Wound Healing In Children Research Articles

Nutritional Profile and Topic Management for Wound Healing in Children with Epidermolysis Bullosa: What Is the Evidence? A Systematic Review

Epidermolysis Bullosa (EB) is a rare genetic disorder characterized by fragile skin that blisters and tears easily, leading to significant morbidity and mortality. Depending on the specific genetic mutations and the proteins involved, EB can be classified into several subtypes whose molecular complexity is compounded by the variability in mutation types (missense, nonsense, insertions, deletions), their locations within the genes, and the resultant effects on protein function. This systematic review aimed to identify and synthesize available evidence on wound healing interventions and the nutritional profile of children diagnosed with EB. A comprehensive search yielded 28 articles, including 21 clinical trials and seven observational studies, encompassing 994 patients with various EB subtypes. The majority of studies described subtypes such as Simplex EB (EBS), Junctional EB (JEB), Dystrophic EB (DEB), and EB Kindler. The primary interventions for wound healing included dressings with collagen, biocellulose, and various topical creams. Nutritional assessment was limited, with only six studies examining nutritional status, predominantly through anthropometry and dietary intake analysis. Subgroup analyses indicated higher malnutrition rates among patients with DEB compared to JEB. The review underscores the importance of addressing wound healing and nutritional challenges in EB management. Further research is needed to explore effective interventions and optimize care for this vulnerable population.<strong>Keyword</strong><strong>s</strong>Nutrition; pediatrics; wound healing; epidermolysis bullosa

Analysis of Factors Influencing Trauma Healing in Children with Second-Degree Burns: A Single-Center Retrospective Study

Background: The complexity of studying secondary burn wound healing in children arises from the varying ability of skin tissue regeneration across different ages. Despite advancements, there are still gaps in our understanding. Objectives: This study aimed to explore factors influencing wound healing in children with second-degree burns to guide clinical treatment and nursing practices. Methods: We conducted a retrospective analysis of children with second-degree burns treated in our burn surgery department from January 2020 to December 2022. Based on the events per variable (EPV) rule, 220 children were included. They were categorized based on the quality of wound healing 14 days post-admission (good or poor), evaluated by the healing rate and scar formation. Children's clinical data were extracted from medical records for analysis. Binary logistic regression identified factors associated with poor healing outcomes in second-degree burns. Results: Among 220 patients with secondary burns, 166 (75.46%) experienced good wound healing, while 54 (24.54%) had poor outcomes. The Hosmer-Lemeshow test indicated a good model fit (χ2 = 9.739, P = 0.28). Significant variables included burn area (odds ratio [OR] = 1.217, 95% confidence interval [CI] = 1.109 - 1.335, P < 0.05), number of drug changes (OR = 1.902, 95%CI = 1.392 - 2.599, P < 0.05), white blood cell count (OR = 1.076, 95%CI = 1.008 - 1.150, P < 0.05), neutrophil count (OR = 1.080, 95%CI = 1.018 - 1.146, P < 0.05), and neutrophil ratio (OR = 1.040, 95%CI = 1.002 - 1.081, P < 0.05). Conclusions: Effective treatment and nursing of children with second-degree burns should prioritize managing large burn areas and high levels of inflammatory markers. Additionally, minimizing drug changes during the nursing process can enhance wound healing in children.

Influence of magnetotherapy on various systems of the body and on the process of wound healing in children with cleft lip and palate

In this article we present the results of magnetic therapy on the wound healing process in children with cleft lip and palate after cheiloplasty surgery. At the same time, there is an improvement in metabolic processes in tissues, which contributes to their proper nutrition and restoration.Inflammation and associated soft tissue swelling are eliminated. Locally, blood vessels dilate and blood supply improves. The pain is relieved.Magnetotherapy is a method of physiotherapy that uses magnetic fields of varying strengths and frequencies for the treatment, rehabilitation or prevention of diseases. To carry it out, stationary and portable devices have been developed. The principle is simple: one or more electromagnetic applicators are installed on certain areas of the body, or the patient is placed in a large-diameter magnetic chamber or on a special mattress. The method is based on the fact that a magnetic field affects electrically charged particles moving in the human body. They are found in biological fluids - blood, lymph, cytoplasm of cells. Under the influence of a magnet, weak electric currents arise in these environments. They cause many responses: metabolism, blood properties, the speed of transmission of nerve impulses change, microcirculation and the delivery of oxygen and micronutrients improve. This leads to the following effects: reduction of tissue swelling, suppression of the inflammatory process, local anesthesia, reduction of blood viscosity, normalization of blood pressure, acceleration of healing and tissue restoration, stimulation of the immune system.

