Surgical Management of Hidradenitis Suppurativa: A 14-Year Retrospective Review of 98 Consecutive Patients.

Hidradenitis suppurativa (HS) is a debilitating suppurative disease of the apocrine/follicular glands. Medical treatment has some efficacy in early-stage disease but is costly and requires frequent physician visits. Advanced disease usually requires surgical intervention.

An Evaluation of Factors Related to Postoperative Pain Control in Burn Patients.

Satisfactory treatment of burn pain continues to be elusive. The perioperative period is particularly challenging. The contributions of acute tolerance and opioid-induced hyperalgesia have not been previously explored in burn patients.

Patient education and recall regarding postsplenectomy immunizations.

Background: The purpose of this study was to determine the rates of initial vaccinations after splenectomy for trauma, assess the effectiveness of patient education on reimmunizations, and evaluate patients' utilization of their knowledge regarding immunization after discharge.

Methods: From June 1996-December 2011, 144 patients underwent splenectomy after traumatic injury. A telephone survey was completed in 100 of 144 splenectomized patients (69%) at a mean of 7.

Factors related to child maltreatment in children presenting with burn injuries.

The underpinnings of maltreatment in children presenting with burn injuries are necessary to discern as detection and prevention rest on a clear delineation of factors associated with maltreatment. Inaccurate identification of child victims can result in perpetuation of the maltreatment and its attendant neuropsychological sequela. The authors sought to determine factors associated with maltreatment in children presenting with burn injuries, which would guide the burn team in assessing the likelihood of maltreatment.

A pilot study of the use of biocide-impregnated gauze as an adjunct to wound care in a burn population.

The aim of this study was to evaluate the use of a polyhexamethylene biguanide biocide-impregnated gauze (Kerlix™ AMD gauze dressing, Covidien d/b/a Tyco Healthcare Group LP) as an adjuvant to routine burn care and its impact on the incidence of hospital-associated infections in burn population. One hundred eight burn patients admitted to the Burn Treatment Center were prospectively enrolled from August 2008 to June 2009 and matched 1:2 with historic controls who were admitted from March 2006 to July 2008. Clinical care remained otherwise unchanged; however, several hospital initiatives (the national surgical improvement project, the surgical care improvement project, and a central venous line bundle) were initiated before and during the study.

Risk factors for acquiring vancomycin-resistant Enterococcus and methicillin-resistant Staphylococcus aureus on a burn surgery step-down unit.

The incidence of hospital-associated infections secondary to methicillin-resistant Staphylococcus aureus (MRSA) and those caused by vancomycin-resistant enterococci (VRE) continue to increase, despite the publication of evidence-based guidelines on infection control. We sought to determine modifiable risks factors for acquisition of MRSA or VRE or both on a burn trauma unit (BTU). We performed a retrospective single-center-matched control study.

The evolution of resource utilization in regional burn centers.

Regional burn centers provide unique multidisciplinary care that has been associated with dramatically improved outcomes for burn victims. Patients with complex skin and soft tissue injuries are increasingly admitted to these centers for definitive care. This study was designed to assess current trends in burn center resource utilization.

Long-term outcomes of patients with necrotizing fasciitis.

Context: Necrotizing fasciitis is an aggressive infection affecting the skin and soft tissue. It has a very high acute mortality. The long-term survival and cause of death of patients who survive an index hospitalization for necrotizing fasciitis are not known.

Autopsy after traumatic death--a shifting paradigm.

Objective: The role of autopsy in evaluating missed injury after traumatic death is well established and discussed in the literature. The frequency of incidental findings in trauma patients has not been reported. We believe that incidental findings are under recognized and reported by trauma surgeons.

The effect of burn center and burn center volume on the mortality of burned adults--an analysis of the data in the National Burn Repository.

Regional variations of care, and improved outcomes with larger volumes, have been well described in the medical and surgical literature for a variety of conditions including heart surgery, vascular surgery, and orthopedic surgery. Burn care has not been recently subjected to such an analysis. The National Burn Repository (NBR) contains de-identified patient and burn center data to allow this analysis.

Onset of symptomatic hydrocephalus requiring emergency cerebrospinal fluid diversion following high-voltage electrical burn injury.

High-voltage electrical injuries have been reported to cause a plethora of neurological complications including cognitive, motor, and sensory deficits in an immediate or delayed fashion. In this setting, new-onset symptomatic hydrocephalus requiring CSF shunt placement has not been described. The authors present the case of an 18-year-old man who sustained a high-voltage electrical injury with a calvarial contact point that required emergency CSF diversion within hours of injury and subsequently required placement of a lumboperitoneal shunt.

The efficacy of hair and urine toxicology screening on the detection of child abuse by burning.

Abuse by burning is estimated to occur in 1 to 25% of children admitted with burn injuries annually. Hair and urine toxicology for illicit drug exposure may provide additional confirmatory evidence for abuse. To determine the impact of hair and urine toxicology on the identification of child abuse, we performed a retrospective chart review of all pediatric patients admitted to our burn unit.

