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Current concepts in pediatric burn care: General management of severe burns
INTERNATIONAL
498
tion of seat belt injuries of the abdomen and spine requires legislation that ensures that all children use effective restraints that are appropriate for their age, size and position within the vehicle.Prem Pun’
ABSTRACTS
ate autografting have become the standard in most burn centers. The authors present their concept based on prompt excision of third-degree burns. Practice of burn surgery, intermediate wound cover, wound dressing, and future aspects are discussed.-Thomas A. Angerpointner
Anencephalics: A Potential Source of Donor Livers. B.L. Connolly, D. luneafq, D. Kenny, etal. Pediatr Surg Int 7~187-191,(May),
1992. This study examines whether anencephalic babies might be potential neonatal liver donors. One hundred seventy-four anencephalic babies born in the National Maternity Hospital, Dublin between 1970 and 1987 were studied. Of these, 22 (13%) were live born, term or older, and weighed more than 2.5 kg. They constituted the ‘potential donor group’. Only four had serious associated anomalies, and there were no hepatic anomalies. Liver weights fell within 20% of the predicted range. Liver histology was examined to assess maturity, extramedullary hematopoiesis, and any biliary pathology. When compared with a control group of neonates, there was no statistical difference in liver histology. The authors conclude that physically and structurally these livers may be suitable for transplantation, but the ethical dilemma remains.-Ceorge Ninan The Use of Golytely for Bowel Cleansing in the First Three Months of Life. R.A. Wheeler, N. Davies, D.M. GriJiths, et al.
Pediatr Surg Int 7:364-365, (August), 1992. This is a prospective study of 10 patients under 3 months of age to assess the efficacy of Golytely (Baintree Laboratories, Baintree, MA) for bowel preparation prior to colonic surgery. The mean age of babies in the series was 7.4 weeks (range, 3 to 12), the mean weight 4.66 kg (range, 3.0 to 8.07). The mean volume of Golytely administered was 580 mL (range, 400 to 750 mL) over a mean duration of 5.1 hours (range, 4 to 8). The bowel preparation was recorded as excellent in eight cases, fair in one, and poor in one. Following Golytely administration no significant changes in weight, electrolyte concentrations, or plasma osmolarity were observed. The authors conclude that Golytely is safe and effective for preoperative bowel preparation in babies.-Bern Pti INTEGUMENT
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Current Concepts in Pediatric Burn Care: General Management of Severe Burns. M. Me&and H. Lochbiihier. Eur J Pediatr
Current Concepts in Pediatric Burn Care: Artificial Skin-Its Place in the System of Pediatric Burn Care. J.F. Burke. Eur J
Pediatr Surg 2:205-206, (August), 1992. Prompt removal of all deeply injured tissue and immediate physiologic wound closure is mandatory in the treatment of pediatric burns. Prompt eschar removal and immediate closure, however, may pose substantial problems. A successful solution must meet the following criteria: (1) immediate availability of a permanent skin replacement at the time of injury; (2) replacement of both dermal and epidermal function; (3) skin with near-normal mechanical and cosmetic behavior and appearance; (4) normal defense against bacterial invasion; (5) effective wound healing; and (6) growth as the patient grows. Artificial skin fulfils all of these criteria. Once grafted to a burn wound it evolves into a completely viable biological self-skin replacement. Artificial skin has been in clinical use for 10 years. In the treatment of small and most medium-sized deep burns, artificial skin has no clear advantage unless the cosmetic scar in the split-thickness skin donor site would cause unusually severe consequences. However, there appears to be considerable advantage in the use of artificial skin where the area of deep burn exceeds that of the area available for practical use as donor site.-Thomas A. Angerpointner Current Concepts in Pediatric Burn Care: Management of Burn Wounds With Cultured Epidermal Autografts. S. Knapp, M. Benathan, M Me&i, et a/. Eur J Pediatr Surg 2:210-215, (Au-
