Skin Grafting Of Burns Research Articles

Early graft in patients with burn wounds: A two-year retrospective study of 582 patients at a referral burn center in northern Iran

Skin graft is the main treatment for burn wounds, which provides a favorable functional and aesthetic scar outcome. This study aimed to assess early graft in patients with burn wounds admitted to a referral burn center in northern Iran. This retrospective research was conducted on 582 patients with burn wounds with an early graft between May 2019 to 2021 at a referral burn center in northern Iran. Data gathering was conducted from May 2019 to 2021. A total of 582 patients with burn wounds with early graft were enrolled in this research. Of the patients, 91.41% were treated with one graft and 60.14% were treated with grafts less than 10% in size. The average graft/burn ratio in patients with burn wounds was 0.75 (SD=0.52). Also, 55.15% of patients with burn wounds had Graft/burn ratio less than 0.75 (P=0.03). The mean length of stay in hospital in patients with burn wounds was 7.20 (SD=6.10). 61.34% of patients with burn wounds had stayed less than seven days in the hospital after early grafting. 4.12% of patients with burn wounds died due to early grafts (P<0.001). Although in the past decades, progress had been made in skin grafts for burns in Iran, however, prevention of complications and negative outcomes of burns and timely treatment of patients is still weak in Iran. Overall, the present study showed that patients with burn wounds with early grafts in Iran have had better clinical outcomes compared with low- and middle-income countries.

106 Heads or Tails? Scalp versus Non-scalp Donor Sites for Split-thickness Skin Grafting of Burns: A Systematic Review and Retrospective Review

Abstract Introduction The scalp is an appealing donor site for split-thickness skin grafting (STSG) of burns due to its concealment upon hair regrowth and healing potential; however, it is often reserved for massive burns with limited donor sites. This study aims to understand scalp donor site (SDS) outcomes and complications to elucidate viability of the SDS as a first-line option for coverage of burns. Methods A systematic review across five databases was conducted. Original research reporting cohort outcomes of STSG coverage of burns using the SDS was included. Donor site healing time, graft thickness, graft take, and complications were analyzed. Thereafter, a retrospective chart review of patients who had SDS-STSGs for burns from 2010–2018 was done. Outcomes and complications were compared to non-SDS-STSGs (NSDS-STSGs) in criteria-matched controls. Results Systematic Review: 1489 articles were reviewed. 15 cohort studies met inclusion criteria, yielding 1761 patients who has SDS-STSG (mean age=17 yrs, mean TBSA=37%). Alopecia and folliculitis occurred in 5% and 3% of patients, respectively; folliculitis was associated with certain hair types. Other complications (eg. hypertrophic scarring, hair transfer) were seen in less than 1.5% of patients. Rapid donor site healing times (mean=8 days) and capacity for re-harvest (mean=2 harvests/patient) were noted. Retrospective Review: 30 patients underwent grafting with SDS-STSGs, 23 of whom also received NSDS-STSGs and were thus self-controls; criteria-matched controls were found for the remaining 7. Graft thickness and graft take did not differ between SDS and NSDS groups, while donor site healing time was faster for SDSs vs NSDSs (9 vs 11 days, p=0.02). SDS complications included: alopecia (n=2), delayed healing (3), and folliculitis (1). NSDS complications included: delayed healing (n=1), dyspigmentation (2), and hypertrophic scarring (3). These complications could not be attributed to age, ethnicity, graft thickness, number of graft harvests, comorbidity burden, TBSA, or inhalational injury status. Conclusions The scalp donor site may represent a viable first-line option for split-thickness skin grafting of burns. Our cohort suggests that scalp donor sites pose comparable risks to non-scalp donor sites. Further studies elucidating the role of hair type in SDS-STSG complications are required to optimize outcomes with patient-specific donor site selection. Applicability of Research to Practice In select patients, the scalp may be considered as a first-line donor site for split-thickness skin grafting of burns, with potentially faster donor site healing time and comparable risks to non-scalp donor sites. Some scalp-specific complications may be linked to differences in hair type.

