Surgical Treatment Of Burns Research Articles

Early Tangential Excision and Split-Thickness Skin Graft Reduced Hospitalized Length Stays for Burn Injuries

ABSTRACT Introduction: Burns pose a physical, psychological, health system, and long-term length of stay problem. Surgical treatment of burns is an important intervention in their management. The optimal timing of early tangential excision and split-thickness skin graft varies. Early excision of burned tissue to remove dead tissue and inhibit the inflammatory process decreases the risk of infection. Early excision and grafting of burns is the standard of practice for most major burns. Methods: The research was a cross-sectional study with a descriptive design of secondary data. Burn patients were treated at Dr. Soetomo General Academic Hospital Surabaya, Indonesia, from 2018 to 2022. Inclusion criteria in this study were all patients who underwent early tangential excision and split-thickness skin graft. Achieving statistical analysis and data analysis using SPSS 25 on Windows. Results: A greater amount of time on total body surface area (TBSA) is linked to early tangential excision and split-thickness skin grafts. There are statistically significant variations in the burn area (TBSA 20.5%–30%, P = 0.036 (P = 0.05), TBSA 30.5%–40%, P < 0.001, and burn area (TBSA 40.5%–50%, P = 0.003). The current findings demonstrated that split-thickness skin grafts and early tangential excisions done on burns with TBSA 20% at partial thickness–full thickness depth had statistically significant outcomes, shortening the length of stay for burn patients. Conclusions: An analysis of the current data, burn patients’ duration of stay was reduced when burns with TBSA >20% with partial thickness–full thickness depth underwent early tangential excision and split–thickness skin transplant had statistically positive results.

The experience of using “ChitoPran” wound coating for treating a patient with combined injury

Background. Resolution of problems related to burn injuries remains relevant and extremely complex in the modern medicine. Biological wound coatings are actively used in the treatment of patients with burn injury. Researchers at the Scientific Research Institute at the Ochapovsky Regional Clinical Hospital No. 1 have been using the biological wound coating ChitoPran since 2017. This coating creates a dry environment in the wound for borderline depth burns and after autoplasty, which contributes to the acceleration of epithelization. For deeper burns after necrectomy, the ChitoPran accelerates the growth of granulation tissues.
 Clinical case. This article presents the clinical case of the successful treatment of a 17-year-old burn patient with a combined injury. The patient presented with a blunt abdominal injury on the background of a deep burn of the anterior abdominal wall. The patient underwent a median laparotomy on the first day and an early necrectomy with primary cutaneous autoplasty with the ChitoPran closing of the wounds on a day later.
 Discussion. The use of the ChitoPran wound coating in combination with skin autoplasty for the early surgical treatment of burns contributes to the acceleration of epithelization of wounds in comparison with stage-based surgical treatment. This coating is hence comparable in terms of cellular epithelization with the use of fibroblasts.
 Conclusions. Creating optimal conditions for epithelization in the wound can prevent the development of purulent complications (such as the failure of skin sutures of the anterior abdominal wall). The use of ChitoPran wound coating showed improved outcomes in the treatment of patients with burn injuries through accelerated restoration of the skin and reduced suppuration in the wound.

Evaluation of cell metabolic adaptation in wound and tumour by Fluorescence Lifetime Imaging Microscopy

Acidic pH occurs in acute wounds progressing to healing as consequence of a cell metabolic adaptation in response to injury-induced tissue hypoperfusion. In tumours, high metabolic rate leads to acidosis affecting cancer progression. Acidic pH affects activities of remodelling cells in vitro. The pH measurement predicts healing in pathological wounds and success of surgical treatment of burns and chronic ulcers. However, current methods are limited to skin surface or based on detection of fluorescence intensity of specific sensitive probes that suffer of microenvironment factors. Herein, we ascertained relevance in vivo of cell metabolic adaptation in skin repair by interfering with anaerobic glycolysis. Moreover, a custom-designed skin imaging chamber, 2-Photon microscopy (2PM), fluorescence lifetime imaging (FLIM) and data mapping analyses were used to correlate maps of glycolytic activity in vivo as measurement of NADH intrinsic lifetime with areas of hypoxia and acidification in models of skin injury and cancer. The method was challenged by measuring the NADH profile by interfering with anaerobic glycolysis and oxidative phosphorylation in the mitochondrial respiratory chain. Therefore, intravital NADH FLIM represents a tool for investigating cell metabolic adaptation occurring in wounds, as well as the relationship between cell metabolism and cancer.

A comparative description of dynamics of metabolic response indexes in the phases of burn disease course depending on terms of the onset of surgical intervention.

