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Goh M, Du M, Peng WR, Saw PE, Chen Z. Advancing burn wound treatment: exploring hydrogel as a transdermal drug delivery system. Drug Deliv 2024; 31:2300945. [PMID: 38366562 PMCID: PMC10878343 DOI: 10.1080/10717544.2023.2300945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/05/2023] [Indexed: 02/18/2024] Open
Abstract
Burn injuries are prevalent and life-threatening forms that contribute significantly to mortality rates due to associated wound infections. The management of burn wounds presents substantial challenges. Hydrogel exhibits tremendous potential as an ideal alternative to traditional wound dressings such as gauze. This is primarily attributed to its three-dimensional (3D) crosslinked polymer network, which possesses a high water content, fostering a moist environment that supports effective burn wound healing. Additionally, hydrogel facilitates the penetration of loaded therapeutic agents throughout the wound surface, combating burn wound pathogens through the hydration effect and thereby enhancing the healing process. However, the presence of eschar formation on burn wounds obstructs the passive diffusion of therapeutics, impairing the efficacy of hydrogel as a wound dressing, particularly in cases of severe burns involving deeper tissue damage. This review focuses on exploring the potential of hydrogel as a carrier for transdermal drug delivery in burn wound treatment. Furthermore, strategies aimed at enhancing the transdermal delivery of therapeutic agents from hydrogel to optimize burn wound healing are also discussed.
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Affiliation(s)
- MeeiChyn Goh
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, China
| | - Meng Du
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, China
| | - Wang Rui Peng
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, China
- The Seventh Affiliated Hospital, Hunan Veterans Administration Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Phei Er Saw
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Nanhai Translational Innovation Center of Precision Immunology, Sun Yat-Sen Memorial Hospital, Foshan, China
| | - Zhiyi Chen
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, China
- The Seventh Affiliated Hospital, Hunan Veterans Administration Hospital, Hengyang Medical School, University of South China, Changsha, China
- The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
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Dobson GP, Morris JL, Letson HL. Pathophysiology of Severe Burn Injuries: New Therapeutic Opportunities From a Systems Perspective. J Burn Care Res 2024; 45:1041-1050. [PMID: 38517382 PMCID: PMC11303127 DOI: 10.1093/jbcr/irae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Indexed: 03/23/2024]
Abstract
Severe burn injury elicits a profound stress response with the potential for high morbidity and mortality. If polytrauma is present, patient outcomes appear to be worse. Sex-based comparisons indicate females have worse outcomes than males. There are few effective drug therapies to treat burn shock and secondary injury progression. The lack of effective drugs appears to arise from the current treat-as-you-go approach rather than a more integrated systems approach. In this review, we present a brief history of burns research and discuss its pathophysiology from a systems' perspective. The severe burn injury phenotype appears to develop from a rapid and relentless barrage of damage-associated molecular patterns, pathogen-associated molecular patterns, and neural afferent signals, which leads to a state of hyperinflammation, immune dysfunction, coagulopathy, hypermetabolism, and intense pain. We propose that if the central nervous system control of cardiovascular function and endothelial-glycocalyx-mitochondrial coupling can be restored early, these secondary injury processes may be minimized. The therapeutic goal is to switch the injury phenotype to a healing phenotype by reducing fluid leak and maintaining tissue O2 perfusion. Currently, no systems-based therapies exist to treat severe burns. We have been developing a small-volume fluid therapy comprising adenosine, lidocaine, and magnesium (ALM) to treat hemorrhagic shock, traumatic brain injury, and sepsis. Our early studies indicate that the ALM therapy holds some promise in supporting cardiovascular and pulmonary functions following severe burns. Future research will investigate the ability of ALM therapy to treat severe burns with polytrauma and sex disparities, and potential translation to humans.
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Affiliation(s)
- Geoffrey P Dobson
- Heart and Trauma Research Laboratory, College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia
| | - Jodie L Morris
- Heart and Trauma Research Laboratory, College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia
| | - Hayley L Letson
- Heart and Trauma Research Laboratory, College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia
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Buta MR, Donelan MB. Evolution of Burn Care: Past, Present, and Future. Clin Plast Surg 2024; 51:191-204. [PMID: 38429043 DOI: 10.1016/j.cps.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Burn care evolved slowly from primitive treatments depicted in cave drawings 3500 years ago to a vibrant medical specialty which has made remarkable progress over the past 200 years. This evolution involved all areas of burn care including superficial dressings, wound assessment, fluid resuscitation, infection control, pathophysiology, nutritional support, burn surgery, and inhalation injury. Major advances that contributed to current standards of care and improved outcomes are highlighted in this article. New innovations are making possible a future where severe burn injuries will require less morbid interventions for acute care and outcomes will restore patients more closely to their pre-injury condition.
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Affiliation(s)
- Martin R Buta
- Plastic, Reconstructive, and Laser Surgery, Shriners Hospitals for Children, Boston, MA, USA; Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA, USA
| | - Matthias B Donelan
- Plastic, Reconstructive, and Laser Surgery, Shriners Hospitals for Children, Boston, MA, USA; Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA, USA.
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Parvez MA, Yashiro K, Nagahama Y, Tsunoi Y, Saitoh D, Sato S, Nishidate I. In vivo visualization of burn depth in skin tissue of rats using hemoglobin parameters estimated by diffuse reflectance spectral imaging. JOURNAL OF BIOMEDICAL OPTICS 2024; 29:026003. [PMID: 38361505 PMCID: PMC10869121 DOI: 10.1117/1.jbo.29.2.026003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/04/2024] [Accepted: 01/24/2024] [Indexed: 02/17/2024]
Abstract
Significance Burn injuries represent a global public health problem that kills an estimated 180,000 people annually. Non-fatal burns result in prolonged hospitalization, disfigurement, and disability. The most common, convenient, and widely used method for assessing burn depth is physical or visual examination, but the accuracy of this method is reportedly poor (60% to 75%). Rapid, correct assessment of burn depth is very important for the optimal management and treatment of burn patients. New methods of burn depth assessment that are inexpensive, simple, rapid, non-contact, and non-invasive are therefore needed. Aim The aim of this study was to propose an approach to visualize the spatial distribution of burn depth using hemoglobin parameters estimated from spectral diffuse reflectance imaging and to demonstrate the feasibility of the proposed approach for differentiating burn depth in a rat model of scald burn injury. Approach The new approach to creating a spatial map of burn depth was based on canonical discriminant analysis (CDA) of total hemoglobin concentration, tissue oxygen saturation, and methemoglobin saturation as estimated from spectral diffuse reflectance images. Burns of three different degrees of severity were created in rat dorsal skin by 10-s exposure to water maintained at 70°C, 78°C, and 98°C, respectively. Spectral images for dorsal regions were acquired under anesthesia immediately after burn injury and at 24 h, 48 h, and 72 h after injury. Results Most areas of images in the group with skin exposed to 70°C water and 98°C water were classified as 70°C burn and 98°C burn, respectively. In contrast, no significant difference between areas classified as 78°C burn and 98°C burn from 24 h to 72 h was evident in the group with skin exposed to 78°C water, suggesting that burn depth was heterogeneous. Conclusions The proposed approach combining diffuse reflectance spectral imaging and CDA appears promising for differentiating 70°C burns from 78°C burns and 98°C burns, and 98°C burns from 70°C burns and 78°C burns at 24 to 72 h after burn injury in a rat model of scald burn injury.
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Affiliation(s)
- Md. Anowar Parvez
- Tokyo University of Agriculture and Technology, Graduate School of Bio-Applications and Systems Engineering, Tokyo, Japan
| | - Kazuhiro Yashiro
- Tokyo University of Agriculture and Technology, Graduate School of Bio-Applications and Systems Engineering, Tokyo, Japan
| | - Yuki Nagahama
- Tokyo University of Agriculture and Technology, Department of Biomedical Engineering, Tokyo, Japan
| | - Yasuyuki Tsunoi
- National Defense Medical College Research Institute, Division of Bioinformation and Therapeutic Systems, Saitama, Japan
| | - Daizoh Saitoh
- Kokushikan University, Graduate School of Emergency Medical System, Tokyo, Japan
| | - Shunichi Sato
- National Defense Medical College Research Institute, Division of Bioinformation and Therapeutic Systems, Saitama, Japan
| | - Izumi Nishidate
- Tokyo University of Agriculture and Technology, Graduate School of Bio-Applications and Systems Engineering, Tokyo, Japan
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Yu J, Kong YG, Park JY, Kim HY, Kwon M, Han YJ, Lee N, Seo YJ, Kim YK. Chart-Derived Frailty Index and 90-Day Mortality After Burn Surgery. J Surg Res 2024; 293:291-299. [PMID: 37806214 DOI: 10.1016/j.jss.2023.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/31/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Frailty is a reduced physiological reserve condition associated with postoperative morbidity and mortality. The chart-derived frailty index (CFI) can measure frailty using demographic and laboratory values. We evaluated the association of preoperative CFI with 90-d mortality after burn surgery. METHODS This large retrospective study included burn intensive care unit (ICU) patients between 2012 and 2021 and calculated CFI using the sum of the following five variables: age >70 y, body mass index <18.5 kg/m2, hematocrit <35%, albumin <3.4 g/dL, and creatinine >2.0 mg/dL; high CFI was a score of 3-5. Postoperative 90-d mortality rate, major adverse cardiac events (MACE), pneumonia, continuous renal replacement therapy (CRRT) requirement, and prolonged ICU stay (>60 d) were evaluated. RESULTS Of 1118 patients, 147 (13.1%) had high CFI. High CFI patients had a higher 90-d mortality rate than did low CFI patients (38.8% versus 22.6%, P < 0.001). A high CFI was significantly associated with postoperative 90-d mortality (hazard ratio = 4.124, 95% confidence interval = 2.980-5.707, P < 0.001) in multivariate Cox regression analysis. Kaplan-Meier analysis revealed significantly different postoperative 90-d mortality rates between patients with high and low CFIs (log-rank test, P < 0.001). Incidences of postoperative MACE, pneumonia, the need for CRRT, and prolonged ICU stay were significantly higher in patients with high CFIs than in those with low CFIs. CONCLUSIONS Preoperative high CFI was associated with increased 90-d mortality, MACE, pneumonia, CRRT requirement, and ICU stay following burn surgery.
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Affiliation(s)
- Jihion Yu
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yu-Gyeong Kong
- Department of Anesthesiology and Pain Medicine, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Jun-Young Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hee Yeong Kim
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Republic of Korea
| | - Miyoung Kwon
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Republic of Korea
| | - Yun Jae Han
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Republic of Korea
| | - Narae Lee
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Young Joo Seo
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
| | - Young-Kug Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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De La Tejera G, Corona K, Efejuku T, Keys P, Joglar A, Villarreal E, Gotewal S, Wermine K, Huang L, Golovko G, El Ayadi A, Palackic A, Wolf SE, Song J. Early wound excision within three days decreases risks of wound infection and death in burned patients. Burns 2023; 49:1816-1822. [PMID: 37369613 PMCID: PMC10721718 DOI: 10.1016/j.burns.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 03/08/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION In lieu of limited studies on the timing of burn wound eschar excision for burns, a more comprehensive analysis is indicated to determine the effects of early wound excision following burns. This study aims to address the outcomes of early wound excision in burn patients. METHODS Data collection were from TriNetX research database. Three groups of burn patients were stratified by the number of days in which they received burn wound excision within 14 days of injury. Five outcomes were observed: death, wound infection, sepsis, myocardial contractile dysfunction, and blood transfusion. Risk and incidence of various health outcomes were compared between the groups after propensity-matching age, sex, ethnicity, race and burn size using a z-test with p < 0.05 considered significant. RESULTS We identified 6158 burn patients with wound excision within 14 days of injury, the majority of whom (60.1%) received burn wound excision between 0 and 3 days after burn. 72.5% of patients had burns covering less than 20% of total body surface area. After propensity matching, we found a significantly lower risk of mortality in those who received burn wound excision within the first three days (3.84%) as compared to 8-14 days after burn (6.09%) (p < 0.05). Moreover, we found a decreased risk of wound infection in patients with burn wound excision within 0-3 days (37.84%) compared to those 4-7 days (42.48%) (p < 0.05). No statistical difference was detected in propensity-matched groups for myocardial contractile dysfunction, blood transfusion, or sepsis. In addition, the risk of hypertrophic scaring significantly decreased when wound excision was performed within 0-3 days (22% within 0-3 days, 28% within 4-7 days, p < 0.05). CONCLUSION Burn wound excision within 3 days of injury is beneficial when comparing to later treatment between 4 and 14 days, which results in a significantly lowered risk of mortality and infection in burn patient.
