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Sample records for radioinduced skin burns

  1. Hair bleaching and skin burning

    PubMed Central

    Forster, K.; Lingitz, R.; Prattes, G.; Schneider, G.; Sutter, S.; Schintler, M.; Trop, M.

    2012-01-01

    Summary Hairdressing-related burns are preventable and therefore each case is one too many. We report a unique case of a 16-yr-old girl who suffered full-thickness chemical and thermal burns to the nape of her neck and superficial burns to the occiput after her hair had been dyed blond and placed under a dryer to accelerate the highlighting procedure. The wound on the nape of the neck required surgical debridement and skin grafting. The grafted area resulted in subsequent scar formation. PMID:23766754

  2. Hair bleaching and skin burning.

    PubMed

    Forster, K; Lingitz, R; Prattes, G; Schneider, G; Sutter, S; Schintler, M; Trop, M

    2012-12-31

    Hairdressing-related burns are preventable and therefore each case is one too many. We report a unique case of a 16-yr-old girl who suffered full-thickness chemical and thermal burns to the nape of her neck and superficial burns to the occiput after her hair had been dyed blond and placed under a dryer to accelerate the highlighting procedure. The wound on the nape of the neck required surgical debridement and skin grafting. The grafted area resulted in subsequent scar formation.

  3. Detecting Skin Burns Induced by Surface Electrodes

    DTIC Science & Technology

    2007-11-02

    density image were taken, the electrode peeled off the skin, and a photograph taken to complete the post-burn dataset. Finally, the used electrodes were...suggesting the breakdown of the barrier layer capacitance in the skin epidermis . Line monitoring of the skin impedance can predict the onset of the burns

  4. Heating pad burns in anesthetic skin.

    PubMed

    Stevenson, T R; Hammond, D C; Keip, D; Argenta, L C

    1985-07-01

    Patients requiring reconstruction by muscle or musculocutaneous flaps often have an associated area of skin anesthesia. This skin is susceptible to trauma because of its insensibility. This study reports 3 cases in which patients sustained deep partial-thickness burns of anesthetic skin following flap reconstruction. All burns healed by reepithelialization. Following flap reconstruction, patients should be warned regarding the use of heating pads. Burns of this type represent a preventable complication of flap reconstruction.

  5. Ultrasonic technique for characterizing skin burns

    DOEpatents

    Goans, Ronald E.; Cantrell, Jr., John H.; Meyers, F. Bradford; Stambaugh, Harry D.

    1978-01-01

    This invention, a method for ultrasonically determining the depth of a skin burn, is based on the finding that the acoustical impedance of burned tissue differs sufficiently from that of live tissue to permit ultrasonic detection of the interface between the burn and the underlying unburned tissue. The method is simple, rapid, and accurate. As compared with conventional practice, it provides the important advantage of permitting much earlier determination of whether a burn is of the first, second, or third degree. In the case of severe burns, the usual two - to three-week delay before surgery may be reduced to about 3 days or less.

  6. Alteration of biomechanical properties of burned skin.

    PubMed

    Held, M; Rahmanian-Schwarz, A; Rothenberger, J; Schiefer, J; Janghorban Esfahani, B; Schaller, H E; Jaminet, P

    2015-06-01

    The prevalence of burns in the general population is high. Despite new research findings, skin burns and its resulting tissue damage are still not entirely understood. In particular, little is known about the depth-dependent alteration of skin biomechanical properties of these wounds. Thirty-six burn wounds with six different depths were generated on the abdomen of six Göttingen minipigs. The alteration of skin biomechanical properties was evaluated objectively after 15 and 360 min using a Cutometer device. Biopsies for histological evaluation were taken and the depth of burn was correlated with biomechanical properties. Firmness of skin (R0), overall elasticity (R8) and calculated elasticity (Ue) demonstrated a continuous decrease with an increasing depth of burn 15 min after wound generation. Gross elasticity (R2), net elasticity (R5) and amount of elasticity of the whole curve (R7), however, showed an increase of values with increasing depth of injury. A further decrease of elasticity was demonstrated 360 min after wound generation. The alteration of skin biomechanical properties is a function of damaged tissue structures. The presented results demonstrate a depth-dependent decrease of principal elastic parameters with an increasing depth of burn and the results indicate progressive tissue damage over the time. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  7. Dose-surface analysis for prediction of severe acute radio-induced skin toxicity in breast cancer patients.

    PubMed

    Pastore, Francesco; Conson, Manuel; D'Avino, Vittoria; Palma, Giuseppe; Liuzzi, Raffaele; Solla, Raffaele; Farella, Antonio; Salvatore, Marco; Cella, Laura; Pacelli, Roberto

    2016-01-01

    Severe acute radiation-induced skin toxicity (RIST) after breast irradiation is a side effect impacting the quality of life in breast cancer (BC) patients. The aim of the present study was to develop normal tissue complication probability (NTCP) models of severe acute RIST in BC patients. We evaluated 140 consecutive BC patients undergoing conventional three-dimensional conformal radiotherapy (3D-CRT) after breast conserving surgery in a prospective study assessing acute RIST. The acute RIST was classified according to the RTOG scoring system. Dose-surface histograms (DSHs) of the body structure in the breast region were extracted as representative of skin irradiation. Patient, disease, and treatment-related characteristics were analyzed along with DSHs. NTCP modeling by Lyman-Kutcher-Burman (LKB) and by multivariate logistic regression using bootstrap resampling techniques was performed. Models were evaluated by Spearman's Rs coefficient and ROC area. By the end of radiotherapy, 139 (99%) patients developed any degree of acute RIST. G3 RIST was found in 11 of 140 (8%) patients. Mild-moderate (G1-G2) RIST was still present at 40 days after treatment in six (4%) patients. Using DSHs for LKB modeling of acute RIST severity (RTOG G3 vs. G0-2), parameter estimates were TD50=39 Gy, n=0.38 and m=0.14 [Rs = 0.25, area under the curve (AUC) = 0.77, p = 0.003]. On multivariate analysis, the most predictive model of acute RIST severity was a two-variable model including the skin receiving ≥30 Gy (S30) and psoriasis [Rs = 0.32, AUC = 0.84, p < 0.001]. Using body DSH as representative of skin dose, the LKB n parameter was consistent with a surface effect for the skin. A good prediction performance was obtained using a data-driven multivariate model including S30 and a pre-existing skin disease (psoriasis) as a clinical factor.

  8. [Compression treatment for burned skin].

    PubMed

    Jaafar, Fadhel; Lassoued, Mohamed A; Sahnoun, Mahdi; Sfar, Souad; Cheikhrouhou, Morched

    2012-02-01

    The regularity of a compressive knit is defined as its ability to perform its function in a burnt skin. This property is essential to avoid the phenomenon of rejection of the material or toxicity problems But: Make knits biocompatible with high burnet of human skin. We fabric knits of elastic material. To ensure good adhesion to the skin, we made elastic material, typically a tight loop knitted. The Length of yarn absorbed by stitch and the raw matter are changed with each sample. The physical properties of each sample are measured and compared. Surface modifications are made to these samples by impregnation of microcapsules based on jojoba oil. Knits are compressif, elastic in all directions, light, thin, comfortable, and washable for hygiene issues. In addition, the washing can find their compressive properties. The Jojoba Oil microcapsules hydrated the human burnet skin. This moisturizer is used to the firmness of the wound and it gives flexibility to the skin. Compressive Knits are biocompatible with burnet skin. The mixture of natural and synthetic fibers is irreplaceable in terms comfort and regularity.

  9. Skin Burns Degree Determined by Computer Image Processing Method

    NASA Astrophysics Data System (ADS)

    Li, Hong-yan

    In this paper a new method determining the degree of skin burns in quantities is put forward. Firstly, with Photoshop9.0 software, we analyzed the statistical character of skin burns images' histogram, and then turned the images of burned skins from RGB color space to HSV space, to analyze the transformed color histogram. Lastly through Photoshop9.0 software we get the percentage of the skin burns area. We made the mean of images' histogram,the standard deviation of color maps,and the percentage of burned areas as indicators of evaluating burns,then distributed indicators the weighted values,at last get the burned scores by summing the products of every indicator of the burns and the weighted values. From the classification of burned scores, the degree of burns can be evaluated.

  10. The use of skin substitutes in hand burns.

    PubMed

    Lou, Richard Benjamin; Hickerson, William L

    2009-11-01

    Several skin substitutes are available that can be used in the management of hand burns; some are intended as temporary covers to expedite healing of shallow burns and others are intended to be used in the surgical management of deep burns. An understanding of skin biology and the relative benefits of each product are needed to determine the optimal role of these products in hand burn management.

  11. A Model to Predict Human Skin Burns

    DTIC Science & Technology

    1974-12-01

    AD/A-003 918 A MODEL TO PtKEDICT HUMAN SKIN BURNS David T. Kilminster Ballistic Research Laboratories Aberdeen Proving Ground, Maryland December 1974...ON GRANT NUMBER(S) David T. Kilminster 9. PERFORMING ORGANIZATION NAMSE AND AFIORESS 10. PROGRAM ELEMENT. PROJECT, TASK USA Ballistic Research ...Laberatories AREAS WORK UNIT NUMOtRS Aberdeen Proving Ground, MD 21005 RDT&IL No. lT7b2708A068 1. CONTROLL ING oFFICs NAME AND ADDRESS 12 REPORT DATE US

  12. Comparative study of 1,064-nm laser-induced skin burn and thermal skin burn.

    PubMed

    Zhang, Yi-Ming; Ruan, Jing; Xiao, Rong; Zhang, Qiong; Huang, Yue-Sheng

    2013-01-01

    Infrared lasers are widely used in medicine, industry, and other fields. While science, medicine, and the society in general have benefited from the many practical uses of lasers, they also have inherent safety issues. Although several procedures have been put forward to protect the skin from non-specific laser-induced damage, individuals receiving laser therapy or researchers who use laser are still at risk for skin damage. This study aims to understand the interaction between laser and the skin, and to investigate the differences between the skin damage caused by 1,064-nm laser and common thermal burns. Skin lesions on Wistar rats were induced by a 1,064-nm CW laser at a maximum output of 40 W and by a copper brass bar attached to an HQ soldering iron. Histological sections of the lesions and the process of wound healing were evaluated. The widths of the epidermal necrosis and dermal denaturalization of each lesion were measured. To observe wound healing, the epithelial gap and wound gap were measured. Masson's trichrome and picrosirius red staining were also used to assess lesions and wound healing. The thermal damage induced by laser intensified significantly in both horizontal dimension and in vertical depth with increased duration of irradiation. Ten days after wounding, the dermal injuries induced by laser were more severe. Compared with the laser-induced skin damage, the skin burn induced by an HQ soldering iron did not show a similar development or increased in severity with the passage of time. The results of this study showed the pattern of skin damage induced by laser irradiation and a heated brass bar. This study also highlighted the difference between laser irradiation and thermal burn in terms of skin damage and wound healing, and offers insight for further treatment.

  13. Emotional associations with skin: differences between burned and non-burned individuals.

    PubMed

    Titscher, A; Lumenta, D B; Kamolz, L P; Mittlboeck, M; Frey, M

    2010-09-01

    The appearance of skin is crucial for our physical and psychological integrity, and is strongly associated with our emotional self-awareness. Burn victims have to cope with negative and even threatening sensations resulting from the changed appearance of their skin after injury and also linked to experiences during the treatment. The aim of this study was to analyse differences regarding the emotional associations with skin in burn victims (burn group) to persons not having subdued any burn (control group). In the first instance over 960 volunteers were recruited for the rating of emotional associations with skin in the control group and thereby a representative profile for non-injured individuals. In the second part, 44 burn patients of the Vienna Burn Center answered the same questionnaire. The quantitative rating of emotional associations with skin was performed with a newly designed questionnaire using a semantic differential on eight dimensions with a 5-point scale system. Both groups have positive associations with skin. One significant difference (p=0.0090, Chi-square test for trend) was the overall rating of the item "importance": for burn victims skin is more "important" than for controls. Patients with visible burns tended to put more emphasize on the possible exposure to danger ("threatened") of skin, and patients with >/=20% TBSA rated skin as more "noticeable" and "strong" as compared to small burns (<20% TBSA). Patients with burns to the face, hands and neck ("visible burns") were more likely to judge skin as threatened item. Our poll suggests that despite long treatment, rehabilitation and even near-death experiences burn patients continue to have positive associations with skin. This in turn, should encourage all specialists dealing with burns to engage in a continuous follow-up as well as enhance psychological and social support. 2010 Elsevier Ltd and ISBI. All rights reserved.

  14. Method and apparatus to measure the depth of skin burns

    DOEpatents

    Dickey, Fred M.; Holswade, Scott C.

    2002-01-01

    A new device for measuring the depth of surface tissue burns based on the rate at which the skin temperature responds to a sudden differential temperature stimulus. This technique can be performed without physical contact with the burned tissue. In one implementation, time-dependent surface temperature data is taken from subsequent frames of a video signal from an infrared-sensitive video camera. When a thermal transient is created, e.g., by turning off a heat lamp directed at the skin surface, the following time-dependent surface temperature data can be used to determine the skin burn depth. Imaging and non-imaging versions of this device can be implemented, thereby enabling laboratory-quality skin burn depth imagers for hospitals as well as hand-held skin burn depth sensors the size of a small pocket flashlight for field use and triage.

  15. [THERMOMETRY APPLICATION FOR ESTIMATION OF THE SKIN BURNS DEPTH].

    PubMed

    Kovalenko, A O

    2015-04-01

    Determination of the burn wound depth, using noncontact infrared thermometry, permits to predict the burn affection severity, basing on the revealed difference between local, perifocal temperature and temperature in certain nonaffected areas of the body surface. The temperature difference (ΔT) over 1 °C constitutes a strict criterion of the skin burn presence. The temperature 34 °C have been considered a border one for the skin burns. If the burn wound temperature in 24 h after trauma was lower 34 °C and ΔT 2 °C and more, it have witnessed the presence of deep burn of the skin. High sensitivity (87%) and specificity (96%) of thermometric test in 24 h after trauma were established. In epidermal burns the temperature of the burn wounds have constituted (35.9 ± 0.3) °C at average, in superficial burns of the skin--(35.1 ± 0.6) °C, and in the deep burns--(33.6 ± 0.8) °C.

  16. [Burn scars: rehabilitation and skin care].

    PubMed

    Rochet, Jean-Michel; Zaoui, Affif

    2002-12-15

    Burn rehabilitation main goal is to minimize the consequences of hypertrophic scars and concomitant contractures. The treatment principles rely on the association of joint posture, continuous pressure completed with range of motion to prevent joint fusion (which happens to adults but not to children). Throughout the different treatment phases and wound evolution, reassessment is necessary to review rehabilitation goals and activities. During the acute phase the alternance of positioning is prioritized in order to keep the affected extremities in antideformity position using splint or other devices. At the rehabilitation phase, treatment is focussed on active/passive range of motion (skin posture) strengthening exercises and use of dynamic splint is introduced to correct contractures. After their discharge home, patients benefit from outpatient rehab until scar maturation (approximately 18 months). The treatment consists mainly on active/passive range of motion, scar massage, strengthening exercise and endurance retraining. Also modalities (such as thermal bath and high pressure water spray) are used to address itching problems and for scar softening. Finally, reconstructive surgery can be performed to correct excessive scarring or joint contracture for better functional or cosmetic outcome.

  17. Coherent diagnostics of burned skin: experiments with phantoms

    NASA Astrophysics Data System (ADS)

    Bednov, Andrey A.; Cheng, Cecil; Ulyanov, Sergey S.; Yodh, Arjun G.

    2000-04-01

    Modeling of skin burns has been realized in this study. Autocorrelation functions of intensity fluctuations of scattered light were measured for two-layered turbid media. The first layer served as a model of motionless scatterers whereas the second one simulated dynamic light scattering. This medium was used as a model of skin burns. A theory related quasi-elastic light scattering measurements to cutaneous blood flow was used. The dependencies of statistical properties of Doppler signal on the properties of skin burns as well as on the velocity of cutaneous blood flow has ben investigated. Predictions were verified by measurements both of dynamic and stationary light scattering in model media. Experimental results might be used as a basis for blood micro circulation diagnostics as well as for precise measurements of a depth of burned skin.

  18. Polarized Reflectance Measurement of Burned Skin Tissues

    NASA Astrophysics Data System (ADS)

    de Pedro, Hector Michael; Chang, Chuan-I.; Zarnani, Faranak; Glosser, Robert; Maas, D.; Idris, A.

    2011-10-01

    In the US, there are over 400,000 burn victims with 3,500 deaths in 2010. Recent evidence suggests that early removal of burn tissues can significantly increase the success of their recovery, since burns continue to spread and damage surrounding tissues after hours of injury. The rationale behind this procedure is that burns trigger the body's immune system to overreact, causing additional damage. Therefore, it is important to distinguish burn areas so that it can be removed. The problem with this is that it is difficult to recognize the margins of the burn area. In our project, we use polarized reflectance as a tool to identify the burned tissues from unburned ones.

  19. Nature and determinants of skin "burns" after transthoracic cardioversion.

    PubMed

    Pagan-Carlo, L A; Stone, M S; Kerber, R E

    1997-03-01

    Skin biopsies obtained 24 hours after elective cardioversion of 30 patients showed variable epidermal necrosis and upper dermal perivascular inflammation, most noticeably in patients receiving high individual peak (> or = 300 J) and cumulative (> or = 350 J) shock energies. Thus, damped sine wave shocks cause skin injury--first degree burns--the severity of which is a function of peak and cumulative shock energy.

  20. Skin stretching for primary closure of acute burn wounds.

    PubMed

    Verhaegen, Pauline D H M; Bloemen, Monica C T; van der Wal, Martijn B A; Vloemans, Adrianus F P M; Tempelman, Fenike R H; Beerthuizen, Gerard I J M; van Zuijlen, Paul P M

    2014-12-01

    In burn care, a well-acknowledged problem is the suboptimal scar outcome from skin grafted burn wounds. With the aim of improving this, we focused on a new technique: excision of the burn wound followed by primary closure, thereby using a skin-stretching device to stretch the adjacent healthy skin. The short- and long-term effect of Skin Stretch was compared to split skin grafting (SSG) in a randomized controlled trial. Patients with burn wounds were randomized for SSG or primary wound closure using Skin Stretch. Follow-up was performed at 3 and 12 months postoperatively. The scar surface area was calculated and the scar quality was assessed, using subjective and objective measurement methods. No significant differences between the SSG and the Skin Stretch group were found for scar surface area. In the Skin Stretch group, a significant reduction of the surface area from 65.4cm(2) (13.6-129.1) to 13.4cm(2) (3.0-36.6) was found at 3 months (p=0.028) and at 12 months postoperatively (65.4cm(2) (13.6-129.1) to 33.0cm(2) (8.9-63.7), p=0.046, Wilcoxon signed ranks test). Skin Stretch for primary closure of acute burn wounds is a suitable technique and can be considered for specific circumscript full-thickness burn wounds. However, future research should be performed to provide additional scientific evidence. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  1. Boundary element method with bioheat equation for skin burn injury.

    PubMed

    Ng, E Y K; Tan, H M; Ooi, E H

    2009-11-01

    Burns are second to vehicle crashes as the leading cause of non-intentional injury deaths in the United States. The survival of a burn patient actually depends on the seriousness of the burn. It is important to understand the physiology of burns for a successful treatment of a burn patient. This has prompted researchers to conduct investigations both numerically and experimentally to understand the thermal behaviour of the human skin when subjected to heat injury. In this study, a model of the human skin is developed where the steady state temperature during burns is simulated using the boundary element method (BEM). The BEM is used since it requires boundary only discretion and thus, reduces the requirement of high computer memory. The skin is modeled as three layered in axisymmetric coordinates. The three layers are the epidermis (uppermost), dermis (middle) and subcutaneous fat. Burning is applied via a heating disk which is assumed to be at constant temperature. The results predicted by the BEM model showed very good agreement with the results obtained using the finite element method (FEM). The good agreement despite using only linear elements as compared to quadratic elements in the FEM model shows the versatility of the BEM. A sensitivity analysis was conducted to investigate how changes in the values of certain skin variables such as the thermal conductivity and environmental conditions like the ambient convection coefficient affect the temperature distribution inside the skin. The Taguchi method was also applied to identify the combination of parameters which produces the largest increase in skin temperature during burns.

  2. Mesh-independent prediction of skin burns injury.

    PubMed

    Ng, E Y; Chua, L T

    2000-01-01

    This paper presents a robust finite element model (FEM) with multiple-layers of varying properties for investigation of burn effects on human skin during a burning process resulting from exposure of skin surface to a contact heat source and a hot moving fluid. Henriques' theory of skin burns is used in conjunction with two-dimensional Pennes bioheat transfer equation for determining the spatial and temporal extent of burn injury. The model developed is a two-dimensional axisymmetric model in cylindrical coordinates. The various tissue layers account for changing thermal properties with respect to skin anatomy. A finite element scheme that uses the backward Euler method is used to solve the problem. The injury processes of skin subsequent to the removal of the heat source (post-burn) will also be inspected. The mesh employed in this model consists of a high density of nodes and elements in which a thorough mesh convergence study was done. A comparison of the transient temperature field computed by this model against Diller's results using the FE technique with a comparatively coarse mesh of 125 elements and experimental data by Orgill et al. has been done in the present study. It concluded that improved accurate solutions have been performed using the robust model developed due to the achievement of a mesh-independent solution.

  3. In vivo terahertz imaging of rat skin burns

    NASA Astrophysics Data System (ADS)

    Tewari, Priyamvada; Kealey, Colin P.; Bennett, David B.; Bajwa, Neha; Barnett, Kelli S.; Singh, Rahul S.; Culjat, Martin O.; Stojadinovic, Alexander; Grundfest, Warren S.; Taylor, Zachary D.

    2012-04-01

    A reflective, pulsed terahertz (THz) imaging system was used to acquire high-resolution (d10-90/ λ~1.925) images of deep, partial thickness burns in a live rat. The rat's abdomen was burned with a brass brand heated to ~220°C and pressed against the skin with contact pressure for ~10 sec. The burn injury was imaged beneath a Mylar window every 15 to 30 min for up to 7 h. Initial images display an increase in local water concentration of the burned skin as evidenced by a marked increase in THz reflectivity, and this likely correlates to the post-injury inflammatory response. After ~1 h the area of increased reflectivity consolidated to the region of skin that had direct contact with the brand. Additionally, a low reflecting ring of tissue could be observed surrounding the highly reflective burned tissue. We hypothesize that these regions of increased and decreased reflectivity correlate to the zones of coagulation and stasis that are the classic foundation of burn wound histopathology. While further investigations are necessary to confirm this hypothesis, if true, it likely represents the first in vivo THz images of these pathologic zones and may represent a significant step forward in clinical application of THz technology.

  4. Tissue engineered fetal skin constructs for pediatric burns

    PubMed Central

    Norbury, William B; Jeschke, Marc G; Herndon, David N

    2005-01-01

    The management of patients with partial thickness (second degree) burns is problematic due to the different treatments needed for varying depths of injury. A report recently published in The Lancet describes a novel treatment for deep second degree burns using a fetal skin construct (FSC). The authors included eight pediatric patients with small second degree burns. They showed that FSCs reduced the need for autografting of deep second degree burns, with little hypertrophy of new skin and no skin contraction. This technology is new and exciting, but in our opinion several issues must be addressed before FSCs can enter the clinical arena. All of the patients were included in the treatment group, and therefore no comparison with conventional skin substitutes was possible. There is no mention of the use of laser Doppler in any initial assessment of patients. The debridement carried out before application of the FSC is not elaborated upon, and the surface areas involved in the study were very small in most cases, which limits the relevance to patients with larger burns. The use of FSCs gives us an additional option in a range of possible treatments for this notoriously difficult-to-treat patient group. PMID:16356232

  5. [Skin substitutes reconstructed in the laboratory: application in burn treatment].

    PubMed

    Braye, F; Hautier, A; Bouez, C; Damour, O

    2005-12-01

    The development of skin substitutes started 25 years ago with the cultivation of keratinocytes to replace the epidermis of extensively burned patients. It is now possible to reproduce in vitro the two layers of skin, epidermis and dermis. Cultured epidermises are now usually used in burn centers dealing with the more severe patients. They are provided by hospital or private laboratories. Dermal substrates are some collagen matrices, which act in vivo as a guide for the reconstruction of a neodermis. Living dermis include living fibroblasts. Different models are now available for clinical use. Living skin equivalent is obtained by coculturing fibroblast and keratinocytes on a collagen support. Clinical essays are going on for chronic wounds. We present the different skin equivalent models and their clinical applications.

  6. Microvascular regeneration in meshed skin transplants after severe burns.

    PubMed

    Meier, T O; Guggenheim, M; Vetter, S T; Husmann, M; Haile, S R; Amann-Vesti, B R

    2011-09-01

    Function of the skin lymphatics as well as blood perfusion of a meshed transplant is crucial for the healing. The lymphatic regeneration and arterial perfusion of skin transplants after severe burns of the extremities had been studied in eight patients by microlymphography, laser doppler perfusion imaging and transcutaneous oxygen pressure measurements 1, 6 and 18 months after transplantation. One month after transplantation, only fragmented as well as many giant lymphatic skin vessels were present in the transplant. After 6 months a normal lymphatic network had developed in all grafts. The extension of the dye in the lymphatics decreased from 4.5 (0-16) at 1 month to 3.0 (1-6) mm after 18 months, indicating improved lymph drainage capacity. The permeability of the lymphatics in the graft was normal. After 1 month, median laser flux in the transplant was 155.6% (105-246%) of the normal skin but it normalised within 18 months. By contrast, transcutaneous oxygen measurement (TcPO(2)) increased from 44 (21-47) to 55 (50-76) mmHg. In meshed transplants used to cover severely burned skin morphological and functional normal lymphatics develop within 6 months and the initially increased laser flux due to inflammatory reaction normalises. Our results provide important insights into the healing process of skin transplants after burn.

  7. Squamous cell carcinoma arising in previously burned or irradiated skin

    SciTech Connect

    Edwards, M.J.; Hirsch, R.M.; Broadwater, J.R.; Netscher, D.T.; Ames, F.C.

    1989-01-01

    Squamous cell carcinoma (SCC) arising in previously burned or irradiated skin was reviewed in 66 patients treated between 1944 and 1986. Healing of the initial injury was complicated in 70% of patients. Mean interval from initial injury to diagnosis of SCC was 37 years. The overwhelming majority of patients presented with a chronic intractable ulcer in previously injured skin. The regional relapse rate after surgical excision was very high, 58% of all patients. Predominant patterns of recurrence were in local skin and regional lymph nodes (93% of recurrences). Survival rates at 5, 10, and 20 years were 52%, 34%, and 23%, respectively. Five-year survival rates in previously burned and irradiated patients were not significantly different (53% and 50%, respectively). This review, one of the largest reported series, better defines SCC arising in previously burned or irradiated skin as a locally aggressive disease that is distinct from SCC arising in sunlight-damaged skin. An increased awareness of the significance of chronic ulceration in scar tissue may allow earlier diagnosis. Regional disease control and survival depend on surgical resection of all known disease and may require radical lymph node dissection or amputation.

  8. Bilayer Hydrogel with Autologous Stem Cells Derived from Debrided Human Burn Skin for Improved Skin Regeneration

    DTIC Science & Technology

    2013-02-01

    grafting surgeries using autologous skin. Unfortunately, large surface burn wounds lack autologous viable unin- jured tissue for grafting , making...1 Natesan et al 19 skin or tissue-engineered substitutes containing allogeneic and/or autologous cells. These tissue- engineered wound dressings...dsASC-bilayer hydrogels contribute significantly to wound healing and provide support for their use as a vascularized dermal substitute for skin

  9. Dermoscopic insight into skin microcirculation--Burn depth assessment.

    PubMed

    Mihara, Kyomi; Nomiyama, Tomoko; Masuda, Koji; Shindo, Hajime; Yasumi, Maki; Sawada, Takahiro; Nagasaki, Kotaro; Katoh, Norito

    2015-12-01

    To investigate the effectiveness of dermoscopic observation of skin microcirculation, the dermal capillary integrity of burn wounds was evaluated by dermoscopy according to a proposed algorithm that is designed to distinguish burn wounds between superficial dermal burns: SDB, and deep dermal burns: DDB. As the gold standard for comparison, two widely accepted endpoints of primary healing within 21 days (SDB) or over 21 days after injury (DDB) were used. A number of dermatologists conducted diagnostic imaging by dermoscopy. Comparison among polarized noncontact dermoscopy (PNCD), polarized contact dermoscopy (PCD) and nonpolarized contact dermoscopy (NPD) was also conducted. Images from the three modalities were evaluated for color, pattern and qualitative differences among them. The results of dermoscopy measurements according to the proposed algorithm showed accuracy of 96.7%, sensitivity of 100.0% and specificity of 94.4%. Dermoscopy measurements were significantly more accurate than clinical assessment (p<0.05). The recognition of dots increased for NPD, vessels were most clearly observed under PCD and colours tended to be more distinctly recognized under polarized light. Dermoscopy is a useful and simple tool to evaluate not only epidermal and superficial dermal skin components but also the skin microcirculation.

  10. The nitric acid burn trauma of the skin.

    PubMed

    Kolios, L; Striepling, E; Kolios, G; Rudolf, K-D; Dresing, K; Dörges, J; Stürmer, K M; Stürmer, E K

    2010-04-01

    Nitric acid burn traumata often occur in the chemical industry. A few publications addressing this topic can be found in the medical database, and there are no reports about these traumata in children. A total of 24 patients, average 16.6 years of age, suffering from nitric acid traumata were treated. Wound with I degrees burns received open therapy with panthenol-containing creams. Wound of II degrees and higher were initially treated by irrigation with sterile isotonic saline solution and then by covering with silver-sulphadiazine dressing. Treatment was changed on the second day to fluid-absorbent foam bandages for superficial wounds (up to IIa degrees depth) and occlusive, antiseptic moist bandages in combination with enzymatic substances for IIb degrees -III degrees burns. After the delayed demarcation, necrectomy and mesh-graft transplantation were performed. All wounds healed adequately. Chemical burn traumata with nitric acid lead to specific yellow- to brown-stained wounds with slower accumulation of eschar and slower demarcation compared with thermal burns. Remaining wound eschar induced no systemic inflammation reaction. After demarcation, skin transplantation can be performed on the wounds, as is commonly done. The distinguishing feature of nitric-acid-induced chemical burns is the difficulty in differentiation and classification of burn depth. An immediate lavage should be followed by silver sulphadiazine treatment. Thereafter, fluid-absorbent foam bandages or occlusive, antiseptic moist bandages should be used according to the burn depth. Slow demarcation caused a delay in performing surgical treatments. Copyright 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. Plasma, urine and skin pharmacokinetics of cefepime in burns patients.

    PubMed

    Sampol, E; Jacquet, A; Viggiano, M; Bernini, V; Manelli, J C; Lacarelle, B; Durand, A

    2000-08-01

    We studied the pharmacokinetics of cefepime (2 g bd) in six burns patients. Blood, urine and skin samples were collected to measure cefepime concentrations. A two-compartment model was fitted to the data. At day 1, t(1/2beta) was 2.45 +/- 0.56 h, V(ss) 0.36 +/- 0.1 L/kg, total clearance 152 +/- 25.2 mL/min, and AUC 217 +/- 34 mg*h/L. There was no statistical difference between day 1 and day 3 for any of the pharmacokinetic parameters. We demonstrated good penetration of cefepime in skin. These results show that it is not necessary to change the standard dosage of cefepime in burns patients.

  12. Major full thickness skin burn injuries in premature neonate twins.

    PubMed

    Rimdeika, R; Bagdonas, R

    2005-02-01

    Burns in neonates have been reported following the use of pulse oximeters, various electrodes, chemical disinfecting agents and phototherapy blankets. Burn injuries in premature neonates are very rare and there have been no reports on major full skin thickness injuries. This case reports on preterm neonate male twins delivered at a Community Hospital. After the delivery they were placed on water warmers for 15-20 min and then transported into incubators. Burn injuries were noticed 1h after the delivery. Infant One, weight 1500 g, had an injury of 20% TBSA on his dorsum, waist and buttocks. The other infant, weight 1835 g, had an injury of 14% TBSA on the same areas. The infants were transported to the University Hospital. At the seventh day after the injury they recovered from respiratory distress and surgical procedures started. The eschar was excised deep to fascia and wounds were grafted with 0.1mm thickness skin grafts harvested from the thigh and cut into islets. Autografts were protected by overlay with fresh allograft harvested from the twins' father. Surgery procedures were performed in two steps, each second day, not exceeding 10% of total body area during excision. Donor sites healed at the eighth day after the surgery. Burn wounds healed gradually by way of spontaneous replacement of allograft and wound closure by spontaneous epithelization from the autograft islets. Eighteen days after the surgery all the grafted wounds were found epithelized. We conclude that in premature neonates relatively low temperatures may cause deep burn injuries. We recommend the delivery of preterm childbirths at well equipped facilities with staff qualified in nursing of premature neonates.

  13. Burns

    MedlinePlus

    ... cause swelling, blistering, scarring and, in serious cases, shock, and even death. They also can lead to infections because they damage your skin's protective barrier. Treatment for burns depends on the cause of the ...

  14. The treatment of alkaline burns of the skin by neutralization.

    PubMed

    Andrews, Kris; Mowlavi, Arian; Milner, Stephen M

    2003-05-01

    Literature reports dating as far back as 1927 have lured clinicians into the belief that alkaline skin burns are best treated by water dilution and that neutralization attempts should be avoided. Although this belief has never been substantiated, neutralization of an alkaline burn of the skin with acid was thought to increase tissue damage secondary to the exothermic nature of acid-base reactions. The authors proposed that topical treatment of alkaline burns with a weak acid such as 5% acetic acid (i.e., household vinegar) would result in rapid tissue neutralization and reduction of injury in comparison to water irrigation alone. In a rat skin burn model, animals were exposed to an alkaline injury when filter paper (2 cm in diameter) saturated with 2N sodium hydroxide was placed over the volar aspect of the animal for a period of 1 minute. Treatment was initiated 1 minute after injury and included either neutralization with a 5% acetic acid solution (n = 8) or irrigation (n = 8) with water. Skin temperature and pH were monitored using subdermal needle probes until the pH of the skin returned to physiologic values. Punch-biopsy specimens were obtained from the wound edges 24 hours after injury to assess burn depth and leukocyte infiltration, and biopsies were repeated 10 days later to assess wound healing. The authors proposed that neutralization of an alkaline substance with household vinegar (i.e., 5% acetic acid solution) would result in rapid neutralization and thus reduce extent of tissue injury. Animals treated with acetic acid demonstrated a more rapid return to physiologic pH (14.69 +/- 4.06 minutes versus 31.62 +/- 2.83 minutes; p < 0.001), increased depth of dermal retention (0.412 +/- 0.136 mm versus 0.214 +/- 0.044 mm; p = 0.015), decreased leukocyte infiltrate (31.0 +/- 5.1 cells/high-power field versus 51.8 +/- 6.8 cells/high-power field; p < 0.001), and improved epithelial regeneration (4.0 +/- 0.6 cell layers versus 1.7 +/- 0.5 cell layers; p < 0

  15. Staphylococcal scalded skin syndrome mimicking child abuse by burning.

    PubMed

    Porzionato, Andrea; Aprile, Anna

    2007-05-03

    Child abuse by burning comprises 6-20% of all child abuse cases, but misdiagnosis may arise in cases of some medical conditions. We present two cases of suspected inflicted burns, later diagnosed as staphylococcal scalded skin syndrome (SSSS). In case 1, a 6-month-old girl was referred to hospital for small round ulcerations on the face and abdomen, resembling cigarette burns. Because of the inconsistency of the mother's report (insect bites) with the injury pattern and an unstable family history, hospitalization was decided. The following day, new bullous lesions were visible on the neck and nose, indicating the natural origin of the findings, finally diagnosed as SSSS. In case 2, a 2-month-old boy was hospitalized for erythema, with bullous lesions on the abdomen. He was transferred to another hospital, with suspected congenital or autoimmune skin disorder but negative searches led to a diagnosis of inflicted scalds: a report was sent to the judicial authorities, and the child was entrusted to his grandparents. In fact, a review of the clinical documentation showed that, in the second hospitalization, new erythematous and bullous lesions had been described, which could not be ascribed to inflicted injuries. Child abuse was finally ruled out, and SSSS was diagnosed. In cases of suspected inflicted child burns, observation during hospitalization may reveal changes in lesions, ascribed to the evolution of medical conditions. SSSS diagnosis is mainly based on clinical grounds but, if the suspicion of abuse remains, isolation and phage typing of Staphylococcus aureus from nasal, pharyngeal or cutaneous swabs may confirm the diagnosis.

