Bums (1991) 17, (6), 519-520 Printed in Great Britain 519

Abstracts

CLINICAL STUDIES Jonsson A., Cassuto J. and Hanson B. (1991) Inhibition of bum pain by intravenous lignocaine infusion. Lancet 338, 151-152.

Incidence of ischaemic intestinal complications A retrospective review of the clinical and autopsy records of all patients admitted over a 7-year period (n = 1488) showed that of all the deaths (n=49), 53 per cent of adults and 61 per cent of children (0-17 years) were found to have had ischaemic intestinal pathologies, ranging in severity between superficial necrosis to full thickness necrosis extending into the omentum. More than 80 per cent of the patients were septic at the time of death, with endogenous intestinal organisms most frequently identified as the causative agent. Although some of the septic episodes may have originated from the bum wound, it seems highly likely that bacterial translocation from the gut was a major contributary factor to the fatal septicaemias.

Desai M. H., Hemdon D. N., Rutan R. L. et al. (1991) Ischemic intestinal complications in patients with bums. Surg. Gynecol. Obsfef. 172, (4), 257-261.

Fluid resuscitation and pulmonary dysfunction Forty-six patients with a mean burn size of about 60 per cent TBSA were resuscitated with either hypertonic lactate saline (HLS) or Ringer’s lactate solution. The two groups of patients received the same sodium inputs, the HLS patients received a smaller input of water.

Compared with the findings in the patients receiving Ringer’s lactate, the use of HLS reduced the respiratory index, the functional extracellular fluid volume and the ratio of plasma volume to interstitial fluid volume. Respiratory distress was reduced in the HLS group, whereas almost half of the Ringer’s lactate-treated patients required endotracheal intubation.

Shimazaki S., Yukioka T. and Matuda H. (1991) Fluid distribu- tion and pulmonary dysfunction following bum shock. 1. Trauma 31, (5), 623-628.

Improved ventilatory support High frequency percussive ventilation (HFPV) was used in 54 patients with a mean burn size of 47.8 per cent TBSA and with proven inhalation injury. Such ventilation started within 24 h of injury and was maintained for an average of 15.3 days (range 1-150 days). The results were compared with those observed in an historic cohort treated with conventional ventilatory support. Fourteen patients (25.9 per cent) treated with HFPV developed pneumonia compared with the historic frequency of 45.8 per cent. Ten patients treated with HFPV died whereas there were 23 deaths in the earlier conventionally treated patients.

Cioffi W. G., Rue L. G., Graves T. A. et al. (1991) Prophylactic use of high frequency percussive ventilation in patients with inhalation injury. Ann. Surg. 213, (6), 575-582.

Burn pain relief As an alternative to opiate analgesia for painful bum wound dressings it was found that intravenous lignocaine (o.s-1.0mg/kg/h) was very effective. There was a striking reduction in self-assessed pain scores in seven adult patients with deep partial skin thickness bums covering 10-30 per cent of the body surface area.

%“ 1991 Butterworth-Heinemann Ltd 0305-4 179/91/0605 19-02

Survival of cultured epidermal allografts Cultured epidermal allografts were applied to six partial skin thickness bums. Biopsies were obtained between 8 and 100 days postgrafting. During the second week after grafting clinically noted re-epithelialization of the allografted sites was confirmed histologically. Blood group and sex mis-match studies showed that the allografted cells were no longer present between 8 and 100 days postgrafting, suggesting that the newly formed epithe- lium was generated by the host.

Kaawach W. F., Oliver A. M., Weiler-Mithoff E. et al. (1991) Survival assessment of cultured epidennal allografts applied onto partial thickness bum wounds. Br. J Phst. Surg. 44, (5). 321-324.

Wound excision and oxygen usage Twelve patients with deep bums (TBSA= 30-50 per cent) received sequential bum wound excisions and skin grafting between I and 3 days postbum. Most of the deep bum had been removed by day 7 but with the addition of a donor site area of 20-25 per cent TBSA. There was no observed decrease in oxygen consumption as a result of the removal .of the burned tissue. A transient further increase in oxygen consumption was noted early after the excision, especially with surgical procedures performed after 5 days. This response could not be attributed to wound manipulation-induced bacteraemias and was likely to be the result of the existence of the donor site and any non-excised burned tissue.

Demling R. H., Frye E. and Read T. (1991) Effect of sequential early bum wound excision and closure on postbum oxygen consumption, Crit. Care Med. 19, (7), 861-866.

Propranolol and blood flows Indirect calorimetry and leg blood flow measurements were made in five patients with severe bums (TBSA= 55 f 7 per cent) who were given 8/.rg/kg/min of propranolol for a period of 2 h. Compared with prepropranolol measurements there was a signifi- cant reduction in cardiac index and heart rate with an increased leg vascular resistance resulting in a decrease in extremity perfusion. In contrast with the findings in burned patients the administration of 5 pg/kg/min to four healthy volunteers produced a comparable decrease in heart rate but no change in leg vascular resistance or extremity perfusion. Propranolol administration also decreased the plasma lactate levels.

Gore D. C., Honeycutt D., Jahoor F. et al. (1991) Propranolol diminishes extremity blood flow in burned patients. 14nn. Surg. 213, (6), 568-574.

Dressings for skin graft donor sites Sixty-five split skin graft donor sites were randomly assigned to be covered with either hydrocolloid or alginate dressings. Both dressings were found to encourage prompt healing of the donor sites. The mean time from operation to complete healing was 10.0 days beneath the hydrocolloid dressing and 15.5 days beneath the alginate dressing. The wound discomfort was comparable between the two groups of patients. The hydrocolloid dressings