Full Skin Thickness Burn Research Articles

Bioengineering a human plasma-based epidermal substitute with efficient grafting capacity and high content in clonogenic cells.

Cultured epithelial autografts (CEAs) produced from a small, healthy skin biopsy represent a lifesaving surgical technique in cases of full-thickness skin burn covering >50% of total body surface area. CEAs also present numerous drawbacks, among them the use of animal proteins and cells, the high fragility of keratinocyte sheets, and the immaturity of the dermal-epidermal junction, leading to heavy cosmetic and functional sequelae. To overcome these weaknesses, we developed a human plasma-based epidermal substitute (hPBES) for epidermal coverage in cases of massive burn, as an alternative to traditional CEA, and set up critical quality controls for preclinical and clinical studies. In this study, phenotypical analyses in conjunction with functional assays (clonal analysis, long-term culture, or in vivo graft) showed that our new substitute fulfills the biological requirements for epidermal regeneration. hPBES keratinocytes showed high potential for cell proliferation and subsequent differentiation similar to healthy skin compared with a well-known reference material, as ascertained by a combination of quality controls. This work highlights the importance of integrating relevant multiparameter quality controls into the bioengineering of new skin substitutes before they reach clinical development. This work involves the development of a new bioengineered epidermal substitute with pertinent functional quality controls. The novelty of this work is based on this quality approach.

Effect of topical aloe vera on the process of healing of full-thickness skin burn: a histological and immunohistochemical study

Abstract Background: Skin burn is common universal problem that may lead to ugly scarring, serious handicapping. Availability of natural biological treatment to improve its outcome becomes concern of many

Effectiveness of Woven Silk Dressing Materials on Full-skin Thickness Burn Wounds in Rat Model.

Purpose:This study evaluated woven silk textile for burn wound dressing materials in an animal model.Methods:Ten rats were used in this experiment. Full-thickness 2×2 cm burn wounds were created on the back of the rats under anesthesia. In the experimental group, the wounds were treated with three different dressing materials from woven silk textile. In the control group, natural healing without any dressing material was set as control. The wound surface area was measured at five days, seven days, and 14 days. Wound healing was evaluated by histologic analysis.Results:There were no statistically significant differences among groups at five days post injury. The mean defect size at seven days was largest in Group 3 (462.87 mm2), and smallest in Group 1 (410.89 mm2), not a significant difference (P =0.341). The mean defect size at 14 days was smallest at the Group 3 (308.28 mm2) and largest in the control group (388.18 mm2), not a significant difference (P =0.190). The denuded area was smaller in Group 1 (84.57 mm2) and Group 2 (82.50 mm2) compared with the control group (195.93 mm2), not statistically significant differences (P =0.066, 0.062). The difference between Group 3 and control was also not statistically significant (P =0.136). In histologic analysis, the experimental groups re-epithelialized more than control groups. No evidence was found of severe inflammation.Conclusion:The healing of burn wounds was faster with silk weave textile more than the control group. There was no atypical inflammation with silk dressing materials. In conclusion, silk dressing materials could be used to treat burn wounds.

Efficacy of silver-loaded nanofiber dressings in Candida albicans-contaminated full-skin thickness rat burn wounds.

In this experimental study, the effects of nanofiber dressings containing different forms of silver on full-thickness rat burn contaminated with Candida albicans was analyzed. A full-thickness skin burn was formed on a total of 32 Sprague-Dawley rats. After the burn wound was seeded with a 10 colony-forming units/ml standard strain of Candida albicans ATCC90028, the animals were divided into four groups. The effects of topical silver sulfadiazine and two recently designed nanofiber dressings containing nanosilver and silversulfadiazine as active materials were compared with the control group. There was a significant difference in the Candida growth on the burn eschar tissue among the groups. The difference for Candida growth in the burn eschar between the control group and the 1% silver sulfadiazine-containing nanofiber dressing group was statistically significant (P< 0.01). Silver sulfadiazine-containing nanofiber dressing was the most effective agent in the treatment of Candida albicans-contaminated burn wounds. Because of their regenerative potential, silver-loaded nanofiber dressings could be a good alternative for infected burn wounds.

Unusual complications after occupational exposure to giant hogweed (Heracleum mantegazzianum): A case report

Exposure to giant hogweed brings about the risk of serious skin damage, usually in the form of phytophotodermatitis. Initially, skin changes are signaled by a burning sensation, followed by a vesiculobullous rash and long-term hyperpigmentation. Usually, skin disorders improve after the application of topical and oral corticosteroids. In extremely rare instances, full skin thickness burns or epidermal necrosis occur. The study presents a case of occupational exposure to hogweed, which resulted in extensive skin lesions leading to the disablement of a 27-year-old man. The principles of procedure to be followed when contact with giant hogweed is an occupational hazard are also outlined.