Exposure of Skin Homografts from Related Living Donors to Radiotherapy and Its Effects on Acute Rejection and Wound Healing in Children with Deep Burns: A Randomized Controlled Trial.

Background The ideal skin substitute should be more similar to normal skin function while causing fewer reactions. The purpose of this study was to assess the effect of radiotherapy on minimizing acute rejection and enhancing wound healing in children with deep burns. Patients and Methods A prospective randomized control study included 34 children admitted to the burn unit with deep burns under the age of 12 years. Through the tomotherapy device, a skin homograft from a related living donor was exposed to a local dose of radiotherapy of 500 centigray (cGy). It was immediately used for coverage of the prepared bed after the irradiation was completed. Results The mean values of the laboratory parameters (ESR, CRP, IL-6, and TNF) for all burn patients in the study showed a significant difference, with p < 0.001. The mean ± standard deviation (SD) of the time from homograft coverage to the appearance of rejection was 9.62 ± 1.45 in group 1 and 14.35 ± 2.8 in group 2, with p < 0.001 (highly significant difference), indicating that exposure to radiotherapy can reduce graft rejection. Conclusions The exposure of skin homografts from related living donors to a local low dose of radiotherapy can reduce a graft's ability to initiate inflammatory and immunological reactions, thereby minimizing rejection of a graft and enhancing epithelialization in children with deep second- and third-degree burns.

Effects of Photobiomodulation and Split-Thickness Skin Grafting in the Prognosis of Wound Healing in Children with Deep Burn Ulcers.

Background: Split-thickness skin grafting (STSG) is a standard therapeutic technique in patients with extensive and deep ulcers. Hospitalization and surgery can result in complications, especially in children. Photobiomodulation (PBM) has been applied in a variety of conditions such as healing of surgical, venous, pressure, and diabetic wounds, but no clinical trial using this method for healing of burn ulcers in children was found on searching the literature. The aim of the study was to evaluate the effect of PBM on the outcome of burn ulcers in children. Materials and methods: Informed consent and protocols were reviewed according to Shahid Beheshti University of Medical Sciences' Medical Ethics Board (IR.SBMU.REC.1394.363) and the Iranian Registry of Clinical Trials (IRCT2016011726069N1). Forty children with deep burn ulcers, who were candidates for STSG, were divided into PBM and STSG groups. A 650-nm laser (power 150 mW, spot size 0.6 cm2, time 10 sec, and energy point 1.5 J) was used for irradiation over the burn area every other day until complete healing in the PBM group. STSG was performed in the STSG group. All other therapeutic care protocols were identical. Results: Thirty-nine children completed the study. The mean ulcer size in the two groups was similar before treatment (PBM = 60.72 cm2 ± 13.8 and STSG = 63.74 ± 7.6). In the PBM group, all wounds healed within 10-12 sessions. Analysis of the burn area was performed 1, 3, and 6 months after injury. There was a significant difference (t test) in the burn area after 6 months in the PBM group compared with the STSG group (t test; p > 0.001). Conclusions: This is the first study to compare PBM and STSG in burn ulcers in children. Results indicated that PBM was an effective alternative to STSG, significantly decreasing the rate of scar and hypertrophic scar formation. Potential mechanisms of PBM that may be involved in burn tissue repair are discussed.

Examining Factors That Contribute to Delayed Wound Healing in Children with Tracheostomy Wounds.

