烧伤创面多自由度精密激光切痂系统

针对复杂空间创面法向自动聚焦和切痂的关键技术问题,提出了一套由5自由度运动平台和2自由度激光光路控制机构组成的激光切痂控制系统.对激光切痂并联机构进行运动学逆解分析,推导了运动平台和激光光路控制机构的位置对应关系.结合所推导的位置对应关系和复杂创面轮廓三维扫描结果,该系统可实现激光轨迹的自动规划,从而完成激光自动切痂.基于所提出的激光切痂系统,进行了激光切痂实验研究,实验测试结果表明:该激光切痂系统能很好完成人体手部区域的三维轮廓扫描与重建,并自动规划激光焦点光斑运动轨迹并切痂.     

Improved accuracy of burn wound assessment using laser Doppler

The utility of the laser Doppler for determining burn depth has been questioned because of problems with technology and methodology. This study prospectively evaluates the ability of a new laser Doppler technique to predict burn healing time. Using the Periflux System 4000 laser Doppler, readings were taken on 305 burns (147 patients) on postburn day 3 or 4. Sixty-six wounds were used to derive a predictive function (phase I) and 152 wounds were used to test the function (phase II). Blood flow dynamics (flux), microvascular dilation capacity of the wounds to beat stress, and flow motion wave pattern (vasomotion) were studied using the laser Doppler, and seven parameters were evaluated to determine their relative contribution to the prediction of healing time. These parameters are hyperemic flux (flux value after heating to 42 degrees C), average hyperemic wave amplitude (AHWA), number of average flux units >100(F100), number readings with wave amplitude 75 (A5), average flux change (AFC), percentage of average flux increase, and relative flow capacity (RFC = AFC/average hyperemic flux). After readings were made, the wounds were observed and divided into two groups: those that healed in less than 14 days and those that healed or were grafted after 14 days. A step-wise discriminant analysis was used to assess the relative contribution of the Doppler-derived measures to healing time prediction. AHWA, F100, and RFC were included in the final discriminant function explaining 72% of the healing time variance (Wilks' lambda value 0.28; p value <0.0001). Predicted outcome = 0.05(AHWA) + 0.31(F100) + 5.0(RFC) - 2.3. With this derived function, there is 94% accuracy in the prediction of burn wound healing time compared with a physician predictive accuracy of 70%.     

Modified use of extremity tourniquets for burn wound debridement

A modified technique of tourniquet use for sequential burn wound debridement is described. With partial exsanguination of the extremity, intermittent release and rapid reinflation of the tourniquet will allow the surgeon to assess the adequacy of debridement and to decrease reactive hyperemia and blood loss during the excision. This controlled method to decrease blood loss in the upper extremities during debridement, in combination with epinephrine soaks and compressive wraps, can be mastered so that transfusion is not necessary during excisions of less than 12% total body surface area. Visible hemostasis is assessed with this method before final application of skin grafts to optimize skin graft revascularization and minimize wound hematomas.     

A randomized controlled trial of hypnosis for burn wound care.

Purpose/Objective: There have been few randomized controlled studies on the effectiveness of clinical hypnotic analgesia. The authors' goal was to improve on previous methodologies and gain a better understanding of the effects of hypnosis on different components of pain in a clinical setting. Research Method/Design: This study used a randomized controlled design in which the nurses and data collectors were unaware of treatment condition to compare hypnotic analgesia with an attention-only placebo for burn pain during wound debridements. Data were analyzed on a total of 46 adult participants. Results: The authors found that the group receiving hypnosis had a significant drop in pain compared with the control group when measured by the McGill Pain Questionnaire but not when measured by other pain rating scales. Conclusion: The McGill Pain Questionnaire total score reflects multiple pain components, such as its affective component and various qualitative components, and is not merely a measure of pain intensity. Thus, the findings suggest that hypnosis affects multiple pain domains and that measures that assess these multiple domains may be more sensitive to the effects of hypnotic analgesia treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Infusion of hot crystalloid during operative burn wound debridement

