Vitamin D deficiency in burn patients.

Vitamin D deficiency has been reported in pediatric burn patients; however, no formal studies have been conducted in adult burn populations. The available literature on vitamin D status in burn patients has been reviewed. A literature search was conducted using Medline™, the Cochrane central register of controlled trials, and EMBASE to identify any trials of vitamin D deficiency in burn patients. Six published studies regarding vitamin D status in burn patients were found; however, five of these were in pediatric populations and several did not assess vitamin D levels as a major endpoint. Vitamin D deficiency has been demonstrated to result in itching, muscle weakness, and neuropathy, all of which are common postburn sequelae. The major source of vitamin D is synthesis in the skin with a small amount being absorbed through dietary intake. Population groups are at higher risk of vitamin D deficiency if they have inadequate exposure to UV light or reduced biosynthetic capability due to skin damage. Burn patients fall into both risk groups and also suffer common complaints that overlap with those reported by patients with vitamin D deficiency. Further research in adult burn patients is needed to determine the prevalence of deficiency in this population and whether vitamin D deficiency might influence postburn injury symptoms reported by patients.

Neck contracture release with matriderm collagen/elastin dermal matrix.

AIMS: To demonstrate success with immediate split-skin graft application over Matriderm dermal matrix in a difficult neck contracture release. METHODS: An aggressive neck contracture release, accompanied by complete platysmectomy, was followed by application of Matriderm, split-skin graft, Mepitel, and vacuum-assisted closure (VAC) dressing. RESULTS: At VAC removal (day 7), graft take was almost complete over the dermal matrix and with minor "touch-up" were complete by day 9 postrepair. RESULTS at 4 months show graft contraction and a marked diminution of the release obtained. The results, however, are still good and the patient is very happy. CONCLUSION: Immediate grafting over a dermal matrix appears to provide a good solution, with a gentle surgical learning curve, in this difficult postburn scenario. Postrelease contraction is, however, as inevitable as with other techniques.

Social issues prolong elderly burn patient hospitalization.

A retrospective audit of length of hospital inpatient stay of all patients admitted to the Royal Adelaide Hospital Burns Unit over a 5-year period was performed. Data gathered from the Burns Unit database and records allowed patient division into two comparison groups: those younger than 70 years and those aged 70 years or older. Further comparison based on discharge destination was made in the ≥70 years group. Outcomes included length of stay, burn size, and discharge destination. A total of 1641 patients were included. The median length of stay was 5.0 days for patients younger than 70 years and 10.0 days for those aged 70 years or older (P < .0001). The mean percentage of TBSA burned was similar. A greater proportion of those aged 70 years or older were discharged to supported care facilities, such as nursing homes, and a greater proportion needed assessment for placement (P < .001) when compared with those younger than 70 years. The median length of stay of those aged 70 years or older who did not need assessment for placement was 9.0 days compared with 38.0 days for those who needed assessment (P < .0001). Elderly patients have, generally, nearly twice the length of stay of younger patients; when further subdivided according to discharge destination, the effect of placement delay (a social issue) becomes apparent and disturbing. This has significant implications, given the limited capacity and high cost of burn unit admission. A geriatrician will be appointed to the Burn Service over the next 12 months to assess whether earlier geriatric assessment can decrease the length of inpatient admission by facilitating a more efficient placement process.

Using biobrane: techniques to make life easier.

AIMS: To facilitate the use of Biobrane for those burn care practitioners not familiar with this material. METHODS: Two techniques have been developed through extensive use of Biobrane over many years, in both sheet and glove form. These techniques have been described and illustrated with photographs. RESULTS: The use of these techniques has allowed the corresponding author to markedly reduce operating time and to easily apply the material single-handedly. CONCLUSION: Biobrane is a biosynthetic skin substitute primarily designed for the definitive treatment of superficial partial-thickness to mid-dermal burn injury. Once experienced with its use, the material is quite ubiquitous. The described techniques will facilitate the use of Biobrane for those not familiar with it.