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Thomas R, Wicks S, Dale M, Toose C, Pacey V. Cutaneous functional units prediction in outcomes of early and intensive splinting following palmar burn injury in young children: a prospective study. Burns 2024; 50:717-729. [PMID: 38184424 DOI: 10.1016/j.burns.2023.12.009] [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: 05/05/2023] [Revised: 09/06/2023] [Accepted: 12/17/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Palmar burn injuries are common in young children and can result in contracture. METHODS A prospective longitudinal study describes outcomes of palm and digit extension splint use following burn in 75 children (83 hands) aged < 5 years and determines whether specific cutaneous functional units (CFUs) are associated with early signs of contracture (ESC). Outcomes were assessed up to 9-18 months following burn. Routine clinical data was collected at therapy reviews. RESULTS Children were splinted > 12 h/day for a mean of 158 days following burn. The mean time to splint cessation was 264 days following burn. Fourteen hands developed ESC (17%): 12 hands had full ROM restored following conservative management, 2 hands (3%) progressed to contracture. Hands that developed ESC had greater healing time (p = 0.002), greater number of CFUs affected (p < 0.001), and greater number of immediate first webspace and extended first webspace CFUs affected (p = 0.002, p < 0.001 respectively). ESC risk increases for each day to heal (odds ratio [OR] 1.1, 95% CI 1.0-1.2) and each CFU in extended first webspace (OR 2.8, 95% CI 1.5-5.0). CONCLUSION Early and intensive splinting following palmar burn results in excellent ROM. Burns involving more CFUs or the first webspace are associated with ESC.
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Affiliation(s)
- Rhianydd Thomas
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, New South Wales, Australia; Burns Unit, The Children's Hospital at Westmead, New South Wales, Australia.
| | - Stephanie Wicks
- Burns Unit, The Children's Hospital at Westmead, New South Wales, Australia
| | - Marita Dale
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Claire Toose
- Burns Unit, The Children's Hospital at Westmead, New South Wales, Australia
| | - Verity Pacey
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, New South Wales, Australia
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Spronk I, Wood FM, Fear MW, Lansdorp CA, Edgar DW. The Short- and Long-Term Outcome Priorities of a Western Australian Adult Burn Population. J Burn Care Res 2024; 45:451-458. [PMID: 37936534 PMCID: PMC10911694 DOI: 10.1093/jbcr/irad175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Indexed: 11/09/2023]
Abstract
To optimize patient recovery, understanding which outcomes are most important to burn patients is key. However, research to determine what outcomes are patient priorities is limited. Therefore, we assessed what outcomes are most important to Western Australian burn patients, separately in the short-term (<6 months) and long-term (6-24 months) after injury. Adult patients who had a burn injury 3-36 months ago completed a survey, rating the importance of 36 short- and long-term outcomes. The survey items were ranked according to the number of patients reporting the outcome as "very important." Results were compared between subgroups based on age, gender, burn size, and number of surgeries. Ninety-three patients were included. In the short-term, "not having a wound infection" (87.1%), "good wound healing" (83.9%), and "walking or moving around" (74.7%) were the most important outcomes. "Lifting or moving something" (67.6%), "walking or moving around" (66.2%), and "being independent" (66.2%) were reported as most important in the long-term. Scar-related outcomes were more important to females and to patients with multiple surgeries; mental health outcomes were priorities for females and patients with major burns; walking and moving around to males and older patients; and social and financial outcomes were rated highly by patients with major burns and multiple surgeries. In conclusion, the most important outcomes were consistent across time periods, indicating the importance of core outcomes in longitudinal follow-up. The wide range of priority outcomes and differences between subgroups underlines the need for multidisciplinary care and a patient-centered approach to support patients.
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Affiliation(s)
- Inge Spronk
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, 3000CA, The Netherlands
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, 3007AC, The Netherlands
- Dutch Burns Foundation, Beverwijk, 1941AJ, The Netherlands
| | - Fiona M Wood
- State Adult Burn Unit, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6150, Australia
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Crawley, WA 6009, Australia
- Fiona Wood Foundation, Murdoch, WA 6150, Australia
| | - Mark W Fear
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Crawley, WA 6009, Australia
- Fiona Wood Foundation, Murdoch, WA 6150, Australia
| | - Corine A Lansdorp
- Department Plastic, Reconstructive and Hand Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, 1007MB, The Netherlands
| | - Dale W Edgar
- State Adult Burn Unit, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6150, Australia
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Crawley, WA 6009, Australia
- Fiona Wood Foundation, Murdoch, WA 6150, Australia
- Institute for Health Research, Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, WA 6959, Australia
- Safety and Quality Unit, Armadale Kalamunda Group Health Service, East Metropolitan Health Service, Mt Nasura, WA 6992, Australia
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Spronk I, van Uden D, van Dammen L, van Baar ME, Nieuwenhuis M, Pijpe A, Visser I, van Schie C, van Zuijlen P, Haanstra T, Lansdorp CA. Outcomes that matter most to burn patients: A national multicentre survey study in the Netherlands. Burns 2024; 50:31-40. [PMID: 37985268 DOI: 10.1016/j.burns.2023.10.018] [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: 04/19/2023] [Revised: 10/09/2023] [Accepted: 10/29/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The use of patient-reported outcomes to improve burn care increases. Little is known on burn patients' views on what outcomes are most important, and about preferences regarding online Patient Reported Outcome Measures (PROMs). Therefore, this study assessed what outcomes matter most to patients, and gained insights into patient preferences towards the use of online PROMs. METHODS Adult patients (≥18 years old), 3-36 months after injury completed a survey measuring importance of outcomes, separately for three time periods: during admission, short-term (<6 months) and long-term (6-24 months) after burn injury. Both open and closed-ended questions were used. Furthermore, preferences regarding the use of patient-reported outcome measures in burn care were queried. RESULTS A total of 140 patients were included (response rate: 27%). 'Not having pain' and 'good wound healing' were identified as very important outcomes. Also, 'physical functioning at pre-injury level', 'being independent' and 'taking care of yourself' were considered very important outcomes. The top-ten of most important outcomes largely overlapped in all three time periods. Most patients (84%) had no problems with online questionnaires, and many (67%) indicated that it should take up to 15 minutes. Patients' opinions differed widely on the preferred frequency of follow-up. CONCLUSIONS Not having pain and good wound healing were considered very important during the whole recovery of burns; in addition, physical functioning at pre-injury level, being independent, and taking care of yourself were deemed very important in the short and long-term. These outcomes are recommended to be used in burn care and research, although careful selection of outcomes remains crucial as patients prefer online questionnaires up to 15 minutes.
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Affiliation(s)
- I Spronk
- Erasmus MC University Medical Centre Rotterdam, Department of Public Health, Rotterdam, the Netherlands; Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands; Dutch Burns Foundation, Beverwijk, the Netherlands.
| | - D van Uden
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
| | - L van Dammen
- Dutch Burns Foundation, Beverwijk, the Netherlands
| | - M E van Baar
- Erasmus MC University Medical Centre Rotterdam, Department of Public Health, Rotterdam, the Netherlands; Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
| | - M Nieuwenhuis
- Association of Dutch Burn Centres, Martini Hospital, Groningen, the Netherlands; University of Groningen, University Medical Centre Groningen, Department of Human Movement Sciences, Groningen, the Netherlands; Hanze University of Applied Sciences, Groningen Research Group Healthy Ageing Allied Health Care and Nursing, Groningen, the Netherlands
| | - A Pijpe
- Burn Centre Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic Reconstructive and Hand Surgery, Amsterdam, the Netherlands; Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam Movement Sciences (AMS) Institute Amsterdam UMC, Amsterdam, the Netherlands
| | - I Visser
- Dutch Association of Burn Survivors, Beverwijk, the Netherlands
| | - C van Schie
- Dutch Burns Foundation, Beverwijk, the Netherlands
| | - P van Zuijlen
- Burn Centre Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic Reconstructive and Hand Surgery, Amsterdam, the Netherlands; Amsterdam Movement Sciences (AMS) Institute Amsterdam UMC, Amsterdam, the Netherlands; Department of Plastic Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam UMC location University of Amsterdam, Paediatric Surgical Centre, Emma Children's Hospital, Amsterdam, the Netherlands
| | - T Haanstra
- Dutch Burns Foundation, Beverwijk, the Netherlands; Department of Dermal Therapy, Faculty of Health Nutrition & Sport, The Hague University of Applied Sciences, The Hague, the Netherlands; Research Group Relational Care Centre of Expertise Health Innovation, The Hague University of Applied Sciences, The Hague, the Netherlands
| | - C A Lansdorp
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic Reconstructive and Hand Surgery, Amsterdam, the Netherlands
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Abstract
Wound healing occurs as a response to disruption of the epidermis and dermis. It is an intricate and well-orchestrated response with the goal to restore skin integrity and function. However, in hundreds of millions of patients, skin wound healing results in abnormal scarring, including keloid lesions or hypertrophic scarring. Although the underlying mechanisms of hypertrophic scars and keloid lesions are not well defined, evidence suggests that the changes in the extracellular matrix are perpetuated by ongoing inflammation in susceptible individuals, resulting in a fibrotic phenotype. The lesions then become established, with ongoing deposition of excess disordered collagen. Not only can abnormal scarring be debilitating and painful, it can also cause functional impairment and profound changes in appearance, thereby substantially affecting patients' lives. Despite the vast demand on patient health and the medical society, very little progress has been made in the care of patients with abnormal scarring. To improve the outcome of pathological scarring, standardized and innovative approaches are required.
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Affiliation(s)
- Marc G Jeschke
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Fiona M Wood
- Burns Service of Western Australia, Fiona Stanley Hospital, Perth Children's Hospital, Perth, Western Australia, Australia
- Burn Injury Research Unit, University of Western Australia, Perth, Western Australia, Australia
| | - Esther Middelkoop
- Burn Center, Red Cross Hospital, Beverwijk, Netherlands
- Association of Dutch Burn Centers (ADBC), Beverwijk, Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Amsterdam, Netherlands
| | - Ardeshir Bayat
- Medical Research Council Wound Healing Unit, Hair and Skin Research Lab, Division of Dermatology, Department of Medicine, University of Cape Town & Groote Schuur Hospital, Cape Town, South Africa
| | - Luc Teot
- Department of Plastic Surgery, Burns, Wound Healing, Montpellier University Hospital, Montpellier, France
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - Gerd G Gauglitz
- Department of Dermatology and Allergy, Ludwig-Maximilian University Munich, Munich, Germany
- Haut- und Laserzentrum Glockenbach, Munich, Germany
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Yelvington M, Whitehead C, Turgeon L. Special Considerations for Pediatric Burn Injuries. Phys Med Rehabil Clin N Am 2023; 34:825-837. [PMID: 37806700 DOI: 10.1016/j.pmr.2023.05.004] [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: 10/10/2023]
Abstract
Burns are the fifth leading cause of non-fatal childhood injuries. Physiological differences between children and adults lead to unique considerations when treating young burn survivors. In addition to the physical and psychological concerns which must be considered in adult burn rehabilitation, pediatric burn rehabilitation must also consider the developmental stage of the child, preexisting developmental delays, and the impact of scaring on growth and motor skill attainment. Treatment of pediatric burn survivors requires a multidisciplinary approach centered around caring for not only the child but also for their parents, siblings, and other caregivers. For children who sustain burns early in life, long-term follow-up is essential and should be conducted under the guidance of a burn center for the early identification of needed interventions during periods of growth and development. This article considers pediatric-specific factors, which may present during the rehabilitation of a child with a burn injury.
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Affiliation(s)
- Miranda Yelvington
- Arkansas Children's Hospital, 1 Children's Way, Slot 104, Little Rock, AR 72202, USA.
| | | | - Lori Turgeon
- Shriners Children's Boston, 51 Blossom Street, Boston, MA 02114, USA
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Bharadia SK, Burnett L, Gabriel V. Hypertrophic Scar. Phys Med Rehabil Clin N Am 2023; 34:783-798. [PMID: 37806697 DOI: 10.1016/j.pmr.2023.05.002] [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: 10/10/2023]
Abstract
Hypertrophic scars frequently develop post-burn, and are characterized by their pruritic, painful, raised, erythematous, dyschromic, and contractile qualities. This article aims to synthesize knowledge on the clinical and molecular development, evolution, management, and measurement of hypertrophic burn scar for both patient and clinician knowledge.
