Burns : journal of the International Society for Burn Injuries
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Review Case Reports
Burn scar carcinoma with longer lag period arising in previously grafted area.
A case of Marjolin's ulcer that arose in previously grafted area of right ankle 55 years after initial burn injury was managed by below knee amputation and right inguinal lymph node dissection. The characteristics of this malignancy were reviewed, and rarely seen features particular to this case, which are a longer lag period and rapid growth in a previously grafted area, were discussed.
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A program of early excision, increased outpatient care, and aggressive discharge planning was introduced gradually over a 5 yr period from 1991 to 1995 with the goal of decreasing the length of stay for burn patients. Results from 1 January 1991, to 30 June 1993, were compared with results from 1 July 1993 to 31 December 1995. ⋯ There was also a significant reduction in LOS of 23.7 percent for burns over 25% TSA. There was no significant difference in age, burn size or mortality between the early and late groups.
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Case Reports Clinical Trial
Reconstruction of burn deformity using artificial dermis combined with thin split-skin grafting.
Twelve patients with post-burn contracture were treated using artificial dermis combined with thin split-skin grafting during the period January 1994 to April 1996. Bilayer artificial dermis was grafted onto full thickness open wounds of the skin, after excision of scar contracture tissue. About 3 weeks later, the silicone layer was removed and thin split-skin, 8/1000 in. thick, was grafted onto the newly synthesized dermis-like tissue in the wound bed. ⋯ Postoperative management was performed in accordance with conventional skin grafting. Postoperative contraction or hypertrophic scar was observed in three cases, but a soft, favorable quality was obtained in the other nine cases. Treatment of burn deformity with artificial dermis may be beneficial in selected cases.
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A dermal substitute was used for wound management and after early scar release on a 4-year-old child with mostly full thickness burns covering 60 per cent of the body surface. The biosynthetic material (INTEGRA Artificial Skin) consists of an upper silicone film and a lower layer of porous cross-linked collagen and chondroitin-6-sulfate as a template for dermal regeneration. Eight sheets each 4 x 10 in. were used to cover the patient's whole trunk after staged tangential necrectomy. ⋯ Seven weeks after admission an early neck contracture was released and the skin defect also covered with INTEGRA Artificial Skin. Following the same principle, transplantation of the thin unmeshed autograft was performed successfully 3 weeks later. The good results regarding handling, final take, apparent initial scar reduction, and early recovery may favourably effect initial treatment and reconstruction planning after extensive full-thickness burn injuries.
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Self-inflicted burns are a regular source of admissions to burns units world wide. This study examines the characteristics and outcomes of those who deliberately burn themselves. The medical records of all patients admitted to the Royal Brisbane Hospital Burns Unit and identified as having suffered a self-inflicted burn between 1990 and 1995 were reviewed. ⋯ Self-immolation with flammable liquid resulted in severe burns with a 45 per cent mortality. A number of differences was demonstrated between those patients who had attempted suicide and those who had deliberately burnt themselves without suicidal attempt. Self-immolators constitute a considerable proportion of major burns admitted to this unit.