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Liu HY, Alessandri-Bonetti M, Kasmirski JA, Stofman GM, Egro FM. Free Flap Failure and Contracture Recurrence in Delayed Burn Reconstruction: A Systematic Review and Meta-analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6026. [PMID: 39129842 PMCID: PMC11315556 DOI: 10.1097/gox.0000000000006026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/12/2024] [Indexed: 08/13/2024]
Abstract
Background Free tissue transfer is often considered a last resort in burn reconstruction due to its complexity and associated risks. A comprehensive review on free flap outcomes in delayed burn reconstruction is currently lacking. The study aimed to evaluate the available evidence on the failure and contracture recurrence rates in free flap delayed burn reconstruction. Methods A systematic review and meta-analysis was conducted and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The protocol was registered on PROSPERO (CRD42023404478). The following databases were accessed: Embase, PubMed, Web of Science, and Cochrane Library. The measured outcomes were free flap loss and contracture recurrence rate. Results Of the 1262 retrieved articles, 40 qualified for inclusion, reporting on 1026 free flaps performed in 928 patients. The mean age was 29.25 years [95% confidence interval (CI), 24.63-33.88]. Delayed burn reconstruction was performed at an average of 94.68 months [95% CI, - 9.34 to 198.70] after initial injury, with a follow-up period of 23.02 months [95% CI, 4.46-41.58]. Total flap loss rate was 3.80% [95% CI, 2.79-5.16] and partial flap loss rate was 5.95% [95% CI, 4.65-7.57]. Interestingly, burn contracture recurrence rate was 0.62% [95% CI, 0.20-1.90]. Conclusions This systematic review provides a comprehensive evaluation of the free flap outcomes in delayed burn reconstruction. The flap loss rate was relatively low, given the complexity of the procedure and potential risks. Furthermore, burn contracture rate was found to be extremely low. This study demonstrates that free flaps are a safe and effective option for delayed burn reconstruction.
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Affiliation(s)
- Hilary Y. Liu
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | | | - Julia A Kasmirski
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Guy M Stofman
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Francesco M. Egro
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
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Yunus J, Jamaluddin H, Wan Dagang WRZ. Debridement efficacy of serine protease and formulated cream by In Vitro assessment against artificial wound eschar. Enzyme Microb Technol 2024; 180:110478. [PMID: 39074421 DOI: 10.1016/j.enzmictec.2024.110478] [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: 05/20/2024] [Revised: 07/05/2024] [Accepted: 07/06/2024] [Indexed: 07/31/2024]
Abstract
Chronic wounds typically comprise of necrotic tissue and dried secretions, often culminating in the formation of a thick and tough layer of dead skin known as eschar. Removal of eschar is imperative to facilitate wound healing. Conventional approach for eschar removal involves surgical excision and grafting, which can be traumatic and frequently leads to viable tissue damage. There has been growing interest in the use of enzymatic agents for a gentler approach to debridement, utilizing proteolytic enzymes. In this study, a purified intracellular recombinant serine protease from Bacillus sp. (SPB) and its cream formulation were employed to evaluate their ability to degrade artificial wound eschar; composed of collagen, fibrin, and elastin. Degradation was assessed based on percentage weight reduction of eschar biomass, analysis via sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE), and scanning electron microscopy (SEM). Both SPB and its cream formulation were able to degrade up to 50 % artificial wound eschar, with the SPB cream maintaining its degradation efficiency for up to 24 hours. Additionally, the SPB-based cream demonstrated the ability to hydrolyze proteinaceous components of eschars individually (fibrin and collagen) as determined through qualitative assessment. These findings suggest that SPB holds promise for the debridement of wound eschar.
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Affiliation(s)
- Julia Yunus
- Department of Biosciences, Faculty of Science, Universiti Teknologi Malaysia, Skudai, Johor 81310, Malaysia
| | - Haryati Jamaluddin
- Department of Biosciences, Faculty of Science, Universiti Teknologi Malaysia, Skudai, Johor 81310, Malaysia.
| | - Wan Rosmiza Zana Wan Dagang
- Department of Biosciences, Faculty of Science, Universiti Teknologi Malaysia, Skudai, Johor 81310, Malaysia.
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Pathak D, Mazumder A. A critical overview of challenging roles of medicinal plants in improvement of wound healing technology. Daru 2024; 32:379-419. [PMID: 38225520 PMCID: PMC11087437 DOI: 10.1007/s40199-023-00502-x] [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: 02/01/2023] [Accepted: 12/25/2023] [Indexed: 01/17/2024] Open
Abstract
PURPOSE Chronic diseases often hinder the natural healing process, making wound infections a prevalent clinical concern. In severe cases, complications can arise, potentially leading to fatal outcomes. While allopathic treatments offer numerous options for wound repair and management, the enduring popularity of herbal medications may be attributed to their perceived minimal side effects. Hence, this review aims to investigate the potential of herbal remedies in efficiently treating wounds, presenting a promising alternative for consideration. METHODS A literature search was done including research, reviews, systematic literature review, meta-analysis, and clinical trials considered. Search engines such as Pubmed, Google Scholar, and Scopus were used while retrieving data. Keywords like Wound healing 'Wound healing and herbal combinations', 'Herbal wound dressing', Nanotechnology and Wound dressing were used. RESULT This review provides valuable insights into the role of natural products and technology-based formulations in the treatment of wound infections. It evaluates the use of herbal remedies as an effective approach. Various active principles from herbs, categorized as flavonoids, glycosides, saponins, and phenolic compounds, have shown effectiveness in promoting wound closure. A multitude of herbal remedies have demonstrated significant efficacy in wound management, offering an additional avenue for care. The review encompasses a total of 72 studies, involving 127 distinct herbs (excluding any common herbs shared between studies), primarily belonging to the families Asteraceae, Fabaceae, and Apiaceae. In research, rat models were predominantly utilized to assess wound healing activities. Furthermore, advancements in herbal-based formulations using nanotechnology-based wound dressing materials, such as nanofibers, nanoemulsions, nanofiber mats, polymeric fibers, and hydrogel-based microneedles, are underway. These innovations aim to enhance targeted drug delivery and expedite recovery. Several clinical-based experimental studies have already been documented, evaluating the efficacy of various natural products for wound care and management. This signifies a promising direction in the field of wound treatment. CONCLUSION In recent years, scientists have increasingly utilized evidence-based medicine and advanced scientific techniques to validate the efficacy of herbal medicines and delve into the underlying mechanisms of their actions. However, there remains a critical need for further research to thoroughly understand how isolated chemicals extracted from herbs contribute to the healing process of intricate wounds, which may have life-threatening consequences. This ongoing research endeavor holds great promise in not only advancing our understanding but also in the development of innovative formulations that expedite the recovery process.
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Affiliation(s)
- Deepika Pathak
- Noida Institute of Engineering and Technology (Pharmacy Institute), 19 Knowledge Park-II, Institutional Area, Greater Noida, UP, 201306, India.
| | - Avijit Mazumder
- Noida Institute of Engineering and Technology (Pharmacy Institute), 19 Knowledge Park-II, Institutional Area, Greater Noida, UP, 201306, India
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Chen X, Huang H, Song X, Dong T, Yu J, Xu J, Cheng R, Cui T, Li J. Carboxymethyl chitosan-based hydrogel-Janus nanofiber scaffolds with unidirectional storage-drainage of biofluid for accelerating full-thickness wound healing. Carbohydr Polym 2024; 331:121870. [PMID: 38388058 DOI: 10.1016/j.carbpol.2024.121870] [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: 11/27/2023] [Revised: 01/17/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024]
Abstract
Self-pumping wound scaffolds designed for directional biofluid transport are extensively investigated. They efficiently extract excessive biofluids from wounds, while maintaining an optimally humid wound environment, thus facilitating rapid wound healing. However, the existing designed scaffolds are insufficiently focused on stimulating the hydrophobic layer at the wound site, thereby exacerbating inflammation and impeding the wound healing process. Herein, we engineered and fabricated a hydrophilic-hydrophobic-hydrophilic sandwich-structured hydrogel-Janus nanofiber scaffold (NFS) employing a Layer-by-Layer (LbL) method. This scaffold comprises a hydrophilic carboxymethyl chitosan/silver (CMCS-Ag) hydrogel component in conjunction with a poly(caprolactone)/poly(caprolactone)-poly(citric acid)-co-ε-polylysine (PCL/PCL-PCE) Janus NFS. It is noteworthy that the hydrogel-Janus nanofiber scaffold not only demonstrates outstanding water absorption (202.2 %) and unidirectional biofluid transport capability but also possesses high breathability (308.663 m3/m2 h kPa), appropriate pore size (6.7-7.5 μm), excellent tensile performance (270 ± 10 %), and superior mechanical strength (26.36 ± 1.77 MPa). Moreover, in vitro experimentation has convincingly demonstrated the impeccable biocompatibility of hydrogel-Janus NFS. The inherent dual-antibacterial properties in CMCS-Ag and PCE significantly augment fibroblast proliferation and migration. In vivo studies further underscore its capability to expedite wound healing by absorption and expulsion of wound exudates, thereby fostering collagen deposition and vascularization. As such, this work potentially provides fresh insights into the design and fabrication of multifunctional biomimetic scaffolds, holding immense potential in the medical field for efficient wound healing.
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Affiliation(s)
- Xinhao Chen
- Department of General Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 210000, PR China
| | - Hui Huang
- Department of General Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 210000, PR China
| | - Xinru Song
- Department of General Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 210000, PR China
| | - Ting Dong
- State Key Laboratory of Materials-Oriented Chemical Engineering, College of Chemical Engineering, Nanjing Tech University, Nanjing 210009, PR China
| | - Jiafei Yu
- Department of General Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 210000, PR China
| | - Jieyan Xu
- Department of General Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 210000, PR China
| | - Rui Cheng
- State Key Laboratory of Materials-Oriented Chemical Engineering, College of Chemical Engineering, Nanjing Tech University, Nanjing 210009, PR China.
| | - Tingting Cui
- Department of General Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 210000, PR China; State Key Laboratory of Materials-Oriented Chemical Engineering, College of Chemical Engineering, Nanjing Tech University, Nanjing 210009, PR China.
| | - Jun Li
- Department of General Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 210000, PR China.
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Li Z, Song Y, Ling Y, Liu Y, Yi J, Hao L, Zhu J, Kang Q, Huang J, Lu J. Structural characterization of a glycoprotein from white jade snails (Achatina Fulica) and its wound healing activity. Int J Biol Macromol 2024; 263:130161. [PMID: 38367791 DOI: 10.1016/j.ijbiomac.2024.130161] [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: 11/17/2023] [Revised: 02/03/2024] [Accepted: 02/11/2024] [Indexed: 02/19/2024]
Abstract
Snail mucus is rich in proteins and polysaccharides, which has been proved to promote wound healing in mice in our previous research. The aim of this study was to investigate the effective component in snail mucus that can exert the wound healing potential and its structural characterization. Here, the glycoprotein from the snail mucus (SM1S) was obtained by DEAE-Sepharose Fast Flow and Sephacryl S-300 columns. The structural characteristics of SM1S were investigated via chromatographic techniques, periodic acid oxidation, FT-IR spectroscopy and NMR spectroscopy. Results showed that SM1S was a glycoprotein with a molecular weight of 3.8 kDa (83.23 %), consists of mannose, glucuronic acid, glucose, galactose, xylose, arabinose, fucose at a ratio of 13.180:4.875:1043.173:7.552:1:3.501:2.058. In addition, the periodic acid oxidation and NMR analysis showed that SM1S contained 1,6-glycosidic bonds, and might also contain 1 → 4 and 1 → 2 glycosidic or 1 → 3 glycosidic bonds. Furthermore, the migration experiment of human skin fibroblasts in vitro suggested that SM1S had a good effect to accelerate the scratch healing of cells. This study suggested that SM1S may be a prospective candidate as a natural wound dressing for the development of snail mucus products.
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Affiliation(s)
- Zhipeng Li
- School of Life Sciences, Zhengzhou University, Zhengzhou, Henan 450001, China
| | - Yiming Song
- School of Life Sciences, Zhengzhou University, Zhengzhou, Henan 450001, China
| | - Yunying Ling
- School of Life Sciences, Zhengzhou University, Zhengzhou, Henan 450001, China
| | - Yingxin Liu
- School of Life Sciences, Zhengzhou University, Zhengzhou, Henan 450001, China
| | - Juanjuan Yi
- School of Life Sciences, Zhengzhou University, Zhengzhou, Henan 450001, China.
| | - Limin Hao
- Systems Engineering Institute, Academy of Military Sciences PLA China, Beijing 100010, China
| | - Jiaqing Zhu
- School of Life Sciences, Zhengzhou University, Zhengzhou, Henan 450001, China
| | - Qiaozhen Kang
- School of Life Sciences, Zhengzhou University, Zhengzhou, Henan 450001, China
| | - Jinyong Huang
- School of Life Sciences, Zhengzhou University, Zhengzhou, Henan 450001, China
| | - Jike Lu
- School of Life Sciences, Zhengzhou University, Zhengzhou, Henan 450001, China.
