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Radzikowska-Büchner E, Łopuszyńska I, Flieger W, Tobiasz M, Maciejewski R, Flieger J. An Overview of Recent Developments in the Management of Burn Injuries. Int J Mol Sci 2023; 24:16357. [PMID: 38003548 PMCID: PMC10671630 DOI: 10.3390/ijms242216357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
According to the World Health Organization (WHO), around 11 million people suffer from burns every year, and 180,000 die from them. A burn is a condition in which heat, chemical substances, an electrical current or other factors cause tissue damage. Burns mainly affect the skin, but can also affect deeper tissues such as bones or muscles. When burned, the skin loses its main functions, such as protection from the external environment, pathogens, evaporation and heat loss. Depending on the stage of the burn, the patient's condition and the cause of the burn, we need to choose the most appropriate treatment. Personalization and multidisciplinary collaboration are key to the successful management of burn patients. In this comprehensive review, we have collected and discussed the available treatment options, focusing on recent advances in topical treatments, wound cleansing, dressings, skin grafting, nutrition, pain and scar tissue management.
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Affiliation(s)
- Elżbieta Radzikowska-Büchner
- Department of Plastic, Reconstructive and Maxillary Surgery, National Medical Institute of the Ministry of the Interior and Administration, Wołoska 137 Street, 02-507 Warszawa, Poland;
| | - Inga Łopuszyńska
- Department of Plastic, Reconstructive and Maxillary Surgery, National Medical Institute of the Ministry of the Interior and Administration, Wołoska 137 Street, 02-507 Warszawa, Poland;
| | - Wojciech Flieger
- Department of Human Anatomy, Medical University of Lublin, Jaczewskiego 4 Street, 20-090 Lublin, Poland;
| | - Michał Tobiasz
- Department of Plastic Surgery, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, Krasnystawska 52 Street, 21-010 Łęczna, Poland;
| | - Ryszard Maciejewski
- Faculty of Medicine, University of Warsaw, Żwirki i Wigury 101 Street, 02-089 Warszawa, Poland;
| | - Jolanta Flieger
- Department of Analytical Chemistry, Medical University of Lublin, Chodźki 4A Street, 20-093 Lublin, Poland
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Kennedy DL, Chism-Balangue T, Furniss D. Reporting of scar outcomes in the hand and wrist; a state-of-the-art literature review. BMC Musculoskelet Disord 2023; 24:249. [PMID: 37004025 PMCID: PMC10064537 DOI: 10.1186/s12891-023-06296-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 03/07/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVES The aim of this literature review was to synthesise and report current practice in evaluation and reporting of scar outcomes in hand and wrist clinical research. METHODS A systematic search from inception to 2022 was conducted using three electronic databases. English language randomized controlled trials and observational cohort studies reporting standardised scar outcome measures and/or scar symptoms, appearance, impairment, function, or mental health outcomes in patients with hand and wrist scars were included. Two independent reviewers determined study eligibility and performed data extraction of a priori identified scar outcome domains. Data analysis included descriptive statistics and identification of discordance in taxonomy. RESULTS Fifty-nine studies were included. Elective surgery cohorts were the most frequently included clinical population (n = 28; 47%) followed by burns (n = 16; 27%). Six different standardised scar outcome measures were reported by 25% of studies however only 7% of studies utilised a patient-reported measure. Scar symptoms were the most frequently reported outcome domain (81%); but taxonomy was incongruous, constructs lacked working definitions required for generalisability and outcome measurement was variable and unreported. Nineteen different measures of scar appearance and structure were reported by 30 (51%) of studies however only nine (23%) were patient-reported. Seven different hand function PROMs were reported by 25 (43%) studies. Person-centred domains including scar acceptability (12%), mental health impact (5%), and social participation (4%) were rarely reported. CONCLUSIONS This review highlights that evaluation and reporting of hand and wrist scar outcomes is not standardised, assessment methods and measures are under-reported and there is discordance in taxonomy. Evaluation is not person-centred, rather it is dependent on clinician assessment. Domains including scar acceptability, mental health, and social participation are rarely addressed. A stakeholder consensus derived hand and wrist scar core outcome measurement set will promote standardisation and underpin improvements in clinical research quality, transparency, and rigour.
