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Schlottmann F, Bucan V, Vogt PM, Krezdorn N. A Short History of Skin Grafting in Burns: From the Gold Standard of Autologous Skin Grafting to the Possibilities of Allogeneic Skin Grafting with Immunomodulatory Approaches. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:225. [PMID: 33801228 PMCID: PMC7998351 DOI: 10.3390/medicina57030225] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/05/2021] [Accepted: 02/22/2021] [Indexed: 12/13/2022]
Abstract
Due to groundbreaking and pioneering developments in the last century, significant improvements in the care of burn patients have been achieved. In addition to the still valid therapeutic standard of autologous split-thickness skin grafting, various commercially available skin substitutes are currently available. Significant progress in the field of tissue engineering has led to the development of promising therapeutic approaches. However, scientific advances in the field of allografting and transplant immunology are of great importance. The achievement of various milestones over the past decades has provided thought-provoking impulses in the field of skin allotransplantation. Thus, biologically viable skin allotransplantation is still not a part of the clinical routine. The purpose of this article is to review the achievements in burn surgery with regards to skin allotransplantation in recent years.
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Affiliation(s)
- Frederik Schlottmann
- Department of Plastic, Aesthetic, Hand- and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany; (V.B.); (P.M.V.); (N.K.)
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Huang X, Guo F, Zhou Z, Chang M, Wang F, Dou Y, Wang Z, Huan J. Relation between dynamic changes of platelet counts and 30-day mortality in severely burned patients. Platelets 2017; 30:158-163. [PMID: 29252068 DOI: 10.1080/09537104.2017.1379599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Thrombocytopenia is a common event in severely burned patients and associated with adverse outcome. The underlying relationship between the dynamic changes of platelet counts and mortality has not been well defined. We performed a 6-year retrospective chart of adult patients with a burn index of 50 or greater admitted to two burn centers and collected data on patient demographics, laboratory results, and patient outcomes. The mean daily increase in the platelet count (∆PC/∆t) from day 3 to day 10 was calculated, and 30-day mortality was determined. For the study, 141 survivors and 65 nonsurvivors were enrolled. The sequential changes in PCs presented a biphasic pattern after admission, with a slump to the nadir during the first 3 days and a subsequent recovery. With respect to 30-day mortality, compared with the AUC of APACHE-Ⅱ score (0.841), no significant difference was noted between ΔPC/ΔT and APACHE-Ⅱ score (p = 0.0648). The ΔPC/ΔT associated with the best discrimination between survivors and nonsurvivors was 20.57 × 109/L due to the cutoff with optimal Youden index (0.453). By multiple logistic regression, ΔPC/ΔT < 20.57 × 109/L was one of the prognostic predictors of 30-day mortality. Furthermore, Kaplan-Meier estimates of hospital survival according to the size of ΔPC/ΔT revealed that a blunted increase with ΔPC/ΔT < 20.57 × 109/L was associated with increased 30-day mortality. A blunted daily increase in PCs, especially ΔPC/ΔT < 20.57 × 109/L, is associated with increased 30-day mortality, which provides prognostic information for mortality risk assessment in severely burned patients.
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Affiliation(s)
- Xiaoqin Huang
- a Department of Burn and Plastic Surgery , Shanghai Jiao Tong University, School of Medicine, Rui Jin Hospital , Shanghai , China
| | - Feng Guo
- a Department of Burn and Plastic Surgery , Shanghai Jiao Tong University, School of Medicine, Rui Jin Hospital , Shanghai , China
| | - Zengding Zhou
- a Department of Burn and Plastic Surgery , Shanghai Jiao Tong University, School of Medicine, Rui Jin Hospital , Shanghai , China
| | - Mengling Chang
- a Department of Burn and Plastic Surgery , Shanghai Jiao Tong University, School of Medicine, Rui Jin Hospital , Shanghai , China
| | - Fei Wang
- b Department of Burns , the First Affiliated Hospital of Anhui Medical University , Hefei , Anhui , China
| | - Yi Dou
- a Department of Burn and Plastic Surgery , Shanghai Jiao Tong University, School of Medicine, Rui Jin Hospital , Shanghai , China
| | - Zhiyong Wang
- a Department of Burn and Plastic Surgery , Shanghai Jiao Tong University, School of Medicine, Rui Jin Hospital , Shanghai , China
| | - Jingning Huan
- a Department of Burn and Plastic Surgery , Shanghai Jiao Tong University, School of Medicine, Rui Jin Hospital , Shanghai , China
