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Bovis JL, Walsh K, King IC, Hallam MJ, Gilbert PM. Estimation of wound surface area: an evaluation of medical professionals' assessment in a plastic surgery unit. J Wound Care 2023; 32:376-382. [PMID: 37300857 DOI: 10.12968/jowc.2023.32.6.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The percentage of skin graft take following the resurfacing of burn injuries is routinely calculated in a subjective fashion, in order to make management decisions. Given the gravity of decisions made based on this clinical assessment of graft check, it is notable that limited research has been carried out on this subject. No standardised subjective assessment tools exist to measure surface area of graft take in a manner similar to that of Wallace's Rule of Nines or Lund and Browder. This study set out to examine the accuracy of visual assessments of graft take within the multidisciplinary team regularly making assessments of newly grafted burn wounds. A total of 15 digitally drawn images were used to assess 36 staff members' estimations of percentage of surface area. The results showed a wide variation in estimation in all staff types, including senior burns surgeons, who were found to underestimate surface area by as much as 30%. The British Burns Association has removed 'healing time' as an outcome measurement from its guidance, as it recognises how hard it is to make a standardised assessment of wound healing. This study demonstrates the difficulty in subjectively assessing surface area and makes some suggestions for further research and clinical applications of technology to aid assessment.
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Affiliation(s)
- Joanna L Bovis
- Queen Victoria Hospital, East Grinstead, West Sussex, UK
| | - Karl Walsh
- Queen Victoria Hospital, East Grinstead, West Sussex, UK
| | - Ian Cc King
- Queen Victoria Hospital, East Grinstead, West Sussex, UK
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Ray WC, Rajab A, Alexander H, Chmil B, Rumpf RW, Thakkar R, Viswanathan M, Fabia R. A 1%TBSA chart reduces math errors while retaining acceptable first-estimate accuracy. J Burn Care Res 2021; 43:665-678. [PMID: 34665849 PMCID: PMC9113823 DOI: 10.1093/jbcr/irab192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Life-threatening and treatment-altering errors occur in estimates of the percentage of total body surface area burned (%TBSA burned) with unacceptable frequency. In response, numerous attempts have been made to improve the charts commonly used for %TBSA-burned estimation. Recent research shows that the largest errors in %TBSA-burned estimates probably come from sources other than inaccurate values in the charts. Here, we develop a taxonomy of the possible sources of error and their impact on %TBSA-burned estimates. Also, we observe that different caregivers have different estimation needs: First-responders require a rapid estimate with sufficient accuracy to enable them to begin care and determine patient transport options, while burn surgeons ordering skin grafts desire accuracy to the square centimeter, and can afford considerable time to attain that accuracy. These competing needs suggest that a one-tool-fits-all-caregivers approach is suboptimal. We therefore present a validated, simplified burn chart that minimizes one of the largest sources of random errors in %TBSA-burned estimates—simple calculation errors—while also being quick and requiring little training. NCHart-1 also enables simple consensus estimates, as well as separation of estimation subtasks across caregivers, leading to several potential improvements in mass casualty situations. Our results demonstrate that NCHart-1 possesses the accuracy necessary for first responders, while reliably producing results in less than 2 minutes. Of 76 healthcare professionals surveyed, a large majority indicated a preference for NCHart-1 over their previous methods for ease of both use and training. For clinical or commercial use of NCHart-1, please contact: tech.commercialization@nationwidechildrens.org
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Affiliation(s)
- William C Ray
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus OH.,The Interdisciplinary Graduate Program in Biophysics at The Ohio State University, Columbus OH
| | - Adrian Rajab
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus OH
| | | | | | | | | | - Madhubalan Viswanathan
- Gies College of Business, University of Illinois, Urbana-Champaign IL.,College of Business Administration, Loyola Marymount, University, Los Angeles CA
