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Omotoye S, Singleton MJ, Zagrodzky J, Clark B, Sharma D, Metzl MD, Gallagher MM, Meininghaus DG, Leung L, Garg J, Warrier N, Panico A, Tamirisa K, Sanchez J, Mickelsen S, Sardana M, Shah D, Athill C, Hayat J, Silva R, Clark AT, Gray M, Levi B, Kulstad E, Girouard S, Zagrodzky W, Montoya MM, Bustamante TG, Berjano E, González-Suárez A, Daniels J. Mechanisms of action behind the protective effects of proactive esophageal cooling during radiofrequency catheter ablation in the left atrium. Heart Rhythm O2 2024; 5:403-416. [PMID: 38984358 PMCID: PMC11228283 DOI: 10.1016/j.hroo.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Abstract
Proactive esophageal cooling for the purpose of reducing the likelihood of ablation-related esophageal injury resulting from radiofrequency (RF) cardiac ablation procedures is increasingly being used and has been Food and Drug Administration cleared as a protective strategy during left atrial RF ablation for the treatment of atrial fibrillation. In this review, we examine the evidence supporting the use of proactive esophageal cooling and the potential mechanisms of action that reduce the likelihood of atrioesophageal fistula (AEF) formation. Although the pathophysiology behind AEF formation after thermal injury from RF ablation is not well studied, a robust literature on fistula formation in other conditions (eg, Crohn disease, cancer, and trauma) exists and the relationship to AEF formation is investigated in this review. Likewise, we examine the abundant data in the surgical literature on burn and thermal injury progression as well as the acute and chronic mitigating effects of cooling. We discuss the relationship of these data and maladaptive healing mechanisms to the well-recognized postablation pathophysiological effects after RF ablation. Finally, we review additional important considerations such as patient selection, clinical workflow, and implementation strategies for proactive esophageal cooling.
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Affiliation(s)
| | | | - Jason Zagrodzky
- St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas
| | | | | | - Mark D. Metzl
- NorthShore University Health System, Evanston, Illinois
| | - Mark M. Gallagher
- St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Lisa Leung
- St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jalaj Garg
- Loma Linda University Medical Center, Loma Linda, California
| | - Nikhil Warrier
- MemorialCare Heart & Vascular Institute, Fountain Valley, California
| | | | - Kamala Tamirisa
- Cardiac Electrophysiology, Texas Cardiac Arrhythmia Institute, Dallas, Texas
| | - Javier Sanchez
- Cardiac Electrophysiology, Texas Cardiac Arrhythmia Institute, Dallas, Texas
| | | | | | - Dipak Shah
- Ascension Providence Hospital, Detroit, Michigan
| | | | - Jamal Hayat
- Department of Gastroenterology, St George’s University Hospital, London, United Kingdom
| | - Rogelio Silva
- Department of Medicine, Division of Gastroenterology, University of Illinois at Chicago, Chicago, Illinois
- Advocate Aurora Christ Medical Center, Chicago, Illinois
| | - Audra T. Clark
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Benjamin Levi
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Erik Kulstad
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | | | | | - Enrique Berjano
- Department of Electronic Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Ana González-Suárez
- Translational Medical Device Lab, School of Medicine, University of Galway, Galway, Ireland
- Valencian International University, Valencia, Spain
| | - James Daniels
- University of Texas Southwestern Medical Center, Dallas, Texas
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An H, Gu Z, Huang Z, Huo T, Xu Y, Dong Y, Wen Y. Novel microneedle platforms for the treatment of wounds by drug delivery: A review. Colloids Surf B Biointerfaces 2024; 233:113636. [PMID: 37979482 DOI: 10.1016/j.colsurfb.2023.113636] [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: 08/28/2023] [Revised: 10/25/2023] [Accepted: 11/06/2023] [Indexed: 11/20/2023]
Abstract
The management and treatment of wounds are complex and pose a substantial financial burden to the patient. However, the complex environment of wounds leads to inadequate drug absorption to achieve the desired therapeutic effect. As a novel technological platform, microneedles are widely used in drug delivery because of their multiple drug loading, multistage drug release, and multiple designs of topology. This study systematically summarizes and analyzes the manufacturing methods and limitations of different microneedles, as well as the latest research advances in pain management, drug delivery, and healing promotion, and presents the challenges and opportunities for clinical applications. On this basis, the development of microneedles in external wound repair and management is envisioned, and it is hoped that this study can provide guidelines for the design of microneedle systems in different application contexts, including the selection of materials, preparation methods, and structural design, to achieve better healing and regeneration results.
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Affiliation(s)
- Heng An
- Beijing Key Laboratory for Bioengineering and Sensing Technology, Daxing Research Institute, School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Zhen Gu
- Beijing Key Laboratory for Bioengineering and Sensing Technology, Daxing Research Institute, School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Zhe Huang
- Beijing Key Laboratory for Bioengineering and Sensing Technology, Daxing Research Institute, School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Tong Huo
- Beijing Key Laboratory for Bioengineering and Sensing Technology, Daxing Research Institute, School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Yongxiang Xu
- Department of Dental Materials, Peking University School and Hospital of Stomatology, Beijing, 100081 China.
| | | | - Yongqiang Wen
- Beijing Key Laboratory for Bioengineering and Sensing Technology, Daxing Research Institute, School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing 100083, China.
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3
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Watson F, Chen R, Percival SL. In vitro prevention and inactivation of biofilms using controlled-release iodine foam dressings for wound healing. Int Wound J 2024; 21:e14365. [PMID: 37715349 PMCID: PMC10788590 DOI: 10.1111/iwj.14365] [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: 06/20/2023] [Revised: 08/02/2023] [Accepted: 08/08/2023] [Indexed: 09/17/2023] Open
Abstract
Microbial biofilms are a major hindrance in the wound healing process, prolonging the inflammatory response phase, thus making them a target in treatment. The aim of this study is to assess the antibacterial properties of commercially available wound dressings, of various material composition and antibacterial agents, towards multiple in vitro microbial and biofilm models. A variety of in vitro microbial and biofilm models were utilised to evaluate the ability of wound dressing materials to sequester microbes, prevent dissemination and manage bioburden. Sequestering and dissemination models were used to evaluate the ability of wound dressing materials to prevent the biofilm-forming bacterium, Pseudomonas aeruginosa, from migrating through dressing materials over a 24-72 h challenge period. Additionally, Centre for Disease Control (CDC) Bioreactor and Drip Flow models were used to evaluate antibacterial killing efficacy towards established P. aeruginosa and Staphylococcus aureus biofilms using more challenging, wound-like models. Controlled-release iodine foam and silver-impregnated carboxymethylcellulose (CMC) wound dressing materials demonstrated potent biofilm management properties in comparison to a methylene blue and gentian violet-containing foam dressing. Both the iodine-containing foam and silver-impregnated CMC materials effectively prevented viable P. aeruginosa dissemination for up to 72 h. In addition, the controlled-release iodine foam and silver-impregnated CMC materials reduced P. aeruginosa bioburden in the Drip Flow model. The controlled-release iodine foam demonstrated superiority in the CDC Bioreactor model, as both the silver- and iodine-containing materials reduced S. aureus to the limit of detection, but P. aeruginosa growth was only completely reduced by controlled-release iodine foam dressing materials. The data generated within the in vitro biofilm models supports the clinical data available in the public domain for the implementation of iodine foam dressings for effective biofilm management and control in wound care.
