Deep Partial Skin Thickness Burns Research Articles

The comparison of two methods of treatment evaluating complications and deficiency of functions of hands after deep partial skin thickness hand burns

Hands actively participate in daily activities of a human; therefore, hands are the most vulnerable parts of the human body. People injure hands so often because namely hands are in the closest position to the dangerous equipment. According to the data of various authors, the injuries of hands and fingers make even 30-75% of all industrial traumas, and burns of hands account for about 6% of all traumas of hands. The aim of the study was to compare the effectiveness of active surgical treatment method with conservative treatment method, applied for the treatment of deep dermal partial skin thickness burns of the hands, wrists, and forearms of distal third. A total of 49 patients with burned hands participated in the perspective study of random sample (totally 79 hands). All these patients were treated in the Department of Plastic and Reconstructive Surgery, Hospital of Kaunas University of Medicine, during the period of 2001-2005. The patients were assessed after 3, 6, and 12 months. Applying conservative method of treatment of deep partial skin thickness burns, the frequency of infectious complications was increased. In order to evaluate the state of scar, we applied the scale of Vancouver and analyzed the pigmentation of a scar, its height, flexibility, and color. After statistical analysis had been performed, we determined that more changes of skin were seen in the group, which received active surgical treatment (P<0.05). Statistically significantly fewer complications were in the group of active surgical treatment in the early (fewer infectious complications, smaller area of unnaturalized autograft) and in the late (scars were less rough, with less changes of pigmentation) postoperative periods.

Corticosteroid-impairment of healing and gastric pentadecapeptide BPC-157 creams in burned mice

The amelioration of corticosteroid-impairment of healing by a stable gastric pentadecapeptide BPC-157 (GEPPPGKPADDAGLV, M w 1419, currently in early clinical trials for inflammatory bowel disease) was studied in thermally injured mice. Its effects on corticosteroid impaired healing of deep partial skin thickness burns, and burn-gastric lesions were investigated. Male NMRI-Hannover mice (sacrificed at 1–3,7,14 and 21 days following burning 20% of total burn area at the back (open flame for 7 s) received intraperitoneally (per kg bw) 6α-methylprednisolone (Depo-medrol, 1.0 or 10.0 mg), or an equal volume of saline (5.0 ml), once daily, first application 30 min after injury, last 24 h before sacrifice. The injury was subsequently treated by topical application of a thin layer of pentadecapeptide BPC-157 cream at three different levels a neutral cream of no treatment. Pentadecapeptide BPC-157 consistently improved given burn healing (both microscopical and tensionmetry assessment), and counteracted corticosteroid-impairment of burn healing. In burn-gastric lesions investigation of the effects of BPC showed an anti-ulcer effect of its own in burned non-corticosteroid-treated mice and potentiated the anti-ulcer effect observed in 6α-methylprednisolone-treated mice. Pentadecapeptide BPC-157 inhibited corticosteroid immunosuppression. In vitro, in spleenic cells assessment, animals (sacrificed at day 21) treated with 6α-methylprednisolone 1 mg showed decreased reactivity to nitrogen in comparison with control, healthy animals, while the addition of BPC-157 (1 μg/g cream) returned cell reactivity to values noted in control healthy animals.

Pentadecapeptide BPC 157 cream improves burn-wound healing and attenuates burn-gastric lesions in mice

