Burns : journal of the International Society for Burn Injuries
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Local adipofascial turn-over flaps overlaid with skin grafts were used successfully to reconstruct nine deep burn wounds following electric injuries or contact burns in seven patients. Durable flap coverage of the exposed tendons, joints or bones can be achieved with a one-stage procedure. ⋯ The adipofascial turn-over flap is a reliable and simple technique for reconstruction of certain deep burn wounds if the surrounding soft tissue is available. The functional and cosmetic results in our series have been rewarding and satisfactory.
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The first 12 months of a new consultation-liaison service to a burns unit is described. Management of contact between the psychiatrist and the burns team is discussed and diagnostic categories are given for referrals seen. Diagnostic criteria are not achieved for many patients assessed, and yet the burns team still requires help managing patients who are psychologically disturbed. Education and a forum for team discussion are used as a way for the burns team to integrate psychological work in the management of their patients.
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This report describes the statistical analysis of 629 burn patients treated between January 1989 and August 1990. The analysed data include age, sex, cause of burn and mortality in relation to age, cause and extent of burn injuries. Additional information with regard to socioeconomic status, marital status, place of burn, family size, type of burn, time of accident and time between injury and hospital admission was obtained from analysis of 271 of the 629 patients admitted between January 1990 and August 1990. ⋯ Flame burns resulted in maximum deaths (62.1 per cent). In patients with over 40 per cent burns, the mortality was about 80 per cent. There were no survivors in patients with over 70 per cent TBSA burns in our series.
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Postburn metabolic and immunological alterations may in part be due to translocation of gut exotoxin and endotoxin, which can result in tumour necrosis factor (TNF) and prostaglandin E (PGE) production by macrophages. We evaluated the effect of burn injury, plus exotoxin and endotoxin on TNF-alpha and PGE production by Kupffer cells, and peritoneal macrophages. Adult Wistar rats underwent 30 per cent TBSA burn or sham burn. ⋯ The increased TNF-alpha production was inversely related to PGE levels. In conclusion, both burn injury and Exo-A potentiate the responsiveness of Kupffer cells and peritoneal macrophages to endotoxin as measured by the rate of production of TNF-alpha and PGE. PGE may locally downregulate the immune response by limiting Kupffer cells' and peritoneal macrophages' TNF-alpha production.
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A prospective study was performed that allowed a quantitative estimation of blood loss in excision and grafting of adult burn injuries. The average value for blood loss was 9.2 per cent of the patient's estimated blood volume or 387 ml per 1 per cent burn excised and grafted. ⋯ These values do not apply to the very young, the very old and those patients who have bleeding disorders, and when using various methods to limit blood loss. This figure allows adequate cross-matched whole blood to be available preoperatively.