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Bairagi A, Frear C, Sweeting C, Kimble R, Griffin B. A pilot study comparing two burn wound stereophotogrammetry systems in a paediatric population. Burns 2021; 48:85-90. [PMID: 33934905 DOI: 10.1016/j.burns.2021.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/01/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Stereophotogrammetry (SPG) provides a more objective measurement of burn wound area than traditional clinical assessments. The recently developed Intel® RealSense™ D415/Wound Measure SPG system has yet to undergo formal evaluation in a paediatric population. METHODS A pilot study comparing the Intel® RealSense™ D415/Wound Measure to the previously validated LifeVizII®/DermaPix® SPG system, for burn assessment was conducted at a tertiary paediatric burn centre. Both systems were used to photograph and analyse the same acute wounds for each patient. Three independent raters measured wound area and perimeter. Level of agreement between systems and raters was estimated by calculating the intra-class correlation coefficient. RESULTS Wound area measurements were completed in both systems for 25 burns from 13 patients (median age, 2 years). The participants were mainly female (n = 9), with a median TBSA-B of 9% (IQR 3-20%). There was strong agreement between the systems 0.757 (95% CI 0.521, 0.885, p < 0.001). Within each SPG system, there was excellent inter-rater reliability. CONCLUSION The Intel® RealSense™ D415/Wound Measure system may be a viable addition to the clinician's toolkit in the assessment of paediatric burn wound area. As with other SPG systems, there were significant challenges measuring wounds to highly contoured surfaces.
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Affiliation(s)
- Anjana Bairagi
- Centre for Children's Burns and Trauma Research, Queensland Health Centre for Children's Health Research, Brisbane, Queensland, Australia; Queensland University of Technology, Brisbane, Queensland, Australia; Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia.
| | - Cody Frear
- Centre for Children's Burns and Trauma Research, Queensland Health Centre for Children's Health Research, Brisbane, Queensland, Australia; The University of Queensland, Brisbane, Queensland, Australia.
| | | | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Queensland Health Centre for Children's Health Research, Brisbane, Queensland, Australia; Queensland University of Technology, Brisbane, Queensland, Australia; Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia; The University of Queensland, Brisbane, Queensland, Australia.
| | - Bronwyn Griffin
- Centre for Children's Burns and Trauma Research, Queensland Health Centre for Children's Health Research, Brisbane, Queensland, Australia; Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia; Griffith University, Menzies Health Institute of Queensland, Brisbane, Queensland, Australia.
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A Rule of Thumb for Evaluating Surface Areas of Chronic Wounds. Adv Skin Wound Care 2021; 34:196-202. [PMID: 33739949 DOI: 10.1097/01.asw.0000734372.16803.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rapid estimation of the area of chronic wounds is clinically important. A simple method using the thumb was investigated for universal physical measurement, particularly of small and multiple wounds; the thumb surface area (TSA) was then compared with the total body surface area (TBSA). METHODS A cross-sectional observational study and random sampling were used to obtain the characteristics of 343 participants. Data related to handprint surface area of the thumb and palm were collected using a scanner and laptop and assessed using image software. The TSA as a percentage of TBSA was confirmed based on the traditional rule that regards palmar surface area as 1% of TBSA. Information on factors potentially influencing measurement was gathered with questionnaires to analyze correlations. RESULTS The left and right TSAs were on average 4.27% and 4.28%, respectively, of the palmar surface area for all participants. Multiple linear regression analysis found that male and older participants had higher TSA:TBSA proportions (sex, P = .0020; age, P < .0001). The TSA:TBSA proportion increased by age for both males (by age group, 0.0418%, 0.0426%, 0.0432%, and 0.0460%, respectively) and females (0.0400%, 0.0409%, 0.0427%, and 0.0430%, respectively). CONCLUSIONS Thumb size is relatively stable in relation to TBSA, lending itself to a universal method for estimating the size of chronic wounds as a percentage of TBSA. It therefore represents a convenient physical measurement for assessing the area of burns and other wounds.