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Affiliation(s)
- Donna L Kennedy
- Therapy Department, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK.
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, UK.
| | | | - Dominic Furniss
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Science, University of Oxford, Botnar Research Centre, Oxford, UK
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desJardins-Park HE, Gurtner GC, Wan DC, Longaker MT. From Chronic Wounds to Scarring: The Growing Health Care Burden of Under- and Over-Healing Wounds. Adv Wound Care (New Rochelle) 2022; 11:496-510. [PMID: 34521257 PMCID: PMC9634983 DOI: 10.1089/wound.2021.0039] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 09/03/2021] [Indexed: 12/26/2022] Open
Abstract
Significance: Wound healing is the largest medical market without an existing small molecule/drug treatment. Both "under-healing" (chronic wounds) and "over-healing" (scarring) cause a substantial biomedical burden and lifelong consequences for patients. These problems cost tens of billions of dollars per year in the United States alone, a number expected to grow as the population ages and the prevalence of common comorbidities (e.g., diabetes) rises. However, no therapies currently exist to produce the "ideal" healing outcome: efficient wound repair through regeneration of normal tissue. Recent Advances: Ongoing research continues to illuminate possible therapeutic avenues for wound healing. By identifying underlying mechanisms of wound repair-for instance, tissue mechanics' role in fibrosis or cell populations that modulate wound healing and scarring-novel molecular targets may be defined. This Advances in Wound Care Forum issue includes reviews of scientific literature and original research from the Hagey Laboratory for Pediatric Regenerative Medicine at Stanford and its alumni, including developing approaches for encouraging wound healing, minimizing fibrosis, and coaxing regeneration. Critical Issues: Wound healing problems reflect an enormous and rapidly expanding clinical burden. The issues of both under- and over-healing wound outcomes will continue to expand as their underlying causes (e.g., diabetes) grow. Targeted treatments are needed to enable wound repair with functional tissue restoration and decreased scarring. Future Directions: Basic scientists will continue to refine understanding of factors driving undesirable wound outcomes. These discoveries are beginning to be translated and, in the coming years, will hopefully form the foundation for antiscarring drugs and other wound therapeutics.
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Affiliation(s)
- Heather E. desJardins-Park
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery; Stanford, California, USA
- Institute for Stem Cell Biology and Regenerative Medicine; Stanford University School of Medicine, Stanford, California, USA
| | - Geoffrey C. Gurtner
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery; Stanford, California, USA
| | - Derrick C. Wan
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery; Stanford, California, USA
| | - Michael T. Longaker
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery; Stanford, California, USA
- Institute for Stem Cell Biology and Regenerative Medicine; Stanford University School of Medicine, Stanford, California, USA
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Nguyen JQ, Sanjar F, Karna SLR, Fourcaudot AB, Wang LJ, Silliman DT, Lai Z, Chen Y, Leung KP. Comparative Transcriptome Analysis of Superficial and Deep Partial-Thickness Burn Wounds in Yorkshire vs Red Duroc Pigs. J Burn Care Res 2022; 43:1299-1311. [PMID: 35255138 DOI: 10.1093/jbcr/irac028] [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: 11/13/2022]
Abstract
Hypertrophic scars are a common negative outcome of deep partial-thickness burn wounds resulting in increased dermal thickness, wound area contracture, and inflammation of the affected area. The red Duroc and Yorkshire porcine breeds are common large animal models for studying dermal wounds due to their structural similarities to human skin; however, the porcine transcriptomic profiles of dermal burn wounds and healing process are not well known. In response, a longitudinal transcriptomic comparative study was conducted comparing red Duroc and Yorkshire superficial and DPT burn wounds to their respective control uninjured tissue. Using next-generation RNA-sequencing, total RNAs were isolated from burn wound tissue harvested at 0, 3, 7, 15, 30, and 60 days post-burn and mRNA-seq and gene expression read counts were generated. Significant differentially expressed genes relative to uninjured tissue were defined and active biological processes were determined using gene set enrichment analyses. Additionally, collagen deposition, α-SMA protein concentration, epidermal and dermal thickness measurements, and wound area changes in response to burn injury were characterized. Overall, the red Duroc pigs, in response to both burn wound types, elicited a more robust and prolonged inflammatory immune response, fibroblast migration and proliferation as well as heightened levels of extracellular matrix modulation relative to respective burn types in the Yorkshire pigs. Collectively, the red Duroc deep partial-thickness burn wounds produce a greater degree of hypertrohic scar like response compared to Yorkshire DPT burn wounds. These findings will facilitate future porcine burn studies down-selecting treatment targets and determining effects of novel therapeutic strategies.
