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Khamise A, Lapid H, Mishra A, Murray AM. Acute healing outcomes in paediatric partial thickness burns using Epiprotect® and Biobrane®: A retrospective comparative study. J Plast Reconstr Aesthet Surg 2024; 95:55-61. [PMID: 38875874 DOI: 10.1016/j.bjps.2024.05.026] [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: 02/03/2024] [Revised: 04/29/2024] [Accepted: 05/24/2024] [Indexed: 06/16/2024]
Abstract
AIM To compare the acute healing outcomes of Biobrane® and Epiprotect® in paediatric partial thickness (PT) burns. METHODS All paediatric patients (age <18 years) with PT burns managed using either Biobrane® or Epiprotect® over a 5-year period at our burns unit were included. The primary outcome was time to complete healing. Secondary outcomes included adherence, infection rates, length of hospital stay, duration of acute follow-up and return to the theatre. RESULTS Among the 99 patients included, 38 received Epiprotect® and 61 received Biobrane®. The mean total body surface area (TBSA) was 6% (range 1%-15%) and median age was 21 months (range 5-169 months). Median time to healing in the Epiprotect® group was 19.5 days and 16 days in the Biobrane® group (P = .14). The median hospitalisation length was the same for both products (2 days, P = .85). Infection rate was lower in the Epiprotect® group (2.6% vs 16.4%, P = .048). There was no difference in adherence rate. These trends were preserved when depth sub-groups were analysed. Adherence and infection rates were not affected by post-operative antibiotics (P > .99 and P = .65, respectively) in either group. The rate of return to the theatre for further surgery was 13.2% for both products (P > .99). CONCLUSION Our findings demonstrate that acute healing outcomes with Epiprotect® in paediatric PT burns are comparable to those with Biobrane®, with significantly lower infection rates for Epiprotect®. These results suggest that Epiprotect® is a viable alternative to Biobrane®. Nevertheless, further prospective randomised studies are required to investigate the short- and long-term outcomes.
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Affiliation(s)
- Ameer Khamise
- The University of Buckingham Medical School, Hunter Street, MK18 1EG Buckingham, United Kingdom
| | - Hadas Lapid
- Department of Software Engineering, Afeka College of Engineering, Tel Aviv, Israel
| | - Ankit Mishra
- Plastic Surgery Department, Stoke Mandeville Hospital, Mandeville Road, HP21 8AL Aylesbury, United Kingdom.
| | - Alexandra Mary Murray
- Plastic Surgery Department, Stoke Mandeville Hospital, Mandeville Road, HP21 8AL Aylesbury, United Kingdom
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2
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Jogezai U, Kalsi A. Long-term complications and management of dental trauma in the adult patient - Part 2: discoloured, displaced and missing teeth. Br Dent J 2024; 237:171-178. [PMID: 39123018 DOI: 10.1038/s41415-024-7672-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 03/23/2024] [Accepted: 04/12/2024] [Indexed: 08/12/2024]
Abstract
The second paper in this two-part review series aims to outline the long-term complications of dental trauma in the adult patient in relation to discoloured, displaced or missing teeth. A brief overview of the cause of discolouration is outlined, followed by assessment and management options. These can include bleaching, veneers, or crown restorations to mask the discolouration. Displacement of teeth from the socket can occur due to luxation injuries. Management can include simple digital manipulation, surgical repositioning, or orthodontic extrusion based on the severity of extrusion and the time from injury. Teeth can be lost early or in the long-term following dental trauma and associated hard and soft tissues deficiencies may also ensue. Replacement options can include a removable partial prosthesis, resin-retained bridge or dental implants. Often, hard and soft tissue augmentation procedures may be required to address any defects and rebuild lost anatomical contours. A thorough assessment followed by the development of a sound management plan which takes patients' general and local factors into account can ensure a predictable and successful treatment outcome. This would end in an aesthetically pleasing and a functionally stable result for the patient.
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Affiliation(s)
- Ursala Jogezai
- Specialty Registrar in Restorative Dentistry, Royal National ENT and Eastman Dental Hospitals, UK.
| | - Amardip Kalsi
- Consultant in Restorative Dentistry, Cambridge University Hospitals, UK
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3
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Kenny EM, Lagziel T, Hultman CS, Egro FM. Skin Substitutes and Autograft Techniques: Temporary and Permanent Coverage Solutions. Clin Plast Surg 2024; 51:241-254. [PMID: 38429047 DOI: 10.1016/j.cps.2023.12.001] [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: 03/03/2024]
Abstract
Coverage of burn wounds is crucial to prevent sequalae including dehydration, wound infection, sepsis, shock, scarring, and contracture. To this end, numerous temporary and permanent options for coverage of burn wounds have been described. Temporary options for burn coverage include synthetic dressings, allografts, and xenografts. Permanent burn coverage can be achieved through skin substitutes, cultured epithelial autograft, ReCell, amnion, and autografting. Here, we aim to summarize the available options for burn coverage, as well as important considerations that must be made when choosing the best reconstructive option for a particular patient.
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Affiliation(s)
- Elizabeth M Kenny
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | - Tomer Lagziel
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C Scott Hultman
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; WPP Plastic and Reconstructive Surgery, WakeMed Health and Hospitals, Raleigh, NC 27610, USA
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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4
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Garcia N, Patel OU, Graham L. Novel pain management therapies for patients with pemphigus. Int J Dermatol 2023; 62:575-578. [PMID: 35781697 DOI: 10.1111/ijd.16331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/24/2022] [Accepted: 06/14/2022] [Indexed: 11/28/2022]
Abstract
Pemphigus is a class of rare autoimmune diseases that causes incredibly painful blistering of the skin and significantly impacts patients' day-to-day lives and well-being. Many strides have been made in treating pemphigus; however, no comprehensive literature exists on how to treat the pain that accompanies the disease. It is important to remember that treating pemphigus involves a two-fold treatment plan assessing both the underlying autoimmune disease and the pain involved with the lesions. This literature review explores novel therapies that have been shown to be effective in treating pain in pemphigus.
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Affiliation(s)
- Natalie Garcia
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Om U Patel
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Lauren Graham
- University of Alabama at Birmingham Hospital, Department of Dermatology, Birmingham, Alabama, USA
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5
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Dixit K, Bora H, Lakshmi Parimi J, Mukherjee G, Dhara S. Biomaterial mediated immunomodulation: An interplay of material environment interaction for ameliorating wound regeneration. J Biomater Appl 2023; 37:1509-1528. [PMID: 37069479 DOI: 10.1177/08853282231156484] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Chronic wounds are the outcome of an imbalanced inflammatory response caused by sustenance of immune microenvironment. In this context, tissue engineered graft played great role in healing wounds but faced difficulty in scar remodelling, immune rejection and poor vascularization. All the limitations faced are somewhere linked with the immune cells involved in healing. In this consideration, immunomodulatory biomaterials bridge a large gap with the delivery of modulating factors for triggering key inflammatory cells responsible towards interplay in the wound micro-environment. Inherent physico-chemical properties of biomaterials substantially determine the nature of cell-materials interaction thereby facilitating differential cytokine gradient involved in activation or suppression of inflammatory signalling pathways, and followed by surface marker expression. This review aims to systematically describe the interplay of immune cells involved in different phases in the wound microenvironment and biomaterials. Additionally, it also focuses on modulating innate immune cell responses in the context of triggering the halted phase of the wound healing, i.e., inflammatory phase. The various strategies are highlighted for modulation of wound microenvironment towards wound regeneration including stem cells, cytokines, growth factors, vitamins, and anti-inflammatory agents to induce interactive ability of biomaterials with immune cells. The last section focuses on prospective approaches and current potential strategies for wound regeneration. This includes the development of different models to bridge the gap between mouse models and human patients. Emerging new tools to study inflammatory response owing to biomaterials and novel strategies for modulation of monocyte and macrophage behaviour in the wound environment are also discussed.
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Affiliation(s)
- Krishna Dixit
- Biomaterials and Tissue Engineering Laboratory, School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, India
- Immunology and Inflammation Laboratory, School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Hema Bora
- Biomaterials and Tissue Engineering Laboratory, School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Jhansi Lakshmi Parimi
- Biomaterials and Tissue Engineering Laboratory, School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Gayatri Mukherjee
- Immunology and Inflammation Laboratory, School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Santanu Dhara
- Biomaterials and Tissue Engineering Laboratory, School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, India
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6
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Jorgensen AM, Mahajan N, Atala A, Murphy SV. Advances in Skin Tissue Engineering and Regenerative Medicine. J Burn Care Res 2023; 44:S33-S41. [PMID: 36567474 PMCID: PMC9790899 DOI: 10.1093/jbcr/irac126] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
There are an estimated 500,000 patients treated with full-thickness wounds in the United States every year. Fire-related burn injuries are among the most common and devastating types of wounds that require advanced clinical treatment. Autologous split-thickness skin grafting is the clinical gold standard for the treatment of large burn wounds. However, skin grafting has several limitations, particularly in large burn wounds, where there may be a limited area of non-wounded skin to use for grafting. Non-cellular dermal substitutes have been developed but have their own challenges; they are expensive to produce, may require immunosuppression depending on design and allogenic cell inclusion. There is a need for more advanced treatments for devastating burns and wounds. This manuscript provides a brief overview of some recent advances in wound care, including the use of advanced biomaterials, cell-based therapies for wound healing, biological skin substitutes, biological scaffolds, spray on skin and skin bioprinting. Finally, we provide insight into the future of wound care and technological areas that need to be addressed to support the development and incorporation of these technologies.
