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Palackic A, Rego A, Parry I, Sen S, Branski LK, Hallman TG, Spratt H, Lee JO, Herndon DN, Wolf SE, Suman OE. Effects of Aerobic Exercise in the Intensive Care Unit on Patient-Reported Physical Function and Mental Health Outcomes in Severely Burned Children-A Multicenter Prospective Randomized Trial. J Pers Med 2023; 13:455. [PMID: 36983636 PMCID: PMC10058069 DOI: 10.3390/jpm13030455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023] Open
Abstract
Severe burns are life-altering and can have lasting effects on patients' physical and mental health. Alterations in physical function, changes in appearance, and psychological disturbances resulting from severe burns are especially concerning in children, as they are still in the early stages of identity formation. Exercise in the nonburn population has been shown to improve quality of life and result in better physical and mental status. However, the effect of early exercise on the quality of life in pediatric burn patients requires more research. METHODS Forty-eight children between the ages of seven and seventeen with ≥30% total body surface area (TBSA) burn were randomized in a 1:2 fashion to receive treatment with standard-of-care (SOC) or standard-of-care plus exercise (SOC+Ex). Surveys administered at admission and discharge collected patient-reported information regarding physical and mental health outcomes. The results are given as means +/- standard deviation. Significance was set at p < 0.05. RESULTS The average age of the SOC and SOC+Ex groups were 12 ± 3 and 13 ± 4 years, respectively. The average %TBSA burned in the SOC and SOC+Ex groups were 54 ± 17 and 48 ± 14, respectively. The SOC+Ex group averaged 10 ± 9 exercise sessions (range of 1 to 38 sessions) with an attendance rate of 25% (10 sessions out of 40 BICU days). Both groups demonstrated significant improvement in patient-reported physical and mental outcomes during hospital admission (p < 0.05) However, additional exercise did not exhibit any additional benefits for measured levels. CONCLUSIONS Our recommendation is for all pediatric patients in the BICU to continue with the SOC and consult with their physician over the benefits of additional aerobic exercise. This study suggests that perhaps there is potential for increasing the amount of exercise that can be administered to pediatric burn survivors beyond SOC as we did not find aerobic exercise to be of any harm to any patients if it is performed properly and under supervision.
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Affiliation(s)
- Alen Palackic
- Department of Surgery, School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Andrea Rego
- Department of Surgery, School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Ingrid Parry
- Department of Surgery, University of California, Davis, CA 95616, USA
| | - Soman Sen
- Department of Surgery, University of California, Davis, CA 95616, USA
| | - Ludwik K. Branski
- Department of Surgery, School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Taylor G. Hallman
- Department of Surgery, School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Heidi Spratt
- Department of Biostatistics and Data Science, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Jong O. Lee
- Department of Surgery, School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - David N. Herndon
- Oxford University Press, Wolters Kluwer N.V., 2400BA Alphen aan den Rijn, The Netherlands
| | - Steven E. Wolf
- Department of Surgery, School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Oscar E. Suman
- Department of Surgery, School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
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Palackic A, Jay JW, Duggan RP, Branski LK, Wolf SE, Ansari N, El Ayadi A. Therapeutic Strategies to Reduce Burn Wound Conversion. Medicina (B Aires) 2022; 58:medicina58070922. [PMID: 35888643 PMCID: PMC9315582 DOI: 10.3390/medicina58070922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/02/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022] Open
Abstract
Burn wound conversion refers to the phenomenon whereby superficial burns that appear to retain the ability to spontaneously heal, convert later into deeper wounds in need of excision. While no current treatment can definitively stop burn wound conversion, attempts to slow tissue damage remain unsatisfactory, justifying the need for new therapeutic interventions. To attenuate burn wound conversion, various studies have targeted at least one of the molecular mechanisms underlying burn wound conversion, including ischemia, inflammation, apoptosis, autophagy, generation of reactive oxygen species, hypothermia, and wound rehydration. However, therapeutic strategies that can target various mechanisms involved in burn wound conversion are still lacking. This review highlights the pathophysiology of burn wound conversion and focuses on recent studies that have turned to the novel use of biologics such as mesenchymal stem cells, biomaterials, and immune regulators to mitigate wound conversion. Future research should investigate mechanistic pathways, side effects, safety, and efficacy of these different treatments before translation into clinical studies.
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Affiliation(s)
- Alen Palackic
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.P.); (J.W.J.); (R.P.D.); (L.K.B.); (S.E.W.)
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, A-8036 Graz, Austria
| | - Jayson W. Jay
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.P.); (J.W.J.); (R.P.D.); (L.K.B.); (S.E.W.)
| | - Robert P. Duggan
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.P.); (J.W.J.); (R.P.D.); (L.K.B.); (S.E.W.)
| | - Ludwik K. Branski
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.P.); (J.W.J.); (R.P.D.); (L.K.B.); (S.E.W.)
| | - Steven E. Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.P.); (J.W.J.); (R.P.D.); (L.K.B.); (S.E.W.)
| | - Naseem Ansari
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Amina El Ayadi
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.P.); (J.W.J.); (R.P.D.); (L.K.B.); (S.E.W.)
- Correspondence:
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Chao T, Parry I, Palackic A, Sen S, Spratt H, Mlcak RP, Lee JO, Herndon DN, Wolf SE, Branski LK, Suman OE. The effects of short bouts of ergometric exercise for severely burned children in intensive care: A randomized controlled trial. Clin Rehabil 2022; 36:1052-1061. [PMID: 35473409 PMCID: PMC9420547 DOI: 10.1177/02692155221095643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the effects of short bouts of ergometric exercises on the number of days in the burn intensive care unit (ICU), body mass, and functional ambulation. DESIGN Multi-center, randomized controlled trial. SETTING Burn intensive care unit. PARTICIPANTS Children ages 7-17 with severe burns covering over 30% total body surface area (TBSA). INTERVENTION All patients received standard of care (Control) with the experimental group receiving additional exercise with a cycle ergometer (Exercise). MAIN MEASURES The number of days in the ICU, total weight, lean body mass (LBM), and functional ambulation were taken shortly after randomization and again within one week of the scheduled hospital discharge. Results of outcomes are expressed as median ± interquartile range (IQR), unless otherwise noted (e.g. demographics). RESULTS Fifty-four severely burned children (n = 18 Control, n = 36 Exercise) were included. The average ± standard deviation for age was 12 ± 3 years and TBSA was 48 ± 16%. The median ± IQR ICU days for Control was 46 ± 51 days vs 31 ± 29 days for Exercise. The median total weight loss for Control was 2.2 ± 1.2 kg vs 1.8 ± 1.4 kg in Exercise. Control lost 0.75 ± 0.8 kg of LBM vs 0.46 ± 0.43 kg in Exercise. Both groups showed significant improvement in functional ambulation (p < 0.01). However, exercise did not add additional benefits. CONCLUSION Short bouts of ergometric exercises are feasible for severely burned patients while receiving care in the ICU but did not add additional benefits.
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Affiliation(s)
- Tony Chao
- Department of Physical Therapy, School of Health Professions, 12338University of Texas Medical Branch, Galveston, TX, USA
| | - Ingrid Parry
- 8789University of California-Davis, Shriners Children's Northern California Hospital, Sacramento, CA, USA
| | - Alen Palackic
- Department of Surgery, School of Medicine, 12338University of Texas Medical Branch, Galveston, TX, USA.,Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, 31475Medical University of Graz, Graz, Austria
| | - Soman Sen
- 8789University of California-Davis, Shriners Children's Northern California Hospital, Sacramento, CA, USA
| | - Heidi Spratt
- Office of Biostatistics, 351229Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Ronald P Mlcak
- 24174Shriners Children's Texas Hospital, Galveston, TX, USA
| | - Jong O Lee
- Department of Surgery, School of Medicine, 12338University of Texas Medical Branch, Galveston, TX, USA
| | - David N Herndon
- 276672Joseph Still Burn Research Foundation, Journal of Burn Care and Research, Augusta, USA
| | - Steven E Wolf
- Department of Surgery, School of Medicine, 12338University of Texas Medical Branch, Galveston, TX, USA
| | - Ludwik K Branski
- Department of Surgery, School of Medicine, 12338University of Texas Medical Branch, Galveston, TX, USA
| | - Oscar E Suman
- Department of Surgery, School of Medicine, 12338University of Texas Medical Branch, Galveston, TX, USA
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Houschyar KS, Borrelli MR, Rein S, Tapking C, Popp D, Palackic A, Puladi B, Ooms M, Houschyar M, Branski LK, Schmitt L, Modabber A, Rübben A, Hölzle F, Yazdi AS. Head and neck squamous cell carcinoma: a potential therapeutic target for the Wnt signaling pathway. Eur J Plast Surg 2022. [DOI: 10.1007/s00238-022-01958-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Squamous cell carcinoma (SCC) of the head and neck region accounts for 3% of all tumors worldwide. The incidence is higher in men, with most carcinomas found in the oral cavity. At the point of initial diagnosis, distant metastases are rare. The Wnt signaling pathway is critically involved in cell development and stemness and has been associated with SCC. Understanding precisely how Wnt signaling regulates SCC progression and how it can, therefore, be modulated for the therapeutic benefit has enormous potential in the treatment of head and neck SCC. In this review, we will describe the underlying mechanisms of Wnt signaling and outline how Wnt signaling controls cellular processes both in homeostasis and in the development and progression of SCC.Level of evidence: Not gradable.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Duggan RP, Brondeel KC, Mahony WL, Torres G, Palackic A, Branski LK. 546 Health Disparities Among Rural Burn Patients. Journal of Burn Care & Research 2022. [PMCID: PMC8946566 DOI: 10.1093/jbcr/irac012.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction Socioeconomic status is a risk factor for sustaining a burn and for burn mortality. Patients from rural areas make up a minority of the population but are frequently more isolated from life-saving care and burn centers. Lower socioeconomic status patients may delay seeking treatment of their burns for concern over medical costs, time away from work, and overall distance from accredited burn centers. We aim to explore disparities in burn outcomes at our institution based on patient socioeconomic status. Methods Between January 2020 and January 2021, patients presenting for management of acute burns were reviewed. Patient demographics and outcomes were collected, including time to presentation, total body surface area burned, presence of inhalational injury, and mortality. Patient socioeconomic status and rural designations were assigned based on a validated metric derived from Census endpoints, with higher scores reflecting lower socioeconomic status. Results A total of 524 patients were identified. Overall, 30% of our patients were from areas defined as being small towns or rural by the Census. Racial demographics did not differ between rural and urban areas (p = 0.099), but Hispanic ethnicity was less common (16% vs. 29%, p = 0.002). Rates of alcohol, tobacco, and illicit drug use did not differ between groups. Compared to the urban/suburban cohort, rural patients were from less affluent areas (63.6 vs. 58.5, p = 0.001) and traveled farther to our center (112 miles vs. 70 miles, p = 0.029). Despite these distances, rural patients did not have a higher rate of delayed presentation (35.7% vs. 43.3%, p = 0.105), or longer average time to presentation (3.4 days vs 4.4 days, p = 0.222). Flame burns were the most common mechanism overall (44.3%) and were significantly more common in the rural population (59.2% vs. 37.8%, p < 0.001), Scalds, the second most common burn mechanism (25.9%), occurred less frequently in rural patients (18.5% vs. 29.2%, p = 0.011). Controlling for age, TBSA, inhalational injury, and ventilator requirement, patients from rural areas were at a significantly higher risk of mortality (OR 24, p = 0.024). Conclusions Rural burn patients face many challenges receiving appropriate care following a burn. They frequently come from less affluent backgrounds, limiting their ability to access care, and they must travel greater distances to a qualified burn surgeon. Despite these barriers, our rural patient population did not present any later following a burn compared to our more urban patients. Rural patients sustained more extensive burns but were not hospitalized at a greater rate. Even when controlling for numerous factors associated with burn mortality, rural patients were still at an increased risk. Burn prevention strategies targeting rural communities should address the unique challenges facing these areas.
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Affiliation(s)
- Robert P Duggan
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; The University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas
| | - Kimberley C Brondeel
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; The University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas
| | | | | | - Alen Palackic
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; The University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas
| | - Ludwik K Branski
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; The University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas
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Mefford AT, Duggan RP, Kirk K, Palackic A, Branski LK. 565 Impact of Municipal Ordinances on Firework-Related Injuries. Journal of Burn Care & Research 2022. [PMCID: PMC8945863 DOI: 10.1093/jbcr/irac012.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction There is significant heterogeneity in firework-related legislation across the country, with some states outright banning sales, possession, and use. Others restrict the dates and types of fireworks that can be purchased. Municipalities often adopt firework ordinances that apply within their city limits, pushing the sale and use into unincorporated areas or permitting easy access to illegal fireworks for transport into city limits. We seek to understand how effective firework ordinances are at preventing firework injuries. We hypothesize lax municipal ordinances will have a limited effect on firework-related injuries. Methods Two time periods where the commercial sale of fireworks is legal were identified, and we reviewed patients presenting during those windows for the acute management of firework-related burns. This corresponds to June 24 – July 11 and December 20 – January 8. Patient demographics and burn outcomes were collected. Socioeconomic status was determined using a standardized scale (0-100) that incorporates Census data, with higher scores reflecting more disadvantaged communities. Legality was determined by a review of municipal ordinances and patient residence. Results Thirty-five patients were identified between December 2016 and January 2021. More injuries occurred around July 4th compared to New Year’s (54% vs. 46%). The cohort was predominantly men (77%) with an average age of 29 years. Patients most commonly came from suburban areas (34.3%), compared to rural (25.7%), urban (20%), or small towns (17.1%). Alcohol use at the time of injury was reported in 14% of cases. Explosive fireworks (e.g., mortar shells) (63%) were more common than sparklers. Hands were the most frequently injured area (83%), but no amputations, traumatic or surgical, occurred. Eye injuries occurred in 17.1% of patients, but no long-term damage to vision was sustained. Eight patients (23.9%) required inpatient management, and six (17.1%) required operative management. Split thickness skin grafting and local tissue rearrangement were the extent of the operations performed. One patient required neurosurgical intervention after a mortar shell detonated adjacent to their cranium, representing the lone fatality in the cohort. There was no significant difference in the number of legal (18) and illegal (17) firework injuries. Socioeconomic status was not different between legal and illicit groups (46 vs. 54, p = 0.101). Conclusions A substantial number of patients sustained firework-related injuries in municipalities where fireworks are banned, giving the impression that current ordinances are ineffective. Public health officials and legislatures may consider the more widespread implementation of regulations or increased penalties to combat firework-related injuries.