To identify variables that may contribute to delayed wound healing times in pediatric patients with tracheostomy wounds. Researchers identified 134 charts spanning January 2013 to June 2017; 95 charts met the inclusion criteria. The study examined Pressure Ulcer Scale for Healing (PUSH) scores, pressure injury staging, and albumin levels. Arkansas Children's Hospital. Patients (birth to 18 years) who developed or were admitted with a wound caused by a tracheostomy device. Time in days to wound closure. There was a moderate positive correlation between albumin and days to healing (r = 0.432, n = 22, P = .045) with higher albumin levels associated with shorter healing times. The PUSH scores and pressure injury stage were significant in explaining 14.1% of variance in days to healing (F77,2 = 7.458; P < .001). Wound healing appears to be multifactorial in nature in the pediatric population; albumin levels, pressure injury stage, and PUSH scores are all positively correlated with healing times. Further research is needed to investigate the contribution of race to healing time predication for the pediatric population.

The Effect of Lactate Level on Early Mortality and Late Wound Healing in Children with Thoracoabdominal Trauma with Fluid Treatment Before Hospital

Background: In this study, we aimed to evaluate the effect of serum lactate levels on early mortality and late wound healing in patients with childhood thoracoabdominal trauma, pre-hospital fluid replacement in patients admitted to the emergency department. Methods: This study included 479 patients under the age of 18 who applied to the emergency room for thoracoabdominal trauma between January 2014 and December 2018. Of these, 278(58%) were male, with a mean age of 8.34 years (range, 1-16 years). Demographic characteristics, fluid resuscitation, and serum lactate levels, trauma pattern, and mortality results of these patients were evaluated retrospectively. Results: 474 (98.9%) of the cases were blunt and 5 (1.1%) were penetrating trauma. 225 (47%) of the trauma cases were less than one meter falling, 162 (33.8%) were over one meter falling from the high, and 87 (18.2%) were car accidents inside and outside. Mortality was found most common in falling from height cases, which were related to prolonged hospitalization and high lactate level (p &lt; 0.05). Wound healing times of patients undergoing pre-hospital fluid resuscitation and wound healing times of patients without pre-hospital fluid resuscitation were compared. Multivariate regression analysis, lactate level, and wound healing time were found to be predictive of the values found to be significant in the univariate regression analysis with fluid resuscitation and mortality (p &lt; 0.05). Conclusion: Most thoracoabdominal traumas can be treated with conservative methods. Pre-hospital fluid treatment in severe trauma cases may lead to decreased lactate levels, reduced mortality, and shortened wound healing time.

Surgical wound care: A survey of parental knowledge and expectations

BackgroundParents play an integral role in postoperative wound care. Existing parental knowledge is potentially variable. Our aim was to evaluate for any gaps or misconceptions in the parental knowledge base to determine the need for targeted educational programs. MethodsParents of children presenting to a tertiary pediatric center were surveyed in the preoperative stage. This consisted of 26 questions relating to wound healing, complications, and postoperative care. Participants were asked to complete the questionnaire for a same-day, clean abdominal procedure with a 2 cm incision to standardize responses. Expert responses from pediatric surgeons were utilized as a benchmark for nominating concordant answers. Results200 parents were surveyed. 129 parents (64.5%) had previous experience with surgical wound care. Only 64.5% of parents recognized the most concerning features of wound infection, with 65% of parents correctly identifying when infection is most likely to occur. Parents misjudged the time required before return to school (73.5%) and physical activity (51%). More than half of parents (51.5%) expected postoperative antibiotics to be given. Contrary to our routine surgical practice, 80% and 46% of parents respectively felt that regular dressing changes and application of antiseptics to the wound were necessary postoperatively. ConclusionsThere is a deficit of parental knowledge concerning wound healing in children. Therefore, there is a requirement for standardization of advice provided to parents with regards to wound and dressing care, development of wound complications, antibiotic and antiseptic use, and the timing of return to regular activities. Type of studySurvey. Level of evidenceIII

Effects of silver sulfadiazine and Actilite® honey on bacteria wound colonisation and wound healing in children with partial superficial burn wounds at University Teaching Hospital, Lusaka, Zambia

