The Journal of craniofacial surgery
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Burns are common injuries in the pediatric population, with an estimated 250,000 pediatric burn patients seeking medical care annually. A relative few require inpatient management. This article discusses suggestions for burn prevention, as well as acute burn care and long-term management of small burns.
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Advances in cellular biology and knowledge in wound healing and growth factors have given us a wide variety of choices to attack the problem of the complex burn wound. Split-thickness skin grafting with autograft is at present the standard of care. It, however, is not an ideal substitute and frequently is not available for full-burn coverage. This article will review honey, human amnion, xenograft, allograft, cultured epithelial autograft, and various engineered commercial products for use in the biologic treatment of burn wounds.
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Electrical burns of the upper extremity, particularly high-voltage injuries, are becoming more prevalent in today's society and are often times devastating to the patients' appearance and functionality. The basic tenants of flame burn reconstruction apply to electrical injuries. ⋯ Whereas the role of the surgeon continues to be the creation of ingenious techniques to deal with complications, the real treatment lies in education and prevention. This article will look to do a comprehensive review of electrical injuries to the upper extremity.
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Unique anatomic and pathophysiologic features of the thermally burned pediatric hand are reviewed, with a focus on direct management of the injured tissue in the early phases of the treatment process. A nonoperative approach to most pediatric hand burns is advocated, and principles of early wound care, including antimicrobial therapy, and escharotomy are described. ⋯ Finally, basic techniques for splinting, positioning, and exercising the burned pediatric hand are described. When properly applied, the principles discussed herein have rendered the severely scarred, functionless hand a rarity after thermal injury.
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Catastrophic burn injuries often leave patients in shock or incommunicative, creating complex ethical situations. Patient autonomy and the ability to make competent decisions become key issues. Although patient surrogates may aid in decision making, few patient advocates possess appropriate perspective of burn injury, management options, and likely outcomes. ⋯ At what point does caring for the severely burned patient become futile, and who defines it as such? Whereas formulas and algorithms guide medical management, very few well-defined principles direct ethical decision making in severe burn management. The physician must rely on his or her understanding of medical ethics to marshal a complex team of burn personnel, maintain institutional protocol, and work closely with patients and patient advocates. Only thorough, thoughtful rational application of ethics can one provide maximal respect for patient autonomy while optimally managing the severe burn injury.