Marjolin's ulcers in the post-burned lesions and scars.

Marjolin's ulcer (MU) represents malignant degeneration that typically ensues over a period of time in the post-burned lesions and scars or any other chronic wound. This review highlights various facets of the presentation and management of MUs that originate from post-burned lesions. The incidence of MUs in such lesions is reported to be 0.77%-2%. This malignancy characteristically develops in the areas of full thickness skin burns that had been allowed for weeks to months to heal spontaneously by secondary intention, or burn wounds which never healed completely over years and the unstable post-burned scars. In the majority of cases, the MU is a squamous cell carcinoma (SCC). The MUs contribute to an overall 2% of all SCCs and 0.03% of all basal cell carcinomas of the skin. Clinically MUs present in two major morphologic forms. The commoner form is the flat, indurated, ulcerative variety while the less common form is the exophytic papillary variety. Lower limbs represent the most frequently affected body parts. Surgical resection of the primary tumor with 2-4 cm horizontal clearance margin, nodal clearance and radiotherapy constitute the cornerstones of effective oncologic management. Despite best efforts, the overall mortality is reported to be 21%.

Assessment of the Effectiveness of Silver-Coated Dressing, Chlorhexidine Acetate (0.5%), Citric Acid (3%), and Silver Sulfadiazine (1%) for Topical Antibacterial Effects Against the Multi-Drug Resistant Pseudomonas Aeruginosa Infecting Full-Skin Thickness Burn Wounds on Rats

The aim of this study was to compare the effects of four different topical antimicrobial dressings on a multi-drug resistant Pseudomonas aeruginosa contaminated full-thickness burn wound rat model. A total of 40 adult male Wistar albino rats were used. The control group (group 1), silver sulfadiazine (1%) group 2, chlorhexidine acetate (0.5%) group 3, citric acid (3%) group 4, and silver-coated dressing group 5 were compared to assess the antibacterial effects of a daily application to a 30% full-skin thickness burn wound seeded 10 minutes earlier with 10(8) CFU (colony forming unit)/0.5 mL of a multi-drug resistant Pseudomonas aeruginosa strain. Five groups (1 control group and 4 treatment groups) were compared. The administration of third-degree burns to all rats was confirmed based on histopathologic data. The tissue cultures from groups 2 and 5 exhibited significant differences compared to those of the other 3 groups, whereas no significant differences were observed between groups 1, 3, and 4. The effectiveness of the treatments was as follows: 1% silver sulfadiazine > silver-coated dressing > 3% citric acid > 0.5% chlorhexidine acetate > control group. Our results supported the efficacy of topical therapy by silver sulfadiazine and silver-coated dressing on infections caused by multi-drug resistant Pseudomonas spp.

Application of acellular dermal xenografts in full-thickness skin burns

The aim of this study was to explore the clinical value of the porcine acellular dermal xenograft (ADX) in combination with autologous split-thickness skin and pure autologous split-thickness skin grafting applied in deep full-thickness burns and scar wounds. A total of 30 patients with deep burns were randomly divided into experimental and control groups following escharectomy. The patients were separately treated with porcine acellular dermal xenograft (ADX) in combination with autologous split-thickness skin and pure autologous split-thickness skin graft. The wound healing was observed routinely and the scores were evaluated using Vancouver scar scale at different times following transplant surgery. The samples of cograft regions and the control group (pure transplant split-thickness skin autograft) were observed using light microscopy and electron microscopy, and the follow-up results were recorded. No conspicuous rejections on the cograft wound surface were observed. Compared with the control group, the cograft wounds were smooth, presented no scar contracture and exhibited good skin elasticity and recovery of the joint function. The cografted skin combined well and displayed a clear and continuous basal membrane, as well as gradually combined skin structure, a mature stratum corneum, downward extended rete pegs, a mainly uniform dermal collagen fiber structure, regular alignment, and fewer blood capillaries. Clear desmosome cograft regions were identified among heckle cells, as well as a clear and continuous basal membrane. The cografted skin of the combined split-thickness autograft and the acellular heterologous (porcine) dermal matrix showed an improved shape and functional recovery compared with the pure split-thickness skin autograft. The combination of the meshed ADX and the split-thickness skin autograft applied in deep full-thickness burns and scar wounds may induce tissue regeneration via dermis aiming. This method also has superior shape and functional recovery, and has an extensive clinical application value.