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Affiliation(s)
- Adam M Jorgensen
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Naresh Mahajan
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Anthony Atala
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Sean V Murphy
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
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7
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Treatment of superficial second-degree burns with a nanofiber tissue matrix: A case report. BURNS OPEN 2022. [DOI: 10.1016/j.burnso.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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8
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Jung M, Harish V, Wijewardena A, Kerridge I, Gillies R. Management strategies for perioperative anaemia in the severely burn-injured Jehovah’s Witness patients who decline a blood transfusion: A systematic review with illustrative case reports. Burns 2022; 49:716-729. [PMID: 35941026 DOI: 10.1016/j.burns.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/09/2022] [Accepted: 07/07/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The management of severe burn-injured Jehovah's Witness patients who decline a blood transfusion poses unique challenges. The literature is scant for guiding perioperative anaemia management in these patients. We present a systematic review of this patient group, along with illustrative, consecutive case reports of our experience. METHODS A systematic review was performed on Embase, MEDLINE and PubMed databases on articles discussing the treatment of burn-injured Jehovah's Witness patients. Articles were excluded if discussing isolated inhalation injury, or if blood transfusions were permitted. RESULTS Nine articles including a total of 11 patients revealed consistent themes. A multimodal medical and surgical approach is suggested. Medical strategies are directed at reducing blood loss and optimising haematopoiesis and include rationalising blood collection, reversing coagulopathy, administering tranexamic acid and regular erythropoietin. Surgical strategies include staged aggressive debridement, tumescent adrenaline infiltration and limb tourniquets. We found that the argon beam coagulator was an effective haemostatic adjunct not previously described in literature. DISCUSSION Management of anaemia in severely burn-injured Jehovah's Witness patients is challenging. This systematic review presents a summary of strategies directed at minimising blood loss, and optimising haematopoiesis. Careful preoperative planning, meticulous surgical technique, and postoperative physiological support are caveats to success.
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9
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Paediatric Partial-Thickness Burn Therapy: A Meta-Analysis and Systematic Review of Randomised Controlled Trials. Life (Basel) 2022; 12:life12050619. [PMID: 35629287 PMCID: PMC9144506 DOI: 10.3390/life12050619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/01/2022] [Accepted: 04/19/2022] [Indexed: 12/28/2022] Open
Abstract
Background: Paediatric second-degree burn injuries are a significant source of medical challenges to the population that may cause severe, lifelong complications. Currently, there are dozens of therapeutic modalities and we aimed to summarise their reported outcomes and determine their effectiveness, compared to the widely used silver sulphadiazine (SSD). Methods: We conducted the meta-analysis and systematic review of randomised controlled trials (RCTs), which investigated the performance of dressings in acute paediatric partial-thickness burns. The evaluated endpoints were time until wound closure, grafting and infection rate, number of dressing changes and length of hospitalisation. Results: Twenty-nine RCTs were included in the qualitative and 25 in the quantitative synthesis, but only three trials compared SSD directly to the same intervention (Biobrane). Data analysis showed a tendency for faster healing times and a reduced complication rate linked to biosynthetic, silver foam and amnion membrane dressings. A substantial difference was found between the number of dressing changes associated with less pain, narcosis and treatment duration. Conclusions: Considerable between-study heterogeneity was caused by the unequal depth subcategory ratio and surface area of the injuries; therefore, no significant difference was found in the main outcomes. Further research is necessary to establish the most effective treatment for these burns.
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10
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Palackic A, Duggan RP, Campbell MS, Walters E, Branski LK, Ayadi AE, Wolf SE. The Role of Skin Substitutes in Acute Burn and Reconstructive Burn Surgery: An Updated Comprehensive Review. Semin Plast Surg 2022; 36:33-42. [PMID: 35706557 PMCID: PMC9192152 DOI: 10.1055/s-0042-1743455] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractBurns disrupt the protective skin barrier with consequent loss of cutaneous temperature regulation, infection prevention, evaporative losses, and other vital functions. Chronically, burns lead to scarring, contractures, pain, and impaired psychosocial well-being. Several skin substitutes are available and replace the skin and partially restore functional outcomes and improve cosmesis. We performed a literature review to update readers on biologic and synthetic skin substitutes to date applied in acute and reconstructive burn surgery. Improvement has been rapid in the development of skin substitutes in the last decade; however, no available skin substitute fulfills criteria as a perfect replacement for damaged skin.
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Affiliation(s)
- Alen Palackic
- Department of Surgery, Division of Burn and Trauma Surgery, University of Texas Medical Branch, Galveston, Texas
- Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Robert P. Duggan
- Department of Surgery, Division of Burn and Trauma Surgery, University of Texas Medical Branch, Galveston, Texas
| | | | - Elliot Walters
- Department of Surgery, Division of Burn and Trauma Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Ludwik K. Branski
- Department of Surgery, Division of Burn and Trauma Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Amina El Ayadi
- Department of Surgery, Division of Burn and Trauma Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Steven E. Wolf
- Department of Surgery, Division of Burn and Trauma Surgery, University of Texas Medical Branch, Galveston, Texas
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11
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Review of History of Basic Principles of Burn Wound Management. Medicina (B Aires) 2022; 58:medicina58030400. [PMID: 35334576 PMCID: PMC8954035 DOI: 10.3390/medicina58030400] [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: 01/06/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 01/09/2023] Open
Abstract
Thermal energy is an essential and useful resource to humans in modern society. However, a consequence of using heat carelessly is burns. Burn injuries have various causes, such as exposure to flame, radiation, electrical, and chemical sources. In this study, we reviewed the history of burn wound care while focusing on the basic principles of burn management. Through this review, we highlight the need for careful monitoring and customization when treating burn victims at each step of wound care, as their individual needs may differ. We also propose that future research should focus on nanotechnology-based skin grafts, as this is a promising area for further improvement in wound care.
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12
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Bay C, Chizmar Z, Reece EM, Yu JZ, Winocour J, Vorstenbosch J, Winocour S. Comparison of Skin Substitutes for Acute and Chronic Wound Management. Semin Plast Surg 2021; 35:171-180. [PMID: 34526865 DOI: 10.1055/s-0041-1731463] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Chronic and acute wounds, such as diabetic foot ulcers and burns, respectively, can be difficult to treat, especially when autologous skin transplantations are unavailable. Skin substitutes can be used as a treatment alternative by providing the structural elements and growth factors necessary for reepithelialization and revascularization from a nonautologous source. As of 2020, there are 76 commercially available skin substitute products; this article provides a review of the relevant literature related to the major categories of skin substitutes available.
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Affiliation(s)
- Caroline Bay
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Zachary Chizmar
- Michael E. DeBakey Department of Surgery, Division of General Surgery, Baylor College of Medicine, Houston, Texas
| | - Edward M Reece
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Jessie Z Yu
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Julian Winocour
- Department of Plastic Surgery, Vanderbilt University, Nashville, Tennessee
| | | | - Sebastian Winocour
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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13
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Schiefer JL, Andreae J, Bagheri M, Fuchs PC, Lefering R, Heitzmann W, Schulz A. A clinical comparison of pure knitted silk and a complex synthetic skin substitute for the treatment of partial thickness burns. Int Wound J 2021; 19:178-187. [PMID: 33973387 PMCID: PMC8684860 DOI: 10.1111/iwj.13613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 01/02/2023] Open
Abstract
Currently, many dressings are commercially available for the treatment of burn wounds. Some of these wound dressings remain on the wound, prevent painful dressing changes, and reduce tissue scarring. Nevertheless, still a wound dressing that is cost-effective, produces good wound healing properties, and has a high patient satisfaction is needed. Standard care of superficial burn wounds differs between burn centres. This study aimed to determine a dressing with easy appliance, accurate pain control, favourable outcome, and cost-effectiveness. Therefore, we compared the widely used but expensive Suprathel with the rather new but much cheaper Dressilk in the clinical setting. In a prospective clinical study, the healing of partial thickness burn wounds after simultaneous treatment with Suprathel and Dressilk was examined in 20 patients intra-individually. During wound healing, pain, infection, exudation, and bleeding were evaluated. A subjective scar evaluation was performed using the Patient and Observer Scar Scale. Both dressings were easy to apply, remained on the wound in place, and were gradually cut back as reepithelisation proceeded and showed similar times to wound closure. Dressing changes were not necessary, and neither infections nor bleeding was detected. Overall exudation and pain were highest in the beginning but declined during the wound-healing phase without significant differences. In the follow-up scar evaluation after 12 months, patients reported overall high satisfaction. Overall, the modern dressings Suprathel and Dressilk (solely made out of pure silk) led to safe wound healing without infection and rapidly reduced pain. There was no need for dressing changes, and they had similar clinical outcomes in scar evaluation. Therefore, both dressings seem to be ideal for the treatment of superficial burns. Because acquisition costs remain one of the main factors in the treatment of burns, Dressilk, which is ~20 times cheaper than Suprathel, remains a good option for the treatment of partial thickness burns.
