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Ji S, Xiao S, Xia Z. Consensus on the treatment of second-degree burn wounds (2024 edition). BURNS & TRAUMA 2024; 12:tkad061. [PMID: 38343901 PMCID: PMC10858447 DOI: 10.1093/burnst/tkad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/29/2023] [Accepted: 12/08/2023] [Indexed: 02/21/2024]
Abstract
Second-degree burns are the most common type of burn in clinical practice and hard to manage. Their treatment requires not only a consideration of the different outcomes that may arise from the dressing changes or surgical therapies themselves but also an evaluation of factors such as the burn site, patient age and burn area. Meanwhile, special attention should be given to the fact that there is no unified standard or specification for the diagnosis, classification, surgical procedure, and infection diagnosis and grading of second-degree burn wounds. This not only poses great challenges to the formulation of clinical treatment plans but also significantly affects the consistency of clinical studies. Moreover, currently, there are relatively few guidelines or expert consensus for the management of second-degree burn wounds, and no comprehensive and systematic guidelines or specifications for the treatment of second-degree burns have been formed. Therefore, we developed the Consensus on the Treatment of Second-Degree Burn Wounds (2024 edition), based on evidence-based medicine and expert opinion. This consensus provides specific recommendations on prehospital first aid, nonsurgical treatment, surgical treatment and infection treatment for second-degree burns. The current consensus generated a total of 58 recommendations, aiming to form a standardized clinical treatment plan.
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Affiliation(s)
- Shizhao Ji
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
| | - Shichu Xiao
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
| | - Zhaofan Xia
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
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Sharma D, Jain S, Mishra AK, Sharma R, Tanwar A. Medicinal Herbs from Phyto-informatics: An aid for Skin Burn Management. Curr Pharm Biotechnol 2022; 23:1436-1448. [PMID: 35272596 DOI: 10.2174/1389201023666220310141308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/13/2021] [Accepted: 01/03/2022] [Indexed: 01/08/2023]
Abstract
Skin burn injury is the most common cause of trauma that is still considered a dreadful condition in healthcare emergencies around the globe. Due to the availability of a variety of regimes, their management remains a dynamical challenge for the entire medical and paramedical community. Indeed, skin burn injuries are accompanied by a series of several devastating events that lead to sepsis and multiple organ dysfunction syndromes. Hence the challenge lies in to develop better understanding as well as clear diagnostic criteria and predictive biomarkers which are important in their management. Though there are several regimes available in the market, there are still numerous limitations and challenges in the management. In this review article, we have discussed the various biomarkers that could be targeted for managing skin burn injuries. Instead of focusing on allopathic medication which has its adverse events per se, we have discussed the history, ethnopharmacology properties, and prospects of identified phytomedicines from a well-established herbal informatics model. This review article not only discusses the benefits of scrutinized phytocompounds but also leads to develop novel druggable Phyto-compounds to target skin burn injury at lower cost with no adverse effects.
