Burns : journal of the International Society for Burn Injuries
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Comparative Study
Extension of flaps associated with burn scar reconstruction: A key difference between island and skin-pedicled flaps.
The choice between local flap designs for burn reconstruction is largely shaped by aesthetic, vascularity, procedural complexity, and wound-closure considerations. However, another key consideration is how well specific local flap designs release post-burn scar contractures. This is because constant tension on wound edges can generate pathological scarring. However, the ability of specific local flap to release post-burn scar contractures is poorly understood. This question was addressed by this study of patients who underwent local flap surgery to release post-burn scar contractures. ⋯ While it was technically easier to transfer island flaps to the recipient site, they released contractures less effectively than skin-pedicled flaps. The postoperative extensibility of flaps should be considered when determining which flap design is optimal for the individual patient.
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Stevens Johnson Syndrome/toxic epidermal necrolysis (SJS/TEN) are rare, potentially fatal desquamative disorders characterised by large areas of partial thickness skin and mucosal loss. The degree of epidermal detachment that occurs has led to SJS/TEN being described as a burn-like condition. These patients benefit from judicious critical care, early debridement and meticulous wound care. This is best undertaken within a multidisciplinary setting led by clinicians experienced in the management of massive skin loss and its sequelae. In this study, we examined the clinical outcomes of SJS/TEN overlap & TEN patients managed by our regional burns service over a 12-year period. We present our treatment model for other burn centres treating SJS/TEN patients. ⋯ Management in our burns service with an aggressive wound care protocol involving debridement of blistered epidermis and wound closure with synthetic and biological dressings seems to have produced benefits in mortality when compared to predicted outcomes.
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Observational Study
Characterization of variables for potential impact on vancomycin pharmacokinetics in thermal or inhalation injury.
To characterize the pharmacokinetics of vancomycin dosing in thermal or inhalation injury as they relate to percent total body surface area burn (TBSA) and days since injury (DSI). ⋯ DSI, percent TBSA, and CrCl can be used to predict faster vancomycin CL and need for higher total daily doses. Augmented pharmacokinetics can occur as early as two days after injury and decrease with time. Acceptable target trough attainment is still lacking and this data should assist in performance improvements for initial vancomycin dosing.
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Recent studies demonstrate that burn patients are undergoing unnecessary intubations. We sought to determine the clinical criteria that predict intubations with benefit. ⋯ Intubation should be considered for patients displaying the Denver criteria, which includes full thickness facial burns, stridor, respiratory distress, swelling on laryngoscopy, upper airway trauma, altered mentation, hypoxia/hypercarbia, hemodynamic instability, suspected smoke inhalation, and singed facial hair. Patients lacking these criteria should not be intubated.
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Journal clubs allow discussion of the quality and findings of recent publications. However, journal clubs have not historically been multidisciplinary. Burn care is recognized as a true collaborative care model, including regular multidisciplinary rounds. Since 2011 we have offered a multidisciplinary burn journal club at our institution. We present an evaluation of the factors that have made the sessions successful to facilitate others to commence their own club. ⋯ The success of the journal club has been possible through the engagement of the entire burn team. Champions within each discipline, facilitated discussion and evaluation tools have helped nurture a nonthreatening team based learning environment.