Feeding gastrostomy for the severely burned patient

Twenty-two patients underwent feeding gastrostomy. Their ages ranged from 17 to 76 years. Their burn injuries were extensive, ranging from 31% to 88% total body surface area, with a mean of 60%. Nine gastrostomies were done through intact unburned skin, 12 were done through the burn wound itself, and one was done through a split-thickness skin graft donor site. No evidence of intraperitoneal or wound infection was observed. No intraoperative and only three postoperative complications were encountered. One patient had a wound dehiscence while in the hospital. Following discharge from the hospital, two other patients manifested incisional hernias. Initially, we were reluctant to consider this operative procedure for our patients because of anticipated intra-abdominal and wound complications. In view of our experience thus far, however, we are now more confident of the procedure.     

Thromboembolic events in a severely burned patient

A patient with severe burns suffered spontaneous bilateral peripheral arterial thromboses which were successfully treated with recombinant human tissue plasminogen activator (rt PA) (Actilyse). The patient later died from complications of burns.     

Emotional problems of the severely burned patient.

In this article we have tried to present an overview of some of the common emotional responses and problems seen in severely burned patients. We have suggested that first consideration be given to learning what sort of person the patient is and becoming familiar with what the burned patient experiences. General preventive measures were suggested that included establishment of clear communication between patient and staff so that the patient has the best understanding possible of the nature of the injury and the treatment, allowing the patients as much control as possible in the treatment process, and providing adequate analgesic medication. We have described what may be observed when patients become anxious, fearful, angry, depressed, regressed, and psychotic, and have attempted to facilitate an understanding of what is occurring in patients showing these responses. Some common reactions of medical and nursing staff to the various emotional reactions were mentioned. In the final section we attempted to deal briefly with the responses of children and measures that can be taken with them. Most of the therapeutic measures suggested can be carried out by nonpsychiatric personnel if they are able to be empathetic and in touch with their own reactions to patients and to utilized common sense.     

Case report: prehospital therapy of the severely burned patient

On the basis of a case report the prehospital management of severely burned patients is discussed. The prevention of hypovolemia, hypothermia or hypoxemia are the primary targets. It is necessary to estimate the burn size and depth. The burn shock fluid resuscitation, prevention of hypothermia, pain- and airway management are described as well as the transport from the scene of accident to a proximal emergency unit or to a specialized burn intensive care unit.     

Maggot therapy for repairing serious infective wound in a severely burned patient

The larvae of musca domestica were put in use to discard the dead tissue of a case of severe burn.A total of 50 000 aseptic maggots were put onto the infective wound surface,and aseptic dressings overl...     

What constitutes the proper solution for resuscitation of the severely burned patient?

This is a report of thirteen patients with major burns resuscitated with hypertonic lactated saline solution. The average gain in body weight was only 7.4 per cent. The total volume of fluid given in the first forty-eight hours was 23 per cent less and the sodium load administered 86 per cent greater than would have been given using the formula of the Brooke Army Hospital.     

A team approach with severely burned children in a multi-disciplinary rehabilitation setting

A scheme for the rehabilitation of children with severe burns in the setting of a multi-disciplinary centre for physically disabled children is described. Our results suggest that early transfer from an acute hospital to a more homelike residential facility with a team approach, hastens rehabilitation both physically and emotionally.     

Acute cholecystitis in severely burned patients

Acute acalculous cholecystitis in burned patients develops due to general disturbances of microcirculation of polyetiological origin. Early laparotomy can facilitate diagnosis of acute acalculous cholecystitis in burned patients. Rapidly developing destruction of the gallbladder walls requires an active surgical tactics.     

Micrografting in the treatment of severely burned patients

The micrografting technique, employed to treat patients with extensive TBSA burns and reduced areas of healthy donor skin, was assessed simultaneously with traditional mesh grafts (STSG) or Tiersch grafts in the treatment five severely burned subjects (average TBSA burned 35.6 per cent; average per cent of full thickness wounds 32.6 per cent).

At the first clinical control on day 6 post-surgery 93 per cent of the micrografted area was in situ and healthy: epithelialization of the wound sites was complete at day 21. Meshed STSG yielded 90 per cent attachment at day 6 post-surgery, with epithelialization complete at 12 ± 2 days post-surgery.

Functional results were equivalent no matter what technique was used, while aesthetic results were better in the areas where micrografting was carried out.

Although the micrograft technique is labour-intensive, if the expansion needed is at least 1:6, the aesthetic and functional results obtained are comparable to, or better than, those with meshed grafts. Also, large segments of micrograft are not compromised if a small area of mesh becomes detached, and epithelialization is faster and more uniform, enabling a reduction in both infection and length of hospital stay.     

Basophil releasability in severely burned patients.

Thermal injury is known to induce dysregulation of the immune system; however, the precise mechanisms have to be clarified. We investigated the histamine release of basophil granulocytes from severely burned patients (n = 12) after stimulation with anti-IgE or the Ca-ionophore A 23187, respectively. The anti-IgE-induced basophil histamine release of all patients was reduced in comparison to healthy donors beginning at day one postburn (p.b.) (5.0 +/- 2.3% vs. 30.5 +/-3.4%), while the Ca-ionophore-induced release was not decreased before day two p.b. Basophils of patients who finally succumbed to their injuries showed poor responsiveness (to zero levels) over the total time. In contrast, the basophil releasability of surviving patients returned to nearly normal levels (fifth to seventh week p.b.). Already in the second week p.b. there was a significant difference in histamine release between survivors and nonsurvivors [e.g., days 6-9 p.b.: 23.7 +/- 4.0 vs. 6.9 +/- 2.7 (p less than 0.005) after Ca-ionophore stimulation]. The altered basophil histamine release was neither due to a diminished dose- or a delayed time-response to the stimuli nor due to differences in the basophil counts or the cellular histamine content. Our data indicate that the decrease of the basophil releasability, which may be secondary to altered signal transduction pathways in severely burned patients correlates with the clinical outcome.