Cases reported "Burns"

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1/65. Self-inflicted burn injuries: an 11-year retrospective study.

    The burns unit at the Royal Brisbane Hospital accepted a total of 2275 admissions from 1986 to 1996. During this 11-year period, 65 cases of self-inflicted burn injury were treated, which made up 2.9% of the total number of admissions. A mortality rate of 21.5% (14 patients) is noted, with all patients dying after admission to the hospital. A common feature of people that self-inflict burn injuries is a psychiatric history, with many patients having histories of self-harm or suicide attempts. Two distinct groups were identified--those with suicidal intent and those with intent of self-harm. Those patients with self-inflicted injuries have an increased mean of 31.4% total body surface area burned as compared with those patients whose injuries are accounted for as accidental, which have a mean total body surface area burned of 10%. Additionally, the mean length of stay in the hospital for patients with self-inflicted injuries was 40 days for acute injuries, which is prolonged; the mean length of stay for acute injuries that were not self-inflicted was 14 days. This investigation discovered 3 cases of repeated self-inflicted burn injury.
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2/65. Reduction mammaplasty in postburn breasts.

    Thermal injury to the anterior chest in the adolescent girl can lead to severe disfigurement of the breasts. Just as in certain non-burn female patients, mammary hyperplasia can occur in patients with previous full-thickness burns of their breasts. Most plastic surgeons have been reluctant to perform reduction mammaplasty in these patients for fear of devascularizing the skin graft or the nipple-areola complex. A series of six patients with full-thickness burns of the breasts and subsequent skin graft coverage before reduction mammaplasty is reported. Four patients had bilaterally burned breasts requiring reduction. Two patients had one burned breast reduced, and one required a balancing procedure on the unburned side. Reduction mammaplasty was performed using the inferior-pedicle technique. The mean amount of tissue removed for the left and right breasts was 454 and 395 g, respectively. There was no nipple loss, hematoma, infection, or major loss of skin flaps. Reduction mammaplasty in this group of patients is safe and carries minimal risk if certain key concepts are followed carefully.
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3/65. Toxic shock syndrome in adult burns.

    Toxic shock syndrome is associated with burn injuries in children and is a cause of significant morbidity in this group. Despite multiple cases of toxic shock syndrome in adults being reported since its original description it has not been reported in adult burn patients. We report a case of toxic shock syndrome in an adult following 25% flame burns.
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4/65. Resurfacing deep wound of upper extremities with pedicled groin flaps.

    A total of 29 axial pedicled groin skin flaps were applied clinically with satisfactory result excepting for one flap which tailed on transplantation. These cases included severe scar contracture of the dorsum of hands in 20 patients, deeply burned wounds with infection and exposure of deep structure in upper extremities in nine patients, such as electrical burns and hot-crushing injuries. The flap is supplied by two groups of nutrient vessels with abundant vascularization and located in a hidden area. Therefore, the pedicled groin skin flap is still valuable due to its advantages as safe, easy operation and strong antiinfective ability although the free groin flap is more widely used today.
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5/65. Cardiac compromise in a patient with Down's syndrome: a lesson learnt.

    A 49 year old burn victim with Down's syndrome (trisomy 21) was admitted with 15% body surface area (BSA) superficial burns. This was complicated by a large atrioseptal defect. Her course was stormy with difficulties encountered in managing her fluid status. Adequate fluid resuscitation was difficult to maintain with a fragile compromise between pulmonary insufficiency and renal impairment. She expired 12 days post-injury. Cardiac anomalies are not uncommon in the subgroup of patients with major burns who respond poorly to fluid resuscitation.
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6/65. Amniotic membrane transplantation for acute chemical or thermal burns.

