A study to determine the efficacy of treatments for hydrofluoric acid burns.

Hydrofluoric acid burns are characterized by progressive tissue destruction and severe pain. Fluoride ion chelators, such as salts of calcium and magnesium, have been used to treat these burns. This study was designed to compare the efficacy of several treatment methods that involve the use of these salts. Standard hydrofluoric acid burns were produced on the shaved hindquarters of rats. After being rinsed with water, the chemical burns were treated by one of seven experimental methods. The progress of the chemical burn damage was observed for 1 week by measuring the surface areas of the burns. Calcium gluconate burn jelly, 20% calcium gluconate in water, and 50% aqueous dimethyl sulfoxide did not significantly slow the spread of the burn area. However, subcutaneous injections of calcium gluconate or magnesium sulfate and topical applications of calcium gluconate in a solution of dimethyl sulfoxide significantly slowed the progress of the burns during the first 24 hours and enhanced tissue recovery for the remainder of the observation period. These results indicate that subcutaneous injections of magnesium or calcium salts appear to be more effective than conventional topical applications in the treatment of hydrofluoric acid burns. More significantly, topically applied calcium gluconate combined with a penetration enhancer, such as dimethyl sulfoxide, is as effective as injection treatments in reducing damage caused by hydrofluoric acid.

Effects of argon beam coagulation on split thickness skin graft survival in the swine model.

Argon beam coagulation (ABC) uses argon gas to evacuate blood in an operative field and simultaneously to transport a coagulating electric current to bleeding sites. This allows a 'no touch' method of coagulation which is faster, more precise, and less destructive than conventional electrocautery. The technique has been used to reduce blood loss in liver surgery, trauma surgery and neck dissections. In this study, the effect of ABC treatment of the recipient graft beds on the survival of split thickness skin grafts was assessed in pigs, testing the hypothesis that ABC treatment of the recipient bed would have no adverse effect on skin graft survival. Nine 20 kg mixed breed pigs had split thickness skin grafts raised on each side of the paraspinous area. The graft beds on one side were prepared using ABC and the contralateral side served as controls. The percentage of graft survival on the ABC treated sides was compared to control graft survival on the other side at 12 days postsurgery. Our results confirm the hypothesis that treatment of the recipient bed with ABC does not adversely affect the survival of split thickness skin grafts.

National Burn Awareness Week: how are burn care facilities in the United States participating?

A survey was conducted from burn care facilities (BCF) regarding their participation in National Burn Awareness Week (NBAW). The second week in February has been proclaimed NBAW. This is the only national campaign of this scope and is supported by the American Burn Association. The NBAW Task Force meets annually to compose and review the burn awareness materials that are sent to all BCF. A telephone survey was conducted, and responses to questions were obtained from all 148 of the BCF listed in the American Burn Association's "Burn Care Resources in North America 1991-1992." The purpose of the study was to answer questions regarding BCF involvement with NBAW and burn prevention programs. Review of the literature reveals this to be the first national study to elicit this type of information. Information sharing of this magnitude can have a dynamic effect on the participation of BCF in NBAW and can result in increased burn awareness in the BCF's local communities. An added benefit is that the task force receives specific input direct from those using the campaign, which validates the continuation of NBAW and the support of the ABA.

Infant monitoring resulting in burns-tissue damage: literature review and case report.

Noninvasive infant monitoring occasionally results in burns and tissue damage. The medical literature now contains 14 isolated reports that were summarized for this review. All 14 victims were less than 24 months of age, and of these 14, two died by electrocution. Burns and tissue damage resulted from infant respiratory monitors (six), pulse oximeters (four), electrocardiographic monitors (two), an anal myoneural junction monitor (one), and a fetal scalp monitor (one). Infant extremities were injured most often (40%), and the trunk was burned somewhat less frequently (23%). Infants were burned in the hospital (57%) only slightly more often than at home (43%). Household burns involved only infant cardiorespiratory monitors. The most common mechanism of injury was the misapplication or improper connection of electrode lead wires (57%). A full one third of infants with burns required a reconstructive surgical procedure, usually a skin graft. Risk factors related to monitor-induced burns and tissue damage have been identified and presented. Injury prevention principles are also outlined.