Background: Burn wounds are a global public health concern and Zambia has not been spared. Burn wounds account for 6% of surgical admissions yearly and yet are amongst the common causes of mortality at University Teaching Hospital (UTH). Burn wounds seen at UTH affect children more than adults and the common size is £20 per cent and partial superficial thickness in depth. The hospital has no burns unit and as such patients are admitted in general wards where cross infection is not uncommon. With high infection and mortality rates at UTH this study is of importance as it examined the effects of Actilite® honey and Silver sulfadiazine on bacteria wound colonisation and wound healing in paediatric partial superficial burn wounds of £20 per cent total body surface area.&#x0D; Methods: This two-arm open label randomised trial was done at UTH over a period of seven months (July 2017-January, 2018). Children under twelve years with £20% partial superficial burn wounds were recruited. Simple randomisation was used to allocate patients to either honey or SSD group. Patients' clinical characteristics were noted on recruitment. Swabs for microbiological evaluation were collected on day 0, 3, 7 and 10 and wounds were assessed for healing. The University of Zambia Biomedical Research and Ethics Committee approved the research.&#x0D; Results: Of the 64 patients, 32 were allocated to each group. The modal age distribution was 1-2 years and the percentage burn wound surface area was 6-10 percent in both age groups. At baseline there was no significant association between the two treatment methods and bacterial wound colonisation (80% in honey group and 83% in SSD group; p = 0.74) using Chi-squared test. However, by day 10 on treatment, there was significant reduction in bacterial wound colonisation (Honey Vs SSD; P = 0.026). Using Student T-test it was found that wounds treated with Actilite® honey healed quicker than those treated with SSD (Mean 11± 4, 15±6, P=0.0049). &#x0D; Conclusion: The study showed that treatment of children under 12years with partial superficial burn wounds of £20 per cent TBSA using Actilite® honey significantly reduced levels of bacteria wound colonisation by day 10. Furthermore, wounds in the Actilite® honey group healed quicker than SSD group. Therefore, use of Actilite Honey on burn wounds could be explored as alternative to SSD in managing paediatric partial superficial burn wounds of 20% and below at UTH.

Reduced Need of Infiltration Anesthesia Accompanied With Other Positive Outcomes in Diode Laser Application for Frenectomy in Children.

Introduction: The abnormal maxillary labial frenum is common in children during the primary or mixed dentition stage. A conventional surgery for this abnormality usually requires infiltration anesthesia which leads to fear in children and consequent noncooperation during the surgery. The aim of present study was to evaluate the reduction in the need of infiltration anesthesia, intraoperative bleeding control and postoperative pain and wound healing in children when using the diode laser for abnormal labial frenum in the maxilla. Methods: The present study was carried out among 30 children attending the Hanoi Medical University, Vietnam. A Diode Laser with 810 nm wavelength and power of 0.8 W was used for frenectomy. Results: The proportion of procedures without any need of infiltration anesthesia was 70%, while 93.34% of children demonstrated positive and very positive behavior. Proportion of indolence on the first day after surgery was 83.3%. While 83.3% of children did not take any analgesics, not a single child complained of any pain 3 days after surgery. Conclusion: Our results indicated that the use of diode laser showed several benefits in maxillary labial frenectomy in children. These included reducing the need of infiltration anesthesia, increasing the children's cooperation as well as decreasing the postoperative pain.

Changes in levels of cytokines in the treatment of infected wounds and festering in children

Informative and prognostic significance of cytokines in assessing the effectiveness of treatment tactics no doubt. The aim was to study the levels of pro- and anti-inflammatory cytokines in the dynamics of the treatment of infected wounds and purulent (IWP) in children using the proposed optimized local treatment compared with standard procedure. Materials and methods. 45 children with IWP who were treated in the department of purulent surgery of Zaporozhye Regional Children's Hospital during the period of 2015-2016 years were divided into main (n = 26) and control groups (n = 19) depending on the tactics of treatment. The therapy of the main group patients were added by optimized integrated local treatment, which included a combination of magnetic therapy, antibacterial drug liposomal solutions and hirudotherapy. Efficacy of treatment was assessed by clinical characteristics and serum levels of IL-1β and IL-10 on the 1 st and the 7 th day of treatment. Results. The highest levels of pro-inflammatory IL-1β were defined in children with lymphadenitis on the first day of treatment. Common trends in the dynamics of cytokines content changes on the 7 th day were in the line with generally accepted: decreased in IL-1β and increased in IL-10 levels. The level of IL-1β was not statistically different on the 7 th day only in children with phlegmon. The most significant changes in IL-10 were observed in children with abscesses and lymphadenitis than in children with infected wound and phlegmon. Changes in markers of inflammation conform to positive changes in the clinical course of wound healing in children at the study. Generally, there was a lag dynamics of cytokines changes in the children who received standard therapy compared with the children who received the proposed optimized local treatment. Conclusions. The use of proposed IWP complex treatment in children showed the most significant effect on the anti-inflammatory IL-10 level in children with abscesses and lymphadenitis. Serum level of IL-1β and IL-10 can not be used to assess the dynamics of wound healing in children with phlegmon.