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Yu H, Wang L, Pan C. The impact of cognitive behavioural therapy-based psychological intervention on emotional improvement in elderly patients with extensive burns. Int Wound J 2024; 21:e14594. [PMID: 38379217 PMCID: PMC10843987 DOI: 10.1111/iwj.14594] [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: 11/03/2023] [Accepted: 12/08/2023] [Indexed: 02/22/2024] Open
Abstract
To evaluate the efficacy of cognitive behavioural therapy (CBT) as a psychological intervention for elderly patients with extensive burns, focusing on its impact on emotional well-being, self-efficacy and quality of life. A prospective, randomized study involving 200 elderly burn patients was conducted from November 2021 to January 2023. The patients were randomly assigned to receive either standard care (control group) or burn care based on cognitive behavioural therapy (CBT-B) (study group), with 100 patients in each group. Outcome measures included the Visual Analog Scale (VAS) for pain assessment, 36-item Short Form Survey (SF-36) for quality of life, General Self-Efficacy Scale (GSES) and Rosenberg Self-Esteem Scale (RSES). The study revealed that CBT-based intervention significantly reduced anxiety and depression scores compared with standard care (p < 0.05). Additionally, patients in the CBT group exhibited improved self-efficacy, self-esteem and quality of life (p < 0.05). CBT proves to be a valuable intervention for elderly burn patients, effectively addressing emotional distress and enhancing their psychological well-being. By modifying negative cognitive patterns, providing coping mechanisms and fostering problem-solving skills, CBT-based care contributes to a more positive recovery experience and improved quality of life.
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Affiliation(s)
- Hong‐Mei Yu
- Burn and Wound Repair SurgeryProvincial Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Ling Wang
- Coronary Heart Disease, Two Departments and One WardeJinan Central HospitalJinanChina
| | - Cui‐Zhen Pan
- Endocrine Department for the ElderlyProvincial Hospital affiliated to Shandong First Medical UniversityJinanChina
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7
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Shen C, Zhang B, Liu X, Cai J, Sun T, Li D, Deng H, Yuan H. A novel skin grafting modality: prefabricated large sheet of postage-stamp autografts and allografts to repair extensive burn wounds; a prospective matched-control study. Int J Surg 2023; 109:3967-3973. [PMID: 38258998 PMCID: PMC10720813 DOI: 10.1097/js9.0000000000000724] [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: 06/01/2023] [Accepted: 08/21/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND The excessively long operative time has been the greatest barrier to the success of transplanting postage-stamp auto- and allografts directly and piece-by-piece onto extensive burn wounds. To solve this challenge, the authors present a novel grafting modality, that is, the prefabricated-large-sheet grafting that moves the labor-intensive and time-consuming process of grafts-positioning before grafting and thereby markedly shortens the operative time. METHODS Twenty-one operations using the novel modality were performed on 11 patients with extensive deep burns. The grafting time using the novel modality was recorded and compared with that of the conventional piece-by-piece grafting. Eventually, the take rates of the two modalities were compared. RESULTS All patients were healed and discharged. The average grafting time per unit area (100 cm2) of prefabricated-large-sheet grafting and piece-by-piece grafting were (0.41±0.09) min and (7.46±1.07) min, respectively, and the difference is statistically significant(P<0.001). The average take rate of the prefabricated sheets was (85.43±6.14)% and that of the piece-by-piece transplanted grafts was (87.29±5.23)% and there is no significant difference(P>0.05). CONCLUSIONS The prefabricated-large-sheet grafting significantly reduces the intraoperative grafting time while ensures uniformity of the skin grafts and secures good outcomes, thereby making the intermingled transplantation of postage-stamp auto- and allografts, which has been an excellent modality per se but limited to repair small residual wounds, now feasible to repair extensive deep burn wounds. It is worth wider understanding and application in the treatment of extensive deep burns.
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Affiliation(s)
- Chuan’an Shen
- Department of Burns and Plastic Surgery, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, People’s Republic of China
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de Alencar Fernandes Neto J, Simões TMS, de Oliveira TKB, Dos Santos Pereira J, Nonaka CFW, de Vasconcelos Catão MHC. Effects of photobiomodulation with blue Light Emitting Diode (LED) on the healing of skin burns. Lasers Med Sci 2023; 38:275. [PMID: 37993749 DOI: 10.1007/s10103-023-03929-5] [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: 07/12/2023] [Accepted: 10/30/2023] [Indexed: 11/24/2023]
Abstract
The management of skin burns is still challenging. Among the therapeutic methods used, there are topical treatments with pharmacological and herbal agents, low-intensity therapeutic ultrasound, use of biomaterials, reconstructive techniques and photobiomodulation therapy. The aim of this study was to evaluate the effects of photobiomodulation with blue Light Emitting Diode (LED) on burn healing. Fifty Wistar rats were divided into control (CTRL) (n = 25) and blue LED (LED) (n = 25), with subgroups (n = 5) for each time of euthanasia (7, 14, 21, 28 and 32 days). Treated animals were daily irradiated (470 nm, 1W, 0.44 W/cm2, 50 J/cm2). Clinical evaluations were performed and the Wound Retraction Index (WRI) was determined. Histological sections were submitted to hematoxylin-eosin, toluidine blue and the immunohistochemical technique, with anti-α-SMA and anti-TGF-β1 antibodies. All data were directly collected by previously calibrated evaluators in a blind manner. The values were included in a statistical program. For all statistical tests used, 5% significance level (p < 0.05) was considered. No statistically significant differences in WRI between groups were observed (p > 0.05). Re-epithelialization was higher using LED at 7 and 14 days (p < 0.05) and greater amount of inflammatory cells was observed at 7 days (p = 0.01). With LED at 21 and 32 days, greater number of mast cells were observed (p < 0.05), as well as smaller number of myofibroblasts at 14, 21, 28 and 32 days (p < 0.05) and lower percentage of TGF-β1 positive cells in the conjunctiva at 7, 14 and 21 days (p < 0.05). Negative correlations were observed in LED between the percentage of TGF-β1 in the epithelium and the mean number of inflammatory cells and number of myofibroblasts (p < 0.05). The results suggest that, depending on the period, blue LED can modulate the healing processes of third-degree skin burns, such as re-epithelialization, inflammatory response, mast cell concentration, myofibroblast differentiation and TGF-β1 immunoexpression. Despite these effects, this therapy does not seem to have significant influence on the retraction of these wounds. Future studies, using different protocols, should be carried out to expand the knowledge about the photobiomodulatory mechanisms of this type of light in the healing process.
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Affiliation(s)
- José de Alencar Fernandes Neto
- Graduate Program in Dentistry, State University of Paraiba, R. Baraúnas, 531, Bodocongó, Campina Grande, PB, 58429-500, Brazil
| | - Thamyres Maria Silva Simões
- Graduate Program in Dentistry, State University of Paraiba, R. Baraúnas, 531, Bodocongó, Campina Grande, PB, 58429-500, Brazil
| | - Tharcia Kiara Beserra de Oliveira
- Faculty of Medical Sciences, University Center UniFacisa, Av. Sen. Argemiro de Figueiredo, 1901, Itararé, Campina Grande, PB, 58411-020, Brazil
| | - Joabe Dos Santos Pereira
- Department of Pathology, Federal University of Rio Grande do Norte, R. General Gustavo Cordeiro de Faria, s/n, Petrópolis, Natal, RN, 59012-570, Brazil
| | - Cassiano Francisco Weege Nonaka
- Graduate Program in Dentistry, State University of Paraiba, R. Baraúnas, 531, Bodocongó, Campina Grande, PB, 58429-500, Brazil
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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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10
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Esmaeili A, Biazar E, Ebrahimi M, Heidari Keshel S, Kheilnezhad B, Saeedi Landi F. Acellular fish skin for wound healing. Int Wound J 2023; 20:2924-2941. [PMID: 36924081 PMCID: PMC10410342 DOI: 10.1111/iwj.14158] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
Fish skin grafting as a new skin substitute is currently being used in clinical applications. Acceleration of the wound healing, lack of disease transmission, and low cost of the production process can introduce fish skin as a potential alternative to other grafts. An appropriate decellularization process allows the design of 3D acellular scaffolds for skin regeneration without damaging the morphology and extracellular matrix content. Therefore, the role of decellularization processes is very important to maintain the properties of fish skin. In this review article, recent studies on various decellularization processes as well as biological, physical, and mechanical properties of fish skin and its applications with therapeutic effects in wound healing were investigated.
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Affiliation(s)
- Ali Esmaeili
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Esmaeil Biazar
- Tissue Engineering Group, Department of Biomedical EngineeringTonekabon Branch, Islamic Azad UniversityTonekabonIran
| | - Maryam Ebrahimi
- Department of Tissue Engineering, School of Advanced Technologies in MedicineTehran University of Medical SciencesTehranIran
| | - Saeed Heidari Keshel
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Bahareh Kheilnezhad
- Department of Biomedical EngineeringAmirkabir University of TechnologyTehranIran
| | - Farzaneh Saeedi Landi
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in MedicineShahid Beheshti University of Medical SciencesTehranIran
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11
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Maruccia M, Tedeschi P, Corrao C, Elia R, La Padula S, Di Summa PG, Maggio GMM, Giudice G. Meek Micro-Skin Grafting and Acellular Dermal Matrix in Pediatric Patients: A Novel Approach to Massive Extravasation Injury. J Clin Med 2023; 12:4587. [PMID: 37510702 PMCID: PMC10380205 DOI: 10.3390/jcm12144587] [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: 05/22/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Extravasation injuries in pediatric patients can lead to significant harm if they are not promptly diagnosed and treated. However, evidence-based standardization on extravasation management remains limited, particularly for extensive wound necrosis. This case report presents the management of an 8-week-old premature patient with an extensive extravasation injury involving the right forearm and dorsum of the hand. (2) Methods: The patient was evaluated by a multidisciplinary team in our Neonatal Intensive Care Unit. Surgical intervention involved the debridement of necrotic tissues, followed by temporary coverage with an acellular dermal matrix. Definitive coverage was achieved through Meek micrografting after three weeks. Physical therapy was provided with pre- and post-rehabilitation range of motion assessed using goniometric measurements. Scar quality was evaluated using the Vancouver Scar Scale. (3) Results: The engraftment rate of the Meek micrografts was 93%, with 16 out of 226 micrografts lost. The patient achieved a Vancouver Scar Scale score of 6, indicating a moderate degree of scarring. Significant improvements in elbow, wrist, and finger joint range of motion were observed at a 1-year follow-up. (4) Conclusions: Close observation and heightened awareness of extravasation risks by trained personnel are crucial. Meek micrografting combined with dermal substitute coverage represents an innovative approach to managing extravasation wounds in pediatric patients.
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Affiliation(s)
- Michele Maruccia
- Division of Plastic and Reconstructive Surgery, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, Piazza Giulio Cesare, 70121 Bari, Italy
| | - Pasquale Tedeschi
- Division of Plastic and Reconstructive Surgery, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, Piazza Giulio Cesare, 70121 Bari, Italy
| | - Claudia Corrao
- Division of Plastic and Reconstructive Surgery, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, Piazza Giulio Cesare, 70121 Bari, Italy
| | - Rossella Elia
- Division of Plastic and Reconstructive Surgery, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, Piazza Giulio Cesare, 70121 Bari, Italy
| | - Simone La Padula
- Department of Plastic and Reconstructive Surgery, Università degli Studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy
| | - Pietro G Di Summa
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), 1015 Lausanne, Switzerland
| | - Giulio M M Maggio
- Division of Plastic and Reconstructive Surgery, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, Piazza Giulio Cesare, 70121 Bari, Italy
| | - Giuseppe Giudice
- Division of Plastic and Reconstructive Surgery, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, Piazza Giulio Cesare, 70121 Bari, Italy
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12
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Bagheri M, von Kohout M, Zoric A, Fuchs PC, Schiefer JL, Opländer C. Can Cold Atmospheric Plasma Be Used for Infection Control in Burns? A Preclinical Evaluation. Biomedicines 2023; 11:biomedicines11051239. [PMID: 37238910 DOI: 10.3390/biomedicines11051239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023] Open
Abstract
Wound infection with Pseudomonas aeruginosa (PA) is a serious complication and is responsible for higher rates of mortality in burn patients. Because of the resistance of PA to many antibiotics and antiseptics, an effective treatment is difficult. As a possible alternative, cold atmospheric plasma (CAP) can be considered for treatment, as antibacterial effects are known from some types of CAP. Hence, we preclinically tested the CAP device PlasmaOne and found that CAP was effective against PA in various test systems. CAP induced an accumulation of nitrite, nitrate, and hydrogen peroxide, combined with a decrease in pH in agar and solutions, which could be responsible for the antibacterial effects. In an ex vivo contamination wound model using human skin, a reduction in microbial load of about 1 log10 level was observed after 5 min of CAP treatment as well as an inhibition of biofilm formation. However, the efficacy of CAP was significantly lower when compared with commonly used antibacterial wound irrigation solutions. Nevertheless, a clinical use of CAP in the treatment of burn wounds is conceivable on account of the potential resistance of PA to common wound irrigation solutions and the possible wound healing-promoting effects of CAP.