The effect of instruction on burn prevention in eighth-grade students in preparation for babysitting.

New parents quickly discover that the greatest resource for child care at the least cost are teenage babysitters. These sitters assume the responsibility for burn prevention of young children. This study tested the effect of a burn prevention presentation on pre- and posttest scores of eighth-grade students (N = 119) from five sections of a science class. Students were between the ages of 12 and 14 years and 99 of them (83.2%) were babysitters. Multiple analysis of variance was calculated, and differences were seen between information regarding burns from hot bath water, cigarette lighters, and baby bottles that were heated in microwave ovens; however, the differences were not significant. This study concluded that eighth-grade students learned burn prevention before they entered the eighth grade but that there is a need to update these babysitters on burn prevention and new hazards such as cigarette lighters and microwave ovens.

Reconstruction of the burned lower extremity.

Many of the long-term sequelae and deformities are preventable by early wound closure and aggressive physical managements. Concurrent and associated injuries and medical problems may place a patient with lower extremity burn injury into different clinical subsets. The standard care may have to be modified to accommodate these differences. The scars, the deformities, and the morbidity have decreased dramatically with early aggressive care and physical management. When contractures and deformities are recognized early in the rehabilitation phase, many of these can be satisfactorily corrected by physical means. If the contractures cause functional limitations, surgical release is indicated. The donor defects of free grafts or flaps should not be more deforming than the original injury. The goal is to return the patient to society as normal in function and appearance as possible.

Gasoline-induced contact burns.

Gasoline contact may cause significant full-thickness burn injuries. Systemic complications may result from the absorption of hydrocarbons through the skin. Regional neuromuscular absorption may produce transient or even permanent impairment. It is vital that the physician be aware of the possible full-thickness injuries and complications that may result from cutaneous exposure to gasoline.

Postburn heterotopic ossification: insights for management decision making.

An analysis of 1,478 consecutive admissions to the University of Kansas Burnett Burn Center revealed 18 patients who developed heterotopic ossification (1.2% incidence). Seventeen patients developed this disease in the elbows; one patient had shoulder involvement. Two patients eventually developed bilateral elbow disease. All patients initially presented with pain and limitation of joint motion. The diagnosis was then confirmed radiographically. All patients suspected of heterotopic ossification received physical therapy consisting of active range of motion only. Ten patients responded to conservative treatment and regained functional range of motion, and eight patients developed refractory ankylosis requiring surgical management. All surgically managed patients achieved a functional range of motion with an average followup of 35.0 months.

Chemical burns: retrospective review.

The records of 51 patients with chemical burns were reviewed to identify demographics, mechanism and place of injury, cause, distribution, initial management, and outcome of treatment. Patients were classified as having received adequate (immediate dilution or neutralization of the chemical treatment--group A, or inadequate (delayed or inappropriate) treatment--group B. Inpatient mortality for chemical burns was 13% compared to 15% overall burn center mortality. Of the burns, 79% occurred in the 21-50 age group; 69% of burns were work-related in men and 17% in women. In group A, 19% required skin grafting (mortality 9.5%); in group B, 36% required grafting (mortality 21%). Alkali were the most frequent cause of burns, followed by sulfuric acid and, less often, gasoline, anhydrous ammonia, white phosphorus, and hydrofluoric acid.

Heterotopic ossification: are range of motion exercises contraindicated?

The incidence, time of onset, and role of exercise in the progression of heterotopic ossification were documented retrospectively in burn patients. In 12 of 1,066 patients (1.2%) consecutively admitted to a burn center, the abnormal bone formed posteriorly around the elbow joint. The initial signs were localized joint pain and rapid decrease in range of motion, and the average time of onset was 12 weeks after thermal injury. Prior to the diagnosis of heterotopic ossification, all patients were managed with an exercise program of active and active-assisted movements. In patients who persisted with passive and active-assisted range of motion, especially beyond the range of pain-free movements, the ossification progressed to complete ankylosis and required surgical intervention to remove the heterotopic bone. On the other hand, postoperative patients and patients who followed a program of active exercise within the pain-free range gained excellent range of motion. It was concluded that passive stretching of the periarticular structures during the acute phase of heterotopic bone formation is detrimental to the final outcome.

