Burns : journal of the International Society for Burn Injuries
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Case Reports
Stenotrophomonas maltophilia: a serious and rare complication in patients suffering from burns.
Stenotrophomonas maltophilia is rarely implicated in clinical infections but it constitutes a significant nosocomial pathogen, especially in immunocompromised patients. This report describes the first case of a generalised infection caused by S. maltophilia that included bacteremia, wound and respiratory tract infection in a patient suffering from burns. Given the emergence of S. maltophilia nosocomial infections, especially in patients with burns, isolation of the bacterium from blood cultures should prompt the commencement of adequate antibiotic treatment.
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Fibrin glue is an excellent template for cellular migration and has been shown to be an effective delivery system for cultured autologous keratinocytes. We have investigated whether fibrin glue has any benefit on the percentage of epithelial cover when cultured autologous keratinocytes are sprayed onto a freshly debrided wound bed. Three pigs were used for this study. ⋯ There was no statistically significant difference between the two groups (P=0.802). This surprising result was confirmed by histological analysis of the wound biopsies, with a good correlation between histological and image analysis data (R=0.967). There was no observable difference in the quality of the epithelium on histological and immunohistological analysis of either group.
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Akita Prefecture has had the highest suicide rate in Japan for the past 9 years. To obtain further information on suicide attempts by self-immolation in Akita, we performed a statistical analysis of patients in this prefecture who attempted to burn themselves. Over the past 6 years, 541 patients suffering from burns were transferred to medical emergency units. ⋯ The total burn surface area (TBSA), burn index (BI), rate of inhalation injury, and mortality rate were all significantly higher in the patients who attempted self-immolation than in those with nonsuicidal burns. Most (68.6%) of the self-immolation attempts were made indoors. Because the Japanese are not generally a very religious people, training to help them cultivate a philosophy of life and educating them in moral science to help them form a personal view of life and death may be necessary to prevent suicides.
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Case Reports
Double reverse V-Y-plasty in postburn scar contractures: a new modification of V-Y-plasty.
Several techniques have been defined to use in surgical treatment of postburn scar contractures. However, distal flap necrosis is frequently seen since most of these techniques require random-pattern flaps and there is often poor vascular supply to scar tissue. In the Z-plasty, V-Y-plasty and their analogues, excess tissue requires excision of the dog-ear. A new modification of V-Y-plasty, called "double reverse V-Y-plasty", is discussed. Nineteen postburn scar contractures were successfully treated with double reverse V-Y-plasty. The postoperative results represent the versatility of this technique in the surgical treatment of postburn scar contractures, especially neck and extremities. There was no distal flap necrosis. Double reverse V-Y-plasty is effective and alternative to the current techniques in surgical treatment of every kind of postburn scar contractures with one or more contracture lines. It does not need any surgical knack. ⋯ (i) double reverse V-Y-plasty is safely useful, when skin tension across the contracture line is too great to use any local flaps; (ii) when superficial scarring is localized in the contracture site, it is superior to other local flaps because of rich vascularity and mobility; (iii) double reverse V-Y-plasty is advised to the inexperienced surgeon, since it is easy to use; (iv) color and texture matches are cosmetically acceptable, and the resultant contracture is as much as with other techniques; (v) there is no necessity to use excision of the dog-ear; (vi) it can be utilized under local anesthesia almost in all cases; and (vii) it requires a shorter period of operation, and hospitalization.
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The management of seven children with vacuum cleaner friction burns is described. Six of the children sustained full thickness burns. Four were treated operatively. Indications for surgery are outlined and important accident prevention strategies are highlighted.