Alisa Savetamal

Use of continuous local anesthetic infusion in the management of postoperative split-thickness skin graft donor site pain.

Donor sites from split-thickness skin grafts (STSG) impose significant pain on patients in the early postoperative period. We report the use of continuous local anesthetic infusion as a method for the management of postoperative STSG donor site pain. Patients undergoing single or dual, adjacent STSG harvest from the thigh (eight patients) or back (one patient) were included in this study. Immediately after STSG harvest, subcutaneous catheters were placed for continuous infusion of local anesthetic. Daily donor site–specific pain severity scores were prospectively recorded in nine patients receiving local anesthetic infusion. Patient characteristics, technical aspects, and postoperative complications were identified in the study. The thigh was the anatomic location chosen for most donor sites. A single catheter was placed for donor sites limited to 4 inches in width or less. A dual catheter system was used for those wider than 4 inches. An elastomeric pump delivered continuously a total of 4 ml/hr of a solution of 0.5% bupivacaine. The average anesthetic infusion duration was 3.1 days. A substantial decrease in worst, least, and average donor site pain scores was found from the first 24 hours to the second postoperative day in our patients, a treatment trend that continued through postoperative day 3. One patient developed minor anesthetic leakage from the catheter insertion site; and in three cases, accidental dislodgement of the catheters occurred. There were no cases of donor site secondary infection. All donor sites were completely epithelialized at 1-month follow-up. Continuous local anesthetic infusion is technically feasible and may represent an option for postoperative donor site pain control after STSG harvesting. Relative cost–benefit of the technique remains to be determined.

Characteristics of patients with injury secondary to smoking on home oxygen therapy transferred intubated to a burn center.

BACKGROUND The aim of this study was to compare outcomes of patients who sustained burn and ostensible inhalation injuries while on home oxygen therapy with those suffering equivalent injuries via other mechanisms. STUDY DESIGN Between December 2002 and January 2006, 109 burn patients were transferred to our center intubated. Their charts were retrospectively reviewed. Patients who sustained injuries while on home oxygen therapy were age and total body surface area matched to patients with inhalation and burn injuries secondary to other mechanisms. RESULTS Fourteen of 109 patients were injured while smoking on home oxygen therapy (15.26%). All 14 had COPD. Mean age was 63 years (range 53 to 77 years) and average total body surface area burned was 4% (range 0% to 10%). Charges for the 14 hospitalizations totaled

A Multicenter Study of Preventable Contact Burns From Glass Fronted Gas Fireplaces

1,097,860 (

A case of pyogenic liver abscesses in a previously healthy adolescent man.

8,003 to

American Burn Association consensus statements.

284,835; mean

Summary of the 2012 ABA Burn Quality Consensus conference.

78,418 per admission). Average time to extubation was 5.7 ± 10.2 days and average length of stay was 11.4 ± 15.2 days. No significant differences in the average time to extubation, length of stay, cost of hospitalization, or clinical signs of inhalation injury (ie, soot and edema in the pharynx) were noted between our series and the control group. CONCLUSIONS Injury secondary to smoking on home oxygen therapy is a perennial problem, and guidelines for prescribing home oxygen therapy for smokers should be reassessed. Despite underlying lung disease, patients in our series did as well as patients without COPD who sustained similar injuries.

486 How Burn Patients Die: Burns and End of Life Decisions

Glass fronted gas fireplaces (GFGFs) have exterior surfaces that can reach extremely high temperatures. Burn injuries from contact with the glass front can be severe with long-term sequelae. The Consumer Product Safety Commission reported that these injuries are uncommon, whereas single-center studies indicate a much higher frequency. The purpose of this multi-institutional study was to determine the magnitude and severity of GFGF injuries in North America. Seventeen burn centers elected to participate in this retrospective chart review. Chart review identified 402 children ⩽10 years of age who sustained contact burns from contact with GFGF, who were seen or admitted to the study hospitals from January 2006 to December 2010. Demographic, burn, treatment, and financial data were collected. The mean age of the study group was 16.8 ± 13.3 months. The majority suffered burns to their hands (396, 98.5%), with burns to the face being the second, much less common site (14, 3.5%). Two hundred and sixty-nine required rehabilitation therapy (66.9%). The number of GFGF injuries reported was 20 times greater than the approximately 30 injuries estimated by the Consumer Product Safety Commission’s 10-year review. For the affected children, these injuries are painful, often costly and occasionally can lead to long-term sequelae. Given that less than a quarter of burn centers contributed data, the injury numbers reported herein support a need for broader safety guidelines for gas fireplaces in order to have a significant impact on future injuries.

438 How Burn Patients Die: End of Life Decisions

An 18-year-old, previously healthy man admitted with abdominal pain, high-grade fevers, nausea and emesis was found to have multiple hepatic abscesses. Aspiration cultures grew Fusobacterium necrophorum, a rare bacterium causing potentially fatal liver abscesses in humans. Following sequential percutaneous drainages and narrowing of antibiotics, the patient was discharged on a 6-week antibiotic course and showed no signs of infection. A week after presentation it was discovered that he had experienced upper respiratory symptoms and sore throat prior to presentation. Because oropharyngeal infections are a potential source of bacteremia, they must be considered in the differential diagnosis of patients presenting with hepatic abscesses and no evidence of immunocompromise.