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Auxenfans C, Shipkov H, Bach C, Catherine Z, Lacroix P, Bertin-Maghit M, Damour O, Braye F. Cultured allogenic keratinocytes for extensive burns: a retrospective study over 15 years. Burns 2013; 40:82-8. [PMID: 23764150 DOI: 10.1016/j.burns.2013.05.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Revised: 03/25/2013] [Accepted: 05/13/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED The aim was to review the use and indications of cultured allogenic keratinocytes (CAlloK) in extensive burns and their efficiency. MATERIALS AND METHODS This retrospective study comprised 15 years (1997-2012). INCLUSION CRITERIA all patients who received CAlloK. EXCLUSION CRITERIA patients who died before complete healing. Evaluation criteria were clinical. Time and success of wound healing after CAlloK use were evaluated. RESULTS The CAlloK were used for 2 indications - STSG donor sites and deep 2nd degree burns in extensively burned patients. A total of 70 patients were included with severity Baux score of 99.2 (from 51 to 144) and mean percentage of TBSA of 63.49% (from 21 to 96%). Fifty nine patients received CAlloK for STSG donor sites with a mean number of applications of 4 and mean surface of 3800 cm(2) per patient. Treated donor sites were re-harvested 2.5 times. The mean time of complete epithelialization was 7 days. In 11 patients, CAlloK were used for deep 2nd degree burns. The mean percentage of burned surface was 73.7%. The mean surface of CAlloK per patient was 2545 cm(2). Complete healing was achieved in 6.4 days. CONCLUSION The CAlloK allow rapid healing of STSG donor-sites and deep 2nd second degree burns in extensively burned patients.
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Affiliation(s)
- Celine Auxenfans
- Bank of Skin Substitutes, Edouard Herriot Hospital, Lyon, France; Department of Burns and Plastic and Reconstructive Surgery, Edouard Herriot Hospital, Lyon, France
| | - Hristo Shipkov
- Bank of Skin Substitutes, Edouard Herriot Hospital, Lyon, France; Department of Burns and Plastic and Reconstructive Surgery, Edouard Herriot Hospital, Lyon, France.
| | - Christine Bach
- Bank of Skin Substitutes, Edouard Herriot Hospital, Lyon, France; Department of Burns and Plastic and Reconstructive Surgery, Edouard Herriot Hospital, Lyon, France
| | - Zulma Catherine
- Bank of Skin Substitutes, Edouard Herriot Hospital, Lyon, France; Department of Burns and Plastic and Reconstructive Surgery, Edouard Herriot Hospital, Lyon, France
| | - Pierre Lacroix
- Bank of Skin Substitutes, Edouard Herriot Hospital, Lyon, France; Department of Burns and Plastic and Reconstructive Surgery, Edouard Herriot Hospital, Lyon, France
| | - Marc Bertin-Maghit
- Bank of Skin Substitutes, Edouard Herriot Hospital, Lyon, France; Department of Burns and Plastic and Reconstructive Surgery, Edouard Herriot Hospital, Lyon, France
| | - Odile Damour
- Bank of Skin Substitutes, Edouard Herriot Hospital, Lyon, France; Department of Burns and Plastic and Reconstructive Surgery, Edouard Herriot Hospital, Lyon, France
| | - Fabienne Braye
- Bank of Skin Substitutes, Edouard Herriot Hospital, Lyon, France; Department of Burns and Plastic and Reconstructive Surgery, Edouard Herriot Hospital, Lyon, France
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Guo F, Wang X, Huan J, Liang X, Chen B, Tang J, Gao C. Association of platelet counts decline and mortality in severely burnt patients. J Crit Care 2012; 27:529.e1-7. [DOI: 10.1016/j.jcrc.2011.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 12/02/2011] [Accepted: 12/08/2011] [Indexed: 11/16/2022]
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Wendt H, Hillmer A, Reimers K, Kuhbier JW, Schäfer-Nolte F, Allmeling C, Kasper C, Vogt PM. Artificial skin--culturing of different skin cell lines for generating an artificial skin substitute on cross-weaved spider silk fibres. PLoS One 2011; 6:e21833. [PMID: 21814557 PMCID: PMC3144206 DOI: 10.1371/journal.pone.0021833] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 06/12/2011] [Indexed: 12/31/2022] Open
Abstract
Background In the field of Plastic Reconstructive Surgery the development of new innovative matrices for skin repair is in urgent need. The ideal biomaterial should promote attachment, proliferation and growth of cells. Additionally, it should degrade in an appropriate time period without releasing harmful substances, but not exert a pathological immune response. Spider dragline silk from Nephila spp meets these demands to a large extent. Methodology/Principal Findings Native spider dragline silk, harvested directly out of Nephila spp spiders, was woven on steel frames. Constructs were sterilized and seeded with fibroblasts. After two weeks of cultivating single fibroblasts, keratinocytes were added to generate a bilayered skin model, consisting of dermis and epidermis equivalents. For the next three weeks, constructs in co-culture were lifted on an originally designed setup for air/liquid interface cultivation. After the culturing period, constructs were embedded in paraffin with an especially developed program for spidersilk to avoid supercontraction. Paraffin cross- sections were stained in Haematoxylin & Eosin (H&E) for microscopic analyses. Conclusion/Significance Native spider dragline silk woven on steel frames provides a suitable matrix for 3 dimensional skin cell culturing. Both fibroblasts and keratinocytes cell lines adhere to the spider silk fibres and proliferate. Guided by the spider silk fibres, they sprout into the meshes and reach confluence in at most one week. A well-balanced, bilayered cocultivation in two continuously separated strata can be achieved by serum reduction, changing the medium conditions and the cultivation period at the air/liquid interphase. Therefore spider silk appears to be a promising biomaterial for the enhancement of skin regeneration.