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Affiliation(s)
- Deepti Sharma
- Division of CBRN Defence, Institute of Nuclear Medicine and Allied Sciences, Delhi 110054, India
| | - Sapna Jain
- Vaccine and Infectious Disease Research Center, Translational Health Science and Technology Institute, Haryana,121001, India
| | - Amit Kumar Mishra
- Faculty of Life Science and Biotechnology, South Asian University, New Delhi 110021, India
| | - Ruby Sharma
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, New York, NY, 10461, USA
| | - Ankit Tanwar
- Department of Cell Biology, Albert Einstein College of Medicine, New York, NY, 10461, USA
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Ayaz M, Karami MY, Deilami I, Moradzadeh Z. Effects of Early Versus Delayed Excision and Grafting on Restoring the Functionality of Deep Burn-Injured Hands: A Double-Blind, Randomized Parallel Clinical Trial. J Burn Care Res 2019; 40:451-456. [DOI: 10.1093/jbcr/irz033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Mehdi Ayaz
- Division of Burn and Reconstructive Surgery, Department of Surgery, Shiraz, Iran
| | | | - Iman Deilami
- Division of Burn and Reconstructive Surgery, Department of Surgery, Shiraz, Iran
| | - Zahra Moradzadeh
- Physiotherapy and Rehabilitation Department, Shiraz University of Medical Sciences, Shiraz, Iran
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Bache SE, Fitzgerald O’Connor E, Drake PJ, Philp B, Dziewulski P. Development and validation of the Burnt Hand Outcome Tool (BHOT): A patient-led questionnaire for adults with hand burns. Burns 2018; 44:2087-2098. [DOI: 10.1016/j.burns.2018.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 06/11/2018] [Accepted: 07/26/2018] [Indexed: 01/08/2023]
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Zikaj G, Xhepa G, Belba G, Kola N, Isaraj S. Electrical Burns and Their Treatment in a Tertiary Hospital in Albania. Open Access Maced J Med Sci 2018; 6:835-838. [PMID: 29875855 PMCID: PMC5979827 DOI: 10.3889/oamjms.2018.206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/13/2018] [Accepted: 04/14/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION: The electrical current burns represent a very aggressive pathology that leaves many functional and aesthetic consequences. AIM: To evaluate the epidemiology of electrical burn injury and its associated complications and treatment. MATERIAL AND METHODS: Demographic data, aetiology, burn percentage and other measures related to electrical burn injury of 33 electrical burn patients in a tertiary hospital during the years 2015-2017. RESULTS: The mean age of patients is 31 (± 8.3) years old with a predominance of males (94%). The vast majority of injuries occurred at work (p < 0.01), superior extremities were more affected with hand (21.2%) and fingers (18.2%) being the main point of contact (p < 0.01). Muscular fasciotomy was performed in all patients who were treated surgically (n = 27), amputation was performed in 11 (40.7%) of cases, but amputated sites were more than the number of patients affected. Myoglobinuria (39.4%), cardio-respiratory distress (12.1%) contusion cerebri (6.1%), were the complication encountered in patients. CONCLUSIONS: Electrical burn injuries are still amongst the highest accident-related morbidities. Educating the population about the dangers and hazards associated with improper use of electrical devices and instruments is imperative.
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Affiliation(s)
- Gentian Zikaj
- Institute of Public Health - Epidemiology and Biostatistics, 80 Aleksander Moisiu Str, Tirana, Albania
| | - Gezim Xhepa
- Department of Morphology, Clinic of Plastic and Burn Surgery, University Hospital Center "Mother Teresa", Faculty of Medicine, Tirana, Albania
| | - Gjergji Belba
- General Surgery, University Hospital Center "Mother Teresa", Tirana, Albania
| | - Nardi Kola
- Service of Burns and Plastic Surgery, UHC Mother Tereza, Rruga e Dibres Nr 370, Tirana, Albania
| | - Sokol Isaraj
- Service of Burns and Plastic Surgery, UHC Mother Tereza, Rruga e Dibres Nr 370, Tirana, Albania
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Abstract
The hand is commonly affected in burn injuries. Joints and extensor tendons are vulnerable given their superficial location. Durable coverage that permits relative frictionless tendon gliding and minimizes scar contracture is required to optimize functional outcomes. When soft tissue donor sites are limited, the use of dermal skin substitutes provides stable coverage with minimal scarring, good mobility, and acceptable appearance. A comprehensive review of dermal skin substitutes and their use with burn reconstruction of the hand is provided.
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Affiliation(s)
- Ian C Sando
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340, USA
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340, USA.
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Bache SE, Fitzgerald O’Connor E, Theodorakopoulou E, Frew Q, Philp B, Dziewulski P. The Hand Burn Severity (HABS) score: A simple tool for stratifying severity of hand burns. Burns 2017; 43:93-99. [DOI: 10.1016/j.burns.2016.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/24/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
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Abstract
Chemical Burns make up 3% of burns center admissions and have a mortality rate that varies from 4.1 to 13%. There are over 25,000 products capable of causing chemical burns. These injuries may cause significant tissue necrosis and have the potential for systemic toxicity. This article gives an overview of the various types of chemical burns along with their management. Chemical warfare agents and extravasation injuries will also be briefly discussed.
