ABSTRACT
INTRODUCTION: Helicopter emergency medical services play a valuable role in the transfer of critically ill patients. This paper reviews the role of air ambulance services in the provision of regional burns care and suggests guidelines for their use. METHODS: A retrospective review of patients treated at the Midlands Adult Burns Centre over a 3-year period. RESULTS: 27 adult burns patients were transported by air ambulance during the study period. Patients were aged 19-89 years (average 41.3 years) with an estimated burn size of 5-70% TBSA. Distance travelled was 11-79 miles (average 41.2 miles). All patients were appropriately referred to the burns centre according to national referral guidelines but in 7 cases (26%) it was felt that transport by air ambulance was not clinically indicated and land transfer would have been safe and appropriate. CONCLUSION: Air ambulances offer a fast and effective means of transferring patients to a regional burns centre in selected cases. There is limited data for the beneficial effects of helicopters and survival benefit is seen only in the most severely injured patients. We suggest criteria for the use of air ambulances in burns patients in order to maximise the benefit and reduce unnecessary flights.
Subject(s)
Air Ambulances/statistics & numerical data , Needs Assessment , Transportation of Patients , Adult , Aged , Aged, 80 and over , Air Ambulances/standards , Female , Guidelines as Topic , Humans , Male , Middle Aged , Retrospective Studies , Transportation of Patients/standards , United Kingdom , Utilization Review , Young AdultABSTRACT
INTRODUCTION: Several studies have reported laser treatment of Capillary Malformations (CMs) using systems other than pulsed dye lasers (PDL). Few, however, have compared different systems in the same patients. This study aimed to directly compare CM fading using five different systems. METHODS: Eighteen previously PDL-treated patients were test-patched using the alexandrite, KTP, and Nd:YAG lasers and intense pulsed light (IPL) with additional PDL patches as a control. Pre- and post-treatment videomicroscopy, and colour measurements using Munsell colour charts were carried out. RESULTS: Four patients failed to respond to any test patches. The alexandrite laser test patches had the largest mean improvement in Munsell colour following treatment (P = 0.023) and resulted in CM fading in 10 patients, although 4 patients developed hyperpigmentation, and 1 patient scarring, following treatment. In addition, the alexandrite laser caused a significant decrease in mean post-treatment capillary diameter (P = 0.007), which was not mirrored by the other systems. The KTP and Nd:YAG lasers were least effective, with fading seen in two patients for both systems, whilst IPL patches resulted in CM fading in six patients. In addition, five patients had further CM fading using double-passed PDL treatment. Mean pre-treatment capillary diameter measurements were predictive of those patients likely to respond to laser treatment. CONCLUSIONS: Alexandrite laser treatment was the most effective, but resulted in hyperpigmentation and scarring in four patients, probably due to its deeper penetration and lower specificity for oxyhaemoglobin causing non-specific dermal damage. Double passing of the PDL can result in further CM fading even in previously treated patients. Videomicroscopy measurements of capillary diameter before treatment may be predictive of the likelihood for patient's to respond to laser treatment.
Subject(s)
Capillaries/abnormalities , Laser Therapy/methods , Lasers, Solid-State , Skin Diseases, Vascular/surgery , Adult , Analysis of Variance , Cohort Studies , Female , Humans , Lasers, Dye , Male , Middle Aged , Probability , Risk Assessment , Sensitivity and Specificity , Skin Diseases, Vascular/congenital , Skin Diseases, Vascular/pathology , Skin Tests , Telangiectasis/congenital , Telangiectasis/surgery , Treatment OutcomeSubject(s)
Arteriovenous Malformations/radiotherapy , Beryllium , Low-Level Light Therapy/methods , Tongue Diseases/radiotherapy , Veins/abnormalities , Adult , Arteriovenous Malformations/diagnosis , Female , Follow-Up Studies , Humans , Risk Assessment , Severity of Illness Index , Tongue Diseases/diagnosis , Treatment OutcomeABSTRACT
BACKGROUND: It has been documented that capillary malformations (CMs) located on the limbs tend to respond less well to laser treatment than those sited on the head and neck. However, there is little evidence available to explain this observation. OBJECTIVES: To investigate potential differences between CMs located on the head and neck with those on the limbs, by comparing their response to increasing ambient temperature. METHODS: Fifteen previously untreated subjects with CMs were compared as the ambient temperature was increased from 20 degrees C to 28 degrees C. These included 10 with head and neck CMs and 5 with limb CMs. The following measurements were taken at 2 degrees C intervals: cutaneous blood flow, capillary diameter, density and depth, CM color, skin and core temperatures. RESULTS: There were no statistically significant differences in mean capillary depth, diameter, density, or CM color between groups. Cutaneous blood flow increased with ambient temperature in the head and neck CMs (P = 0.009) and was significantly higher than that in the limb CMs at all temperatures (P < 0.001), while the limb CMs did not demonstrate any increase in cutaneous blood flow with temperature. CONCLUSIONS: These results suggest a possible reason for the poorer response to laser treatment seen in limb CMs: since cutaneous blood flow is a product of the blood flow velocity and hemoglobin concentration, malformations with lower blood perfusion would have less chromophore available and therefore be less suitable for laser destruction.