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Affiliation(s)
- Mahsa Bagheri
- Plastic Surgery, Hand Surgery, Burn Center, Cologne-Merheim Hospital, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
- Institute for Research in Operative Medicine (IFOM), Cologne-Merheim Hospital, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Maria von Kohout
- Plastic Surgery, Hand Surgery, Burn Center, Cologne-Merheim Hospital, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
- Institute for Research in Operative Medicine (IFOM), Cologne-Merheim Hospital, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Andreas Zoric
- Institute for Research in Operative Medicine (IFOM), Cologne-Merheim Hospital, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Paul C Fuchs
- Plastic Surgery, Hand Surgery, Burn Center, Cologne-Merheim Hospital, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Jennifer L Schiefer
- Plastic Surgery, Hand Surgery, Burn Center, Cologne-Merheim Hospital, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Christian Opländer
- Institute for Research in Operative Medicine (IFOM), Cologne-Merheim Hospital, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
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13
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Mansour RN, Hasanzadeh E, Abasi M, Gholipourmalekabadi M, Mellati A, Enderami SE. The Effect of Fetal Bovine Acellular Dermal Matrix Seeded with Wharton's Jelly Mesenchymal Stem Cells for Healing Full-Thickness Skin Wounds. Genes (Basel) 2023; 14:genes14040909. [PMID: 37107668 PMCID: PMC10138153 DOI: 10.3390/genes14040909] [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: 03/05/2023] [Revised: 03/23/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
The treatment of full-thickness skin wounds is a problem in the clinical setting, as they do not heal spontaneously. Extensive pain at the donor site and a lack of skin grafts limit autogenic and allogeneic skin graft availability. We evaluated fetal bovine acellular dermal matrix (FADM) in combination with human Wharton's jelly mesenchymal stem cells (hWJ-MSCs) to heal full-thickness skin wounds. FADM was prepared from a 6-month-old trauma-aborted fetus. WJ-MSCs were derived from a human umbilical cord and seeded on the FADM. Rat models of full-thickness wounds were created and divided into three groups: control (no treatment), FADM, and FADM-WJMSCs groups. Wound treatment was evaluated microscopically and histologically on days 7, 14, and 21 post-surgery. The prepared FADM was porous and decellularized with a normal range of residual DNA. WJ-MSCs were seeded and proliferated on FADM effectively. The highest wound closure rate was observed in the FADM-WJMSC group on days 7 and 14 post-surgery. Furthermore, this group had fewer inflammatory cells than other groups. Finally, in this study, we observed that, without using the differential cell culture media of fibroblasts, the xenogeneic hWJSCs in combination with FADM could promote an increased rate of full-thickness skin wound closure with less inflammation.
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Affiliation(s)
- Reyhaneh Nassiri Mansour
- Department of Tissue Engineering and Regenerative Medicine, School of Advanced Technologies in Medicine, Mazandaran University of Medical Sciences, Sari 4815733971, Iran
| | - Elham Hasanzadeh
- Department of Tissue Engineering and Regenerative Medicine, School of Advanced Technologies in Medicine, Mazandaran University of Medical Sciences, Sari 4815733971, Iran
| | - Mozhgan Abasi
- Department of Tissue Engineering and Regenerative Medicine, School of Advanced Technologies in Medicine, Mazandaran University of Medical Sciences, Sari 4815733971, Iran
| | - Mazaher Gholipourmalekabadi
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran
- Department of Tissue Engineering & Regenerative Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran 1449614535, Iran
- Department of Medical Biotechnology, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Amir Mellati
- Department of Tissue Engineering and Regenerative Medicine, School of Advanced Technologies in Medicine, Mazandaran University of Medical Sciences, Sari 4815733971, Iran
- Molecular and Cell Biology Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari 4815733971, Iran
| | - Seyed Ehsan Enderami
- Immunogenetics Research Center, Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Mazandaran University of Medical Sciences, Sari 4815733971, Iran
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14
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Knoedler S, Matar DY, Knoedler L, Obed D, Haug V, Gorski SM, Kim BS, Kauke-Navarro M, Kneser U, Panayi AC, Orgill DP, Hundeshagen G. Association of age with perioperative morbidity among patients undergoing surgical management of minor burns. Front Surg 2023; 10:1131293. [PMID: 36923377 PMCID: PMC10008887 DOI: 10.3389/fsurg.2023.1131293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/13/2023] [Indexed: 03/01/2023] Open
Abstract
Introduction Burn injuries are associated with significant morbidity, often necessitating surgical management. Older patients are more prone to burns and more vulnerable to complications following major burns. While the relationship between senescence and major burns has already been thoroughly investigated, the role of age in minor burns remains unclear. To better understand differences between elderly and younger patients with predominantly minor burns, we analyzed a multi-institutional database. Methods We reviewed the 2008-2020 ACS-NSQIP database to identify patients who had suffered burns according to ICD coding and underwent initial burn surgery. Results We found 460 patients, of which 283 (62%) were male and 177 (38%) were female. The mean age of the study cohort was 46 ± 17 years, with nearly one-fourth (n = 108; 23%) of all patients being aged ≥60 years. While the majority (n = 293; 64%) suffered from third-degree burns, 22% (n = 99) and 15% (n = 68) were diagnosed with second-degree burns and unspecified burns, respectively. An average operation time of 46 min, a low mortality rate of 0.2% (n = 1), a short mean length of hospital stay (1 day), and an equal distribution of in- and outpatient care (51%, n = 234 and 49%, n = 226, respectively) indicated that the vast majority of patients suffered from minor burns. Patients aged ≥60 years showed a significantly prolonged length of hospital stay (p<0.0001) and were significantly more prone to non-home discharge (p<0.0001). In univariate analysis, advanced age was found to be a predictor of surgical complications (p = 0.001) and medical complications (p = 0.0007). Elevated levels of blood urea nitrogen (p>0.0001), creatinine (p>0.0001), white blood cell count (p=0.02), partial thromboplastin time (p = 0.004), and lower levels of albumin (p = 0.0009) and hematocrit (p>0.0001) were identified as risk factors for the occurrence of any complication. Further, complications were more frequent among patients with lower body burns. Discussion In conclusion, patients ≥60 years undergoing surgery for predominantly minor burns experienced significantly more complications. Minor lower body burns correlated with worse outcomes and a higher incidence of adverse events. Decreased levels of serum albumin and hematocrit and elevated values of blood urea nitrogen, creatinine, white blood count, and partial thromboplastin time were identified as predictive risk factors for complications.
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Affiliation(s)
- Samuel Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.,Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Dany Y Matar
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Leonard Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.,Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Doha Obed
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Valentin Haug
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Sabina M Gorski
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Martin Kauke-Navarro
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Adriana C Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Dennis P Orgill
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Gabriel Hundeshagen
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
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15
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Tolstov AV, Novikov IV, Milyudin ES, Yunusov RR, Kivaeva OI. The results of bacterial contamination of dangerous and borderline cases of burns. BULLETIN OF THE MEDICAL INSTITUTE "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH) 2022. [DOI: 10.20340/vmi-rvz.2023.1.clin.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The aim is to study the microbiological picture of purulent inflammation of superficial local burns in the center of thermal lesions of Samara.Material and methods. The etiological structure of local burn infection was analyzed in 29 patients with limited, borderline burns of I-II degree in all phases of the wound process. The collection of wound material was carried out in accordance with the requirements of the Methodological Guidelines of MU 4.2.2039-05 "Technique of collecting and transporting biomaterials to microbiological laboratories". The material was delivered to the laboratory in test tubes with a transport medium under isothermal conditions at a temperature of 20–22 °C within a day after collection.Results. The analysis of the etiological structure of burn infection showed that staphylococcus (St. aureus, St. warneri, St. gallinarium, St. spp, St. epidermidis) plays a leading role in microbiological examination – in 26 patients (89.6 %) and E. coli (E. coli) in 11 (37.9 %). There were no significant differences in the studied signs in the comparison groups (p > 0.05, p = 0.55, χ2 = 3.841).Conclusion. The obtained results of the etiological structure of purulent inflammation of limited burns are statistically reliable and can be used in the development of antibacterial agents for the treatment of burn infection.
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Affiliation(s)
| | - I. V. Novikov
- Samara City Clinical Hospital No. 1 named after N.I. Pirogov
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16
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Abla H, Brown E, Pang A, Batchinsky M, Raghuram A, Venable A, Kesey J, Dissanaike S, Bharadia D, Griswold J. Synergistic Use of Novel Technological Advances in Burn Care Significantly Reduces Hospital Length of Stay Below Predicted: A Case Series. J Burn Care Res 2022; 43:1440-1444. [PMID: 36075204 DOI: 10.1093/jbcr/irac133] [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] [Indexed: 11/12/2022]
Abstract
Length of stay is an important metric in healthcare systems, primarily because it reflects the cost of care provided. In the US, as in many countries, inpatient hospital stays are significantly more expensive than outpatient care across all healthcare conditions [1], so earlier discharge and transition to outpatient care is crucial to help control the ever-increasing cost of healthcare. In burn patients, length of stay has traditionally been estimated at 1 day per 1% total body surface area of burn. This estimation was first described in a round table discussion in 1986.[2] However, since that time there has been significant evolution in the quality of care available to burn patients, in both the operating room and ICU. The use of new harvesting techniques, synthetic dermal substitution, and autologous epidermal skin cell suspension are allowing large, deep burns to be excised and covered in much quicker time frames than historically were possible. Examples include the skin harvesting and wound debridement device for grafting and excision, biodegradable temporizing matrix as a fully synthetic dermal template, and regenerative epidermal suspension concerning cell harvesting. Although these modalities can all be used separately, we believe that using them in conjunction has allowed us to shorten the length of stay in patients with severe partial and full-thickness burns. We present an initial case series of 3 patients with anticipated hospital lengths of stay of 54.5, 55, and 51 days, who were ready for discharge in 37, 35, and 43 days, respectively.
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Affiliation(s)
- Habib Abla
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, School of Medicine, 3601 Fourth Street, MS6207, Lubbock, Texas, 79430, USA
| | - Elizabeth Brown
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, School of Medicine, 3601 Fourth Street, MS6207, Lubbock, Texas, 79430, USA
| | - Alan Pang
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, School of Medicine, 3601 Fourth Street, MS6207, Lubbock, Texas, 79430, USA
| | - Maria Batchinsky
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, School of Medicine, 3601 Fourth Street, MS6207, Lubbock, Texas, 79430, USA
| | - Akshay Raghuram
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, School of Medicine, 3601 Fourth Street, MS6207, Lubbock, Texas, 79430, USA
| | - Amanda Venable
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, School of Medicine, 3601 Fourth Street, MS6207, Lubbock, Texas, 79430, USA
| | - Jennifer Kesey
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, School of Medicine, 3601 Fourth Street, MS6207, Lubbock, Texas, 79430, USA
| | - Sharmila Dissanaike
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, School of Medicine, 3601 Fourth Street, MS6207, Lubbock, Texas, 79430, USA
| | - Deepak Bharadia
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, School of Medicine, 3601 Fourth Street, MS6207, Lubbock, Texas, 79430, USA
| | - John Griswold
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, School of Medicine, 3601 Fourth Street, MS6207, Lubbock, Texas, 79430, USA
- Department of Surgery, Texas Tech University Health Sciences Center, Clinical Research Institute, 3601 Fourth Street, MS8138, Lubbock, Texas, 79430, USA
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17
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Qian S, Wang J, Liu Z, Mao J, Zhao B, Mao X, Zhang L, Cheng L, Zhang Y, Sun X, Cui W. Secretory Fluid-Aggregated Janus Electrospun Short Fiber Scaffold for Wound Healing. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2022; 18:e2200799. [PMID: 35266631 DOI: 10.1002/smll.202200799] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Indexed: 06/14/2023]
Abstract
Exudate management is critical to improve chronic wound healing. Herein, inspired by a Janus-structured lotus leaf with asymmetric wettability, a Janus electrospun short fiber scaffold is fabricated via electrospinning technologies and short fiber modeling. This scaffold is composed of hydrophilic 2D curcumin-loaded electrospun fiber and hydrophobic 3D short fiber via layer-by-layer assembly and electrostatic interactions which can aggregate the wound exudate by pumping from the hydrophobic layer to the hydrophilic via multiple contact points between hydrophilic and hydrophobic fibers, and simultaneously trigger the cascade release of curcumin in the upper 2D electrospun fiber. The 3D short fiber with high porosity and hydrophobicity can quickly aggregate exudate within 30 s after compounding with hydrophilic 2D electrospun fiber via a spontaneous pump. In vitro experiments show that Janus electrospun short fiber has good biocompatibility, and the cascade release of curcumin can significantly promote the proliferation and migration of fibroblasts. In vivo experiments show that it can trigger cascade release of curcumin by aggregating wound exudate, so as to accelerate wound healing process and promote collagen deposition and vascularization. Hence, this unique biometric Janus scaffold provides an alternative for chronic wound healing.
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Affiliation(s)
- Shutong Qian
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, P. R. China
| | - Juan Wang
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Zhimo Liu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, P. R. China
| | - Jiayi Mao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, P. R. China
| | - Binfan Zhao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, P. R. China
| | - Xiyuan Mao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, P. R. China
| | - Liucheng Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, P. R. China
| | - Liying Cheng
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, P. R. China
| | - Yuguang Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, P. R. China
| | - Xiaoming Sun
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, P. R. China
| | - Wenguo Cui
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, P. R. China
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
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18
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Fan Y, Jin G, Pan Y, Cui S, Li J, Huang N. The Trend of Burn Injury Patients in Ningbo between 2012 and 2021: A Clinical Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:9969158. [PMID: 35990832 PMCID: PMC9391097 DOI: 10.1155/2022/9969158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022]
Abstract
Objective This study was designed to understand the local changes of burn injuries in recent 10 years, so as to provide reliable reference data and viewpoints for prevention and vigilance of local burn injuries. Methods In this study, 184 patients with a burn injury admitted to our hospital from 2012 to 2021 were enrolled and analyzed retrospectively. According to their information in the electronic database, the number of patients with burn injuries and the location of each disaster each year were analyzed, and the age, sex, hospital stay and hospitalization expense of each patient were collected. With 5 years as the boundary, the patients were divided into a 2012-2016 group and a 2017-2021 group and the differences of the two groups in the abovementioned aspects were compared. Results During 2012-2021, the incidence rate of burn injuries in men was higher than that in women and workplaces had a higher burn injury rate than residents' homes. Compared with the period of 2012-2016, the number of fires or explosions and the number of patients with a burn injury during 2017-2028 both increased, but there was no significant change in disaster location, male-female ratio, age, average hospital stay, and average hospitalization expense. Conclusion In the face of the increasing prevalence of burn injuries, we should strengthen fire-fighting knowledge-related education and fire prevention management and actively explore post-burn injury treatment strategies and potential treatment targets to promote the development of burn injury management and treatment strategies.
