Roger E. Salisbury

Physiologic profile monitoring in burned patients.

Physiologic profile monitoring was performed on 18 elderly patients (mean age, 71.3 +/- 11.7 years) with major burns (mean, 49% +/- 17% BSA) on days 1 to 4. Nine had associated inhalation injury. Ten patients survived more than 10 days. Degree of myocardial dysfunction in response to burn injury is unpredictable. Sixteen of the total 18 patients needed inotropic support. Cardiac output is probably a more accurate means of assessing efficacy of resuscitation than hourly urine output. Maintenance of cardiac index at higher than normal levels is a physiologic necessity. Failure of cardiac index to remain high after 3 days predicted nonsurvival in this group of patients. In presence of combined cutaneous and inhalation burn injury fluid requirement is unpredictable, and the optimum resuscitation in these patients merits further definition. Physiologic profile monitoring in these older patients is a very useful guide to the precise management of fluid resuscitation, early detection, and treatment of ventricle dysfunction, and results in improved survival.

Evaluation of early excision of dorsal burns of the hand.

To determine the best method for treating deep second- and third-degree burned hands in our institution, a prospective study comparing early excision and grafting with nonsurgical treatment was undertaken. The patients were randomly assigned to two groups, and the hands in the first group were excised and grafted within 5 days after the burn. In the second group, burns were treated with topical chemotherapy and hydrotherapy, and the eschar was allowed to separate spontaneously and heal. Some required skin grafting, forming a subgroup. All hands in the study received the same vigorous physical therapy twice daily, and splints were applied according to the patients individual needs to maintain an anti-deformity position. Grip strength, power pinch, and accurate range-of-motion measurements of each finger joint were measured upon discharge and 1, 2, 3, 6, and 12 months after the burn. A mean total degrees of motion (including flexion and extension) in each joint and strength values were determined for comparison among the three groups. At discharge, the spontaneously healed hands had the best range of motion and function. Although the rate of improved function was greatest in the interval from discharge to 6 months in all groups, by 1 year there was no statistical difference in function regardless of the initial treatment. Thus in deep second- and third-degree burns of the dorsum of the hand, care may be individualized according to other systemic factors without fear of sacrificing ultimate function.

Comparison of the bacterial clearing effects of different biologic dressings on granulating wounds following thermal injury.

In 16 patients with thermal injury, no difference in bacterial clearing was noted when wounds were dressed with cadaver homograft skin, porcine skin, either mesh or sheet, and with amnion. Because of cost and ease we prefer fresh porcine skin for second- and third-degree burns.

EVALUATION OF DIGITAL ESCHAROTOMY IN BURNED HANDS

A controlled study of digital escharotomy showed a statistically significant increase in the number of salvaged phalanges. This procedure has minimal risk and should be considered in patients with vascular compromise of the upper extremity requiring escharotomy, who also have circumferentially burned fingers.

Results of a Multicenter Outpatient Burn Study on the Safety and Efficacy of Dimac-ssd, a New Delivery System for Silver Sulfadiazine

Dimac with silver sulfadiazine (Dimac-SSD), a new silver sulfadiazine delivery system, was evaluated prospectively in a multicenter study for the treatment of outpatient burn injuries. The goal of this study was to evaluate the effect of Dimac-SSD on the microbiology of the burn wounds and to quantitate its clinical safety and efficacy. A total of 197 patients were evaluated. Eight (4%) of these patients did not complete the study. Six patients withdrew because of local discomfort caused by the Dimac-SSD and two patients were terminated because of technical problems. The mean +/- SD duration of treatment with Dimac-SSD was 12 +/- 8.5 days, during which time the mean number of dressing changes was 2.9 per patient. During treatment with Dimac-SSD, the burn wound bacterial flora remained stable and overgrowth with Pseudomonas species or Gram-negative bacilli did not occur. Only four (2%) patients developed clinical infections; thus the Dimac-SSD appeared to have good antimicrobial effectiveness. This dressing was not associated with any organ system or metabolic side-effects and patient discomfort during application and removal was minimal. Thus this new delivery system for silver sulfadiazine was associated with excellent wound healing, a low incidence of wound infections, reduced frequency for dressing changes, and excellent patient compliance.

THE EFFECT OF EARLY SURGICAL EXCISION AND HOMOGRAFTING ON SURVIVAL OF BURNED RATS AND OF INTRAPERITONEALLY-INFECTED BURNED RATS

The effects of early and delayed surgical excision and skin homografting on survival in burned, uninfected rats and in burned rats infected with Pseudomonas aeruginosa, intraperitoneally, has been studied. The survival rate in animals treated with surgical excision and no coverage was significantly worse than in the animals who were simply burned. Immediate excision of the burn wound followed by prompt coverage with skin homografts resulted in decrease in the mortality rate from subsequent intraperitoneal infection of Pseudomonas. The beneficial effects of early surgical excisions and immediate skin homograft coverage were also achieved when formalin-fixed skin homografts were used.

Laser, scalpel, electrosurgical, and tangential excisions of third degree burns. A preliminary report.

Our clinical experience with laser, electrosurgical, scalpel, and tangential burn wound excisions in 26 patients is presented.