Base deficit as an indicator or resuscitation needs in patients with burn injuries.

The utility of base deficit (BD) as a marker of shock and as an indicator of resuscitation requirements has been recognized in the trauma population. Base deficit in thermally injured patients has not been closely examined. The purpose of this study was to evaluate the usefulness of initial BD related to other resuscitation parameters in thermally injured patients. Burn center records over a 2-year period were reviewed; patients who survived at least 24 hours and had initial arterial blood gases were included. Parkland estimated fluid requirements underestimated actual volume requirements, but Parkland-calculated fluid requirements were related (p < 0.01) to actual volume requirements. BD had a better correlation to actual volume requirements, and a BD of -6 or less correlated with larger burn size (23% +/- 2% vs 47% +/- 9% total body surface area), and markedly increased mortality rate (9% vs 72%, p < 0.001).

Comparison of wick and fibreoptic catheters in measurement of interstitial pressures in burned extremities.

We have performed simultaneous compartmental pressure monitoring in 14 burned extremities using both the established wick catheter and the recently developed fibreoptic catheter system. Initial pressures recorded by both systems correlated well. Discrepancies in subsequent values were considered to be either due to improper limb positioning or because of catheter damage or obstruction. Both systems are position sensitive, but the problem can be minimized by careful anchoring of the catheters. The fibreoptic catheter is more fragile, but the wick catheter, despite a constant slow infusion of heparinized fluid, is liable to obstruct. While it has proven difficult to compare cost-effectiveness for the two systems, it is our impression that the fibreoptic system offers advantages in terms of ease of placement and maintenance and long-term reliability of measurements. Experience from other burn groups with the two systems will be important. Finally, the parallel use of the two catheters emphasizes the potential fallibility of either system, and the necessity of applying clinical judgement in evaluating circumferentially burned extremities even though direct pressure monitoring is employed.

Sulfuric acid burns in a child: histologic examination as an indication of wound depth.

We present a case of extensive cutaneous chemical burns from sulfuric acid in a baby girl. The patient's age and the appearance of her wounds made it difficult to judge the depth of the wounds in the early stages of care. Because of the uniform appearance of the wounds and the large areas of injury, tangential excision was considered but delayed; the wounds were monitored with serial histologic biopsies for assessment of depth and progression of healing. The presence of viable dermal tissue and adnexal structures on histologic examination encouraged a program of observation and local wound care, which led to progressive healing of the wounds in 18 days. Histologic monitoring of the wounds proved to be a helpful adjunct in the clinical management of this difficult case.

Biosynthetic skin substitute versus frozen human cadaver allograft for temporary coverage of excised burn wounds.

During the past 2 years a multicenter study was performed comparing Biobrane (Woodroof) and frozen cadaver allograft as temporary dressings on freshly excised full-thickness burns before the application of autograft. Each biologic dressing was evaluated with respect to the other on the same patient. Seventy-one patients were evaluated. The mean burn size was 35 +/- 20% with a mean full-thickness burn of 28 +/- 20%. Mean patient age was 34 +/- 21 years. Overall survival was 82%. The mean time of wound coverage was 10.2 +/- 6.7 days. There was no significant difference in the number of dressing changes, area changed, purulence, autograft take, and final results between allograft- and Biobrane-covered sites. There were no complications following use of either Biobrane or allograft. We conclude that Biobrane is as effective as frozen human cadaver allograft for the temporary coverage of freshly excised full-thickness burn wounds before autografting.

Clinical experience with Biobrane biosynthetic dressing in the treatment of partial thickness burns.

Biobrane, a synthetic, bicomposite wound dressing, has been used to treat 17 patients with partial thickness burn wounds covering 0.5-12.5 per cent of the total body surface area (mean 4.4 per cent). In 16 patients we found complete healing of the wound after removal of the dressing, 6-15 days after the injury. In one patient, the wounds were determined on the third day post-injury to be deeper than initially suspected, and she was taken to the operating room for surgical debridement and grafting. Biobrane is an effective wound covering for clean, superficial partial thickness burns of limited extent; the simultaneous use of topical antimicrobial agents for such wounds is not necessary.