    PURPOSE: To determine whether preserved human amniotic membrane (AM) can be used to treat ocular burns in the acute stage. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Thirteen eyes from 11 patients with acute burns, 10 eyes with chemical burns and 3 with thermal burns of grades II-III (7 eyes) and grade IV (6 eyes), treated at 7 different facilities. methods: patients received amniotic membrane transplantation (AMT) within 2 weeks after the injury. MAIN OUTCOME MEASURES: Integrity of ocular surface epithelium and visual acuity during 9 months of follow-up. RESULTS: Ten patients were male and one patient was female; most were young (38.2 /- 10.6 years). For a follow-up of 8.8 4.7 months, 11 of 13 eyes (84.63%) showed epithelialization within 2 to 5 weeks (23.7 /- 9.8 days), and final visual acuity improved > or = 6 lines (6 eyes), 4 to 5 lines (2 eyes), and 1 to 3 lines (2 eyes); only one eye experienced a symblepharon. Eyes with burns of grade II to III showed more visual improvement (7.3 /- 3 lines) than those with burns of grade IV (2.3 /- 3.0 lines; P < 0.05, unpaired t test). In the group with grade II or III burns, none had limbal stem cell deficiency. All eyes in the group with grade IV burns did experience limbal stem cell deficiency. CONCLUSIONS: Amniotic membrane transplantation is effective in promoting re-epithelialization and reducing inflammation, thus preventing scarring sequelae in the late stage. In mild to moderate burns, AMT alone rapidly restores both corneal and conjunctival surfaces. In severe burns, however, it restores the conjunctival ocular surface without debilitating symblepharon and reduces limbal stromal inflammation, but does not prevent limbal stem cell deficiency, which requires further limbal stem cell transplantation. These results underscore the importance of immediate intervention in the acute stage of eyes with severely damaged ocular surface. Further prospective randomized studies including a control group are required to determine the effectiveness of AMT in acute chemical and thermal burns of the eye.
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7/65. Lethal burn trauma in children.

    The aims of this retrospective study covering the years 1984-1998 were: 1. to survey burn injuries in children at the present time and 2. to compare the current results with the conclusions of an analogous study performed in the years 1964-1983. A decline in the occurrence of lethal burn wounds was found, as well as in burn shock as a direct cause of death. Children 1-4 years old continue to be the most frequent victims of fatal accidents. The most common cause of burn injury in this group remains scalding in the household.
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8/65. corneal perforation with extrusion of lens in a burn patient.

    The incidence of ophthalmologic injuries has been reported to be between 20 and 25% in all the burn patients. As most of the eye injuries are associated with severe burns, attention is often directed towards the life-threatening events and eye injuries may be overlooked and undertreated. This case report presents a patient who had 40% flame burn and had recently been transferred from another hospital. He was examined by an ophthalmologist at the referring hospital and it was documented that both of his eyes were normal. He was transferred into the burns Unit at the Prince of wales Hospital 8 h later. Unfortunately, all the attention was directed to save his life and it was not until post-burn day 11 that he was found to have right corneal ulceration. Despite vigorous ophthalmologic treatment, the cornea perforated 2 days later with subsequent extrusion of the lens. In view of his grave prognosis with multi-organ failure, he was treated conservatively and he died the following day. It is mandatory to refer patients with facial burns to the ophthalmologist for ocular examination. We recommend that serial eye examinations should be carried out in burn patients who are unconscious or intubated for ventilatory support even if the initial ophthalmologic examinations are normal as the potential risk of serious ocular injuries are high in this particular group of patients.
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9/65. Cephalic vein-pedicled arterialized anteromedial arm venous flap for head and neck reconstruction.

    The authors describe a case of transfer of an arterialized cephalic venous flap from the anteromedial arm region to the neck with the cranial limb of the cephalic vein serving as the drainage vein and a pedicle. The burn scar contracture of a 45-year-old man was released and repaired with a venous flap based on the cephalic vein in the anteromedial arm. After dissection of the cranial end of the cephalic vein as a drainage vein in the deltopectoral groove, until the flap could be transposed easily to the neck defect pedicled on the dissected cranial limb of the cephalic vein, the flap was arterialized by anastomosing the caudal end of the cephalic vein to a recipient artery in the neck The donor defect was skin grafted and the flap survived completely. The neck contracture improved substantially.
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10/65. The use of a PEG tube in a burn centre.

    patients with extensive burn injuries frequently require supplemental tube feeds in order to maintain caloric balance. Conventionally, nutrition is supplied via a naso-gastric tube (NGT). However, NGTs cause discomfort and numerous complications have been described, particularly following prolonged use.An alternative route to the gastro-intestinal tract comprises the percutaneous endoscopic gastrostomy (PEG) tube. This study describes by means of a retrospective analysis our experiences with the PEG tube in comparison with the NGT in a burn centre. Twelve burn patients, including two children and two patients with toxic epidermal necrolysis (TEN), were treated with a PEG tube. We could find no contra-indications to the placement of PEG tubes in this group. Placement of the tube through partial or full-thickness burn wounds did not give rise to complications. In a comparable group of 12 consecutive patients who were fed using a NGT, the NGT did give substantial discomfort to the patients and caused complications, especially in the patients with TEN. The complications that occurred during the use of a PEG tube were mainly caused by the small diameter, single-lumen design. Our experience suggests that the PEG tube is preferable to the NGT for patients who require prolonged feeding. For burn patients, modification of the design of the tube to include two exchangeable lumens of sufficient diameter, would improve performance.
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