Burn Therapy Research Articles

Corticosteroid derivatives in the treatment of inhalation burns

COMPARED with other fields of burn therapy, thermal respiratory injuries still pose a formidable problem with a high rate of mortality. How urgent this problem really is becomes evident when considering the incidence of such injuries during the recent war actions in Indo-China, in the Near East and in Cyprus. The crews of armoured vehicles, of aircraft and in ships are the preferential victims. Taking civilian accidents into account as well, such as industrial explosions, traffic accidents and big fires this problem reaches serious proportions. From a pathophysiological point of view the evaluations given by Dressler and Skornik (1971), by Song et al. (1971) and by Ohura et al. (1971) are still valid. The analysis of Ginzburg (1971) applies even more so to inhalation burns. The purpose of this study was to evaluate possibilities of dealing with the oedema that develops very soon after the inhalation of hot air or steam. It is the first stage in the ensuing process which leads to respiratory insufficiency, cellular damage, and sepsis often enough to death. The scale of injury ranges from superficial burns of the respiratory tract and oedema to extensive damage of the alveolar walls, the bronchial epithelia and the oro-pharyngeal tract. The therapeutics of choice would appear to be the whole range of corticosteroids. Schmiedek et al. (1972) and Reulen et al. (1972) showed in the case of traumatic and inflammatory brain oedema that these drugs not only reduce the oedema but normalized the cellular metabolism at the same time, the intraas well as extracellular electrolytes and cellular membrane function. Dressler and Skornik examined the question of corticosteroids in burns very thoroughly. They showed that dexamethasone by systemic applicationraised the mortality of scaldedanimals from 5 to 64 per cent. In animals seeded with Pseudomonas the mortality rose to over 96 per cent in spite of antibacterial treatment. Trying to find a way out of this dilemma, that is, on the one hand the need for corticosteroids and their anti-inflammatory and anti-oedematous effect, and on the other the apparent total and fatal breakdown of the resistance against infection as a result of systemic application of the same corticosteroids, two possibilities offered themselves for study, the local use of glucocorticoids and the aldosterone antagonist, spironolactone.

Evaluation of a New Topical Agent for Burn Therapy

Silver sulfadiazine is a new topical antimicrobial agent that is used effectively to prevent and treat sepsis in patients with second- and third-degree burns. Because of its low toxicity, relative freedom from complications, and wide spectrum of antimicrobial activity, silver sulfadiazine represents an advance in the pharmacologic management of the burned patient. (<i>JAMA</i>230:1184-1185, 1974)

Evaluation of a new topical agent for burn therapy. Silver sulfadiazine (silvadene)

Evaluation of a new topical agent for burn therapy. Silver sulfadiazine (silvadene)

Prognosis and therapy of burns in infants

Prognosis and therapy of burns in infants

Studies in burns. XII. Evaporative water loss is related to postburn hypermetabolism

A partitional calorimetric evaluation was made of unanesthetized rabbits in the unburned, 20% burned, and burned-treated state. Treatment comprised spraying ethyl linoleate (ethyl (9–12- cis, cis-octadecadienoate) 0.01 ml/cm 2, onto the burn at, or after, the 12th hr postburn. Evaporative water loss, increased 3- to 6-fold postburn, and metabolic heat production increased 2- to 3-fold. Within 30 min of spraying with ethyl linoleate both water-loss and heat production returned virtually to preburn control levels. Additionally, burned-untreated animals had decreased O 2 consumption, CO 2 production, and activity rates, Their body temperatures fell toward room temperature. These physiologic parameters also returned toward normal within 15–30 min of ethyl linoleate spraying. Ethyl linoleate, which appears to be the naturally occurring water-holding lipid of skin, may offer significant therapeutic effectiveness in burn treatment. It is inexpensive; seems to have minimal toxicity; and may have lower antiinfective properties. However, it remains to be determined if the agent will perform in the presence of currently used topical antibacterial agents and/or hydrotherapy; will function in man as it does in animals; will be effective over many days; and will not affect healing adversely. Finally, the mechanism of action of the agent needs more precise definition. Despite the areas in effect and mechanism of action yet to be defined, the possibility that the agent will prove a valuable adjunct in burn therapy is exhilarating.