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Affiliation(s)
- Shyla Kajal Bharadia
- Cumming School of Medicine, University of Calgary, Foothills Medical Centre, 1403-29 Street Northwest, Calgary, Alberta T2N 2T9, Canada
| | - Lindsay Burnett
- Alberta Health Services, University of Calgary, Foothills Medical Centre, 1403-29 Street Northwest, Calgary, Alberta T2N 2T9, Canada
| | - Vincent Gabriel
- Department of Clinical Neurosciences, University of Calgary, Foothills Medical Centre, 1403-29 Street Northwest, Calgary, Alberta T2N 2T9, Canada; Department of Surgery, University of Calgary, Foothills Medical Centre, 1403-29 Street Northwest, Calgary, Alberta T2N 2T9, Canada; Medical Director, Calgary Firefighters Burn Treatment Centre, Foothills Medical Centre, 1403-29 Street Northwest, Calgary, Alberta T2N 2T9, Canada.
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Thomas R, Wicks S, Toose C, Dale M, Pacey V. Reliability, Validity, and Predictive Validity of Cutaneous Functional Units Predicted to Scar Following Palmar Burn Injury in Young Children. J Burn Care Res 2023; 44:918-924. [PMID: 36478206 DOI: 10.1093/jbcr/irac179] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Identification of children at risk of palmar burn scar is important for early initiation of scar management. This study determined the interrater reliability of face-to-face and photographic assessments of 29 palmar cutaneous functional units (CFUs) predicted to scar following palmar burn. The validity of photographic compared to face-to-face assessment, and the predictive validity of both assessment types to identify scarring at 3 to 6 months following burn, was also established. Thirty-nine children (40 hands) post burn injury were assessed face-to-face in the clinical setting, following healing of their palmar burn, by three burn therapists. Photographs of the children's hands at initial assessment were assessed by the same therapists a minimum of 6 months later. To determine which CFUs scarred, children were reassessed face-to-face in the clinical setting 3 to 6 months following their burn. For analysis, 29 CFUs were merged into eight separate groups to determine the number of CFUs predicted to scar per CFU group for face-to-face and photographic assessments. The range of agreement for individual CFUs within CFU groups was also calculated for both assessment types. Excellent interrater reliability was established for face-to-face assessment in all eight CFU groups (ICC2,1 0.83-0.96). Photographic assessment demonstrated good to excellent interrater reliability in six CFU groups (ICC2,1 0.69-0.90) and validity in seven CFU groups (ICC2,1 0.66-0.87). Good to excellent predictive validity was established for both assessment types in seven CFU groups (face-to-face ICC2,1 0.60-0.95, photographic ICC2,1 0.69-0.89). Experienced therapists can reliably assess CFUs face-to-face or via photographs and predict future scar development.
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Affiliation(s)
- Rhianydd Thomas
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Burns Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Stephanie Wicks
- Burns Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Claire Toose
- Burns Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Marita Dale
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Verity Pacey
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Milaire A, Grosset A, Ngo B, Duhoux A, Brachet M, Duhamel P, Bey E, Baus A. Modified Colson flap with subcutaneous liposuction for one-stage donor site removal: A case series. ANN CHIR PLAST ESTH 2023:S0294-1260(23)00015-8. [PMID: 37045656 DOI: 10.1016/j.anplas.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/09/2023] [Accepted: 03/12/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the functional and cosmetic results of an innovative procedure for modified Colson flap-graft consisting of immediate defatting of the flap by a liposuction cannula. METHODS A cross-sectional study was performed among patients with deep hand burns requiring a modified Colson flap between 2018 and 2021. Outcomes included functional and cosmetic assessment of the hand through a quality-of-life questionnaire, a sensitivity scale and a scar assessment scale. RESULTS During this period, 7 patients were operated on using our technique. One patient was lost to follow-up; 7 patients with a median age of 44 years were included, with a total of 10 burned hands. The burns were thermal in 5 out of 7 cases and the coverage concerned the whole hand in 50% of the cases. The flaps all received cannula defatting. The median time to flap weaning was 23 days (20 to 30 days). The median follow-up was 16 months. One case required remote flap weaning. The median POSAS (Patient and Observer Scar Assessment Scale) per patient was 4 and 2 per observer. The median BMRCSS (British Medical Research Council Sensory Scale) was 122. One case had recovered S2 sensitivity, the other cases had S3 or S4 sensitivity. CONCLUSION Immediate defatting is one of the factors in tegumental quality allowing rapid functional recovery of the hand. The cannula defatting technique does not appear to require additional defatting time. The use of the liposuction cannula allows a one-step, homogeneous, and easier defatting, with a lower risk of devascularization.
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Affiliation(s)
- Alexia Milaire
- Department of Orthopedic, Trauma and Reconstructive Surgery, Percy Military teaching hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - Antoine Grosset
- Department of Orthopedic, Trauma and Reconstructive Surgery, Percy Military teaching hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - Benjamin Ngo
- Department of Plastic, Reconstructive and Aesthetic Surgery, PERCY Military Teaching Hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - Alexandre Duhoux
- Department of Plastic, Reconstructive and Aesthetic Surgery, PERCY Military Teaching Hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - Michel Brachet
- Department of Plastic, Reconstructive and Aesthetic Surgery, PERCY Military Teaching Hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - Patrick Duhamel
- Department of Plastic, Reconstructive and Aesthetic Surgery, PERCY Military Teaching Hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France; Department of Surgery, French Military Health Service Academy, Val-de-Grâce School, Paris, France
| | - Eric Bey
- Department of Plastic, Reconstructive and Aesthetic Surgery, PERCY Military Teaching Hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France; Department of Surgery, French Military Health Service Academy, Val-de-Grâce School, Paris, France
| | - Arnaud Baus
- Department of Plastic, Reconstructive and Aesthetic Surgery, Sainte-Anne Military Teaching Hospital, 2, boulevard Sainte-Anne, 83000 Toulon, France.
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Mekereș GM, Buhaș CL, Tudoran C, Csep AN, Tudoran M, Manole F, Iova CS, Pop NO, Voiţă IB, Domocoș D, Voiţă-Mekereş F. The practical utility of psychometric scales for the assessment of the impact of posttraumatic scars on mental health. Front Public Health 2023; 11:1103714. [PMID: 37089486 PMCID: PMC10113612 DOI: 10.3389/fpubh.2023.1103714] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/02/2023] [Indexed: 04/09/2023] Open
Abstract
BackgroundScars are a natural consequence of the healing process, but with an impact on the psychological and social level for the individual, which can even lead to withdrawal and social stigmatization. We aimed to analyze the psychosocial impact determined by post-traumatic scars, using psychometric scales, to assess the effectiveness of the Mekereș’ Psychosocial Internalization Scale (MPIS), and to identify relevant predictors of traumatic and surgical scar internalization.MethodsOur cohort included 293 participants, 149 women and 144 men, aged 18–64 years who were screened for scar characteristics and completed a set of psychological scales. We compared the results obtained in two subgroups: 153 subjects with posttraumatic scars and 140 with surgical scars.ResultsRelevant predictors for posttraumatic scar internalization (R2 = 0.721) are adaptation time, age of the occurrence and subjective appraisal, while for the depression, and hopelessness relevant predictors are the subjective appraisal of the scars and the posttraumatic quality of life.ConclusionThe psychological and social reporting of the aftermath of trauma, that has been followed by scar-ring, is an indicator of how a person will react and could indicate the susceptibility to psycho-pathology.
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Affiliation(s)
| | | | - Cristina Tudoran
- Department VII, Internal Medicine II, University of Medicine and Pharmacy “Victor Babes” Timisoara, Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, Timisoara, Romania
- County Emergency Hospital “Pius Brinzeu”, Timisoara, Romania
- *Correspondence: Cristina Tudoran,
| | | | - Mariana Tudoran
- County Emergency Hospital “Pius Brinzeu”, Timisoara, Romania
| | - Felicia Manole
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | | | | | - Ioan Bogdan Voiţă
- Regional Institute of Gastroenterology and Hepatology “Prof. Octavian Fodor”, Cluj-Napoca, Romania
| | - Daniela Domocoș
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
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Rijpma D, Pijpe A, Claes K, Hoeksema H, de Decker I, Verbelen J, van Zuijlen P, Monstrey S, Meij-de Vries A. Outcomes of Meek micrografting versus mesh grafting on deep dermal and full thickness (burn) wounds: Study protocol for an intra-patient randomized controlled trial. PLoS One 2023; 18:e0281347. [PMID: 36787292 PMCID: PMC9928116 DOI: 10.1371/journal.pone.0281347] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/16/2022] [Indexed: 02/15/2023] Open
Abstract
INTRODUCTION Autologous split thickness skin grafting is the standard-of-care for most deep dermal and full thickness skin defects. Historically, mesh grafting is used to expand skin grafts for smaller defects and other techniques such as Meek micrografting is used to enable expansion for larger skin defects. Yet, Meek micrografting is increasingly used for smaller skin defects as well. Both techniques are frequently used, especially in burn centers, but evidence on which one is preferable for relative smaller skin defects is lacking. Therefore, an intra-patient randomized controlled trial was designed to adequately compare multiple outcomes of the Meek micrografting and mesh grafting techniques. MATERIALS AND METHODS A multicenter intra-patient controlled randomized trial is being performed in two burn centers (the Netherlands and Belgium) to compare multiple outcomes of Meek micrografting and mesh grafting burns or skin defects. Study registration number (NL74274.029.20). Adult patients with a (burn) wound and an indication for surgical excision and skin grafting were screened for inclusion. In total 70 patients will be included and the primary outcome is scar quality twelve months post-surgery assessed by the Patient and Observer Scar Assessment Scale. Moreover, graft take, re-epithelialization, infection rate, donor site size and patients' preference are also measured within hospital admission, on 3 months and 12 months post-surgery. DISCUSSION This is the first randomized trial that is intra-patient controlled, which enables a proper comparison between both skin expansion techniques. The results of this study will contribute to the clarification of the indications of both techniques and ample attention is paid for the patients' opinion on the surgical treatment options.
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Affiliation(s)
- Danielle Rijpma
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Plastic, Reconstructive and Hand Surgery, Amsterdam, The Netherlands
- Association of Dutch Burn Centers, Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
- * E-mail: (DR); (AMV)
| | - Anouk Pijpe
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Plastic, Reconstructive and Hand Surgery, Amsterdam, The Netherlands
- Association of Dutch Burn Centers, Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
| | - Karel Claes
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
- Ghent Burn Center, Ghent University Hospital, Ghent, Belgium
| | - Henk Hoeksema
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
- Ghent Burn Center, Ghent University Hospital, Ghent, Belgium
| | - Ignace de Decker
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
- Ghent Burn Center, Ghent University Hospital, Ghent, Belgium
| | - Jozef Verbelen
- Ghent Burn Center, Ghent University Hospital, Ghent, Belgium
| | - Paul van Zuijlen
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Plastic, Reconstructive and Hand Surgery, Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands
- Department of Pediatric Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Stan Monstrey
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
- Ghent Burn Center, Ghent University Hospital, Ghent, Belgium
| | - Annebeth Meij-de Vries
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
- Department of Pediatric Surgery, Amsterdam UMC, Amsterdam, The Netherlands
- Department Surgery, Red Cross Hospital, Beverwijk, The Netherlands
- * E-mail: (DR); (AMV)
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11
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Schiefer JL, Aretz FG, Fuchs PC, Lefering R, Yary P, Opländer C, Schulz A, Daniels M. Comparison of Long-Term Skin Quality and Scar Formation in Partial-Thickness Burn Wounds Treated with Suprathel ® and epicite hydro® Wound Dressings. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1550. [PMID: 36363504 PMCID: PMC9698741 DOI: 10.3390/medicina58111550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/12/2022] [Accepted: 10/26/2022] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Scar formation after burn trauma has a significant impact on the quality of life of burn patients. Hypertrophic scars or keloids can be very distressing to patients due to potential pain, functional limitations, or hyper- or hypopigmentation. In a previous study comparing Suprathel® and the new and cheaper dressing epicitehydro®, we were able to show that pain reduction, exudation, and time until wound-healing of partial-thickness burn wounds were similar, without any documented infections. No study exists that objectively measures and compares skin and scar quality after treatment with Suprathel® and epicitehydro® at present. Materials and Methods: In this study, the scar quality of 20 patients who had been treated with Suprathel® and epicitehydro® was objectively assessed using the Cutometer®, Mexameter®, and Tewameter®, as well as subjectively with the Patient and Observer Scar Assessment Scale, 3, 6, and 12 months after burn injury. Results: In all performed measurements, no significant differences were detected in scar formation after treatment of partial-thickness burn wounds with the two dressings. Conclusions: Both the newer and less expensive wound-dressing epicitehydro® and the well-known wound-dressing Suprathel® resulted in stable wound closure and showed good cosmetic results in the follow-up examinations.
