The Unna 'sleeve': an effective postoperative dressing for pediatric arm burns.

The goal of this study was to develop a postoperative plan for sheet grafts that would protect the graft, yet would also eliminate the need for daily wound care. Eleven pediatric patients (13 arms burns) who underwent excision and grafting were included in our study. The total area on the arm ranged from 1% to 5% total body surface area. All grafts were sheet grafts held in place with steri-strips or sutures. The grafts were covered with a layer of greasy gauze, followed by an Unna done paste dressing, and then an elastic bandage. The Unna "sleeve" remained in place for an average of 6 days (range, 3 to 10 days). In eight cases, a second Unna sleeve was applied and removed 6 to 7 days later. In all 13 cases, additional wound care for grafts was unnecessary, and patients did not require extended inpatient hospitalization. Graft take was 100% in all cases, and no reconstruction was required.

Skeletal and dental disturbances after facial burns and pressure garments.

Pressure garments alter facial growth. We conducted a prospective study of facial growth in children wearing such garments to quantify these skeletal and dental disturbances. Three children with total face masks and three children with devices covering the lower face were studied. Panoramic and cephalometric radiographs were obtained at the start of treatment, approximately 6 months later, and at the end of the treatment. Clinical examinations were performed to document occlusal status and subsequent changes. Total face masks affected maxillary horizontal growth more than vertical growth. Mandibular growth changed from the normal anterior and inferior direction to a more inferior direction. With partial face masks, the most notable change was increased proclination of anterior teeth. Facial growth and the position of anterior teeth appear to be affected by the combination of the extent of the burn and skin graft and the type of pressure garments worn during the time of rehabilitation.

Impairment, time out of school, and time off from work after burns.

Objective measurement of impairment after burns is important to patients, physicians, lawyers, and insurance companies. Even so, we could not find any references in the English literature describing how to objectively rate the physical impairment of burn survivors. The American Medical Association (AMA) has published the book Guides to Evaluation of Permanent Impairment, which is commonly used by surgeons to rate injuries. We decided to use this document to rate the impairment of burn patients. We studied patients who were treated at the University of Washington Burn Center during the years 1981, 1982, and 1983; survived the injury; were hospitalized 5 or more days or were skin grafted; and were followed until their condition was fixed (usually 12 months). This group included 325 patients. The mean age was 28.2 years and the mean total body surface area burned (TBSA) was 11.6 percent. We measured whole-man impairment (WMI) as described by the Guides to the Evaluation of Permanent Impairment. The mean whole-man impairment was 7.7 percent. In addition, we recorded time off from work and out of school after burns. The average time off from work was 12.7 weeks, and the average time out of school was 8.5 weeks. We conclude that the AMA publication can be used to rate burn patients and that the whole-man impairment of burn survivors is quite low if amputation, loss of range of motion, and nerve damage can be prevented.