OBJECTIVE: To investigate the effect of heterogeneous (swine) acellular dermal matrix (s-ADM) and autologous overthin split-thickness skin (auto-OTS) composite grafting in repair of deep burns at articular sites. METHODS: From May 1999 to April 2000, 19 articular sites in 16 patients, including 14 males and 2 females, were treated. In all the 19 sites of deep burn, the total burn area varied from 2% to 48% and the full-thickness burn area varied from 1% to 35%. After the primary escharectomy (1 to 5 days later) and complete hemostasis, the s-ADM was utilized to cover the exposed articular sites and the auto-OTS was transferred on the surface of sutured s-ADM. The size of s-ADM applied to each patient varied from 25 cm2 to 150 cm2. Regular skin grafting was adopted elsewhere other than the articular site. The survival rate of all skin grafting was evaluated and pathological examination was performed. RESULTS: The survival rate of the composite skin was (90.80 +/- 18.34)%, which was obvious higher than the survival rate of contiguous granulosum skin grafting (P lt; 0.05) and almost the same with that of snip skin grafting(P gt; 0.05). The survived composite skin appeared as smooth and soft as normal skin, and the function of articular site almost recovered with neglectable hypertrophic scar. The pathological examination revealed that the normal cell grew into s-ADM with regularly arranged collagen fiber and neovascularization in the matrix. CONCLUSION: The combination of s-ADM and auto-OTS graft is cheap and effective method to cover wound and minimize hypertrophic scar.
Abstract From March, 1987 through May, 1996, a total of 13 cases of severe deep burn and bone defect of hand and wrist were treated by groin skin and iliac bone composite graft with vascular pedicle and had resulted in satisfactory result. The operation was relatively simple. Because thecomposite graft carried its own blood supply in the pedicle, it was not necessary to revascularize the composite graft by anastomosis of blood vessel during operation. Owing to the presence of abundant vascular supply of the iliac bone, the antiinfection potency was high, so its application was suitable for those conditions such as fresh severe deep burn with infection and bone defect. As a result, this technique gave the best chance to save the limb from amputation, and the duration required for treatment could be markedly shortened. This method provided the possibility to solve effectively the difficult problem dealing with the treatment of severe deep burn with infection and bone defect of the hand and wrist.
An experimental study was designed on the treatment of 8 superficial burn wounds and 5 wounds after removing the split-thickness skin grafts with 200GS permanent magnetic flat dressings, and some of the wounds were chosen at random which did not received any treatment and would be served as control. It was noted that the volume of exudate in the treatment group was 11.9 50.7％ less than that of the control group, and the total protein, the albumin and globulin contents in the treatment cases were far less in exudate than those of the control cases. It was concluded that the magnetic therapy not only decresed the exudate, but also diminished the amount of total protein, albumin and globulin in the exudating fluid and it was of benefit to wound recovery.
The ulcer resulting from snake-bite injury was characterized by deep and wide tissue necrosis and secondary infection. The patient was at high risk of loss of function of his extremity. From 1989 to 1996, 16 cases with deep ulcer of the upper extremity resulting from snake-bite injury were treated with different types of axial thoraco-abdominal skin flaps, depending on the location of the ulcer. Thoraco-umbilical skin flap was used in 2 cases, lateral thoracoabdominal skin flap in 1 case, iliolumbar skin flaps in 5 cases, lower abdominal skin flaps in 6 cases, lower abdominal divided foliated skin flap in 1 case and Y-shaped hypogastric skin flap in 1 case. Reparative operation was carried out within 3 weeks after injury and primary repair were undertaken in 6 of them. The pedicles were divided in 17 to 24 days after operation. Twelve flaps survived. Three of the 6 flaps had mild signs of inflammation which disappeared after administration of antibiotics. One had necrosis of the distal part of the flap, and was healed with split skin graft. This type of skin flap was an ideal method for the treatment of snake-bite injury of the upper extremity.
It is in urgent need clinically to look for an ideal substance for the coverage of burn wounds owing to shortage of autografts or allografts. After the cadaveric skin was extracted with acetic acid, salted out with NaCl and freeze-dried to prepare a porous collagen membrane. The membrane was seeded with allo-epidermal cells and allo-fibroblasts on its two sides, respectively, and then was cultured to achieve an artificial composite allograft. The artificial composite allograft was then transplanted onto ten severly burned wounds. One-year follow-up showed satisfactory results and the histological examination confirmed that the composite allograft could improve the adherence and growth of the epidermal cells and was helpful for blood vessels and healing of non-inflammatory connective tissues in the wounds.
