Burns : journal of the International Society for Burn Injuries
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This review article addresses the principles and controversies associated with thermal injury to the hand and upper limb. Accepted principles are outlined and areas of controversy are discussed in a balanced manner. The importance of hand burns is described functionally and epidemiologically. ⋯ The general principles of inpatient management are given, including the controversial issue to timing of surgery and treatment of the exposed tendon or joint. The extent of surgery, methods of wound closure and difficult problem of palm burns are also discussed. Reconstructive principles are outlined and a problem oriented approach to the most common reconstructive problems given.
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Over the last decade the concept of quality in healthcare has gained increasing prominence, not least in the field of skin and tissue banking. This was brought into sharp focus by the appearance of HIV, however, over the decade other viruses have also gained notoriety, e.g. ⋯ This has also provided an opportunity to consider other aspects of skin banking that might also affect quality and to offer standards or guidelines to optimise these aspects. The purpose of this review is to highlight these various quality issues in order to allow surgeons to make informed choices and decisions regarding their sources and uses of skin allografts.
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Methicillin-resistant Staphylococcus aureus (MRSA) has become a frequent cause of nosocomial infection, its increasing prevalence posing serious therapeutic and infection control problems within the hospital environment. MRSA is a major challenge to the burn patient, with potential to cause significant morbidity and mortality. Burn patients have been shown to become colonised and infected more readily than other patient groups. ⋯ Extended hospitalisation and antibiotic therapy have been identified as additional risk factors for MRSA carriage and infection. Microbial surveillance, epidemiological studies and the introduction of strict infection control regimes can reduce the prevalence of MRSA but may be insufficient for eradication or prevention of outbreak situations. Recognition of the clinical importance of MRSA to the burn patient highlights the need to take appropriate measures to minimise transmission and infection in this vulnerable group of patients.