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Affiliation(s)
- Youfen Fan
- Burn Department, HwaMei Hospital, University of Chinese Academy of Sciences, No. 41 Northwest Street, Haishu District, Ningbo 315010, Zhejiang Province, China
| | - Guoying Jin
- Burn Department, HwaMei Hospital, University of Chinese Academy of Sciences, No. 41 Northwest Street, Haishu District, Ningbo 315010, Zhejiang Province, China
| | - Yanyan Pan
- Burn Department, HwaMei Hospital, University of Chinese Academy of Sciences, No. 41 Northwest Street, Haishu District, Ningbo 315010, Zhejiang Province, China
| | - Shengyong Cui
- Burn Department, HwaMei Hospital, University of Chinese Academy of Sciences, No. 41 Northwest Street, Haishu District, Ningbo 315010, Zhejiang Province, China
| | - Jiliang Li
- Burn Department, HwaMei Hospital, University of Chinese Academy of Sciences, No. 41 Northwest Street, Haishu District, Ningbo 315010, Zhejiang Province, China
| | - Neng Huang
- Burn Department, HwaMei Hospital, University of Chinese Academy of Sciences, No. 41 Northwest Street, Haishu District, Ningbo 315010, Zhejiang Province, China
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19
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Korzeniowski T, Strużyna J, Torres K. Evaluation of Bromelain-Based Enzymatic Debridement Combined with Laser Doppler Imaging and Healing of Burn Wounds. MEDICAL SCIENCE MONITOR : INTERNATIONAL MEDICAL JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022; 28:e936713. [PMID: 35918878 PMCID: PMC9358983 DOI: 10.12659/msm.936713] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Accurate estimation of burn depth is crucial for correct treatment decision making. Bromelain-based enzymatic debridement (ED) may improve clinical assessment of burn depth. Laser Doppler imaging (LDI) provides a valuable indicator of burn depth by analyzing microcirculation within tissue beds. This study aimed to evaluate bromelain-based enzymatic debridement combined with laser Doppler imaging and healing of 42 wounds in 19 patients with mixed second- and third-degree thermal burns. Material/Methods We included 42 wounds in 19 patients with mixed deep dermal and full-thickness thermal burns. All patients were treated with eschar-specific removal agent for ED. The perfusion of each wound after ED was assessed using LDI. Healing time was estimated by 2 experienced burn surgeons and marked by the observation of epithelization. The usefulness of the LDI performed after ED in predicting healing time was estimated. The findings were analyzed to determine a cut-off value for LDI that indicates if a burn will heal spontaneously. Results We observed that burn wounds with higher mean perfusion healed faster. The analysis showed a strong relationship between perfusion after ED and healing time (Spearman rank correlation coefficient=−0.803). A mean perfusion greater than 296.89 indicated that the wound could heal spontaneously and does not require skin grafting. Conclusions LDI examination of an already debrided wound allows for a reliable assessment of perfusion at an early stage of treatment. The use of a safe and effective debridement method in conjunction with a non-invasive diagnostic tool could improve burn management.
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Affiliation(s)
- Tomasz Korzeniowski
- The East Centre of Burns Treatment and Reconstructive Surgery in Łęczna, Łęczna, Poland.,Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, Lublin, Poland
| | - Jerzy Strużyna
- The East Centre of Burns Treatment and Reconstructive Surgery in Łęczna, Łęczna, Poland.,Department of Plastic, Reconstructive and Burns Surgery, Medical University of Lublin, Lublin, Poland
| | - Kamil Torres
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, Lublin, Poland
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20
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Louri NA, Dey N, AlHasan RN, Abdulla SH, Elsakka M, Gulreez R, Darwish AH, Kadalmani B, Al Khalifa KBA. Abdominoplasty Panniculus as a Source for Human Acellular Dermis: A Preliminary Report. Tissue Eng Regen Med 2022; 19:727-738. [PMID: 35325403 PMCID: PMC9294103 DOI: 10.1007/s13770-022-00439-3] [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: 08/11/2021] [Revised: 01/07/2022] [Accepted: 02/02/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND In extensive deep dermal burn injuries, split-thickness skin graft (STSG) has been the most preferred treatment option for resurfacing burn wounds. A thick split-thickness skin graft is ideal for preventing graft contracture but is associated with delayed donor healing and the lack of adequate donor skin. When applied with STSG, the dermal substitutes offer better-reconstructed skin than STSG alone. Human-derived acellular dermal matrix (HADM) obtained from cadaver skin is a dermal equivalent with good clinical outcomes. However, high cost and limited cadaver donor skin availability limit its clinical utility. Developing a low-cost preparation method and finding an alternate source of human donated skin can help reduce the cost. The objective of this study was to explore the feasibility of making HADM from abdominoplasty panniculus skin. METHODS Skin samples were collected from the abdominoplasty panniculus of ten eligible donors with their informed consent. A combination of low-cost reagents-sodium chloride and hypotonic solution (water for injection) was used for decellularizing the skin. Characterization of the prepared Acellular Dermis Matrix prototype was done. RESULTS The skin was deepidermized with one molar NaCl treatment at 37 °C for 24 h. The deepidermized dermis became acellular with hypotonic solution treatment at 4 °C for two weeks. The hematoxylin and eosin staining and cytotoxicity test confirmed the acellularity and non-cytotoxicity of the prepared HADM prototype. The HADM prototype also facilitated the formation of neo-epithelium in the 3D cell co-culture model. CONCLUSION This study confirms that abdominoplasty panniculus can be a viable alternative for HADM preparation. Further characterization studies are required to prove the concept.
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Affiliation(s)
- Nayef Abdulrahman Louri
- Department of Plastic Surgery and Burn Unit, Bahrain Defence Force Royal Medical Services Military Hospital, Riffa, Southern Governorate, 28743, Bahrain.
| | - Nigamananda Dey
- Department of Plastic Surgery and Burn Unit, Bahrain Defence Force Royal Medical Services Military Hospital, Riffa, Southern Governorate, 28743, Bahrain
- Department of Animal Science, Bharathidasan University, Tiruchirappalli, Tamil Nadu, 620024, India
| | - Rashed N AlHasan
- Department of Plastic Surgery and Burn Unit, Bahrain Defence Force Royal Medical Services Military Hospital, Riffa, Southern Governorate, 28743, Bahrain
| | - Safa Hassan Abdulla
- Department of Pathology, Bahrain Defence Force Royal Medical Services, Riffa, Bahrain
| | - Mohamed Elsakka
- Department of Plastic Surgery and Burn Unit, Bahrain Defence Force Royal Medical Services Military Hospital, Riffa, Southern Governorate, 28743, Bahrain
| | - Rasheeqa Gulreez
- Department of Plastic Surgery and Burn Unit, Bahrain Defence Force Royal Medical Services Military Hospital, Riffa, Southern Governorate, 28743, Bahrain
| | | | - Balamuthu Kadalmani
- Department of Animal Science, Bharathidasan University, Tiruchirappalli, Tamil Nadu, 620024, India
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Kovalchuk-Bolbatun TV, Zinchuk VV, Smotrin SM, Gulуai IE. Influence of Eearly Necrectomy in Pregnant Rats with Deep Thermal Skin Burns on Maternal Oxygen-Dependent Processes and Further Course of Pregnancy. J EVOL BIOCHEM PHYS+ 2022. [DOI: 10.1134/s0022093022020120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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22
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Ortiz-Arrabal O, Chato-Astrain J, Crespo PV, Garzón I, Mesa-García MD, Alaminos M, Gómez-Llorente C. Biological Effects of Maslinic Acid on Human Epithelial Cells Used in Tissue Engineering. Front Bioeng Biotechnol 2022; 10:876734. [PMID: 35662841 PMCID: PMC9159156 DOI: 10.3389/fbioe.2022.876734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/08/2022] [Indexed: 12/04/2022] Open
Abstract
In the present work, we evaluated the potential of maslinic acid (MA) to improve currently available keratinocyte culture methods for use in skin tissue engineering. Results showed that MA can increase cell proliferation and WST-1 activity of human keratinocytes after 24, 48, and 72 h, especially at the concentration of 5 μg/ml, without affecting cell viability. This effect was associated to a significant increase of KI-67 protein expression and upregulation of several genes associated to cell proliferation (PCNA) and differentiation (cytokeratins, intercellular junctions and basement membrane related genes). When human keratinocytes were isolated from skin biopsies, we found that MA at the concentration of 5 μg/ml significantly increased the efficiency of the explant and the cell dissociation methods. These results revealed the positive effects of MA to optimize human keratinocyte culture protocols for use in skin tissue engineering.
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Affiliation(s)
- Olimpia Ortiz-Arrabal
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
- Doctoral Program in Biochemistry and Molecular Biology, University of Granada, Granada, Spain
| | - Jesús Chato-Astrain
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
| | - Pascual Vicente Crespo
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
| | - Ingrid Garzón
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
| | - María Dolores Mesa-García
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
- Department of Biochemistry and Molecular Biology II, School of Pharmacy, Campus Universitario de Cartuja, Granada, Spain
- Biomedical Research Center, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, Granada, Spain
- *Correspondence: María Dolores Mesa-García, ; Miguel Alaminos,
| | - Miguel Alaminos
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
- *Correspondence: María Dolores Mesa-García, ; Miguel Alaminos,
| | - Carolina Gómez-Llorente
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
- Department of Biochemistry and Molecular Biology II, School of Pharmacy, Campus Universitario de Cartuja, Granada, Spain
- Biomedical Research Center, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, Granada, Spain
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de Souza da Fonseca A, de Paoli F, Mencalha AL. Photodynamic therapy for treatment of infected burns. Photodiagnosis Photodyn Ther 2022; 38:102831. [PMID: 35341978 DOI: 10.1016/j.pdpdt.2022.102831] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/17/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022]
Abstract
Burns are among the most debilitating and devastating forms of trauma. Such injuries are influenced by infections, causing increased morbidity, mortality, and healthcare costs. Due to the emergence of multidrug-resistant infectious agents, efficient treatment of infections in burns is a challenging issue. Antimicrobial photodynamic therapy (aPDT) is a promising approach to inactivate infectious agents, including multidrug-resistant. In this review, studies on PubMed were gathered, aiming to summarize the achievements regarding the applications of antimicrobial photodynamic therapy for the treatment of infected burns. A literature search was carried out for aPDT published reports assessment on bacterial, fungal, and viral infections in burns. The collected data suggest that aPDT could be a promising new approach against multidrug-resistant infectious agents. However, despite important results being obtained against bacteria, experimental and clinical studies are necessary yet on the effectiveness of aPDT against fungal and viral infections in burns, which could reduce morbidity and mortality of burned patients, mainly those infected by multidrug-resistant strains.
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Affiliation(s)
- Adenilson de Souza da Fonseca
- Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Boulevard Vinte e Oito de Setembro, 87, Fundos, Vila Isabel, Rio de Janeiro 20551030, Brazil; Departamento de Ciências Fisiológicas, Instituto Biomédico, Universidade Federal do Estado do Rio de Janeiro, Rua Frei Caneca, 94, Rio de Janeiro 20211040, Brazil; Centro de Ciências da Saúde, Centro Universitário Serra dos Órgãos, Avenida Alberto Torres, 111, Teresópolis, Rio de Janeiro 25964004, Brazil.
| | - Flavia de Paoli
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, Rua José Lourenço Khelmer - s/n, Campus Universitário, São Pedro, Juiz de Fora, Minas Gerais 36036900, Brazil
| | - Andre Luiz Mencalha
- Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Boulevard Vinte e Oito de Setembro, 87, Fundos, Vila Isabel, Rio de Janeiro 20551030, Brazil
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Estimation of the repair efficiency of collagen matrices on the model of thermal burn. ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.1.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background. In the world, dozens of new local wound healing agents are developed and improved every year, which undergo preliminary tests on laboratory animals due to the presence of common phases of the course of the wound process with humans.The aim of the study was to evaluate the wound healing effect of matrices obtained on the basis of the recycling of collagen-containing waste.Materials and methods. Collagen matrices are obtained from substandard leather raw materials subjected to treatment with fermented milk composition (KM1) and lactic acid (KM2). The wound healing effect was studied on the model of thermal burns on Wistar rats in 5 groups: 1st – control (natural wound healing); 2nd – experimental 1 (processing KM1); 3rd – experimental 2 (processing KM2); 4th – experimental 3, comparison group (“Levomekol”) and 5th – intact animals (normal, without burns). Wound healing was assessed by the results of planimetry on days 1, 3, 5, 7, 9, and 13 and by histological analysis of the skin tissue on days 6, 13, and 20. On days 6 and 13, the summary antioxidant activity, the total content of leukocytes, erythrocytes, the activity of the catalase enzyme, and the content of malondialdehyde were determined in the blood of rats.Results. With thermal damage to the skin, an IIIA degree burn was formed, accompanied by the development of dry coagulation necrosis. The use of collagen matrices restored the total content of leukocytes, reduced the area of the burn wound, normalized the content of malondialdehyde, the total antioxidant activity and the activity of catalase in the blood. Histomorphometric studies have confirmed the dynamics of skin tissue recovery after a burn. The effectiveness of the use of matrices was comparable to the pharmacopoeial drug “Levomekol”. A higher wound healing effect was noted when using the KM1 matrix.Conclusion. On the model of thermal burn, the wound-healing effect of collagen matrices was established, as evidenced by the results of restoring the number of leukocytes, reducing the area of the burn wound and restoring the histostructure of the skin. One of the molecular and cellular mechanisms of wound healing is the inhibition of lipid peroxidation reactions and the restoration of the antioxidant potential of the body.