gust), 1992. The authors report their experience with cultured epidermal autografts (CEA) in 21 patients. The areas covered with CEA measured from 500 cm* to 3.160 cm*. The take of CEA is over 75% when applied to dermis. Scar formation has not been a problem, and results are reported to be good. It is concluded that CEA transplantation on dermis provides a definitive functional and esthetic skin replacement in the management of extensive burns.Thomas A. Angelpointner
Surg 2195-200, (August), 1992. Severe burns and scalds are still frequent in children. The burned child should be ideally taken care of in a specialized pediatric burn center. The goals of burn care are to preserve life, to preserve function, to limit physical and psychological sequelae, and to provide social reintegration. The system of burn care essentially consists of adequate initial resuscitation followed by early surgery aimed at rapid and definitive wound closure. Vigorous nutritional support, as well as early rehabilitation and continuous psychological care, are of paramount importance. The paper summarizes the essentials of pediatric burn care (burn surgery excluded), such as prehospital care, emergency measures, fluid resuscitation, monitoring and laboratory investigations, prophylaxis of stress lesions, infection and immunology, metabolism and nutrition, as well as rehabilitation.-Thomas A. Angerpointner Current Concepts in Pediatric Burn Care: Surgery of Severe Burns. H. Lochbiihler and M. Meuli. Eur J Pediatr Surg 2:201-204,
(August), 1992. Optimal surgical therapy of severe burns in children has been controversial for a long time. A review of the current literature shows that prompt surgical excision of necrotic tissue and immedi-
Current Concepts in Pediatric Burn Care: The Biology of Cultured Epithelial Autografts: An Eight-Year Study in Pediatric Burn Patients. CC. Compton. Eur J Pediatr Surg 2:216-222,
(August), 1992. An g-year histopathological study of skin regeneration and wound healing in 22 pediatric patients treated with cultured epithelial autografts (CEA) grafted to full-thickness burn wounds excised to muscle fascia is reported. Biopsies of CEA have been analyzed by light microscopic, immunohistochemical, morphometric, electronmicroscopic, and ultrastructurat immunolabeling techniques and compared to controls of meshed split-thickness autograft (MSTA) interstices at comparable times postgrafting. At transplantation, CEA are undifferentiated and lack both granular and cornified cell layers. By 6 days postgrafting, CEA differentiate into all normal epidermal strata but lack rete ridges. De novo formation of a confluent basal lamina and mature hemidesmosomes is complete by about 3 weeks. Anchoring fibrils appear sparse and immature (as in MSTA controls) compared to normal skin until about 6 to 12 months. CEA develop rete ridges and a neodermis with normal stromal and vascular organization at about 6 to 12 months, whereas MSTA interstice controls do not. At 4 to 5 years, elastin expression
498
tion of seat belt injuries of the abdomen and spine requires legislation that ensures that all children use effective restraints that are appropriate for their age, size and position within the vehicle.Prem Pun’
ABSTRACTS
ate autografting have become the standard in most burn centers. The authors present their concept based on prompt excision of third-degree burns. Practice of burn surgery, intermediate wound cover, wound dressing, and future aspects are discussed.-Thomas A. Angerpointner
Anencephalics: A Potential Source of Donor Livers. B.L. Connolly, D. luneafq, D. Kenny, etal. Pediatr Surg Int 7~187-191,(May),
1992. This study examines whether anencephalic babies might be potential neonatal liver donors. One hundred seventy-four anencephalic babies born in the National Maternity Hospital, Dublin between 1970 and 1987 were studied. Of these, 22 (13%) were live born, term or older, and weighed more than 2.5 kg. They constituted the ‘potential donor group’. Only four had serious associated anomalies, and there were no hepatic anomalies. Liver weights fell within 20% of the predicted range. Liver histology was examined to assess maturity, extramedullary hematopoiesis, and any biliary pathology. When compared with a control group of neonates, there was no statistical difference in liver histology. The authors conclude that physically and structurally these livers may be suitable for transplantation, but the ethical dilemma remains.-Ceorge Ninan The Use of Golytely for Bowel Cleansing in the First Three Months of Life. R.A. Wheeler, N. Davies, D.M. GriJiths, et al.
