Wound Depth Research Articles

Interventional Program on Nurses Practices Regarding Burn Wound Dressing

Background: Wound management is a crucial aspect of patient care and the nurse often is faced with the question of which approaches to use to provide an environment that supports healing and prevents complications. Important questions include how different types of wounds should be dressed, what method of debridement to use, whether dressings should be changed using sterile versus unsterile technique, and which adjunctive therapies to select under given circumstances, thus the aim of this study is to evaluate the effect of an intervention program on nurse's practices regarding dressing burn wound. Methodology: A quantitative (one pre experimental) design had been adapted through the present study with the application of pre- post-test approach during the period of 17th October, 2020 to 20th March, 2022. A non-probability (convenient) sample of 24 nurses who work at burns and plastic surgery center at Azady teaching hospital. The interventional program and study instrument is designed based on of the nurse's practice assessment need, review of literature, scientific lecturer and previous study. The content of the program and instrument are evaluated by 16 experts in different field and the reliability of instrument is determined through the use of test and retest, measurement of effectiveness for nursing education program carried out through (24) items concerning clinical guidelines regarding burn management. The analysis of data is performed through the application of descriptive statistic as well as inferential statistic by using statistical package of social science version 22. Result: shows that vast majority of the sample were male, 30-39 years old, high school graduate, less than 5 years of experience. Most of the samples participate in burn courses, one course in number, their courses inside Iraq. Comparisons significant at P<0.01 was high regarding initial survey’s, secondary survey's, total body surface, initial assessment of the depth of the burn wounds, burn wounds, removing dead tissue and cleaning the burn's. Conclusion: study conclude that Nurses' Practice improvements due to applying of the proposed interventional program with relative to demographical characteristics. The study recommends that nurses practice toward burn management should be updated periodically as well as encourage nurses to participate in sessions, conferences and seminar related to care of burn Keywords: Burns; Hydrogels; Peptides; Wound dressings, Skin

Research advances on the techniques for diagnosing burn wound depth

The accurate diagnosis of burn wound depth is particularly important for evaluating the disease prognosis of burn patients. In the past, the diagnosis of burn wound depth often relied on the subjective judgment of doctors. With the continuous development of diagnostic technology, the methods for judging the depth of burn wound have also been updated. This paper mainly summarizes the research progress in the applications of indocyanine green angiography, laser Doppler imaging, laser speckle contrast imaging, and artificial intelligence in the diagnosis of burn wound depth, and compares the advantages and disadvantages of these techniques, so as to provide ideas for accurate diagnosis of burn wound depth.

Effect of plane of nutrition and analgesic drug treatment on wound healing and pain following cautery disbudding in preweaning dairy calves

The objective of this study was to determine the effect of a biologically normal plane of nutrition compared with a limited plane on the primary outcome wound healing, and one dose of nonsteroidal anti-inflammatory drug (NSAID) compared with 2 on the secondary outcomes: lying behavior, haptoglobin concentrations, and mechanical nociceptive threshold (MNT) in calves disbudded via cautery iron. Eighty female Holstein calves were enrolled at birth, individually housed, and fed via a Calf Rail system (Förster Technik). A 2 × 2 factorial design was used to assess the effect of plane of nutrition and an additional NSAID. Calves were randomly assigned to a biologically normal plane of nutrition (BN; offered up to 15 L/d) or a limited plane (LP; offered up to 6 L/d) and to receive one or 2 doses of meloxicam. All calves received a lidocaine cornual nerve block and a subcutaneous injection of meloxicam 15 min before cautery disbudding at 18 to 25 d of age, and half the calves received an additional injection of meloxicam (0.5 mg/kg) 3 d after disbudding. Tissue type present, wound diameter, and wound depth were evaluated 2 times per week for 7 to 8 wk as measures of wound healing, lying behavior was recorded beginning 1 to 2 wk before disbudding until 7 to 8 wk after as a behavioral indicator of pain, haptoglobin concentrations were measured once per day for 7 d after disbudding, and MNT was evaluated 2 times/wk for 3 wk. Survival analyses were analyzed using Cox regression models (wound healing) and continuous data were analyzed using mixed-effect linear regression models. Only 12% of horn buds were completely healed by 7 to 8 wk after disbudding and 54% had re-epithelized at this time. At any time, wounds from BN calves were more likely to have had re-epithelization occur compared with wounds from LP calves (hazard ratio: 1.93, 95% CI: 1.18-3.14). Wounds from calves that received only one dose of NSAID were more likely to have re-epithelization occur, compared with wounds from calves given 2 doses (hazard ratio: 1.87, 95% CI: 1.15-3.05). Wounds from BN calves had smaller diameters and depths over time beginning on wk 3 compared with LP calves. Wounds from calves that received an additional NSAID had larger diameters and depths over time beginning on wk 4 and 3 respectively, compared with calves that only received one dose of NSAID. Calves that received an extra NSAID tended to be less sensitive 7, 10, and 17 d after disbudding compared with calves that only received one dose and spent less time lying in the week after disbudding. Calves on the BN milk program were more active compared with LP calves with lower lying times, fewer lying bouts per day, and longer average lying bouts. Our results indicate that a BN milk feeding program for calves can result in faster healing times and more activity, and that providing an extra NSAID 3 d after disbudding appears to slow the healing process but may result in less pain experienced by the calf 1 to 2 wk after the procedure. This study is also among the first to demonstrate that after the complete removal of the horn bud, wounds can take more than 8 weeks to re-epithelize and fully heal.