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Affiliation(s)
- Jennifer Lynn Schiefer
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Cologne, Germany
| | - Janine Andreae
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Cologne, Germany
| | - Mahsa Bagheri
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Cologne, Germany
| | - Paul Christian Fuchs
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Cologne, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany
| | - Wolfram Heitzmann
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Cologne, Germany
| | - Alexandra Schulz
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Cologne, Germany
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El Khatib A, Jeschke MG. Contemporary Aspects of Burn Care. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:386. [PMID: 33923571 PMCID: PMC8073568 DOI: 10.3390/medicina57040386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 02/06/2023]
Abstract
The past one hundred years have seen tremendous improvements in burn care, allowing for decreased morbidity and mortality of this pathology. The more prominent advancements occurred in the period spanning 1930-1980; notably burn resuscitation, early tangential excision, and use of topical antibiotic dressings; and are well documented in burn literature. This article explores the advancements of the past 40 years and the areas of burn management that are presently topics of active discussion and research.
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Affiliation(s)
- Arij El Khatib
- Unité des Grands Brûlés, University of Montreal Medical Centre Sanguinet, 1051, Rue Sanguinet, Montréal, QC H2X 0C1, Canada
| | - Marc G. Jeschke
- Department of Surgery, Division of Plastic Surgery, Department of Immunology, Ross Tilley Burn Centre-Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, 2075 Bayview Avenue, Rm D704, Toronto, ON M4N 3M5, Canada;
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15
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Manita PG, Garcia-Orue I, Santos-Vizcaino E, Hernandez RM, Igartua M. 3D Bioprinting of Functional Skin Substitutes: From Current Achievements to Future Goals. Pharmaceuticals (Basel) 2021; 14:ph14040362. [PMID: 33919848 PMCID: PMC8070826 DOI: 10.3390/ph14040362] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 12/14/2022] Open
Abstract
The aim of this review is to present 3D bioprinting of skin substitutes as an efficient approach of managing skin injuries. From a clinical point of view, classic treatments only provide physical protection from the environment, and existing engineered scaffolds, albeit acting as a physical support for cells, fail to overcome needs, such as neovascularisation. In the present work, the basic principles of bioprinting, together with the most popular approaches and choices of biomaterials for 3D-printed skin construct production, are explained, as well as the main advantages over other production methods. Moreover, the development of this technology is described in a chronological manner through examples of relevant experimental work in the last two decades: from the pioneers Lee et al. to the latest advances and different innovative strategies carried out lately to overcome the well-known challenges in tissue engineering of skin. In general, this technology has a huge potential to offer, although a multidisciplinary effort is required to optimise designs, biomaterials and production processes.
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Affiliation(s)
- Paula Gabriela Manita
- NanoBioCel Research Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV-EHU), Paseo de la Universidad 7, 01006 Vitoria-Gasteiz, Spain; (P.G.M.); (I.G.-O.); (E.S.-V.)
- Bioaraba, NanoBioCel Research Group, 01006 Vitoria-Gasteiz, Spain
| | - Itxaso Garcia-Orue
- NanoBioCel Research Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV-EHU), Paseo de la Universidad 7, 01006 Vitoria-Gasteiz, Spain; (P.G.M.); (I.G.-O.); (E.S.-V.)
- Bioaraba, NanoBioCel Research Group, 01006 Vitoria-Gasteiz, Spain
- Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBERBBN), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Edorta Santos-Vizcaino
- NanoBioCel Research Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV-EHU), Paseo de la Universidad 7, 01006 Vitoria-Gasteiz, Spain; (P.G.M.); (I.G.-O.); (E.S.-V.)
- Bioaraba, NanoBioCel Research Group, 01006 Vitoria-Gasteiz, Spain
- Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBERBBN), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Rosa Maria Hernandez
- NanoBioCel Research Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV-EHU), Paseo de la Universidad 7, 01006 Vitoria-Gasteiz, Spain; (P.G.M.); (I.G.-O.); (E.S.-V.)
- Bioaraba, NanoBioCel Research Group, 01006 Vitoria-Gasteiz, Spain
- Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBERBBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Correspondence: (R.M.H.); (M.I.)
| | - Manoli Igartua
- NanoBioCel Research Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV-EHU), Paseo de la Universidad 7, 01006 Vitoria-Gasteiz, Spain; (P.G.M.); (I.G.-O.); (E.S.-V.)
- Bioaraba, NanoBioCel Research Group, 01006 Vitoria-Gasteiz, Spain
- Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBERBBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Correspondence: (R.M.H.); (M.I.)
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Haines M, Allan J, Wijewardana A, Cha J, Vandervord J. Treating the burnt auricle using Biobrane. ANZ J Surg 2021; 91:453-454. [PMID: 33740300 DOI: 10.1111/ans.16462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/03/2020] [Accepted: 11/07/2020] [Indexed: 11/29/2022]
Abstract
Auricle burns remain a challenge for surgeons who must navigate the common and morbid complication of chondritis through often complex and painful dressing regimes. Our technique involving the application of Biobrane promotes healing, is individualized, single application and conducive to topical antimicrobial application. We find it is a simple and effective approach to treating the burnt auricle.
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Affiliation(s)
- Morgan Haines
- Department of Burns, Reconstructive and Plastic Surgery, Royal North Shore Hospital, Reserve Rd, Sydney, New South Wales, 2065, Australia
| | - James Allan
- Department of Burns, Reconstructive and Plastic Surgery, Royal North Shore Hospital, Reserve Rd, Sydney, New South Wales, 2065, Australia
| | - Aruna Wijewardana
- Department of Burns, Reconstructive and Plastic Surgery, Royal North Shore Hospital, Reserve Rd, Sydney, New South Wales, 2065, Australia
| | - Jeon Cha
- Department of Burns, Reconstructive and Plastic Surgery, Royal North Shore Hospital, Reserve Rd, Sydney, New South Wales, 2065, Australia
| | - John Vandervord
- Department of Burns, Reconstructive and Plastic Surgery, Royal North Shore Hospital, Reserve Rd, Sydney, New South Wales, 2065, Australia
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Las Heras K, Igartua M, Santos-Vizcaino E, Hernandez RM. Chronic wounds: Current status, available strategies and emerging therapeutic solutions. J Control Release 2020; 328:532-550. [DOI: 10.1016/j.jconrel.2020.09.039] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 02/07/2023]
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Oualla-Bachiri W, Fernández-González A, Quiñones-Vico MI, Arias-Santiago S. From Grafts to Human Bioengineered Vascularized Skin Substitutes. Int J Mol Sci 2020; 21:E8197. [PMID: 33147759 PMCID: PMC7662999 DOI: 10.3390/ijms21218197] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 12/18/2022] Open
Abstract
The skin plays an important role in the maintenance of the human's body physiological homeostasis. It acts as a coverage that protects against infective microorganism or biomechanical impacts. Skin is also implied in thermal regulation and fluid balance. However, skin can suffer several damages that impede normal wound-healing responses and lead to chronic wounds. Since the use of autografts, allografts, and xenografts present source limitations and intense rejection associated problems, bioengineered artificial skin substitutes (BASS) have emerged as a promising solution to address these problems. Despite this, currently available skin substitutes have many drawbacks, and an ideal skin substitute has not been developed yet. The advances that have been produced on tissue engineering techniques have enabled improving and developing new arising skin substitutes. The aim of this review is to outline these advances, including commercially available skin substitutes, to finally focus on future tissue engineering perspectives leading to the creation of autologous prevascularized skin equivalents with a hypodermal-like layer to achieve an exemplary skin substitute that fulfills all the biological characteristics of native skin and contributes to wound healing.
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Affiliation(s)
- Wasima Oualla-Bachiri
- Cell Production and Tissue Engineering Unit, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (W.O.-B.); (M.I.Q.-V.); (S.A.-S.)
