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1.
Zhonghua Shao Shang Za Zhi ; 36(1): 54-57, 2020 Jan 20.
Artigo em Chinês | MEDLINE | ID: mdl-32023719

RESUMO

Objective: To investigate the occurrence and risk factors of deep venous thrombosis (DVT) in adult burn patients. Methods: The clinical data of 1 219 adult burn patients admitted to the Department of Burns of Zhengzhou First People's Hospital from January 1, 2015 to August 31, 2016, conforming to the study criteria, were analyzed retrospectively by the method of case-control study, including 811 males and 408 females, aged 18-102 years. According to whether DVT occurred during hospitalization or not, the patients were divided into group DVT (n=12) and non-DVT group (n=1 207). The incidence of DVT, the diagnosis time of DVT, affected limbs, and DVT classification were counted and recorded. The gender, age, total burn area, D-dimer, lower limb burn, full-thickness burn, femoral vein indwelling central venous catheter (CVC) , inhalation injury, sepsis/infection shock, surgical operation, and infusion of concentrated red blood cells of patients between the two groups were compared with chi-square test, and then the indicators with statistically significant differences between the two groups were processed by multivariate binary logistic regression analysis to screen the independent risk factors of DVT in the adult burn patients. Results: (1) The incidence of DVT of adult burn patients was 0.98% (12/1 219), and DVT was diagnosed 24-138 days after injury, with a median of 61.5 days. DVT occurred in the right lower limb of 2 patients, left lower limb of 8 patients, and bilateral lower limbs of 2 patients, and DVT classification included 6 cases of mixed type and 6 cases of peripheral type. (2) There were no statistically significant differences in gender, age, and full-thickness burn of patients between the two groups ( χ(2)=1.524, 0.021, 3.115, P>0.05). There were statistically significant differences in total burn area, lower limb burn, inhalation injury, sepsis/infection shock, D-dimer, femoral vein indwelling CVC, surgical operation, and infusion of concentrated red blood cells among patients between the two groups (χ(2)=17.975, 6.206, 3.987, 8.875, 5.447, 15.124, 10.735, 14.031, P<0.05 or P<0.01). (3) Total burn area, D-dimer, and femoral vein indwelling CVC were independent risk factors for DVT in adult burn patients (odds ratio=10.927, 4.762, 9.394, 95% confidence interval=3.078-38.789, 1.197-18.934, 2.631-33.540, P<0.05 or P<0.01). Conclusions: The incidence of DVT in adult burn patients is relatively low, and the diagnosis time of DVT is 3 weeks after burn, with DVT classification of mixed type and peripheral type. The total burn area, femoral vein indwelling CVC, and D-dimer are independent risk factors for predicting DVT in adult burn patients.


Assuntos
Queimaduras , Trombose Venosa , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Queimaduras/complicações , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Trombose Venosa/etiologia , Adulto Jovem
3.
Khirurgiia (Mosk) ; (2): 95-99, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32105263

RESUMO

A 51-year-old severely burned woman had hospitalized at the Clinic of Thermal Injuries of the S.M. Kirov Military Medical Academy with a diagnosis: flame burn in a surface area of 40% (11%)/II-III b degrees of head, neck, trunk, limbs. Inhalation injury of moderate severity. The infusion drug of the combined action reamberin, which has a volemic and antihypoxic effect, had added to the complex antishock therapy. The presented clinical observation demonstrates the favorable course of burn shock: stopping of burn shock 28 hours after injury.


