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Nuhiji E. Trends and Innovation in Negative Pressure Wound Therapy: A Review of Burn Wound Management. Adv Wound Care (New Rochelle) 2024; 13:391-399. [PMID: 37933900 DOI: 10.1089/wound.2023.0114] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
Significance: Burns result in irretrievable cell damage, which can occur upon exposure to hot surfaces, liquids, gases, ultraviolet or ionizing radiation, and through friction. Standard of care in burn management involves protecting the patient, limiting burn progression, and achieving wound closure. Negative pressure wound therapy (NPWT) and NPWT with instillation and dwell time (NPWTi-d) are two wound management options that have been shown to improve outcomes for burn patients in recent years. This work provides a general review of NPWT and NPWTi-d use in burn wound management. A literature search was performed using PubMed and Embase for peer-reviewed publications and conference abstracts written in English and reporting on burn management using NPWT and/or NPWTi-d from a single manufacturer between 2000 and 2021. All burn types were included. Recent Advances: Thirteen studies and 308 patients were available for assessment. Use of NPWT was reported in a majority of studies (n = 11). When conventional NPWT was applied, graft take of >90% was observed and consistent final wound closure was achieved. Two studies described NPWTi-d use for burn wound management. NPWTi-d use promoted granulation tissue development in burn wounds. Critical Issues: Limited high-level prospective evidence exists for use of NPWT and NPWTi-d in burn wound management. Future Directions: Available literature on the use of NPWT and/or NPWTi-d in burn care has reported improved outcomes in wound bed preparation, which can ultimately lead to final wound closure. The use of these modalities should be considered in management of burn care patients.
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Affiliation(s)
- Edin Nuhiji
- Global Medical Sciences, 3M Health Care, North Ryde, New South Wales, Australia
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2
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Gardien KLM, Pijpe A, Brouwer KM, Stoop M, Singh SK, Timmermans FW, Vlig M, van Zuijlen PPM, Middelkoop E. Short- and Long-term Outcomes of an Acellular Dermal Substitute versus Standard of Care in Burns and Reconstructions: A Phase I/II Intrapatient Randomized Controlled Trial. Adv Skin Wound Care 2023; 36:540-548. [PMID: 37729164 PMCID: PMC10545063 DOI: 10.1097/asw.0000000000000040] [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: 05/04/2023] [Accepted: 07/11/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE Dermal substitutes promote dermal regeneration and improve scar quality, but knowledge gaps remain regarding their efficacy and indications for use. The authors investigated the safety and short- and long-term efficacy of an acellular dermal substitute in patients with full-thickness wounds. METHODS This intrapatient randomized controlled, open-label, phase I (safety) and phase II (efficacy) study compared treatment with Novomaix (Matricel GmbH), a dermal collagen/elastin-based scaffold, with split-thickness skin graft (STSG) only. The primary safety outcome was graft take at 5 to 7 days postsurgery. Postsurgical scar quality was assessed by measuring elasticity, color, and scores on the Patient and Observer Scar Assessment Scale at 3 months, 12 months, and 6 years. RESULTS Twenty-five patients were included, of which 24 received treatment allocation. Graft take and wound healing were statistically significantly lower/delayed in the dermal matrix group compared with STSG alone (P < .004). Serious adverse events were delayed epithelialization in four dermal matrix and three STSG study areas. At 12 months postsurgery, skin extension (P = .034) and elasticity (P = .036) were better for the dermal matrix group compared with the group receiving STSG alone. Other scar quality parameters at 12 months and 6 years did not differ between treatment arms. CONCLUSIONS The dermal substitute was a safe treatment modality for full-thickness wounds. Compared with STSG alone, time to wound healing was slightly increased. Nevertheless, scar quality at 12 months seemed somewhat improved in the wounds treated with the dermal substitute, indicative of enhanced scar maturation. In the long term, final scar quality was similar for both treatment modalities.
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Affiliation(s)
- Kim L M Gardien
- Kim L. M. Gardien, MD, is Burn Physician and Anouk Pijpe, PhD, is Epidemiologist and Research Coordinator, Association of Dutch Burn Centres, Beverwijk, the Netherlands; Burn Center, Red Cross Hospital, Beverwijk; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam; and Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC. Katrien M. Brouwer, PhD, is Senior Researcher, Association of Dutch Burn Centres. Matthea Stoop, RN, is Research Nurse, Association of Dutch Burn Centres; Burn Center, Red Cross Hospital, Beverwijk; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam. Simarjeet K. Singh is Research Student, Burn Center, Red Cross Hospital, Beverwijk. Floyd W. Timmermans, MD, PhD, is Clinical Researcher, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam; and AMS Institute, Amsterdam UMC. Marcel Vlig, BAS, is Senior Technician, Association of Dutch Burn Centres. Paul P. M. van Zuijlen, MD, PhD, is Plastic Surgeon and Professor of Burn Care, Burn Center, Red Cross Hospital, Beverwijk; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam; AMS Institute, Amsterdam UMC; and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk. Esther Middelkoop, PhD, is Director of Research and Professor of Wound Healing and Skin Regeneration, Association of Dutch Burn Centres, Beverwijk, the Netherlands; Burn Center, Red Cross Hospital, Beverwijk; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam; and AMS Institute, Amsterdam UMC
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Logan J, Scott G, Peake C, Watson JJ, Jose R. Topical Negative Pressure Wound Dressing and Its Applications in the Hand-A Review of the Literature. J Hand Microsurg 2022; 14:276-283. [PMID: 36398157 PMCID: PMC9666070 DOI: 10.1055/s-0041-1729467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The use of topical negative pressure wound therapy (NPWT) has become increasingly popular in the management of complex wounds. There are many theories as to the mechanism of action of NPWT, but the essential components of the various systems remain consistent. There are many attractive potential properties of negative pressure dressings that lend themselves to the management of upper limb injuries. This article explores the technique of negative pressure wound dressing, the theories pertaining to mechanism of action, and the increasingly broad indications described for the use of NPWT in the hand. The literature pertaining to the efficacy of NPWT in general is also discussed.
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Affiliation(s)
- James Logan
- Department of Trauma and Orthopedics, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Georgia Scott
- Department of Trauma and Orthopedics, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Christopher Peake
- Department of Trauma and Orthopedics, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Jay James Watson
- Department of Trauma and Orthopedics, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Rajive Jose
- Department of Hand Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
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Trubelja A, Kasper FK, Farach-Carson MC, Harrington DA. Bringing hydrogel-based craniofacial therapies to the clinic. Acta Biomater 2022; 138:1-20. [PMID: 34743044 PMCID: PMC9234983 DOI: 10.1016/j.actbio.2021.10.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/06/2021] [Accepted: 10/29/2021] [Indexed: 01/17/2023]
Abstract
This review explores the evolution of the use of hydrogels for craniofacial soft tissue engineering, ranging in complexity from acellular injectable fillers to fabricated, cell-laden constructs with complex compositions and architectures. Addressing both in situ and ex vivo approaches, tissue restoration secondary to trauma or tumor resection is discussed. Beginning with relatively simple epithelia of oral mucosa and gingiva, then moving to more functional units like vocal cords or soft tissues with multilayer branched structures, such as salivary glands, various approaches are presented toward the design of function-driven architectures, inspired by native tissue organization. Multiple tissue replacement paradigms are presented here, including the application of hydrogels as structural materials and as delivery platforms for cells and/or therapeutics. A practical hierarchy is proposed for hydrogel systems in craniofacial applications, based on their material and cellular complexity, spatial order, and biological cargo(s). This hierarchy reflects the regulatory complexity dictated by the Food and Drug Administration (FDA) in the United States prior to commercialization of these systems for use in humans. The wide array of available biofabrication methods, ranging from simple syringe extrusion of a biomaterial to light-based spatial patterning for complex architectures, is considered within the history of FDA-approved commercial therapies. Lastly, the review assesses the impact of these regulatory pathways on the translational potential of promising pre-clinical technologies for craniofacial applications. STATEMENT OF SIGNIFICANCE: While many commercially available hydrogel-based products are in use for the craniofacial region, most are simple formulations that either are applied topically or injected into tissue for aesthetic purposes. The academic literature previews many exciting applications that harness the versatility of hydrogels for craniofacial soft tissue engineering. One of the most exciting developments in the field is the emergence of advanced biofabrication methods to design complex hydrogel systems that can promote the functional or structural repair of tissues. To date, no clinically available hydrogel-based therapy takes full advantage of current pre-clinical advances. This review surveys the increasing complexity of the current landscape of available clinical therapies and presents a framework for future expanded use of hydrogels with an eye toward translatability and U.S. regulatory approval for craniofacial applications.
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Affiliation(s)
- Alen Trubelja
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, UTHealth Science Center at Houston, Houston, TX 77054, United States; Department of Bioengineering, Rice University, Houston, TX 77005, United States
| | - F Kurtis Kasper
- Department of Orthodontics, School of Dentistry, UTHealth Science Center at Houston, Houston, TX 77054, United States
| | - Mary C Farach-Carson
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, UTHealth Science Center at Houston, Houston, TX 77054, United States; Department of Bioengineering, Rice University, Houston, TX 77005, United States; Department of BioSciences, Rice University, Houston, TX 77005, United States
| | - Daniel A Harrington
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, UTHealth Science Center at Houston, Houston, TX 77054, United States; Department of Bioengineering, Rice University, Houston, TX 77005, United States; Department of BioSciences, Rice University, Houston, TX 77005, United States.