Spinal cord injuries following electrical accidents.

Injuries from high tension electrical current result in approximately 1000 deaths per year and account for 3% of all major thermal injuries in the United States. Even though the complications from electrical injury can affect almost every organ system in the body, a neurological complication is perhaps the most common non-lethal one. 116 cases of electrical accidents among 1206 burn patients admitted to Kansas University Medical Center were reviewed. There were 5 cases of spinal cord injury which were detected from a few days up to four weeks from the injury. All had incomplete lesions. Two of them had quadriparesis, and 3 paraparesis. Clinical manifestations included motor and sensory involvement, predominantly motor. Possible mechanisms for the spinal cord damage include heating effect, electrogenic changes and vascular damage. Spinal cord injury following an electrical accident is more frequently encountered than is generally recognized.

Fluid resuscitation of the thermally injured patient. Current concepts with definition of clinical subsets and their specialized treatment.

The key to successful fluid resuscitation of the thermally injured patient is close monitoring of the clinical response. Individualized resuscitation based on the parameters described allows for approximation of this goal. An eclectic approach used by the authors has been described with reference to clinical subsets that may require specialized resuscitative methods. Efforts should be made to use the smallest volume of fluid needed to optimize end organ perfusion. The goals of fluid resuscitation have been summarized and a variety of formulas have been described. We anticipate that our understanding of patient subsets outlined in this paper will undergo further evolution.

Ambulatory management of thermal injuries.

The majority of thermal injuries that occur in this country can be adequately treated on an ambulatory-care basis. The determination regarding ambulatory care can be arrived at using the simple algorithm. The primary concern in outpatient burn care is the management of the burn wound. Aggressive wound cleansing, frequent dressing changes, and appropriate antimicrobials should permit rapid re-epithelialization and prevention of bacterial infection. A nonhealing burn wound should be grafted if it takes more than two to three weeks to heal. Aftercare with splints and elastic compression may be required to obtain maximal functional and cosmetic results.

The effect of informational feedback on food intake of adult burn patients.

The effect of informational feedback on the protein and caloric consumption of burn patients was investigated using a multiple-baseline across subjects. The patients were four severely burned adult males who failed to consume sufficient foods to achieve prescribed levels of protein or kilocalories via standard burn unit procedures during recovery. Feedback consisted of informing patients of (a) their prescribed levels of protein and kilocalories, (b) the protein and kilocalorie content of hospital foods and beverages, and (c) their actual intake of protein and kilocalories. Following the provision of feedback, there was an increase in protein and kilocalorie intakes and in the number of days during which prescribed levels for protein and kilocalories were achieved. These results suggest that the informational feedback was effective for improving the oral caloric intake of burn patients.

Metabolic profiles of thermal trauma.

The study was designed to establish where significant correlations exist in a variety of metabolic substrates and hormone mediators in patients sustaining thermal injury. The factors studied were insulin, human growth hormone, cortisol, glucagon, free fatty acid, triglyceride and glucose. Incorporated into this design was an evaluation of the impact of quantitated severity of injury upon these correlations. In patients sustaining a low severity of injury (Probability of death (p = 2.2 to 33.9) there appeared a loss of glucose regulation in conjunction with insulin resistance without significant interplay of other factors studied. In contrast, patients sustaining high severity injury (p = 46.9 to 100) evidenced correlations between glucagon and glucose (negative), cortisol and free fatty acid indicating a significant role of hyperglucagonemia in these patients. A discriminant function analysis was employed to incorporate all significant variables into a probability model. Only insulin, glucose and glucagon appeared in the optimal classification equation.

Burn wound biopsy bacterial quantitation: a statistical analysis.

Sequential paired punch biopsy samples were taken from three separate locations on each of four burn patients and were quantitated for the number of viable bacteria per gram of tissue. The range (log10 0.02 to log10 1.51) and the standard deviation (log10 0.67) were determined for each pair. The 95 per cent confidence interval based on any single observation, x, was determined to be x +/- 1.31. It is concluded that the burn wound biopsy is a reliable procedure for quantitating organisms in a burn wound and that changes in sequential samples give an indication of the dynamics of infection in the burn patients.