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Affiliation(s)
| | - Kassandra Corona
- School of Medicine, University of Texas Medical Branch, Galveston, United States
| | - Tsola Efejuku
- School of Medicine, University of Texas Medical Branch, Galveston, United States
| | - Phillip Keys
- School of Medicine, University of Texas Medical Branch, Galveston, United States
| | - Alejandro Joglar
- School of Medicine, University of Texas Medical Branch, Galveston, United States
| | - Elvia Villarreal
- School of Medicine, University of Texas Medical Branch, Galveston, United States
| | - Sunny Gotewal
- School of Medicine, University of Texas Medical Branch, Galveston, United States
| | - Kendall Wermine
- School of Medicine, University of Texas Medical Branch, Galveston, United States
| | - Lyndon Huang
- School of Medicine, University of Texas Medical Branch, Galveston, United States
| | - George Golovko
- Department of Pharmacology, University of Texas Medical Branch, Galveston, United States
| | - Amina El Ayadi
- Department of Surgery, University of Texas Medical Branch, Galveston, United States
| | - Alen Palackic
- Department of Surgery, University of Texas Medical Branch, Galveston, United States
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, United States
| | - Juquan Song
- Department of Surgery, University of Texas Medical Branch, Galveston, United States.
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Shoham Y, Krieger Y, Goverman J. Anacaulase-bcdb for the treatment of severe thermal burns. Expert Opin Biol Ther 2023; 23:1185-1191. [PMID: 37833828 DOI: 10.1080/14712598.2023.2270903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/11/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION Accurate burn depth assessment and early excision of burn eschar with maximal dermal preservation are key concepts in the optimal care of burn injury. Although excision with knife has long since been standard of care, a newer technique for wound bed preparation utilizing a bromelain-based enzyme has gained popularity worldwide and may offer several advantages. AREAS COVERED Here we report the pharmacologic properties, evidence for clinical efficacy, safety, and tolerability of anacaulase-bcdb for the treatment of deep partial thickness and full thickness burns. EXPERT OPINION Anacaulase-bcdb is a safe, non-surgical, selective eschar removal agent. It offers advantages over surgical excision of burn with knife and fulfills two unmet needs: burn depth assessment and dermal preservation during excision. Evidence supports a faster time to complete eschar removal; reduced number of operations; reduction in the amount of autografting, length of stay, and blood loss; prevention of burn induced compartment syndrome; and improved cosmetic outcome.
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Affiliation(s)
- Yaron Shoham
- Plastic and Reconstructive Surgery Department and Burn Unit, Soroka University Medical Center, Beer Sheba, Israel
- Plastic Surgery Department and Burn Unit, Ben-Gurion University of the Negev Faculty of Health Sciences, Plastic Surgery, Beer-Sheva, Israel
| | - Yuval Krieger
- Plastic and Reconstructive Surgery Department and Burn Unit, Soroka University Medical Center, Beer Sheba, Israel
- Plastic Surgery Department and Burn Unit, Ben-Gurion University of the Negev Faculty of Health Sciences, Plastic Surgery, Beer-Sheva, Israel
| | - Jeremy Goverman
- Mass General Brigham, Inc. Department of Surgery, Massachusetts General Hospital, Sumner Redstone Burn Center, Harvard Medical School, Boston, MA, USA
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The effect of Tarantula cubensis D6 on zone of stasis in a rat burn model. Burns 2023; 49:444-454. [PMID: 35654705 DOI: 10.1016/j.burns.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/04/2022] [Accepted: 05/03/2022] [Indexed: 11/21/2022]
Abstract
AIM Burn injuries are one of the most devastating injuries. Saving the zone of stasis decreases burn size, morbidity, and mortality. Tarantula cubensis (TC) increases epithelization of wounds, and increases wound contraction. In this study, we investigated the effects of TC on the stasis zone. MATERIALS AND METHODS 36 Wistar albino female rats were divided into 3 groups. Using brass comb burn model, at days 0 and 3, physiological serum solution in group 2, TC injection in group 3and no injection in group 1 was applied. Thermal and normal images were taken on day 10 and rats were sacrificed for histopathological examination. RESULTS We found a statistically significant difference between the 1st and 3rd group, 2nd and 3rd group regarding viable wound areas (p < 0.05), temperature difference (body-stasis zone) and mean body temperature (p < 0.05). We found no statistically significant difference between groups regarding neovascularization, inflammatory density, and vital cutaneous appendages. We found a statistically significant difference in epithelial layer thickness between the1st and 3rd groups, 2nd and 3rd groups(p < 0.05). CONCLUSION TC increases stasis zone viability macroscopically, increases epithelial layer thickness histopathologically, thus it promotes wound healing in burn wounds. This increase in stasis zone viability was also established with thermal imaging.
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Chen J, Zhang D, Zhang J, Wang Y. Pathological changes in the brain after peripheral burns. BURNS & TRAUMA 2023; 11:tkac061. [PMID: 36865685 PMCID: PMC9972189 DOI: 10.1093/burnst/tkac061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 12/22/2022] [Indexed: 02/09/2023]
Abstract
Brain injuries are common complications in patients with thermal burns and are associated with unpleasant outcomes. In clinical settings, it was once believed that brain injuries were not major pathological processes after burn, at least in part due to the unavailability of specific clinical manifestations. Burn-related brain injuries have been studied for more than a century, but the underlying pathophysiology has not been completely clarified. This article reviews the pathological changes in the brain following peripheral burns at the anatomical, histological, cytological, molecular and cognitive levels. Therapeutic indications based on brain injury as well as future directions for research have been summarized and proposed.
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Affiliation(s)
- Jigang Chen
- Department of Burn and Plastic Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Danfeng Zhang
- Department of Neurosurgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
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Muacevic A, Adler JR. Pediatric First-Degree Burn Management With Honey and 1% Silver Sulfadiazine (Ag-SD): Comparison and Contrast. Cureus 2022; 14:e32842. [PMID: 36570107 PMCID: PMC9779910 DOI: 10.7759/cureus.32842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 12/24/2022] Open
Abstract
Background The cardinal area of managing fire wounds is guided by adequately evaluating the burn-induced lesion's profundity and size. Superficial second-degree burns are often treated through daily reinstating with fresh sterile bandaging with appropriate topical antimicrobials to allow rapid spontaneous epithelialization. Around the world, a wide variety of substances are used to treat these wounds, from honey to synthetic biological dressings. Objective This study intended to determine honey's therapeutic potential compared with 1% silver sulfadiazine (Ag-SD) in arsenal-caused contusion medicament fulfillment. Methods A total of 70 cases were evaluated in this research work after fulfilling the required selection criteria during the study period of January 2014 to December 2014 and January 2017 to December 2017. Purposive selection criteria were adopted in the study to select research patients. The patients in Group-1 (n = 35) relied on honey as medication, while patients in Group-2 (n = 35) relied on 1% Ag-SD. Results In Group-1, exudation (68.4%) and sloughing (82.9%) were substantially reduced by Days 3 and 5 of therapeutic intervention, respectively. However, in Group-2, a reduction of exudation (17.1%) and sloughing (22.9%) occurred after Days 3 and 5 of treatment, respectively. Completion of the epithelialization process was observed among Group-1 and Group-2 cases. It was detected after Days 7 and 10 of treatment at 36.3% and 77% (Group-1) and 27% and 67% (Group-2), respectively. Around 3 ml of 1% honey was required per body surface area per dressing in Group-1. On the other hand, in Group-2, 2 gm Ag-SD was needed per body surface area per dressing. Conclusion Patients treated with honey found better clinical outcomes in managing superficial partial-thickness burns.
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Stuart K, Culhane J, Brown D, Mercier P, Kaswan S, Israel H, Moran V. Burn trauma from a space heater requiring thoracolumbar spine reconstruction and paraspinal muscle flap back reconstruction with skin grafting: A case report. Trauma Case Rep 2022; 42:100738. [DOI: 10.1016/j.tcr.2022.100738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 11/24/2022] Open
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What do we know about experiencing end-of-life in burn intensive care units? A scoping review. Palliat Support Care 2022:1-17. [PMID: 36254708 DOI: 10.1017/s1478951522001389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aim of this article is to review and synthesize the evidence on end-of-life in burn intensive care units. METHODS Systematic scoping review: Preferred Reporting Items for Systemic Reviews extension for Scoping Reviews was used as a reporting guideline. Searches were performed in 3 databases, with no time restriction and up to September 2021. RESULTS A total of 16,287 documents were identified; 18 were selected for analysis and synthesis. Three key themes emerged: (i) characteristics of the end-of-life in burn intensive care units, including end-of-life decisions, decision-making processes, causes, and trajectories of death; (ii) symptom control at the end-of-life in burn intensive care units focusing on patients' comfort; and (iii) concepts, models, and designs of the care provided to burned patients at the end-of-life, mainly care approaches, provision of care, and palliative care. SIGNIFICANCE OF RESULTS End-of-life care is a major step in the care provided to critically ill burned patients. Dying and death in burn intensive care units are often preceded by end-of-life decisions, namely forgoing treatment and do-not-attempt to resuscitate. Different dying trajectories were described, suggesting the possibility to develop further studies to identify triggers for palliative care referral. Symptom control was not described in detail. Palliative care was rarely involved in end-of-life care for these patients. This review highlights the need for early and high-quality palliative and end-of-life care in the trajectories of critically ill burned patients, leading to an improved perception of end-of-life in burn intensive care units. Further research is needed to study the best way to provide optimal end-of-life care and foster integrated palliative care in burn intensive care units.
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Enache AC, Samoila P, Cojocaru C, Bele A, Bostanaru AC, Mares M, Harabagiu V. Amphiphilic Chitosan Porous Membranes as Potential Therapeutic Systems with Analgesic Effect for Burn Care. MEMBRANES 2022; 12:973. [PMID: 36295732 PMCID: PMC9611202 DOI: 10.3390/membranes12100973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Eliminating or at least lessening the pain is a crucial aspect of burns management, as pain can negatively affect mental health and quality of life, and it can also induce a delay on wound healing. In this context, new amphiphilic chitosan 3D porous membranes were developed and investigated as burns therapeutic systems with analgesic effect for delivery of lidocaine as local anesthetic. The highly porous morphology of the membranes and the structural modifications were evidenced by scanning electron microscopy (SEM), energy dispersive X-ray (EDX) analysis and infrared spectroscopy (FTIR). Improved compression mechanical properties, long-term hydrolytic degradation (28 days) evaluation and high swelling capacities (ranging from 8 to 22.6 g/g) indicate an increased capacity of the prepared membranes to absorb physiological fluids (burns exudate). Lidocaine in vitro release efficiency was favored by the decreased content of cross-linking agent (reaching maximum value of 95.24%) and the kinetic data modeling, indicating that lidocaine release occurs by quasi-Fickian diffusion. In addition to the in vitro evaluation of analgesic effect, lidocaine-loaded chitosan membranes were successfully investigated and proved antibacterial activity against most common pathogens in burns infections: Staphylococcus aureus and Methicillin-resistant Staphylococcus aureus.