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Chen Y, Niu Z, Yin X, Li Y, Han Y, Chai M, Li D, Tao R, Guo L, Lei Y, Han Y. Treatment of Severe Postburn Contracture of the Elbow via Distraction With External Circular Frame in Pediatric Patient. Ann Plast Surg 2021; 87:253-259. [PMID: 34397514 DOI: 10.1097/sap.0000000000002960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although external circular frame (ECF) has been widely used for the correction of knee and ankle deformities, few studies reported the use of ECF for the treatment of severe postburn elbow contracture and stiffness (SPECS). The purpose of this retrospective study was to investigate the effectiveness and safety of the distraction using ECF in treating SPECS. METHODS After institutional review board approval, we implemented a retrospective single-center case series study composed of consecutive patients treated for SPECS at Chinese PLA General Hospital between January 2010 and January 2018. After scar release and skin grafting, distraction with ECF was performed for 4 to 6 weeks, and the frame was retained for 2 more weeks before removal. Four weeks of splinting and at least 1 year of rehabilitation were recommended. Patient demographics, active and passive range of motion (ROM) of the elbow at different time points (preoperative, postdistraction, and final follow-up), and complications were collected from the electronic medical record. The primary outcome was the long-term improvement of the ROM. Other outcomes included complications and recurrence. RESULTS The ECF was used to treat SPECS in 6 patients (3 males and 3 females, average age of 11.7 ± 2.6 years). Scar release and distraction with ECF significantly increased both active (from 3° preoperative to 38.7° postdistraction) and passive (from 3.5° preoperative to 48.3° postdistraction) ROM over an average distraction duration of 5.2 weeks. The long-term improvement of active and passive ROM was 38° ± 13.4° and 46° ± 14.7°, respectively, over a median follow-up of 4.1 years. Pin-tract infection occurred in 2 patients and were treated with local wound care and oral antibiotics. A tendon readhesion developed in 1 of the 6 patients because of noncompliance with splinting and physiotherapy, and was treated with revision surgery. CONCLUSIONS The 3C strategy (i.e., contracture release, coverage of the defect with skin grafting, and correction of articular angle with gradual distraction using the ECF) is able to increase the ROM with minor complications. We recommend distraction with ECF as part of the treatment arsenal, particularly for severe contractures in which 1-stage correction is unfeasible because of considerable soft tissue shortening.
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Affiliation(s)
- Youbai Chen
- From the Department of Plastic and Reconstructive Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
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Lipový B, Raška F, Kocmanová I, Hanslianová M, Hladík M, Holoubek J, Bezdíček M, Macháček C. Trichoderma longibrachiatum and Aspergillus fischeri Infection as a Cause of Skin Graft Failure in a Patient with Critical Burns after Liver Transplantation. J Fungi (Basel) 2021; 7:jof7060487. [PMID: 34207136 PMCID: PMC8234584 DOI: 10.3390/jof7060487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/03/2021] [Accepted: 06/14/2021] [Indexed: 11/16/2022] Open
Abstract
Infectious complications are responsible for the majority of mortalities and morbidities of patients with critical burns. Although bacteria are the predominant etiological agents in such patients, yeasts and fungi have become relatively common causes of infections over the last decade. Here, we report a case of a young man with critical burns on 88% TBSA (total body surface area) arising as a part of polytrauma. The patient's history of orthotopic liver transplantation associated with the patient's need to use combined immunosuppressant therapy was an additional complication. Due to deep burns in the forearm region, we have (after a suitable wound bed preparation) applied a new bi-layered dermal substitute. The patient, however, developed a combined fungal infection in the region of this dermal substitute caused by Trichoderma longibrachiatum and Aspergillus fischeri (the first case ever reported). The infection caused the loss of the split-thickness skin grafts (STSGs); we had to perform repeated hydrosurgical and mechanical debridement and a systemic antifungal treatment prior to re-application of the STSGs. The subsequent skin transplant was successful.
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Affiliation(s)
- Břetislav Lipový
- Department of Burns and Plastic Surgery, Institution Shared with University Hospital Brno, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (B.L.); (F.R.); (J.H.)
- CEITEC—Central European Institute of Technology, Brno University of Technology, 612 00 Brno, Czech Republic
| | - Filip Raška
- Department of Burns and Plastic Surgery, Institution Shared with University Hospital Brno, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (B.L.); (F.R.); (J.H.)
| | - Iva Kocmanová
- Department of Clinical Microbiology, University Hospital Brno, 625 00 Brno, Czech Republic;
| | - Markéta Hanslianová
- Department of Clinical Microbiology, Vyškov Hospital, 628 01 Vyškov, Czech Republic;
| | - Martin Hladík
- Department of Burns and Plastic Surgery, Institution Shared with University Hospital Brno, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (B.L.); (F.R.); (J.H.)
- Correspondence: ; Tel.: +420-532-232-206
| | - Jakub Holoubek
- Department of Burns and Plastic Surgery, Institution Shared with University Hospital Brno, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (B.L.); (F.R.); (J.H.)
| | - Matěj Bezdíček
- Centre of Molecular Biology and Gene Therapy, Department of Internal Medicine—Hematology and Oncology, Institution Shared with University Hospital Brno, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic;
| | - Ctirad Macháček
- Department of Pathology, Institution Shared with University Hospital Brno, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic;
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Ruppert DS, Mohammed MM, Ibrahim MM, Bachtiar EO, Erning K, Ansari K, Everitt JI, Brown D, Klitzman B, Koshut W, Gall K, Levinson H. Poly(lactide-co-ε-caprolactone) scaffold promotes equivalent tissue integration and supports skin grafts compared to a predicate collagen scaffold. Wound Repair Regen 2021; 29:1035-1050. [PMID: 34129714 DOI: 10.1111/wrr.12951] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/23/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
Dermal scarring from motor vehicle accidents, severe burns, military blasts, etc. is a major problem affecting over 80 million people worldwide annually, many of whom suffer from debilitating hypertrophic scar contractures. These stiff, shrunken scars limit mobility, impact quality of life, and cost millions of dollars each year in surgical treatment and physical therapy. Current tissue engineered scaffolds have mechanical properties akin to unwounded skin, but these collagen-based scaffolds rapidly degrade over 2 months, premature to dampen contracture occurring 6-12 months after injury. This study demonstrates a tissue engineered scaffold can be manufactured from a slow-degrading viscoelastic copolymer, poly(ι-lactide-co-ε-caprolactone), with physical and mechanical characteristics to promote tissue ingrowth and support skin-grafts. Copolymers were synthesized via ring-opening polymerization. Solvent casting/particulate leaching was used to manufacture 3D porous scaffolds by mixing copolymers with particles in an organic solvent followed by casting into molds and subsequent particle leaching with water. Scaffolds characterized through SEM, micro-CT, and tensile testing confirmed the required thickness, pore size, porosity, modulus, and strength for promoting skin-graft bioincorporation and dampening fibrosis in vivo. Scaffolds were Oxygen Plasma Treatment and collagen coated to encourage cellular proliferation. Porosity ranging from 70% to 90% was investigated in a subcutaneous murine model and found to have no clinical effect on tissue ingrowth. A swine full-thickness skin wound model confirmed through histology and Computer Planimetry that scaffolds promote skin-graft survival, with or without collagen coating, with equal safety and efficacy as a commercially available tissue engineered scaffold. This study validates a scalable method to create poly(ι-lactide-co-ε-caprolactone) scaffolds with appropriate characteristics and confirms in mouse and swine wound models that the scaffolds are safe and effective at supporting skin-grafts. The results of this study have brought us closer towards developing an alternative technology that supports skin grafts with the potential to investigate long-term hypertrophic scar contractures.
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Affiliation(s)
- David S Ruppert
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Mahmoud M Mohammed
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Mohamed M Ibrahim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Emilio O Bachtiar
- Department of Mechanical Engineering and Materials Science, Edmund T. Pratt Jr. School of Engineering, Duke University, Durham, North Carolina, USA
| | - Kevin Erning
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Kayvan Ansari
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Jeffrey I Everitt
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina, USA
| | - David Brown
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Bruce Klitzman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Duke University, Durham, North Carolina, USA
| | - William Koshut
- Department of Mechanical Engineering and Materials Science, Edmund T. Pratt Jr. School of Engineering, Duke University, Durham, North Carolina, USA
| | - Ken Gall
- Department of Mechanical Engineering and Materials Science, Edmund T. Pratt Jr. School of Engineering, Duke University, Durham, North Carolina, USA
| | - Howard Levinson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Duke University, Durham, North Carolina, USA.,Department of Pathology, Duke University School of Medicine, Durham, North Carolina, USA
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Lin D, Kao Y, Chen C, Wang H, Chiu W. Negative pressure wound therapy for burn patients: A meta-analysis and systematic review. Int Wound J 2021; 18:112-123. [PMID: 33236845 PMCID: PMC7949461 DOI: 10.1111/iwj.13500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 12/11/2022] Open
Abstract
Negative pressure wound therapy (NPWT), which has been applied in various medical specialties to accelerate wound healing, has been the object of a few investigations. We explored the effectiveness of NPWT and the possibility of its inclusion in burn management guidelines. Randomised controlled trials comparing NPWT with non-NPWT treatments for burn wounds were extracted from PubMed. For the risk of bias analysis, all included studies were evaluated according to the Cochrane risk of bias tool and the approaches outlined in the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) Handbook. Outcomes such as graft take rate in the first week, infection rate, and overall complication rate were analysed. Six studies that included a total of 701 patients met our inclusion criteria. Qualitative analysis revealed that the NPWT group had a significantly better overall graft rate in the first week (P = 0.001) and a significantly lower infection rate (P = 0.04). No significant difference in the overall complication rate was found. Our results indicate that NPWT is a safe method for stimulating healing and lowering the infection rate of burn wounds. NPWT can be part of general burn management, and its incorporation into burn treatment guidelines is recommended.