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Affiliation(s)
- Austin T Mefford
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas
| | - Robert P Duggan
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas
| | - Katie Kirk
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas
| | - Alen Palackic
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas
| | - Ludwik K Branski
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas
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Duggan RP, Mefford AT, Palackic A, Owolabi A, Branski LK. 31 Regional Anesthesia for Reducing Postoperative Opioid Use in Split Thickness Skin Grafting. J Burn Care Res 2022. [PMCID: PMC8946201 DOI: 10.1093/jbcr/irac012.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction Split thickness skin grafting is ubiquitous in the management of acute burns and burn reconstruction. Patients describe the resulting partial-thickness donor site wound as one of the most painful aspects of burn care. Managing donor site pain is challenging and frequently involves potent opioid regimens. Rapid reepithelization of the donor site makes long-acting local and regional anesthesia an attractive option for reducing opioid use. This study aims to determine the efficacy of graft donor site regional anesthesia at reducing postoperative opioid consumption in burn patients. Methods A retrospective review of burn patients undergoing split-thickness skin grafting at our institution was performed. Patient demographics, burn mechanism, and percent burned total body surface area were collected. The type of regional anesthesia, when it was performed, and the anesthetic agents used were also determined. Milligram morphine equivalents (MME) were calculated for three 24-hour periods postoperatively to quantify opioid usage. The total MME in 72h postoperatively was also determined and used to calculate per day MME requirements. Mean, and peak pain scores in the first 24h postoperatively were collected. Univariate and multivariate analyses were performed to determine the efficacy of regional anesthesia. Results Twenty-five patients were identified, 14 who received donor site regional anesthesia and 11 who did not. The two groups did not differ significantly in age, gender, race, BMI, or burn mechanism. The regional anesthesia group had a significantly lower percent burned TBSA (5.3 vs. 21.6, p < 0.001). Still, donor site dimensions did not differ significantly between groups (363 cm2 vs. 411 cm2, p = 0.247). The use of regional anesthesia was associated with significantly lower MME requirements in the first 24h postoperatively (22.5 vs. 84.9, p = 0.023), lower total requirements after 72h (47.3 vs. 147.8, p = 0.016), and lower per day requirements (17.6 vs., 51, p = 0.014). The regional anesthesia group was discharged on average one week sooner (5.1 days vs. 12.4 days, p = 0.031). Multivariate analysis demonstrated the use of regional anesthesia independently predicted decreasing MME requirements in the first 24h after surgery, decreasing MME requirements in total, and decreasing per day MME requirements. No patients experienced anesthesia-related complications. Conclusions In a cohort of burn patients undergoing split-thickness skin grafting, the use of regional anesthesia was highly effective at reducing opioid requirements in the immediate postoperative period. We believe regional anesthetic blockades should be considered to provide long-lasting donor site analgesia. More investigation is warranted into ideal anesthetic agents, the maximum donor site dimensions, and the extent of cost savings.
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Affiliation(s)
- Robert P Duggan
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas
| | - Austin T Mefford
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas
| | - Alen Palackic
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas
| | - Adebukola Owolabi
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas
| | - Ludwik K Branski
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas
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Palackic A, Rontoyanni VG, Branski LK, Duggan RP, Schneider JC, Ryan CM, Kowalske KJ, Gibran NS, Stewart BT, Wolf SE, Suman-Vejas OE, Herndon D. 68 The Association Between Body Mass Index and Physical Function in Adult Burn Survivors. J Burn Care Res 2022. [PMCID: PMC8945842 DOI: 10.1093/jbcr/irac012.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
An area of rehabilitation research in burns is the impact of co-morbidities. Obesity is one of these, is an increasing public health concern, and its role remains controversial regarding burn injury and physical recovery. Our aim was to evaluate associations between body mass index (BMI) as a measure of obesity, at discharge and self-reported physical function (PF) during recovery of adult burn survivors.
Methods
This study included data that was collected by four American Burn Association-verified burn centers, which contribute to the Burn Model System National Database project. The data included BMI obtained at hospital discharge and self-reported Patient-Reported Outcomes Measurement Information System (PROMIS)-29 PF-mobility and upper extremity scores assessed at 6-, 12-, and 24-months after burn. Mixed linear models for repeated measures and regression models were used to assess associations between BMI and PROMIS-29 PF scores over time. Values are expressed as means ± SD. Significance was set at p< 0.05.
Results
A total of 502 adult patients aged 47 ± 16 years were included, with mean total body surface area burned (TBSA) of 17 ± 18 % (range; 1.0-88%) and mean BMI of 23.1 ± 5.4 kg*m-2 (range; 14.0-64.7 kg*m-2). We found no significant effect at 6 months (beta=-0.045, p= 0.54) nor at 12 months after injury (beta=-0.063, p= 0.44) when adjusted for age, burn size, and sex, however, BMI at discharge had a significant negative effect on self-reported mobility scores 24 months after injury (beta=0.218, p=< 0.05).
Conclusions
Increased weight (i.e. BMI) at discharge was negatively associated with PF during recovery. Benefiting from a large sample size, our analysis suggests that long term recovery and restoration of PF in adult burn survivors is compromized by excess body weight.
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Affiliation(s)
- Alen Palackic
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; , Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Wa
| | - Victoria G Rontoyanni
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; , Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Wa
| | - Ludwik K Branski
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; , Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Wa
| | - Robert P Duggan
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; , Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Wa
| | - Jeffrey C Schneider
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; , Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Wa
| | - Colleen M Ryan
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; , Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Wa
| | - Karen J Kowalske
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; , Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Wa
| | - Nicole S Gibran
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; , Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Wa
| | - Barclay T Stewart
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; , Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Wa
| | - Steven E Wolf
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; , Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Wa
| | - Oscar E Suman-Vejas
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; , Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Wa
| | - David Herndon
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; , Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Wa
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10
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Abstract
Introduction Here we present the case of chemical burns following professional eyebrow tinting, a phenomenon rarely described in the literature. Methods A 50-year-old previously healthy female presented to our emergency department for evaluation and treatment of chemical burns to her eyebrows. Fifteen days prior, she underwent professional eyebrow tinting by a local esthetician. Blistering developed the following day, and progressive swelling prompted her to present to an outside hospital. There she was prescribed acyclovir, ketoconazole cream, and silver sulfadiazine, but despite these measures, her symptoms progressed, leading to her presentation to our facility. Both brows were remarkable for significant swelling with exudative crushing on the surface concerning for superficial infection of partial-thickness chemical burns. She was prescribed bacitracin, prednisone, and clindamycin and discharged with instructions to follow up in burn clinic. Six days later, both brows had developed 2x3 cm scabs, but no signs of infection were appreciated. She was instructed to apply bacitracin/polymyxin B ointment to the scabbing areas and open wounds. Forty-nine days after her tinting, both brows were noted to be completely healed with no alopecia. Results Burns following cosmetic procedures most commonly occur during hair lightening treatments where products frequently contain caustic chemicals such a hydrogen peroxide or persulphates leading to oxidation reactions lightening the hair. Thermal burns in hair salons have also been reported to heated hair-dressing instruments or external heat to hasten the highlighting process. The periorbital area is becoming an increasingly popular target for nonsurgical cosmetic procedures, including permanent eyelid tattooing, eyelash dying, and extensions, more recently, eyebrow tinting. Eyebrow tinting involves the application of semipermanent dyes to give the appearance of a fuller brow. There are no FDA-approved brow tinting formulations, and many contain para-phenylenediamine (PPD), a dying agent frequently associated with allergic dermatitis and less commonly chemical burns. This patient underwent brow tinting in a professional setting and still experienced a chemical burn. As the popularity of brow tinting increases, some patients will undoubtfully seek out readily available, unregulated products for self-application. The potential for dermatitis and chemical burns following eyebrow tinting will only increase. Conclusions Eyebrow tinting is not a benign cosmetic procedure, and even professional application of dyes may lead to chemical burns. We believe an increased awareness of brow tinting and its potential complications is warranted given its increasing popularity, the preponderance of unregulated products, and the potential for poor cosmetic outcomes.
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Affiliation(s)
- Kimberley C Brondeel
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas
| | - Robert P Duggan
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas
| | - Katie Kirk
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas
| | - Alen Palackic
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas
| | - Ludwik K Branski
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas
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11
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Houschyar KS, Borrelli MR, Rein S, Tapking C, Popp D, Puladi B, Ooms M, Schulz T, Maan ZN, Branski LK, Siemers F, Philipp-Dormston WG, Yazdi AS, Duscher D. Wnt ligand expression in malignant melanoma: new insights. Eur J Plast Surg 2022. [DOI: 10.1007/s00238-022-01941-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Houschyar KS, Tapking C, Borrelli MR, Puladi B, Ooms M, Wallner C, Duscher D, Pförringer D, Rein S, Reumuth G, Schulz T, Nietzschmann I, Maan ZN, Grieb G, Philipp-Dormston WG, Branski LK, Siemers F, Lehnhardt M, Schmitt L, Yazdi AS. Stevens-Johnson syndrome and toxic epidermal necrolysis: a systematic review and meta-analysis. J Wound Care 2021; 30:1012-1019. [PMID: 34881995 DOI: 10.12968/jowc.2021.30.12.1012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare and severe skin and mucosal reactions that are associated with high mortality. Despite the severity, an evidence-based treatment protocol for SJS/TEN is still lacking. METHOD In this systematic review and meta-analysis, the PubMed database was searched using the following terms: [Stevens-Johnson syndrome] OR [toxic epidermal necrolysis] AND [therapy] OR [treatment] over a 20-year period (1999-2019) in the German and English language. All clinical studies reporting on the treatment of SJS/TEN were included, and epidemiological and diagnostic aspects of treatment were analysed. A meta-analysis was conducted on all comparative clinical studies that met the inclusion criteria. RESULTS A total of 88 studies met the inclusion criteria, reporting outcomes in 2647 patients. Treatment was either supportive or used systemic corticosteroid, intravenous immunoglobulin, plasmapheresis, cyclosporine, thalidomide or cyclophosphamide therapy. The meta-analysis included 16 (18%) studies, reporting outcomes in 976 (37%) patients. Systemic glucocorticoids showed a survival benefit for SJS/TEN patients in all analyses compared with other forms of treatment. Cyclosporine treatment also showed promising results, despite being used in a small cohort of patients. No beneficial effects on mortality could be demonstrated for intravenous immunoglobulins. CONCLUSION Glucocorticoids and cyclosporine may be tentatively recommended as the most promising immunomodulatory therapies for SJS/TEN, but these results should be investigated in future prospective controlled trials.
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Affiliation(s)
- Khosrow S Houschyar
- Department of Dermatology and Allergology, University Hospital Aachen, Germany
| | - Christian Tapking
- Department of Surgery, Shriners Hospitals for Children-Galveston, University of Texas Medical Branch, 815 Market Street, Galveston, TX 77550, US.,Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | - Mimi R Borrelli
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, US
| | - Behrus Puladi
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH, Aachen
| | - Mark Ooms
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH, Aachen
| | - Christoph Wallner
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Dominik Duscher
- Department of Plastic Surgery and Hand Surgery, Technical University Munich, Munich, Germany
| | - Dominik Pförringer
- Clinic and Policlinic of Trauma Surgery, Klinikum Rechts der Isar, Technische Universität München, Germany
| | - Susanne Rein
- Department of Plastic and Hand Surgery-Burn Center-Clinic St. Georg, Leipzig, Germany
| | - Georg Reumuth
- Department of Plastic Surgery and Hand Surgery, Evangelische Elisabeth Klinik, Luetzowstraße 26, 10785 Berlin, Germany
| | - Torsten Schulz
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Halle, Germany
| | - Ina Nietzschmann
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Halle, Germany
| | - Zeshaan N Maan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, US
| | - Gerrit Grieb
- Department of Plastic Surgery and Hand Surgery, Gemeinschaftskrankenhaus Havelhoehe, Teaching Hospital of the Charité Berlin, Kladower Damm 221, 14089 Berlin, Germany
| | | | - Ludwik K Branski
- Department of Surgery, Shriners Hospitals for Children-Galveston, University of Texas Medical Branch, 815 Market Street, Galveston, TX 77550, US
| | - Frank Siemers
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Halle, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Laurenz Schmitt
- Department of Dermatology and Allergology, University Hospital Aachen, Germany
| | - Amir S Yazdi
- Department of Dermatology and Allergology, University Hospital Aachen, Germany
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13
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Houschyar KS, Tapking C, Borrelli MR, Nietzschmann I, Puladi B, Ooms M, Rein S, Houschyar M, Duscher D, Maan ZN, Reumuth G, Branski LK, Modabber A, Kluwig D, Schmitt L, Philipp-Dormston WG, Yazdi AS, Siemers F. Stevens-Johnson syndrome and toxic epidermal necrolysis: a 10-year experience in a burns unit. J Wound Care 2021; 30:492-496. [PMID: 34121430 DOI: 10.12968/jowc.2021.30.6.492] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Stevens-Johnson syndrome (SJS) and its more severe counterpart, toxic epidermal necrolysis (TEN), are skin hypersensitivity reactions defined by epidermal blistering and necrosis. The exact pathophysiology of SJS/TEN is yet to be deciphered, but a number of risk factors have been identified including adverse drug reactions. The diagnosis of SJS/TEN is made on a clinical basis, and treatment consists of supportive care and occasionally immunosuppressants, such as cyclosporin, high-dose intravenous immunoglobulins and/or corticosteroids. Mortality rates can reach 20-25% in adults but are reduced with early intervention. To identify optimal treatment regimens, to better understand the patient cohort affected, and to help identify key risk factors for mortality, we report our experience with the treatment and management of SJS/TEN patients. METHODS A retrospective review of consecutive patients with SJS and/or TEN admitted to a single burns centre in Germany, between 2008 and 2018, was conducted. The primary outcomes of demographics, clinical course, treatment and patient-reported outcomes were recorded and compared with a control group of patients with burns without a diagnosis of SJS/TEN. RESULTS A total of 23 patients with SJS/TEN met the inclusion criteria: 17 (74%) with TEN; four (17%) with SJS/TEN overlap; and two (9%) with SJS. Of the patients, 14 (61%) were female and nine (39%) were male. Patient age ranged from 32-78 years (mean: 52 years). A matched cohort of 23 patients with burns served as the control group. All patients received standard of care with a multidisciplinary team. Compared with the control group, SJS/TEN patients had higher mortality rates (n=6, 26% versus n=8, 35%, respectively). The average age of death was 69 years in SJS/TEN patients versus 63 years in control group patients. Age and SCORTEN scores were significant predictors of mortality. CONCLUSIONS SJS and TEN are rare but extreme reactions of the skin and mucosa, associated with high disease mortality rates. This 10-year single-centre retrospective review contributes to the bank of information for reviews evaluating the management of SJS/TEN patients.