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Affiliation(s)
- Jesse Q Nguyen
- Division of Combat Wound Repair, US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, USA
| | - Fatemeh Sanjar
- Division of Combat Wound Repair, US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, USA
| | - S L Rajasekhar Karna
- Division of Combat Wound Repair, US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, USA
| | - Andrea B Fourcaudot
- Division of Combat Wound Repair, US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, USA
| | - Li-Ju Wang
- Greehey Childern's Cancer Research Institute, University of Texas - Health San Antonio, San Antonio, TX
| | - David T Silliman
- Division of Combat Wound Repair, US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, USA
| | - Zhao Lai
- Greehey Childern's Cancer Research Institute, University of Texas - Health San Antonio, San Antonio, TX.,Department of Molecular Medicine, University of Texas - Health San Antonio, San Antonio, TX
| | - Yidong Chen
- Greehey Childern's Cancer Research Institute, University of Texas - Health San Antonio, San Antonio, TX.,Department of Epidemiology and Biostatistics, University of Texas - Health San Antonio, San Antonio, TX
| | - Kai P Leung
- Division of Combat Wound Repair, US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, USA
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Wang Q, Zhang X, Sun W, Li H. Clinical study on vacuum assisted closure combined with multiple flaps in the treatment of severe hand trauma. Pak J Med Sci 2022; 38:248-253. [PMID: 35035434 PMCID: PMC8713221 DOI: 10.12669/pjms.38.1.4631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/20/2021] [Accepted: 08/30/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives: To investigate the effect and clinical value of the application of vacuum assisted closure (VAC) combined with multiple flaps in the treatment of severe hand trauma. Methods: A total of 100 patients with severe hand trauma admitted to Harrison International Peace Hospital from September 2015 to September 2020 were selected and randomly divided into two groups according to the randomized block method: the single flap repair group and the combined repair group, with 50 patients in each group. Patients in the single flap repair group underwent flap repair according to their condition, while those in the combined repair group were treated with VAC prior to flap repair. The range of motion and hand sensation scores were compared between the two groups, and their levels of interleukin-8 (IL-8), tumor necrosis factor (TNF) and lipopolysaccharide (LPS) were tested by enzyme-linked immunosorbent assay (ELIS). Moreover, the flap survival rate and the incidence of adverse events were recorded and compared between the two groups. Results: Compared with the single flap repair group, the combined repair group had higher range of motion and hand sensation score (p<0.05), lower levels of IL-8, TNF and LPS (p<0.05), higher flap survival rate (p<0.05), and lower incidence of adverse events (p<0.05). Conclusion: VAC combined with multiple flaps boasts significant trauma repair effect and preferable clinical application value in the treatment of patients with severe hand trauma, which is principally reflected in significantly improving the hand function of patients and remarkably alleviating the inflammatory response of patients.