EFFICACY OF UNANI FORMULATION MARHAM-E-EJAZ IN THE MANAGEMENT OF NON-HEALING ULCER: A CASE REPORT

Background and Aim: A Non-healing ulcer is defined as an ulcer that does not heal after 6 weeks of conservative therapy. It is estimated that 1-2% of the people of the world experience a chronic wound during their lifetime. There is direct impact on the physical (amputation), psychological (depression) and social life of individual. Present study was carried out to assess the acclaimed effect of Unani formulation Marham-e-Ejaz in a patient. Material And Method: A female patient of Non-healing ulcer presented in the surgery OPD of our institute. She presented with a chief complaint of wound at the right elbow joint. The diagnosis made was post burn wound. The wound had a history of more than 9 month. The case was treated with Unani Topical formulation, Marham-e-Ejaz for 30 days. The formulation was applied after cleaning it with Normal saline, dressing was changed after every alternate day. The wound was assessed for pain, discharge, size and depth of wound at 0th, 15th, 30th day. Result: On the first day wound size was 2 square cm, depth 0.2 cm, and the floor filled with pale granulation tissue. On 30th day ulcer was completely healed with 100% epithelization. Conclusion: It was observed that there was significant healing of the ulcer. So, Marham-e-Ejaz has potential efficacy in healing Non-healing ulcer.

Phenotypic and Genotypic Identification of Yeast Species Isolated from Diabetic Foot Patients in Al-Najaf Province, Iraq.

Opportunistic yeasts, such as <i>Trichosporon</i> and <i>Candida</i> species (spp.), are reported to cause high rates of morbidity and mortality in immunocompromised and underlying patients. This study was conducted to investigate the phenotypic and genotypic identification of yeast spp. isolated from diabetic patients in Al-Najaf province, Iraq. Samples were collected from the depth of diabetic foot patients' wounds. They were then cultured on Sabouraud Dextrose Agar (SDA) and incubated at 30°C to 35°C for 5 to 7 days for the growth of yeast spp. The colonies were identified based on their microscopic features. Afterward, these yeast samples were cultured in CHROMagar for the isolation and identification of yeast spp. All collected samples were cultured on the SDA through the use of CHROMagar, which is considered a differential agar since the colonies obtained from <i>Candida intermedia</i> and <i>Trichosporon asahii</i> appear in different colors on this media. The Polymerase Chain Reaction assay was performed to amplify the internal transcribed spacer 1 (ITS1) and Internal transcribed spacer 4 (ITS4) sequences for the identification of the yeast spp. Furthermore, the products were sequenced by the Sanger method and compared to the reference global sequences in the national center for biotechnology information Gene Bank. The results showed different molecular sizes of the ITS regions of yeast spp. The primer pair was used for the same sample (i.e., ITS1-ITS4) and targeted the ITS regions. Yeast spp. can be considered the most common fungal agent of life-threatening invasive infections in patients with severe immunodeficiency or underlying diseases, and the treatment of these infections requires long stays in the intensive care units.

To Summarize and Analyze the Epidemiological Characteristics and Prognostic Risk Factors of Patients with Pelvic Fracture Complicated with Perineal Injury.