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Affiliation(s)
- Andra-Cristina Enache
- Laboratory of Inorganic Polymers, “Petru Poni” Institute of Macromolecular Chemistry, 41A Grigore Ghica Voda Alley, 700487 Iasi, Romania
| | - Petrisor Samoila
- Laboratory of Inorganic Polymers, “Petru Poni” Institute of Macromolecular Chemistry, 41A Grigore Ghica Voda Alley, 700487 Iasi, Romania
| | - Corneliu Cojocaru
- Laboratory of Inorganic Polymers, “Petru Poni” Institute of Macromolecular Chemistry, 41A Grigore Ghica Voda Alley, 700487 Iasi, Romania
| | - Adrian Bele
- Laboratory of Inorganic Polymers, “Petru Poni” Institute of Macromolecular Chemistry, 41A Grigore Ghica Voda Alley, 700487 Iasi, Romania
| | - Andra-Cristina Bostanaru
- Laboratory of Antimicrobial Chemotherapy, “Ion Ionescu de la Brad” University of Life Sciences, 8 Mihail Sadoveanu Alley, 700489 Iasi, Romania
| | - Mihai Mares
- Laboratory of Antimicrobial Chemotherapy, “Ion Ionescu de la Brad” University of Life Sciences, 8 Mihail Sadoveanu Alley, 700489 Iasi, Romania
| | - Valeria Harabagiu
- Laboratory of Inorganic Polymers, “Petru Poni” Institute of Macromolecular Chemistry, 41A Grigore Ghica Voda Alley, 700487 Iasi, Romania
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14
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Günter CI, Ilg FP, Hapfelmeier A, Egert-Schwender S, Jelkmann W, Giri S, Bader A, Machens HG. Relation Between Gender and Concomitant Medications With Erythropoietin-Treatment on Wound Healing in Burn Patients. Post Hoc Subgroup-Analysis of the Randomized, Placebo-Controlled Clinical Trial “EPO in Burns”. Front Pharmacol 2022; 13:812888. [PMID: 35847006 PMCID: PMC9284535 DOI: 10.3389/fphar.2022.812888] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/25/2022] [Indexed: 11/21/2022] Open
Abstract
Burns are leading causes of mortality and morbidity, including prolonged hospitalization, disfigurement, and disability. Erythropoietin (EPO) is a well-known hormone causing erythropoiesis. However, EPO may play a role in healing acute and chronic wounds due to its anti-inflammatory and pro-regenerative effects. Therefore, the large, prospective, placebo-controlled, randomized, double-blind, multi-center clinical trial “EPO in Burns” was initiated to investigate the effects of EPO versus placebo treatment in severely burned patients. The primary endpoint of “EPO in Burns” was defined as the time elapsed until complete re-epithelialization of a defined split skin graft donor site. Additional analyses of post hoc defined subgroups were performed in view of the primary endpoint. The verum (n 45) and control (n 39) groups were compared with regard to the time it took for study wounds (a predefined split skin graft donor site) to reach the three stages of wound healing (re-epithelialization levels). In addition, the effects of gender (females n 18) and concomitant medications insulin (n 36), non-steroidal anti-inflammatory drugs (NSAIDs) (n 41), and vasopressor agents (n 43) were tested. Life tables were used to compare study groups (EPO vs. placebo) within subgroups. The Cox regression model was applied to evaluate interactions between the study drug (EPO) and concomitant medications for each re-epithelialization level. Using our post hoc defined subgroups, we observed a lower chance of wound healing for women compared to men (in terms of hazard ratio: hr100%: 5.984 [95%-CI: (0.805–44.490), p = 0.080]) in our study population, regardless of the study medication. In addition, results indicated an earlier onset of re-epithelialization in the first days of EPO treatment (EPO: 10% vs. Placebo: 3%). Moreover, the interpretation of the hazard ratio suggested EPO might have a positive, synergistic effect on early stages of re-epithelialization when combined with insulin [hr50%: 1.307 (p = 0.568); hr75%: 1,199 (p = 0.715)], as well as a stabilizing effect on critically ill patients [reduced need for vasopressors in the EPO group (EPO: 44% vs. Placebo 59%)]. However, additional high-quality data from clinical trials designed to address these endpoints are required to gain further insight into these effects.
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Affiliation(s)
- Christina Irene Günter
- Clinic for Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
- *Correspondence: Christina Irene Günter,
| | - Felicitas Paula Ilg
- Clinic for Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Alexander Hapfelmeier
- Institute of Medical Informatics, Statistics and Epidemiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Silvia Egert-Schwender
- Müncher Studienzentrum, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | | | - Shibashish Giri
- Institute for Cell Techniques and Applied Stem Cell Biology, University of Leipzig, Leipzig, Germany
| | - Augustinus Bader
- Institute for Cell Techniques and Applied Stem Cell Biology, University of Leipzig, Leipzig, Germany
| | - Hans-Günter Machens
- Clinic for Plastic and Hand Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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15
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Palackic A, Duggan RP, Campbell MS, Walters E, Branski LK, Ayadi AE, Wolf SE. The Role of Skin Substitutes in Acute Burn and Reconstructive Burn Surgery: An Updated Comprehensive Review. Semin Plast Surg 2022; 36:33-42. [PMID: 35706557 PMCID: PMC9192152 DOI: 10.1055/s-0042-1743455] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractBurns disrupt the protective skin barrier with consequent loss of cutaneous temperature regulation, infection prevention, evaporative losses, and other vital functions. Chronically, burns lead to scarring, contractures, pain, and impaired psychosocial well-being. Several skin substitutes are available and replace the skin and partially restore functional outcomes and improve cosmesis. We performed a literature review to update readers on biologic and synthetic skin substitutes to date applied in acute and reconstructive burn surgery. Improvement has been rapid in the development of skin substitutes in the last decade; however, no available skin substitute fulfills criteria as a perfect replacement for damaged skin.
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Affiliation(s)
- Alen Palackic
- Department of Surgery, Division of Burn and Trauma Surgery, University of Texas Medical Branch, Galveston, Texas
- Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Robert P. Duggan
- Department of Surgery, Division of Burn and Trauma Surgery, University of Texas Medical Branch, Galveston, Texas
| | | | - Elliot Walters
- Department of Surgery, Division of Burn and Trauma Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Ludwik K. Branski
- Department of Surgery, Division of Burn and Trauma Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Amina El Ayadi
- Department of Surgery, Division of Burn and Trauma Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Steven E. Wolf
- Department of Surgery, Division of Burn and Trauma Surgery, University of Texas Medical Branch, Galveston, Texas
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16
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Review of History of Basic Principles of Burn Wound Management. Medicina (B Aires) 2022; 58:medicina58030400. [PMID: 35334576 PMCID: PMC8954035 DOI: 10.3390/medicina58030400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 01/09/2023] Open
Abstract
Thermal energy is an essential and useful resource to humans in modern society. However, a consequence of using heat carelessly is burns. Burn injuries have various causes, such as exposure to flame, radiation, electrical, and chemical sources. In this study, we reviewed the history of burn wound care while focusing on the basic principles of burn management. Through this review, we highlight the need for careful monitoring and customization when treating burn victims at each step of wound care, as their individual needs may differ. We also propose that future research should focus on nanotechnology-based skin grafts, as this is a promising area for further improvement in wound care.
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17
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Simões TMS, de Alencar Fernandes Neto J, Nonaka CFW, de Vasconcelos Catão MHC. Effects of photobiomodulation therapy with red LED on inflammatory cells during the healing of skin burns. Lasers Med Sci 2022; 37:2817-2822. [PMID: 35237887 DOI: 10.1007/s10103-022-03537-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/23/2022] [Indexed: 11/25/2022]
Abstract
The aim of this study was to evaluate the effects of red light emitting diode (LED) photobiomodulation therapy protocol on inflammatory cells during the healing of third-degree skin burns. Fifty Wistar rats were randomly divided into control group (CTRL) (n = 25) and red group (RED) (n = 25), with subgroups (n = 5) for each time of euthanasia (7, 14, 21, 28, and 32 days). Treatment animals were daily irradiated (630 nm ± 10 nm, 300 mW, 9 J/cm2 per point, 30 s, continuous emission mode) at the 4 angles of the wound (total: 36 J/cm2). After specimen removal, histological sections were stained with hematoxylin and eosin for quantitative analysis of the inflammatory infiltrate (neutrophils and lymphocytes) under light microscopy. Greater number of inflammatory cells was observed in irradiated groups when compared to CTRL at 7, 14, 21, and 28 days, but with statistically significant difference only at 14 days (p = 0.02). At 32 days, higher inflammatory cell value was observed in CTRL when compared to RED, but with no statistically significant difference (p = 0.91). The results suggest that red LED, according to the protocol used, modulates the number of inflammatory cells in the early stages of the healing of third-degree skin burns. Nevertheless, this low-intensity light therapy may not, be efficient in reducing the number of neutrophils and lymphocytes in advanced stages of the repair process of skin burns. Further studies with other therapy protocols are needed to assess the effects of this type of light on the inflammatory response of skin burns.
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18
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Versajet™ versus knife excision for burn wound preparation: a randomized controlled trial. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-021-01935-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Ozhathil DK, Wolf SE. Prevention and treatment of burn wound infections: the role of topical antimicrobials. Expert Rev Anti Infect Ther 2022; 20:881-896. [PMID: 35188850 DOI: 10.1080/14787210.2022.2044795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Infections related to the skin are the principal drivers of morbidity and mortality following severe burn, therefore a diverse armamentarium of topical antimicrobial agents were developed over the history of burn care. The last 30 years witnessed dramatic changes in the application of surgical intervention and utilization of topical therapies. AREAS COVERED We explore well-known topical antimicrobial products used in burn care. First, we investigate how fundamental changes in the practice of burn surgery influenced the choice of topical therapies used. Then, we examine antimicrobial creams and ointments commonly recognized due to their long record of use in burn care. Next, we dive into antimicrobial solutions commonly used as adjuncts to surgical intervention. Finally, we explore representative antimicrobial dressings, an ever-advancing roster of products opening the door to the next era in burn care. We also describe how these new agents relate to already established tools in present-day burn care. EXPERT OPINION In the current day, though the wisdom of early excision and wound closure remains valid, we continue to strive to minimize aggressive wound excision and disfiguring donor tissue collection while securing rapid wound closure. To this end, antimicrobial therapies are titrated to optimize operative outcomes and provide non-operative wound care when appropriate. Antimicrobial agents bridge the gap with the next generation of skin substitute and skin replacement therapies.
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Affiliation(s)
- Deepak K Ozhathil
- Department of Surgery, University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, Texas
| | - Steven E Wolf
- Division Chief, Burns, Trauma & Acute Care surgery, Department of Surgery, University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, Texas 77555-1220
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Al Dhafiri M, Kaliyadan F, Alghadeer MA, AL-Jaziri ZY, Alabdulmuhsin ZA, Alaithan ZA. Knowledge, Attitudes, and Practices toward First Aid Management of Skin Burns in Saudi Arabia. Clin Pract 2022; 12:97-105. [PMID: 35200264 PMCID: PMC8870400 DOI: 10.3390/clinpract12010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/27/2022] [Accepted: 02/10/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Burns are considered a serious health affection that leads to several consequences affecting a person both physically and emotionally. Herbal and traditional medicine have become popular remedies among patients worldwide. Aim: This study explores common practices followed in burns as first aid management. Methods: A cross-sectional study was conducted in the Eastern province of Saudi Arabia using a designed questionnaire distributed electronically through different social media. The questionnaire consisted of socio-demographic details, history of burns, causative material, and practices followed in response to burns. Results: 461 individuals have participated in this study. The commonest reason for burns was hot water or steam. The majority of the respondents (63%) had a satisfactory response to self-aid alone at home. The most common first aid options for managing burns at home were cold water alone 195 (42%), any sort of cream alone 177 (38%), or both 317 (69%). Overall, the result shows no statistically significant difference between the outcome of burn injury and the most commonly used burn aids. Conclusions: Most people use creams and water as the first-aid management of burns, while a good number of people use traditional medicine. Overall, people who receive hospital treatment after getting first aid at home give a better outcome.
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Affiliation(s)
- Mahdi Al Dhafiri
- Division of Dermatology, Department of Internal Medicine, College of Medicine, King Faisal University, Al-Ahsa 31982, Saudi Arabia
- Correspondence: or
| | - Feroze Kaliyadan
- Department of Dermatology, Sree Narayana Institute of Medical Sciences, Ernakulam 683101, India;
| | | | - Zainab Y. AL-Jaziri
- Medical Intern, College of Medicine, King Faisal University, Al-Ahsa 31982, Saudi Arabia; (Z.Y.A.-J.); (Z.A.A.); (Z.A.A.)
| | - Zainab A. Alabdulmuhsin
- Medical Intern, College of Medicine, King Faisal University, Al-Ahsa 31982, Saudi Arabia; (Z.Y.A.-J.); (Z.A.A.); (Z.A.A.)
| | - Zainab A. Alaithan
- Medical Intern, College of Medicine, King Faisal University, Al-Ahsa 31982, Saudi Arabia; (Z.Y.A.-J.); (Z.A.A.); (Z.A.A.)