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Affiliation(s)
- Jennifer Lynn Schiefer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, 58455 Witten, Germany
| | - Friederike Genoveva Aretz
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, 58455 Witten, Germany
| | - Paul Christian Fuchs
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, 58455 Witten, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, Witten/Herdecke University, 51109 Cologne, Germany
| | - Pouyan Yary
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, 58455 Witten, Germany
| | - Christian Opländer
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, Witten/Herdecke University, 51109 Cologne, Germany
| | - Alexandra Schulz
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, 58455 Witten, Germany
| | - Marc Daniels
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, 58455 Witten, Germany
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12
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Van Loey NEE, de Jong AEE, Hofland HWC, van Laarhoven AIM. Role of burn severity and posttraumatic stress symptoms in the co-occurrence of itch and neuropathic pain after burns: A longitudinal study. Front Med (Lausanne) 2022; 9:997183. [PMID: 36314001 PMCID: PMC9596796 DOI: 10.3389/fmed.2022.997183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
Itch and pain are common after burns. Neuropathic mechanisms may underlie both modalities but remain not well-understood. This study aims to prospectively document neuropathic pain symptoms and to identify potential itch symptom profiles that differ regarding duration and co-occurrence with neuropathic pain which may inform underlying pathophysiological mechanisms and respond to different treatments. Adult burn survivors (n = 192) self-reported itch and neuropathic pain at 2 weeks post-discharge, 3, 6, 12, and 18 months post-burn. Based on the presence of itch and pain symptoms over time, participants were allocated to one itch profile: transient itch/pain, chronic itch, or chronic itch & pain. Profiles were compared on itch intensity over time using General Linear Modeling. Age, gender, burn severity, posttraumatic stress (PTS) symptoms and baseline itch intensity were examined as potential predictors of the profiles in a Multi-nominal regression analysis. Neuropathic pain occurred in 54% after discharge which decreased to 24% 18 months later. Itch intensity was highest in the chronic itch & pain profile. Compared to the transient itch profile, the chronic itch & pain profile was associated with higher burn severity and more PTS symptoms. Compared to the chronic itch profile, the chronic itch & pain profile was associated with more PTS symptoms. Findings suggest that biological and psycho-dermatological processes underlie both chronic neuropathic pain and itch processes in burn scars. Further research should elucidate the mechanisms underlying the different itch profiles, with specific focus on skin innervation and psychological factors.
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Affiliation(s)
- N. E. E. Van Loey
- Association of Dutch Burn Centres, Maasstad Hospital, Department of Burn Center, Rotterdam, Netherlands,Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands,*Correspondence: N. E. E. Van Loey
| | | | - H. W. C. Hofland
- Association of Dutch Burn Centres, Maasstad Hospital, Department of Burn Center, Rotterdam, Netherlands
| | - A. I. M. van Laarhoven
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands,Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, Netherlands
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13
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Cao YL, Liu ZC, Chen XL. Efficacy of hydrosurgical excision combined with skin grafting in the treatment of deep partial-thickness and full-thickness burns: a two-year retrospective study. Burns 2022:S0305-4179(22)00194-2. [DOI: 10.1016/j.burns.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/26/2022]
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14
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Abd-Elsayed A, Pope J, Mundey DA, Slavin KV, Falowski S, Chitneni A, Popielarski SR, John J, Grodofsky S, Vanetesse T, Fishman MA, Kim P. Diagnosis, Treatment, and Management of Painful Scar: A Narrative Review. J Pain Res 2022; 15:925-937. [PMID: 35411187 PMCID: PMC8994628 DOI: 10.2147/jpr.s355096] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/29/2022] [Indexed: 12/26/2022] Open
Abstract
Painful scars can develop after surgery or trauma, with symptoms ranging from a minor itch to intractable allodynia. The problem of the painful scar may involve both intraneural and extraneural structures, requiring a systematic approach to diagnosis and treatment of this neuropathic pain condition that can impact quality of life and function profoundly. In this review, we outline the algorithm for the diagnosis, management, medical and surgical treatment of painful scars.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Correspondence: Alaa Abd-Elsayed, FASA Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA, Tel +1 608-263-8100, Fax +1 608-263-0575, Email
| | - Jason Pope
- Evolve Restorative Center, Santa Rosa, CA, USA
| | | | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
- Neurology Service, Jesse Brown Veterans Administration Medical Center, Chicago, IL, USA
| | | | - Ahish Chitneni
- Department of Rehabilitation and Regenerative Medicine, New York-Presbyterian Hospital - Columbia and Cornell, New York, NY, USA
| | | | - Jarod John
- Argires Marotti Neurosurgical Associates, Lancaster, PA, USA
| | | | - Tony Vanetesse
- Center for Interventional Pain Spine, LLC., Wilmington, DE, USA
| | | | - Philip Kim
- Center for Interventional Pain Spine, LLC., Wilmington, DE, USA
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15
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Predictors for Estimating Scars’ Internalization in Victims with Post-Traumatic Scars versus Patients with Postsurgical Scars. Healthcare (Basel) 2022; 10:healthcare10030550. [PMID: 35327027 PMCID: PMC8951544 DOI: 10.3390/healthcare10030550] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/06/2022] [Accepted: 03/14/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Scars are the consequence of physiological inherent healing processes of post-traumatic and surgical lesions with a psychological impact. Post-traumatic scarring may induce emotional and behavioral changes through social stigma. In this study we analyze the internalization of scars and their impact on hopelessness, depression, or the perception of social support in subjects with post-traumatic scars compared to people with surgical scars. (2) Methods: to research this suggested model, we analyzed data collected from 110 participants 61 women and 49 men, aged between 18 and 64 years; 55 participants had post-traumatically and 55 surgically acquired scars. They all were examined to assess the characteristics of scars, were asked to complete four psycho-social scales, and the results were compared. (3) Results: our results indicate that people with post-traumatic scars are oriented toward the internalization of scars, depending on their shape and size. We argue that hopelessness, appreciation of scars, age, and how scars are produced are important predictors of internalization. (4) Conclusions: the patient’s attitude toward the appearance of a scar is an indicator of how he/she will react in the future and it could predict the vulnerability to hopelessness. Finally, we nuance the impact of objective bodily harm on the psychological and moral suffering.
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16
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Brewin M, Docherty S, Heaslip V, Breheny K, Pleat J, Rhodes S. Early Laser for Burn Scars (ELABS): protocol for a multi-centre randomised, controlled trial of both the effectiveness and cost-effectiveness of the treatment of hypertrophic burn scars with Pulsed Dye Laser and standard care compared to standard care alone [version 1; peer review: 2 approved]. NIHR OPEN RESEARCH 2022; 2:1. [PMID: 35392303 PMCID: PMC7612584 DOI: 10.3310/nihropenres.13234.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/22/2022]
Abstract
This paper outlines the protocol for a study that is being carried out at multiple centres across the UK in the next three years. It is a Research for Patient Benefit (RfPB) study funded by the National Institute for Healthcare Research (NIHR). The aim is to assess the effectiveness of treating hypertrophic burns scars with pulsed dye laser (PDL) at an early stage of scar formation. The objective is to improve Quality of Life for the patient by improving both the appearance and quality of burn scarring, as well as reducing its psychological impact. This is a parallel-arm randomised, controlled trial to compare PDL and standard care against standard care alone. The difference is measured between baseline and six-month follow-up. Recruits are within three months of healing from a burn injury; with wounds showing a defined potential for hypertrophic scarring. A total of 120 patients are recruited in a multi-centre study; with randomisation in a 1:1 allocation to each arm. The treatment arm receives 3 PDL treatments at six-week intervals in addition to standard care, whereas the control arm receives standard care alone. The primary outcome is the patient-rated part of the Patient and Observer Scar Scale (POSAS). Psychological and psycho-social impact is evaluated using the CARe burn scale (UWE, Bristol) and Quality Adjusted Life Years (QALY) is determined using the Short-Form Health Survey (SF-12). The study evaluates both the cost-effectiveness through an economic analysis and the patient-reported experience of the treatment by phone interviews.
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Affiliation(s)
- Mark Brewin
- Burns & Plastics, Salisbury NHS Foundation Trust, Salisbury, Wiltshire, SP2 8BJ, UK
| | | | | | | | - Jonathon Pleat
- Burns & Plastics, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - Shelley Rhodes
- Exeter Clinical Trials Unit, University of Exeter, Exeter, EX4 4SB, UK
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17
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Müller B, Mazza E, Schiestl C, Elrod J. Longitudinal monitoring and prediction of long-term outcome of scar stiffness on pediatric patients. BURNS & TRAUMA 2021; 9:tkab028. [PMID: 34604394 PMCID: PMC8484205 DOI: 10.1093/burnst/tkab028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/25/2021] [Indexed: 11/13/2022]
Abstract
Background Hypertrophic scarring after burn injury is one of the greatest unmet challenges in patients with burn injuries. A better understanding of the characteristics of scar maturation and early prediction of the long-term outcome of scarring are prerequisites for improving targeted therapies and pivotal for patient counselling. Methods Repeated measurements of scar stiffness in 11 pediatric patients were performed over the course of 1 year using 2 suction devices, the Cutometer and the Nimble. In addition, the observer pliability score of the Patient and Observer Scar Assessment Scale was applied. This longitudinal study allowed quantification of the ability of each of the measured parameters to reflect scar maturation, as indicated by change in skin pliability/stiffness, over time (using linear regression); the ability to distinguish individual patients (intraclass correlation coefficient (ICC)); the correlation of the devices (Spearman correlation coefficient); and the ability to predict long-term scar maturation based on early scar assessment (using receiver operating characteristic). Results All the tools used showed significant longitudinal decrease of scar stiffness from 3 months until 12 months after the injury. The Nimble (ICCpatient Nimble = 0.99) and the Cutometer (ICCpatient Cuto = 0.97) demonstrated an excellent ability to distinguish between individual patients. The Nimble seemed to be able to predict the 12-month pliability of scars based on early (3-month) measurements (area under the curve (AUC)12m POSAS = 0.67; AUC12m C = 0.46; AUC12m N = 0.79). Conclusions The results of this preliminary study suggest that all 3 tools provide suitable means to quantify alterations in scar stiffness over time. Initial evidence suggests the Nimble is most favorable for predicting changes in stiffness associated with long-term scar maturation. Further studies with a larger sample size are required to validate tissue suction as a clinical tool for analysis of changes of scar stiffness over time.
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Affiliation(s)
- Bettina Müller
- Institute for Mechanical Systems, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, 8092 Zurich, Switzerland
| | - Edoardo Mazza
- Institute for Mechanical Systems, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, 8092 Zurich, Switzerland
| | - Clemens Schiestl
- Burn Center, Division of Plastic and Reconstructive Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zürich, Switzerland
| | - Julia Elrod
- Burn Center, Division of Plastic and Reconstructive Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zürich, Switzerland
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18
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Davies P, Cuttle L, Young A. A Scoping Review of the Methodology Used in Studies of Genetic Influences on the Development of Keloid or Hypertrophic Scarring in Adults and Children After Acute Wounding. Adv Wound Care (New Rochelle) 2021; 10:557-570. [PMID: 33975469 PMCID: PMC8312015 DOI: 10.1089/wound.2020.1386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Significance: Keloid and hypertrophic scarring are common following acute wounds. However, the variability in scarring outcomes between individuals and in particular, the association between genetic factors and scarring, is not well understood. This scoping review aims to summarize the methodology used in studies of genetic influences on the development of keloid or hypertrophic scarring in adults and children after acute wounding. The objectives were to determine the study designs used, the characteristics of participants included, the tools used to assess scarring and the length of follow-up after wounding. Recent Advances: The review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline, Excerpta Medica Database (EMBASE), Web of Science, Biosciences Information Service (BIOSIS), Prospective Register of Systematic Reviews (PROSPERO), The Human Genetic Epidemiology (HuGE) Navigator (database of genetic association studies), and the genome-wide association study Catalog were searched from January 2008 to April 2020. Cohort studies and case–control studies that examined the association between one or more genetic variations and the development of keloid or hypertrophic scarring were eligible for inclusion. A narrative synthesis that grouped studies by wound type was conducted. Critical Issues: Nine studies met the inclusion criteria (five in burns, four surgical wounds, and none in other types of acute wounds). Seven assessed hypertrophic scarring, one keloid scarring, and one both scar types. Seven studies used a prospective cohort design. All studies used subjective methods (clinician or patient observation) to assess scarring. There was considerable variation in how scar scales were operationalized. Future Directions: This review identified a small body of evidence on genetic susceptibility to scarring after acute wounding. Further studies are needed, and in a wide range of populations, including patients with wounds caused by trauma.