A question of possibilities of influence on decline of progressing systemic response on the burn trauma remains open, despite actuality and active study of this problem. The aim of this work was carrying out a comparative description of dynamics of metabolic response indexes in the phases of burn disease (BD) course depending on terms of the beginning of the surgical intervention. Рatients with a thermal trauma were inspected and analyzed in this work. All the patients were estimated for the index of the thermal defeat severity, the percentage of the area of deep burn, a general area of burn, the age of a patient and the presence of respiration system burn. According to these, all the patients were divided into separate groups of research. The 1st group included 46 injured with the index of thermal defeat severity (TDS) from 61 to 90 units. The 2 group included 29 patients with the TDS index over 91 units. According to the terms of surgical intervention, patients of these groups were divided into sub-groups: 1.1 and 2.1, where the first surgical intervention was conducted five days before burn disease; 1.2 and 2.2, where the first surgical intervention was conducted five days after of burn disease. The level of cortisol and glycaemia of blood serum of injured people on different stages of inspection were taken into consideration. The diagnostically-curative program was conducted according to the clinical protocol of medical care to injured with thermal trauma. Estimating the dynamics of cortisol level, there was a considerable increase of it over the first twenty-four hours in both groups, which preserved during an acute period of burn disease. In the patients of the sub-group 2.1, with the TDS index over 91 units, who underwent early surgical tactics, the further activating of a sympathic adrenal system on the 7th day after the burn (an increase in cortisol by 82% compared with the previous indicator) was noted. From the first twenty-four hours after the burn, injured people suffered from a stress-induced hyperglycaemia which developed in all research groups, the latter did not depend on the severity of the burn trauma and did not correlate with the cortisol level of blood serum. With the early surgical treatment of burns, a more rapid normalization of blood glucose level in patients of 1.1 and 2.1 sub-groups on the 5th and 7th day of burn disease accordingly occurred.

FEATURES OF SURGICAL TREATMENT OF MINERS, WHO ARE VICTIMS OF METHANE-COAL MIXTURE EXPLOSION

The article studied an influence of operative treatment on miners in the stage of burn shock, complicated by multi- and combined trauma and how these treatment options have changed the lethality and burn complications rates. All data based on an analysis of retrospective research. A primary surgical treatment of burn wounds was performed using simultaneous grafting by temporary biological cover for superficial burns during the burn shock stage in the main group of patients. For miners of comparison group this strategy hasn't been applied and they were operated after ending of burn shock. The rate of development of burn sepsis decreased in 3,2 times (p=0,0001), the frequency of pneumonia reduced in 2,91 times (p=0,0001) and toxic encephalopathy - in 1,7 times (p=0,004) in the main group in relation to the comparison group. The authors made a conclusion, that significant reduction of the rate of the most dangerous complications of burns allowed decrease of lethality in patients of main group in 2,6 times in relation to the comparison group. There wasn't carried out the primary surgical treatment of burns with covering of postoperative wound surfaces by temporary biological material during burn shock stage in comparison group.

Effect of artificial colloids on blood coagulation during shock stage of severe burn injury