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21
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Seo YJ, Yu J, Park JY, Lee N, Lee J, Park JH, Kim HY, Kong YG, Kim YK. Red cell distribution width/albumin ratio and 90-day mortality after burn surgery. BURNS & TRAUMA 2022; 10:tkab050. [PMID: 35097135 PMCID: PMC8793164 DOI: 10.1093/burnst/tkab050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/03/2021] [Indexed: 01/13/2023]
Abstract
Background Red cell distribution width (RDW) and serum albumin concentration are associated with postoperative outcomes. However, the usefulness of the RDW/albumin ratio in burn surgery remains unclear. Therefore, we evaluated the association between RDW/albumin ratio and 90-day mortality after burn surgery. Methods Between 2013 and 2020, a retrospective review of patients in a burn intensive care unit (ICU) was performed. Receiver operating characteristic curve, multivariate Cox logistic regression, multivariate logistic regression and Kaplan–Meier analyses were conducted to evaluate the association between RDW/albumin ratio and 90-day mortality after burn surgery. Additionally, prolonged ICU stay rate (>60 days) and ICU stay were assessed. Results Ninety-day mortality was 22.5% (210/934) in burn patients. Risk factors for 90-day mortality were RDW/albumin ratio at postoperative day 1, age, American Society of Anesthesiologists physical status, diabetes mellitus, inhalation injury, total body surface area burned, hypotensive event and red blood cell transfusion volume. The area under the curve of the RDW/albumin ratio at postoperative day 1 to predict 90-day mortality, after adjusting for age and total body surface area burned, was 0.875 (cut-off value, 6.8). The 90-day mortality was significantly higher in patients with RDW/albumin ratio >6.8 than in those with RDW/albumin ratio ≤6.8 (49.2% vs 12.3%, p < 0.001). Prolonged ICU stay rate and ICU stay were significantly higher and longer in patients with RDW/albumin ratio >6.8 than in those with RDW/albumin ratio ≤6.8 (34.5% vs 26.5%; 21 [11–38] vs 18 [7–32] days). Conclusion RDW/albumin ratio >6.8 on postoperative day 1 was associated with higher 90-day mortality, higher prolonged ICU stay rate and longer ICU stay after burn surgery.
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Affiliation(s)
- Young Joo Seo
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07247, Republic of Korea
| | - Jihion Yu
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Jun-Young Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Narea Lee
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07247, Republic of Korea
| | - Jiwoong Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Ji Hyun Park
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul 04564, Republic of Korea
| | - Hee Yeong Kim
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul 04564, Republic of Korea
| | - Yu-Gyeong Kong
- Department of Anesthesiology and Pain Medicine, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Republic of Korea
| | - Young-Kug Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
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22
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ŞAHİN Y, GÜN GÖK Z, ALÇIĞIR ME, ÇINAR M. Effects of functional poly(ethylene terephthalate) nanofibers modified with sericin-capped silver nanoparticles on histopathological changes in parenchymal organs and oxidative stress in a rat burn wound model. ANKARA ÜNIVERSITESI VETERINER FAKÜLTESI DERGISI 2022. [DOI: 10.33988/auvfd.990270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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23
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Schulman CI, Namias N, Pizano L, Rodriguez-Menocal L, Aickara D, Guzman W, Candanedo A, Maranda E, Beirn A, Badiavas EV. The effect of mesenchymal stem cells improves the healing of burn wounds: a phase 1 dose-escalation clinical trial. Scars Burn Heal 2022; 8:20595131211070783. [PMID: 35781931 PMCID: PMC9247372 DOI: 10.1177/20595131211070783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Stem cell therapy holds promise to improve healing and stimulate tissue
regeneration after burn injury. Preclinical evidence has supported this;
however, clinical studies are lacking. We examined the application of bone
marrow-derived mesenchymal stem cells (BM-MSC) to deep second-degree burn
injuries using a two-dose escalation protocol. Methods Ten individuals aged 18 years or older with deep second-degree burn wounds
were enrolled. The first five patients were administered 2.5 × 10³
BM-MSC/cm2 to their wounds. After safety of the initial dose
level was assessed, a second group of five patients was treated with a
higher concentration of 5 × 10³ allogeneic BM-MSC/cm2. Safety was
assessed clinically and by evaluating cytokine levels in mixed recipient
lymphocyte/donor BM-MSC reactions (INFγ, IL-10 and TNFα). At each visit, we
performed wound measurements and assessed wounds using a Patient and
Observer Scar Assessment Scale (POSAS). Results All patients responded well to treatment, with 100% closure of wounds and
minimal clinical evidence of fibrosis. No adverse reactions or evidence of
rejection were observed for both dose levels. Patients receiving the first
dose concentration had a wound closure rate of 3.64 cm2/day.
Patients receiving the second dose concentration demonstrated a wound
closure rate of 10.47 cm2/day. The difference in healing rates
between the two groups was not found to be statistically significant
(P = 0.17). Conclusion BM-MSC appear beneficial in optimising wound healing in patients with deep
second-degree burn wounds. Adverse outcomes were not observed when
administering multiple doses of allogeneic BM-MSC. Lay Summary Thermal injuries are a significant source of morbidity and mortality,
constituting 5%–20% of all injuries and 4% of all deaths. Despite overall
improvements in the management of acutely burned patients, morbidities
associated with deeper burn injuries remain commonplace. Burn patients are
too often left with significant tissue loss, scarring and contractions
leading to physical loss of function and long-lasting psychological and
emotional impacts. In previous studies, we have demonstrated the safety and efficacy of
administering bone marrow-derived mesenchymal stem cells (BM-MSC) to chronic
wounds with substantial improvement in healing and evidence of tissue
regeneration. In this report, we have examined the application of BM-MSC to
deep second-degree burn injuries in patients. The aim of the present phase I/II clinical trial was to examine the safety
and efficacy of administering allogeneic BM-MSC to deep second-degree burns.
We utilised two different dose levels at concentrations 2.5 × 103
and 5 × 103 cells/cm2. Patients with deep
second-degree burn wounds up to 20% of the total body surface area were
eligible for treatment. Allogeneic BM-MSC were applied to burn wounds
topically or by injection under transparent film dressing <7 days after
injury. Patients were followed for at least six months after treatment. Using two dose levels allowed us to gain preliminary information as to
whether different amounts of BM-MSC administered to burn wounds will result
in significant differences in safety/ clinical response. Once the safety and
dose-response analysis were completed, we evaluated the efficacy of
allogeneic stem cell therapy in the treatment of deep second-degree burn
wounds. In this study, we examined the role of allogeneic BM-MSC treatment in
patients with deep second-degree burn injuries, in a dose-dependent manner.
No significant related adverse events were reported. Safety was evaluated
both clinically and by laboratory-based methods. Efficacy was assessed
clinically through evidence of re-pigmentation, hair follicle restoration
and regenerative change. While these findings are encouraging, more studies
will be needed to better establish the benefit of BM-MSC in the treatment of
burn injuries.
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Affiliation(s)
- Carl I Schulman
- Department of Surgery, Ryder Trauma Center, University of Miami School of Medicine, Miami, FL, USA
| | - Nicholas Namias
- Department of Surgery, Ryder Trauma Center, University of Miami School of Medicine, Miami, FL, USA
| | - Louis Pizano
- Department of Surgery, Ryder Trauma Center, University of Miami School of Medicine, Miami, FL, USA
| | - Luis Rodriguez-Menocal
- Department of Dermatology and Cutaneous Surgery. Leonard M Miller School of Medicine, University of Miami, Interdisciplinary Stem Cell Institute, Miami, FL, USA
| | - Divya Aickara
- Department of Dermatology and Cutaneous Surgery. Leonard M Miller School of Medicine, University of Miami, Interdisciplinary Stem Cell Institute, Miami, FL, USA
| | - Wellington Guzman
- Department of Surgery, Ryder Trauma Center, University of Miami School of Medicine, Miami, FL, USA
| | - Ambar Candanedo
- Department of Surgery, Ryder Trauma Center, University of Miami School of Medicine, Miami, FL, USA
| | - Eric Maranda
- Department of Dermatology and Cutaneous Surgery. Leonard M Miller School of Medicine, University of Miami, Interdisciplinary Stem Cell Institute, Miami, FL, USA
| | - Audrey Beirn
- Department of Dermatology and Cutaneous Surgery. Leonard M Miller School of Medicine, University of Miami, Interdisciplinary Stem Cell Institute, Miami, FL, USA
| | - Evangelos V Badiavas
- Department of Dermatology and Cutaneous Surgery. Leonard M Miller School of Medicine, University of Miami, Interdisciplinary Stem Cell Institute, Miami, FL, USA
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Pavel B, Popescu MR, Skolozubova D, Flutur E, Voiculescu VM, Brezeanu AC. Early Low Level of Procalcitonin Is Associated with a Favorable Outcome in a Case of a Surviving Patient with 80% Body Surface Area Thermal Burn. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e934052. [PMID: 35642541 PMCID: PMC8635220 DOI: 10.12659/ajcr.934052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/22/2021] [Accepted: 09/28/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Burns covering a large skin surface area represent a life-threatening condition due to the release of cytokines and the activation of a systemic inflammatory response, as well as the potential for septic complications. Outcome for these patients is related to the burn surface, age, and coexisting diseases. Although some severity scores are available, such as the Abbreviated Burn Severity Index (ABSI), Baux score, R-Baux score, Boston score, and Belgian Outcome Burn Injury (BOBI) score, none can provide a solid picture of the final outcome. Recent studies claim that procalcitonin, a known sepsis marker, can assist in estimating a burn patient's chance of survival from the time of admission, and can also assist in estimating the chance of sepsis occurrence during hospitalization. CASE REPORT In this manuscript we report the case of a 28-year-old man who suffered burn injuries on approximately 80% of his body surface due to poor handling of a gasoline can in August 2018. Despite high severity index scores and early high values of C-reactive protein, we noticed a low level of early procalcitonin. In this case, as well in our previous experience, early low procalcitonin was associated with a favorable outcome. CONCLUSIONS Early procalcitonin values might prove to be a promising prognosis marker in some cases of extensive burns.
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Affiliation(s)
- Bogdan Pavel
- Division of Physiology and Neurosciences, „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Anesthesia and Intensive Care, Clinical Emergency Hospital of Plastic Surgery and Burns, Bucharest, Romania
| | - Mihaela Roxana Popescu
- Division of Physiology and Neurosciences, „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Cardiology, „Elias” Emergency Hospital, Bucharest, Romania
| | - Daria Skolozubova
- Division of Physiology and Neurosciences, „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Elena Flutur
- Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | - Vlad Mihai Voiculescu
- Division of Physiology and Neurosciences, „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Dermatology, „Elias” Emergency Hospital, Bucharest, Romania
| | - Ariana Cristina Brezeanu
- Division of Physiology and Neurosciences, „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Plastic Surgery and Burns, Clinical Emergency Hospital of Plastic Surgery and Burns, Bucharest, Romania
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25
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Li J, Fu S, Lu KW, Christie O, Gozelski MT, Cottone MC, Cottone P, Kianian S, Feng KC, Simon M, Rafailovich M, Dagum AB, Singh G. Engineering functional skin constructs: A quantitative comparison of three-dimensional bioprinting with traditional methods. Exp Dermatol 2021; 31:516-527. [PMID: 34727395 DOI: 10.1111/exd.14488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/07/2021] [Accepted: 10/15/2021] [Indexed: 11/27/2022]
Abstract
Tissue engineering has been successful in reproducing human skin equivalents while incorporating new approaches such as three-dimensional (3D) bioprinting. The latter method offers a plethora of advantages including increased production scale, ability to incorporate multiple cell types and printing on demand. However, the quality of printed skin equivalents compared to those developed manually has never been assessed. To leverage the benefits of this method, it is imperative that 3D-printed skin should be structurally and functionally similar to real human skin. Here, we developed four bilayered human skin epidermal-dermal equivalents: non-printed dermis and epidermis (NN), printed dermis and epidermis (PP), printed epidermis and non-printed dermis (PN), and non-printed epidermis and printed dermis (NP). The effects of printing induced shear stress [0.025 kPa (epidermis); 0.049 kPa (dermis)] were characterized both at the cellular and at the tissue level. At cellular level, no statistically significant differences in keratinocyte colony-forming efficiency (CFE) (p = 0.1641) were observed. In the case of fibroblasts, no significant differences in the cell alignment index (p < 0.1717) and their ability to contract collagen gel (p = 0.851) were detected. At the tissue levels, all the four skin equivalents were characterized using histological and immunohistochemical analysis with no significant differences found in either epidermal basal cell count, thickness of viable epidermis, and relative intensity of filaggrin and claudin-1. Our results demonstrated that 3D printing can achieve the same high-quality skin constructs as have been developed traditionally, thus opening new avenues for numerous high-throughput industrial and clinical applications.