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Affiliation(s)
- Philippa Davies
- Bristol Center for Surgical Research and Bristol Biomedical Research Center, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Leila Cuttle
- Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Amber Young
- Bristol Center for Surgical Research and Bristol Biomedical Research Center, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Children's Burn Research Center, University Hospital Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
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19
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Cost-effectiveness of adjunctive negative pressure wound therapy in paediatric burn care: evidence from the SONATA in C randomised controlled trial. Sci Rep 2021; 11:16650. [PMID: 34404842 PMCID: PMC8371025 DOI: 10.1038/s41598-021-95893-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/30/2021] [Indexed: 11/24/2022] Open
Abstract
Negative pressure wound therapy (NPWT) has been shown to improve clinical outcomes for children with burns by accelerating wound re-epithelialisation. Its effects on healthcare costs, however, remain poorly understood. The aim of this study was to evaluate the cost-effectiveness of NPWT from a healthcare provider perspective using evidence from the SONATA in C randomised controlled trial, in which 101 children with small-area burns were allocated to either standard care (silver-impregnated dressings) or standard care in combination with adjunctive NPWT. The primary outcome, time to re-epithelialisation, was assessed through a blinded photographic review. Resource usage and costs were prospectively recorded for each participant for up to 6 months. Incremental cost-effectiveness ratios and dominance probabilities were estimated and uncertainty quantified using bootstrap resampling. Mean costs per participant—including dressings, labour, medication, scar management, and theatre operations—were lower in the NPWT group (AUD $903.69) relative to the control group (AUD $1669.01). There was an 89% probability that NPWT was dominant, yielding both faster re-epithelialisation and lower overall costs. Findings remained robust to sensitivity analyses employing alternative theatre costs and time-to-re-epithelialisation estimates for grafted patients. In conclusion, adjunctive NPWT is likely to be a cost-effective and dominant treatment for small-area paediatric burns (ANZCTR.org.au:ACTRN12618000256279).
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20
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Legemate CM, Lucas Y, Oen IMMH, van der Vlies CH. Regrafting of the Split-Thickness Skin Graft Donor-Site: Is It Beneficial? J Burn Care Res 2021; 41:211-214. [PMID: 31630196 DOI: 10.1093/jbcr/irz166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Split-thickness skin grafting remains a fundamental treatment for patients with deep burns and other traumatic injuries. Unfortunately, the donor site wound that remains after split skin graft (SSG) harvesting may also cause problems for the patient; they can lead to discomfort and scars with a poor cosmetic outcome. Regrafting of the donor site is one of the methods described to improve donor site healing and scarring. In this report, we describe a case of a 26-year-old woman with a self-inflicted chemical burn (0.5% TBSA) who underwent split skin grafting. During surgery, only part of the donor site was regrafted with split skin graft remnants. This part healed faster and had a better scar quality at 3 months postsurgery. Nevertheless, the appearance and patients' opinion on the regrafted part deteriorated after 12 months. With this case report, we aim to create awareness of the long-term consequences of regrafting, which may differ from short-time results. Patients expected to have poor reepithelialization potential may benefit from regrafting of the SSG on the donor site. But in healthy young individuals, timewise there would be no benefit since it can lead to an aesthetically displeasing result.
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Affiliation(s)
- Catherine M Legemate
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Burn Center, Maasstad Hospital, AC Rotterdam, the Netherlands
| | - Ymke Lucas
- Burn Center, Maasstad Hospital, AC Rotterdam, the Netherlands
| | - Irma M M H Oen
- Burn Center, Maasstad Hospital, AC Rotterdam, the Netherlands
| | - Cornelis H van der Vlies
- Burn Center, Maasstad Hospital, AC Rotterdam, the Netherlands.,Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Trauma Research Unit, Rotterdam, The Netherlands
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21
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Nabai L, Pourghadiri A, Ghahary A. Hypertrophic Scarring: Current Knowledge of Predisposing Factors, Cellular and Molecular Mechanisms. J Burn Care Res 2021; 41:48-56. [PMID: 31999336 DOI: 10.1093/jbcr/irz158] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hypertrophic scarring (HSc) is an age-old problem that still affects millions of people physically, psychologically, and economically. Despite advances in surgical techniques and wound care, prevention and treatment of HSc remains a challenge. Elucidation of factors involved in the development of this common fibroproliferative disorder is crucial for further progress in preventive and/or therapeutic measures. Our knowledge about pathophysiology of HSc at the cellular and molecular level has grown considerably in recent decades. In this article, current knowledge of predisposing factors and the cellular and molecular mechanisms of HSc has been reviewed.
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Affiliation(s)
- Layla Nabai
- BC Professional Firefighters' Burn & Wound Healing Research Laboratory, Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amir Pourghadiri
- BC Professional Firefighters' Burn & Wound Healing Research Laboratory, Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aziz Ghahary
- BC Professional Firefighters' Burn & Wound Healing Research Laboratory, Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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22
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Correa-Gallegos D, Rinkevich Y. Cutting into wound repair. FEBS J 2021; 289:5034-5048. [PMID: 34137168 DOI: 10.1111/febs.16078] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/02/2021] [Accepted: 06/16/2021] [Indexed: 11/28/2022]
Abstract
The skin is home to an assortment of fibroblastic lineages that shape the wound repair response toward scars or regeneration. In this review, we discuss the distinct embryonic origins, anatomic locations, and functions of fibroblastic lineages, and how these distinct lineages of fibroblasts dictate the skin's wound response across injury depths, anatomic locations, and embryonic development to promote either scarring or regeneration. We highlight the supportive role of the fascia in dictating scarring outcomes; we then discuss recent findings that indicate fascia mobilization by its resident fibroblasts supersede the classical de novo deposition program of wound matrix formation. These recent findings reconfigure our traditional view of wound repair and present exciting new therapeutic avenues to treat scarring and fibrosis across a range of medical settings.
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Affiliation(s)
- Donovan Correa-Gallegos
- Institute of Lung Biology and Disease, Comprehensive Pneumology Center, Helmholtz Zentrum München, Munich, Germany
| | - Yuval Rinkevich
- Institute of Regenerative Biology and Medicine, Helmholtz Zentrum München, Munich, Germany
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23
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Spronk I, Stortelers A, van der Vlies CH, van Zuijlen PPM, Pijpe A. Scar quality in children with burns 5-7 years after injury: A cross-sectional multicentre study. Wound Repair Regen 2021; 29:951-960. [PMID: 34133037 PMCID: PMC8596883 DOI: 10.1111/wrr.12953] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/15/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022]
Abstract
Long-term scar formation is an important adverse consequence in children with burns, however, information regarding scar quality in the long-term is lacking. Therefore, we evaluated scar quality and its predictors in children with burns 5-7 years after injury. Parents of children with mild/intermediate burns (≤10% total body surface area burned), and of children with severe burns (>10% burned) completed the patient scale of the Patient and Observer Scar Assessment Scale (POSAS 2.0) for their children's-in their opinion-worst scar 5-7 years post-burn. Outcomes and predictive factors of scar quality were studied, and, for children with severe burns, POSAS parent scores were compared with observer scores. We included 103 children with mild/intermediate burns and 28 with severe burns (response rate: 51%). Most children (87%) had scars that differed from normal skin, with most differences reported for colour, and least for pain. Except for colour, children with severe burns had significantly higher scores (difference 0-2 points) on all scar characteristics (representing poorer scar quality) compared with children with mild/intermediate burns. Parent POSAS scores were on average 2.0-2.6 points higher compared to observer scores. Number of surgeries predicted both the mean POSAS and the mean overall opinion of a scar. In conclusion, 5-7 years post-burn, the scar of the majority of children differed from normal skin, especially on the characteristic colour. The uncovered insights are useful in counselling of children and their parents on expectations of the final outcome of their (children's) scar(s), and help in further targeting scar prevention strategies for the individual child.
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Affiliation(s)
- Inge Spronk
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | - Cornelis H van der Vlies
- Burn Centre, Maasstad Hospital, Rotterdam, Netherlands.,Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Paul P M van Zuijlen
- Burn Centre, Red Cross Hospital, Beverwijk, Netherlands.,Dept. of Plastic, Reconstructive & Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, Netherlands.,Paediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, Amsterdam, Netherlands
| | - Anouk Pijpe
- Burn Centre, Red Cross Hospital, Beverwijk, Netherlands.,Dept. of Plastic, Reconstructive & Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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24
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Wiseman J, Simons M, Kimble R, Ware RS, McPhail SM, Tyack Z. Effectiveness of topical silicone gel and pressure garment therapy for burn scar prevention and management in children 12-months postburn: A parallel group randomised controlled trial. Clin Rehabil 2021; 35:1126-1141. [PMID: 34107792 DOI: 10.1177/02692155211020351] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The longer-term effectiveness of silicone and pressure burn scar interventions was evaluated at 12-months postburn. DESIGN Parallel group, randomised trial. SETTING Hospital outpatient clinics, research centre. PARTICIPANTS Children referred for burn scar management following grafted or spontaneously healed acute burn injuries or scar reconstruction surgery. INTERVENTIONS Participants were randomised to: (1) topical silicone gel only, (2) pressure garment only, or (3) combined topical silicone gel and pressure garment. MAIN MEASURES Primary outcomes were scar thickness (blinded ultrasound measurement) and itch intensity (caregiver proxy-report, numeric rating scale). RESULTS Of 153 participants randomised who received the interventions (silicone n = 51, pressure garment n = 49, combined n = 53), 86 were followed-up at 12-months postburn (n = 34, n = 28, n = 24). No differences were identified for the primary outcomes using intention-to-treat analysis. Scar thickness mean difference (95% confidence interval) = 0.00 cm (-0.04, 0.05); -0.03 cm (-0.07, 0.02); 0.03 cm (-0.02, 0.08) and scar itch = 0.09 (-0.88, 1.06); -0.21 (-1.21, 0.79); 0.30 (-0.73, 1.32) for silicone vs pressure; silicone vs combined and combined vs pressure respectively. No serious adverse effects occurred. CONCLUSION Similar to short-term results, the combined intervention offered no statistically or clinically significant benefit for improving the primary outcomes compared to each intervention alone. No differences in the primary outcomes were identified between the silicone and pressure alone groups.
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Affiliation(s)
- Jodie Wiseman
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, the University of Queensland, Brisbane, QLD, Australia
| | - Megan Simons
- Department of Occupational Therapy, Queensland Children's Hospital, Brisbane, QLD, Australia.,Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, the University of Queensland, Brisbane, QLD, Australia.,Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Clinical Informatics Directorate, Metro South Health, Woolloongabba, QLD, Australia
| | - Zephanie Tyack
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, the University of Queensland, Brisbane, QLD, Australia.,Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia
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25
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Agrawal A, Ding J, Agrawal B, Kwan PO, Tredget EE. Stimulation of toll-like receptor pathways by burn eschar tissue as a possible mechanism for hypertrophic scarring. Wound Repair Regen 2021; 29:810-819. [PMID: 34043867 DOI: 10.1111/wrr.12940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/28/2021] [Accepted: 04/09/2021] [Indexed: 01/02/2023]
Abstract
Hypertrophic scars (HTS) are a common complication following burn injuries with prolonged inflammation. They do not respond well to current treatment options including mechanical, biomolecular and surgical therapies. Toll-like receptor (TLR) 2 and 4 respond to microbes and damaged endogenous ligands to trigger pro-inflammatory pathways, and they are expressed more in HTS fibroblasts compared to normal skin fibroblasts. TLR2 responds to microbial lipoteichoic acid (LTA) while TLR4 responds to microbial lipopolysaccharide (LPS) and endogenous ligands. We investigated the role of burn tissue and small leucine-rich proteoglycans (decorin and biglycan) in the stimulation of TLR2 and TLR4 pathways using cells stably transfected with TLR2 or TLR4 linked to a reporter system. Normal skin (n = 5) was collected post-abdominoplasty, and burn eschar samples (n = 18) were collected from 18 patients between 0 and 14 days post-burn. We found that burn tissue stimulates TLR2 activity significantly more than normal tissue and contains significantly higher levels of LTA. Burn tissue was a stronger stimulator of TLR4 than was normal skin. Burn tissue samples' stimulation of TLR4 and TLR2 correlated. The time post-burn (0-14 days) of wound tissue sampling correlated positively but moderately with TLR2 and TLR4 simulation. In comparison to the dose-dependent effects of natural decorin or biglycan on TLR4 activation, their denatured forms exhibited stronger or weaker stimulation, respectively. They were not potent stimulators of TLR2. TLR2 and TLR4 stimulation is not limited to bacteria in wounds and likely involves multiple endogenous damage-associated molecular patterns. Insight into mechanisms of HTS will facilitate the development of future targeted therapies to modify wound progression and provide benefits to patients suffering with HTS and other fibroproliferative disorders.