- Biosanitary Institute of Granada (ibs. GRANADA), 18014 Granada, Spain
- Andalusian Network of Design and Translation of Advanced Therapies, 41092 Sevilla, Spain
| | - Ana Fernández-González
- Cell Production and Tissue Engineering Unit, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (W.O.-B.); (M.I.Q.-V.); (S.A.-S.)
- Biosanitary Institute of Granada (ibs. GRANADA), 18014 Granada, Spain
- Andalusian Network of Design and Translation of Advanced Therapies, 41092 Sevilla, Spain
| | - María I. Quiñones-Vico
- Cell Production and Tissue Engineering Unit, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (W.O.-B.); (M.I.Q.-V.); (S.A.-S.)
- Biosanitary Institute of Granada (ibs. GRANADA), 18014 Granada, Spain
- Andalusian Network of Design and Translation of Advanced Therapies, 41092 Sevilla, Spain
| | - Salvador Arias-Santiago
- Cell Production and Tissue Engineering Unit, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (W.O.-B.); (M.I.Q.-V.); (S.A.-S.)
- Biosanitary Institute of Granada (ibs. GRANADA), 18014 Granada, Spain
- Andalusian Network of Design and Translation of Advanced Therapies, 41092 Sevilla, Spain
- Dermatology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain
- Dermatology Department, School of Medicine, Granada University, 18016 Granada, Spain
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Abstract
The field of Tissue Engineering and Regenerative Medicine has evolved rapidly over the past thirty years. This review will summarize its history, current status and direction through the lens of clinical need, its progress through science in the laboratory and application back into patients. We can take pride in the fact that much effort and progress began with the surgical problems of children and that many surgeons in the pediatric surgical specialties have become pioneers and investigators in this new field of science, engineering, and medicine. Although the field has yet to fulfill its great promise, there have been several examples where a therapy has progressed from the first idea to human application within a short span of time and, in many cases, it has been applied in the surgical care of children.
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McNamara SA, Hirt PA, Weigelt MA, Nanda S, de Bedout V, Kirsner RS, Schachner LA. Traditional and advanced therapeutic modalities for wounds in the paediatric population: an evidence-based review. J Wound Care 2020; 29:321-334. [PMID: 32530778 DOI: 10.12968/jowc.2020.29.6.321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Children can have non-healing wounds due to a wide range of pathologies, including epidermolysis bullosa (EB), pilonidal disease and Stevens-Johnson syndrome, with some causes being iatrogenic, including extravasation injuries and medical device-related hospital-acquired pressure ulcers. Furthermore, paediatric wounds are vastly different from adult wounds and therefore require a different treatment approach. While there are numerous types of dressings, topical remedies, and matrices with high-tier evidence to support their use in adults, evidence is scarce in the neonatal and paediatric age groups. The purpose of this review is to discuss the basic principles in paediatric wound management, as well as to present new treatment findings published in the literature to date. The benefits and risks of using different types of debridement are discussed in this review. Various topical formulations are also described, including the need to use antibiotics judiciously. METHOD Databases were searched for relevant sources including Pubmed, Embase, Web of Science and DynaMed. Search terms used included 'wound care', 'wound management', 'paediatrics', 'children', 'skin substitutes', and 'grafts'. Additionally, each treatment and disease entity was searched for relevant sources, including, for example: 'Apligraf', 'dermagraft', 'Manuka honey', 'antibiotic', 'timolol', and 'negative pressure wound therapy' (NPWT). RESULTS Amniotic membrane living skin equivalent is a cellular matrix that has been reportedly successful in treating paediatrics wounds and is currently under investigation in randomised clinical trials. Helicoll is an acellular matrix, which shows promise in children with recessive dystrophic EB. NPWT may be used as a tool to accelerate wound closure in children; however, caution must be taken due to limited evidence to support its safety and efficacy in the paediatric patient population. Integra has been reported as a useful adjunctive treatment to NPWT as both may act synergistically. Hospitalised children and neonates frequently have pressure ulcers, which is why prevention in this type of wound is paramount. CONCLUSION Advancements in wound care are rapidly expanding. Various treatments for non-healing wounds in paediatric and neonatal patients have been reported, but high tier evidence in these populations is scarce. We hope to shed light on existing evidence regarding the different therapeutic modalities, from debridement techniques and dressing types to tissue substitutes and topical remedies. There have been promising results in many studies to date, but RCTs involving larger sample sizes are necessary, in order to determine the specific role these innovative agents play in paediatric wounds and to identify true safety and efficacy.
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Affiliation(s)
- Stephanie A McNamara
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Penelope A Hirt
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Maximillian A Weigelt
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Sonali Nanda
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Valeria de Bedout
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Robert S Kirsner
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Lawrence A Schachner
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
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Abstract
Major advances in burn care have reduced post-burn morbidity and mortality. The development and incorporation of new wound healing modalities into the clinical arena have contributed to this improvement by allowing standard-of-care regimens to be established. These regimens range from early excision to the use of cultured epithelial autograft. Here, we review the wound care options that are now well established and used by many burn surgeons.
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Rezk AI, Lee JY, Son BC, Park CH, Kim CS. Bi-layered Nanofibers Membrane Loaded with Titanium Oxide and Tetracycline as Controlled Drug Delivery System for Wound Dressing Applications. Polymers (Basel) 2019; 11:polym11101602. [PMID: 31581516 PMCID: PMC6836055 DOI: 10.3390/polym11101602] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/20/2019] [Accepted: 09/30/2019] [Indexed: 12/19/2022] Open
Abstract
The aim of this study is to develop a novel functional bi-layered membrane loaded titanium oxide (TiO2) and tetracycline (TTC) for application in wound dressing. The advantages of the electrospinning technique have to be considered for the uniform distribution of nanoparticles and TTC drug. The as prepared nanofibers and TiO2 were characterized in terms of morphology, fiber diameter, mechanical properties and surface wettability. The in vitro drug release study revealed initial burst release followed by a sustained control release of TTC for 4 days. The in vitro antibacterial of the bi-layered nanofibers was conducted against Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli) bacteria species showing excellent antibacterial effect for drug loaded samples compared with PCL nanofibers. Subsequently, cell counting kit-8 (CCK-8) and confocal laser scanning microscopy (CLSM) were used to evaluate its biocompatibility in vitro. Our results revealed that the bi-layered membrane has better antibacterial and cell compatibility than the control fiber. This suggests that the fabricated biocompatible scaffold is appropriate for a variety of wound dressing applications.
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Affiliation(s)
- Abdelrahman I. Rezk
- Department of Bionanosystem Engineering, Jeonbuk National University, Jeonju, Jeonbuk 561-756, Korea; (A.I.R.); (B.C.S.)
| | - Ji Yeon Lee
- Division of Mechanical Design Engineering, Jeonbuk National University, Jeonju, Jeonbuk 561-756, Korea;
| | - Byeong Cheol Son
- Department of Bionanosystem Engineering, Jeonbuk National University, Jeonju, Jeonbuk 561-756, Korea; (A.I.R.); (B.C.S.)
| | - Chan Hee Park
- Department of Bionanosystem Engineering, Jeonbuk National University, Jeonju, Jeonbuk 561-756, Korea; (A.I.R.); (B.C.S.)
- Division of Mechanical Design Engineering, Jeonbuk National University, Jeonju, Jeonbuk 561-756, Korea;
- Correspondence: (C.H.P.); (C.S.K.); Tel.: +82-63-270-4284 (C.S.K.); Fax: +82-63-270-2460 (C.S.K.)
| | - Cheol Sang Kim
- Department of Bionanosystem Engineering, Jeonbuk National University, Jeonju, Jeonbuk 561-756, Korea; (A.I.R.); (B.C.S.)
- Division of Mechanical Design Engineering, Jeonbuk National University, Jeonju, Jeonbuk 561-756, Korea;
- Correspondence: (C.H.P.); (C.S.K.); Tel.: +82-63-270-4284 (C.S.K.); Fax: +82-63-270-2460 (C.S.K.)