This study is aimed at summarizing and analyzing the epidemiological characteristics and prognostic risk factors of patients with a pelvic fracture with perineal injury. The clinical data of 153 patients with pelvic fracture with perineal injury treated in our hospital from January 2012 to June 2021 were analyzed retrospectively. The data of sex, age, injury mechanism, pelvic fracture type, shock index (SI), perineal wound depth, concomitant injury, total hospital stay, and death were collected by the electronic medical record system. Among the 153 patients, there were 94 males and 59 females, with an average age of (43.2 ± 16.8) years. The cases were mainly concentrated into two age groups: 20–29 years old and 50–59 years old. In a year, pelvic fractures were mainly concentrated in 1–2 months and 11–12 months. In terms of injury time, there were mainly two periods of time in a day: 10 : 00～12 : 00 and 15 : 00～18 : 00. The MOTS-RTS scores of the patients in the undead group and the dead group were (7.12 ± 1.52), (2.69 ± 0.96), ISS scores were (27.36 ± 15.84), (61.32 ± 7.08), GCS scores were (12.84 ± 3.69), (4.13 ± 1.25), APACH II scores were (12.87 ± 8.84), (32.41 ± 6.98), and SOFA scores were (6.68 ± 5.87), (17.12 ± 3.12). The MOTS-RTS and GCS scores of the nondeath group were significantly higher, while the ISS score, APACH II score, SOFA score, and shock index were significantly lower. The overall mortality rate of 153 patients was 13.7%. The average area of perineal trauma in undead and dead patients was (54.5 ± 113.52) cm2 and (262.63 ± 300.84) cm2, respectively. The average depth of perineal trauma was (9.63 ± 7.22) cm and (16.23 ± 10.13) cm, respectively. The larger the area of perineal injury and the deeper the depth of perineal trauma, the worse their prognosis. Cox multivariate analysis showed that complications, MOTS-RTS score, ISS score, GCS score, perineal trauma area, and perineal trauma depth were independent risk factors affecting the prognosis of patients with pelvic fracture with perineal injury. Most of the patients with pelvic fracture complicated with perineal injury are 20–29 years old and 50–59 years old. The more serious the perineal injury is, the higher the mortality is. The main causes of death are refractory hemorrhagic shock and infection.

19 Minced Skin Grafts Can Be Expanded up to 500 Times to Re-epithelialize Full-thickness Burns

IntroductionDeep and large burns require hospitalization and, without exception, surgical treatment. Skin graft expansion in major burns currently is restricted to a 1:6 expansion ratio (possibly 1:9) by current methods. For this reason, skin transplants are limited by donor site availability for patients with extensive burns, who may have only small areas of healthy skin for use as donor sites. The objective of this project is to demonstrate the efficacy of pixel grafting, to produce split-thickness skin grafts (STSG) and dermal grafts which can be expanded at least 100 times (1 cm2 donor skin will cover 100 cm2). Pixel grafts are skin grafts that are prepared from split-thickness donor skin that is 0.3 mm (12/1000 of an inch) thick and minced into pieces that are 0.3 x 0.3 mm. The methodology relies on mincing a small area of donor skin using a hand-held mincer to create uniform skin pieces, each of which will serve as a small center of skin regeneration.MethodsDeep partial-thickness burns were created on the dorsum of Yorkshire pigs. Three days post injury the burns were debrided and grafted with epidermal/dermal and dermal pixel grafts using expansion ratios from 1:2 to 1:500. The pixel grafts were prepared by harvesting 0.3 mm thick skin grafts from the same donor site going down in depth (Layer 1: STSG; Layer 2: dermal graft). Subsequently, the grafts were minced to 0.3 x 0.3 x 0.3 mm pixel grafts, suspended in a small volume of hydrogel and transplanted onto debrided porcine burn wounds. Healing was monitored up to 28 days and biopsies were collected on days 6, 10 and 14. The wounds were excised and fixed in formalin for histologic analysis. In addition, to measure wound area reduction and wound depth, wound images were taken. Multiple wound healing parameters were used to assess the quality of healing and the results were compared to STSG (standard of care treatment).ResultsHistology demonstrated that when both STSG pixel grafts and dermal grafts were transplanted onto porcine full-thickness wounds in a 1:2 ratio they were able to fully re-epithelialize the wounds in 14 days. At day 14, re-epithelialization-% using other expansion ratios varied from 46 % (1:500) to 64 % (1:10) and by day 28 all the wounds were fully re-epithelialized. Wound images obtained at different time points showed that by day 28 all the pixel graft grafted wounds had reduced in area efficiently, from 70 % (dermal pixel grafts 1:50) to 81% (STSG 1:100). No statistically significant differences were observed between the pixel graft study groups and STSG (standard of care).ConclusionsThis study concluded that both epidermal/dermal and dermal pixel grafts can be suspended in a hydrogel and transplanted onto wounds regardless of orientation (dermal side up or down), making the transplantation greatly simplified.