  16. Cultured Skin Substitutes Reduce Donor Skin Harvesting for Closure of Excised, Full-Thickness Burns

    PubMed Central

    Boyce, Steven T.; Kagan, Richard J.; Yakuboff, Kevin P.; Meyer, Nicholas A.; Rieman, Mary T.; Greenhalgh, David G.; Warden, Glenn D.

    2002-01-01

    Objective Comparison of cultured skin substitutes (CSS) and split-thickness skin autograft (AG) was performed to assess whether donor-site harvesting can be reduced quantitatively and whether functional and cosmetic outcome is similar qualitatively in the treatment of patients with massive cutaneous burns. Summary Background Data Cultured skin substitutes consisting of collagen-glycosaminoglycan substrates populated with autologous fibroblasts and keratinocytes have been shown to close full-thickness skin wounds in preclinical and clinical studies with acceptable functional and cosmetic results. Methods Qualitative outcome was compared between CSS and AG in 45 patients on an ordinal scale (0, worst; 10, best) with primary analyses at postoperative day 28 and after about 1 year for erythema, pigmentation, pliability, raised scar, epithelial blistering, and surface texture. In the latest 12 of the 45 patients, tracings were performed of donor skin biopsies and wounds treated with CSS at postoperative days 14 and 28 to calculate percentage engraftment, the ratio of closed wound:donor skin areas, and the percentage of total body surface area closed with CSS. Results Measures of qualitative outcome of CSS or AG were not different statistically at 1 year after grafting. Engraftment at postoperative day 14 exceeded 75% in the 12 patients evaluated. The ratio of closed wound:donor skin areas for CSS at postoperative day 28 was significantly greater than for conventional 4:1 meshed autografts. The percentage of total body surface area closed with CSS at postoperative day 28 was significantly less than with AG. Conclusions The requirement for harvesting of donor skin for CSS was less than for conventional skin autografts. These results suggest that acute-phase recovery of patients with extensive burns is facilitated and that complications are reduced by the use of CSS together with conventional skin grafting. PMID:11807368

  17. Local burn injury impairs epithelial permeability and antimicrobial peptide barrier function in distal unburned skin.

    PubMed

    Plichta, Jennifer K; Droho, Steve; Curtis, Brenda J; Patel, Parita; Gamelli, Richard L; Radek, Katherine A

    2014-06-01

    Our objective was to characterize the mechanisms by which local burn injury compromises epithelial barrier function in burn margin, containing the elements necessary for healing of the burn site, and in distal unburned skin, which serves as potential donor tissue. Experimental mouse scald burn injury. University Research Laboratory. C57/Bl6 Male mice, 8-12 weeks old. To confirm that dehydration was not contributing to our observed barrier defects, in some experiments mice received 1 mL of saline fluid immediately after burn, while a subgroup received an additional 0.5 mL at 4 hours and 1 mL at 24 hours following burn. We then assessed skin pH and transepidermal water loss every 12 hours on the burn wounds for 72 hours postburn. Burn margin exhibited increased epidermal barrier permeability indicated by higher pH, greater transepidermal water loss, and reduced lipid synthesis enzyme expression and structural protein production up to 96 hours postburn. By contrast, antimicrobial peptide production and protease activity were elevated in burn margin. Skin extracts from burn margin did not exhibit changes in the ability to inhibit bacterial growth. However, distal unburned skin from burned mice also demonstrated an impaired response to barrier disruption, indicated by elevated transepidermal water loss and reduced lipid synthesis enzyme and structural protein expression up to 96 hours postburn. Furthermore, skin extracts from distal unburned skin exhibited greater protease activity and a reduced capacity to inhibit bacterial growth of several skin pathogens. Finally, we established that antimicrobial peptide levels were also altered in the lung and bladder, which are common sites of secondary infection in burn-injured patients. These findings reveal several undefined deficiencies in epithelial barrier function at the burn margin, potential donor skin sites, and organs susceptible to secondary infection. These functional and biochemical data provide novel insights into

  18. Rationalization of thermal injury quantification methods: application to skin burns.

    PubMed

    Viglianti, Benjamin L; Dewhirst, Mark W; Abraham, John P; Gorman, John M; Sparrow, Eph M

    2014-08-01

    Classification of thermal injury is typically accomplished either through the use of an equivalent dosimetry method (equivalent minutes at 43 °C, CEM43 °C) or through a thermal-injury-damage metric (the Arrhenius method). For lower-temperature levels, the equivalent dosimetry approach is typically employed while higher-temperature applications are most often categorized by injury-damage calculations. The two methods derive from common thermodynamic/physical chemistry origins. To facilitate the development of the interrelationships between the two metrics, application is made to the case of skin burns. This thermal insult has been quantified by numerical simulation, and the extracted time-temperature results served for the evaluation of the respective characterizations. The simulations were performed for skin-surface exposure temperatures ranging from 60 to 90 °C, where each surface temperature was held constant for durations extending from 10 to 110 s. It was demonstrated that values of CEM43 at the basal layer of the skin were highly correlated with the depth of injury calculated from a thermal injury integral. Local values of CEM43 were connected to the local cell survival rate, and a correlating equation was developed relating CEM43 with the decrease in cell survival from 90% to 10%. Finally, it was shown that the cell survival/CEM43 relationship for the cases investigated here most closely aligns with isothermal exposure of tissue to temperatures of ~50 °C. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  19. Skin burns after laser exposure: histological analysis and predictive simulation.

    PubMed

    Museux, Nathanaëlle; Perez, Laetitia; Autrique, Laurent; Agay, Diane

    2012-08-01

    Thermal effects of laser irradiation on skin are investigated in this paper. The main purpose is to determine the damage level induced by a laser exposure. Potential burns induced by two lasers (wavelength 808nm and 1940nm) are studied and animal experimentations are performed. Several exposure durations and laser powers are tested. Based on previous works, a mathematical model dedicated to temperature prediction is proposed and finite-element method is implemented. This numerical predictive tool based on the bioheat equation takes into account heat losses due to the convection on skin surface, blood circulatory and also evaporation. Thermal behavior of each skin layer is also described considering distinct thermal and optical properties. Since the mathematical model is able to estimate damage levels, histological analyses were also carried through. It is confirmed that the mathematical model is an efficient predictive tool for estimation of damage caused by lasers and that thermal effects sharply depend on laser wavelength. Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.

  20. Bilayer hydrogel with autologous stem cells derived from debrided human burn skin for improved skin regeneration.

    PubMed

    Natesan, Shanmugasundaram; Zamora, David O; Wrice, Nicole L; Baer, David G; Christy, Robert J

    2013-01-01

    The objective of this study was to demonstrate that stem cells isolated from discarded skin obtained after debridement can be used with collagen and fibrin-based scaffolds to develop a tissue-engineered vascularized dermal equivalent. Discarded tissue samples were collected from severely burned patients undergoing wound debridement. Stem cells were isolated from the adipose tissue layer and their growth and immunophenotype characterized. To develop a skin equivalent, debrided skin adipose stem cells (dsASCs) were added to a collagen-polyethylene glycol (PEG) fibrin-based bilayer hydrogel and analyzed in vitro. The effect of the bilayered hydrogels on wound healing was demonstrated using an excision wound model in athymic rats. The dsASCs isolated from all samples were CD90, CD105, and stromal cell surface protein-1 positive, similar to adipose stem cells isolated from normal human lipoaspirates. Within the bilayer hydrogels, dsASCs proliferated and differentiated, maintained a spindle-shaped morphology in collagen, and developed a tubular microvascular network in the PEGylated fibrin. Rat excision wounds treated with bilayer hydrogels showed less wound contraction and exhibited better dermal matrix deposition and epithelial margin progression than controls. Stem cells can be isolated from the adipose layer of burned skin obtained during debridement. When dsASCs are incorporated within collagen-PEGylated fibrin bilayer hydrogels, they develop stromal and vascular phenotypes through matrix-directed differentiation without use of growth factors. Preliminary in vivo studies indicate that dsASC-bilayer hydrogels contribute significantly to wound healing and provide support for their use as a vascularized dermal substitute for skin regeneration to treat large surface area burns.

  1. A novel dermal matrix generated from burned skin as a promising substitute for deep-degree burns therapy.

    PubMed

    Yu, Guanying; Ye, Lan; Tan, Wei; Zhu, Xuguo; Li, Yaonan; Jiang, Duyin

    2016-03-01

    The extensive skin defects induced by severe burns are dangerous and can be fatal. Currently, the most common therapy is tangential excision to remove the necrotic or denatured areas of skin, followed by skin grafting. Xenogeneic dermal substitutes, such as porcine acellular dermal matrix (ADM), are typically used to cover the burn wounds, and may accelerate wound healing. It is assumed that burned skin that still maintains partial biological activity may be recycled to construct an autologous acellular dermal matrix, termed 'deep‑degree burned dermal matrix (DDBDM)'. In theory, DDBDM may avoid the histoincompatibility issues associated with foreign or xenogeneic dermal matrices, and reduce therapy costs by making full use of discarded skin. In the present study, the collagens within prepared DDBDM were thickened, disorganized and partially fractured, however, they still maintained their reticular structure and tensile strength (P<0.01). Through microarray analysis of the cytokines present in ADM and DDBDM, it was determined that the DDBDM did not produce excessive levels of harmful burn toxins. Following 4 weeks of subcutaneous implantation, ADM and DDBDM were incompletely degraded and maintained good integrity. No significant inflammatory reaction or rejection were observed, which indicated that ADM and DDBDM have good histocompatibility. Therefore, DDBDM may be a useful material for the treatment of deep‑degree burns.

  2. A novel dermal matrix generated from burned skin as a promising substitute for deep-degree burns therapy

    PubMed Central

    YU, GUANYING; YE, LAN; TAN, WEI; ZHU, XUGUO; LI, YAONAN; JIANG, DUYIN

    2016-01-01

    The extensive skin defects induced by severe burns are dangerous and can be fatal. Currently, the most common therapy is tangential excision to remove the necrotic or denatured areas of skin, followed by skin grafting. Xenogeneic dermal substitutes, such as porcine acellular dermal matrix (ADM), are typically used to cover the burn wounds, and may accelerate wound healing. It is assumed that burned skin that still maintains partial biological activity may be recycled to construct an autologous acellular dermal matrix, termed 'deep-degree burned dermal matrix (DDBDM)'. In theory, DDBDM may avoid the histoincompatibility issues associated with foreign or xenogeneic dermal matrices, and reduce therapy costs by making full use of discarded skin. In the present study, the collagens within prepared DDBDM were thickened, disorganized and partially fractured, however, they still maintained their reticular structure and tensile strength (P<0.01). Through microarray analysis of the cytokines present in ADM and DDBDM, it was determined that the DDBDM did not produce excessive levels of harmful burn toxins. Following 4 weeks of subcutaneous implantation, ADM and DDBDM were incompletely degraded and maintained good integrity. No significant inflammatory reaction or rejection were observed, which indicated that ADM and DDBDM have good histocompatibility. Therefore, DDBDM may be a useful material for the treatment of deep-degree burns. PMID:26846279

  3. Engineered alternative skin for partial and full-thickness burns

    PubMed Central

    Wessels, Quenton

    2014-01-01

    Engineered alternative skin in all its forms and shapes serve to provide temporary or permanent wound closure such as in the case of partial and full-thickness burns. The need for collagen-based regeneration templates is motivated by the fact that dermal regeneration of full-thickness injuries does not occur spontaneously and is inundated by contraction and scarring. Partial-thickness burns in turn can regress as a result of infection and improper treatment and require appropriate treatment. Nylon-silicone laminates such as Biobrane®, and more recently AWBAT®, address this by serving as a temporary barrier. Enhanced collagen-based scaffolds today, although not perfect, remain invaluable. Our initial approach was to characterize the design considerations and explore the use of collagen in the fabrication of a dermal regeneration matrix and a silicone-nylon bilaminate. Here we expand our initial research on scaffold fabrication and explore possible strategies to improve the outcome of collagen-scaffold medicated wound healing. PMID:24651001

  4. Engineered alternative skin for partial and full-thickness burns.

    PubMed

    Wessels, Quenton

    2014-01-01

    Engineered alternative skin in all its forms and shapes serve to provide temporary or permanent wound closure such as in the case of partial and full-thickness burns. The need for collagen-based regeneration templates is motivated by the fact that dermal regeneration of full-thickness injuries does not occur spontaneously and is inundated by contraction and scarring. Partial-thickness burns in turn can regress as a result of infection and improper treatment and require appropriate treatment. Nylon-silicone laminates such as Biobrane(®), and more recently AWBAT(®), address this by serving as a temporary barrier. Enhanced collagen-based scaffolds today, although not perfect, remain invaluable. Our initial approach was to characterize the design considerations and explore the use of collagen in the fabrication of a dermal regeneration matrix and a silicone-nylon bilaminate. Here we expand our initial research on scaffold fabrication and explore possible strategies to improve the outcome of collagen-scaffold medicated wound healing.

  5. Grafting of burns with widely meshed autograft split skin and Langerhans cell-depressed allograft split skin overlay

    SciTech Connect

    Alsbjoern, B.F.S.; Sorensen, B.

    1986-12-01

    Extensively burned patients suffer from lack of sufficient autologous donor skin. Meshing and wide expansion of the obtained split skin has met the requirement to a large degree. However, the wider the expansion, the less chance of a proper take. By covering widely expanded autografts with viable cadaver split skin, the take has been improved. If the epidermal Langerhans cells in the cadaver split skin are depressed by ultraviolet B light and glucocorticosteroids before grafting, a prolonged allograft take can be achieved and the healing of the underlying autografts is ensured for an extended period. Grafting results in 6 patients with extensive burns are reported.

  6. Extra corporeal shockwave lithotripsy resulting in skin burns--a report of two cases.

    PubMed

    Rao, Sandhya R; Ballesteros, Natalia; Short, Kerry L; Gathani, Krishna K; Ankem, Murali K

    2014-01-01

    Severe skin injury after extracorporeal shock wave lithotripsy (ESWL) is rare. We describe two patients who suffered full thickness skin burns following ESWL for renal calculi. One patient was treated conservatively and the other underwent debridement with skin grafting. We speculate that failure of the thermostatic mechanism of the lithotripter, leading to overheating of the water-filled cushion, resulted in this very rare adverse event. Proper preoperative patient counseling regarding the risk of serious burn injuries will help to avoid potential litigation.

  7. The use of banked skin in the Burns Centre of Verona

    PubMed Central

    Bosco, Federica; Governa, Maurizio; Rossati, Leonardo; Vigato, Enrico; Vassanelli, Aurora; Aprili, Giuseppe; Franchini, Massimo

    2011-01-01

    Background. The use of glycerol and subsequent research enabling the conservation of tissues over time have led to the establishment and development of tissue banks, first in the USA and then in Europe. The Verona Tissue Bank was instituted in 2003 as the Regional Centre for the storage of skin and bone, adding to the already existing Italian banks at Turin, Milan, Cesena and Siena. This retrospective study analyses the use of banked skin (autologous and allogeneic grafts) from April 2003 (date of starting activity) to December 2007, in 171 patients with burns and four with necrotising fasciitis at the Burns Centre of Verona. Materials and methods. Homologous skin was used for superficial and deep skin burns to protect the residual structures, thus facilitating healing by spontaneous re-epithelialisation, and for deep burns after eschar removal to clean and prepare the base of the lesion for the definitive autologous graft. The placement of a homologous graft alone led to spontaneous healing of lesions in 65 patients (36 aged >15 years and 29 aged <15 years) with superficial skin burns, while the remaining 106 patients (84 aged >15 years and 22 aged <15 years) with deeper burns underwent surgery. Conclusions. The results obtained confirm the essential role of banked skin in covering superficial burns in order to protect important underlying structures and in deep burns by guaranteeing a good preparation of the base of the lesion for the subsequent definitive autologous graft. PMID:21251463

  8. Effect of piracetam and nimodipine on full-thickness skin burns in rabbits.

    PubMed

    Sari, Elif; Dincel, Gungor C

    2016-08-01

    The potential of several drugs for full-thickness skin burns has been investigated, but the treatment of such burns remains a challenge in plastic surgery. The present study was designed to determine the effect of systemic and topical administration of piracetam and nimodipine on full-thickness skin burn wound healing. A total of 36 New Zealand male rabbits were divided into six groups. Full-thickness skin burns were produced in all the groups, except the control group. Piracetam was administered systemically (piracetam-IV) and topically (piracetam-C) for 14 days, and nimodipine was administered systemically (nimodipine-IV) and topically (nimodipine-C) over the burn wounds for 14 days. The sham group underwent burn injury but was not administered any drug. After 21 days, gross examination and histopathological analysis were performed and the results were compared statistically. Nimodipine-C and nimodipine-IV had no effect on burn wound healing. However, both piracetam-IV and piracetam-C significantly enhanced the healing of the full-thickness skin burn wounds, although the latter was more effective, useful and practical in burn wound healing. The histopathological features of the wounds in the piracetam-C group were closer to those of the control group than those of the other groups. Piracetam-C rather than piracetam-IV may promote full-thickness burn wound healing in rabbits. © 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  9. Precordial skin burns after endoscopic submucosal dissection for gastric tube cancer.

    PubMed

    Miyagi, Motoshi; Yoshio, Toshiyuki; Hirasawa, Toshiaki; Ishiyama, Akiyoshi; Yamamoto, Yorimasa; Tsuchida, Tomohiro; Fujisaki, Junko; Igarashi, Masahiro

    2015-11-01

    Endoscopic submucosal dissection (ESD) is useful as a minimally invasive treatment option for early gastric cancer. ESD is also used in the management of postoperative remnant gastric cancers in the stomach and gastric tube cancers. Perforation and delayed bleeding have been the main complications of ESD reported in the management of gastric tube cancer. However, in the current literature, there is no description of precordial skin burns caused by electrical coagulation. While we treated 22 patients with gastric tube cancers by ESD from 2005 to 2014, we experienced five skin burns in four patients after ESD. We retrospectively analyzed clinical characteristics of precordial skin burn as a complication of ESD. All skin burns occurred in patients reconstructed using a presternal route, whose incidence of precordial skin burn was 55.6%. In all cases, lesions were located in the upper or middle third of gastric tubes irrespective of their direction. Skin burn developed on postoperative day (POD) 1 or POD 2, taking 4-7 days to heal and was accompanied by high fever in 60% of cases. The present study suggests that when carrying out ESD for gastric tube cancer using the presternal route, it is necessary to consider the occurrence of a precordial skin burn as a possible complication. © 2015 The Authors. Digestive Endoscopy © 2015 Japan Gastroenterological Endoscopy Society.

  10. Forensic diagnosis of ante- and postmortem burn based on aquaporin-3 gene expression in the skin.

    PubMed

    Kubo, Hidemichi; Hayashi, Takahito; Ago, Kazutoshi; Ago, Mihoko; Kanekura, Takuro; Ogata, Mamoru

    2014-05-01

    In order to diagnose death associated with fire, it is essential to show that the person was exposed to heat while still alive. We investigated both AQP1 and AQP3 expression in the skin of an experimental burn model, as well as in forensic autopsy cases, and discuss its role in the differential diagnosis of ante- and postmortem burns. In animal experiments, there was no difference in AQP1 gene expression among four groups (n=4): antemortem burn, postmortem burn, mechanical wound, and control. However, AQP3 expression in the antemortem burn was increased significantly compared with that of the other groups even at 5min after burn. Water content of the skin was decreased significantly by the burn procedure. Consistent with animal experiments, AQP3 gene expression in the skin of antemortem burn cases was increased significantly compared with postmortem burns, mechanical wounds, and controls (n=12 in each group). These observations suggest that dermal AQP3 gene expression was increased to maintain water homeostasis in response to dehydration from burn. Finally, our results suggest that AQP3 gene expression may be useful for forensic molecular diagnosis of antemortem burn.

  11. Current density imaging and electrically induced skin burns under surface electrodes.

    PubMed

    Patriciu, Andrei; Yoshida, Ken; Struijk, Johannes J; DeMonte, Tim P; Joy, Michael L G; Stødkilde-Jørgensen, Hans

    2005-12-01

    The origin of electrical burns under gel-type surface electrodes is a controversial topic that is not well understood. To investigate the phenomenon, we have developed an excised porcine skin-gel model, and used low-frequency current density imaging (LFCDI) to determine the current density (CD) distribution through the skin before and after burns were induced by application of electrical current (200 Hz, 70% duty cycle, 20-35 mA monophasic square waveform applied to the electrodes for 30-135 min). The regions of increased CD correlate well with the gross morphological changes (burns) observed. The measurement is sensitive enough to show regions of high current densities in the pre-burn skin, that correlate with areas were burn welts were produced, thus predicting areas where burns are likely to occur. Statistics performed on 28 skin patches revealed a charge dependency of the burn areas and a relatively uniform distribution. The results do not support a thermal origin of the burns but rather electro-chemical mechanisms. We found a statistically significant difference between burn area coverage during anodic and cathodic experiments.

  12. The treatment of extensively burned patients and {beta} irradiational injury skin burn patients with irradiated pigskin

    SciTech Connect

    Tang Zhong Yi; Lu Xing An; Jing Ling; Qi Qiang

    1994-12-31

    Obvious therapeutic effects achieved by the covering of irradiation sterilized pigskin on burn wounds, escarectomized 3rd degree burn wounds and {beta} injured burns are introduced. The article introduces also the manufacture processes of irradiated pigskins and the selection of surgical treatments of various burns.

  13. [Application of skin and soft tissue expansion in treatment of burn injury].

    PubMed

    Wang, N Z; Shen, Z Y; Ma, C X

    2000-09-01

    To evaluate the application of skin and soft tissue expansion in the treatment of deformity due to extensive severe burn injury and repair of severe deep electrical burned scalp and skull with fresh wound. From 1988, 83 cases of application of skin and soft tissue expansion were reported. In those patients with deformity due to severe burn of large area and with whole nasal defect, soft tissue expander was used under the forehead skin graft and venter frontalis, followed by reconstruction of nose with the expanded vascularized skin flap and carved cartilago costalis as nasal frame. In patients of severe deep electrical burned scalp and skull with fresh wound, skin and soft tissue expansion were used to repair the wound simultaneously with scalp burn alopecia, anesthetics and antibiotics injected into the extracapsular space of the expander in case of pain and infection. All of the cases were successfully treated with little pain and minimized infection. Skin and soft tissue expansion in a safe and reliable measure in the treatment of deformity due to extensive severe burn injury and repair of severe deep electrical burned scalp and skull with fresh wound.

  14. Skin resurfacing in a circumferential full thickness burn to the penis: lessons learnt

    PubMed Central

    Jabir, Shehab; Frew, Quentin; Thompson, Richard; Dziewulski, Peter

    2013-01-01

    A circumferential full-thickness burn to the penis is a rarely encountered injury. However, when it does occur, it proves a management challenge to the plastic and burns surgeon in terms of reconstruction. This is due to the need of not only regaining adequate function of the organ, but also because of the need for a pleasing aesthetic outcome. Split-skin grafts have been utilised successfully to resurface full thickness burns of the penis and have given good results. Yet the success of split-skin grafts, especially those applied to an anatomically challenging region of the body such as the penis, depends on a number of carefully thought-out steps. We discuss the case of a circumferential full-thickness burn to the penis which was treated with split-skin grafting and highlight important pitfalls that the plastic and burns surgeon need to be aware of to ensure a successful outcome. PMID:23946511

  15. Skin resurfacing in a circumferential full thickness burn to the penis: lessons learnt.

    PubMed

    Jabir, Shehab; Frew, Quentin; Thompson, Richard; Dziewulski, Peter

    2013-08-13

    A circumferential full-thickness burn to the penis is a rarely encountered injury. However, when it does occur, it proves a management challenge to the plastic and burns surgeon in terms of reconstruction. This is due to the need of not only regaining adequate function of the organ, but also because of the need for a pleasing aesthetic outcome. Split-skin grafts have been utilised successfully to resurface full thickness burns of the penis and have given good results. Yet the success of split-skin grafts, especially those applied to an anatomically challenging region of the body such as the penis, depends on a number of carefully thought-out steps. We discuss the case of a circumferential full-thickness burn to the penis which was treated with split-skin grafting and highlight important pitfalls that the plastic and burns surgeon need to be aware of to ensure a successful outcome.

  16. Local Burn Injury Impairs Epithelial Permeability and Antimicrobial Peptide Barrier Function in Distal Unburned Skin*

    PubMed Central

    Plichta, Jennifer K.; Droho, Steve; Curtis, Brenda J.; Patel, Parita; Gamelli, Richard L.; Radek, Katherine A.

    2014-01-01

    Objectives Our objective was to characterize the mechanisms by which local burn injury compromises epithelial barrier function in burn margin, containing the elements necessary for healing of the burn site, and in distal unburned skin, which serves as potential donor tissue. Design Experimental mouse scald burn injury. Setting University Research Laboratory. Subjects C57/Bl6 Male mice, 8–12 weeks old. Interventions To confirm that dehydration was not contributing to our observed barrier defects, in some experiments mice received 1 mL of saline fluid immediately after burn, while a subgroup received an additional 0.5 mL at 4 hours and 1 mL at 24 hours following burn. We then assessed skin pH and transepidermal water loss every 12 hours on the burn wounds for 72 hours postburn. Measurements and Main Results Burn margin exhibited increased epidermal barrier permeability indicated by higher pH, greater transepidermal water loss, and reduced lipid synthesis enzyme expression and structural protein production up to 96 hours postburn. By contrast, antimicrobial peptide production and protease activity were elevated in burn margin. Skin extracts from burn margin did not exhibit changes in the ability to inhibit bacterial growth. However, distal unburned skin from burned mice also demonstrated an impaired response to barrier disruption, indicated by elevated transepidermal water loss and reduced lipid synthesis enzyme and structural protein expression up to 96 hours postburn. Furthermore, skin extracts from distal unburned skin exhibited greater protease activity and a reduced capacity to inhibit bacterial growth of several skin pathogens. Finally, we established that antimicrobial peptide levels were also altered in the lung and bladder, which are common sites of secondary infection in burn-injured patients. Conclusions These findings reveal several undefined deficiencies in epithelial barrier function at the burn margin, potential donor skin sites, and organs

  17. The use of Biobrane® to dress split-thickness skin graft in paediatric burns.

    PubMed

    Farroha, A; Frew, Q; El-Muttardi, N; Philp, B; Dziewulski, P

    2013-06-30

    Biobrane(®) is commonly used in paediatric burns to cover partial thickness burns and donor sites of split thickness skin (SSG). The purpose of this study is to evaluate the use of Biobrane(®) in dressing SSG adjacent to skin graft donor sites or partial thickness burns. A retrospective review was undertaken to determine the use of Biobrane(®) in dressing SSG, where the grafted areas were adjacent to donor sites or partial thickness burns. Between 2009 and 2012, we reported five cases of using Biobrane(®) to dress SSG, where the grafted areas were adjacent to partial thickness burns and two cases where the grafted areas were adjacent to donor sites. Biobrane(®) promoted adherence of the SSG to the wound, prevented shearing, and allowed fluid drainage. At the same time, Biobrane(®) also facilitated healing of the adjacent donor sites or partial thickness burns.

  18. Effect of Scutellariae herba extracts in experimental model of skin burns: histological and immunohistochemical assessment.

    PubMed

    Bejenaru, Cornelia; Mogoşanu, George Dan; Bejenaru, Ludovic Everard; BiŢă, Andrei; Bălşeanu, Tudor Adrian; Ionică, Floriana Elvira

    2016-01-01

    The skin burns are an issue of great interest and seriousness in the public health domain, by their destructive features. Natural medicinal products are extensively used from ancient times, in ethnopharmacology, for the treatment of skin injuries (burns, wounds, ulcerations) due to the local modulation of the cellular response, in terms of emollient, demulcent, astringent, anti-inflammatory, antimicrobial, epithelizing, wound-healing, immunomodulatory and antioxidant effects.

  19. The uncertainty in burn prediction as a result of variable skin parameters: an experimental evaluation of burn-protective outfits.

    PubMed

    Gasperin, Matej; Juricić, Dani

    2009-11-01

    The reliable prediction of burns, resulting from exposure to elevated levels of heat, received early interest in physiology and later on in various branches of applied research and engineering. In this paper we address the problem of estimating the extent of skin burns in the context of a quantitative assessment of protective garments from the statistical point of view. We rely on the experimental platform built around the thermal mannequin equipped with an array of thermal sensors. The dressed mannequin is first exposed to the flash fire, in order to determine the incident heat flux on the mannequin's surface. This information is then used in a heat-transfer model of the skin, the result of which is an estimate of the degree of injury that would occur to a human exposed to the same flame conditions. The methods used so far, employed a deterministic skin model defined with the nominal thermal and geometrical parameters. However, skin properties differ from human to human and from one location on the body to another; this results in different configurations of the areas affected by injuries. In this paper we apply a Monte-Carlo approach to estimate the dispersion of the burns over a broad population of humans. The results obtained from experimental data records indicate that the variations in the dermis are the most decisive for increased dispersions at the estimated second- and third-degree burn areas.

  20. Long-term outcomes in patients surviving large burns: the skin.

    PubMed

    Holavanahalli, Radha K; Helm, Phala A; Kowalske, Karen J

    2010-01-01

    The objective of this study was to evaluate persons who have survived severe burns and to describe the long-term residual problems relating to the skin. This is a cross-sectional descriptive study that included a one-time evaluation of 98 burn survivors (18 years old or older) who survived >or=30% TBSA burns, were >or=3 years postinjury, and consented to participate. Study participants were required to undergo a physical examination conducted by the Physical Medicine and Rehabilitation physicians in addition to completing study questionnaires. Participants were predominantly male (63%) and Caucasian (69%). The average time from injury was 17 years (range 3-53 years), and the average TBSA burn was 57% (range 30-97%). Problems with hot and cold temperature, sensory loss, raised scars, and itching continued to pose problems many years after burn injury. Reports of open wounds, skin rash, painful scars, and shooting pain in scars tended to decrease over time, whereas reports of fragile burns, including cuts and tears, tended to increase over time. Findings from the physical examination of the participants include hypertrophic scars in grafted areas (92%) and in nongrafted areas (38%), decreased sensation to pin in grafted areas (71%), hyperpigmentation in grafted areas (53%), fingernail deformities (35%), and skin breakdown (32%). Individuals with large burns deserve more long-term attention. As survivors of large burns continue to face significant burn-related issues, there is a critical need for long-term follow-up both in the clinic and in research.

  1. An optimized animal model for partial and total skin thickness burns studies.

    PubMed

    Campelo, Ana Paula Bomfim Soares; Campelo, Marcio Wilker Soares; Britto, Gerly Anne de Castro; Ayala, Alejandro Pedro; Guimarães, Sergio Botelho; Vasconcelos, Paulo Roberto Leitão de

    2011-01-01

    Development of an improved animal model for studying skin burns in rats. Twenty-four male Wistar rats were randomly assigned to four groups (n=6): G1-Control, G2- T100°C, G3-T150°C and G4-T200°C. Two 10 x 10 mm squares were outlined with a sterile surgical marker on each side and along the vertebral column using a prepared template positioned between the anterior and posterior limbs. G2-G4 rats were subjected to 100°C, 150°C and 200ºC thermal burns, respectively. G1 rats served as controls. Burns were inflicted by applying a copper plate connected to an electronic temperature controlling device to the dorsal skin of anesthetized rats. Four burns were produced on each animal (total area: 4 cm²/animal) leaving about 1 cm of undamaged skin between burn areas. Analgesia was administered during 24 h after burn injury by adding 30 mg codeine phosphate hemihydrate to 500 ml tap water. The application of 100°C and 150ºC resulted in partial thickness skin burns with central reepithelialization of the burned area only at 100°C. In G4 group the whole thickness of the skin was injured without central reepithelialization. However, there was marginal reepithelialization in all groups. The model studied is inexpensive and easily reproducible, enabling the achievement of controlled burns with partial or total impairment of the skin in experimental animals.

  2. Burns from acetylene gas: more than skin deep

    PubMed Central

    Al-Hassani, Fawaz; Amin, Kavit; Lo, Steven

    2014-01-01

    Oxyacetylene welding torches are commonly used in industry, yet serious burns are fortunately rare. When dealing with the sequelae of these burn injuries, one must be aware of the high pressure component of these flame burns, which can penetrate and dissect the subcutaneous tissue. Appropriate initial assessment and preoperative planning are, therefore, essential to exclude and identify problems such as, compartment syndrome, subcutaneous emphysema and acute carpal tunnel syndrome. We present a case in which an innocuous palmar burn revealed a penetrating flame injury into the carpal tunnel. PMID:24842344

  3. [Changes in mesenteric microcirculation in rats following repeated skin burns].

    PubMed

    Shtykhno, Iu M

    1976-07-01

    Acute experiments were conducted on rats; repeated extensive burn of a convalescent who formerly sustained the burn disease was better tolerated, led tono fatal outcome and was accompanied by moderate microcirculatory disturbances. The smae burn was accompanied in intact rats by a severe shock followed by death, intravascular aggregation of erythrocytes and significant microcirculatory disturbances leading to disturbance of tissue nutrition. It is supposed that the results obtained could serve as an indirect proof that toxemia played an important role in the genesis of intravascular aggregation of erythrocytes in burn shock.

  4. Burns from acetylene gas: more than skin deep.

    PubMed

    Al-Hassani, Fawaz; Amin, Kavit; Lo, Steven

    2014-05-19

    Oxyacetylene welding torches are commonly used in industry, yet serious burns are fortunately rare. When dealing with the sequelae of these burn injuries, one must be aware of the high pressure component of these flame burns, which can penetrate and dissect the subcutaneous tissue. Appropriate initial assessment and preoperative planning are, therefore, essential to exclude and identify problems such as, compartment syndrome, subcutaneous emphysema and acute carpal tunnel syndrome. We present a case in which an innocuous palmar burn revealed a penetrating flame injury into the carpal tunnel.

  5. [The experimental application of chitosan membrane for treating chemical burns of the skin].

    PubMed

    Pogorielov, M; Kalinkevich, O; Gortinskaya, E; Moskalenko, R; Tkachenko, Yu

    2014-01-01

    The basic method for skin damage treatment, including chemical wounds, is a topical application of different agents. Their objective is to repair structure of the skin and its functions. All dressings for treating wounds are classified as biological, artificial and composites containing both synthetic and natural materials. There are many studies concerning application of chitosan, which is a derivate of natural polymer chitin, as a basis for topical materials to treat burns. However, data are rather limited about application of chitosan for treating acid burns. Thus, the aim of research is to study the morphological futures of skin regeneration after the chemical burn applying chitosan membranes. We performed the experiment on 60 young rats (3 months old) with the chemical burns of third-degree (IIIA degree) to study the morphofunctional features of skin regeneration. Later we applied the chitosan membranes on the burns. We carried out a histologic investigation on the biopsy specimens of wound to determine the morphological features of wound regeneration. The results confirmed that earlier granulation and epithelialization of the skin surface happened as the chitosan membrane was applied on the acid effected surface. The final result of the application of chitosan film is to achieve full epithelialization, preserve the structure of tissues beneath the burn and prevent getting scars.

