Burns : journal of the International Society for Burn Injuries
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
The use of a collagen sponge/living cell composite material to treat donor sites in burn patients.
The objective of this study was to examine the safety and efficacy of bilayered cellular matrix, (OrCel) Ortec International, Inc., New York, NY in facilitating timely wound closure of split-thickness donor sites in severely burned patients. We utilized a matched pairs design; each patient had two designated donor sites of equivalent surface area and depth. Sites were randomized to receive a single treatment of either OrCel or the standard dressing Biobrane-L (Bertek Pharmaceuticals) Sugarland, TX. ⋯ This acceleration of wound healing was clinically important in enabling earlier recropping. OrCel sites also exhibited reduced scarring. Therefore, treatment of donor site wounds with OrCel is well tolerated, promotes more rapid healing, and results in reduced scarring when compared with conventional therapy with Biobrane-L.
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Comparative Study Clinical Trial Controlled Clinical Trial
Subeschar clysis in deep burns.
Six hundred thirteen patients with deep burn of up to 50% total body surface area (TBSA) were treated with 0.25% povidone iodine subeschar clysis (PVP-SEC) in addition to surface application of povidone iodine + Neosporin in the form of "crust". The results were compared with those of 595 age, sex and percentage of burn, matched patients treated only by "crust application". ⋯ Significantly more number of patients, with burns up to 50% TBSA, could be grafted within 20 days in the SEC group. The graft acceptance rate in this group was 90%.
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Case Reports
Expanded occipito-cervico-pectoral flap for reconstruction of burned cervical contracture.
Postburn neck contracture and hypertrophic scarring can cause functional limitation and aesthetic disfigurement. Reconstruction of severe deformities and scar of neck following healing from burns confronts the surgeon with some of the most challenging problems in reconstructive surgery. ⋯ The aim of this article is to assess the role of expanded occipito-cervico-pectoral (o-c-p) flap for reconstruction in a series of four patients with severe burn scar of neck and involvement of shoulder back but intact anterior aspect of chest. This is an alternative method of reconstruction burn scar of neck area.
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The key decision in the treatment of thermal injuries is the determination of the depth of the burn wound and the resultant decision on treatment options. The trend in the treatment of deep dermal and full thickness burns is toward very early excision and grafting to reduce the risk of infection, decrease scar formation, shorten hospital stay, and thereby reducing costs. Traditionally, this has involved serial clinical examinations, which involves primarily subjective judgment. ⋯ In conclusion, ICG video angiography seems to be a practical method to describe vascular patency in a burn wound. The results indicate that ICG fluorescence angiography is a practical, accurate, and effective adjunct to clinical methods for estimating burn wound depth and thereby to assist in the rational assessment of treatment options. Furthermore, it allows an objective, qualitative and quantitative observation of the dynamic changes in burn wound depth, which are observed during the acute post-burn period, thereby indicating optimal timing of the first operation.
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This study was designed to assess intestinal drug transport via transcellular absorption and intestinal P-glycoprotein content following thermal injury in rats using propranolol as a marker substrate. Male, Sprague Dawley rats (n=30) underwent either a 30% total body surface area full thickness burn or sham treatment. Twenty-four hours later, animals were anesthetized, underwent laparotomy and the proximal jejunum was cannulated. ⋯ P-glycoprotein and villin content in the jejunum were significantly decreased in burn animals. The transcellular transport of propranolol is unaffected 24h following thermal injury in rats, despite alterations in intestinal P-glycoprotein content. The decrease in P-glycoprotein and villin content in thermally injured animals may reflect loss of mature enterocytes at the villus tips.