Accelerating the healing process and reducing pain during healing are beneficial for the following reasons: faster return to work, lower risk of wound infection, improved quality of life, and possibly reduced need for analgesia. This clinical study assessed the effectiveness of a new oxygen-diffusion dressing (OxyBand; Oxyband Technologies, St. Louis, MO) compared with standard Xeroform gauze dressings (Convidien, Mansfield, MA), in the care of skin-graft donor sites in burn patients. Time to healing was the primary endpoint, and pain scores and cosmetic outcome were also assessed. This was a prospective, randomized, controlled study of burn patients undergoing harvesting of two donor sites. Patients were followed at predetermined time points for 30 to 45 days to determine the time to reepithelialization, cosmetic appearance, and pain. Subjects were adult burn patients with less than 30% TBSA burns admitted to the burn center, who required excision and grafting. Twenty patients were enrolled, of whom 17 completed the study. Average age was 35 years. Average burn size was 9.2% TBSA. Patients underwent harvesting of split-thickness skin grafts with one donor wound dressed with OxyBand and the other dressed in Xeroform gauze. Wounds were inspected and photographed on postoperative days 4 and 8, and then every 2 days until the donor wounds were healed. Pain scores at each site were also collected at these visits (rated by patients on a scale from 0 to 10). Mean time to wound healing for OxyBand was 9.3 ± 1.7 days; for Xeroform, 12.4 ± 2.7 days (P < .001). Pain scores were lower (P < .01) at the OxyBand site compared with the Xeroform site at all time points during postoperative days 4 to 12. There was no difference in the cosmetic outcome of the wounds at 30 to 45 days postoperatively. This study revealed a decrease in the time to healing and in pain at donor sites dressed with an oxygen-diffusion dressing.

Saksenaea erythrospora is a newly described species of the order Mucorales which has not previously been reported as a cause of human infection. We report a fatal case of S. erythrospora invasive burn wound infection in a 26-year-old male injured during combat operations in Iraq. CASE REPORTA 26-year-old male sustained 56% total body surface area burns following an improvised explosive device blast in Iraq in November 2005. Injuries were significant for deep, fullthickness facial burns and partial-thickness and full-thickness burns affecting his head, arms, and legs. No evidence of significant smoke inhalation injury was noted on fiber-optic bronchoscopy. At a combat support hospital in Iraq, he was resuscitated and taken to the operating room for bilateral canthotomies, four extremity escharotomies, and four extremity fasciotomies. After initial stabilization, he was evacuated to Germany, where he was found to be in persistent circulatory shock and taken back to the operating room. He was found to have nonviable muscle in the right anterior tibialis compartment, and muscle debridement was performed. He was subsequently stabilized and transferred to the U.S. Army Institute of Surgical Research burn center approximately 4 days postburn. On postburn day 5, the patient underwent tangential excision of his extremity burn wounds and split-thickness skin graft placement. On postburn day 14, the patient was found to have proptosis of his left eye on a routine physical evaluation and underwent a head computed tomography (CT) scan. The CT scan revealed displacement of his left orbit in the inferior lateral direction due to swelling in the orbital fossa. He was rushed to the operating room, where he underwent enucleation of the left eye and debridement of nonviable-appearing tissue in the orbital fossa. Histopathology of the surgical specimen revealed mucormycosis (Fig. 1). Broad-width, aseptate hyphae consistent with Mucorales infection (mucormycosis) were noted on histopathologic examination of tissue from his head and neck multiple times during subsequent serial wound debridements over the course of his hospitalization (days 19, 20, 21, 52, and 85). Multiple cultures were obtained over the course of this management, including mycologic cultures. Most of the fungal cultures were overgrown with bacteria, but they occasionally revealed broad, ribbonlike hyphae on Calcofluor staining. A single culture recovered Saksenaea erythrospora during the course of his hospitalization. The mold was recovered from scalp wound fluid placed into blood culture (aerobic) medium on day 19 postinjury.In addition to radical debridement, flap coverage of the left side of his face was attempted on two separate occasions during the course of his hospitalization. Both of these attempts were unsuccessful. His course was also complicated by recurrent bacterial infections and sepsis, in addition to this inability to control his facial mucormycosis, and 100 days following his initial injury, he expired. At autopsy, invasive fungal infection of the l...

In our prospective study of prehospital LSIs performed in a combat zone, we observed a higher rate of incorrectly performed and missed LSIs in airway and chest (breathing) interventions than hemorrhage control interventions. The most commonly performed LSIs had lower incorrect and missed LSI rates.

The humerus is a suitable alternative site for IO placement, with a potential for higher flow rates than the proximal tibia and distal femur when resuscitating a patient.

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The authors report on a single case of a large, civilian burn cared for at a U.S. military hospital during Operation Iraqi Freedom. The management of the patient, using a large negative pressure wound therapy device and the Meek grafting technique, is reviewed. This is a case report. The patient survived his injury. In Iraq, most patients with this severity of injury succumb to the injury. By using two innovative techniques, the authors found that the patient was able to survive his injury and return to his home.

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