  6. Prediction methods of skin burn for performance evaluation of thermal protective clothing.

    PubMed

    Zhai, Li-Na; Li, Jun

    2015-11-01

    Most test methods use skin burn prediction to evaluate the thermal protective performance of clothing. In this paper, we reviewed different burn prediction methods used in clothing evaluation. The empirical criterion and the mathematical model were analyzed in detail as well as their relationship and limitations. Using an empirical criterion, the onset of skin burn is determined by the accumulated skin surface energy in certain periods. On the other hand, the mathematical model, which indicates denatured collagen, is more complex, which involves a heat transfer model and a burn model. Further studies should be conducted to examine the situations where the prediction methods are derived. New technologies may be used in the future to explore precise or suitable prediction methods for both flash fire tests and increasingly lower-intensity tests.

  7. Burn depth determination in human skin using polarization-sensitive optical coherence tomography

    NASA Astrophysics Data System (ADS)

    Pierce, Mark C.; Sheridan, Robert L.; Park, Boris H.; Cense, Barry; de Boer, Johannes F.

    2003-07-01

    Accurate evaluation of the depth of injury in burn victims is of considerable practical value to the surgeon, both for initial determination of resuscitation fluid requirements, and in deciding whether excision and closure of the wound is necessary. Currently, burn depth is most accurately evaluated by visual inspection, though decisions concerning treatment may not be possible for a number of days post-injury. As part of our ongoing efforts to provide an objective, quantitative method for burn depth determination, we present here the results of a study using polarization-sensitive optical coherence tomography (PS-OCT) to detect and measure thermally induced changes in collagen birefringence in skin excised from burn patients. We find that PS-OCT is capable of imaging and quantifying significantly reduced birefringence in burned human skin.

  8. Can Skin Allograft Occasionally Act as a Permanent Coverage in Deep Burns? A Pilot Study.

    PubMed

    Rezaei, Ezzatollah; Beiraghi-Toosi, Arash; Ahmadabadi, Ali; Tavousi, Seyed Hassan; Alipour Tabrizi, Arash; Fotuhi, Kazem; Jabbari Nooghabi, Mehdi; Manafi, Amir; Ahmadi Moghadam, Shokoofeh

    2017-01-01

    Skin allograft is the gold standard of wound coverage in patients with extensive burns; however, it is considered as a temporary wound coverage and rejection of the skin allograft is considered inevitable. In our study, skin allograft as a permanent coverage in deep burns is evaluated. Skin allograft survival was assessed in 38 patients from March 2009 to March 2014, retrospectively. Because of the lack of tissue specimen from the skin donors, patients with long skin allograft survival in whom the gender of donor and recipient of allograft was the same were excluded. Seven cases with skin allograft longevity and opposite gender in donor and recipient were finally enrolled. A polymerase chain reaction (PCR) test on the biopsy specimen from recipients and donors were undertaken. PCR on the biopsy specimen from recipients confirmed those specimens belong to the donors. All patients received allograft from the opposite sex. Two (28.57%) patients received allograft from their first-degree blood relatives, and in one (14.29%) case, the allograft was harvested from an alive individual with no blood relation. The rest were harvested from multiorgan donors. In eight months of follow up, no clinical evidence of graft rejection was noted. Long term persistence of skin allograft in patients is worthy of more attention. Further studies An increase in knowledge of factors influencing this longevity could realize the dream of burn surgeons to achieve a permanent coverage other than autograft for major burn patients.

  9. Modeling of bioheat equation for skin and a preliminary study on a noninvasive diagnostic method for skin burn wounds.

    PubMed

    Lee, Shong-Leih; Lu, Yung-Hsiang

    2014-08-01

    Heat transfer in a unit three-dimensional skin tissue with an embedded vascular system of actual histology structure is computed in the present work. The tissue temperature and the blood temperatures in artery and vein vessels are solved with a multi-grid system. The mean temperature of the tissue over the cross-section of the unit skin area is evaluated. The resulting one-dimensional function is regarded as the temperature of healthy tissue (or injured skin but the blood perfusion is still normally working) for large area of skin in view of the symmetric and periodic structure of the paired artery-vein vessels in nature. A three-dimensional bioheat equation then is formulated by the superposition of the skin burn wound effect and the healthy skin temperature with and without thermal radiation exposure. When this bioheat equation is employed to simulate ADT process on burn wounds, the decaying factor of the skin surface temperature is found to be a sharply decreasing function of time in the self-cooling stage after a thermal radiation heating. Nevertheless, the boundary of non-healing (needing surgery) and healing regions in a large burn wound can be estimated by tracking the peak of the gradient of decaying factor within 30 s after the thermal radiation is turned off. Experimental studies on the full ADT procedure are needed to justify the assumptions in the present computation.

  10. RGTA OTR4120, a heparan sulfate mimetic, is a possible long-term active agent to heal burned skin.

    PubMed

    Garcia-Filipe, S; Barbier-Chassefiere, V; Alexakis, C; Huet, E; Ledoux, D; Kerros, M E; Petit, E; Barritault, D; Caruelle, J P; Kern, P

    2007-01-01

    Burn-related skin fibrosis leads to loss of tissue function and hypertrophic scar formation with damaging consequences for the patient. There is therefore a great need for an efficient agent to treat burned skin. We report that ReGeneraTing Agent (RGTA) reduces burn-induced skin alteration. The tissue-regenerating effect of RGTA OTR4120 was evaluated after 1-6 days and after 10 months in a rat skin burn model. This effect was also examined in vitro using fibroblasts isolated from control and 6-day-old burned skins. We measured production of dermal collagen I, III, and V and activities of metalloproteinases 2 and 9 (MMP-2 and MMP-9). Ratio of collagen III over collagen I production increased 6 days after the burn, because of a decrease in collagen I production. After 10 months, ratio of collagen III over collagen I in burn sites was still increased compared with control skin, because of an increase in collagen III production. Both abnormalities were corrected by OTR4120. OTR4120 increased pro- and active MMP-2 and MMP-9, compared with healthy and burned controls and therefore accelerated remodeling. Similar data were obtained with cultured fibroblasts from healthy and burned skins. OTR4120 enhanced healing in short- and long-term after burns, reducing the formation of fibrotic tissue, and then represents a potential agent to improve burned skin healing.

  11. Significant skin burns may occur with the use of a water balloon in HIFU treatment

    NASA Astrophysics Data System (ADS)

    Ritchie, Robert; Collin, Jamie; Wu, Feng; Coussios, Constantin; Leslie, Tom; Cranston, David

    2012-10-01

    HIFU is a minimally-invasive therapy suitable for treating selected intra-abdominal tumors. Treatment is safe although skin burns may occur due to pre-focal heating. HIFU treatment of a renal transplant tumor located in the left lower abdomen was undertaken in our centre. Treatment was performed prone, requiring displacement of the abdominal wall away from the treatment field using a water balloon, constructed of natural rubber latex and filled with degassed water. Intra-operatively, ultrasound imaging and physical examination of the skin directly over the focal region was normal. Immediately post-operative, a full-thickness skin burn was evident at the periphery of the balloon location, outside the expected HIFU path. Three possibilities may account for this complication. Firstly, the water balloon may have acted as a lens, focusing the HIFU to a neo-focus off axis. Secondly, air bubbles may have been entrapped between the balloon and the skin, causing heating at the interface. Finally, heating of the isolated water within the balloon may have been sufficient to cause burning. In this case, the placement of a water balloon caused a significant skin burn. Care should be taken in their use as burns, situated off axis, may occur even if the overlying skin appears normal.

  12. Utilization of skin flap for reconstruction of the genitalia after an electric burn.

    PubMed

    Castro, Rodrigo B; Oliveira, Ana B; Favorito, Luciano A

    2006-01-01

    The objective of this article is to describe a case of an electric burn to the genitalia causing scrotal and testicular lesion, and the subsequent reconstruction using a skin graft. The patient was a 10-year-old boy who was victim of an electric burn that harmed the genitalia. There was extended skin loss, penile, scrotal and partial testicular lesion. The treatment consisted of plastic surgery to reconstruct the genitalia with skin flaps grafted on the left thigh, the scrotum and the base of the penis. The patient recovered well and was discharged after two weeks. We concluded that in severe cases of electric burns to the genitalia, skin graft offer a good therapeutic option.

  13. The influence of pulsed electrical stimulation on the wound healing of burned rat skin.

    PubMed

    Castillo, E; Sumano, H; Fortoul, T I; Zepeda, A

    1995-01-01

    Electrostimulation of wounds caused healing to proceed in a thoroughly organized manner. A trial using rats subjected to second degree burns was conducted to evaluate, under scanning electron microscopy (SEM), the healing capabilities of skin to which an antiseptic (iodine) and referred electrical stimulation were applied. Untreated, unharmed skin was also studied as control. Images obtained using SEM revealed that only the repaired skin of the electrostimulated group had an appearance similar to that of the control skin (kappa = 1), and that the overall appearance of the repaired skin was compatible with a well organized healing process.

  14. Histological and immunohistochemical study of cutaneous angiogenesis process in experimental third-degree skin burns treated with allograft.

    PubMed

    Busuioc, Cristina Jana; Popescu, Florina Carmen; Mogoşanu, G D; Pârvănescu, H; Streba, Liliana; Mogoantă, L

    2012-01-01

    Skin burns are a rather high incidence lesions which, depending on their depth and extension, can severely affect not only the skin but the entire organism. Third-degree skin burns extended on over 20% of the body surface often require skin graft. Skin allograft is a therapeutic alternative when autograft cannot be used. We investigated the allograft influence on the angiogenesis process in third-degree skin burns, using an experimental model. We noticed that the allograft induces a stronger inflammatory reaction associated with intense angiogenesis process by about 10-15% compared to control group.

  15. Iatrogenic surgical microscope skin burns: A systematic review of the literature and case report.

    PubMed

    Lopez, Joseph; Soni, Ashwin; Calva, Daniel; Susarla, Srinivas M; Jallo, George I; Redett, Richard

    2016-06-01

    Cutaneous burns associated with microscope-use are perceived to be uncommon adverse events in microsurgery. Currently, it is unknown what factors are associated with these iatrogenic events. In this report, we describe the case of a 1-year-old patient who suffered a full thickness skin burn from a surgical microscope after a L4-S1 laminectomy. Additionally, we present a systematic review of the literature that assessed the preoperative risk, outcome, and management of iatrogenic microscope skin burns. Lastly, a summary of the Food and Drug Administration's (FDA) Manufacturer and User Facility Device Experience (MAUDE) database of voluntary adverse events was reviewed and analyzed for clinical cases of microscope thermal injuries. The systematic literature review identified only seven articles related to microsurgery-related cutaneous burns. From these seven studies, 15 clinical cases of iatrogenic skin burns were extracted for analysis. The systematic review of the FDA MAUDE database revealed only 60 cases of cutaneous burns associated with surgical microscopes since 2004. Few cases of microscope burns have been described in the literature; this report is, to our knowledge, one of the first comprehensive reports of this iatrogenic event in the literature.

  16. Influence of body mass index on skin grafting in pediatric burns.

    PubMed

    Sharp, Nicole E; Thomas, Priscilla G; Sherman, Ashley K; St Peter, Shawn D; Juang, David

    2015-03-01

    There is heterogeneous literature on the association of obese and underweight body habitus on burn outcomes in adult and pediatric literature. We examine the effect of standardized pediatric body mass index (BMI) categories skin graft utilisation. A retrospective chart review was performed on children who underwent burn treatment from January 1995 to November 2011. BMI was categorized by standard definitions: underweight (<5%), normal (5-85%), overweight (85-95%), obese (>95%). There were 1164 patients: 77 underweight, 604 normal, 215 overweight, and 268 obese patients. No differences existed between group demographics. Grafts were performed in 39% of underweight, 27% of normal, 22% of overweight, and 27% of obese patients. Underweight children had nearly a 2 fold increase in their risk of full thickness burns and were 1.8 times more likely to undergo skin grafting than normal BMI children. Overweight children had a significant decrease in the incidence skin grafting by 23% then compared to normal weight children. There were no differences in percent TBSA burned or percent TBSA grafted using ANOVA. Underweight pediatric burn victims have an increased risk for skin grafting while mildly overweight children are slightly protected from skin grafting. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  17. Investigation of burn effect on skin using simultaneous Raman-Brillouin spectroscopy, and fluorescence microspectroscopy

    NASA Astrophysics Data System (ADS)

    Coker, Zachary; Meng, Zhaokai; Troyanova-Wood, Maria; Traverso, Andrew; Ballmann, Charles; Petrov, Georgi; Ibey, Bennett L.; Yakovlev, Vladislav

    2017-02-01

    Burns are thermal injuries that can completely damage or at least compromise the protective function of skin, and affect the ability of tissues to manage moisture. Burn-damaged tissues exhibit lower elasticity than healthy tissues, due to significantly reduced water concentrations and plasma retention. Current methods for determining burn intensity are limited to visual inspection, and potential hospital x-ray examination. We present a unique confocal microscope capable of measuring Raman and Brillouin spectra simultaneously, with concurrent fluorescence investigation from a single spatial location, and demonstrate application by investigating and characterizing the properties of burn-afflicted tissue on chicken skin model. Raman and Brillouin scattering offer complementary information about a material's chemical and mechanical structure, while fluorescence can serve as a useful diagnostic indicator and imaging tool. The developed instrument has the potential for very diverse analytical applications in basic biomedical science and biomedical diagnostics and imaging.

  18. Epidemiology of skin cancer arisen from the burn scars in Nigerian Ibos.

    PubMed

    Onuigbo, Wilson I B

    2006-08-01

    During the period 20 February 1970-19 February 2000, burns resulting in squamous cell carcinoma of the skin were documented by using a histopathology data pool of surgical specimens kept by the author as regards his Ibos ethnic group in Nigeria, West Africa. There were 21 cases. The males outnumbered the females in the ratio of 3:1. The youngest patient was aged 8 years and the oldest 75 years (mean age 39 years). Most of the antecedent injuries occurred during childhood. The two etiologic agents of albinism and burns were combined in one patient while another rarity was the presentation of the cancer within keloids. In conclusion, in dark skinned races, research should be directed on the comparative role of burns in predisposing to squamous cell carcinoma in individuals whose skin is compromised by either albinism or keloids.

  19. Numerical design of experiment for sensitivity analysis--application to skin burn injury prediction.

    PubMed

    Autrique, Laurent; Lormel, Corine

    2008-04-01

    Temperature evolution and skin burn process resulting from a laser radiation exposure are investigated in this paper. Transient temperature in skin is numerically estimated using a 1-D multilayered model based on Penne's equation. The degree of burn injury is numerically evaluated by using an Arrhenius-type function. Unfortunately, most of the mathematical model parameters are not well defined in literature. Thus, a sensitivity analysis has been performed in order to evaluate the effect of each parameters inaccuracy on temperature estimation and on burn injuries prediction (according to several authors' characterization). Investigated parameters uncertainties that crucially invalidate the thermal model are as follows: epidermis and dermis volumetric heat, extinction coefficient, and skin thickness of the affected area. Considering the damage prediction, the activation energy is a key parameter for the validation of an efficient predictive tool.

  20. The role of skin substitutes in the treatment of burn injuries.

    PubMed

    Shakespeare, Peter G

    2005-01-01

    Extensive burn wounds are difficult to manage and repair. Several engineered skin substitutes have been developed to aid in this process. These substitutes are designed with particular objectives in mind which dictate the circumstances under which they can, and should, be employed to promote healing or prepare the burn wound for final closure with autograft. This article discusses some of the rationale behind the use of skin substitutes and reviews some of the substitutes in use at the present time. Current perspectives suggest that skin substitute use is still in its infancy and that there is some way to go before their role in clinical practice becomes clear. Nevertheless the prospect of being able to supply new wound repair components and to influence the healing process to modify outcome and improve the quality of the healed burn wound will ensure a continuing high degree of interest in these potentially useful and beneficial medical devices.

  1. Dextran hydrogel scaffolds enhance angiogenic responses and promote complete skin regeneration during burn wound healing

    PubMed Central

    Sun, Guoming; Zhang, Xianjie; Shen, Yu-I; Sebastian, Raul; Dickinson, Laura E.; Fox-Talbot, Karen; Reinblatt, Maura; Steenbergen, Charles; Harmon, John W.; Gerecht, Sharon

    2011-01-01

    Neovascularization is a critical determinant of wound-healing outcomes for deep burn injuries. We hypothesize that dextran-based hydrogels can serve as instructive scaffolds to promote neovascularization and skin regeneration in third-degree burn wounds. Dextran hydrogels are soft and pliable, offering opportunities to improve the management of burn wound treatment. We first developed a procedure to treat burn wounds on mice with dextran hydrogels. In this procedure, we followed clinical practice of wound excision to remove full-thickness burned skin, and then covered the wound with the dextran hydrogel and a dressing layer. Our procedure allows the hydrogel to remain intact and securely in place during the entire healing period, thus offering opportunities to simplify the management of burn wound treatment. A 3-week comparative study indicated that dextran hydrogel promoted dermal regeneration with complete skin appendages. The hydrogel scaffold facilitated early inflammatory cell infiltration that led to its rapid degradation, promoting the infiltration of angiogenic cells into the healing wounds. Endothelial cells homed into the hydrogel scaffolds to enable neovascularization by day 7, resulting in an increased blood flow significantly greater than treated and untreated controls. By day 21, burn wounds treated with hydrogel developed a mature epithelial structure with hair follicles and sebaceous glands. After 5 weeks of treatment, the hydrogel scaffolds promoted new hair growth and epidermal morphology and thickness similar to normal mouse skin. Collectively, our evidence shows that customized dextran-based hydrogel alone, with no additional growth factors, cytokines, or cells, promoted remarkable neovascularization and skin regeneration and may lead to novel treatments for dermal wounds. PMID:22171002

  2. Dextran hydrogel scaffolds enhance angiogenic responses and promote complete skin regeneration during burn wound healing.

    PubMed

    Sun, Guoming; Zhang, Xianjie; Shen, Yu-I; Sebastian, Raul; Dickinson, Laura E; Fox-Talbot, Karen; Reinblatt, Maura; Steenbergen, Charles; Harmon, John W; Gerecht, Sharon

    2011-12-27

    Neovascularization is a critical determinant of wound-healing outcomes for deep burn injuries. We hypothesize that dextran-based hydrogels can serve as instructive scaffolds to promote neovascularization and skin regeneration in third-degree burn wounds. Dextran hydrogels are soft and pliable, offering opportunities to improve the management of burn wound treatment. We first developed a procedure to treat burn wounds on mice with dextran hydrogels. In this procedure, we followed clinical practice of wound excision to remove full-thickness burned skin, and then covered the wound with the dextran hydrogel and a dressing layer. Our procedure allows the hydrogel to remain intact and securely in place during the entire healing period, thus offering opportunities to simplify the management of burn wound treatment. A 3-week comparative study indicated that dextran hydrogel promoted dermal regeneration with complete skin appendages. The hydrogel scaffold facilitated early inflammatory cell infiltration that led to its rapid degradation, promoting the infiltration of angiogenic cells into the healing wounds. Endothelial cells homed into the hydrogel scaffolds to enable neovascularization by day 7, resulting in an increased blood flow significantly greater than treated and untreated controls. By day 21, burn wounds treated with hydrogel developed a mature epithelial structure with hair follicles and sebaceous glands. After 5 weeks of treatment, the hydrogel scaffolds promoted new hair growth and epidermal morphology and thickness similar to normal mouse skin. Collectively, our evidence shows that customized dextran-based hydrogel alone, with no additional growth factors, cytokines, or cells, promoted remarkable neovascularization and skin regeneration and may lead to novel treatments for dermal wounds.

  3. Estimating the time and temperature relationship for causation of deep-partial thickness skin burns.

    PubMed

    Abraham, John P; Plourde, Brian; Vallez, Lauren; Stark, John; Diller, Kenneth R

    2015-12-01

    The objective of this study is to develop and present a simple procedure for evaluating the temperature and exposure-time conditions that lead to causation of a deep-partial thickness burn and the effect that the immediate post-burn thermal environment can have on the process. A computational model has been designed and applied to predict the time required for skin burns to reach a deep-partial thickness level of injury. The model includes multiple tissue layers including the epidermis, dermis, hypodermis, and subcutaneous tissue. Simulated exposure temperatures ranged from 62.8 to 87.8°C (145-190°F). Two scenarios were investigated. The first and worst case scenario was a direct exposure to water (characterized by a large convection coefficient) with the clothing left on the skin following the exposure. A second case consisted of a scald insult followed immediately by the skin being washed with cool water (20°C). For both cases, an Arrhenius injury model was applied whereby the extent and depth of injury were calculated and compared for the different post-burn treatments. In addition, injury values were compared with experiment data from the literature to assess verification of the numerical methodology. It was found that the clinical observations of injury extent agreed with the calculated values. Furthermore, inundation with cool water decreased skin temperatures more quickly than the clothing insulating case and led to a modest decrease in the burn extent.

  4. Survey of early complications of primary skin graft and secondary skin graft (delayed) surgery after resection of burn waste in hospitalized burn patients.

    PubMed

    Enshaei, A; Masoudi, N

    2014-09-18

    Burning is the second most common cause of home injuries in Iran that is often the cause of conflicts between children and young adults. Burning can lead to early and late complications that scar and contracture are the most common. Burn waste treatment is done by two methods: excision and then skin graft after the formation of granulation tissue; and excision and graft simultaneously that in this study, these two methods are compared. This was performed as a quasi-experimental analysis and retrospective study on all patients who were hospitalized for burn scar. All patients who have associated with weak eningimmune diseases such as diabetes, acquired immunodeficiency or congenital, taking steroids and patients undergoing chemotherapy etc. are excluded. The method of grafting in patients is primary graft procedure that was compared with patients who are treated using secondary graft. Data collected through review of patients' hospital and clinic chart. The mean burn percentage in the primary repair group was 14.4% and in the delayed repair group was 16.6%, respectively. The incidence of hematoma in both groups was zero. Skin necrosis and graft rejection and infection in the primary repair group was in 3.7% of patients and in the delayed repair group was in 1.2% of cases (P=0.5) CONCLUSION: Based on the findings of this study, no difference was observed between the two methods of excision and primary graft with delayed graft in the incidence of graft rejection. Due to the shorter treatment of primary graft and patient satisfaction and also according to the findings of this study excision and primary graft method seems appropriate method for treating old waste burning

  5. Skin regeneration after chemical burn under the effect of taxifolin-based preparations.

    PubMed

    Shubina, V S; Shatalin, Yu V

    2012-11-01

    We studied the effect of liposome preparation containing taxifolin oligomers and taxifolin conjugates with carbonyl compounds on skin regeneration after chemical burn. The preparations containing flavonoid conjugates intensified regeneration processes and reparation of hair follicles and sebaceous glands after chemical burn. The preparation based on taxifolin conjugate with acetaldehyde was most effective; its activity was comparable with that of the wound-healing preparation Olasol. Taxifolin conjugates with carbonyl compounds can be used for the creation of combined wound- and burn-healing preparations.

  6. Development of a Skin Burn Predictive Model adapted to Laser Irradiation

    NASA Astrophysics Data System (ADS)

    Sonneck-Museux, N.; Scheer, E.; Perez, L.; Agay, D.; Autrique, L.

    2016-12-01

    Laser technology is increasingly used, and it is crucial for both safety and medical reasons that the impact of laser irradiation on human skin can be accurately predicted. This study is mainly focused on laser-skin interactions and potential lesions (burns). A mathematical model dedicated to heat transfers in skin exposed to infrared laser radiations has been developed. The model is validated by studying heat transfers in human skin and simultaneously performing experimentations an animal model (pig). For all experimental tests, pig's skin surface temperature is recorded. Three laser wavelengths have been tested: 808 nm, 1940 nm and 10 600 nm. The first is a diode laser producing radiation absorbed deep within the skin. The second wavelength has a more superficial effect. For the third wavelength, skin is an opaque material. The validity of the developed models is verified by comparison with experimental results (in vivo tests) and the results of previous studies reported in the literature. The comparison shows that the models accurately predict the burn degree caused by laser radiation over a wide range of conditions. The results show that the important parameter for burn prediction is the extinction coefficient. For the 1940 nm wavelength especially, significant differences between modeling results and literature have been observed, mainly due to this coefficient's value. This new model can be used as a predictive tool in order to estimate the amount of injury induced by several types (couple power-time) of laser aggressions on the arm, the face and on the palm of the hand.

  7. Comparative assessment of cultured skin substitutes and native skin autograft for treatment of full-thickness burns.

    PubMed Central

    Boyce, S T; Goretsky, M J; Greenhalgh, D G; Kagan, R J; Rieman, M T; Warden, G D

    1995-01-01

    OBJECTIVE: Comparison of cultured skin substitutes (CSSs) and split-thickness autograft (STAG) was performed to assess whether the requirement for autologous skin grafts may be reduced in the treatment of massive burns. SUMMARY BACKGROUND DATA: Cultured skin substitutes consisting of collagen-glycosaminoglycan substrates populated with autologous fibroblasts and keratinocytes have been demonstrated to close full-thickness skin wounds in athymic mice and to express normal skin antigens after closure of excised wounds in burn patients. METHODS: Data were collected from 17 patients between days 2 and 14 to determine incidence of exudate, incidence of regrafting, coloration, keratinization, and percentage of site covered by graft (n = 17). Outcome was evaluated on an ordinal scale (0 = worst; 10 = best) beginning at day 14, with primary analyses at 28 days (n = 10) and 1 year (n = 4) for erythema, pigmentation, epithelial blistering, surface roughness, skin suppleness, and raised scar. RESULTS: Sites treated with CSSs had increased incidence of exudate (p = 0.06) and decreased percentage of engraftment (p < 0.05) compared with STAG. Outcome parameters during the first year showed no differences in erythema, blistering, or suppleness. Pigmentation was greater, scar was less raised, but regrafting was more frequent in CSS sites than STAG. No differences in qualitative outcomes were found after 1 year, and antibodies to bovine collagen were not detected in patient sera. CONCLUSIONS: These results suggest that outcome of engrafted CSSs is not different from STAG and that increased incidence of regrafting is related to decreased percentage of initial engraftment. Increased rates of engraftment of CSSs may lead to improved outcome for closure of burn wounds, allow greater availability of materials for grafting, and reduce requirements for donor skin autograft. Images Figure 1. Figure 2. PMID:8526581

  8. Early excision and skin grafting versus delayed skin grafting in deep hand burns (a randomised clinical controlled trial).

    PubMed

    Mohammadi, Ali Akbar; Bakhshaeekia, Ali Reza; Marzban, Saeed; Abbasi, Siroos; Ashraf, Ali Reza; Mohammadi, Mohammad Kazem; Toulide-Ie, Hamid Reza; Tavakkolian, Ahmad Reza

    2011-02-01

    Early excision and grafting (E&G) of burn wounds has been reported to decrease hospital stay, hospital costs and septic complications, and some purport reduced mortality while decreasing hospital costs. In today's practice, all burn wounds unlikely to achieve spontaneous closure within 3 weeks are excised and grafted. Early studies did not demonstrate dramatic differences in cosmetic or functional results. This is particularly true with burns of the face, hands and feet. In this study, early excision and skin grafting was compared with delayed skin grafting in deep hand burns. From September 2006 to February 2008, 50 patients with hand burns and average burn size less than 30% total body surface area (TBSA) deep second- and third-degree were randomly divided into early E&G group (group I) and delayed grafting group (group II). Gradual and careful limb and digit range of motion was started on about 10th-14th postoperative day. We used a questionnaire based on the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire to evaluate final functional outcome. Further, hypertrophic scar formation, contracture and deformities were followed and managed accordingly. The most common site of involvement was the metacarpophalangeal (MCP) joint with frequency of 39% and 40% in groups I and II, respectively. There were no statistically significant differences between both groups regarding deformity severity, scar formation, sensation, major activities and overall satisfaction. In treating burns of the hand, the primary goal should always be to restore the functionality of the hand. Although early surgery shortens the healing time and lessens the hospital stay, our results did not show any significant difference between these two methods regarding the function, scar formation, daily activity limitation and overall satisfaction. Copyright © 2010 Elsevier Ltd and ISBI. All rights reserved.

  9. Altered leukocyte delivery to specific and nonspecific inflammatory skin lesions following burn injury

    SciTech Connect

    Tchervenkov, J.I.; Latter, D.A.; Psychogios, J.; Christou, N.V.

    1988-05-01

    This study assessed the effect of burn trauma on the in vivo leukocyte cell delivery during the first 24 hr of the delayed type hypersensitivity (DTH) skin test reaction and a bacterial skin abscess. Inbred male Lewis rats sensitized to keyhole limpet hemocyanin (KLH) were given a 30% scald burn or sham burn. Three days later the animals were injected intradermally, at different sites, with 0.3 mg of KLH, 10(8) organisms of S. aureus 502A, and 0.1 cc of saline, at 2 to 24 hr. Leukocytes labelled with Indium-111 oxine(leu-111) were injected intravenously. In sham rats the peak leu-111 influx in the DTH reaction occurred at 2-4 hr while in the abscess it was biphasic with peaks at 3 hr and 6-8 hr. In burn trauma rats there was a markedly increased leu111 peak at 2 hr in both the DTH and abscess reactions followed by a significantly lower than normal leu111 delivery in the late (6-24) hours. This marked early leukocyte influx in burned rats was paralleled by a reduced DTH skin test lesion (8.2 +/- 1.1 mm to 4.2 +/- 1.1 mm) and an increased bacterial abscess (5.1 +/- 1.1 mm to 8.1 +/- 0.9 mm) post burn. There was a direct correlation between leukocyte cell delivery to a DTH reaction and a bacterial abscess (r8 = 0.69, Spearman rank; p less than 0.001). We conclude that burn trauma results in altered leukocyte delivery to inflammatory lesions and the DTH response can be used to assess the ability of a burn trauma host to recruit leukocytes at a site of infection.

  10. THz Imaging of Skin Burn: Seeing the Unseen—An Overview

    PubMed Central

    Dutta, Moumita; Bhalla, Amar S.; Guo, Ruyan

    2016-01-01

    Significance: This review article puts together all the studies performed so far in realizing terahertz (THz) spectra as a probing mechanism for burn evaluation, summarizing their experimental conditions, observations, outcomes, merits, and demerits, along with a comparative discussion of other currently used technologies to present the state of art in a condensed manner. The key features of this noncontact investigation technique like its precise burn depth analysis and the approaches it follows to convert the probed data into a quantitative measure have also been discussed in this article. Recent Advances: The current research developments in THz regime observed in device design technologies (like THz time domain spectrometer, quantum cascade THz lasers, THz single-photon detectors, etc.) and in understanding its unique properties (like nonionizing nature, penetrability through dry dielectrics, etc.) have motivated the research world to realize THz window as a potential candidate for burn detection. Critical Issues: Application of appropriate medical measure for burn injury is primarily subjective to proper estimation of burn depth. Tool modality distinguishing between partial and full-thickness burn contributing toward correct medical care is indeed awaited. Future Directions: The overview of THz imaging as a burn assessment tool as provided in this article will certainly help in further nurturing of this emerging diagnostic technique particularly in improving its detection and accompanied image processing methods so that the minute nuances captured by the THz beam can be correlated with the physiological–anatomical changes in skin structures, caused by burn, for better sensitivity, resolution, and quantitative analysis. PMID:27602253

  11. The use of skin substitutes and burn care-a survey.

    PubMed

    Wurzer, Paul; Keil, Hildegard; Branski, Ludwik K; Parvizi, Daryousch; Clayton, Robert P; Finnerty, Celeste C; Herndon, David N; Kamolz, Lars P

    2016-04-01

    The aim of our Internet survey was to assess the preferences of burn specialists who use skin substitutes in patients with burns covering 20% or more of their total body surface area (TBSA). An open, voluntary Internet-based cross-sectional survey was performed. Responses to 19 noncompulsory questions, and participant career and location information were collected. One hundred eleven specialists from 36 countries responded to our questionnaire. Sixty participants were located in Europe (54%), followed by 31 (28%) in North America, 15 (14%) in Asia, three (3%) in South America, one (1%) in Africa, and one (1%) in Australia. The importance of skin substitutes in medium-sized burns (covering 20%-60% TBSA) was rated as "essential" by 28% and "desirable" by 56% of the respondents. In severe burns >60% of TBSA, 81% of responders rated the use of skin substitutes as "essential" and 14% as "desirable". Skin substitutes were used in daily clinical practice by 96% of all participants. Biological and synthetic dressings were used by 53%. A majority (86%) think that biological dressings do not pose a risk to patients. Allografts represent the most frequently used wound coverage (51%), followed by xenografts (28%). All participants of the survey indicated that as of yet, there is no ideal skin substitute available. Split-thickness autografts still represent the most used wound cover for definitive treatment of severe burns. However, creation and implementation of an ideal skin substitute have yet to be achieved and therefore should be the focus of future work. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Post Junctional Sudomotor and Cutaneous Vascular Responses in Noninjured Skin Following Heat Acclimation in Burn Survivors.

    PubMed

    Pearson, James; Ganio, Matthew S; Schlader, Zachary J; Lucas, Rebekah A I; Gagnon, Daniel; Rivas, Eric; Davis, Scott L; Kowalske, Karen J; Crandall, Craig G

    Thermal tolerance is improved in burn survivors following 7 days of exercise heat acclimation. It is unknown whether post junctional sudomotor and/or cutaneous vascular adaptations in noninjured skin contribute to this improvement. Thirty-three burn survivors were stratified into moderately (17-40% BSA grafted, n = 19) and highly (>40% BSA grafted, n = 14) skin-grafted groups. Nine nonburned subjects served as controls. All subjects underwent a 7-day heat acclimation protocol, which improved thermal tolerance in all groups. Before and after this heat acclimation protocol, post junctional cutaneous vascular responses were assessed by administering increasing doses of sodium nitroprusside (SNP) and methacholine (MCh) using intradermal microdialysis in noninjured skin. MCh infusion was also used to assess post junctional responses in sudomotor function in noninjured skin. Cutaneous vascular responses to SNP and MCh were not different between pre- and post heat acclimation in either group of burn survivors (both P > .05). The maximal sweating rate to MCh increased post acclimation in the control group (0.41 ± 0.20 to 0.54 ± 0.21 mg·min·cm; P = .016) but was unchanged in both groups of burn survivors (both P > .05). The number of sweat glands activated during the highest dose of MCh was elevated in the >40% BSA-grafted group (49 ± 16 to 56 ± 18 glands·cm; P = .005) but was unchanged in control subjects and the <40% BSA-grafted group (both P > .05). Given that post junctional administration of MCh and SNP did not alter sweating or skin blood flow from noninjured skin of burn survivors, improved thermal tolerance in these individuals following heat acclimation is more likely a result of either an increased sweating efficiency or an increased neural drive for sweating.

  13. Early burn wound excision and skin grafting postburn trauma restores in vivo neutrophil delivery to inflammatory lesions

    SciTech Connect

    Tchervenkov, J.I.; Epstein, M.D.; Silberstein, E.B.; Alexander, J.W.