Nutrition Interventions to Optimize Pediatric Wound Healing: An Evidence-Based Clinical Pathway.

Background and Objective: There is no accepted nutrition approach for wound healing in children. Our aims were to determine optimal nutrition support for pediatric wound healing. Methods: We applied local methods to create evidence- and consensus-based recommendations, supported by implementation tools, including algorithms, clinical decision supports, and measures. We applied these recommendations to the care of 49 patients from December 5, 2011, to December 5, 2012. Results: Six articles were found that addressed our clinical questions, and we formulated 5 clinical recommendations. Evidence supported evaluating patients for vitamin C, zinc, and protein deficiency. Of the patients where laboratory values were checked, 9 patients were zinc deficient (33%) and 12 patients were vitamin C deficient (48%). Discussion and Practical Application: The implementation of our recommendations has led to increased identification of micronutrient deficiencies and closer monitoring of nutrition status and intake. Online clinical decision supports can accelerate the adoption of clinical recommendations and reduce provider practice variation.

A comparative analysis of advanced techniques for skin reconstruction with autologous keratinocyte culture in severely burned children: own experience.

IntroductionThe local treatment in burns larger than 50% of total body surface area is still the great challenge for surgeons.AimThis paper presents a review of different solutions for deep burn wound healing in children and the early outcomes of treatment with combined autologous cell culture technique.Material and methodsFor this study, 20 children aged between 4 and 12 years with 55–65% of TBSA III grade burn injury were analyzed. A skin sample, 1 cm × 1 cm in size, for keratinocyte cultivation, was taken on the day of the burn. After necrotic tissue excision, the covering of the burned area with an isolated meshed skin graft was carried out between day 4 and 7. After 7 days of keratinocyte cultivation, the mentioned areas were covered with cells from the culture. We divided the burned regions, according to the way of wound closure, into 3 groups each consisting of 15 treated regions of the body. We used meshed split thickness skin grafts (SSG group), cultured autologous keratinocytes (CAC group), and both techniques applied in one stage (SSG + CAC group).ResultsIn the SSG group, the mean time for complete closure of wounds was 12.7 days. Wounds treated with CAC only needed a non-significantly longer time to heal – 14.2 days (p = 0.056) when compared to SSG. The shortest time to heal was observed in the group treated with SSG + CAC – 8.5 days, and it was significantly shorter when compared to the SSG and CAC groups (p < 0.001).ConclusionsThis study suggests that cultured keratinocytes obtained after short-time multiplication, combined with meshed autologous split thickness skin grafts, constitute the optimal wound closure in burned children.

Laser Doppler Line Scan Burn Imager (LDLS-BI): Sideways move or a step ahead?

ObjectiveTo assess the accuracy of a Laser Doppler Line Scanner (LDLS) in predicting burn wound healing in children compared to conventional Laser Doppler Imaging (LDI). MethodsA prospective study comparing a LDLS with a conventional LDI to assess burn wound Healing Potential (HP) was performed in 50 paediatric patients presenting to our institution between February 2010 and March 2011, as part of a multi-centre, international trial. Inclusion criteria were superficial to deep dermal burns that were able to be scanned between 42h and 5 days of the burn. ResultsOf the 50 patients enrolled, one was excluded from subsequent analysis as they were unable to present for wound reviews at 14 and 21 days. Ninety scans were performed of 59 burn wounds in the remaining 49 patients. The mean age was 4 years and 9 months (range 8 months to 16 years) and the mean Total Body Surface Area burnt was 8.3% (range 0.1–15%). The most common mechanism of injury was a scald, followed by contact and flame burns. A limb was the most common site of injury. Overall accuracy of the scanners was 94.5% (LDI) and 95% (LDLS), with accuracy lowest for indeterminate burns that healed within 14–21 days. ConclusionThe LDLS was found to be as accurate as the LDI in predicting burn wound HP in children. Whilst the LDLS scan resolution was lower, with more scans of larger burns required, its smaller size and greater scan speed proved valuable in children.