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Affiliation(s)
- Ambika Agrawal
- Division of Plastic Surgery, University of Alberta, Edmonton, Alberta, Canada.,Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jie Ding
- Division of Plastic Surgery, University of Alberta, Edmonton, Alberta, Canada.,Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Babita Agrawal
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Peter O Kwan
- Division of Plastic Surgery, University of Alberta, Edmonton, Alberta, Canada.,Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Edward E Tredget
- Division of Plastic Surgery, University of Alberta, Edmonton, Alberta, Canada.,Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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26
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NİGUSSİE G, IBRAHİM F, WEREDE Y. Phytochemistry, Ethnomedicinal uses and Pharmacological Properties of Rhamnus prinoides: a review. INTERNATIONAL JOURNAL OF SECONDARY METABOLITE 2021. [DOI: 10.21448/ijsm.833554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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27
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Thomas R, Wicks S, Dale M, Pacey V. Outcomes of Early and Intensive Use of a Palm and Digit Extension Orthosis in Young Children After Burn Injury. J Burn Care Res 2021; 42:245-257. [PMID: 32820803 DOI: 10.1093/jbcr/iraa137] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Burns to the palmar aspect of the hand are prevalent in young children. The development of scar tissue across the flexor surface of the hand combined with the years of growth ahead may result in considerable complications. This study was undertaken to describe outcomes of early and intensive use of a palm and digit extension orthosis with the elbow immobilized at 90° flexion following a palmar hand burn. A retrospective review of 107 children (mean age 18 months [SD 10]) treated at a statewide Pediatric Burns Unit from 2012 to 2016 was performed. Three children (3%) developed contracture during the 24-month study follow-up period. The other 104 children (97%) had full ROM at 24 months or at either the point of discharge or loss to follow-up. Early signs of contracture, defined as loss of full movement or significant banding, developed in 26 children (24%) in the first 9 months after burn. With intensive physiotherapy, 23 children regained full movement by 12 months after burn. Children who did not achieve complete wound healing at 1 month after burn and children with hypertrophic scarring at 2 months after burn were significantly more represented among cases of early signs of contracture (P = .013). When undertaken with regular clinical review, early and intensive use of a palm and digit extension orthosis can maintain full extension of the palm and digits in children after palmar burn.
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Affiliation(s)
- Rhianydd Thomas
- Department of Health Professions, Macquarie University, North Ryde, New South Wales, Australia.,Burns Unit, The Children's Hospital at Westmead, New South Wales, Australia
| | - Stephanie Wicks
- Burns Unit, The Children's Hospital at Westmead, New South Wales, Australia
| | - Marita Dale
- Discipline of Physiotherapy, The University of Sydney, Lidcombe, New South Wales, Australia
| | - Verity Pacey
- Department of Health Professions, Macquarie University, North Ryde, New South Wales, Australia
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28
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Legemate CM, Ooms PJ, Trommel N, Middelkoop E, van Baar ME, Goei H, van der Vlies CH. Patient-reported scar quality of donor-sites following split-skin grafting in burn patients: Long-term results of a prospective cohort study. Burns 2020; 47:315-321. [PMID: 33419665 DOI: 10.1016/j.burns.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/02/2020] [Accepted: 12/04/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Skin grafting is the current gold standard for treatment of deeper burns. How patients appraise the donor-site scar is poorly investigated. The aim of this study was to evaluate long-term patient-reported quality of donor-site scars after split skin grafting and identify possible predictors. METHODS A prospective cohort study was conducted. Patients were included in a Dutch burn centre during one year. Patient-reported quality of donor-site scars and their worst burn scar was assessed at 12 months using the Patient and Observer Scar Assessment Scale (POSAS). Mixed model analyses were used to identify predictors of scar quality. RESULTS This study included 115 donor-site scars of 72 patients with a mean TBSA burned of 11.2%. The vast majority of the donor-site scars (84.4%) were rated as having at least minor differences with normal skin (POSAS item score ≥2) on one or more scar characteristics and the overall opinion on 80.9% of the donor-site scars was that they deviated from normal skin 12 months after surgery. The overall opinion on the donor-site scar was 3.2 ± 2.1 vs. 5.1 ± 2.4 on the burn scar. A younger age, female gender, a darker skin type, and location on the lower leg were predictors of reduced donor-site scar quality. In addition, time to re-epithelization was associated with scar quality. CONCLUSION This study provided new insights in long-term scar quality of donor-sites. Donor-site scars differed from normal skin in a large part of the population 12 months after surgery. Results of this study can be used to inform patients on the long-term outcomes of their scars and to tailor preventive or therapeutic treatment options.
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Affiliation(s)
- Catherine M Legemate
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Maasstad Hospital, Burn Centre, Rotterdam, The Netherlands.
| | - Pauline J Ooms
- Maasstad Hospital, Burn Centre, Rotterdam, The Netherlands
| | - Nicole Trommel
- Maasstad Hospital, Burn Centre, Rotterdam, The Netherlands
| | - Esther Middelkoop
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, The Netherlands
| | - Margriet E van Baar
- Maasstad Hospital, Burn Centre, Rotterdam, The Netherlands; Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands; Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands
| | - Harold Goei
- Maasstad Hospital, Burn Centre, Rotterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Cornelis H van der Vlies
- Maasstad Hospital, Burn Centre, Rotterdam, The Netherlands; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Özkal Ö, Seyyah M, Topuz S, Konan A. Letter to the Editor in response to "Lower limb functional status and its determinants in moderate/major burns 3-6 months following injury: A two-center observational study". Burns 2020; 47:741-742. [PMID: 33272741 DOI: 10.1016/j.burns.2020.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Özden Özkal
- Bursa Uludağ University Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation Nilüfer, Bursa, 16059 Turkey.
| | - Mine Seyyah
- University of Health Sciences Kartal Dr. Lütfi Kırdar Education and Research Hospital, Burn and Wound Treatment Department, İstanbul, Turkey
| | - Semra Topuz
- Hacettepe University Faculty of Physcial Therapy and Rehabilitation Department, Ankara, Turkey
| | - Ali Konan
- Hacettepe University School of Medicine, Department of General Surgery, Ankara, Turkey
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30
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Early physiotherapy experience with a biodegradable polyurethane dermal substitute: Therapy guidelines for use. Burns 2020; 47:1074-1083. [PMID: 33339655 DOI: 10.1016/j.burns.2020.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/08/2020] [Accepted: 10/21/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate and develop range of motion (ROM) and mobilisation guidelines in adult patients where a newly developed synthetic dermal substitute was applied in our adult burn centre. METHOD A retrospective case note audit was conducted on the first 20 acute burn injured patients who had a synthetic dermal substitute applied. Data collected included days to commencement of ROM, days to clearance for mobilisation, and joint ROM achieved after dermal substitute application (prior to delamination) and after split skin grafting (SSG) for the elbow, knee and shoulder joints. Scar assessments were completed at 12 months after injury using two scar assessment scales. RESULTS Clearance to mobilise occurred at mean 10.4 and 4.9 days after dermal substitute and after skin graft application to lower limbs respectively. ROM commenced at a mean of 9.9 (upper limbs) and 12.7 (lower limbs) days after dermal substitute application. Following skin grafting, ROM commenced at a mean of 6.6 and 6.5 days for upper limbs and lower limbs respectively. Prior to dermal substitute delamination mean flexion at the knee (86.3°), elbow (114.0°) and shoulder (143.4°) was achieved. Mean ROM continued to improve after grafting with knee (133.2°), elbow (126.1°) and shoulder (151.0°) flexion approaching normal ROM in most cases. Mean extension of the elbow (-4.6°) was maintained close to normal levels after skin grafting. There were no recorded instances of knee extension contracture. Patient and Observer Scar Assessment Scale and Matching Assessment of Photographs of Scars scores indicated good cosmetic outcomes with relatively low levels of itch and minimal pain reported at 12 months after injury. CONCLUSION A steep learning curve was encountered in providing therapy treatment for patients managed with this relatively new synthetic dermal substitute. Trends indicated that as experience with this new dermal substitute grew, patients progressed toward active therapy earlier. A guideline for therapy treatment has been developed but will continue to be evaluated and adjusted when required.
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31
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Özkal Ö, Seyyah M, Topuz S, Konan A. Lower limb functional status and its determinants in moderate/major burns 3-6 months following injury: A two-center observational study. Burns 2020; 47:676-683. [PMID: 32859438 DOI: 10.1016/j.burns.2020.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Severe complications which may cause impaired physical functionoften develops over time following severe burn to the lower extremities. The purpose of this study was to clarify the clinical determinants of lower limb functional status, functional mobility and exercise capacity in moderate/major burns 3-6 months following the injury. METHODS The study included 42 patients, 12 with moderate injury and 30 with major injury, aged 19-59 years old. Lower Limb Functional Index was used to determine the lower limb functional status. Functional mobility and exercise capacity were evaluated with the Timed Up and Go test and the 6-min walk test, respectively. Scar quality and kinesiophobia were assessed with the Patient and Observer Scar Assessment Scale (POSAS) and the Tampa Scale for Kinesiophobia, respectively. Active range of motion (ROM) was measured with a universal goniometer. RESULTS Significant and independent predictors of lower limb functional status, functional mobility and exercise capacity related to POSAS score, kinesiophobia level, gender, burn severity, the number of operations, the presence of burnsinvolving any of the lower limb joints, knee ROM limitations, limitation in any of the lower limb joint ROMs, comorbidities, and truncal burns (p < 0.05). CONCLUSIONS Burn characteristics and clinical evaluations of patients are important determinants of the lower limb functional status, mobility and exercise capacity in burn patients. These predictors should be considered to improve physical functions related to the lower limb when creating a personalized rehabilitation program.
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Affiliation(s)
- Özden Özkal
- Bursa Uludağ University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Bursa, Turkey.
| | - Mine Seyyah
- University of Health Sciences, Kartal Dr. Lütfi Kırdar Education and Research Hospital, Burn and Wound Treatment Department, İstanbul, Turkey
| | - Semra Topuz
- Hacettepe University, Faculty of Physcial Therapy and Rehabilitation, Ankara, Turkey
| | - Ali Konan
- Hacettepe University, School of Medicine, Department of General Surgery, Ankara, Turkey
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Legemate CM, Ooms PJ, Trommel N, Goei H, Lucas Y, Middelkoop E, Baar ME, Vlies CH. Course of scar quality of donor sites following split skin graft harvesting: Comparison between patients and observers. Wound Repair Regen 2020; 28:696-703. [DOI: 10.1111/wrr.12840] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Catherine M. Legemate
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences Amsterdam UMC, Vrije Univeristeit Amsterdam Amsterdam the Netherlands
- Maasstad Hospital, Burn Center Rotterdam the Netherlands
| | | | - Nicole Trommel
- Maasstad Hospital, Burn Center Rotterdam the Netherlands
| | - Harold Goei
- Department of Surgery, Amsterdam Movement Sciences Amsterdam UMC, Vrije Univeristeit Amsterdam Amsterdam the Netherlands
| | - Ymke Lucas
- Maasstad Hospital, Burn Center Rotterdam the Netherlands
| | - Esther Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences Amsterdam UMC, Vrije Univeristeit Amsterdam Amsterdam the Netherlands
- Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk the Netherlands
| | - Margriet E. Baar
- Maasstad Hospital, Burn Center Rotterdam the Netherlands
- Department of Public Health, Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands
| | - Cornelis H. Vlies
- Maasstad Hospital, Burn Center Rotterdam the Netherlands
- Department of Public Health, Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands
- Trauma Research Unit, Department of Surgery, Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands
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Specht M, Kelm S, Mirastschijski U. [Suitability of biological acellular dermal matrices as a skin replacement]. HANDCHIR MIKROCHIR P 2020; 52:533-544. [PMID: 32731271 DOI: 10.1055/a-1200-1189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Tissue defects are associated with loss of epidermal and dermal components of the skin. For full-thickness tissue defects, dermal equivalents are useful to enable rapid wound closure. Split-thickness skin grafts are associated with loss of tissue elasticity resulting in scar contractures that can impair joint mobility. Synthetic collagen matrices and allogeneic acellular dermal matrices (ADM) are commercially available and could serve as skin tissue replacement. The aim of this study was to investigate whether ADM of different dermal layers or bioartificial matrices can serve as cutaneous replacement. For this purpose, cellular migration, differentiation and the inflammatory reaction were studied in an established ex vivo skin organ model. MATERIALS AND METHODS Human split-thickness skin grafts were transplanted onto ADM (Epiflex, DIZG, Berlin, Germany), de-epidermized dermis (DED) or an artificial collagen-elastin matrix (Matriderm, Dr. Suwelack, Billerbeck, Germany). Epithelial migration was studied using an established skin culture model at the air-liquid interface. In addition, the effect of tissue from different dermal compartments, e. g. papillar and reticular dermis, on epithelial migration was compared. Epithelial resurfacing and differentiation of matrices as well as the inflammatory reaction were studied using histological, immunohistochemical and biochemical analyses. RESULTS AND CONCLUSION Significantly more epithelial outgrowth area was found on DED (2.54 mm ± 0.43 mm, mean ± SEM) compared to papillary ADM (1.32 mm ± 0.44 mm, p = 0.039), to reticular ADM (no horizontal growth, p < 0.0001) and collagen-elastin matrix (0.78 mm ± 0.11 mm, p = 0.0056) measured by fluorescence microscopy over 10 days presumably due to the presence of pro-migratory basement membrane residues on DED. Reepithelialization was significantly higher (p < 0.002) on papillary dermis compared to ADM of reticular origin. In contrast to the biological matrices, a complete horizontal penetration was found in the macroporous collagen-elastin matrix. Pro-inflammatory mediators varied depending on the human skin donor and matrix. In summary, the biochemical structure of the matrix' surface and its origin influenced the epithelial behaviour with regard to migration, differentiation and inflammatory response.