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Affiliation(s)
- Quan Wang
- Quan Wang, Department of Hand and foot surgery, Harrison International Peace Hospital, Hebei, Hengshui 053000, China
| | - Xu Zhang
- Xu Zhang, Department of Orthopedics, Orthopedic Hospital of Sichuan Province, Chengdu, Sichuan 610041, China
| | - Wentao Sun
- Wentao Sun, Department of Hand and foot surgery, Harrison International Peace Hospital, Hebei, Hengshui 053000, China
| | - Hua Li
- Hua Li, Department of Hand and foot surgery, Harrison International Peace Hospital, Hebei, Hengshui 053000, China
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An injectable adhesive antibacterial hydrogel wound dressing for infected skin wounds. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 134:112584. [DOI: 10.1016/j.msec.2021.112584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/11/2021] [Accepted: 11/27/2021] [Indexed: 11/18/2022]
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da Costa PTL, Echevarría-Guanilo ME, Gonçalves N, Girondi JBR, Gonçalves ADC. Subjective Tools for Burn Scar Assessment: An Integrative Review. Adv Skin Wound Care 2021; 34:1-10. [PMID: 33979826 DOI: 10.1097/01.asw.0000749732.09228.a9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To review the clinical and scientific literature on the subjective ways of assessing burn scars and describe their main characteristics. DATA SOURCES The Latin American, Caribbean Health Sciences Literature, Nursing Database, PubMed, CINAHL, and Scopus and Web of Science databases were used to search for studies published between 2014 and 2018 using descriptors in Portuguese, Spanish, and English. STUDY SELECTION After establishing the research question and the location and definition of the studies, as well as accounting for differences among databases and application of filters based on inclusion and exclusion criteria, 886 references remained. DATA EXTRACTION Investigators reviewed the titles and abstracts of the sample and selected 188 relevant studies for full review. DATA SYNTHESIS Twenty-six subjective forms of assessment were found; most research concerned the Patient and Observer Scar Assessment Scale and the Vancouver Scar Scale. CONCLUSIONS The Patient and Observer Scar Assessment Scale and the Vancouver Scar Scale are the most common scales for assessing burn scars and have similar evaluation points such as vascularization, pliability, pigmentation, and height, which are the main parameters that contribute to the general assessment and severity of a scar. There is a need to improve instructions for application of the scales to facilitate better understanding and improve agreement among evaluators.
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Affiliation(s)
- Pollyana Thays Lameira da Costa
- At the Department of Nursing, Universidade Federal de Santa Catarina, Florianópolis, Brazil, Pollyana Thays Lameira da Costa, MSN, RN, is a Doctorate Student and Maria Elena Echevarría Guanilo, DNP, RN; Natália Gonçalves, PhD, RN; and Juliana Balbinot Reis Girondi, PhD, RN, are Professors. Adriana da Costa Gonçalves, PhD, is Professor of Physical Therapy, Centro Universitário Barão de Mauá de Ribeirão Preto, Brazil. Acknowledgment: This study was completed as part of a scholarship funded by the Higher Education Personnel Improvement Coordination (Coordenação Aperfeiçoamento Pessoal do Nível Superior). The authors have disclosed no other financial relationships related to this article. Submitted September 3, 2020; accepted in revised form November 5, 2020
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Batra N, Zheng Y, Alberto EC, Ahmed OZ, Cheng M, Shupp JW, Burd RS. Pediatric Treadmill Friction Burns to the Hand: Outcomes of an Initial Nonoperative Approach. J Burn Care Res 2021; 42:434-438. [PMID: 33022715 DOI: 10.1093/jbcr/iraa178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Treadmill burns that occur from friction mechanism are a common cause of hand burns in children. These burns are deeper and more likely to require surgical intervention compared to hand burns from other mechanisms. The purpose of this study was to identify the factors associated with healing time using an initial nonoperative approach. A retrospective chart review was performed examining children (<15 years) who were treated for treadmill burns to the hand between 2012 and 2019. Patient age, burn depth, total body surface area of the hand injury, and time to healing were recorded. Topical wound management strategies (silver sheet, silver cream, non-silver sheet, and non-silver cream) and associated treatment durations were determined. For patients with burns to bilateral hands, the features, treatment, and outcomes of each hand were assessed separately. Cox regression analysis was used to evaluate the association between time to healing and patient characteristics and treatment type. Seventy-seven patients with 86 hand burns (median age 3 years, range 1-11) had a median total body surface area per hand burn of 0.8% (range 0.1-1.5%). Full-thickness burns (n = 47, 54.7%) were associated with longer time to healing compared to partial-thickness burns (HR 0.28, CI 0.15-0.54, P < .001). Silver sheet treatment was also associated with more rapid time to healing compared to treatment with a silver cream (HR 2.64, CI 1.01-6.89, P = .047). Most pediatric treadmill burns can be managed successfully with a nonoperative approach. More research is needed to confirm the superiority of treatment with silver sheets compared to treatment with silver creams.