Emerging Gram-Negative Infections in Burn Wounds

Gram-negative infection remains a major contributor to morbidity, mortality, and cost of care. In the absence of comparative multinational epidemiological studies specific to burn patients, we sought to review literature trends in emerging Gram-negative burn wound infections within the past 60 years. Mapping trends in these organisms, although in a minority compared with the six "ESKAPE" pathogens currently being targeted by the Infectious Diseases Society of North America, would identify pathogens of increasing concern to burn physicians in the near future and develop patient profiles that may predict susceptibility to infection. Aeromonas hydrophila infection was identified as the emerging pathogen of note, constituting 76% of the identified publications. A. hydrophila constituted 96% of Aeromonas spp. isolates (mortality 10.7%). The following patient profile indicated predisposition to Aeromonas infection: mean age (mean 33.7 years, range 17 ≤ R ≤ 80, SD = 15.6); TBSA (mean 41.1%, range 8% ≤ R ≤ 80%, SD = 15.2); full-thickness skin burns (mean 27.7%, range 3% ≤ R ≤ 60%, SD = 16.6); and a male predominance (81.3%). Other pathogens included Stenotrophomonas maltophilia Vibrio spp., Chryseobacterium spp., Alcaligenes xylosoxidans, and Cedecia lapigei. Arresting the thermal injury by untreated water was the common predisposing factor. These emerging infections clearly constitute a minority of Gram-negative bacterial infections in burn patients at present. However, these are the infections most likely to pose significant clinical challenge because of the high prevalence of multidrug resistance, rapid acquisition of multidrug resistance, high mortality, and ubiquity in the natural environment. This article therefore presents a rationale for understanding and recognizing the role of these emerging infections in burn patients.

Bebekte Küvöze Bağli Major Tam Kat Cilt Yaniği: Olgu Sunumu

Burns in neonates have been reported following the use of water warmers, pulse oximeters, various electrodes, chemical disinfecting agents and phototherapy blankets. Major full skin thickness burn injuries in neonates and infants are very rare reports. This case reports on a burn injury of full skin thickness in male infant who was admitted to the Birth and Children Hospital. The baby’s body touched the metal heater. This infant, weighing 4000 g, had an injury of 15% TBSA on his dorsum, arm and buttocks. The infant was transported to the Training and Research Hospital. Fluid resuscitation, analgesic therapy, and enteral feeding were started immediately. At the seventh day after the injury appeared, surgical procedures began. The eschar was excised, and 7 days after the excision, the wounds were grafted with 0.1 mm thickness skin grafts. 14 days after the grafts, all the grafted wounds were found epithelized. We conclude that in neonates and infants, relatively low temperatures may cause deep burn injuries. We therefore recommend the delivery of preterm childbirths at well equipped facilities with staff who are qualified to nurse premature neonates.

Comparison of silver-coated dressing (Acticoat ®), chlorhexidine acetate 0.5% (Bactigrass ®) and nystatin for topical antifungal effect in Candida albicans-contaminated, full-skin-thickness rat burn wounds

Background In this experimental animal study, the effects of three different topical antimicrobial dressings on Candida albicans contaminated full-thickness burn in rats were analyzed. Methods In total 32 adult Wistar rats (body weight 200–220 g) were used. Silver-coated dressing (Acticoat™ ®), chlorhexidine acetate 0.5% (Bactigrass ®) and Mycostatine (Nystatin ®) were compared to assess the antifungal effect of a once-daily application on experimental rat 15% full-skin thickness burn wound seeded 24 h earlier with a 10 8 CFU/mL standard strain of C. albicans ATCC 90028. All the animals were sacrificed at post burn day 7. The quantitative counts of seeded organism in burn eschar and subjacent muscle were determined, in addition to the cultures of left ventricle blood and lung biopsies. Results While there were significant differences between Acticoat™ ® group (4 ± 10 × 10 4) and control group (5 ± 6 × 10 6), and between Nystatin group (4 ± 4 × 10 4) and control group ( P = 0.01, P = 0.01), there were no significant differences between chlorhexidine acetate 0.5% group (2 ± 3 × 10 4) and control group ( P = 0.7 ) respectively. Acticoat™ ® and Nystatin were sufficient to prevent to C. albicans from invading to the muscle and from causing systemic infection. Conclusions The animal data suggest that nystatin is the most effective agents in the treatment of C. albicans-contaminated burn wounds, and Acticoat™ ® is a choice of treatment on fungal burn wound infection with antibacterial effect and the particular advantage of limiting the frequency of replacement of the dressing.