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Affiliation(s)
- Marcin Specht
- Klinikum Bremen-Mitte gGmbH Plastisc, Reconstructive and Aesthetic Surgery
| | - Sorge Kelm
- University of Bremen CBIB, Faculty of Biology and Biochemistry
| | - Ursula Mirastschijski
- University of Bremen CBIB, Faculty of Biology and Biochemistry.,Mira-Beau gender esthetics, Berlin
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Hoogewerf CJ, Hop MJ, Nieuwenhuis MK, Oen IM, Middelkoop E, Van Baar ME. Topical treatment for facial burns. Cochrane Database Syst Rev 2020; 7:CD008058. [PMID: 32725896 PMCID: PMC7390507 DOI: 10.1002/14651858.cd008058.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Burn injuries are an important health problem. They occur frequently in the head and neck region. The face is the area central to a person's identity that provides our most expressive means of communication. Topical interventions are currently the cornerstone of treatment of burns to the face. OBJECTIVES To assess the effects of topical interventions on wound healing in people with facial burns of any depth. SEARCH METHODS In December 2019 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA Randomised controlled trials (RCTs) that evaluated the effects of topical treatment for facial burns were eligible for inclusion in this review. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, data extraction, risk of bias assessment and GRADE assessment of the certainty of the evidence. MAIN RESULTS In this first update, we included 12 RCTs, comprising 507 participants. Most trials included adults admitted to specialised burn centres after recent burn injuries. Topical agents included antimicrobial agents (silver sulphadiazine (SSD), Aquacel-Ag, cerium-sulphadiazine, gentamicin cream, mafenide acetate cream, bacitracin), non-antimicrobial agents (Moist Exposed Burn Ointment (MEBO), saline-soaked dressings, skin substitutes (including bioengineered skin substitute (TransCyte), allograft, and xenograft (porcine Xenoderm), and miscellaneous treatments (growth hormone therapy, recombinant human granulocyte-macrophage colony-stimulating factor hydrogel (rhGMCS)), enzymatic debridement, and cream with Helix Aspersa extract). Almost all the evidence included in this review was assessed as low or very low-certainty, often because of high risk of bias due to unclear randomisation procedures (i.e. sequence generation and allocation concealment); lack of blinding of participants, providers and sometimes outcome assessors; and imprecision resulting from few participants, low event rates or both, often in single studies. Topical antimicrobial agents versus topical non-antimicrobial agents There is moderate-certainty evidence that there is probably little or no difference between antimicrobial agents and non-antimicrobial agents (SSD and MEBO) in time to complete wound healing (hazard ratio (HR) 0.84 (95% confidence interval (CI) 0.78 to 1.85, 1 study, 39 participants). Topical antimicrobial agents may make little or no difference to the proportion of wounds completely healed compared with topical non-antimicrobial agents (comparison SSD and MEBO, risk ratio (RR) 0.94, 95% CI 0.68 to 1.29; 1 study, 39 participants; low-certainty evidence). We are uncertain whether there is a difference in wound infection (comparison topical antimicrobial agent (Aquacel-Ag) and MEBO; RR 0.38, 95% CI 0.12 to 1.21; 1 study, 40 participants; very low-certainty evidence). No trials reported change in wound surface area over time or partial wound healing. There is low-certainty evidence for the secondary outcomes scar quality and patient satisfaction. Two studies assessed pain but it was incompletely reported. Topical antimicrobial agents versus other topical antimicrobial agents It is uncertain whether topical antimicrobial agents make any difference in effects as the evidence is low to very low-certainty. For primary outcomes, there is low-certainty evidence for time to partial (i.e. greater than 90%) wound healing (comparison SSD versus cerium SSD: mean difference (MD) -7.10 days, 95% CI -16.43 to 2.23; 1 study, 142 participants). There is very low-certainty evidence regarding whether topical antimicrobial agents make a difference to wound infection (RR 0.73, 95% CI 0.46 to 1.17; 1 study, 15 participants). There is low to very low-certainty evidence for the proportion of facial burns requiring surgery, pain, scar quality, adverse effects and length of hospital stay. Skin substitutes versus topical antimicrobial agents There is low-certainty evidence that a skin substitute may slightly reduce time to partial (i.e. greater than 90%) wound healing, compared with a non-specified antibacterial agent (MD -6.00 days, 95% CI -8.69 to -3.31; 1 study, 34 participants). We are uncertain whether skin substitutes in general make any other difference in effects as the evidence is very low certainty. Outcomes included wound infection, pain, scar quality, adverse effects of treatment and length of hospital stay. Single studies showed contrasting low-certainty evidence. A bioengineered skin substitute may slightly reduce procedural pain (MD -4.00, 95% CI -5.05 to -2.95; 34 participants) and background pain (MD -2.00, 95% CI -3.05 to -0.95; 34 participants) compared with an unspecified antimicrobial agent. In contrast, a biological dressing (porcine Xenoderm) might slightly increase pain in superficial burns (MD 1.20, 95% CI 0.65 to 1.75; 15 participants (30 wounds)) as well as deep partial thickness burns (MD 3.00, 95% CI 2.34 to 3.66; 10 participants (20 wounds)), compared with antimicrobial agents (Physiotulle Ag (Coloplast)). Miscellaneous treatments versus miscellaneous treatments Single studies show low to very low-certainty effects of interventions. Low-certainty evidence shows that MEBO may slightly reduce time to complete wound healing compared with saline soaked dressing (MD -1.7 days, 95% CI -3.32 to -0.08; 40 participants). In addition, a cream containing Helix Aspersa may slightly increase the proportion of wounds completely healed at 14 days compared with MEBO (RR 4.77, 95% CI 1.87 to 12.15; 43 participants). We are uncertain whether any miscellaneous treatment in the included studies makes a difference in effects for the outcomes wound infection, scar quality, pain and patient satisfaction as the evidence is low to very low-certainty. AUTHORS' CONCLUSIONS There is mainly low to very low-certainty evidence on the effects of any topical intervention on wound healing in people with facial burns. The number of RCTs in burn care is growing, but the body of evidence is still hampered due to an insufficient number of studies that follow appropriate evidence-based standards of conducting and reporting RCTs.
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Affiliation(s)
| | - M Jenda Hop
- Burn Centre, Maasstad Hospital, Association of Dutch Burn Centres, Rotterdam, Netherlands
| | - Marianne K Nieuwenhuis
- Burn Centre, Martini Hospital, Association of Dutch Burn Centres, Groningen, Netherlands
| | - Irma Mmh Oen
- Burn Centre, Maasstad Hospital, Association of Dutch Burn Centres, Rotterdam, Netherlands
| | - Esther Middelkoop
- Plastic Reconstructive and Hand Surgery, Amsterdam Movement Sciences and Association of Dutch Burn Centers, Red Cross Hospital, Amsterdam, Netherlands
| | - Margriet E Van Baar
- Burn Centre, Maasstad Hospital, Association of Dutch Burn Centres, Rotterdam, Netherlands
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Evaluation of Patient-Reported Outcomes in Burn Survivors Undergoing Reconstructive Surgery in the Rehabilitative Period. Plast Reconstr Surg 2020; 146:171-182. [PMID: 32590661 PMCID: PMC9836002 DOI: 10.1097/prs.0000000000006909] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Health-related quality of life is decreased in burn survivors, with scars implicated as a cause. The authors aim to characterize the use of reconstructive surgery following hospitalization and determine whether patient-reported outcomes change over time. The authors hypothesized improvement in health-related quality of life following reconstructive surgery. METHODS Adult burn survivors undergoing reconstructive surgery within 24 months after injury were extracted from a prospective, longitudinal database from 5 U.S. burn centers (Burn Model System). Surgery was classified by problem as follows: scar, contracture, and open wound. The authors evaluated predictors of surgery using logistic regression. Short Form-12/Veterans RAND 12 health survey outcomes at 6, 12, and 24 months were compared at follow-up intervals and matched with nonoperated participants using propensity score matching. RESULTS Three hundred seventy-two of 1359 participants (27.4 percent) underwent one or more reconstructive operation within 24 months of injury. Factors that increased the likelihood of surgery included number of operations during index hospitalization (p < 0.001), hand (p = 0.001) and perineal involvement (p = 0.042), and range-of-motion limitation at discharge (p < 0.001). Compared to the physical component scores of peers who were not operated on, physical component scores increased for participants undergoing scar operations; however, these gains were only significant for those undergoing surgery more than 6 months after injury (p < 0.05). Matched physical component scores showed nonsignificant differences following contracture operations. Mental component scores were unchanged or lower following scar and contracture surgery. CONCLUSIONS Participants requiring more operations during index admission were more likely to undergo reconstructive surgery. There were improvements in Short Form-12/Veterans RAND 12 scores for those undergoing scar operations more than 6 months after injury, although contracture operations were not associated with significant differences in Short Form-12/Veterans RAND 12 scores.
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The Presence of Scarring and Associated Morbidity in the Burn Model System National Database. Ann Plast Surg 2020; 82:S162-S168. [PMID: 30724824 DOI: 10.1097/sap.0000000000001826] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Postburn scarring is common, but the risk factors, natural history, and consequences of such scars are still poorly understood. This study aims to describe the frequency of scar-related morbidity for up to 2 years after injury and to analyze the impact of burn scars on long-term functional, psychosocial, and reintegration outcomes. METHODS Analysis was conducted on data collected between January 2006 and May 2014 from 960 patients (2440 anatomic burn sites) using the Burn Model System (BMS) database. Study population demographics were analyzed and odds ratios for the development of raised or thick scarring were determined. Regression analyses were used to evaluate the impact of hypertrophic scarring (HTS) on psychosocial outcomes, including the Community Integration Questionnaire, Satisfaction with Life Scale, Distress, and the Short Form 12. Symptoms associated with scarring were analyzed at discharge and 6, 12, and 24 months after burn using a set of questions on scarring developed by the BMS. Mixed-effect modeling was used to determine linear change over time and the significance of symptoms. RESULTS The study population was primarily white (65.0%) and male (71.8%), with a mean (SD) age of 44.0 (15.2) years and mean total body surface area burned of 19.6% (17.9%). The incidence of raised or thick scars increased from 65% to 80% (P < 0.0001) for the 2-year follow-up period. The presence of scarring was not associated with Community Integration Questionnaire, Satisfaction with Life Scale, or Short Form 12 scores. Most patients reported symptoms associated with scarring at 2 years after burn, including dry or fragile skin, scars that restrict range of motion at a joint, issues with hand function, and scar pain and itch. CONCLUSIONS In this large, longitudinal, multicenter cohort of burn survivors, nearly all patients noted the presence of scarring, and a majority noted additional symptoms and morbidity related to their scars even at 2 years after injury. This study demonstrates a need for the continued support of burn survivors to address scar-related morbidity. Furthermore, future studies examining the impact of novel treatments for scarring should use similar scar problem questionnaires and distress scores.