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Chavez-Navin M, Ali B, Choi EE, Keffer R, Cooper S, Elks W, Andujo V, Borah G. Surface Area Graphic Evaluation (SAGE) Diagram Documentation in Burn Patients: Room for Quality Improvement. Cureus 2021; 13:e13731. [PMID: 33842109 PMCID: PMC8021001 DOI: 10.7759/cureus.13731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The first step in the management of burn patients is an accurate estimation of the total body surface area (TBSA) involvement. Depending on which, burns are categorized as major (>20%) and minor (<20%). This then dictates fluid resuscitation and level of care. At the University of New Mexico Burn Center, we use Surface Area Graphic Evaluation (SAGE) diagramming to objectively estimate the body surface area involvement. We hypothesized patients undergoing SAGE documentation will have better outcomes. Methods This is a retrospective study of 320 consecutive patients from 2014-2018 at the University of New Mexico Burn Center. Only patients treated surgically were included. We recorded patient demographics, comorbidities, and burn details. The primary measure of interest was SAGE documentation and the secondary measure of interest was outcomes associated with it. Results We found that a SAGE diagram was only documented for a minority of patients (40%). After comparing patients in the SAGE group vs. No SAGE group, we found that the patients were the same in both groups with regards to demographics, comorbidities, and burn characteristics. The use of a SAGE diagram did not appear to be a significant predictor of complications, including surgical site infections, graft loss, donor site complications, postoperative pneumonia, urinary tract infections, deep vein thrombosis, or myocardial infarction (p=0.254). Conclusion Only a minority of patients get a SAGE diagram documented. However, our study did not find any improved outcomes with the use of a SAGE diagram. There is a need for prospective studies to validate the utility of SAGE diagramming in predicting adverse outcomes in major burns.
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Affiliation(s)
| | - Barkat Ali
- Surgery, The University of New Mexico Health Sciences Center, Albuquerque, USA
| | - EunHo Eunice Choi
- Biostatistics, The University of New Mexico Health Sciences Center, Albuquerque, USA
| | - Ryan Keffer
- General Surgery, The University of New Mexico Health Sciences Center, Albuquerque, USA
| | - Sydney Cooper
- General Surgery, Baylor Scott & White Health, Temple, USA
| | - Whitney Elks
- General Surgery, University of Nevada, Las Vegas (UNLV), Las Vegas, USA
| | - Victor Andujo
- General Surgery, Oregon Health and Science University School of Medicine, Portland, USA
| | - Gregory Borah
- Surgery, University of New Mexico School of Medicine, Albuquerque, USA
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Smith K, Poterlowicz K, Southern S, Mahajan AL, Jivan S. The effect of a known object in a static image of a burn to improve the burn size estimation. Burns 2021; 47:1295-1299. [PMID: 33495039 DOI: 10.1016/j.burns.2020.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/27/2020] [Accepted: 12/31/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Currently information regarding burn size from referring departments to burn centres varies in accuracy. Inaccurate assessment of burn size can lead to over or under treatment. Photographs of injuries may improve accuracy of assessment. We aimed to assess the accuracy of measuring burn size on a static image by including a standard object in the image. METHODS Simulated burn areas were drawn on different body parts of the model. Using an iPhone® model 5 s with an 8 megapixel camera we took photos of the marked area, and repeated them with the palm, a standard bank card and a penny in the picture. First the Du Bois formula, was used to calculate body surface area. Members of the Burns team were asked to view the photos (n = 30) and estimate the percentage of the simulated burn. RESULTS We found an overall overestimation of burn size. Small areas of the forearm were better estimated and within 1.1% of the calculated surface area, however we found no improvement when using a standard object in these images. The back areas were most overestimated ranging from 0.9%-8.9% despite all being the same sized area. CONCLUSIONS Static images tend to overestimate burn size despite the use of a standard object in the image.