Friction Burn Injuries to the Dorsum of the Hand After Car and Industrial Accidents: Classification, Management, and Functional Recovery

A total of 65 cases of friction burn injuries to the dorsum of the hand after car and industrial accidents were reviewed. The mean age of the study population was 31 years (range 18-68 years). The injury sustained from friction was graded into four grades: grade I (n = 6), isolated second-degree skin burn, grade II (n = 6), full-thickness skin burn without extensor tendon exposure, grade III (n = 45) the friction injury affected and exposed the extensor tendons, and grade IV (n = 8) the friction injury extended to bones and joints. Management was by dressing, split skin grafting, local/pedicle flap, and free muscle flap in grades I to IV, respectively. Functional recovery of the hand in terms of percentage normal range of motion and grip strength was best in grade I and worst in grade IV injury. Complications of reverse-pedicled forearm flaps were higher than free muscle flaps. However, the aesthetic appearance of grafted free muscle flaps on the dorsum of the hand was inferior to fasciocutaneous flaps.

The clinical application of the repair of burn wound with acellular allogenic dermis matrix with split-thickness autologous skin graft

Objective To approach the clinical applieation of burn wound with composite transplanta-tion of acellular dermal matrix with split-thickness autologous skin graft. Methods A clinical observation in 63 patients who had been treated by acellular allogenic dermis matrix with split-thickness autologous skin graft from 2003 in our division. In the peases, 37 cases are burn scars and 26 cases are function site full thickness skin burn wound. THe repair of wound by one time operation only.In this cases, acellular dermal matrix with split-thickness autologous skin grafting are 49, with snip skin grafting are 7, and with mesh skin grafting are 7.Results The composite skin survived after all in 63 examples.Skin grafting and donor site scars proliferation were not obvious after aeerte function rebound satisfaction pigmenatation appearaneed less.Patients feel satisfaction at appoaran ce. Con-clusion The repair of bum wound with cellular allogenic dermis with split-thickness autologous skin graft is a good treatment. Key words: Acellular allogenic dermis matrix; Split-thickness autulogous skin; Composite graft; Wound repair

Comparison of octenidine dihydrochloride (Octenisept®), polihexanide (Prontosan®) and povidon iodine (Betadine®) for topical antibacterial effects in Pseudomonas aeruginosa-contaminated, full-skin thickness burn wounds in rats

Abstract Pseudomonas aeruginosa is one of the most frequently isolated organisms from infected burn wounds and a significant cause of nosocomial infection and septic mortality among burn patients. In this animal study, three antiseptic agents which were Octenidine dihydrochloride (Octenisept®, Schülke &amp; Mayr, Norderstedt, Germany), polyhexanide (Prontosan®, B. Braun, Melsungen AG, Germany) and povidon iodine (Betadine, Purdue Pharma L.P, Stamford, USA) were compared to assess the antiseptic effect of their applications on experimental burn wounds in in rats contaiminated with P. aeruginosa. All treatment modalities were effective against P. aeruginosa because there were significant differences between treatment groups and control groups. The mean eschar concentrations were not different between polyhexanide and povidon iodine groups, but there were significant differences between the octenidine dihydrochloride group and the other treatment groups, indicating that the Octenidine dihydrochloride significantly eliminated P. aeruginosa more effectively in the tissues compared to the to other agents. All treatment modalities were sufficient to prevent the P. aeruginosa invasion into the muscle and to cause systemic infection. In conclusion, Octenidine dihydrochloride is the most effective antiseptic agent in the treatment of the P. aeruginosa-contaminated burn wounds; Octenidine dihydrochloride can be considered as a treatment choice because of its peculiar ability of limit the frequency of replacing wound dressings.

Purpura Fulminans: A Case Series Managed at a Regional Burn Center

Purpura fulminans (PF) is a protein C deficiency disease process with a high case fatality rate; however, overall incidence of the disease remains relatively very low. The similarity between skin necrosis secondary to PF and full-thickness skin burns provides the rationale for treating PF case in a burn center. In this case series we reviewed our experiences in managing PF and their associated favorable outcomes. Retrospective chart review of five PF cases managed between September 2004 and August 2006 at our Burn Center with 100% survival. Management of cases following the standard care of the Burn Center for a full-thickness burn included antibiotics, fluid resuscitation, surgical debridement with skin grafting, and activated protein C (Drotrecogin alfa) replacement. Two patients required amputations of extremities and all had surgical debridement. One required hemodialysis and two needed both hemodialysis and positive-pressure mechanical ventilator. No patient experienced any bleeding complications during or after surgery while receiving activated protein C. Early diagnosis and treatment at a burn center may reduce mortality and morbidity and loss of extremities in PF cases.