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Affiliation(s)
- Hanna Wendt
- Department of Plastic, Hand, and Reconstructive Surgery, Medical School Hannover, Hannover, Germany.
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Guo F, Chen XL, Wang YJ, Wang F, Chen XY, Sun YX. Management of burns of over 80% of total body surface area: a comparative study. Burns 2008; 35:210-4. [PMID: 18786768 DOI: 10.1016/j.burns.2008.05.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Accepted: 05/11/2008] [Indexed: 11/27/2022]
Abstract
The aim of this retrospective, comparative study was to analyse the management of extensive burns so as to decrease morbidity and mortality. Over 1987-1996, 24 people with burns >80% of total body surface area and >50% full-thickness burn were admitted to the burn unit of Anhui Medical University Hospital (group A); 30 similar admissions over 1997-2006 formed group B. No significant difference was found in age, male:female ratio, % total body surface or full-thickness burn area between the two groups. Severe shock developed in 19/24 cases in group A and 23/30 cases in group B, following inadequate fluid resuscitation, although group B received a higher mean resuscitation fluid volume during the first 24h after burn. Early excision and grafting was performed for 8/24 people in group A and 23/30 in group B. Inhalation injury was seen in 18/24 cases in group A and 28/30 cases in group B. Prophylactic tracheotomy was undergone by 8/24 casualties in group A and 22/30 in group B. Mortality in group A was significantly higher than in group B (95.8% vs. 63.3%, p<0.05) and survival was longer in group B. These results showed that refinements in burn shock resuscitation, and advances in early wound excision, skin grafting and respiratory management were associated with decreased morbidity and mortality after severe burn.
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Affiliation(s)
- Feng Guo
- Department of Burns, First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, PR China
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Yongqiang F, Yibing W, Dechang W, Baohua L, Mingqing W, Ran H. Epidemiology of Hospitalized Burn Patients in Shandong Province: 2001–2005. J Burn Care Res 2007; 28:468-73. [PMID: 17438493 DOI: 10.1097/bcr.0b013e318053d28b] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of the article was to describe the epidemiology of burn injuries requiring hospitalization at Shandong Provincial Hospital and to provide information necessary for the design and implementation of effective prevention programs. The records of patients with burn injury admitted to our burn unit over a 5-year period (1 January 2001 to 31 December 2005) were reviewed. Medical record review provided basic demographic information and details on the extent of injury, time of day burns occurred, month of admission, cause of burn, accident site, first aid, number of operations, length of hospital stay, and mortality. There was no trend in annual admissions. The male-to-female ratio was 3:1. The age distribution of burn patients showed peaks occurring at the age groups of 0 to 10 and 20 to 30 years. Over the course of a day, burn injuries occurred most frequently from 1700 to 1900 hours. Scalds accounted for 45.23% (502) of the 1110 patients, and flame burns accounted for 42.33% (471). Only 29% of all patients received proper first aid with cool water or burn cream. The average length of hospital stay was 22 days. Children under 10 years and adults between 20 and 30 years of age are the most susceptible populations, and first aid is performed poorly in Shandong Province. Burn prevention and first aid education campaigns should be launched to encourage safe lifestyle and work habits.