52 Refinement of a Histologic Algorithm for Burn Depth Categorization Using 1142 Consecutive Burn Wound Biopsies

IntroductionOur group previously reported a theoretical burn biopsy algorithm (BBA-V1) for the categorization of burn wound depth based on histologic analysis, and informed it with the largest series of burn wound biopsies in the literature. That iteration of the BBA resulted in clinical misclassification rates consistent with past literature. Since our last report of that process, we have refined the algorithm with new criteria and a larger repository of burn wound biopsies. Here, we sought to promulgate this newer, simpler version of the BBA (BBA-V2).MethodsThis was an IRB-approved, prospective, multicenter study. Patients with burn wounds assessed by burn experts as requiring excision and autograft underwent 4mm biopsies procured every 25cm2. Serial still photos were obtained at enrollment and at excision intraoperatively.Using H&E with whole slide scanning, a board-certified dermatopathologist assessed each burn biopsy. The criteria used for categorization of burn wound depth in BBA-V1 were: 1) proportion of necrotic adnexal structures, and 2) presence/absence of each of epidermis, papillary dermis, and reticular dermis. The criteria used for BBA-V2 were: 1) magnitude of reticular dermal degeneration, 2) proportion of necrotic adnexal structures, and 3) magnitude of vessel thrombosis.Biopsy pathology results were correlated with still photos by 3 burn experts for consensus of final burn depth diagnosis. Superficial partial thickness (SPT) wounds were considered to be burn wounds likely to have healed without surgery, while deep partial thickness (DPT) and full thickness (FT) were considered unlikely to heal by 21 days.ResultsThe development of BBA V-1 was previously informed by 66 subjects with 117 wounds and 816 biopsies, and resulted in wound categorizations as follows: SPT (20%), DPT (43%), and FT (37%). Therefore, according to BBA-V1, 20% of burn wounds were incorrectly judged as needing excision and grafting by the clinical team. The overall cohort was enlarged to 162 subjects with 294 wounds and 1142 biopsies. The most recent 838 burn wound biopsies were then re-reviewed and re-categorized according to the new BBA-V2 criteria and algorithm. Under BBA-V2, 3% of all burn wound biopsies were categorized as superficial partial thickness, 69% were categorized as deep partial thickness, and 29% were categorized as full thickness.ConclusionsOur study demonstrates that by adding dermal degeneration severity and vessel thrombosis to our previous criterion of adnexal structure necrosis, BBA-V2 had a much higher rate of concordance with visual clinical assessment for burn wounds clinically judged as needing surgical excision. This study serves as the largest analysis of burn biopsies by modern day burn experts.

47 Successful Prevention of Secondary Burn Progressions Using Topical Tacrolimus and Infliximab Hydrogel

IntroductionThe pathophysiology of partial- to full-thickness burn wound conversion remains poorly understood. Recent studies have demonstrated that an altered inflammatory response may play be implicated in this secondary conversion to deeper wounds. Therefore, reduction in early inflammation may decrease burn severity and morbidity.Specifically, TNF-ɑ has been shown to detrimentally affect the healing process after injury through a variety of mechanisms. We hypothesized that microcapillary alginate hydrogel loaded with immunosuppressive medications applied to partial-thickness burns would reduce inflammation and prevent further progression to full-thickness burns.The purpose of this study was to determine whether topical application of infliximab or tacrolimus could decrease burn wound depth.MethodsAssembly of the microfluidic hydrogels was achieved by embedding microfibers within a hydrogel scaffold composed of an alginate blend. The treatment cohorts received either (1) infliximab loaded hydrogel or (2) tacrolimus skin ointment covered by hydrogel. The control cohort only received an occlusive dressing.There were 12 young (2-4 months) and 12 old ( >16 months) mice, which were separated into treatment and control cohorts. All mice were anesthetized and given partial thickness burns by a validated scalding protocol. Mice were euthanized on post-burn day 3, and skin samples were taken. Burn depth was evaluated using Vimentin immunostaining.ResultsIn young mice, infliximab hydrogel (p=.002) and tacrolimus hydrogel (p=.002) significantly decreased burn depth compared to controls. In old mice, infliximab hydrogel (p=.005) and tacrolimus hydrogel (p< .001) significantly decreased burn depth compared to controls.In young mice, infliximab and tacrolimus were similarly efficacious (p > .05). In old mice, tacrolimus significantly decreased burn depth compared to infliximab (p=.002).In controls, old mice had deeper burn wound progression than young mice (p< .001). Similarly, in those treated with infliximab, old mice had deeper burn wound progression than young mice (p=.002). Interestingly, tacrolimus was able to decrease burn wound depth in old mice such that their burn wound thickness was similar to young mice (p >.05).ConclusionsApplication of a novel microcapillary alginate hydrogel infused with infliximab or topical tacrolimus reduced partial- to full-thickness burn wound conversion in mice. Application of immunosuppressive dressings may be a promising avenue for further clinical investigation to reduce morbidity and mortality associated with burn injuries.