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Affiliation(s)
- Juyi Li
- Department of Materials Science and Chemical Engineering Stony Brook, Stony Brook University, New York, USA
| | - Shi Fu
- Department of Materials Science and Chemical Engineering Stony Brook, Stony Brook University, New York, USA
| | - Kimberly W Lu
- Department of Materials Science and Chemical Engineering Stony Brook, Stony Brook University, New York, USA
| | - Olias Christie
- Department of Materials Science and Chemical Engineering Stony Brook, Stony Brook University, New York, USA
| | - Michael T Gozelski
- Department of Materials Science and Chemical Engineering Stony Brook, Stony Brook University, New York, USA
| | - Michael C Cottone
- Department of Materials Science and Chemical Engineering Stony Brook, Stony Brook University, New York, USA
| | - Philip Cottone
- Department of Materials Science and Chemical Engineering Stony Brook, Stony Brook University, New York, USA
| | - Sara Kianian
- Department of Surgery, Stony Brook University, Stony Brook, New York, USA
| | - Kuan-Che Feng
- Department of Materials Science and Chemical Engineering Stony Brook, Stony Brook University, New York, USA
| | - Marcia Simon
- Department of Oral Biology and Pathology, Stony Brook University, Stony Brook, New York, USA
| | - Miriam Rafailovich
- Department of Materials Science and Chemical Engineering Stony Brook, Stony Brook University, New York, USA
| | - Alexander B Dagum
- Department of Surgery, Stony Brook University, Stony Brook, New York, USA
| | - Gurtej Singh
- Department of Surgery, Stony Brook University, Stony Brook, New York, USA
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Gao C, Diao J, Jia J, Zhang L. Investigation on Potential of Novel Carrier System Containing Silver and Gold Nanoparticles for Burn Surgery: Evaluation in Rat Model. J BIOMATER TISS ENG 2021. [DOI: 10.1166/jbt.2021.2538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The main aim of the study was to optimization and evaluation of a suitable dosage form i.e., tropical gel containing silver and gold nanoparticles which are synthesized by green synthesis as this is the rapid and better alternative to chemical synthesis. For burn injury systemic route
of administration is not suitable due to damaged skin hence tropical route selected to provide controlled effects, low systemic toxicity and easy application. Silver nanoparticles were synthesized by green synthesis by use of neem leaves and gold nanoparticles by Aloe vera. Characterization
was done by UV spectroscopy, particle size distribution, TEM and zeta potential. Gel was formulated by simple mixing and stirring method and evaluated for color, homogeneity, Spreadability, viscosity, in vitro release, antimicrobial study and in vivo study. In this study, the
combination of Carbopol 934 P and HPMC (ratio 1:3) was found to be ideal formulation (Formulation F5) with optimum viscosity and Spread-ability i.e., 4459 cP and 5.7 gmcm/sec resp. in vitro release was found to be 98.66% in 12 hours. in vitro antimicrobial study and in vivo
study on rat showed maximum effects than standard formulations. From this study it can be concluded that, tropical gel is the superior dosage form containing silver and gold nanoparticles which acts as the antimicrobial agents and is effective in treatment of burn surgery.
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Affiliation(s)
- Cong Gao
- Department of Burn Rehabilitation, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, 250013, China
| | - Jianjun Diao
- Department of Medical Records Management, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, 250013, China
| | - Jun Jia
- Department of Burn Rehabilitation, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, 250013, China
| | - Lei Zhang
- Department of Burn Rehabilitation, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, 250013, China
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27
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Megas IF, Beier JP, Grieb G. The History of Carbon Monoxide Intoxication. ACTA ACUST UNITED AC 2021; 57:medicina57050400. [PMID: 33919037 PMCID: PMC8143000 DOI: 10.3390/medicina57050400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 11/16/2022]
Abstract
Intoxication with carbon monoxide in organisms needing oxygen has probably existed on Earth as long as fire and its smoke. What was observed in antiquity and the Middle Ages, and usually ended fatally, was first successfully treated in the last century. Since then, diagnostics and treatments have undergone exciting developments, in particular specific treatments such as hyperbaric oxygen therapy. In this review, different historic aspects of the etiology, diagnosis and treatment of carbon monoxide intoxication are described and discussed.
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Affiliation(s)
- Ioannis-Fivos Megas
- Department of Plastic Surgery and Hand Surgery, Gemeinschaftskrankenhaus Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany;
| | - Justus P. Beier
- Burn Center, Department of Plastic Surgery and Hand Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany;
| | - Gerrit Grieb
- Department of Plastic Surgery and Hand Surgery, Gemeinschaftskrankenhaus Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany;
- Burn Center, Department of Plastic Surgery and Hand Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany;
- Correspondence:
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El Khatib A, Jeschke MG. Contemporary Aspects of Burn Care. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:386. [PMID: 33923571 PMCID: PMC8073568 DOI: 10.3390/medicina57040386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 02/06/2023]
Abstract
The past one hundred years have seen tremendous improvements in burn care, allowing for decreased morbidity and mortality of this pathology. The more prominent advancements occurred in the period spanning 1930-1980; notably burn resuscitation, early tangential excision, and use of topical antibiotic dressings; and are well documented in burn literature. This article explores the advancements of the past 40 years and the areas of burn management that are presently topics of active discussion and research.
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Affiliation(s)
- Arij El Khatib
- Unité des Grands Brûlés, University of Montreal Medical Centre Sanguinet, 1051, Rue Sanguinet, Montréal, QC H2X 0C1, Canada
| | - Marc G. Jeschke
- Department of Surgery, Division of Plastic Surgery, Department of Immunology, Ross Tilley Burn Centre-Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, 2075 Bayview Avenue, Rm D704, Toronto, ON M4N 3M5, Canada;
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Burn wound excision within 24 h: A 9-year review. Burns 2020; 47:1300-1307. [PMID: 33419667 DOI: 10.1016/j.burns.2020.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/21/2020] [Accepted: 12/14/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Severe burns are accompanied by an acute and prolonged hypermetabolic response typified by elevated levels of proinflammatory cytokines and acute phase proteins. When persistent, this inflammatory response can result in multi-organ dysfunction and death. Regarded as the standard of care, early removal of devitalised tissue and eschar mitigates this hypermetabolic response. Ascertaining the optimal time point for early excision, which remains controversial, has several clinical implications. METHODS This retrospective observational study included 836 adult thermal burns patients with total burned surface area ≥20% from all Burns Registry of Australia and New Zealand (BRANZ) Hospital sites, including the Victorian Adult Burns Service (VABS), from July 1 2009 to June 30 2018. Patients were divided into two groups, "early" and "delayed", based on a 24-hour excision cut-off from when the injury occurred. Outcome measurements included mortality, hospital length of stay, intensive care unit length of stay, ventilation requirements and the incidence of positive blood cultures. RESULTS Among all patients at BRANZ sites, excision within 24 h was associated with reduced mean length of ICU stay (6.6 ± 8.1 vs. 9.2 ± 10.6 days; p = 0.008) and lower mean mechanical ventilator hourly use (94.9 ± 160.8 vs. 159.2 ± 219.1 h; p = 0.001) in the 20-29% TBSA sub-group. Beyond this, no significant differences were observed in outcome measurements. CONCLUSIONS While it is physiologically important to perform early burn wound excision to mitigate the inflammatory response, delaying excision beyond 24 h for surgical planning, possibly up to 72 h after injury, may be a reasonable approach for certain patient groups.
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Ziegler B, Fischer S, Pieper D, Mathes T, Kneser U, Hirche C. Evidence and Trends in Burn Wound Debridement: An Evidence Map. Plast Surg (Oakv) 2020; 28:232-242. [PMID: 33215038 DOI: 10.1177/2292550320928553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Treatment of the burn wound is crucial in care of severely burned patients. Surgical strategies differ in technique and timing of wound excision and are considered to have an impact on morbidity and mortality of burn patients. Most techniques and strategies have been established during the last century and are still standard of care. Nonetheless, several newer techniques have been presented and evaluated recently. To summarize the evidence and trends for eschar removal by burn wound debridement currently available, an evidence map as variant of the systematic review, was prepared. For this purpose, a systematic literature search was performed in the PubMed databases until December 2016. While overall evidence in this domain is low, recent publications focus on optimal timing of wound excision, enzymatic debridement, and hydrosurgery. Several studies report the benefit of an early wound excision in terms of shorter hospital stay, lower wound infection rate, and reduction of postburn metabolic changes. Enzymatic debridement has been shown to be an effective tool for early eschar removal and in addition reduces the need for autografting of the debrided burn wound with a relatively high level of evidence (LoE 2-). Wound debridement by means of hydrosurgery is more precise compared to conventional wound excision and preserves viable dermis, but a positive effect on wound healing or scar formation could not been shown (LoE 2). Furthermore, rarely reported techniques comprise larvae therapy, debridement by laser, and other technical adjuncts, but the level of evidence is limited (LoE 4-/5).
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Affiliation(s)
- Benjamin Ziegler
- Department of Hand, Plastic and Reconstructive Surgery - Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Heidelberg, Germany
| | - Sebastian Fischer
- Department of Hand, Plastic and Reconstructive Surgery - Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Heidelberg, Germany
| | - Dawid Pieper
- Department for Evidence Based Health Service Research, Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Tim Mathes
- Department for Evidence Based Health Service Research, Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery - Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Heidelberg, Germany
| | - Christoph Hirche
- Department of Hand, Plastic and Reconstructive Surgery - Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Heidelberg, Germany
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Yilmaz E, Andsoy II. Traditional and modern practices in wounds and burn injuries in a population of North Western Turkey. Burns 2020; 46:1436-1443. [DOI: 10.1016/j.burns.2020.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/19/2020] [Accepted: 01/24/2020] [Indexed: 11/25/2022]
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Shahin H, Elmasry M, Steinvall I, Söberg F, El-Serafi A. Vascularization is the next challenge for skin tissue engineering as a solution for burn management. BURNS & TRAUMA 2020; 8:tkaa022. [PMID: 32766342 PMCID: PMC7396265 DOI: 10.1093/burnst/tkaa022] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/23/2020] [Indexed: 12/19/2022]
Abstract
Skin regeneration represents a promising line of management for patients with skin loss, including burn victims. The current approach of spraying single cells over the defective areas results in variable success rates in different centers. The modern approach is to synthesize a multilayer skin construct that is based on autologous stem cells. One of the main complications with different types of transplants is sloughing due to the absence of proper vascularization. Ensuring proper vascularization will be crucial for the integration of skin constructs with the surrounding tissues. Combination of the right cells with scaffolds of proper physico-chemical properties, vascularization can be markedly enhanced. The material effect, pore size and adsorption of certain proteins, as well as the application of appropriate growth factors, such as vascular endothelial growth factors, can have an additive effect. A selection of the most effective protocols is discussed in this review.
