Burns : journal of the International Society for Burn Injuries
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Six hands from five patients were seen with full-thickness burns following a ritual practice between June 1993 and June 1994. Three hands were treated with excision and medium-thickness split-skin grafts, one patient was treated with a medium-thickness split skin graft taken from the instep of the foot. The first patient with bilateral burns of the palms refused surgery and returned 3 months later with contractures of the palms. The results of the treated hands are presented.
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A technique to overcome the problems of inlay grafting for burn scar contracture release is described. A greater release can be achieved by moving the point of release away from the flexure crease, with the added advantage of grafting on to a 'flat non-mobile' surface. A simplified method of graft fixation and compression is described, along with the use of contact media in the postoperative management to prevent graft shrinkage and the recurrence of contracture. During a 6-year period, burn scar contracture release with inlay grafting was performed on 24 patients (10 limbs with 17 split-skin grafts and 14 fingers with 21 full-thickness grafts) with no recurrence.
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A retrospective analysis of 435 consecutive admissions to a regional burns unit over an 8-year period is presented. The majority were domestic accidents, while a few were suicidal and two were due to child abuse. ⋯ In spite of these known adverse factors the overall outcome was satisfactory, with a case fatality rate of 7.4 per cent and a residual disability rate of 10.8 per cent. Good initial resuscitation, a low infection rate (18.4 per cent) and the ready availability of appropriate surgical intervention (35.6 per cent), with good intensive care support, could account for the satisfactory outcome.
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An unusual full-thickness burn of the scalp and cranial bones due to a lightning strike is reported. A thick nylon cover protected the head from the direct effects of the lightning injury, but heated water over the thick nylon cover caused full-thickness burn of the scalp and cranial bones. The relevant literature has been reviewed.