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25
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Zhu W, Shu Z, Hu G, Zhou L, Song H. The impact of initial surgical management on outcome in patients with severe burns: a 9-year retrospective analysis. J Burn Care Res 2022; 43:1154-1159. [PMID: 35018463 DOI: 10.1093/jbcr/irac002] [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: 11/14/2022]
Abstract
PURPOSE To investigate the prognostic value of the factors related to the initial surgical management of burn wounds in severely burned patients. METHODS A total of 189 severely burned adult patients who were admitted to our institute between January 2012 and December 2020 and met the inclusion criteria were recruited. Patients were divided into survival and nonsurvival groups. The patient data included sex, age, total burn surface area (TBSA), burn index (BI), inhalation injury, mechanical ventilation, initial surgical management of the burn wound (including post-injury time before surgery, surgical duration, surgical area, intraoperative fluid replenishment, intraoperative blood loss, and intraoperative urine output), and duration in the burn intensive care unit (BICU). Independent samples t tests, Mann-Whitney U tests, and χ 2 tests were performed on these data. those of which with statistically significant differences were subjected to univariate and multivariate Cox regression analyses to identify independent risk factors affecting the prognosis of severely burned patients. Receiver operating characteristic (ROC) curves were plotted, and the area under the curve (AUC), optimal cut-off value were calculated. Patients were divided into two groups, according to the optimal cut-off value of the independent risk factors. The TBSA, surgical area and survival rates of the two groups during hospitalization were analysed. RESULTS The survival group (146 patients) and the nonsurvival group (43 patients) differed significantly in TBSA, burn index, inhalation injury, mechanical ventilation, initial surgical area, intraoperative fluid replenishment, intraoperative blood loss, and duration in the BICU (P<0.05). Univariate Cox regression analysis showed that TBSA, burn index, mechanical ventilation, initial surgical area, intraoperative fluid replenishment, and intraoperative blood loss were risk factors for death in severely burned patients (P<0.05). Multivariate Cox regression analysis showed that the burn index and intraoperative blood loss were independent risk factors for death in severely burned patients (P<0.05). When the intraoperative blood loss during the initial surgical management of burn wounds was used to predict death in 189 severely burned patients, the AUC was 0.637 (95% confidence interval (CI): 0.545-0.730, P=0.006), and the optimal cut-off for intraoperative blood loss was 750 ml. Kaplan-Meier survival analysis showed that the prognosis of the group with intraoperative blood loss ≤750 ml was better than that of the group with intraoperative blood loss >750 ml (P=0.008). Meanwhile, the TBSA and surgical area in the group with intraoperative blood loss ≤750 ml were significantly lower than that of the group with intraoperative blood loss >750 ml (P<0.05). CONCLUSION The burn index and intraoperative blood loss during the initial surgical management of burn wounds are independent risk factors affecting the outcome of severely burned patients with good predictive values. During surgery, haemostatic and anaesthetic strategies should be adopted to reduce bleeding, and the bleeding volume should be controlled within 750 ml to improve the outcome.
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Affiliation(s)
- Wei Zhu
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ziqin Shu
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Gaozhong Hu
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ling Zhou
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Huapei Song
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Sasaki J, Matsushima A, Ikeda H, Inoue Y, Katahira J, Kishibe M, Kimura C, Sato Y, Takuma K, Tanaka K, Hayashi M, Matsumura H, Yasuda H, Yoshimura Y, Aoki H, Ishizaki Y, Isono N, Ueda T, Umezawa K, Osuka A, Ogura T, Kaita Y, Kawai K, Kawamoto K, Kimura M, Kubo T, Kurihara T, Kurokawa M, Kobayashi S, Saitoh D, Shichinohe R, Shibusawa T, Suzuki Y, Soejima K, Hashimoto I, Fujiwara O, Matsuura H, Miida K, Miyazaki M, Murao N, Morikawa W, Yamada S. Japanese Society for Burn Injuries (JSBI) Clinical Practice Guidelines for Management of Burn Care (3rd Edition). Acute Med Surg 2022; 9:e739. [PMID: 35493773 PMCID: PMC9045063 DOI: 10.1002/ams2.739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 01/28/2023] Open
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Kaita Y, Otsu A, Tanaka Y, Yoshikawa K, Matsuda T, Yamaguchi Y. Epidemiology of bloodstream infections and surface swab cultures in burn patients. Acute Med Surg 2022; 9:e752. [PMID: 35572048 PMCID: PMC9080972 DOI: 10.1002/ams2.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/20/2022] [Indexed: 11/11/2022] Open
Abstract
Aim For infection control in burn patients, it is essential to understand the epidemiology of bloodstream infection (BSI) and the local microbiological situation. There are few studies on blood and swab culture results among burn patients in Japan. The purpose of this study was to investigate the epidemiology of BSI and swab cultures in burn patients. Methods Data from 355 burn patients over 13 years from 2008 were analyzed retrospectively. Bloodstream infection was defined as the isolation of bacteria or fungi from two or more blood cultures. The characteristics of burn patients and microorganisms detected from various cultures were analyzed. Results The mortality rate among burn patients with BSI was 37.8%, which was more than twice that among burn patients without BSI. The univariate analysis showed that inhalation injury, total burn surface area (TBSA), and mortality were associated with BSI. The multivariate logistic analysis indicated that TBSA was an independent risk factor for BSI. The most frequently isolated organism from blood and swab cultures were Candida species and Pseudomonas aeruginosa, respectively. Seventy‐five percent of the microorganisms isolated from blood were detected previously in swab cultures performed within 1 week from blood cultures. Conclusions The prognosis of burn patients with BSI was poor, and TBSA was an independent risk factor for BSI. The predominant organisms isolated from blood and swab cultures were Candida species and P. aeruginosa, respectively. Surveillance wound swab cultures could be utilized for monitoring the local microbiological situation in burn patients.
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Affiliation(s)
- Yasuhiko Kaita
- Department of Trauma and Critical Care Medicine Kyorin University School of Medicine Tokyo Japan
| | - Akiyasu Otsu
- Department of Trauma and Critical Care Medicine Kyorin University School of Medicine Tokyo Japan
| | - Yuya Tanaka
- Department of Trauma and Critical Care Medicine Kyorin University School of Medicine Tokyo Japan
| | - Kei Yoshikawa
- Department of Trauma and Critical Care Medicine Kyorin University School of Medicine Tokyo Japan
| | - Takeaki Matsuda
- Department of Trauma and Critical Care Medicine Kyorin University School of Medicine Tokyo Japan
| | - Yoshihiro Yamaguchi
- Department of Trauma and Critical Care Medicine Kyorin University School of Medicine Tokyo Japan
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Carney BC, Oliver MA, Erdi M, Kirkpatrick LD, Tranchina SP, Rozyyev S, Keyloun JW, Saruwatari MS, Daristotle JL, Moffatt LT, Kofinas P, Sandler AD, Shupp JW. Evaluation of Healing Outcomes Combining A Novel Polymer Formulation with Autologous Skin Cell Suspension to Treat Deep Partial and Full Thickness Wounds in a Porcine Model; A Pilot Study. Burns 2022; 48:1950-1965. [DOI: 10.1016/j.burns.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/29/2021] [Accepted: 01/16/2022] [Indexed: 11/02/2022]
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Abstract
Burn-induced coagulopathy is not well understood, and consensus on diagnosis, prevention, and treatments are lacking. In this review, literature on burn-induced (and associated) coagulopathy is presented along with the current understanding of the effects of burn injury on the interactions among coagulation, fibrinolysis, and inflammation in the acute resuscitative phase and reconstructive phase of care. The role of conventional tests of coagulopathy and functional assays like thromboelastography or thromboelastometry will also be discussed. Finally, reported methods for the prevention and treatment of complications related to burn-induced coagulopathy will be reviewed.
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Concomitant Pediatric Burns and Craniomaxillofacial Trauma. J Craniofac Surg 2021; 32:2097-2100. [PMID: 34260468 DOI: 10.1097/scs.0000000000007839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT This study is the first to investigate pediatric craniomaxillofacial (CMF) trauma patients that present with concomitant burns. The authors aim to identify differing etiologies, presentations, facial fracture patterns, interventions, and outcomes between pediatric CMF trauma patients with versus without concomitant burns. In this retrospective cohort study of a tertiary care center between the years 1990 and 2010, concomitant burns were identified among pediatric patients presenting with CMF fractures. Patient charts were reviewed for demographics, presentation, burn characteristics (total body surface area %, location, and degree), imaging, interventions, involvement of child protective services, and long-term outcomes. Data were analyzed using two-tailed Student t tests and chi-square analysis. Of the identified 2966 pediatric CMF trauma patients (64.0% boys; age 7 ± 4.7 years), 10 (0.34%) patients presented with concomitant burns. Concomitant burn and CMF traumas were more likely to be due to penetrating injuries (P < 0.0001) and had longer hospital lengths of stay (13 ± 18.6 versus 4 ± 6.2 days, P < 0.0001). 40% were due to child abuse, 40% due to motor vehicle collisions, and 20% due to house fires. All four child abuse patients presented in a delayed fashion; operative burn care was prioritized and 70% of the CMF fractures were managed nonoperatively. Concomitant burn and CMF trauma is a rare injury pattern in pediatrics and warrants skeletal surveys with suspicious injury patterns. Future research is necessary to develop practice guidelines.
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Song H, Yuan Z, Peng Y, Luo G. Extracorporeal membrane oxygenation combined with continuous renal replacement therapy for the treatment of severe burns: current status and challenges. BURNS & TRAUMA 2021; 9:tkab017. [PMID: 34212063 PMCID: PMC8240511 DOI: 10.1093/burnst/tkab017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/26/2021] [Indexed: 11/25/2022]
Abstract
Severe burns often cause various systemic complications and multiple organ dysfunction syndrome, which is the main cause of death. The lungs and kidneys are vulnerable organs in patients with multiple organ dysfunction syndrome after burns. Extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) have been gradually applied in clinical practice and are beneficial for severe burn patients with refractory respiratory failure or renal dysfunction. However, the literature on ECMO combined with CRRT for the treatment of severe burns is limited. Here, we focus on the current status of ECMO combined with CRRT for the treatment of severe burns and the associated challenges, including the timing of treatment, nutrition support, heparinization and wound management, catheter-related infection and drug dosing in CRRT. With the advancement of medical technology, ECMO combined with CRRT will be further optimized to improve the outcomes of patients with severe burns.
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Affiliation(s)
- Huapei Song
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Chongqing 400038, China
| | - Zhiqiang Yuan
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Chongqing 400038, China
| | - Yizhi Peng
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Chongqing 400038, China
| | - Gaoxing Luo
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Chongqing 400038, China
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Lipový B, Raška F, Kocmanová I, Hanslianová M, Hladík M, Holoubek J, Bezdíček M, Macháček C. Trichoderma longibrachiatum and Aspergillus fischeri Infection as a Cause of Skin Graft Failure in a Patient with Critical Burns after Liver Transplantation. J Fungi (Basel) 2021; 7:jof7060487. [PMID: 34207136 PMCID: PMC8234584 DOI: 10.3390/jof7060487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/03/2021] [Accepted: 06/14/2021] [Indexed: 11/16/2022] Open
Abstract
Infectious complications are responsible for the majority of mortalities and morbidities of patients with critical burns. Although bacteria are the predominant etiological agents in such patients, yeasts and fungi have become relatively common causes of infections over the last decade. Here, we report a case of a young man with critical burns on 88% TBSA (total body surface area) arising as a part of polytrauma. The patient's history of orthotopic liver transplantation associated with the patient's need to use combined immunosuppressant therapy was an additional complication. Due to deep burns in the forearm region, we have (after a suitable wound bed preparation) applied a new bi-layered dermal substitute. The patient, however, developed a combined fungal infection in the region of this dermal substitute caused by Trichoderma longibrachiatum and Aspergillus fischeri (the first case ever reported). The infection caused the loss of the split-thickness skin grafts (STSGs); we had to perform repeated hydrosurgical and mechanical debridement and a systemic antifungal treatment prior to re-application of the STSGs. The subsequent skin transplant was successful.
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Affiliation(s)
- Břetislav Lipový
- Department of Burns and Plastic Surgery, Institution Shared with University Hospital Brno, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (B.L.); (F.R.); (J.H.)
- CEITEC—Central European Institute of Technology, Brno University of Technology, 612 00 Brno, Czech Republic
| | - Filip Raška
- Department of Burns and Plastic Surgery, Institution Shared with University Hospital Brno, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (B.L.); (F.R.); (J.H.)
| | - Iva Kocmanová
- Department of Clinical Microbiology, University Hospital Brno, 625 00 Brno, Czech Republic;
| | - Markéta Hanslianová
- Department of Clinical Microbiology, Vyškov Hospital, 628 01 Vyškov, Czech Republic;
| | - Martin Hladík
- Department of Burns and Plastic Surgery, Institution Shared with University Hospital Brno, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (B.L.); (F.R.); (J.H.)