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Affiliation(s)
- Kirsty Smith
- Plastic Surgery and Burns Research Unit, The University of Bradford, Richmond Road, Bradford, BD7 1DP, UK; Bradford Teaching Hospitals, Duckworth Lane, Bradford, BD9 6RJ, UK.
| | - Krzystof Poterlowicz
- Department of Life Sciences, The University of Bradford, Richmond Road, Bradford, BD7 1DP, UK
| | | | - Ajay L Mahajan
- Plastic Surgery and Burns Research Unit, The University of Bradford, Richmond Road, Bradford, BD7 1DP, UK; Bradford Teaching Hospitals, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Sharmila Jivan
- Pinderfields Hospital, Aberford Road, Wakefield, WF1 4DG, UK
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A digital workflow for design and fabrication of bespoke orthoses using 3D scanning and 3D printing, a patient-based case study. Sci Rep 2020; 10:7028. [PMID: 32341404 PMCID: PMC7184736 DOI: 10.1038/s41598-020-63937-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 04/08/2020] [Indexed: 02/07/2023] Open
Abstract
This study demonstrates the development and application of a novel workflow for designing and fabricating orthoses, using a combination of 3D scanning and 3D printing technologies. The workflow is applied to a clinically relevant translational case study in a patient with a neurological disorder and complex clinical needs. All traditional and commercial approaches to helping the patient’s cervical instability and resulting ‘head-drop’ had previously failed, with associated progressive deterioration in the patient’s clinical state and posture. The workflow was developed to design and fabricate a bespoke device for this patient with no viable alternative therapy. The workflow was developed to generate 3D printable geometry from obtained 3D scan data. The workflow includes algorithms to relax geometry, distribute material efficiently and for variational cutting of orthosis padding material. The 3D patient scan was validated against actual measurements to ensure accuracy of measurements. A total of four prototypes were produced with each iteration being improved based on patient and clinical feedback. There was a progressive improvement in subjective feedback through each iteration at sites of discomfort and overall comfort score. There was a marked improvement in the patient’s posture with correction at the cervical and lumbar spine with the 3D-printed padded collar being worn for 4 hour periods. This study has implications for the rapid production of personalised orthoses which can help reduce patient waiting time, improve patient compliance, reduce pain and reduce further deterioration. The workflow could form the basis for an integrated process, whereby a single hospital visit results in a bespoke orthosis optimised and personalised for each patient.
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Pham C, Collier Z, Gillenwater J. Changing the Way We Think About Burn Size Estimation. J Burn Care Res 2020; 40:1-11. [PMID: 30247559 DOI: 10.1093/jbcr/iry050] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Burn size estimation is a crucial component of acute burn management that guides referral to burn centers, fluid resuscitation parameters, hospital resource distribution, and mortality-based interventions. Referring providers often misestimate the total BSA (TBSA) of burn injury, which contributes to unnecessary healthcare costs, misappropriation of limited resources, and delay in provision of appropriate patient care. A systematic literature review of articles available on PubMed, Scopus, Google Scholar, OvidSP Medline, and Web of Science was performed. All articles were evaluated in a standardized fashion by a panel of reviewers to assess applicability to the research question. Twenty-six relevant articles identified pervasive TBSA miscalculations ranging from 5% to 339% regardless of provider level with < 20% TBSA burns being disproportionately overestimated. This resulted in up to 77% of burns being inappropriately transferred to burn centers from referring hospitals. Improper use of TBSA estimation tools (palm, hand, Rule of 9s) without considering patient body mass index, race, age, and sex standards contributes to TBSA misestimation. Few studies with limited sample sizes argue that TBSA misestimations significantly affect fluid resuscitation volume, although the findings suggest that small burns (<20% TBSA) are over-estimated and over-resuscitated-the opposite of larger burns. TBSA misestimation is associated with an increased incidence of inappropriate transfers to burn centers and the associated costs. The data remains lacking, however, and larger studies are required to further elucidate the clinical impact of such errors. A systematic approach with telemedicine-facilitated computer-based burn assessments is required.