    1988-12-01

    This study assessed the effect of early vs delayed postburn wound excision and skin grafting on the in vivo neutrophil delivery to a delayed-type hypersensitivity (DTH) reaction and a bacterial skin lesion (BSL). Male Lewis rats were presensitized to keyhole-limpet hemocyanin. Group 1 comprised sham controls. Groups 2 through 4 were given a 30% 3 degrees scald burn, but the burn wounds were excised, and skin was grafted on days 1, 3, and 7, respectively, after the burn. Group 5 comprised burn controls. Twelve days after burn trauma, all rats were injected at different intervals (during a 24-hour period) with a trio of intradermal injections of keyhole-limpet hemocyanin, Staphylococcus aureus 502A, and saline at different sites. In vivo neutrophil delivery to these dermal lesions was determined by injecting indium in 111 oxyquinoline-labeled neutrophils isolated from similarly treated groups of rats. Neutrophil delivery to DTH and BSL lesions was restored to normal by excision and skin grafting of the burn wound one day after burn trauma. Waiting three days after burn trauma to excise and skin graft the wound partially, but not completely, restored the in vivo neutrophil delivery to DTH and BSL lesions. Waiting one week to excise and skin graft a burn wound resulted in no improvement in neutrophil delivery to DTH and BSL dermal lesions. It was concluded that burn wound excision and skin grafting immediately after burn trauma restored in vivo neutrophil delivery to a BSL and DTH dermal lesion. This may, in part, explain the beneficial effect of early aggressive burn wound debridement in patients with burn injuries.

  14. Tests of Flammability of Cotton Fabrics and Expected Skin Burns in Microgravity

    NASA Technical Reports Server (NTRS)

    Cavanagh, Jane M.; Torvi, David A.; Gabriel, Kamiel S.; Ruff, Gary A.

    2004-01-01

    During a shuttle launch and other portions of space flight, astronauts wear specialized flame resistant clothing. However during most of their missions on board the Space Shuttle or International Space Station, astronauts wear ordinary clothing, such as cotton shirts and pants. As the behaviour of flames is considerably different in microgravity than under earth s gravity, fabrics are expected to burn in a different fashion in microgravity than when tested on earth. There is interest in determining how this change in burning behaviour may affect times to second and third degree burn of human skin, and how the results of standard fabric flammability tests conducted under earth s gravity correlate with the expected fire behaviour of textiles in microgravity. A new experimental apparatus was developed to fit into the Spacecraft Fire Safety Facility (SFSF), which is used on NASA s KC-135 low gravity aircraft. The new apparatus was designed to be similar to the apparatus used in standard vertical flammability tests of fabrics. However, rather than using a laboratory burner, the apparatus uses a hot wire system to ignite 200 mm high by 80 mm wide fabric specimens. Fabric temperatures are measured using thermocouples and/or an infrared imaging system, while flame spread rates are measured using real time observations or video. Heat flux gauges are placed between 7 and 13 mm away from the fabric specimen, so that heat fluxes from the burning fabric to the skin can be estimated, along with predicted times required to produce skin burns.

  15. A porcine model of full-thickness burn, excision and skin autografting

    PubMed Central

    Branski, Ludwik K.; Mittermayr, Rainer; Herndon, David N.; Norbury, William B.; Masters, Oscar E.; Hofmann, Martina; Traber, Daniel L.; Redl, Heinz; Jeschke, Marc G.

    2008-01-01

    Acute burn wounds often require early excision and adequate coverage to prevent further hypothermia, protein and fluid losses, and the risk of infection. Meshed autologous skin grafts are generally regarded as the standard treatment for extensive full-thickness burns. Graft take and rate of wound healing, however, depend on several endogenous factors. This paper describes a standardized reproducible porcine model of burn and skin grafting which can be used to study the effects of topical treatments on graft take and re-epithelialization. Procedures provide a protocol for successful porcine burn wound experiments with special focus on pre-operative care, anesthesia, burn allocation, excision and grafting, postoperative treatment, dressing application, and specimen collection. Selected outcome measurements include percent area of wound closure by planimetry, wound assessment using a clinical assessment scale, and histological scoring. The use of this standardized model provides burn researchers with a valuable tool for the comparison of different topical drug treatments and dressing materials in a setting that closely mimics clinical reality. PMID:18617332

  16. A porcine model of full-thickness burn, excision and skin autografting.

    PubMed

    Branski, Ludwik K; Mittermayr, Rainer; Herndon, David N; Norbury, William B; Masters, Oscar E; Hofmann, Martina; Traber, Daniel L; Redl, Heinz; Jeschke, Marc G

    2008-12-01

    Acute burn wounds often require early excision and adequate coverage to prevent further hypothermia, protein and fluid losses, and the risk of infection. Meshed autologous skin grafts are generally regarded as the standard treatment for extensive full-thickness burns. Graft take and rate of wound healing, however, depend on several endogenous factors. This paper describes a standardized reproducible porcine model of burn and skin grafting which can be used to study the effects of topical treatments on graft take and re-epithelialization. Procedures provide a protocol for successful porcine burn wound experiments with special focus on pre-operative care, anesthesia, burn allocation, excision and grafting, postoperative treatment, dressing application, and specimen collection. Selected outcome measurements include percent area of wound closure by planimetry, wound assessment using a clinical assessment scale, and histological scoring. The use of this standardized model provides burn researchers with a valuable tool for the comparison of different topical drug treatments and dressing materials in a setting that closely mimics clinical reality.

  17. The evolution of acute burn care - retiring the split skin graft.

    PubMed

    Greenwood, J E

    2017-07-01

    The skin graft was born in 1869 and since then, surgeons have been using split skin grafts for wound repair. Nevertheless, this asset fails the big burn patient, who deserves an elastic, mobile and robust outcome but who receives the poorest possible outcome based on donor site paucity. Negating the need for the skin graft requires an autologous composite cultured skin and a material capable of temporising the burn wound for four weeks until the composite is produced. A novel, biodegradable polyurethane chemistry has been used to create two such products. This paper describes the design, production, optimisation and evaluation of several iterations of these products. The evaluation has occurred in a variety of models, both in vitro and in vivo, employing Hunterian scientific principles, and embracing Hunter's love and appreciation of comparative anatomy. The process has culminated in significant human experience in complex wounds and extensive burn injury. Used serially, the products offer robust and elastic healing in deep burns of any size within 6 weeks of injury.

  18. [Combination of a universal antidote and temporary skin substitute for chemical burns: Extended case report].

    PubMed

    Liodaki, E; Schopp, B E; Lindert, J; Krämer, R; Kisch, T; Mailänder, P; Stang, F

    2015-09-01

    In this article we describe our experiences in the treatment of chemical burns with Diphoterine(®) solution and Suprathel(®) as a temporary skin substitute material, a treatment which in the past was not commonly used for this pattern of injuries. In the study period from October 2012 to December 2013 we treated five patients (four male and one female including two children and three adults) with chemical burns by decontamination with Diphoterine(®) and wound covering with Suprathel(®). The control group included five patients with similar injury patterns who were treated with Diphoterine(®) and occlusive wound dressings. No wound infections occurred in any of the five cases and no interactions were observed between Suprathel(®) and the chemical substance involved. In four cases the skin areas with IIa-IIb degree damage showed good wound healing and only slight scarring in the follow-up after 3 months and one of the five patients had to be treated surgically. Suprathel(®) can be used as a temporary skin substitute for the treatment of skin burns and is also available for the treatment of chemical burns.

  19. Ingestion of white spirit resulting in perineal skin burns: a case report and review of the literature.

    PubMed

    Vanhoucke, Joke; Buylaert, Walter; Colpaert, Kirsten; De Paepe, Peter

    2017-03-02

    In the literature, possible systemic effects on health of inhalation or ingestion of white spirit are well described. Only a few case reports discuss the toxic skin effects that can occur following massive ingestion. Ingestion of large amounts of white spirit produces a watery diarrhoea with a high concentration of white spirit, resulting in perineal skin burns when there is prolonged contact. We describe a patient who developed partial thickness perineal skin burns after ingestion of white spirit and review the literature. The present data indicate that conservative therapy of the skin burns is recommended.

  20. Evaluation of hand function after early excision and skin grafting of burns versus delayed skin grafting: a randomized clinical trial.

    PubMed

    Omar, Mohammed T Ahmed; Hassan, Ahmed A

    2011-06-01

    Thermal injury of the hand is characterized by disfigurement and deformity with marked problems because the patient is no longer able to perform the daily living activities and function at school or work. Early excision and grafting (E&G) were introduced to decrease hospital stay, hospital cost, and septic complications and to eliminate burn toxins. In this study, E&G was compared with delayed skin grafting in deep hand burns. 40 patients with deep second- and third- degree hand burns with average burn size less than 30% total body surface area (TBSA) were randomly divided into E&G group and delayed grafting group. All hands in both groups were subjected to pre and post operative program of physiotherapy. Measurement of total active motion (TAM) of each digit and grip strength was recorded pre and post operative. Hand function using Jebsen-Taylor hand function test (JTHFT) was recorded three months after operation in both groups. There were statistically significant differences in both groups regarding to TAM, hand grip strength and Jebsen-Taylor hand function test favoring the E&G group. The study concluded that early excision and skin grafting with physiotherapy gave better results than delayed grafting in terms of preservation of hand function and shortened hospital stay. Copyright © 2010 Elsevier Ltd and ISBI. All rights reserved.

  1. An Exploration of Molecular Correlates Relevant to Radiation Combined Skin-Burn Trauma

    PubMed Central

    Islam, Aminul; Ghimbovschi, Svetlana; Zhai, Min; Swift, Joshua M.

    2015-01-01

    Background Exposure to high dose radiation in combination with physical injuries such as burn or wound trauma can produce a more harmful set of medical complications requiring specialist interventions. Currently these interventions are unavailable as are the precise biomarkers needed to help both accurately assess and treat such conditions. In the present study, we tried to identify and explore the possible role of serum exosome microRNA (miRNA) signatures as potential biomarkers for radiation combined burn injury (RCBI). Methodology Female B6D2F1/J mice were assigned to four experimental groups (n = 6): sham control (SHAM), burn injury (BURN), radiation injury (RI) and combined radiation skin burn injury (CI). We performed serum multiplex cytokine analysis and serum exosome miRNA expression profiling to determine novel miRNA signatures and important biological pathways associated with radiation combined skin-burn trauma. Principal Findings Serum cytokines, IL-5 and MCP-1, were significantly induced only in CI mice (p<0.05). From 890 differentially expressed miRNAs identified, microarray analysis showed 47 distinct miRNA seed sequences significantly associated with CI mice compared to SHAM control mice (fold change ≥ 1.2, p<0.05). Furthermore, only two major miRNA seed sequences (miR-690 and miR-223) were validated to be differentially expressed for CI mice specifically (fold change ≥ 1.5, p<0.05). Conclusions Serum exosome miRNA signature data of adult mice, following RCBI, provides new insights into the molecular and biochemical pathways associated with radiation combined skin-burn trauma in vivo. PMID:26247844

  2. Utilities of scrotal flap for reconstruction of penile skin defects after severe burn injury.

    PubMed

    Guo, Le; Zhang, Minghua; Zeng, Jizhang; Liang, Pengfei; Zhang, Pihong; Huang, Xiaoyuan

    2017-06-06

    In the present study, we aimed to present our experience of an effective two-stage surgical approach using scrotal skin flap for patients with penile skin defects following severe burn injury. A total of 17 patients with penile skin defects underwent scheduled two-stage reconstruction using scrotal skin flap from January 2004 to October 2016. Patients, who were selected as eligible candidates for scrotal flap, exhibited a wide range of indications, including iatrogenic injuries (e.g., diathermy treatment after circumcision), scalding, flame injuries and electrical burns. During the first stage, the denuded penis secondary to debridement was temporally embedded in scrotal skin flap through an intrascrotal tunnel created between the skin and darto's fascia. During the second stage, the skin around the penis was separated and divided from the scrotum after incising the scrotal skin at the ventral penile base. After a mean follow-up of 30 months, the reconstructed penises yielded satisfactory aesthetic outcomes and maintained erectile function. The mean age of patients was 35 years (19-55 years), and the median follow-up was 30 months (12-60 months). No major perioperative complication occurred except for dehiscence of scrotal skin after 2nd stage in three patients, and split-thickness skin grafts were applied for recovery of scrotum. Of 17 cases, 15 patients (88.2%) were in satisfactory cosmetic appearance. All patients regained penile sensation and normal voiding function in standing position. The International Index of Erectile Function (IIEF) was used to assess sexual function, with 13 patients (76.5%) reported normal erectile function, while the rest 4 reported mild erectile dysfunction. With regards to intercourse satisfaction domain, encouraging results indicated a total of 17 patients resumed sexual intercourse after surgery. In overall satisfaction domain, 11/17 (64.7%) reported a satisfaction from "very" to "moderately" with their overall sex life and

  3. Light attenuation in rat skin following low level laser therapy on burn healing process

    NASA Astrophysics Data System (ADS)

    Teixeira Silva, Daniela Fátima; Simões Ribeiro, Martha

    2010-04-01

    Low-level laser therapy (LLLT) is commonly used to accelerate wound healing. Besides, the technique of imaging the light distribution inside biological tissues permits us to understand several effects about light-tissue interaction. The purpose of this study was to determine the relative attenuation coefficient of the light intensity in healthy and burned skin rats during cutaneous repair following LLLT or not. Two burns about 6mm in diameter were cryogenerated using liquid N2 on the back of 15 rats. Lesion L was irradiated by a He-Ne laser (λ= 632.8nm) and fluence 1.0J/cm2; Lesion C was control and received sham irradiation. A healthy skin area (H) was also analyzed. The lesions were irradiated at days 3, 7, 10 and 14 post-burning. The animals were euthanized at days 3, 10 and 31 and skin samples were carefully removed and placed between two microscope slides, spaced by z= 1mm. A laser beam irradiated the sandwiched tissue from epidermis to dermis. A CCD camera was placed orthogonal to the beam path and it photographed the distribution of the scattered light. The light decay occurred according to the Beer's Law. Significance was accepted at p <0.01 by using t-Student test. Our results show that the light decay along any direction was close to an exponential. Burned skin samples presented decay significantly faster than healthy skin samples. Besides, attenuation coefficient changed during burning healing comparing treated and control lesions. These findings suggest that the relative attenuation coefficient is a suitable parameter to optimize LLLT during wound healing.

  4. The use of physical hydrogels of chitosan for skin regeneration following third-degree burns.

    PubMed

    Boucard, Nadège; Viton, Christophe; Agay, Diane; Mari, Eliane; Roger, Thierry; Chancerelle, Yves; Domard, Alain

    2007-08-01

    Skin repair is an important field of the tissue engineering, especially in the case of extended third-degree burns, where the current treatments are still insufficient in promoting satisfying skin regeneration. Bio-inspired bi-layered physical hydrogels only constituted of chitosan and water were processed and applied to the treatment of full-thickness burn injuries. The aim of the study was at assessing whether this material was totally accepted by the host organism and allowed in vivo skin reconstruction of limited area third-degree burns. A first layer constituted of a rigid protective gel ensured good mechanical properties and gas exchanges. A second soft and flexible layer allowed the material to follow the geometry of the wound and ensured a good superficial contact. To compare, highly viscous solutions of chitosan were also considered. Veterinary experiments were performed on pig's skins and biopsies at days 9, 17, 22, 100 and 293, were analysed by histology and immuno-histochemistry. Only one chitosan material was used for each time. All the results showed that chitosan materials were well tolerated and promoted a good tissue regeneration. They induced inflammatory cells migration and angiogenetic activity favouring a high vascularisation of the neo-tissue. At day 22, type I and IV collagens were synthesised under the granulation tissue and the formation of the dermal-epidermal junction was observed. After 100 days, the new tissue was quite similar to a native skin, especially by its aesthetic aspect and its great flexibility.

  5. Concise review: tissue-engineered skin and nerve regeneration in burn treatment.

    PubMed

    Blais, Mathieu; Parenteau-Bareil, Rémi; Cadau, Sébastien; Berthod, François

    2013-07-01

    Burns not only destroy the barrier function of the skin but also alter the perceptions of pain, temperature, and touch. Different strategies have been developed over the years to cover deep and extensive burns with the ultimate goal of regenerating the barrier function of the epidermis while recovering an acceptable aesthetic aspect. However, patients often complain about a loss of skin sensation and even cutaneous chronic pain. Cutaneous nerve regeneration can occur from the nerve endings of the wound bed, but it is often compromised by scar formation or anarchic wound healing. Restoration of pain, temperature, and touch perceptions should now be a major challenge to solve in order to improve patients' quality of life. In addition, the cutaneous nerve network has been recently highlighted to play an important role in epidermal homeostasis and may be essential at least in the early phase of wound healing through the induction of neurogenic inflammation. Although the nerve regeneration process was studied largely in the context of nerve transections, very few studies have been aimed at developing strategies to improve it in the context of cutaneous wound healing. In this concise review, we provide a description of the characteristics of and current treatments for extensive burns, including tissue-engineered skin approaches to improve cutaneous nerve regeneration, and describe prospective uses for autologous skin-derived adult stem cells to enhance recovery of the skin's sense of touch.

  6. Demographic characteristics and outcome of burn patients requiring skin grafts: a tertiary hospital experience

    PubMed Central

    Shlash, Saud Othman Al; Madani, Jamal Omran Al; Deib, Jamal Ismail El; Alsubhi, Fatemah Suliman; Saifi, Sara Saud Al; Helmi, Ayman Mohammed Adel; Al-Mutairi, Sultan Khalaf; Khurram, Javed Akhtar

    2016-01-01

    Split thickness skin graft (STSG) and full thickness skin graft (FTSG) are the integral part of burn wound management. However the impact of these graft types on the outcome still remain a matter of controversy. The purpose of this study was to determine the demographic characteristics and outcome of graft surgery of the patients undergone STSG and FTSG at Plastic Surgery Department of Prince Sultan Military Medical City (PSMMC), Riyadh, Kingdom of Saudi Arabia. This retrospective study included 85 burn patients who received STSG (56 cases) and FTSG (29 cases) at PSMMC during 2010-2015. Demographic characteristics (age, gender, etiology of burn, and area of burn) and outcome (graft loss, graft contraction, skin pigmentation, altered sensation, infection rate and duration of hospital stay) were recorded among the patients who received STSG or FTSG. Out of 85 patients 50 patients were male and 35 female with a ratio of 1.42:1. The patients under the age of 10 years comprised the largest burn group with 28 cases (32.9%) out of total 85 patients. The number of patients above the age of 30 years was relatively smaller. Flame (49.3%) and scald (27%) burns constituted the majority of burn cases. The incidence of contraction among STSG (12.5%) and in FTSG (17.2%) cases was similar. Altered sensation was observed in 7.05% of STSG patients and 13.7% of FTSG cases. Loss of graft was observed in 16% of STSG and 20.6% of FTSG patients. The pigmentation was quite similar in STSG (21.4%) and FTSG (24. 1%). The hospitalization time in FTSG (28 days) patients was also comparable with STSG (26.9 days) group. This study showed that majority of the skin graft cases at PSMMC were male under the age of 30 years mostly affected by flame or scald burns. The outcome following STSG and FTSG surgery was comparable with no significant advantage of one over the other. It may be deduced that both STSG and FTSG have relative merits and demerits and either of these grafting procedure may be

  7. Clinical application and viability of cryopreserved cadaveric skin allografts in severe burn: a retrospective analysis.

    PubMed

    Cleland, Heather; Wasiak, Jason; Dobson, Hannah; Paul, Michelle; Pratt, George; Paul, Eldho; Herson, Marisa; Akbarzadeh, Shiva

    2014-02-01

    Cadaveric cutaneous allografts are used in burns surgery both as a temporary bio-dressing and occasionally as definitive management of partial thickness burns. Nonetheless, limitations in the understanding of the biology of these grafts have meant that their role in burns surgery continues to be controversial. A review of all patients suffering 20% or greater total body surface area (TBSA) burns over an eight year period that received cadaveric allografts were identified. To investigate whether tissue viability plays a role in engraftment success, five samples of cryopreserved cadaveric cutaneous allograft processed at the Donor Tissue Bank of Victoria (DTBV) were submitted to our laboratory for viability analysis using two methods of Trypan Blue Exclusion and tetrazolium salt (MTT) assays. During the study period, 36 patients received cadaveric allograft at our institution. The average total burn surface area (TBSA) for this group of patients was 40% and all patients received cadaveric skin as a temporizing measure prior to definitive grafting. Cadaveric allograft was used in complicated cases such as wound contamination, where synthetic dressings had failed. Viability tests showed fewer than 30% viability in processed allografts when compared to fresh skin following the thawing process. However, the skin structure in the frozen allografts was histologically well preserved. Cryopreserved cutaneous cadaveric allograft has a positive and definite role as an adjunct to conventional dressing and grafting where available, particularly in patients with large TBSA burns. The low viability of cryopreserved specimens processed at DTBV suggests that cell viability in cadaveric allograft may not be essential for its clinical function as a wound dressing or even as permanent dermal substitute. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  8. The transfer of technology to measure skin burn depth in humans

    NASA Technical Reports Server (NTRS)

    Yost, William T.; Cantrell, John H.

    1991-01-01

    Discussed here is the use of ultrasonic techniques originally used to locate cracks in metal structues to measure burn wound depth in humans. Acoustic impedance, performance tests, and the theoretical model are discussed. Measurements of skin burns on anesthetized pigs made with the the ultrasonic instrumentation were in agreement with diagnoses made by a physician, and subsequently confirmed by the healing process. Researchers felt that the concept proved useful in a clinical setting and that the instrument and concept were ready to extend to the manufacturer.

  9. In vivo imaging of dermal collagen in skin burn by collagen-sensitive second-harmonic-generation microscopy

    NASA Astrophysics Data System (ADS)

    Yasui, Takeshi; Tanaka, Ryosuke; Hase, Eiji; Fukushima, Shu-ichiro; Araki, Tsutomu

    2013-02-01

    Optical assessment of skin burns is possible with second-harmonic-generation (SHG) microscopy due to its high sensitivity to thermal denaturation of collagen molecules. In contrast to previous studies that were performed using excised tissue specimens ex vivo, in this study, we demonstrated in vivo observation of dermal collagen fibers in living rat burn models with SHG microscopy. We confirmed that changes in SHG vanishing patterns in the SHG images depended on the burn degree. The results imply that SHG microscopy can be used as a low-invasiveness, highly quantitative tool for skin burn assessment.

  10. Management of facial burns with a collagen/glycosaminoglycan skin substitute-prospective experience with 12 consecutive patients with large, deep facial burns.

    PubMed

    Klein, Matthew B; Engrav, Loren H; Holmes, James H; Friedrich, Jeffrey B; Costa, Beth A; Honari, Shari; Gibran, Nicole S

    2005-05-01

    Management of deep facial burns remains one of the greatest challenges in burn care. We have developed a protocol over the past 20 years for management of facial burns that includes excision and coverage with thick autograft. However, the results were not perfect. Deformities of the eyelids, nose and mouth as well as the prominence of skin graft junctures demonstrated the need to explore novel approaches. Integra has been used with success in the management of burns of the trunk and extremities. The purpose of this study was to prospectively evaluate the aesthetic outcome of the use of Integra for deep facial burns. Twelve consecutive patients underwent excision of large, deep facial burns and placement of Integra. Integra provides excellent color and minimally visible skin graft junctures. The texture is good but not as supple as thick autograft. Integra is not well suited for use in the coverage of eyelid burns due to the need to wait 2 weeks for adequate vascularization. In summary, thick autograft remains the gold standard for deep facial burns. However, for patients with extensive burns and limited donor sites, Integra provides an acceptable alternative.

  11. Spray-on-skin cells in burns: a common practice with no agreed protocol.

    PubMed

    Allouni, Ammar; Papini, Remo; Lewis, Darren

    2013-11-01

    Cultured epithelial autograft (CEA) has been used for skin coverage after burn wound excision since 1981. It is used in burn units and centres throughout the U.K.; however, there appears to be no agreed standards of practice. We aimed to investigate the experience and current practice with its usage in the management of acute burn injury. An online survey was sent to twenty-five burns consultants in the U.K., who are members of the British Burn Association. We received 14 responses. Rarely have the responders agreed to the same practice in most of the questions. Different choices were given by responders with regards the indications for cell culture, techniques used, primary and secondary dressings used, first wound review timing, and measures used to evaluate outcomes. In the current economic environment, the NHS needs to rationalize services on the basis of cost effectiveness. CEA is an expensive procedure that requires an adequately sterile laboratory, special equipments and highly experienced dedicated staff. When dealing with expensive management options, it is important to have an agreed protocol that can form the standard that can be referred to when auditing practices and results to improve burn management and patients' care. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  12. Incidence and Factors Predicting Skin Burns at the Site of Indifferent Electrode during Radiofrequency Catheter Ablation of Cardiac Arrhythmias

    PubMed Central

    Ibrahim, Hussain; Finta, Bohuslav; Rind, Jubran

    2016-01-01

    Radiofrequency catheter ablation (RFA) has become a mainstay for treatment of cardiac arrhythmias. Skin burns at the site of an indifferent electrode patch have been a rare, serious, and likely an underreported complication of RFA. The purpose of this study was to determine the incidence of skin burns in cardiac RFA procedures performed at one institution. Also, we wanted to determine the factors predicting skin burns after cardiac RFA procedures at the indifferent electrode skin pad site. Methods. A retrospective case control study was performed to compare the characteristics in patients who developed skin burns in a 2-year period. Results. Incidence of significant skin burns after RFA was 0.28% (6/2167). Four of the six patients were female and all were Caucasians. Four controls for every case were age and sex matched. Burn patients had significantly higher BMI, procedure time, and postprocedure pain, relative to control subjects (p < 0.05, one-tailed testing). No one in either group had evidence of dispersive pad malattachment. Conclusions. Our results indicate that burn patients had higher BMI and longer procedure times compared to control subjects. These findings warrant further larger studies on this topic. PMID:27213077

  13. The "stegosaurus" dressing: a simple and effective method of securing skin grafts in the burn patient.

    PubMed

    Fullerton, J K; Smith, C E; Milner, S M

    2000-10-01

    Skin grafts are vulnerable to shear stress, infection, and hematoma formation during the postoperative period, all of which reduce graft survival. Various methods of dressing application and materials have been described in the literature to try and prevent graft loss. The authors report the use of the "stegosaurus dressing" (Eggcrate Pad) in 6 patients to secure skin grafts. Patients chosen were those who were either noncompliant or who sustained burns in unfavorable anatomic sites. All grafts demonstrated complete take without infection and hematoma formation. This foam dressing provides an even pressure to the recipient bed, absorbs drainage, and protects the graft from shearing. It also demonstrates the versatility to be used in difficult nonburn skin graft areas. The stegosaurus dressing is easy to apply, inexpensive, and provides a very secure dressing over the skin graft.

  14. Contracture of skin graft in human burns: effect of artificial dermis.

    PubMed

    Hur, Gi-Yeun; Seo, Dong-Kook; Lee, Jong-Wook

    2014-12-01

    Skin grafts with an artificial dermis have been widely used as a part of the efforts to minimize contractures and reduce donor-site scars. We conducted a prospective randomized clinical trial to study the effect of a dermal substitute by measuring the size of the graft after surgery for months. The artificial dermis (Matriderm, Dr. Suwelack Skin and Health Care AG, Billerbeck, Germany) was applied in combination with a split-thickness autograft in 40 patients with acute burn wounds or scar reconstruction. Demographic and medical data were collected on each patient. We directly measured the graft size by using a transparent two-ply film (Visitrak Grid, Smith & Nephew Wound Management, Inc, Largo, FL, USA) intraoperatively and 1, 2, 3, and 6 months postoperatively. For effective data comparison, the size of the graft at the time of surgery was taken to be "100%." Then, the size in each phase was estimated in percentage (%). During the 1st month, the average size was 89%. The figure decreased to 86% and 82% in the 2nd and 3rd months, respectively. In the 6th month, it slightly rebounded to 85% but failed to return to the original state. The size of patients with acute burns was smaller than the size of scar patients as follows: 85-91% in the 2nd month, 81-87% in the 3rd month, and 85-96% in the 6th month. This study examined the progress of skin grafts through the measurement of graft size in the human body. The grafted skin underwent contracture and remodeling for 3-6 months. In terms of skin contraction, an acute burn was more serious than scar reconstruction. The use of an artificial dermis that contains elastin is very effective from the functional and esthetic perspective by minimizing contractures and enhancing skin elasticity. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  15. [Role of skin substitutes in surgical repair of the sequelae of burn injuries].

    PubMed

    Dantzer, E

    2011-10-01

    The therapeutic management of the sequelae of deep burns always relies in principle on dermal-epidermal grafts. The latter, the price of which to pay is heavy scarring, cannot always be performed because the surface of skin available may not be sufficient. Research pathways have turned towards the creation of skin substitutes to minimise the scarring and improve the cosmetic quality of the grafts. We review the technical characteristics of collagen matrixes (Intégra(®) - Matriderm(®)) and their method of use. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  16. A 12-year retrospective study of non-burn skin loss (burn-like syndromes) at a tertiary burns unit in a developing country.

    PubMed

    Ugburo, A O; Temiye, E O; Ilombu, C A

    2008-08-01

    A retrospective study of the presentation, etiology, and prognosis of non-burn epidermal loss managed at the Lagos University Teaching Hospital Nigeria over a 12-year period. Admission records of patients managed for non-burn skin loss were retrieved from the medical records. Demographic details of the patients, the initial diagnosis, final diagnosis, treatment and outcome of treatment was noted. A total of 23 patients were identified, 17 (74%) had idiosyncratic drug reactions. Of this 17, 6 (26%) had Steven Johnson Syndrome, 6 (26%) had Steven Johnson Syndrome/toxic epidermal necrolysis while 5 (22%) presented with toxic epidermal necrolysis. Three of the five patients with toxic epidermal necrolysis died. The age range of patients with idiosyncratic adverse drug reactions was 2-28 years, mean, 10.18+/-1.44 years and male to female ratio of 1:1.83. The body surface area involved ranged from 8 to 78%; mean 26.65+/-6.08%. The agents suspected for the reactions were Co-trimoxazole (41.2%) and combination of Co-trimoxazole, and Fansidar (17.6%). Other conditions seen were two (9%) Staphylococcal Scalded Skin Syndrome, three (13%) had Necrotizing Faciitis, one of whom was HIV positive and died. One (4%) patient presented with pemphigus vulgaris. The presentation and management of the patients was discussed.

  17. Algorithm for Primary Full-thickness Skin Grafting in Pediatric Hand Burns.

    PubMed

    Park, Yang Seo; Lee, Jong Wook; Huh, Gi Yeun; Koh, Jang Hyu; Seo, Dong Kook; Choi, Jai Koo; Jang, Young Chul

    2012-09-01

    Pediatric hand burns are a difficult problem because they lead to serious hand deformities with functional impairment due to rapid growth during childhood. Therefore, adequate management is required beginning in the acute stage. Our study aims to establish surgical guidelines for a primary full-thickness skin graft (FTSG) in pediatric hand burns, based on long-term observation periods and existing studies. From January 2000 to May 2011, 210 patients underwent primary FTSG. We retrospectively studied the clinical course and treatment outcomes based on the patients' medical records. The patients' demographics, age, sex, injury site of the fingers, presence of web space involvement, the incidence of postoperative late deformities, and the duration of revision were critically analyzed. The mean age of the patients was 24.4 months (range, 8 to 94 months), consisting of 141 males and 69 females. The overall observation period was 6.9 years (range, 1 to 11 years) on average. At the time of the burn, 56 cases were to a single finger, 73 to two fingers, 45 to three fingers, and 22 to more than three. Among these cases, 70 were burns that included a web space (33.3%). During the observation, 25 cases underwent corrective operations with an average period of 40.6 months. In the volar area, primary full-thickness skin grafting can be a good indication for an isolated injured finger, excluding the web spaces, and injuries of less than three fingers including the web spaces. Also, in the dorsal area, full-thickness skin grafting can be a good indication. However, if the donor site is insufficient and the wound is large, split-thickness skin grafting can be considered.

  18. Effects of Topical Emu Oil on Burn Wounds in the Skin of Balb/c Mice

    PubMed Central

    Afshar, Mohammad; Ghaderi, Reza; Zardast, Mahmoud; Delshad, Parvin

    2016-01-01

    The goal of this study was to determine the effect of topical Emu oil on the healing of burn wounds and hair follicle restoration in superficial II-degree burns in the skin of Balb/c mice. Thirty-two male Balb/c mice with burns on the back of the neck were divided into two groups: The Emu oil group received topical Emu oil twice daily, whereas the control was left untreated. Skin biopsies were obtained on days 4, 7, 10, and 14 of the experiment. Then the specimens were viewed with Olympus SZX research microscope. The Emu oil treated burns were found to heal more slowly and inflammation lasted longer in this group. The number of hair follicles in the margins of the wounds increased through time in the Emu oil group compared to the control group. Also, the hair follicles in the Emu oil group were in several layers and seemed to be more active and mature. Moreover, Emu oil had a positive effect on fibrogenesis and synthesis of collagen. The findings indicate that although Emu oil delays the healing process, it has a positive effect on wound healing and it increases the number of hair follicles in the margins of the wound. PMID:27069472

  19. Expression of DNA repair genes in burned skin exposed to low-level red laser.

    PubMed

    Trajano, Eduardo Tavares Lima; Mencalha, Andre Luiz; Monte-Alto-Costa, Andréa; Pôrto, Luís Cristóvão; de Souza da Fonseca, Adenilson

    2014-11-01

    Although red laser lights lie in the region of non-ionizing radiations in the electromagnetic spectrum, there are doubts whether absorption of these radiations causes lesions in the DNA molecule. Our aim was to investigate the expression of the genes involved with base excision and nucleotide excision repair pathways in skin tissue submitted to burn injury and exposed to low-level red laser. Wistar rats were divided as follows: control group-rats burned and not irradiated, laser group-rats burned and irradiated 1 day after injury for five consecutive days, and later laser group-rats injured and treated 4 days after injury for five consecutive days. Irradiation was performed according to a clinical protocol (20 J/cm(2), 100 mW, continuous wave emission mode). The animals were sacrificed on day 10, and scarred tissue samples were withdrawn for total RNA extraction, complementary DNA (cDNA) synthesis, and evaluation of gene expression by quantitative polymerase chain reaction. Low-level red laser exposure (1) reduces the expression of APE1 messenger (mRNA), (2) increases the expression of OGG1 mRNA, (3) reduces the expression of XPC mRNA, and (4) increases the expression of XPA mRNA both in laser and later laser groups. Red laser exposure at therapeutic fluences alters the expression of genes related to base excision and nucleotide excision pathways of DNA repair during wound healing of burned skin.

  20. Effects of Topical Emu Oil on Burn Wounds in the Skin of Balb/c Mice.

    PubMed

    Afshar, Mohammad; Ghaderi, Reza; Zardast, Mahmoud; Delshad, Parvin

    2016-01-01

    The goal of this study was to determine the effect of topical Emu oil on the healing of burn wounds and hair follicle restoration in superficial II-degree burns in the skin of Balb/c mice. Thirty-two male Balb/c mice with burns on the back of the neck were divided into two groups: The Emu oil group received topical Emu oil twice daily, whereas the control was left untreated. Skin biopsies were obtained on days 4, 7, 10, and 14 of the experiment. Then the specimens were viewed with Olympus SZX research microscope. The Emu oil treated burns were found to heal more slowly and inflammation lasted longer in this group. The number of hair follicles in the margins of the wounds increased through time in the Emu oil group compared to the control group. Also, the hair follicles in the Emu oil group were in several layers and seemed to be more active and mature. Moreover, Emu oil had a positive effect on fibrogenesis and synthesis of collagen. The findings indicate that although Emu oil delays the healing process, it has a positive effect on wound healing and it increases the number of hair follicles in the margins of the wound.

  1. Accelerated healing of skin burns by anti-Gal/alpha-gal liposomes interaction.

    PubMed

    Galili, Uri; Wigglesworth, Kim; Abdel-Motal, Ussama M

    2010-03-01

    will be effective also in patients with burns and other skin wounds. Copyright (c) 2009 Elsevier Ltd and ISBI. All rights reserved.

  2. Free water content and monitoring of healing processes of skin burns studied by microwave dielectric spectroscopy in vivo.