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Haldar S, Sharma A, Gupta S, Chauhan S, Roy P, Lahiri D. Bioengineered smart trilayer skin tissue substitute for efficient deep wound healing. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 105:110140. [PMID: 31546402 DOI: 10.1016/j.msec.2019.110140] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/11/2019] [Accepted: 08/26/2019] [Indexed: 01/13/2023]
Abstract
Skin substitutes for deep wound healing require meticulous designing and fabrication to ensure proper structural and functional regeneration of the tissue. Range of physical and mechanical properties conducive for regeneration of different layers of skin is a prerequisite of an ideal scaffold. However, single or bilayer substitutes, lacking this feature, fail to heal full thickness wound. Complete scar free regeneration of skin is still a big challenge. This study reports fabrication of a trilayer scaffold, from biodegradable polymers that can provide the right ambience for simultaneous regeneration of all the three layers of skin. The scaffold was developed through optimization of different fabrication techniques, namely, casting, electrospinning and lyophilisation, for obtaining a tailored trilayer structure. It has mechanical strength similar to skin layers, can maintain a porosity-gradient and provides microenvironments suitable for simultaneous regeneration of epidermis, dermis and hypodermis. A co-culture model, of keratinocytes and dermal fibroblasts, confirms the efficiency of the scaffold in supporting proliferation and differentiation of different types of cells, into organized tissue. The scaffold showed improved and expedited wound healing in-vivo. Taken together, these compelling evidences successfully established the engineered trilayer scaffold as a promising template for skin tissue regeneration in case of deep wound.
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Affiliation(s)
- Swati Haldar
- Tissue Engineering Lab, Centre of Nanotechnology, IIT Roorkee, India; Biomaterials and Multiscale Mechanics Lab, Department of Metallurgical and Materials Engineering, IIT Roorkee, India; Molecular Endocrinology Lab, Department of Biotechnology, IIT Roorkee, Roorkee, Uttarakhand 247667, India
| | - Akriti Sharma
- Tissue Engineering Lab, Centre of Nanotechnology, IIT Roorkee, India; Biomaterials and Multiscale Mechanics Lab, Department of Metallurgical and Materials Engineering, IIT Roorkee, India
| | - Sumeet Gupta
- Department of Pharmacology, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala 133207, India
| | - Samrat Chauhan
- Department of Pharmacology, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala 133207, India
| | - Partha Roy
- Tissue Engineering Lab, Centre of Nanotechnology, IIT Roorkee, India; Molecular Endocrinology Lab, Department of Biotechnology, IIT Roorkee, Roorkee, Uttarakhand 247667, India
| | - Debrupa Lahiri
- Tissue Engineering Lab, Centre of Nanotechnology, IIT Roorkee, India; Biomaterials and Multiscale Mechanics Lab, Department of Metallurgical and Materials Engineering, IIT Roorkee, India.
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25
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Cheng X, Huang H, Shi B, Li J. A novel intraoral injection technique for rat levator veli palatini muscle regeneration. Ann Anat 2019; 223:77-84. [DOI: 10.1016/j.aanat.2019.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 11/17/2022]
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Feng JJ, See JL, Choke A, Ooi A, Chong SJ. Biobrane™ for burns of the pubic region: minimizing dressing changes. Mil Med Res 2018; 5:29. [PMID: 30144827 PMCID: PMC6109452 DOI: 10.1186/s40779-018-0177-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 08/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The pubic region is often involved in accidental hot water or soup-spill burns. Most of these wounds are superficial partial thickness burns. Due to their proximity to the urinary system, as well as vaginal and anal openings, these burns are easily contaminated. Daily dressings are routinely prescribed as the sole treatment. The cumbersome dressing process is uncomfortable and embarrassing for patients. Biobrane™ is a bilayered biosynthetic dressing. Its coverage of superficial partial thickness burns promotes wound healing and allows one-time application. CASE PRESENTATIONS We report two patients who suffered superficial dermal burns over their pubic region. One patient had 23% total body surface area (TBSA) burns over her lower abdomen, both thighs and pubic region. The second patient had 10% TBSA burns that involved her perineum and the medial sides of both thighs and buttocks. Both were managed with the standard resuscitation protocol in the initial phase. Their burn injuries were managed by shaving, Foley catheterization and Biobrane™ coverage. Their wounds healed uneventfully without complications. Full epithelization was achieved by post-operative day seven. Both patients consented to medical photography and academic publication. CONCLUSION Shaving and catheterization improved the hygiene of the burns of the pubic area. The Biobrane™ method circumvents the need of regular dressing changes, eliminating the pain due to dressing changes and preserving patient dignity.
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Affiliation(s)
- Jia-Jun Feng
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore, Singapore.
| | - Jia Le See
- University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Abby Choke
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Adrian Ooi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Si Jack Chong
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore, Singapore
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27
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Lerma V, Macías M, Toro R, Moscoso A, Alonso Y, Hernández O, de Abajo FJ. Care in patients with epidermal necrolysis in burn units. A nursing perspective. Burns 2018; 44:1962-1972. [PMID: 30005991 DOI: 10.1016/j.burns.2018.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 05/03/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To describe how nursing care is delivered to patients with epidermal necrolysis in burn units/specialized units in Spain and a selection of countries. METHOD Descriptive cross-sectional study. Data were collected through a structured questionnaire which was sent to nurse managers in all burn units in Spain and a selection of countries. Descriptive statistics was used to summarize the results. RESULTS All BU/SUs in Spain (n=12) and seven BU/SUs from a selection of countries completed the questionnaire. A lack of specific nursing protocols on Epidermal Necrolysis was observed in most burn units in Spain. Skin cleansing techniques such as showering were only reported by participants from Spain. Use of antiseptics was less frequent in other countries. Conservative skin management was the most extended practice reported by all participants. The use of vaginal molds to prevent synechiae and coverage of the ocular surface with amniotic membrane to minimize sequelae were rarely reported. Pain assessment was not always documented in sedated patients and few participants reported the use of specific scales for this purpose. All nurses agreed in the need for consensus nursing care guidelines on the disease. CONCLUSIONS Nursing care in patients with epidermal necrolysis varied between burn units in Spain. Differences and similarities were observed when compared with burn units in other countries. Genital and ocular care were outdated in all BU/SUs. Pain assessment documentation was suboptimal. Evidence-based nursing care guidelines were generally demanded by all participants to help reduce mortality and morbidity of this rare and often devastating disease.
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Affiliation(s)
- V Lerma
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, IRYCIS, Alcalá de Henares, Madrid, Spain.
| | - M Macías
- Quality Unit, Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain
| | - R Toro
- Care Research Unit, Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain
| | - A Moscoso
- Burn Unit, University Hospital of Getafe, Getafe, Madrid, Spain
| | - Y Alonso
- Burn Unit, University Hospital of Getafe, Getafe, Madrid, Spain
| | - O Hernández
- Burn Unit, La Paz University Hospital, Madrid, Spain
| | - F J de Abajo
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Department of Biomedical Sciences, University of Alcalá, IRYCIS, Alcalá de Henares, Madrid, Spain
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Davison-Kotler E, Sharma V, Kang NV, García-Gareta E. A Universal Classification System of Skin Substitutes Inspired by Factorial Design. TISSUE ENGINEERING PART B-REVIEWS 2018; 24:279-288. [PMID: 29336231 DOI: 10.1089/ten.teb.2017.0477] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The complexity of the dermal layer of skin means that damage to this section can result in permanent impairment of function. Partial or total dermal loss is a feature of deep burns and chronic wounds such as pressure sores or diabetic ulcers. The issues posed by traditional skin grafts have led to substantial research being carried out in the fields of tissue engineering and biomaterials science to develop a vast array of alternative skin substitutes. Given the large number of different materials, manufacturing methods, and techniques for implementation described for artificial skin substitutes, many classification systems have been created to simplify their categorization. Some of these systems are oriented toward clinicians while others toward researchers. However, none address the needs of both groups and none are intuitive. The creation of an effective classification system would be particularly helpful in the regulation, distribution, organization, and selection of skin substitutes. The aim of this review is to examine existing methods of classification of skin substitutes, and to propose a new system that uses an algorithm that is inspired by factorial design. Our system allows multiple factors to be simultaneously investigated or in this case, described, since all skin substitutes possess multiple characteristics: (1) cellularity (acellular or cellular), (2) layering (single layer or bilayer), (3) replaced region (epidermis, dermis, or both), (4) materials used (natural, synthetic, or both), and (5) permanence (temporary or permanent). The factors and levels are combined into an algorithm where all the possible combinations are shown. The multifactorial and palindromic structure of our system should enable all users to quickly understand the makeup of a selected skin substitute, or search for a skin substitute depending on their specific requirements. We feel that our proposed classification can be used by clinicians and biomedical researchers alike, which should be an advantage given the multidisciplinary nature of the tissue engineering field and the science that underpins the development of skin substitutes. We also touch upon some of the state-of-the-art skin substitutes that are commercially available or under development to demonstrate how our new method of classification might work.