The use of allogeneic freeze-dried skin grafts in the oral environment: A clinical and histologic evaluation

Allogeneic freeze-dried skin has been used for many years in burn therapy. It can be stored indefinitely at room temperatures and is nonimmunogenic. It has potential use in the oral cavity where there is a limited supply of donor tissue or where the creation of a donor area wound is undesirable. Allogeneic freeze-dried skin was sutured into place over connective-tissue-bed recipient sites in the oral cavities of Macaca mulatta monkeys. Block sections were obtained at 0, 1, 4, 7, 21, 180, and 360 days. Clinical evaluation showed an enhanced uncomplicated healing sequence. Histologic examination revealed a biologic acceptance and incorporation of the collagen fibers of the graft tissue by the host, along with a postoperative reduction in inflammatory and osteoclastic response.

Contemporary Burn Management.

This is a practical and clinically useful book which is a compilation of the thoughts of 25 experts in the field of burn therapy. It is divided into the six clinically important aspects of burn management. In each section contributing authors of different backgrounds and experience describe their preferred techniques. The alternative points of view will familiarize the reader with several acceptable ways of rendering good burn care, and leave him better prepared to cope with the complicated problems he will encounter in treating a patient with a severe burn. In the following two statements from the preface the editors sum up the intent of their book: The methods of clinical management described here are the products of a better understanding of the anatomic, physiologic and bacteriologic alterations both local and systemic attending thermal burns... By insisting that each of the six parts be thoroughly founded in theory prior to

Topical therapy of burns.

The burn problem in the United States is a very costly one, in terms of both human suffering and economic loss. Significant advances in topical therapy for burns have been made in recent years, including tangential excision, homografts and heterografts, and drugs to combat superficial infection. Ultimately, however, physicians will save more lives by preventive efforts than by topical therapy.

Energy balance and weight loss in burned patients

Increased awareness of the changes in body weight associated with burn therapy can improve patient care during resuscitation as well as convalescence. Weight loss in the later stages of burn injury reflects a large resting energy expenditure thought to be related to evaporative heat loss. The difficulties involved in balancing the caloric equation by increased intake have led to efforts to reduce evaporative losses. A review of recent studies relating vaporizational losses and resting metabolic expenditure shows a more complex relationship than had been previously suspected. Despite the well-documented clinical importance of evaporative cooling, burn hypermetabolism is evidently the result of multiple mechanisms and will require more than reduction of evaporative water loss if weight loss is to be minimized.

Current problems in burns: a perspective

A comparison of fluid and electrolyte formulas in common usage reveals that the quantities of sodium and water recommended for burned children by the Evans, Brooke, and Shriner's Burn Institute (Boston) formulas, though calculated differently, are essentially the same. In large burns (80%), the Baxter formula gives twice as much sodium as the Evans or Brooke. In moderate burns (40%), the difference is considerably less. The use of colloid is necessary in severely burned children and in adults diminishes the need for lactated Ringer's solution. Mafenide acetate (Sulfamylon Cream), silver nitrate, and gentamicin reduce burn wound bacteria significantly and effect significant control over burn wound infection. Skin homografts and xenografts have made a major contribution to burn therapy. A new standard for fabric flammability for children's nightwear is proposed which could save hundreds of lives.

Energy balance and weight loss in burned patients.

Increased awareness of the changes in body weight associated with burn therapy can improve patient care during resuscitation as well as convalescence. Weight loss in the later stages of burn injury reflects a large resting energy expenditure thought to be related to evaporative heat loss. The difficulties involved in balancing the caloric equation by increased intake have led to efforts to reduce evaporative losses. A review of recent studies relating vaporizational losses and resting metabolic expenditure shows a more complex relationship than had been previously suspected. Despite the well-documented clinical importance of evaporative cooling, burn hypermetabolism is evidently the result of multiple mechanisms and will require more than reduction of evaporative water loss if weight loss is to be minimized.

Current problems in burns. A perspective.

A comparison of fluid and electrolyte formulas in common usage reveals that the quantities of sodium and water recommended for burned children by the Evans, Brooke, and Shriner's Burn Institute (Boston) formulas, though calculated differently, are essentially the same. In large burns (80%), the Baxter formula gives twice as much sodium as the Evans or Brooke. In moderate burns (40%), the difference is considerably less. The use of colloid is necessary in severely burned children and in adults diminishes the need for lactated Ringer's solution. Mafenide acetate (Sulfamylon Cream), silver nitrate, and gentamicin reduce burn wound bacteria significantly and effect significant control over burn wound infection. Skin homografts and xenografts have made a major contribution to burn therapy. A new standard for fabric flammability for children's nightwear is proposed which could save hundreds of lives.

