Innovations in caring for a large burn in the Iraq war zone.

The authors report on a single case of a large, civilian burn cared for at a U.S. military hospital during Operation Iraqi Freedom. The management of the patient, using a large negative pressure wound therapy device and the Meek grafting technique, is reviewed. This is a case report. The patient survived his injury. In Iraq, most patients with this severity of injury succumb to the injury. By using two innovative techniques, the authors found that the patient was able to survive his injury and return to his home.

Massive Marjolin's ulcer in a burn graft site 46 years later.

Marjolin's ulcers, or malignancy originating from burn scars, have been recorded in the literature since the first century AD (Ozek et al. Marjolin's ulcers arising in burn scars. J Burn Care Rehabil 2001;22:384-9). The majority of cases of Marjolin's ulcers occur in primary burn scar sites with few reported cases following secondary graft placement. We report a case of Marjolin's ulcer that developed in a 57-year-old man, 46 years after initial skin graft placement following a left lower extremity burn. The patient presented to us following diagnosis of squamous cell carcinoma of the verucous type lesion. Wide surgical excision was performed and a split thickness skin graft was applied. The postoperative course was uneventful and no recurrences have occurred. To our knowledge, this is the largest reported Marjolin's case recorded in the literature.

Methamphetamine-associated burn injuries: a retrospective analysis.

Methamphetamine production and use has increased dramatically during the past 10 years. Methamphetamine production requires combining hazardous and volatile chemicals that expose the manufacturer to burn injuries from explosions and chemical spills. We sought to review the epidemiology of burn injuries in a rural burn center secondary to the use of amphetamine or methamphetamine and/or the manufacture of methamphetamine. Review of the records of 507 patients who were admitted to our burn unit from December 1, 1998, to December 31, 2001, revealed 34 patients who were involved in the use of amphetamines or methamphetamines and/or the manufacture of methamphetamine. Thirty-one patients tested positive for either amphetamine (n = 2) or methamphetamine (n = 29) on routine admission urine drug screens. Twenty of these patients were involved in the manufacture of methamphetamines. Three additional patients were identified as methamphetamine manufacturers but tested negative for the use of methamphetamines. The mean age of the study population was 31.88 +/- 7.65 years, with a male:female ratio of 10.3:1. The average burn size was 18.86 +/- 20.72, with the majority secondary to flame (n = 26). Patient burn admission histories were vague, and the patient's involvement in the manufacture of methamphetamine was often only later confirmed by media, the fire marshal, family members, or the patient. Fifteen patients showed the usual withdrawal pattern of agitation and hypersomnolence, with seven patients requiring detoxification with benzodiazepines. Two were admitted acutely to the psychiatric ward for uncontrollable agitation. Eighteen patients were offered chemical dependency treatment, and two completed therapy. There was one mortality. The mean cost per person was US 77,580 dollars (range, US 112 dollars - US 426,386 dollars). The increasing use of and manufacture of methamphetamine presents new challenges for the burn team because these patients can become violent and frequently need assistance with detoxification. Routine drug screens are mandatory in identifying methamphetamine use to alert burn unit personnel to particular management problems and target individuals who may be receptive to drug rehabilitation.