Background There are controversies about the use of artificial colloids. This research was aimed to determine the effect of various artificial colloids on blood coagulation in the shock stage of severe burn injury. Methods Totally, 18 female Ba-Ma mini-pigs were subjected to a 40% total body surface third-degree flame burn under anesthesia. Resuscitation therapy was applied 2 hours after the injury, using the burn shock fluid resuscitation formula commonly accepted in the surgical treatment of burns. The Ba-Ma mini-pigs were randomly assigned to three groups (six pigs in each group): succinylated gelatin group (the artificial colloid used was succinylated gelatin Injection), hydroxyethyl starch group (the artificial colloid used was hydroxyethyl starch (130/0.4)), and allogeneic plasma group (the colloid used was allogeneic plasma). Blood samples were collected from the animals prior to the burn injury and again at intervals of 4, 8, 24 and 48 hours post-injury. The platelet count (PLT), prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen (Fib) were measured, followed by a statistical analysis of all results. Results The PLT of succinylated gelatin group and hydroxyethyl starch group at intervals of 24 and 48 hours were (124.3±52.7), (78.8±16.4)×109/L and (159.0±62.8), (87.3±32.0) × 109/L respectively. But in the allogeneic plasma group at intervals of 8, 24, and 48 hours were (234.3±52.6), (136.0±47.4), (75.8±31.0) × 109/L. The decrease were all statistically significant (P <0.05, P <0.01) when compared to pre-burn ((383.3±77.9), (382.7±65.7), (381.0±49.4) × 109/L). The PLT among the three groups, at all the time points, had no statistical difference (P >0.05). Compared to pre-burn ((10.8±0.9), (11.4± 0.8), (10.6±0.7) seconds), the PT of succinylated gelatin group and hydroxyethyl starch group at 24 hours were (14.5±1.5) and (16.2±1.3) seconds, whereas in the allogeneic plasma group at 8 and 24 hours the PT were (13.0±0.9) and (14.5±1.5) seconds, i.e., an increase in the statistical significance (P >0.01). Statistical significance was observed at 8 and 48 hours between the succinylated gelatin group and hydroxyethyl starch group, and at 48 hours between the hydroxyethyl starch and allogeneic plasma group (P <0.05). The INR at 24 hours were (1.26±0.13) in the succinylated gelatin group, (1.40±0.11) in the hydroxyethyl starch group, and (1.13± 0.07) and (1.26±0.13) at 8 and 24 hours in the allogeneic plasma group. When compared with pre-burn ((0.94±0.08), (0.99± 0.07), and (0.92±0.06) seconds), the other groups have increased significantly (P>0.01). The comparison at 8 and 48 hours between the succinylated gelatin group and the hydroxyethyl starch group, at 48 hours between hydroxyethyl starch group and allogeneic plasma group showed statistical difference (P <0.01). The APTT of succinylated gelatin group and hydroxyethyl starch group at 24 hours were (13.1±1.1) and (14.6±2.9) seconds. The APTT of the allogeneic plasma group at 4, 8 and 24 hours were (10.9±1.4), (11.8±1.1), and (13.7±1.5) seconds. Compared to pre-burn ((11.5±4.2), (11.2±3.3), (10.1±1.4) seconds), they were statistically significant (P <0.05). There was no statistical difference in the APTT between the three groups, at all the time points. The Fib of the succinylated gelatin group at 24 and 48 hours were (4.3±0.3) and (4.7±0.2) g/L, (4.1±0.3), and (5.0±0.1) g/L in allogeneic plasma group, and at 8, 24, and 48 hours the Fib for the hydroxyethyl starch group was (2.9±0.4), (4.0±0.5), and (4.6±0.6) g/L. Compared to pre-burn ((2.4±0.2), (2.5±0.3), (2.6±0.5) g/L), they were all statistically significant (P <0.01). There was no statistical difference in APTT between the three groups, at all time points. Conclusion The changes of the indices in blood coagulation during the shock phase of a severe burn injury correlate with the stress response to the burn, rather than to the application of HES (130/0.4) and succinylated gelatin.

Place du Hyalomatrix PA ® au sein des substituts cutanés. À propos de dix cas

During the surgical treatment of burns and reconstructive surgery, we can use autografts, allografts, xenografts or dermal substitutes. Acellular dermal substitutes, implantable medical devices of class III are composed mostly of collagen but also, more recently, derivatives of hyaluronic acid (Hyalomatrix PA(®)). Their mechanism of action is based on revascularization and colonization by fibroblasts of the patient. They are then used to screen for delayed epidermal grafting (2-stage procedure for Integra(®), Matriderm(®) 2mm, Renoskin(®), Hyalomatrix PA(®)) or simultaneous (1-time procedure for IntegraSL(®), Matriderm(®) 1mm). We report 10 cases of clinical use of Hyalomatrix PA(®) in the service of burns and plastic surgery of Nantes.

Klinische Erfahrungen mit dem Versajet-System® in der Verbrennungsbehandlung - Indikationen und Anwendungen

Early debridement and early skin grafting are the "Gold standard" in the surgical treatment of burns. There are different debridement methods available. Concerning the treatment of burns, surgical-sharp debridement, laser ablation and hydrosurgery system are used. While in full thickness burns the sharp debridement is advisable, the Versajet shows its benefits in the treatment of partial thickness burns. Especially for debridement of difficult to treat areas - face, neck, lips, fingers, interdigital spaces, convex and concave areas the Versajet System shows its benefits. With the Versajet System, tissue excision is precise; moreover it helps to avoid the damage of viable tissue and its vascular supply.

