Journal of burn care & research : official publication of the American Burn Association
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There is an emerging mechanism of burn injury as a result of the ignition of butane, during the manufacture of a tetrahydrocannabinol concentrate known as butane honey oil. The authors report of a series of patients who presented with this mechanism of injury and a description of the process that causes these burns. Patient data were gathered from the medical records of eight patients treated at the University of California Davis Medical Center and Shriners Hospital of Northern California. ⋯ Although considered to be safer than previous methods, multiple casualties with extensive burn injuries have resulted from this process. Associated injuries from blast trauma or chemical burns are not likely to occur in these types of explosions and have not been observed in the series reported in this article. In light of the increasing popularity of honey oil, it is important for burn care providers to gain awareness and understanding of this problem and its growing presence in the community.
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The goal of burn surgical therapy is to minimize mortality and to return survivors to their preinjury state. Prompt removal of the burn eschar, early durable coverage, and late corrections of functional deformities are the basic surgical principles. The operative burden, while presumed to be substantial and significant, is neither well described nor quantified. ⋯ Battle vs nonbattle (OR, 0.546; 95% CI, 0.360-0.829; P = .0045), and TBSA of the upper extremities (OR, 1.008; 95% CI, 1.002-1.013; P = .0042) were noted to be significant variables in predicting late reconstruction operations. The operative burden of burn, not previously well characterized, consists of operations performed during as well as after the initial hospitalization. While injury severity and truncal involvement are significant determinants of acute surgical therapy, the presence of upper extremity burns is a significant determinant of reconstruction following discharge.
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In order to further understand the role of the cholinergic anti-inflammatory pathway, the authors determined the effects of burn plasma from donor rats (DRs) on the microvascular circulation of healthy recipient rats and whether these could be altered by pretreatment with physostigmine (PT). DRs underwent thermal injury (100°C water, 12 seconds, 30% BSA) for positive controls. For negative controls DRs underwent sham burn (same procedure but water at 37°C). ⋯ After 120 minutes no significant changes in the systemic circulation (mean arterial pressure, heart rate, wall shear rate) were found between the groups. Burn plasma transfer results in significant increases in plasma extravasation and leukocyte-endothelial wall adherence, which are reversed by pretreatment with PT. These results suggest that the cholinergic anti-inflammatory pathway may play a role in the microcirculatory response to thermal injury.
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Randomized Controlled Trial Comparative Study
Prospective randomized controlled trial comparing two methods of securing skin grafts using negative pressure wound therapy: vacuum-assisted closure and gauze suction.
Negative pressure wound therapy (NPWT) has revolutionized the management of complicated wounds and has contributed an additional modality for securing split thickness skin grafts (STSG). The standard for NPWT is the vacuum-assisted closure (VAC) device. The authors' institution has accumulated experience using standard gauze sealed with an occlusive dressing and wall suction (GSUC) as their primary mode for NPWT. ⋯ The mean percent take in the GSUC group was 96.12% vs 96.21% in the VAC arm (P = .98). The use of NPWT in securing STSG is a useful method to promote adherence and healing. This study demonstrates that a low-cost, readily accessible system utilizing gauze dressings and wall suction (GSUC) results in comparable skin graft take in comparison to the VAC device.
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Review Case Reports
Methylene blue for burn-induced vasoplegia: case report and review of literature.
We report the use of a single dose of methylene blue in a patient with burn-induced vasoplegia refractory to fluids, vasopressors, and steroids. Administration of methylene blue allowed for cessation of epinephrine infusion within 2 hours of administration, and reduction in excessive fluid resuscitation. The patient's clinical course continued for 2 months and was complicated by severe acute respiratory distress syndrome, pneumonia, septic shock, poor skin graft adherence, renal failure requiring continuous renal replacement therapy, cutaneous mucormycosis, and ultimately, withdrawal of care and death. Despite the eventual outcome, this is the longest reported survival following methylene blue administration for vasoplegia secondary to burn injury.