Effectiveness of universal screening for vancomycin-resistant enterococcus and methicillin-resistant Staphylococcus aureus on admission to a burn-trauma step-down unit.

Vancomycin-resistant enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) are significant healthcare-associated pathogens. We sought to identify factors that could be used to predict which patients carry or are infected with VRE or MRSA on admission so that we could obtain cultures selectively from high-risk patients on our burn-trauma unit. We conducted a case-control study of patients admitted to our burn-trauma unit from September 2000 to March 2005 who were colonized or infected with either VRE or MRSA (cases) and patients who were not colonized or infected with one of these organisms (controls).

Rural versus urban trauma: demographic influences on autopsy rates.

Background: The autopsy has long been considered the gold standard for quality assurance review. Studies characterizing autopsies have been completed in large urban centers, but there is a paucity of research regarding autopsies at rural trauma centers. This is problematic considering that a majority of preventable trauma deaths occur in rural areas and death rates for unintentional injuries in rural populations are higher than urban populations.

Carbon monoxide toxicity.

Inhalation injury consists of a multitude of insults, the first of which is the toxic gases inhaled during the combustion of organic and inorganic substances. Significant morbidity and mortality in patients with burn injury occur due to the varying effects of these gases. This section of the compendium initially addresses two classically described inhaled gases: carbon monoxide and cyanide, followed by a discussion of a gas associated with illicit drug use: metamphetamine.

Emergence of the USA300 strain of methicillin-resistant Staphylococcus aureus in a burn-trauma unit.

Community-associated methicillin-resistant Staphylococcus aureus (MRSA), particularly USA300, is a major pathogen in the outpatient setting. We suspected that USA300 had been introduced into our burn-trauma unit (BTU) when three burn patients presented with numerous simultaneous abscesses. We did molecular typing on 206 MRSA isolates from all patients on the BTU who had MRSA isolated from either nares cultures or clinical specimens obtained between April 11, 2002 and October 24, 2006.

Methamphetamine-related burns in the cornbelt.

Methamphetamine (MA) is a highly addictive drug that is easily manufactured from everyday household products and chemicals found at local farm stores. The proliferation of small MA labs has led to a dramatic increase in patients sustaining thermal injury while making and/or using MA. We hypothesized that these patients have larger injuries with longer hospital stays, and larger, nonreimbursed hospital bills compared with burn patients not manufacturing or using MA.

A prospective analysis of trash, brush, and grass burning behaviors.

Burn injuries sustained during residential trash, brush, and grass burning cause significant morbidity and mortality in rural areas. To further prevention efforts, we surveyed individuals who incurred injuries from residential burning. Thirty-six individuals injured while burning trash, brush, or grass from June 2003 through September 2005 were asked to respond to a self-administered written survey.

Prospective analysis of nosocomial infection rates, antibiotic use, and patterns of resistance in a burn population.

Despite significant advances in burn care, infection remains a major cause of morbidity and mortality in burn patients. We sought to determine accurate infection rates, risk factors for infection, and the percentage of infections caused by resistant organisms. In addition, we attempted to identify interventions to decrease the use of antimicrobial drugs.

Complications after therapeutic trauma laparotomy.

Background: Therapeutic trauma laparotomy (TTL) is a common emergency procedure after traumatic abdominal injury, but it can lead to complications and even death. We explored the role of the time from emergency department (ED) arrival to surgical intervention as a predictor of complications and mortality from TTL.

Study Design: This is a retrospective study of 175 patients receiving TTL between July 1997 and October 2003 in a Level I teaching hospital serving a primarily rural population.

Hyperbaric oxygen for the treatment of fournier's gangrene.

Purpose: Fournier's gangrene is a necrotizing fasciitis of the genitalia that is associated with high morbidity and mortality. Groups at many institutions have initiated routine adjuvant hyperbaric oxygen (HBO) therapy. We examined whether HBO has made a difference in the morbidity, mortality and costs associated with treating this disease.

Methamphetamine-associated burn injuries: a retrospective analysis.

Methamphetamine production and use has increased dramatically during the past 10 years. Methamphetamine production requires combining hazardous and volatile chemicals that expose the manufacturer to burn injuries from explosions and chemical spills. We sought to review the epidemiology of burn injuries in a rural burn center secondary to the use of amphetamine or methamphetamine and/or the manufacture of methamphetamine.

The prevalence of venous thromboembolism of the lower extremity among thermally injured patients determined by duplex sonography.

Background: Morbidity and mortality from venous thromboembolism (VTE) remains a significant problem for hospitalized patients. Despite the ample prospective literature defining the prevalence of VTE in hospitalized patient populations, the prevalence of VTE in the thermally injured population remains largely unknown.

Methods: We prospectively studied 148 thermally injured patients with hospital stays of greater than 3 days with lower extremity duplex ultrasonograms obtained at admission and discharge.