Burns : journal of the International Society for Burn Injuries
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The Patient and Observer Scar Assessment Scale (POSAS) is used to judge scars and involves patients and caregivers. Although the opinions of both are integrated, agreement between them is poorly investigated, especially in donor site scars (DSSs). Furthermore, it is unknown which POSAS-items are mostly associated with overall cosmetic satisfaction with the scar. ⋯ Patients and caregivers appreciate different aspects of scar characteristics using the POSAS. This calls for shared decision-making, in which patient opinions are incorporated in the treatment choice.
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Intestinal barrier damage after scald and burns, other trauma or major operations result in severe intestinal infections that cause serious consequences. Therefore, it is important to develop methods to protect intestinal barrier after severe burns. ⋯ All the indices including body weight detected in GIK group were improved to those in insulin group. Taken together, these results show that GIK and insulin show protective effect on intestine after severe burn, which may relate to controlling hyperglycaemia and regulating intestinal expression of NFκB and pro-inflammatory and anti-inflammatory cytokine genes by GIK and insulin; the protective effect of GIK on intestinal tissue after severe burn is superior to that of using insulin alone, which may attribute to improving the nutritional status by glucose supplement and the relatively higher dose of insulin in the GIK group.
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Excess split-skin autografts harvested and meshed during burn surgery are often stored at 4°C temporarily for later use. The quality of the stored skin is critical to clinical outcome and needs to be assured. ⋯ Culture media instead of saline or Hartman's solution should be used for temporary storage of mSSG at 4°C. The stored mSSS should be used within seven days to have sufficient viable number and cell growth efficiency. After then, the efficacy of stored mSSG as a source of living cells for wound closure could be full of uncertainty due to significant decrease of keratinocyte colony forming efficiency. Precaution should be taken during skin harvest and storage to minimize the risk of sample contamination. Inclusion of antimicrobial agents in storage solution and microbiological testing are advisable to ensure the quality and clinical outcome.
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Smoke inhalation injury frequently increases the risk of pneumonia and mortality in burn patients. The pathophysiology of acute lung injury secondary to burn and smoke inhalation is well studied, but long-term pulmonary function, especially the process of lung tissue healing following burn and smoke inhalation, has not been fully investigated. By contrast, early burn excision has become the standard of care in the management of major burn injury. While many clinical studies and small-animal experiments support the concept of early burn wound excision, and show improved survival and infectious outcomes, we have developed a new chronic ovine model of burn and smoke inhalation injury with early excision and skin grafting that can be used to investigate lung pathophysiology over a period of 3 weeks. ⋯ The early excision model closely resembles practice in a clinical setting and allows long-term observations of pulmonary function following burn and smoke inhalation injury. Further studies are warranted to assess lung tissue scarring and measuring collagen deposition, lung compliance and diffusion capacity.
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To fulfill Food and Drug Administration and Department of Health and Human Services emergency care research informed consent requirements, our burn center planned and executed a deferred consent strategy gaining Institutional Review Board (IRB) approval to proceed with the clinical study. These federal regulations dictate public disclosure and community consultation unique to acute care research. ⋯ Our communication strategy should provide a paradigm other burn centers may appropriate and adapt when planning and executing a deferred consent initiative.