Burns : journal of the International Society for Burn Injuries
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The body's reaction to thermal injury is much more than an initial, local inflammatory response. The burn wound is a continuous, severe threat against the rest of the body due to invasion of infectious agents, antigen challenge and repeated additional trauma caused by wound cleaning and excision. The inflammatory mediators which control blood supply and microvascular permeability in the wound have been extensively studied and are largely understood. ⋯ The defects causing immunosuppression are still very much under consideration. An understanding of these defects is essential for the development of therapies. The increasing interest in the control of the inflammatory reactions by cytokines may, in the near future, be of great importance.
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Methicillin-resistant Staph, aureus (MRSA) colonization and infection was studied in 231 patients who were admitted to our burn unit and remained for 3 days or more between 1986 and 1994 (patients with inhalation injury only and no burn wound were excluded). The study was divided into two periods: from 1988 to 1989 and from 1990 to 1994. MRSA was found in 80 patients. ⋯ The effectiveness of these measures was confirmed. Moreover, the first operation was carried out significantly earlier in the later period. Early excision and early closure of the wound was more effective in preventing and controlling MRSA colonization and infection.
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Toxic epidermal necrolysis (TEN) is the most severe of the Stevens-Johnson syndrome-toxic epidermal necrolysis (SJS-TEN) spectrum. It is characterized by epidermal exfoliation and mucositis and carries an average mortality of 25 per cent. In this 6-year retrospective study, we reviewed 23 patients with drug-induced SJS-TEN. ⋯ The length of hospital stay was prolonged when non-ocular complications supervened. The percentage mortality in our series was 10 per cent. It is our contention that the best results are obtained with treatment of the SJS-TEN patient in a burns centre with an internist, dermatologist and infectious disease specialist as part of the management team.
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Burn injury in pregnant patients is not uncommon in developing countries. The results of the management of six pregnant burns patients, admitted during an 18-month period, were analysed. Successful management of burn injuries ranging from 25 to 65 per cent TBSA occurred in patients during the second and third trimester of pregnancy, using early burn wound excision and skin grafting in four patients and by late skin grafting of a granulating wound in one patient. ⋯ One patient with 60 per cent TBSA burns who was unsuitable for early excision, died of septicaemia. This report suggests the need for early burn wound excision and skin grafting in burns patients with pregnancy, in order to improve maternal and fetal survival. However, in developing countries early surgery is not advisable in patients with extensive burns because of the non-availability of biological skin substitutes.
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The use of quantitative bacteriology in the burns unit has been thought to be efficient in predicting sepsis or graft loss. To examine the relationship between clinical outcome and bacterial densities on and in the burn wound, 69 biopsy/surface swab pairs were collected from 47 patients on 64 occasions, either immediately prior to excision and grafting, or at routine change of dressings. The mean per cent TBSA burn was 16 (range 1-65). ⋯ There was no significant difference in bacterial counts between patients judged to be a clinical success or clinical failure (72 h follow-up), either after undergoing excision and grafting, or change of dressings, and no difference in counts between patients with perioperative bacteraemia and those without. With burns > 15 per cent TBSA, a relationship between bacterial counts and subsequent sepsis or graft loss still was not demonstrated. It is suggested that quantitative bacteriology by burn wound biopsy or surface swab does not aid the prediction of sepsis or graft loss.