Assuntos
Queimaduras , Meglumina/análogos & derivados , Militares , Choque , Succinatos , Queimaduras/complicações , Feminino , Hidratação , Humanos , Meglumina/uso terapêutico , Pessoa de Meia-Idade , Choque/etiologia , Choque/terapia , Succinatos/uso terapêutico
4.
FP Essent ; 489: 11-15, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31995349

RESUMO

Patients with bacterial skin and soft tissue infections (SSTIs) commonly present to family physicians. Common uncomplicated bacterial SSTIs include impetigo, ecthyma, cellulitis, erysipelas, abscesses, furuncles, and carbuncles. Risk factors for SSTIs include older age and chronic medical conditions, such as diabetes and cardiopulmonary or renal disease, and immunocompromise. Staphylococci and streptococci are the most common pathogens. Uncomplicated impetigo and ecthyma can be managed with topical antibiotics. Oral antibiotics should be prescribed for patients with complicated impetigo and ecthyma and for patients with cellulitis. For patients with cellulitis and systemic signs of infection, systemic antibiotics are indicated but hospitalization or intravenous administration may not be required. Erysipelas can be managed with oral or intravenous penicillin. Purulent SSTIs by definition involve collections of pus and include abscesses, furuncles, and carbuncles. Larger abscesses are appropriate for incision and drainage. Patients with uncomplicated carbuncles or abscesses may not require antibiotics afterward. However, antibiotics are recommended for patients with systemic inflammatory response syndrome (SIRS), patients with carbuncles or abscesses who have not improved with initial antibiotic therapy, patients with impaired host defenses, and patients with SIRS and hypotension.


Assuntos
Queimaduras , Dermatopatias Bacterianas , Infecções dos Tecidos Moles , Idoso , Antibacterianos , Queimaduras/complicações , Queimaduras/microbiologia , Humanos , Pacientes Ambulatoriais , Fatores de Risco , Dermatopatias Bacterianas/tratamento farmacológico , Infecções dos Tecidos Moles/tratamento farmacológico
5.
FP Essent ; 489: 16-20, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31995350

RESUMO

Fungal and viral skin infections are common and typically are managed by family physicians. The fungal skin infections commonly seen in family practice include the various forms of tinea: tinea corporis, tinea gladiatorum, tinea cruris, tinea pedis, tinea capitis, and tinea unguium (eg, onychomycosis). Common viral skin infections include herpes simplex virus infection, herpes zoster, cutaneous and genital warts, and molluscum contagiosum. Many fungal and viral skin infections have a classic appearance but variations and atypical manifestations can make patients with these conditions difficult to diagnose definitively. Confirmatory testing often is not required. In complex cases with atypical features, microscopy, culture, or blood tests can help in making a diagnosis. For some infections, treatment may be initiated before confirmatory test results are received. Most fungal skin infections can be managed effectively with topical antifungals. Tinea capitis and onychomycosis should be managed with oral drugs. Oral antiviral drugs are used to manage most viral skin infections but dosages vary based on the condition and phase of the infectious process. Cutaneous warts typically are managed with salicylic acid and/or cryotherapy.


Assuntos
Queimaduras , Dermatomicoses , Dermatopatias Infecciosas , Tinha , Queimaduras/complicações , Queimaduras/microbiologia , Dermatomicoses/diagnóstico , Dermatomicoses/tratamento farmacológico , Dermatomicoses/etiologia , Humanos , Pacientes Ambulatoriais , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/tratamento farmacológico , Dermatopatias Infecciosas/etiologia , Tinha dos Pés
6.
FP Essent ; 489: 21-26, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31995351

RESUMO

Diabetes is associated with many complications, including foot ulcers. Individuals with diabetes have a 15% to 25% likelihood of developing a foot ulcer in their lifetime. The pathophysiologic mechanisms are multifactorial but the major etiologic factors are peripheral vascular disease and diabetic neuropathy. Foot examinations are recommended at least annually for patients with diabetes to assess the risk of foot ulcers and to detect, diagnose, and manage them. Management includes avoidance of walking, weight-bearing limitation, use of therapeutic footwear, use of dressings and debridement, and antibiotics. Due to immune dysfunction, diabetic neuropathy, and poor circulation, patients with diabetes are at increased risk of other types of infections. These include erythrasma, candidiasis, paronychia, onychomycosis, necrotizing fasciitis, Fournier gangrene, otitis externa, and nontuberculous mycobacterial skin infections. A high index of suspicion is required to diagnose these conditions. Patient evaluation may include a detailed physical examination, imaging, laboratory tests, and biopsies and cultures. Management may involve mechanical or surgical debridement, topical and oral antibiotics, and abscess drainage.