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Affiliation(s)
- R. Seth
- St Thomas' Hospital, Guys and St Thomas' Hospital,
| | - D. Chester
- University Hospital Birmingham NHS Foundation Trust
| | - N. Moiemen
- University Hospital Birmingham NHS Foundation Trust
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Nascimento R, Horta R, Silva Á. "Pierced finger ring": A rare case of a neglected burned hand. Burns 2016; 42:e39-41. [PMID: 27167052 DOI: 10.1016/j.burns.2016.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/10/2016] [Indexed: 11/29/2022]
Abstract
Neglected hand burns are common in developing countries but rare in developed countries due to easier access to healthcare. They can lead to severe deformities compromising hand function. The authors present an extreme case of a neglected chemical burn of the hand. The purpose of this article was to alert healthcare professionals and also the mass media to the need for burn care education of the general population.
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Affiliation(s)
- Ricardo Nascimento
- Department of Plastic, Reconstructive and Aesthetic Surgery and Burn Unit, Centro Hospitalar de São João, Porto University Medical School, Porto, Portugal.
| | - Ricardo Horta
- Department of Plastic, Reconstructive and Aesthetic Surgery and Burn Unit, Centro Hospitalar de São João, Porto University Medical School, Porto, Portugal
| | - Álvaro Silva
- Department of Plastic, Reconstructive and Aesthetic Surgery and Burn Unit, Centro Hospitalar de São João, Porto, Portugal
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Gupta RK, Jindal N, Kamboj K. Neglected post burns contracture of hand in children: Analysis of contributory socio-cultural factors and the impact of neglect on outcome. J Clin Orthop Trauma 2014; 5:215-20. [PMID: 25983501 PMCID: PMC4263997 DOI: 10.1016/j.jcot.2014.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/28/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND No study has ever evaluated the causes and effect of neglect on the outcome of post burns contractures of hand in children. METHODS 66 hands in 61 children (mean age 12.22 years) with a mean neglect of 11.6 years (range 5-17 years) were assessed for the causes of neglect and the outcome of surgery. Average follow up was 6.6 years. The results were assessed in two groups of 5-10 years neglect as group I and >10 years neglect as group II. RESULTS In a total number of 134 contracted rays in 66 hands, the surgical procedures included local Z/V-Y flap (51 rays), cross finger flap (48 rays), full thickness graft (35 rays). Additional external fixator with a distracter was used in 3 patients treated at a delay of 14, 16 and 17 years. 50 (81.96%) patients belonged to rural and slum areas. The reasons for delayed treatment included poverty - 33 patients, lack of awareness of surgical treatment - 16 patients; and indifference of parents - 12 patients. 44 (72.13%) children were illiterates. With treatment the average DASH score improved from 65.10 to 36.90 (p < .000) and from 68.14 to 45.93 (p < .000) in group I and II respectively. The results were significantly superior in group I (p < .000). CONCLUSION The main factors for neglect in treatment of post burns contracture include poverty, lack of awareness and illiteracy. All the patients showed significant improvement in function after the surgery. Contractures with higher neglect had significantly inferior outcome.