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Karlsson M, Steinvall I, Sjöberg F, Olofsson P, Elmasry M. Burn scar outcome at six and 12 months after injury in children with partial thickness scalds: Effects of dressing treatment. Burns 2020; 46:546-551. [PMID: 32165027 DOI: 10.1016/j.burns.2020.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/29/2020] [Accepted: 02/15/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION In line with other researchers in the field of burns' care, we think that research investigating the long-term outcome of scars is largely lacking. As scarring is of the utmost importance to the patient, clinicians who treat burns must aim to find treatments that lead to a good end result. The aim of this study was to study scar outcomes at six and 12 months after injury. It is an extension of a previous randomised controlled trial (RCT) in which two dressings (porcine xenograft and silver foam dressing) were examined with respect to their ability to help heal partial thickness scalds. METHOD Children aged six months - six years with acute partial thickness scalds, on the trunk, or extremities, or both, were included. In the previous study, the silver foam was found to have significantly shorter healing times than the xenograft. Children were assessed at six and 12 months after injury for this study, and photographs were taken of the burn site, and both the patient and observer scar assessment scale (POSAS) and the Vancouver scar scale (VSS) were completed and evaluated by blinded observers. RESULTS Of the 58 children from the original RCT, 39 returned to the clinic for evaluation of their scars at six months, and 34 at 12 months after injury. There were no differences in POSAS, VSS total scores, or incidence of hypertrophic scarring between the different dressings. Fifteen children were assessed as having hypertrophic scarring, all of whom had healing times that had extended beyond 14 days. CONCLUSIONS This study compared burn scarring after two different treatments for burns in children with partial-thickness scalds and the data suggested that neither dressing had a more favourable impact on scar outcome. The conclusion is, however, tempered by the non-return of all the patients to the follow up. However, as anticipated, regardless of the dressing used, longer healing times were associated with higher scar scores (more scarring) and hypertrophic scarring.
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Affiliation(s)
- Matilda Karlsson
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Ingrid Steinvall
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Folke Sjöberg
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Anesthesiology and Intensive Care, Linköping University, Linköping, Sweden
| | - Pia Olofsson
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Moustafa Elmasry
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Course of prevalence of scar contractures limiting function: A preliminary study in children and adolescents after burns. Burns 2019; 45:1810-1818. [DOI: 10.1016/j.burns.2019.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 02/28/2019] [Accepted: 05/01/2019] [Indexed: 10/25/2022]
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The Brisbane Burn Scar Impact Profile (child and young person version) for measuring health-related quality of life in children with burn scars: A longitudinal cohort study of reliability, validity and responsiveness. Burns 2019; 45:1537-1552. [DOI: 10.1016/j.burns.2019.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/19/2019] [Accepted: 07/10/2019] [Indexed: 12/24/2022]
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Meuli M, Hartmann-Fritsch F, Hüging M, Marino D, Saglini M, Hynes S, Neuhaus K, Manuel E, Middelkoop E, Reichmann E, Schiestl C. A Cultured Autologous Dermo-epidermal Skin Substitute for Full-Thickness Skin Defects: A Phase I, Open, Prospective Clinical Trial in Children. Plast Reconstr Surg 2019; 144:188-198. [PMID: 31246829 DOI: 10.1097/prs.0000000000005746] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The management of deep partial-thickness and full-thickness skin defects remains a significant challenge. Particularly with massive defects, the current standard treatment, split-thickness skin grafting, is fraught with donor-site limitations and unsatisfactory long-term outcomes. A novel, autologous, bioengineered skin substitute was developed to address this problem. METHODS To determine whether this skin substitute could safely provide permanent defect coverage, a phase I clinical trial was performed at the University Children's Hospital Zurich. Ten pediatric patients with acute or elective deep partial- or full-thickness skin defects were included. Skin grafts of 49 cm were bioengineered using autologous keratinocytes and fibroblasts isolated from a patient's small skin biopsy specimen (4 cm), incorporated in a collagen hydrogel. RESULTS Graft take, epithelialization, infection, adverse events, skin quality, and histology were analyzed. Median graft take at 21 days postoperatively was 78 percent (range, 0 to 100 percent). Healed skin substitutes were stable and skin quality was nearly normal. There were four cases of hematoma leading to partial graft loss. Histology at 3 months revealed a well-stratified epidermis and a dermal compartment comparable to native skin. Mean follow-up duration was 15 months. CONCLUSIONS In the first clinical application of this novel skin substitute, safe coverage of skin defects was achieved. Safety and efficacy phase II trials comparing the novel skin substitute to split-thickness skin grafts are ongoing. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Martin Meuli
- From the Pediatric Burn Center, Plastic and Reconstructive Surgery, Children's Skin Center, the Tissue Biology Research Unit, Department of Surgery, and the Children's Research Center, University Children's Hospital Zurich; and the Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam Movement Sciences
| | - Fabienne Hartmann-Fritsch
- From the Pediatric Burn Center, Plastic and Reconstructive Surgery, Children's Skin Center, the Tissue Biology Research Unit, Department of Surgery, and the Children's Research Center, University Children's Hospital Zurich; and the Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam Movement Sciences
| | - Martina Hüging
- From the Pediatric Burn Center, Plastic and Reconstructive Surgery, Children's Skin Center, the Tissue Biology Research Unit, Department of Surgery, and the Children's Research Center, University Children's Hospital Zurich; and the Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam Movement Sciences
| | - Daniela Marino
- From the Pediatric Burn Center, Plastic and Reconstructive Surgery, Children's Skin Center, the Tissue Biology Research Unit, Department of Surgery, and the Children's Research Center, University Children's Hospital Zurich; and the Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam Movement Sciences
| | - Monia Saglini
- From the Pediatric Burn Center, Plastic and Reconstructive Surgery, Children's Skin Center, the Tissue Biology Research Unit, Department of Surgery, and the Children's Research Center, University Children's Hospital Zurich; and the Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam Movement Sciences
| | - Sally Hynes
- From the Pediatric Burn Center, Plastic and Reconstructive Surgery, Children's Skin Center, the Tissue Biology Research Unit, Department of Surgery, and the Children's Research Center, University Children's Hospital Zurich; and the Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam Movement Sciences
| | - Kathrin Neuhaus
- From the Pediatric Burn Center, Plastic and Reconstructive Surgery, Children's Skin Center, the Tissue Biology Research Unit, Department of Surgery, and the Children's Research Center, University Children's Hospital Zurich; and the Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam Movement Sciences
| | - Edith Manuel
- From the Pediatric Burn Center, Plastic and Reconstructive Surgery, Children's Skin Center, the Tissue Biology Research Unit, Department of Surgery, and the Children's Research Center, University Children's Hospital Zurich; and the Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam Movement Sciences
| | - Esther Middelkoop
- From the Pediatric Burn Center, Plastic and Reconstructive Surgery, Children's Skin Center, the Tissue Biology Research Unit, Department of Surgery, and the Children's Research Center, University Children's Hospital Zurich; and the Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam Movement Sciences
| | - Ernst Reichmann
- From the Pediatric Burn Center, Plastic and Reconstructive Surgery, Children's Skin Center, the Tissue Biology Research Unit, Department of Surgery, and the Children's Research Center, University Children's Hospital Zurich; and the Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam Movement Sciences
| | - Clemens Schiestl
- From the Pediatric Burn Center, Plastic and Reconstructive Surgery, Children's Skin Center, the Tissue Biology Research Unit, Department of Surgery, and the Children's Research Center, University Children's Hospital Zurich; and the Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam Movement Sciences
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Kwa KA, Pijpe A, Middelkoop E, van Baar ME, Niemeijer AS, Breederveld RS, Nieuwenhuis MK, Kuipers H, Meij-de Vries A, Rashaan Z, Goei H, Trommel N, Hiddingh J, Allersma D, van Ramshorst G, Tuinebreijer W. Comparing doxepin cream to oral antihistamines for the treatment of itch in burn patients: A multi-center triple-blind randomized controlled trial. BURNS OPEN 2019. [DOI: 10.1016/j.burnso.2019.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Wiseman J, Ware RS, Simons M, McPhail S, Kimble R, Dotta A, Tyack Z. Effectiveness of topical silicone gel and pressure garment therapy for burn scar prevention and management in children: a randomized controlled trial. Clin Rehabil 2019; 34:120-131. [PMID: 31565952 PMCID: PMC6943962 DOI: 10.1177/0269215519877516] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective: To determine the effectiveness of silicone and pressure garments (alone and in combination) in children receiving scar management post-burn. Design: Multicentre, parallel-group, randomized controlled trial. Setting: Hospital outpatient clinics, colocated research centre, or the participant’s home. Participants: Children (0–18 years) referred for burn scar management. Interventions: Participants were randomized to (1) topical silicone gel only, (2) pressure garment therapy only, or (3) combined topical silicone gel and pressure garment therapy. Main measures: Primary outcomes included scar thickness and itch intensity at the primary end-point of six months post-burn injury. The outcome assessor and data analyst were blinded for scar thickness. Results: Participants (N = 153; silicone n = 51, pressure n = 49, combined n = 53) had a median (inter-quartile range) age of 4.9 (1.6, 10.2) years and percent total body surface area burn of 1% (0.5%, 3%) and were 65% male. At six months post-burn injury, intention-to-treat analysis identified thinner scars in the silicone (n = 51 scar sites) compared to the combined group (n = 48 scar sites; mean difference (95% confidence interval) = –0.04 cm (–0.07, –0.00), P = 0.05). No other between-group differences were identified for scar thickness or itch intensity at six months post-burn. Conclusion: No difference was identified in the effectiveness of silicone and pressure interventions alone. No benefit to a combined silicone and pressure intervention was identified for the prevention and management of abnormal scarring in children at six months post-burn injury, compared to the silicone or pressure interventions alone.
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Affiliation(s)
- Jodie Wiseman
- Children's Burns and Trauma Research Group, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | - Megan Simons
- Department of Occupational Therapy, Queensland Children's Hospital, Brisbane, QLD, Australia.,Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Steven McPhail
- Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Centre for Functioning and Health Research, Metro South Health, Buranda, QLD, Australia
| | - Roy Kimble
- Children's Burns and Trauma Research Group, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.,Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Anne Dotta
- Department of Medical Imaging and Nuclear Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Zephanie Tyack
- Children's Burns and Trauma Research Group, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.,Centre for Functioning and Health Research, Metro South Health, Buranda, QLD, Australia
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Thomas R, Wicks S, Toose C, Pacey V. Outcomes of Early Use of an End of Range Axilla Orthotic in Children Following Burn Injury. J Burn Care Res 2019; 40:678-688. [PMID: 30950500 DOI: 10.1093/jbcr/irz058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Scar contracture is a significant complication of burn injury. This study aimed to describe outcomes of early axilla orthotic use at end of range abduction in children, following a burn to the axilla region. A retrospective review of 76 children (mean age 3.9 years [SD 3.6]) treated at a tertiary children's hospital from 2006 to 2016 was conducted. No child developed axilla contracture for the duration of the 2-year study follow-up with no adverse events recorded. If orthotic use was ceased <60 days post-burn, it was considered not an essential intervention to maintain range of movement, leaving 49 children using the orthotic ≥60 days. Compared with the children who ceased orthotic use in <60 days, children who required the orthotic ≥60 days had a significantly higher frequency of deep-dermal burn (59 vs 25%, p = .01), flame mechanism (25 vs 5%, p = .03), and burn injury distribution involving the anterior trunk, flank, and arm (18 vs 3%, p = .03). Early signs of contracture, considered loss of full axilla range or significant banding, developed in nine children within 3 months post-burn. With intensive therapy, all returned to full axilla range by 9 months post-burn. Children with skin tension at end of range shoulder movement at the 1-month clinical assessment were 11 times more likely to develop early signs of contracture (95% confidence interval [CI]: 1.9-62.1, p = .007). Intensive orthotic use at end of range shoulder abduction in children with axilla burns is well tolerated. When undertaken with ongoing therapist review, full axilla range can be maintained.
