eMedicine Specialties > Pediatrics: Surgery > General Surgery
Burns: Surgical Perspective: Follow-up
Updated: Mar 10, 2009
Outcome and Prognosis
With the exception of infants, the prognosis for survival in children and adolescents is quite good. In the past decade, the size of a survivable injury has increased from 70% BSA burned to more than 95% BSA burned in children younger than 15 years.
Future and Controversies
Numerous areas in both the clinical and basic sciences are undergoing active research. One such area of interest is the hypermetabolic response to severe burns and the association with increased energy expenditure and muscle-protein catabolism. Studies have investigated different mechanisms to attenuate the muscle-protein catabolism that occurs frequently, despite appropriate nutritional support, in children with large burns.3 These studies are promising because attenuation of muscle-protein losses may improve strength and ability to recuperate.
A prospective randomized controlled trial of recombinant human growth hormone in combination with the beta-blocker propanolol demonstrated attenuated hypermetabolism and inflammatory and acute phase responses after severe burn injury.2 Human growth hormone improves posttraumatic hypermetabolism, but its use alone is associated with hyperglycemia and increased free fatty acids and triglycerides. Concomitant administration of propanolol improved fat metabolism and insulin sensitivity and avoided the adverse effects of recombinant growth hormone alone.
Another active area of research is in the development of cultured skin to treat very large burns. At present, cultured epidermal autografts (CEAs), which are grown from the patient's own uninjured epidermis, are commonly used. However, these grafts are very thin and fragile. In the future, cultured bilayered skin (epidermis and dermis) should lead to better functional and cosmetic results.
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Follow-up: Burns: Surgical Perspective |
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References
Lowell G, Quinlan K, Gottlieb LJ. Preventing unintentional scald burns: moving beyond tap water. Pediatrics. Oct 2008;122(4):799-804. [Medline].
Jeschke MG, Finnerty CC, Kulp GA, Przkora R, Micak RP, Herndon DN. Combination of recombinant human growth hormone and propanol decreases hypermetabolism and inflammation in severely burned children. Pediatr Crit Care Med. Mar 2008;9:209-216. [Medline].
Chan MM, Chan GM. Nutritional therapy for burns in children and adults. Nutrition. Mar 2009;25(3):261-9. [Medline].
Besner GE. Burns. In: Glick PL, Pearl RH, Irish MS, et al, eds. Pediatric Surgery Secrets. ed. Philadelphia, PA: Hanley & Belfus; 2000:246-52.
Heimbach D. What's new in general surgery: burns and metabolism. J Am Coll Surg. Feb 2002;194(2):156-64. [Medline].
Herndon DN, Hart DW, Wolf SE, et al. Reversal of catabolism by beta-blockade after severe burns. N Engl J Med. Oct 25 2001;345(17):1223-9. [Medline].
Hildreth M, Gottschlich M. Nutritional support of the burned patient. In: Herndon D, ed. Total Burn Care. Philadelphia, PA: WB Saunders Co; 1996:237-45.
Paddock HN, Fabia R, Giles S, Hayes J, Lowell W, Besner G. A Silver Impregnated Antimicrobial Dressing Reduces Hospital Length of Stay for Pediatric Burn Patients. J Burn Care Research. May-Jun 2007;28:409-411. [Medline].
Peters DA, Verchere C. Healing at Home: Comparing Cohorts of Children with Medium-Sized Burns Treated as Outpatients With In-Hospital Applied Acticoat (TM) to those Children Treated as Inpatients with Silver Sulfadiazine. J Burn Care Research. Mar-Apr 2006;27:198-201. [Medline].
Sheridan RL, Weber JM, Schnitzer JJ, et al. Young age is not a predictor of mortality in burns. Pediatr Crit Care Med. Jul 2001;2(3):223-224. [Medline].
Further Reading
Keywords
burns, skin grafting, burn excision, partial-thickness burn, superficial partial-thickness burn, deep partial-thickness burn, full-thickness burn, electrical burn, frostbite, body surface area, BSA, thermal injury, child abuse, scald burn, scalding injury, flame burns, hypothermia, weeping blisters, frostbite, chemical burns, pulmonary failure, renal failure, hepatic failure
Follow-up: Burns: Surgical Perspective