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Affiliation(s)
- Hady Shahin
- Department of Hand Surgery and Plastic Surgery and Burns, Linköping University Hospital, 581 85, Linköping, Östergötland, Sweden
- The Department of Biomedical and Clinical Sciences, Linköping University, Linköping University Hospital, 581 83, Linköping, Östergötland, Sweden
- Faculty of Biotechnology, MSA University, 26 July Mehwar Road, 125 85, 6th October City. Egypt
| | - Moustafa Elmasry
- Department of Hand Surgery and Plastic Surgery and Burns, Linköping University Hospital, 581 85, Linköping, Östergötland, Sweden
- The Department of Biomedical and Clinical Sciences, Linköping University, Linköping University Hospital, 581 83, Linköping, Östergötland, Sweden
| | - Ingrid Steinvall
- Department of Hand Surgery and Plastic Surgery and Burns, Linköping University Hospital, 581 85, Linköping, Östergötland, Sweden
- The Department of Biomedical and Clinical Sciences, Linköping University, Linköping University Hospital, 581 83, Linköping, Östergötland, Sweden
| | - Folke Söberg
- Department of Hand Surgery and Plastic Surgery and Burns, Linköping University Hospital, 581 85, Linköping, Östergötland, Sweden
- The Department of Biomedical and Clinical Sciences, Linköping University, Linköping University Hospital, 581 83, Linköping, Östergötland, Sweden
| | - Ahmed El-Serafi
- Department of Hand Surgery and Plastic Surgery and Burns, Linköping University Hospital, 581 85, Linköping, Östergötland, Sweden
- The Department of Biomedical and Clinical Sciences, Linköping University, Linköping University Hospital, 581 83, Linköping, Östergötland, Sweden
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Asif M, Chin AGM, Lagziel T, Klifto KM, Modica AD, Duraes E, Caffrey J, Hultman CS. The Added Benefit of Combining Laser Doppler Imaging With Clinical Evaluation in Determining the Need for Excision of Indeterminate-Depth Burn Wounds. Cureus 2020; 12:e8774. [PMID: 32742824 PMCID: PMC7384459 DOI: 10.7759/cureus.8774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/22/2020] [Indexed: 11/23/2022] Open
Abstract
Background Managing indeterminate-depth burn wounds remains challenging. Laser Doppler Imaging (LDI) has been validated for burn wound depth and can influence the clinical assessment. Our study investigated the value of LDI as an adjunct in determining the need for excision. Methods Seventy American Burn Association (ABA)-verified burn centers were surveyed. A controlled pre-test assessment without LDI and post-test assessment with LDI of 100 indeterminate-depth burn wounds was conducted to evaluate the influence on the clinical judgment among different health professionals. Relative risk, analysis of variance (ANOVA), paired t-test, and intention-to-treat were used for analysis. A p-value [Formula: see text] 0.05 was considered significant. Results Among 32 burn centers, three confirmed using LDI. Six thousand grader-image interactions were analyzed. There was a significant difference in the predictive accuracy for pre-LDI and post-LDI assessments when all graders were considered (51.9% ± 7.0 vs. 72.9% ± 7.9; p < 0.0001). Post-LDI assessment added 20.9% more accuracy than the pre-LDI assessment. The post-LDI assessment was 1.4 times more likely to correctly predict the need for excision and skin-grafting than the pre-LDI assessment. All groups had an improved performance post-LDI: Group 1 (physicians), 51.9 ± 7.5 versus 76.4±5; Group 2 (nurses), 52.1 ± 6.1 versus 72.7±7.7; and Group 3 (others), 51.7 ± 9.2 versus 68.6 ± 10.1. No statistical difference was observed between groups (p = 0.92). Conclusion LDI makes the clinical examination of indeterminate-depth burn wounds more accurate. For every five LDI evaluations performed, one assessor changed their treatment plan as a result of this imaging technique. LDI is cost-effective and increases the accuracy of determining the severity of indeterminate-depth burn wounds.
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Affiliation(s)
- Mohammed Asif
- Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | | | - Tomer Lagziel
- Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
- Medicine, Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, ISR
| | - Kevin M Klifto
- Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Ashley D Modica
- Plastic Surgery, University of South Florida (USF) Health, Tampa, USA
| | - Eliana Duraes
- Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Julie Caffrey
- Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Charles S Hultman
- Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
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Cheng RY, Eylert G, Gariepy JM, He S, Ahmad H, Gao Y, Priore S, Hakimi N, Jeschke MG, Günther A. Handheld instrument for wound-conformal delivery of skin precursor sheets improves healing in full-thickness burns. Biofabrication 2020; 12:025002. [PMID: 32015225 PMCID: PMC7042907 DOI: 10.1088/1758-5090/ab6413] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The current standard of care for patients with severe large-area burns consists of autologous skin grafting or acellular dermal substitutes. While emerging options to accelerate wound healing involve treatment with allogeneic or autologous cells, delivering cells to clinically relevant wound topologies, orientations, and sizes remains a challenge. Here, we report the one-step in situ formation of cell-containing biomaterial sheets using a handheld instrument that accommodates the topography of the wound. In an approach that maintained cell viability and proliferation, we demonstrated conformal delivery to surfaces that were inclined up to 45° with respect to the horizontal. In porcine pre-clinical models of full-thickness burn, we delivered mesenchymal stem/stromal cell-containing fibrin sheets directly to the wound bed, improving re-epithelialization, dermal cell repopulation, and neovascularization, indicating that this device could be introduced in a clinical setting improving dermal and epidermal regeneration.
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Affiliation(s)
- Richard Y. Cheng
- Institute of Biomaterials and Biomedical Engineering, University of Toronto 164 College Street, Toronto, Ontario M5S 3G9, Canada
| | - Gertraud Eylert
- Institute of Medical Science, University of Toronto 1 King’s College Circle, Room 2374, Toronto, Ontario M5S 1A8, Canada
| | - Jean-Michel Gariepy
- Department of Mechanical and Industrial Engineering, University of Toronto 5 King’s College Road, Toronto, Ontario M5S3G8, Canada
| | - Sijin He
- Department of Mechanical and Industrial Engineering, University of Toronto 5 King’s College Road, Toronto, Ontario M5S3G8, Canada
| | - Hasan Ahmad
- Department of Mechanical and Industrial Engineering, University of Toronto 5 King’s College Road, Toronto, Ontario M5S3G8, Canada
| | - Yizhou Gao
- Department of Mechanical and Industrial Engineering, University of Toronto 5 King’s College Road, Toronto, Ontario M5S3G8, Canada
| | - Stefania Priore
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, 2075 Bayview Ave, Room D704, Toronto, Ontario M4N 3M5, Canada
| | - Navid Hakimi
- Department of Mechanical and Industrial Engineering, University of Toronto 5 King’s College Road, Toronto, Ontario M5S3G8, Canada
| | - Marc G. Jeschke
- Institute of Medical Science, University of Toronto 1 King’s College Circle, Room 2374, Toronto, Ontario M5S 1A8, Canada
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, 2075 Bayview Ave, Room D704, Toronto, Ontario M4N 3M5, Canada
- Department of Surgery, Department of Immunology, Division of Plastic Surgery and General Surgery, University of Toronto, 149 College Street, Toronto, Ontario M5T 1P5, Canada
| | - Axel Günther
- Institute of Biomaterials and Biomedical Engineering, University of Toronto 164 College Street, Toronto, Ontario M5S 3G9, Canada
- Department of Mechanical and Industrial Engineering, University of Toronto 5 King’s College Road, Toronto, Ontario M5S3G8, Canada
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Abstract
OBJECTIVE Treating burn patients in the battlefield is one of the biggest challenges that military doctors and medical personnel can face. Wound patterns have been changed over time due to the introduction of new weapons, and many different aspects play a major role in the management of those burns nowadays. There is a potential gap in care of burn patients in war zones. METHODS A thorough literature search in PubMed, scientific journals, and Internet sites was conducted in regard to burn patients and trauma in war zones. RESULTS It is crucial for military surgeons to be able to stabilize burn patients during wartime conflicts, especially those patients who suffer from extreme burn injuries, as specialized treatment should be given. Medical personnel should be aware of all medication types used, the ways to minimize the risk of bacterial infection, and the ways to keep the injured safe. CONCLUSIONS Injured civilians with burn trauma in the field of battle are deserving care, and special recognition should be given to the non-governmental organizations (NGOs) that strive to ease human suffering in war zones. Proper management of burn patients in war zones is crucial, and military medical staff and NGOs can play a key role in that purpose.
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Wang W, Zhang J, Lv Y, Zhang P, Huang Y, Xiang F. Epidemiological Investigation of Elderly Patients with Severe Burns at a Major Burn Center in Southwest China. Med Sci Monit 2020; 26:e918537. [PMID: 31905188 PMCID: PMC6977601 DOI: 10.12659/msm.918537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background The treatment of elderly patients with severe burns is difficult and the mortality rate is high. The aim of this study was to investigate the epidemiological features of elderly patients with severe burns. Material/Methods Data from 109 elderly patients with severe burns between January 2009 and December 2018 were retrospectively analyzed. Demographic data, clinical characteristics, treatments, and outcomes were statistically analyzed. Results Among the 109 elderly patients with severe burns, the male-to-female ratio was 1.73: 1.0. The median age of the elderly patients was 67 years, and the median total body surface area (TBSA) burned was 42%. Notably, 67.9% of burns occurred at home and most frequently occurred in summer (38.5%) and winter (28.4%); flame and flash burns predominated (83.4%). The incidence of inhalation injury was 35.8%, and pre-existing comorbidities were observed in approximately 51.4% of the patients. The median length of stay in the hospital per TBSA burned was 0.4 days. The mortality rate in the elderly patients was 24.8%, and the mortality rates in the ≥70% TBSA group, inhalation injury group, and patients with 3 or more pre-existing comorbidities were significantly higher than in the other groups. The risk of death increased with an increase in the number of pre-existing comorbidities (odds ratio: 2.222; 95% confidence interval: 1.174–4.205). Conclusions At a major burn center in Southwest China, the incidence and mortality of elderly patients with severe burns displayed no downward trend. There are etiological characteristics of these age groups that should be considered for prevention. Meanwhile, multidisciplinary treatment in a hospital and an increase in the social support for the elderly population might improve outcomes.
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Affiliation(s)
- Wensheng Wang
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China (mainland)
| | - Junhui Zhang
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China (mainland)
| | - Yanling Lv
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China (mainland)
| | - Peng Zhang
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China (mainland)
| | - Yuesheng Huang
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China (mainland)
| | - Fei Xiang
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China (mainland)
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Agabalyan NA, Sparks HD, Tarraf S, Rosin NL, Anker K, Yoon G, Burnett LN, Nickerson D, Di Martino ES, Gabriel VA, Biernaskie J. Adult Human Dermal Progenitor Cell Transplantation Modulates the Functional Outcome of Split-Thickness Skin Xenografts. Stem Cell Reports 2019; 13:1068-1082. [PMID: 31735655 PMCID: PMC6915850 DOI: 10.1016/j.stemcr.2019.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 02/01/2023] Open
Abstract
Following full-thickness skin injuries, epithelialization of the wound is essential. The standard of care to achieve this wound "closure" in patients is autologous split-thickness skin grafting (STSG). However, patients living with STSGs report significant chronic impairments leading to functional deficiencies such as itch, altered sensation, fragility, hypertrophic scarring, and contractures. These features are attributable to the absence of functional dermis combined with the formation of disorganized fibrotic extracellular matrix. Recent work has demonstrated the existence of dermal progenitor cells (DPCs) residing within hair follicles that function to continuously regenerate mesenchymal tissue. The present work examines whether cultured DPCs could regenerate dermis within an STSG and improve overall graft function. Adult human DPCs were transplanted into a full-thickness skin wound in immune-compromised mice and closed with a human STSG. At 3 months, human DPCs (hDPCs) had successfully integrated into the xenograft and differentiated into various regionally specified phenotypes, improving both viscoelastic properties of the graft and mitigating pruritus.
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Affiliation(s)
- Natacha A Agabalyan
- Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Holly D Sparks
- Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Samar Tarraf
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada
| | - Nicole L Rosin
- Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Katie Anker
- Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Grace Yoon
- Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Duncan Nickerson
- Calgary Firefighters Burn Treatment Centre, Calgary, AB, Canada; Section of Plastic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Elena S Di Martino
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada; Department of Civil Engineering, Centre for Bioengineering Research and Education, University of Calgary, Calgary, AB, Canada
| | - Vincent A Gabriel
- Calgary Firefighters Burn Treatment Centre, Calgary, AB, Canada; Departments of Clinical Neurosciences, Surgery and Paediatrics, University of Calgary, Calgary, AB, Canada; McCaig Institute of Bone and Joint Research, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Jeff Biernaskie
- Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada; Section of Plastic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Hotchkiss Brain Institute, Calgary, AB, Canada.