The scalp as a donor site for skin grafting in burns: retrospective study on complications

BackgroundSplit skin grafting (SSG) is the cornerstone in the treatment of deep burns and large skin defects. Frequently used donor sites are the thigh, abdomen and buttocks. The scalp is less common while considered as a reliable donor site. Advantages are a large surface area, rapid wound healing, cosmetically favourable results and multiple harvests from the same donor site. Complications include scab formation, chronic folliculitis and alopecia but have been recorded sporadically in previous studies. This article evaluates the complication rate of the scalp donor site in the treatment of deep burns in the Beverwijk Burn Centre.MethodsA retrospective study was performed of all patients who received a skin graft from the scalp at the Beverwijk Burn Centre between January 2004 and December 2012. Data were collected from medical files of included patients, including gender, age, type of burn (scald, flame, other) and total body surface area (TBSA) burned at the time of first surgery. Postoperative variables were healing time of the donor site and incidence of complications. During follow-up, the incidence of late complications was reviewed.ResultsA total number of 105 grafts were analysed in 93 patients: 58 males (62 %) and 35 females (38 %), with a median age of 2 years and 3 months old. Of the patients, 30 (32 %) had flame burns and 57 (61 %) had scald burns. Eighty-seven percent of patients had a TBSA burned of 5 % or less. All donor sites healed within 14 days. No alopecia or scar hypertrophy developed at the donor sites. Two patients (2.2 %) developed folliculitis; one patient (1.1 %) showed scab formation.ConclusionsThe scalp as a donor site in our Burn Centre shows a comparable short-term complication rate to the previous literature, with quick healing and no long-term complications. Therefore, we propose the consideration of the scalp as a primary donor site, especially in young children, where the scalp offers a larger donor site area than the buttocks or thighs.

Localized flexural bullous pemphigoid

A 63-year-old male agriculturist presented with a spontaneously appearing bullous eruption localized to the axillae and groins, with intense pruritus of 3 weeks duration. He was also a known hypertensive, diagnosed with renal failure on treatment with ACE inhibitors and amlodepin since 1 year. On examination there were tense vesicles and bullae associated with crusting and erosions in the axillae (Fig. 1), upper medial aspect of arms and groins bilaterally (Fig. 2). The rest of the skin including the mucous membranes, palms, soles, genitalia were normal. Histopathology revealed subepidermal blisters, direct immunofluorescence assay of perilesional skin showed linear deposits of IgG and C3 along the basement membrane zone and the indirect immunofluorescence demonstrated antibasement membrane antibodies bound to the epidermal side of the salt split normal human skin thus confirming our diagnosis of localized bullous pemphigoid. Patient was accordingly started on prednisolone 60 mg daily in tapering doses which resulted in complete healing of the erosions within a month. Fig. 1 Tense vesicles and bullae in the axilla Fig. 2 Tense vesicles and bullae in the groins Localized bullous pemphigoid (LBP) is a rare autoimmune subepidermal blistering disease of the elderly characterized by chronic intermittent eruptions affecting only a restricted area of the body. Though it accounts for 16% to 29% of all cases of bullous pemphigoid, the true incidence may be greater as it is often misdiagnosed and is highly responsive to topical steroids. LBP has got similar clinical, histopathological and immunofluorescence features to generalized bullous pemphigoid.1 Three types have been identified which include: 1) mucous membrane pemphigoid or cicatricial pemphigoid 2) localized scarring pemphigoid or Brunsting Perry pemphigoid affecting the head and neck 3) localized non scarring pemphigoid usually seen over the pretibial region, vulva, breast and the soles. The diagnosis of this last entity tends to be delayed because it can mimic other localized vesicobullous diseases and dyshidrotic eczema.2 While the pathogenesis of generalized bullous pemphigoid is well elucidated, it is unknown why patients with LBP have limited disease. The pathogenesis most likely could be similar to that of generalized bullous pemphigoid because patients in both the groups recognize the same BP antigens.3 LBP has been documented following radiotherapy,4 PUVA therapy, trauma,5 sunexposure,6 split skin grafting for burns,7 around peristomal lesions8 and several authors have thus postulated that these local factors might play a role in the induction of lesions in immunologically susceptible individuals. In a study on the distribution of bullous pemphigoid antigens in normal human skin the greatest expression was seen in the skin obtained from the flexor aspect of arms, legs and thighs9 which probably explains the predominant flexural localization of lesions in our case. Whether the ACE inhibitors contributed in triggering the bullous eruption here is not clear as the patient had been taking the above medications for almost a year. Nevertheless this case emphasizes the need to follow-up such patients regularly as they are at risk of developing a generalized eruption later in life.