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Affiliation(s)
- Nikita Batra
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
| | - Yinan Zheng
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
| | - Emily C Alberto
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
| | - Omar Z Ahmed
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
| | - Megan Cheng
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
| | - Jeffrey W Shupp
- Burn Center, MedStar Washington Hospital Center, Department of Surgery, Georgetown University School of Medicine, District of Columbia
| | - Randall S Burd
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
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Dargan D, Kazzazi D, Limnatitou D, Cochrane E, Stubbington Y, Shokrollahi K, Ralston D. Acute Management of Thermal Hand Burns in Adults: A 10-Year Review of the Literature. Ann Plast Surg 2021; 86:517-531. [PMID: 33675628 DOI: 10.1097/sap.0000000000002755] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Advances in the evidence base of acute thermal hand burns help to guide the management of these common injuries. The aim of this literature review was to evaluate recent evidence in the field over 10 years. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols methodology was used as a guide for this literature review. PubMed, MEDLINE, EMBASE, CINAHL, and Google Scholar were searched for English language articles related to hand burns published between 2009 and 2018 inclusive, and the Cochrane Library was reviewed. Exclusion criteria were as follows: participants younger than 18 years, scar or contracture management, rehabilitation, outcomes assessment, late reconstruction, and electrical or chemical burns. RESULTS An initial search retrieved 6493 articles, which was narrowed to 403 full-text articles that were reviewed independently by 3 of the authors and categorized. Of 202 included articles, there were 8 randomized controlled trials and 2 systematic reviews. Six evidence-based guidelines were reviewed. Referral of hand burns to specialist centers, use of telemedicine, early excision and grafting, and immediate static splintage have been recommended. Enzymatic debridement results in earlier intervention, more accurate burn assessment, preservation of vital tissue, and fewer skin grafts, and ideally requires regional anesthesia. Guidance on escharotomy emphasizes indication, technique and adequate intervention, and potential for enzymatic debridement. Inclusion of topical negative pressure, dermal regenerative templates, acellular dermal matrices, and noncellular skin substitutes in management has helped improve scar and functional outcomes. DISCUSSION The results of this literature review demonstrate that multiple national and international societies have published burns guidelines during the decade studied, with aspects directly relevant to hand burns, including the International Society for Burn Injuries guidelines. There are opportunities for evidence-based quality improvement across the field of hand burns in many centers. CONCLUSIONS More than 200 articles globally in 10 years outline advances in the understanding of acute management of thermal hand burns. Incorporating the evidence base into practice may facilitate optimization of triage referral pathways and acute management for hand burns.
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Affiliation(s)
| | - Diana Kazzazi
- From the Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital
| | | | - Elliott Cochrane
- From the Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital
| | | | - Kayvan Shokrollahi
- Mersey Regional Burns Centre, St Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Merseyside, Prescot, United Kingdom
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Salehi SH, Momeni M, Vahdani M, Moradi M. Clinical Value of Debriding Enzymes as an Adjunct to Standard Early Surgical Excision in Human Burns: A Systematic Review. J Burn Care Res 2020; 41:1224-1230. [PMID: 32424404 DOI: 10.1093/jbcr/iraa074] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Burns are a significant public health burden worldwide. In addition to those who die, millions remain with life-threatening deformities and disabilities resulting in stigma and rejection. Surgical excision is currently the standard of care for removing necrotic tissues in burn wounds to prepare the wound bed for grafting or enhancing the healing process. However, there is a growing interest on enzymatic debridement as an adjunct therapy in burn wounds. The aim of this study was to investigate clinical trials using debriding agents for burn wound in humans in a systematic review. This was a systematic review of electronic databases including CINAHL, PubMed, Ovid Medline, Web of Science, Google Scholar, and Embase from January 1969 to February 2019. The study protocol was registered in PROSPERO registry. The following keywords were searched: "burn wounds", "enzymatic debridement", "papain", "papain-urea", "pine apple", "Bromelain", "collagenases", "Nexobrid", "Debrase", "Debridase", "Actinidia deliciosa", "Sutilains", "Debrace", "piruvat acid". Those studies fulfilling the inclusion and exclusion criteria with low score of bias based on Cochrane Bias Tool were reviewed. Sixteen investigations fulfilled our inclusion criteria to be reviewed. Six, seven, and three clinical trials on humans were found regarding collagenase, bromelain, and miscellaneous agents. Collagenase has been reported to be effective in burns below 25% of TBSA, especially in outpatients' clinics. However, Nexobrid has been shown to be effective in deep burns and decreases the percentage of graft without significant adverse effects. There was not enough evidence supporting the clinical values of Papain, Sutilains, Urea, etc. Surgical excision still remains the standard of care for burn wounds debridement. However, enzymatic debridement, especially Bromelain might help to reduce sessions for surgical debridement or area under graft as an adjunct treatment. Despite the fact, more studies with larger sample sizes and with less conflicts of interest are needed to clearly elucidate the exact role of Bromelain.