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Affiliation(s)
- Evan Davison-Kotler
- 1 Regenerative Biomaterials Group, RAFT Institute , Mount Vernon Hospital, Northwood, United Kingdom
| | - Vaibhav Sharma
- 1 Regenerative Biomaterials Group, RAFT Institute , Mount Vernon Hospital, Northwood, United Kingdom
| | | | - Elena García-Gareta
- 1 Regenerative Biomaterials Group, RAFT Institute , Mount Vernon Hospital, Northwood, United Kingdom
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29
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Fan C, Pek CH, Por YC, Lim GJS. Biobrane dressing for paediatric burns in Singapore: a retrospective review. Singapore Med J 2018; 59:360-365. [PMID: 29297087 DOI: 10.11622/smedj.2017116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The ideal burn dressing for children should aim to alleviate pain, decrease length of hospital stay and minimise complications such as conversion and infection. The current literature is still inconclusive with regard to the gold standard burn dressing for the paediatric population. METHODS We retrospectively reviewed children with superficial partial thickness burns admitted to our paediatric burns unit from January 2014 to April 2015. A total of 30 patients were included in our study, of whom 13 had Biobrane® dressing. The remaining 17 patients were treated with conventional silver foam dressing (i.e. Biatain® Ag) and served as matched controls. Long-term follow-up scar evaluation was carried out at an average interval of two years after injury. RESULTS In the Biobrane group, the length of hospital stay was significantly shorter (Biobrane vs. silver foam: 4.76 ± 2.64 days vs. 8.88 ± 5.09 days; p = 0.01) and the infection rate was significantly lower (Biobrane vs. silver foam: 0% vs. 35.3%; p = 0.02). The Biobrane group had no hypergranulation or wound infection and did not require skin grafting. Long-term follow-up scar evaluation did not reveal any statistical difference between the patient groups at the two-year interval. CONCLUSION Paediatric patients with partial thickness burns treated with Biobrane dressing had shorter hospital stay and lower incidence of infection compared to those treated with conventional silver foam dressing. Biobrane and silver foam dressings did not demonstrate any significant difference in terms of long-term scar outcomes over an average follow-up duration of two years.
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Affiliation(s)
- Cong Fan
- Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital, Singapore
| | - Chong Han Pek
- Plastic, Reconstructive and Aesthetic Surgery Section, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Yong Chen Por
- Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital, Singapore
| | - Gale Jue Shuang Lim
- Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital, Singapore
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Mathias E, Srinivas Murthy M. Pediatric Thermal Burns and Treatment: A Review of Progress and Future Prospects. MEDICINES (BASEL, SWITZERLAND) 2017; 4:medicines4040091. [PMID: 29232903 PMCID: PMC5750615 DOI: 10.3390/medicines4040091] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 05/17/2023]
Abstract
Burn injuries are a devastating critical care problem. In children, burns continue to be a major epidemiologic problem around the globe resulting in significant morbidity and death. Apparently, treating these burn injuries in children and adults remains similar, but there are significant physiological and psychological differences. The dermal layer of the skin is generally thinner in neonates, infants, and children than in adults. Enhanced evaporative loss and need for isotonic fluids increases the risk of hypothermia in the pediatric population. The pain management of the children with major burns challenges the skills of the personnel of every unit. Managing these wounds requires intensive therapeutic treatment for multi-organ dysfunction, and surgical treatment to prevent sepsis and other complications that further delay wound closure. Alternatives to the practice of donor site harvest and autografting for the treatment of severe burns and other complex skin defects are urgently needed for both adult and pediatric populations. This review article focuses on thermal burn pathophysiology and pain management and provides an overview of currently approved products used for the treatment of pediatric burn wounds. A new promising approach has been presented as a first-line therapy in the treatment of burns to reduce surgical autografting in pediatric patients.
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Affiliation(s)
- Elton Mathias
- Department of Clinical Research, Mallinckrodt Pharmaceuticals, Bedminster, NJ 07921, USA.
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The use of Biobrane ® for wound coverage in Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis. Burns 2017; 43:1464-1472. [DOI: 10.1016/j.burns.2017.03.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 03/13/2017] [Accepted: 03/19/2017] [Indexed: 12/14/2022]
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Bharadia D, Sinha I, Pomahac B. Role of Facial Vascularized Composite Allotransplantation in Burn Patients. Clin Plast Surg 2017; 44:857-864. [DOI: 10.1016/j.cps.2017.05.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Haddad AG, Giatsidis G, Orgill DP, Halvorson EG. Skin Substitutes and Bioscaffolds. Clin Plast Surg 2017; 44:627-634. [DOI: 10.1016/j.cps.2017.02.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Abstract
PURPOSE Oral soft tissue augmentation or grafting procedures are often necessary to achieve proper wound closure after deficits resulting from tumor excision, clefts, trauma, dental implants, and tooth recessions. MATERIALS AND METHODS Autologous soft tissue grafts still remain the gold standard to acquire a functionally adequate zone of keratinized attached gingiva. However, soft tissue substitutes are more commonly used because they minimize morbidity and shorten surgical time. RESULTS This review aimed to assess soft tissue grafting techniques and materials used in the oral cavity from existing literature. There are a large variety of materials and techniques, including grafts, local flaps, allogenic derived matrices such as acellular dermal allograft, xenogenic tissue matrices from animal origin, and synthetic materials. CONCLUSIONS Tissue engineering of oral mucosa represents an interesting alternative to obtain sufficient autologous tissue for reconstructing oral wounds using biodegradable scaffolds, and may improve vascularization and epithelialization, which are critical for successful outcomes.
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Abstract
The hand is commonly affected in burn injuries. Joints and extensor tendons are vulnerable given their superficial location. Durable coverage that permits relative frictionless tendon gliding and minimizes scar contracture is required to optimize functional outcomes. When soft tissue donor sites are limited, the use of dermal skin substitutes provides stable coverage with minimal scarring, good mobility, and acceptable appearance. A comprehensive review of dermal skin substitutes and their use with burn reconstruction of the hand is provided.
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Affiliation(s)
- Ian C Sando
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340, USA
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340, USA.
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Schiefer JL, Arens E, Grigutsch D, Rath R, Hoffmann A, Fuchs PC, Schulz A. A prospective intra-individual evaluation of silk compared to Biobrane for the treatment of superficial burns of the hand and face. Burns 2017; 43:539-548. [DOI: 10.1016/j.burns.2016.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/07/2016] [Accepted: 09/08/2016] [Indexed: 11/16/2022]
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Glik J, Kawecki M, Kitala D, Klama-Baryła A, Łabuś W, Grabowski M, Durdzińska A, Nowak M, Misiuga M, Kasperczyk A. A new option for definitive burn wound closure - pair matching type of retrospective case-control study of hand burns in the hospitalised patients group in the Dr Stanislaw Sakiel Centre for Burn Treatment between 2009 and 2015. Int Wound J 2017; 14:849-855. [PMID: 28220597 DOI: 10.1111/iwj.12720] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/17/2017] [Indexed: 11/30/2022] Open
Abstract
Nearly 80% of all burns include the hands of affected individuals. Skin grafting is the gold standard in burns treatment, but in the case of the burn wound bed, it may require the necessity of utilising skin substitutes to facilitate closure. The aim of this study is to assess the impact of a porcine-derived wound dressing (Oasis™) for application to hand burns compared to a synthetic dressing (Suprathel™). Comparative assessments were made, including the time to heal, quality of healing and pain intensity. A retrospective, unblinded, matching pair case-control of hand burns was performed. A control group of 24 patients was treated with Suprathel dressing, and a study group of six patients underwent application of the Oasis dressing. The wound healing process was evaluated by taking histopathological specimens and also utilising the Bates-Jensen Wound Assessment Tool. A 10-cm Visual Analogue Scale (VAS) was used for pain assessment. Other parameters measured included dressing loss because of infection and the need of rehabilitation. The progress of wound healing on the fourth day in the study group was 30%. A decrease in the level of pain was recorded on the fourth day after surgery. There was a decrease of 5% in the risk of rehabilitation in the treatment group.