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Affiliation(s)
- Rhianydd Thomas
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia.,Physiotherapy Department, The Children's Hospital at Westmead, New South Wales, Australia
| | - Stephanie Wicks
- Physiotherapy Department, The Children's Hospital at Westmead, New South Wales, Australia
| | - Claire Toose
- Physiotherapy Department, The Children's Hospital at Westmead, New South Wales, Australia
| | - Verity Pacey
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia
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44
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Prevalence and Risk Factors for Hypertrophic Scarring of Split Thickness Autograft Donor Sites in a Pediatric Burn Population. Burns 2019; 45:1066-1074. [DOI: 10.1016/j.burns.2019.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/31/2018] [Accepted: 02/07/2019] [Indexed: 11/19/2022]
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45
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Rashaan ZM, Kwa KAA, van der Wal MBA, Tuinebreijer WE, van Zuijlen PPM, Breederveld RS. Patterns and predictors of burn scar outcome in the first 12 months after burn: The patient's perspective. Burns 2019; 45:1283-1290. [PMID: 31176509 DOI: 10.1016/j.burns.2019.03.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/22/2019] [Accepted: 03/26/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study aimed to provide insight into the patterns and factors that predict burn scar outcomes at 3, 6 and 12 months after burn. METHODS The Patient and Observer Scar Assessment Scale (POSAS) was used to assess the scar formation of each patient. Structural equation modelling was used. The predictor variables used in this study were sex, three age categories, TBSA, depth of the wound and cause of the burn. RESULTS The POSAS patient total and individual item scores demonstrated a statistically significant decrease in the first 12 months after burn, except for the relief item. Male patients had a lower total and items scores (better scar quality) for pain and pruritus compared with female patients. Full thickness burns had a higher scores for pruritus, pliability, thickness and relief compared to the partial-thickness burns. Ages younger than 5 years, higher TBSA values and flame burns were predictors of various POSAS items at 3 and 6 months after burn. CONCLUSION The POSAS patient total and individual item scores demonstrated a statistically significant improvement in the scar quality in the first 12 months after burn, except for the relief. Sex, age, depth of the wound, the percentage of TBSA and flame burns were predictors of various POSAS patient items at 3, 6 and 12 months after burn.
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Affiliation(s)
- Z M Rashaan
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, Leiden, The Netherlands; Burn Centre and Department of Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands.
| | - K A A Kwa
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, Leiden, The Netherlands; Burn Centre and Department of Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands.
| | - M B A van der Wal
- Association of Dutch Burn Centres, Zeestraat 27-29, 1941 AJ, Beverwijk, The Netherlands.
| | - W E Tuinebreijer
- Burn Centre and Department of Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands.
| | - P P M van Zuijlen
- Burn Centre and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands; Department of Plastic and Reconstructive Surgery and MOVE Research Institute, VU University of Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - R S Breederveld
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, Leiden, The Netherlands; Burn Centre and Department of Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands.
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46
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Simons M, Kimble R, McPhail S, Tyack Z. The longitudinal validity, reproducibility and responsiveness of the Brisbane Burn Scar Impact Profile (caregiver report for young children version) for measuring health-related quality of life in children with burn scars. Burns 2019; 45:1792-1809. [PMID: 31147101 DOI: 10.1016/j.burns.2019.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/22/2019] [Accepted: 04/16/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND The measurement of health-related quality of life (HRQoL) provides information about the perceived burden of the health condition and treatments from a lived experience. The Brisbane Burn Scar Impact Profile (caregiver report for young children, BBSIP0-8), developed in 2013, is a proxy-report measure of burn scar-specific HRQoL. The aim of this study was to report its psychometric properties in line with an evaluative purpose. METHODS Caregivers of children up to 8 years of age at risk of burn scarring were recruited into a prospective, longitudinal cohort study. Caregivers completed the BBSIP0-8, Pediatric Quality of Life Inventory and Patient Observer Scar Assessment Scale at baseline (approximately ≥85% of the total body surface area re-epithelialised), 1-2 weeks after baseline and 1-month after baseline. Psychometric properties measured included internal consistency, test-retest reliability, validity and responsiveness. RESULTS Eighty-six caregivers of mostly male children (55%), of a median age (IQR) of 1 year, 10 months (2 years, 1 month) and total body surface area burn of 1.5% (3.0%) were recruited. Over one third of participants were grafted and 15% had contractures or skin tightness at baseline. Internal consistency of ten item groups ranged from 0.73 to 0.96. Hypothesised correlations of changes in the BBSIP0-8 items with changes in criterion measures supported longitudinal validity (ρ ranging from -0.73 to 0.68). The majority of item groups had acceptable reproducibility (ICC = 0.65-0.83). The responsiveness of five item groups was supported (AUC = 0.71-0.90). CONCLUSION The psychometric properties tested support the use of the BBSIP0-8 as an evaluative measure of burn scar-related health-related quality of life for children aged below eight years in the early post-acute period of rehabilitation. Further investigation at longer time period after burn injury is indicated.
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Affiliation(s)
- M Simons
- Department of Occupational Therapy, Queensland Children's Hospital, 501 Stanley St, South Brisbane, Queensland 4101, Australia; Centre for Burns and Trauma Research, Child Health Research Centre, Level 7, Centre for Children's Health Research, Raymond Terrace, South Brisbane, 4101, Australia.
| | - R Kimble
- Centre for Burns and Trauma Research, Child Health Research Centre, Level 7, Centre for Children's Health Research, Raymond Terrace, South Brisbane, 4101, Australia; Department of Paediatric Surgery, Urology, Neonatal Surgery, Burns and Trauma, Queensland Children's Hospital, Brisbane, Queensland 4101, Australia; School of Medicine, The University of Queensland, St Lucia, Queensland 4067, Australia.
| | - S McPhail
- Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland 4059, Australia; Centre for Functioning and Health Research, Metro South Health, Buranda, Queensland 4102, Australia.
| | - Z Tyack
- Centre for Burns and Trauma Research, Child Health Research Centre, Level 7, Centre for Children's Health Research, Raymond Terrace, South Brisbane, 4101, Australia; Centre for Functioning and Health Research, Metro South Health, Buranda, Queensland 4102, Australia.
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47
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Spronk I, Polinder S, Haagsma JA, Nieuwenhuis M, Pijpe A, van der Vlies CH, Middelkoop E, van Baar ME. Patient-reported scar quality of adults after burn injuries: A five-year multicenter follow-up study. Wound Repair Regen 2019; 27:406-414. [PMID: 30793408 PMCID: PMC6850449 DOI: 10.1111/wrr.12709] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/12/2019] [Indexed: 12/28/2022]
Abstract
Scar formation is an important adverse consequence of burns. How patients appraise their scar quality is often studied shortly after sustaining the injury, but information in the long‐term is scarce. Our aim was, therefore, to evaluate long‐term patient‐reported quality of burn scars. Adults with a burn center admission of ≥1 day between August 2011 and September 2012 were invited to complete a questionnaire on long‐term consequences of burns. We enriched this sample with patients with severe burns (>20% total body surface area [TBSA] burned or TBSA full thickness >5%) treated between January 2010 and March 2013. Self‐reported scar quality was assessed with the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS). Patients completed this scale for their—in their opinion—most severe scar ≥5 years after burns. This study included 251 patients with a mean %TBSA burned of 10%. The vast majority (91.4%) reported at least minor differences with normal skin (POSAS item score ≥2) on one or more scar characteristics and 78.9% of the patients’ overall opinion was that their scar deviated from normal skin. Patients with severe burns had higher POSAS scores, representing worse scar quality, than patients with mild/intermediate burns, except for color, which was high in both groups. A longer hospital stay predicted reduced scar quality (both mean POSAS and mean overall opinion of the scar) in multivariate analyses. In addition, female gender was also associated with a poorer overall opinion of the scar. In conclusion, this study provides new insights in long‐term scar quality. Scars differed from normal skin in a large part of the burn population more than 5 years after burns, especially in those with severe burns. Female gender is associated with a poorer patients’ overall opinion of their scar, which may be an indication of gender differences in perception of scar quality after burns.
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Affiliation(s)
- Inge Spronk
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Juanita A Haagsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marianne Nieuwenhuis
- Association of Dutch Burn Centres, Martini Hospital, Groningen, The Netherlands.,Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anouk Pijpe
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Burn Centre, Red Cross Hospital, Beverwijk, The Netherlands
| | - Cornelis H van der Vlies
- Burn Centre, Maasstad Hospital, Rotterdam, The Netherlands.,Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Esther Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, The Netherlands
| | - Margriet E van Baar
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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48
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Wiseman J, Simons M, Kimble R, Tyack Z. Variability of pressure at the pressure garment-scar interface in children after burn: A pilot longitudinal cohort study. Burns 2019; 45:103-113. [DOI: 10.1016/j.burns.2018.08.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/10/2018] [Accepted: 08/30/2018] [Indexed: 11/29/2022]
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49
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Zang T, Cuttle L, Broszczak DA, Broadbent JA, Tanzer C, Parker TJ. Characterization of the Blister Fluid Proteome for Pediatric Burn Classification. J Proteome Res 2019; 18:69-85. [PMID: 30520305 DOI: 10.1021/acs.jproteome.8b00355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Blister fluid (BF) is a novel and viable research matrix for burn injury study, which can reflect both systemic and local microenvironmental responses. The protein abundance in BF from different burn severities were initially observed using a 2D SDS-PAGE approach. Subsequently, a quantitative data independent acquisition (DIA) method, SWATH, was employed to characterize the proteome of pediatric burn blister fluid. More than 600 proteins were quantitatively profiled in 87 BF samples from different pediatric burn patients. These data were correlated with clinically assessed burn depth and time until complete wound re-epithelialization through several different statistical analyses. Several proteins from these analyses exhibited significant abundance change between different burn depth or re-epithelialization groups, and can be considered as potential biomarker candidates. Further gene ontology (GO) enrichment analysis of the significant proteins revealed the most significant burn related biological processes (BP) that are altered with burn depth, including homeostasis and oxygen transport. However, for wounds with re-epithelialization times more or less than 21 days, the significant GO annotations were related to enzyme activity. This quantitative proteomics investigation of burn BF may enable objective classification of burn wound severity and assist with clinical decision-making. Data are available via ProteomeXchange with identifier PXD011102.
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Affiliation(s)
- Tuo Zang
- Tissue Repair and Translational Physiology Program , Institute of Health and Biomedical Innovation, Queensland University of Technology , Kelvin Grove , Queensland 4059 , Australia.,School of Biomedical Sciences, Faculty of Health , Queensland University of Technology , Brisbane , Queensland 4000 , Australia.,Wound Management Innovation Co-operative Research Centre , Brisbane , Queensland 4000 , Australia
| | - Leila Cuttle
- Tissue Repair and Translational Physiology Program , Institute of Health and Biomedical Innovation, Queensland University of Technology , Kelvin Grove , Queensland 4059 , Australia.,School of Biomedical Sciences, Faculty of Health , Queensland University of Technology , Brisbane , Queensland 4000 , Australia.,Centre for Children's Burns and Trauma Research, Queensland University of Technology , Institute of Health and Biomedical Innovation at the Centre for Children's Health Research , South Brisbane , Queensland 4101 , Australia
| | - Daniel A Broszczak
- Tissue Repair and Translational Physiology Program , Institute of Health and Biomedical Innovation, Queensland University of Technology , Kelvin Grove , Queensland 4059 , Australia.,School of Biomedical Sciences, Faculty of Health , Queensland University of Technology , Brisbane , Queensland 4000 , Australia.,School of Science, Faculty of Health Sciences , Australian Catholic University , Brisbane , Queensland 4014 , Australia
| | - James A Broadbent
- Tissue Repair and Translational Physiology Program , Institute of Health and Biomedical Innovation, Queensland University of Technology , Kelvin Grove , Queensland 4059 , Australia.,School of Biomedical Sciences, Faculty of Health , Queensland University of Technology , Brisbane , Queensland 4000 , Australia
| | - Catherine Tanzer
- Tissue Repair and Translational Physiology Program , Institute of Health and Biomedical Innovation, Queensland University of Technology , Kelvin Grove , Queensland 4059 , Australia.,Wound Management Innovation Co-operative Research Centre , Brisbane , Queensland 4000 , Australia.,Centre for Children's Burns and Trauma Research, Queensland University of Technology , Institute of Health and Biomedical Innovation at the Centre for Children's Health Research , South Brisbane , Queensland 4101 , Australia
| | - Tony J Parker
- Tissue Repair and Translational Physiology Program , Institute of Health and Biomedical Innovation, Queensland University of Technology , Kelvin Grove , Queensland 4059 , Australia.,School of Biomedical Sciences, Faculty of Health , Queensland University of Technology , Brisbane , Queensland 4000 , Australia
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50
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Duration of Scar Maturation: Retrospective Analyses of 361 Hypertrophic Scars Over 5 Years. Adv Skin Wound Care 2019; 32:26-34. [DOI: 10.1097/01.asw.0000547415.38888.c4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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