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Affiliation(s)
- Seyed Hamid Salehi
- Department of Surgery, Motahari Burn Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahnoush Momeni
- Department of Surgery, Motahari Burn Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Vahdani
- Department of general surgery, Shahed faculty of medicine, shahed university, Tehran, Iran
| | - Mohammad Moradi
- Department of General Surgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
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Zheng Z, Bian S, Li Z, Zhang Z, Liu Y, Zhai X, Pan H, Zhao X. Catechol modified quaternized chitosan enhanced wet adhesive and antibacterial properties of injectable thermo-sensitive hydrogel for wound healing. Carbohydr Polym 2020; 249:116826. [PMID: 32933673 DOI: 10.1016/j.carbpol.2020.116826] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 06/29/2020] [Accepted: 07/23/2020] [Indexed: 02/08/2023]
Abstract
Wound dressings based on injectable thermo-sensitive hydrogel possess several advantages over preformed conventional dressings such as rapid reversible sol-gel transition behavior and the capacity of filling the irregular wound defect. Nevertheless, its clinical application is hindered by the weak tissue adhesiveness. Therefore, in this study, the catechol modified quaternized chitosan (QCS-C) was fabricated and incorporated into poly(d,l-lactide)-poly(ethylene glycol)-poly(d,l-lactide) (PLEL) hydrogel to develop an injectable hydrogel with the properties of thermo-sensitive, antibacterial and tissue adhesive. QCS-C could lower the LCST of hydrogel for easy gelation at physiological temperature, and significantly enhanced the tissue adhesion. For wound generation, nano-scaled bioactive glass (nBG:80 SiO2, 16 CaO and 4 P2O5; mol%) was loaded into hydrogel to promote angiogenesis. The mice partial laceration experiment showed that PLEL-nBG-QCS-C hydrogel could effectively seal the ruptured skin and significantly accelerate wound healing. Thus, our findings established a new type of clinical treatment technology for complicated wounds.
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Affiliation(s)
- Zhiqiang Zheng
- Research Center for Human Tissue and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology Chinese Academy of Sciences, Shenzhen, 518055, PR China
| | - Shaoquan Bian
- Research Center for Human Tissue and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology Chinese Academy of Sciences, Shenzhen, 518055, PR China
| | - Zhiqiang Li
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, PR China
| | - Zhiyang Zhang
- School of Materials Science and Engineering, The Key Laboratory of Advanced Ceramics and Machining Technology by the Ministry of Education of China, Tianjin University, 300072, Tianjin, PR China
| | - Yuan Liu
- Research Center for Human Tissue and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology Chinese Academy of Sciences, Shenzhen, 518055, PR China
| | - Xinyun Zhai
- Tianjin Key Lab for Rare Earth Materials and Applications, School of Materials Science and Engineering, Nankai University, 300350, Tianjin, PR China
| | - Haobo Pan
- Research Center for Human Tissue and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology Chinese Academy of Sciences, Shenzhen, 518055, PR China
| | - Xiaoli Zhao
- Research Center for Human Tissue and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology Chinese Academy of Sciences, Shenzhen, 518055, PR China.