- Correspondence: ; Tel.: +420-532-232-206
| | - Jakub Holoubek
- Department of Burns and Plastic Surgery, Institution Shared with University Hospital Brno, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (B.L.); (F.R.); (J.H.)
| | - Matěj Bezdíček
- Centre of Molecular Biology and Gene Therapy, Department of Internal Medicine—Hematology and Oncology, Institution Shared with University Hospital Brno, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic;
| | - Ctirad Macháček
- Department of Pathology, Institution Shared with University Hospital Brno, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic;
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Carney BC, Moffatt LT, Travis TE, Nisar S, Keyloun JW, Prindeze NJ, Oliver MA, Kirkpatrick LD, Shupp JW. A Pilot Study of Negative Pressure Therapy with Autologous Skin Cell Suspensions in a Porcine Model. J Surg Res 2021; 267:182-196. [PMID: 34153561 DOI: 10.1016/j.jss.2021.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 03/22/2021] [Accepted: 05/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Negative pressure wound therapy (NPWT) is an option for securing meshed split thickness skin grafts (mSTSGs) after burn excision to optimize skin graft adherence. Recently, the use of autologous skin cell suspension (ASCS) has been approved for use in the treatment of burn injuries in conjunction with mSTSGs.To date, limited data exists regarding the impact of NPWT on healing outcomes when the cellular suspension is utilized. It was hypothesized that NPWT would not negatively impact wound healing of ASCS+mSTSG. MATERIALS AND METHODS A burn, excision, mSTSG, ASCS ± NPWT model was used. Two Duroc pigs were utilized in this experiment, each with 2 sets of paired burns. Four wounds received mSTSG+ASCS+NPWT through post-operative day 3, and 4 wounds received mSTSG+ACSC+ traditional ASCS dressings. Cellular viability was characterized prior to spraying. Percent re-epithelialization, graft-adherence, pigmentation, elasticity, and blood perfusion and blood vessel density were assessed at multiple time points through 2 weeks. RESULTS All wounds healed within 14 days with minimal scar pathology and no significant differences in percent re-epithelialization between NPWT, and non-NPWT wounds were observed. Additionally, no differences were detected for pigmentation, perfusion, or blood vessel density. NPWT treated wounds had less graft loss and improved elasticity, with elasticity being statistically different. CONCLUSIONS These data suggest the positive attributes of the cellular suspension delivered are retained following the application of negative pressure. Re-epithelialization, revascularization, and repigmentation are not adversely impacted. The use of NPWT may be considered as an option when using ASCS with mSTSGs for the treatment of full-thickness burns.
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Affiliation(s)
- Bonnie C Carney
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, Washington, DC; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC; Department of Surgery, Georgetown University School of Medicine, Washington, DC
| | - Lauren T Moffatt
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, Washington, DC; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC; Department of Surgery, Georgetown University School of Medicine, Washington, DC
| | - Taryn E Travis
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC; The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, DC; Department of Surgery, Georgetown University School of Medicine, Washington, DC
| | - Saira Nisar
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC
| | - John W Keyloun
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC; Department of Surgery, MedStar Washington Hospital Center and MedStar Georgetown University Hospital, Washington, DC
| | - Nicholas J Prindeze
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC; Department of Surgery, MedStar Washington Hospital Center and MedStar Georgetown University Hospital, Washington, DC
| | - Mary A Oliver
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC
| | - Liam D Kirkpatrick
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC
| | - Jeffrey W Shupp
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, Washington, DC; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC; The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, DC; Department of Surgery, Georgetown University School of Medicine, Washington, DC.
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Gao C, Diao J, Jia J, Zhang L. Investigation on Potential of Novel Carrier System Containing Silver and Gold Nanoparticles for Burn Surgery: Evaluation in Rat Model. J BIOMATER TISS ENG 2021. [DOI: 10.1166/jbt.2021.2538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The main aim of the study was to optimization and evaluation of a suitable dosage form i.e., tropical gel containing silver and gold nanoparticles which are synthesized by green synthesis as this is the rapid and better alternative to chemical synthesis. For burn injury systemic route
of administration is not suitable due to damaged skin hence tropical route selected to provide controlled effects, low systemic toxicity and easy application. Silver nanoparticles were synthesized by green synthesis by use of neem leaves and gold nanoparticles by Aloe vera. Characterization
was done by UV spectroscopy, particle size distribution, TEM and zeta potential. Gel was formulated by simple mixing and stirring method and evaluated for color, homogeneity, Spreadability, viscosity, in vitro release, antimicrobial study and in vivo study. In this study, the
combination of Carbopol 934 P and HPMC (ratio 1:3) was found to be ideal formulation (Formulation F5) with optimum viscosity and Spread-ability i.e., 4459 cP and 5.7 gmcm/sec resp. in vitro release was found to be 98.66% in 12 hours. in vitro antimicrobial study and in vivo
study on rat showed maximum effects than standard formulations. From this study it can be concluded that, tropical gel is the superior dosage form containing silver and gold nanoparticles which acts as the antimicrobial agents and is effective in treatment of burn surgery.
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Affiliation(s)
- Cong Gao
- Department of Burn Rehabilitation, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, 250013, China
| | - Jianjun Diao
- Department of Medical Records Management, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, 250013, China
| | - Jun Jia
- Department of Burn Rehabilitation, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, 250013, China
| | - Lei Zhang
- Department of Burn Rehabilitation, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, 250013, China
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Teklay S, Balai E, Patel L. The Complexity of Managing a Burned Irreducible Umbilical Hernia in an Adult. Cureus 2021; 13:e14030. [PMID: 33898118 PMCID: PMC8059485 DOI: 10.7759/cureus.14030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We present a case of a 65-year-old male with a longstanding non-symptomatic irreducible umbilical hernia who presented with a three-day-old full-thickness thermal burn to the hernia. The burn was sustained while operating a metal drop forger, where the patient was repeatedly exposed to 30-second bursts of heat from the furnace, with temperature exceeding 1350°C. He estimated he had this exposure approximately 48 times during an 8-hour shift, giving him a total of 24 minutes cumulative exposure to the heat. The patient reported that he normally wore an abdominal binder under his heat-resistant apron to temporarily flatten and protect his hernia. On the day of the injury, he had not been wearing this binder. The patient was initially unaware that he had sustained a burn; upon delayed presentation to the hospital, he had cellulitis surrounding a 0.25% total body surface area (TBSA) full-thickness burn. Contrast-enhanced CT abdomen demonstrated an umbilical hernia with a neck diameter of 2.3cm, with breach of the hernia fascia but no communication between the bowel and burnt tissue. After discussion between Plastic Surgery and General Surgery teams the decision was made to manage the burn non-operatively with daily flamazine dressings and empirical antibiotics for the cellulitis. Once this area had healed, elective mesh repair of the umbilical hernia was carried out. This is the first adult case of a full-thickness burn overlying an umbilical hernia to be reported in the literature. The case highlights both an unusual aetiology and a rare injury, as well as the multi-disciplinary teamwork required to manage it successfully.
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Affiliation(s)
- Samuel Teklay
- Plastic Surgery, Queen Elizabeth Hospital, Birmingham, GBR
| | - Edward Balai
- Plastic Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, GBR
| | - Lopa Patel
- Plastic Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, GBR
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Qiu L, Jin X, Wang JJ, Tang XD, Fang X, Li SJ, Wang F, Chen XL. Plasma Neutrophil-to-Lymphocyte Ratio on the Third Day Postburn is Associated with 90-Day Mortality Among Patients with Burns Over 30% of Total Body Surface Area in Two Chinese Burns Centers. J Inflamm Res 2021; 14:519-526. [PMID: 33658827 PMCID: PMC7917389 DOI: 10.2147/jir.s294543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/03/2021] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Neutrophil-to-lymphocyte ratio (NLR) is a marker of inflammation. This study aimed to evaluate the potential role of NLR to predict 90-day mortality. METHODS Data of 577 patients with burns over 30% of total body surface area were collected and retrospectively analyzed. The risk factors for 90-day mortality were evaluated using logistic regression analyses. Receiver operating characteristic (ROC) curve analysis of the 3rd day NLR was performed and the optimal cut-off value was calculated. The 90-day mortality rates were compared between high and low NLR groups using Kaplan-Meier analysis. RESULTS Age, mechanical ventilation, burn index, 3rd day NLR, and 7th day red blood cell and platelet (PLT) counts were found to be independent predictive values for 90-day mortality. In contrast, percentage of total body surface area burned, inhalation injury, 1st day white blood cell and neutrophil counts, the 3rd day lymphocytes and PLT counts, and 7th day hemoglobin level were not independently associated with 90-day mortality. The area under the ROC curve of the 3rd day NLR for severe burn-delayed death prediction was 0.665 (95% confidence interval, 0.591-0.739), and the optimal cut-off value of the 3rd day NLR was 10.50. The 90-day mortality rates differed significantly between the NLR >10.5 group and the NLR ≤ 10.5 group (17.03% vs 5.92%, respectively; P < 0.01). CONCLUSION These results suggested that the 3rd day NLR was associated with an increased risk of death in severely burned patients; thus, it can provide useful information to predict 90-day mortality.
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Affiliation(s)
- Le Qiu
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Xu Jin
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Jun-Jie Wang
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Xu-Dong Tang
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Xiao Fang
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Shi-Ji Li
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Fei Wang
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Xu-Lin Chen
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
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Morsalivachin Z, Salehi H, Dahmardehei M, Mousavipour M, Karimi H, Jafarian A, Momeni M. A comparison on the scar development when done through overlapping versus approximating seams techniques - A clinical trial. Burns 2021; 47:1602-1607. [PMID: 33933305 DOI: 10.1016/j.burns.2021.01.007] [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: 07/07/2020] [Revised: 01/04/2021] [Accepted: 01/15/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Skin autografting is performed widely for deep burn wounds as an ideal coverage. Scaring at the site of grafting has been always a challenge for surgeons. Many methods have been proposed to lessen the probability of scaring, but conflicting results have been obtained. It is said that the suture type is important in the development of scaring. Seams technique has also been introduced to decrease scar after autografting. OBJECTIVE We sought to compare two approximating (AP) and overlapping (OV) Seams technique to compare the development of scars. METHODS AND MATERIALS Patients with deep burns of 10% to 50% TBSA who were candidates for grafting entered this double-blind randomized trial. One side of the graft was fixed with a stapler using the "approximating" technique and the other side was fixed by the "overlapping" technique with a 1-2 mm margin overlap. The Vancouver Scar Scale (VSS) standard was used to evaluate scar formation at the graft edges at six months. Data entered SPSS 16 and analyzed. A P-value below 0.05 was considered as statistically significant. RESULTS Thirty-six patients entered. Two (5.6%) were females and 34 (94.4%) males. The mean age of patients was 39.14 ± 8.53 years. The mean burn surface area percentage was 15.2 ± 2.84. Vascularity Scar index had no statistically significant difference between the overlapping and approximating techniques (P = 0.564). However, pigmentation (P = 0.014), pliability (P = 0.008) and the height indices (P < 0.001) were statistically significantly better in the approximating technique. The mean of total score of Vancouver was better in the approximating technique as well (P < 0.001). CONCLUSION We compared two techniques of Seams between the normal skin and the graft edge for the first time. We showed that the AP method had a better Vancouver score compared to the OV regarding pigmentation, height, and pliability indices.
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Affiliation(s)
- Zeinab Morsalivachin
- Department of Surgery School of Medicine, Iran University of Medical Sciences, Iran
| | - Hamid Salehi
- Department of General Surgery, School of Medicine, Burn Research Center, Shahid Motahari Burns Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Dahmardehei
- Department of Plastic Surgery, School of Medicine, Burn Research Center, Shahid Motahari Burns Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Mousavipour
- Department of Psychiatry School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Karimi
- Department of Plastic Surgery, School of Medicine, Burn Research Center, Shahid Motahari Burns Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Jafarian
- Iran University of Medical Sciences, Tehran, Iran
| | - Mahnoush Momeni
- Department of General Surgery, School of Medicine, Burn Research Center, Shahid Motahari Burns Hospital, Iran University of Medical Sciences, Tehran, Iran.
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Seo YJ, Kong YG, Yu J, Park JH, Kim SJ, Kim HY, Kim YK. The prognostic nutritional index on postoperative day one is associated with one-year mortality after burn surgery in elderly patients. BURNS & TRAUMA 2021; 9:tkaa043. [PMID: 33709002 PMCID: PMC7935376 DOI: 10.1093/burnst/tkaa043] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/13/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Burn injury in elderly patients can result in poor outcomes. Prognostic nutritional index (PNI) can predict the perioperative nutritional status and postoperative outcomes. We aim to evaluate the risk factors, including PNI, for one-year mortality after burn surgery in elderly patients. METHODS Burn patients aged ≥65 years were retrospectively included. PNI was calculated using the following equation: 10 × serum albumin level (g/dL) + 0.005 × total lymphocyte count (per mm3). Cox regression, receiver operating characteristic curve and Kaplan-Meier survival analyses were performed to evaluate the risk factors for postoperative one-year mortality. RESULTS Postoperative one-year mortality occurred in 71 (37.6%) of the 189 elderly burn patients. Risk factors for one-year mortality were PNI on postoperative day one (hazard ratio (HR) = 0.872; 95% CI = 0.812-0.936; p < 0.001), Sequential Organ Failure Assessment score (HR = 1.112; 95% CI = 1.005-1.230; p = 0.040), American Society of Anesthesiologists physical status (HR = 2.064; 95% CI = 1.211-3.517; p = 0.008), total body surface area burned (HR = 1.017; 95% CI = 1.003-1.032; p = 0.015) and preoperative serum creatinine level (HR = 1.386; 95% CI = 1.058-1.816; p = 0.018). The area under the curve of PNI for predicting one-year mortality after burn surgery was 0.774 (optimal cut-off value = 25.5). Patients with PNI ≤25.5 had a significantly lower one-year survival rate than those with PNI >25.5 (32.1% vs 75.9%, p < 0.001). CONCLUSIONS PNI on postoperative day one was associated with postoperative one-year mortality in elderly burn patients. The postoperative one-year survival rate was lower in patients with PNI ≤25.5 than in those with PNI >25.5. These findings indicate the importance of identifying elderly burn patients with low PNI, thereby reducing the mortality after burn surgery.
