Burns : journal of the International Society for Burn Injuries
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Because death of a patient is one of the most emotionally disruptive events in the health professionals' life as well as the bereaved, it was hypothesized that surgeons' and nurses' attitudes in the burn centre would interfere with their emotional support of the bereaved family. Consequently, we performed a psychometric assessment of the surgeons', nurses' and bereaved families' attitudes about death and dying in the burn centre. A psychometric instrument was developed and validated that assessed 13 surgical directors' of burn centres, 13 burn nurses' and nine bereaved family members' attitudes on death and dying in the burn centre. ⋯ Over half the burn surgeons (seven) and nurses (seven) felt that the process of dealing with the bereaved family was different from that experienced in other hospital settings. The surgeons attributed this difference to the long duration of the patients' illnesses, while the nurses felt that it was due to the traumatic and painful qualities of burn injury. These emotional difficulties experienced by the staff in dealing with the dying patients were associated with a relatively low frequency of contact with the bereaved families after the patients' death.(ABSTRACT TRUNCATED AT 250 WORDS)
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This study describes the epidemiology and mortality of patients with burns involving over 30 per cent of the body surface who were hospitalized between 1 January 1988 and 1 January 1990. During this period 302 patients were hospitalized (8.1 per cent of those treated); of these, 52 (16.7 per cent) had burns affecting more than 30 per cent of the total body surface. ⋯ The mean burn extent was 55.3 per cent of the total body surface, and the most common cause was fire (75 per cent); 67.3 per cent of accidents occurred at home. Patient mortality in our series was 30.7 per cent with a mean survival of 10.3 days.
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Case Reports
Usefulness of narrow pedicled intercostal cutaneous perforator flap for coverage of the burned hand.
A narrow pedicled intercostal cutaneous perforator (np-ICP) flap is used for reconstruction of hand scar contractures after burns. This flap is designed with a narrow pedicle which includes some intercostal cutaneous perforators of 4-7th intercostal spaces, and with a wide distal area which lies over the costal cage and upper abdomen. ⋯ It seems that this flap is more useful, not only functionally but also aesthetically, than conventional methods. This report describes the technique and concept, with a demonstration of some clinical examples.
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A technique for recording the shape and size of hypertrophic burns scars during conservative treatment is described. This technique is extremely useful not only for an objective assessment of the healing process but also as an adjunctive research method for comparing two or more differing techniques of treatment. ⋯ These cast models can be easily obtained and are very precise. They represent the height, size and general appearance of the scar, so that by taking positive impression models at regular intervals, and combining them with photographic and tonometric evaluations, they help in the evaluation of conservative treatment or in studying the mode of action of treatment.
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The use of cultured epidermal cell sheets has become a recognized method for the coverage of extensive burns. The disadvantages are a long time-lag until the cells are available, the fragility and difficult handling of the grafts, an unpredictable 'take' and extremely high costs. In three patients with deep partial and full skin thickness burns we have applied cultured autologous keratinocytes suspended in fibrin glue. ⋯ The epidermis of the allogeneic overgrafts desquamated within a few days without signs of inflammation, but there are indications that the STS-allograft dermis is at least partly integrated into the new skin and may serve as a scaffold for the grafted cell culture. The fibrin glue matrix seems to give sufficient adherence stability to keratinocytes that are grafted in an actively proliferating state. Further advantages are the easy repetition and application, as well as a reduction in operating time and costs in these severely injured patients.