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Affiliation(s)
- Fergus Watson
- Centre of Excellence for Biofilm Science (CEBS)5D Health Protection Group Ltd.LiverpoolUK
| | - Rui Chen
- Centre of Excellence for Biofilm Science (CEBS)5D Health Protection Group Ltd.LiverpoolUK
| | - Steven L. Percival
- Centre of Excellence for Biofilm Science (CEBS)5D Health Protection Group Ltd.LiverpoolUK
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4
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Su L, Jia Y, Fu L, Guo K, Xie S. The emerging progress on wound dressings and their application in clinic wound management. Heliyon 2023; 9:e22520. [PMID: 38076148 PMCID: PMC10709065 DOI: 10.1016/j.heliyon.2023.e22520] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND In addition to its barrier function, the skin plays a crucial role in maintaining the stability of the body's internal environment and normal physiological functions. When the skin is damaged, it is important to select proper dressings as temporary barriers to cover the wound, which can exert significant effects on defence against microbial infection, maintaining normal tissue/cell functions, and coordinating the process of wound repair and regeneration. It now forms an important approach in clinic practice to facilitate wound repair. SEARCH STRATEGIES We conducted a comprehensive literature search using online databases including PubMed, Web of Science, MEDLINE, ScienceDirect, Wiley Online Library, CNKI, and Wanfang Data. In addition, information was obtained from local and foreign books on biomaterials science and traumatology. RESULTS This review focuses on the efficacy and principles of functional dressings for anti-bacteria, anti-infection, anti-inflammation, anti-oxidation, hemostasis, and wound healing facilitation; and analyses the research progress of dressings carrying living cells such as fibroblasts, keratinocytes, skin appendage cells, and stem cells from different origins. We also summarize the recent advances in intelligent wound dressings with respect to real-time monitoring, automatic drug delivery, and precise adjustment according to the actual wound microenvironment. In addition, this review explores and compares the characteristics, advantages and disadvantages, mechanisms of actions, and application scopes of dressings made from different materials. CONCLUSION The real-time and dynamic acquisition and analysis of wound conditions are crucial for wound management and prognostic evaluation. Therefore, the development of modern dressings that integrate multiple functions, have high similarity to the skin, and are highly intelligent will be the focus of future research, which could drive efficient wound management and personalized medicine, and ultimately facilitate the translation of health monitoring into clinical practice.
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Affiliation(s)
- Linlin Su
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, 710032, China
| | - Yanhui Jia
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, 710032, China
| | - Lanqing Fu
- Department of Orthopedics, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, 430063, China
| | - Kai Guo
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, 710032, China
| | - Songtao Xie
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, 710032, China
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Ring NAR, Dworak H, Bachmann B, Schädl B, Valdivieso K, Rozmaric T, Heimel P, Fischer I, Klinaki E, Gutasi A, Schuetzenberger K, Leinfellner G, Ferguson J, Drechsler S, Mildner M, Schosserer M, Slezak P, Meyuhas O, Gruber F, Grillari J, Redl H, Ogrodnik M. The p-rpS6-zone delineates wounding responses and the healing process. Dev Cell 2023; 58:981-992.e6. [PMID: 37098351 DOI: 10.1016/j.devcel.2023.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/31/2023] [Accepted: 04/01/2023] [Indexed: 04/27/2023]
Abstract
The spatial boundaries of tissue response to wounding are unknown. Here, we show that in mammals, the ribosomal protein S6 (rpS6) is phosphorylated in response to skin injury, forming a zone of activation surrounding the region of the initial insult. This p-rpS6-zone forms within minutes after wounding and is present until healing is complete. The zone is a robust marker of healing as it encapsulates features of the healing process, including proliferation, growth, cellular senescence, and angiogenesis. A mouse model that is unable to phosphorylate rpS6 shows an initial acceleration of wound closure, but results in impaired healing, identifying p-rpS6 as a modulator but not a driver of healing. Finally, the p-rpS6-zone accurately reports on the status of dermal vasculature and the effectiveness of healing, visually dividing an otherwise homogeneous tissue into regions with distinct properties.
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Affiliation(s)
- Nadja Anneliese Ruth Ring
- Ludwig Boltzmann Research Group Senescence and Healing of Wounds, 1200 Vienna, Austria; Ludwig Boltzmann Institute for Traumatology, The Research Centre in Cooperation with AUVA, 1200 Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Helene Dworak
- Ludwig Boltzmann Research Group Senescence and Healing of Wounds, 1200 Vienna, Austria; Ludwig Boltzmann Institute for Traumatology, The Research Centre in Cooperation with AUVA, 1200 Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Barbara Bachmann
- Ludwig Boltzmann Research Group Senescence and Healing of Wounds, 1200 Vienna, Austria; Ludwig Boltzmann Institute for Traumatology, The Research Centre in Cooperation with AUVA, 1200 Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Barbara Schädl
- Ludwig Boltzmann Institute for Traumatology, The Research Centre in Cooperation with AUVA, 1200 Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria; University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Karla Valdivieso
- Ludwig Boltzmann Research Group Senescence and Healing of Wounds, 1200 Vienna, Austria; Ludwig Boltzmann Institute for Traumatology, The Research Centre in Cooperation with AUVA, 1200 Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria; Institute of Molecular Biotechnology, Department of Biotechnology, University of Natural Resources and Life Sciences, 1180 Vienna, Austria
| | - Tomaz Rozmaric
- Ludwig Boltzmann Research Group Senescence and Healing of Wounds, 1200 Vienna, Austria; Ludwig Boltzmann Institute for Traumatology, The Research Centre in Cooperation with AUVA, 1200 Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Patrick Heimel
- Ludwig Boltzmann Institute for Traumatology, The Research Centre in Cooperation with AUVA, 1200 Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria; Core Facility Hard Tissue and Biomaterial Research, Karl Donath Laboratory, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Ines Fischer
- Ludwig Boltzmann Institute for Traumatology, The Research Centre in Cooperation with AUVA, 1200 Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Eirini Klinaki
- Ludwig Boltzmann Institute for Traumatology, The Research Centre in Cooperation with AUVA, 1200 Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Aniko Gutasi
