Indices of hypertrophic scar tissue maturity
1
72 Burns (1985) Vol. 12/No. 1 normal range in 37 of the patients for virtually all the time they were in hospital, the more severe the burn the lower the testosterone levels. LH levels were below normal during the first 4 days after the burn and remained thereafter in the low or mid normal range. Sex hormone-binding globulin levels were normal or only slightly low. These observations suggest a central defect in the release of LH which may have been mediated by the treatment of pain with opiates. Vogel A. V., Peake G. T. and Rada R. T. (1985) Pituitary testicular axis dysfunction in burned men. J. Clin. Endocrinol. Mefab. 60, 658. Burns and motor vehicle accidents A survey of 178 patients with burns sustained in road traffic accidents indicated a mean area of burning of 33.9 per cent (range 2-95 per cent) of the body surface area and a mortality rate of 24.7 per cent. The fatally injured patients had a mean burned area of 63.9 per cent. Inhalation injury was most commonly associated with death. Apart from the burns, 36 per cent of the patients sustained other injuries, most commonly affecting the musculoskeletal system. Only severe mul- tiple injuries increased the mortality rate, although burn wound care was complicated bv fractures unless the latter were surgically stabilized soon after injury. Purdue G. F., Hunt J. L., Layton T. R. et al. (1985) Burns in motor vehicle accidents. J. Trauma 25, 216. Isolation of immunosuppressive activity A protein fraction with a molecular weight of less than 25 000 daltons isolated from serum obtained from 3 patients with deep flame burns covering more than 40 per cent of the body area was found to have immuno- suppressive activity when tested against neutrophil che- motaxis and mixed lymphocyte culture activity. Further purification of this protein fraction indicated that this suppressive activity was contained in a material with a molecular weight of between 1000 and 5000 daltons, that it was a complex containing protein, lipid and carbohydrate moieties and had a structure that was heat and pH stable, and unaffected by treatment with trypsin, proteinase K, DNAse and RNAse. The mater- ial had a non-cytotoxic immunosuppressive mode of ac- tion which may involve the prostaglandins. Ninnemann J. L. and Ozkan A. N. (1985) Definition of a burn injury induced immuno suppressive serum component. J. Trauma 25, 113. Should outpatient burns be treated with antibiotics? Two groups of outpatients with small burns were treated with or without prophylactic antibiotics. The infection rates of the wounds were 3.8 per cent in the 133 treated patients and 3.1 per cent in the 161 untre- ated patients. The patient groups were comparable with respect to age, size, location and cause of the burn, the time since injury and the presence of other illnesses. The only significant difference between the groups (P<O.O5) was the extent of injury in the treated group. As even after controlling for extent of burn the antibiotic usage did not lower the infection rate, there seems to be no good reason for routine use of systemic antibiotics in the treatment of outpatient burns. Boss W. K., Brand D. A., Acampora D. et al. (1985) Effectiveness of prophylactic antibiotics in the out- patient treatment of burns. J. Trauma 25, 224. Indices of hypertrophic scar tissue maturity Measurements of transcutaneous oxygen tension and thermographic determinations of scar temperature were made in 16 patients undergoing compression treatment for scar hypertrophy. Rising levels of trans- cutaneous oxygen tension in treated scars correlated well with a reduction in scar thickness assessed both clinically and by ultrasound. In contrast, scar tempera- ture measurements were not of value. The observed low levels of transcutaneous oxygen tension in imma- ture scars are probably the result of low diffusibility of oxygen rather than increased metabolic usage of oxy- gen. Berry R. B., Tan 0. T., Cooke E. D. et al. (1985) Transcutaneous oxygen tension as an index of maturity in hypertrophic scars treated by compression. Br. J. Plast. Surg. 38, 163. Ketone production by major burns Eleven patients with a mean burned area of 49 per cent (range 31-82 per cent) were studied during a 3-day period of starvation immediately following burning and during days 3-6 after burning during unrestricted feed- ing when the energy input averaged 2157 Kcal per day. All patients showed a marked nitrogen excretion which averaged 17.1 g N per day. In contrast, 10 control non-burn patients admitted for elective surgery for cholelithiasis excreted on average only 11.8 g N per day during a 3-day period of starvation. As a group the burned patients failed to produce a marked ketone response during starvation since their plasma ketone levels only rose to 385+77 umol/litre compared to a rise to 727+81 umoUI (P<O.Ol) in the control patients. Abbott W. C., Schiller W. R., Long C. L. et al. (1985) The effect of major thermal injury on plasma ketone body levels. J. Parent. Entr. Nurr. 9, 153. Myocardial damage and electrical injury Serial electrocardiograms, creatine kinase (CK and MB) determinations, “““Tc stannous pyrophosphate scans and 24-hour Holter monitorings were carried out in 16 patients with non-flash electrical injury to deter- mine the incidence of possible myocardial damage. Abnormal electrocardiograms were found in 5 patients, elevations in the CK-MB isoenzyme were found in 9 patients and only one patient had a transient abnormal Holter monitoring. No patient had an abnormal “mT~ pyrophosphate cardiac scan. Of the 9 patients with elevated CK and MB levels, only 2 had abnormal electrocardiograms. Abnormal cardiac function was not observed in any patient. The incidence of myocar- dial damage following electrical injury thus appears to be relatively low.