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Affiliation(s)
- Justyna Glik
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland.,Department of Chronic Wounds Management Organization, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Marek Kawecki
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland.,Department of Health Sciences, Technical-Humanistic Academy, Bielsko-Biała, Poland
| | - Diana Kitala
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland
| | | | - Wojciech Łabuś
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland
| | - Marek Grabowski
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland
| | - Agata Durdzińska
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland
| | - Mariusz Nowak
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland
| | - Marcelina Misiuga
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland
| | - Aleksandra Kasperczyk
- Department of Biochemistry, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Zabrze, Poland
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Fletcher JL, Cancio LC, Sinha I, Leung KP, Renz EM, Chan RK. Inability to determine tissue health is main indication of allograft use in intermediate extent burns. Burns 2015; 41:1862-1867. [PMID: 26471053 DOI: 10.1016/j.burns.2015.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 08/31/2015] [Accepted: 09/09/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Cutaneous allograft is commonly used in the early coverage of excised burns when autograft is unavailable. However, allograft is also applied in intermediate-extent burns (25-50%), during cases in which it is possible to autograft. In this population, there is a paucity of data on the indications for allograft use. This study explores the indications for allograft usage in moderate size burns. METHODS Under an IRB-approved protocol, patients admitted to our burn unit between March 2003 and December 2010 were identified through a review of the burn registry. Data on allograft use, total burn surface area, operation performed, operative intent, number of operations, intensive care unit length of stay, and overall length of stay were collected and analyzed. Data are presented as means±standard deviations, except where noted. RESULTS In the study period, 146 patients received allograft during their acute hospitalization. Twenty-five percent of allograft recipients sustained intermediate-extent burns. Patients with intermediate-extent burns received allograft later in their hospitalization than those with large-extent (50-75% TBSA) burns (6.8 days vs. 3.4 days, p=0.01). Allografted patients with intermediate-extent burns underwent more operations (10.8 vs. 6.1, p=0.002) and had longer hospitalizations (78.3 days vs. 40.9 days, p<0.001) than non-allografted patients, when controlled for TBSA. Clinical rationale for placement of allograft in this population included autograft failure, uncertain depth of excision, lack of autograft donor site, and wound complexity. When uncertain depth of excision was the indication, allograft was universally applied onto the face. In half of allografted intermediate-extent burn patients the inability to identify a viable recipient bed was the ultimate reason for allograft use. CONCLUSIONS Unlike large body surface area burns, allograft skin use in intermediate-extent injury occurs later in the hospitalization and is driven by the inability to determine wound bed suitability for autograft application. Allograft application can be utilized to test recipient site viability in cases of autograft failure or uncertain depth of excision.
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Affiliation(s)
- John L Fletcher
- Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234, United States; Clinical Division and Burn Center, U.S. Army Institute of Surgical Research, 3650 Chambers Pass, Fort Sam Houston, TX 78234-6315, United States; Dental and Trauma Research Detachment, U.S. Army Institute of Surgical Research, 3650 Chambers Pass, Fort Sam Houston, TX 78234-6315, United States
| | - Leopoldo C Cancio
- Clinical Division and Burn Center, U.S. Army Institute of Surgical Research, 3650 Chambers Pass, Fort Sam Houston, TX 78234-6315, United States
| | - Indranil Sinha
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA 02115, United States
| | - Kai P Leung
- Dental and Trauma Research Detachment, U.S. Army Institute of Surgical Research, 3650 Chambers Pass, Fort Sam Houston, TX 78234-6315, United States
| | - Evan M Renz
- Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234, United States
| | - Rodney K Chan
- Clinical Division and Burn Center, U.S. Army Institute of Surgical Research, 3650 Chambers Pass, Fort Sam Houston, TX 78234-6315, United States; Dental and Trauma Research Detachment, U.S. Army Institute of Surgical Research, 3650 Chambers Pass, Fort Sam Houston, TX 78234-6315, United States.
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Woo CH, Choi YC, Choi JS, Lee HY, Cho YW. A bilayer composite composed of TiO2-incorporated electrospun chitosan membrane and human extracellular matrix sheet as a wound dressing. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2015; 26:841-54. [PMID: 26096447 DOI: 10.1080/09205063.2015.1061349] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We designed bilayer composites composed of an upper layer of titanium dioxide (TiO2)-incorporated chitosan membrane and a sub-layer of human adipose-derived extracellular matrix (ECM) sheet as a wound dressing for full-thickness wound healing. The dense and fibrous top layer, which aims to protect the wound from bacterial infection, was prepared by electrospinning of chitosan solution followed by immersion in TiO2 solution. The sponge-like sub-layer, which aims to promote new tissue regeneration, was prepared with acellular ECM derived from human adipose tissue. Using a modified drop plate method, there was a 33.9 and 69.6% reduction in viable Escherichia coli and Staphylococcus aureus on the bilayer composite, respectively. In an in vivo experiment using rats, the bilayer composites exhibited good biocompatibility and provided proper physicochemical and compositional cues at the wound site. Changes in wound size and histological examination of full-thickness wounds showed that the bilayer composites induced faster regeneration of granulation tissue and epidermis with less scar formation, than control wounds. Overall results suggest that the TiO2-incorporated chitosan/ECM bilayer composite can be a suitable candidate as a wound dressing, with an excellent inhibition of bacterial penetration and wound healing acceleration effects.
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Affiliation(s)
- Chang Hee Woo
- a Department of Chemical Engineering , Hanyang University , Ansan , Gyeonggi-do 426-791 , Republic of Korea
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Tan H, Wasiak J, Paul E, Cleland H. Effective use of Biobrane as a temporary wound dressing prior to definitive split-skin graft in the treatment of severe burn: A retrospective analysis. Burns 2015; 41:969-76. [PMID: 25767062 DOI: 10.1016/j.burns.2014.07.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 06/03/2014] [Accepted: 07/12/2014] [Indexed: 10/23/2022]
Abstract
AIMS To report on the use of Biobrane, a synthetic skin substitute, as a temporary wound cover in patients with severe burn. In particular we wished to examine the role of Biobrane in maintaining a healthy wound bed following surgical excision and identify factors associated with regrafting. METHODS A retrospective case series review was performed on patients with severe burns (≥ 20% TBSA), admitted to the Victorian Adult Burns Service, in Melbourne, from January 2009 to June 2012. Logistic regression analysis was performed to identify factors associated with regrafting. RESULTS Out of 58 patients with median %TBSA burn of 30%, 22 patients (37.9%) required regrafting of at least one area previously treated with Biobrane and split-skin graft. On univariate analysis, need for regrafting was significantly associated with increasing %TBSA (OR 1.04, 95% CI: 1.01-1.08; p=0.02); and after multivariate analysis to adjust for this effect, hospital LOS (OR 1.04, 95% CI: 1.02-1.07; p=0.001); total operative time (OR 1.16, 95% CI; 1.06-1.28; p=0.002) and total number of surgeries (OR 1.69, 95% CI: 1.27-2.26, p<0.001) remained significantly associated with regrafting. Age, gender, time to surgical debridement and Biobrane application, and anatomical region were not found to be associated with regraft. CONCLUSION At our institution, Biobrane has emerged as an alternative option to maintain a healthy wound bed after burn excision and prior to grafting. Our small number of extensive graft failures, small areas of regrafting and low infection rate following Biobrane application reflects our current experience with Biobrane. Precise indications and most appropriate methods for Biobrane use are yet to be established.
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Affiliation(s)
- Hannah Tan
- Victorian Adult Burns Service, Department of Surgery, Monash University, The Alfred Hospital, Commercial Rd, Melbourne, Victoria, Australia
| | - Jason Wasiak
- Victorian Adult Burns Service, School of Public Health and Preventive Medicine, Monash University, The Alfred Hospital, Commercial Rd, Melbourne, Victoria, Australia.
| | - Eldho Paul
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, Australia
| | - Heather Cleland
- Victorian Adult Burns Service, Department of Surgery, Monash University, The Alfred Hospital, Commercial Rd, Melbourne, Victoria, Australia
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The safety of general anaesthesia in paediatric patients undergoing the application of Biobrane® for small scalds. Burns 2015; 41:1221-6. [PMID: 25724104 DOI: 10.1016/j.burns.2015.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/02/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Each year more than 5000 children present to English and Welsh hospitals for the management of scalds; 60% of these are small scalds of less than 10% body surface area. There are no agreed UK care pathways for this injury. One method of management is to use a biosynthetic wound dressing after thorough wound cleaning. In children, this usually utilises general anaesthesia. This study investigates the incidence of adverse events during anaesthesia for the application of biosynthetic dressings in children with small-area scalds. METHODS The medical records of 500 consecutive admissions to a tertiary care paediatric burn centre between July 1st 2007 and June 30th 2012 were analysed. The primary outcome was any patient-related adverse event incurred as a result of the general anaesthesia. Secondary outcomes included delays in discharge and any recovery sequelae to the adverse events. RESULTS There were 21 (4.2%) documented adverse events associated with 500 episodes of anaesthesia. Of these, the majority (52%) were documented as self-resolving laryngospasm. All episodes were temporary with no recovery sequelae and did not delay discharge from the post-anaesthetic recovery area. CONCLUSIONS The use of general anaesthesia in this setting for the application of biosynthetic dressings in children with small-area scalds has a low incidence of anaesthesia-related complications with no associated long-term sequelae. This incidence is similar to that quoted for adverse events related to anaesthesia for other procedures and is lower than that reported for procedures using sedation.