- Ludwig Boltzmann Institute for Traumatology, The Research Centre in Cooperation with AUVA, 1200 Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Kornelia Schuetzenberger
- Ludwig Boltzmann Institute for Traumatology, The Research Centre in Cooperation with AUVA, 1200 Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Gabriele Leinfellner
- Ludwig Boltzmann Institute for Traumatology, The Research Centre in Cooperation with AUVA, 1200 Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - James Ferguson
- Ludwig Boltzmann Institute for Traumatology, The Research Centre in Cooperation with AUVA, 1200 Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Susanne Drechsler
- Ludwig Boltzmann Institute for Traumatology, The Research Centre in Cooperation with AUVA, 1200 Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Michael Mildner
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria
| | - Markus Schosserer
- Austrian Cluster for Tissue Regeneration, Vienna, Austria; Institute of Molecular Biotechnology, Department of Biotechnology, University of Natural Resources and Life Sciences, 1180 Vienna, Austria; Institute of Medical Genetics, Center for Pathobiochemistry and Genetics, Medical University of Vienna, 1090 Vienna, Austria
| | - Paul Slezak
- Ludwig Boltzmann Institute for Traumatology, The Research Centre in Cooperation with AUVA, 1200 Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Oded Meyuhas
- Department of Biochemistry and Molecular Biology, Institute for Medical Research Israel-Canada, Hebrew University-Hadassah Medical School, 91120 Jerusalem, Israel
| | - Florian Gruber
- Austrian Cluster for Tissue Regeneration, Vienna, Austria; Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria
| | - Johannes Grillari
- Ludwig Boltzmann Institute for Traumatology, The Research Centre in Cooperation with AUVA, 1200 Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria; Institute of Molecular Biotechnology, Department of Biotechnology, University of Natural Resources and Life Sciences, 1180 Vienna, Austria
| | - Heinz Redl
- Ludwig Boltzmann Research Group Senescence and Healing of Wounds, 1200 Vienna, Austria; Ludwig Boltzmann Institute for Traumatology, The Research Centre in Cooperation with AUVA, 1200 Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Mikolaj Ogrodnik
- Ludwig Boltzmann Research Group Senescence and Healing of Wounds, 1200 Vienna, Austria; Ludwig Boltzmann Institute for Traumatology, The Research Centre in Cooperation with AUVA, 1200 Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria.
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Zhao Y, Liu J, Ding Z, Ge W, Wang S, Zhang J. ATP-induced hypothermia improves burn injury and relieves burn pain in mice. J Therm Biol 2023; 114:103563. [PMID: 37344025 DOI: 10.1016/j.jtherbio.2023.103563] [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: 11/14/2021] [Revised: 03/05/2023] [Accepted: 04/02/2023] [Indexed: 06/23/2023]
Abstract
Thermal burn injury is a severe and life-threatening form of trauma that presents a significant challenge to clinical therapy. Therapeutic hypothermia has been shown to be beneficial in various human pathologies. Adenosine triphosphate (ATP) induces a hypothermic state that resembles hibernation-like suspended animation in mammals. This study investigates the potential protective role of ATP-induced hypothermia in thermal burn injury. Male C57BL/6 mice underwent a sham procedure or third-degree burn, and ATP-induced hypothermia was applied immediately or 1 h after burn injury. Our results show that ATP-induced hypothermia significantly improved burn depth progression and reduced collagen degradation. Moreover, hypothermia induced by ATP alleviated burn-induced hyperinflammatory responses and oxidative stress. Metabolomic profiling revealed that ATP-induced hypothermia reversed the shifts of metabolic profiles of the skin in burn mice. In addition, ATP-induced hypothermia relieved nociceptive and inflammatory pain, as observed in the antinociceptive test. Our findings suggest that ATP-induced hypothermia attenuates burn injury and provides new insights into first-aid therapy after thermal burn injury.
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Affiliation(s)
- Yang Zhao
- Center for Molecular Metabolism, Nanjing University of Science & Technology, Nanjing, 210094, China
| | - Junhao Liu
- Center for Molecular Metabolism, Nanjing University of Science & Technology, Nanjing, 210094, China
| | - Zhao Ding
- Center for Molecular Metabolism, Nanjing University of Science & Technology, Nanjing, 210094, China
| | - Wenhao Ge
- Center for Molecular Metabolism, Nanjing University of Science & Technology, Nanjing, 210094, China
| | - Shiming Wang
- Center for Molecular Metabolism, Nanjing University of Science & Technology, Nanjing, 210094, China
| | - Jianfa Zhang
- Center for Molecular Metabolism, Nanjing University of Science & Technology, Nanjing, 210094, China.
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7
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Ciudad P, Escandón JM, Bravo LL, Manrique OJ. Management of Facial Second-Degree Burns with Nanocellulose-Based Dressing: A Case Series and Systematic Review. Facial Plast Surg 2023; 39:130-141. [PMID: 35609875 DOI: 10.1055/a-1860-8504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Previous studies have evaluated the effectiveness of bacterial nanocellulose (BNC) for the treatment of thermal injuries, but the synergic effect of platelet-rich plasma (PRP) with BNC-based dressing for burns still requires further investigation. Herein, we evaluated the effectiveness of BNC dressings in the management of facial burns using PRP. Patients with second-degree facial burns were treated with BNC-based wound dressings after debridement. The burn's depth and epithelialization were evaluated by clinical assessment. Besides using the dressings, we injected PRP subcutaneously into the left-hemifacial burns. The right hemiface was only treated with the dressings. Scar quality was assessed using the Patient and Observer Scar Assessment Scale (POSAS). Eight patients were included with superficial second-degree burns in 75% of the cases and deep second-degree burns in 25%. Overall, dressings were placed 3.25 days after the initial insult. None of the patients presented with complications after dressing placement. Dressing changes were not required, and no further surgical management was necessary. The mean time for epithelialization was 11.4 days. During subgroup analysis, we did not find a significant difference in the epithelialization time when comparing BNC-based dressings (11.8 days) to BNC-based dressings + PRP (11 days, p = 0.429). The mean POSAS scores from a patient (17 vs. 12.3, p = 0.242) and surgeon (13.5 vs. 11.3, p = 0.26) standpoint were not significantly different using BNC-based dressings versus BNC-based dressings + PRP. Nanocellulose-based dressings are effective to treat second-degree facial burns. It enhances reepithelialization with optimal esthetic outcomes with or without PRP.
