Burns : journal of the International Society for Burn Injuries
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Despite the fact that early excision and grafting have significantly improved burn outcomes, the management of severely burned patients whose burn size exceeds 70% total body surface area (TBSA) still represents a big challenge for burn surgeons all over the world. During the period of 1997-2010 at our centre, aggressive excision and microskin autografting were performed in 63 severely burned patients. Their burn sizes ranged from 70% to 98% TBSA with a mean of 84.9%. ⋯ Microskin autografting yielded an overall survival rate of 63.5%; only 23 patients died. Our clinical experience in using the microskin autografting for burn coverage suggests that the technique is very effective in covering extensive burns, and that it is particularly useful when graft donor sites are very limited due to its high utilization rate of donor site. The factors affecting the outcome of microskin autografting are discussed herein.
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To develop the Leuven Itch Scale (LIS), which measures itching through evaluation of the dimensions of the itch experience; and to provide evidence of the validity, reliability, and responsiveness of the LIS. ⋯ The Leuven Itch Scale is a useful and clinimetrically sound instrument to measure pruritus in different patient populations affected by itching.
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Self-immolation remains a significant contemporary problem. Its epidemiology and causes, and the intervention strategies these suggest vary significantly between higher- and lower-income countries. We summarize what is known about suicide by self-immolation in terms of its demographic and psychiatric risk factors, causes, local patterns and means employed, and points of possible intervention. ⋯ Reports in the literature of self-immolation divide most informatively into two groups according to the higher- or lower-income of the societies affected. This classification is not arbitrary, as it correlates with other measures of development, and the epidemiologic patterns revealed show distinct differences, suggesting differing causes and intervention strategies. Analytical studies are needed to distinguish associations from underlying causes and identify efficient points of intervention.
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Cultured epithelial autografts (CEAs) have long been used to tackle limited donor site availability and difficulty of permanent skin coverage in massive burns, but this approach still has limited documentation. ⋯ Although complex and costly, CEAs can be used with reasonable success and satisfying survival results for the treatment of massive burns. In this study, favorable outcome was principally associated with young age and low number of infectious complications.
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Despite advances in burn care some injuries remain non survivable. Good end of life care for these patients is arguably as important as life prolonging care. The Liverpool Care Pathway is a useful tool for providing good quality end of life care. It has previously been modified for the acute setting. We modified it further specifically for use in burn care in 2007 and would like to share our experience of using it. ⋯ The BM-LCP appears to be an appropriate tool for assisting in end of life care in burns and when used appears to improve end of life care. We recommend its use and would encourage others to implement its use.