The effects of the gastric pentadecapeptide BPC 157 were investigated when administered topically or systemically in burned mice. This agent is known to have a beneficial effect in a variety of models of gastrointestinal lesions, as well as on wound or fracture healing. Deep partial skin thickness burns (1.5×1.5 cm) covering 20% of total body area, were induced under anesthesia on the back of mice by controlled burning and gastric lesions were assessed 1, 2, 3, 7, 14 and 21 days following injury. The first application of BPC 157 was immediately following burning, and thereafter, once daily, until 24 h before sacrifice. In the initial experiments, exposure to direct flame for 5 s, the BPC 157 was applied at 10 μg or 10 ng/kg b.w. intraperitoneally (i.p.) by injection or alternatively, topically, at the burn, as a thin layer of cream (50 μg of BPC 157 dissolved in 2 ml of distilled water was mixed with 50 g of commercial neutral cream (also used as local vehicle-control)), while silver sulfadiazine 1% cream was a standard agent acting locally. Others received no local medication: they were treated i.p. by injection of distilled water (distilled water-control) or left without any medication (control). In subsequent experiments involving deeper burns (direct flame for 7 s), BPC 157 creams (50 μg, 5 μg, 500 ng, 50 ng or 5 ng of BPC 157 dissolved in 2 ml of distilled water was mixed with 50 g of commercial neutral cream), or vehicle as a thin layer of cream, were applied topically, at the burn. Compared with untreated controls, in both experiments, in the BPC 157 cream-treated mice all parameters of burn healing were improved throughout the experiment: less edema was observed and inflammatory cell numbers decreased. Less necrosis was seen with an increased number of capillaries along with an advanced formation of dermal reticulin and collagen fibers. An increased number of preserved follicles were observed. Two weeks after injury, BPC 157 cream-treated mice completely reversed the otherwise poor re-epithelization ratio noted in the untreated control or mice treated with vehicle only. Tensiometry investigation showed an increased breaking strength and relative elongation of burned skin, while water content in burned skin decreased. This was, however, not the case with the vehicle or silver sulfadiazine. Relative to the control values, in silver sulfadiazine cream-treated mice, only collagen fiber formation was increased, in addition to a decreased inflammatory cell number. Relative to control values, BPC 157 given i.p. decreased the number of inflammatory cells, lowered water content in burned skin, and raised breaking strength and relative elongation of burned skin during tensiometry. Through the experimental period, gastric lesions were continuously noted in all thermally injured mice left without local medication and they were consistently attenuated only by BPC 157 treatments: either given i.p. (at either dose), or given locally (at either concentration). Other treatments (i.e. local treatment with silver sulfadiazine cream or neutral cream in mice subjected for 5 s to direct flame), led to only poor, if any attenuation. This stable gastric pentadecapeptide appears to be active and gives a stimulation to burn healing at the defect site. The agent may act by causing an upregulation of the growth factors, as well as influencing other local factors.

Evaluation of the effects of a new Water-Jel system on specific bacterial and yeast strains in laboratory conditions

In three previous studies the Water-Jel (WJ) system was found to protect burn wounds from microbial contamination, to have excellent analgesic and cooling effects when used as a first-aid dressing and to be bactericidal to 15 microorganisms including yeasts tested from the Ostrava Burn Unit. Now a new WJ system has been introduced without povidone iodine. An extensive bacteriological laboratory evaluation of the new WJ system showed quite clearly its excellent antimicrobial and antimycotic properties for 13 of the 15 strains of microorganisms tested, the only exceptions being Clostridium difficile and partially Streptococcus faecalis. In a preliminary study, the new WJ system was used for 24–48 h in 74 burned patients with superficial partial and deep partial skin thickness burns. In 89 per cent of them there were no signs of infection on their burn wound after 48 h. The new WJ system was well tolerated and no allergic reactions appeared.

Porcine dermal collagen as a wound dressing for skin donor sites and deep partial skin thickness burns

Collagen was extracted by pepsin digestion from porcine skin, and collagen membrane was prepared by salt precipitation. The porcine collagen membrane was evaluated as a burn wound dressing in deep partial skin thickness burn wounds in rats. Burn wounds, 4 × 4 cm, were inflicted by exposure of skin to 75°C for 15 s followed by de-epithelialization. Wound healing was assessed by planimetry of epithelialization on day 10 after injury. Open wounds exhibited 24 per cent of wound area re-epithelialized. Collagen membrane dressing significantly improved the healing to 69 per cent of wound area (P < 0.0001). In a completely separate experiment, the porcine collagen membrane was applied as a wound dressing to the donor sites of burn patients, and its effect on wound healing was compared with that of a petroleum jelly gauze dressing. The donor sites covered with petroleum jelly gauze had re-epithelialized by an average of 14.5 days (ranging from 13 to 16 days) after wounding. The wounds dressed with collagen membrane demonstrated a significant increase in the healing rate. Complete re-epithelialization was observed by 10.3 days (ranging from 10 to 12 days) after wounding (P < 0.0001).

Skin substitutes in the treatment of deep partial skin thickness burns in children: clinical experience and long-term results

This report describes the use of skin substitutes in the treatment of deep partial skin thickness burns in childhood. These are lesions that, if treated inadequately, can result in severe scarring. However, if treated appropriately, they can heal without any sequelae, which is obviously crucial for aesthetic and psychological reasons. This review contains children admitted to the authors' Burn Unit over a 5-year period (1984–1988) with deep partial skin thickness lesions which were treated with synthetic and/or biosynthetic skin substitutes and without surgical procedures. This group of children has been compared with another group hospitalized for burns of the same depth and treated with conventional closed wound management. First, short-term results are presented, highlighting healing time, followed by the long-term results from an aesthetic and functional viewpoint.

