M. L. Moore

Early excision and grafting of face and neck burns in patients over 20 years

&NA; Although excision and grafting of burns has become common and standard, many surgeons have been reluctant to excise and graft face burns. In fact, we could find photographic results at 1 year after grafting of only eight patients in the English literature. We began excision and grafting of face burns in 1979 and presented our first 16 patients in 1986 in this journal. With encouragement from Janzěkovič and Jackson, we continued and have now used essentially the same procedure for more than 20 years in approximately 100 patients and, from this large series, are able to present outcomes. From January of 1979 to May of 1999, we performed excision and grafting on 91 patients with deep face burns. Data were recorded and 35‐mm photographs were obtained throughout the 20‐year period. We reviewed that database and the slide files of these patients. We found 45 patients with complete photographic sets including 1‐year follow‐up. Since, in our opinion, there is no useful, objective measure of appearance, we decided to simply publish all 45 sets of complete photographs, permitting the reader to subjectively form an opinion of the outcome of this procedure. The results are all shown as “full” face burns and two “partial” face burns. We continue to believe that early excision and grafting is indicated for face burns that will not heal within 3 weeks and that the procedure yields results that permit the burn victims to return to society and minimizes the time off work or out of school. (Plast. Reconstr. Surg. 109: 1266, 2002.)

A clarion to recommit and reaffirm burn rehabilitation.

Burn rehabilitation has been a part of burn care and treatment for many years. Yet, despite of its longevity, the rehabilitation outcome of patients with severe burns is less than optimal and appears to have leveled off. Patient survival from burn injury is at an all-time high. Burn rehabilitation must progress to the point where physical outcomes parallel survival statistics in terms of improved patient well-being. This position article is a treatise on burn rehabilitation and the state of burn rehabilitation patient outcomes. It describes burn rehabilitation interventions in brief and why a need is felt to bring this issue to the forefront. The article discusses areas for change and the challenges facing burn rehabilitation. Finally, the relegation and acceptance of this responsibility are addressed.

Assessment of functional limitation after necrotizing soft tissue infection.

Previous literature on necrotizing soft tissue infections (NSTIs) has focused on its diagnosis and high mortality, but to our knowledge, none have reported on the functional outcomes of patients surviving this devastating disease. The purpose of this study was to evaluate the management and assess factors associated with decreased physical function in patients who survived this life-threatening infection. A retrospective review was conducted on patients treated for NSTI in whom an evaluation of functional status was performed between 2002 and 2006. Measurements were based on the American Medical Association Guides of impairment rating, and categorized into a functional class from “minimal or no limitation” to “severe limitation.” Multivariate analyses were performed to discern independent factors associated with functional limitation. Final disposition status after discharge was also recorded. A total of 297 patients were treated for NSTI during this time. Of these, 119 (41%) patients met inclusion criteria for review. Mean number of débridements and coverage procedures were 3.4 and 2.0, respectively. Although mean percent functional limitation was 7.1, which is classified as “minimal or no limitation,” 30% of patients had “mild” to “severe” functional limitation. Extremity involvement was independently associated with a higher functional limitation class (P < .01). Functional limitation may challenge recovery from NSTI in many survivors. In this series, the involvement of an extremity predicted a higher functional limitation class at the time of discharge. Development of validated functional assessment tools and accurate longitudinal follow-up are necessary to measure the functional impact of NSTI.

Dexter: a tool to facilitate impairment ratings.

Calculating impairment in burn patients is crucial to understanding outcome. However, it is rarely reported after burns, presumably because the process of calculating impairment ratings is complicated and tedious. Computerized systems have been developed that facilitate the process, but it has not been established in burn patients that these systems reduce the time required to calculate impairment. We evaluated the Dexter Evaluation and Therapy System by Cedaron Medical Inc (Davis, CA). A sample of 10 manually recorded ratings was compared with 10 performed on the Dexter. Mean time for the manual technique was 65 +/- 35 minutes versus 37 +/- 13 minutes for the Dexter (P < .05, Mann-Whitney). The time taken to perform impairment ratings in burn survivors is significantly reduced by the use of the Dexter system. Time saving occurs primarily at three points: (1) electronic data entry directly from the measuring instruments, (2) compilation of data, and (3) rapid generation of reports.