Assuntos
Queimaduras , Complicações do Diabetes , Dermatopatias Infecciosas , Queimaduras/complicações , Desbridamento , Humanos , Pacientes Ambulatoriais , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/tratamento farmacológico , Dermatopatias Infecciosas/etiologia
7.
J Surg Res ; 246: 490-498, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31635838

RESUMO

BACKGROUND: Burn patients are at high risk of infection, and as sepsis contributes significantly to morbidity and mortality, early diagnosis is essential. Procalcitonin (PCT) is a biomarker released in response to inflammation and specifically bacterial infection. This study aimed to determine the value of PCT as a diagnostic biomarker of sepsis in burns patients in Johannesburg, South Africa. MATERIALS AND METHODS: All adult patients admitted to two burns intensive care units in Johannesburg over a 3-year study period were included in a retrospective data review. Records of 178 patients were accessible and reviewed. RESULTS: The most significant risk factor for sepsis was percentage total body surface area burned (P = 0.012). A rise in PCT was a significant biomarker for bacterial infection in the early phase after a burn (P = 0.03) but not after day eight. PCT correlated with C-reactive protein as a biomarker for sepsis (P < 0.001), but not with other biomarkers. The mean PCT in patients who died was significantly higher on every study day until death compared with those who remained alive (P < 0.02, consistently). Patients on inotropes also had a significantly increased PCT level (P = 0.0001), as did those who were not discharged from intensive care unit by day 14. CONCLUSIONS: PCT may be useful as an adjunct biomarker of infection in burn patients and has potential as a predictive biomarker of early discharge.


Assuntos
Queimaduras/complicações , Pró-Calcitonina/sangue , Sepse/diagnóstico , Adulto , Biomarcadores/sangue , Queimaduras/sangue , Queimaduras/diagnóstico , Proteína C-Reativa/análise , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Sepse/sangue , Sepse/etiologia , África do Sul , Adulto Jovem
8.
Clin Plast Surg ; 47(1): 119-130, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739888

RESUMO

This article presents the authors' experience with the use of fat grafting via the Coleman technique, for the adjuvant treatment of facial burn wounds and their sequelae. It demonstrates the regenerative effects of fat injected under the wound and/or the scar as well as of fat delivered to the debrided surface of the wound and to the surface of the scar after laser treatment or microneedling.


Assuntos
Tecido Adiposo/transplante , Queimaduras/complicações , Queimaduras/cirurgia , Cicatriz/cirurgia , Traumatismos Faciais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Cicatriz/etiologia , Desbridamento , Humanos , Transplante Autólogo
9.
Clin Plast Surg ; 47(1): 131-138, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739889

RESUMO

Autologous fat grafting has become more and more popular among plastic surgeons in the last few years due to recent discoveries on the mesenchymal stem cells stored in the harvested fat. These cells have a great regenerative potential and have the ability to restore the damaged tissues. The authors focused their practice on the treatment of the facial scars (derived from burns, trauma, degenerative diseases, and radiotherapy) and confirm that lipofilling is an excellent solution because it is able to improve the quality of the damaged tissues in terms of better scar color, pliability, thickness, relief, itching, pain, scar vascularization, and pigmentation.


Assuntos
Tecido Adiposo/transplante , Cicatriz/cirurgia , Traumatismos Faciais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Queimaduras/complicações , Queimaduras/cirurgia , Cicatriz/etiologia , Traumatismos Faciais/complicações , Humanos , Transplante Autólogo
10.
Rev Infirm ; 68(256): 23-24, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31870473

RESUMO

The experience of pain during a severe burn is multifactorial, both in the typology of the burn and in the circumstances of its occurrence. Third-degree burns are painless as the dermis and its nociception sensors are damaged. After a severe burn, from initial management, to home care, to a long hospital stay, pain evolves with its etiology and requires specific management.