Viability of skin subjected to deep partial skin thickness thermal damage: experimental studies

Secondary tissue loss in burn wounds (due to necrosis in the zone of stasis) is interpreted as a sequel of progressive vascular occulsion and dehydration of thermally damaged tissue. In this study on rats, delayed healing represented an additional factor in determining the fate of tissue that had sustained deep partial skin thickness burns. Early revascularization induced by excision and subsequent replantation of the burned skin resulted in survival of a large part of the corium. Replantation reduced the loss of full thickness skin seen in controls left to heal spontaneously to partial loss in treated wounds. The experiments substantiate the theory that deep partial skin thickness thermal damage is at least partly reversible and indicate that with tangential excision of dermal burns a viable part of the corium is sacrificed. This deeper part of the corium can be saved by early excision and replantation.

Deep partial skin thickness burns: A reproducible animal model to study burn wound healing

A reproducible deep partial skin thickness burn model using guinea-pigs to study the healing process of this injury is described. Round aluminium templates heated to 75°C and applied for 5 s to the moistened, clipped and depilated dorsal skin produced the desired depth of injury. This model is applicable for the study of the three main components of the burn wound healing process: epithelialization, contraction and scar formation. It is recommended that the India ink injection technique be used to confirm the depth of the burn wound.

Use of cultured human epidermal keratinocytes for allografting burns and conditions for temporary banking of the cultured allografts

Five children who suffered burns clinically regarded as full skin thickness loss were grafted with cultured allogeneic skin from newborn prepuce. The wounds had remained open and infected without healing for about 20 days before the patients were received in the burn unit. To avoid losing surviving deep epidermal cells the wounds were débrided but not deeply excised and, a few days before allografting, they were washed with isodine solution and sterile water, and treated with silvadene cream application. All children received 76 cultured allografts of about 60 cm 2 each. After allografting, the wounds were epithelized in 7–10 days and the allogeneic grafted skin began desquamation suggesting that the allograft did not 'take' permanently but was replaced by the newly formed skin. On the other hand, since allografting is an adequate therapy to provide early temporary coverage in extensively burned patients, we developed conditions for banking cultured skin to make it available for immediate use. The conditions described allow banking of the cultured grafts for 15–20 days with retention of clonal growth ability similar to that of unstored epithelia. The results show that cultured epidermal cells obtained from human newborn foreskin, when used as allografts for coverage of full skin or deep partial skin thickness burns, allow rapid epithelization of the burn wounds.

Long-term experience with 1 per cent topical silver sulphadiazine cream in the management of burn wounds

Three hundred and forty-two patients with 10–50 per cent body surface area burns were studied prospectively over the 5-year period from 1982 to 1986 for the effectiveness of topical 1 per cent silver sulphadiazine. Various parameters were studied including: (i) healing time of deep partial skin thickness burns, (ii) eschar separation time, (iii) conversion rate of deep dermal burns to full skin thickness burns, (iv) burn wound surface bacterial flora and their changing pattern over the years, (v) incidence of invasive sepsis and (vi) overall mortality. There was a remarkable decrease in the time taken for the healing of deep dermal burns, and the conversion rate of deep dermal burns to full skin thickness was significantly reduced. Eschar separation was delayed considerably. There was a total change in the predominent surface micro-organisms from Staph. aureus, which was predominant in 1982, to pseudomonas species and klebsiella in 1986. Moreover, there was the emergence of a new variety of micro-organism within the last 2 years. The incidence of invasive infection and overall mortality was significantly reduced.

Topical acidification promotes healing of experimental deep partial thickness skin burns: a randomized double-blind preliminary study

The effects of three buffered solutions with pH values of 3·5, 7·42 and 8·5, respectively, on the healing rate of deep partial skin thickness burns, was followed for 21 days in 16 guinea-pigs. Two symmetrical burns were inflicted on the back of each animal and then each individual wound was dressed with an irrigation disc dressing; solutions were coded (no. 1 to no. 3) and the animals were randomly divided and blindly treated as follows: Group A, solution no. 1 v. solution no. 2 ( n=4); Group B, solution no. 2 v. solution no. 3 ( n=4); Group C, solution no. 1 v. solution no. 3 ( n=4); Group D, non-irrigated disc dressings ( n=4). The solutions were applied to the surface of the burn wounds at a rate of 0·15 ml/cm 2. Dressings were changed every 7 days to assess contraction and epithelialization by a sonic digitizer. On post-burn day 21 the newly formed scar tissue was measured in all wounds. After computation of the healing rate at the end of the study, the data were then related to the coded treating agent. Contraction did not differ in all test groups during the study. Epithelialization was significantly faster in the pH 3·5-treated burns than in the other treated wounds ( P<0·001). The present study indicates that topical acidification of experimental deep partial skin thickness burns promoted healing. The precise mechanism should be elucidated.