Employing human keratinocytes cultured on macroporous gelatin spheres to treat full thickness-wounds: An in vivo study on athymic rats

Providing cutaneous wounds with sufficient epidermis to prevent infections and fluid loss is one of the most challenging tasks associated with surgical treatment of burns. Recently, application of cultured keratinocytes in this context has allowed this challenge to be met without several of the limitations connected with the use of split-thickness skin grafts. The continuous development of this novel approach has now revealed that transplantation of cultured autologous keratinocytes as single-cell suspensions exhibits several advantages over the use of cultured epidermal grafts. However, a number of methodological problems remain to be solved, primarily with regards to the complexity of culturing these cells; loss of viability and other negative effects during their preparation and transportation; the relatively long period of time required following transplantation to obtain a sufficiently protective epidermis. In the present investigation we attempted to eliminate these limitations by culturing the keratinocytes on macroporous gelatin spheres. Accordingly, the efficacies of normal human keratinocytes in single-cell suspension or growing on macroporous gelatin spheres, as well as of split-thickness skin grafts in healing wounds on athymic rats were compared. Human keratinocytes were found to adhere and proliferate efficiently both on the surface and within the pores of such spheres. Transplantation of such cells adherent to the spheres resulted in significantly more rapid formation of a stratified epidermis than did transplantation of single-cell suspensions or spheres alone. Twenty-three days after transplantation, the epidermis formed from the cells bound to the spheres was not as thick as the epidermis on wounds covered with split-thickness skin grafts, but significantly thicker than on wounds to which single-cell suspensions, spheres alone or no transplant at all was applied. Furthermore, fluorescence in situ hybridisation revealed that the transplanted keratinocytes, both those adherent to gelatin spheres and those in single-cell suspension, were components of the newly formed epidermis. These findings indicate that application of biodegradable macroporous spheres may prove to be of considerable value in designing cell-based therapies for the treatment of acute and persistent wounds.

Enzymatic necrolysis and chemical necrectomy using benzoic acid: Their value in the surgical treatment of burns

Enzymatic necrolysis and chemical necrectomy using benzoic acid: Their value in the surgical treatment of burns

The surgical treatment of acute burns

BACKGROUND: In the last decades, burn care has improved, so the trend in the current treatment extends beyond the preservation of life; the ultimate goal is the return of burn victims, as full members, back into their families and communities. This paper was prepared to consider the complex treatment of burns. METHODS: This paper is mainly based on our experience in treating patients suffering from burn injuries. RESULTS: One of the major problems that face any burn surgeon is the decision on the nature of treatment (conservative versus operative), so the key decision in the treatment is based on the exact determination of burn wound depth. In case of deep lesions early excision and suitable grafting and coverage should be performed whenever possible. Moreover, the adequate nutritional support is of utmost importance for the surgical treatment of burns. CONCLUSIONS: This paper is designed as a guideline and instruction manual to guide those with less experience through difficult situations in surgical burn care. Moreover it should be used as a guide to detect patients that require a referral to a burn centre after initial assessment.

Surgical treatment of burns in elderly patients.

This study evaluates our experience with surgical treatment of burns in the elderly. Forty-two patients more than 59 years old were treated from 1982 to 1986. The mean age was 73, and the mean TBSA burned was 29%. The patients were divided into three groups. Group I had 22 patients with less than 20% TBSA burn (mean of 11%, with a mean of 6% full-thickness burns). Their survival rate was 91%. Group II had 11 patients with 21-40% TBSA burns (mean of 32%, with a mean of 17% full-thickness burns). Their survival rate was 82%. Group III had nine patients with burns greater than 40% TBSA (mean, 71%). None of these patients survived. Twenty of 29 (68%) survivors required a total of 36 operations. The mean area grafted per procedure was 8%. Each procedure required a mean of 2U packed red blood cells, and a mean of 2 1/4 hours. The complication rate was 33%, with partial graft loss (14%) being the most frequent. The average hospital stay was 27 days in Group I and 45 days in Group II. Only 25% of the patients required nursing home assistance at discharge.

Considerations on Early Surgery in the Treatment of Extensive Burns

The results obtained with early surgical treatment of burns have been re-examined from various aspects. Early escharectomy, which tranforms the necrobiotic tissue into a surgical lesion, reduces the chemical factors of inflammation, lowers the lactic acid level and depresses the activity and disordered proliferation of the fibroblasts and the consequent laying down of immature collagen which is responsible for the pathological evolution of the burn scar. The removal of toxic material with proteasic activity, the reduction in the risk of sepsis, the saving of work for the immunopoietic mechanism, a reduction in the weight loss through improved nitrogen balance and an increase in the anabolic phase of muscular metabolism by early movement as well as a shortening of the period of hospitalization--all are factors in favour of the early surgical technique. Better healing is obtained by the elimination of the necrotic tissue, a reduction in the haematologic tissue inflammation mediators, an increase in the antibacterial defence following the reconstruction of the skin surface with covering materials and the rapid articular reduction; not to mention the inhibition of the formation of granulation tissue.

Modern orientations in surgical treatment of burns

Modern orientations in surgical treatment of burns

The surgical treatment of burns by early excision and grafting

The surgical treatment of burns by early excision and grafting

Anaesthesia in the surgical treatment of burns

Anaesthesia in the surgical treatment of burns