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Sandal burns
S16
Burns 3 3 S ( 2 0 0 7 ) S1–S172
Half of the total amount should be infused in the first 2 h after admission under close monitoring of hemodynamics. The amount ´ ´ infused for the first 24 h (ml) = TBSA (£¥)¡Abody weight (kg)¡A1£¬the ratio of colloid to electrolytes is 1:1, water = 2000 m1. doi:10.1016/j.burns.2006.10.040 Advance in burn wound management improves burn survival rate Huang Yue-Sheng, Yizhi P., Xusheng L., Xusheng L. Institute of Burn Research, State Key Laboratory, China E-mail address: [email protected] (Y.-S. Huang). Objective: To clarify the effects of progress of burn wound management on the improvement of burn survival rate during the past 45 years. Methods: The general clinical data (hospitalization time, survival rate, operation times) of 15,568 burn patients were enrolled and divided in terms of three periods as 1958–1980, 1981–1990, and 1991–2002. The beneficial effects of post-burn immediate escharectomy en masse, the systemic application of recombinant human growth hormone (rhGH), the topical application of epithelial growth factor (EGF) and the coverage of split-skin donor sites with blade-thick skin and artificial skin on wound healing and overall therapeutic results were observed. Results: There has been an increase of burn patients admitted to our burn institute in the last decade. The overall survival rate, especially that of major burn patients was increased significantly with the improvement of burn wound management. The hospitalization time was shortened and wound healing time was cut short. Conclusion: Escharectomy en masse as early as possible, systemic application of growth hormone, topical application of EGF and artificial skin, are beneficial to early healing of burn wound and improves survival rate of burn patients. Keywords: Burn wound; Escharectomy en masse; Growth hormone; Epithelial growth factor doi:10.1016/j.burns.2006.10.041 Sandal burns Shakirov B.M. Samarkand State Medical Institute, Uzbekistan E-mail address: [email protected]. Sandal in ancient, primitive heating device that is still in use by both poor and rich people in mountain areas of Middle Asia. In the case of sandal burns, it usually in not only skin that is injured but also underlying tissues: subcutaneous fat, fascial, muscles, and even bones. The characteristics of sandal burns include coagulation necrosis because of the contact with live coals, circular vascular and nerve compression and, as a result, secondary necrosis. In the Samarkand Inter-Regional Burn Center in Uzbekistan the method of treatment was developed unital surgical debridement of the wound, necrotomy with applications of chemotherapeutic medications and early necrotomy, the removal of necrotic tissues and preparation the wound for early autodermoplastic surgery, to decrease the postburn contractures and deformities. doi:10.1016/j.burns.2006.10.042 A single institution experience with fresh frozen plasma resuscitation of critically burned patients Juang D., Caushaj P., Caushaj P., Goldfarb I.W., Slater H., Tissue K., Aballay A. The Western Pennsylvania Hospital, USA E-mail address: [email protected] (K. Tissue). The disagreement and controversy regarding the amount and composition of fluid for optimal resuscitation still continues in today’s burn literature. Edema of tissue not injured by heat is a common complication after resuscitation of burns. Our own published studies have shown that fresh frozen plasma (FFP) reduces the volume requirements for resuscitation of burn patients and markedly reduces post resuscitation edema. Resuscitation of burn patients continues to be done with FFP in some patients and lactated ringers (LR) in other patients. A retrospective review of 91 patients with burns greater than 35% from 1996 to 2006 to determine if survival, initial fluid requirements, and days on the ventilator showed trends that would allow us to establish pre-resuscitation criteria of fluids. Twelve patients with LR were removed as they represented lethal injuries and made comfort measures only. Forty-two patients were resuscitated with FFP and 37 with LR. Thirty-six patients survived in the FFP group while 26 survived in the LR group. The difference in the TBSA burned (FFP = 51% versus LR = 49%) was found to not be significant. The average age was 38 years in the FFP group and 28 years in the LR group. The average ventilatory days were 32 with FFP and 15 with LR. The average fluid
