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Indeterminate-Depth Burn Injury-Exploring the Uncertainty.

不确定深度烧伤-探索不确定性。

  • 影响因子:2.01
  • DOI:10.1016/j.jss.2019.07.063
  • 作者列表:"Karim AS","Shaum K","Gibson ALF
  • 发表时间:2020-01-01
Abstract

:In the management of indeterminate-depth burns (IDB), common challenges include the ability to predict time to healing and regenerative potential, risk of burn wound progression, and timing of excision. Several technologies exist to aid in determination of the depth of a burn injury, yet surgeons continue to rely on the naked eye-visual assessment-as the standard of care. Newer and improved imaging technologies are closing in on the goal of inexpensive, accurate, noninvasive modalities for depth determination. Likewise, management of IDB is becoming more sophisticated as newer wound healing technologies continue to be developed. By describing what is meant by "indeterminate" depth burns, and their associated challenges, we hope to stimulate interest in research to develop new therapies and management strategies. The ultimate goal is to treat IDB without the need for autografts.

摘要

: 在深度不定烧伤 (IDB) 的处理中,常见的挑战包括预测愈合时间和再生潜力的能力、烧伤创面进展的风险和切除的时机。有几种技术可以帮助确定烧伤的深度,但外科医生继续依靠肉眼-视觉评估-作为护理标准。更新和改进的成像技术正在接近廉价、准确、无创的深度确定模式的目标。同样,随着较新的伤口愈合技术的不断发展,IDB的管理也变得越来越复杂。通过描述 “不确定” 深度烧伤的含义及其相关的挑战,我们希望激发研究兴趣,以开发新的疗法和管理策略。最终目标是治疗IDB而不需要自体移植。

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影响因子:2.01
发表时间:2020-01-01
DOI:10.1016/j.jss.2019.07.022
作者列表:["Egro FM","Saliu OT","Zhu X","Corcos AC","Ziembicki JA"]

METHODS:BACKGROUND:Dermatome-induced lacerations are a known complication; however, there is a paucity of literature discussing the incidence and predisposing factors. The aim of this study was to determine the incidence and risk factors to develop a preventive algorithm. METHODS:An 18-question survey was sent to all US and Canadian burn unit directors. Surgeons were queried about type and location of their practices, average annual caseload of skin graft harvesting, and number of dermatome-induced lacerations. The survey also asked about donor site location, harvesting technique and equipment, laceration severity, and causative factors. An algorithm was developed based on the results. RESULTS:Fifty-six responses (42% response rate) were received from the burn unit directors. They reported an estimated 133 lacerations over the past 5 y. The overall incidence of dermatome-induced lacerations was approximately 0.1% per year (1.3 per 1000 cases). The most commonly attributed causes were excessive pressure (25.0%) and patient factors (18.4%). Most lacerations occurred when using air dermatomes (73.0%) with a 4-inch guard (63.5%), 0.010- to 0.015-inch thickness (78.4%), and 30°-45° angulation (47.3%); the most common brand was Zimmer (71.6%). The dermatome was typically set up by a scrub tech or nurse (48.6%), whereas the skin harvesting was performed by residents (39.2%) or attendings (35.1%). Lacerations typically extended to subcutaneous tissue (70.3%), with no neurovascular injury (86.5%). CONCLUSIONS:Our study showed that dermatome-induced lacerations are rare events and that certain factors predispose patients to injury. An algorithm was developed to provide guidance on risk factor identification and the set up and use of dermatomes.

翻译标题与摘要 下载文献
影响因子:2.01
发表时间:2020-01-01
DOI:10.1016/j.jss.2019.07.063
作者列表:["Karim AS","Shaum K","Gibson ALF"]

METHODS::In the management of indeterminate-depth burns (IDB), common challenges include the ability to predict time to healing and regenerative potential, risk of burn wound progression, and timing of excision. Several technologies exist to aid in determination of the depth of a burn injury, yet surgeons continue to rely on the naked eye-visual assessment-as the standard of care. Newer and improved imaging technologies are closing in on the goal of inexpensive, accurate, noninvasive modalities for depth determination. Likewise, management of IDB is becoming more sophisticated as newer wound healing technologies continue to be developed. By describing what is meant by "indeterminate" depth burns, and their associated challenges, we hope to stimulate interest in research to develop new therapies and management strategies. The ultimate goal is to treat IDB without the need for autografts.

翻译标题与摘要 下载文献
影响因子:1.60
发表时间:2020-01-01
DOI:10.1016/j.annemergmed.2019.06.028
作者列表:["Griffin BR","Frear CC","Babl F","Oakley E","Kimble RM"]

METHODS:STUDY OBJECTIVE:First-aid guidelines recommend the administration of cool running water in the early management of thermal injury. Our objective is to analyze the associations between first aid and skin-grafting requirements in children with burns. METHODS:This cohort study used a prospectively collected registry of patients managed at a tertiary children's hospital. Multivariate logistic regression models were used to evaluate the relationship between first aid and the requirement for skin grafting. Secondary outcomes included time to re-epithelialization, wound depth, hospital admission and length of stay, and operating room interventions. Adequate first aid was defined as 20 minutes of cool running water within 3 hours of injury. RESULTS:In our cohort of 2,495 children, 2,259 (90.6%) received first aid involving running water, but only 1,780 (71.3%) were given the adequate duration. A total of 236 children (9.5%) required grafting. The odds of grafting were decreased in the adequate first aid group (odds ratio [OR] 0.6; 95% confidence interval [CI] 0.4 to 0.8). The provision of adequate running water was further associated with reductions in full-thickness depth (OR 0.4; 95% CI 0.2 to 0.6), hospital admission (OR 0.7; 95% CI 0.3 to 0.9), and operating room interventions (OR 0.7; 95% CI 0.5 to 0.9), but not hospital length of stay (hazard ratio=0.9; 95% CI 0.7 to 1.2; P=.48). CONCLUSION:Burn severity and clinical outcomes improved with the administration of cool running water. Adequate first aid must be prioritized by out-of-hospital and emergency medical services in the preliminary management of pediatric burns.

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翻译标题与摘要 下载文献
烧伤方向

一般指热力,包括热液(水、汤、油等)、蒸气、高温气体、火焰、炽热金属液体或固体(如钢水、钢锭)等所引起的组织损害

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