eMedicine Specialties > Pediatrics: Surgery > General Surgery

Burns: Surgical Perspective: Follow-up

Author: Gail E Besner, MD, John E Wilson Endowed Professor of Neonatal Research, Nationwide Children's Hospital; Professor of Surgery and Pediatrics, Department of Surgery, Ohio State University College of Medicine; Director, Pediatric Surgical Research, Department of Surgery, Nationwide Children's Hospital
Coauthor(s): Iyore Amy Otabor, MD, Clinical Instructor House Staff, Department of General Surgery, The Ohio State University College of Medicine
Contributor Information and Disclosures

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.

 


More on Burns: Surgical Perspective

Overview: Burns: Surgical Perspective
Workup: Burns: Surgical Perspective
Treatment: Burns: Surgical Perspective
Follow-up: Burns: Surgical Perspective
Multimedia: Burns: Surgical Perspective
References

References

  1. Lowell G, Quinlan K, Gottlieb LJ. Preventing unintentional scald burns: moving beyond tap water. Pediatrics. Oct 2008;122(4):799-804. [Medline].

  2. 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].

  3. Chan MM, Chan GM. Nutritional therapy for burns in children and adults. Nutrition. Mar 2009;25(3):261-9. [Medline].

  4. Besner GE. Burns. In: Glick PL, Pearl RH, Irish MS, et al, eds. Pediatric Surgery Secrets. ed. Philadelphia, PA: Hanley & Belfus; 2000:246-52.

  5. Heimbach D. What's new in general surgery: burns and metabolism. J Am Coll Surg. Feb 2002;194(2):156-64. [Medline].

  6. 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].

  7. 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.

  8. 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].

  9. 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].

  10. 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

Contributor Information and Disclosures

Author

Gail E Besner, MD, John E Wilson Endowed Professor of Neonatal Research, Nationwide Children's Hospital; Professor of Surgery and Pediatrics, Department of Surgery, Ohio State University College of Medicine; Director, Pediatric Surgical Research, Department of Surgery, Nationwide Children's Hospital
Gail E Besner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Burn Association, American College of Surgeons, American Gastroenterological Association, American Medical Association, American Medical Women's Association, American Pediatric Surgical Association, Association for Academic Surgery, Federation of American Societies for Experimental Biology, Society of Critical Care Medicine, Society of Surgical Oncology, and Society of University Surgeons
Disclosure: Trillium Therapeutics, Inc. Consulting fee Consulting; Trillium Therapeutics, Inc. Grant/research funds Other

Coauthor(s)

Iyore Amy Otabor, MD, Clinical Instructor House Staff, Department of General Surgery, The Ohio State University College of Medicine
Iyore Amy Otabor, MD is a member of the following medical societies: American College of Surgeons, American Medical Student Association/Foundation, and Student National Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Denis Bensard, MD, Director, Pediatric Trauma, Division of Pediatric Surgery, Children's Hospital of Denver; Associate Professor, University of Colorado Health Sciences Center
Denis Bensard, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Association for Academic Surgery, and Society of University Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Michael G Caty, MD, Professor of Surgery and Pediatrics, State University of New York at Buffalo; Consulting Staff, Department of Pediatric Surgery, Children's Hospital of Buffalo
Michael G Caty, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Physician Executives, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Association for Academic Surgery, and Association for Surgical Education
Disclosure: Nothing to disclose.

CME Editor

H Biemann Othersen Jr, MD, Professor of Surgery and Pediatrics, Emeritus Head, Division of Pediatric Surgery, Medical University of South Carolina
H Biemann Othersen Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American Cancer Society, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society for Parenteral and Enteral Nutrition, American Surgical Association, American Thoracic Society, British Association of Paediatric Surgeons, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, South Carolina Medical Association, Southeastern Surgical Congress, Southern Medical Association, Southern Society for Pediatric Research, and Southern Thoracic Surgical Association
Disclosure: Nothing to disclose.

Chief Editor

Harsh Grewal, MD, FACS, FAAP, Professor of Surgery and Pediatrics, Temple University School of Medicine; Chief, Section of Pediatric Surgery, Temple University School of Medicine
Harsh Grewal, MD, FACS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Association for Surgical Education, Children's Oncology Group, Eastern Association for the Surgery of Trauma, International Pediatric Endosurgery Group, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons, and Southwestern Surgical Congress
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.