Safety evaluation of silver-ion dressings in a porcine model of deep dermal wounds: A GLP study.

Introduction: Silver ion has strong antimicrobial properties and is used in a number of wound dressings. In burn models, silver-nylon dressings produce elevated silver levels in the wound along with minimal systemic effect. We evaluated systemic toxicity in a non-burn wound model to see if a similar pattern of silver ion distribution would occur.

Debridement of Sulfur Mustard Skin Burns: A Comparison of Three Methods.

Sulfur mustard burns are characterized by delayed symptoms, slow healing, and recurrence after closure. Incomplete debridement at the level of the basement membrane is the postulated cause. Graham pioneered laser debridement of mustard burns.

Blood and Tissue Silver Levels Following Application of Silver-Based Dressings to Sulfur Mustard Chemical Burns.

Silver-based dressings are commonly used in burn care. Silver sulfadiazine use is associated with elevated blood, urine, and tissue levels of silver ion. We examined wound and tissue levels of silver ion in a two-species model of sulfur mustard chemical burn injury treated with two different silver-based dressings.

The antimicrobial spectrum of Xeroform.

Introduction/background: Xeroform is a petrolatum-based fine mesh gauze containing 3% bismuth tribromophenate. Bismuth, similar to other metals, has antimicrobial properties. Xeroform has been used for decades in burn and plastic surgery as a donor site dressing and as a covering for wounds or partial thickness burns.

Silver in medicine: the basic science.

Silver compounds are increasingly used in medical applications and consumer products. Confusion exists over the benefits and hazards associated with silver compounds. In this article, the biochemistry and physiology of silver are reviewed with emphasis on the use of silver for wound care.

Silver in medicine: a brief history BC 335 to present.

Silver is a naturally occurring element. Similar to other metals, the ionized form of silver (Ag(+1)) has known antimicrobial properties. A number of wound dressings incorporating silver ion or silver compounds have recently been developed and marketed.

A literature review of the military uses of silver-nylon dressings with emphasis on wartime operations.

Medical support of military operations involves treatment of massive soft tissue wounds, thermal burns, open fractures, blast injuries and traumatic amputations under conditions that are often austere and far from supply lines. Military hospitals, as recently deployed in Iraq and Afghanistan, are designed and equipped for stabilization and rapid transfer of injured patients back to their home nation. These austere facilities are often tasked with the emergency or long-term treatment of local populations when injured or burned, further stressing the medical resupply system.

High-frequency percussive ventilation for intercontinental aeromedical evacuation.

High-frequency percussive ventilation (HFPV) has been used for the management of patients with smoke inhalation injury for more than 20 years and is considered a standard of care at many burn centers. Because the ventilator is powered by air and oxygen rather than electricity, prehospital use has been limited by large-volume medical gas requirements. Since 2003, Operations Iraqi Freedom and Enduring Freedom have created a need for long-range aeromedical transfer of service members with severe burn and inhalation injuries.

Simple derivation of the initial fluid rate for the resuscitation of severely burned adult combat casualties: in silico validation of the rule of 10.

Background: In practice, current burn resuscitation formulas, designed to estimate 24-hour fluid resuscitation needs, provide only a starting point for resuscitation. To simplify this process, we devised the "rule of 10" to derive the initial fluid rate.

Methods: We performed an in silico study to determine whether the rule of 10 would result in acceptable initial fluid rates for adult patients.

Deployment and operation of a transportable burn intensive care unit in response to a burn multiple casualty incident.

In many hospitals, intensive care units (ICUs) operate at or above capacity on a daily basis. Multiple casualty incidents will create a sudden need for additional ICU beds and hospital planning for disaster response must anticipate the need for rapid ICU expansion. In this article, the authors describe the management of 6 patients who were burned in Guam and successfully transported a distance of 7,268 miles to San Antonio, TX, for tertiary burn center care.

Resuscitation of severely burned military casualties: fluid begets more fluid.

Background: In November 2005, institution of a military-wide burn resuscitation guideline requested the documentation of the initial 24-hour resuscitation of severely burned military casualties on a burn flow sheet to provide continuity of care. The guidelines instruct the providers to calculate predicted 24-hour fluid requirements and initial fluid rate based on the American Burn Association Consensus recommendation of 2 (modified Brooke) mL x kg(-1) x % total body surface area (TBSA)(-1) to 4 (Parkland) mL x kg(-1) x %TBSA(-1) burn. The objective of this study was to evaluate the relationship between the estimated fluid volumes calculated, either by the Modified Brooke or the Parkland formulas, and actual volumes received.