Efficacy and safety of ALA-PDT in treatment of diabetic foot ulcer with infection

BackgroundDiabetic foot ulcers (DFUs) with infection is a major clinical issue, as the infection not only potentially devastate the wound healing, but also is the factor that most often leads to amputation. Nevertheless, traditional antibiotic treatment is often insufficient to clear the infection, which could lead to side effects. Photodynamic therapy (PDT) has broad-spectral antibacterial activity. Meanwhile, it is difficult to induce antibiotic resistance. Here, we aim to evaluate the safety and efficacy of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) in the treatment of DFUs with infection. MethodsIn our study, 5 diabetic patients with infectious DFUs were diagnosed by pathological examination and the depth of wound was examined by X-Ray. All patients’ wounds were firstly irradiated with 20% ALA-PDT (635 nm, 100 J/cm2, 80 mW/cm2) using the red LED to control the infection. Treatment will be combined with debridement if there is granulation necrosis or secretion on the wound surface. PDT sessions were performed weekly in all patients until healing was achieved. All patients were followed up for 0.6–1.2 years after treatment. ResultsIn 5 patients, the DFUs with infection was completely controlled by ALA-PDT. There was no recurrence of DFUs in the follow-up of 0.9 years (range, 0.6–1.2 years) after the treatment. ConclusionsALA-PDT treatment for DFUs with infection show successful outcomes and might ultimately avoid amputation.

Evaluation of skin tissue effects from treatment with a novel hand-held plasma energy device.

Plasma IQ™, the first FDA-cleared hand-held plasma energy device, is indicated for removal and destruction of skin lesions and coagulation of tissue. Treatment involves use of an electrostatic plasma spark to heat the skin and create discrete microthermal wounds. Microthermal wounds on pre-auricular and upper eyelid skin from two individual subjects were created using multiple treatment parameters to assess the impacts of power, pulse duration and needle electrode type on wound depth, width and thermal spread, and analyzed using histology to characterize treatment effects. Device power had a statistically significant impact on upper eyelid skin microthermal wound depth and width (2-sided t-test p<0.0001 for both) but not on thermal spread (p=0.1171). No meaningful differences in wound width, depth, or thermal spread were observed based on pulse duration or electrode type. All microthermal wounds demonstrated dual zones of tissue injury and extended to the superficial reticular dermis. Treatment with the Plasma IQ™ device creates focal microthermal wounds of reproducible depth and width that are comprised of dual thermal injury zones similar to other plasma energy skin rejuvenation devices. Device power is the most important factor determining microthermal wound depth and width.

Rescuing the negative effects of aging in burn wounds using tacrolimus applied via microcapillary hydrogel dressing