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Affiliation(s)
- Feng Yongqiang
- Department of Burn & Plastic Surgery, Shandong Provincial Hospital, Shandong University, Jinan 250021, China
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LaBorde P. Burn epidemiology: the patient, the nation, the statistics, and the data resources. Crit Care Nurs Clin North Am 2004; 16:13-25. [PMID: 15062410 DOI: 10.1016/j.ccell.2003.10.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Throughout the years, bum care treatment in the United States has made major strides in the ability to save the lives of those once rendered helpless as a result of an extensive bum injury. Bum care professionals are able to assist these individuals to live as normal a life as possible as they heal from one of the most devastating injuries a human being can endure. The only way to remedy the suffering and the costs in health care resources and in productivity is to reduce the incidence of bum injuries and death. Communities must be concerned with consistently establishing preventive measures and with the proactive treatment of bums to help decrease incidence. Activities on the community, state, and national level to obtain accurate data regarding the epidemiologic characteristics must be implemented to provide a more accurate picture of bum injuries in the United States. Addressing issues surrounding the persons at high risk of bum injury will help to decrease the incidence of bum trauma. Funding must be strengthened to ensure the continued existence of bum programs that truly provide high-quality standards of care. In these programs, the burn victim is given every opportunity to become a survivor. In light of the recent terrorist activity in the United States, the nation must address another area that might affect the history of bum care and treatment, the multiple-trauma victim with an extensive burn injury caused by massive explosions, chemical warfare,missiles, and weapons of mass destruction. One out-come from the recent terrorist attack was recognition of the need for facilities to be capable of providing care for this type of patient. Efforts to strengthen these programs and bum care facilities must be continued to maintain and strengthen the care needed for bum patients of the future.
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Affiliation(s)
- Pam LaBorde
- Patient Care Services, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 526, Little Rock, AR 72205, USA.
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Abstract
The increase in the survival rate of burned patients has stressed the need to study their rehabilitation. The purpose of our study was to characterize the factors influencing such patients' return to work. We conducted a mail survey among 316 patients aged 15-65 years, treated at Töölö Hospital Burns Unit between 11 November 1988 and 31 December 1994. Of 175 participants, 130 (74 per cent) were men and 45 (26 per cent) women. The mean TBSA was 14.0 per cent, mean FT 6.4 per cent and the mean time of hospital treatment (TOT) 17.5 days. Statistical significance was calculated by Mann-Whitney U test, Kruskall-Wallis one-way analysis of variance and Chi-square test as appropriate, with a probability level of 0.05. In the study, 54 per cent of patients whose burn area was 1-10 per cent, returned to work within 2 months. No difference was found between patients who had hand burns and those who had burn injuries in other parts of the body. Patients who did not return to work were significantly older (mean age 45 years) than those who did (mean ages varying from 33 to 36 years; P < 0.05). Total body surface area burned (TBSA), FT, TOT, age and employment status at the time of injury were the factors predicting the resumption of working ability after burn injury.
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Affiliation(s)
- K Tanttula
- Department of Plastic Surgery, Töölö Hospital, Helsinki University Central Hospital, Finland
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Periti P, Donati L. Survival and therapy of burn patients at the threshold of the twenty-first century: a review. J Chemother 1995; 7:475-502. [PMID: 8667032 DOI: 10.1179/joc.1995.7.6.475] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This review summarizes the progress achieved in care of burned patients over the last half century by analyzing the most significant results published between 1949 and 1995. Improved survival has paralleled the development of new antibiotics as well as major advances in resuscitation, nutritional support, immunomodulating agents, surgical techniques and wound care. Today the average burn size associated with a 50% mortality breakpoint is about 70% of the total body surface area--a notable increase over figures from the past.
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Affiliation(s)
- P Periti
- Department of Pharmacology, University of Florence, Italy
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Abstract
This study attempts to measure and quantify changes in workload and outcome in clinically ill burn patients admitted to the intensive care unit at this institution over the 11-year period 1982-92. The case notes were studied for all patients admitted to the intensive care unit, 163 cases in total, but information was incomplete in 14. Mortality over the period is compared, using Chi squared analysis with Yates correction, with mortality probability from Bull's chart relating age and body surface area of burn (1971). The trends show increasing admission rates and referral rates to ICU from other hospitals in the region, despite declining admission rates to the regional burn unit as a whole. The duration of stay for admitted patients also shows an increase, the combination of these factors suggesting an increasing workload. There has been no change in outcome over the period. The figures provide a baseline for comparison of outcome in critically ill burn patients and are an important means by which to measure future change.
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Affiliation(s)
- D C Jerwood
- South Birmingham Trauma Unit, General Hospital, UK
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Abstract
This report gives the results of follow-up observations on patients with massive burns covering > or = 50 percent TBSA (total body surface area) who survived for more than 2 years. The relationship between the functional and occupational recovery, and a discussion of the factors that may influence the functional rehabilitation and return to occupation or productivity, are presented.
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Affiliation(s)
- J Xiao
- Burn and Plastic Surgery Department, 205 Hospital, Jin Zhou, Liao Ning, PR China
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