Objective To explore the mechanism of full-thickness burn wound healing with autoskin grafting in fault hypodermis wound of granulation excision and to evaluate its effect.Methods By the techniques of clinical observation, histopathology, immunohistochemistry,TEM and FCM,we observed changes of the activity andstructure of grafted skin and the granulation tissue,collagnous fiber,microvessels,the ultramicrostructure of fibroblasts and the expression of basic fibroblast growth factor(bFGF) in the base of autoskin grafting in fault hypodermis wound in burned adult minipigs(Group A), and compared with traditional method of autoskingrafting on the basilar fibrous tissue wound of scraped partly granulation being(Group B) and control group (Group C, without treatment except de-fur).Results The grafted skin survived after 3 days of operation, and it had less injury and higher proliferative index(PI) in group A than in group B. The hyperplasiaof granulation tissue and vascular endothelial and the expression of bFGF were more evident in group A. After 5 days, the proliferation of endothelial cells and granulation and the protein synthesis of fibroblasts were more active in groupA, and at this moment, fresh collagen appeared and proliferated more actively in group B. After 7-14 days, epidermic structure and dermic microvascular density became normal gradually, the granulation on grafting base matured and transformed into fibrous connective tissue in group A. The same change deferred about 2 days in group B. After 21 days, the above pathologic change in group A was less than that in group B. After 3060 days of operation, Group A achieved much less contraction and transfiguration than Group B, and the grafted skin was tender and movable. Conclusion Autoskin grafting in fault hypodermis wound of granulation excision has a better effect than traditional operation.
OBJECTIVE: To evaluate the clinical efficacy of fasciocutaneous flap in the repair of the III degree burn wound in the facio-cervical region. METHODS: From January 1997 to October 2001, 11 cases of III degree burn wounds in the facio-cervical region were repaired with the cervical-thoracic fasciocutaneous flap ranging from 18 cm x 8 cm to 13 cm x 5 cm. Donor sites were covered with "Z" plasty or skin grafting. RESULTS: Except for partial necrosis of distal end of the flap in 1 case, the flaps in the other 10 cases all survived and presented satisfactory appearance and function during the following up. CONCLUSION: The fasciocutaneous flap in the cervical-thoracic region may provide a large area of flap, and can be easily transferred. It’s an ideal flap for the repair of skin defect in the facio-cervical region, especially for the repair of the wounds with infection or exposure of vessel, nerve and tendon.
OBJECTIVE: To investigate the efficiency of recombinant human epidermal growth factor (rhEGF) on burn wound healing and to explore the effective density of the ointments. METHODS: A total of 120 cases of burn in superficial II degree and profound II degree were randomly divided into 2 groups. In the first group of 15 cases of superficial II degree, the wounds were treated by rhEGF ointments of different density, 0.5 microgram/g, 10 micrograms/g and 50 micrograms/g, to screen out the effective density. And in the other 105 cases of the second group, optimal density of the ointments based on the result of the first group were employed to treat the burn wound in superficial II degree and profound II degree, with the self-corresponding wounds of the same degree as control, to study the efficiency of rhEGF on wound healing, according to the wound healing time, and adverse reaction of the ointment. RESULTS: In the first group, the average healing time of superficial II wound treated by ointments of 10 micrograms/g and 50 micrograms/g significantly shortened when compared with that treated by ointments of 0.5 microgram/g(P lt; 0.01), but there was no obvious difference between the cases treated by ointments of 10 micrograms/g and 50 micrograms/g. In the second group, the healing time of superficial II wound treated by ointments of 10 micrograms/g was (8.39 +/- 2.25) days, (9.52 +/- 2.56) days in the control (P lt; 0.01); and healing time of profound II burn treated by ointments of 10 micrograms/g was (16.80 +/- 2.99) days, (18.27 +/- 3.17) days in the control (P lt; 0.01). And healing rates of burn wound at different periods were higher than those of the control. CONCLUSION: The above results indicate that rhEGF ointments can enhance burn wound healing significantly, and the ointment of 10 micrograms/g is a good choice for clinical application.
OBJECTIVE: To investigate the changes of fibroblast growth factor (FGF) in burn wounds. METHODS: The FGF expression in the center of wound granulation, the edge of wound, the healed part of wound, the normal skin of patients, and the heal course of second degree burn wounds were detected by immunohistochemical methods. RESULTS: The expression intensity of FGF was different in the different sites of third degree burn wounds. The highest contents of FGF was in the center granulation of burn wounds, the less was in the borderline of wound and healed skin, and the least was in the healed skin. FGF expression mainly concentrated in the middle layer of wound, and almost no FGF expression in normal skin. The most FGF expression was occurred at 14 days after injury in second degree of burn wound. CONCLUSION: The changes of FGF in wounds are closely related to the wound healing, and rational use of FGF can promote wound healing.
ObjectiveTo investigate the effect of burn on brown adipose tissue (BAT) in BALB/c mice. MethodsForty 3-4 months old male BALB/c mice with initial body weight of (20±3) g were randomly divided into control group and burn group (n=20).BALB/c mice in burn group were subjected to a 30% total body surface area (TBSA) full-thickness thermal injury.BALB/c mice in control group were not treated.The body weight and temperature were observed before and after burn.At 7 days after burn,morphological changes of white adipose tissue (WAT) and BAT were observed,the gene and protein expressions of uncoupling protein 1 (UCP-1) were detected. ResultsThere was no significant difference in the body weight and body temperature before burn (P>0.05).At 1,2,3,and 4 weeks after burn,the body weight was significantly lower in burn group than in control group (P<0.05).At 1,2,3,and 7 days after burn,the body temperature was significantly higher in burn group than in control group (P<0.05).At 7 days after burn,the weight of WAT was significantly reduced,and the weight of BAT was significantly increased in burn group (P<0.05); WAT and BAT cells became smaller,cell number increased,the cytoplasm and mitochondria appeared as compact.The UCP-1 gene and protein expressions of burn group were significantly higher than those of control group (P<0.05). ConclusionBAT plays an important role in burn-induced hypermetabolism.