IntroductionDelays in treatment of burn injuries can lead to significant morbidity, loss of function, and poor aesthetic appearance. Preventing conversion from partial- to full-thickness burns may help mitigate these sequelae. The pathophysiology of burn wound conversion remains unknown, but an overactive immune response is thought to be implicated. The purpose of this study was to determine whether downregulating the immune response via tacrolimus can decrease burn wound conversion. MethodsAssembly of the microfluidic hydrogels was achieved by embedding microfibers within a hydrogel scaffold composed of a gelatin-alginate blend. Tacrolimus stock solution for intraperitoneal injection was made by re-suspending powdered tacrolimus in DMSO at 10 mg/mL. 24 young (2–4 months) and 24 old (>16 months) mice were given partial thickness burns. The treatment cohort received either tacrolimus ointment with a hydrogel dressing (6 young and 6 old) or an intraperitoneal injection of a tacrolimus solution (6 young and 6 old), while the control cohort only received either only the microcapillary hydrogel dressing or an intraperitoneal injection of saline. Mice were euthanized at day 3 after injury and skin samples were taken. Burn depth was evaluated using Vimentin immunostaining. ResultsIn old mice, intraperitoneal injection of tacrolimus was able to significantly reduce burn wound depth compared to intraperitoneal injection of saline (p = 0.011). Similarly in old mice, topical hydrogel with tacrolimus was able to significantly reduce burn wound depth compared to hydrogel alone (p < 0.001). Topical hydrogel with tacrolimus was able to mitigate the detrimental effects of older age on wound conversion, such that burn wounds of older mice treated with tacrolimus hydrogel dressing had similar burn depths as younger mice (p = 0.240). ConclusionsUtilizing a combination treatment of tacrolimus and microcapillary hydrogel is able to rescue the negative effects of aging and prevent partial- to full-thickness burn wound conversion. Hopefully these findings will encourage deeper investigation into the possible therapeutic advantages of utilizing immunosuppressive agents to decrease morbidity after burn injuries. Future research will need to specifically investigate IL-2 as an inhibitory target in the acute inflammatory cascade of burn injury.

Surgical treatment of hemispheric and subcortical gliomas adjacent to corticospinal tract in children using MR tractography and intraoperative electrophysiological monitoring

Difficult total resection of supratentorial gliomas adjacent to the corticospinal tract (CST) is due to the high risk of its injury and disability of patients. The main methods for preventing intraoperative CST damage are preoperative MR tractography and intraoperative electrophysiological monitoring. The problem of total resection of gliomas adjacent to the CST with preservation of high functional status is difficult due to immaturity and plasticity of brain structures in children. Moreover, the advantages of MR tractography combined with intraoperative monitoring have not been described. The authors present surgical treatment of supratentorial gliomas adjacent to the CST at different anatomical levels. Patients underwent preoperative and postoperative MR tractography and intraoperative electrophysiological monitoring. MR tractography provided preoperative data on CST lesion. Intraoperative monitoring made it possible to identify and preserve CST in the depth of surgical wound. MR tractography and intraoperative electrophysiological monitoring increase resection quality in patients with hemispheric and subcortical gliomas without postoperative functional deterioration.

Increase of coffee tree susceptibility to stem canker disease mediated by glyphosate application

Stem canker is a major disease of coffee in Indonesia, caused by Fusarium solani. Previous studies showed a correlation between stem canker incidence and glyphosate application. The study aimed to determine the effect of glyphosate application on coffee stem canker and the underlying physiological mechanisms. The research used glyphosate treatments with the concentrations of 0, 4, 8, and 16 ml.L−1. In vitro experiments were carried out by measuring the growth of F. solani colony after glyphosate treatment. In planta, tests were conducted by artificial inoculation on glyphosate-treated coffee seedlings. The severity of stem canker was assessed. In a separate test, coffee seedlings were treated with glyphosate without pathogen inoculation. In the second experiment, physiological change was determined by measuring photosynthetic pigments, gas-exchange properties, lipid peroxidation, and activity of ascorbate peroxidase (APX) and catalase (CAT) enzymes. In vitro tests showed that glyphosate had antifungal activity against F. solani. In planta, the test showed that glyphosate treatment caused higher susceptibility to stem canker in coffee seedlings, indicated by the increase of canker wound depth. Glyphosate treatment on coffee decreased the chlorophyll, carotene contents, and reduced photosynthesis rate, caused oxidative stress depicted by higher lipid peroxidation and increased enzyme APX and CAT activity.

FASTER–RCNN for Skin Burn Analysis and Tissue Regeneration

Skin is the largest body organ that is prone to the environment most specifically. Therefore the skin is susceptible to many damages, including burn damage. Burns can endanger life and are linked to high morbidity and mortality rates. Effective diagnosis with the help of accurate burn zone and wound depth evaluation is important for clinical efficacy. The following characteristics are associated with the skin burn wound, such as healing, infection, painand stress and keloid formation. Tissue regeneration also takes a significant amount of time for formation while considering skin healing after a burn injury. Deep neural networks can automatically assist in the extraction of features from a burn image. In our approach to burn wound analysis and regeneration of the tissue of the skin burn wound, we use the Faster RCNN (Regional Convolutional Neural Network), which is based on their severity of the burn wound. The success rates of skin cure for burning injuries can be dramatically increased with the use of different skin replacements. Our objective is to analyze different deep learning techniques that may help to analyze and classify burn wounds in a superficial, partial and complete thickness, while treating burn wounds more accurately. The application of Faster RCNN effectively classifies wound without first degree, second and third degree confusion, thus providing a suitable solution to burning wounds. The advancement in the field of profound training offers an important path in the field of the processing and burning of trauma.

