Burns : journal of the International Society for Burn Injuries
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Burn wound infection with Aeromonas hydrophila appears to be very uncommon. This study reports on nine cases of A. hydrophila in burn patients treated over a 21 month period at the New Somerset Hospital Burn Unit. The average age of the patients was 31 years (range 24-60 years) and the average TBSA was 33% (range 16-51%). ⋯ Small, superficial burns which culture A. hydrophila can be treated by topical therapy alone. Large and/or deep burns, require antibiotic therapy and debridement of all necrotic tissue, particularly when myonecrosis is present. The antibiotics of choice are the aminoglycosides or the quinolones.
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It has been our impression over the years that the most common cause of death in our burn patients is multiple organ failure, despite the clinical absence of uncontrolled infection at the time of death. A six year review of all deaths in our unit confirmed this impression, revealing that multiorgan failure is indeed the most common cause of death (48 patients, 67 per cent), followed rather distantly by early withdrawal of support (15 patients, 21 per cent), resuscitation failure (4 patients, 6 per cent) and isolated pulmonary failure (4 patients, 6 per cent). Finally, we found that our patients dying of multiorgan failure, although often having had multiple small infections during their course, were indeed clinically uninfected at the time of death. These findings are consistent with the supposition that uncontrolled systemic inflammation, initially triggered by tissue injury and isolated infection, persists despite control of these infections and leads to multiple organ failure and death.
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Comparative Study
Comparison of the characteristics and features of pressure garments used in the management of burn scars.
Two companies provide custom-made pressure garments to clients with burn scars at Westmead Hospital. This prospective study was completed in order to make objective decisions about which garments were most appropriate and cost effective to provide to clients. Issues such as cost, durability, fit and client preferences were investigated. ⋯ Second Skin garments had significantly more favourable results on the variables of time for delivery, fit at follow-up, garment design, quality of fabric and seams, overall satisfaction and garment preference for ongoing wear. On all other variables there was no significant difference between the garments. Second Skin provided the most optimal and appropriate option for pressure garments in the management of burn scars for our clients.
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Comparative Study
A study of vascular response to thermal injury on hairless mice by fibre optic confocal imaging, laser doppler flowmetry and conventional histology.
Burn injury causes vascular thrombosis and occlusion by thermal damage to the vascular network in the dermis. In this study, fibre optic confocal imaging (FOCI) and laser doppler flowmetry were used to detect changes in vascular morphology and local dermal blood flux over 4 h, in three defined zones after a thermal burn (50 degrees C, 20 s duration, 3 mm in diameter) was induced on fully anaesthetised hairless mice. FITC-dextran (i.v.) was used to enable FOCI of vascular morphology including three-dimensional imaging of the burn site and its surrounding areas. ⋯ The zone of stasis showed an initial reduction in blood flux and confocal imaging of the area indicated significant vessel leakage during the first 2 h which later improved. The zone of hyperaemia showed an initial increase in total blood flux and confocal imaging of the area showed initial blood vessel dilatation. This study demonstrates that FOCI is a useful non-invasive tool in the assessment of vascular changes in thermal burns in vivo, and compares the findings of FOCI with those from laser doppler flowmetry and histology.