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Affiliation(s)
- Young Joo Seo
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, 12, Beodeunaru-ro 7-gil, Yeongdeungpo-gu, Seoul 07247, Republic of Korea
| | - Yu-Gyeong Kong
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, 12, Beodeunaru-ro 7-gil, Yeongdeungpo-gu, Seoul 07247, Republic of Korea
| | - Jihion Yu
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Ji Hyun Park
- Department of Anesthesiology and Pain Medicine, National Medical Center, 245, Euljiro, Jung-gu, Seoul 04564, Republic of Korea
| | - Su-Jin Kim
- Department of Anesthesiology and Pain Medicine, National Medical Center, 245, Euljiro, Jung-gu, Seoul 04564, Republic of Korea
| | - Hee Yeong Kim
- Department of Anesthesiology and Pain Medicine, National Medical Center, 245, Euljiro, Jung-gu, Seoul 04564, Republic of Korea
| | - Young-Kug Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
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Chato-Astrain J, Chato-Astrain I, Sánchez-Porras D, García-García ÓD, Bermejo-Casares F, Vairo C, Villar-Vidal M, Gainza G, Villullas S, Oruezabal RI, Ponce-Polo Á, Garzón I, Carriel V, Campos F, Alaminos M. Generation of a novel human dermal substitute functionalized with antibiotic-loaded nanostructured lipid carriers (NLCs) with antimicrobial properties for tissue engineering. J Nanobiotechnology 2020; 18:174. [PMID: 33228673 PMCID: PMC7686763 DOI: 10.1186/s12951-020-00732-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/13/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Treatment of patients affected by severe burns is challenging, especially due to the high risk of Pseudomonas infection. In the present work, we have generated a novel model of bioartificial human dermis substitute by tissue engineering to treat infected wounds using fibrin-agarose biomaterials functionalized with nanostructured lipid carriers (NLCs) loaded with two anti-Pseudomonas antibiotics: sodium colistimethate (SCM) and amikacin (AMK). RESULTS Results show that the novel tissue-like substitutes have strong antibacterial effect on Pseudomonas cultures, directly proportional to the NLC concentration. Free DNA quantification, WST-1 and Caspase 7 immunohistochemical assays in the functionalized dermis substitute demonstrated that neither cell viability nor cell proliferation were affected by functionalization in most study groups. Furthermore, immunohistochemistry for PCNA and KI67 and histochemistry for collagen and proteoglycans revealed that cells proliferated and were metabolically active in the functionalized tissue with no differences with controls. When functionalized tissues were biomechanically characterized, we found that NLCs were able to improve some of the major biomechanical properties of these artificial tissues, although this strongly depended on the type and concentration of NLCs. CONCLUSIONS These results suggest that functionalization of fibrin-agarose human dermal substitutes with antibiotic-loaded NLCs is able to improve the antibacterial and biomechanical properties of these substitutes with no detectable side effects. This opens the door to future clinical use of functionalized tissues.
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Affiliation(s)
- Jesús Chato-Astrain
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, Avenida de la Investigación 11, 18016, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
| | - Isabel Chato-Astrain
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, Avenida de la Investigación 11, 18016, Granada, Spain
| | - David Sánchez-Porras
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, Avenida de la Investigación 11, 18016, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
| | - Óscar-Darío García-García
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, Avenida de la Investigación 11, 18016, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
| | - Fabiola Bermejo-Casares
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, Avenida de la Investigación 11, 18016, Granada, Spain
| | - Claudia Vairo
- BioKeralty Research Institute AIE, Albert Einstein, 25-E3, 01510, Miñano, Spain
| | | | - Garazi Gainza
- BioKeralty Research Institute AIE, Albert Einstein, 25-E3, 01510, Miñano, Spain
| | - Silvia Villullas
- BioKeralty Research Institute AIE, Albert Einstein, 25-E3, 01510, Miñano, Spain
| | | | - Ángela Ponce-Polo
- Red Andaluza de Diseño Y Traslación de Terapias Avanzadas, Sevilla, Spain
| | - Ingrid Garzón
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, Avenida de la Investigación 11, 18016, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
| | - Víctor Carriel
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, Avenida de la Investigación 11, 18016, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
| | - Fernando Campos
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, Avenida de la Investigación 11, 18016, Granada, Spain.
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain.
| | - Miguel Alaminos
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, Avenida de la Investigación 11, 18016, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
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Allorto N, Rencken CA, Wall S, Pompermaier L. Factors impacting time to surgery and the effect on in-hospital mortality. Burns 2020; 47:922-929. [PMID: 33342553 DOI: 10.1016/j.burns.2020.09.002] [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: 07/02/2020] [Revised: 08/26/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Early surgery improves outcomes after burn injuries but is often not available in limited resource settings (LRS), where a more conservative approach is widespread. This study aimed to analyze factors associated with delay in surgical treatment, and the impact on in-hospital mortality. METHODS All patients with burns treated with surgery between 2016 and 2019 at the Pietermaritzburg Burn Service, in South Africa, were included in this retrospective study. Early surgery was defined as patients who underwent surgery within 7 days from injury. The population was analyzed descriptively and differences between groups were tested using t-test, and χ2 test or Fisher's exact test, as appropriate. Multivariable logistic regression was used to analyze the effect of delay in surgical treatment on in-hospital mortality, after adjustment for confounders. RESULTS During the study period, 620 patients with burns underwent surgery. Of them, 16% had early surgery. The early surgery group had a median age and TBSA of 11 years (3-35) and 12.0% (5-22) compared to 7 years (2-32) and 6.0% (3-13) in the late surgery group (p=0.45, p<0.001). In logistic regression, female sex [aOR: 3.30 (95% CI: 1.47-7.41)], TBSA% [aOR: 1.09 (95% CI: 1.05-1.12)], and FTB [aOR: 3.21 (95% CI: 1.43-7.18)] were associated with in-hospital mortality, whereas having early surgery was not [aOR: 1.74 (95% CI: 0.76-3.98)]. CONCLUSION This study found that early surgery was not associated with in-hospital mortality. Independent predictors of in-hospital mortality were female sex, presence of full thickness burn, and larger burn size. Future studies should investigate if burn care capacity in LRS may influence the association between early excision and outcome.
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Affiliation(s)
- Nikki Allorto
- Pietermaritzburg Burn Service, University of KwaZulu-Natal, KZN, South Africa
| | | | - Shelley Wall
- Pietermaritzburg Burn Service, University of KwaZulu-Natal, KZN, South Africa; DRILL Fellow: Developing Research, Innovation, Localization and Leadership, Univeristy of KwaZulu-Natal, KZN, South Africa
| | - Laura Pompermaier
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
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García-Díaz A, Durán-Romero AJ, PurificaciónGacto-Sánchez, Carbajal-Guerrero J, Gómez-Cía T, Pereyra-Rodríguez JJ. Trends in burn injury mortality in Spain (1979-2018): Sex-specific age-cohort-period effects. Burns 2020; 47:714-720. [PMID: 32878699 DOI: 10.1016/j.burns.2020.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/08/2020] [Accepted: 08/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies about burns mortality are often exclusively based on hospital and burn centre data. National population-based reports on this topic are rather limited. The aim of this study was to analyse sex- and age-specific mortality rates of burns in Spain during the period 1979-2018. METHODS Age-standardised burns mortality rates were calculated from death records and mid-year population data were provided by the Spanish National Statistics Institute. Joinpoint regression analyses were used to identify significant points of change in trends over time and to compute average annual per cent change (AAPC). Age, period and cohort effects were also analysed. RESULTS Mortality due to burn injury decreased in both sexes between 1979 and 2018: from the first quinquennium of this period up to the last one age-adjusted mortality rates decreased from 1.37 to 0.49 per 100,000 in men and from 0.96 to 0.26 per 100,000 in women. CONCLUSIONS Burns mortality rates in Spain have been decreasing during the last decades. Promotion of primary prevention measures should continue.
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Affiliation(s)
- Antonio García-Díaz
- Plastic Surgery Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | | | - Tomás Gómez-Cía
- Plastic Surgery Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Thibodeaux KT, Speyrer MS, Thibodeaux RP, Rogers AA, Rippon MG. Management of postoperative bleeding in surgically debrided wounds: topical haemostat versus electrocautery. J Wound Care 2020; 29:444-451. [PMID: 32804032 DOI: 10.12968/jowc.2020.29.8.444] [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: 11/11/2022]
Abstract
OBJECTIVE To compare the effectiveness of a temporary topical external haemostat (OMNI-STAT Granules, Omni-stat Medical Inc., US) versus the use of electrocautery for bleeding control in patients who have undergone surgical wound debridement. Time saved in the operating room (OR) was evaluated. METHOD A prospective evaluation of use of a topical haemostat in an OR setting was compared with retrospective data collected using electrocautery to understand the time-saving benefits of using a topical haemostat versus electrocautery. RESULTS A total of 52 patients were treated with the topical haemostat, and 89 patients with electrocautery. The topical haemostat was shown to be as effective in achieving haemostasis post-surgical debridement as electrocautery, with the added benefits of significant time savings in the OR (reducing the mean total OR time by 19.1%). Additionally, preprocedure and surgical procedure times in patients treated with the topical haemostat were significantly reduced. The results showed that wounds treated with the topical haemostat demonstrated a more advanced stage of healing, which may be a result of the lack of tissue damage demonstrated with the topical haemostat compared with electrocautery. CONCLUSION This study found that the temporary topical haemostat was equally as effective as cauterisation in achieving haemostasis. In addition, significant saving in OR time was demonstrated relative to electrocautery. The improved OR times may translate into increased cost-effectiveness, relative to electrocautery, by increasing the number of surgical cases per day and/or using resources more effectively to treat more patients. It may also enable bleeding control in the outpatient clinic or at the bedside, freeing up costly OR time and enabling more effective management of healthcare resources.
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Affiliation(s)
| | | | - Ryan P Thibodeaux
- Medical Data Generation, Medical Management Ink, Opelousas, Louisiana, US
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Italian recommendations on enzymatic debridement in burn surgery. Burns 2020; 47:408-416. [PMID: 32723513 DOI: 10.1016/j.burns.2020.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/21/2020] [Accepted: 07/06/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Nexobrid®, a bromelain-based type of enzymatic debridement, has become more prevalent in recent years. We present the recommendations on enzymatic debridement (Nexobrid®)'s role based on the practice knowledge of expert Italian users. METHODS The Italian recommendations, endorsed by SIUST (Italian Society of Burn Surgery), on using enzymatic debridement to remove eschars for burn treatment were defined. The definition followed a process to evaluate the level of agreement (a measure of consensus) among selected experts, representing Italian burn centers, concerning defined clinical aspects of enzymatic debridement. The consensus involved a multi-phase process based on the Delphi method. RESULTS The consensus panel included experts from Italy with a combined experience of 1068 burn patients treated with enzymatic debridement. At the end of round 3 of the Delphi method, the panel reached 100% consensus on 26 out of 27 statements. The panel achieved full, strong consensus (all respondents strongly agreed on the statement) on 24 out of 27 statements. DISCUSSION The statements provided by the Italian consensus panel represent a "ready to use" set of recommendations for enzymatic debridement in burn surgery that both draw from and complete the existing scientific literature on the topic. These recommendations are specific to the Italian experience and are neither static nor definitive. As such, they will be updated periodically as further quality evidence becomes available.
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Subrata SA. A concept analysis of burn care in nursing. Scand J Caring Sci 2020; 35:75-85. [PMID: 32319697 DOI: 10.1111/scs.12847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/04/2020] [Accepted: 03/11/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Burn is a life-threatening injury that requires long-term treatment and concomitant hospital stay. Relevant clinical studies in burns have been accomplished and published in the literature. However, none of these studies reported the concept analysis of burn care in nursing. Therefore, analysing the concept of burn care acts as an imperative strategy to provide comprehensive management of burn injury. OBJECTIVE The study aims to describe the concept of burn care in nursing. METHOD Walker and Avant's method (2013) was used to achieve the objective of the study. FINDINGS A model of burn care in nursing was generated that consists of assessment and diagnosis, intervention and evaluation. In addition, the biopsychosocial model developed by George L. Engel (1977) was also integrated to examine how these aspects play a significant role in burn care. CONCLUSION Implementing the concept of burn care will improve the quality of nursing care, cosmetic outcomes and vice versa, reduce the comorbidities on burn injury.
