Basic Problems in Burns

This publication comprises the reports presented at the Symposium on the Treatmenr­ of Burns, held in Prague on September 13-15, 1973 by the Czech Society of Plastic Surgeons under the auspices of the ISBI on the occasion of the 20th anniversary of the foundation of the Prague Burns Unit. The program of the symposium was confined to four topics which under the present state of burn treatment represent the basic range of clinical problems. They are: surgery of the burn wound, anaesthesiology and resuscitation, septicaemia and complications of the burn illness. Most of the reports presented at the Symposium are printed in this book in full, as they were submitted by the authors. Only in some cases were the editors obliged to make minor formal adjustments in the interest of the earliest possible publication of the book. We hope that, after careful study, this publication will arouse the interest of further specialists in such an intricate field as is the treatment of burns and that it will stimulate all those concerned to further work. We should like to thank all those who facilitated the publication of this book by their­ participation in the Symposium and by their co-operation. The Editors Welcoming Address of the President of the Symposium On behalf of the organizing committee I would like to welcome all participants in this symposium.

Surgery of the Burn Wound.- The tactics of necrectomy and grafting at the Prague Burns Centre.- Excision of acute burns with immediate meshed autografting.- Early excision of third-degree burned skin areas under bioptical control.- Survival of severely burned patients with intermediate duration skin transplantation and immunosuppression.- Epigard ― a new synthetic wound dressing: Comparative clinical studies with porcine xenograft.- Temporary skin cover.- Trial of Epigard in the burned patient.- Synkryt (Syncover) ― synthetic graft.- The use of xenografts as temporary coverage on mesh grafts in extensive burns.- Changes in evaporative water loss and hypermetabolism in burned patients after application of xenografts.- Primary excision of full thickness burns up to 40 P.C. of body surface followed immediately by micro- or meshgrafts.- Clinical experience with chorion-amnion grafts used as biological dressing.- Enzymatic debridement of burn necrosis.- Experience from five-year use of early surgery in deep burns.- New modification of the Mowlem-Jackson method.- Collagen foam as a biological burn dressing.- Anesthesiology, Resuscitation and Intensive Care.- Principles of burn resuscitation.- Anaesthesia for early excision of extensive full-thickness burns.- Anaesthesia and resuscitation in burned children.- Analgesia in the treatment of burns.- Ketalar in premedication of children.- General anaesthesia in experimental burn shock in piglets.- Infusion therapy of burns with dextran and Ringer lactate 2 1/2 years’ results of a controlled trial.- Oral ingestion of an electrolyte solution as shock prophylaxis in burn patients.- Modified gelatine and polyvinylpyrrolidone for volume replacement in extensive burns ― a comparative study.- Recommandation for a clinical concept based on experimental data for initial treatment of the burn shock.- Therapeutic role of escharectomies in the period of burn shock.- Hyperbaric oxygen therapy in third degree burn wounds ― a microangiographic study.- The value of hyper-pressure ― oxygen in the treatment of burn disease.- Enteral tube feeding in burned children in the shock and toxicoinfection phase.- Criteria, principles and results of the treatment of burn disease.- Septicaemia.- Contemporary problems of infection in burns.- Contamination of burn wound in Prague Burns Center in 1969–1972.- Bacteriological examination of burn wounds by means of semiquantitative method.- Maximum tolerated doses of gentamicin and the sulfamethoxazoltrimethoprim-gentamicin combination in the therapy of severe infections in burned patients.- Frequency of septicaemia.- Phagocytic properties of leukocytes in burns.- Immunotherapy in burns.- The role of the reticuloendothelial system in burn infection.- A study on the appearance of auto-immune phenomena in burn patients and its clinical relevance.- Complement and acute burn trauma.- The epidemiology of burn wound sepsis in an intensive care unit.- Patterns of burn wound sepsis during the past 30 years.- Tables aiding differential diagnosis of burn sepsis.- Therapy of burns in children.- Warm air treatment of burns in the sterair unit.- Detection of endotoxin in human plasma using Limulus test.- Complications of the Burn Illness.- The sick cell syndrome in burns.- Acute functional and morphological alterations after scalding with special regard to the lung: an experimental study.- Respiratory complications in the early post burn period.- Renal disease in severe burns.- Immunoreactive insulin, somatotropin, renin, angiotensin II, ACTH and LH levels in severely burned patients.- Contemporary changes in the clinical presentation of the burn disease.- Production of the endogenous erythropoietin in burned rats and its influence by anaemisation and testosterone.- Icterus in burn illness.- Clinical picture of liver damage in burn illness.- Morphological findings in hepatic tissue of burned patients.- Treatment of respiratory insufficiency in burned patients.- The influence of burns on jaw and denture development.- Psychopathologic phenomena and their treatment in burns.- Author Index.