ABSTRACT
Nurses caring for severely burned patients need to know not only a burn injury's multisystem consequences, but also the effects and expected outcomes of burn treatment. Excision and grafting remain the primary interventions to promote wound healing, but severely burned patients may have little or no skin available for autograft harvesting. INTEGRA artificial skin, a commercial dermal regeneration template, is a new option for complete physiologic wound closure in a variety of clinical situations. This article reviews the physiologic effects, complications, and expected outcomes of INTEGRA artificial skin and compares it with other methods of closing burn wounds.
Subject(s)
Burns/therapy , Skin, Artificial , Adult , Burns/physiopathology , Humans , Male , Postoperative Care/methods , Skin, Artificial/adverse effects , Treatment Outcome , Wound HealingABSTRACT
Survival of major burn injuries has improved markedly from an expected survival of 10% to 20% in both children and adults to an expected survival of 60% in children with burns greater than 70% BSA. Increased survival for adults after similar burn injuries has been less dramatic than in children because of the profound influences of advancing age and the coexistent processes of aging upon survival after a major injury. Consecutive admissions of patients with massive burn injuries (greater than or equal to 70% BSA) to the Massachusetts General Hospital Adult Burn Unit from 1974 to 1986 were analyzed statistically using univariate and multiple logistic regression analysis to identify factors associated with survival and to identify patient characteristics associated with increases in expected survival. Survival of adults with massive burn injuries has improved markedly, from 24% of adults admitted to the Adult Burn Center in 1974-75 to 48% of adults admitted in 1984-86. An increased likelihood of survival was shown to be associated with the use of artificial skin. Improved survival rates in these massive burn injuries were attributed to multiple factors including wound management of prompt eschar excision and immediate wound closure.
Subject(s)
Artificial Organs , Burns/mortality , Silicones , Skin , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Burns/therapy , Female , Humans , Male , Medical Records , Middle Aged , Prognosis , Retrospective Studies , Severity of Illness Index , Sex Factors , Silicone Elastomers , Skin TransplantationABSTRACT
Major burn trauma produces large elevations in metabolic energy expenditure (MEE) during acute care. However, overfeeding can occur and is detrimental to recovery. The formulae often used to estimate caloric support to meet MEE are based on body weight, predicted resting metabolic rate (RMR), body surface area, or the total body surface area burned (BSAB). These predictive equations originate from studies of less than or equal to 30 patients generally lacking measurements beyond the third week of convalescence. We report 565 measurements by indirect calorimetry for 122 adults between the burn day and day 149 postburn. A standardized protocol of nutritional support and early wound closure was followed. Predictions of MEE are compared in subcategories of BSAB (2-25%; 30-50%; 51-75%; and 76-98%). For major burns exceeding 30% BSAB, 2X the predicted RMR was consistently closest to the measured MEE, assuring adequate calorie provision while minimizing the risk of overfeeding.