До питання щодо способів діагностики і прогнозування розвитку ускладнень у постраждалих з опіками (огляд літератури)

The aim. The article is devoted to the methods used in combustiology practice to assess the condition of patients and predict general and local complications. Results. With severe thermal trauma, there is a risk of developing life-threatening conditions in the victims, in particular, sepsis and multiple organ failure. Informative for assessing the course of burn disease is a modified scale of physiological disorders, which takes into account the syndrome of systemic inflammatory response, endogenous intoxication during periods of toxemia and septicotoxemia, and concomitant pathology. The development of intoxication in severe burn injuries requires determining the degree of severity of the process and its assessment in dynamics. The toxicity of blood plasma is studied by the resistance of red blood cell membranes in the acid hemolysis reaction, indicators of the red blood cell intoxication index, and the content of universal markers of intoxication, in particular, medium-weight molecules. Methods for biosensor indication of cytotoxic factors have also been developed. Assessment of the severity of the condition of victims with burns and monitoring the effectiveness of therapy is carried out taking into account the level of procalcitonin and presepsin. To determine the effect of the wound process on the formation of early sepsis in patients with burns in the capillary zone of thermal damage, the content of homocysteine, endothelin and nitric oxide is studied. To assess the severity of the condition of burn patients and predict the development of complications, the values of integral hematological indices are informative. Reliable data on the depth of a burn wound are obtained using thermotopometry and pH measurement of burn wounds, the method of magnetic resonance imaging. In order to assess violations and dynamics of blood supply restoration in the area of thermal damage, the method of laser Doppler flowmetry and optical tissue oximetry is used. Determination of interstitial pressure in burns of the extremities and intra-abdominal pressure in common burns is a way to predict the development of compartment syndrome. To monitor the patient's glycemic status, it is proposed to determine the level of glycosylated hemoglobin. Microbiological research data is used to predict the risk of developing general complications of burn disease, as well as – together with cytological data and methods for determining the maturity of granulation tissue – to assess the readiness of granulating wounds for autodermoplasty. Conclusion. The development of new effective ways to predict and prevent the development of complications in burns is promising

Experimental Models for Controlled Burn Injuries in Rats: A Systematic Analysis of Original Methods and Burn Devices.

Despite a wide variety of models found in literature, choosing the right one can be difficult as many of them are lacking precise methodology. This study aims to analyze and compare original burn models in terms of burn device and technique, parameters, and wound depth assessment. A systematic search was performed according to PRISMA guidelines on studies describing original experimental burn models in rats. The adapted PICO formula and ARRIVE checklist were followed for inclusion and assessment of quality of studies. Characteristics of animals, burn technique, burn parameters, and method of histological confirmation of burn depth were recorded. Twenty-seven studies were included in the final analysis. Most studies used direct contact with skin for burn infliction (n = 20). The rat's dorsum was the most common site (n = 18). Ten studies used manually controlled burn devices, while 10 designed automatic burn devices with control over temperature (n = 10), exposure time (n = 5), and pressure (n = 5). Most studies (n = 7) used a single biopsy taken from the center of the wound to confirm burn depth immediately after burn infliction. From the wide variety of burn models in current literature, our study provides an overview of the most relevant experimental burn models in rats aiding researchers to understand what needs to be addressed when designing their burn protocol. Models cannot be compared as burn parameters variate significantly. Assessment of burn depth should be done in a standardized, sequential fashion in future burn studies to increase reproducibility.

Deep Learning-Assisted Burn Wound Diagnosis: Diagnostic Model Development Study.