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Affiliation(s)
- Khosrow S Houschyar
- Department of Dermatology and Allergology, University Hospital RWTH Aachen, Germany.,Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Halle, Germany
| | - Christian Tapking
- Department of Surgery, Shriners Hospital for Children-Galveston, University of Texas Medical Branch, Galveston, US.,Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | - Mimi R Borrelli
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, US
| | - Ina Nietzschmann
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Halle, Germany
| | - Behrus Puladi
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH, Aachen, Germany
| | - Mark Ooms
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH, Aachen, Germany
| | - Susanne Rein
- Department of Plastic and Hand Surgery-Burn Center-Clinic St. Georg, Leipzig, Germany
| | - Madeline Houschyar
- Department of Dermatology and Allergology, University Hospital RWTH Aachen, Germany
| | - Dominik Duscher
- Department of Plastic Surgery and Hand Surgery, Technical University Munich, Munich, Germany
| | - Zeshaan N Maan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, US
| | - Georg Reumuth
- Department of Plastic Surgery and Hand Surgery, Evangelische Elisabeth Klinik, Berlin, Germany
| | - Ludwik K Branski
- Department of Surgery, Shriners Hospital for Children-Galveston, University of Texas Medical Branch, Galveston, US
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH, Aachen, Germany
| | - David Kluwig
- Department of Dermatology and Allergology, University Hospital RWTH Aachen, Germany
| | - Laurenz Schmitt
- Department of Dermatology and Allergology, University Hospital RWTH Aachen, Germany
| | | | - Amir S Yazdi
- Department of Dermatology and Allergology, University Hospital RWTH Aachen, Germany
| | - Frank Siemers
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Halle, Germany
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14
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Gray KM, Peterson JM, Padilla PL, Smith JM, Zapata-Sirvent RL, Branski LK, Norbury WB, Dziewulski P. Vascularized Composite Allotransplantation in Burn Reconstruction: Systematic Review and Meta-analysis. J Burn Care Res 2021; 42:465-472. [PMID: 33091131 DOI: 10.1093/jbcr/iraa188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Vascularized composite allotransplantation has been successfully employed for burn reconstruction since 2003. However, its safety in this population has been questioned due to high levels of alloimmunization from burn care-related tissue exposures. To investigate this, a systematic review of vascularized composite allotransplantation employed for burn reconstruction was conducted, evaluating literature from January 2000 to September 2019. Articles containing vascularized composite allotransplantation, composite tissue allotransplantation, and burn reconstructive surgery were included; articles without published outcomes were excluded. Observational meta-analysis of pooled mortality and acute rejection episodes relative to allograft type (face vs extremity) and reconstruction type (burn vs non-burn) was performed. Twenty-four of the 63 identified articles met the criteria for inclusion, with 5 more articles added after secondary review. To date, 152 allotransplantations have been performed in 117 patients: 45 face transplants and 107 extremity transplants. Of these, 34 (22%) were performed for burn reconstruction in 25 patients (21%) with an overall higher 1-year mortality rate (12.0% vs 1.1%, P = .030). Of these deaths, 75% received three or more simultaneous allografts. Additionally, more episodes of acute rejection occurred compared to non-burn patients (4.4 vs 2.4, P = .035). Vascularized composite allotransplantation performed for burn reconstruction was found to be associated with a greater risk of 1-year mortality and nearly twice the number of episodes of acute rejection. Future studies should seek to identify unique risk factors of burn patients undergoing this operation and evaluate the relationship between antigenic burden and surgical outcomes.
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Affiliation(s)
- Kelsey M Gray
- School of Medicine, University of Texas Medical Branch, Galveston
| | - Joshua M Peterson
- Division of Plastic Surgery, Department of Surgery, University of Texas Medical Branch, Galveston
| | - Pablo L Padilla
- Division of Plastic Surgery, Department of Surgery, University of Texas Medical Branch, Galveston
| | - Jeffrey M Smith
- Division of Plastic Surgery, Department of Surgery, University of Texas Medical Branch, Galveston
| | - Ramón L Zapata-Sirvent
- Division of Plastic Surgery, Department of Surgery, University of Texas Medical Branch, Galveston.,Shriners Hospitals for Children, Galveston, Texas
| | - Ludwik K Branski
- Division of Plastic Surgery, Department of Surgery, University of Texas Medical Branch, Galveston.,Shriners Hospitals for Children, Galveston, Texas
| | - William B Norbury
- Division of Plastic Surgery, Department of Surgery, University of Texas Medical Branch, Galveston.,Shriners Hospitals for Children, Galveston, Texas
| | - Peter Dziewulski
- Division of Plastic Surgery, Department of Surgery, University of Texas Medical Branch, Galveston.,Shriners Hospitals for Children, Galveston, Texas
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15
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Haller HL, Blome-Eberwein SE, Branski LK, Carson JS, Crombie RE, Hickerson WL, Kamolz LP, King BT, Nischwitz SP, Popp D, Shupp JW, Wolf SE. Porcine Xenograft and Epidermal Fully Synthetic Skin Substitutes in the Treatment of Partial-Thickness Burns: A Literature Review. ACTA ACUST UNITED AC 2021; 57:medicina57050432. [PMID: 33946298 PMCID: PMC8146423 DOI: 10.3390/medicina57050432] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 12/24/2022]
Abstract
Background and Objectives: Porcine xenografts have been used successfully in partial thickness burn treatment for many years. Their disappearance from the market led to the search for effective and efficient alternatives. In this article, we examine the synthetic epidermal skin substitute Suprathel® as a substitute in the treatment of partial thickness burns. Materials and Methods: A systematic review following the PRISMA guidelines has been performed. Sixteen Suprathel® and 12 porcine xenograft studies could be included. Advantages and disadvantages between the treatments and the studies’ primary endpoints have been investigated qualitatively and quantitatively. Results: Although Suprathel had a nearly six times larger TBSA in their studies (p < 0.001), it showed a significantly lower necessity for skin grafts (p < 0.001), and we found a significantly lower infection rate (p < 0.001) than in Porcine Xenografts. Nonetheless, no significant differences in the healing time (p = 0.67) and the number of dressing changes until complete wound healing (p = 0.139) could be found. Both products reduced pain to various degrees with the impression of a better performance of Suprathel® on a qualitative level. Porcine xenograft was not recommended for donor sites or coverage of sheet-transplanted keratinocytes, while Suprathel® was used successfully in both indications. Conclusion: The investigated parameters indicate that Suprathel® to be an effective replacement for porcine xenografts with even lower subsequent treatment rates. Suprathel® appears to be usable in an extended range of indications compared to porcine xenograft. Data heterogeneity limited conclusions from the results.
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Affiliation(s)
| | - Sigrid E. Blome-Eberwein
- Lehigh Valley Health Network 1200 S. Cedar Crest Blvd. Kasych 3000, Allentown, PA 18103, USA; (S.E.B.-E.); (S.E.W.)
| | - Ludwik K. Branski
- Department of Surgery—Burn Surgery, The University of Texas Medical Branch and Shriners Hospitals for Children, 301 University BLVD, Galveston, TX 77555, USA;
| | - Joshua S. Carson
- Department of Surgery, UF Health Shands Burn Center, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610, USA;
| | - Roselle E. Crombie
- Connecticut Burn Center, Yale New Haven Heal System, 267 Grant St, Bridgeport, CT 06610, USA;
| | - William L. Hickerson
- Memphis Medical Center Burn Center, 890 Madison Avenue, Suite TG032, Memphis, TN 38103, USA;
| | - Lars Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University, 8053 Graz, Austria; (L.P.K.); (S.P.N.); (D.P.)
| | - Booker T. King
- Division of Burn Surgery, Department of Surgery, 101 Manning Drive CB #7206, Chapel Hill, NC 27599, USA;
| | - Sebastian P. Nischwitz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University, 8053 Graz, Austria; (L.P.K.); (S.P.N.); (D.P.)
| | - Daniel Popp
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University, 8053 Graz, Austria; (L.P.K.); (S.P.N.); (D.P.)
| | - Jeffrey W. Shupp
- The Burn Center, Department of Surgery, MedStar Washington Hospital Center, 110 Irving St NW, Washington, DC 20010, USA;
| | - Steven E. Wolf
- Lehigh Valley Health Network 1200 S. Cedar Crest Blvd. Kasych 3000, Allentown, PA 18103, USA; (S.E.B.-E.); (S.E.W.)
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16
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Ozhathil DK, Tay MW, Wolf SE, Branski LK. A Narrative Review of the History of Skin Grafting in Burn Care. ACTA ACUST UNITED AC 2021; 57:medicina57040380. [PMID: 33920783 PMCID: PMC8071142 DOI: 10.3390/medicina57040380] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/28/2021] [Accepted: 04/07/2021] [Indexed: 01/17/2023]
Abstract
Thermal injuries have been a phenomenon intertwined with the human condition since the dawn of our species. Autologous skin translocation, also known as skin grafting, has played an important role in burn wound management and has a rich history of its own. In fact, some of the oldest known medical texts describe ancient methods of skin translocation. In this article, we examine how skin grafting has evolved from its origins of necessity in the ancient world to the well-calibrated tool utilized in modern medicine. The popularity of skin grafting has ebbed and flowed multiple times throughout history, often suppressed for cultural, religious, pseudo-scientific, or anecdotal reasons. It was not until the 1800s, that skin grafting was widely accepted as a safe and effective treatment for wound management, and shortly thereafter for burn injuries. In the nineteenth and twentieth centuries skin grafting advanced considerably, accelerated by exponential medical progress and the occurrence of man-made disasters and global warfare. The introduction of surgical instruments specifically designed for skin grafting gave surgeons more control over the depth and consistency of harvested tissues, vastly improving outcomes. The invention of powered surgical instruments, such as the electric dermatome, reduced technical barriers for many surgeons, allowing the practice of skin grafting to be extended ubiquitously from a small group of technically gifted reconstructive surgeons to nearly all interested sub-specialists. The subsequent development of biologic and synthetic skin substitutes have been spurred onward by the clinical challenges unique to burn care: recurrent graft failure, microbial wound colonization, and limited donor site availability. These improvements have laid the framework for more advanced forms of tissue engineering including micrografts, cultured skin grafts, aerosolized skin cell application, and stem-cell impregnated dermal matrices. In this article, we will explore the convoluted journey that modern skin grafting has taken and potential future directions the procedure may yet go.
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17
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Tapking C, Houschyar KS, Rontoyanni VG, Hundeshagen G, Kowalewski KF, Hirche C, Popp D, Wolf SE, Herndon DN, Branski LK. The Influence of Obesity on Treatment and Outcome of Severely Burned Patients. J Burn Care Res 2020; 40:996-1008. [PMID: 31294797 DOI: 10.1093/jbcr/irz115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Obesity and the related medical, social, and economic impacts are relevant multifactorial and chronic conditions that also have a meaningful impact on outcomes following a severe injury, including burns. In addition to burn-specific difficulties, such as adequate hypermetabolic response, fluid resuscitation, and early wound coverage, obese patients also present with common comorbidities, such as arterial hypertension, diabetes mellitus, or nonalcoholic fatty liver disease. In addition, the pathophysiologic response to severe burns can be enhanced. Besides the increased morbidity and mortality compared to burn patients with normal weight, obese patients present a challenge in fluid resuscitation, perioperative management, and difficulties in wound healing. The present work is an in-depth review of the current understanding of the influence of obesity on the management and outcome of severe burns.
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Affiliation(s)
- Christian Tapking
- Department of Surgery, University of Texas Medical Branch, Galveston.,Shriners Hospitals for Children, Galveston, Texas.,Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | - Khosrow S Houschyar
- Department of Plastic Surgery, Hand Surgery, Sarcoma Center, BG University Hospital, Ruhr University, Bochum, Germany
| | - Victoria G Rontoyanni
- Department of Surgery, University of Texas Medical Branch, Galveston.,Metabolism Unit, Shriners Hospitals for Children, Galveston, Texas
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | | | - Christoph Hirche
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | - Daniel Popp
- Department of Surgery, University of Texas Medical Branch, Galveston.,Shriners Hospitals for Children, Galveston, Texas.,Department of Urology, University Medical Center Mannheim, University of Heidelberg, Germany
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston.,Shriners Hospitals for Children, Galveston, Texas
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch, Galveston
| | - Ludwik K Branski
- Department of Surgery, University of Texas Medical Branch, Galveston.,Shriners Hospitals for Children, Galveston, Texas.,Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
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18
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Abstract
Background: Fungal burn wound infections are among the most devastating complications in patients who are severely burned. Increasing incidence of burn wound infections caused by fungi led to new challenges in diagnostic and therapeutic approaches. The wide use of broad-spectrum antibiotic agents, an increased prevalence of molds and non-Candida albicans spp., and the variety of available antifungal agents underline the importance of identifying the causative species, to initiate adequate therapy within an adequate timeframe. Methods: Review of the pertinent English and German literature. Results: Fungal burn wound infections go along with a delay of identifying the causative fungus species and can be mistaken for early bacterial burn wound infection. Recently, an increase of uncommon fungal pathogens and fungi resistance against antifungal agents has been reported. Amphotericin B and voriconazole remain the antifungal drugs used most commonly. Conclusions: Adequate therapy remains challenging. Early radical debridement and wound closure play an imperative part, particularly in preventing infections caused by yeasts and molds or any other agent. Prophylactic empiric pharmacologic treatment is reserved for those highly at risk for invasive burn wound infection only. Because of the emergence of drug-resistant fungi, the development of new antifungal drugs is essential for the battle against fungal burn wound infections.