Assuntos
Queimaduras , Manejo da Dor , Dor , Queimaduras/complicações , Humanos , Dor/etiologia , Medição da Dor
11.
Rev Infirm ; 68(256): 28-29, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31870475

RESUMO

The nutrition of the severely burned patient is one of the pillars of his or her care, from the first few hours after the accident to rehabilitation. When properly conducted, there is a recognized beneficial effect on morbidity and even mortality.


Assuntos
Queimaduras , Apoio Nutricional , Queimaduras/complicações , Humanos , Estado Nutricional
12.
Rev Infirm ; 68(256): 30-31, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31870476

RESUMO

Dressings are a real challenge in the care of patients with thermal burns. They help to heal and prevent or treat possible skin infections. Paramedical teams must have a perfect strategy for organizing, managing pain and optimizing hygiene and asepsis rules. The purpose is to facilitate the understanding and implementation of this treatment by suggesting protocols that can be applied by all. It remains essential to mobilize specialized services to promote the evolution of burns.


Assuntos
Bandagens , Queimaduras , Adulto , Queimaduras/complicações , Queimaduras/terapia , Dermatite/etiologia , Humanos , Dor , Cicatrização
13.
S Afr Med J ; 109(12): 911-913, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31865951

RESUMO

South Africa (SA) has a high incidence of deaths from trauma and injuries. Trauma has been identified as one part of the quadruple burden of disease afflicting the country. This article is concerned with the management of burns, which 3% of the population suffer from annually. Ketamine, acknowledged for its versatility and safety profile, remains a critical component in the medical arsenal of anaesthesiologists and clinicians treating both acute and chronic pain. In the management of burn-injured patients in particular, ketamine is the cornerstone of many analgesia protocols. However, issues pertaining to shortages of this medicine in SA warrant concern and discussion, particularly in view of the high reliance of doctors on ketamine for first-line procedural analgesia in the management of burns in both adult and paediatric patients. This article attempts to highlight the issues related to ketamine shortages, which often have significant clinical, safety, operational and research implications.


Assuntos
Analgésicos/provisão & distribução , Ketamina/provisão & distribução , Dor/tratamento farmacológico , Queimaduras/complicações , Humanos , Dor/etiologia , África do Sul
14.
Pan Afr Med J ; 33: 189, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692788

RESUMO

Introduction: Burn injuries are a major cause of hospitalization and are associated with significant morbidity and mortality, particularly in children aged four years or below. In Cameroon, the mortality rate of pediatric severe burns was estimated at 41.2%. There is need to determine the predictors of such mortality in order to guide appropriate management. Methods: This study is aimed at assessing the predictors of mortality of pediatric patients who sustained a burn injury over a period of 11 years (between 1st of January 2006 and 31st of December 2016) in Douala General Hospital (DGH). The data for this study was entered in an electronic questionnaire and analyzed using Epi info version 7. All variables thought to be associated with mortality were entered in a multiple binary logistic regression model. The magnitude or risk was measured by odds ratio, and the 95% confidence interval was estimated. Results: A total of 125 cases of pediatric burns were recorded over the study period. A total of 69 (55.65%) were males, giving a male to female ratio of 1.25:1. The median age was 4 years. Most pediatric burns resulted from accidents. Most patient 78 (69%) came before 8 hours following injury. Scalding was the predominant mechanism of injury in 56 (45.5%) of patients. Most patients had partial thickness burn and most burns involved 1-9.9% body surface areas (BSA). The mean length of hospital stay in this study was 7 days, more than half of the patients had no complications during admission. Among those that developed complications, 19 (35%) developed sepsis. Conclusion: Mortality rate of pediatric burns obtained in this study was 29%, mostly due to cardiac arrest. Flame burns (p=0.03) and BSA >25% (p=0.001) were statistically significant predictors of mortality.


