F Bailie’s research while affiliated with Lancashire Teaching Hospitals NHS Foundation Trust and other places

Postburn scarring and contracture affecting function remain the most frustrating late complications of burn injury. Various techniques are used to release contractures; the choice depends on their location and/or the availability of unaffected skin adjacent to the contracture or elsewhere. A retrospective review was carried out of the case notes of patients who had skin grafting for the release of postburn contracture at the Burns Unit, City Hospital, Nottingham between May of 1984 and August of 1994 to evaluate the experience over this period. Information was obtained about the burn injury, contracture site, interval between burn and release of contracture, indication, age at first release, intervals between releases, operative details (donor and graft sites), complications and nonoperative treatment, and follow-up to the end of the study period. A total of 129 patients underwent skin grafting for release of contractures as opposed to any other method of correction. Full-thickness skin grafts were used in 81 patients (63 percent) and split-thickness skin grafts in 26 (20 percent). Twenty-two patients (17 percent) had both types used on different occasions. Flame burns (41 percent) were the most common causes, followed by scalds (38 percent). Two hundred thirty-nine sites of contracture were released, with the axilla (59) and the hand/wrist (59) being the most common sites involved, followed by the head/neck region (42). It was found that for the same site, release with split-thickness skin grafts was associated with more rereleases of the contracture than with full-thickness skin grafts. Also, the interval between the initial release and first rerelease was shorter than with full-thickness skin grafts (p < 0.048). It was also noted that children required more procedures during growth spurts, reflecting the differential effect of the growth of normal skin and contracture tissue. Patients reported more satisfaction with texture and color match with the full-thickness skin grafts. There was comparable donor-site and graft morbidity with both graft types. The use of skin grafts is simple, reliable, and safe. Whenever possible, the authors recommend the use of full-thickness skin grafts in preference to split-thickness skin grafts in postburn contracture release.

Fluid therapy by the oral route is the accepted method of treatment for smaller burns in children (less than 10%). [Settle JAD. Burns - the first five days. Essex: Smith and Nephew Pharmaceuticals Ltd, 1986.] A phone survey was carried out of all the hospitals in the United Kingdom that manage burns, to record their oral fluid therapy practices for burns (5-10% BSA) in paediatric patients. Included in the survey was an assessment of the uniformity of the contents of the fluids, their palatability and acceptance by patients and any side-effects from this form of treatment. There appears to be no uniformity in policies regarding fluid therapy in children with this percentage of burns. Treatment ranged from a formula guided resuscitation therapy (as practised generally with large burns) to a 'drink as you like' policy. Fluids used varied from electrolyte to non-electrolyte containing solutions and fruit juices and were, therefore, markedly different in content. The electrolyte solutions were reported as being non-palatable unless flavoured with fruit juices. No complication was reported although one unit queried a possible case of fluid overload. Potential complications from this mode of therapy are discussed. The cost implications of using various fluid types are also presented.