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Affiliation(s)
- Dai‐Zhu Lin
- College of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Yu‐Chien Kao
- College of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Chiehfeng Chen
- Division of Plastic Surgery, Department of SurgeryTaipei Municipal Wanfang Hospital, Taipei Medical UniversityTaipeiTaiwan
- Department of Public HealthTaipei Medical UniversityTaipeiTaiwan
- Cochrane TaiwanTaipei Medical UniversityTaipeiTaiwan
| | - Hsian‐Jenn Wang
- Division of Plastic Surgery, Department of SurgeryTaipei Municipal Wanfang Hospital, Taipei Medical UniversityTaipeiTaiwan
| | - Wen‐Kuan Chiu
- Division of Plastic Surgery, Department of SurgeryTaipei Municipal Wanfang Hospital, Taipei Medical UniversityTaipeiTaiwan
- Department of Surgery, School of MedicineCollege of Medicine, Taipei Medical UniversityTaipeiTaiwan
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Ou KL, Tzeng YS, Liu HH, Wu CJ, Chen CY, Chou YY, Hsu KF, Wang CH, Dai NT, Chang CK. Negative Pressure Wound Therapy in Conjunction With Artificial Dermis for Burned Hand Reconstruction. Ann Plast Surg 2021; 86:S13-S17. [PMID: 33438950 DOI: 10.1097/sap.0000000000002676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Proper wound care along with the use of skin grafts over deep burn wounds has been the standard treatment. However, the goal in burn wound care has shifted from achieving a satisfactory survival rate to improving long-term form and function of the healed wound, which is sometimes hindered by scar contracture. This has prompted surgeons to find alternative ways to treat burn wounds without compromising function. Among burn cases, hand injuries are the most problematic when it comes to delicate function recovery. METHODS This study presents the results of conjunctive use of a bilayer artificial dermis, negative pressure wound therapy, and split-thickness skin grafts for grafting over acute burn wounds and scar-releasing defects after severe hand burns. RESULTS Three months after the operation, the scar was soft and pliable, the aesthetic outcome was good, and the patients gained much improvement in hand function and quality oflife. CONCLUSIONS The combined technique achieved a good scar quality and aesthetic effect on burned hands as well as excellent functional outcome, which resulted in major improvements and an independent life for the patient.
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Affiliation(s)
| | - Yuan-Sheng Tzeng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Hung-Hui Liu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Chien-Ju Wu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Chun-Yu Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | | | - Kuo-Feng Hsu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Chih-Hsin Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Niann-Tzyy Dai
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
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Abstract
This study aims to present the outcomes from current alternative treatment modalities combined with the conventional techniques used in the treatment of burn contractures. Twenty-nine patients were included in the study. Patients were divided into three groups according to the severity of contractures: 1- mild, 2- moderate, and 3- severe. Skin defects that occurred following the incision and scar contracture release were closed with a collagen-elastin acellular dermal matrix (ADM). The split-thickness skin graft was evenly placed on the ADM and fixed with absorbable sutures. The grafts were closed with NPWT (negative pressure wound therapy system) dressings. In platelet-rich plasma (PRP) mild cases as well as moderate and severe PRP cases, stem cell and fat injection were applied. PRP injection was applied to the scar base before the contracture; fat injection and stem cells were applied at the 3rd and 6th months. Preoperative and postoperative range of motion (ROM), Patient and Observer Scars Evaluation Scale (POSAS), and histopathological scores were evaluated. There was a statistically significant decrease in postoperative POSAS scores (p < .05) and a significant increase in the ROM score (p < .05). Histopathological examination revealed an increased postoperative collagen accumulation and organization, increased vascularization, decreased scar tissue thickness and increased subcutaneous tissue thickness. There was no difference in treatment outcomes between the groups.Based on the current findings, we conclude that ADM, stem cell-rich fat grafting, and PRP therapies combined with conventional methods could satisfactorily improve functional outcomes in the repair of burn contractures.
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Affiliation(s)
- Percin Karakol
- Department of Plastic, Reconstructive and Aesthetic Surgery, Health Science University Bağcılar Education and Training Hospital, Istanbul, Turkey
| | - Mehmet Bozkurt
- Department of Plastic, Reconstructive and Aesthetic Surgery, Health Science University Bağcılar Education and Training Hospital, Istanbul, Turkey
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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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12
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The Combined Use of Negative-Pressure Wound Therapy and Dermal Substitutes for Tissue Repair and Regeneration. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8824737. [PMID: 33344649 PMCID: PMC7732395 DOI: 10.1155/2020/8824737] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/04/2020] [Accepted: 11/29/2020] [Indexed: 11/18/2022]
Abstract
In clinical practice, skin defects occur frequently due to various kinds of acute and chronic diseases. The standard treatment for these wounds is autografting, which usually results in complications such as scar formation and new wounds at donor sites. The advent of dermal substitutes has provided a novel method for wound repair, and rapid angiogenesis of the dermal substitutes is crucial for the graft to take. At present, many strategies have been developed to improve the process of vascularisation, some of which have shown promising potentials, but they could be very far from clinical applications. Most recently, negative-pressure wound therapy (NPWT) has been used extensively in clinical practice for wound care and management. It has been reported that NPWT reduces the time required for vascular ingrowth into the dermal substitute and improves graft take, indicating great potentials for wound repair. This article presents a comprehensive overview of the combined use of NPWT and dermal substitutes for tissue repair and regeneration. Relative concerns and prospects are also discussed.
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13
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Zens Y, Barth M, Bucher HC, Dreck K, Felsch M, Groß W, Jaschinski T, Kölsch H, Kromp M, Overesch I, Sauerland S, Gregor S. Negative pressure wound therapy in patients with wounds healing by secondary intention: a systematic review and meta-analysis of randomised controlled trials. Syst Rev 2020; 9:238. [PMID: 33038929 PMCID: PMC7548038 DOI: 10.1186/s13643-020-01476-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/07/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Negative pressure wound therapy (NPWT) is a widely used method of wound treatment. We performed a systematic review of randomised controlled trials (RCTs) comparing the patient-relevant benefits and harms of NPWT with standard wound therapy (SWT) in patients with wounds healing by secondary intention. METHODS We searched for RCTs in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and study registries (last search: July 2018) and screened reference lists of relevant systematic reviews and health technology assessments. Manufacturers and investigators were asked to provide unpublished data. Eligible studies investigated at least one patient-relevant outcome (e.g. wound closure). We assessed publication bias and, if feasible, performed meta-analyses, grading the results into different categories (hint, indication or proof of a greater benefit or harm). RESULTS We identified 48 eligible studies of generally low quality with evaluable data for 4315 patients and 30 eligible studies with missing data for at least 1386 patients. Due to potential publication bias (proportion of inaccessible data, 24%), we downgraded our conclusions. A meta-analysis of all wound healing data showed a significant effect in favour of NPWT (OR 1.56, 95% CI 1.15 to 2.13, p = 0.008). As further analyses of different definitions of wound closure did not contradict that analysis, we inferred an indication of a greater benefit of NPWT. A meta-analysis of hospital stay (in days) showed a significant difference in favour of NPWT (MD - 4.78, 95% CI - 7.79 to - 1.76, p = 0.005). As further analyses of different definitions of hospital stay/readmission did not contradict that analysis, we inferred an indication of a greater benefit of NPWT. There was neither proof (nor indication nor hint) of greater benefit or harm of NPWT for other patient-relevant outcomes such as mortality and adverse events. CONCLUSIONS In summary, low-quality data indicate a greater benefit of NPWT versus SWT for wound closure in patients with wounds healing by secondary intention. The length of hospital stay is also shortened. The data show no advantages or disadvantages of NPWT for other patient-relevant outcomes. Publication bias is an important problem in studies on NPWT, underlining that all clinical studies need to be fully reported.
