Degradation of Interface Pressure under Tubular Compressive Bandage (Tubifast™) for 6 Days

PURPOSE: Pressure garment is the most effective tool in treatment of burn scar hypertrophy. But most patients feel discomfort to pressure garment. So tubular compressive bandage (TCB; Tubifast™) is widely used as a substitute. We checked daily pressure of tubular pressure bandage for 6 days and tried to find out the proper use. METHODS: Three doctors and two nurses were included in this study. They wore the TCB on both arms. One arm worn with one layer and the other arm with two layers. For six days, we checked the average pressure on arm and forearm with Picopress®. We used the SPSS (PASW statistics 18) as a statistics. RESULTS: During the first three days the pressure was markedly declined on both arm and forearm when with two layers. After then the pressure showed plateau. But one layer showed slow and continuous declining. The plateau pressure was above 10 mmHg with two layers and below 7 mmHg with one layer. CONCLUSION: Wearing the tubular compressive bandage (TCB; Tubifast™) is better with two layers than one layer and must be changed it in every 4 days.

Cooling Effect of Biocellulose Sheet (Bestian M(R) Pack) in Burn Patients

PURPOSE: The optimal initial treatment for burn wound is generally applying cold running tap water of temperature 12~18degrees C for approximately 20 minutes. But most of the patients are not susceptible to this initial treatment because they are likely to get embarrassed in such situation. According to statistics of our hospital, 92.2% of patients who visited ER (emergency room) had less than 10 minutes of water cooling. In this study, our aim was to find out the clinical effect of biocellulose sheet (Bestian M(R) pack) as an emergent treatment. METHODS: Between November 2010 and October 2011, 93 patients with burn wound showing first or superficial second degree at first inspection were evaluated in our study. Biocellulose sheet (Bestian M(R) pack) was applied at the wound as soon as possible for 25 minutes and second inspection was done. Routine moisture dressing was done thereafter and patients were followed as outpatient. RESULTS: Among 93 patients, 28 were male and 65 were female. Scalding burn, contact burn, flame burn and other causes were 78, 6, 4 and 5 patients respectively. Average complete healing time was 7.99 days and average follow-up time was 5.49. CONCLUSION: Biocellulose sheet has the effect of cooling down the skin temperature up to 6~8degrees C after 10 minutes of its application. Recent studies reported that appropriate cooling in burn wound improves the zone of stasis and zone of erythema histologically eventually reducing the chance of skin graft. Therefore, biocellulose sheet has the effect of improving initial pain, histologic status, healing time and cost in patients with burn wound whose depth is not deep. Furthermore it reduces the risk of scar formation.

Treatment of Sequelae of Burn Injury with Microneedling Procedure (Dermastamp(R))

PURPOSE: Many burn patients have been suffered from sequelae of burn injury (itching, pain, heating sense, etc.). The treatment of those symptoms was not successful even though they are approached multiply. Some patients depend on folk remedies. We try to find the effectiveness of microneedling procedure (dermastamp(R)) which is used for esthetic purpose. METHODS: 25 patients were included who had been treated with the skin massage therapy from September 2008 to March 2009. They received the dermastamp(R) procedure once a week and surveyed from 2 months after procedure. The survey items were itching, pain, tightness, firmness, shape of scar, joint deformities. We divided the severity of symptoms into digit scale form 0 (no symptoms) to 10 (too severe to sleep) and the severity was estimated by patients. Statistical method was Wilcoxon signed rank test. RESULTS: The patient group consisted of 8 males and 17 females. The mean age was 22.2+/-13.8 years old. The average time that felt the effectiveness was 4.4+/-2.3 times. Statistically significant responses showed in itching, firmness (P<0.05), pain and tightness (P<0.01). Improvement of the shape of scar and joint deformities were not statistically significant. CONCLUSION: Even now, no definite treatment against the sequelae of burn injury. Multimodalities of treatment in sequelae of burn injury are using and dermastamp(R) can be an additional method for sequelae of burn injury.

The Surgical Treatment of Acute Necrotizing Pancreatitis : Does Presense of Infection Affect on Determinant of Intervention?

We retrospectively analyzed 17 necrotizing pancreatitis patients who were treated surgicaly at the Department of Surgery, Yonsei University, from April 1983 to October 1996 in order to identify that the presence of intra-abdominal infection. The mean age was 46.5 years old. There were 11 male patients and 6 female patients. The most common etiology was alcohol and trauma. The mortality rate was 6%, for which etiology was alcohol. We grouped the patients into three groups, which is the infected, non-infected, and no culture performed. There were 6 non-infected patients, 6 infected patients, and 5 no culture performed patients. The most frequent infecting organism was E. coli. Others were E. faecalis, P. aeruginosa, K. pneumonia, and E. cloacae. There were 6 non-infected patients. The complication rate was 50% in infected cases, the 67% in non-infected cases, and 80% in no culture performed cases. In non-infected patients, Ranson's criteria, APACHE II score, total transfusion of packed red blood cell, and hospital stay were greater than infected patients. The ICU stay was longer in infected patients. However, there were no significant differences among the three groups. The basic operation procedure was necrosectomy and drainage. Others were cholecystectomy, segmental resection of colon, etc. We concluded that the presense of intra-abdominal infection should not be the sole determinant for intervention, so, the early and aggressive surgical intervention in case of symptomatic pancreatic necrosis is more beneficial irrespective of infection.