortality, length of stay, and ventilator days than matched controls.
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Comparative Study Controlled Clinical Trial
Exploration of nonsurgical scar modification options: can the irregular surface of matured mesh graft scars be smoothed with microdermabrasion?
The purpose of this study was to determine, in principle, whether microdermabrasion can alter waffle-pattern (meshed split-thickness skin graft) burn scars after scar maturation. Matured waffle-pattern mesh-graft scars were treated with multiple microdermabrasion sessions over the course of a year (maximum 20). Before and after treatment, the treated scars and the control scar on the same patient were assessed with subjective and objective scar assessment tools (scar scales, cutometer [elasticity], laser Doppler flowmeter [vascularity], Semmes-Weinstein filaments [sensation], and high-resolution ultrasound [thickness]). ⋯ Both Vancouver scar scale and patient assessment scales showed significant improvement. The study showed that even mature waffle pattern scars can be modified by minimally invasive interventions. Larger study groups and more economic treatment modalities need to be studied in the future.
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Comparative Study
Predictors of patient satisfaction with pain management and improvement 3 months after burn injury.
Very little is known about what influences patient satisfaction with burn pain management. The aim of this prospective study was to examine predictors of patient satisfaction with pain management following burn injury. ⋯ These findings suggest that acute medication use and reductions in perceived pain symptoms are less closely related to patient satisfaction compared with treatment expectations, current pain and posttrauma symptoms. Collectively, these findings indicate a need to proactively address treatment expectations about pain management, and manage current pain and psychological distress following burn injury in order to improve patient satisfaction with care received.
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The aim of this study was to evaluate the use of a polyhexamethylene biguanide biocide-impregnated gauze (Kerlix™ AMD gauze dressing, Covidien d/b/a Tyco Healthcare Group LP) as an adjuvant to routine burn care and its impact on the incidence of hospital-associated infections in burn population. One hundred eight burn patients admitted to the Burn Treatment Center were prospectively enrolled from August 2008 to June 2009 and matched 1:2 with historic controls who were admitted from March 2006 to July 2008. Clinical care remained otherwise unchanged; however, several hospital initiatives (the national surgical improvement project, the surgical care improvement project, and a central venous line bundle) were initiated before and during the study. ⋯ Implementation of polyhexamethylene biguanide biocide-impregnated gauze was temporally correlated with a significant decrease in healthcare-associated infections in burn population. As there was no corresponding decrease in wound infections, the impact of the gauze on healthcare-associated infections, if any, cannot be conclusively determined by this study. A larger prospective study powered to detect a decrease in wound-related infections is warranted.