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Affiliation(s)
- Yvonne Zens
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
| | - Michael Barth
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
- Basel Institute for Clinical Epidemiology & Biostatistics, University Hospital Basel and University of Basel, Basel, Switzerland
- Düsseldorf, Germany
| | - Heiner C. Bucher
- Basel Institute for Clinical Epidemiology & Biostatistics, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Katrin Dreck
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
| | - Moritz Felsch
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
| | - Wolfram Groß
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
| | - Thomas Jaschinski
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
| | - Heike Kölsch
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
| | - Mandy Kromp
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
| | - Inga Overesch
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
| | - Stefan Sauerland
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
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14
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Zomer HD, Jeremias TDS, Ratner B, Trentin AG. Mesenchymal stromal cells from dermal and adipose tissues induce macrophage polarization to a pro-repair phenotype and improve skin wound healing. Cytotherapy 2020; 22:247-260. [PMID: 32234290 DOI: 10.1016/j.jcyt.2020.02.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/09/2020] [Accepted: 02/19/2020] [Indexed: 12/15/2022]
Abstract
The process of wound healing restores skin homeostasis but not full functionality; thus, novel therapeutic strategies are needed to accelerate wound closure and improve the quality of healing. In this context, tissue engineering and cellular therapies are promising approaches. Although sharing essential characteristics, mesenchymal stromal cells (MSCs) isolated from different tissues might have distinct properties. Therefore, the aim of this study was to comparatively investigate, by a mouse model in vivo assay, the potential use of dermal-derived MSCs (DSCs) and adipose tissue-derived MSCs (ASCs) in improving skin wound healing. Human DSCs and ASCs were delivered to full-thickness mouse wounds by a collagen-based scaffold (Integra Matrix). We found that the association of both DSCs and ASCs with the Integra accelerated wound closure in mice compared with the biomaterial only (control). Both types of MSCs stimulated angiogenesis and extracellular matrix remodeling, leading to better quality scars. However, the DSCs showed smaller scar size,superior extracellular matrix deposition, and greater number of cutaneous appendages. Besides, DSCs and ASCs reduced inflammation by induction of macrophage polarization from a pro-inflammatory (M1) to a pro-repair (M2) phenotype. In conclusion, both DSCs and ASCs were able to accelerate the healing of mice skin wounds and promote repair with scars of better quality and more similar to healthy skin than the empty scaffold. DSCs associated with Integra induced superior overall results than the Integra alone, whereas scaffolds with ASCs showed an intermediate effect, often not significantly better than the empty biomaterial.
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Affiliation(s)
- Helena Debiazi Zomer
- Department of Cell Biology, Embryology and Genetics, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Talita da Silva Jeremias
- Department of Cell Biology, Embryology and Genetics, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Buddy Ratner
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Andrea Goncalves Trentin
- Department of Cell Biology, Embryology and Genetics, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil; National Institute of Science and Technology for Regenerative Medicine, Rio de Janeiro, Brazil.
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15
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Spronk I, Edgar DW, van Baar ME, Wood FM, Van Loey NEE, Middelkoop E, Renneberg B, Öster C, Orwelius L, Moi AL, Nieuwenhuis M, van der Vlies CH, Polinder S, Haagsma JA. Improved and standardized method for assessing years lived with disability after burns and its application to estimate the non-fatal burden of disease of burn injuries in Australia, New Zealand and the Netherlands. BMC Public Health 2020; 20:121. [PMID: 31996206 PMCID: PMC6988230 DOI: 10.1186/s12889-020-8233-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/16/2020] [Indexed: 12/16/2022] Open
Abstract
Background Burden of disease estimates are an important resource in public health. Currently, robust estimates are not available for the burn population. Our objectives are to adapt a refined methodology (INTEGRIS method) to burns and to apply this new INTEGRIS-burns method to estimate, and compare, the burden of disease of burn injuries in Australia, New Zealand and the Netherlands. Methods Existing European and Western-Australian health-related quality of life (HRQL) datasets were combined to derive disability weights for three homogenous burn injury groups based on percentage total body surface area (%TBSA) burned. Subsequently, incidence data from Australia, New Zealand, and the Netherlands from 2010 to 2017 were used to compute annual non-fatal burden of disease estimates for each of these three countries. Non-fatal burden of disease was measured by years lived with disability (YLD). Results The combined dataset included 7159 HRQL (EQ-5D-3 L) outcomes from 3401 patients. Disability weights ranged from 0.046 (subgroup < 5% TBSA burned > 24 months post-burn) to 0.497 (subgroup > 20% TBSA burned 0–1 months post-burn). In 2017 the non-fatal burden of disease of burns for the three countries (YLDs/100,000 inhabitants) was 281 for Australia, 279 for New Zealand and 133 for the Netherlands. Conclusions This project established a method for more precise estimates of the YLDs of burns, as it is the only method adapted to the nature of burn injuries and their recovery. Compared to previous used methods, the INTEGRIS-burns method includes improved disability weights based on severity categorization of burn patients; a better substantiated proportion of patients with lifelong disability based; and, the application of burn specific recovery timeframes. Information derived from the adapted method can be used as input for health decision making at both the national and international level. Future studies should investigate whether the application is valid in low- and middle- income countries.
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Affiliation(s)
- Inge Spronk
- Erasmus MC, Department of Public Health, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands. .,Amsterdam UMC, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - Dale W Edgar
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Burn Injury Research Node, The University of Notre Dame, Fremantle, Western Australia, Australia.,Fiona Wood Foundation, Murdoch, Western Australia, Australia
| | - Margriet E van Baar
- Erasmus MC, Department of Public Health, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
| | - Fiona M Wood
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Fiona Wood Foundation, Murdoch, Western Australia, Australia
| | - Nancy E E Van Loey
- Association of Dutch Burn Centres, Department Behavioural Research, Beverwijk, the Netherlands.,Department Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Esther Middelkoop
- Amsterdam UMC, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands
| | - Babette Renneberg
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Caisa Öster
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Lotti Orwelius
- Department of Anaesthesiology and Intensive Care, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Asgjerd L Moi
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Plastic, Hand and Reconstructive Surgery, National Burn Centre, Haukeland University Hospital, Bergen, Norway
| | - 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
| | - 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
| | - Suzanne Polinder
- Erasmus MC, Department of Public Health, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Juanita A Haagsma
- Erasmus MC, Department of Public Health, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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16
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Spronk I, Van Loey NEE, Sewalt C, Nieboer D, Renneberg B, Moi AL, Oster C, Orwelius L, van Baar ME, Polinder S. Recovery of health-related quality of life after burn injuries: An individual participant data meta-analysis. PLoS One 2020; 15:e0226653. [PMID: 31923272 PMCID: PMC6953837 DOI: 10.1371/journal.pone.0226653] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/29/2019] [Indexed: 01/23/2023] Open
Abstract
Background A prominent outcome measure within burn care is health related quality of life (HRQL). Until now, no model for long-term recovery of HRQL exists for adult burn patients which requires large samples with repeated measurements. Re-use and the combination of existing data is a way to achieve larger data samples that enable the estimation of long-term recovery models. The aim of this secondary data analysis was to assess the recovery of HRQL after a burn injury over time. Methods and findings Data from ten European studies on generic HRQL assessed in adult burn patients (either with the EQ-5D or SF-36) from five different countries were merged into one dataset. SF-36 outcomes were transformed into EQ-5D outcomes. A 24-month recovery of HRQL (EQ-5D utility) was modeled using a linear mixed-effects model and adjusted for important patient and burn characteristics. Subgroups of patients with mild and intermediate burns (≤20% total body surface area (TBSA) burned) and with major burns (>20% TBSA burned) were compared. The combined database included 1687 patients with a mean age of 43 (SD 15) years and a median %TBSA burned of 9% (IQR 4–18). There was large improvement in HRQL up to six months after burns, and HRQL remained relatively stable afterwards (studied up to 24 months post burn). However, the estimated EQ-5D utility scores remained below the norm scores of the general population. In this large sample, females, patients with a long hospital stay and patients with major burns had a delayed and worse recovery. The proportion of patients that reported problems for the EQ-5D dimensions ranged from 100% (pain/discomfort at baseline in patients with major burns) to 10% (self-care ≥3 months after injury in patients with mild and intermediate burns). After 24 months, both subgroups of burn patients did not reach the level of the general population in the dimensions pain/discomfort and anxiety/depression, and patients with major burns in the dimension usual activities. A main limitation of the study includes that the variables in the model were limited to age, gender, %TBSA, LOS and time since burn as these were the only variables available in all datasets. Conclusions The 24-month recovery model can be used in clinical practice to inform patients on expected HRQL outcomes and provide clinicians insights into the expected recovery of HRQL. In this way, a delayed recovery can be recognized in an early stage and timely interventions can be started in order to improve patient outcomes. However, external validation of the developed model is needed before implementation into clinical practice. Furthermore, our study showed the benefit of secondary data usage within the field of burns.
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Affiliation(s)
- Inge Spronk
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, Netherlands
- * E-mail:
| | - Nancy E. E. Van Loey
- Association of Dutch Burn Centres, Department Behavioural Research, Beverwijk, the Netherlands
- Utrecht University, Department Clinical Psychology, Utrecht, the Netherlands
| | - Charlie Sewalt
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
| | - Daan Nieboer
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
| | - Babette Renneberg
- Freie Universität Berlin, Department of Clinical Psychology and Psychotherapy, Berlin, Germany
| | - Asgjerd Litleré Moi
- Western Norway University of Applied Sciences, Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Bergen, Norway
- National Burn Centre, Haukeland University Hospital, Department of Plastic, Hand and Reconstructive Surgery, Bergen, Norway
| | - Caisa Oster
- Uppsala University, Department of Neuroscience, Psychiatry, Sweden
| | - Lotti Orwelius
- Linköping University, Department of Anaesthesiology and Intensive Care, and Department of Clinical and Experimental Medicine, Linköping, Sweden
| | - Margriet E. van Baar
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
| | - Suzanne Polinder
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
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17
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Urciuolo F, Casale C, Imparato G, Netti PA. Bioengineered Skin Substitutes: the Role of Extracellular Matrix and Vascularization in the Healing of Deep Wounds. J Clin Med 2019; 8:E2083. [PMID: 31805652 PMCID: PMC6947552 DOI: 10.3390/jcm8122083] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 12/21/2022] Open
Abstract
The formation of severe scars still represents the result of the closure process of extended and deep skin wounds. To address this issue, different bioengineered skin substitutes have been developed but a general consensus regarding their effectiveness has not been achieved yet. It will be shown that bioengineered skin substitutes, although representing a valid alternative to autografting, induce skin cells in repairing the wound rather than guiding a regeneration process. Repaired skin differs from regenerated skin, showing high contracture, loss of sensitivity, impaired pigmentation and absence of cutaneous adnexa (i.e., hair follicles and sweat glands). This leads to significant mobility and aesthetic concerns, making the development of more effective bioengineered skin models a current need. The objective of this review is to determine the limitations of either commercially available or investigational bioengineered skin substitutes and how advanced skin tissue engineering strategies can be improved in order to completely restore skin functions after severe wounds.