Hydrofluoric acid burn therapy

Hydrofluoric acid burn therapy

The measurement of edema following burns.

Abstract An accurate, rapid, and reproducible method (thermal analysis) of measuring edema was investigated in white Wistar rats subjected to second degree thermal contact burns. Skin samples taken one through 96 hours following burn or anesthesia (controls) were analyzed with the use of differential thermal analysis (DTA), thermogravimetric analysis (TGA), mass spectrometry, and histologic studies. TGA provided an accurate measurement of water content of the tissue. Control skin showed a slight increase in water content from one through 96 hours, while burn skin peaked at 4 hours and returned toward control levels by 48 hours. DTA thermograms showed a characteristic 3 endothermal peak pattern in controls, due to different binding energies of the water in the sample. This also reflected the amount of each type of water present. Burned skin showed 2 different endotherms which reflected the early increase in "free" water due to edema. After 24 hours, the thermograms of burned skin suggested tissue healing with return toward the 3 endothermal peak pattern of the controls. Thermal analysis is an accurate method for measuring edema following burns and could be of value in monitoring burn therapy.

Operative Surgery—11: The Hand

Few people could supervise the production of a multiauthored, comprehensive, yet less-than-encyclopedic treatise on operative surgery of the hand. A lifetime of experience and respect by his colleagues eminently qualify Mr. R. Guy Pulvertaft to edit this text written by an outstanding group of "hand surgeons." Content ranges from practical step-by-step treatment of common injuries and defects (subungual hematoma and ganglion) to a survey of complex surgical procedures (pollicization, substitutions for intrinsic muscles, and neurovascular pedicle flaps). The dissertation on acute injuries includes valuable admonitions about appropriate anesthesia, use of plaster to immobilize children's hands, proper utilization of physical therapy, and the frequently overlooked avulsion fracture of the thumb metacarpal-phalangeal collateral ligament. Essayists on tendon and nerve repair, burn therapy, skin replacement, Dupuytren's contracture, rheumatoid arthritis, and tenosynovitis review the disorders, delineate surgical indications, and describe operative technique. Most authors followed this predetermined format. The discussion of infection fails to

The Use of Homografts in Burn Therapy

The Use of Homografts in Burn Therapy

Central venous pressure:an unreliable guide to fluid therapy in burns

Central venous pressure:an unreliable guide to fluid therapy in burns

Today's challenge in burn therapy.

Today's challenge in burn therapy.

The topical therapy of burns in children : E. I. Smith and M. S. DeWeese. Arch. Surg. 98:462–468 (April), 1969

The topical therapy of burns in children : E. I. Smith and M. S. DeWeese. Arch. Surg. 98:462–468 (April), 1969

Early Excision And Skin Allograft Helps To Control Infection In Major Burn At Burn Unit Cipto Mangunkusumo Hospital

Backgrounds: Burns are systemic complex injuries following an exposure to thermal energy and can cause damage to the skin. Skin, as body cover, will protect the underlying tissue from infection, act as a thermo regulator and control the evaporations. The principle of burn therapy is to remove the necrotic tissue and to replace the function of the skin in the body by using a temporary cover with synthetic dressings or skin allograft. Skin allograft remains an ideal temporary cover, particularly when sufficient autograft skin is not available.Patients and Methods: We performed early excision and cover the wound with cadaver skin allograft in two patients suffered from major burn admitted to Cipto Mangunkusumo Hospital in 2012. We observed the wound clinically and monitored the leukocytes count to evaluate the rate of infection.Results: We observed four patients with major burn. Two patients treated with early excision and skin allograft has decreasing in exudates production, less bad odor in wound area, body temperature stable in normal value and also the decreasing leukocytes counts gradually. The results of wound area and body temperature in two patients treated conventionally are not much different from the initial wound and have high leukocytes count more than 10.000 in the majority of laboratory findings. The skin allograft can control the infection by suppressing the bacterial proliferation, promote epithelialization and prepare the wound better.Summary: Patient in this study treated with early excision and skin allograft has better outcome compared to patients treated conservatively.