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OXFORD MEDICAL PUBLICATIONS
Burns
ii
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Oxford Specialist
Handbooks inSurgery
Burns
Edited by
Iain S.Whitaker
Chair in Burns & Plastic Surgery, Swansea University
Medical School
Honorary Consultant Plastic Surgeon, The Welsh Centre
for Burns & Plastic Surgery
Deputy Editor, Journal of Plastic, Reconstructive and
Aesthetic Surgery ( JPRAS)
Director, Reconstructive Surgery & Regenerative Medicine
Research Group (http://www.reconregen.com/)
SAC Lead, Academic Plastic Surgery
Kayvan Shokrollahi
Consultant Plastic Surgeon
Mersey Regional Burns and Plastic Surgery Unit,
WhistonHospital, Liverpool, UK
Medical Director, The Katie Piper Foundation, UK
William A.Dickson
Consultant Plastic Surgeon and
Clinical Lead for the South West Burn Operational
Delivery Network (Adults), NHS England, UK
Editorial assistant
Nicholas Marsden
Registrar in Plastic Surgery Welsh Regional Centre for Burns and
Plastic Surgery, Morriston Hospital, Swansea, UK
1
iv
https://t.me/med1917
1
Great Clarendon Street, Oxford, OX2 6DP,
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Oxford University Press in the UK and in certain other countries
© Oxford University Press 2019
The moral rights of the authors have been asserted
First Edition published in 2019
Impression:1
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a retrieval system, or transmitted, in any form or by any means, without the
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address above
You must not circulate this work in any other form
and you must impose this same condition on any acquirer
Published in the United States of America by Oxford University Press
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British Library Cataloguing in Publication Data
Data available
Library of Congress Control Number:2018966726
ISBN 978– 0– 19– 969953– 7
Printed and bound in China by
C&C Oset Printing Co., Ltd.
Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check
the product information and clinical procedures with the most up- to- date
published product information and data sheets provided by the manufacturers
and the most recent codes of conduct and safety regulations. The authors and
the publishers do not accept responsibility or legal liability for any errors in the
text or for the misuse or misapplication of material in this work. Except where
otherwise stated, drug dosages and recommendations are for the non- pregnant
adult who is not breast- feeding
Links to third party websites are provided by Oxford in good faith and
for information only. Oxford disclaims any responsibility for the materials
contained in any third party website referenced in this work.
https://t.me/med1917
To my dearest Sara, my world, and to my parents without
whose support I would never have made it this far.
KAYVAN SHOKROLLAHI
To my beautiful daughter Lara, who makes each and every day a
joy, and my wife Sairan, who tolerates the countless hours of work.
IAIN S. WHITAKER
vi
https://t.me/med1917
vi
Foreword (UK)
‘Sometimes wrong, never in doubt’
The often-quoted phase above concerning surgeons remains as true today
as ever. The Oxford Handbook of Burns aims to reduce uncertainty and
error by giving a contemporary, comprehensive and concise review of
burn care.
Burn injury represents a global and systemic disease that requires a multidisciplinary approach to optimize survival, function, and aesthetic outcome.
This is reected in the multidisciplinary and multinational authorship of the
book and acknowledges the vital contributions made to patient care by all
members of the burn team. The Handbook reects and incorporates the
latest scientic knowledge, national guidelines, and international recommendations. Many of the authors are world authorities on their subjects
and because of the book’s format and size the reader does truly have an
expert in their pocket.
In years to come it is the hope of the authors that the Handbook becomes a valued and trusted source for burn care professionals from whatever discipline to learn and update their knowledge and skills, prepare for
exams, and to deliver excellent clinical care. For the more experienced
practitioners, it is intended to be a useful and practical review that ensures
up-to-date knowledge, particularly in areas outside areas of direct interest.
The book is aimed at all members of the burn multidisciplinary team to
explain and inform on all aspects of care so that shared knowledge and
understanding of treatment strategies and goals can improve collaboration
and truly integrated care.
Consultant Plastic and Reconstructive Surgeon
St Andrews Centre for Plastic Surgery and Burns
Visiting Professor, School of Medicine, Anglia Ruskin University
Chelmsford, Essex, UK
Peter Dziewulski
https://t.me/med1917
Foreword (USA)
On Mondays and Thursdays, all the members of our practice make rounds
together on all of our inpatients. We begin in the Burn Intensive Care Unit.