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Affiliation(s)
- Alen Palackic
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Daniel Popp
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Christian Tapking
- Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany
| | - Khosrow S Houschyar
- Clinic of Dermatology and Allergology, University Hospital RWTH Aachen, Aachen, Germany
| | - Ludwik K Branski
- Department of Surgery, Shriners Hospitals for Children, University of Texas Medical Branch, Galveston, Texas, USA
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19
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Tapking C, Popp D, Herndon DN, Armenta AM, Branski LK, Murton AJ, Suman OE. Cardiovascular Effect of Varying Interval Training Frequency in Rehabilitation of Severely Burned Children. J Burn Care Res 2020; 40:34-38. [PMID: 30247564 DOI: 10.1093/jbcr/iry051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Structured exercise programs initiated after acute hospitalization can improve muscle strength and mass, cardiorespiratory capacity, and quality of life in severely burned children. In this retrospective study, we compared the cardiovascular effects of an exercise program incorporating a large number of interval training sessions with a traditional exercise program incorporating a small number of interval training sessions. Severely burned children who completed a large number of sessions (at least three sessions per week, N = 40) were matched to those completing a small number of sessions (a maximum of two sessions per week, N = 40). Maximal oxygen consumption (VO2 max) was measured via the modified Bruce treadmill protocol at discharge, on completion of the exercise program, and at follow-up visits at 6, 12, and 24 months postburn. Both groups were comparable in age (large 13.5 ± 3.0 years vs small 13.1 ± 3.3 years) and percent total BSA burned (large 50.8 ± 14.8% vs small 49.2 ± 13.3%). For both groups, VO2 max increased from discharge (large 22.6 ± 3.8 ml/kg/min; small 22.6 ± 5.0 ml/kg/min) to postexercise (large 29.5 ± 6.0 ml/kg/min; small 28.0 ± 5.8 ml/kg/min), 6 months (large 33.2 ± 5.9 ml/kg/min; small 29.6 ± 7.0 ml/kg/min), 12 months (large 35.0 ± 7.5 ml/kg/min; small 31.7 ± 7.1 ml/kg/min), and 24 months (large 37.0 ± 7.2 ml/kg/min; small 32.4 ± 9.2 ml/kg/min, P < .001). VO2 increased to a greater extent with a large number of interval sessions than with a small number at 6 and 24 months (both P = .021). These findings suggest that a large number of interval training sessions impart a greater benefit on cardiorespiratory fitness than a small number of sessions.
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Affiliation(s)
- Christian Tapking
- Department of Surgery, Shriners Hospitals for Children-Galveston and University of Texas Medical Branch.,Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | - Daniel Popp
- Department of Surgery, Shriners Hospitals for Children-Galveston and University of Texas Medical Branch.,Division of Hand, Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - David N Herndon
- Department of Surgery, Shriners Hospitals for Children-Galveston and University of Texas Medical Branch
| | - Andrew M Armenta
- School of Medicine, University of Texas Medical Branch, Galveston
| | - Ludwik K Branski
- Department of Surgery, Shriners Hospitals for Children-Galveston and University of Texas Medical Branch.,Division of Hand, Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - Andrew J Murton
- Department of Surgery, Shriners Hospitals for Children-Galveston and University of Texas Medical Branch
| | - Oscar E Suman
- Department of Surgery, Shriners Hospitals for Children-Galveston and University of Texas Medical Branch
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20
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Houschyar KS, Borrelli MR, Tapking C, Popp D, Puladi B, Ooms M, Chelliah MP, Rein S, Pförringer D, Thor D, Reumuth G, Wallner C, Branski LK, Siemers F, Grieb G, Lehnhardt M, Yazdi AS, Maan ZN, Duscher D. Molecular Mechanisms of Hair Growth and Regeneration: Current Understanding and Novel Paradigms. Dermatology 2020; 236:271-280. [PMID: 32163945 DOI: 10.1159/000506155] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/27/2020] [Indexed: 11/19/2022] Open
Abstract
Hair is a defining feature of mammals and has critical functions, including protection, production of sebum, apocrine sweat and pheromones, social and sexual interactions, thermoregulation, and provision of stem cells for skin homeostasis, regeneration, and repair. The hair follicle (HF) is considered a "mini-organ," consisting of intricate and well-organized structures which originate from HF stem and progenitor cells. Dermal papilla cells are the main components of the mesenchymal compartments in the hair bulb and are instrumental in generating signals to regulate the behavior of neighboring epithelial cells during the hair cycle. Mesenchymal-epithelial interactions within the dermal papilla niche drive HF embryonic development as well as the postnatal hair growth and regeneration cycle. This review summarizes the current understanding of HF development, repair, and regeneration, with special focus on cell signaling pathways governing these processes. In particular, we discuss emerging paradigms of molecular signaling governing the dermal papilla-epithelial cellular interactions during hair growth and maintenance and the recent progress made towards tissue engineering of human hair follicles.
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Affiliation(s)
- Khosrow Siamak Houschyar
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Mimi R Borrelli
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, California, USA
| | - Christian Tapking
- Department of Surgery, Shriners Hospitals for Children-Galveston, University of Texas Medical Branch, Galveston, Texas, USA.,Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany
| | - Daniel Popp
- Department of Surgery, Shriners Hospitals for Children-Galveston, University of Texas Medical Branch, Galveston, Texas, USA.,Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Behrus Puladi
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH, Aachen, Germany
| | - Mark Ooms
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH, Aachen, Germany
| | - Malcolm P Chelliah
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, California, USA
| | - Susanne Rein
- Department of Plastic and Hand Surgery, Burn Center, Clinic St. Georg, Leipzig, Germany
| | - Dominik Pförringer
- Clinic and Policlinic of Trauma Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Dominik Thor
- College of Pharmacy, University of Florida Gainesville, Gainesville, Florida, USA
| | - Georg Reumuth
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Halle, Germany
| | - Christoph Wallner
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Ludwik K Branski
- Department of Surgery, Shriners Hospitals for Children-Galveston, University of Texas Medical Branch, Galveston, Texas, USA
| | - Frank Siemers
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Halle, Germany
| | - Gerrit Grieb
- Department of Plastic Surgery and Hand Surgery, Gemeinschaftskrankenhaus Havelhoehe, Teaching Hospital of the Charité Berlin, Berlin, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Amir S Yazdi
- Department of Dermatology and Allergology, University Hospital Aachen, Aachen, Germany
| | - Zeshaan N Maan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, California, USA
| | - Dominik Duscher
- Department of Plastic Surgery and Hand Surgery, Technical University Munich, Munich, Germany,
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21
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Houschyar M, Borrelli MR, Tapking C, Maan ZN, Rein S, Chelliah MP, Sheckter CC, Duscher D, Branski LK, Wallner C, Behr B, Lehnhardt M, Siemers F, Houschyar KS. Burns: modified metabolism and the nuances of nutrition therapy. J Wound Care 2020; 29:184-191. [PMID: 32160092 DOI: 10.12968/jowc.2020.29.3.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To review the effects of burn injury on nutritional requirements and how this can best be supported in a healthcare setting. METHOD A literature search for articles discussing nutrition and/or metabolism following burn injury was carried out. PubMed, Embase and Web of Science databases were searched using the key search terms 'nutrition' OR 'metabolism' AND 'burn injury' OR 'burns'. There was no limitation on the year of publication. RESULTS A total of nine articles met the inclusion criteria, the contents of which are discussed in this manuscript. CONCLUSION Thermal injury elicits the greatest metabolic response, among all traumatic events, in critically ill patients. In order to ensure burn patients can meet the demands of their increased metabolic rate and energy expenditure, adequate nutritional support is essential. Burn injury results in a unique pathophysiology, involving alterations in endocrine, inflammatory, metabolic and immune pathways and nutritional support needed during the inpatient stay varies depending on burn severity and idiosyncratic patient physiologic parameters.
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Affiliation(s)
- Madeline Houschyar
- 1 Institute of Agricultural and Nutrition Sciences, Martin Luther University of Halle-Wittenberg, Germany
| | - Mimi R Borrelli
- 2 Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, US
| | - Christian Tapking
- 3 Department of Surgery, Shriners Hospital for Children-Galveston, University of Texas Medical Branch, Galveston, US.,4 Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | - Zeshaan N Maan
- 2 Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, US
| | - Susanne Rein
- 5 Department of Plastic and Hand Surgery, Burn Center, Sankt Georg Hospital, Leipzig, Germany
| | - Malcolm P Chelliah
- 2 Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, US
| | - Clifford C Sheckter
- 2 Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, US
| | - Dominik Duscher
- 2 Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, US
| | - Ludwik K Branski
- 3 Department of Surgery, Shriners Hospital for Children-Galveston, University of Texas Medical Branch, Galveston, US
| | - Christoph Wallner
- 7 Department of Plastic Surgery and Burn Centre, BG University Hospital Bergmannsheil GmbH, Ruhr University Bochum, Bochum, Germany
| | - Bjö Behr
- 7 Department of Plastic Surgery and Burn Centre, BG University Hospital Bergmannsheil GmbH, Ruhr University Bochum, Bochum, Germany
| | - Marcus Lehnhardt
- 7 Department of Plastic Surgery and Burn Centre, BG University Hospital Bergmannsheil GmbH, Ruhr University Bochum, Bochum, Germany
| | - Frank Siemers
- 8 Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Germany
| | - Khosrow S Houschyar
- 7 Department of Plastic Surgery and Burn Centre, BG University Hospital Bergmannsheil GmbH, Ruhr University Bochum, Bochum, Germany
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22
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Houschyar KS, Tapking C, Duscher D, Maan ZN, Sheckter CC, Rein S, Chelliah MP, Nietzschmann I, Weissenberg K, Reumuth G, Schulz T, Branski LK, Siemers F. Optimising management of self-inflicted burns: a retrospective review. J Wound Care 2019; 28:317-322. [PMID: 31166860 DOI: 10.12968/jowc.2019.28.6.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Self-inflicted burns typically result in extensive injuries requiring intensive care and attention in a specialised burn unit. Burn units should be familiar with the optimal management of self-inflicted burns, including the psychological and psychiatric treatment. This paper describes the experiences of managing these challenging injuries in a German burn centre. METHODS A retrospective review of patients with self-inflicted burns admitted to the burn centre between 2000 and 2017. Demographics, details of injury, presence of psychiatric disorder, clinical course, operative management and patient outcomes were recorded and compared with a control group without self-inflicted burns. Outcome measures included graft take rate, complications and need for further surgery. RESULTS There were a total of 2055 burn patient admissions, with 17 cases (0.8%) of self-inflicted burns. The mean age was 36±11 years with an mean percentage total body surface area (%TBSA) burned of 43.5±22.5% which was not significantly different from the control group (p=0.184). Schizophrenia and personality disorder were the most common diagnoses in the self-inflicted burns patients (n=11; 65%). Of these, four had sustained previous self-inflicted burns. Length of hospital stay was significantly longer in the self-inflicted burn group than in the control group (49.0±16.7 days, respectively, p=0.002). CONCLUSION Attempted suicide by self-inflicted burns represents <1% of burn admissions. This population demonstrates a high incidence of prior psychiatric disorders. Successful treatment includes multidisciplinary management of acute medical, surgical, and psychiatric care.