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Affiliation(s)
- Francesco Urciuolo
- Department of Chemical, Materials and Industrial Production Engineering (DICMAPI) University of Naples Federico II, P.le Tecchio 80, 80125 Naples, Italy; (C.C.); (P.A.N.)
- Interdisciplinary Research Centre on Biomaterials (CRIB), University of Naples Federico II P.le Tecchio 80, 80125 Naples, Italy
| | - Costantino Casale
- Department of Chemical, Materials and Industrial Production Engineering (DICMAPI) University of Naples Federico II, P.le Tecchio 80, 80125 Naples, Italy; (C.C.); (P.A.N.)
| | - Giorgia Imparato
- Center for Advanced Biomaterials for HealthCare@CRIB, Istituto Italiano di Tecnologia, Largo Barsanti e Matteucci 53, 80125 Naples, Italy;
| | - Paolo A. Netti
- Department of Chemical, Materials and Industrial Production Engineering (DICMAPI) University of Naples Federico II, P.le Tecchio 80, 80125 Naples, Italy; (C.C.); (P.A.N.)
- Interdisciplinary Research Centre on Biomaterials (CRIB), University of Naples Federico II P.le Tecchio 80, 80125 Naples, Italy
- Center for Advanced Biomaterials for HealthCare@CRIB, Istituto Italiano di Tecnologia, Largo Barsanti e Matteucci 53, 80125 Naples, Italy;
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18
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Green T, Kavros S, Springer S, Drez D, McCabe M, Gremillion J. Team Approach: Complex Dermal Wound-Healing Utilizing Negative-Pressure Wound Therapy (NPWT) in Orthopaedic Trauma. JBJS Rev 2019; 6:e1. [PMID: 29509555 DOI: 10.2106/jbjs.rvw.17.00042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Tyson Green
- Imperial Health Center for Orthopaedics, Lake Charles, Louisiana
| | | | - Steve Springer
- Imperial Health Center for Orthopaedics, Lake Charles, Louisiana
| | - David Drez
- Imperial Health Center for Orthopaedics, Lake Charles, Louisiana
| | - Matthew McCabe
- Imperial Health Center for Orthopaedics, Lake Charles, Louisiana
| | - Jared Gremillion
- Imperial Health Center for Orthopaedics, Lake Charles, Louisiana
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19
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Jeffery S, Leaper D, Armstrong D, Lantis J. Using negative pressure wound therapy to prevent surgical site infection. J Wound Care 2019; 27:S5-S13. [PMID: 29509094 DOI: 10.12968/jowc.2018.27.sup3.s5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
It is estimated that, at the very least, 5% of patients who undergo surgery develop a surgical site infection (SSI). There has been much interest in the use of negative pressure wound therapy (NPWT) as a prophylactic treatment to reduce the risk of SSI. Evidence suggests it can accelerate healing times, reduce both the length of hospital stay and the frequency of dressing changes, and improve patients' quality of life. The efficacy of traditional and portable NPWT systems is similar. However, the latter has an advantage in that it increases patient mobility and does not hinder individuals from carrying out activities of daily living. There are also economic data suggesting that portable NPWT devices are associated with long-term cost savings.
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Affiliation(s)
- Steven Jeffery
- Consultant Burns and Plastic Surgeon, Professor of Wound Study, Birmingham City University, UK
| | - David Leaper
- Emeritus Professor of Surgery, University of Newcastle upon Tyne, Emeritus Professor of Clinical Sciences, University of Huddersfield and Visiting Professor, Imperial College, London, UK
| | - David Armstrong
- Professor of Surgery and Director, Southwestern Academic Limb Salvage Alliance (SALSA), Keck School of Medicine, University of Southern California, US
| | - John Lantis
- Vice Chairman, Department of Surgery, Chief of Vascular and Endovascular Surgery, Mount Sinai St Luke's and West Hospitals, Professor of Surgery, Icahn School of Medicine, USA
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20
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Young AE, Davies A, Bland S, Brookes S, Blazeby JM. Systematic review of clinical outcome reporting in randomised controlled trials of burn care. BMJ Open 2019; 9:e025135. [PMID: 30772859 PMCID: PMC6398699 DOI: 10.1136/bmjopen-2018-025135] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Systematic reviews collate trial data to provide evidence to support clinical decision-making. For effective synthesis, there must be consistency in outcome reporting. There is no agreed set of outcomes for reporting the effect of burn care interventions. Issues with outcome reporting have been identified, although not systematically investigated. This study gathers empirical evidence on any variation in outcome reporting and assesses the need for a core outcome set for burn care research. METHODS Electronic searches of four search engines were undertaken from January 2012 to December 2016 for randomised controlled trials (RCTs), using medical subject headings and free text terms including 'burn', 'scald' 'thermal injury' and 'RCT'. Two authors independently screened papers, extracted outcomes verbatim and recorded the timing of outcome measurement. Duplicate outcomes (exact wording ± different spelling), similar outcomes (albumin in blood, serum albumin) and identical outcomes measured at different times were removed. Variation in outcome reporting was determined by assessing the number of unique outcomes reported across all included trials. Outcomes were classified into domains. Bias was reduced using five researchers and a patient working independently and together. RESULTS 147 trials were included, of which 127 (86.4%) were RCTs, 13 (8.8%) pilot studies and 7 (4.8%) RCT protocols. 1494 verbatim clinical outcomes were reported; 955 were unique. 76.8% of outcomes were measured within 6 months of injury. Commonly reported outcomes were defined differently. Numbers of unique outcomes per trial varied from one to 37 (median 9; IQR 5,13). No single outcome was reported across all studies demonstrating inconsistency of reporting. Outcomes were classified into 54 domains. Numbers of outcomes per domain ranged from 1 to 166 (median 11; IQR 3,24). CONCLUSIONS This review has demonstrated heterogeneity in outcome reporting in burn care research which will hinder amalgamation of study data. We recommend the development of a Core Outcome Set. PROSPERO REGISTRATION NUMBER CRD42017060908.
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Affiliation(s)
- Amber E Young
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anna Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Sara Brookes
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Jane M Blazeby
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Piaggesi A, Låuchli S, Bassetto F, Biedermann T, Marques A, Najafi B, Palla I, Scarpa C, Seimetz D, Triulzi I, Turchetti G, Vaggelas A. Advanced therapies in wound management: cell and tissue based therapies, physical and bio-physical therapies smart and IT based technologies. J Wound Care 2018; 27:S1-S137. [DOI: 10.12968/jowc.2018.27.sup6a.s1] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Alberto Piaggesi
- Prof, Director, EWMA Scientific Recorder (Editor), Diabetic Foot Section of the Pisa University Hospital, Department of Endocrinology and Metabolism, University of Pisa, Lungarno Pacinotti 43, 56126 Pisa, Italy
| | - Severin Låuchli
- Chief of Dermatosurgery and Woundcare, EWMA Immediate Past President (Co-editor), Department of Dermatology, University Hospital, Zurich, Råmistrasse 100, 8091 Zärich, Schwitzerland
| | - Franco Bassetto
- Prof, Head of Department, Clinic of Plastic and Reconstructive Surgery, University of Padova, Via Giustiniani, 35100 Padova
| | - Thomas Biedermann
- Tissue Biology Research Unit, Department of Surgery, University Children's Hospital Zurich, August Forel-Strasse 7, 8008 Zürich, Switzerland
| | - Alexandra Marques
- University of Minho, 3B's Research Group in Biomaterials, Biodegradables and Biomimetics, Avepark - Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco GMR, Portugal
| | - Bijan Najafi
- Professor of Surgery, Director of Clinical Research, Division of Vascular Surgery and Endovascular Therapy, Director of Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS: BCM390, Houston, TX 77030-3411, US
| | - Ilaria Palla
- Institute of Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Carlotta Scarpa
- Clinic of Plastic and Reconstructive Surgery, University of Padova, Via Giustiniani, 35100 Padova
| | - Diane Seimetz
- Founding Partner, Biopharma Excellence, c/o Munich Technology Center, Agnes-Pockels-Bogen 1, 80992 Munich, Germany
| | - Isotta Triulzi
- Institute of Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Giuseppe Turchetti
- Fulbright Scholar, Institute of Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Annegret Vaggelas
- Consultant, Biopharma Excellence, c/o Munich Technology Center, Agnes-Pockels-Bogen 1, 80992 Munich, Germany
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22
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Burn injury: Challenges and advances in burn wound healing, infection, pain and scarring. Adv Drug Deliv Rev 2018; 123:3-17. [PMID: 28941987 DOI: 10.1016/j.addr.2017.09.018] [Citation(s) in RCA: 304] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 12/18/2022]
Abstract
Severe burn injuries are the most traumatic and physically debilitating injuries affecting nearly every organ system and leading to significant morbidity and mortality. Early burn wound excision and skin grafting are common clinical practices that have significantly improved the outcomes for severe burn injured patients by reducing mortality rate and days of hospital stay. However, slow wound healing, infection, pain, and hypertrophic scarring continue to remain a major challenge in burn research and management. In the present article, we review and discuss issues in the current treatment of burn injuries; the advances and novel strategies developed in the past decade that have improved burn management; and also, pioneer ideas and studies in burn research which aims to enhance burn wound care with a focus on burn wound infection, pain management, treatments for scarring and skin tissue engineering.