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Affiliation(s)
- Pedro Ciudad
- Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru
- Academic Department of Surgery, Hipolito Unanue School of Medicine, Federico Villarreal National University, Lima, Peru
| | - Joseph M Escandón
- Division of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Strong Memorial Hospital, New York, New York
| | - Lilyan L Bravo
- Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru
| | - Oscar J Manrique
- Division of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Strong Memorial Hospital, New York, New York
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Ong XR, Chen AX, Li N, Yang YY, Luo HK. Nanocellulose: Recent Advances Toward Biomedical Applications. SMALL SCIENCE 2022. [DOI: 10.1002/smsc.202200076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Xuan-Ran Ong
- Agency for Science, Technology and Research Institute of Sustainability for Chemicals, Energy and Environment 1 Pesek Road, Jurong Island Singapore 627833 Singapore
| | - Adrielle Xianwen Chen
- Agency for Science, Technology and Research Institute of Bioengineering and Bioimaging 31 Biopolis Way Singapore 138669 Singapore
| | - Ning Li
- Agency for Science, Technology and Research Institute of Bioengineering and Bioimaging 31 Biopolis Way Singapore 138669 Singapore
| | - Yi Yan Yang
- Agency for Science, Technology and Research Institute of Bioengineering and Bioimaging 31 Biopolis Way Singapore 138669 Singapore
| | - He-Kuan Luo
- Agency for Science, Technology and Research Institute of Sustainability for Chemicals, Energy and Environment 1 Pesek Road, Jurong Island Singapore 627833 Singapore
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9
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The Impact of Antiseptic-Loaded Bacterial Nanocellulose on Different Biofilms-An Effective Treatment for Chronic Wounds? J Clin Med 2022; 11:jcm11226634. [PMID: 36431111 PMCID: PMC9692265 DOI: 10.3390/jcm11226634] [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] [Received: 10/01/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction: Pathogenic biofilms are an important factor for impaired wound healing, subsequently leading to chronic wounds. Nonsurgical treatment of chronic wound infections is limited to the use of conventional systemic antibiotics and antiseptics. Wound dressings based on bacterial nanocellulose (BNC) are considered a promising approach as an effective carrier for antiseptics. The aim of the present study was to investigate the antimicrobial activity of antiseptic-loaded BNC against in vitro biofilms. Materials and Methods: BNC was loaded with the commercially available antiseptics Prontosan® and Octenisept®. The silver-based dressing Aquacel®Ag Extra was used as a positive control. The biofilm efficacy of the loaded BNC sheets was tested against an in vitro 24-hour biofilm of Staphylococcus aureus and Candida albicans and a 48-hour biofilm of Pseudomonas aeruginosa. In vivo tests using a porcine excisional wound model was used to analyze the effect of a prolonged treatment with the antiseptics on the healing process. Results: We observed complete eradication of S. aureus biofilm in BNC loaded with Octenisept® and C. albicans biofilm for BNC loaded with Octenisept® or Prontosan®. Treatment with unloaded BNC also resulted in a statistically significant reduction in bacterial cell density of S. aureus compared to untreated biofilm. No difference on the wound healing outcome was observed for the wounds treated for seven days using BNC alone in comparison to BNC combined with Prontosan® or with Octenisept®. Conclusions: Based on these results, antiseptic-loaded BNC represents a promising and effective approach for the treatment of biofilms. Additionally, the prolonged exposure to the antiseptics does not affect the healing outcome. Prevention and treatment of chronic wound infections may be feasible with this novel approach and may even be superior to existing modalities.
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10
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Schiefer JL, Aretz FG, Fuchs PC, Lefering R, Yary P, Opländer C, Schulz A, Daniels M. Comparison of Long-Term Skin Quality and Scar Formation in Partial-Thickness Burn Wounds Treated with Suprathel ® and epicite hydro® Wound Dressings. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1550. [PMID: 36363504 PMCID: PMC9698741 DOI: 10.3390/medicina58111550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/12/2022] [Accepted: 10/26/2022] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Scar formation after burn trauma has a significant impact on the quality of life of burn patients. Hypertrophic scars or keloids can be very distressing to patients due to potential pain, functional limitations, or hyper- or hypopigmentation. In a previous study comparing Suprathel® and the new and cheaper dressing epicitehydro®, we were able to show that pain reduction, exudation, and time until wound-healing of partial-thickness burn wounds were similar, without any documented infections. No study exists that objectively measures and compares skin and scar quality after treatment with Suprathel® and epicitehydro® at present. Materials and Methods: In this study, the scar quality of 20 patients who had been treated with Suprathel® and epicitehydro® was objectively assessed using the Cutometer®, Mexameter®, and Tewameter®, as well as subjectively with the Patient and Observer Scar Assessment Scale, 3, 6, and 12 months after burn injury. Results: In all performed measurements, no significant differences were detected in scar formation after treatment of partial-thickness burn wounds with the two dressings. Conclusions: Both the newer and less expensive wound-dressing epicitehydro® and the well-known wound-dressing Suprathel® resulted in stable wound closure and showed good cosmetic results in the follow-up examinations.
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Affiliation(s)
- Jennifer Lynn Schiefer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, 58455 Witten, Germany
| | - Friederike Genoveva Aretz
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, 58455 Witten, Germany
| | - Paul Christian Fuchs
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, 58455 Witten, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, Witten/Herdecke University, 51109 Cologne, Germany
| | - Pouyan Yary
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, 58455 Witten, Germany
| | - Christian Opländer
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, Witten/Herdecke University, 51109 Cologne, Germany
| | - Alexandra Schulz
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, 58455 Witten, Germany
| | - Marc Daniels
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, 58455 Witten, Germany
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Melnikov N, Kobel P, Detinis T, Segni AD, Leichtmann-Bardoogo Y, Haik J, Maoz BM. An automated high-throughput platform for experimental study of burn injuries - in vitro and ex vivo. Burns 2022:S0305-4179(22)00228-5. [DOI: 10.1016/j.burns.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 08/04/2022] [Accepted: 08/29/2022] [Indexed: 11/02/2022]
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12
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Palackic A, Jay JW, Duggan RP, Branski LK, Wolf SE, Ansari N, El Ayadi A. Therapeutic Strategies to Reduce Burn Wound Conversion. Medicina (B Aires) 2022; 58:medicina58070922. [PMID: 35888643 PMCID: PMC9315582 DOI: 10.3390/medicina58070922] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/02/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022] Open
Abstract
Burn wound conversion refers to the phenomenon whereby superficial burns that appear to retain the ability to spontaneously heal, convert later into deeper wounds in need of excision. While no current treatment can definitively stop burn wound conversion, attempts to slow tissue damage remain unsatisfactory, justifying the need for new therapeutic interventions. To attenuate burn wound conversion, various studies have targeted at least one of the molecular mechanisms underlying burn wound conversion, including ischemia, inflammation, apoptosis, autophagy, generation of reactive oxygen species, hypothermia, and wound rehydration. However, therapeutic strategies that can target various mechanisms involved in burn wound conversion are still lacking. This review highlights the pathophysiology of burn wound conversion and focuses on recent studies that have turned to the novel use of biologics such as mesenchymal stem cells, biomaterials, and immune regulators to mitigate wound conversion. Future research should investigate mechanistic pathways, side effects, safety, and efficacy of these different treatments before translation into clinical studies.