    PubMed

    Hayashi, Yoshihito; Miura, Nobuhiro; Shinyashiki, Naoki; Yagihara, Shin

    2005-02-21

    We have investigated the dielectric properties of human skin in vivo at frequencies up to 10 GHz using a time-domain reflectometry method with open-ended coaxial probes. Since gamma-dispersion results from the reorientation of free water molecules, the free water content of skin is quantitatively determined by dielectric measurements. The free water content of finger skin increased by about 10% after soaking in 37 degrees C water for 30 min, and it systematically decreased again through the drying process, as expected. Thus this analytical method has been applied to the study of skin burns. The free water content of burned human cheek skin due to hydrofluoric acid was significantly lower than that of normal skin, and the burned skin recovered through the healing process. In the case of a human hand skin burn due to heat, although the free water content was almost the same as that of normal skin at the beginning, it decreased during the healing process for the first 10 days, then began to increase. Although the number of test subjects was one for each experiment, it was shown that free water content is a good indicator for evaluating skin health and can be well monitored by dielectric spectroscopy.

  3. Free water content and monitoring of healing processes of skin burns studied by microwave dielectric spectroscopy in vivo

    NASA Astrophysics Data System (ADS)

    Hayashi, Yoshihito; Miura, Nobuhiro; Shinyashiki, Naoki; Yagihara, Shin

    2005-02-01

    We have investigated the dielectric properties of human skin in vivo at frequencies up to 10 GHz using a time-domain reflectometry method with open-ended coaxial probes. Since γ-dispersion results from the reorientation of free water molecules, the free water content of skin is quantitatively determined by dielectric measurements. The free water content of finger skin increased by about 10% after soaking in 37 °C water for 30 min, and it systematically decreased again through the drying process, as expected. Thus this analytical method has been applied to the study of skin burns. The free water content of burned human cheek skin due to hydrofluoric acid was significantly lower than that of normal skin, and the burned skin recovered through the healing process. In the case of a human hand skin burn due to heat, although the free water content was almost the same as that of normal skin at the beginning, it decreased during the healing process for the first 10 days, then began to increase. Although the number of test subjects was one for each experiment, it was shown that free water content is a good indicator for evaluating skin health and can be well monitored by dielectric spectroscopy.

  4. Tests of Flammability of Cotton Fabrics and Expected Skin Burns in Microgravity

    NASA Technical Reports Server (NTRS)

    Cavanagh, Jane M.; Torvi, David A.; Gabriel, Kamiel S.; Ruff, Gary A.

    2004-01-01

    During a shuttle launch and other portions of space flight, astronauts wear specialized flame resistant clothing. However during most of their missions on board the Space Shuttle or International Space Station, astronauts wear ordinary clothing, such as cotton shirts and pants. As the behaviour of flames is considerably different in microgravity than under earth's gravity, fabrics are expected to burn in a different fashion in microgravity than when tested on earth. There is interest in determining how this change in burning behaviour may affect times to second and third degree burn of human skin, and how the results of standard fabric flammability tests conducted under earth's gravity correlate with the expected fire behaviour of textiles in microgravity. A new experimental apparatus was developed to fit into the Spacecraft Fire Safety Facility (SFSF), which is used on NASA's KC-135 low gravity aircraft. The new apparatus was designed to be similar to the apparatus used in standard vertical flammability tests of fabrics. However, rather than using a laboratory burner, the apparatus uses a hot wire system to ignite 200 mm high by 80 mm wide fabric specimens. Fabric temperatures are measured using thermocouples and/or an infrared imaging system, while flame spread rates are measured using real time observations or video. Heat flux gauges are placed between 7 and 13 mm away from the fabric specimen, so that heat fluxes from the burning fabric to the skin can be estimated, along with predicted times required to produce skin burns. In November of 2003, this new apparatus was used on the KC-135 aircraft to test cotton and cotton/polyester blend fabric specimens in microgravity. These materials were also been tested using the same apparatus in 1-g, and using a standard vertical flammability test that utilizes a flame. In this presentation, the design of the test apparatus will be briefly described. Examples of results from the KC-135 tests will be provided, including

  5. Tests of Flammability of Cotton Fabrics and Expected Skin Burns in Microgravity

    NASA Technical Reports Server (NTRS)

    Cavanagh, Jane M.; Torvi, David A.; Gabriel, Kamiel S.; Ruff, Gary A.

    2004-01-01

    During a shuttle launch and other portions of space flight, astronauts wear specialized flame resistant clothing. However during most of their missions on board the Space Shuttle or International Space Station, astronauts wear ordinary clothing, such as cotton shirts and pants. As the behaviour of flames is considerably different in microgravity than under earth's gravity, fabrics are expected to burn in a different fashion in microgravity than when tested on earth. There is interest in determining how this change in burning behaviour may affect times to second and third degree burn of human skin, and how the results of standard fabric flammability tests conducted under earth's gravity correlate with the expected fire behaviour of textiles in microgravity. A new experimental apparatus was developed to fit into the Spacecraft Fire Safety Facility (SFSF), which is used on NASA's KC-135 low gravity aircraft. The new apparatus was designed to be similar to the apparatus used in standard vertical flammability tests of fabrics. However, rather than using a laboratory burner, the apparatus uses a hot wire system to ignite 200 mm high by 80 mm wide fabric specimens. Fabric temperatures are measured using thermocouples and/or an infrared imaging system, while flame spread rates are measured using real time observations or video. Heat flux gauges are placed between 7 and 13 mm away from the fabric specimen, so that heat fluxes from the burning fabric to the skin can be estimated, along with predicted times required to produce skin burns. In November of 2003, this new apparatus was used on the KC-135 aircraft to test cotton and cotton/polyester blend fabric specimens in microgravity. These materials were also been tested using the same apparatus in 1-g, and using a standard vertical flammability test that utilizes a flame. In this presentation, the design of the test apparatus will be briefly described. Examples of results from the KC-135 tests will be provided, including

  6. Burns

    MedlinePlus

    ... clothing, except clothing imbedded in the burn. Run cool - not cold - water over the burn or hold ... chemicals should be flushed off affected areas with cool running water for 20 minutes or longer or ...

  7. Burns

    MedlinePlus

    ... occur by direct or indirect contact with heat, electric current, radiation, or chemical agents. Burns can lead to ... is. The burn is caused by chemicals or electricity. The person shows signs of shock . The person ...

  8. Development of a Vascularized Skin Construct Using Adipose-Derived Stem Cells from Debrided Burned Skin

    DTIC Science & Technology

    2012-01-01

    markers . These results indicate that stem cells isolated from debrided skin can be used as a single autologous cell source to develop a vascularized skin...sensitivity was adjusted to collect a gated population of cells. Total percentage of cells staining positive for individual markers from the gated...within a collagen gel using adipogenic differentiation media. Early during the induction of differentiation, the dsASCs proliferate within collagen

  9. Transdermal treatment of the surgical and burned wound skin via phytochemical-capped gold nanoparticles.

    PubMed

    Lee, Jaewook; Kim, JiEun; Go, Jun; Lee, Jong Ho; Han, Dong-Wook; Hwang, DaeYoun; Lee, Jaebeom

    2015-11-01

    The biological activities and therapeutic potential of phytochemical-decorated Au nanoparticles (Phyto-AuNPs) were investigated through the treatment of Phyto-AuNPs on the dorsal skin of rats via transdermal drug delivery process in order to regenerate surgical wounded and burned skin. Two different Phyto-AuNPs were applied to the dorsal skin: gallic acid-isoflavone--covered AuNPs (GI-AuNPs) and protocatechuic acid-isoflavone--covered AuNPs (PI-AuNPs). From the biological activity monitoring, it has been resulted that 5-fold thicker epidermis (ER), 50% reduction of metalloproteinase-1 (MMP-1) level, 3-fold higher superoxide dismutase (SOD) activity were obtained in the Phyto-AuNP-treated group, compared with a vehicle group (deionized water (DI-water) treatment). Moreover, the Phyto-AuNPs treatment on the surgical and burn damaged Sprague-Dawley (SD) rats induced higher expression of vascular endothelial growth factor (VEGF) and angiopoietin-2 (Ang-2). It would be plausible that antioxidant property of Phyto-AuNPs assist the acceleration and activation of biomolecules in the healing mechanism, where Phyto-AuNPs can be potential candidates for skin regeneration and wound healing.

  10. Use of split thickness plantar skin grafts in the treatment of hyperpigmented skin-grafted fingers and palms in previously burned patients.

    PubMed

    Moon, Suk-Ho; Lee, So-Young; Jung, Sung-No; Kim, Sang-Wha; Seo, Bommie F; Kwon, Ho; Sohn, Won-Il

    2011-06-01

    Palmar and finger burns are often seen in children, and are usually as a result of contact burns. Some patients with deep hand burns are treated with full-thickness or split-thickness skin grafts. Skin graft is commonly used for hand reconstruction. However, the grafted skin would be more pigmented than the adjacent skin and different from skin texture. 19 patients who showed hyperpigmentation after skin graft of finger and palm were treated. They all were injured by hand burns. We performed mechanical dermabrasion of the hyperpigmentation scar and application of a split thickness skin harvested from medial aspect of plantar of foot. Patients were asked about their level of satisfaction with the procedure and scar appearance was assessed using a five-point Likert scale. Also scar appearances were assessed using a Vancouver Scar Scale (VSS). The grafts were completely taken in all 19 patients. The color of the graft became similar to adjacent tissue. 15 patients were very satisfied, and four patients were relatively satisfied. The average score of the patients postoperative appearance improvement was 4.5 (improved to significantly improved postoperative appearance). Average VSS score was improved from 9.53 to 2.53. There was no hypertrophic scar on plantar donor site. The technique of the split-thickness plantar skin graft after mechanical dermabrasion is simple and provided good results in both color and texture for the patients who showed hyperpigmentation after grafting.

  11. Randomized, Paired-Site Comparison of Autologous Engineered Skin Substitutes and Split-Thickness Skin Graft for Closure of Extensive, Full-Thickness Burns.

    PubMed

    Boyce, Steven T; Simpson, Peggy S; Rieman, Mary T; Warner, Petra M; Yakuboff, Kevin P; Bailey, J Kevin; Nelson, Judith K; Fowler, Laura A; Kagan, Richard J

    Stable closure of full-thickness burn wounds remains a limitation to recovery from burns of greater than 50% of the total body surface area (TBSA). Hypothetically, engineered skin substitutes (ESS) consisting of autologous keratinocytes and fibroblasts attached to collagen-based scaffolds may reduce requirements for donor skin, and decrease mortality. ESS were prepared from split-thickness skin biopsies collected after enrollment of 16 pediatric burn patients into an approved study protocol. ESS and split-thickness autograft (AG) were applied to 15 subjects with full-thickness burns involving a mean of 76.9% TBSA. Data consisted of photographs, tracings of donor skin and healed wounds, comparison of mortality with the National Burn Repository, correlation of TBSA closed wounds with TBSA full-thickness burn, frequencies of regrafting, and immunoreactivity to the biopolymer scaffold. One subject expired before ESS application, and 15 subjects received 2056 ESS grafts. The ratio of closed wound to donor areas was 108.7 ± 9.7 for ESS compared with a maximum of 4.0 ± 0.0 for AG. Mortality for enrolled subjects was 6.25%, and 30.3% for a comparable population from the National Burn Repository (P < .05). Engraftment was 83.5 ± 2.0% for ESS and 96.5 ± 0.9% for AG. Percentage TBSA closed was 29.9 ± 3.3% for ESS, and 47.0 ± 2.0% for AG. These values were significantly different between the graft types. Correlation of % TBSA closed with ESS with % TBSA full-thickness burn generated an R value of 0.65 (P < .001). These results indicate that autologous ESS reduce mortality and requirements for donor skin harvesting, for grafting of full-thickness burns of greater than 50% TBSA.

  12. Temperature and burn injury prediction of human skin exposed to microwaves: a model analysis.

    PubMed

    Ozen, Sukru; Helhel, Selcuk; Bilgin, Suleyman

    2011-08-01

    A one-dimensional multi-layer model is presented to characterize skin temperature rises and burn processes resulting from skin exposure to microwaves. Temperature variations and damage function analyses in the skin tissue exposed to microwaves were predicted depending on blood perfusion rate, thermal conductivity, power density, and exposure time. Thermal wave model was applied and the bio-heat transfer equation was solved using the finite difference time domain method. The thermal wave model of bio-heat transfer predicts a lower temperature rise than a model that uses Pennes' equation. When approaching steady state, the solutions overlaps with that obtained using the Pennes' equation. The results obtained may help to analyze the consequences of short-time high-power MW exposures in biological tissues.

  13. Skin regeneration for children with burn scar contracture using autologous cultured dermal substitutes and superthin auto-skin grafts: preliminary clinical study.

    PubMed

    Fujimori, Yasushi; Ueda, Koichi; Fumimoto, Hiromichi; Kubo, Kentaro; Kuroyanagi, Yoshimitsu

    2006-10-01

    We have evaluated a novel treatment of burn scar contracture in children. This method involves the application of an autologous cultured dermal substitute (CDS), followed by a graft of superthin split-thickness skin. In the first operation, the autologous CDS was applied to the skin defect that had occurred after releasing the scar contracture. In the second operation, a superthin thickness skin graft (4 approximately 6/1000 inches) was applied 5 approximately 12 days after the first operation. The autologous CDS was applied to 10 sites of 5 children. On 8 sites, the skin grafts were contracted to some extent at an early stage. However, these skin grafts were stretched gradually to a range from 60% to 100% of an original size. At 2 sites, the skin grafts had stretched from 110% to 130% of the original size. This strategy may be useful for the treatment of burn scar contracture in children.

  14. Construction of Skin Graft Seams in Burn Patients: A Prospective Randomized Double-Blinded Study.

    PubMed

    Isaac, Kathryn; Umraw, Nisha; Cartotto, Robert

    Prominent scars and contractures may form along the seams between adjacent skin grafts. Seams may be constructed either by approximating the graft edges (AP), or by slightly overlapping the graft edges (OV), but it is not known if one technique creates a less conspicuous seam scar. The purpose of this study was to compare seam scars between seams constructed using the AP and OV techniques. This was a prospective within-patient and within-seam controlled study in adult burn patients treated at an American Burn Association-verified burn center. At skin graft application and seam construction, study seams were divided in half. One half of the seam was made by approximating the graft edges (AP group), while the other half was made by overlapping graft edges (OV group), before identical staple or suture fixation of each half. The AP or OV technique was randomly assigned to the medial or lateral ends of transversely oriented seams or to the proximal and distal ends of longitudinally oriented seams. At 3, 6, and 12 months post surgery, a blinded rater compared the two halves of each study seam scar using the Vancouver Scar Score (VSS). Subjects were also blinded and rated each half of their study seam using a 0 (poor) to 10 (excellent) visual analogue scale. Values are shown as the median (Q1-Q3). There were 44 study seams among 19 subjects (age 51 [36-70] years, with % TBSA burn 10 [7-18], % BSA full-thickness burn 8 [6-15]). Study seams were constructed at 10 (4-15) days post burn. Study seam length was 14.5 (10.3-18.0) cm, with 25% transversely oriented and 75% longitudinally oriented, and with 35/44 seams (80%) between meshed grafts and 9/44 (20%) between sheet grafts. There were no significant differences in any of the individual domain VSS scores (height, pliability, vascularity, and pigmentation) or total VSS score between AP and OV seams at 3, 6, and 12 months. At 12 months, among the 30 study seams that were visible to the subjects, the visual analogue scale

  15. Temporal expression of wound healing-related genes in skin burn injury.

    PubMed

    Kubo, Hidemichi; Hayashi, Takahito; Ago, Kazutoshi; Ago, Mihoko; Kanekura, Takuro; Ogata, Mamoru

    2014-01-01

    Determination of the age of burns, as well as of wounds induced mechanically, is essential in forensic practice, particularly in cases of suspected child abuse. Here, we investigated temporal changes in the expression of 13 genes during wound healing after a burn. The expression of cytokines (IL-1β, IL-6, IL-10, TNF-α, and IFN-γ), chemokines (KC, MCP-1), proliferative factors (TGF-β, VEGF), proteases (MMP-2, 9, 13) and type I collagen in murine skin was examined by real-time PCR at 3, 6, 9, and 12 h and 1, 2, 3, 5, 7, and 14 days after a burn. Based on macroscopic and histological appearance, the healing process of a burn consists of 3 phases: inflammatory (from 3 h to 1 day after the burn), proliferative (from 1 to 7 days), and maturation (from 7 to 14 days). Expression of IL-1β, IL-6, TNF-α, IFN-γ and KC increased significantly in a biphasic pattern from 3 or 6 h to 12 h or 1 day and from 3 or 5 days to 7 days. Expression of MCP-1 increased significantly from 6 h to 5 days. Expression of both IL-10 and TGF-β increased significantly from 12 h to 7 days. Expression of VEGF, MMP-2, MMP-13 and type I collagen increased significantly from 3 days to 7 or 14 days. Expression of MMP-9 increased significantly from 6 h to 14 days. Our results suggest that evaluating the expression of a combination of these genes would enable the exact estimation of the age of a burn. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  16. In vivo visualization of dermal collagen fiber in skin burn by collagen-sensitive second-harmonic-generation microscopy

    NASA Astrophysics Data System (ADS)

    Tanaka, Ryosuke; Fukushima, Shu-ichiro; Sasaki, Kunihiko; Tanaka, Yuji; Murota, Hiroyuki; Matsumoto, Takeshi; Araki, Tsutomu; Yasui, Takeshi

    2013-06-01

    Optical assessment of skin burns is possible with second-harmonic-generation (SHG) microscopy due to its high sensitivity to thermal denaturation of collagen molecules. In contrast to previous studies that were performed using excised tissue specimens ex vivo, in vivo observation of dermal collagen fibers in living rat burn models with SHG microscopy is demonstrated. Changes in signal vanishing patterns in the SHG images are confirmed to be dependent on the burn degree. Comparison of the SHG images with Masson's trichrome-stained images indicated that the observed patterns were caused by the coexistence of molten and fibrous structures of dermal collagen fibers. Furthermore, a quantitative parameter for burn assessment based on the depth profile of the mean SHG intensity across the entire SHG image is proposed. These results and discussions imply a potential of SHG microscopy as a minimally invasive, highly quantitative tool for skin burn assessment.

  17. Can Skin Allograft Occasionally Act as a Permanent Coverage in Deep Burns? A Pilot Study 

    PubMed Central

    Rezaei, Ezzatollah; Beiraghi-Toosi, Arash; Ahmadabadi, Ali; Tavousi, Seyed Hassan; Alipour Tabrizi, Arash; Fotuhi, Kazem; Jabbari Nooghabi, Mehdi; Manafi, Amir; Ahmadi Moghadam, Shokoofeh

    2017-01-01

    BACKGROUND Skin allograft is the gold standard of wound coverage in patients with extensive burns; however, it is considered as a temporary wound coverage and rejection of the skin allograft is considered inevitable. In our study, skin allograft as a permanent coverage in deep burns is evaluated. METHODS Skin allograft survival was assessed in 38 patients from March 2009 to March 2014, retrospectively. Because of the lack of tissue specimen from the skin donors, patients with long skin allograft survival in whom the gender of donor and recipient of allograft was the same were excluded. Seven cases with skin allograft longevity and opposite gender in donor and recipient were finally enrolled. A polymerase chain reaction (PCR) test on the biopsy specimen from recipients and donors were undertaken. RESULTS PCR on the biopsy specimen from recipients confirmed those specimens belong to the donors. All patients received allograft from the opposite sex. Two (28.57%) patients received allograft from their first-degree blood relatives, and in one (14.29%) case, the allograft was harvested from an alive individual with no blood relation. The rest were harvested from multiorgan donors. In eight months of follow up, no clinical evidence of graft rejection was noted. CONCLUSION Long term persistence of skin allograft in patients is worthy of more attention. Further studies An increase in knowledge of factors influencing this longevity could realize the dream of burn surgeons to achieve a permanent coverage other than autograft for major burn patients.

  18. Early escharectomy and concurrent composite skin grafting over human acellular dermal matrix scaffold for covering deep facial burns.

    PubMed

    Tang, Bing; Zhu, Bin; Liang, Yue-Ying; Bi, Liang-Kuan; Chen, Bin; Hu, Zhi-Cheng; Zhang, Kai; Zhu, Jia-Yuan

    2011-04-01

    Although escharectomy and full-thickness skin autografting have been widely used to treat deep facial burns, the clinical outcomes remain unacceptable. Composite razor-thin skin grafting over acellular dermal matrix scaffold has been used successfully in repairing burns of the trunk and limbs, but its use in covering deep facial burns has rarely been reported. In this study, the authors investigated the clinical outcomes of early escharectomy and concurrent composite razor-thin skin autografting and acellular dermal matrix scaffold for treating deep facial burns. Patients with deep facial burns (n = 16) involving 8 to 30 percent of the total body surface area received early escharectomy by postburn day 3 and concurrent, one-stage, large, razor-thin skin autografting on top of human acellular dermal matrix scaffold. Wound dressings were changed on postoperative days 7, 9, and 12 to examine the survival of skin autografts. Patients were followed up for 12 months to evaluate their facial profiles. The take rate of composite skin autografts was 97.3 percent at postoperative day 12. At the follow-up visit, the skin autografts appeared normal in color, with soft texture and good elasticity. The skin junctures showed little scarring. The patients exhibited a chubby facial appearance and abundant expression, except for one patient with microstomia and two patients with ectropion who required further plastic surgical interventions. Early escharectomy and concurrent composite razor-thin skin autografting on top of acellular dermal matrix scaffold constitute an effective and favorable option for covering deep facial burns, especially for patients with limited donor sites.

  19. In vivo photodynamic inactivation of Psuedomonas aeruginosa in burned skin in rats

    NASA Astrophysics Data System (ADS)

    Hirao, Akihiro; Sato, Shunichi; Terakawa, Mitsuhiro; Saitoh, Daizoh; Shinomiya, Nariyoshi; Ashida, Hiroshi; Obara, Minoru

    2010-02-01

    Control of infection in wounds is critically important to avoid transition to sepsis; however, recent rise of drug-resistant bacteria makes it difficult. Thus, antimicrobial photodynamic therapy (APDT) has recently received considerable attention. In this study, we examined methylene blue (MB)-mediated photodynamic inactivation of Psuedomonas aeruginosa in rat burned skin. Two days after infection, the wound surface was contacted with a MB solution at different concentrations, and thereafter the wound was irradiated with cw 665-nm light at a constant power density of 250 mW/cm2 for different time durations. We obtained a two orders of magnitude decrease in the number of bacteria by PDT with a 2-h contact of 0.5-mM MB solution and a illumination of 480 J/cm2, demonstrating the efficacy of PDT against infection with Ps. aeruginosa in burns.

  20. Prevention of radioinduced cystitis by orgotein: a randomized study.

    PubMed

    Sanchiz, F; Millá, A; Artola, N; Julià, J C; Moya, L M; Pedro, A; Vila, A

    1996-01-01

    On the basis of previous experiences indicating that the anti-oxidant agent Cu/Zn superoxide dismutase (SOD) is an effective drug in reducing acute and late radiation-induced tissue injury, in the Center of Radiotherapy and Oncology of Catalonia, Barcelona, Spain in 1990 we implemented a randomized prospective study to analyze the incidence and grade of side effects in a group of bladder cancer patients. After surgery patients were randomly allocated to receive either: Option A: Radiotherapy or Option B: Radiotherapy + SOD 8 mgr/IM/day, after each radiotherapeutic application. Between January 1990 and January 1995 a total of 448 patients were included (226 A/ 222 B). Apart from cutaneous side effects, a highly significant incidence of radioinduced acute cystitis and rectitis was detected in patients not treated by SOD. Which was similar to the delayed side effects. From our data we can conclude that SOD is effective in decreasing acute radioinduced damage, and also in preventing the appearance of more delayed disorders.

  1. Collagen-chitosan scaffold - Lauric acid plasticizer for skin tissue engineering on burn cases

    NASA Astrophysics Data System (ADS)

    Widiyanti, Prihartini; Setyadi, Ewing Dian; Rudyardjo, Djony Izak

    2017-02-01

    The prevalence of burns in the world is more than 800 cases per one million people each year and this is the second highest cause of death due to trauma after traffic accident. Many studies are turning to skin substitute methods of tissue engineering. The purpose of this study is to determine the composition of the collagen, chitosan, and lauric acid scaffold, as well as knowing the results of the characterization of the scaffold. The synthesis of chitosan collagen lauric acid scaffold as a skin tissue was engineered using freeze dried method. Results from making of collagen chitosan lauric acid scaffold was characterized physically, biologically and mechanically by SEM, cytotoxicity, biodegradation, and tensile strength. From the morphology test, the result obtained is that pore diameter size ranges from 94.11 to 140.1 µm for samples A,B,C,D, which are in the range of normal pore size 63-150 µm, while sample E has value below the standard which is about 37.87 to 47.36 µm. From cytotoxicity assay, the result obtained is the percentage value of living cells between 20.11 to 21.51%. This value is below 50% the standard value of living cells. Incompatibility is made possible because of human error mainly the replication of washing process over the standard. Degradation testing obtained values of 19.44% - 40% by weight which are degraded during the 7 days of observation. Tensile test results obtained a range of values of 0.192 - 3.53 MPa. Only sample A (3.53 MPa) and B (1.935 MPa) meet the standard values of skin tissue scaffold that is 1-24 MPa. Based on the results of the characteristics of this study, composite chitosan collagen scaffold with lauric acid plasticizer has a potential candidate for skin tissue engineering for skin burns cases.

  2. The use of MatriDerm in early excision and simultaneous autologous skin grafting in burns--a pilot study.

    PubMed

    Ryssel, H; Gazyakan, E; Germann, G; Ohlbauer, M

    2008-02-01

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

  3. [Wounds and burns of the skin polluted by alpha irradiation in personnel of radiochemistry enterprises].

    PubMed

    Bazhin, A G; Khokhriakov, V F; Shevkunov, V A

    1994-01-01

    Records of pollution by plutonium and americium 241 of skin wounds and burns in the personnel of the Mayak plant in 1948-1992 are analyzed. Traumas occurred in 286 (7.2%) workers, mechanical injuries were 84.1% of these. A high incidence of wound contamination was recorded in the workers engaged in mechanical processing of plutonium. Altogether 34.1% of injuries had alpha-radiators in residual amounts after debridement, though their levels did not surpass the minimal levels of radionuclide detection.

  4. A system for 3D representation of burns and calculation of burnt skin area.

    PubMed

    Prieto, María Felicidad; Acha, Begoña; Gómez-Cía, Tomás; Fondón, Irene; Serrano, Carmen

    2011-11-01

    In this paper a computer-based system for burnt surface area estimation (BAI), is presented. First, a 3D model of a patient, adapted to age, weight, gender and constitution is created. On this 3D model, physicians represent both burns as well as burn depth allowing the burnt surface area to be automatically calculated by the system. Each patient models as well as photographs and burn area estimation can be stored. Therefore, these data can be included in the patient's clinical records for further review. Validation of this system was performed. In a first experiment, artificial known sized paper patches were attached to different parts of the body in 37 volunteers. A panel of 5 experts diagnosed the extent of the patches using the Rule of Nines. Besides, our system estimated the area of the "artificial burn". In order to validate the null hypothesis, Student's t-test was applied to collected data. In addition, intraclass correlation coefficient (ICC) was calculated and a value of 0.9918 was obtained, demonstrating that the reliability of the program in calculating the area is of 99%. In a second experiment, the burnt skin areas of 80 patients were calculated using BAI system and the Rule of Nines. A comparison between these two measuring methods was performed via t-Student test and ICC. The hypothesis of null difference between both measures is only true for deep dermal burns and the ICC is significantly different, indicating that the area estimation calculated by applying classical techniques can result in a wrong diagnose of the burnt surface. Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.

  5. Palmar crease release and secondary full-thickness skin grafts for contractures in primary full-thickness skin grafts during growth spurts in pediatric palmar hand burns.

    PubMed

    Oh, Suk-Joon; Kim, Seon Gyu; Cho, Jin Kyung; Sung, Chang Min

    2014-01-01

    Pediatric palmar hand burns are a difficult problem because of the serious hand deformity, with functional impairment resulting from rapid growth. In cases of severe pediatric palmar hand burns, a secondary full-thickness skin graft after a primary full-thickness skin graft offers a reliable way of obtaining the required functional and aesthetic outcomes.This study retrospectively evaluated 28 children who required palmar crease releases and secondary full-thickness skin grafts during the past 12 years. The case records were reviewed for sex and age distributions, injury mechanism, and time interval between the primary and secondary full-thickness skin grafts. Surgical procedures included secondary full-thickness skin grafts and incisional releases of grafted skin on the involved creases. There were 19 men and 9 women. The mean age at the time of the burn injury was 10.1 months (range, 5-19 months). The mean age at the time of the secondary full-thickness skin graft was 8.3 years (range, 3-17 years). The most common mechanism of burn injury was steam (n = 24). The median time interval from the primary to the secondary full-thickness skin graft was 67 months (range, 8-156 months). The number of released creases was 81. The number of palmar web contractures in 23 patients was 52. A secondary full-thickness skin graft was more frequently necessary in patients with a primary full-thickness skin graft in the proximal digital crease and palmar web areas. All patients achieved adequate digital length and palmar web contour after surgery. Our patients should be observed until the rapid pubertal growth period.

  6. Forty-Year Follow-up of Full-Thickness Skin Graft After Thermal Burn Injury to the Volar Hand

    PubMed Central

    Kasdan, Morton L.; Wilhelmi, Bradon J.

    2016-01-01

    Background: The hands are commonly affected in severe thermal burn injuries. Resulting contractures lead to significant loss of function. Burn contracture release and skin grafting are necessary to restore hand function. We report a case in which surgical reconstruction of a volar hand burn was performed with full-thickness skin grafting. The patient had a 40-year follow-up to assess the function and cosmesis of the repaired hand. Methods: We report a case in which a 15-month-old boy presented after receiving third-degree burns to the left volar hand, including the flexural aspects of the index, long, and ring fingers by placing it on a hot kitchen stove burner. The patient subsequently underwent scar contracture release and full-thickness skin grafting. Results: Eleven years after reconstruction, further contractures developed associated with the patient's growth, which were reconstructed with repeat full-thickness skin graft from the inguinal region. No recurrence was witnessed afterward and 40 years after initial injury, the patient maintains full activities of daily living and use of his hand in his occupation. Conclusions: There is debate regarding the superiority of split-thickness versus full-thickness grafts during reconstruction. Our case strengthens the argument for durability of a full-thickness skin graft following thermal burn injury. PMID:27555888

  7. Forty-Year Follow-up of Full-Thickness Skin Graft After Thermal Burn Injury to the Volar Hand.

    PubMed

    Weeks, Dexter; Kasdan, Morton L; Wilhelmi, Bradon J

    2016-01-01

    The hands are commonly affected in severe thermal burn injuries. Resulting contractures lead to significant loss of function. Burn contracture release and skin grafting are necessary to restore hand function. We report a case in which surgical reconstruction of a volar hand burn was performed with full-thickness skin grafting. The patient had a 40-year follow-up to assess the function and cosmesis of the repaired hand. We report a case in which a 15-month-old boy presented after receiving third-degree burns to the left volar hand, including the flexural aspects of the index, long, and ring fingers by placing it on a hot kitchen stove burner. The patient subsequently underwent scar contracture release and full-thickness skin grafting. Eleven years after reconstruction, further contractures developed associated with the patient's growth, which were reconstructed with repeat full-thickness skin graft from the inguinal region. No recurrence was witnessed afterward and 40 years after initial injury, the patient maintains full activities of daily living and use of his hand in his occupation. There is debate regarding the superiority of split-thickness versus full-thickness grafts during reconstruction. Our case strengthens the argument for durability of a full-thickness skin graft following thermal burn injury.

  8. [Skin burns, necrosis and ulcers caused by wet cement, ready-mixed concrete and lime. 8 cases].

    PubMed

    Koch, P

    1996-01-01

    Skin burns and caustic ulcers caused by wet cement, due to calcium hydroxyde, are rarely reported in the literature. They occur mostly among amateur cement users. We report seven cases of skin burns, necrosis and ulcerations after use of wet cement and ready-mixed concrete, and one case of caustic ulcers induced by wet lime. Even short skin contacts to wet cement or concrete may induce extensive lesions in some cases. However, we were not able to incriminate with certainty any special concrete additives which could increase skin penetration of calcium hydroxyde. Warning notices about the danger of skin contact should be prominent on sacked cement. When ready-mixed concrete is delivered, the purchaser should be handed a note explaining the risk of kneeling in wet concrete and the importance of protective measures. This may probably contribute to reduce the frequency of those accidents.

  9. Prospective trial of thick vs standard split-thickness skin grafts in burns of the hand.

    PubMed

    Mann, R; Gibran, N S; Engrav, L H; Foster, K N; Meyer, N A; Honari, S; Costa, B A; Heimbach, D M

    2001-01-01

    For best function and appearance, thick skin grafts for hands are generally preferred to thinner grafts. But how thick is thick enough? This prospective randomized trial was designed to compare 0.015-inch skin grafts for burned hands to hand grafts that are 0.025 inches thick. Consecutive patients receiving skin grafts to hands were randomized to have sheet grafts using donor sites of 0.015-inch or 0.025-inch thickness. To prevent delayed healing and potential hypertrophic scarring, the thick graft donor sites were grafted with 0.008-inch grafts. There were no significant differences in range of motion, final appearance, or patient satisfaction between the two groups at 1 year. There were problems with donor site healing in both groups. We recommend that hand grafts for adults be at least 0.015 inches thick but do not see an advantage to the use of very thick (0.025-inch) grafts, even with thin split-thickness skin grafts to the donor site.

  10. Paracrine Factors from Irradiated Peripheral Blood Mononuclear Cells Improve Skin Regeneration and Angiogenesis in a Porcine Burn Model

    PubMed Central

    Hacker, Stefan; Mittermayr, Rainer; Nickl, Stefanie; Haider, Thomas; Lebherz-Eichinger, Diana; Beer, Lucian; Mitterbauer, Andreas; Leiss, Harald; Zimmermann, Matthias; Schweiger, Thomas; Keibl, Claudia; Hofbauer, Helmut; Gabriel, Christian; Pavone-Gyöngyösi, Mariann; Redl, Heinz; Tschachler, Erwin; Mildner, Michael; Ankersmit, Hendrik Jan

    2016-01-01

    Burn wounds pose a serious threat to patients and often require surgical treatment. Skin grafting aims to achieve wound closure but requires a well-vascularized wound bed. The secretome of peripheral blood mononuclear cells (PBMCs) has been shown to improve wound healing and angiogenesis. We hypothesized that topical application of the PBMC secretome would improve the quality of regenerating skin, increase angiogenesis, and reduce scar formation after burn injury and skin grafting in a porcine model. Full-thickness burn injuries were created on the back of female pigs. Necrotic areas were excised and the wounds were covered with split-thickness mesh skin grafts. Wounds were treated repeatedly with either the secretome of cultured PBMCs (SecPBMC), apoptotic PBMCs (Apo-SecPBMC), or controls. The wounds treated with Apo-SecPBMC had an increased epidermal thickness, higher number of rete ridges, and more advanced epidermal differentiation than controls. The samples treated with Apo-SecPBMC had a two-fold increase in CD31+ cells, indicating more angiogenesis. These data suggest that the repeated application of Apo-SecPBMC significantly improves epidermal thickness, angiogenesis, and skin quality in a porcine model of burn injury and skin grafting. PMID:27125302

  11. Paracrine Factors from Irradiated Peripheral Blood Mononuclear Cells Improve Skin Regeneration and Angiogenesis in a Porcine Burn Model.