Pediatr Surg Int 7:364-365, (August), 1992. This is a prospective study of 10 patients under 3 months of age to assess the efficacy of Golytely (Baintree Laboratories, Baintree, MA) for bowel preparation prior to colonic surgery. The mean age of babies in the series was 7.4 weeks (range, 3 to 12), the mean weight 4.66 kg (range, 3.0 to 8.07). The mean volume of Golytely administered was 580 mL (range, 400 to 750 mL) over a mean duration of 5.1 hours (range, 4 to 8). The bowel preparation was recorded as excellent in eight cases, fair in one, and poor in one. Following Golytely administration no significant changes in weight, electrolyte concentrations, or plasma osmolarity were observed. The authors conclude that Golytely is safe and effective for preoperative bowel preparation in babies.-Bern Pti INTEGUMENT
AND
CONNECTIVE
TISSUE
Current Concepts in Pediatric Burn Care: General Management of Severe Burns. M. Me&and H. Lochbiihier. Eur J Pediatr
Current Concepts in Pediatric Burn Care: Artificial Skin-Its Place in the System of Pediatric Burn Care. J.F. Burke. Eur J
Pediatr Surg 2:205-206, (August), 1992. Prompt removal of all deeply injured tissue and immediate physiologic wound closure is mandatory in the treatment of pediatric burns. Prompt eschar removal and immediate closure, however, may pose substantial problems. A successful solution must meet the following criteria: (1) immediate availability of a permanent skin replacement at the time of injury; (2) replacement of both dermal and epidermal function; (3) skin with near-normal mechanical and cosmetic behavior and appearance; (4) normal defense against bacterial invasion; (5) effective wound healing; and (6) growth as the patient grows. Artificial skin fulfils all of these criteria. Once grafted to a burn wound it evolves into a completely viable biological self-skin replacement. Artificial skin has been in clinical use for 10 years. In the treatment of small and most medium-sized deep burns, artificial skin has no clear advantage unless the cosmetic scar in the split-thickness skin donor site would cause unusually severe consequences. However, there appears to be considerable advantage in the use of artificial skin where the area of deep burn exceeds that of the area available for practical use as donor site.-Thomas A. Angerpointner Current Concepts in Pediatric Burn Care: Management of Burn Wounds With Cultured Epidermal Autografts. S. Knapp, M. Benathan, M Me&i, et a/. Eur J Pediatr Surg 2:210-215, (Au-
gust), 1992. The authors report their experience with cultured epidermal autografts (CEA) in 21 patients. The areas covered with CEA measured from 500 cm* to 3.160 cm*. The take of CEA is over 75% when applied to dermis. Scar formation has not been a problem, and results are reported to be good. It is concluded that CEA transplantation on dermis provides a definitive functional and esthetic skin replacement in the management of extensive burns.Thomas A. Angelpointner
Surg 2195-200, (August), 1992. Severe burns and scalds are still frequent in children. The burned child should be ideally taken care of in a specialized pediatric burn center. The goals of burn care are to preserve life, to preserve function, to limit physical and psychological sequelae, and to provide social reintegration. The system of burn care essentially consists of adequate initial resuscitation followed by early surgery aimed at rapid and definitive wound closure. Vigorous nutritional support, as well as early rehabilitation and continuous psychological care, are of paramount importance. The paper summarizes the essentials of pediatric burn care (burn surgery excluded), such as prehospital care, emergency measures, fluid resuscitation, monitoring and laboratory investigations, prophylaxis of stress lesions, infection and immunology, metabolism and nutrition, as well as rehabilitation.-Thomas A. Angerpointner Current Concepts in Pediatric Burn Care: Surgery of Severe Burns. H. Lochbiihler and M. Meuli. Eur J Pediatr Surg 2:201-204,
(August), 1992. Optimal surgical therapy of severe burns in children has been controversial for a long time. A review of the current literature shows that prompt surgical excision of necrotic tissue and immedi-
Current Concepts in Pediatric Burn Care: The Biology of Cultured Epithelial Autografts: An Eight-Year Study in Pediatric Burn Patients. CC. Compton. Eur J Pediatr Surg 2:216-222,
(August), 1992. An g-year histopathological study of skin regeneration and wound healing in 22 pediatric patients treated with cultured epithelial autografts (CEA) grafted to full-thickness burn wounds excised to muscle fascia is reported. Biopsies of CEA have been analyzed by light microscopic, immunohistochemical, morphometric, electronmicroscopic, and ultrastructurat immunolabeling techniques and compared to controls of meshed split-thickness autograft (MSTA) interstices at comparable times postgrafting. At transplantation, CEA are undifferentiated and lack both granular and cornified cell layers. By 6 days postgrafting, CEA differentiate into all normal epidermal strata but lack rete ridges. De novo formation of a confluent basal lamina and mature hemidesmosomes is complete by about 3 weeks. Anchoring fibrils appear sparse and immature (as in MSTA controls) compared to normal skin until about 6 to 12 months. CEA develop rete ridges and a neodermis with normal stromal and vascular organization at about 6 to 12 months, whereas MSTA interstice controls do not. At 4 to 5 years, elastin expression