This study was undertaken to compare pain, healing time, infection rate, and cosmetic outcome between Aquacel Ag (Convatec) and Glucan II (Brennan Medical) as donor site dressings. The authors performed a prospective, randomized, patient-controlled study. Eligible patients had two donor sites harvested. One site was dressed with Aquacel Ag and the other site with Glucan II. Patients were followed at set time points for 6 months to determine the rate of epithelialization, patient's perceived pain, infection rate, and the cosmetic outcome. A total of 20 patients were enrolled in the study. All patient data were collected through reepithelialization. The average time to wound healing for Aquacel Ag was 12.5 ± 2.07 days compared with Glucan II 12.7 ± 1.99 days. Perceived pain scores for each donor site were recorded. On postoperative day 5, patients reported significantly less pain with the Aquacel Ag site (Aquacel Ag 1.75 vs Glucan II 2.5, P = .02). Three donor sites showed clinical signs of infection (two Glucan II and one Aquacel Ag) prompting culture and dressing removal. There was no statistically significant difference in cosmetic outcomes of the donor sites at any time point. When comparing Aquacel Ag and Glucan II, our study has determined that there is no significant difference with regard to healing time, infection rates, and cosmetic outcomes. Both dressings are comparable with regard to ease of application and postoperative care.

Current embodiments of negative pressure wound therapy (NPWT) create a hermetically sealed chamber at the surface of the body using polyurethane foam connected to a vacuum pump, which is then covered by a flexible adhesive drape. Commercially available NPWT systems routinely use flexible polyethylene films that have a sticky side, coated with the same acrylate adhesives used in other medical devices such as ECG leads and grounding pads. Severe reactions to the acrylate adhesives in these other devices, although uncommon, have been reported. We describe the case of a 63-year-old woman with an intractable leg ulcer resulting from external-beam radiotherapy (XRT). Treatment with a standard commercial NPWT system induced severe inflammation of the skin in direct contact with drape adhesive. We successfully administered prolonged, outpatient NPWT to the patient using an alternative method (first described by Bagautdinov in 1986), using plain polyethylene film and petrolatum. The necessary hermetic seal is achieved by smearing the skin with petrolatum before applying the polyethylene film and activating the vacuum pump. The Bagautdinov method is a practical solution to the problem of adapting NPWT to patients with contact sensitivity or skin tears related to the adhesive compounds in the flexible drapes. Its use of a circumferential elastic wrap to maintain constant pressure on the seal probably limits the Bagautdinov technique to the extremities.

Multiple reports have demonstrated a wide prevalence of both depression and posttraumatic stress disorder (PTSD) within 1 year of burn injury. The purpose of this study is to determine outcomes of burn patients after a positive outpatient screen for depression or PTSD at an American Burn Association-verified burn center. All patients who screened positive were offered referral for psychologic and/or psychiatric counseling. Rescreening was performed with a goal of approximately 6 months. A total of 445 patients were enrolled with 91 (20.6%) screening positive for depression and 59 (13.4%) for PTSD. TBSA burned was associated with a positive screen for depression (P = .008) and PTSD (P = .012) while electrical injury was associated with a positive screen for depression (P = .029). Rescreening was done in 15.5% with 23% rescreening positive for depression and 15% for PTSD. The study validated the need for early screening and referral for psychologic and/or psychiatric counseling in this population.

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Introduction Access to quality health care services is important for acute burn care, but comprehensive burn care goes beyond acute hospitalization. Follow up is an essential part of recovery, where providers can assess late effects of burn and help the patients with community re-integration, injury rehabilitation, and mental health. However, not all patients return for follow up after burn injury due to barriers in care and patient characteristics. We hypothesized that patients with neuropsychiatric comorbidities and 0–10% of total body surface (TBSA%) are more likely to be lost at follow up compared to patients with no neuropsychiatric comorbidities and higher TBSA. Methods A retrospective analysis was completed on patients that were admitted to a verified Burn Center from January 2016 to June 2019. Patients that were under 18 years of age and patients that died prior to discharge were excluded. Patient characteristics included were age, gender, TBSA, discharge location, payer, and comorbidities. Univariate analysis was completed using Tableau and multiple logistic regression analysis using Stata. Neuropsychiatric comorbidities were defined as dementia, alcoholism, major psychiatric disease, and drug dependence. Lost to follow up was defined as no follow up in clinic after inpatient discharge date within 1 month. Results Of 562 patients, 35.94% (n=202) were female and 65.12% (n=366) were Caucasian followed by Asian 13.7% (n=77) and Other Race 13.7% (n=77). Of the 562 patients, 157 (27.95%) were lost to follow up. After adjusting for insurance type, race, and medical comorbidities, patients with neuropsychiatric comorbidities had double the risk (OR 2.052; 1.377 - 3.057 p< 0.001) to be lost at follow up compared with those that did not have neuropsychiatric disorders. Homelessness was collinear with neuropsychiatric comorbidities suggesting an association. Patients with a TBSA >20% (n=37) were 3 times more likely to be lost at follow up in comparison with patients with 0–10% TBSA. (OR 2.921; 1.455–5.861 p< 0.003). Race, medical comorbidities, and insurance status had no significant impact on follow up. Conclusions Patients with dementia, alcoholism, major psychiatric disease, and drug dependence were more likely to be lost at follow up. Contrary to intuition, patients with burns >20% TBSA were also less likely to follow-up. Additional research is needed to better identify how psychosocial factors affect follow up in our burn patients and how to address those barriers. By focusing on our population and their needs, we can adjust our practices to make sure that we are providing holistic burn care.