Effects of Insulin on Hepatic Inflammation Induced by Ethanol and Burn Injury in a Murine Model of Critical Illness

In recent, landmark clinical trials, insulin to maintain euglycemia in critically ill patients improved clinical outcomes, including decreased all-cause mortality. Novel antiinflammatory effects of insulin have recently been described. Thermal injury is an excellent model of critical illness. The addition of ethanol to the model is of great clinical relevance because nearly 50% of the patients admitted to hospitals for burn injuries have ethanol in their circulation. Utilizing a murine model of critical illness (ethanol and skin burn), we tested the hypothesis that insulin treatment in ethanol-exposed, burn-injured mice reduced hepatic inflammation, a potential mechanism for the benefit of insulin. Adult male C57BL/6 mice were given a single intraperitoneal injection of ethanol or saline, were given a 15% total body full-thickness skin burn, or were sham-burned and killed 24 hours later. In each group, half the animals were given subcutaneous injections of the long-lasting basal insulin glargine; the other half, the appropriate vehicle. Hepatic inflammatory markers, including polymorphonuclear infiltration, a chemokine, an important adhesion molecule, proinflammatory cytokines, and nuclear factor kappaB, were measured, and all were increased by ethanol and/or burn. These increases were prevented by insulin. An antiinflammatory cytokine was reduced by ethanol and/or burn. Insulin prevented this decrease. Thus, insulin has a substantial antiinflammatory effect, and this may underlie its dramatic clinical benefit in critical illness.

Accidental Burn Injury During Knee Arthroscopy

A case is described in which hot irrigation fluid used during a routine knee arthroscopy caused severe morbidity. The patient sustained full-thickness skin burns requiring debridement, a muscle flap, and split-skin grafting. The extent of the joint damage required fusion. The underlying factors included equipment failure but also a delay in appreciating the severity of the soft-tissue damage. This case highlights the need for a robust protocol for the management of warming the irrigation fluid, as well as monitoring the actual fluid temperature.

Pretibial Full Thickness Skin Burn following Indirect Contact from Bone-Cement Use in a Giant Cell Tumour

Bone cement reaches significant temperatures and is known to cause thermal and chemical damage to various tissues. All the reports of such damage occurred following a direct contact of the tissue or structure with cement. We report the case of a patient with a giant cell tumour of the proximal tibia who underwent curettage and bone cement application through a posterior approach and subsequently developed full thickness pretibial skin damage despite showing no evidence of any direct contact of the involved skin with bone cement. This is the first report of its kind and though anecdotal is a serious complication that surgeons should be aware of.

Full-thickness Burn Formation After the Use of Electrical Stimulation for Rehabilitation of Unicompartmental Knee Arthroplasty

Electrical stimulation and interferential current are commonly used modalities in the physical rehabilitation of patients who have undergone joint arthroplasty surgery. Sparse data are available in the literature regarding potential complications from using these modalities. We report on a patient who underwent a unicompartmental knee arthroplasty with a subsequent full-thickness skin burn over the metal implant after electrical stimulation and interferential current modalities in physical therapy.

Comparison of Silver-Coated Dressing (Acticoat???), Chlorhexidine Acetate 0.5% (Bactigrass??), and Silver Sulfadiazine 1% (Silverdin??) for Topical Antibacterial Effect in Pseudomonas Aeruginosa-Contaminated, Full-Skin Thickness Burn Wounds in Rats

Acticoat (Smith and Nephew, Istanbul, Turkey), chlorhexidine acetate 0.5%, and silver sulfadiazine 1% were compared to assess the antibacterial effect of their application on experimental burn wounds in contaminated with Pseudomonas aeruginosa in rats. All treatment modalities were effective against P. aeruginosa because there were significant differences between treatment groups and control groups. The mean eschar concentrations did not differ significantly between Acticoat and chlorhexidine acetate groups, but there were significant differences between the silver sulfadiazine group and the other treatment groups, indicating that silver sulfadiazine significantly eliminated P. aeruginosa more effectively in the tissues than did the other two agents. All treatment modalities were sufficient to prevent the P. aeruginosa from invading to the muscle and from causing systemic infection. In conclusion, silver sulfadiazine is the most effective agent in the treatment of the P. aeruginosa-contaminated burn wounds; Acticoat can be considered as a treatment choice because of its peculiar ability of limiting the frequency of replacing wound dressings.