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Affiliation(s)
- Khosrow S Houschyar
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Germany
| | - Christian Tapking
- Department of Surgery, Shriners Hospital for Children-Galveston, University of Texas Medical Branch, 815 Market Street, Galveston, TX 77550, US.,Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | - Dominik Duscher
- Department of Plastic Surgery and Hand Surgery, Technical University Munich, Munich, Germany
| | - Zeshaan N Maan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, US
| | - Clifford C Sheckter
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, US
| | - Susanne Rein
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Germany
| | - Malcolm P Chelliah
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, US
| | - Ina Nietzschmann
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Germany
| | - Kristian Weissenberg
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Germany
| | - Georg Reumuth
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Germany
| | - Torsten Schulz
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Germany
| | - Ludwik K Branski
- Department of Surgery, Shriners Hospital for Children-Galveston, University of Texas Medical Branch, 815 Market Street, Galveston, TX 77550, US
| | - Frank Siemers
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Germany
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23
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Houschyar KS, Tapking C, Puladi B, Popp D, Duscher D, Rein S, Reumuth G, Grieb G, Branski LK, Siemers F, Lehnhardt M, Yazdi AS. [Correction: Wnt signaling in cutaneous wound healing]. HANDCHIR MIKROCHIR P 2019; 52:E1. [PMID: 31797344 DOI: 10.1055/a-1072-9912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- K S Houschyar
- Klinik für Dermatologie und Allergologie - Hautklinik, Universitätsklinik der RWTH Aachen
| | - C Tapking
- Klinik für Hand-, Plastische- und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Unfallklinik Ludwigshafen, Universität Heidelberg.,Department of Surgery, Shriners Hospitals for Children-Galveston, University of Texas Medical Branch, 815 Market Street, Galveston, TX, 77550, USA
| | - B Puladi
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinik der RWTH Aachen
| | - D Popp
- Department of Surgery, Shriners Hospitals for Children-Galveston, University of Texas Medical Branch, 815 Market Street, Galveston, TX, 77550, USA.,Klinische Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Universitätsklinik für Chirurgie, Medizinische Universität Graz, Österreich
| | - D Duscher
- Klinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar, Technische Universität München
| | - S Rein
- Klinik für Plastische und Handchirurgie mit Schwerbrandverletztenzentrum, Klinikum Sankt Georg, Delitzscher Straße 141, 04129 Leipzig
| | - G Reumuth
- Abteilung für Plastische Chirurgie und Handchirurgie, Evangelische Elisabeth Klinik, Lehrkrankenhaus der Charité Berlin, Lützower Straße 24 - 26, 10785 Berlin
| | - G Grieb
- Klinik für Plastische Chirurgie und Handchirurgie, Gemeinschaftskrankenhaus Havelhöhe, Lehrkrankenhaus der Charité Berlin, Kladower Damm 221, 14089 Berlin
| | - L K Branski
- Department of Surgery, Shriners Hospitals for Children-Galveston, University of Texas Medical Branch, 815 Market Street, Galveston, TX, 77550, USA
| | - F Siemers
- Berufsgenossenschaftliches Klinikum Bergmannstrost Halle, Klinik für Plastische und Handchirurgie, Brandverletztenzentrum, Merseburger Str 165, 06112 Halle (Saale)
| | - M Lehnhardt
- Klinik für Plastische Chirurgie und Schwerbrandverletzte, Handchirurgiezentrum, Operatives Referenzzentrum für Gliedmaßentumore, BG Universitätskliniken Bergmannsheil, Bochum
| | - A S Yazdi
- Klinik für Dermatologie und Allergologie - Hautklinik, Universitätsklinik der RWTH Aachen
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24
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Houschyar KS, Tapking C, Puladi B, Popp D, Duscher D, Rein S, Reumuth G, Grieb G, Branski LK, Siemers F, Lehnhardt M, Yazdi AS. [Wnt signaling in cutaneous wound healing]. HANDCHIR MIKROCHIR P 2019; 52:151-158. [PMID: 31724136 DOI: 10.1055/a-1017-3600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Human skin is an efficient barrier that protects the organism from noxious substances. Wounds destroy this barrier. Wound healing is a phased physiological regeneration of the destroyed tissue that ideally leads to occlusion of a wound, in particular by regeneration of connective tissue and capillaries. The Wnt signaling pathway is a highly conserved signal transduction cascade across the animal kingdom that controls basic cellular interactions in multicellular organisms. Accordingly, through the Wnt signaling path many processes, e. g. as the balance between proliferation and differentiation or apoptosis, coordinated. Wnt signaling is activated by a wound and participates in each subsequent phase of the healing process, beginning with inflammatory control and programmed cell death, to the mobilization of stem cells within the wound. Endogenous Wnt signaling is an attractive therapeutic approach to assist in the repair of skin wounds, as the complex mechanisms of the Wnt signaling pathway have become increasingly understood over the years. This review summarizes current data to clarify the role of Wnt signaling in the wound healing process of the skin.
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Affiliation(s)
- K S Houschyar
- Klinik für Dermatologie und Allergologie - Hautklinik, Universitätsklinik der RWTH Aachen
| | - C Tapking
- Klinik für Hand-, Plastische- und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Unfallklinik Ludwigshafen, Universität Heidelberg.,Department of Surgery, Shriners Hospitals for Children-Galveston, University of Texas Medical Branch, 815 Market Street, Galveston, TX, 77550, USA
| | - B Puladi
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinik der RWTH Aachen
| | - D Popp
- Department of Surgery, Shriners Hospitals for Children-Galveston, University of Texas Medical Branch, 815 Market Street, Galveston, TX, 77550, USA.,Klinische Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Universitätsklinik für Chirurgie, Medizinische Universität Graz, Österreich
| | - D Duscher
- Klinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar, Technische Universität München
| | - S Rein
- Klinik für Plastische und Handchirurgie mit Schwerbrandverletztenzentrum, Klinikum Sankt Georg, Delitzscher Straße 141, 04129 Leipzig
| | - G Reumuth
- Abteilung für Plastische Chirurgie und Handchirurgie, Evangelische Elisabeth Klinik, Lehrkrankenhaus der Charité Berlin, Lützower Straße 24 - 26, 10785 Berlin
| | - G Grieb
- Klinik für Plastische Chirurgie und Handchirurgie, Gemeinschaftskrankenhaus Havelhöhe, Lehrkrankenhaus der Charité Berlin, Kladower Damm 221, 14089 Berlin
| | - L K Branski
- Department of Surgery, Shriners Hospitals for Children-Galveston, University of Texas Medical Branch, 815 Market Street, Galveston, TX, 77550, USA
| | - F Siemers
- Berufsgenossenschaftliches Klinikum Bergmannstrost Halle, Klinik für Plastische und Handchirurgie, Brandverletztenzentrum, Merseburger Str 165, 06112 Halle (Saale)
| | - M Lehnhardt
- Klinik für Plastische Chirurgie und Schwerbrandverletzte, Handchirurgiezentrum, Operatives Referenzzentrum für Gliedmaßentumore, BG Universitätskliniken Bergmannsheil, Bochum
| | - A S Yazdi
- Klinik für Dermatologie und Allergologie - Hautklinik, Universitätsklinik der RWTH Aachen
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Nischwitz SP, Bernardelli de Mattos I, Hofmann E, Groeber-Becker F, Funk M, Mohr GJ, Branski LK, Mautner SI, Kamolz LP. Continuous pH monitoring in wounds using a composite indicator dressing - A feasibility study. Burns 2019; 45:1336-1341. [PMID: 31371230 DOI: 10.1016/j.burns.2019.02.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/05/2019] [Accepted: 02/27/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE Modern burn care strives for new means to guarantee optimised wound healing. Several studies have shown a correlation between the pH value in a (burn) wound and successful wound healing. A multitude of devices to monitor pH is available, all requiring direct wound contact and removal of the dressing for pH monitoring. The aim of this feasibility study was to create a sterile and easy to handle method for pH monitoring while simultaneously using an advanced wound dressing. MATERIALS AND METHODS Dressing sheets of biotechnologically generated nanofibrillar cellulose (epicitehydro) were chemically functionalised with the indicator dye GJM-534. pH-donors with increasing pH were subsequently applied to the created indicator dressing. To investigate temporal resolution and continuous monitoring we used circular pH-donors with different pH (7 and 10) and decreasing diameters that were placed on another dressing sheet. Clinically relevant spatial resolution was checked by a wound bed simulation with small areas (8 mm) of higher pH (10) on a field of lower pH (7) and vice versa. RESULTS The indicator dressing showed a gradual colouring from yellow to dark orange with increasing pH in steps of 0.3. After conversion of digital pictures to greyscale values, a sigmoidal distribution with a pKa-value of 8.4 was obtained. A ring-like pattern with alternating colour change corresponding to the pH was observed in the continuous monitoring experiment and the wound bed simulation delivered excellent local resolution. CONCLUSION Since the pH of a (burn) wound can have a significant influence on wound healing, a pH indicator was successfully linked to an advanced, temporary, alloplastic wound dressing material. We were able to show the possibility of pH monitoring by the dressing itself. Additional testing, including studies with large case numbers for optimisation are necessary before clinical implementation.
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Affiliation(s)
- S P Nischwitz
- COREMED - Cooperative Centre for Regenerative Medicine, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
| | - I Bernardelli de Mattos
- Fraunhofer Institute for Silicate Research ISC, Translational Center Regenerative Therapies, Wuerzburg, Germany
| | - E Hofmann
- COREMED - Cooperative Centre for Regenerative Medicine, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - F Groeber-Becker
- Fraunhofer Institute for Silicate Research ISC, Translational Center Regenerative Therapies, Wuerzburg, Germany
| | - M Funk
- QRSKIN GmbH, Wuerzburg, Germany
| | - G J Mohr
- MATERIALS - Institute for Surface Technologies and Photonics, Joanneum Research Forschungsgesellschaft mbH, Weiz, Austria
| | - L K Branski
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria; Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children-Galveston®, Galveston, TX, USA
| | - S I Mautner
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria; HEALTH - Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
| | - L P Kamolz
- COREMED - Cooperative Centre for Regenerative Medicine, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
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Tapking C, Hundeshagen G, Popp D, Lee JO, Herndon DN, Zapata-Sirvent R, Branski LK. The Frequency and Reason For Amputations in Electrically Burned Pediatric Patients. J Burn Care Res 2019; 40:107-111. [PMID: 30371857 DOI: 10.1093/jbcr/iry056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Electrical injuries induce substantial morbidity and mortality. Amputations are often necessary to enable survival and based on tissue nonviability, development of life-threatening infection, or expected nonfunctional outcome. They analyzed occurrence and type of amputations in their institution for electrical and nonelectrical pediatric burns and the number of reconstructive operations. Patients who underwent any amputation between 1999 and 2017 were identified. Patients with electrical burns (EB) were matched regarding age, sex, and percent total body surface area (%TBSA) burned to patients with nonelectrical burns (NEB). Both groups (n = 35 EB, n = 70 NEB) were comparable regarding age (EB, 11.6 ± 4.5 years; NEB, 11.1 ± 4.5 years, P = .550) and %TBSA (36.7 ± 15.4% and 37.7 ± 12.9%, P = .738). Major amputations (above wrist or ankle) were performed in 77% of EB vs 31% of NEB (P < .001). Amputations above knee or elbow were performed in 13 (37.1%) vs two patients (2.9%, P < .001). Eight (22.9%) vs six patients (8.6%) underwent combination of two or more major amputations (P = .042). In both groups, most amputations were performed for functional reasons. Length of stay was shorter in EB group (33 ± 27 vs 47 ± 38 days, P = .040). EB patients underwent 9.9 ± 7.1 total operations compared with 14.4 ± 5.1 operations (P < .001). Of these, 6.5 ± 3.6 and 7.9 ± 3.3 (P = .023) were performed during acute stay and 3.3 ± 4.8 and 6.5 ± 3.5 after acute stay (P < .001), respectively. Mortality was comparable. EB were associated with larger extent of limb loss and more major amputations than NEB with amputations. They furthermore required a smaller number of reconstructive procedures. EB require extra attention of caregivers, because of their extensive tissue damage.
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Affiliation(s)
- Christian Tapking
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children-Galveston® Galveston, Texas.,Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Gabriel Hundeshagen
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children-Galveston® Galveston, Texas.,Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Daniel Popp
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children-Galveston® Galveston, Texas.,Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Jong O Lee
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children-Galveston® Galveston, Texas
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children-Galveston® Galveston, Texas
| | - Ramón Zapata-Sirvent
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children-Galveston® Galveston, Texas
| | - Ludwik K Branski
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children-Galveston® Galveston, Texas.,Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
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Tapking C, Popp D, Herndon DN, Branski LK, Mlcak RP, Suman OE. Estimated versus achieved maximal oxygen consumption in severely burned children maximal oxygen consumption in burned children. Burns 2018; 44:2026-2033. [PMID: 30005988 PMCID: PMC6289624 DOI: 10.1016/j.burns.2018.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 06/15/2018] [Indexed: 01/01/2023]
Abstract
PURPOSE In burned children, exercise training increases maximal oxygen consumption (VO2 max) and can be combined with the nonspecific beta-blocker propranolol to decrease cardiac work. VO2 max is estimated if indirect calorimetry is not available. We compared measured and estimated VO2 max in severely burned children treated with or without propranolol to determine the suitability of commonly used formulas in these populations. METHODS Patients received propranolol or placebo (control) during acute hospitalization. VO2 max was measured during a modified Bruce treadmill test at discharge and compared to values obtained using the Cooper, Bruce, American College of Sports Medicine, and Porro formulas. Pearson correlations and Bland-Altman analyses were used to compare measured and estimated values. RESULTS Ninety-nine children (propranolol n=46,control n=53) admitted at our facility between 2003 and 2016 were analyzed. Age at burn (propranolol 12±4years, control 12±3years,p=0.893) and total body surface area burned (propranolol 44±15%,control 49±14%,p=0.090) were comparable between groups. Measured VO2 max was higher in the propranolol group (25.5±6.0mL/min/kg vs. 22.0±4.7mL/min/kg,p=0.002) and was generally lower than estimated values. Age, sex, inhalation injury, body mass index, exercise time, and maximal speed were predictive of measured VO2 max in the control group. Age, sex, and maximal speed were predictive in the propranolol group. Backward selection yielded the formula [7.63+ 2.16×sex(females=0,males=1)+0.41×age(years)+0.15×maximal speed(m/min)] (R2=0.6525). CONCLUSIONS Propranolol seems to have beneficial effects on cardiorespiratory capacity in burned children. However, estimated VO2 max with common formulas were too high. The VO2 max formula reported here is suitable for propranolol-treated children and the Porro formula for non-propranolol-treated children.
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Affiliation(s)
- Christian Tapking
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children(®)-Galveston, 815 Market Street, Galveston, TX 77550, USA; Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | - Daniel Popp
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children(®)-Galveston, 815 Market Street, Galveston, TX 77550, USA; Division of Hand, Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children(®)-Galveston, 815 Market Street, Galveston, TX 77550, USA
| | - Ludwik K Branski
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children(®)-Galveston, 815 Market Street, Galveston, TX 77550, USA; Division of Hand, Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Ronald P Mlcak
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children(®)-Galveston, 815 Market Street, Galveston, TX 77550, USA
| | - Oscar E Suman
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children(®)-Galveston, 815 Market Street, Galveston, TX 77550, USA.
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Schryver E, Klein GL, Herndon DN, Suman OE, Branski LK, Sousse LE. Bone metabolism in pediatric burned patients: A review. Burns 2018; 44:1863-1869. [PMID: 30077487 PMCID: PMC9810107 DOI: 10.1016/j.burns.2018.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/07/2018] [Accepted: 04/24/2018] [Indexed: 01/07/2023]
Abstract
Severe burns in children can lead to growth delays, bone loss, and wasting of lean body mass and muscle with subsequent long-term effects such as osteoporosis. The following review examines 11 randomized, placebo-controlled, prospective clinical trials in pediatric burns between 1995 and 2017. These studies included approximately 250 burned children, and they were conducted to evaluate the impact of severe burn on markers of bone formation and bone metabolism. Some trials also analyzed current therapy regimens such as pamidronate and vitamin D. The clinical utility of these outlined biomarkers is uncertain with regard to acute burn care, as the current literature remains unclear. This review thus serves to address the impact of severe burn on markers of bone formation and bone metabolism in pediatric patients but will not focus on the clinical utility of the markers. The aim of this review is to summarize the findings of the trials to guide the future care of burned patients to maximize bone recovery.
