Browsing by Author "D.N. Herndon"

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    Modulation of the Hypermetabolic Response After Thermal Injury
    (Başkent Üniversitesi, 2006-01) R.Y. Fram; V.E. Watson; D.N. Herndon
    Major thermal injuries have traditionally been associated with mortality and poor outcomes. Over the past three decades, however, patient survival has improved due to greater understanding of the hypermetabolic stress response and advancements in burn care treatment. The hypermetabolic response is not only an acute phenomenon, but continues for at least 9-12 months post-injury. Circulating levels of glucagon, cortisol and catecholamines are increased leading to a catabolic state that results in loss of lean body mass and muscle wasting. An important intervention after a burn injury is attenuation of the catabolic activity occurring. Non-pharmacological interventions include early excision and grafting, control of infection, sustaining room temperatures to an ambient level of 33ºC, and instituting a high carbohydrate enteral diet early in the acute setting. Pharmacological alternatives include the use of recombinant human growth hormone, insulin-like growth factor-1, insulin, oxandralone, and propranolol. The purpose of this paper is to review the mechanisms of the hypermetabolic response and the current modes of treatment to provide optimal care and improved outcomes for the severely burned patient.
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    Trends in Burn Reconstruction-Our Experience With Early Reconstruction
    (Başkent Üniversitesi, 2006-01) N. Nugent,; S.P. Fagan,; T. Huang,; D.N. Herndon
    Aim: Historically, burn reconstruction has taken place after maturation of the burn scar. Usually this means delay until two years post burn injury. However, the recent trend is to commence reconstructive surgery early (within two years of burn injury), once stable wound coverage has been achieved. We present our experience with early burn reconstruction, and the operative methods we use. Materials and Methods: From 2002 to 2004, 828 patients underwent a total of 3045 burn reconstructive procedures at our institute. 68.3% of these patients were within one year of burn injury. 47.5% of procedures consisted of head and neck surgeries, 36.1% were hand reconstructive procedures, and the remainder were divided between trunk, lower extremities, perineum and genitalia. We used a variety of techniques including skin grafting, local flaps and tissue expansion. Discussion: Traditionally, the burn scar was left to mature fully before consideration for operative reconstruction was undertaken. However, early surgical intervention to release contractures and reconstruct deformities is increasingly becoming accepted. Advantages of early reconstruction include earlier recovery of function/range of movement and earlier reconstruction of cosmetically distressing deformities. Disadvantages of early surgical intervention include operating on scars that are not fully mature, which can be technically more demanding, and postoperatively more detailed wound care may be required. Conclusion: Early burn reconstruction can provide good functional and cosmetic outcomes. Although, it may be technically more demanding due to the immature wound, and require detailed wound care, earlier functional recovery and aesthetic improvement can be provided to the burn patient.