Burns : journal of the International Society for Burn Injuries
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A scar is an expected result of wound healing. However, in some individuals, and particularly in burn victims, the wound healing processes may lead to a fibrotic hypertrophic scar, which is raised, red, inflexible and responsible for serious functional and cosmetic problems. It seems that a wide array of subsequent processes are involved in hypertrophic scar formation, like an affected haemostasis, exaggerated inflammation, prolonged reepithelialization, overabundant extracellular matrix production, augmented neovascularization, atypical extracellular matrix remodeling and reduced apoptosis. ⋯ Following the chronology of normal wound healing, we unravel, clarify and reorganize the complex molecular and cellular key processes that may be responsible for hypertrophic scars. It remains unclear whether these processes are a cause or a consequence of unusual scar tissue formation, but raising evidence exists that immunological responses early following wounding play an important role. Therefore, when developing preventive treatment modalities, one should aim to put the early affected wound healing processes back on track as quickly as possible.
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The specific aim of this study was to investigate the pharmacokinetic parameters of antibiotics represented by vancomycin and amikacin in the subeschar tissue fluid (STF) in patients with early stage severe burn. Twenty patients were studied: age 30.7+/-8.0 years old, weight 60.6+/-8.4 kg, total burn surface area (TBSA) 68.39+/-17.85%, creatinine clearance (CCr) 95.45+/-23.14 ml/min, mean+/-S. D. ⋯ Their effective inhibitory concentration were maintained at least for 24h. There was antibiotic retention in the third space after early and short-term use of potent antibiotics. An antibiotic barrier could form in the STF, and could prevent an invasive bacterial infection from burn wound.
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Comparative Study
Accuracy of early burn depth assessment by laser Doppler imaging on different days post burn.
Accurate diagnosis of burn depth is essential in selecting the most appropriate treatment. Early assessment of burn depth by clinical means only has been shown to be inaccurate, resulting in unnecessary operations or delay of grafting procedures. Laser Doppler imaging (LDI) was reported as an objective technique to determine the depth of a burn wound, but the accuracy on very early days post burn has never been investigated yet. ⋯ The accuracies of burn depth assessments on the day of burn and post burn days 0, 1, 3, 5 and 8 using LDI were 54%, 79.5%, 95%, 97% and 100% compared with clinical assessment accuracies of 40.6%, 61.5%, 52.5%, 71.4% and 100%, respectively. LDI accuracy was significantly higher than clinical accuracy on day 3 (p<0.001) and day 5 (p=0.005). Burn depth conversion was also considered. This is the first study to quantify the advantage of LDI scanning over clinical assessments during these important early after burn days.
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Multicenter Study Comparative Study
Mortality estimates in the elderly burn patients: the Northern Ireland experience.
There is a relative paucity of mortality data in the medical literature from UK burn units. The objective of this study was to audit our mortality in the elderly during a 10-year period and compare it with the most robust data available in the UK from Birmingham. Data were collected on all patients 65 years of age and older between 1st January 1996 and 31st December 2005. ⋯ This difference was found to be statistically significant (x(2)=8.92, d.f.=1, p<0.005). In conclusion, our experience has shown better survival in the elderly than was expected. This we mainly attribute to an aggressive therapy approach including admission to the intensive care unit and early surgery.