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Affiliation(s)
- Eric Schryver
- Shriners Hospital for Children―Galveston, University of Texas Medical Branch, Galveston, Texas 77555, USA
| | - Gordon L. Klein
- Shriners Hospital for Children―Galveston, University of Texas Medical Branch, Galveston, Texas 77555, USA.,Department of Orthopedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas 77555, USA
| | - David N. Herndon
- Shriners Hospital for Children―Galveston, University of Texas Medical Branch, Galveston, Texas 77555, USA.,Department of Surgery, University of Texas Medical Branch, Galveston, Texas 77555, USA.,Institute for Translational Sciences, University of Texas Medical Branch, Galveston, Texas 77555, USA
| | - Oscar E. Suman
- Shriners Hospital for Children―Galveston, University of Texas Medical Branch, Galveston, Texas 77555, USA.,Department of Surgery, University of Texas Medical Branch, Galveston, Texas 77555, USA
| | - Ludwik K. Branski
- Shriners Hospital for Children―Galveston, University of Texas Medical Branch, Galveston, Texas 77555, USA.,Department of Surgery, University of Texas Medical Branch, Galveston, Texas 77555, USA
| | - Linda E. Sousse
- Shriners Hospital for Children―Galveston, University of Texas Medical Branch, Galveston, Texas 77555, USA.,Department of Surgery, University of Texas Medical Branch, Galveston, Texas 77555, USA
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Padilla PL, Freudenburg EP, Kania K, Laney RW, Branski LK, Herndon DN. Negative Pressure Wound Therapy with Instillation and Dwell for the Management of a Complex Burn: A Case Report and Review of the Literature. Cureus 2018; 10:e3514. [PMID: 30613456 PMCID: PMC6314793 DOI: 10.7759/cureus.3514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Research over the last 50 years has led to significant improvements in outcomes for burn victims. Advances in infection control, attenuation of the hypermetabolic response, and new improved surgical approaches have led to decreased morbidity and mortality. Early wound excision eliminates the devitalized tissue, which is the main reservoir for pathogen propagation. Immediate autografting reestablishes the natural barrier of the skin, which blocks pathogen access to the host. Advances in burn care have increased treatment options for patients with devastating injuries presenting with multiple comorbidities. Over the last 20 years, negative pressure assisted wound therapy (NPWT) has shown to improve wound management and healing as well as decrease the length of recovery in burn patients. As NPWT applications evolve, the development of negative pressure wound therapy with instillation and dwell time (NPWTi-d) for the management of complex and infected wounds has proven vital for patient care. We present the case of a 68-year-old male patient presenting with a three-day-old third-degree burn wound spanning 46% of the total body surface area (TBSA). After the infected wound was treated unsuccessfully with the standard of care (excision, debridement, and grafting), the team utilized NPWTi-d in order to mitigate the infection and promote the formation of granulation tissue, leading to the successful grafting of the burn wound. NPWTi-d was a useful adjunct in treating and stimulating wound healing in a complex patient. This is the first case report of its kind, utilizing a whole-body vacuum assisted closure (VAC) with NPWTi-d, with successful results showing a decreased bacterial burden, decreased morbidity and mortality, and patient wound closure.
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Affiliation(s)
- Pablo L Padilla
- Plastic and Reconstructive Surgery, The University of Texas Medical Branch, Galveston, USA
| | | | - Katarzyna Kania
- Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, USA
| | - Rece W Laney
- Plastic and Reconstructive Surgery, The University of Texas Medical Branch, Galveston, USA
| | - Ludwik K Branski
- Plastic and Reconstructive Surgery, The University of Texas Medical Branch, Galveston, USA
| | - David N Herndon
- Plastic and Reconstructive Surgery, The University of Texas Medical Branch, Galveston, USA
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Tapking C, Armenta AM, Popp D, Herndon DN, Branski LK, Lee JO, Suman OE. Relationship between lean body mass and isokinetic peak torque of knee extensors and flexors in severely burned children. Burns 2018; 45:114-119. [PMID: 30279019 DOI: 10.1016/j.burns.2018.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/11/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Severe burns cause hypermetabolic responses and prolonged hospitalization, resulting in loss of body mass and muscle strength. This study aimed to determine whether long-term gains in lean body mass (LBM) after structured exercise programs are functionally meaningful and related to greater muscle strength in severely burned children. STUDY DESIGN LBM and muscle strength were measured at discharge and at 6, 12, 24, and 36 months after burn in 349 children. Body composition, including LBM, was measured via dual-emission X-ray-absorptiometry. Peak torque was measured using Biodex dynamometer at varying angular velocities (90, 120, 150, 180°/s). Pearson correlation analysis evaluated the association between LBM and peak torque. RESULTS LBM progressively increased from discharge (32.5±11.5kg) to 36 months following injury (40.2±12.3kg). Peak torque and peak torque/LBM increased from discharge (56.4±34.0Nm and 1.7±34.0Nmkg-1) to 36 months after burn (102.3±43.8Nm and 2.5±0.7Nmkg-1, p<0.01 for both). LBM and peak torque at all angular velocities showed moderate/strong correlations, with 120°/s being the strongest (all time-points: R2≥0.57). CONCLUSION In severely burned children participating in a rehabilitative exercise program, gains in LBM over time are related to increases in muscle strength, suggesting that gained muscle mass is functional. Measurement of muscle strength at an angular velocity of 120°/s best reflects gains in LBM and should be considered for reliable measure of strength in future studies.
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Affiliation(s)
- Christian Tapking
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children(®)-Galveston, Galveston, TX 77550, USA; Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | - Andrew M Armenta
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Daniel Popp
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children(®)-Galveston, Galveston, TX 77550, USA; Division of Hand, Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children(®)-Galveston, Galveston, TX 77550, USA
| | - Ludwik K Branski
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children(®)-Galveston, Galveston, TX 77550, USA; Division of Hand, Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Jong O Lee
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children(®)-Galveston, Galveston, TX 77550, USA
| | - Oscar E Suman
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children(®)-Galveston, Galveston, TX 77550, USA.
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Cambiaso-Daniel J, Rontoyanni VG, Foncerrada G, Nguyen A, Capek KD, Wurzer P, Lee JO, Hundeshagen G, Voigt CD, Branski LK, Finnerty CC, Herndon DN. Correlation between invasive and noninvasive blood pressure measurements in severely burned children. Burns 2018; 44:1787-1791. [PMID: 30153960 DOI: 10.1016/j.burns.2018.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/05/2018] [Accepted: 03/03/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Accurate blood pressure monitoring is essential for burn management, with the intra-arterial line method being the gold standard. Here we evaluated agreement between cuff and intra-arterial line methods. METHODS Data from burned children admitted from 1997 to 2016 were retrospectively reviewed. Simultaneously collected intra-arterial and cuff measurements were cross-matched and linear regression performed to assess agreement for systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP). RESULTS We identified 9969 matches for SBP, DBP, and MAP in 872 patients (579 male) aged 8±5years with burns covering 52±20% of the total body surface area and a hospitalization lasting 33±31 days. Intra-arterial lines had a complication rate of 1%. The mean bias (95% CI) between methods was 1.3 (0.5, 2.1) mm Hg for SBP, -6.4 (-7.0, -5.7) mmHg for DBP, and -5.8 (-6.4, -5.3) mmHg for MAP. The standard deviation of the bias (95% limit of agreement) was 12.1 (-22.5, 25.1) mmHg for SBP, 9.9 (-25.8, 13.0) mmHg for DBP, and 8.7 (-22.8, 11.1) mmHg for MAP. CONCLUSIONS Cuff measurements vary widely from those of intra-arterial lines, which have a low complication rate. Intra-arterial lines are advisable when tight control of the hemodynamic response is essential.
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Affiliation(s)
- Janos Cambiaso-Daniel
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria.
| | - Victoria G Rontoyanni
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA; Metabolism Unit, Shriners Hospitals for Children, Galveston, TX, USA.
| | - Guillermo Foncerrada
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA.
| | - Anthony Nguyen
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | - Karel D Capek
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA.
| | - Paul Wurzer
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria.
| | - Jong O Lee
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA.
| | - Gabriel Hundeshagen
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA; Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany.
| | - Charles D Voigt
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA.
| | - Ludwik K Branski
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria.
| | - Celeste C Finnerty
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA; Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, USA.
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA.
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Zavlin D, Chegireddy V, Boukovalas S, Nia AM, Branski LK, Friedman JD, Echo A. Multi-institutional analysis of independent predictors for burn mortality in the United States. Burns Trauma 2018; 6:24. [PMID: 30151396 PMCID: PMC6103989 DOI: 10.1186/s41038-018-0127-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/16/2018] [Indexed: 11/10/2022]
Abstract
Background Previous reports individually identified different factors that predict death after burns. The authors employed the multi-center American Burn Association's (ABA) National Burn Repository (NBR) to elucidate which parameters have the highest negative impact on burn mortality. Methods We audited data from the NBR v8.0 for the years 2002-2011 and included 137,061 patients in our study. The cases were stratified into two cohorts based on the primary outcome of death/survival and then evaluated for demographic data, intraoperative details, and their morbidity after admission. A multivariable regression analysis aimed to identify independent risk factors associated with mortality. Results A total of 3.3% of patients in this analysis did not survive their burn injuries. Of those, 52.0% expired within 7 days after admission. Patients in the mortality cohort were of older age (p < 0.001), more frequently female (p < 0.001), and had more pre-existing comorbidities (p < 0.001). Total body surface area (TBSA), inhalation injury, hospitalization time, and occurrence of complications were higher compared to survivors (p < 0.001). Lack of insurance (odds ratio (OR) = 1.84, confidence interval (CI) 1.38-2.46), diabetes (OR = 1.24, CI 1.01-1.53), any complication (OR = 4.09, CI 3.27-5.12), inhalation injury (OR = 3.84, CI 3.38-4.36), and the need for operative procedures (OR = 2.60, CI 2.20-3.08) were the strongest independent contributors to mortality after burns (p < 0.001). Age (OR = 1.07, CI 1.06-1.07) and TBSA (OR = 1.09, CI 1.09-1.09) were significant on a continuous scale (p < 0.001) while overall comorbidities were not a statistical risk factor. Conclusion Uninsured status, inhalation injury, in-hospital complications, and operative procedures were the strongest mortality predictors after burns. Since most fatal outcomes (52.0%) occur within 7 days after injury, physicians and medical staff need to be aware of these risk factors upon patient admission to a burn center.
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Affiliation(s)
- Dmitry Zavlin
- 1Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, 6560 Fannin Street, Scurlock Tower, Suite 2200, Houston, TX 77030 USA
| | - Vishwanath Chegireddy
- 1Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, 6560 Fannin Street, Scurlock Tower, Suite 2200, Houston, TX 77030 USA
| | - Stefanos Boukovalas
- 2Division of Plastic Surgery, The University of Texas Medical Branch, Galveston, TX USA
| | - Anna M Nia
- 3School of Medicine, The University of Texas Medical Branch, Galveston, TX USA
| | - Ludwik K Branski
- 2Division of Plastic Surgery, The University of Texas Medical Branch, Galveston, TX USA
| | - Jeffrey D Friedman
- 1Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, 6560 Fannin Street, Scurlock Tower, Suite 2200, Houston, TX 77030 USA
| | - Anthony Echo
- 1Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, 6560 Fannin Street, Scurlock Tower, Suite 2200, Houston, TX 77030 USA
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Affiliation(s)
- Paul Wurzer
- Shriners Hospitals for Children, University of Texas Medical Branch, Galveston, Texas Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University Graz, Graz, Austria Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University Graz, Graz, Austria Shriners Hospitals for Children, University of Texas Medical Branch, Galveston, Texas
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Tapking C, Herndon DN, Branski LK, Suman OE. Comparison Of Estimated And Achieved Metabolic Equivalents In Children With Severe Burns. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000538751.04573.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hundeshagen G, Jay JW, Prasai A, Foncerrada G, Smith JM, Nguyen AV, Cambiaso-Daniel J, Herndon DN, Enkhbaatar P, Branski LK, Finnerty CC. 35 First in Vitro and in Vivo Experiences with a New Synthetic Dermal Substitute with Dual Microporous Structure. J Burn Care Res 2018. [DOI: 10.1093/jbcr/iry006.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- G Hundeshagen
- University of Texas Medical Branch, Galveston, TX; Shrines Hospitals for Children Galveston, Galveston, TX
| | - J W Jay
- University of Texas Medical Branch, Galveston, TX; Shrines Hospitals for Children Galveston, Galveston, TX
| | - A Prasai
- University of Texas Medical Branch, Galveston, TX; Shrines Hospitals for Children Galveston, Galveston, TX
| | - G Foncerrada
- University of Texas Medical Branch, Galveston, TX; Shrines Hospitals for Children Galveston, Galveston, TX
| | - J M Smith
- University of Texas Medical Branch, Galveston, TX; Shrines Hospitals for Children Galveston, Galveston, TX
| | - A V Nguyen
- University of Texas Medical Branch, Galveston, TX; Shrines Hospitals for Children Galveston, Galveston, TX
| | - J Cambiaso-Daniel
- University of Texas Medical Branch, Galveston, TX; Shrines Hospitals for Children Galveston, Galveston, TX
| | - D N Herndon
- University of Texas Medical Branch, Galveston, TX; Shrines Hospitals for Children Galveston, Galveston, TX
| | - P Enkhbaatar
- University of Texas Medical Branch, Galveston, TX; Shrines Hospitals for Children Galveston, Galveston, TX
| | - L K Branski
- University of Texas Medical Branch, Galveston, TX; Shrines Hospitals for Children Galveston, Galveston, TX
| | - C C Finnerty
- University of Texas Medical Branch, Galveston, TX; Shrines Hospitals for Children Galveston, Galveston, TX
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Houschyar KS, Chelliah MP, Rein S, Maan ZN, Weissenberg K, Duscher D, Branski LK, Siemers F. Role of Wnt signaling during inflammation and sepsis: A review of the literature. Int J Artif Organs 2018; 41:247-253. [PMID: 29562813 DOI: 10.1177/0391398818762357] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Despite the development of modern intensive care and new antimicrobial agents, the mortality of patients with severe sepsis and septic shock remains high. Systemic inflammation is a consequence of activation of the innate immune system. It is characterized by the intravascular release of proinflammatory cytokines and other vasoactive mediators, with concurrent activation of innate immune cells. The Wnt signaling pathway plays a critical role in the development of multicellular organisms. Abnormal Wnt signaling has been associated with many human diseases, ranging from inflammation and degenerative diseases to cancer. This article reviews the accumulating evidence that the Wnt signaling pathway plays a distinct role in inflammation and sepsis.