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Affiliation(s)
- Alen Palackic
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.P.); (J.W.J.); (R.P.D.); (L.K.B.); (S.E.W.)
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, A-8036 Graz, Austria
| | - Jayson W. Jay
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.P.); (J.W.J.); (R.P.D.); (L.K.B.); (S.E.W.)
| | - Robert P. Duggan
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.P.); (J.W.J.); (R.P.D.); (L.K.B.); (S.E.W.)
| | - Ludwik K. Branski
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.P.); (J.W.J.); (R.P.D.); (L.K.B.); (S.E.W.)
| | - Steven E. Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.P.); (J.W.J.); (R.P.D.); (L.K.B.); (S.E.W.)
| | - Naseem Ansari
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Amina El Ayadi
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.P.); (J.W.J.); (R.P.D.); (L.K.B.); (S.E.W.)
- Correspondence:
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Rostami E, Maleki M, Koohestani R, Oghazi MR, Safavi EA, Hayati F. Effect of intermittent fasting on saving zone of stasis in burn wounds in rats. Burns 2022; 49:901-913. [PMID: 35787965 DOI: 10.1016/j.burns.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/30/2022] [Accepted: 06/15/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Intermittent Fasting (IF) has proved to have various positive effects on life span, diseases, and healing of tissues in rodents. We evaluated the protective effect of fasting in maintaining the ischemic zones in burn wounds. METHODS In this study, 20 rats were divided into two groups where the IF rats were deprived of food for three months. Burn wounds were created by burn comb model on the back of all rats. On days 3 and 21 after injury, five rats in each group were euthanized whereby samples were collected for histopathological, immunohistochemical (Bcl2, P53 and VEGF), and biochemical (MDA, TAC, HP) evaluations. RESULTS Histopathological analysis revealed epithelial layer and zone of ischemia remained viable in the intermittent fasting group on day 3. On the 21st day, epithelialization, angiogenesis, inflammation, fibrocyte-fibroblast, and collagen density were different in the ischemic and necrotic zones between the control and intermittent fasting groups (p<0.05). We found no statistical differences in Bcl2, P53, VEGF, MDA, TAC, and HP on day 3 between the intermittent fasting and control groups. CONCLUSIONS Intermittent fasting before burn wounds reduces tissue damage caused by ischemia and enhanced the viability of cells in zone of stasis. It also accelerated wound healing by increasing epithelialization and collagen production in the skin and regulating inflammatory responses. This intervention appears to be related to better collagen arrangement and angiogenesis.
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Bacterial Cellulose—Adaptation of a Nature-Identical Material to the Needs of Advanced Chronic Wound Care. Pharmaceuticals (Basel) 2022; 15:ph15060683. [PMID: 35745602 PMCID: PMC9228795 DOI: 10.3390/ph15060683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/19/2022] [Accepted: 05/21/2022] [Indexed: 12/10/2022] Open
Abstract
Modern wound treatment calls for hydroactive dressings. Among the variety of materials that have entered the field of wound care in recent years, the carbohydrate polymer bacterial cellulose (BC) represents one of the most promising candidates as the biomaterial features a high moisture-loading and donation capacity, mechanical stability, moldability, and breathability. Although BC has already gained increasing relevance in the treatment of burn wounds, its potential and clinical performance for “chronic wound” indications have not yet been sufficiently investigated. This article focuses on experimental and clinical data regarding the application of BC within the indications of chronic, non-healing wounds, especially venous and diabetic ulcers. A recent clinical observation study in a chronic wound setting clearly demonstrated its wound-cleansing properties and ability to induce healing in stalling wounds. Furthermore, the material parameters of BC dressings obtained through the static cultivation of Komagataeibacter xylinus were investigated for the first time in standardized tests and compared to various advanced wound-care products. Surprisingly, a free swell absorptive capacity of a BC dressing variant containing 97% moisture was found, which was higher than that of alginate or even hydrofiber dressings. We hypothesize that the fine-structured, open porous network and the resulting capillary forces are among the main reasons for this unexpected result.
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15
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Maurer K, Renkert M, Duis M, Weiss C, Wessel LM, Lange B. Application of bacterial nanocellulose-based wound dressings in the management of thermal injuries: Experience in 92 children. Burns 2022; 48:608-614. [PMID: 34303573 DOI: 10.1016/j.burns.2021.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/11/2021] [Accepted: 07/06/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Management of pediatric thermal injuries involves a high standard of care in a multidisciplinary setting. To avoid physical and psychological sequelae, wound dressings should minimize hospitalization time and anesthesia while maximizing patient comfort. PATIENTS AND METHODS 190 children with thermal injuries of the torso, arms and legs were treated with polyurethane foam dressings or bacterial nanocellulose sheets. Data were analyzed retrospectively regarding hospitalization, procedures with general anesthesia, scar formation, rate of infection and need for skin grafting. RESULTS The groups did not differ significantly concerning age, gender distribution or percentage of injured total body surface area. Statistical analysis showed that length of hospitalized care and procedures undergoing anesthesia were significantly reduced in the nanocellulose group (each p < 0.0001). There was no significant difference in rate of complications, wound healing and rate of skin grafting between the two subgroups. DISCUSSION Acting as a temporary epidermal substitute, bacterial nanocellulose enables undisturbed reepithelialization without further wound dressing changes. In children, no additional topical antimicrobial agents are indicated for unimpaired wound healing. CONCLUSIONS Bacterial nanocellulose is superior to polyurethane foam regarding length of hospitalization and number of interventions under anesthesia. It offers a safe, cost-effective treatment option and provides excellent comfort in pediatric patients.
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Affiliation(s)
- Kristina Maurer
- Medical Faculty Mannheim, Heidelberg University, University Medical Center Mannheim, Department of Pediatric Surgery, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany.
