Burns : journal of the International Society for Burn Injuries
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Research on the psychological impact of burn injuries has concentrated on major burns, while small burns have been largely neglected. In a prospective study, 45 patients with burn injuries ranging from 1 per cent or less up to 40 per cent total body surface area were assessed using semi-structured interviews within 2 weeks of sustaining the burn, and followed-up at approximately 3 months postburn to investigate the prevalence of mental health problems. ⋯ Patients with small burn injuries of 1 per cent or less also experienced clinically significant levels of psychological difficulties postburn. The implications for the identification of patients at risk of future psychological morbidity are discussed.
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Case Reports Clinical Trial
The use of an 'adhesive contact medium' (Hypafix) for split skin graft fixation: a 12-year review.
Since the introduction in 1985 of the technique of graft fixation with Hypafix, the method has been adapted for use in burns of all sites and extent, and has proven to be effective in over 500 burn patients. The technique is versatile, safe, simple, reliable and inexpensive. More importantly, there is a significant improvement in cosmesis due to the earlier introduction of an 'Adhesive Contact Media', the blending of the graft at the edges, and the lack of skin bridges and shoulders. ⋯ Graft fixation with Hypafix. Continuing use of appropriate 'contact media'. Continuing close supervision in a designated Burn Scar Clinic.
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The authors present two patients affected by scars resulting from burning of over 60 per cent of the total body area, in which the pre-expansion of a free flap has been used to increase the tissue surface useful for transfer from the only area of residual healthy skin (left forearm, left parascapular region). In both cases it was possible to transfer abundant healthy tissue into the desired areas, obtaining a rapid release of the region, which made possible an early physical rehabilitation of the patient starting after the second postoperative week. ⋯ The pre-expansion of free flaps provides an advantage in that it allows the few integral residual areas to be used, improving vascularization and therefore increasing the available surface. Furthermore, as pre-expansion reduces tension on the margins, it allows for the easier closing of the donor area, with a minor risk of complications and a better scar outcome.
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Electrocution due to contact of construction equipment with power lines is not uncommon as a source of industrial injury. We report seven such cases. Two patients sustained cardiac arrest and were successfully resuscitated at the scene. ⋯ In all cases, the patient was on the ground touching the machinery or touching cables connected to the machinery at the time of injury. The importance of exercising due care in industrial safety measures is stressed. Prompt CPR was life saving in two cases.
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Comparative Study Clinical Trial
Micrografting in the treatment of severely burned patients.
The micrografting technique, employed to treat patients with extensive TBSA burns and reduced areas of healthy donor skin, was assessed simultaneously with traditional mesh grafts (STSG) or Tiersch grafts in the treatment five severely burned subjects (average TBSA burned 35.6 per cent; average per cent of full thickness wounds 32.6 per cent). At the first clinical control on day 6 post-surgery, 93 per cent of the micrografted area was in situ and health; epithelialization of the wound sites was complete at day 21. ⋯ Although the micrograft technique is labour-intensive, if the expansion needed is at least 1:6, the aesthetic and functional results obtained are comparable to, or better than, those with meshed grafts. Also, large segments of micrograft are not compromised if a small area of mesh becomes detached, and epithelialization is faster and more uniform, enabling a reduction in both infection and length of hospital stay.