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Affiliation(s)
- Sumarno A Subrata
- Philosophy Program in Nursing, International and Collaborative Program with Foreign University Program, Mahidol University, Phaya Thai, Thailand.,Department of Nursing and Wound Research Center, Faculty of Health Sciences, Universitas Muhammadiyah Magelang, Magelang, Indonesia
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Cinotti R, Besnard N, Desmedt L, Floch RL, Perrot P, Bekara F, Klouche K, Larcher R, Mahé PJ, Frasca D, Asehnoune K, Jung B, Roquilly A. Feasibility and impact of the implementation of a clinical scale-based sedation-analgesia protocol in severe burn patients undergoing mechanical ventilation. A before-after bi-center study. Burns 2020; 46:1310-1317. [PMID: 32156477 DOI: 10.1016/j.burns.2020.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/28/2020] [Accepted: 02/15/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Severe burn patients undergo prolonged administration of sedatives and analgesics for burn care. There are currently no guidelines for the dose adaptation of sedation-analgesia in severe burn patients. METHODS We performed a before-after 2-center study to demonstrate the feasibility and efficacy of a sedation-analgesia scale-based protocol in severely burned patients receiving ≥24h of invasive mechanical ventilation. Before the intervention, continuous infusion of hypnotic and morphine derivatives was continued. During the Intervention phase, general anesthesia was relayed from day 1 by RASS/BPS-titrated continuous infusion of hypnotic and morphine derivatives and with short half-life drugs adminstered for daily burn dressings. The primary outcome was the duration of invasive mechanical ventilation in the ICU. RESULTS Eighty-seven (46.2%) patients were included in the Control phase and 101 (53.7%) in the Intervention phase. The median burned cutaneous surface was 20% [11%-38%] and median ABSI was 7 [5-9]. The durations of hypnotic and opioid infusions were not statistically different between the 2 phases (8 days [2-24] vs. 6 days [2-17] (P=0.3) and 17 days [4-32] vs. 8 days [3-23] (P=0.06), respectively). The duration of mechanical ventilation was 14 days [3-29] in the Control phase and 7 days [2-24] in the Intervention phase (P=0.7). When taking into account the competition between mortality and weaning from mechanical ventilation, we found no significant difference between the 2 phases (Gray test, P=0.4). The time-series analysis showed no difference for the duration of mechanical ventilation in the Intervention phase (P=0.6). Eighteen (20.7%) patients died in the Control phase, and 18 (18%) in the Intervention phase (P=0.6). CONCLUSION Scale-based lightening of continuous sedation-analgesia with repeated short general anesthesia for dressing is feasible in severe burn patients but failed to demonstrate a decrease in the duration of invasive mechanical ventilation.
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Affiliation(s)
- Raphaël Cinotti
- Department of Anesthesia and Critical Care, Hôpital Guillaume et René Laennec, University Hospital of Nantes, Boulevard Jacques Monod, Saint-Herblain 44800, France.
| | - Noémie Besnard
- Medical Intensive Care Unit, Hôpital Lapeyronie, Montpellier University and MontpellierTeaching Hospital, 191, Avenue du Doyen Gaston Giraud, MontpellierCedex 5, Montpellier, 34295, France
| | - Luc Desmedt
- Anesthesia and Critical Care, University Hospital of Nantes, Hôtel Dieu, 1 place Alexis Ricordeau, Nantes 44093, France
| | - Ronan Le Floch
- Anesthesia and Critical Care, University Hospital of Nantes, Hôtel Dieu, 1 place Alexis Ricordeau, Nantes 44093, France
| | - Pierre Perrot
- Department of Plastic and Burn Surgery, University Hospital of Nantes, Hôtel Dieu, 1 place Alexis Ricordeau, Nantes 44093, France
| | - Farid Bekara
- Department of Plastic and Burn Surgery, Montpellier University and Montpellier Teaching Hospital, Hôpital Lapeyronie 191, Avenue du Doyen Gaston Giraud, Montpellier Cedex 5, Montpellier 34295, France
| | - Kada Klouche
- Medical Intensive Care Unit, Hôpital Lapeyronie, Montpellier University and MontpellierTeaching Hospital, 191, Avenue du Doyen Gaston Giraud, MontpellierCedex 5, Montpellier, 34295, France; INSERM U1046, CNRS UMR9214, Hôpital Lapeyronie 191, Avenue du Doyen Gaston Giraud, MontpellierCedex 5, Université deMontpellier, Montpellier 34295, France
| | - Romaric Larcher
- Medical Intensive Care Unit, Hôpital Lapeyronie, Montpellier University and MontpellierTeaching Hospital, 191, Avenue du Doyen Gaston Giraud, MontpellierCedex 5, Montpellier, 34295, France
| | - Pierre-Joachim Mahé
- Anesthesia and Critical Care, University Hospital of Nantes, Hôtel Dieu, 1 place Alexis Ricordeau, Nantes 44093, France
| | - Denis Frasca
- Department of Anesthesia and Critical Care, Centre Hospitalo-Universitaire, University Hospital of Poitiers, 2 rue de la Milétrie Poitiers 86021, France; INSERM SPHERE U1246 «MethodS for Patients-centered outcomes and HEalth REsearch», UFR des sciences pharmaceutiques, University of Nantes, University of Tours, 22 boulevard Benoni-Goullin, Nantes 44200, France
| | - Karim Asehnoune
- Anesthesia and Critical Care, University Hospital of Nantes, Hôtel Dieu, 1 place Alexis Ricordeau, Nantes 44093, France; Laboratoire UPRES EA 3826 «Thérapeutiques cliniques et expérimentales des infections». University hospital of Nantes, 22 boulevard Benoni-Goullin, Nantes 44200, France
| | - Boris Jung
- Medical Intensive Care Unit, Hôpital Lapeyronie, Montpellier University and MontpellierTeaching Hospital, 191, Avenue du Doyen Gaston Giraud, MontpellierCedex 5, Montpellier, 34295, France
| | - Antoine Roquilly
- Anesthesia and Critical Care, University Hospital of Nantes, Hôtel Dieu, 1 place Alexis Ricordeau, Nantes 44093, France; Laboratoire UPRES EA 3826 «Thérapeutiques cliniques et expérimentales des infections». University hospital of Nantes, 22 boulevard Benoni-Goullin, Nantes 44200, France
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Analgesic use in contemporary burn practice: Applications to burn mass casualty incident planning. Burns 2019; 46:90-96. [PMID: 31859088 DOI: 10.1016/j.burns.2019.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 02/14/2019] [Accepted: 02/19/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Determining the amount of analgesics required will help burn centers improve their ability to plan for a burn mass casualty incident (BMCI). We sought to quantify the amount of analgesics needed in an inpatient burn population. We hoped that assessing the analgesic use in daily burn care practice will potentially help estimate opioid needs in a burn mass casualty incident (BMCI). METHODS We included patients with burns covering equal to or less than 30% total body surface area (TBSA), admitted from spring 2013 to spring 2015. Patient records were reviewed for analgesics and adjuncts, pain scores, age and TBSA. The doses of the different opioids administered were converted into morphine equivalent doses (MED). RESULTS We enrolled 141 acute burn survivors with a mean TBSA of 8.2±0.6%. The lowest daily average MED per person was 24.6±2.0mg MED, recorded on the day of injury. The daily average MED per person increased until it peaked at 52.5±5.6mg MED at day 8 post-burn. Then, it declined to 24.6±3.4mg MED by day 14. Bivariate regression analysis of average MED by TBSA showed a significant positive correlation (p<0.001). The analysis of average MED by age showed a significant negative correlation (p<0001). CONCLUSION Our study quantified opioid requirements in an inpatient burn population and identified TBSA (positively) and age (negatively) as significant predictors.
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Nickl S, Fochtmann-Frana A, Nedomansky J, Hitzl W, Kamolz LP, Haslik W. Air-fluidized therapy in the treatment of severe burns: A retrospective study from a burn intensive care unit in Austria. Burns 2019; 46:136-142. [PMID: 31420263 DOI: 10.1016/j.burns.2019.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 05/30/2019] [Accepted: 07/18/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Air-fluidized therapy (AFT) has long been used in the treatment of severe burns. In patients with extensive burns involving the posterior trunk, we aim to keep affected posterior areas dry and to postpone their treatment, initially applying available split-thickness skin grafts in functionally more important regions. We retrospectively assessed the impact of AFT on the survival of patients treated in the burn intensive care unit (ICU) of the Medical University of Vienna, Austria, between 2003 and 2016. METHODS This retrospective single-center study included patients aged ≥18 years with burned total body surface area (TBSA) ≥20% and IIb-III° thermal injuries on the posterior trunk who received AFT. Survival rates were compared with those predicted by the abbreviated burn severity index (ABSI). Demographic, clinical, and surgical data were analyzed. RESULTS Seventy-five of 110 patients with posterior trunk burns received AFT. Their survival rate exceeded that predicted by the ABSI score (mean ABSI, 10.0 ± 2.0; 73.3% (95% CI: 62-83%) survival rate vs. 20-40% predicted; p < 0.0001); no such difference was observed in the non-AFT group (mean, 8.8 ± 1.9; 65.7% (95% CI: 48-81%) survival rate vs. 50-70% predicted). Patients receiving AFT had significantly greater TBSA (median, 50% (35-60) vs. 30% (25-45) and longer ICU stays (median, 63 (36-92) vs. 18 (9-52) days; both p < 0.0001). Fifty-one (68.0%) patients in the AFT group and 26 (74.3%) patients in the non-AFT group underwent posterior trunk surgery (p = 0.66) a median of 16 (10-26) and 5 (2.5-9.5) days, respectively, after admission (p < 0.0001). CONCLUSIONS Patients receiving AFT had significantly better survival than predicted by ABSI score in contrast to patients not receiving AFT although burn injuries in this group were more severe (greater TBSA, higher ABSI). As intensive care was similar in these groups aside from AFT, the better survival could be attributed to this additional therapy.
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Affiliation(s)
- Stefanie Nickl
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Austria.
| | - Alexandra Fochtmann-Frana
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Austria.
| | - Jakob Nedomansky
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Austria.
| | - Wolfgang Hitzl
- Research Office (Biostatistics), Paracelsus Medical University Salzburg, Austria; Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, Austria.
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria; COREMED - Centre for Regenerative Medicine, Joanneum Research Forschungsgesellschaft mbH, Austria.
| | - Werner Haslik
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Austria.
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Schell A, Copp J, Bogie KM, Wetzel R. Honey-Based Salve and Burdock Leaf Dressings as an Alternative to Surgical Debridement of a Traumatic Wound Eschar. Adv Wound Care (New Rochelle) 2019; 8:101-107. [PMID: 30911441 PMCID: PMC6430982 DOI: 10.1089/wound.2018.0806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/17/2018] [Indexed: 01/24/2023] Open
Abstract
Objective: Nonviable necrotic eschar is an impedance to wound healing and can ultimately lead to failure of soft tissue coverage in traumatic or high-risk wounds. Topical therapeutic agents can provide a less invasive management alternative to surgical debridement of eschar. Approach: The case of a 40-year-old male with a traumatic right lower extremity amputation complicated by surgical incision ischemic eschar formation is reported. Honey-based salve with burdock leaf dressings was used to noninvasively manage eschar extending over the incision site. Images were obtained for 5 months of follow-up. Results: Five-month follow-up demonstrated complete resolution of eschar and re-epithelialization of skin in the affected region. Innovation: Honey-based salve with burdock leaf dressings shows promise for enhancing healing outcomes in traumatic wounds that develop nonviable eschar. Conclusion: Surgical debridement of an amputation stump with large ischemic eschar was avoided with the use of honey-based salve with burdock leaf dressings.
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Affiliation(s)
- Adam Schell
- Department of Orthopaedics, Case Western Reserve University, Cleveland, Ohio
| | - Jonathan Copp
- Department of Orthopaedics, Case Western Reserve University, Cleveland, Ohio
| | - Kath M. Bogie
- Department of Orthopaedics, Case Western Reserve University, Cleveland, Ohio
- APT Center of Excellence, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Robert Wetzel
- Department of Orthopaedics, Case Western Reserve University, Cleveland, Ohio
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Moreira E, Burghi G, Manzanares W. Update on metabolism and nutrition therapy in critically ill burn patients. Med Intensiva 2017; 42:306-316. [PMID: 28951113 DOI: 10.1016/j.medin.2017.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/16/2017] [Accepted: 07/24/2017] [Indexed: 11/19/2022]
Abstract
Major burn injury triggers severe oxidative stress, a systemic inflammatory response, and a persistent hypermetabolic and hypercatabolic state with secondary sarcopenia, multiorgan dysfunction, sepsis and an increased mortality risk. Calorie deficit, negative protein balance and antioxidant micronutrient deficiency after thermal injury have been associated to poor clinical outcomes. In this context, personalized nutrition therapy with early enteral feeding from the start of resuscitation are indicated. Over the last four decades, different nutritional and pharmacological interventions aimed at modulating the immune and metabolic responses have been evaluated. These strategies have been shown to be able to minimize acute malnutrition, as well as modulate the immunoinflammatory response, and improve relevant clinical outcomes in this patient population. The purpose of this updating review is to summarize the most current evidence on metabolic response and nutrition therapy in critically ill burn patients.
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Affiliation(s)
- E Moreira
- Centro de Tratamiento Intensivo del Hospital Maciel, ASSE, Montevideo, Uruguay
| | - G Burghi
- Centro Nacional de Quemados, Hospital de Clínicas, Facultad de Medicina, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - W Manzanares
- Cátedra de Medicina Intensiva, Hospital de Clínicas, Facultad de Medicina, Universidad de la República (UdelaR), Montevideo, Uruguay.
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