Burns : journal of the International Society for Burn Injuries
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A method for preparing acellular allogeneic dermal matrix (ADM) and its effectiveness as a dermal substitute are described. Treatment of rat skin with Dispase followed by Triton X-100 completely removed cellular components from the dermis. Subcutaneously implanted ADM evoked no immunological reaction and 20 weeks after implantation, the size of the implanted ADM was reduced to about 60 per cent of its original area. ⋯ A second layer of ADM placed onto the implanted ADM served as an excellent dressing, providing mechanical protection and permitting vascularization of the underlying implant. Onlay skin autografts placed onto vascularized allogeneic ADM showed good survival when the skin was grafted more than 1 week after ADM implantation. Dispase/detergent treated ADM derived from animal or human skin may be useful in full thickness skin defects providing a vascularized bed for subsequent epidermal coverage.
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A retrospective analysis of all burns admitted to the Welsh Regional Burns and Plastic Surgery Unit, Chepstow, in the period 1 January 1990 to 1 October 1993, highlighted a group of 50 patients who had sustained contact burns from the radiators of domestic central heating systems. There was a male prevalence, with an average age of 43.4 years (range 6 months to 100 years). The mean TBSA burned was 1.58 per cent (range 0.13-6.0 per cent) and half of the injuries were full thickness depth. ⋯ The aim of the audit was to investigate the mechanism of injury and link precipitating factors. The contribution of the high surface temperature of the radiator to the burn injury is alluded to. The various methods available to reduce this risk are discussed and the use of the low surface temperature radiator, already routinely used in health care premises, is advocated.
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Combined transplantation of skin autograft and allograft was used for the treatment of severe burns. The allografts were obtained from cadavers and were pretreated with 15 per cent glycerol for 2 h at 4 degrees C then frozen at -80 degrees C until used. Patches of autografts were placed over the burns and were covered by a stretched mesh of allografts. ⋯ At 3 weeks, the dermal components of the allograft were covered by epithelial cells from recipient tissue and were invaded by fibroblasts and capillaries. At 4 weeks, allografted skin was replaced by granulation tissue, which mediated the adhesion of the grafts to the underlying tissue. Skin allografts with a freeze-thawing pretreatment provide an appropriate matrix for the epithelial relining and for the growth of granulation tissue in burned skin.
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This report is a review of the literature and the clinical experience of electrical burns of the mouth in the West Midlands Regional Burns Unit at the Birmingham Accident Hospital, UK, over the past 10 years. There were five patients, four were children, 9 months to 5 years of age, and one adult. All patients had electrical conduction injuries involving the lips and perioral structures with involvement of the oral commissure. ⋯ Early intraoral splinting has been suggested in the literature. It was not used in any of the patients in this series and, though it may be beneficial, the patient compliance of a paediatric population may be questionable. The incidence of electrical burns has been on the decline, but those affecting the mouth still continue to be a major problem in management.
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Thirty-two patients were admitted to the South-East Scotland Burn Unit over a 4-year period (1990-94), with burns sustained as a consequence of chip-pan fires. This represented 7 per cent of all admissions to the unit. Fourteen patients came from the Edinburgh city area, and 18 from surrounding countries. ⋯ Fourteen patients were managed conservatively, and 18 needed operative intervention. The patients spent an average of 19.4 days in hospital, and they required 46.3 days for complete healing to take place. Prevention by increased community awareness and widespread education is necessary to minimize the incidence, morbidity and cost of this relatively common and preventable type of burn.