| | - Miriam Renkert
- Medical Faculty Mannheim, Heidelberg University, University Medical Center Mannheim, Department of Pediatric Surgery, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany
| | - Malte Duis
- Medical Faculty Mannheim, Heidelberg University, University Medical Center Mannheim, Department of Pediatric Surgery, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany
| | - Christel Weiss
- Medical Faculty Mannheim, Heidelberg University, University Medical Center Mannheim, Department of Medical Statistics and Biomathematics, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany
| | - Lucas M Wessel
- Medical Faculty Mannheim, Heidelberg University, University Medical Center Mannheim, Department of Pediatric Surgery, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany
| | - Bettina Lange
- Medical Faculty Mannheim, Heidelberg University, University Medical Center Mannheim, Department of Pediatric Surgery, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany
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16
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Kamolz LP, Nischwitz S, Tuca A, Holzer-Geissler J, Kotzbeck P. The use of bacterial nanocellulose based dressings in burns - Future perspectives. Burns 2022; 48:479-480. [PMID: 34887125 DOI: 10.1016/j.burns.2021.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Lars-Peter Kamolz
- COREMED - Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
| | - Sebastian Nischwitz
- COREMED - Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Alexandrou Tuca
- COREMED - Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Judith Holzer-Geissler
- COREMED - Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Petra Kotzbeck
- COREMED - Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
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17
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Shi W, Song N, Huang Y, He C, Zhang M, Zhao W, Zhao C. Improved Cooling Performance of Hydrogel Wound Dressings via Integrating Thermal Conductivity and Heat Storage Capacity for Burn Therapy. Biomacromolecules 2022; 23:889-902. [PMID: 35090105 DOI: 10.1021/acs.biomac.1c01334] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Burn injury has become a crucial public health issue worldwide. It is necessary to explore new methods to reduce heat damage and improve healing efficiency during burn injury treatment. In this study, a kind of hydrogel combining heat storage capacity and thermal conductivity was fabricated via a one-pot method for burn therapy. The novel hydrogel was easily prepared by in situ cross-linking polymerization, using poly(ethylene glycol) (PEG) derivatives, oligo(ethylene glycol) methacrylate and 2-(2-methoxyethoxy) ethyl methacrylate, as thermally responsive base materials and hydroxylated multiwall carbon nanotubes (CNT-OH) as thermally conductive fillers. By dispersing CNT-OH, a thermally conductive network was formed in the hydrogel, leading to an increase in the thermal conductivity. The cooling performance, thermal conductivity, heat storage property, swelling performance, rheological and mechanical properties, biocompatibility, in vivo cooling effect, and wound healing properties of the prepared hydrogel were systematically investigated. The hydrogel consisted of thermally responsive PEG derivatives, and CNT-OH performed a function of rapid heat absorption, further reduced thermal damage, and promoted wound healing. The improved cooling performance of the hydrogel was ascribed to the improved thermal conductivity, enhanced heat storage capacity, and good adhesive ability. Thus, the hydrogel has great potential to be practically applied in burn therapy, laser treatment, cooling fabrics, heat-protective clothing, and other emergency scenarios.
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Affiliation(s)
- Wenbin Shi
- College of Chemical Engineering, Sichuan University, Chengdu 610065, China.,College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, China.,State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Nijia Song
- College of Chemistry and Materials Science, Sichuan Normal University, Chengdu 610068, China
| | - Yanping Huang
- College of Chemical Engineering, Sichuan University, Chengdu 610065, China
| | - Chao He
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, China
| | - Man Zhang
- College of Biomedical Engineering, Sichuan University, Chengdu 610065, China
| | - Weifeng Zhao
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, China
| | - Changsheng Zhao
- College of Chemical Engineering, Sichuan University, Chengdu 610065, China.,College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, China.,State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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18
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Luca-Pozner V, Nischwitz SP, Conti E, Lipa G, Ghezal S, Luze H, Funk M, Remy H, Qassemyar Q. The use of a novel burn dressing out of bacterial nanocellulose compared to the French standard of care in paediatric 2nd degree burns - A retrospective analysis. Burns 2021; 48:1472-1480. [PMID: 34924226 DOI: 10.1016/j.burns.2021.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/18/2021] [Accepted: 11/23/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE Paediatric burn care is a delicate discipline which benefits from special attention. Despite being highly effective, the current standard of care for second degree burns in the largest paediatric burn center in France - exposure to infrared light - involves long hospital stays, straining economic and professional resources, especially in times of a pandemic. The present study investigated this standard of care and compared it to the use of a bacterial nanocellulose dressing. MATERIALS AND METHODS A retrospective analysis of two groups has been performed: the control group assessed thirty consecutive children treated with the standard of care, and the intervention group assessed thirty consecutive children treated with the bacterial nanocellulose dressing. Parameters evaluated were: healed wounds, additional treatments, rate of infections, hospital length of stay, pain experience and overall satisfaction. RESULTS The two groups did not differ significantly in terms of age and TBSA. A significant reduction in hospital length of stay (p < .001) and pain experience (p < .001) could be observed. In terms of healed wounds, additional treatments and infections, the two groups were equally matched (p > .05) with satisfactory results in both groups. Tendencies towards better results could be seen in the intervention group. CONCLUSION The use of bacterial nanocellulose wound dressings is an important tool in the armamentarium of today's burn surgeons. Satisfying results were achieved, ameliorating burn care for children. Future studies are indicated to further support its value and assess the economic impact.
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Affiliation(s)
- V Luca-Pozner
- Armand Trousseau Hospital, Department of Plastic and Reconstructive Surgery, 28 Av du Dr Arnold Netter, Paris, France; Sorbonne University, 91-105 Boulevard de l'Hopital, Paris, France
| | - S P Nischwitz
- COREMED - Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
| | - E Conti
- Armand Trousseau Hospital, Department of Plastic and Reconstructive Surgery, 28 Av du Dr Arnold Netter, Paris, France
| | - G Lipa
- Armand Trousseau Hospital, Department of Plastic and Reconstructive Surgery, 28 Av du Dr Arnold Netter, Paris, France
| | - S Ghezal
- Armand Trousseau Hospital, Department of Plastic and Reconstructive Surgery, 28 Av du Dr Arnold Netter, Paris, France
| | - H Luze
- COREMED - Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - M Funk
- EVOMEDIS GmbH, Graz, Austria
| | - H Remy
- Armand Trousseau Hospital, Department of Plastic and Reconstructive Surgery, 28 Av du Dr Arnold Netter, Paris, France
| | - Q Qassemyar
- Armand Trousseau Hospital, Department of Plastic and Reconstructive Surgery, 28 Av du Dr Arnold Netter, Paris, France; Sorbonne University, 91-105 Boulevard de l'Hopital, Paris, France
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19
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Prolonged cooling of burn wounds leads to significant tissue survival. Burns 2021; 47:1937-1938. [PMID: 34649748 DOI: 10.1016/j.burns.2021.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 11/21/2022]
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20
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Schiefer JL, Aretz GF, Fuchs PC, Bagheri M, Funk M, Schulz A, Daniels M. Comparison of wound healing and patient comfort in partial-thickness burn wounds treated with SUPRATHEL and epicte hydro wound dressings. Int Wound J 2021; 19:782-790. [PMID: 34390204 PMCID: PMC9013577 DOI: 10.1111/iwj.13674] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 11/27/2022] Open
Abstract
Among the available dressings for partial‐thickness burn wound treatment, SUPRATHEL has shown good usability and effectiveness for wound healing and patient comfort and has been used in many burn centres in the last decade. Recently, bacterial nanocellulose (BNC) has become popular for the treatment of wounds, and many studies have demonstrated its efficacy. epicitehydro, consisting of BNC and 95% water, is a promising product and has recently been introduced in numerous burn centres. To date, no studies including direct comparisons to existing products like SUPRATHEL have been conducted. Therefore, we aimed to compare epicitehydro to SUPRATHEL in the treatment of partial‐thickness burns. Twenty patients with partial‐thickness burns affecting more than 0.5% of their total body surface area (TBSA) were enrolled in this prospective, unicentric, open, comparative, intra‐individual clinical study. After debridement, the wounds were divided into two areas: one was treated with SUPRATHEL and the other with epicitehydro. Wound healing, infection, bleeding, exudation, dressing changes, and pain were documented. The quality of the scar tissue was assessed subjectively using the Patient and Observer Scar Scale. Wound healing in patients with a mean TBSA of 9.2% took 15 to 16 days for both treatments without dressing changes. All wounds showed minimal exudation, and patients reported decreased pain with the only significant difference between the two dressings on day 1. No infection or bleeding occurred in any of the wounds. Regarding scar evaluation, SUPRATHEL and epicitehydro did not differ significantly. Both wound dressings were easy to use, were highly flexible, created a safe healing environment, had similar effects on pain reduction, and showed good cosmetic and functional results without necessary dressing changes. Therefore, epicitehydro can be used as an alternative to SUPRATHEL for the treatment of partial‐thickness burn wounds.