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Mance M, Prutki M, Dujmovic A, Miloševic M, Vrbanovic-Mijatovic V, Mijatovic D. Changes in total body surface area and the distribution of skin surfaces in relation to body mass index. Burns 2019; 46:868-875. [PMID: 31735404 DOI: 10.1016/j.burns.2019.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/09/2019] [Accepted: 10/20/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND A correct estimation of total burn surface area is important since it is used for determining fluid resuscitation volumes, nutritional estimates and hospital admission criteria. Wallace's rule of nines is the most commonly used methods for this purpose. However, fat distribution is non-uniform and the total body surface area changes with obesity. The aim of this study was to determine if the rule of nines applies to all body mass index groups. METHODS A total of 217 individuals were included in the study. The patients were divided into 4 groups according to their BMI (18.5-25kg/m2 (60 persons)), 25-29.9kg/m2 (61 individuals)), 30-34.9kg/m2 (55 persons)), >35kg/m2 (41 persons)). Each patient underwent a complete duel-energy X-ray absorptiometry body scan to determine the surface area (cm2) of the various regions of the body. RESULTS We found no statistically significant variations between the Wallace body percentage distributions and our results in the men for all BMI ranges (head p=0.331, arms p=0.861, legs p=0.282, trunk p=0.696). In contrast, among women we found a statistically significant change in body surface area percentage distribution between the BMI groups and specific body regions (head p=0.000, legs p=0.000 and trunk p=0.001). CONCLUSION The Wallace rule of nines is a quick and acceptable method for estimating the total burn surface area percentage in men of all BMI ranges. However, for women, a more accurate method of burn area estimation is required as proposed by our BMI adjusted charts.
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Affiliation(s)
- Marko Mance
- University Hospital Rebro, Department of Plastic, Reconstructive and Aesthetic Surgery, Kispaticeva 12, 10000 Zagreb, Croatia.
| | - Maja Prutki
- Clinical Hospital Centre Zagreb, School of Medicine, University of Zagreb, Department of Radiology, Kispaticeva 12, Zagreb, Croatia
| | - Anto Dujmovic
- University Hospital Rebro, Department of Plastic, Reconstructive and Aesthetic Surgery, Kispaticeva 12, 10000 Zagreb, Croatia
| | - Milan Miloševic
- Andrija Stampar School of Public Health, University of Zagreb, School of Medicine, Mirogojska cesta 16, 10000 Zagreb, Croatia
| | - Vilena Vrbanovic-Mijatovic
- University Hospital Rebro, Department of Anesthesiology and Intensive Care Medicine, Kispaticeva 12, Zagreb, Croatia
| | - Davor Mijatovic
- University Hospital Rebro, Department of Plastic, Reconstructive and Aesthetic Surgery, Kispaticeva 12, 10000 Zagreb, Croatia
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Fang H, Wang GY, Wang X, He F, Su JD. Potentially fatal electrolyte imbalance caused by severe hydrofluoric acid burns combined with inhalation injury: A case report. World J Clin Cases 2019; 7:3341-3346. [PMID: 31667189 PMCID: PMC6819295 DOI: 10.12998/wjcc.v7.i20.3341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/04/2019] [Accepted: 09/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hydrofluoric acid (HF) is one of the most common causes of chemical burns. HF burns can cause wounds that deepen and progress aggressively. As a result, HF burns are often severe even if they involve a small area of the skin. Published cases of HF burns have mostly reported small HF burn areas. Few cases of HF inhalation injury have been reported to date.
CASE SUMMARY A 24-year-old man suffered from extensive hydrofluoric acid burns covering 60% of the total body surface area (TBSA), including deep second degree burns on 47% and third degree burns on 13% of the TBSA, after he fell into a pickling pool containing 15% HF. Comprehensive treatments were carried out after the patient was admitted. Ventricular fibrillation occurred 9 times within the first 2 h, and the lowest serum Ca2+ concentration was 0.192 mmol/L. A dose of calcium gluconate (37 g) was intravenously supplied during the first 24 h, and the total amount of calcium gluconate supplementation was 343 g. Extracorporeal membrane oxygenation (ECMO) was applied for 8 d to handle the acute respiratory distress syndrome (ARDS) induced by the HF inhalation injury. The patient was discharged after 99 d of comprehensive treatment, including skin grafting.
CONCLUSION Extensive HF burns combined with an inhalation injury led to a potentially fatal electrolyte imbalance and ARDS. Adequate and timely calcium supplementation and ECMO application were the keys to successful treatment of the patient.
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Affiliation(s)
- He Fang
- Department of Burn Surgery, Changhai Hospital Affiliated to the Naval Medical University, Shanghai 200433, China
| | - Guang-Yi Wang
- Department of Burn Surgery, Changhai Hospital Affiliated to the Naval Medical University, Shanghai 200433, China
| | - Xun Wang
- Department of Burn and Plastic Surgery, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou 215002, Jiangsu Province, China
| | - Fang He
- Department of Burn and Plastic Surgery, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou 215002, Jiangsu Province, China
| | - Jian-Dong Su
- Department of Burn and Plastic Surgery, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou 215002, Jiangsu Province, China
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40
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Adibfar A, Retrouvey H, Padeanu S, Jeschke MG, Shahrokhi S. Current State of Selected Wound Regeneration Templates and Temporary Covers. CURRENT TRAUMA REPORTS 2019. [DOI: 10.1007/s40719-019-00165-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Moiemen N, Mathers J, Jones L, Bishop J, Kinghorn P, Monahan M, Calvert M, Slinn G, Gardiner F, Bamford A, Wright S, Litchfield I, Andrews N, Turner K, Grant M, Deeks J. Pressure garment to prevent abnormal scarring after burn injury in adults and children: the PEGASUS feasibility RCT and mixed-methods study. Health Technol Assess 2019; 22:1-162. [PMID: 29947328 DOI: 10.3310/hta22360] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Eleven million people suffer a fire-related injury worldwide every year, and 71% have significant scarring. Pressure garment therapy (PGT) is a standard part of burn scar management, but there is little evidence of its clinical effectiveness or cost-effectiveness. OBJECTIVE To identify the barriers to, and the facilitators of, conducting a randomised controlled trial (RCT) of burn scar management with and without PGT and test whether or not such a trial is feasible. DESIGN Web-based surveys, semistructured individual interviews, a pilot RCT including a health economic evaluation and embedded process evaluation. SETTING UK NHS burns services. Interviews and the pilot trial were run in seven burns services. PARTICIPANTS Thirty NHS burns services and 245 staff provided survey responses and 15 staff participated in individual interviews. Face-to-face interviews were held with 24 adult patients and 16 parents of paediatric patients who had undergone PGT. The pilot trial recruited 88 participants (57 adults and 31 children) who were at risk of hypertrophic scarring and were considered suitable for scar management therapy. Interviews were held with 34 participants soon after recruitment, with 23 participants at 12 months and with eight staff from six sites at the end of the trial. INTERVENTIONS The intervention was standard care with pressure garments. The control was standard care comprising scar management techniques involving demonstration and recommendations to undertake massage three or four times per day with moisturiser, silicone treatment, stretching and other exercises. MAIN OUTCOME MEASURES Feasibility was assessed by eligibility rates, consent rates, retention in allocated arms, adherence with treatment and follow-up and completion of outcome assessments. The outcomes from interview-based studies were core outcome domains and barriers to, and facilitators of, trial participation and delivery. RESULTS NHS burns services treat 2845 patients per annum (1476 paediatric and 1369 adult) and use pressure garments for 6-18 months, costing £2,171,184. The majority of staff perceived a need for a RCT of PGT, but often lacked equipoise around the research question and PGT as a treatment. Strong views about the use of PGT have the potential to influence the conduct of a full-scale RCT. A range of outcome domains was identified as important via the qualitative research: perceptions of appearance, specific scar characteristics, function, pain and itch, broader psychosocial outcomes and treatment burden. The outcome tools evaluated in the pilot trial did not cover all of these domains. The planned 88 participants were recruited: the eligibility rate was 88% [95% confidence interval (CI) 83% to 92%], the consent rate was 47% (95% CI 40% to 55%). Five (6%) participants withdrew, 14 (16%) were lost to follow-up and 8 (9%) crossed over. Adherence was as in clinical practice. Completion of outcomes was high for adult patients but poorer from parents of paediatric patients, particularly for quality of life. Sections on range of movement and willingness to pay were found to be challenging and poorly completed. LIMITATIONS The Brisbane Burn Scar Impact Profile appears more suitable in terms of conceptual coverage than the outcome scales that were used in the trial but was not available at the time of the study. CONCLUSIONS A definitive RCT of PGT in burn scar management appears feasible. However, staff attitudes to the use of pressure garments may lead to biases, and the provision of training and support to sites and an ongoing assessment of trial processes are required. FUTURE WORK We recommend that any future trial include an in-depth mixed-methods recruitment investigation and a process evaluation to account for this. TRIAL REGISTRATION Current Controlled Trials ISRCTN34483199. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 36. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Naiem Moiemen
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Laura Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan Bishop
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Philip Kinghorn
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Mark Monahan
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Gemma Slinn
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Fay Gardiner
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Amy Bamford
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Susan Wright
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ian Litchfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nicole Andrews
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Karen Turner
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Margaret Grant
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Jonathan Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
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Frear CC, Griffin B, Cuttle L, McPhail SM, Kimble R. Study of negative pressure wound therapy as an adjunct treatment for acute burns in children (SONATA in C): protocol for a randomised controlled trial. Trials 2019; 20:130. [PMID: 30760332 PMCID: PMC6374905 DOI: 10.1186/s13063-019-3223-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 01/28/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although negative pressure wound therapy (NPWT) is widely used in the management of several wound types, its efficacy as a primary therapy for acute burns has not yet been adequately investigated, with research in the paediatric population particularly lacking. There is limited evidence, however, that NPWT might benefit children with burns, amongst whom scar formation, wound progression and pain continue to present major management challenges. The purpose of this trial is to determine whether NPWT in conjunction with standard therapy accelerates healing, reduces wound progression and decreases pain more effectively than standard treatment alone. METHODS/DESIGN A total of 104 children will be recruited for this trial. To be eligible, candidates must be under 17 years of age and present to the participating children's hospital within 7 days of their injury with a thermal burn covering <5% of their total body surface area. Facial and trivial burns will be excluded. Following a randomised controlled parallel design, participants will be allocated to either an active control or intervention group. The former will receive standard therapy consisting of Acticoat™ and Mepitel™. The intervention arm will be treated with silver-impregnated dressings in addition to NPWT via the RENASYS TOUCH™ vacuum pump. Participants' dressings will be changed every 3 to 5 days until their wounds are fully re-epithelialised. Time to re-epithelialisation will be studied as the primary outcome. Secondary outcomes will include pain, pruritus, wound progression, health-care-resource use (and costs), ease of management, treatment satisfaction and adverse events. Wound fluid collected during NPWT will also be analysed to generate a proteomic profile of the burn microenvironment. DISCUSSION The study will be the first randomised controlled trial to explore the clinical effects of NPWT on paediatric burns, with the aim of determining whether the therapy warrants implementation as an adjunct to standard burns management. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12618000256279 . Registered on 16 February 2018.