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Affiliation(s)
- Christopher Pham
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles
| | - Zachary Collier
- Division of Plastic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles
| | - Justin Gillenwater
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles.,Division of Plastic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles
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9
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Malone M, Schwarzer S, Walsh A, Xuan W, Al Gannass A, Dickson HG, Bowling FL. Monitoring wound progression to healing in diabetic foot ulcers using three-dimensional wound imaging. J Diabetes Complications 2020; 34:107471. [PMID: 31859145 DOI: 10.1016/j.jdiacomp.2019.107471] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/02/2019] [Accepted: 10/08/2019] [Indexed: 12/19/2022]
Abstract
AIM 3D wound imaging has provided clinicians with even greater wound measurement options. No data is available to guide clinicians as to which 3D measurements may yield the most reflective marker of wound progression to healing. METHOD A prospective pilot study was undertaken to assess the accuracy of five 3D wound measurements that best reflect metrics of interest to clinicians. Twenty-one diabetic foot ulcers were enrolled from initial ulcer presentation, through to healing. The relationship between mean wound healing measurement variables was examined using linear regression and Pearsons correlation coefficient, in addition to assessing clinician inter-rater reliability of measurements using Intra-class correlation coefficients (ICC). RESULTS Statistical analysis demonstrated a linear healing slope for each wound measurement as having a value greater than R 0.70 and a statistical significance of p = 0.0001. This suggests that all five wound measurements are useful prognostic markers of wound progression to healing. Low variability of measurements between users indicates good inter-observer reliability. CONCLUSION 3D wound measurements demonstrate a linear correlation between the measurement and time to healing. This suggests they could be effective prognostic markers of a wounds progression to healing and closure. It may also provide important early identification of wounds not responding to standard care. Larger studies are required to validate our results.
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Affiliation(s)
- Matthew Malone
- High Risk Foot Service, Liverpool Hospital, Locked Bag 7103, Liverpool, NSW 2170, Australia; South West Sydney Limb Preservation and Wound Research, South Western Sydney Local Health District, Ingham Institute of Applied Medical Research, Liverpool, NSW 2170, Australia; Western Sydney University, School of Medicine, Infectious Diseases and Microbiology, Sydney, Australia; Ingham Institute of Applied Medical Research, Liverpool, NSW 2170, Australia.
| | - Saskia Schwarzer
- High Risk Foot Service, Liverpool Hospital, Locked Bag 7103, Liverpool, NSW 2170, Australia; South West Sydney Limb Preservation and Wound Research, South Western Sydney Local Health District, Ingham Institute of Applied Medical Research, Liverpool, NSW 2170, Australia; Ingham Institute of Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Annie Walsh
- High Risk Foot Service, Liverpool Hospital, Locked Bag 7103, Liverpool, NSW 2170, Australia; South West Sydney Limb Preservation and Wound Research, South Western Sydney Local Health District, Ingham Institute of Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Wei Xuan
- Ingham Institute of Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Abdulaziz Al Gannass
- National Guard Health Affairs, Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Hugh G Dickson
- High Risk Foot Service, Liverpool Hospital, Locked Bag 7103, Liverpool, NSW 2170, Australia; South West Sydney Limb Preservation and Wound Research, South Western Sydney Local Health District, Ingham Institute of Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Frank L Bowling
- Central Manchester Foundation Trust, University of Manchester, UK
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Bairagi A, Griffin B, Tyack Z, Vagenas D, McPhail SM, Kimble R. Comparative effectiveness of Biobrane®, RECELL® Autologous skin Cell suspension and Silver dressings in partial thickness paediatric burns: BRACS randomised trial protocol. BURNS & TRAUMA 2019; 7:33. [PMID: 31696127 PMCID: PMC6822367 DOI: 10.1186/s41038-019-0165-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 07/26/2019] [Indexed: 05/05/2023]
Abstract