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Affiliation(s)
- Jennifer Lynn Schiefer
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten/Herdecke, Cologne, Germany
| | - Genoveva Friederike Aretz
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten/Herdecke, Cologne, Germany
| | - Paul Christian Fuchs
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten/Herdecke, Cologne, Germany
| | - Mahsa Bagheri
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten/Herdecke, Cologne, Germany
| | | | - Alexandra Schulz
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten/Herdecke, Cologne, Germany
| | - Marc Daniels
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten/Herdecke, Cologne, Germany
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21
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Wright EH. Response to: Holzer JCJ, Tiffner K, Kainz S, Reisenegger P, Bernardelli de Mattos I, Funk M, et al. A novel human ex-vivo burn model and the local cooling effect of a bacterial nanocellulose-based wound dressing. Burns 2020;46:1924-32. Burns 2021; 48:244-245. [PMID: 34839959 DOI: 10.1016/j.burns.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Edmund Hugh Wright
- Department of Plastic Surgery, Leeds Teaching Hospitals, Leeds, LS13EX, UK.
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22
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Holzer-Geissler JCJ, Kotzbeck P, Kamolz LP. Heat transfer depends on the region of the body and the thickness of the skin. Burns 2021; 48:245. [PMID: 34304931 DOI: 10.1016/j.burns.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/09/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Judith C J Holzer-Geissler
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
| | - Petra Kotzbeck
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria; COREMED - Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH Graz, Austria
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria; COREMED - Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH Graz, Austria
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Hao D, Nourbakhsh M. Recent Advances in Experimental Burn Models. BIOLOGY 2021; 10:526. [PMID: 34204763 PMCID: PMC8231482 DOI: 10.3390/biology10060526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 12/13/2022]
Abstract
Experimental burn models are essential tools for simulating human burn injuries and exploring the consequences of burns or new treatment strategies. Unlike clinical studies, experimental models allow a direct comparison of different aspects of burns under controlled conditions and thereby provide relevant information on the molecular mechanisms of tissue damage and wound healing, as well as potential therapeutic targets. While most comparative burn studies are performed in animal models, a few human or humanized models have been successfully employed to study local events at the injury site. However, the consensus between animal and human studies regarding the cellular and molecular nature of systemic inflammatory response syndrome (SIRS), scarring, and neovascularization is limited. The many interspecies differences prohibit the outcomes of animal model studies from being fully translated into the human system. Thus, the development of more targeted, individualized treatments for burn injuries remains a major challenge in this field. This review focuses on the latest progress in experimental burn models achieved since 2016, and summarizes the outcomes regarding potential methodological improvements, assessments of molecular responses to injury, and therapeutic advances.
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Affiliation(s)
| | - Mahtab Nourbakhsh
- Department of Geriatric Medicine, RWTH Aachen University Hospital, 52074 Aachen, Germany;
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24
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Nischwitz SP, Luze H, Popp D, Winter R, Draschl A, Schellnegger M, Kargl L, Rappl T, Giretzlehner M, Kamolz LP. Global burn care and the ideal burn dressing reloaded - A survey of global experts. Burns 2021; 47:1665-1674. [PMID: 33838957 DOI: 10.1016/j.burns.2021.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/15/2021] [Accepted: 02/03/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE Burn care is a highly relevant medical specialty in every part of the world. Different infrastructure, healthcare systems and access to medical supplies lead to different needs, treatment strategies and outcomes. A fundamental tool in a burn care provider's armamentarium is the use of different dressings. Several studies have investigated the question of the ideal burn dressing, but none could achieve a proper global perspective. With advanced dressings being on the rise, we conducted this study to get a global understanding of the actual use and idea of the ideal burn dressing. OBJECTIVE The objective of this study was to investigate the understanding of an 'ideal burn dressing' on a global scale. MATERIALS AND METHODS A questionnaire about burn care and the ideal burn dressing has been created and translated to five of the most spoken languages world-wide (English, Spanish, French, Chinese, Indonesian). It has been uploaded to an online survey platform and sent out to burn experts worldwide. The voluntary participation was possible for a period of four weeks. RESULTS In total, 196 respondents from 49 countries participated in the study, yielding a response rate of 24.5%. The most important burn dressing characteristics in a cumulative ranking were (1) lack of adhesion (80.54%), (2) pain-free dressing change (79.87%), (3) requirement of fewer dressing changes, while in a linear ranking they were (1) anti-infective (35.14% 1st), pain-reduction (24.14% 2nd), and high absorbency (23.49% 3rd). Silver-based dressings are the most used dressings for superficial (45.21%) and deep (52.78%). 94.81% believe that the choice of burn dressing affects the outcome. CONCLUSION This investigation has delivered valuable insights into the global perspective of the ideal burn dressing. Yet, the question of the ideal burn dressing is still inconclusive. Wound dressing research is of fundamental interest for patients, healthcare providers and healthcare systems.