Negative Pressure Wound Therapy With Reticulated Open Cell Foam in Children: An Overview

This article summarizes the results of a comprehensive review of the literature on the use of negative pressure wound therapy with reticulated open cell foam (NPWT/ROCF) as delivered by V.A.C.(R) Therapy (KCI, San Antonio, TX) in pediatric patients. A review of the literature revealed 20 articles that discussed the use of NPWT/ROCF in exclusively pediatric patients. Nine articles were retrospective reviews, and 11 were case studies. This review discusses the insights from these articles. This review discusses the versatility of NPWT/ROCF for use with pediatric patients with infected wounds; full-thickness burns; open fractures; large soft tissue wounds; surgical wounds of the chest, abdomen, and spine; pilonidal disease; and pressure ulcers. NPWT/ROCF has been used in children as young as a few weeks of age, and in children with comorbidities such as congenital heart disease, immunosuppression, and spina bifida. Wound healing in children can be delayed by impaired perfusion, infection, edema, and poor nutrition. Clinical considerations for using NPWT/ROCF in children can include differences in healing due to higher granulation rates requiring more frequent dressing changes, poor nutritional status, small size, and low weight. With pediatric patients, there is no consensus on foam (white or black) selection, optimum amount of negative pressure, frequency of NPWT/ROCF dressing changes, and interposing contact layer selection. Randomized prospective studies are needed to make recommendations for safe and efficacious clinical practice. Research regarding the effects of dressing types, adjunctive treatment, and wound healing in neonates and children is needed.

Gabapentin for the treatment of itching produced by burns and wound healing in children: a pilot study

We describe the use of gabapentin for the treatment of itching in wound healing in 35 children. All children were already treated with chlorpheniramine and trimeprazine but they remained irritable and were constantly rubbing their wounds. Within 24 h of commencing treatment itching had improved significantly in all of the children.

Duration of surgery and patient age affect wound healing in children.

The migration of inflammatory cells into a wound and their subsequent changes during wound healing are essential for the complex processes of tissue repair to occur. The aim of this work was to investigate the number of wound leukocytes during early wound healing at different time periods in children. Wound cells of 184 children aged 0-15 years, operated on for a benign disease in the lower abdominal region, were harvested with the Cellstick(R) device. The device was removed from the wound at 3, 6, or 24 hours after surgery and differential cell counts were performed. The cellular patterns were significantly influenced by the age of the patient and by the duration of the surgery. The proportions of neutrophils, lymphocytes, and monocytes changed significantly from 3-24 hours. Our results suggest that there is a distinct time-related change in the pattern of inflammatory cells in the early phase of wound healing in children. This pattern is affected by the age of the child and by the duration of the surgery.

Correlation between interleukin-6 and matrix metalloproteinase-9 in early wound healing in children.

Interleukin-6 and matrix metalloproteinase-9 concentrations in the wound fluid and their associations to cellular changes were determined in early wound healing. Wound healing of 75 children who underwent elective operations was studied with the Cellstick(R) device, which was inserted into the wound at the end of the operation and removed 3 or 24 hours post-wounding. Differential counts of the wound cells and interleukin-6 and matrix metalloproteinase-9 concentrations in the wound fluid were analyzed. Interleukin-6 and the matrix metalloproteinase-9 concentrations increased in parallel (r = 0.81). The proportion of wound neutrophils increased (p < 0.0001) and lymphocytes decreased (p < 0. 0001) between the observation times. The number of wound neutrophils had a strong correlation with both interleukin-6 (adjusted R2 = 0.41, p < 0.0001) and matrix metalloproteinase-9 concentrations (adjusted R2 = 0.37, p < 0.0001). The extracellular matrix degradation process of the early wound healing seems to be closely linked to the inflammatory response. Both of these measured markers are associated significantly with the neutrophil proportion in the wound.

Wound management in children.

This article explains the physiological events in wound healing in children, the rationale for dressing selection and the importance of taking a holistic approach to wound management.

Wound management in children

This article explains the physiological events in wound healing in children, the rationale for dressing selection and the importance of taking a holistic approach to wound management