    PubMed

    Hacker, Stefan; Mittermayr, Rainer; Nickl, Stefanie; Haider, Thomas; Lebherz-Eichinger, Diana; Beer, Lucian; Mitterbauer, Andreas; Leiss, Harald; Zimmermann, Matthias; Schweiger, Thomas; Keibl, Claudia; Hofbauer, Helmut; Gabriel, Christian; Pavone-Gyöngyösi, Mariann; Redl, Heinz; Tschachler, Erwin; Mildner, Michael; Ankersmit, Hendrik Jan

    2016-04-29

    Burn wounds pose a serious threat to patients and often require surgical treatment. Skin grafting aims to achieve wound closure but requires a well-vascularized wound bed. The secretome of peripheral blood mononuclear cells (PBMCs) has been shown to improve wound healing and angiogenesis. We hypothesized that topical application of the PBMC secretome would improve the quality of regenerating skin, increase angiogenesis, and reduce scar formation after burn injury and skin grafting in a porcine model. Full-thickness burn injuries were created on the back of female pigs. Necrotic areas were excised and the wounds were covered with split-thickness mesh skin grafts. Wounds were treated repeatedly with either the secretome of cultured PBMCs (Sec(PBMC)), apoptotic PBMCs (Apo-Sec(PBMC)), or controls. The wounds treated with Apo-Sec(PBMC) had an increased epidermal thickness, higher number of rete ridges, and more advanced epidermal differentiation than controls. The samples treated with Apo-Sec(PBMC) had a two-fold increase in CD31+ cells, indicating more angiogenesis. These data suggest that the repeated application of Apo-Sec(PBMC) significantly improves epidermal thickness, angiogenesis, and skin quality in a porcine model of burn injury and skin grafting.

  12. Effectiveness of composition based on oxidized dextran in the treatment of grade IIIB skin burns.

    PubMed

    Shkurupy, V A; Karpov, M A; Troitskii, A V; Arkhipov, S A; Neshchadim, D V

    2015-03-01

    Grade IIIB skin burns were treated with a composition based on oxidized dextran with a molecular weight of 40 kDa (oxidation of 7% glucose residues). On day 32 after burn infliction and from the start of the treatment, the area of skin defect in rats was 30% less than in the group without treatment and by 2.3 times less than in rats treated with panthenol. In rats treated with dextran-based composition or panthenol, the eschar was absent on day 21 after the start of the treatment; by day 32, we found cells of surface epithelium, hair follicles, and sebaceous glands above the scar tissue that were absent in untreated animals; in rats treated with the composition, their number was higher by 2.5 times than in animals treated with panthenol. Treatment with the composition increased volume density (by 2.5 times) and numerical density (by more than 3 times) of blood vessels in the wound and reduced signs of inflammation and fibroplastic activity of fibroblasts in comparison with the corresponding parameters in untreated animals or animals treated with panthenol.

  13. Measurement of change in the mechanical properties of burned skin to therapist intervention with a vacuum device.

    PubMed

    Gabriel, Vincent; Kowalske, Karen

    2015-06-01

    The currently available clinical scales used to describe healed burn wounds have limitations. Quantitative measurement of the outcomes from burn therapy treatment would be useful in planning clinical care, resource allocation and research. The purpose of this study was to observe the measurements of a portable materials testing device before and after burn therapist intervention for closed burns. A recording was taken using a hand-held vacuum device to measure deformation of the skin in the same location prior to and following a treatment session with a burn therapist in an outpatient clinic at a tertiary burn center. Twenty-eight subjects were recruited to the study. Statistically significant differences were noted in modulus and elasticity change between sheet and meshed split thickness autografts (p=0.0233). Positive change in modulus was correlated with increasing therapy time (R=0.46), specifically for meshed grafts (R=0.70). Positive change in modulus was noted in therapy time greater than 48 min. Quantitative measurement of the outcomes of burn therapies on the mechanical properties of healed burns is possible in an outpatient clinic setting. Improvement in the stiffness of burn scars was observed in treatment sessions that last at least 48 min. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  14. In situ visualization of dermal collagen dynamics during skin burn healing using second-harmonic-generation microscopy

    NASA Astrophysics Data System (ADS)

    Yasui, Takeshi; Hase, Eiji; Tanaka, Ryosuke; Fukushima, Shu-ichiro; Araki, Tsutomu

    2015-06-01

    Burn healing is a process to repair thermally damaged tissues. Although burn healing has many aspects, it is common for dynamics of collagen fiber, such as decomposition, production, or growth, to be closely related with burn healing. If such healing process can be visualized from the viewpoint of the collagen dynamics, one may obtain new findings regarding biological repairing mechanisms in the healing process. To this end, second-harmonic-generation (SHG) light will be an effective optical probe because of high selectivity and good image contrast to collagen molecules as well as high spatial resolution, optical three-dimensional (3D) sectioning, minimal invasiveness, deep penetration, the absence of interference from background light, and in situ measurement without additional staining. Furthermore, since SHG light arises from a non-centrosymmetric triple helix of three polypeptide chains in the collagen molecule, its intensity decreases and finally disappears when thermal denaturation caused by the skin burn changes the structure of this molecule to a centrosymmetric random coil. Therefore, optical assessment of skin burn has been investigated by SHG microscopy. In this paper, we applied SHG microscopy for in situ imaging of the healing process in animal skin burn and successfully visualized the decomposition, production, and growth of renewal collagen fibers as a series of time-lapse images in the same subject.

  15. Copigmentation triggers the development of skin burning disorder on peach and nectarine fruit [Prunus persica (L.) Batsch].

    PubMed

    Cantín, Celia M; Tian, Li; Qin, Xiaoqiong; Crisosto, Carlos H

    2011-03-23

    Skin burning is a new type of skin damage related to exposure to high pH values during the brushing-waxing postharvest operations that has been observed recently on some newly released peach and nectarine [Prunus persica (L.) Batsch] cultivars. In this work, we described this skin disorder for the first time and studied its triggers and biological basis. Different skin burning susceptibility was observed after screening 21 peach and nectarine cultivars. The stability of the skin phenolic extracts to pH in the range 7-10 was studied by UV-visible spectroscopy. This study demonstrated that fruit skin phenolics are not stable at high pH and that the transformations occurring at high pH are reversible and time-dependent. The changes on the UV-visible absorption spectra at different pH values pointed out the copigmentation of anthocyanins as the mechanism beyond the skin burning disorder. Finally, some recommendations to minimize this postharvest damage are also discussed.

  16. Activated skin γδ T-cells regulate T-cell infiltration of the wound site after burn.

    PubMed

    Rani, Meenakshi; Zhang, Qiong; Scherer, Michael R; Cap, Andrew P; Schwacha, Martin G

    2015-02-01

    Burn induces an immunopathological response involving multiple immune cell types that includes γδ T-cells. Nonetheless, the role of γδ T-cells at the wound site after burn is not clearly defined. Wild type and γδ T-cell receptor deficient (δ TCR(-/-)) mice were subjected to a major burn or sham procedure. At 1-7 d thereafter, skin samples were collected and T-cell populations analyzed. The majority of T-cells in the skin of sham mice were γδ T-cells. After burn, however, an increase in the total T-cells was observed at the wound site and these cells were predominantly αβ T-cells. Their influx was γδ T-cell dependent, as it was markedly reduced in injured δ TCR(-/-) mice. Burn wound γδ T-cells were activated with increased expression of TLRs and CD69. In contrast, the infiltrating αβ T-cells TLR and CD69 expressions were attenuated after burn. Thus, burn is associated with of γδ T-cell activation at the injury site, which initiates a massive infiltration of the wound with αβ T-cells that likely facilitate the transition from the inflammatory to the proliferative phase of healing.

  17. Lyell syndrome revisited: analysis of 18 cases of severe bullous skin disease in a burns unit.

    PubMed

    Neff, Ph; Meuli-Simmen, C; Kempf, W; Gaspert, T; Meyer, V E; Künzi, W

    2005-01-01

    Over the last few years, understanding of the pathophysiology of toxic epidermal necrolysis (TEN), or Lyell's disease, has substantially increased. However, differentiation of severe bullous skin disease remains a challenge for the clinician, and one that is often complicated by late patient referral. We performed a retrospective analysis of all patients with severe bullous skin disease, admitted between 1997 and 2002 to the Burn Centre, which is an integrated part of the Division for Plastic, Hand- and Reconstructive Surgery at the University Hospital of Zurich, Switzerland. We present an overview of our strategies and of the diagnostic and therapeutic difficulties encountered. The final diagnoses of the 18 patients referred to the unit were as follows: eight cases of TEN, one case of staphylococcal scalded-skin syndrome (SSSS), two cases of generalised drug eruption, one case of acute generalised exanthematic pustulosis and one case of febrile ulceronecrotic pityriasis lichenoides et varioliformis acuta (PLEVA). In two cases, the diagnosis remained unclear. In three cases, paraneoplastic origins were suspected but not demonstrated. The overall mortality rate was 33% (six of 18 patients). Remarkably, all patients with histologically confirmed TEN survived. Six of these patients were successfully treated with intravenous immunoglobulins (IVIG). The most common single causative drug inducing TEN (four cases out of eight) was Phenytoin. Establishing an accurate diagnosis-based on a skin biopsy, harvested at an early stage-is more important than ever, because more specific and effective therapeutic modalities are available. As these potentially life-threatening bullous skin disorders are rare, we recommend, that care be provided by an experienced interdisciplinary team, comprising a dermatologist, or dermatopathologist, an intensive care specialist and a plastic surgeon.

  18. [Effects of Meek skin grafting on patients with extensive deep burn at different age groups].

    PubMed

    Di, H P; Niu, X H; Li, Q; Li, X L; Xue, J D; Cao, D Y; Han, D W; Xia, C D

    2017-03-20

    Objective: To investigate the effect of Meek skin grafting on patients with extensive deep burn at different age groups. Methods: Eighty-four patients with extensive deep burns conforming to the study criteria were hospitalized in our unit from April 2011 to April 2015. Patients were divided into children group (C, with age less than 12 years old), young and middle-aged group (YM, with age more than 18 years and less than 50 years old), and old age group (O, with age more than 55 years old) according to age, with 28 patients in each group. All patients received Meek skin grafting treatment. The use of autologous skin area, operation time, wound healing time, and hospitalization time were recorded. The survival rate of skin graft on post operation day 7, complete wound healing rate in post treatment week 2, and the mortality were calculated. Data were processed with one-way analysis of variance, t test, and χ(2) test. Results: The use of autologous skin area of patients in group C was (5.1±1.0)% total body surface area (TBSA), significantly less than (8.3±1.0)%TBSA and (8.3±1.4)%TBSA in groups YM and O, respectively (with t values 32.900 and 52.624, respectively, P values below 0.05). The operation time, wound healing time, and hospitalization time of patients in group C were (1.368±0.562) h, (9.6±0.6) and (32±11) d, significantly shorter than those in group YM [(3.235±0.011) h, (16.9±2.6) and (48±12) d, respectively] and group O [(3.692±0.481) h, (17.3±2.6) and (46±13) d, respectively, with t values from 4.350 to 21.160, P values below 0.05]. The survival rate of skin graft of patients on post operation day 7 in group C was (92±15)%, significantly higher than (81±10)% and (72±12)% in groups YM and O, respectively (with t values 5.509 and 3.229, respectively, P values below 0.05). The above indexes in groups YM and O were similar (with t values from 0.576 to 22.958, P values above 0.05). Complete wound healing rate in post treatment week 2 and the

  19. [Influence of escharectomy and skin grafting during early burn stage on acute-phase response in severely burned rats and its significance].

    PubMed

    Chai, Jiake; Wu, Yanqiu; Sheng, Zhiyong

    2002-10-25

    To investigate the influence of escharectomy and skin-grafting during early burn stage on the production of acute-phase reactants by the liver in severely burned rats. Ninety-six Wistar rats were randomly divided into three groups: normal control group (C), escharectomy on postburn day (PBD) 1 group (0) and escharectomy on PBD4 group (F). 30% III degrees (total body surface area full-thickness) burn injury was caused by immersing the back in boiling water for 10 seconds. Escharectomy and skin grafting with cryopreserved allogeneic skin were performed one day or 4 days after the burn injury. ON days 1, 2, 4, 5 and 7 after burn injury blood was withdrawn from the abdominal aorta of 8 rats for each experimental group. The serum contents al-antitrypsin (AT), al-acid glycoprotein (AGP), C-reactive protein (CRP), albumin (Alb), and transferrin (Trf) were measured by turbidimetry. Significant increase in concentrations of positive acute-phase reactant, CRP, AGP, and AT, was observed in group O and group F as compared with normal control, (P < 0.05), while the concentrations of negative acute-phase reactants, Alb and Trf, decreased markedly (P < 0.05). The serum concentrations of AT and AGP in group O began to decrease significantly on PBD 5 and PBD7 respectively in comparison with that of the group F (P < 0.05), however, they still maintained a rather higher levels on PBD7. The concentration of CRP in group O began to decrease on PBD4, and the values on PBD4, 5, and 7 were significantly lower than those of the group F (P < 0.05). The concentration of CRP in PBD1 group reached the normal level on PBD7, however, the concentration of CRP in group F kept increasing till PBD5, and remained significantly higher than that in group C (P < 0.05). The concentration of Alb in group O was significantly higher on PBD7 than that in group F (P < 0.05). The concentration of Trf in group O on PBD5 and PBD7 was significantly higher than those in group F (P < 0.05). Escharectomy and skin

  20. Photograph-based diagnosis of burns in patients with dark-skin types: the importance of case and assessor characteristics.

    PubMed

    Boissin, C; Laflamme, L; Wallis, L; Fleming, J; Hasselberg, M

    2015-09-01

    This study assessed whether photographs of burns on patients with dark-skin types could be used for accurate diagnosing and if the accuracy was affected by physicians' clinical background or case characteristics. 21 South-African cases (Fitzpatrick grades 4-6) of varying complexity were photographed using a camera phone and uploaded on a web-survey. Respondents were asked to assess wound depth (3 categories) and size (in percentage). A sample of 24 burn surgeons and emergency physicians was recruited in South-Africa, USA and Sweden. Measurements of accuracy (using percentage agreement with bedside diagnosis), inter- (n=24), and intra-rater (n=6) reliability (using percentage agreement and kappa) were computed for all cases aggregated and by case characteristic. Overall diagnostic accuracy was 67.5% and 66.0% for burn size and depth, respectively. It was comparable between burn surgeons and emergency physicians and between countries of practice. However, the standard deviations were smaller, showing higher similarities in diagnoses for burn surgeons and South-African clinicians compared to emergency physicians and clinicians from other countries. Case characteristics (child/adult, simple/complex wound, partial/full thickness) affected the results for burn size but not for depth. Inter- and intra-rater reliability for burn depth was 55% and 77%. Size and depth of burns on patients with dark-skin types could be assessed at least as well using photographs as at bedside with 67.5% and 66.0% average accuracy rates. Case characteristics significantly affected the accuracy for burn size, but medical specialty and country of practice seldom did in a statistically significant manner. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  1. Modelling of experimentally created partial-thickness human skin burns and subsequent therapeutic cooling: a new measure for cooling effectiveness.

    PubMed

    Van de Sompel, Dominique; Kong, Tze Yean; Ventikos, Yiannis

    2009-07-01

    Rapid post-injury cooling of a skin burn has been shown to have both symptomatic and therapeutic benefits. However, the latter cannot be explained by temperature reduction alone, and must thus be secondary to an altered biological response. In this study, we construct a computational model to calculate the heat transfer and damage accumulation in human skin during and after a burn. This enables us to assess the effectiveness of various cooling protocols (involving both free and forced convection to air and water respectively) in terms of their reduction in Arrhenius tissue damage. In this process, we propose an extension of the Arrhenius damage model in the form of a new measure xi, which estimates the relevance of post-burn accrued damage. It was found that the reduction in Arrhenius damage integrals near the skin surface was too small to be physiologically relevant. Hence our results confirm that while the reduction in tissue temperatures is indeed quicker, the therapeutic benefit of cooling cannot be explained by thermal arguments (i.e. based on Arrhenius damage models) alone. We plan to validate this hypothesis by conducting future microarray analyses of differential gene expression in cooled and non-cooled burn lesions. Our computational model will support such experiments by calculating the necessary conditions to produce a burn of specified severity for a given experimental setup.

  2. Cytotoxicity testing of silver-containing burn treatments using primary and immortal skin cells.

    PubMed

    Boonkaew, Benjawan; Kempf, Margit; Kimble, Roy; Cuttle, Leila

    2014-12-01

    A novel burn wound hydrogel dressing has been previously developed which is composed of 2-acrylamido-2-methylpropane sulfonic acid sodium salt with silver nanoparticles (silver AMPS). This study compared the cytotoxicity of this dressing to the commercially available silver products; Acticoat™, PolyMem Silver(®) and Flamazine™ cream. Human keratinocytes (HaCaT and primary HEK) and normal human fibroblasts (NHF) were exposed to dressings incubated on Nunc™ polycarbonate inserts for 24, 48 and 72h. Four different cytotoxicity assays were performed including; Trypan Blue cell count, MTT, Celltiter-Blue™ and Toluidine Blue surface area assays. The results were expressed as relative cell viability compared to an untreated control. The cytotoxic effects of Acticoat™ and Flamazine™ cream were dependent on exposure time and cell type. After 24h exposure, Acticoat™ and Flamazine™ cream were toxic to all tested cell lines. Surprisingly, HaCaTs treated with Acticoat™ and Flamazine™ had an improved ability to survive at 48 and 72h while HEKs and NHFs had no improvement in survival with any treatment. The novel silver hydrogel and PolyMem Silver(®) showed low cytotoxicity to all tested cell lines at every time interval and these results support the possibility of using the novel silver hydrogel as a burn wound dressing. Researchers who rely on HaCaT cells as an accurate keratinocyte model should be aware that they can respond differently to primary skin cells.

  3. Burns (image)

    MedlinePlus

    ... degree burns damage the outer layer of skin (epidermis) and cause pain, redness and swelling (erythema). Second degree burns damage the epidermis and the inner layer, the dermis, causing erythema ...

  4. An in vivo comparison of commonly used topical antimicrobials on skin graft healing after full-thickness burn injury.

    PubMed

    Abbas, Ozan L; Borman, Huseyin; Bahar, Taner; Ertaş, Nilgün M; Haberal, Mehmet

    2015-01-01

    Topical antimicrobials are frequently used for local control of infections in burn patients. It has been postulated that these agents retard wound healing. There are limited data about the effects of topical antimicrobial agents on skin graft healing. In this study, we aimed to evaluate the effects of nitrofurazone, 1% silver sulfadiazine, and povidone-iodine on skin graft healing. Forty male rats were used in this study. A meshed skin graft, placed on an excised burn wound, was used as a model to compare topical agents with a control group. Skin graft survival rates, closure of meshed graft interstices (based on physical parameters, namely epithelialization and wound contraction), and histological changes were analyzed. Graft take was more than 85% in all groups. There was no difference between the mean values of the percent graft survival for each group (P > .05). Epithelialization occurred significantly earlier in animals in the nitrofurazone group (P < .05). There was no significant difference between groups in wound contraction rates (P >.05). There was no histological difference between the biopsy specimens of skin grafts. In specimens obtained from the interstices of the meshed graft, no significant differences were found among the groups regarding the wound healing parameters (P > .05). We found that nitrofurazone, silver sulfadiazine, and povidone-iodine had no negative effect on graft healing and take in noncontaminated burn wounds.

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

    PubMed

    Ciloglu, N Sinem; Mert, A Irem; Doğan, Zarife; Demir, Ali; Cevan, Simin; Aksaray, Sebahat; Tercan, Mustafa

    2014-01-01

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

  6. Comparative study of microvascular density in experimental third-degree skin burns treated with topical preparations containing herbal extracts.

    PubMed

    Mogoşanu, G D; Popescu, Florina Carmen; Busuioc, Cristina Jana; Lascăr, I; Mogoantă, L

    2013-01-01

    During the healing process of third-degree skin burns, a very complex response involves different cells and tissues linked together by intra- and extra-cellular mechanisms. For the restoration of damaged tissues, angiogenesis is the key point in the formation of new blood vessels. By their emollient, astringent, antiseptic, anti-inflammatory, biostimulator, epithelizing and cicatrizing effect, active principles from natural products contribute to the acceleration of the wound-healing process. In our study, we investigated the angiogenesis process in experimental model of third-degree skin burns treated with three topical preparations (cold-creams) containing 10% herbal extracts, comparing with 1% sulfadiazine cream and cold-cream base respectively. By their biostimulator, epithelizing and cicatrizing effect, cold-creams with herbal extracts are locally modulators of the cellular response and support the wound healing. The phytocomplex stimulates the favorable evolution of the burnt skin wounds and the development of neoangiogenesis capillaries.

  7. Application of split-thickness dermal grafts in deep partial- and full-thickness burns: a new source of auto-skin grafting.

    PubMed

    Coruh, Atilla; Yontar, Yalcin

    2012-01-01

    Early tangential excision of nonviable burn tissue, followed by immediate skin grafting with autograft or allograft, has resulted in the improvement of burn patient survival. The aim of this study was to add split-thickness dermal grafts (STDGs) as a new source of auto-skin grafting tool to our reconstructive armamentarium in deep partial- and full-thickness burns and soft tissue defects. The authors successfully applied STDGs along with split-thickness skin grafts as a new source of auto-skin grafting in 11 deep partial- and full-thickness burns over a period of 1 year without any significant donor site morbidity. Dermal graft take was complete in all but one patient. There was no donor site healing problem, and donor site epithelization was completed generally 1 week later than split-thickness skin graft by semi-open technique. Autologous split-thickness skin grafting still remains the standard therapy for burn wound closure but may be in limited availability in severe burns. The authors conclude that STDGs may be a new source of auto-skin grafting tool in extensive deep partial- and full-thickness burns.

  8. Human allogeneic keratinocytes cultured on acellular xenodermis: the use in healing of burns and other skin defects.

    PubMed

    Matousková, Eva; Broz, Ludomír; Stolbová, Vlasta; Klein, Leo; Konigová, Radana; Veselý, Pavel

    2006-01-01

    The tissue engineered skin should be composed of both dermal and epidermal layers. We combined cultured human allogeneic keratinocytes with acellular xenodermis prepared from pig xenografts. The resulting composite skin was termed recombined human/pig skin (RHPS), and could be cultured in both, undifferentiated and differentiated phenotype. The undifferentiated RHPS was grown submerged and formed 1-2 layers of keratinocytes. The differentiated phenotype (D-RHPS) was grown at the air-liquid interface and formed 5-20 cell layers similar to the normal epidermis, including the granular and horny layers. Undifferentiated RHPS has skin-like consistency and has been successfully used for treatment of burns and skin defects using "upside-down" application. Donor sites and deep dermal burn wounds prepared by tangential excision or deep dermabrasion grafted with RHPS healed in the course of about one week after keratinocyte transplantation. Simple acellular xenodermis without keratinocytes can also be used as temporary cover for donor sites, small to medium leg ulcers and other skin defects. Xenodermis can be fully sterilized and stored at the room temperature.

  9. Effects of low-intensity polarized visible laser radiation on skin burns: a light microscopy study.

    PubMed

    Ribeiro, Martha Simões; Da Silva, Daniela De Fátima Teixeira; De Araújo, Carlos Eugênio Nabuco; De Oliveira, Sérgio Ferreira; Pelegrini, Cleusa Maria Raspantini; Zorn, Telma Maria Tenório; Zezell, Denise Maria

    2004-02-01

    This study was carried out to investigate the influence of low-intensity polarized visible laser radiation on the acceleration of skin wound healing. Low-level laser therapy (LLLT) at adequate wavelength, intensity, and dose can accelerate tissue repair. However, there is still unclear information about light characteristics, such as coherence and polarization. Some studies indicate that linearly polarized light can survive through long propagation distance in biological tissue. Three burns about 6 mm in diameter were created on the back of rats with liquid N(2). Lesion "L(//)" was irradiated by He-Ne laser (lambda = 632.8 nm), D= 1.0 J/cm(2), with linear polarization parallel to the spinal column of the rat. Lesion "L(inverted v)" was irradiated using the same laser and dose, but the light polarization was aligned perpendicularly to the relative orientation. Lesion "C" was not irradiated in order to be considered as control. The animals were sacrificed at day 3-17 after lesion creation. Samples were collected and prepared for histological analysis. Histological analysis showed that the healing of irradiated wounds was faster than that of non-irradiated wounds. Moreover, it was observed that skin wound repair is dependent on polarization orientation with respect to a referential axis as the animal's spinal column. Consequently, "L(//)" was completely healed after 17 days, whereas "L (perpendicular) " showed a moderate degree of healing after the same period. These results indicate that the relative direction of the laser polarization plays an important role in the wound healing process when highly coherent He-Ne laser is used.

  10. Correlation between radio-induced lymphocyte apoptosis measurements obtained from two French centres.

    PubMed

    Mirjolet, C; Merlin, J L; Dalban, C; Maingon, P; Azria, D

    2016-07-01

    In the era of modern treatment delivery, increasing the dose delivered to the target to improve local control might be modulated by the patient's intrinsic radio-sensitivity. A predictive assay based on radio-induced lymphocyte apoptosis quantification highlighted the significant correlation between CD4 and CD8 T-lymphocyte apoptosis and grade 2 or 3 radiation-induced late toxicities. By conducting this assay at several technical platforms, the aim of this study was to demonstrate that radio-induced lymphocyte apoptosis values obtained from two different platforms were comparable. For 25 patients included in the PARATOXOR trial running in Dijon the radio-induced lymphocyte apoptosis results obtained from the laboratory of Montpellier (IRCM, Inserm U1194, France), considered as the reference (referred to as Lab 1), were compared with those from the laboratory located at the Institut de cancérologie de Lorraine (ICL, France), referred to as Lab 2. Different statistical methods were used to measure the agreement between the radio-induced lymphocyte apoptosis data from the two laboratories (quantitative data). The Bland-Altman plot was used to identify potential bias. All statistical tests demonstrated good agreement between radio-induced lymphocyte apoptosis values obtained from both sites and no major bias was identified. Since radio-induced lymphocyte apoptosis values, which predict tolerance to radiotherapy, could be assessed by two laboratories and showed a high level of robustness and consistency, we can suggest that this assay be extended to any laboratories that use the same technique. Copyright © 2016 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  11. The correlation between time to skin grafting and hypertrophic scarring following an acute contact burn in a porcine model.

    PubMed

    Chan, Queenie E; Harvey, John G; Graf, Nicole S; Godfrey, Craig; Holland, Andrew J A

    2012-01-01

    One sequelae of burn injury remains the development of hypertrophic scarring. This appears more likely when the healing has been prolonged. Early excision of deep dermal burns and subsequent split skin grafting (SSG) may provide a more favorable result. The optimal timing of grafting for deeper dermal burns remains controversial. This study sought to establish evidence for the optimal grafting time using a porcine model. Five Large White female pigs were exposed to four contact burn injuries for duration of 20 seconds at 92°C. Each site was randomized to a treatment arm: dressing only as the control, SSG day 3, SSG day 14, and SSG day 21. Burn wound biopsies were obtained at days 0, 3, 14, 21, and 99 after the burn injury, together with microbiological swabs. Digital photographs were taken to assess scarring using the Vancouver scar scale. All biopsies were subject to histological and immunohistochemical analysis. Vancouver scar scale scores and histopathological analysis indicated that areas grafted on day 3 had the least fibrosis and scarring (P = 0.031). There was a strong correlation between the histological evaluation of the degree of fibrosis and α-smooth muscle actin levels (r = .60, P = .014). A greater degree of fibrosis was observed in the presence of infection (P = .028). Sites grafted on day 3 consistently exhibited the best clinical and histological scar outcome. The increased fibrosis observed in delayed grafting may have been be related to progression of burn depth and infection. These results suggest that early grafting of deep dermal burns may be preferential.

  12. [Efficacies of treating large area third-degree burns by tangential excision and skin grafting for subcutaneous tissue wounds].

    PubMed

    Song, Guodong; Jia, Jun; Ma, Yindong; Shi, Wen; Wang, Fang; Li, Peilong; Gao, Cong; Zuo, Haibin; Fan, Chunjie; Yang, Tao; Wu, Qiuhe; Shao, Yang

    2014-12-02

    To explore the efficacies of treating patients with large area third-degree burns by tangential excision and skin grafting for subcutaneous tissue wounds. From January 2002 to December 2013, the medical records were retrospectively reviewed for 31 consecutive adult patients with a third-degree burn area exceeding 70% and undergoing tangential excision and skin grafting on subcutaneous tissue wound (TESGSTW) for the first time within 7 days postburn at Burn Center, Affiliated Jinan Central Hospital, Shandong University. For 31 patients, wounds with relative integrity eschar underwent TESGSTW by stages. Tourniquet was not used in some extremities. The relevant clinical data including patient condition on admission, causes of death, blood loss of tangential excision wound, surgical procedures and efficacies in cured group were analyzed. Average age, burn total area and third-degree burn area of 31 patients were (32.4 ± 12.8) years, (89.0 ± 6.2)% and (80.4 ± 7.6)% respectively. There were inhalation injury (n = 25, 80.6%) and early-stage shock before hospitalization (n = 22, 71.0%). Among 18 cured ones (58.1%), 2 patients had a third-degree burn area ≥ 90%. And 13 patients (41.9%) died and 10 of them died at 4 to 19 days postburn. Burn area was a risk factor of burn mortality. Sepsis and multiple organ dysfunction syndrome (MODS) were major mortality causes. Four patients died from early-stage sepsis. Within 14 days postburn, average blood loss volume per 1% tangential excision area in non-tourniquet group was slightly higher than that in the tourniquet group, but the difference was insignificant. For 18 cured patients, TESGSTW were performed 41 times. For 14 patients (77.8%), TESGSTW was performed twice. The average time of the first tangential excision was (4.1 ± 0.6) days postburn, the time interval between the first two tangential excisions was (6.4 ± 2.0) days, the first tangential excision area (33.8 ± 7.6)% and accumulated tangential excision area (58

  13. [Previously expanded full-thickness skin grafts. Technical principles. Indications in the repair of sequelae of burns. Apropos of 22 cases].

    PubMed

    Foyatier, J L; Gounot, N; Comparin, J P; Delay, E; Masson, C L; Latarjet, J

    1995-06-01

    Burns raise difficult repair problems. Previously expanded full-thickness skin grafts represent a good solution in many situations. Based on their experience of 22 cases, the authors present a review of the various indications for this technique.

  14. Evolution of skin grafting for treatment of burns: Reverdin pinch grafting to Tanner mesh grafting and beyond.

    PubMed

    Singh, Mansher; Nuutila, Kristo; Collins, K C; Huang, Anne

    2017-09-01

    Skin grafting is the current standard care in the treatment of full thickness burns. It was first described around 1500 BC but the vast majority of advancements have been achieved over the past 200 years. An extensive literature review was conducted on Pubmed, Medline and Google Scholar researching the evolution of skin grafting techniques. The authors concentrated on the major landmarks of skin grafting and also provide an overview of ongoing research efforts in this field. The major innovations of skin grafting include Reverdin pinch grafting, Ollier grafting, Thiersch grafting, Wolfe grafting, Padgett dermatome and modifications, Meek-wall microdermatome and Tanner mesh grafting. A brief description of the usage, advantages and limitations of each technique is included in the manuscript. Skin grafting technique have evolved significantly over past 200 years from Reverdin pinch grafting to modern day meshed skin grafts using powered dermatome. Increasing the expansion ratio and improving the cosmetic and functional outcome are the main focus of ongoing skin grafting research and emerging techniques (such as Integra(®), Recell(®), Xpansion(®)) are showing promise. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  15. The 1999 clinical research award. Cultured skin substitutes combined with Integra Artificial Skin to replace native skin autograft and allograft for the closure of excised full-thickness burns.

    PubMed

    Boyce, S T; Kagan, R J; Meyer, N A; Yakuboff, K P; Warden, G D

    1999-01-01

    Prompt and permanent closure of excised full-thickness burns remains a critical factor in a patient's recovery from massive burn injuries. Hypothetically, Integra Artificial Skin (Integra) may replace the need for allografts for immediate wound coverage, and cultured skin substitutes (CSS) that contain stratified epithelium may replace the need for autografts for definitive wound closure. To test this hypothesis, 3 patients with full-thickness burns of greater than 60% of their total body surface areas had their eschar excised within 14 days of admission. Integra was applied, and a skin biopsy was collected from each patient for the preparation of CSS. At 3 weeks or more after the application of the Integra and the collection of skin biopsies, the outer silastic cover of the Integra was removed and CSS were grafted. The CSS were irrigated with nutrients and antimicrobials for 6 days and then dressed with antimicrobial ointment and cotton gauze. Treated wounds were traced on days 14 and 28 after the grafting of CSS for determination of engraftment and wound closure, respectively. Cost analysis was not performed. Engraftment on postoperative day (POD) 14 was 98%+/-1% (mean +/- standard error of the mean), the ratio of closed:donor areas on POD 28 was 52.3+/-5.2, and no treated sites required regrafting. The histology of the closed wounds showed stable epithelium that covered a layer of newly formed fibrovascular tissue above the reticulated structure of the degrading Integra. The clinical outcomes of the closed wounds after POD 28 demonstrated smooth, pliable, and hypopigmented skin. Two patients who had received CSS grafts over Integra on their backs were positioned supine on air beds from POD 8 or POD 9 with minimal graft loss because of mechanical loading. One patient with a full-thickness burn of 88% of the total body surface area was covered definitively at 55 days postburn. These results demonstrate that the combination of CSS and Integra can accomplish

  16. [Systemic therapy for defects of skin and soft tissue on the knees after severe trauma or burn].

    PubMed

    Tao, Ke; Hu, Da-hai; Zhu, Xiong-xiang; Han, Jun-tao; Zheng, Zhao; Xie, Song-tao; Ge, Jin-bo; Hu, Xiao-long

    2013-04-01

    To explore the methods of systemic treatment of defects of skin and soft tissue on the knees after severe trauma or burn. Twenty patients with defects of skin and soft tissue on the knees after severe trauma or burn hospitalized in our center from January 2009 to December 2011. The injury areas on the knees ranged from 5 cm×4 cm to 30 cm×20 cm. The wounds were treated with radical debridement, vacuum sealing drainage, and douche through dripping to control infection in early stage. Then they were covered with transplantation of skin grafts plus flap or only with flap. Totally 8 local flaps (including 6 local rotation or transposition flaps and 2 saphenous artery flaps) and 12 free flaps (including 8 anterolateral thigh flaps and 4 latissimus dorsi musculocutaneous flaps) were used. The flap size ranged from 6 cm×5 cm to 32 cm×22 cm. The rehabilitation training of the knee joints was carried out in the early stage after wound healing. All free skin grafts and flaps used in 15 patients survived. Thirteen of them were primarily healed, while some small parts of skin grafts of the other two patients were in poor condition because of infection, and they healed after another session of skin transplantation. Infection occurred under the free flap in one of the 5 patients transplanted with flaps only, which was healed after continuous douche through dripping and another surgical debridement following wet dressing. The knee joints were in good function during the follow-up period of 1 - 3 years. The systemic therapy of radical debridement, vacuum sealing drainage technique, douche through dripping, transplantation of large autologous grafts and flaps, and the early rehabilitation training are effective and reliable in repairing defects of skin and soft tissue at the knee region after severe injuries.

  17. The Protective Effects of Epigallocatechin Gallate Against Distant Organ Damage After Severe Skin Burns--Experimental Study Using a Rat Model of Thermal Trauma.

    PubMed

    Hosnuter, Mubin; Melikoglu, Cenk; Aslan, Cem; Saglam, Gulcan; Sutcu, Recep

    2015-01-01

    Epigallocatechin gallate (EGCG), a green tea polyphenol, has potent antioxidant properties. The purpose of the present study was to examine the possible preventative effects of EGCG against internal organ injury due to large-surface skin burns in a rat model. The study design involved three groups of rats: a sham group and two groups with 25-30% full-thickness burns: (a) the sham group without burns or treatment (n=18); (b) the control burn group (burns+sterile saline, n=18); and (c) the burn treatment group (burns+treatment with EGCG, n=18). EGCG was administered intraperitoneally immediately after the thermal injury, and daily in 100 μmol/kg doses. Kidney and lung tissue samples were taken to determine the levels of malondialdehyde (MDA), superoxide dismutase (SOD), tumor necrosis factor-α (TNF-α), and glutathione peroxidase (GPX) after the first, third and seventh post-burn days. In the EGCG-treated burn group, SOD and GPX activity were significantly higher than in the burn control group. Additionally, MDA and TNF-α levels were significantly lower in the EGCG-treated burn group. Based on this study, it might be anticipated that EGCG treatment may be beneficial in burn injury cases.

