A randomized prospective trial of hyperbaric oxygen in a referral burn center population.

Various studies of the effect of hyperbaric oxygen (HBO) in a wide variety of disease entities have been carried out. In the treatment of burns, animal and human studies have yielded somewhat contradictory results. Controlled studies in humans are limited. A randomized study on the effect of HBO was conducted involving 125 burn patients admitted within 24 hours of injury who were matched by age, burn size, and presence or absence of inhalation injury. Patients in the treatment arm received oxygen at two atmospheres of pressure for 90 minutes twice a day for a minimum of 10 treatments and a maximum of one treatment per total body surface per cent burn. The control group was treated in a similar fashion, except for the absence of HBO. There were no statistically significant differences between the two groups for the outcome measures of mortality, number of operations, and length of stay for the survivors. In this large clinical trial, we were unable to demonstrate any significant benefit to burn patients from the use of HBO.

An unusual mechanism of burn injury due to flaming drinks.

Bars and cocktail lounges serve various forms of flaming drinks, usually made with very high-proof alcohol. The drinks are lit and then served. If additional alcohol from the bottle is added to a still-burning drink, flames may spread up the stream of alcohol into the bottle and cause a flash of flame out the bottle's neck. Injuries can require grafting. Three cases are reported. A 32-year-old white female sustained burns covering 10 per cent of her body surface, including the face. Surgery with split-thickness grafts were required. Pressure garments were prescribed for 6 months. A 34-year-old black female was burned by a "volcano" drink. Burns covered 20 per cent of her body surface, including the face. Split-thickness grafts were required on multiple occasions. Infected wounds healed slowly. Reconstructive surgery has so far required eight procedures. A 39-year-old white male sustained severe burns to 10 per cent of his body, including the face. Grafting was carried out. Pressure garments were required. Permanent visible facial scarring is present in all three cases. This type of accident is readily preventable.

Electrocution due to contact of industrial equipment with power lines.

Electrocution due to contact of construction equipment with power lines is not uncommon as a source of industrial injury. We report seven such cases. Two patients sustained cardiac arrest and were successfully resuscitated at the scene. Four patients lost consciousness and in two cases, amnesia for the event was encountered. No long-term cardiac or neurologic effects were noted. Surgery including amputation was sometimes required. In all cases, the patient was on the ground touching the machinery or touching cables connected to the machinery at the time of injury. The importance of exercising due care in industrial safety measures is stressed. Prompt CPR was life saving in two cases.

Burns due to exposure to steam.

Injuries due to accidental contact with steam are occasionally encountered. They can be quite severe, especially when associated respiratory problems are present. Thirteen patients with burns resulting from exposure to steam were admitted to the Joseph M. Still Burn Center during a 2-year period. All injuries were employment related. Twelve burns resulted from the rupture of pipes carrying steam. One additional case was due to a cooking accident. There were 12 males and one female. Burn size ranged from 1 to 57% (mean 26.2%). Age ranged from 26 to 53 years (mean 33). Seven had inhalation injuries with blistering and slough of bronchial mucosa. The hospital stay ranged from 2 to 41 days. One patient died of respiratory problems. From one to five operations were required by the survivors; two required later reconstructive surgery. Closer supervision of industrial plants in which pipes carrying steam are present may have prevented some of these accidents.

Use of cultured epidermal autografts in the treatment of large burns.

Mortality in patients with large areas of full skin thickness burns is, in part, due to complications developing during the period of prolonged delay required to obtain enough wound healing to permit skin grafting from limited donor sites. Cultured epithelial autograft (CEA) has become available as an alternative measure to the use of expanded skin autografts and regrafting. Small biopsies are taken and transported to the laboratories of BioSurface Technology where keratinocytes are grown to cover large areas during a 3-week period. The cultured keratinocytes are then available on petroleum jelly gauze which is applied to the patient. The gauze is used as a temporary dressing. To date, 37 patients have been biopsied. Grafts have been applied in 15. Graft 'take' averaged 71.5 per cent at our institution. Two of the patients grafted with CEA died of sepsis. One patient had a 100 per cent loss of the CEA grafts. In 12 patients, the use of CEA probably contributed significantly to wound coverage and survival. Such grafts are more susceptible to mechanical loss than routine autograft, although long-term coverage after several years is considered to be satisfactory. The cost of the process is high.

Purulent pericarditis in an adult burn patient treated with survival.

A 41-year-old white-skinned male admitted with 40 per cent total body surface area partial and full skin thickness burns developed septic pericarditis. He had a severe inhalation injury and subsequent pneumothorax. Multiple fibreoptic bronchoscopies were required. The septic pericarditis required pericardectomy which was carried out in two stages. The extensive burns required multiple operations. The patient eventually made a complete recovery.

Neuroleptic malignant syndrome in a burn patient.

A 39 year old white male with a 55% total body surface burn who developed neuroleptic malignant syndrome (NMS) during his acute course is reported. The patient had several acute sinusitis and septic episodes during his acute course. On postburn day 31, he developed a temperature of 108.4 degrees F (42.4 degrees C). This responded promptly to Dantrolene and Bromocriptene. His recovery was uneventful. NMS is a drug-related response to various medications, such as Haloperidol, which the patient was receiving. NMS must be considered as part of the differential diagnosis of fever in burn patients receiving medication known to cause the syndrome.

Lawn mower-related burns.

Lawn mower-related injuries are fairly common and are usually caused by the mower blades. Burns may also be associated with the use of power lawn mowers. We describe 27 lawn mower-related burn injuries of 24 male patients and 3 female patients. Three of the patients with burn injuries were children. Burn sizes ranged from 1% to 99% of the total body surface area (mean, 18.1%). Two of the patients died. The hospital stay ranged from 1 day to 45 days. Twenty-six injuries involved gasoline, which is frequently associated with refueling accidents. Safety measures should involve keeping children away from lawn mowers that are being used. The proper use and storage of gasoline is stressed.

Burns due to flammable solvents ignited with floor buffers.

Three patients, employed by janitorial service agencies, were burned severely while buffing floors. A solvent to remove floor lacquer was used in one case, and a solvent to remove glue that held carpet to the floor was used in the other two cases. The solvent used in each case is flammable and was ignited when a floor buffer was used near it. The floor buffers are specifically labeled as unsafe to operate near flammable liquids. The patients' injuries were severe. All three patients survived. This represents a rather unusual and unsafe industrial practice that should be avoided.

Malignant melanoma in a burn scar.

Cancers of various sorts are occasionally encountered in burn scars. These lesions are usually squamous cell carcinomas, and the burn scars are usually old. Very rarely, malignant melanoma is encountered. An 87-year-old nursing home patient who had been burned by a lightening strike at age 16 was evaluated. She had sustained a wound covering 2% or 3% of her body surface involving her neck and the upper portion of her anterior trunk that had required several grafts. A lesion was noted over the suprasternal notch approximately 3 months before admission. The biopsy was reported as malignant melanoma. She was subsequently treated by wide reexcision with an associated Z-plasty for neck release. Because of the patient's age and the presence of four areas of regional lymph nodes nearby into which metastasis might spread, no lymph node dissections were carried out. The specimen from the reexcision was reported as squamous cell carcinoma in situ, melanoma in situ, and multinucleated giant cell reaction, acute and chronic infiltrates. The wound margins were clear.