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12
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Lotfi M, Mirza Aghazadeh A, Davami B, Khajehgoodari M, Aziz karkan H, Khalilzad MA. Development of nursing care guideline for burned hands. Nurs Open 2020; 7:907-927. [PMID: 32587709 PMCID: PMC7308693 DOI: 10.1002/nop2.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 11/24/2019] [Accepted: 12/09/2019] [Indexed: 11/26/2022] Open
Abstract
Aim To develop an evidence-based guideline to care for hand-burned patients. Design An integrative review. Method The search was conducted of EMBASE, PubMed, Web of Science, SCOPUS, Clinical Key, Iranmedex, Magiran, Scientific Information Database (SID), Cochran, CINAHL and Google Scholar databases from January 2000-August 2019. Following the formation of the research team, two researchers independently selected the eligible studies. The initial search resulted in 2,230 records; ultimately, 40 articles were identified to be the review after screening the records based on the study's inclusion and exclusion criteria. Quality of selected studies was evaluated with the MMAT method. Results Data syntheses of selected studies, coded by highlighting the relevant parts of the text, and assigning code words to these areas were done. Following this, a constant comparison was used to develop categories by combining codes. Finally, hand burns nursing care guideline was developed by categorizing descriptive themes in two main phases. Conclusion This review results have shown that evidence-based guidelines present high-quality recommendations for the healthcare team, which improves the quality of clinical care. Due to a lack of established guidelines in our context, it seems to be helpful to use evidence-based guidelines in managing burned hands.
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Affiliation(s)
- Mojgan Lotfi
- Department of Medical Surgical NursingFaculty of Nursing and MidwiferySina HospitalTabriz University of Medical SciencesTabrizIran
| | - Ahmad Mirza Aghazadeh
- Department of Basic sciencesParamedical FacultyTabriz University of Medical SciencesTabrizIran
| | - Babak Davami
- Faculty of MedicineSina HospitalTabriz University of Medical SciencesTabrizIran
| | - Mohammad Khajehgoodari
- Department of Medical Surgical NursingFaculty of Nursing and MidwiferyTabriz University of Medical SciencesTabrizIran
| | - Hanieh Aziz karkan
- Department of Medical Surgical NursingFaculty of Nursing and MidwiferyTabriz University of Medical SciencesTabrizIran
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Liu M, Zhu H, Yan R, Yang J, Zhan R, Yu X, Hu X, Zhang X, Luo G, Qian W. Epidemiology and Outcome Analysis of 470 Patients with Hand Burns: A Five-Year Retrospective Study in a Major Burn Center in Southwest China. Med Sci Monit 2020; 26:e918881. [PMID: 32417848 PMCID: PMC7222659 DOI: 10.12659/msm.918881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background This retrospective study aimed to investigate the epidemiology of burns to the hand, including the causes, demographic data, management, and outcome in a single center in Southwest China between 2012 and 2017. Material/Methods A retrospective study included 470 patients with hand burns who were treated at a single hospital in Southwest China between 2012 and 2017. Demographic, injury-related, and clinical data were obtained from the clinical electronic data collection system. Results In 470 patients, men were more commonly admitted to hospital with hand burns (73.62%). Children under 10 years (29.57%) were the main patient group. Hospital admissions occurred in the coldest months, from December to March (55.11%). In 60.21% of cases, hand burns occurred outside the workplace. Fire (40.42%), electricity (30.85%), and hot liquids (20.21%) were the main causes of hand burns. Data from 428 patients showed that burns with a larger total body surface area and deeper burns were associated with surgery and amputation. Burn depth was a risk factor for skin grafting, and lack of burn cooling before hospital admission increased the risk of amputation. Data from 117 patients with localized burns showed that full-thickness burns and lack of cooling before admission were associated with an increased hospital stay. Conclusions The findings suggest that in Southwest China, prevention programs for children aged 0–9 years, injuries occurring in winter and non-workplace sites, and fire burns were imperative.