  18. Patients With Burns Versus Patients With Complex Skin and Soft-Tissue Disease: An Analysis of Outcomes in the United States.

    PubMed

    Maximus, Steven; Phelan, Michael; Joe, Victor C

    2016-01-01

    With the incidence of burns decreasing nationally, burn units are caring for more patients with nonburn conditions. The American Burn Association National Burn Repository does not currently report data regarding patients cared for in burn units without a diagnosis of burn. Using the National Inpatient Sample, we examined if there was a difference in characteristics and outcomes of patients admitted for burns compared with those with a primary admitting diagnosis of necrotizing skin infections and soft-tissue infections and exfoliative skin conditions. This is a retrospective study querying the National Inpatient Sample database to identify 56,102 patients from 2007 to 2012 who were admitted with a diagnosis of a burn (burn group). This group was then compared with 375,857 patients who had a primary admitting diagnosis of a necrotizing skin and/or soft-tissue infection or exfoliative skin conditions (nonburn group). Clinical and demographic variables were analyzed to determine characteristics of each patient group including length of stay, disposition, complications, comorbidities, and mortality. The average age of the nonburn group was 63.7 years, whereas the average age of the burn group was 40.1 years. Overall length of stay was higher in the nonburn patients than in burn patients (10.5 vs 8.4 days, P < .001). Nonburn patients had a higher rate of medical comorbidities. Nonburn patients had higher rates of mortality (6.9% vs 2.7%) and complications. After adjusting for confounders, such as age, gender, ethnicity, and comorbidities, the nonburn group was found to have higher rates of all recorded complications. Burn patients were more likely to undergo a major operating room procedure (39.3% vs 28.1%) and routine discharge (68.4% vs 26.3%) compared with the nonburn group. Patients with necrotizing skin and soft-tissue infections and exfoliative skin conditions are older, have more comorbidities, higher complication rates, and higher mortality rates than burn

  19. Phases of the cutaneous angiogenesis process in experimental third-degree skin burns: histological and immunohistochemical study.

    PubMed

    Busuioc, Cristina Jana; Mogoşanu, G D; Popescu, Florina Carmen; Lascăr, I; Pârvănescu, H; Mogoantă, L

    2013-01-01

    Skin burns represent a major problem of public health because of their frequency and because of their seriousness, too. The healing process of the burnt wound is extremely complex, as it requires a well-coordinated collaboration among different tissues and cellular strings. From the morphological point of view, the stages of the repairing process of the skin wounds include processes of inflammation, proliferation and tissular remodeling. Angiogenesis has a role of extreme importance within the healing process of third-degree skin burns. That is because the vascularization remake is necessary for feeding the tissue of granulation with nutritive substances and oxygen. The angiogenesis started relatively fast. Three days after the producing of the burn, there could be identified strings of CD34+ endothelial precursor cells at the edges and deep into the wound, all these having contact with the normal blood vessels or with those lees affected by the thermal aggression. After the lumenization of the newly-formed capillary vessels, there appeared the pericytes within their membrane. The CD34+ endothelial precursor cells (EPc), as well as the pericytes, participate at the synthesis of the base membrane of the angiogenesis vessels. The density of the angiogenesis vessels on the surface unit within the tissue of granulation grew from three to 12 days. After that, they reduced progressively while the tissue of granulation was becoming mature. The angiogenesis vessels go through a process of reshuffling and maturation at the same time with the maturation of the tissue of granulation, but these processes did not appear to be finished when the skin was completely healed, and the epidermis was totally recovered.

  20. Antecedent thermal injury worsens split-thickness skin graft quality: A clinically relevant porcine model of full-thickness burn, excision and grafting.

    PubMed

    Carlsson, Anders H; Rose, Lloyd F; Fletcher, John L; Wu, Jesse C; Leung, Kai P; Chan, Rodney K

    2017-02-01

    Current standard of care for full-thickness burn is excision followed by autologous split-thickness skin graft placement. Skin grafts are also frequently used to cover surgical wounds not amenable to linear closure. While all grafts have potential to contract, clinical observation suggests that antecedent thermal injury worsens contraction and impairs functional and aesthetic outcomes. This study evaluates the impact of antecedent full-thickness burn on split-thickness skin graft scar outcomes and the potential mediating factors. Full-thickness contact burns (100°C, 30s) were created on the backs of anesthetized female Yorkshire Pigs. After seven days, burn eschar was tangentially excised and covered with 12/1000th inch (300μm) split-thickness skin graft. For comparison, unburned wounds were created by sharp excision to fat before graft application. From 7 to 120days post-grafting, planimetric measurements, digital imaging and biopsies for histology, immunohistochemistry and gene expression were obtained. At 120days post-grafting, the Observer Scar Assessment Scale, colorimetry, contour analysis and optical graft height assessments were performed. Twenty-nine porcine wounds were analyzed. All measured metrics of clinical skin quality were significantly worse (p<0.05) in burn injured wounds. Histological analysis supported objective clinical findings with marked scar-like collagen proliferation within the dermis, increased vascular density, and prolonged and increased cellular infiltration. Observed differences in contracture also correlated with earlier and more prominent myofibroblast differentiation as demonstrated by α-SMA staining. Antecedent thermal injury worsens split-thickness skin graft quality, likely by multiple mechanisms including burn-related inflammation, microscopically inadequate excision, and dysregulation of tissue remodeling. A valid, reliable, clinically relevant model of full-thickness burn, excision and skin replacement therapy has been

  1. First-aid with warm water delays burn progression and increases skin survival.

    PubMed

    Tobalem, M; Harder, Y; Tschanz, E; Speidel, V; Pittet-Cuénod, B; Wettstein, R

    2013-02-01

    First aid treatment for thermal injuries with cold water removes heat and decreases inflammation. However, perfusion in the ischemic zone surrounding the coagulated core can be compromised by cold-induced vasoconstriction and favor burn progression. The aim of this study is to evaluate the effect of local warming on burn progression in the rat comb burn model. 24 male Wistar rats were randomly assigned to either no treatment (control) or application of cold (17 °C) or warm (37 °C) water applied for 20 min. Evolution of burn depth, interspace necrosis, and microcirculatory perfusion were assessed with histology, planimetry, respectively with Laser Doppler flowmetry after 1 h, as well as 1, 4, and 7 days. Consistent conversion from a superficial to a deep dermal burn within 24 h was obtained in control animals. Warm and cold water significantly delayed burn depth progression, however after 4 days the burn depth was similar in all groups. Interspace necrosis was significantly reduced by warm water treatment (62±4% vs. 69±5% (cold water) and 82±3% (control); p<0.05). This was attributed to the significantly improved perfusion after warming, which was present 1 h after burn induction and was maintained thereafter (103±4% of baseline vs. 91±3% for cold water and 80±2% for control, p<0.05). In order to limit damage after burn injury, burn progression has to be prevented. Besides delaying burn progression, the application of warm water provided an additional benefit by improving the microcirculatory perfusion, which translated into increased tissue survival. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  2. Skin-derived precursors possess the ability of differentiation into the epidermal progeny and accelerate burn wound healing.

    PubMed

    Bayati, Vahid; Abbaspour, Mohammad Reza; Neisi, Niloofar; Hashemitabar, Mahmoud

    2017-02-01

    Skin-derived precursors (SKPs) are remnants of the embryonic neural crest stem cells that reside in the dermis until adulthood. Although they possess a wide range of differentiation potentials, their differentiation into keratinocyte-like cells and their roles in skin wound healing are obscure. The present study aimed to investigate the differentiation of SKPs into keratinocyte-like cells and evaluate their role in healing of third degree burn wounds. To this aim, SKPs were differentiated into keratinocyte-like cells on tissue culture plate and collagen-chitosan scaffold prepared by freeze-drying. Their differentiation capability was detected by real-time RT-PCR and immunofluorescence. Thereafter, they were cultured on scaffold and implanted in a rat model of burn wound. Histopathological and immunohistochemical analyses were employed to examine the reconstituted skin. The research findings revealed that SKPs were able to differentiate along the epidermal lineage and this ability can be enhanced on a suitable scaffold. Additionally, the results indicated that SKPs apparently promoted wound healing process and accelerate its transition from proliferating stage to maturational phase, especially if they were differentiated into keratinocyte-like cells. Regarding the results, it is concluded that SKPs are able to differentiate into keratinocyte-like cells, particularly when they are cultured on collagen-chitosan scaffold. Moreover, they can regenerate epidermal and dermal layers including thick collagen bundles, possibly through differentiation into keratinocyte-like cells.

  3. Severe post-burn neck contracture release and skin graft harvest using tumescent local anaesthesia as the sole anesthetic technique.

    PubMed

    Prasad, Mukesh Kumar; Puneet, Pulak; Rani, Kanchan; Shree, Divya

    2012-02-01

    Severe post-burn contractures in the neck often cause anatomical distortion and restriction of neck movements, resulting in varying degrees of difficulty in airway management. Any mode of anesthesia that may obviate the need for imperative airway control may be desirable in such situations in which a difficult airway may be anticipated. Here we present one such situation where tumescent local anesthesia was employed to manage a case of severe post-burn neck contractures posted for contracture release and split-skin grafting. The other benefits of this method were minimal blood loss and excellent postoperative analgesia. In conclusion, it can be emphasized that the application of tumescent anesthesia is an important anesthetic tool in patients with predicted difficult airway management.

  4. A retrospective analysis of securing autologous split-thickness skin grafts with negative pressure wound therapy in paediatric burn patients.

    PubMed

    Hoeller, Michael; Schintler, Michael Valentin; Pfurtscheller, Klaus; Kamolz, Lars-Peter; Tripolt, Norbert; Trop, Marija

    2014-09-01

    Deep dermal and full-thickness burn wounds are excised and grafted with split-thickness skin grafts. Especially in less compliant patients such as young children, conventional fixing methods can often be ineffective due to high mobility rates in this age group. The aim of this retrospective single-centre study was to give an overview of our experience in the fixation of autologous split-thickness skin grafts (ASTSGs) on burn wounds by negative pressure wound therapy (NPWT) in paediatric patients. A retrospective analysis describing 53 paediatric patients with burns or burn-related injuries who were treated as 60 individual cases were conducted. All patients received ASTSGs secured by NPWT. Of the individual cases, 60 cases with a mean age of 8±6 years (the youngest was 3 months, the eldest was 24 years old) were treated in a single procedure with ASTSG and NPWT. Total burn surface area (TBSA) was, median (med) 4.5% (3.0-12.0%). The TBSA of deep dermal thickness to full-thickness (IIb-III°) burns was med 4.0% (2.0-6.0%). The TBSA treated with ASTSG and NPWT was med 3.5% (2.0-6.0%). Take rate was, med 96% (90-99%) with a total range of 70-100%. The only significant correlation that could be found was between the grafted TBSA and the take rate. The smaller the grafted TBSA the better the take rate resulted, as expected. In three cases, major complications were noted. To sum up our experience, the NPWT system has developed itself to be a constant, well-implemented and useful tool in securing ASTSGs to the wound bed. The main advantage of the technique is a much higher mobility of the patient compared to conventional fixation methods. The high compliance rate of an often challenging group of patients such as children recompenses possible higher costs compared to conventional fixation methods. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  5. New biological temporary skin cover Xe-Derma(®) in the treatment of superficial scald burns in children.

    PubMed

    Zajicek, Robert; Matouskova, Eva; Broz, Ludomir; Kubok, Richard; Waldauf, Petr; Königova, Radana

    2011-03-01

    Xe-Derma® is a new dry sterile biological cover derived from acellular pig dermis. Hydrated Xe-Derma® displays bio-mechanical features similar to the normal skin. The aim of the present study was to compare the efficacy of Xe-Derma® with hydrocolloid dressing Askina THINSite® for treatment of superficial burns in children in a prospective study. In a prospective study, 86 patients (5 months to 7 years of age) with superficial scald burns on a surface area of 1-35% BSA were enrolled. In the course of the study, 43 patients were treated with Xe-Derma® and 43 patients with Askina THINSite®. We collected data including the percentage of BSA covered with biological or synthetic material, epithelization time, the number of complete conversions (deepening of 100% of covered area into deep dermal wound) under each cover, the number and extent of partial conversions (deepening of less then 100% of covered area into deep dermal wound), infectious complications, the number of reapplications of the temporary cover and the extent in square centimetres of dressing material needed for successful healing of 1% BSA. No significant difference in the epithelization time, percentage of conversion from superficial to deep dermal burns and percentage of infectious complication was detected between the two groups. However, patients in the Xe-Derma® group were burned on a more extensive burn surface area (p ≤ 0.028). Xe-Derma® showed adherence to the wound and therefore there has been no need to be changed The number of reapplications and therefore also the number of square centimetres needed for successful healing of 1% BSA were statistically higher in the Askina THINSite® group (p < 0.01) due to increased secretion and accumulation of fluid underneath this hydrocoloid cover. The minimal frequency of changes of this biological cover material brings a significant benefit to pediatric patients. Acellular pig dermis Xe-Derma® represents a reliable biological cover material. It

  6. A randomized trial comparing ReCell system of epidermal cells delivery versus classic skin grafts for the treatment of deep partial thickness burns.

    PubMed

    Gravante, G; Di Fede, M C; Araco, A; Grimaldi, M; De Angelis, B; Arpino, A; Cervelli, V; Montone, A

    2007-12-01

    Our purpose was to directly compare results obtained with the ReCell system and the classic skin grafting for epidermal replacement in deep partial thickness burns. We recruited all patients with deep partial thickness burns admitted at the Burn Centre of S. Eugenio Hospital in Rome over 2 years. Enrollment was conducted with a controlled strategy--sampling chart--that allowed homogeneous groups (ReCell and skin grafting) for age, gender, type of burns and total burn surface area (TBSA). We evaluated as primary endpoints of the study the (i) time for complete epithelization (both treated area and biopsy site) and (ii) aesthetic and functional quality of the epithelization (color, joint contractures). Secondary endpoints were the assessment of infections, inflammations or any adverse effects of the ReCell procedure, particular medications assumed, postoperative pain. Eighty-two patients were analyzed in two homogeneous groups. All of them received adequate epidermal replacement, but skin grafting was faster than ReCell (p<0.05). On the contrary, ReCell biopsy areas and postoperative pain were smaller than classic grafting (p<0.05). The aesthetic and functional outcomes were similar between procedures. ReCell is a feasible, simple and safe technique. It gives similar results to skin grafting but, harvesting minor areas, can open possible future applications in the management of large-burns patients.

  7. An objective long-term evaluation of Integra (a dermal skin substitute) and split thickness skin grafts, in acute burns and reconstructive surgery.

    PubMed

    Nguyen, Dai Q A; Potokar, Tom S; Price, Patricia

    2010-02-01

    The field of wound healing and tissue repair has advanced rapidly in the last decade, with this there is an increasing emphasis on the importance of the functional and cosmetic outcomes following injury. Integra artificial skin is the most widely used synthetic skin substitute and is reported to have better outcomes in relation to the appearance and elasticity when compared to split thickness skin grafting (SSG). A review of the literature reveals very few trials that are based on an objective evaluation of Integra treated scars as compared to SSGs. This research aimed to provide objective data on the long-term outcome of Integra. All adult patients from the Welsh Burns Centre who had been successfully treated with Integra+/-SSG were invited to attend a clinic for a follow up provided they had been healed for greater than one year. The hypothesis that Integra scars are more pliable than skin grafts was tested objectively using the Cutometer, a suction device which measures skin elasticity. Of the 13 patients eligible, six were available for assessment. The results of this study suggest that Integra treated sites correlate well with normal skin as measured by the Cutometer. This was statistically significant for the parameters Ur/Ue (elastic function) and Ur/Uf (gross elasticity). On the other hand there was no correlation seen between the patients SSG sites and the patient's normal skin. With advances in medicine we are increasingly able to modulate wound healing and the resultant scars. In order to assess new and often costly treatments the need for objective scar measurement tools have become apparent. Integra has been advocated to improve scarring from injury. However, there have been few studies to evaluate the long-term outcome of Integra as compared to traditional methods such as SSG. In the past scar evaluation has been based on subjective scores by patients and clinicians. Now the mechanical properties of the skin can be evaluated using simple

  8. Magnetic Zenith Enhancement of HF Radio-Induced Airglow Production at HAARP

    DTIC Science & Technology

    2003-02-22

    Magnetic zenith enhancement of HF radio-induced airglow production at HAARP T. R. Pedersen,1 M. McCarrick,2 E. Gerken,3 C. Selcher,4 D. Sentman,5 H ...E. Gerken, C. Selcher, D. Sentman, H . C. Carlson, and A. Gurevich, Magnetic zenith enhancement of HF radio- induced airglow production at HAARP...Unambiguous evidence of HF pump-enhanced airglow at auroral latitudes, Geophys. Res. Lett., 26(23), 2561–3564, 1999. Gurevich, A., H . Carlson, M. Kelley, T

  9. Nacre-driven water-soluble factors promote wound healing of the deep burn porcine skin by recovering angiogenesis and fibroblast function.

    PubMed

    Lee, Kyunghee; Kim, Hyunsoo; Kim, Jin Man; Chung, Yeoun Ho; Lee, Tae Yoon; Lim, Hyun-Sook; Lim, Ji-Hye; Kim, Taewoon; Bae, Jin Seung; Woo, Chang-Hoon; Kim, Keuk-Jun; Jeong, Daewon

    2012-03-01

    To assess the recovery effect of water-soluble components of nacre on wound healing of burns, water-soluble nacre (WSN) was obtained from powdered nacre. Alterations to WSN-mediated wound healing characteristics were examined in porcine skin with deep second-degree burns; porcine skin was used as a proxy for human. When WSN was applied to a burned area, the burn-induced granulation sites were rapidly filled with collagen, and the damaged dermis and epidermis were restored to the appearance of normal skin. WSN enhanced wound healing recovery properties for burn-induced apoptotic and necrotic cellular damage and spurred angiogenesis. Additionally, WSN-treated murine fibroblast NIH3T3 cells showed increased proliferation and collagen synthesis. Collectively, the findings indicate that WSN improves the process of wound healing in burns by expeditiously restoring angiogenesis and fibroblast activity. WSN may be useful as a therapeutic agent, with superior biocompatibility to powdered nacre, and evoking less discomfort when applied to a wounded area.

  10. Evaluation of a highly skin permeable low-molecular-weight protamine conjugated epidermal growth factor for novel burn wound healing therapy.

    PubMed

    Lee, Ji Hae; Bae, Il-Hong; Choi, Jin Kyu; Park, Jin Woo

    2013-11-01

    We evaluated the laser induced burn wound healing efficacy of a recombinant low-molecular-weight protamine conjugated epidermal growth factor (rLMWP-EGF). rLMWP-EGF was prepared by genetically combining LMWP with the N-terminal sequence of EGF; we obtained a homogeneous modified EGF without reduced biological activity. Because of the protein transduction domain of LMWP, rLMWP-EGF showed enhanced drug penetration across artificial skin constructs and excised mouse skin layers versus EGF and showed significantly improved burn wound healing efficacy, with accelerated wound closure and minimized eschar and scar formation, compared with EGF or no treatment. Histological examination also revealed that rLMWP-EGF permeated through the intact skin around the wound and facilitated residual epithelial cell proliferation in an integrated manner to reform an intact epidermis. Radiofrequency microwound formation was effective for reducing large hypertrophic scars formed after severe laser burning by collagen remodeling but rLMWP-EGF did not show a meaningful synergistic effect in burn scar reduction. However, rLMWP-EGF was helpful for forming skin with a more normal appearance and texture. Thus, rLMWP-EGF demonstrated therapeutic potential as a novel topical burn wound healing drug with no obvious toxic effect.

  11. Chemical analysis of Agaricus blazei polysaccharides and effect of the polysaccharides on IL-1beta mRNA expression in skin of burn wound-treated rats.

    PubMed

    Sui, ZhiFu; Yang, RongYa; Liu, Biao; Gu, TingMin; Zhao, Zhili; Shi, Dongfang; Chang, DongQing

    2010-08-01

    Agaricus blazei polysaccharides were analyzed by GC-MS. Results indicated that the polysaccharides contained glucose (93.87%), mannose (3.54%), and arabinose (2.25%). The compositional analysis was completed by the methylation data. These data indicated that Agaricus blazei polysaccharides are glucans. Compared to model rats, rats fed with Agaricus blazei polysaccharides showed a decrease of ratio of IL-1beta/beta-actin and IL-1beta level in skin of burn wound. Recovery rate of wound skin increased with increasing dose of polysaccharides. The results indicated that Agaricus blazei polysaccharides could be useful in promote burn wound healing.

  12. Skin Conditions

    MedlinePlus

    Your skin is your body's largest organ. It covers and protects your body. Your skin Holds body fluids in, preventing dehydration Keeps harmful ... it Anything that irritates, clogs, or inflames your skin can cause symptoms such as redness, swelling, burning, ...

  13. Cement Burns

    PubMed Central

    Alam, Munir; Moynagh, M.; Lawlor, C.

    2007-01-01

    Objective: Cement burns account for relatively few admissions to a burn unit; however, these burns deserve separate consideration because of special features of diagnosis and management. Cement burns, even though potentially disabling, have rarely been reported in literature. Methods: A retrospective review was performed of all patients admitted with cement burns injuries to the national burns unit at the St James's Hospital in Dublin, Ireland, over a 10-year period for the years 1996–2005. Results: A total of 46 patients with cement burns were admitted. The majority of patients were aged 16–74 years (mean age = 32 years). Eighty-seven percent of injuries occurred in an industrial and 13% in a domestic setting. The upper and lower extremities were involved in all the patients, and the mean total body surface area affected was 6.5%. The mean length of hospital stay was 21 days with a range of 1–40 days. Thirty-eight (82%) were surgically managed involving debridement and split-thickness skin graft (SSG) and four (9%) were conservatively managed. A further four did not have data available. Conclusion: Widespread inexperience in dealing with this group of cement burns patients and delays in referral to burns unit highlights the potential for greater levels of general awareness and knowledge in both prevention and treatment of these burns. As well, early debridement and split-thickness skin grafting at diagnosis constitutes the best means of reducing the high socioeconomic costs and allows for early return to work. PMID:18091981

  14. Short- and long-term outcomes of small auto- and cryopreserved allograft skin grafting in those with >60%TBSA deep burn wounds.

    PubMed

    Shizhao, Ji; Yongjun, Zheng; Lisen, Zhang; Pengfei, Luo; Xiaopeng, Zheng; Guangyi, Wang; Shihui, Zhu; Xiaoyan, Hu; Shichu, Xiao; Zhaofan, Xia

    2017-02-01

    The shortage of autologous skin sources not only adds difficulty to the repair of extremely large-area deep burn wounds but affects the healing quality. The aim of the present study is to explore an ideal method for repairing large-areas burn wounds with low scar formation. Between 2002 and 2014, we used grafting of small auto- and cryopreserved allo-skin to repair large-area residual burn wounds in wounds after 21 days 21 patients, and after early excision in 17 patients. The wound healing rate and quality were observed. The skin expansion rate was 1:9-1:16, and the mean area of wounds repaired after three weeks was 64.8±7.3%TBSA, the wound healing rate was 91.8±3.7%. The mean area of the early excision group was 65.9±9.8 TBSA, where the healing rate was 94.5±5.6%. After small auto- and cryopreserved allograft skin grafting, the epidermis of the auto-skin gradually replaced the allo-epidermis, and the allo-dermis persisted for a prolonged period. The dermal collagen fibers at the allo-skin grafting sites were well arranged. At 1-2-year follow-up, observation showed that the Vancouver Scar Scale total score was 4·304±2·363, and we did not discern significant contracture and dysfunction in the large joints of the four extremities. Small auto- and cryopreserved allograft skin grafting of small auto- and allo-skin not only raised the graft expansion rate but offers a stable wound healing rate. This new technique may provide an option for repair of large-area deep burn wounds. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

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

    PubMed

    Lee, Woo-Young; Um, In Chul; Kim, Min-Keun; Kwon, Kwang-Jun; Kim, Seong-Gon; Park, Young-Wook

    2014-11-01

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

  16. The Clinical Application of Preexpanded and Prefabricated Super-Thin Skin Perforator Flap for Reconstruction of Post-Burn Neck Contracture.

    PubMed

    Wang, Chunmei; Zhang, Junyi; Yang, Sifen; Hyakusoku, Hiko; Song, Ping; Pu, Lee L Q

    2016-02-01

    Based on our previous animal study, we applied the "bridging effect" to the neighboring axial flap through preexpansion and prefabrication of a skin perforator flap as a new method to reconstruct a large skin defect after release of severe neck burn scar contracture. Twelve patients suffering from severe post-burn cervical contractures underwent reconstruction of large skin defects after surgical release of severe scar contractures with preexpanded and prefabricated super-thin skin perforator flaps supplied primarily by a number of perforators via the "bridging effect" from the branches of the adjacent arteries as 2-stage procedures. During the first-stage operation, 2 tissue expanders were placed accordingly, and this was followed by a subsequent second-stage procedure where an expanded super-thin skin perforator flap was transposed to reconstruct a large neck skin defect. Follow-up was between 6 months and 3 years in this series. All super-thin skin perforator flaps survived in this series with primary healing except one with a distal flap necrosis that was treated with a subsequent skin graft. All patients have had a good contour with improved range of motion in the neck. The preexpansion and prefabrication of a super-thin skin perforator flap can possibly improve the anastomoses between neighboring subdermal vascular plexuses and extend the supplying area of these vessels to the flap. This method may provide a favorable super-thin skin flap that can be used for reconstruction of large neck defects after release of post-burn cervical scar contracture as demonstrated in this case series.

  17. The role of topically applied L-ascorbic acid in ex-vivo examination of burn-injured human skin

    NASA Astrophysics Data System (ADS)

    Pielesz, Anna; Biniaś, Dorota; Bobiński, Rafał; Sarna, Ewa; Paluch, Jadwiga; Waksmańska, Wioletta

    2017-10-01

    Wound treatment and healing is complex and is comprised of an elaborate set of processes including cellular, spectroscopic and biochemical ones as well as the ;reaction; of local tissue to thermal injury. Vitamin C as L-ascorbic acid (LA) prevents injurious effects of oxidants because it reduces reactive oxygen species to stable molecules, it becomes oxidized to the short-lived ascorbyl radical. As a result, antioxidant treatment may contribute to minimizing injury in burn patients. The aim of this study is to assess changes in molecular structure of collagen extracted from human epidermis burn wound scab during incubation of the epidermis in L-ascorbic acid solution. The study will be performed using FTIR and FT Raman spectroscopies. During this research it was observed that the intensity of Raman peaks increased where healing was being modified by LA. The intensity of the amide III band at 1247 cm- 1 relative to the intensity at 1326 cm- 1 was used to test tissue repair degree at the incision site. FTIR spectra were recorded from frozen specimens of serum modified by LA; an analysis of shifts in the amide I band position was conducted. The appearance of a new band for frozen samples modified by LA was observed around 1149-1220 cm- 1. The above conclusions confirmed the creation of hydrogen bonds between Nsbnd H stretch and Cdbnd O. Samples being incubated in solutions of L-ascorbic acid demonstrated the absence of electrophoretic bands of albumin. Alterations in the surface of the skin incubated in L-ascorbic acid were investigated with the use of Scanning Electron Microscopy (SEM). A decrease in external symptoms of burn injury was noted in the damaged epidermis incubated in L-ascorbic acid.

  18. Genetically Modified Porcine Skin Grafts for Treatment of Severe Burn Injuries

    DTIC Science & Technology

    2011-07-01

    graft survival: 2 days). See Figure 3 below. Task 2c Evaluate immune effects of skin graft on cellular and humoral responses (months 18-30...stabilization of criticall-ill patients. We intend to breed and maintain a herd of GalT-KO donor swine for this purpose as a new approach to the initial...of the cellular and humoral immune responses evoked. (Month 3 - Month 18) Task 1. Develop and compare survival of GalT-KO swine skin, normal swine

  19. Correlation between changes in polyphenol composition of peels and incidence of CO₂ skin burning of 'Cameo' apples as influenced by controlled atmosphere storage.

    PubMed

    Harb, Jamil; Kittemann, Dominikus; Neuwald, Daniel Alexandre; Hoffmann, Thomas; Schwab, Wilfried

    2013-04-17

    'Cameo' apples stored under high CO₂ levels suffer from "skin burning". Accordingly, this study is aimed to correlate the incidence of skin burning with different polyphenols. After harvest, apples were sorted into bad- and good-colored fruit and further stored under either high (3%) or low (0.7%) CO₂ level. At frequent intervals, fruit were assessed for incidence of skin burning and relative concentrations of various polyphenols. Results clearly show that bad-colored apples stored under high CO₂ level had the highest incidence percentage. Concerning the polyphenol profile, good-colored and healthy apples had significantly higher concentrations of certain polyphenols, including cyanidin-3-galactoside and rutin. However, bad-colored and injured apples had significantly higher concentrations of another set of polyphenols, including phloridzin, epicatechin, and (epi)catechin→(epi)catechin isomers. Taking into account that quercetins and cyanidins account for more than 80% of antioxidants, it is logical to assume that these polyphenols might give protection to good-colored apples against skin burning.

  20. The use of a polylactide-based copolymer as a temporary skin substitute in deep dermal burns: 1-year follow-up results of a prospective clinical noninferiority trial.

    PubMed

    Selig, Harald F; Keck, Maike; Lumenta, David B; Mittlböck, Martina; Kamolz, Lars P

    2013-01-01

    Deep dermal burns can be covered with different kind of materials and techniques; one of them is a polylactide-based temporary skin substitute. The aim of this study was to intraindividually compare its 1-year outcome with the results obtained by use of autologous skin grafts in patients suffering from deep dermal burns. A prospective noninferiority trial was designed in order to assess skin quality and scar formation by use of subjective (Vancouver Scar Scale; Patient and Observer Scar Assessment Scale) and objective (noninvasive cutometry) burn scar assessment tools. All items of the Patient and Observer Scar Assessment Scale, except vascularity, were found to be noninferior in the areas covered with the temporary skin substitute vs. autologous skin. Results of objective scar evaluation showed comparable viscoelastic parameters without reaching noninferiority. Overall, the outcome of deep dermal burns covered with a polylactide-based temporary skin substitute revealed satisfactory results in terms of scar formation and skin quality as compared with autologous skin. This paper supports its use in deep dermal burns, where autologous skin donor sites require either to be reserved for coverage of full-thickness skin defects in severe burns or to be saved for reduction of additional morbidity in selected patient collectives. © 2013 by the Wound Healing Society.

  1. The treatment of deep dermal hand burns: How do we achieve better results? Should we use allogeneic keratinocytes or skin grafts?

    PubMed

    Haslik, W; Kamolz, L-P; Lumenta, D B; Hladik, M; Beck, H; Frey, M

    2010-05-01

    The treatment of deep dermal burns has a broad spectrum and has been subject to discussion over the past years. The treatment of hand burns is challenging due to the high requirements to aesthetic and functional outcome. 27 patients, 7 women and 20 men with deep dermal hand burns with a mean age of 41.3+/-16.5 and a mean TBSA of 15%+/-19.6% were treated either with allogeneic cryopreserved keratinocytes or with split skin grafts. Long-term follow-up revealed no statistical significant differences between the two groups concerning Vancouver Scar Scale as well as hand function judged by the DASH score; however there was a tendency to higher VSS scores and impaired aesthetic results in the keratinocyte group. Allogeneic keratinocytes are a suitable armentarium for the treatment of deep dermal hand burns; and, if used correctly, they can produce a timely healing comparable to split-thickness skin grafts. Limited availability, high costs as well as the need for special skills are key factors, which render application of this technique outside specialist burn centres virtually impossible. In our opinion, the cultivation and use of keratinocytes should be reserved to these centres in order to facilitate a sensible application for a full range of indications. We recommend usage of allogeneic keratinocytes for deep dermal hand burns only in severely burned patients with a lack of donor sites. Patients with unrestricted availability of donor sites seem to profit from the application of split-thickness skin grafts according to our results. Copyright 2009 Elsevier Ltd and ISBI. All rights reserved.

  2. The Effects of Punica granatum Flower Extract on Skin Injuries Induced by Burn in Rats

    PubMed Central

    Nasiri, Ebrahim; Akbari, Jafar; Azadbakht, Mohammad; Azizi, Soheil

    2017-01-01

    Background. We compared the efficacy of P. granatum (P) flower extract with that of silver sulfadiazine (SSD) for treating thermal burn injuries in rats. Methods. Ten Wistar rats in each group were topically given base cream, normal saline, cream containing 1% SSD, or creams containing 5% or 10% Punica granatum flower extract. The treatments were administered once daily until complete wound healing was observed. The wound area and healing time were assessed. In addition, percentage wound contraction and histopathological characteristics such as neovascularization and collagen formation were determined. The tannin content in P. granatum extract was determined. Results. The decrease in the average size of wounds on day 15 of the treatment was higher in rats treated with creams containing P. granatum extract than in rats treated with cream containing SSD (2.8 ± 0.9 cm2 versus 8.4 ± 3.2 cm2). The wounds completely healed on day 25 of the treatment in rats treated with creams containing P. granatum flower extract compared with those in rats treated with the other agents. Conclusion. These results indicated that P. granatum flower extract promoted wound healing in rats and could be used for managing burn injuries. PMID:28203250

  3. Nongrafted Skin Area Best Predicts Exercise Core Temperature Responses in Burned Humans

    PubMed Central

    Ganio, Matthew S.; Schlader, Zachary J.; Pearson, James; Lucas, Rebekah A.I.; Gagnon, Daniel; Rivas, Eric; Kowalske, Karen J.; Crandall, Craig G.

    2015-01-01

    Grafted skin impairs heat dissipation, but it is unknown to what extent this impacts body temperature during exercise in the heat. PURPOSE We examined core body temperature responses during exercise in the heat in a group of individuals with a large range of grafts covering their body surface area (BSA; 0-75%). METHODS Forty-three individuals (19 females) were stratified into groups based upon BSA grafted: Control (0% grafted, n=9), 17-40% (n=19), and >40% (n=15). Subjects exercised at a fixed rate of metabolic heat production (339 ± 70 W; 4.3 ± 0.8 W/kg) in an environmental chamber set at 40°C, 30% RH for 90 min or until exhaustion (n=8). Whole-body sweat rate and core temperatures were measured. RESULTS Whole body sweat rates were similar between groups (Control: 14.7±3.4 ml/min, 17-40%: 12.6±4.0 ml/min, and >40%: 11.7±4.4 ml/min, P>0.05), but the increase in core temperature at the end of exercise in the >40% BSA grafted group (1.6±0.5°C) was greater than the 17-40% (1.2±0.3°C) and Control (0.9±0.2°C) groups (P<0.05). Absolute BSA of non-grafted skin (expressed in m2) was the strongest independent predictor of the core temperature increase (r2=0.41). When re-grouping all subjects, individuals with the lowest BSA of non-grafted skin (<1.0 m2) had greater increases in core temperature (1.6±0.5°C) than those with >1.5 m2 non-grafted skin (1.0±0.3°C, P<0.05). CONCLUSIONS These data imply that individuals with grafted skin have greater increases in core temperature when exercising in the heat and that the magnitude of this increase is best explained by the amount of non-grafted skin available for heat dissipation. PMID:26378947

  4. [Effectiveness of scar split thickness skin graft combined with acellular allogeneic dermis in treatment of large deep II degree burn scar].