Assuntos
Acidentes/estatística & dados numéricos , Queimaduras/epidemiologia , Parada Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Adolescente , Queimaduras/complicações , Queimaduras/mortalidade , Camarões , Criança , Pré-Escolar , Estudos Transversais , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/mortalidade , Hospitais Gerais , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Masculino , Estudos Retrospectivos , Inquéritos e Questionários
15.
Harefuah ; 158(11): 711-715, 2019 Nov.
Artigo em Hebraico | MEDLINE | ID: mdl-31721512

RESUMO

INTRODUCTION: Burns are one of the most common and painful injuries among babies and children. The pain endured during and in between treatment can be minimized with sedation. These sedations, however, are not without side effects and risks. Given the potential complications, we devised a Burn Analgesic Treatment Protocol that incorporates safe analgesia during burn treatment and throughout the day, thus minimizing the necessity for sedations. AIMS: Assessment of the effectiveness of the analgesic protocol by quantification of overall number of sedations needed for burn treatment and by assessment of the overall experience of the treating medical team exposed to burn care before and after implementation of the protocol. METHODS: A retrospective analysis of analgesic treatment regimens among admitted pediatric burn patients both before and after the implementation of our analgesic protocol was performed. Furthermore, questionnaires were given to the nurses of the treating medical team in order to better assess overall experience with the new analgesic protocol. RESULTS: A total of 87 patients were treated with the new analgesic protocol and 46 patients served as the control group. A significantly lower number of sedations were performed in the group treated with the new protocol compared to the control group (18% vs 30%, p=0.057). The questionnaires filled out by the treating nurses revealed an average score of 4.5 (between 1 - 5), indicating high satisfaction with the protocol. CONCLUSIONS: Our new analgesic protocol allows for highly effective treatment of burn wounds while minimizing the necessity for sedations, thus increasing overall patient safety and reducing potential complications.


Assuntos
Analgésicos , Ansiedade , Queimaduras , Dor , Analgésicos/uso terapêutico , Ansiedade/tratamento farmacológico , Ansiedade/etiologia , Queimaduras/complicações , Criança , Humanos , Dor/tratamento farmacológico , Dor/etiologia , Pacientes , Estudos Retrospectivos
16.
Life Sci ; 239: 116912, 2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31634465

RESUMO

AIMS: Cardiac dysfunction is a major cause of multi-organ dysfunction in critical care units following severe burns. The purpose of this study was to investigate the role of inducible nitric oxide synthase (iNOS) in cardiac dysfunction in burned mice. MATERIALS AND METHODS: Wild-type and iNOS-knockout mice were subjected to 30% total body surface area burns. Next, the expression of iNOS was measured at 1, 3 and 7 days post-burn. Cardiac function, insulin sensitivity, inflammation, oxidative stress, and apoptosis in the hearts of the mice were assessed at 3 days post-burn. KEY FINDINGS: Compared to control mice, iNOS expression was increased and reached a maximum in the heart of burned mice at 3 days post-burn. iNOS deficiency significantly alleviated the cardiac dysfunction and insulin resistance in burned mice. In addition, burn-induced inflammation, oxidative stress, and apoptosis in the heart were markedly reduced in iNOS-knockout burned mice when compared to corresponding values in wild-type burned mice. SIGNIFICANCE: Our study demonstrates that iNOS contributes to insulin resistance in the hearts of mice following burn injury, and iNOS deficiency protects cardiac function against burn injury in mice, suggesting iNOS as a potential therapeutic target to treat burn injuries.


