Causes and treatment of burns from grease.

A large number of burns are sustained every year as the result of kitchen grease. A review of a 13-month period at the Joseph M. Still Burn Center in Augusta, Georgia, revealed 60 cases (9.4% of acute burn admissions). Forty-five (75%) of these patients were adults and 25% were children. There were 23 females and 37 males. Forty-two percent of the adults and 33% of the children had some percentage of third-degree injury. The average total body surface area burn in adults was 5.9% and in children 6.3%. There were no deaths in this series. Burns usually occurred as the result of scalds with grease while cooking. Spilling grease on children in the kitchen was a frequent problem. Burns due to ignition of grease was also a cause of injury. Most of the injuries were potentially preventable, and therefore the importance of burn appropriate safety programs is stressed.

Use of dermal regeneration template in contracture release procedures: a multicenter evaluation.

Integra dermal regeneration template (Integra Life Sciences, Plainsboro, N.J.) is an effective treatment for full-thickness burns. It can also be useful in contracture release procedures; however, the clinical utility of a dermal regeneration template in contracture release procedures has not been adequately characterized. In this multicenter investigation, the outcomes of release procedures incorporating a dermal regeneration template for 89 consecutive patients, who underwent a total of 127 contracture releases, were retrospectively evaluated. The procedures involved the application of Integra, which includes a temporary silicone epidermal substitute and an artificial dermal layer. After formation of a neodermis, the silicone layer is removed and replaced with an epidermal autograft. Data on patient and contracture site history, treatment methods, physician assessments of range of motion or function, patient satisfaction, recurrence, and adverse events were collected with a standardized questionnaire. Release procedures for the study patients involved the neck, axilla, trunk, elbow, knee, hand, and other anatomical sites. The mean postoperative follow-up period was 11.4 months. At 76 percent of the release sites, range of motion or function was rated as good (significant improvement in range of motion or function) or excellent (maximal range of motion or function possible) by physicians. Responding patients expressed satisfaction with the overall results of treatment at 82 percent of the sites. No recurrence of contracture at 75 percent of the sites was observed during follow-up monitoring. Patient age and prior surgical treatment at the site did not significantly affect the results of treatment. However, outcomes were superior at mature sites, i.e., those for which more than 12 months had elapsed since the original injury. Postoperative complications rarely necessitated regrafting. These results indicate that a dermal regeneration template provides a useful alternative technique for contracture release procedures. The study data indicate that this approach leads to favorable functional outcomes and a high rate of patient satisfaction. This modality also seems to be versatile, because a range of anatomical sites are amenable to treatment with a dermal regeneration template, regardless of prior surgical treatment, and both pediatric and adult patients respond well to this form of therapy. Furthermore, Integra confers functional and cosmetic benefits similar to those of full-thickness grafts but without comparable potential for donor-site morbidity.

The use of a collagen sponge/living cell composite material to treat donor sites in burn patients.

The objective of this study was to examine the safety and efficacy of bilayered cellular matrix, (OrCel) Ortec International, Inc., New York, NY in facilitating timely wound closure of split-thickness donor sites in severely burned patients. We utilized a matched pairs design; each patient had two designated donor sites of equivalent surface area and depth. Sites were randomized to receive a single treatment of either OrCel or the standard dressing Biobrane-L (Bertek Pharmaceuticals) Sugarland, TX. The results demonstrate that OrCel was more effective in facilitating timely wound closure of split-thickness skin donor sites than Biobrane-L. The healing time for OrCel sites was significantly shorter than for sites treated with Biobrane-L. This acceleration of wound healing was clinically important in enabling earlier recropping. OrCel sites also exhibited reduced scarring. Therefore, treatment of donor site wounds with OrCel is well tolerated, promotes more rapid healing, and results in reduced scarring when compared with conventional therapy with Biobrane-L.

Experience with necrotizing fasciitis at a burn care center.

Necrotizing fasciitis is a soft tissue infection that causes necrosis of subcutaneous tissue and fascia but usually spares skin and muscle. Management of this condition consists of early diagnosis, broad-spectrum antibiotic coverage, aggressive surgical debridement, wound closure, and intensive supportive care. Mortality estimates reported in the literature have ranged from 20 to 75%. We report the cases of 12 patients treated at the Joseph M. Still Burn Center in Augusta, GA. Because aggressive surgical debridement combined with medical support is required for successful treatment, we recommend that treatment be administered at a burn care center. We performed a retrospective chart review of all patients admitted to our center with a diagnosis of necrotizing fascitis between May 1, 1995, and June 1, 2000. Patients were managed collaboratively by burn surgeons and critical care intensivists in consultation with other appropriate specialists. The mean time from initial diagnosis until transfer to the burn center was 14 days (range, 0-60 d). Complications included pneumonia, heart failure, metabolic abnormalities, anemia, and sepsis. Four (33%) of the 12 patients died, with the primary cause of death being multiorgan failure. Although our sample size is too small to reach statistical significance, the data suggest that early referral to a burn or wound care center improves patient outcome.

