Blinded Comparative Review of Lubricants Commonly Used for Split-Thickness Skin Graft Harvest.

Lubricating agents facilitate effective harvesting of split-thickness skin grafts. Multiple agents, including water-based gel, mineral oil, glycerin, and poloxamer 188, have been utilized in this capacity. The agent selected is typically at the discretion of the provider and institution, as a single "ideal" lubricant remains to be objectively established. Furthermore, a recent discontinuation of Shur-Clens® Skin Wound Cleanser1 (a wound cleansing solution consisting of the surfactant poloxamer 188) has prompted the search for a suitable substitute for many providers. The purpose of this study is to directly compare five lubricants (including a novel surgical lubricant-based solution) to select a preferred agent. Four practitioners blindly tested five lubricants while harvesting a split-thickness skin graft on a porcine skin model (glycerin, mineral oil, saline, poloxamer 188, and a novel lubricant solution created with surgical lube and sterile water). The results were recorded on a Likert scale where 1 indicated poor performance and 5 indicated excellent performance. Data were pooled, and means were compared with analysis of variance and post hoc Tukey test. The cost of each lubricating solution was also reported. Mean scores for each of the solutions were as follows: dry control = 1.1 ± 0.1; glycerin = 2.62 ± 1.02, saline = 3.88 ± 0.81, mineral oil = 3.75 ± 1.00, novel water-based lubricant solution = 4.63 ± 0.71, and poloxamer 188 = 3.88 ± 0.81. All solutions were superior to dry control (P < .01). Glycerin was noted to have statistically lower scores than all of the other solutions (P < .01). The novel water-based surgical lubricant solution had significantly higher mean scores than both glycerin (P < .01) and mineral oil (P < .05). Each solution was compared according to dollars per 100cc with glycerin and Shur-Clens® representing the most expensive options at almost $3/100cc and saline the least expensive at less than $0.15/100cc. In a porcine skin model, the novel water-based surgical lubricant solution had the best performance. It was statistically superior to glycerin and mineral oil and was also found to be the most cost-effective option in terms of overall performance compared with relative cost. Glycerin had the worst performance with statistically lower scores than all other solutions. Glycerin was also found to be the least cost-effective due to a large discrepancy between high cost and low overall performance. Saline performed better than expected. These results may be skewed due to the inherently greasy nature of the butcher shop porcine skin, creating limitations and decreasing the fidelity of the model. In a search for the "ideal" lubricant, other models should be further studied.

Killing Brain Cells and Skin Cells Simultaneously with Inhalant Abuse: Pearls from the National Burn Repository.

Over 20 million Americans have abused inhalants at least once in their lifetime. It is widely known that "huffing" increases risk for liver disease, renal failure, hypoxia, respiratory failure, dysrhythmias, and cardiac arrest. However, it is lesser known that inhalants can also cause thermal or frostbite injury. This study is a review of 2003 to 2012 National Burn Repository (NBR) records with a query for "huff," "inhalant," and corresponding ICD-9 codes. The NBR represents the cumulative data of subjects presenting to regional burn centers throughout the nation. Twenty-eight cases of inhalant injury were found. Approximately one-third were due to frostbite secondary to cold liquids exiting aerosol cans. The remaining two-third were due to thermal injury when the flammable solvent ignited. Median burn size was 3% total BSA (TBSA). Eight patients suffered inhalation injuries and one patient died. Although the median burn size of these patients was relatively small, some had significant injuries requiring long hospital length of stay. Direct costs of healthcare and indirect costs of lost wages make inhalant injury a significant public health problem. Multidisciplinary governmental efforts should be focused on prevention, education, recognition, and early intervention when inhalant abuse is suspected.