Continuous venovenous hemofiltration in severely burned patients with acute kidney injury: a cohort study.

Introduction: Acute kidney injury (AKI) is a common and devastating complication in critically ill burn patients with mortality reported to be between 80 and 100%. We aimed to determine the effect on mortality of early application of continuous venovenous hemofiltration (CVVH) in severely burned patients with AKI admitted to our burn intensive care unit (BICU).

Methods: We performed a retrospective cohort study comparing a population of patients managed with early and aggressive CVVH compared with historical controls managed conservatively before the availability of CVVH.

Military return to duty and civilian return to work factors following burns with focus on the hand and literature review.

Functional recovery and outcome from severe burns is oftentimes judged by the time required for a person to return to work (RTW) in civilian life. The equivalent in military terms is return to active duty. Many factors have been described in the literature as associated with this outcome.

Topical antimicrobials in burn wound care: a recent history.

"It is nearly 100 years since antisepsis came to dominate the treatment of burns. All that has been accomplished, as far as we can see from the data available, has been to offset the good that sound physiological and surgical principles and modern aseptic technique should have afforded."1 Carl A.

Global evacuation of burn patients does not increase the incidence of venous thromboembolic complications.

Background: Case-control studies have suggested that air travel may be a risk factor for the development of Venous Thromboembolism (VTE). Burned patients from the current war in Iraq and Afghanistan, are transported across three continents to our Burn Center with total ground and air transport time being approximately 24 hours spread over 3 days to 4 days. We hypothesized global evacuation results in increased VTE rates.

An emergency medical bag set for long-range aeromedical transportation.

The global war on terror has created the need for urgent long-range aeromedical transport of severely wounded service members over distances of several thousand miles from Afghanistan or Iraq to the United States. This need is met by specialized medical transport teams such as US Air Force Critical Care Air Transport Teams (CCATT) or by the US Army Burn Flight Team (BFT). Both teams travel with multiple bags or cases of emergency equipment, which are comprehensive but cumbersome.

Continuous renal replacement therapy improves survival in severely burned military casualties with acute kidney injury.

Background: Acute kidney injury in severely burned patients is associated with high mortality. We wondered whether early use of continuous renal replacement therapy (CRRT) changes outcomes in severely burned military casualties with predetermined criteria for acute kidney injury.

Methods: Between November 2005 and June 2007, casualties admitted to our burn intensive care unit after sustaining burns in Iraq and Afghanistan, who subsequently developed acute kidney injury or circulatory shock or both, underwent CRRT.

Incidence and severity of combat hand burns after All Army Activity message.

Background: Operations Enduring Freedom and Iraqi Freedom have resulted in severe burns to the hands. Because of the frequency and severity of hand burns, an All Army Activity (ALARACT) message was distributed emphasizing the importance of hand protection (HP). Our purpose was to assess the effectiveness of the ALARACT in reducing the incidence and severity of hand burns.

Joint Theater Trauma System implementation of burn resuscitation guidelines improves outcomes in severely burned military casualties.

Background: Between March 2003 and June 2007, our burn center received 594 casualties from the conflicts in Iraq and Afghanistan. Ongoing acute burn resuscitation as severely burned casualties are evacuated over continents is very challenging. To help standardize care, burn resuscitation guidelines (BRG) were devised along with a burn flow sheet (BFS) and disseminated via the new operational Joint Theater Trauma System to assist deployed providers.

Long range transport of war-related burn casualties.

Background: US military burn casualties are evacuated to the US Army Institute of Surgical Research Burn Center in San Antonio, TX. Patients are transported by US Army Institute of Surgical Research Burn Flight Teams, Air Force Critical Care Air Transport Teams, or routine aeromedical evacuation. This study characterizes the military burn casualties transported by each team and reports associated outcomes.

Lightning injury: a review.

Lightning is an uncommon but potentially devastating cause of injury in patients presenting to burn centers. These injuries feature unusual symptoms, high mortality, and significant long-term morbidity. This paper will review the epidemiology, physics, clinical presentation, management principles, and prevention of lightning injuries.