Burns : journal of the International Society for Burn Injuries
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Fourteen cases suffering full-thickness burns of more than 70 per cent total body surface area (TBSA) have been successfully treated during the last 8 years (1988-1995). Among these patients, 10 cases suffered from burns of more than 90 per cent TBSA. Five cases had full-thickness burns of 80-90 per cent TBSA. ⋯ The temperature and humidity of the ward was controlled by air conditioning and dehumidification. Aggressive excision of eschar and auto-skingrafting was carried out 3 weeks post-injury. Strictly limiting the uncovered wound to less than 5 per cent appeared to be the major effective measure in preventing burn infection.
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Scorched eyelashes and burned eyelids are a common finding in facial burns, though the eye itself is often spared. Affected patients often complain of foreign body sensation and ocular discomfort in the absence of objective physical findings, other than scorched eyelashes and burned eyelash particles in the conjunctival sacs. This study was designed to evaluate the efficacy of prophylactic trimming of scorched eyelashes as a treatment for these findings and complaints. ⋯ Conjunctival hyperemia was reduced. We suggest that shedding of scorched eyelash particles is a major cause of the ocular complaints in facial burn patients. Trimming the eyelash affords a simple and effective method of prophylactic treatment.
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Early excision and skin grafting (EEG) is an established and accepted procedure for deep burn management. This is a retrospective analysis of 100 patients treated with early excision and grafting in burns of all types and up to 65 per cent TBSA. Excisional surgery was performed in the period from day 2 to day 7 post-burn in patients who did not have significant infection (<10(5)) in one to two stages. ⋯ The mortality in the operated group was 10.2 per cent. The main causes of mortality were smoke inhalation injury, septicaemia (probably originating from the non-excised tissue) and extensive burn injury. The functional and aesthetic outcome in EEG patients was far superior in comparison with the conventional method of treatment.
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Methicillin-resistant Staphylococcus aureus (MRSA) has become a frequent cause of nosocomial infection, its increasing prevalence posing serious therapeutic and infection control problems within the hospital environment. MRSA is a major challenge to the burn patient, with potential to cause significant morbidity and mortality. Burn patients have been shown to become colonised and infected more readily than other patient groups. ⋯ Extended hospitalisation and antibiotic therapy have been identified as additional risk factors for MRSA carriage and infection. Microbial surveillance, epidemiological studies and the introduction of strict infection control regimes can reduce the prevalence of MRSA but may be insufficient for eradication or prevention of outbreak situations. Recognition of the clinical importance of MRSA to the burn patient highlights the need to take appropriate measures to minimise transmission and infection in this vulnerable group of patients.
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Comparative Study
Granulocyte-colony stimulating factor improves suppressed neutrophilic phagocytosis against hypernatremic condition.
Phagocytic activity is an important function of neutrophils in the host defense against burn wound infection. In a previous report we demonstrated hypernatremic suppression of neutrophils at sodium concentrations comparable to these in the zone of stasis in the burn wound. At this site the osmotic pressure will be elevated as a result of several factors, especially to increased water loss from the burn wound surface. ⋯ The G-CSF group showed 88.2+/-7.0 at 140, 79.9+/-9.4 at 180, 71.4+/-7.4 at 220, and 56.5+/-14.1 at 260 mmol/l. At 180 and 220 mmol/l significant differences were recognized. Results of this study suggest a favourable effect of G-CSF on suppressed neutrophils under the hypernatremic conditions.