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Affiliation(s)
- Khosrow Siamak Houschyar
- 1 Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Halle, Germany
| | - Malcolm P Chelliah
- 2 Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - Susanne Rein
- 1 Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Halle, Germany
| | - Zeshaan N Maan
- 2 Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - Kristian Weissenberg
- 1 Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Halle, Germany
| | - Dominik Duscher
- 3 Department of Plastic Surgery and Hand Surgery, Technical University Munich, Munich, Germany
| | - Ludwik K Branski
- 4 Department of Surgery, Shriners Hospital for Children-Galveston, University of Texas Medical Branch, Galveston, TX, USA
| | - Frank Siemers
- 1 Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Halle, Germany
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Hundeshagen G, Collins VN, Wurzer P, Sherman W, Voigt CD, Cambiaso-Daniel J, Nunez Lopez O, Sheaffer J, Herndon DN, Finnerty CC, Branski LK. A Prospective, Randomized, Controlled Trial Comparing the Outpatient Treatment of Pediatric and Adult Partial-Thickness Burns with Suprathel or Mepilex Ag. J Burn Care Res 2018; 39:261-267. [PMID: 28557869 PMCID: PMC5700875 DOI: 10.1097/bcr.0000000000000584] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 04/14/2017] [Accepted: 04/16/2017] [Indexed: 11/25/2022]
Abstract
Modern treatment of partial-thickness burns follows the paradigm of less frequent dressing changes to allow for undisturbed reepithelialization of the burn wound. We compared Mepilex Ag (M), a silver-impregnated foam dressing, and Suprathel (S), a DL-lactid acid polymer, in the outpatient treatment of partial-thickness burns in pediatric and adult patients. Patients were enrolled in a randomized, controlled, prospective clinical trial. We monitored time to reepithelialization, wound pain, discomfort during dressing changes, and treatment cost. Objective scar characteristics (elasticity, transepidermal water loss, hydration, and pigmentation) and subjective assessments (Patient and Observer Scar Assessment Scale) were measured at 1 month post burn. Data are presented as mean ± SEM, and significance was accepted at P < 0.05. Sixty-two patients (S n = 32; M n = 30) were enrolled; age, sex, and burn size were comparable between the groups. Time to reepithelialization was not different between the groups (12 days; P = 0.75). Pain ratings were significantly reduced during the first 5 days after burn in the Suprathel group in all patients (P = 0.03) and a pediatric subgroup (P < 0.001). Viscolelasticity of burned skin was elevated compared with unburned skin in the Mepilex Ag group at 1 month post burn. Patients treated with Suprathel reported better overall scar quality (S: 2; M: 4.5; P < 0.001). The cost of treatment per square centimeter for Mepilex Ag was considerably lower than that of Suprathel. Both dressings are feasible and efficacious for the outpatient treatment of minor and selected moderate partial-thickness burns. Reduced pain, especially in a pediatric patient population, may be advantageous, despite increased treatment cost.
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Affiliation(s)
- Gabriel Hundeshagen
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX
- Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | - Vanessa N Collins
- School of Medicine, University of Texas Medical Branch, Galveston, TX
| | - Paul Wurzer
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - William Sherman
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX
| | - Charles D Voigt
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX
| | - Janos Cambiaso-Daniel
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - Omar Nunez Lopez
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX
| | - Jason Sheaffer
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX
| | - Celeste C Finnerty
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX
- Institute for Translational Sciences and the Sealy Center for Molecular Medicine, University of Texas Medical Branch, Galveston, TX
| | - Ludwik K Branski
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
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Cambiaso-Daniel J, Boukovalas S, Bitz GH, Branski LK, Herndon DN, Culnan DM. Topical Antimicrobials in Burn Care: Part 1-Topical Antiseptics. Ann Plast Surg 2018; Publish Ahead of Print:10.1097/SAP.0000000000001297. [PMID: 29319571 PMCID: PMC6037606 DOI: 10.1097/sap.0000000000001297] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Burn wounds disrupt the body's primary defense against invasion and colonization by microorganisms. Topical antimicrobials are one component in burn wound care. These agents suppress microbial growth to advantage skin cells and wound healing. Topical antimicrobials can be divided into 2 superclasses: antiseptics and antibiotics. We review the 4 main classes of topical antiseptics (emulsifiers, acids, oxidizers, and heavy metals) and antiseptic-impregnated dressings in current clinical use and address the mechanisms, as well as the advantages and disadvantages of each antiseptic for burn wound management.
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Affiliation(s)
- Janos Cambiaso-Daniel
- Department of Surgery, University of Texas Medical Branch, and Shriners Hospitals for Children, Galveston, Texas, USA
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - Stafanos Boukovalas
- Division of Plastic Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Genevieve H. Bitz
- JMS Burn and Reconstructive Center, Merit Health Central Hospital, Jackson, Mississippi, USA
| | - Ludwik K. Branski
- Department of Surgery, University of Texas Medical Branch, and Shriners Hospitals for Children, Galveston, Texas, USA
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - David N. Herndon
- Department of Surgery, University of Texas Medical Branch, and Shriners Hospitals for Children, Galveston, Texas, USA
- Division of Plastic Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Derek M. Culnan
- JMS Burn and Reconstructive Center, Merit Health Central Hospital, Jackson, Mississippi, USA
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Hundeshagen G, Herndon DN, Capek KD, Branski LK, Voigt CD, Killion EA, Cambiaso-Daniel J, Sljivich M, De Crescenzo A, Mlcak RP, Kinsky MP, Finnerty CC, Norbury WB. Co-administration of vancomycin and piperacillin-tazobactam is associated with increased renal dysfunction in adult and pediatric burn patients. Crit Care 2017; 21:318. [PMID: 29262848 PMCID: PMC5738705 DOI: 10.1186/s13054-017-1899-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/28/2017] [Indexed: 02/07/2023]
Abstract
Background Burn patients are prone to infections which often necessitate broad antibiotic coverage. Vancomycin is a common antibiotic after burn injury and is administered alone (V), or in combination with imipenem-cilastin (V/IC) or piperacillin-tazobactam (V/PT). Sparse reports indicate that the combination V/PT is associated with increased renal dysfunction. The purpose of this study was to evaluate the short-term impact of the three antibiotic administration types on renal dysfunction. Methods All pediatric and adult patients admitted to our centers between 2004 and 2016 with a burn injury were included in this retrospective review if they met the criteria of exposition to either V, V/IC, or V/PT for at least 48 h, had normal baseline creatinine, and no pre-existing renal dysfunction. Creatinine was monitored for 7 days after initial exposure; the absolute and relative increase was calculated, and patient renal outcomes were classified according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria depending on creatinine increases and estimated creatinine clearance. Secondary endpoints (demographic and clinical data, incidences of septicemia, and renal replacement therapy) were analyzed. Antibiotic doses were modeled in logistic and linear multivariable regression models to predict categorical KDIGO events and relative creatinine increase. Results Out of 1449 patients who were screened, 718 met the inclusion criteria, 246 were adults, and 472 were children. Between the study cohorts V, V/IC, and V/PT, patient characteristics at admission were comparable. V/PT administration was associated with a statistically higher serum creatinine, and lower creatinine clearance compared to patients receiving V alone or V/IC in adults and children after burn injury. The incidence of KDIGO stages 1, 2, and 3 was higher after V/PT treatment. In children, the incidence of KDIGO stage 3 following administration of V/PT was greater than after V/IC. In adults, the incidence of renal replacement therapy was higher after V/PT compared with V or V/IC. Multivariate modeling demonstrated that V/PT is an independent predictor of renal dysfunction. Conclusion Co-administration of vancomycin and piperacillin-tazobactam is associated with increased renal dysfunction in pediatric and adult burn patients when compared to vancomycin alone or vancomycin plus imipenem-cilastin. The mechanism of this increased nephrotoxicity remains elusive and warrants further scientific evaluation. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1899-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gabriel Hundeshagen
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA. .,Shriners Hospitals for Children, 815 Market St., Galveston, TX, 77550, USA. .,Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA.,Shriners Hospitals for Children, 815 Market St., Galveston, TX, 77550, USA
| | - Karel D Capek
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA.,Shriners Hospitals for Children, 815 Market St., Galveston, TX, 77550, USA
| | - Ludwik K Branski
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA.,Shriners Hospitals for Children, 815 Market St., Galveston, TX, 77550, USA.,Department of Plastic Surgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Charles D Voigt
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA.,Shriners Hospitals for Children, 815 Market St., Galveston, TX, 77550, USA
| | - Elizabeth A Killion
- Department of Plastic Surgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Janos Cambiaso-Daniel
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Michaela Sljivich
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA.,Shriners Hospitals for Children, 815 Market St., Galveston, TX, 77550, USA
| | - Andrew De Crescenzo
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA.,Shriners Hospitals for Children, 815 Market St., Galveston, TX, 77550, USA
| | - Ronald P Mlcak
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA.,Shriners Hospitals for Children, 815 Market St., Galveston, TX, 77550, USA
| | - Michael P Kinsky
- Department of Anesthesiology, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA
| | - Celeste C Finnerty
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA.,Shriners Hospitals for Children, 815 Market St., Galveston, TX, 77550, USA
| | - William B Norbury
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA.,Shriners Hospitals for Children, 815 Market St., Galveston, TX, 77550, USA
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Nunez Lopez O, Cambiaso-Daniel J, Branski LK, Norbury WB, Herndon DN. Predicting and managing sepsis in burn patients: current perspectives. Ther Clin Risk Manag 2017; 13:1107-1117. [PMID: 28894374 PMCID: PMC5584891 DOI: 10.2147/tcrm.s119938] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Modern burn care has led to unprecedented survival rates in burn patients whose injuries were fatal a few decades ago. Along with improved survival, new challenges have emerged in the management of burn patients. Infections top the list of the most common complication after burns, and sepsis is the leading cause of death in both adult and pediatric burn patients. The diagnosis and management of sepsis in burns is complex as a tremendous hypermetabolic response secondary to burn injury can be superimposed on systemic infection, leading to organ dysfunction. The management of a septic burn patient represents a challenging scenario that is commonly encountered by providers caring for burn patients despite preventive efforts. Here, we discuss the current perspectives in the diagnosis and treatment of sepsis and septic shock in burn patients.
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Affiliation(s)
- Omar Nunez Lopez
- Department of Surgery, University of Texas Medical Branch.,Shriners Hospitals for Children, Galveston, TX, USA
| | - Janos Cambiaso-Daniel
- Department of Surgery, University of Texas Medical Branch.,Shriners Hospitals for Children, Galveston, TX, USA.,Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Ludwik K Branski
- Department of Surgery, University of Texas Medical Branch.,Shriners Hospitals for Children, Galveston, TX, USA
| | - William B Norbury
- Department of Surgery, University of Texas Medical Branch.,Shriners Hospitals for Children, Galveston, TX, USA
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch.,Shriners Hospitals for Children, Galveston, TX, USA.,Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, USA
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Abstract
Rehabilitation of patients with burn injuries aims to restore strength, coordination, and mobility as closely to normal as possible and should begin immediately after initial admission. In the acute phase, baseline assessments are made against which all subsequent rehabilitation success is held. In the intermediate phase, active, full range-of-motion movement, ambulation of steadily increasing distances, and resistive exercise and stretching aid in the prevention of muscle and bone atrophy and preserve muscle memory and coordination. In the long-term outpatient rehabilitation phase, individualized patient-centered exercise programs can be advantageous in achieving measurable and lasting positive rehabilitation outcomes.
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Affiliation(s)
- Gabriel Hundeshagen
- Department of Surgery, Shriners Hospital for Children-Galveston, University of Texas Medical Branch, 815 Market Street, Galveston, TX 77550, USA; Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Oscar E Suman
- Department of Surgery, Shriners Hospital for Children-Galveston, University of Texas Medical Branch, 815 Market Street, Galveston, TX 77550, USA
| | - Ludwik K Branski
- Department of Surgery, Shriners Hospital for Children-Galveston, University of Texas Medical Branch, 815 Market Street, Galveston, TX 77550, USA.
