Burns : journal of the International Society for Burn Injuries
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While severe pain is a constant component of the burn injury, inadequate pain management has been shown to be detrimental to burn patients. Pain-generating mechanisms in burns include nociception, primary and secondary hyperalgesia and neuropathy. The clinical studies of burn pain characteristics reveal very clear-cut differences between continuous pain and pain due to therapeutic procedures which have to be treated separately. ⋯ Routine pain evaluation is mandatory for efficient and safe analgesia. Special attention must be given to pain in burned children which remains too often underestimated and undertreated. More educational efforts from physicians and nursing staff are necessary to improve pain management in burned patients.
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This report indicates that retention fluid from blisters of partial skin thickness burns, which contains relatively large amounts of cytokines and growth factors, stimulates the wound healing process. Although epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF) levels were low, relatively large amounts of cytokines including platelet derived growth factor (PDGF), interleukin (IL-6) and transforming growth factor (TGF) alpha were present and these exercised stimulatory effects on wound healing. ⋯ Various cytokines were shown to coexist in a balanced state in the retention fluids, suggesting that epithelialization might be regulated via a cytokine network operating on the wound surface. The growth of keratinocytes in culture significantly increased with the addition of 1 per cent or more of blister fluid to the medium.
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Two examples of resuscitation of a scalded child by intraosseous infusion, following failed peripheral venous cannulation, are presented. The technique of intraosseous infusion is reviewed and it is concluded that this technique provides a valuable second-line technique for establishing emergency venous access in children. It is quick, reliable and enables the rapid infusion of intravenous fluids and drugs into the systemic venous system. Complications are rare but can be serious and close observation of the infusion site is advisable.
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Case Reports
An unusual case of lightning injury: a melted silver necklace causing a full thickness linear burn.
An unusual case of lightning injury is shown. Flash-over current caused the fusion of a silver necklace producing a linear full thickness burn in the neck and chest with the silver welded throughout the wound.
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Case Reports
Use of an acellular allograft dermal matrix (AlloDerm) in the management of full-thickness burns.
Scarring and contracture are major long-term sequelae of meshed split-thickness autografting for full-thickness skin injury. In the absence of dermis, mature fibroblasts secrete collagen in the altered pattern of scar. This case report illustrates the use of an acellular dermal matrix processed from human allograft skin (AlloDerm) in the treatment of a full-thickness burn injury. ⋯ No specific immune response was detected, either by histology or by lymphocyte proliferation assay. By providing a dermal replacement, the grafted dermal matrix permitted the use of a thin, widely meshed autograft from the donor site, without the undesirable scarring and contracture at the wound site that commonly results from this technique. If effective, this approach would markedly reduce the amount of donor skin required for split-thickness autografts in full-thickness burn injuries.