The plastic surgeons and nurse practitioners in our practice are joined by
intensivists, a pharmacist, a member of our anesthesia team, our operating
room team manager, a nutritionist, an infection control nurse, the hospital’s
chief nursing ocer, our unit nurse manager, a case manager, physical and
occupational therapists, our research director, respiratory therapists, and
various students and visitors. Each patient is presented by the patient’s
nurse, and the discussion and planning draw input from the entire group.
It has often occurred to me during these rounds that I am practicing
within the widest scope of care in my career. Ten years ago, more or less on
a dare, I became the medical director of a private practice burn center in a
state that had lost its only burn center some years previously and had been
unable to organize burn care since. The president and chief surgeon of the
Joseph M. Still Burn Center in Augusta, Georgia, invited me to organize a
burn unit in Mississippi as an extension of his Georgia practice, which had
been receiving burn patients from Mississippi while that state dithered in
taking responsibility for the burn care of its own citizens.
The burn practice immediately engaged all functioning aspects of my
training in general surgery and plastic surgery. I rapidly had to administratively organize clinics and inpatient units. Operatively, I proceeded to put
together a network of nurse practitioners, clinic, hospital, and operating
room sta as well as transfer protocols and consultants ranging from pediatricians to hospice care.
Personally, I had to upgrade my education base to a point where I could
at least converse with the range of people involved in our burn practice.
I had not practiced primary burn care since my plastic surgery residency
(1984–1986). Drastic remedial instruction was necessary. Each month,
I spent a week in the Augusta unit doing secondary burn reconstruction
but, more importantly for me, observing and participating in burn care at
that truly remarkable center which admits over 4,000 burn patients a year.
Education was rapidly acquired.
Our Mississippi unit is now completing its tenth year, and I realize that
this chapter of my career has made me a better physician and surgeon than
perhaps I had intended. The acute and secondary care of people with burn
injuries truly requires attention, responsiveness, a broad knowledge base,
organizational skills, technical skills, and the ability to deal with the unexpected and unique problems that can be crucial to any burned patient.
This textbook embraces the great complexities of burn care and will be a
valuable addition to my ongoing education. Scanning the table of contents,
the reader will see the many elements of burn care arranged in a pattern
equal to a complete prole of burn care. Systematic reading, or specic
reading of particular topics, will give the reader the details of evaluation and
management applicable to the complexities of burn care. The book will be
immediately applicable to my practice.
vii
FOREWORD (USA)
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viii
As with all textbooks, this one will have missed evolving concepts and
techniques by the time the book is published. The framework of this text,
however, is a solid foundation for assimilating new information, so this rst
edition can be the beginning of many editions that may become a classic
reference for burn care.
Medical Director, JMS Burn and Reconstruction Center, USA,
Editor-in-Chief, Annals of Plastic Surgery, USA
William C. Lineaweaver
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Preface
Within these pages, we have concisely brought together the basic principles
of holistic burn care for the generalist while at the same time catering for
those working in specialist burns teams to provide a solid and accessible
resource. We are especially pleased with unique features of the book such
as the rst publication known to us of a ‘burn care formulary’ of drugs
used in the broad spectrum of indications relevant to burn patients, as well
as various proformas and checklists helpful in day-to-day practice such as
when referring or accepting burn patients.
Hence, the emergency physician will be reminded how to assess burn
depth and body surface area accurately, and the plastic surgeon how to
release and reconstruct burn scar contractures in a very substantial and
well-illustrated chapter on this topic. The principles of rehabilitation and
scar management receive substantial coverage also, as does specialist burns
intensive care and anaesthesia.
Burns remain one of the commonest traumatic injuries, but thankfully
the majority of these are relatively minor, a substantial proportion of which
will be self-managed, managed in the community, managed in primary care,
or managed in the emergency department. Burns experts should not lose
sight of this skew. Similarly, even relatively small burns can result in serious and sometimes life-threatening or life-changing sequelae and require
early specialist input, and this reminder is also worthy of note for generalists and front-line emergency services. We hope this textbook provides,
among other things, a bridge between these two and a rst port of call for
all things burn-related.
Kayvan Shokrollahi, William A. Dickson,
and Iain S. Whitaker
ix
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