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Affiliation(s)
- Ravi Kumar Gupta
- Professor, Department of Orthopaedics, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Nipun Jindal
- Senior Resident, Department of Orthopaedics, Government Medical College and Hospital, Sector 32, Chandigarh, India,Corresponding author. Tel.: +91 9780042438.
| | - Kulbhushan Kamboj
- Senior Resident, Department of Orthopaedics, Government Medical College and Hospital, Sector 32, Chandigarh, India
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Conti E. Les brûlures de la main chez l’enfant. ACTA ACUST UNITED AC 2013; 32 Suppl 1:S63-71. [DOI: 10.1016/j.main.2013.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 05/29/2013] [Accepted: 05/29/2013] [Indexed: 11/25/2022]
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Algorithm for Primary Full-thickness Skin Grafting in Pediatric Hand Burns. Arch Plast Surg 2012; 39:483-8. [PMID: 23094243 PMCID: PMC3474405 DOI: 10.5999/aps.2012.39.5.483] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 07/04/2012] [Accepted: 07/20/2012] [Indexed: 11/08/2022] Open
Abstract
Background Pediatric hand burns are a difficult problem because they lead to serious hand deformities with functional impairment due to rapid growth during childhood. Therefore, adequate management is required beginning in the acute stage. Our study aims to establish surgical guidelines for a primary full-thickness skin graft (FTSG) in pediatric hand burns, based on long-term observation periods and existing studies. Methods From January 2000 to May 2011, 210 patients underwent primary FTSG. We retrospectively studied the clinical course and treatment outcomes based on the patients' medical records. The patients' demographics, age, sex, injury site of the fingers, presence of web space involvement, the incidence of postoperative late deformities, and the duration of revision were critically analyzed. Results The mean age of the patients was 24.4 months (range, 8 to 94 months), consisting of 141 males and 69 females. The overall observation period was 6.9 years (range, 1 to 11 years) on average. At the time of the burn, 56 cases were to a single finger, 73 to two fingers, 45 to three fingers, and 22 to more than three. Among these cases, 70 were burns that included a web space (33.3%). During the observation, 25 cases underwent corrective operations with an average period of 40.6 months. Conclusions In the volar area, primary full-thickness skin grafting can be a good indication for an isolated injured finger, excluding the web spaces, and injuries of less than three fingers including the web spaces. Also, in the dorsal area, full-thickness skin grafting can be a good indication. However, if the donor site is insufficient and the wound is large, split-thickness skin grafting can be considered.
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Danin A, Georgesco G, Touze AL, Penaud A, Quignon R, Zakine G. Assessment of burned hands reconstructed with Integra(®) by ultrasonography and elastometry. Burns 2012; 38:998-1004. [PMID: 22694874 DOI: 10.1016/j.burns.2012.02.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 02/17/2012] [Accepted: 02/18/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Hand injuries have major psychological, social and professional repercussions. Treatment of burned hands is suggested to be early and optimal to avoid catastrophic consequences and allow social and professional rehabilitation. Our study analyses the long-term results obtained with Integra(®), a dermal substitute used for the treatment of deep burns of the hands. PATIENTS AND METHODS A total of 29 hands were treated with Integra(®). Long-term monitoring was performed on 12 hands with a clinical, ultrasonographic and elastometric study. The results were compared with those from a series of healthy hands. This study, with a low number of subjects, is a pilot report. RESULTS This study showed a low complication rate, with a high percentage of engraftment of thin skin, and good cosmetic and functional quality. The thickness and viscoelasticity of the skin treated with Integra(®) in our series appeared to be similar to those of healthy skin. CONCLUSION Integra(®) artificial skin is an attractive alternative in the treatment of deep burns of the hand and can achieve results with aesthetic and functional characteristics that are close to those of healthy skin.