The use of MatriDerm ® in early excision and simultaneous autologous skin grafting in burns—A pilot study

The application of dermal substitutes in deep partial and full-thickness burn wounds in a two-stage procedure prior to skin grafting has become increasingly popular. Synchronous application of dermal substitutes and skin graft has not yet been established as a standard procedure. In a consecutive study 20 wounds in 10 patients with severe burns (age 49.5 ± 16.2 years; TBSA 45.6 ± 14.5%) were treated with either simultaneous transplantation of Matriderm ®, a bovine based collagen I, III, V and elastin hydrolysate based dermal substitute and split-thickness skin grafting (STSG), or STSG alone after appropriate excision of the burn wound. The study was designed as a prospective intra-individual comparative study. After 1 week all wounds were assessed for the percentage of autograft survival. Autograft survival was not altered by simultaneous application of a dermal matrix ( p = 0.015). Skin elasticity was measured after 3–4 months with the Vancouver Burn Skin Score (VBSS). The VBSS demonstrated a significant increase of elasticity in the group with dermal substitutes ( p = 0.04) as compared with non-substituted wounds for sheet autograft, but not for meshed autograft ( p = 0.24). From this pilot study it can be concluded that simultaneous application of a dermal matrix is safe and feasible, yielding significantly better results with respect to skin elasticity. Skin elasticity was considerably improved by the collagen/elastin dermal substitute Matriderm ® in combination with sheet autograft.

Skin grafting of burns. Primary care; treatment; repair. By James Barrett Brown, M.D., Lieutenant-Colonel, Medical Corps, Army of the United States; Senior Consultant in Plastic and Maxillo-facial Injuries and Burns, E.T.O., U.S.A.; Associate Professor of Surgery, Washington University, St. Louis, Missouri; and Frank McDowell, M.D., Assistant in Clinical Surgery, Washington University, St. Louis, Missouri. 10 × 7 in. Pp. 204

Skin grafting of burns. Primary care; treatment; repair. By James Barrett Brown, M.D., Lieutenant-Colonel, Medical Corps, Army of the United States; Senior Consultant in Plastic and Maxillo-facial Injuries and Burns, E.T.O., U.S.A.; Associate Professor of Surgery, Washington University, St. Louis, Missouri; and Frank McDowell, M.D., Assistant in Clinical Surgery, Washington University, St. Louis, Missouri. 10 × 7 in. Pp. 204

Effect of Chronic Wound Exudates and MMP-2/-9 Inhibitor on Angiogenesis In Vitro

New evidence suggests that matrix metalloproteinases (MMPs) may facilitate angiogenesis as well as function to generate angiogenesis inhibitors. In this study, the angiogenic effect of wound exudates from patients with venous insufficiency ulcers was examined in an in vitro angiogenesis model with and without synthetic MMP-2/-9 inhibitor. Wound exudates were obtained from 20 patients with venous insufficiency ulcers and 20 control patients with donor-site wounds after skin grafting for burns. In the angiogenesis model, suramin (20 microg/ml) was used in five wells without wound fluid as negative control, and vascular endothelial growth factor (1 microg/ml) was used in five other wells as positive control. Chronic wound fluids were analyzed without and with a synthetic MMP-2/-9 inhibitor with a concentration of 2 microM and 20 microM in the medium. The total length of tubules was calculated by map reader. Statistical analysis was performed using the Mann-Whitney test. The level of significance was considered to be p < 0.05. Chronic ulcer exudates inhibited angiogenesis significantly (490 +/- 130 microm) compared with acute wound fluids (1740 +/- 320 microm; p < 0.05). In wells with chronic wound exudates and high concentrations of MMP-2/-9 inhibitor, angiogenesis was stimulated significantly (870 +/- 220 microm, p < 0.05). In this model, reduced angiogenesis might be due to an antiangiogenic effect of MMP-2 and MMP-9. MMP-2/-9 inhibition results in a stimulation of angiogenesis and might be an approach for the treatment of patients with chronic wounds and reduced angiogenesis.

Skin grafts for burns.

Skin grafts for burns.

Tetanus following skin grafting for burns

Tetanus following skin grafting for burns

Dermatome Skin Grafts for Burns in Patients Prepared with Dry Dressings and with and without Penicillin

SUCCESSFUL skin grafting is necessary for the rehabilitation of the patient with extensive burns of the full thickness of the skin. Among the important factors essential to success are the following. First, the general and nutritional condition of the patient must be sufficiently good so that cells and blood vessels can grow1; second, contact of the graft with the bed of granulations must be maintained2; and third, infection must be controlled, since in the presence of virulent infection grafts do not live.3 Although cellulitis, lymphangitis and other evidences of spreading infection are infrequent under the present modes of . . .