Assuntos
Queimaduras/fisiopatologia , Óxido Nítrico Sintase Tipo II/metabolismo , Óxido Nítrico Sintase Tipo II/fisiologia , Animais , Apoptose , Queimaduras/complicações , Coração , Cardiopatias/metabolismo , Inflamação/metabolismo , Resistência à Insulina/fisiologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Músculo Esquelético/metabolismo , Miocárdio/metabolismo , Óxido Nítrico/metabolismo , Óxido Nítrico Sintase Tipo I/metabolismo , Óxido Nítrico Sintase Tipo II/genética , Óxido Nítrico Sintase Tipo III/metabolismo , Estresse Oxidativo/fisiologia , Ratos , Ratos Sprague-Dawley
17.
Saudi Med J ; 40(10): 1027-1031, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31588482

RESUMO

OBJECTIVES:   To investigate the prevalence and associated risk factors for venous thromboembolism (VTE) in burn patients.  Methods: This is a cross-sectional study eliciting the risk factors in burn patients who developed thromboembolism. The study took place at the Adult  Burn Unit, King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. Charts of all patients admitted to the burn unit from January 2010 to December 2016 were reviewed. Only patients 16 years of age and older were included. The research team with a consultant plastic surgeon developed the data sheet. A total of 304 patient records met the inclusion criteria. Logistic regression analysis was used to determine the risk factors for developing VTE. Results: Out of the entire study group of 304 patients, the majority (88.8%) of the participants received prophylactic anticoagulation. Twelve patients (3.9%)  developed VTE. All patients who developed VTE received prophylactic anticoagulation. Age, gender, body mass index, and degree of burn were not risk factors for VTE. However, electric burns were found to be an independent significant risk factor for developing VTE using a multivariate logistic regression. Conclusion: Electric burns were found to be the only independent significant risk factor of developing VTE.


Assuntos
Unidades de Queimados/estatística & dados numéricos , Queimaduras/complicações , Tromboembolia/etiologia , Adulto , Anticoagulantes/uso terapêutico , Queimaduras/terapia , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Fatores de Risco , Arábia Saudita/epidemiologia , Tromboembolia/epidemiologia , Tromboembolia/prevenção & controle
18.
Codas ; 31(5): e20180238, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31618317

RESUMO

PURPOSE: Verify the correlation between two scar assessment scales and the presence of orofacial myofunctional disorders (OMD) in patients with head and neck (H&N) burns. METHODS: Participants of this study were 16 adult individuals with H&N full-thickness burns. Data were collected through assessment of mandibular range of movement and application of the following instruments: Patient and Observer Scar Assessment Scale (POSAS), Vancouver Scar Scale, and Orofacial Myofunctional Evaluation with Scores (OMES). RESULTS: Results showed moderate negative correlation between the variables deglutition, breathing, total score of the functions, total score on the OMES and scores on the scar assessment scales, indicating that the higher (more severe) the scores on these scales, the lower the scores on the items of the OMES (indicative of greater OMD severity). No correlations were observed between the items of the OMES and the POSAS Patient scale. CONCLUSION: Results suggest that there is correlation between scar severity in burn patients, measured through clinical scales, and presence of OMD. Patients who present scores indicative of H&N pathological scars should be immediately referred to orofacial myofunctional assessment.


Assuntos
Queimaduras/complicações , Transtornos de Deglutição/etiologia , Traumatismos Faciais/etiologia , Lesões do Pescoço/etiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Adulto Jovem
19.
Zhonghua Shao Shang Za Zhi ; 35(10): 712-714, 2019 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-31658540

RESUMO

Children are a special group, which have unique physiological characteristics and are still in the period of physical and mental growth and development, thus the prevention and treatment of scar in children are different from that in adults. Scar management in children is a complex and multifaceted system engineering. The grade of scar in children needs to be adjusted according to the age, period, and severity. Corresponding method needs to be chosen for the treatment of scar in children according to the classification of the scar. The compliance of children is poor, and the key to scar treatment is the persistence and cooperation of the parents, so doctors should strengthen propaganda and education to the parents of children with scar. For children with scar, individualized and comprehensive treatment should be used according to the characteristics of children to achieve good results.