BackgroundAccurate assessment of the percentage total body surface area (%TBSA) of burn wounds is crucial in the management of burn patients. The resuscitation fluid and nutritional needs of burn patients, their need for intensive unit care, and probability of mortality are all directly related to %TBSA. It is difficult to estimate a burn area of irregular shape by inspection. Many articles have reported discrepancies in estimating %TBSA by different doctors.ObjectiveWe propose a method, based on deep learning, for burn wound detection, segmentation, and calculation of %TBSA on a pixel-to-pixel basis.MethodsA 2-step procedure was used to convert burn wound diagnosis into %TBSA. In the first step, images of burn wounds were collected from medical records and labeled by burn surgeons, and the data set was then input into 2 deep learning architectures, U-Net and Mask R-CNN, each configured with 2 different backbones, to segment the burn wounds. In the second step, we collected and labeled images of hands to create another data set, which was also input into U-Net and Mask R-CNN to segment the hands. The %TBSA of burn wounds was then calculated by comparing the pixels of mask areas on images of the burn wound and hand of the same patient according to the rule of hand, which states that one’s hand accounts for 0.8% of TBSA.ResultsA total of 2591 images of burn wounds were collected and labeled to form the burn wound data set. The data set was randomly split into training, validation, and testing sets in a ratio of 8:1:1. Four hundred images of volar hands were collected and labeled to form the hand data set, which was also split into 3 sets using the same method. For the images of burn wounds, Mask R-CNN with ResNet101 had the best segmentation result with a Dice coefficient (DC) of 0.9496, while U-Net with ResNet101 had a DC of 0.8545. For the hand images, U-Net and Mask R-CNN had similar performance with DC values of 0.9920 and 0.9910, respectively. Lastly, we conducted a test diagnosis in a burn patient. Mask R-CNN with ResNet101 had on average less deviation (0.115% TBSA) from the ground truth than burn surgeons.ConclusionsThis is one of the first studies to diagnose all depths of burn wounds and convert the segmentation results into %TBSA using different deep learning models. We aimed to assist medical staff in estimating burn size more accurately, thereby helping to provide precise care to burn victims.

A Simple Inner-Stopper Guarded Trephine for Creation of Uniform Keratectomy Wounds in Rodents.

PurposeCreating controllable, reproducible keratectomy wounds in rodent corneas can be a challenge due to their small size, thickness, and the lack of usual tools available for human eyes such as a vacuum trephine. The purpose of this work is to provide a consistent, reproducible corneal stromal defect in rats using a simple, economical, and customized inner-stopper guarded trephine.MethodsThe inner-stopper guarded trephine is used to induce a circular wound in rat corneas. After trephination, the corneal flap can be removed by manual dissection using a blunt spatula. We used optical coherence topography (OCT) to measure the defect wound depth induced in ex vivo rat eyes.ResultsDespite a minor learning curve, this simple device enables depth control, reduces variability of manual keratectomy wound depth in rats, and decreases the risk for corneal perforation during keratectomy. Corneal defect creation was highly reproducible across different researchers and was independent of their surgical training.ConclusionThis inner-stopper guarded trephine can be utilized and applied to pre-clinical testing of a wide range of corneal wound healing therapies, including but not limited to biotherapeutics, corneal prosthetics, and regenerative technologies.

Outcomes of present-on-admission pressure injuries at discharge and potential prognostic factors: A historical cohort study in China

BackgroundThe prevalence of present-on-admission pressure injuries (POA-PIs) is much higher than hospital-acquired pressure injuries (HAPIs). But scant attention has been paid to POA-PIs, especially the healing rate and potential prognostic factors. ObjectiveTo describe the characteristics of POA-PIs at admission and the outcomes of POA-PIs at discharge, and to explore potential prognostic factors of POA-PIs wound healing. MethodsThis study analyzed electronic health records (EHRs) for 838 POA-PIs among 586 patients from a Chinese tertiary hospital in 2018. The outcomes of POA-PIs were identified into four categories by comparing POA-PIs' wound area and exudation amount scores at admission and discharge: deteriorating, stable, improving, and healed. The generalized estimating equation (GEE) was carried out to screen the prognostic factors of POA-PIs wound healing. ResultsAmong this population, 66.38% of the patients were male, 44.03% patients had a Braden Score less than 12 and the median of the Charlson comorbidity index was 5. The most common location of POA-PI wounds was the sacrum and the most common stage of them was Stage II. Nearly half of wounds (45.78%) were larger than 15 cm2, 26.61% were deeper than 0.5 cm, and 61.81% of the wounds were painful. When the patients were discharged, 29.71% wounds were healed, 36.16% were in improving status, 25.78% kept stable, and 8.35% wounds were in deteriorating status. Wound depth was the only independent prognostic factor for POA-PIs wound healing. ConclusionsThe healing rate of POA-PIs is quite low, and the only independent prognostic factor of POA-PIs was wound depth.