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Austin RE, Merchant N, Shahrokhi S, Jeschke MG. A comparison of Biobrane™ and cadaveric allograft for temporizing the acute burn wound: Cost and procedural time. Burns 2014; 41:749-53. [PMID: 25458501 DOI: 10.1016/j.burns.2014.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 09/19/2014] [Accepted: 10/03/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In many circumstances early burn excision and autografting is unsafe or even impossible. In these situations, skin substitute dressings can be utilized for temporary wound coverage. Two commonly used dressings for this purpose are cadaveric allograft and Biobrane™. MATERIALS AND METHODS Five year retrospective cohort study evaluating upper extremity burns treated with temporary wound coverage (Biobrane™ or allograft). The primary outcome was to determine the impact choice of wound coverage had on operative time and cost. The secondary outcome was the need for revision of upper extremity debridement prior to definitive autografting. RESULTS 45 patients were included in this study: 15 treated with cadaveric allograft and 30 treated with Biobrane™ skin substitute. Biobrane™ had a significantly lower procedure time (21.12 vs. 54.78 min per %TBSA excised, p=0.02) and cost (1.30 vs. 2.35 dollars per minute per %TBSA excised, p=0.002). Both techniques resulted in 2 revisions due to complications. CONCLUSION Biobrane™ is superior to cadaveric allograft as a temporizing skin substitute in the acute burn wound, both in terms of procedure time and associated cost. We believe that this is largely due to the relative ease of application of Biobrane™. Furthermore, given its unique characteristics, Biobrane™ may serve as a triage and transport option for severe burns in the military and mass casualty settings.
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Affiliation(s)
- Ryan E Austin
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, 149 College St, Stewart Building, 5th Floor, Toronto, ON M5T 1P5, Canada; Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, D704, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
| | - Nishant Merchant
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, D704, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
| | - Shahriar Shahrokhi
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, 149 College St, Stewart Building, 5th Floor, Toronto, ON M5T 1P5, Canada; Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, D704, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
| | - Marc G Jeschke
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, 149 College St, Stewart Building, 5th Floor, Toronto, ON M5T 1P5, Canada; Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, D704, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
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Vyas KS, Vasconez HC. Wound Healing: Biologics, Skin Substitutes, Biomembranes and Scaffolds. Healthcare (Basel) 2014; 2:356-400. [PMID: 27429283 PMCID: PMC4934597 DOI: 10.3390/healthcare2030356] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/08/2014] [Accepted: 08/19/2014] [Indexed: 12/25/2022] Open
Abstract
This review will explore the latest advancements spanning several facets of wound healing, including biologics, skin substitutes, biomembranes and scaffolds.
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Affiliation(s)
- Krishna S Vyas
- Division of Plastic Surgery, Department of Surgery, University of Kentucky, Kentucky Clinic K454, 740 South Limestone, Lexington, KY 40536, USA.
| | - Henry C Vasconez
- Division of Plastic Surgery, Department of Surgery, University of Kentucky, Kentucky Clinic K454, 740 South Limestone, Lexington, KY 40536, USA.
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Herron M, Agarwal A, Kierski PR, Calderon DF, Teixeira LBC, Schurr MJ, Murphy CJ, Czuprynski CJ, McAnulty JF, Abbott NL. Reduction in wound bioburden using a silver-loaded dissolvable microfilm construct. Adv Healthc Mater 2014; 3:916-28. [PMID: 24523027 PMCID: PMC4112187 DOI: 10.1002/adhm.201300537] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 11/21/2013] [Indexed: 01/08/2023]
Abstract
Silver is a widely used antimicrobial agent, yet, when impregnated in macroscopic dressings, it stains wounds, can lead to tissue toxicity, and can inhibit healing. Recently, polymeric nanofilms containing silver nanoparticles were reported to exhibit antimicrobial activity at loadings and release rates of silver that are 100× lower than conventional dressings. Here, fabrication of composite microfilm constructs that provide a facile way to transfer the silver-loaded polymeric nanofilms onto wounds in vivo is reported. The construct is fabricated from a silver nanoparticle-loaded polymeric nanofilm that is laminated with a micrometer-thick-soluble film of polyvinylalcohol (PVA). When placed on a moist wound, the PVA dissolves, leaving the silver-loaded nanofilm immobilized on the wound-bed. In vitro, the immobilized nanofilms release <1 μg cm(-2) d(-1) of silver over 30 d from skin dermis and they kill 5 log10 CFUs of Staphylococcus aureus in 24 h. In mice, wounds inoculated with 10(5) CFU S. aureus presented up to 3 log10 less bacterial burden when treated with silver/nanofilms for 3 d, as compared to unmodified wounds. In uncontaminated wounds, silver/nanofilms allow normal and complete wound closure by re-epithelialization. Dissolvable microfilm constructs may overcome key limitations associated with current uses of silver in wound healing.
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Affiliation(s)
- Maggie Herron
- Department of Chemical and Biological Engineering, University of Wisconsin, 1415 Engineering Drive, Madison, WI 53706 (USA)
| | - Ankit Agarwal
- Department of Chemical and Biological Engineering, University of Wisconsin, 1415 Engineering Drive, Madison, WI 53706 (USA)
| | - Patricia R. Kierski
- Department of Surgery, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr., Madison, WI 53706 (USA)
| | - Diego F. Calderon
- Department of Surgery, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr., Madison, WI 53706 (USA)
| | - Leandro B. C. Teixeira
- Department of Pathobiology, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706 (USA)
| | - Michael J. Schurr
- Department of Surgery, School of Medicine, University of Colorado-Denver, 12631 E. 17 Avenue, Aurora, CO 80045 (USA)
| | - Christopher J. Murphy
- Department of Ophthalmology and Vision Sciences, School of Medicine, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, 1423 Tupper Hall, Davis, CA 95616 (USA)
| | - Charles J. Czuprynski
- Department of Pathobiology, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706 (USA)
| | - Jonathan F. McAnulty
- Department of Surgery, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr., Madison, WI 53706 (USA)
| | - Nicholas L. Abbott
- Department of Chemical and Biological Engineering, University of Wisconsin, 1415 Engineering Drive, Madison, WI 53706 (USA)
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Walker TLJ, Rodriguez DU, Coy K, Hollén LI, Greenwood R, Young AER. Impact of reduced resuscitation fluid on outcomes of children with 10-20% body surface area scalds. Burns 2014; 40:1581-6. [PMID: 24793046 DOI: 10.1016/j.burns.2014.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 01/19/2014] [Accepted: 02/14/2014] [Indexed: 11/18/2022]
Abstract
'Permissive hypovolaemia' fluid regimes in adult burn care are suggested to improve outcomes. Effects in paediatric burn care are less well understood. In a retrospective audit, outcomes of children from the South West Children's Burn Centre (SWCBC) less than 16 years of age with scalds of 10-20% burn surface area (BSA) managed with a reduced volume fluid resuscitation regime (post-2007) were compared to (a) an historical local protocol (pre-2007) and (b) current regimes in burn services across England and Wales (E&W). Outcomes included length of stay per percent burn surface area (LOS/%BSA), skin graft requirement and re-admission rates. 92 SWCBC patients and 475 patients treated in 15 other E&W burn services were included. Median LOS/%BSA for patients managed with the reduced fluid regime was 0.27 days: significantly less than pre-2007 and other E&W burn services (0.54 days, 0.50 days, p<0.001). Skin grafting to achieve healing reduced post-2007 compared to pre-2007 and remains comparable with other E&W services. Re-admission rates were comparable between all groups. A reduced fluid regime has significantly shortened LOS/%BSA without compromising burn depth as measured by skin grafting to achieve healing. A prospective trial comparing permissive hypovolaemia to current regimes for moderate paediatric scald injuries would help clarify.
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Affiliation(s)
- T L J Walker
- Frenchay Hospital, North Bristol NHS Trust, United Kingdom
| | | | - K Coy
- Frenchay Hospital, North Bristol NHS Trust, United Kingdom
| | | | - R Greenwood
- University Hospitals Bristol NHS Foundation Trust, United Kingdom
| | - A E R Young
- Frenchay Hospital, North Bristol NHS Trust, United Kingdom.
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Lepow BD, Downey M, Yurgelon J, Klassen L, Armstrong DG. Bioengineered tissues in wound healing: a progress report. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.11.27] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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47
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Supp DM. Skin substitutes for burn wound healing: current and future approaches. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.10.73] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Abstract
Burns represent a significant cause of morbidity and mortality in children. In this article, a case discussion will serve as a platform for discussing the evaluation and treatment of burns in children. Use of various burn dressings such as hydrocolloids, polyurethane films, hydrogels, biosynthetic skin dressing, and biological dressings will be discussed.
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Kamel RA, Ong JF, Eriksson E, Junker JPE, Caterson EJ. Tissue engineering of skin. J Am Coll Surg 2013; 217:533-55. [PMID: 23816384 DOI: 10.1016/j.jamcollsurg.2013.03.027] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 03/15/2013] [Accepted: 03/18/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Rami A Kamel
- Division of Plastic Surgery, Brigham and Women's Surgery, Harvard Medical School, Boston, MA 02115, USA
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