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Wurzer P, Cole MR, Clayton RP, Hundeshagen G, Nunez Lopez O, Cambiaso-Daniel J, Winter R, Branski LK, Hawkins HK, Finnerty CC, Herndon DN, Lee JO. Herpesviradae infections in severely burned children. Burns 2017; 43:987-992. [PMID: 28420570 DOI: 10.1016/j.burns.2017.01.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 12/31/2016] [Accepted: 01/24/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Burn-related immunosuppression can promote human herpesviridae infections. However, the effect of these infections on morbidity and mortality after pediatric burn injuries is unclear. METHODS We retrospectively analyzed pediatric patients with burns ≥10% of the total body surface area (TBSA) who were admitted between 2010 and 2015. On clinical suspicion of a viral infection, antiviral therapy was initiated. Viral infection was confirmed via Tzanck smear, viral culture, and/or PCR. Study endpoints were mortality, days of antiviral agent administration, type of viral test used, type of viral infection, and length of hospitalization. RESULTS Of the 613 patients were analyzed, 28 presented with clinically diagnosed viral infections. The use of Tzanck smears decreased over the past 5 years, whereas PCR and viral cultures have become standard. Patients with viral infections had significantly larger burns (53±15% vs. 38±18%, p<0.001); however, length of stay per TBSA burn was comparable (0.5±0.4 vs. 0.6±0.2, p=0.211). The most commonly detected herpesviridae was herpes simplex virus 1. Two patients died due to sepsis, which was accompanied by HSV infection. The mortality rate among all patients (2.7%) was comparable to that in the infected group (7.1%, p=0.898). Acyclovir was given systemically for 9±8days (N=76) and/or topically for 9±9days for HSV (N=39, combination of both N=33). Ganciclovir was prescribed in three cases for CMV. CONCLUSIONS Viral infections occur more commonly in patients suffering from larger burns, and HSV infections can contribute to mortality.
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Affiliation(s)
- Paul Wurzer
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, United States; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
| | - Megan R Cole
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, United States
| | - Robert P Clayton
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, United States; Sealy Center for Molecular Medicine and the Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, United States
| | - Gabriel Hundeshagen
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, United States
| | - Omar Nunez Lopez
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, United States
| | - Janos Cambiaso-Daniel
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Raimund Winter
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Ludwik K Branski
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, United States; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Hal K Hawkins
- Department of Pathology, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, United States
| | - Celeste C Finnerty
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, United States; Sealy Center for Molecular Medicine and the Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, United States
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, United States
| | - Jong O Lee
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, United States
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Smolle C, Cambiaso-Daniel J, Forbes AA, Wurzer P, Hundeshagen G, Branski LK, Huss F, Kamolz LP. Recent trends in burn epidemiology worldwide: A systematic review. Burns 2017; 43:249-257. [PMID: 27600982 PMCID: PMC5616188 DOI: 10.1016/j.burns.2016.08.013] [Citation(s) in RCA: 301] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/20/2016] [Accepted: 08/12/2016] [Indexed: 11/30/2022]
Abstract
Burns have been more prevalent among low socioeconomic populations and in less developed regions. Incredible advances in burn care and social development over the recent decades, however, should have placed the incidence and severity of burns in a downwards trend. The aim of this review was to give an overview on current trends in burn epidemiology across the world. Also the socioeconomic development in countries that have published epidemiological data used in this study has been taken into account when comparing the results. There was a worldwide downwards trend of burn incidence, burn severity, length of hospital stay, and mortality rate. These findings were particularly pronounced in very highly developed countries. Data from highly and medium developed countries were more heterogeneous. No studies could be obtained from low and middle income countries. Comparisons between the different studies were compromised by the fact that studies emerged from specialized facilities on one hand and general hospitals on the other. Analyzed studies were also frequently focusing on limited patient populations such as "children" or "elderly". Our findings indicate the need for an international burn database with a minimal data-set in order to obtain objective and comparable results in respect of burn epidemiology.
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Affiliation(s)
- Christian Smolle
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria.
| | - Janos Cambiaso-Daniel
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - Abigail A Forbes
- School of Medicine, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0724, USA
| | - Paul Wurzer
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria; Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0724, USA; Shriners Hospitals for Children, 815 Market St., Galveston, TX 77550-2725, USA
| | - Gabriel Hundeshagen
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0724, USA; Shriners Hospitals for Children, 815 Market St., Galveston, TX 77550-2725, USA
| | - Ludwik K Branski
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria; Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0724, USA; Shriners Hospitals for Children, 815 Market St., Galveston, TX 77550-2725, USA
| | - Fredrik Huss
- Burn Center, Department of Plastic- and Maxillofacial Surgery, Uppsala University Hospital, 751 85 Uppsala, Sweden; Department of Surgical Sciences, Plastic Surgery, Uppsala University, 751 85 Uppsala, Sweden
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
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Kafka M, Collins V, Kamolz LP, Rappl T, Branski LK, Wurzer P. Evidence of invasive and noninvasive treatment modalities for hypertrophic scars: A systematic review. Wound Repair Regen 2017; 25:139-144. [DOI: 10.1111/wrr.12507] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/13/2016] [Accepted: 12/23/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Mona Kafka
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery; Medical University of Graz; Graz Austria
| | - Vanessa Collins
- School of Medicine; University of Texas Medical Branch; Galveston Texas
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery; Medical University of Graz; Graz Austria
| | - Thomas Rappl
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery; Medical University of Graz; Graz Austria
| | - Ludwik K. Branski
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery; Medical University of Graz; Graz Austria
- Division of Plastic Surgery, Department of Surgery; University of Texas Medical Branch; Galveston Texas
| | - Paul Wurzer
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery; Medical University of Graz; Graz Austria
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Finnerty CC, Jeschke MG, Branski LK, Barret JP, Dziewulski P, Herndon DN. Hypertrophic scarring: the greatest unmet challenge after burn injury. Lancet 2016; 388:1427-1436. [PMID: 27707499 PMCID: PMC5380137 DOI: 10.1016/s0140-6736(16)31406-4] [Citation(s) in RCA: 344] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/05/2016] [Accepted: 08/09/2016] [Indexed: 12/21/2022]
Abstract
Improvements in acute burn care have enabled patients to survive massive burns that would have once been fatal. Now up to 70% of patients develop hypertrophic scars after burns. The functional and psychosocial sequelae remain a major rehabilitative challenge, decreasing quality of life and delaying reintegration into society. Approaches to optimise healing potential of burn wounds use targeted wound care and surgery to minimise the development of hypertrophic scarring. Such approaches often fail, and modulation of the established scar is continued although the optimal indication, timing, and combination of therapies have yet to be established. The need for novel treatments is paramount, and future efforts to improve outcomes and quality of life should include optimisation of wound healing to attenuate or prevent hypertrophic scarring, well-designed trials to confirm treatment efficacy, and further elucidation of molecular mechanisms to allow development of new preventive and therapeutic strategies.
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Affiliation(s)
- Celeste C Finnerty
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA; The Institute for Translational Sciences, The University of Texas Medical Branch, Galveston, TX, USA; the Sealy Center for Molecular Medicine, The University of Texas Medical Branch, Galveston, TX, USA; Shriners Hospitals for Children, Galveston, TX, USA.
| | - Marc G Jeschke
- Sunnybrook Research Institute, Toronto, ON, Canada; Division of Plastic Surgery Department of Surgery and Immunology, University of Toronto, ON, Canada; Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ludwik K Branski
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA; Shriners Hospitals for Children, Galveston, TX, USA
| | - Juan P Barret
- Department of Plastic Surgery and Burns, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Peter Dziewulski
- St Andrew's Centre for Burns and Plastic Surgery, Broomfield Hospital, Chelmsford, UK; StAAR Research Unit, Faculty of Medical Sciences, Anglia Ruskin University, Chelmsford, UK
| | - David N Herndon
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA; The Institute for Translational Sciences, The University of Texas Medical Branch, Galveston, TX, USA; Shriners Hospitals for Children, Galveston, TX, USA
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Wurzer P, Forbes AA, Hundeshagen G, Andersen CR, Epperson KM, Meyer WJ, Kamolz LP, Branski LK, Suman OE, Herndon DN, Finnerty CC. Two-year follow-up of outcomes related to scarring and distress in children with severe burns. Disabil Rehabil 2016; 39:1639-1643. [PMID: 27685196 DOI: 10.1080/09638288.2016.1209579] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE We assessed the perception of scarring and distress by pediatric burn survivors with burns covering more than one-third of total body surface area (TBSA) for up to 2 years post-burn. METHODS Children with severe burns were admitted to our hospital between 2004 and 2012, and consented to this IRB-approved-study. Subjects completed at least one Scars Problems and/or Distress questionnaire between discharge and 24 months post burn. Outcomes were modeled with generalized estimating equations or using mixed linear models. Significance was accepted at p < 0.01. RESULTS Responses of 167 children with a mean age of 7 ± 5 years and burns covering an average 54 ± 14% of TBSA were analyzed. Significant improvements over the 2-year period were seen in reduction of pain, itching, sleeping disturbance, tightness, range of motion, and strength (p < 0.01). There was a significantly increased persistent desire to hide the scarred body areas over time (p < 0.01). The perception of mouth scarring, inability to portray accurate facial expressions, and skin coloration did not improve over the follow-up period. CONCLUSIONS According to self-assessment questionnaires, severely burned children exhibit significant improvements in their overall perception of scarring and distress. However, these patients remain self-conscious with respect to their body image even 2 years after burn injury. Implications for Rehabilitation According to self-assessment questionnaires, severely burned children perceive significant improvements in scarring and distress during the first 2 years post burn. Significant improvements were seen in reduction of pain, itching, sleeping disturbances, tightness, range of motion, and strength (p < 0.01). Burn care providers should improve the treatment of burns surrounding the mouth that with result in scarring, and develop strategies to prevent skin discoloration. Careful evaluation of pain and sleeping disorders during the first year post burn are warranted to improve the patient rehabilitation. Overall, significantly more female patients expressed a persistent desire to hide their scarred body areas. The rehabilitation team should provide access to wigs or other aids to pediatric burn survivors to address these needs.
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Affiliation(s)
- Paul Wurzer
- a Department of Surgery , University of Texas Medical Branch Galveston , Galveston , TX , USA.,b Shriners Hospitals for Children , Galveston , TX , USA.,c Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery , Medical University of Graz , Graz , Austria
| | - Abigail A Forbes
- d School of Medicine , University of Texas Medical Branch Galveston , Galveston , TX , USA
| | | | - Clark R Andersen
- a Department of Surgery , University of Texas Medical Branch Galveston , Galveston , TX , USA.,b Shriners Hospitals for Children , Galveston , TX , USA
| | - Kathryn M Epperson
- a Department of Surgery , University of Texas Medical Branch Galveston , Galveston , TX , USA.,b Shriners Hospitals for Children , Galveston , TX , USA
| | - Walter J Meyer
- a Department of Surgery , University of Texas Medical Branch Galveston , Galveston , TX , USA.,b Shriners Hospitals for Children , Galveston , TX , USA
| | - Lars P Kamolz
- c Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery , Medical University of Graz , Graz , Austria
| | - Ludwik K Branski
- a Department of Surgery , University of Texas Medical Branch Galveston , Galveston , TX , USA.,b Shriners Hospitals for Children , Galveston , TX , USA.,c Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery , Medical University of Graz , Graz , Austria
| | - Oscar E Suman
- a Department of Surgery , University of Texas Medical Branch Galveston , Galveston , TX , USA.,b Shriners Hospitals for Children , Galveston , TX , USA
| | - David N Herndon
- a Department of Surgery , University of Texas Medical Branch Galveston , Galveston , TX , USA.,b Shriners Hospitals for Children , Galveston , TX , USA
| | - Celeste C Finnerty
- a Department of Surgery , University of Texas Medical Branch Galveston , Galveston , TX , USA.,b Shriners Hospitals for Children , Galveston , TX , USA.,e Institute of Translational Sciences, University of Texas Medical Branch and Shriners Hospitals for Children , Galveston , TX , USA
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Wurzer P, Guillory A, Parvizi D, Clayton RP, Branski LK, Kamolz LP, Finnerty CC, Herndon DN, Lee JO. Human herpes viruses in burn patients: A systematic review. Burns 2016; 43:25-33. [PMID: 27515422 DOI: 10.1016/j.burns.2016.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/03/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The contribution of human herpes viruses, including herpes simplex virus (HSV), cytomegalovirus (CMV), and varicella zoster virus (VZV) to morbidity and mortality after burns remains controversial. This systematic review was undertaken to assess evidence of herpes virus-related morbidity and mortality in burns. MATERIALS AND METHODS PubMed, Ovid, and Web of Science were searched to identify studies of HSV, CMV, or VZV infections in burn patients. Exclusion criteria included: A level of evidence (LoE) of IV or V; nonhuman in vivo studies; and non-English articles. There was no limitation by publication date. RESULTS Fifty articles were subjected to full-text analysis. Of these, 18 had LoE between I-III and were included in the final review (2 LoE I, 16 LoE II-III). Eight had a prospective study design, 9 had a retrospective study design, and 1 included both. CONCLUSIONS No direct evidence linked CMV and HSV infection with increased morbidity and mortality in burns. Following burn, CMV reactivation was more common than a primary CMV infection. Active HSV infection impaired wound healing but was not directly correlated to mortality. Infections with VZV are rare after burns but when they occur, VZV infections were associated with severe complications including mortality. The therapeutic effect of antiviral agents administered after burns warrants investigation via prospective randomized controlled trials.
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Affiliation(s)
- Paul Wurzer
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, USA; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
| | - Ashley Guillory
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, USA
| | - Daryousch Parvizi
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Robert P Clayton
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, USA; Sealy Center for Molecular Medicine and the Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Ludwik K Branski
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, USA; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Lars-P Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Celeste C Finnerty
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, USA; Sealy Center for Molecular Medicine and the Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, USA
| | - Jong O Lee
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, USA
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Wurzer P, Parvizi D, Lumenta DB, Giretzlehner M, Branski LK, Finnerty CC, Herndon DN, Tuca A, Rappl T, Smolle C, Kamolz LP. Smartphone applications in burns. Burns 2015; 41:977-89. [DOI: 10.1016/j.burns.2014.11.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 10/24/2022]
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Abstract
We have yet to create a human scar model that demonstrates the complex nature of hypertrophic scar and keloid formation as well as ways to prevent them despite emerging advances in our understanding of the immune system, the inflammatory response, and proteomic and genomic changes after injury. Despite more complex in vitro models, we fail to explain the fundamental principles to scar formation, and the timeline of their development. The solution to developing the ideal in vitro scar model is one that mimics the heterogeneous cellular and molecular interactions, as well as the evolving structure and function of human skin.
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Affiliation(s)
- Felicia N Williams
- Shriners Hospital for Children and University of Texas Medical Branch, Galveston, TX, USA
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