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Affiliation(s)
- Sebastian P Nischwitz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria; COREMED - Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria.
| | - Hanna Luze
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria; COREMED - Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
| | - Daniel Popp
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Raimund Winter
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | | | - Marlies Schellnegger
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria; COREMED - Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
| | - Lukas Kargl
- Department of Plastic-, Hand- and Reconstructive Microsurgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
| | - Thomas Rappl
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria; COREMED - Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
| | - Michael Giretzlehner
- Research Unit for Medical-Informatics, RISC Software GmbH, Johannes Kepler University Linz, Linz, Austria
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria; COREMED - Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
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25
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Hofmann E, Fink J, Eberl A, Prugger EM, Kolb D, Luze H, Schwingenschuh S, Birngruber T, Magnes C, Mautner SI, Kamolz LP, Kotzbeck P. A novel human ex vivo skin model to study early local responses to burn injuries. Sci Rep 2021; 11:364. [PMID: 33432026 PMCID: PMC7801530 DOI: 10.1038/s41598-020-79683-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/23/2020] [Indexed: 01/29/2023] Open
Abstract
Burn injuries initiate numerous processes such as heat shock response, inflammation and tissue regeneration. Reliable burn models are needed to elucidate the exact sequence of local events to be able to better predict when local inflammation triggers systemic inflammatory processes. In contrast to other ex vivo skin culture approaches, we used fresh abdominal skin explants to introduce contact burn injuries. Histological and ultrastructural analyses confirmed a partial-thickness burn pathology. Gene expression patterns and cytokine production profiles of key mediators of the local inflammation, heat shock response, and tissue regeneration were analyzed for 24 h after burn injury. We found significantly increased expression of factors involved in tissue regeneration and inflammation soon after burn injury. To investigate purely inflammation-mediated reactions we injected lipopolysaccharide into the dermis. In comparison to burn injury, lipopolysaccharide injection initiated an inflammatory response while expression patterns of heat shock and tissue regeneration genes were unaffected for the duration of the experiment. This novel ex vivo human skin model is suitable to study the local, early responses to skin injuries such as burns while maintaining an intact overall tissue structure and it gives valuable insights into local mechanisms at the very beginning of the wound healing process after burn injuries.
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Affiliation(s)
- Elisabeth Hofmann
- COREMED-Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Julia Fink
- COREMED-Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
| | - Anita Eberl
- HEALTH-Institute for Biomedicine and Health Sciences, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
| | - Eva-Maria Prugger
- HEALTH-Institute for Biomedicine and Health Sciences, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
| | - Dagmar Kolb
- Core Facility Ultrastructure Analysis, Center for Medical Research, Medical University of Graz, Graz, Austria
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Hanna Luze
- COREMED-Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Simon Schwingenschuh
- HEALTH-Institute for Biomedicine and Health Sciences, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
| | - Thomas Birngruber
- HEALTH-Institute for Biomedicine and Health Sciences, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
| | - Christoph Magnes
- HEALTH-Institute for Biomedicine and Health Sciences, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
| | - Selma I Mautner
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- HEALTH-Institute for Biomedicine and Health Sciences, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Lars-Peter Kamolz
- COREMED-Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Petra Kotzbeck
- COREMED-Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria.
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.
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26
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Gibson A, Liu A, Eliceiri K. Response to letter to the editor on "The use of human ex vivo models in burn research - Developments and perspectives". Burns 2020; 47:968-969. [PMID: 33934910 DOI: 10.1016/j.burns.2020.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Angela Gibson
- Department of Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, Madison 53792, United States.
| | - Aiping Liu
- Department of Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, Madison 53792, United States
| | - Kevin Eliceiri
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, United States; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States
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27
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Luze H, Nischwitz SP, Kamolz LP. The use of human ex vivo models in burn research - Developments and perspectives. Burns 2020; 47:966-968. [PMID: 33934911 DOI: 10.1016/j.burns.2020.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/04/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Hanna Luze
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery Medical University of Graz, Graz, Austria; COREMED - Cooperative Centre for Regenerative Medicine, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria.
| | - Sebastian P Nischwitz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery Medical University of Graz, Graz, Austria; COREMED - Cooperative Centre for Regenerative Medicine, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery Medical University of Graz, Graz, Austria; COREMED - Cooperative Centre for Regenerative Medicine, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
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28
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Cattelaens J, Turco L, Berclaz LM, Huelsse B, Hitzl W, Vollkommer T, Bodenschatz KJ. The Impact of a Nanocellulose-Based Wound Dressing in the Management of Thermal Injuries in Children: Results of a Retrospective Evaluation. Life (Basel) 2020; 10:life10090212. [PMID: 32961687 PMCID: PMC7554742 DOI: 10.3390/life10090212] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/14/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022] Open
Abstract
The aim of this retrospective study is to evaluate for the first time the impact of a nanocellulose-based wound dressing in the treatment of pediatric patients with both partial- and deep-thickness burns. Usability and effectiveness were defined based on parameters such as frequency of dressing changes under narcosis, duration of hospital stay, onset of complications, need for additional treatments, and follow up scar formation assessment. Fifty-six children who sustained burns in the year 2018 and were treated with a nanocellulose-based wound dressing were included in the trial. The mean stay in hospital was 6.7 days. Patients underwent dressing changes under narcosis 2.4 times on average, and none had wound-associated infection. In all, 82% of the patients were treated only with nanocellulose-based wound dressings, and reepithelialization occurred after ten days. The majority of patients had scars with normal pigmentation (98%), vascularization (91%), height (92%), and pliability (92%). In conclusion, using a nanocellulose-based wound dressing for the treatment of both superficial, partial-thickness and deep, full-thickness burns has several advantages. Compared with the results published in literature on other wound dressings, it requires a moderate number of dressing changes under narcosis and results in short hospital stays. Additionally, it has a low associated infection rate and promotes wound healing.
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Affiliation(s)
- Julia Cattelaens
- Clinic for Pediatric Surgery, Klinikum Nürnberg Süd, Breslauer Str. 201, 90471 Nuremberg, Germany; (B.H.); (K.J.B.)
- Correspondence: ; Tel.: +49-176-1550-4060
| | - Laura Turco
- Max-Plank-Institute for Dynamics and Self-Organization, Am Fassberg 17, 37077 Göttingen, Germany;
| | - Luc M. Berclaz
- Paracelsus Medizinische Privatuniversität (PMU), Str. 1, 90419 Nuremberg, Germany;
| | - Birgit Huelsse
- Clinic for Pediatric Surgery, Klinikum Nürnberg Süd, Breslauer Str. 201, 90471 Nuremberg, Germany; (B.H.); (K.J.B.)
| | - Wolfgang Hitzl
- Research Office, Biostatistics, Paracelsus Medizinische Privatuniversität (PMU), Strubergasse 21, 5020 Salzburg, Austria;
- Department of Ophthalmology and Optometry, Paracelsus Medizinische Privatuniversität (PMU), Müllner Hauptstr. 48, 5020 Salzburg, Austria
- Research Program, Experimental Ophthalmology and Glaucoma Research, Paracelsus Medizinische Privatuniversität, Muellner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Tobias Vollkommer
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany;
| | - Karl J. Bodenschatz
- Clinic for Pediatric Surgery, Klinikum Nürnberg Süd, Breslauer Str. 201, 90471 Nuremberg, Germany; (B.H.); (K.J.B.)
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