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Affiliation(s)
- Cody C. Frear
- Centre for Children’s Burns and Trauma Research, Level 7, Children’s Health Research Center, The University of Queensland, 62 Graham St., South Brisbane, QLD 4101 Australia
- The Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, Lvl. 5, 501 Stanley St., South Brisbane, QLD 4101 Australia
- The University of Queensland Faculty of Medicine, 288 Herston Rd., Brisbane, QLD 4006 Australia
| | - Bronwyn Griffin
- Centre for Children’s Burns and Trauma Research, Level 7, Children’s Health Research Center, The University of Queensland, 62 Graham St., South Brisbane, QLD 4101 Australia
- The Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, Lvl. 5, 501 Stanley St., South Brisbane, QLD 4101 Australia
- The University of Queensland Faculty of Medicine, 288 Herston Rd., Brisbane, QLD 4006 Australia
| | - Leila Cuttle
- Institute of Health and Biomedical Innovation, Centre for Children’s Burns and Trauma Research, Lvl 8, Children’s Health Research Centre, Queensland University of Technology, South Brisbane, QLD 4101 Australia
| | - Steven M. McPhail
- Centre for Functioning and Health Research, Metro South Health, Queensland Health, Brisbane, QLD 4102 Australia
- School of Public Health & Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD 4059 Australia
| | - Roy Kimble
- Centre for Children’s Burns and Trauma Research, Level 7, Children’s Health Research Center, The University of Queensland, 62 Graham St., South Brisbane, QLD 4101 Australia
- The Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, Lvl. 5, 501 Stanley St., South Brisbane, QLD 4101 Australia
- The University of Queensland Faculty of Medicine, 288 Herston Rd., Brisbane, QLD 4006 Australia
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43
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Edmondson SJ, Ali Jumabhoy I, Murray A. Time to start putting down the knife: A systematic review of burns excision tools of randomised and non-randomised trials. Burns 2018; 44:1721-1737. [DOI: 10.1016/j.burns.2018.01.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 12/14/2017] [Accepted: 01/12/2018] [Indexed: 11/30/2022]
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44
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Ciprandi G, Ramsay S, Budkevich L, Strack A, van Capellen P, Marathovouniotis N. A retrospective systematic data review on the use of a polihexanide-containing product on burns in children. J Tissue Viability 2018; 27:244-248. [DOI: 10.1016/j.jtv.2018.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/29/2018] [Accepted: 08/06/2018] [Indexed: 12/28/2022]
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45
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Parasca SV, Calin MA, Manea D, Miclos S, Savastru R. Hyperspectral index-based metric for burn depth assessment. BIOMEDICAL OPTICS EXPRESS 2018; 9:5778-5791. [PMID: 30460161 PMCID: PMC6238907 DOI: 10.1364/boe.9.005778] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/20/2018] [Accepted: 09/20/2018] [Indexed: 05/27/2023]
Abstract
Burn depth objective classification is of paramount importance for decision making and treatment. Despite the wide variety of burn depth assessment methods tested so far, none of them have gained wide clinical application. Here, we introduce a new approach for burn depth assessment based on hyperspectral imaging combined with a spectral index-based technique that exploits specific spectral bands to map skin areas with different burn degrees. The spectral index amplifies the contrast between normal skin and areas with different degrees of burn, taking advantage of the differences in spectral amplitudes that occur as a result of the morphological and physiological changes occurring in burned skin. We demonstrate that by using the new measurable spectral index, it is possible to generate accurate burn classification maps showing spatial distribution of burn types in the affected body areas, facilitating the decision-making process and prognosis evaluation. The results highlight the potential of the new hyperspectral metric in the field of burn depth classification and its applicability in hospital settings seems promising.
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Affiliation(s)
- Sorin Viorel Parasca
- Plastic and Reconstructive Surgery Department, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, Bucharest 020022, Romania
- Emergency Clinical Hospital for Plastic, Reconstructive Surgery and Burns, 218 Grivitei Street, Bucharest, Romania
| | - Mihaela Antonina Calin
- National Institute of Research and Development for Optoelectronics INOE 2000, 409 Atomistilor Street, P.O. Box MG5, Magurele, Ilfov 077125, Romania
| | - Dragos Manea
- National Institute of Research and Development for Optoelectronics INOE 2000, 409 Atomistilor Street, P.O. Box MG5, Magurele, Ilfov 077125, Romania
| | - Sorin Miclos
- National Institute of Research and Development for Optoelectronics INOE 2000, 409 Atomistilor Street, P.O. Box MG5, Magurele, Ilfov 077125, Romania
| | - Roxana Savastru
- National Institute of Research and Development for Optoelectronics INOE 2000, 409 Atomistilor Street, P.O. Box MG5, Magurele, Ilfov 077125, Romania
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46
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Chan CH, Yang SF, Yeh HW, Yeh YT, Wang YH, Teng YH, Yeh CB. Risk of pneumonia in patients with burn injury: a population-based cohort study. Clin Epidemiol 2018; 10:1083-1091. [PMID: 30214313 PMCID: PMC6121749 DOI: 10.2147/clep.s172980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Burns are the main cause of accidental injury, and pneumonia is a common respiratory disease in humans. Aim The purpose of this study was to investigate the relationship between burn injury and pneumonia. Patients and methods A nationwide population-based cohort study was conducted using data from the National Health Insurance Research Database in Taiwan. We identified and enrolled 2,893 subjects with burn injury, who were individually matched to 2,893 subjects in the comparison group by using the propensity score. Furthermore, we used a self-controlled case-series design to estimate the temporal association between burn injury and pneumonia. Results Exposure to burn injury revealed a higher risk of pneumonia than that to non-burn injury within 1 year. The Cox proportional hazards model revealed that, compared with the non-burn injury, burn injury yielded a 2.39-fold (95% CI=1.44-3.96) increase in risk of pneumonia. The exposure period of burn injury within 30 days showed 2.76-fold increase in risk of pneumonia (95% CI=1.44-3.96) compared with that in the baseline period. Conclusion Burn injury was associated with a significant increased risk of pneumonia, especially occurring within 30 days.
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Affiliation(s)
- Chi-Ho Chan
- Department of Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Shun-Fa Yang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Han-Wei Yeh
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Ying-Tung Yeh
- Graduate School of Dentistry, Chung Shan Medical University, Taichung, Taiwan, Republic of China.,School of Dentistry, Chung Shan Medical University, Taichung, Taiwan, Republic of China.,Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Ying-Hock Teng
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China, .,Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China,
| | - Chao-Bin Yeh
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China, .,Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China,
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47
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Maqsood SE, Cascone N, Grixti A, Kannan R, Nduka C, Malhotra R. Functional and aesthetic outcomes of eyelid skin grafting in facial nerve palsy. Br J Ophthalmol 2018; 103:bjophthalmol-2018-312311. [PMID: 29945894 DOI: 10.1136/bjophthalmol-2018-312311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/03/2022]
Abstract
AIM To report the functional and aesthetic outcomes of eyelid full-thickness skin grafting (FTSG) in patients with facial nerve palsy (FNP). METHODS This is a retrospective, non-comparative, single-centre review of all patients with FNP who underwent FTSG over an 8-year period. Functional outcomes were collected through case notes review: CADS (cornea, static asymmetry and dynamic and synkinesis) score facial nerve grading and lagophthalmos on blink, gentle and forced closure. Marginal reflex distance (MRD1 and MRD2) was calculated on standardised photographs. The aesthetic outcomes were assessed objectively by two blinded independent assessors who assessed standardised photographs based on a mutually agreed grading scale. Both functional and aesthetic outcomes were measured preoperatively, and at early (1-3 months), intermediate (3-6 months) and late (>9 months) postoperative periods. RESULTS A total of 28 eyelid FTSGs were performed on 21 patients (11 female, 10 male) between 2008 and 2016. The mean age was 68 (range, 16-89) years and the mean follow-up was 20.8 (range, 12-30) months. The CADS score (cornea (p<0.001), static asymmetry (p<0.001), dynamic function (p<0.001)), MRD2 (p=0.002) and lagophthalmos (blink (p=0.003), gentle (p<0.001), forced (p=0.003)) improved through early and late postoperative periods. Aesthetically, the grafts appeared to look natural in terms of colour, surface contour and graft edge from the intermediate postoperative period and continued to improve significantly by the late postoperative period. CONCLUSION The use of periocular FTSG is effective in improving lagophthalmos and periorbital symmetry in patients with FNP where skin contraction exists. They should be considered as an adjunct to other oculoplastic procedures for both functional and aesthetic rehabilitation.
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Affiliation(s)
| | - Nikhil Cascone
- Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK
| | - Andre Grixti
- Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK
| | - Ruben Kannan
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, UK
| | - Charles Nduka
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, UK
| | - Raman Malhotra
- Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK
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Oh EJ, Lee HW, Kalimuthu S, Kim TJ, Kim HM, Baek SH, Zhu L, Oh JM, Son SH, Chung HY, Ahn BC. In vivo migration of mesenchymal stem cells to burn injury sites and their therapeutic effects in a living mouse model. J Control Release 2018; 279:79-88. [PMID: 29655989 DOI: 10.1016/j.jconrel.2018.04.020] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 04/06/2018] [Accepted: 04/11/2018] [Indexed: 12/18/2022]
Abstract
Mesenchymal stem cell (MSC)-based therapy has emerged as a promising therapeutic strategy for tissue regeneration and repair. In this study, we non-invasively monitored the tracking of MSCs toward burn injury sites using MSCs expressing firefly luciferase (Fluc) gene in living mice, and evaluated the effects of the MSCs at the injury site. Murine MSCs co-expressing Fluc and green fluorescent protein (GFP) were established using a retroviral system (referred to as MSC/Fluc). To evaluate the ability of MSC migration toward burn injury sites, cutaneous burn injury was induced in the dorsal skin of mice. MSC/Fluc was intravenously administrated into the mice model and bioluminescence imaging (BLI) was performed to monitor MSC tracking at designated time points. BLI signals of MSC/Fluc appeared in burn injury lesions at 4 days after the cell injection and then gradually decreased. Immunoblotting analysis was conducted to determine the expression of neovascularization-related genes such as TGF-β1 and VEGF in burnt skin. The levels of TGF-β1 and VEGF were higher in the MSC/Fluc-treated group than in the burn injury group. Our observations suggested that MSCs might assist burn wound healing and that MSCs expressing Fluc could be a useful tool for optimizing MSC-based therapeutic strategies for burn wound healing.
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Affiliation(s)
- Eun Jung Oh
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea; Department of Plastic and Reconstructive Surgery, Kyungpook National University Hospital, Daegu, South Korea; Cell & Matrix Research Institute, Kyungpook National University, Daegu, South Korea
| | - Ho Won Lee
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea; Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Senthilkumar Kalimuthu
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea; Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Tae Jung Kim
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea; Department of Plastic and Reconstructive Surgery, Kyungpook National University Hospital, Daegu, South Korea
| | - Hyun Mi Kim
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea; Department of Plastic and Reconstructive Surgery, Kyungpook National University Hospital, Daegu, South Korea
| | - Se Hwan Baek
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea; Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Liya Zhu
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea; Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Ji Min Oh
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea; Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Seung Hyun Son
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea; Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Ho Yun Chung
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea; Department of Plastic and Reconstructive Surgery, Kyungpook National University Hospital, Daegu, South Korea.
| | - Byeong-Cheol Ahn
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea; Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, South Korea.
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49
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Abstract
It is unknown whether variations in burn care affect outcomes or affect the success of emerging therapeutics. The purpose of this study was to assess burn surgeons' preferences in excision and grafting to determine if surgical technique affects outcomes. A 71-item survey evaluating skin grafting techniques and preferences was emailed to members of the American Burn Association in July and August 2015. The survey was anonymous and voluntary. Relationships between variables were evaluated using Fisher's exact test. A P-value of ≤.05 was deemed statistically significant. The survey was sent to 607 burn surgeons, and the response rate was 24%. Clinical judgment is the most widely used method to determine depth of injury. Surgeons who practice in the United States and surgeons who are board certified in general surgery are more likely to determine depth of the burn based on clinical judgment alone (P < .001). Fifty-six percent of surgeons will perform excision as early as postburn day 1 and 73% will excise greater than 20% TBSA in one setting. Surgeons at centers with bed number of ≤10 (P = .024) or surgeons with board certification in plastic surgery (P = .008) are more likely to excise deep partial-thickness burns with an attempt to retain viable dermis. Geographic location, board certification, and burn unit size all contribute to variations in practice. Strong individual preferences make standardization of therapies challenging and may affect the success of new technologies. Burn surgery continues to be an art as much as a science, and accurate documentation of techniques and outcomes is essential for optimizing successes and documenting failures of new treatment methods.
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Wearn C, Lee KC, Hardwicke J, Allouni A, Bamford A, Nightingale P, Moiemen N. Prospective comparative evaluation study of Laser Doppler Imaging and thermal imaging in the assessment of burn depth. Burns 2018; 44:124-133. [DOI: 10.1016/j.burns.2017.08.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/06/2017] [Accepted: 08/09/2017] [Indexed: 11/28/2022]
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