Transcript of Indices of hypertrophic scar tissue maturity
72 Burns (1985) Vol. 12/No. 1
normal range in 37 of the patients for virtually all the time they were in hospital, the more severe the burn the lower the testosterone levels. LH levels were below normal during the first 4 days after the burn and remained thereafter in the low or mid normal range. Sex hormone-binding globulin levels were normal or only slightly low. These observations suggest a central defect in the release of LH which may have been mediated by the treatment of pain with opiates.
Vogel A. V., Peake G. T. and Rada R. T. (1985) Pituitary testicular axis dysfunction in burned men. J. Clin. Endocrinol. Mefab. 60, 658.
Burns and motor vehicle accidents A survey of 178 patients with burns sustained in road traffic accidents indicated a mean area of burning of 33.9 per cent (range 2-95 per cent) of the body surface area and a mortality rate of 24.7 per cent. The fatally injured patients had a mean burned area of 63.9 per cent. Inhalation injury was most commonly associated with death. Apart from the burns, 36 per cent of the patients sustained other injuries, most commonly affecting the musculoskeletal system. Only severe mul- tiple injuries increased the mortality rate, although burn wound care was complicated bv fractures unless the latter were surgically stabilized soon after injury.
Purdue G. F., Hunt J. L., Layton T. R. et al. (1985) Burns in motor vehicle accidents. J. Trauma 25, 216.
Isolation of immunosuppressive activity A protein fraction with a molecular weight of less than 25 000 daltons isolated from serum obtained from 3 patients with deep flame burns covering more than 40 per cent of the body area was found to have immuno- suppressive activity when tested against neutrophil che- motaxis and mixed lymphocyte culture activity. Further purification of this protein fraction indicated that this suppressive activity was contained in a material with a molecular weight of between 1000 and 5000 daltons, that it was a complex containing protein, lipid and carbohydrate moieties and had a structure that was heat and pH stable, and unaffected by treatment with trypsin, proteinase K, DNAse and RNAse. The mater- ial had a non-cytotoxic immunosuppressive mode of ac- tion which may involve the prostaglandins.
Ninnemann J. L. and Ozkan A. N. (1985) Definition of a burn injury induced immuno suppressive serum component. J. Trauma 25, 113.
Should outpatient burns be treated with antibiotics? Two groups of outpatients with small burns were treated with or without prophylactic antibiotics. The infection rates of the wounds were 3.8 per cent in the 133 treated patients and 3.1 per cent in the 161 untre- ated patients. The patient groups were comparable with respect to age, size, location and cause of the burn, the time since injury and the presence of other illnesses. The only significant difference between the groups (P<O.O5) was the extent of injury in the treated group. As even after controlling for extent of burn the
antibiotic usage did not lower the infection rate, there seems to be no good reason for routine use of systemic antibiotics in the treatment of outpatient burns.
Boss W. K., Brand D. A., Acampora D. et al. (1985) Effectiveness of prophylactic antibiotics in the out- patient treatment of burns. J. Trauma 25, 224.
Indices of hypertrophic scar tissue maturity Measurements of transcutaneous oxygen tension and thermographic determinations of scar temperature were made in 16 patients undergoing compression treatment for scar hypertrophy. Rising levels of trans- cutaneous oxygen tension in treated scars correlated well with a reduction in scar thickness assessed both clinically and by ultrasound. In contrast, scar tempera- ture measurements were not of value. The observed low levels of transcutaneous oxygen tension in imma- ture scars are probably the result of low diffusibility of oxygen rather than increased metabolic usage of oxy- gen.
Berry R. B., Tan 0. T., Cooke E. D. et al. (1985) Transcutaneous oxygen tension as an index of maturity in hypertrophic scars treated by compression. Br. J. Plast. Surg. 38, 163.
Ketone production by major burns Eleven patients with a mean burned area of 49 per cent (range 31-82 per cent) were studied during a 3-day period of starvation immediately following burning and during days 3-6 after burning during unrestricted feed- ing when the energy input averaged 2157 Kcal per day. All patients showed a marked nitrogen excretion which averaged 17.1 g N per day. In contrast, 10 control non-burn patients admitted for elective surgery for cholelithiasis excreted on average only 11.8 g N per day during a 3-day period of starvation. As a group the burned patients failed to produce a marked ketone response during starvation since their plasma ketone levels only rose to 385+77 umol/litre compared to a rise to 727+81 umoUI (P<O.Ol) in the control patients.
Abbott W. C., Schiller W. R., Long C. L. et al. (1985) The effect of major thermal injury on plasma ketone body levels. J. Parent. Entr. Nurr. 9, 153.
Myocardial damage and electrical injury Serial electrocardiograms, creatine kinase (CK and MB) determinations, “““Tc stannous pyrophosphate scans and 24-hour Holter monitorings were carried out in 16 patients with non-flash electrical injury to deter- mine the incidence of possible myocardial damage. Abnormal electrocardiograms were found in 5 patients, elevations in the CK-MB isoenzyme were found in 9 patients and only one patient had a transient abnormal Holter monitoring. No patient had an abnormal “mT~ pyrophosphate cardiac scan. Of the 9 patients with elevated CK and MB levels, only 2 had abnormal electrocardiograms. Abnormal cardiac function was not observed in any patient. The incidence of myocar- dial damage following electrical injury thus appears to be relatively low.
