Biomedical subjects

S Fletchall

Publications and source records attributed to S Fletchall.

5 recordsLinked to original sources

PubMed1994

Cultured epidermal autografts and allodermis combination for permanent burn wound coverage.

Cultured epidermal autografts (CEA) have been shown to be an effective permanent skin replacement for major burn injuries, but are more sensitive to adverse conditions than split thickness grafts (Clarke et al., 1988). Cuono et al. (1986, 1987) have described the successful use of engrafted allodermis as a wound bed for cultured grafts. We report on a method of preparing allodermis and grafting CEA in five patients with major burns (48-70 per cent TBSA, average 59.6 per cent). The average age was 38.8 years (20-60 years). All full thickness wounds were excised down to fat within 7 days of admission, and covered with meshed split thickness cryopreserved homograft. Over the ensuing 2-3 weeks, the homograft became engrafted. At surgery, the allo-epidermis was removed, leaving the dermal components as a viable bed for the CEA. Keratinocytes derived from a full thickness biopsy were grown to confluence by the method of Rheinwald and Green (1975), and 25 cm2 sheets were stapled to Vaseline gauze backings and applied to freshly excised wounds. Seven to 10 days after surgery, the gauze backings were removed. The average take ranged from 87-100 per cent (average 93.6 per cent). Follow-up for up to 4 years shows supple skin that has been durable, and resistant to trauma and infection.

Adult↗

PubMedDate not supplied

Early upper-extremity prosthetic fit in patients with burns.

Patients with upper-extremity amputations necessitated by burn injury have frequently faced delays in prosthetic fit. At the Regional Medical Center, Memphis, Tennessee, seven patients required amputations because of burns. These injuries were electrical in four cases, thermal and crush in one case, thermal in one case, and steam and crush in one case. Five patients had below-elbow amputations, one had a bilateral below-elbow amputation, and one had a bilateral above-elbow amputation. All patients were fitted with prostheses within 30 days of the last definitive surgery on the amputated extremity. All patients continued to wear a prosthesis and no patient exhibited skin breakdown. Patients returned to independence with self care within 2 weeks and to preamputation activities within an average of 2.5 months.

Adolescent↗

PubMedDate not supplied

Updating upper extremity temporary prosthesis: thermoplastics.

Since 1989 amputees with upper-extremity burns have been fitted with a temporary prosthesis fabricated from low-temperature thermoplastic. Before 1989 conventional temporary prostheses were fabricated with plaster. The use of the thermoplastic material has produced a lightweight, cost-effective, modular system. No patients exhibited skin breakdown with the thermoplastic material. It appears that thermoplastics may be the next major breakthrough in terms of a design for a temporary upper-extremity prosthesis.

Amputation, Surgical↗

PubMedDate not supplied

Quality burn rehabilitation: cost-effective approach.

As funding for health care becomes a national concern, and workman's compensation and private health insurance companies attempt to limit their expenditures in the treatment of the client with burns, it may become the responsibility of the burn specialists to create a cost-effective approach to quality burn rehabilitation. Our outpatient rehabilitation program has taken a cost-effective approach that limits the use of inpatient rehabilitation, emphasizes the burn team guiding the client to a quick functional return to home and work, and concentrates costs for therapy rather than room and board. This cost-effective rehabilitation approach emphasizes an intensive 6-hours-per day, 5-days-per-week outpatient program that begins immediately after discharge. In a 2 1/2-year follow-up of this cost-effective program, the following were identified. (1) A 40% reduction in costs for third-party payers and (2) clients returning to work an average of 4 months after their injury. In the cost-effective rehabilitation approach, 82% of the health care costs are concentrated for therapy. In the traditional inpatient rehabilitation program, room and board costs comprise 57% of the charges. Because it is the responsibility of the burn specialists to educate the health care payers, a program description to implement the cost-effective approach to burn rehabilitation is provided.

Adolescent↗

PubMedDate not supplied

Managed health care: therapist responsibilities.

Goals identified by managed health care organizations are to contain costs and to provide services that produce functional outcomes. Burn clients with managed care have experienced a lack of reimbursement for rehabilitation that results in less than functional outcomes. For therapy to receive reimbursement the therapist's responsibilities must begin on day 1 of burn injury. Traditional burn therapist responsibilities must be coupled with interactions to families, managed care, employers, and case managers. Clinical skills must foster the client assuming responsibility for improvement and returning to preinjury activities. Therapists must develop the ability to communicate and present data illustrating the why of therapy as it relates to costs, goals, and time frames. Anticipating and developing rationale for burn rehabilitation can facilitate reimbursement, minimize delay between inpatient/outpatient therapy programs, and ensure that the client obtains functional outcomes. Information to assist the therapist to develop appropriate information for reimbursement of burn rehabilitation is presented.

Burns↗