The Journal of burn care & rehabilitation最新文献

Occupational burns have been determined to be a serious public health concern. The analysis of workplace risks and risk factors associated with burns are critical to developing effective interventions in the future. In this study, we examined accepted Rhode Island workers' compensation claims (n = 5619) from 1998 to 2002 to assess the rates and risks of occupational burns. We used employment data from the Department of Labor's Current Population Survey (CPS) to estimate claim rates and shift analyses. The overall burn rate was estimated to be 24.3 per 10,000 workers. The claim rate for workers younger than 25 years of age was almost double that for all other age groups. The average per-claim disability duration for claims requiring indemnity was 167.9 days, and average annual total cost of claims was dollar 1,010,166. The highest claim rate identified was for workers in food service occupations and an increased risk was found for chemical burns among evening and night-shift workers. Increased interventions are needed to reduce occupational burns in work settings. Particular diligence should be should address occupational burn hazards in restaurant establishments, and preventative should be measures aimed at young employees and late-shift workers.

This study was designed to determine the possible protective effect of Ginkgo biloba extract (EGb) against oxidative organ damage distant from the original burn wound. Under brief ether anesthesia, the shaved dorsum of the rats was exposed to 90 degrees C (burn group) or 25 degrees C (control group) water bath for 10 seconds. EGb (50 mg/kg/day) or saline was administered intraperitoneally immediately and at 12 hours after the burn injury. Rats were decapitated 24 hours after burn injury and tissue samples from the liver and kidney were taken for the determination of malondialdehyde (MDA) and glutathione (GSH) levels, myeloperoxidase (MPO) activity, and collagen contents. Formation of reactive oxygen species in the tissue samples was monitored by the chemiluminescence technique. Tissues also were examined microscopically. Blood urea nitrogen, creatinine, alanine aminotransferase, and aspartate aminotransferase levels and tumor necrosis factor- and lactate dehydrogenase activity were assayed in serum samples. Severe skin scald injury (30% TBSA) caused a significant decrease in GSH levels and significant increases in MDA levels, MPO activity, and collagen content of hepatic and renal tissues. Treatment of rats with EGb significantly increased the GSH level and decreased the MDA level, MPO activity, and collagen contents. Similarly, serum alanine aminotransferase, aspartate aminotransferase, and blood urea nitrogen levels, as well as lactate dehydrogenase and tumor necrosis factor-, were increased in the burn group as compared with the control group. However, treatment with EGb reversed all these biochemical indices, as well as histopathological alterations that were induced by thermal trauma. Our results show that thermal trauma-induced oxidative damage in hepatic and renal tissues is protected by the administration of EGb, with its antioxidant effects. Therefore, its therapeutic role as a "tissue injury-limiting agent" must be further elucidated in oxidant-induced tissue damage.

This study reviewed the use of an inpatient rehabilitation unit for burn survivors. We hypothesized that adult burn patients admitted earlier to inpatient rehabilitation have an equal or better functional outcome than those remaining in acute burn center for rehabilitation care. Functional Independence Measure (FIM) data were prospectively collected on our burn center admissions dating January 2002 to August 2003. National rehabilitation data were acquired from eRehabData and burn literature. A total of 217 adult patients survived until hospital discharge, with 21 (9.7%) discharged to inpatient rehabilitation (REHAB). REHAB had larger burn injuries, more inhalation injuries, higher incidence hand/foot burns, and longer length of stay (LOS). REHAB had lower FIM upon rehabilitation facility admission than national averages but greater FIM improvement during comparable rehabilitation LOS. Although our earlier rehabilitation admission strategy results in more frequent rehabilitation unit referrals, patients had shorter burn center LOS and greater FIM improvement compared with limited national burn patient functional outcome data currently available.

Goulian and Watson knives work well for tangential burn excision on large flat areas. They do not work well in small areas and in areas with a three-dimensional structure. The Versajet Hydrosurgery System (Smith and Nephew, Key Largo, FL) is a new waterjet-powered surgical tool designed for wound excision. The small size of the cutting nozzle and the ability to easily maneuver the water dissector into small spaces makes it a potentially useful tool for excision of burns of the eyelids, digits and web spaces. The Versajet Hydrosurgery System contains a power console that propels saline through a handheld cutting device. This stream of pressurized saline functions as a knife. We have used the Versajet for burn excision in 44 patients. Although there is a learning curve for both surgeons using and operating room staff setting up the device, the Versajet provides a relatively facile method for excision of challenging aesthetic and functional areas.

The development of contractures is a common complication after burn injuries. Axillary burns often result in limited abduction of the arm and present a major hindrance in rehabilitation. To prevent axillary contractures after burn injury, we perform a special grafting technique. In this study we treated 17 patients with 23 axillary burns using this technique. Patients were splinted early, and an intensive physiotherapy program was started 5 days after splinting. After 12 months, the mean abduction of the successfully treated axillary burns was 152 degrees. A secondary reconstruction was needed in only 5 of the 23 treated axillary burns. For the treatment of axillary burns, we recommend the described grafting technique in combination with early splinting and intensive physiotherapy.

Management of a mass casualty involving burn patients that overwhelms local resources will likely require a triage process in which limited resources are devoted to the patients with the highest likelihood of survival. No objective criteria exist which define how patients could be categorized in such a situation. A table that classifies patients according to their anticipated survival from burn injury, and the resources required to achieve that survival, is presented here. The limitations and restrictions of applying such a guideline are discussed in detail.

This study examined the efficacy of an intensive, short-term social skills training program in improving the psychosocial adjustment of burned adolescents. Sixty-four adolescents who had suffered a burn injury 2 years previously or longer and who were identified as having psychosocial difficulties (elevated behavioral problems and/or diminished competence) were assigned randomly to receive the treatment intervention or to serve as controls (32 in each group). The intervention was a social skills training curriculum provided in a small group residential format. Didactic and experiential techniques were used in a schedule of activities during a 4-day period. One year after the training program, the group who had received the treatment showed significantly more improvement than did the control group. The program appears to offer advantages to a sizeable group of pediatric burn survivors and indicates the need for further study of interventions to enhance psychosocial competence in the development of pediatric burn survivors.

We document the severe burns sustained by three patients with epilepsy who suffered seizures while showering. On the basis of the circumstances of these accidents, we suggest preventative measures to help other patients with epilepsy avoid similar burn injuries. Patient data collected from January 1987 to May 2004 by the Burn Unit of the Department of Plastic Surgery, University of Aachen, Germany, were reviewed. Three patients with epileptic disorders were found who suffered severe burn injuries caused by seizures that occurred while showering. Scald location and depth was assessed. Three patients (two women, one man) sustained extensive scald injuries after epileptic seizures while showering. Burn extent ranged from 20% to 35% TBSA. Scalds primarily affected the trunk, legs, arms, and buttocks. Two of the three patients used showers with levers for controlling water temperature. Safety devices for limiting water temperature were absent. All patients used shower cubicles. Patients with epilepsy may sustain serious burns, typically affecting the trunk, legs, arms, and buttocks, when a seizure occurs while showering. We suggest that individuals with epilepsy use showers designed with pirouetting taps, rather than levers, to regulate water temperature. Pirouetting taps are less likely to be shifted out of position during a seizure. We also recommend that epileptic patients have safety devices installed in their water heaters that limit maximum water temperature. Such safety devices prevent scald injury. And, finally, we suggest that people with comparable disorders generally avoid using shower cubicles. Instead, showers with curtains should be used, which may allow occupants to escape from dangerously hot shower water more easily.