A retrospective study to determine the incidence of pressure ulcers in burn patients using an alternating pressure mattress.

In immobilized patients, unrelieved pressure can create decubitus ulcers over bony prominences. Those burn patients who require prolonged bed rest, are prone to the development of such problems. Various methods of reducing pressure on these areas, including frequent turning and the use of air fluidized and low air loss beds, have been adopted to attempt to prevent the development of this complication. The Pegasus Renaissance alternating pressure mattress is such a device, intended to reduce the incidence of decubitus ulcers. It was introduced at our burn unit and evaluated over a 29-month period. During the study period, 186 (13.4%) of 1390 acutely burned patients, believed to be at high risk for the development of decubiti, were placed on this mattress. Other patients were treated in the standard hospital bed. Care was otherwise the same. No decubitus ulcers developed in any of the patients treated on the Pegasus Renaissance mattress.

A retrospective study to determine the incidence of pressure ulcers in burn patients using a low air loss pressure relieving mattress.

In immobilized patients, unrelieved pressure can create decubitus ulcers over bony prominences. Those burn patients who require prolonged bed rest, are prone to the development of such problems. Various methods of reducing pressure on these areas, including frequent turning and the use of air fluidized and low air loss beds, have been adopted to attempt to prevent the development of this complication. The Pegasus Renaissance alternating pressure mattress is such a device, intended to reduce the incidence of decubitus ulcers. It was introduced at our burn unit and evaluated over a 29-month period. During the study period, 186 (13.4%) of 1390 acutely burned patients, believed to be at high risk for the development of decubiti, were placed on this mattress. Other patients were treated in the standard hospital bed. Care was otherwise the same. No decubitus ulcers developed in any of the patients treated on the Pegasus Renaissance mattress.

Burns caused by carburetors.

During a 10-year period 4645 patients were admitted to the Joseph M. Still Burn Center with acute burns. Of these, 83 (1.79%) were caused by carburetor-related accidents. There were 79 males and 4 females. Ages ranged from 10 to 72 years. Burn size ranged from 1 to 97.5% (mean, 12.3%). There was one death in the group. Eighteen patients required only topical care; 65 patients required a total of 108 operations for debridement and grafting. Length of stay ranged from 1 to 63 days (mean, 11 days). The mechanism of injury was usually the same; in 81 cases the accident occurred while someone was pouring gasoline into a carburetor. In 63 cases the vehicle was an automobile or pickup truck. Explosions resulted in 12 instances; in 65 instances fires were started. These injuries are serious, expensive, fairly common, and may be life threatening. Proper handling of gasoline is stressed. Newer vehicles have fuel injector systems, which may gradually eliminate the problem over time, because pouring gasoline is not required.

Toxic epidermal necrolysis due to administration of celecoxib (Celebrex).

A 41-year-old woman was given celecoxib (Celebrex) for the treatment of carpal tunnel syndrome. An erythematous rash developed that progressed to exfoliative dermatitis, and the patient was diagnosed with toxic epidermal necrolysis. After transfer to the burn unit, she was treated with topical mupirocin calcium cream and bismuth tribromophenatein petrolatum gauze dressings. Her wounds healed well. This is the first case report of toxic epidermal necrolysis due to treatment with celecoxib of which we are aware.

A comparison of the effect of early insertion of standard latex and silver-impregnated latex foley catheters on urinary tract infections in burn patients.

A retrospective study was designed to compare the incidence of urinary tract infections during two different time periods in burn patients treated with two different types of Foley catheters. In time period 1, latex catheters present on admission were not changed. In time period 2, catheters were replaced on admission with silver alloy-impregnated catheters. In time period 1, the rate of symptomatic urinary tract infections was 7.2 per 1,000 catheter-days. In time period 2, the rate was 4.4 per 1,000 catheter-days. Results, compared using Fisher's exact test, revealed a statistically significant P value of .029. The use of silver-impregnated catheters significantly lowered the rate of urinary tract infection at our burn center.