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Ong A, Orozco F, Sheikh ES, Anmuth C, Alfaro A, Kathrins R, Grove GL, Zerweck C, Madden AM, Raspa R, Weis MT. An RCT on the effects of topical CGP on surgical wound appearance and residual scarring in bilateral total-knee arthroplasty patients. J Wound Care 2012; 20:592-8. [PMID: 22240886 DOI: 10.12968/jowc.2011.20.12.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To test the hypothesis that topically applied calcium glycerophosphate (CGP) would improve the appearance of the wound following bilateral knee replacement. METHOD Healthy patients, aged 45-75 years, scheduled for bilateral total-knee replacement surgery were recruited into the study. One knee was randomly assigned to the treatment group, while the contralateral knee was designated the control (standard care). Subjects were instructed to apply a preparation of 10% CGP in an aqueous lotion to the treated knee once daily for 42 days, starting at the third postoperative day. Functional sealing and cosmetic appearance of the incision were evaluated by two surgeons by direct examination of the patient and then by two experienced assessors from photographs. The investigators qualitatively scored the intensity and extent of erythema along the incision and over the entire knee, the appearance of visible oedema along the incision and over the knee, and the overall clinical impression of wound healing. All four assessors were blinded to the subjects' allocation and the latter two assessors to the initial investigators' assessments. Subjects were also followed up for an additional 46 weeks, giving a total study duration of 12 months. RESULTS Twenty patients completed the study. Statistical analysis showed that both the area and intensity of erythema along the incision were significantly reduced in the treated vs untreated knee over the entire study period. The analysis further showed that treatment significantly reduced oedema, both along the incision and across the entire knee. The differences were most marked at the seventh postoperative day and diminished with time. No adverse effects were observed for any patient, in either treated or untreated knees. CONCLUSION These data demonstrate that postoperative application of 10% CGP could improve the appearance of the wound following total knee arthroplasty.
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Affiliation(s)
- A Ong
- Rothman Institute, Philadelphia, USA
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Local and systemic treatments for acute edema after burn injury: a systematic review of the literature. J Burn Care Res 2011; 32:334-47. [PMID: 21252688 DOI: 10.1097/bcr.0b013e31820ab019] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Burn injury is a complex trauma that results in local and generalized edema. Edema fluid limits the exchange of vital nutrients in healing the burn wound and will compromise vulnerable tissues. Although the importance of edema control in tissue salvage is recognized, treatments targeted at edema control have not been critically reviewed. Thus, the objective was to assess the evidence for the effectiveness of local and systemic treatments for edema management immediately after burn injury. Searches for randomized controlled trials were conducted of online databases, research and thesis registers, and grey literature repositories. Handsearches included journals, bibliographies, and proceedings. Authors were contacted to clarify and submit extra study details. Eight studies were included. Management of acute major burn resuscitation including colloid increases lung edema (mean difference [MD], 0.04 ml/ml alv vol; 95% confidence interval [CI], 0.03-0.04; P < .00001) and mortality (risk ratio, 3.67; 95% CI, 1.16-11.58; P = .03). Continuous administration of vitamin C in acute burn resuscitation reduces local wound edema (MD, -3.50 ml/g; 95% CI, -4.63 to -2.37; P < .00001) and systemic fluid retention (MD, -8.60 kg; 95% CI, -13.47 to -3.73; P = .0005). Local acute hand burn edema is reduced (MD, -29.00 ml; 95% CI, -53.14 to -4.86; P = .02), and active hand motion increased (MD, 10.00°; 95% CI, 4.58-15.42; P = .0003), using electrical stimulation with usual physiotherapy. Each review outcome was based on a small single-facility study. Thus, future research in intervention for acute burn edema must focus on multicentre trials and validation of outcome measures in the burn population.
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Evaluation of hand function after early excision and skin grafting of burns versus delayed skin grafting: A randomized clinical trial. Burns 2011; 37:707-13. [DOI: 10.1016/j.burns.2010.12.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 11/11/2010] [Accepted: 12/11/2010] [Indexed: 11/23/2022]
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The Vacuum-Assisted Closure (VAC) Device for Hastened Attachment of a Superficial Inferior-Epigastric Flap to Third-Degree Burns on Hand and Fingers. J Burn Care Res 2009; 30:362-5. [DOI: 10.1097/bcr.0b013e318198a77e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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van Zuijlen PPM, Vloemans AFPM, Tempelman FRH, Kreis RW. The timing of surgery for deep burns of the hands: Early versus delayed surgery. Burns 2007; 33:807. [PMID: 17624676 DOI: 10.1016/j.burns.2007.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2007] [Accepted: 02/05/2007] [Indexed: 11/24/2022]
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