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Lee YJ, Park MC, Park DH, Hahn HM, Kim SM, Lee IJ. Effectiveness of Acellular Dermal Matrix on Autologous Split-Thickness Skin Graft in Treatment of Deep Tissue Defect: Esthetic Subjective and Objective Evaluation. Aesthetic Plast Surg 2017; 41:1049-1057. [PMID: 28526905 DOI: 10.1007/s00266-017-0891-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 04/30/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND A split-thickness skin graft (STSG) is performed to cover a large full-thickness skin defect. Esthetic and functional deficits can result, and many studies have sought to overcome them. This study compared the effectiveness of the acellular dermal matrix (ADM) graft and STSG concerning esthetic and functional effectiveness of ADM on scar quality. METHODS Of the patients who underwent anterolateral thigh free flap from 2011 to 2015, patients who received skin graft only (n = 10) or skin graft with ADM (n = 20) for coverage of the donor site were enrolled. In all cases, autologous STSG was performed with 1:1.5 meshed 0.008-0.010-inch-thick skin. In the skin graft with ADM group, 0.008-0.013-inch-thick meshed ADM (CGderm®; CGBio, Inc., Seungnam, Korea) was co-grafted. Negative-pressure wound therapy (CuraVAC®; CGBio, Inc., Seungnam, Korea) was applied to both groups in continuous mode at -120 mmHg. We investigate early outcomes (skin loss rate, duration of negative-pressure wound therapy, days to removal of stitches, days to achieve complete healing, and complications) and late outcomes in terms of scar quality (vascularity, pigmentation, pliability and height) and graft-related symptoms (itching sensation and pain). Assessments used the Vancouver Scar Scale and the Patient and Observer Scar Assessment Scale. Skin fold was measured to evaluate the elasticity of scar tissue. RESULTS In the Vancouver Scar Scale, vascularity subscore (p = 0.003) and total score (p = 0.016) were significantly lower in the skin graft with ADM group. In Patient and Observer Scar Assessment Scale, the pain (p = 0.037) and stiffness subscores (p = 0.002), and total score (p = 0.017) were significantly lower in the skin graft with ADM group. CONCLUSIONS Skin graft with ADM results in better scar quality in objective and subjective aspects. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Widjaja W, Tan J, Maitz PKM. Efficacy of dermal substitute on deep dermal to full thickness burn injury: a systematic review. ANZ J Surg 2017; 87:446-452. [DOI: 10.1111/ans.13920] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 08/27/2016] [Accepted: 01/05/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Winy Widjaja
- Department of Surgery; Westmead Hospital; Sydney New South Wales Australia
| | - Juen Tan
- Department of Surgery; St George Hospital; Sydney New South Wales Australia
| | - Peter K. M. Maitz
- NSW Severe Burn Injury Unit; Concord Repatriation General Hospital; Sydney New South Wales Australia
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25
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Panayi AC, Leavitt T, Orgill DP. Evidence based review of negative pressure wound therapy. World J Dermatol 2017; 6:1-16. [DOI: 10.5314/wjd.v6.i1.1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/15/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
Vacuum-assisted closure, sometimes referred to as microdeformational wound therapy or most commonly negative pressure wound therapy (NPWT), has significantly improved wound care over the past two decades. NPWT is known to affect wound healing through four primary mechanisms (macrodeformation, microdeformation, fluid removal, and alteration of the wound environment) and various secondary mechanisms (including neurogenesis, angiogenesis, modulation of inflammation, and alterations in bioburden) which are described in this review. In addition, the technique has many established uses, for example in wound healing of diabetic and pressure ulcers, as well as burn and blast wounds. This therapy also has many uses whose efficacy has yet to be confirmed, for example the use in digestive surgery. Modifications of the traditional NPWT have also been established and are described in detail. This therapy has various considerations and contraindications which are summarized in this review. Finally, future perspectives, such as the optimal cycling of the treatment and the most appropriate interface material, are touched upon in the final segment. Overall, despite the fact that questions remain to be answered about NPWT, this technology is a major breakthrough in wound healing with significant potential use both in the hospital but also in the community.
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26
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Kantak NA, Mistry R, Halvorson EG. A review of negative-pressure wound therapy in the management of burn wounds. Burns 2016; 42:1623-1633. [DOI: 10.1016/j.burns.2016.06.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/16/2016] [Accepted: 06/06/2016] [Indexed: 01/07/2023]
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Use of a Dermal Regeneration Template Wound Dressing in the Treatment of Combat-Related Upper Extremity Soft Tissue Injuries. J Hand Surg Am 2016; 41:e453-e460. [PMID: 27743751 DOI: 10.1016/j.jhsa.2016.08.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 08/03/2016] [Accepted: 08/10/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the outcomes of treatment with a dermal regeneration template (DRT) in a cohort of combat casualties with severe upper extremity injuries. METHODS Records of all active duty military patients treated with DRT at our institution between November 2009 and July 2013 were screened. Inclusion criteria were upper extremity open wounds sustained during combat, requiring split-thickness or full-thickness skin grafting for closure. The primary outcome measure was wound healing after the first attempt at definitive treatment (defined as the first application of split-thickness or full-thickness skin graft). Independent variables collected included time from injury to arrival at our facility, mechanism of injury, wound infection, tobacco use, location of wound, number of operative debridements, and patient demographics. RESULTS A total of 60 patients with 69 wounds met the inclusion criteria. Most wounds were to the wrist or forearm (54%) or fingers (19%). All wounds were heavily contaminated, requiring a mean of 2.5 operative debridements before DRT placement. All wounds treated with full-thickness skin grafting after DRT healed completely without further complication. Split-thickness skin grafting was successful in 96% of patients. CONCLUSIONS DRT wound dressings are a helpful adjunct in the treatment of contaminated war wounds to the upper extremity. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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29
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Advances in Bioprinting Technologies for Craniofacial Reconstruction. Trends Biotechnol 2016; 34:700-710. [DOI: 10.1016/j.tibtech.2016.04.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 03/31/2016] [Accepted: 04/01/2016] [Indexed: 12/11/2022]
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30
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van Zuijlen P, Gardien K, Jaspers M, Bos EJ, Baas DC, van Trier A, Middelkoop E. Tissue engineering in burn scar reconstruction. BURNS & TRAUMA 2015; 3:18. [PMID: 27574664 PMCID: PMC4964040 DOI: 10.1186/s41038-015-0017-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/04/2015] [Indexed: 01/05/2023]
Abstract
Nowadays, most patients with severe burns will survive their injury. This evolution is accompanied by the challenge to cover a large percentage of total body surface area burned. Consequently, more and more patients have to deal with the sequelae of burn scars and require (multiple) reconstructions. This review provides a gross overview of developments in the field of tissue engineering for permanent burn wound coverage and reconstructive burn surgery, focusing on usage and clinical effectiveness. Not only skin substitutes will be discussed but also the replacement of subcutaneous fat tissue and cartilage.
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Affiliation(s)
- Ppm van Zuijlen
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands ; Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands ; Association of Dutch Burn Centers, Beverwijk, The Netherlands ; Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Klm Gardien
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands ; Association of Dutch Burn Centers, Beverwijk, The Netherlands ; Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Meh Jaspers
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands ; Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands ; Association of Dutch Burn Centers, Beverwijk, The Netherlands ; Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - E J Bos
- Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - D C Baas
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
| | - Ajm van Trier
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands ; Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - E Middelkoop
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands ; Association of Dutch Burn Centers, Beverwijk, The Netherlands ; Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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31
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Brouwer KM, Lundvig DMS, Middelkoop E, Wagener FADTG, Von den Hoff JW. Mechanical cues in orofacial tissue engineering and regenerative medicine. Wound Repair Regen 2015; 23:302-11. [PMID: 25787133 DOI: 10.1111/wrr.12283] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/11/2015] [Indexed: 01/26/2023]
Abstract
Cleft lip and palate patients suffer from functional, aesthetical, and psychosocial problems due to suboptimal regeneration of skin, mucosa, and skeletal muscle after restorative cleft surgery. The field of tissue engineering and regenerative medicine (TE/RM) aims to restore the normal physiology of tissues and organs in conditions such as birth defects or after injury. A crucial factor in cell differentiation, tissue formation, and tissue function is mechanical strain. Regardless of this, mechanical cues are not yet widely used in TE/RM. The effects of mechanical stimulation on cells are not straight-forward in vitro as cellular responses may differ with cell type and loading regime, complicating the translation to a therapeutic protocol. We here give an overview of the different types of mechanical strain that act on cells and tissues and discuss the effects on muscle, and skin and mucosa. We conclude that presently, sufficient knowledge is lacking to reproducibly implement external mechanical loading in TE/RM approaches. Mechanical cues can be applied in TE/RM by fine-tuning the stiffness and architecture of the constructs to guide the differentiation of the seeded cells or the invading surrounding cells. This may already improve the treatment of orofacial clefts and other disorders affecting soft tissues.