BACKGROUND Mixed partial thickness burns are the most common depth of burn injury managed at a large Australian paediatric hospital specialty burns unit. Prolonged time until re-epithelialisation is associated with increased burn depth and scar formation. Whilst current wound management approaches have benefits such as anti-microbial cover, these are not without inherent limitations including multiple dressing changes. The Biobrane® RECELL® Autologous skin Cell suspension and Silver dressings (BRACS) trial aims to identify the most effective wound management approach for mixed partial thickness injuries in children. METHODS All children presenting with an acute burn injury to the study site will be screened for eligibility. This is a single-centre, three-arm, parallel group, randomised trial. Children younger than 16 years, with burns ≥ 5% total body surface area involving any anatomical location, up to 48 h after the burn injury, and of a superficial partial to mid-dermal depth, will be included. A sample size of 84 participants will be randomised to standard silver dressing or a Regenerative Epithelial Suspension (RES™) with Biobrane® or Biobrane® alone. The first dressing will be applied under general anaesthesia and subsequent dressings will be changed every 3 to 5 days until the wound is ≥ 95% re-epithelialised, with re-epithelialisation time the primary outcome. Secondary outcomes of acute pain, acute itch, scar severity, health-related quality of life, treatment satisfaction, dressing application ease and healthcare resource use will be assessed at each dressing change and 3, 6 and 12 months post-burn injury. DISCUSSION The findings of this study can potentially change the wound management approach for superficial partial to mid-dermal burns in children locally and worldwide. TRIAL REGISTRATION The Australian New Zealand Clinical Trials Registry (ACTRN12618000245291) approved prospective registration on 15 February 2018. Registration details can be viewed at https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374272&isReview=true.
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Affiliation(s)
- Anjana Bairagi
- Centre for Children’s Burns and Trauma Research, Centre for Children’s Health Research, Brisbane, Queensland, Australia
- Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bronwyn Griffin
- Centre for Children’s Burns and Trauma Research, Centre for Children’s Health Research, Brisbane, Queensland, Australia
- Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Zephanie Tyack
- Centre for Children’s Burns and Trauma Research, Centre for Children’s Health Research, Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- Research Methods Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Steven M. McPhail
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Roy Kimble
- Centre for Children’s Burns and Trauma Research, Centre for Children’s Health Research, Brisbane, Queensland, Australia
- Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
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Boyce ST, Lalley AL. Tissue engineering of skin and regenerative medicine for wound care. BURNS & TRAUMA 2018; 6:4. [PMID: 30009192 PMCID: PMC6040609 DOI: 10.1186/s41038-017-0103-y] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/12/2017] [Indexed: 12/11/2022]
Abstract
Engineering of biologic skin substitutes has progressed over time from individual applications of skin cells, or biopolymer scaffolds, to combinations of cells and scaffolds for treatment, healing, and closure of acute and chronic skin wounds. Skin substitutes may be categorized into three groups: acellular scaffolds, temporary substitutes containing allogeneic skin cells, and permanent substitutes containing autologous skin cells. Combined use of acellular dermal substitutes with permanent skin substitutes containing autologous cells has been shown to provide definitive wound closure in burns involving greater than 90% of the total body surface area. These advances have contributed to reduced morbidity and mortality from both acute and chronic wounds but, to date, have failed to replace all of the structures and functions of the skin. Among the remaining deficiencies in cellular or biologic skin substitutes are hypopigmentation, absence of stable vascular and lymphatic networks, absence of hair follicles, sebaceous and sweat glands, and incomplete innervation. Correction of these deficiencies depends on regulation of biologic pathways of embryonic and fetal development to restore the full anatomy and physiology of uninjured skin. Elucidation and integration of developmental biology into future models of biologic skin substitutes promises to restore complete anatomy and physiology, and further reduce morbidity from skin wounds and scar. This article offers a review of recent advances in skin cell thrapies and discusses the future prospects in cutaneous regeneration.
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Affiliation(s)
- Steven T Boyce
- 1Department of Surgery, University of Cincinnati, P.O. Box 670558, Cincinnati, Ohio 45267-0558 USA.,2Research Department, Shriners Hospitals for Children, Cincinnati, Ohio USA
| | - Andrea L Lalley
- 2Research Department, Shriners Hospitals for Children, Cincinnati, Ohio USA
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