Prompt Eschar Excision

Tompkins, Ronald G.; Burke, John F.; Schoenfeld, David; Bondoc, Conrado C.; Quinby, William C.; Behringer, G C; Ackroyd, Frederick W.

doi:10.1097/00000658-198609000-00006

Cited by 182 publications

(12 citation statements)

References 19 publications

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“…3 Survival from extensive burn injuries today is much higher than seen in the U.S. during the 1960s. 4,5 At that time, it was common for patients with burns > 20% total body surface area (TBSA) to die early from the initial cutaneous burn injury, or later from infections or other complications related to the injury. With advances in surgical and critical care management and higher likelihood of treatment in centers specializing in burn care, survival after serious and life threatening burn injury has improved during the 1970’s and 80’s.…”

Section: Introductionmentioning

confidence: 99%

Benchmarking Outcomes in the Critically Injured Burn Patient

et al. 2014

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Objective To determine and compare outcomes with accepted benchmarks in burn care at six academic burn centers. Background Since the 1960s, U.S. morbidity and mortality rates have declined tremendously for burn patients, likely related to improvements in surgical and critical care treatment. We describe the baseline patient characteristics and well-defined outcomes for major burn injuries. Methods We followed 300 adults and 241 children from 2003–2009 through hospitalization using standard operating procedures developed at study onset. We created an extensive database on patient and injury characteristics, anatomic and physiological derangement, clinical treatment, and outcomes. These data were compared with existing benchmarks in burn care. Results Study patients were critically injured as demonstrated by mean %TBSA (41.2±18.3 for adults and 57.8±18.2 for children) and presence of inhalation injury in 38% of the adults and 54.8% of the children. Mortality in adults was 14.1% for those less than 55 years old and 38.5% for those age ≥55 years. Mortality in patients less than 17 years old was 7.9%. Overall, the multiple organ failure rate was 27%. When controlling for age and %TBSA, presence of inhalation injury was not significant. Conclusions This study provides the current benchmark for major burn patients. Mortality rates, notwithstanding significant % TBSA and presence of inhalation injury, have significantly declined compared to previous benchmarks. Modern day surgical and medically intensive management has markedly improved to the point where we can expect patients less than 55 years old with severe burn injuries and inhalation injury to survive these devastating conditions.

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Section: Introductionmentioning

confidence: 99%

Benchmarking Outcomes in the Critically Injured Burn Patient

et al. 2014

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“…Based on these results, Dr. Burke established an adult burn center at the MGH in July 1974 using this same surgical treatment approach. 3 …”

Section: The Era Of Burn Centers At Mghmentioning

confidence: 99%

“…1). 3 In a logit analysis, 3 1,103 adults in two time periods (1974–1977 and 1978–1984) were compared to identify previously unknown factors determining mortality in addition to the known significant factors of burn size and age (p<0.001). After controlling for burn size and age, the treatment comprising prompt excision and immediate wound closure system was also statistically significant (p<0.001).…”

Section: Burn Mortality In Adults and Children From 1974–1984mentioning

confidence: 99%

“…3 This was an era when the medical specialization of care included dedicated general and surgical critical care surgeons and reconstructive plastic surgeons together with medical colleagues including anesthesiology, pediatrics, infectious disease, psychiatry, and other specialties with knowledge, experience, and interest in burn medicine. The burn care system as exemplified by the Verification Program provides the foundation that has enabled the current acute care environment to ensure such a consistently high rate of survival even from otherwise devastating injuries.…”

Section: Conclusion and The Futurementioning

confidence: 99%

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Survival From Burns in the New Millennium

Tompkins

2015

Annals of Surgery

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Objective This review explores the series of published analyses from Massachusetts General Hospital (MGH) to better understand how changes in medical specialization of burn medicine likely enabled the most important increase in survival from burns in the past 70 years. Background Seventy years ago, survival from the most serious burn injuries was not possible even in the most advanced countries until critical advances were introduced. Insights into those few medical advances that actually impacted survival might be better understood from the consideration of a continuous series of survival analyses over seven decades at MGH. Methods Mortality data from previously reported probit and logit analyses from thousands of patients treated at MGH were reviewed. A comparison of mortality from these prior mortality analyses from a more recent multi-center study and a national dataset was performed. Results The only giant leap forward in survival occurred during the 1970s with no improvement either during the preceding or subsequent 30-year intervals. Despite the many modern advances that have been added to the care of these patients since 1984, although these may have represented medical progress, these advances did not impact survival. Conclusions Survival rates from burn injury may have been maximized by current treatment approaches within medical centers of excellence in burn medicine. Further efforts to improve the burn survivor’s quality of life should ultimately have very favorable impact upon the long-term outcomes in these patients who now survive such devastating injuries.

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“…The early tangential excision followed by autologous split-thickness skin graft has been a gold standard procedure [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Allogeneic cultured dermal substitute composed of spongy collagen containing fibroblasts: evaluation in animal test

Tanaka

Nakakita

Yoshimitsu

1999

Journal of Biomaterials Science, Polymer Edition

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The authors developed a cultured dermal substitute (CDS) composed of a spongy collagen containing cultured fibroblasts. The cultured fibroblasts derived from Sprague Dawley rat skin were seeded on a spongy collagen at a density of 5 x 10(5) cells cm(-2) and cultured for 7 days. This CDS was applied to the debrided wound of full-thickness burn which was inflicted experimentally on the dorsum of Wister rat, and then the wound conditions were observed over a period of 2 weeks. The comparative study was conducted using an acellular spongy collagen as well as a commercially available temporary wound dressing, Biobrane, since a different type of cultured dermal substitute, Dermagraft-TC, is composed of Biobrane, whose inner site is combined with cultured fibroblasts. Each covering material was applied on the debrided wound area and exchanged by new one 1 week later. When the debrided wound was covered with Biobrane, a small portion of necrotic tissue was observed 1 week after application, and the granulation tissue formation was greatly delayed. This wound area showed a poor granulation tissue even 2 weeks later. On the contrary, when covered with an acellular spongy collagen, no necrotic tissue was observed. This wound area showed a more or less irregular granulation tissue at 1 week and then a healthy granulation tissue 2 weeks later. This preliminary comparative study suggests that an acellular spongy collagen is able to function as a more suitable matrix for CDS, compared with Biobrane. The wound area covered with a CDS assumed a moist, shiny, and hyperaemic appearance 1 week after application showing a healthy granulation tissue. The macroscopic evaluations indicate that the CDS is able to prepare a healthy granulation tissue at an earlier stage, compared with the acellular spongy collagen. In addition, the histologic views demonstrate that the CDS is able to prepare a thicker and denser granulation tissue, compared with the acellular spongy collagen. Although the fate of cultured fibroblasts in the CDS on the wound surface within 1 week is not clear, these findings suggest that fibroblasts in CDS are able to provide excellent conditions for wound healing.

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Prompt Eschar Excision

Cited by 182 publications

References 19 publications

Benchmarking Outcomes in the Critically Injured Burn Patient

Benchmarking Outcomes in the Critically Injured Burn Patient

Survival From Burns in the New Millennium

Allogeneic cultured dermal substitute composed of spongy collagen containing fibroblasts: evaluation in animal test

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