John A. Twomey

A multicenter clinical trial of a biosynthetic skin replacement, dermagraft-TC, compared with cryopreserved human cadaver skin for temporary coverage of excised burn wounds

This multicenter study compared the use of a biosynthetic human skin substitute with frozen human cadaver allograft for the temporary closure of excised burn wounds. Dermagraft-TC (Advanced Tissue Sciences, Inc.) (DG-TC) consists of a synthetic material onto which human neonatal fibroblasts are cultured. Burn wounds in 66 patients with a mean age of 36 years and a mean burn size of 44% total body surface area (28% total body surface area full-thickness) were surgically excised. Two comparable sites, each approximately 1% total body surface area in size, were randomized to receive either DG-TC or allograft. Both sites were then treated in the same manner. When clinically indicated (> 5 days after application) both skin replacements were removed, and the wound beds were evaluated and prepared for grafting. DG-TC was equivalent or superior to allograft with regard to autograft take at postautograft day 14. DG-TC was also easier to remove, had no epidermal slough, and resulted in less bleeding than did allograft while maintaining an adequate wound bed. Overall satisfaction was better with DG-TC.

Randomized clinical study of Hydrofiber dressing with silver or silver sulfadiazine in the management of partial-thickness burns.

This prospective, randomized study compared protocols of care using either AQUACEL® Ag Hydrofiber® (ConvaTec, a Bristol-Myers Squibb company, Skillman, NJ) dressing with silver (n = 42) or silver sulfadiazine (n = 42) for up to 21 days in the management of partial-thickness burns covering 5% to 40% body surface area (BSA). AQUACEL® Ag dressing was associated with less pain and anxiety during dressing changes, less burning and stinging during wear, fewer dressing changes, less nursing time, and fewer procedural medications. Silver sulfadiazine was associated with greater flexibility and ease of movement. Adverse events, including infection, were comparable between treatment groups. The AQUACEL® Ag dressing protocol tended to have lower total treatment costs (

Management of the difficult split-thickness donor site.

1040 vs.

Slightly hypertonic saline and dextran-40 in resuscitation of methamphetamine burn patients.

1180) and a greater rate of re-epithelialization (73.8% vs 60.0%), resulting in cost-effectiveness per burn healed of

A preliminary report on the spray application of topical silver sulfadiazine to burn wounds.

1,409.06 for AQUACEL® Ag dressing and

INNOVATIONS IN BURN CARE Controlled Air Suspension: An Advantage in Burn Care

1,967.95 for silver sulfadiazine. A protocol of care with AQUACEL® Ag provided clinical and economic benefits compared with silver sulfadiazine in patients with partial-thickness burns.

An open-label study to evaluate the safety and efficacy of tissue plasminogen activator in treatment of severe frostbite

Split-thickness skin graft donor sites are often areas of significant morbidity in the elderly, in immunocompromised patients, and in steroid-dependent patients. We found that managing these donor sites with split-thickness skin and transparent dressings greatly increases the rate of healing and diminishes morbidity.

Survey of perceived stressors and coping strategies among burn unit nurses.

The inherent danger of illegal manufacture of methamphetamine is explosion and fire with the “cookers” presenting to burn centers for treatment. Recent studies have shown that methamphetamine burn patients required resuscitation volumes two to three times that of the standard Parkland formula and experienced a higher mortality rate. The purpose of this study was to compare the fluid resuscitation requirements and other characteristics of our methamphetamine-positive burn patients with a control group of methamphetamine-negative burn patients. A retrospective study of burn patients with methamphetamine-positive urine toxicology screens was conducted from August 1996 to April 2005. The data collected were age, sex, %total body surface area (%TBSA) burn, urine toxicology screen result, length of stay (LOS), ventilator days, weight, urine output, and fluid requirement during the first 24 hours along with fluid type, survival, and hospital charges. Methamphetamine-positive patients were matched to controls for %TBSA, age, and sex. Eleven methamphetamine-positive burn patients were well matched with 11 methamphetamine-negative controls. There was no difference in intubation rate, ventilator days, LOS, and there were no deaths in either group. There was no statistical difference between the two groups for the ratio of the 24-hour fluid resuscitation requirement divided by the estimate from the Parkland formula. Hospital charges were similar for the two groups. The largest volume of fluid infused was lactated Ringers (LR) and the slightly hypertonic fluid combination of LR + 50 mEq sodium bicarbonate + 3.4 mmol potassium phosphate. Both groups also received a dextran-40 (Rheomacrodex) infusion. In contrast to previous studies, our experience with methamphetamine-positive burn patients shows that they did not have an increased initial fluid requirement, a longer LOS, more days on the ventilator, higher hospitalization charges nor an increased mortality rate. The only apparent difference between our study and others is in the method of resuscitation. The slightly hypertonic fluid combination of LR + 50 mEq sodium bicarbonate +3.4 mM potassium phosphate was used for resuscitation along with Rheomacrodex. Prospective trials should be conducted on this fluid resuscitation strategy to determine wider applicability for all large burn patients.

Randomized Controlled Study of Silver Dressing Effects on Partial-thickness Burn Outcomes: P58

A simple, flexible system for spray application of topical antimicrobials has been developed in the Burn Unit at Hennepin County Medical Center. In contrast to previous attempts, this method allows spray application of silver sulfadiazine without dilution. Because of the viscosity of the micronized cream, aerosol spread is minimal. Inexpensive commercially available components are used without modification. This system can be readily adapted to most hospital situations and provides rapid topical antimicrobial application. Time required for dressing changes has been reduced in our Burn Unit by 75% and fewer nursing personnel are required. Spray application avoids direct physical contact with burn wounds, eliminating potential contamination and greatly reducing pain associated with dressing changes. Patient acceptance is high.

Cultured Autologous Skin for Burns

The clinical uses of the air-fluidized Clinitron therapy system and the air suspension KinAir bed are discussed based on a review of 31 patients. The risks of infection and high evaporative water loss on the air-fluidized bed are problems not associated with the air suspension bed. The clinical use of the air suspension bed is much simpler and safer for nursing personnel. The air suspension bed is indicated for patients with massive burn injuries, patients with deep burns of the back, obese burn patients, heavily infected burn patients, and debilitated patients.