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Affiliation(s)
- Mian Liu
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University (Third Military Medical University), People's Liberation Army (PLA), Chongqing, China (mainland)
| | - Haijie Zhu
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University (Third Military Medical University), People's Liberation Army (PLA), Chongqing, China (mainland)
| | - Rongshuai Yan
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University, People's Liberation Army (PLA), Chongqing, China (mainland)
| | - Jiacai Yang
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University (Third Military Medical University), People's Liberation Army (PLA), Chongqing, China (mainland)
| | - Rixing Zhan
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University (Third Military Medical University), People's Liberation Army (PLA), Chongqing, China (mainland)
| | - Xunzhou Yu
- Department of Burn and Plastic Surgery, 80th Group Military Hospital, Weifang, Shandong, China (mainland)
| | - Xiaohong Hu
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University (Third Military Medical University), People's Liberation Army (PLA), Chongqing, China (mainland)
| | - Xiaorong Zhang
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University (Third Military Medical University), People's Liberation Army (PLA), Chongqing, China (mainland)
| | - Gaoxing Luo
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University (Third Military Medical University), People's Liberation Army (PLA), Chongqing, China (mainland)
| | - Wei Qian
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University (Third Military Medical University), People's Liberation Army (PLA), Chongqing, China (mainland)
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14
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Development and characterization of chitosan/polyvinyl alcohol polymer material with elastolytic and collagenolytic activities. Enzyme Microb Technol 2020; 132:109399. [DOI: 10.1016/j.enzmictec.2019.109399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 11/18/2022]
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15
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Karim AS, Shaum K, Gibson AL. Indeterminate-Depth Burn Injury—Exploring the Uncertainty. J Surg Res 2020; 245:183-197. [DOI: 10.1016/j.jss.2019.07.063] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/31/2019] [Accepted: 07/19/2019] [Indexed: 01/08/2023]
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Rashaan ZM, Krijnen P, Kwa KA, van der Vlies CH, Schipper IB, Breederveld RS. Flaminal® versus Flamazine® in the treatment of partial thickness burns: A randomized controlled trial on clinical effectiveness and scar quality (FLAM study). Wound Repair Regen 2019; 27:257-267. [PMID: 30675745 PMCID: PMC6850327 DOI: 10.1111/wrr.12699] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 11/30/2022]
Abstract
Although partial thickness burns are the most frequently reported burn injuries, there is no consensus on the optimal treatment. The objective of this study was to compare the clinical effectiveness and scar quality of Flaminal® Forte to silver sulfadiazine (Flamazine®) in the treatment of partial thickness burns. In this two-arm open label multicenter randomized controlled trial, adult patients with acute partial thickness burns and an affected total body surface area of less than 30% were randomized between Flaminal® Forte and Flamazine® and followed for 12 months. Dressing changes in the Flamazine® group were performed daily, and in the Flaminal® group during the first 3 days post burn and thereafter every other day until complete wound healing or surgery. Forty-one patients were randomly allocated to Flaminal® Forte and 48 patients to Flamazine®. The primary outcome was time to wound healing, which did not differ between the groups: median 18 days with Flaminal® Forte (range 8-49 days) versus 16 days with Flamazine® (range 7-48 days; p = 0.24). Regarding the secondary outcomes during hospital admission, there were no statistically significant differences between the groups concerning need for surgery, pain scores, pruritus, or pain-related and anticipatory anxiety. More patients in the Flaminal® group developed wound colonization (78% versus 32%, p < 0.001), but the treatment groups did not differ regarding the incidence of local infections and use of systemic antibiotics. In terms of scar quality, no statistically significant differences between both treatment groups were found regarding subjective scar assessment (Patient and Observer Scar Assessment Scale (POSAS)), scar melanin and pigmentation (DermaSpectrometer®), and scar elasticity and maximal extension (Cutometer®) during 12 month postburn. In conclusion, time to wound healing did not differ, but the use of Flaminal® Forte seemed favorable because less dressing changes are needed which lowers the burden of wound care.
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Affiliation(s)
- Zjir M. Rashaan
- Department of SurgeryLeiden University Medical CentreLeidenThe Netherlands
- Department of SurgeryRed Cross HospitalBeverwijkThe Netherlands
- Burn CentreRed Cross HospitalBeverwijkThe Netherlands
| | - Pieta Krijnen
- Department of SurgeryLeiden University Medical CentreLeidenThe Netherlands
| | - Kelly A.A. Kwa
- Department of SurgeryLeiden University Medical CentreLeidenThe Netherlands
- Burn CentreRed Cross HospitalBeverwijkThe Netherlands
| | - Cornelis H. van der Vlies
- Burn Centre and Department of SurgeryMaasstad HospitalRotterdamThe Netherlands
- Trauma Research Unit Department of Surgery, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Inger B. Schipper
- Department of SurgeryLeiden University Medical CentreLeidenThe Netherlands
| | - Roelf S. Breederveld
- Department of SurgeryLeiden University Medical CentreLeidenThe Netherlands
- Burn CentreRed Cross HospitalBeverwijkThe Netherlands
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