Davies M R, Rode H, Cywes S, van der Riet R L
Prog Pediatr Surg. 1981;14:33-61.
In this chapter the local therapy for burns is discussed. Between 400 and 500 children with burns are treated every year at the Red Cross War Memorial Children's Hospital in Cape Town, but in only 10% of them do the burns affect over 20% of the body surface. These latter patients are treated in special rooms equipped for intensive therapy. Open and closed methods of treatment for burns used in addition to early excision are compared. The first aim is early skin cover for areas with skin loss preserving as much function as possible and achieving the best possible cosmetic result. Local therapy must be atraumatic to prevent extension of the skin lesion. Bacterial contamination must be prevented as far as possible by keeping the wound clean. Emergency treatment and the course of wound healing up to the third week after the injury using the appropriate dressings are described. Early excision until the fifth day after the accident should be used mainly for burns of the hand, deep second degree burns of up to 10% of the body surface, deep second degree burns over the joints and deep second degree burns of the neck. It must be admitted that the depth of the burn can only be definitely estimated between the seventh and tenth day after the accident. If no autografts are available homografts or grafts from animals are used. The age of the patient, associated injuries, associated diseases and the extent of the burn all play a role in determining the prognosis. Furthermore endogenous bacterial infections, absorption of local therapeutic agents and the state of the surrounding skin do also influence the healing process. Finally the various local therapeutic agents like sulphamylon, silver sulphadiazine and betadine are discussed. A 0.05% solution of silver nitrate is also active against gram-negative infections. Skin transplants are disinfected with a solution containing one third 0.25% acetic acid, one third 3% cent hydrogen peroxide and one third saline. Hydrogen peroxide must not be applied to burns that are healing spontaneously. A classification of burns to help to choose the appropriate local therapy is proposed.
本章讨论烧伤的局部治疗。开普敦红十字战争纪念儿童医院每年收治400至500名烧伤儿童，但其中只有10%的患儿烧伤面积超过体表面积的20%。后一类患者在配备强化治疗设备的特殊病房接受治疗。比较了除早期切除外使用的烧伤开放和闭合治疗方法。首要目标是尽早为皮肤缺失区域覆盖皮肤，尽可能保留功能并获得最佳的美容效果。局部治疗必须无创，以防止皮肤损伤扩大。通过保持伤口清洁，尽可能预防细菌污染。描述了使用适当敷料进行的紧急治疗以及受伤后直至第三周的伤口愈合过程。事故发生后直至第五天的早期切除主要用于手部烧伤、体表面积达10%的深二度烧伤、关节部位的深二度烧伤以及颈部的深二度烧伤。必须承认，烧伤深度只能在事故发生后的第七至十天才能准确估计。如果没有自体移植物，可使用同种异体移植物或动物移植物。患者的年龄、合并伤、合并疾病以及烧伤程度在决定预后方面都起作用。此外，内源性细菌感染、局部治疗药物的吸收以及周围皮肤的状况也会影响愈合过程。最后讨论了各种局部治疗药物，如甲磺灭脓、磺胺嘧啶银和碘伏。0.05%的硝酸银溶液对革兰氏阴性菌感染也有活性。皮肤移植用含有三分之一0.25%醋酸、三分之一3%过氧化氢和三分之一生理盐水的溶液消毒。过氧化氢不得用于正在自行愈合的烧伤。提出了一种烧伤分类方法，以帮助选择合适的局部治疗。
