Alan Phipps

A comparative study of silicone net dressing and paraffin gauze dressing in skin-grafted sites

This prospective randomized study has compared paraffin gauze dressing (n = 19) with silicone net dressing (Mepitel, n = 19) applied as the first layer to newly grafted burn wounds. At the first postoperative dressing visual analogue pain scores were greater in the paraffin gauze group (mean 4.4) than in the silicone net group (mean 1.4, P < 0.01). All patients in the paraffin gauze group experienced some degree of pain on dressing removal, whereas 53 per cent of patients in the silicone net group experienced no pain. Overall graft take was similar in both groups, (silicone net mean 95.7 per cent; paraffin gauze mean 94.3 per cent). Dressings were harder to remove in the paraffin gauze group as assessed by a simple scoring system (P < 0.001). In conclusion silicone net dressing confers advantages over conventional paraffin gauze, especially in reducing patient discomfort during dressing changes.

Changing pattern of adult burn referrals to a regional burns centre.

The National Burn Care Review prompted us to review trends in adult acute admissions to our unit with the intention to implement the guidelines of referral set down in the report. We had recently also adopted a more open admissions policy in keeping with these recommendations. This was achieved by a retrospective casenote analysis with the years 1981, 1991, and 2001 used as reference snapshot years to outline trends. The results showed an increase in the number of patients, a decrease in the depth and extent of burns, a decrease in the number of inpatient days and crude mortality rate. There was also a slight decrease in the age of patients.

Multifocal melanoma of the glans penis.

Malignant melanomas of the penis and urethra are rare.1–7 These lesions typically appear in an older age group.1–3,5–8 Presentation is usually late,1,6 with thick primary lesions9 and a high incidence of regional metastatic disease.1,5,8 Little is known about risk factors for or the pathogenesis of this disease. Furthermore, there is lack of consensus as to the extent of treatment that is indicated. The authors present a case of multifocal melanoma of the glans penis that has not been previously described. A review of the literature with emphasis on the pathogenesis and treatment of melanoma of the penis and urethra is discussed. Further efforts are needed to identify those at increased risk so that earlier diagnosis, surgical intervention, and an improved prognosis for those afflicted with this disease will be possible in the future.

CS gas―Completely safe? A burn case report and literature review

Current threats to the population at large and the requirement for non-lethal methods of incapacitation are resulting in increased usage of lawful crowd-control agents such as ochlorobenzylidene malonitrile (CS), v-chloroacetophenone (CN) and dibenzoxazepine (CR) [1]. CS gas deployment, used by police forces in the UK since 1996, continues to increase both in the public domain and on NHS premises with 16 trusts admitting those patients in their care had been restrained by police with CS gas [2]. Although safety profiles focus primarily on the transient effects of CS exposure on ocular, oral and respiratory mucous membranes, the dermatologic effects following direct skin contact can be both severe and long lasting. In view of this, physicians should be alert to the clinical effects and recommended methods of treatment of patients exposed to such substances. Our aim is to increase awareness of these injuries and the specific treatment required which contrasts with standard treatments for chemical burns.

Surviving ''Payment by Results'': A simple method of improving clinical coding in burn specialised services in the United Kingdom

INTRODUCTION Coding inpatient episodes plays an important role in determining the financial remuneration of a clinical service. Insufficient or incomplete data may have very significant consequences on its viability. We created a document that improves the coding process in our Burns Centre. MATERIALS AND METHODS At Yorkshire Regional Burns Centre an inpatient summary sheet was designed to prospectively record and present essential information on a daily basis, for use in the coding process. The level of care was also recorded. A 3-month audit was conducted to assess the efficacy of the new forms. RESULTS Forty-nine patients were admitted to the Burns Centre with a mean age of 27.6 years and TBSA ranging from 0.5% to 65%. The total stay in the Burns Centre was 758 days, of which 22% were at level B3-B5 and 39% at level B2. The use of the new discharge document identified potential income of about 500,000 GB pound sterling at our local daily tariffs for high dependency and intensive care. CONCLUSION The new form is able to ensure a high quality of coding with a possible direct impact on the financial resources accrued for burn care.

Is there still a place for comfort care in severe burns

Successive improvements in burn care have steadily increased the survivability of many major burn injuries, however for some patients with the most severe injuries comfort care rather than active resuscitation has been seen as the correct course of action. A survey of UK burn unit directors by postal questionnaire sought details of current practice regarding comfort care, the factors involved in the decision making process and their response to eight hypothetical case histories. An 84% response to the survey showed that units would, on average, actively resuscitate thirty-seven patients a year and administer comfort care three times per year. Opinion was often divided regarding the decision to resuscitate in the cases presented.

Temperature profiles during resuscitation predict survival following burns complicated by smoke inhalation injury

Temperature and resuscitation profiles of 15 non-survivors were compared with matched survivors of major burns. All patients were intubated and ventilated for smoke inhalation injury, survived more than 3 days postburn and had a cutaneous burn greater than 15 per cent of the body surface area (mean 32.3 +/- 11.0 per cent SD). Cases were matched for similar ages (within 10 years) and total body surface area burn (within 10 per cent). The rate of core temperature rise following admission to the burn unit was significantly greater in survivors (mean 0.46 +/0 0.18 degree C/h) compared with matched non-survivors (mean 0.30 +/- 0.15 degrees C/h; p < 0.01). Core temperature increased at a rate of 0.27 degrees C/h or greater in all survivors, whereas 7 non-survivors raised their core temperature at a rate less than this. The rate of skin temperature rise was also significantly greater in the survivors (mean 1.35 +/- 0.91 degrees C/h) compared with matched non-survivors (mean 0.63 +/- 0.43 degrees C/h, p < 0.01). In 13/15 survivors, the skin temperature increased at a rate of 0.6 degree C/h or greater, whereas in 8/15 non-survivors skin temperature increased at a rate less than this. There was a negative relationship between initial core temperature and delay from time of burn to admission to the burns unit in non-survivors (correlation coefficient = -0.92; p < 0.01), whereas there was no effect of delay in the survivors. These findings suggest that patients with a high mortality probability can be detected early in their clinical course by means of temperature profiles.