Burns 3 3 S ( 2 0 0 7 ) S1–S172
Half of the total amount should be infused in the first 2 h after admission under close monitoring of hemodynamics. The amount ´ ´ infused for the first 24 h (ml) = TBSA (£¥)¡Abody weight (kg)¡A1£¬the ratio of colloid to electrolytes is 1:1, water = 2000 m1. doi:10.1016/j.burns.2006.10.040 Advance in burn wound management improves burn survival rate Huang Yue-Sheng, Yizhi P., Xusheng L., Xusheng L. Institute of Burn Research, State Key Laboratory, China E-mail address: [email protected] (Y.-S. Huang). Objective: To clarify the effects of progress of burn wound management on the improvement of burn survival rate during the past 45 years. Methods: The general clinical data (hospitalization time, survival rate, operation times) of 15,568 burn patients were enrolled and divided in terms of three periods as 1958–1980, 1981–1990, and 1991–2002. The beneficial effects of post-burn immediate escharectomy en masse, the systemic application of recombinant human growth hormone (rhGH), the topical application of epithelial growth factor (EGF) and the coverage of split-skin donor sites with blade-thick skin and artificial skin on wound healing and overall therapeutic results were observed. Results: There has been an increase of burn patients admitted to our burn institute in the last decade. The overall survival rate, especially that of major burn patients was increased significantly with the improvement of burn wound management. The hospitalization time was shortened and wound healing time was cut short. Conclusion: Escharectomy en masse as early as possible, systemic application of growth hormone, topical application of EGF and artificial skin, are beneficial to early healing of burn wound and improves survival rate of burn patients. Keywords: Burn wound; Escharectomy en masse; Growth hormone; Epithelial growth factor doi:10.1016/j.burns.2006.10.041 Sandal burns Shakirov B.M. Samarkand State Medical Institute, Uzbekistan E-mail address: [email protected]. Sandal in ancient, primitive heating device that is still in use by both poor and rich people in mountain areas of Middle Asia. In the case of sandal burns, it usually in not only skin that is injured but also underlying tissues: subcutaneous fat, fascial, muscles, and even bones. The characteristics of sandal burns include coagulation necrosis because of the contact with live coals, circular vascular and nerve compression and, as a result, secondary necrosis. In the Samarkand Inter-Regional Burn Center in Uzbekistan the method of treatment was developed unital surgical debridement of the wound, necrotomy with applications of chemotherapeutic medications and early necrotomy, the removal of necrotic tissues and preparation the wound for early autodermoplastic surgery, to decrease the postburn contractures and deformities. doi:10.1016/j.burns.2006.10.042 A single institution experience with fresh frozen plasma resuscitation of critically burned patients Juang D., Caushaj P., Caushaj P., Goldfarb I.W., Slater H., Tissue K., Aballay A. The Western Pennsylvania Hospital, USA E-mail address: [email protected] (K. Tissue). The disagreement and controversy regarding the amount and composition of fluid for optimal resuscitation still continues in today’s burn literature. Edema of tissue not injured by heat is a common complication after resuscitation of burns. Our own published studies have shown that fresh frozen plasma (FFP) reduces the volume requirements for resuscitation of burn patients and markedly reduces post resuscitation edema. Resuscitation of burn patients continues to be done with FFP in some patients and lactated ringers (LR) in other patients. A retrospective review of 91 patients with burns greater than 35% from 1996 to 2006 to determine if survival, initial fluid requirements, and days on the ventilator showed trends that would allow us to establish pre-resuscitation criteria of fluids. Twelve patients with LR were removed as they represented lethal injuries and made comfort measures only. Forty-two patients were resuscitated with FFP and 37 with LR. Thirty-six patients survived in the FFP group while 26 survived in the LR group. The difference in the TBSA burned (FFP = 51% versus LR = 49%) was found to not be significant. The average age was 38 years in the FFP group and 28 years in the LR group. The average ventilatory days were 32 with FFP and 15 with LR. The average fluid