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Affiliation(s)
- Katrien M Brouwer
- Department of Orthodontics and Craniofacial Biology, Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Research Institute MOVE, VU University Medical Center, Amsterdam, The Netherlands
| | - Ditte M S Lundvig
- Department of Orthodontics and Craniofacial Biology, Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Esther Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery, Research Institute MOVE, VU University Medical Center, Amsterdam, The Netherlands.,Association of Dutch Burn Centers, Beverwijk, The Netherlands
| | - Frank A D T G Wagener
- Department of Orthodontics and Craniofacial Biology, Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Johannes W Von den Hoff
- Department of Orthodontics and Craniofacial Biology, Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands
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Shi B, Sun J, Cao Y, Yang F, Wu Y, Liang X, Li L. Application of vacuum sealing drainage to the treatment of seawater-immersed blast-injury wounds. Int Wound J 2015; 13:1198-1205. [PMID: 25951775 DOI: 10.1111/iwj.12444] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 02/27/2015] [Indexed: 12/18/2022] Open
Abstract
The aims of this study were to observe the effects of vacuum sealing drainage (VSD) with three different negative pressures on the wound healing rate, macrophage count and the expression of hyaluronic acid (HA) as well as its receptor CD44 in seawater-immersed blast-injury wounds (SIBIW) and to determine the optimal negative pressure value. In a minipig SIBIW model, different suction pressures and routine dressing were applied. Histological and immunohistochemical comparisons as well as molecular biology methods were performed to compare the wound healing conditions, macrophage count and the levels of HA and CD44. The wound healing rate of the VSD group was significantly higher than that of the control group, with the -120 mmHg group exhibiting the best effects. The macrophage count of the VSD group was higher than that of the control group. The HA level fluctuation was higher in the VSD group, with the -120 mmHg and the -180 mmHg groups showing the most significant fluctuation (P < 0·05). CD44 was expressed in the full-thickness wound-limbic tissues and was higher in the treatment group than that in the control group, with the -120 mmHg group having the most obvious expression. VSD significantly improved the healing ability and increased the macrophage count and the HA content. It also promoted CD44 expression. -120 mmHg is the optimal negative pressure value.
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Affiliation(s)
- Bing Shi
- Department of Plastic and Aesthetic Surgery, The 309th Hospital of PLA, Beijing, China
| | - Jingjing Sun
- Department of Plastic and Aesthetic Surgery, The 309th Hospital of PLA, Beijing, China
| | - Yingli Cao
- Department of Plastic and Aesthetic Surgery, The 309th Hospital of PLA, Beijing, China
| | - Fen Yang
- Department of Plastic and Aesthetic Surgery, The 309th Hospital of PLA, Beijing, China
| | - Yujia Wu
- Department of Plastic and Aesthetic Surgery, The 309th Hospital of PLA, Beijing, China
| | - Xianping Liang
- Department of Plastic and Aesthetic Surgery, The 309th Hospital of PLA, Beijing, China
| | - Li Li
- Department of Plastic and Aesthetic Surgery, The 309th Hospital of PLA, Beijing, China
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Gardien KLM, Middelkoop E, Ulrich MMW. Progress towards cell-based burn wound treatments. Regen Med 2015; 9:201-18. [PMID: 24750061 DOI: 10.2217/rme.13.97] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cell therapy as part of the concept of regenerative medicine represents an upcoming platform technology. Although cultured epidermal cells have been used in burn treatment for decades, new developments have renewed the interest in this type of treatment. Whereas early results were hampered by long culture times in order to produce confluent sheets of keratinocytes, undifferentiated proliferating cells can nowadays be applied on burns with different application techniques. The application of cells on carriers has improved early as well as long-term results in experimental settings. The results of several commercially available epidermal substitutes for burn wound treatment are reviewed in this article. These data clearly demonstrate a lack of randomized comparative trials and application of measurable outcome parameters. Experimental research in culture systems and animal models has demonstrated new developments and proof of concepts of further improvements in epidermal coverage. These include combinations of epidermal cells and mesenchymal stem cells, and the guidance of both material and cell interactions towards regeneration of skin appendages as well as vascular and nerve structures.
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Affiliation(s)
- Kim L M Gardien
- Department of Plastic Reconstructive & Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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34
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Reconstructive surgery after burns: A 10-year follow-up study. Burns 2014; 40:1544-51. [DOI: 10.1016/j.burns.2014.04.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 04/18/2014] [Accepted: 04/21/2014] [Indexed: 11/18/2022]
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Rehim SA, Singhal M, Chung KC. Dermal skin substitutes for upper limb reconstruction: current status, indications, and contraindications. Hand Clin 2014; 30:239-52, vii. [PMID: 24731613 PMCID: PMC4158916 DOI: 10.1016/j.hcl.2014.02.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Dermal skin substitutes are a group of biologically engineered materials composed of collagen and glycosaminoglycans and are devoid of cellular structures. These biodegradable materials act as an artificial dermis to promote neovascularization and neodermis formation. Their applications in soft tissue reconstructions are rapidly expanding. In this article, the indications, advantages, and limitations of dermal skin substitutes for reconstruction of soft tissue defects of the upper extremity are reviewed.
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Affiliation(s)
- Shady A Rehim
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Maneesh Singhal
- Department of Surgical Disciplines, All India Institute of Medical Sciences (AIMS), New Delhi, India
| | - Kevin C Chung
- Section of Plastic Surgery, University of Michigan Medical School, University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340, USA.
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36
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Huang C, Leavitt T, Bayer LR, Orgill DP. Effect of negative pressure wound therapy on wound healing. Curr Probl Surg 2014; 51:301-31. [PMID: 24935079 DOI: 10.1067/j.cpsurg.2014.04.001] [Citation(s) in RCA: 269] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 04/15/2014] [Indexed: 12/13/2022]
Abstract
The efficacy of NPWT in promoting wound healing has been largely accepted by clinicians, yet the number of high-level clinical studies demonstrating its effectiveness is small and much more can be learned about the mechanisms of action. In the future, hopefully we will have the data to assist clinicians in selecting optimal parameters for specific wounds including interface material, waveform of suction application, and the amount of suction to be applied. Further investigation into specific interface coatings and instillation therapy are also needed. We believe that advances in mechanobiology, the science of wound healing, the understanding of biofilms, and advances in cell therapy will lead to better care for our patients.
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Verhaegen PDHM, Bloemen MCT, van der Wal MBA, Vloemans AFPM, Tempelman FRH, Beerthuizen GIJM, van Zuijlen PPM. Skin stretching for primary closure of acute burn wounds. Burns 2014; 40:1727-37. [PMID: 24746282 DOI: 10.1016/j.burns.2014.03.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/07/2014] [Accepted: 03/08/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND In burn care, a well-acknowledged problem is the suboptimal scar outcome from skin grafted burn wounds. With the aim of improving this, we focused on a new technique: excision of the burn wound followed by primary closure, thereby using a skin-stretching device to stretch the adjacent healthy skin. The short- and long-term effect of Skin Stretch was compared to split skin grafting (SSG) in a randomized controlled trial. METHODS Patients with burn wounds were randomized for SSG or primary wound closure using Skin Stretch. Follow-up was performed at 3 and 12 months postoperatively. The scar surface area was calculated and the scar quality was assessed, using subjective and objective measurement methods. RESULTS No significant differences between the SSG and the Skin Stretch group were found for scar surface area. In the Skin Stretch group, a significant reduction of the surface area from 65.4cm(2) (13.6-129.1) to 13.4cm(2) (3.0-36.6) was found at 3 months (p=0.028) and at 12 months postoperatively (65.4cm(2) (13.6-129.1) to 33.0cm(2) (8.9-63.7), p=0.046, Wilcoxon signed ranks test). CONCLUSIONS Skin Stretch for primary closure of acute burn wounds is a suitable technique and can be considered for specific circumscript full-thickness burn wounds. However, future research should be performed to provide additional scientific evidence.