BACKGROUND: Hypothermia exacerbates coagulopathy and is thus a potentially devastating morbidity during operative debridement of burn wounds. Current techniques for maintaining body temperature include warming intravenous fluids at 38 degrees C. The purpose of this study was to assess the safety of infusing saline heated to 55-60 degrees C. METHODS: Using a modified fluid warmer, saline heated to 60 degrees C was infused through central venous access in eight adult patients undergoing debridement of burn wounds. The temperature of the saline actually entering the patient was measured by a thermocouple attached at the connection to the central line catheter. RESULTS: The actual infusate temperature was 54.0 +/- 1.2 degrees C. Over the first hour, 1,100 mL of hot saline was given, thus delivering 17.6 kcal more heat than fluid warmed to the traditional 38 degrees C. Core temperature measured via esophageal and Foley catheters had an insignificant trend toward increase during the operative procedure. There was no evidence of intravascular hemolysis or coagulopathy. CONCLUSION: This pilot study suggests that infusion of hot crystalloids given via central venous access is safe and may be an acceptable adjuvant in attenuating hypothermia during operative procedures.     

Report on evaluation of hydron film as burn wound dressing

Hydron Burn Dressing, an amalgam of Polyethylene Glycol-400, and Polyhydroxyethyl methacrylate formed directly on the burn wound has been used in 50 cases with comparable control areas on the same patients which were managed by Polybactrin spray and exposure. The 4-layer film was found to be easily applicable in indoor patients and was pain-free during application and reduced pain after application in superficial burns. It was found to be translucent, pliable, less liable to crack and did not peel off once dried. The rate of infection was found to be 12.5 per cent more than the controls but the healing time was shorter by 2.8 days. Patient's comfort and compliance was better than the scab of the control areas.     

Pulsed dye laser treatment of hypertrophic burn scars

Hypertrophic burn scars are notoriously difficult to treat because of their extensive tissue involvement and tendency to worsen with hypertrophy and contracture formation. Various therapies have been advocated in the past, including surgical excision and grafting, dermabrasion, and corticosteroids, with distinct cosmetic limitations. The 585-nm pulsed dye laser has been shown previously to be effective in the treatment of a variety of traumatic and surgical scars with improvement in scar texture, color, and pliability with minimal side effects. Sixteen patients with 40 hypertrophic burn scars resulting from chemical peels, carbon dioxide laser procedures, and accidental thermal injury were treated with a 585-nm pulsed dye laser. Sequential photographic and clinical assessments were recorded in all patients. Histologic evaluations of skin punch biopsies before and after laser irradiation were performed when possible. Symptomatic improvement of scars was reported after one treatment. Decreased scar erythema with improved texture and pliability was observed after an average of 2.5 treatments. No correlation was found between scar duration, location, or etiology and response to treatment. Normal number of dermal fibroblasts with decreased sclerosis was observed on histologic examination of laser-irradiated scars. The 585-nm pulsed dye laser irradiation of hypertrophic burn scars can effectively improve scar pliability and texture and decrease erythema and associated symptoms yielding cosmetically and functionally acceptable clinical results.     

Carbon dioxide laser serial microtrapdoor flap excision of subglottic stenosis

The recent development of microspot micromanipulators for the carbon dioxide laser with 250-microns spot sizes has greatly facilitated the extension of endolaryngeal procedures to children and neonates. It is possible to accurately develop microtrapdoor flaps within the limited exposures in the pediatric subglottis. We have used serial microtrapdoor flaps in the excision of subglottic scar tissue in eight children. In five children, the stenosis was improved with relief of stridor. In three children, the flaps were used as an adjunct to laryngotracheoplasty. The surgical techniques of this procedure are detailed in this report.     

Use of the scalp as a donor site for large burn wound coverage: review of 150 patients

The characteristics of rapid wound healing and multiple harvest capacity make the scalp an important donor site when dealing with large and deep burn wounds. This paper reports the results of a retrospective analysis of 150 patients treated for large burn wounds. The findings indicated that bleeding during graft skin harvest could be limited to 50 ml by intradermal injection of epinephrine (1:2,000,000), high-concentration epinephrine-soaked gauze compression (1:20,000), and temporary porcine skin coverage. Use of a scalp graft also carried a low risk of complications, with only four (2.7%) major complications including three cases (2.0%) of visible alopecia and one case (0.7%) of hair transplantation. There were no hypertrophic scars, even in the patient who had the largest number (11) of repeat harvests.     

Combination carbon dioxide laser vermilionectomy and wedge excision of the lip

Dermatologic surgeons are very familiar with the use of the carbon dioxide (CO2) laser for treating actinic cheilitis. When squamous cell carcinoma is proven or suspected in the affected lip, then combined CO2 laser vermilionectomy and wedge excision as a one stage procedure has significant advantages for the patient.