Assuntos
Queimaduras/terapia , Cicatriz/reabilitação , Adulto , Queimaduras/complicações , Criança , Cicatriz/etiologia , Humanos , Pais , Pediatria
20.
Zhonghua Shao Shang Za Zhi ; 35(10): 720-725, 2019 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-31658542

RESUMO

Objective: To preliminarily observe the effects of application of micro-negative pressure in children with small-area deep partial-thickness burn. Methods: From January 2016 to August 2018, 64 children with small-area deep partial-thickness burn who were admitted to the Department of Burn Surgery of the First Affiliated Hospital of Naval Medical University were recruited in this prospective randomized controlled study. According to the random number table, they were divided into negative pressure group [18 boys and 14 girls, aged (3.9±1.6) years with total burn area of (5.5±2.2)% total body surface area (TBSA)] and conventional group [20 boys and 12 girls, aged (3.8±1.7) years with total burn area of (5.8±1.6)% TBSA], with 32 patients in each group. After admission, simple debridement was performed in the patients of 2 groups. After that, the children in negative pressure group were treated with micro-negative pressure with negative pressure material replaced every 3 to 5 days. Children in conventional group were treated with silver sulfadiazine cream with dressing change every other day. On post injury day (PID) 14 and 21, general wound observation was performed, the wound healing rate was calculated, the exudates from the wounds were cultured and the positive detection rate was calculated. The number of patients requiring surgical skin grafting was recorded and the rate of surgical skin grafting was calculated, and the complete wound healing time was recorded in the patients of 2 groups. Scar formation was evaluated by the Vancouver Scar Scale (VSS) in 3, 6, and 12 months after wound healing. Data were processed with chi-square test, t test, Bonferroni correction, and analysis of variance for repeated measurement. Results: (1) On PID 14, all the necrotic tissue in the wounds of patients in negative pressure group was removed, with few exudates, and most of the wounds had been epithelialized; most of necrotic tissue in the wounds of patients in conventional group was removed, with more exudates and smaller wound healing area than those in negative pressure group. On PID 21, most of the wounds of patients in negative pressure group were healed, and the exudates were rare, while the wound healing area of patients in conventional group was significantly smaller than that in negative pressure group with more exudates. (2) On PID 14 and 21, the wound healing rates [(49.8±3.3)% and (95.8±2.4)%] of patients in negative pressure group were significantly higher than those in conventional group [(40.0±3.2)% and (75.3±2.5)%, t=11.899, 33.461, P<0.01]. (3) On PID 14 and 21, the positive detection rates of wound bacteria of patients in negative pressure group were significantly lower than those in conventional group (χ(2)=6.275, 5.741, P<0.05). (4) The rate of surgical skin grafting of patients in negative pressure group was significantly lower than that in conventional group (χ(2)=5.333, P<0.05). (5) The complete wound healing time of patients in negative pressure group [(23.9±2.3) d] was significantly shorter than that in conventional group [(27.9±1.8) d, t=-7.806, P<0.01]. (6) In 3, 6, and 12 months after wound healing, the VSS scores [(6.9±1.8), (5.6±1.4), (3.4±1.5) points] of patients in negative pressure group were significantly lower than those in conventional group [(9.0±1.5), (7.4±2.0), (5.7±1.6) points, t=-4.987, -4.127, -5.988, P<0.01]. Conclusions: In comparison with routine dressing change, the treatment of application of micro-negative pressure in children with small-area deep partial-thickness burn can significantly improve the wound healing rate and rate of surgical skin grafting, decrease the wound infection rate, shorten the wound healing time, and improve the wound healing quality.


Assuntos
Queimaduras/terapia , Cicatriz/terapia , Tratamento de Ferimentos com Pressão Negativa/métodos , Transplante de Pele/métodos , Queimaduras/complicações , Criança , Pré-Escolar , Desbridamento , Feminino , Humanos , Masculino , Estudos Prospectivos , Resultado do Tratamento , Cicatrização
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