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Affiliation(s)
- Pauline D H M Verhaegen
- Association of Dutch Burn Centers, Red Cross Hospital, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands; Burn Center, Red Cross Hospital, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, VU Medical Center, Amsterdam, The Netherlands.
| | - Monica C T Bloemen
- Association of Dutch Burn Centers, Red Cross Hospital, Beverwijk, The Netherlands; Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
| | - Martijn B A van der Wal
- Association of Dutch Burn Centers, Red Cross Hospital, Beverwijk, The Netherlands; Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
| | | | | | | | - Paul P M van Zuijlen
- Association of Dutch Burn Centers, Red Cross Hospital, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands; Burn Center, Red Cross Hospital, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, VU Medical Center, Amsterdam, The Netherlands
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Differential item functioning in the Observer Scale of the POSAS for different scar types. Qual Life Res 2014; 23:2037-45. [DOI: 10.1007/s11136-014-0637-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2014] [Indexed: 11/25/2022]
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39
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Boekema BKHL, Vlig M, Olde Damink L, Middelkoop E, Eummelen L, Bühren AV, Ulrich MMW. Effect of pore size and cross-linking of a novel collagen-elastin dermal substitute on wound healing. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2014; 25:423-433. [PMID: 24178984 DOI: 10.1007/s10856-013-5075-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 10/12/2013] [Indexed: 06/02/2023]
Abstract
Collagen-elastin (CE) scaffolds are frequently used for dermal replacement in the treatment of full-thickness skin defects such as burn wounds. But little is known about the optimal pore size and level of cross-linking. Different formulations of dermal substitutes with unidirectional pores were tested in porcine full-thickness wounds in combination with autologous split skin mesh grafts (SSG). Effect on wound healing was evaluated both macro- and microscopically. CE scaffolds with a pore size of 80 or 100 μm resulted in good wound healing after one-stage grafting. Application of scaffolds with a larger average pore size (120 μm) resulted in more myofibroblasts and more foreign body giant cells (FBGC). Moderate crosslinking impaired wound healing as it resulted in more wound contraction, more FBGC and increased epidermal thickness compared to no cross-linking. In addition, take rate and redness were negatively affected compared to SSG only. Vascularization and the number of myofibroblasts were not affected by cross-linking. Surprisingly, stability of cross-linked scaffolds was not increased in the wound environment, in contrast to in vitro results. Cross-linking reduced the proliferation of fibroblasts in vitro, which might explain the reduced clinical outcome. The non-cross-linked CE substitute with unidirectional pores allowed one-stage grafting of SSG, resulting in good wound healing. In addition, only a very mild foreign body reaction was observed. Cross-linking of CE scaffolds negatively affected wound healing on several important parameters. The optimal non-cross-linked CE substitute is a promising candidate for future clinical evaluation.
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Affiliation(s)
- Bouke K H L Boekema
- Association of Dutch Burn Centres, PO Box 15, 1991 AJ, Beverwijk, The Netherlands,
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Wang X, Zhang Y, Han C. Topical negative pressure improves autograft take by altering nutrient diffusion: A hypothesis. Med Sci Monit 2014; 20:61-3. [PMID: 24435118 PMCID: PMC3907490 DOI: 10.12659/msm.889861] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The one-step surgical procedure for dermal substitutes combined with topical negative pressure (TNP) has proven effective for treating deep skin defects with improved graft take. The primary mechanism by which TNP improves autograft take is unknown. Some studies suggest that TNP promotes the rapid angiogenesis of dermal substitutes, improving graft take. However, at the early stage of one-step transplantation, the vascular system has not formed and imbibition is the main mode of nutrient supply. TNP can shorten the diffusion distance from the wound bed to the graft, leading to the timely renewal of the wound exudate via suction, removing any surplus exudate, and reducing tissue edema. In addition, TNP can regulate the local blood flow and inhibit bacterial colonization. Therefore, we hypothesized that TNP establishes a rapid balance between the nutrient supply to the wound bed and nutritional requirement of the graft via these pathways in the relatively closed, moist environment, improving autograft take. However, this balance could be affected by any negative pressure, intermittent or continuous. It is necessary to test this hypothesis in laboratory and clinical studies of the mode of nutrient supply in the imbibition phase and the change in exudate content.
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Affiliation(s)
- Xingang Wang
- Department of Burns & Wound Care Centre, Second Affiliated Hospital of Zhejiang University, Hangzhou, China (mainland)
| | - Yuanhai Zhang
- Department of Burns and Plastic Surgery, Quhua Hospital, Quzhou, China (mainland)
| | - Chunmao Han
- Department of Burns & Wound Care Centre, Second Affiliated Hospital of Zhejiang University, Hangzhou, China (mainland)
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Abstract
Approximately 2457 research articles were published with burns in the title, abstract, and/or keyword in 2012. This number continues to rise through the years; this article reviews those selected by the Editor of one of the major journals in the field (Burns) and his colleague that are most likely to have the greatest likelihood of affecting burn care treatment and understanding. As done previously, articles were found and divided into these topic areas: epidemiology of injury and burn prevention, wound and scar characterization, acute care and critical care, inhalation injury, infection, psychological considerations, pain and itching management, rehabilitation, long-term outcomes, and burn reconstruction. Each selected article is mentioned briefly with comment from the authors; readers are referred to the full papers for further details.
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Affiliation(s)
- Steven E Wolf
- Division of Burn, Trauma, and Critical Care, Department of Surgery, University of Texas - Southwestern Medical Center, Dallas, TX 75390-9158, United States.
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Bloemen MCT, van der Wal MBA, Verhaegen PDHM, Nieuwenhuis MK, van Baar ME, van Zuijlen PPM, Middelkoop E. Dermal substitution in burns: invited commentary on "The roles of topical negative pressure in deep burn wounds treated by dermal substitution". Wound Repair Regen 2013; 21:905-6. [PMID: 24134824 DOI: 10.1111/wrr.12103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wang X, Han C. The roles of topical negative pressure in deep burn wounds treated by dermal substitution. Wound Repair Regen 2013; 21:904. [PMID: 24134142 DOI: 10.1111/wrr.12105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Xingang Wang
- Department of Burns, Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
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Hop MJ, Bloemen MCT, van Baar ME, Nieuwenhuis MK, van Zuijlen PPM, Polinder S, Middelkoop E. Cost study of dermal substitutes and topical negative pressure in the surgical treatment of burns. Burns 2013; 40:388-96. [PMID: 24035577 DOI: 10.1016/j.burns.2013.08.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 08/12/2013] [Accepted: 08/15/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND A recently performed randomised controlled trial investigated the clinical effectiveness of dermal substitutes (DS) and split skin grafts (SSG) in combination with topical negative pressure (TNP) in the surgical treatment of burn wounds. In the current study, medical and non-medical costs were investigated, to comprehensively assess the benefits of this new treatment. METHODS The primary outcome was mean total costs of the four treatment strategies: SSG with or without DS, and with or without TNP. Costs were studied from a societal perspective. Findings were evaluated in light of the clinical effects on scar elasticity. RESULTS Eighty-six patients were included. Twelve months post-operatively, highest elasticity was measured in scars treated with DS and TNP (p=0.027). The initial cost price of treatment with DS and TNP was €2912 compared to treatment with SSG alone €1703 (p<0.001). However, mean total costs per patient did not differ significantly between groups (range €29097-€43774). DISCUSSION Costs of the interventional treatment contributed maximal 7% to the total costs and total costs varied widely within and between groups, but were not significantly different. Therefore, in the selection of the most optimal type of surgical intervention, cost considerations should not play an important role.
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Affiliation(s)
- M Jenda Hop
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Monica C T Bloemen
- 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.
| | | | - Paul P M van Zuijlen
- Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands; Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Esther Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands; Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, The Netherlands
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Hop MJ, Hiddingh J, Stekelenburg C, Kuipers HC, Middelkoop E, Nieuwenhuis MK, Polinder S, van Baar ME. Cost-effectiveness of laser Doppler imaging in burn care in the Netherlands. BMC Surg 2013; 13:2. [PMID: 23369360 PMCID: PMC3574826 DOI: 10.1186/1471-2482-13-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 01/24/2013] [Indexed: 01/28/2023] Open
Abstract
Background Early accurate assessment of burn depth is important to determine the optimal treatment of burns. The method most used to determine burn depth is clinical assessment, which is the least expensive, but not the most accurate. Laser Doppler imaging (LDI) is a technique with which a more accurate (>95%) estimate of burn depth can be made by measuring the dermal perfusion. The actual effect on therapeutic decisions, clinical outcomes and the costs of the introduction of this device, however, are unknown. Before we decide to implement LDI in Dutch burn care, a study on the effectiveness and cost-effectiveness of LDI is necessary. Methods/design A multicenter randomised controlled trial will be conducted in the Dutch burn centres: Beverwijk, Groningen and Rotterdam. All patients treated as outpatient or admitted to a burn centre within 5 days post burn, with burns of indeterminate depth (burns not obviously superficial or full thickness) and a total body surface area burned of ≤ 20% are eligible. A total of 200 patients will be included. Burn depth will be diagnosed by both clinical assessment and laser Doppler imaging between 2–5 days post burn in all patients. Subsequently, patients are randomly divided in two groups: ‘new diagnostic strategy’ versus ‘current diagnostic strategy’. The results of the LDI-scan will only be provided to the treating clinician in the ‘new diagnostic strategy’ group. The main endpoint is the effect of LDI on wound healing time. In addition we measure: a) the effect of LDI on other patient outcomes (quality of life, scar quality), b) the effect of LDI on diagnostic and therapeutic decisions, and c) the effect of LDI on total (medical and non-medical) costs and cost-effectiveness. Discussion This trial will contribute to our current knowledge on the use of LDI in burn care and will provide evidence on its cost-effectiveness. Trial registration NCT01489540
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Affiliation(s)
- M Jenda Hop
- Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands
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Greenhalgh DG. Clinical effectiveness of topical negative pressure for dermal substitutes in burns. Wound Repair Regen 2012; 20:791-2. [PMID: 23110719 DOI: 10.1111/j.1524-475x.2012.00855.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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