    PubMed

    Cui, Zelong; Yang, Xiaohui; Shou, Jiabao; Wang, Guangyi

    2014-12-01

    To investigate the feasibility and effectiveness of using scar split thickness skin grafts combined with acellular allogeneic dermis in the treatment of large deep II degree burn scar. Between January 2013 and December 2013, 20 cases of large deep II degree burn scar undergoing plastic operation were enrolled. There were 14 males and 6 females, aged 4 to 60 years (mean, 40 years). Burn reasons included hydrothermal burns in 10 cases, flame burns in 9 cases, and lime burns in 1 case. The burn area accounted for 70% to 96% total body surface area (TBSA) with an average of 79% TBSA. The time from wound healing to scar repair was 3 months to 2 years (mean, 7 months). Based on self-control, 0.7 mm scar split thickness skin graft was used to repair the wound at the right side of joints after scar resection (control group, n=35), 0.5 mm scar split thickness skin graft combined with acellular allogeneic dermis at the left side of joints (trial group, n=30). Difference was not statistically significant in the scar sites between 2 groups (Z=-1.152, P=0.249). After grafting, negative pressure drainage was given for 10 days; plaster was used for immobilization till wound healing; and all patients underwent regular rehabilitation exercises. No significant difference was found in wound healing, infection, and healing time between 2 groups (P > 0.05). All patients were followed up for 6 months. According to the Vancouver Scar Scale (VSS), the score was 5.23 ± 1.41 in trial group and was 10.17 ± 2.26 in control group, showing significant difference (t=8.925, P=0.000). Referring to Activities of Daily Living (ADL) grading standards to assess joint function, the results were excellent in 8 cases, good in 20 cases, fair in 1 case, and poor in 1 case in trial group; the results were excellent in 3 cases, good in 5 cases, fair in 22 cases, and poor in 5 cases in control group; and difference was statistically significant (Z=-4.894, P=0.000). A combination of scar split thickness skin

  5. Captopril Increases Survival after Whole-Body Ionizing Irradiation but Decreases Survival when Combined with Skin-Burn Trauma in Mice.

    PubMed

    Islam, Aminul; Bolduc, David L; Zhai, Min; Kiang, Juliann G; Swift, Joshua M

    2015-09-01

    Past and recent radiation events have involved a high incidence of radiation combined injury where victims often succumb to serious infections as a consequence of bacterial translocation and subsequent sepsis. The risk of infection is exacerbated in radiation combined skin-burn injury (RCI), which increase vulnerability. Furthermore, no suitable countermeasures for radiation combined skin-burn injury have been established. In this study, we evaluated captopril as a potential countermeasure to radiation combined skin-burn injury. Captopril is an FDA-approved angiotensin-converting enzyme inhibitor that was previously reported to stimulate hematopoietic recovery after exposure to ionizing radiation. Female B6D2F1/J mice were whole-body bilateral (60)Co gamma-photon irradiated (dose rate of 0.4 Gy/min) with 9.5 Gy (LD70/30 for RCI), followed by nonlethal dorsal skin-burn injury under anesthesia (approximately 15% total-body surface-area burn). Mice were provided with acidified drinking water with or without dissolved captopril (0.55 g/l) for 30 days immediately after injury and were administered topical gentamicin (0.1% cream; day 1-10) and oral levofloxacin (90-100 mg/kg; day 3-16). Surviving mice were euthanized on day 30 after analyses of water consumption, body weight and survival. Our data demonstrate that, while treatment with captopril did mitigate mortality induced by radiation injury (RI) alone (55% captopril vs. 80% vehicle; n = 20, P < 0.05), it also resulted in decreased survival after radiation combined skin-burn injury (22% captopril vs. 41% vehicle; n = 22, P < 0.05). Moreover, captopril administration via drinking water produced an uneven dosage pattern among the different injury groups ranging from 74 ± 5.4 to 115 ± 2.2 mg/kg/day. Captopril treatment also did not counteract the negative alterations in hematology, splenocytes or bone marrow cellularity after either radiation injury or radiation combined skin-burn injury. These data suggest that

  6. Burn, thermal - close-up (image)

    MedlinePlus

    ... first degree burns cause only reddening of the epidermis (outer layer of the skin), as seen in this photograph. Second degree burns cause blistering and extend into the dermis (lower layer of skin). Third degree burns cause ...

  7. Chemical burns

    PubMed Central

    Cartotto, Robert C.; Peters, Walter J.; Neligan, Peter C.; Douglas, Leith G.; Beeston, Jeff

    1996-01-01

    Objectives To report a burn unit’s experience with chemical burns and to discuss the fundamental principles in managing chemical burns. Design A chart review. Setting A burn centre at a major university-affiliated hospital. Patients Twenty-four patients with chemical burns, representing 2.6% of all burn admissions over an 8-year period at the Ross Tilley Regional Adult Burn Centre. Seventy-five percent of the burn injuries were work-related accidents. Chemicals involved included hydrofluoric acid, sulfuric acid, black liquor, various lyes, potassium permanganate and phenol. Results Fourteen patients required excision and skin grafting. Complications were frequent and included ocular chemical contacts, wound infections, tendon exposures, toe amputation and systemic reactions from absorption of chemical. One patient died from a chemical scald burn to 98% of the body surface area. Conclusions The key principles in the management of chemical burns include removal of the chemical, copious irrigation, limited use of antidotes, correct estimation of the extent of injury, identification of systemic toxicity, treatment of ocular contacts and management of chemical inhalation injury. Individualized treatment is emphasized. PMID:8640619

  8. The Immune Response to Skin Trauma Is Dependent on the Etiology of Injury in a Mouse Model of Burn and Excision.

    PubMed

    Valvis, Samantha M; Waithman, Jason; Wood, Fiona M; Fear, Mark W; Fear, Vanessa S

    2015-08-01

    Skin trauma has many different causes including incision, blunt force, and burn. All of these traumas trigger an immune response. However, it is currently unclear whether the immune response is specific to the etiology of the injury. This study was established to determine whether the immune response to excision and burn injury of equivalent extent was the same. Using a mouse model of a full-thickness 19 mm diameter excision or 19 mm diameter full-thickness burn injury, we examined the innate immune response at the level of serum cytokine induction, whole-blood lymphocyte populations, dendritic cell function/phenotype, and the ensuing adaptive immune responses of CD4 and CD8 T-cell populations. Strikingly, both the innate and adaptive immune system responses differed between the burn and excision injuries. Acute cytokine induction was faster and different in profile to that of excision injury, leading to changes in systemic monocyte and neutrophil levels. Differences in the immune profile between burn and excision were also noted up to day 84 post injury, suggesting that the etiology of injury leads to sustained changes in the response. This may in part underlie clinical observations of differences in patient morbidity and mortality in response to different skin injury types.

  9. Minor burns - aftercare

    MedlinePlus

    ... all clothes that have the chemical on them. Cool the burn: Use cool water, not ice. The extreme cold from ice ... caused by chemicals, hold the burned skin under cool running water for 10 to 15 minutes until ...

  10. Effects of low level laser therapy on the prognosis of split-thickness skin graft in type 3 burn of diabetic patients: a case series.

    PubMed

    Dahmardehei, Mostafa; Kazemikhoo, Nooshafarin; Vaghardoost, Reza; Mokmeli, Soheila; Momeni, Mahnoush; Nilforoushzadeh, Mohammad Ali; Ansari, Fereshteh; Amirkhani, Amir

    2016-04-01

    Significant populations in burn centers are diabetic burn patients. Healing process in these patients is more difficult due to diabetes complications. The gold standard treatment for patients with grade 3 burn ulcer is split-thickness skin grafting (STSG), but in the diabetic patients, the rate of graft failure and amputation is high due to impaired tissue perfusion. The technique of low level laser therapy (LLLT) improves tissue perfusion and fibroblast proliferation, increases collagen synthesis, and accelerates wound healing. The purpose of this case report is introducing a new therapeutic method for accelerating healing with better prognosis in these patients. The protocols and informed consent were reviewed according to the Medical Ethics, Board of Shahid Beheshti Medical Sciences (IR.SBMU.RAM.REC.13940.363). Diabetic type 2 patients with 13 grade 3 burn ulcers, candidate for amputation, were enrolled in the study. We used a 650-nm red laser light, 2 J/Cm for the bed of the ulcer and an 810-nm infrared laser light 6 J/Cm(2) for the margins along with intravenous laser therapy with a 660-nm red light, before and after STSG for treating grade 3 burn ulcers in 13 diabetic ulcers. The results of this study showed complete healing in the last 8 weeks for all patients who were candidates for amputation. In this case series, we present 13 cases of diabetic ulcer with type 3 burn wound, candidate for amputation, who healed completely using LLLT and STSG. This is the first time that these two techniques are combined for treatment of burn ulcer in diabetic patients. Using LLLT with STSG might be a promising treatment for burn victims especially diabetic patients.

  11. Dorsal skin necrosis secondary to a solar-induced thermal burn in a brown-coated dachshund.

    PubMed

    Sumner, Julia P; Pucheu-Haston, Cherie M; Fowlkes, Natalie; Merchant, Sandra

    2016-03-01

    A 5-year-old neutered male brown dachshund dog was presented for a large dorsal cutaneous burn that occurred following direct sunlight exposure outdoors in high ambient temperatures. Although burns are quite common in dogs, full-thickness solar-induced radiation burns are less common and have not been previously reported in animals without a black hair coat.

  12. Part 2. Comparison of emergency washing solutions in 70% hydrofluoric acid-burned human skin in an established ex vivo explants model

    PubMed Central

    Burgher, François; Mathieu, Laurence; Lati, Elian; Gasser, Philippe; Peno-Mazzarino, Laurent; Blomet, Joël; Hall, Alan H; Maibach, Howard I

    2011-01-01

    Background: Hydrofluoric acid (HF) is a small and partially dissociated acid (pKa 3.2), able to deeply penetrate into human skin in addition to the corrosiveness of the hydrogen ion (H+) and the toxicity of the fluoride ion (F-). However, there has been a lack of experimental studies to objectively characterize the results of human HF skin exposure decontamination. Methodology/principal findings: A previously established experimental method using a human skin explants ex vivo model (Part 1. Experimental 70% hydrofluoric acid (HF) burns: Histological observations in an established human skin explants ex vivo model) described the lesions that appeared following 70% HF penetration. Within 5min, 70% HF penetrates to the dermis. Using the same experimental conditions, a comparison study of two different washing protocols was performed: water + topical calcium gluconate (CaG) versus Hexafluorine®. In these conditions, washing for 15min with running tap water followed by topical CaG ointment only delayed burn onset, while severe tissue damage appeared later. In contrast, after washing with Hexafluorine® over 10 min, no histological lesions developed. These results are in accordance with the results of accidental human industrial case reports. Conclusion/significance: Amphoteric and hypertonic Hexafluorine® can deactivate H+ and chelate F- ions. Based on these results, it should be considered as a promising first-aid decontamination solution to prevent or minimize significant local and systemic consequences of concentrated HF skin exposures. PMID:21083510

  13. [Influences of different rehabilitative methods on function of hands and psychological anxiety of patients with deeply burned hands retaining denatured dermis and grafting large autologous skin].

    PubMed

    Peng, H; Liang, P F; Wang, A; Yue, L Q

    2017-05-20

    Objective: To investigate influences of different rehabilitative methods on function of hands and psychological anxiety of patients with deeply burned hands retaining denatured dermis and grafting large autologous skin. Methods: Forty-four patients with deeply burned hands, conforming to the study criteria were admitted to Department of Burns and Reconstructive Surgery of Xiangya Hospital of Central South University from January 2014 to June 2015. Patients were divided into propaganda education rehabilitation group (PER, n=23) and specially-assigned person rehabilitation group (SAPR, n=21) according to the random number table and patients' willingness. On post injury day 3 to 7, 36 burned hands in group PER and 33 burned hands in group SAPR underwent operation of retaining denatured dermis and grafting large autologous skin. Patients in 2 groups received anti-scar treatment of hands with silicone gel from postoperative day 10. Besides, patients in group PER underwent active functional exercise under guidance of duty nurse and received psychological guidance from duty nurse with grade two psychological consultant certificate. Patients in group SAPR underwent active and passive functional exercise under guidance of rehabilitation therapist and received psychological guidance from psychotherapist with intermediate title. In postoperative month (POM) 1, 3 and 6, ranges of active motion of burned finger joints of patients in 2 groups were measured with joint goniometer to calculate excellent and good ratio of total active motion (TAM) range. Values of grip strength of burned hands of patients were measured with electronic hand dynamometer, and psychological anxiety was scored with Self-rating Anxiety Scale (SAS). Data were processed with chi-square test, independent sample t test, McNemar test, analysis of variance of repeated measurement, SNK test and Bonferroni correction. Results: (1) Ratio of excellent and good of TAM range of burned finger joints of patients in

  14. Serum concentration of amino-terminal propeptide of type III procollagen (PIIINP) as a prognostic marker for skin fibrosis after scar correction in burned patients.

    PubMed

    Ulrich, Dietmar; Noah, Ernst-Magnus; Burchardt, Elmar Reinhardt; Atkins, Derek; Pallua, Norbert

    2002-12-01

    -operative serum values and degree of immunostaining (r(2)=0.45; P<0.05). The increased concentration of PIIINP seen in our burned patients' sera might serve as a marker for the extent of skin fibrosis and for the risk of developing new severe fibrotic reactions after scar correction.

  15. The efficacy of continuous fascia iliaca compartment block for pain management in burn patients undergoing skin grafting procedures.

    PubMed

    Cuignet, Olivier; Pirson, Jean; Boughrouph, Jenna; Duville, Diane

    2004-04-01

    Postoperative pain from split skin donor sites is often more intense than the pain at the grafted site. In this prospective, randomized, double-blind study we assessed the efficacy of a continuous fascia iliaca compartment block (FICB) in reducing the pain at the thigh donor site. Twenty patients, with a total burn surface area of 16% +/- 13% (mean +/- SD) were randomized 1:1 to receive either ropivacaine 0.2% or saline 0.9%. All patients received a general anesthesic followed by preincision continuous FICB with 40 mL of the randomized solution, then an infusion of 10 mL/h of either ropivacaine or saline until the first dressing change (72 h later). Postoperative analgesia consisted of propacetamol 2g/6h, IV patient-controlled analgesia of morphine chlorhydrate (2 mg/mL), and morphine hydrochlorate 0.5 mg/kg PO once 60 min before first dressing change. The visual analog scale (VAS) scores were compared using the Mann-Whitney U-test preoperatively, 24 and 48 h postoperatively, and during the first dressing change. The cumulative morphine consumption was compared with repeated-measures analysis of variance followed by Scheffé's method if indicated. Patients with continuous FICB had significantly reduced postoperative morphine consumption at all time points (23 +/- 20 versus 88 +/- 29 mg after 72 h, study versus control groups, respectively; P < 0.05). In both groups, VAS scores remained low but were only significantly lower for patients with continuous FICB during the first dressing change (3 [1] versus 7 [3]; median [interquartile range]; P < 0.05). We conclude that continuous FICB is an efficient method for diminishing pain at the thigh donor site. (250 words) Postoperative pain at the split skin donor sites is often more intense than the pain at the grafted site. This prospective, randomized, double-blind study assessed the efficacy of a continuous fascia iliaca compartment block in reducing the pain at the thigh donor site.

  16. Combination of medical needling and non-cultured autologous skin cell transplantation (ReNovaCell) for repigmentation of hypopigmented burn scars.

    PubMed

    Busch, K H; Bender, R; Walezko, N; Aziz, H; Altintas, M A; Aust, M C

    2016-11-01

    Burn scars remain a serious physical and psychological problem for the affected people. Clinical studies as well as basic scientific research have shown that medical needling can significantly increase the quality of burn scars with comparatively low risk and stress for the patient with regards to skin elasticity, moisture, erythema and transepidermal water loss. However, medical needling has no influence on repigmentation of large hypopigmented scars. The goal of this study is to evaluate whether two established methods - needling (for improvement of scar quality) and non-cultured autologous skin cell suspension (for repigmentation) - can be successfully combined. Twenty subjects with mean age of 33 years (6-60 years) with scars from deep second and third degree burns have been treated. The average treated surface area was 94cm(2) (15-250cm(2)) and was focused on prominent areas such as the face, neck, chest and arm. Percutaneous collagen induction or "medical needling" was performed using a roller covered with 3mm long needles. The roller is vertically, horizontally and diagonally rolled over the scar, inducing microtrauma. Then, non-cultured autologous skin cell suspension (NCASCS) was produced and applied using the ReNovaCell Autologous Cell Harvesting Device (Avita Medical), according to the manufacturer's instructions. The patients were followed 12 months postoperatively. Pigmentation changes were measured objectively, as well as with patient and observer ratings. Patient satisfaction/preference was also obtained. Taken together, the pigmentation ratings and objective measures indicate individual improvement in 17 of the study participants. The melanin increases seen 12 months after NCASCS treatment are statistically significant. Medical needling in combination with NCASCS shows promise for repigmentation of burn cars. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  17. Phenylephrine tumescence in split-thickness skin graft donor sites in surgery for burn injury- a concentration finding study.

    PubMed

    Mitchell, Ryan T M; Funk, Duane; Spiwak, Rae; Logsetty, Sarvesh

    2011-01-01

    The purpose of this study is to determine the lowest concentration of subcutaneous phenylephrine (neosynephrine) required for effective vasoconstriction in skin graft donor sites. Surgery for burn injury is associated with blood loss. Tourniquet use and tumescence with epinephrine have decreased blood loss. However, absorption of epinephrine has been reported with systemic effects. Phenylephrine, an α1-adrenergic receptor agonist, has vasoconstrictive properties similar to epinephrine's without other α-adrenergic or β-adrenergic activity. The aim of this study is to determine the lowest effective concentration of phenylephrine that will provide vasoconstriction in split-thickness graft donor sites. By using intensive care unit equivalency tables, the authors estimated a concentration of phenylephrine on the basis of current epinephrine tumescence. This concentration was titrated up or down according to an algorithm established a priori, determining the minimum concentration that achieved vasoconstriction in three consecutive patients. The primary outcome was local vasoconstriction. Secondary outcomes measured were pre-, intra-, and postoperative mean arterial pressure, systolic pressure and heart rate, graft take, and donor site healing. The subjects were six otherwise healthy adult patients (five men and one woman) with a mean age of 36 years. The average TBSA was 737.5 cm². Vasoconstriction was achieved at 5 μg/ml. No significant alterations in hemodynamic measures were observed. The optimal concentration of phenylephrine for prevention of bleeding in donor sites appears to be 5 μg/ml. Participants will be able to identify the effects of phenylephrine and epinephrine tumescence. They will also identify the concentration at which phenylephrine will be effective in donor sites.

  18. Effective use of Biobrane as a temporary wound dressing prior to definitive split-skin graft in the treatment of severe burn: A retrospective analysis.

    PubMed

    Tan, Hannah; Wasiak, Jason; Paul, Eldho; Cleland, Heather

    2015-08-01

    To report on the use of Biobrane, a synthetic skin substitute, as a temporary wound cover in patients with severe burn. In particular we wished to examine the role of Biobrane in maintaining a healthy wound bed following surgical excision and identify factors associated with regrafting. A retrospective case series review was performed on patients with severe burns (≥ 20% TBSA), admitted to the Victorian Adult Burns Service, in Melbourne, from January 2009 to June 2012. Logistic regression analysis was performed to identify factors associated with regrafting. Out of 58 patients with median %TBSA burn of 30%, 22 patients (37.9%) required regrafting of at least one area previously treated with Biobrane and split-skin graft. On univariate analysis, need for regrafting was significantly associated with increasing %TBSA (OR 1.04, 95% CI: 1.01-1.08; p=0.02); and after multivariate analysis to adjust for this effect, hospital LOS (OR 1.04, 95% CI: 1.02-1.07; p=0.001); total operative time (OR 1.16, 95% CI; 1.06-1.28; p=0.002) and total number of surgeries (OR 1.69, 95% CI: 1.27-2.26, p<0.001) remained significantly associated with regrafting. Age, gender, time to surgical debridement and Biobrane application, and anatomical region were not found to be associated with regraft. At our institution, Biobrane has emerged as an alternative option to maintain a healthy wound bed after burn excision and prior to grafting. Our small number of extensive graft failures, small areas of regrafting and low infection rate following Biobrane application reflects our current experience with Biobrane. Precise indications and most appropriate methods for Biobrane use are yet to be established. Copyright © 2014. Published by Elsevier Ltd.

  19. Electric heating pad burns.

    PubMed

    Bill, T J; Edlich, R F; Himel, H N

    1994-01-01

    Patients with sensory deficits are especially prone to heating pad burns. Two cases are reported of patients with anesthetic skin who received partial and full-thickness burns of their feet from an electric heating pad. These burn injuries could have been prevented if the patients understood the potential hazard of heating pads.

  20. Application of crystalline cellulose membrane (Veloderm) on split-thickness skin graft donor sites in burn or reconstructive plastic surgery patients.

    PubMed

    Liu, Jian; Li, Yeyang; Rong, Xinzhou; Lin, Weihua; Zhang, Tao; Wang, Bingshun; Li, Xiaoyi Benjamin; Jiang, Su; Zhang, Qin

    2013-01-01

    The present study was performed in China to compare the efficacy and safety of an advanced wound dressing made of crystalline cellulose (Veloderm) to a conventional treatment of three Vaseline gauzes in the management of skin donor sites of burns or reconstructive plastic surgery. In this prospective, multicenter, open-labeled, randomized clinical trial performed in three Chinese burn centers in China, 96 patients who required autologous split skin graft were randomized into either the test (Veloderm) group or the control (Vaseline gauze) group. Average healing times in the test group and in the control group were 8.40±2.90 and 8.92±2.58 days, respectively, with median values of 7.00 and 8.00 days, respectively: the difference between two groups was statistically significant (P=.045). Scores for exudates, pain intensity, and peripheral erythema showed no difference between the groups; however, composite scores of three variables on day 10 postoperatively was significantly lower in the test group (0.00±0.00 vs. 0.13±0.49; P = .043). The need for a dressing change was also significantly lower in the test group (12.5 vs. 31.25%; P = .036). Veloderm is a safe and effective dressing that may offer some advantages over the traditional application of Vaseline gauze in the management of donor sites in burn or reconstructive plastic surgery patients.

  1. Development of a long-term ovine model of cutaneous burn and smoke inhalation injury and the effects of early excision and skin autografting.

    PubMed

    Yamamoto, Yusuke; Enkhbaatar, Perenlei; Sakurai, Hiroyuki; Rehberg, Sebastian; Asmussen, Sven; Ito, Hiroshi; Sousse, Linda E; Cox, Robert A; Deyo, Donald J; Traber, Lillian D; Traber, Maret G; Herndon, David N; Traber, Daniel L

    2012-09-01

    Smoke inhalation injury frequently increases the risk of pneumonia and mortality in burn patients. The pathophysiology of acute lung injury secondary to burn and smoke inhalation is well studied, but long-term pulmonary function, especially the process of lung tissue healing following burn and smoke inhalation, has not been fully investigated. By contrast, early burn excision has become the standard of care in the management of major burn injury. While many clinical studies and small-animal experiments support the concept of early burn wound excision, and show improved survival and infectious outcomes, we have developed a new chronic ovine model of burn and smoke inhalation injury with early excision and skin grafting that can be used to investigate lung pathophysiology over a period of 3 weeks. Eighteen female sheep were surgically prepared for this study under isoflurane anesthesia. The animals were divided into three groups: an Early Excision group (20% TBSA, third-degree cutaneous burn and 36 breaths of cotton smoke followed by early excision and skin autografting at 24h after injury, n=6), a Control group (20% TBSA, third-degree cutaneous burn and 36 breaths of cotton smoke without early excision, n=6) and a Sham group (no injury, no early excision, n=6). After induced injury, all sheep were placed on a ventilator and fluid-resuscitated with Lactated Ringers solution (4 mL/% TBS/kg). At 24h post-injury, early excision was carried out to fascia, and skin grafting with meshed autografts (20/1000 in., 1:4 ratio) was performed under isoflurane anesthesia. At 48 h post-injury, weaning from ventilator was begun if PaO(2)/FiO(2) was above 250 and sheep were monitored for 3 weeks. At 96 h post-injury, all animals were weaned from ventilator. There are no significant differences in PaO(2)/FiO(2) between Early Excision and Control groups at any points. All animals were survived for 3 weeks without infectious complication in Early Excision and Sham groups, whereas two

  2. Development of a long-term ovine model of cutaneous burn and smoke inhalation injury and the effects of early excision and skin autografting

    PubMed Central

    Yamamoto, Yusuke; Enkhbaatar, Perenlei; Sakurai, Hiroyuki; Rehberg, Sebastian; Asmussen, Sven; Ito, Hiroshi; Sousse, Linda E.; Cox, Robert A.; Deyo, Donald J.; Traber, Lillian D.; Traber, Maret G.; Herndon, David N.; Traber, Daniel L.

    2013-01-01

    Smoke inhalation injury frequently increases the risk of pneumonia and mortality in burn patients. The pathophysiology of acute lung injury secondary to burn and smoke inhalation is well studied, but long-term pulmonary function, especially the process of lung tissue healing following burn and smoke inhalation, has not been fully investigated. By contrast, early burn excision has become the standard of care in the management of major burn injury. While many clinical studies and small-animal experiments support the concept of early burn wound excision, and show improved survival and infectious outcomes, we have developed a new chronic ovine model of burn and smoke inhalation injury with early excision and skin grafting that can be used to investigate lung pathophysiology over a period of 3 weeks. Materials and methods Eighteen female sheep were surgically prepared for this study under isoflurane anesthesia. The animals were divided into three groups: an Early Excision group (20% TBSA, third-degree cutaneous burn and 36 breaths of cotton smoke followed by early excision and skin autografting at 24 h after injury, n = 6), a Control group (20% TBSA, third-degree cutaneous burn and 36 breaths of cotton smoke without early excision, n = 6) and a Sham group (no injury, no early excision, n = 6). After induced injury, all sheep were placed on a ventilator and fluid-resuscitated with Lactated Ringers solution (4 mL/% TBS/kg). At 24 h post-injury, early excision was carried out to fascia, and skin grafting with meshed autografts (20/1000 in., 1:4 ratio) was performed under isoflurane anesthesia. At 48 h post-injury, weaning from ventilator was begun if PaO2/FiO2 was above 250 and sheep were monitored for 3 weeks. Results At 96 h post-injury, all animals were weaned from ventilator. There are no significant differences in PaO2/FiO2 between Early Excision and Control groups at any points. All animals were survived for 3 weeks without infectious complication in Early Excision

  3. Combination of medical needling and non-cultured autologous skin cell transplantation (renovacell) for repigmentation of hypopigmented burn scars in children and young people.

    PubMed

    Busch, K H; Bender, R; Walezko, N; Aziz, H; Altintas, M A; Aust, M C

    2016-06-30

    Burn scars remain a serious physical and psychological problem for the affected. Clinical studies as well as basic scientific research have shown that Medical Needling can significantly increase the quality of burn scars with comparatively low risk and stress for the patient with regards to skin elasticity, moisture, erythema and transepidermal water loss. However, Medical Needling has no influence on repigmentation of large hypopigmented scars. The goal is to evaluate whether both established methods - Needling (improvement of scar quality) and ReNovaCell (repigmentation) - can be combined. So far, eight patients with mean age of 20 years (6-28 years) with deep second and third degree burn scars have been treated. The average treated tissue surface was 76cm² (15-250cm²) and was focused on areas like face, neck, chest and arm. Medical Needling is performed using a roller covered with 3mm long needles. The roller is vertically, horizontally and diagonally rolled over the scar, inducing microtrauma. Then, non-cultured autologous skin cell suspension (ReNovaCell) is applied, according to the known protocol. The patients were followed 12 months postoperatively. Pigmentation changes were measured objectively, and with patient and observer ratings. Patient satisfaction/preference was also obtained. We present the final study results. Taken together, pigmentation ratings and objective measures indicate improvement in six of the study participants. Melanin increase seen 12 months after ReNovaCell treatment in the study group as a whole is notable. Medical Needling in combination with ReNovaCell shows promise for repigmentation of burn scars.

  4. Combination of medical needling and non-cultured autologous skin cell transplantation (renovacell) for repigmentation of hypopigmented burn scars in children and young people

    PubMed Central

    Busch, K.H.; Bender, R.; Walezko, N.; Aziz, H.; Altintas, M.A.; Aust, M.C.

    2016-01-01

    Summary Burn scars remain a serious physical and psychological problem for the affected. Clinical studies as well as basic scientific research have shown that Medical Needling can significantly increase the quality of burn scars with comparatively low risk and stress for the patient with regards to skin elasticity, moisture, erythema and transepidermal water loss. However, Medical Needling has no influence on repigmentation of large hypopigmented scars. The goal is to evaluate whether both established methods – Needling (improvement of scar quality) and ReNovaCell (repigmentation) – can be combined. So far, eight patients with mean age of 20 years (6-28 years) with deep second and third degree burn scars have been treated. The average treated tissue surface was 76cm² (15-250cm²) and was focused on areas like face, neck, chest and arm. Medical Needling is performed using a roller covered with 3mm long needles. The roller is vertically, horizontally and diagonally rolled over the scar, inducing microtrauma. Then, non-cultured autologous skin cell suspension (ReNovaCell) is applied, according to the known protocol. The patients were followed 12 months postoperatively. Pigmentation changes were measured objectively, and with patient and observer ratings. Patient satisfaction/preference was also obtained. We present the final study results. Taken together, pigmentation ratings and objective measures indicate improvement in six of the study participants. Melanin increase seen 12 months after ReNovaCell treatment in the study group as a whole is notable. Medical Needling in combination with ReNovaCell shows promise for repigmentation of burn scars. PMID:28149233

  5. Reduction in skin grafting after the introduction of hydrofiber dressings in partial thickness burns: a comparison between a hydrofiber and silver sulphadiazine.

    PubMed

    Dokter, J; Boxma, H; Oen, I M M H; van Baar, M E; van der Vlies, C H

    2013-02-01

    The aim of this study was to compare clinical outcome of children with scald burns treated with a hydrofiber dressing (Aquacel(®), Convatec Inc.) with the former standard of care with silver sulfadiazine (Flammazine(®); Solvay Pharmaceuticals), considering surgical intervention and length of stay (LOS). A retrospective study of all consecutive children from zero to four years with primary scald burns up to 10% admitted to the Burn Centre of the Maasstad Hospital Rotterdam between January 1987 and January 2010 were reviewed. For data collection a prospective computerized database was used. For comparison the study period was divided into two periods representing the period before and after the introduction of the hydrofiber dressing (HFD), respectively 1987-1999 (period 1) and 1999-2010 (period 2). Over the whole study period 27.3% of 502 patients treated with silver sulfadiazine (Ag-SD) underwent surgery, while before the introduction of HFD 30.5% of 338 Ag-SD treated patients were operated upon. After the introduction of the HFD 20.7% of 164 patients treated with Ag-SD eventually underwent skin grafting, a significant difference with the 11.6% of 302 patients whose wounds were dressed with HFD (p<0.01). Compared to silver sulfadiazine treatment a reduced number of surgical interventions was observed in mixed partial thickness scald burns up to 10% TBSA burned in children aged 0-4 years after the introduction of hydrofiber dressings. The mode of treatment with this wound dressing also limited hospital length of stay. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

  6. Pedicled full-thickness abdominal flap combined with skin grafting for the reconstruction of anterior chest wall defect following major electrical burn.

    PubMed

    Zhao, Jing-Chun; Xian, Chun-Jing; Yu, Jia-Ao; Shi, Kai

    2015-02-01

    Successful reconstruction of extensive anterior chest wall defect following major electrical burn represents a very challenging surgery. Herein we report the first case using pedicled full-thickness abdominal flap combined with skin grafting to treat this injury with severe infection and exposure of pericardium and ribs in a Chinese patient. Following the performance of chest debridement to remove necrotic and infected tissues and the injection of broad-spectrum antibiotics to reduce infection, a pedicled full-thickness abdominal flap was used to cover the exposed pericardium and ribs, and skin grafting from the right leg of the patient was done to cover the exposed vital tissues. The patient was followed up for a total of 3·5 years, and satisfactory cosmetic and functional outcomes were obtained without complications. This report provides an effective method for the surgeons who encounter similar cases where reconstruction of extensive anterior chest wall is required.

  7. Long-term IgG response to porcine Neu5Gc antigens without transmission of PERV in burn patients treated with porcine skin xenografts.

    PubMed

    Scobie, Linda; Padler-Karavani, Vered; Le Bas-Bernardet, Stephanie; Crossan, Claire; Blaha, Josef; Matouskova, Magda; Hector, Ralph D; Cozzi, Emanuele; Vanhove, Bernard; Charreau, Beatrice; Blancho, Gilles; Bourdais, Ludovic; Tallacchini, Mariachiara; Ribes, Juan M; Yu, Hai; Chen, Xi; Kracikova, Jitka; Broz, Ludomir; Hejnar, Jiri; Vesely, Pavel; Takeuchi, Yasuhiro; Varki, Ajit; Soulillou, Jean-Paul

    2013-09-15

    Acellular materials of xenogenic origin are used worldwide as xenografts, and phase I trials of viable pig pancreatic islets are currently being performed. However, limited information is available on transmission of porcine endogenous retrovirus (PERV) after xenotransplantation and on the long-term immune response of recipients to xenoantigens. We analyzed the blood of burn patients who had received living pig-skin dressings for up to 8 wk for the presence of PERV as well as for the level and nature of their long term (maximum, 34 y) immune response against pig Ags. Although no evidence of PERV genomic material or anti-PERV Ab response was found, we observed a moderate increase in anti-αGal Abs and a high and sustained anti-non-αGal IgG response in those patients. Abs against the nonhuman sialic acid Neu5Gc constituted the anti-non-αGal response with the recognition pattern on a sialoglycan array differing from that of burn patients treated without pig skin. These data suggest that anti-Neu5Gc Abs represent a barrier for long-term acceptance of porcine xenografts. Because anti-Neu5Gc Abs can promote chronic inflammation, the long-term safety of living and acellular pig tissue implants in recipients warrants further evaluation.

  8. Addition of platelet concentrate to dermo-epidermal skin graft in deep burn trauma reduces scarring and need for revision surgeries.

    PubMed

    Prochazka, Vaclav; Klosova, Hana; Stetinsky, Jiri; Gumulec, Jaromir; Vitkova, Katerina; Salounova, Dana; Dvorackova, Jana; Bielnikova, Hana; Klement, Petr; Levakova, Veronika; Ocelka, Tomas; Pavliska, Lubomir; Kovanic, Pavel; Klement, Giannoula Lakka

    2014-06-01

    [corrected] Deep skin burn injuries, especially those on the face, hands, feet, genitalia and perineum represent significant therapeutic challenges. Autologous dermo-epidermal skin grafts (DESG) have become standard of care for treating deep burns. Additionally, human autologous thrombin activated autologous platelet concentrate (APC) has gained acceptance in the setting of wounds. While each of these interventions has been independently shown to accelerate healing, the combination of the two has never been evaluated. We hypothesized that the addition of platelets (source of growth factors and inhibitors necessary for tissue repair) to the DESG (source of progenitor cells and of tissue proteases necessary for spatial and temporal control of growth regulators released from platelets) would create the optimal environment for the reciprocal interaction of cells within the healing tissues. We used clinical examination (digital photography), standardised scales for evaluating pain and scarring, in combination with blood perfusion (laser Doppler imaging), as well as molecular and laboratory analyses. We show for the first time that the combination of APC and DESG leads to earlier relief of pain, and decreased use of analgesics, antipruritics and orthotic devices. Most importantly, this treatment is associated with earlier discharges from hospital and significant cost savings. Our findings indicate that DESG engraftment is facilitated by the local addition of platelets and by systemic thrombocytosis. This local interaction leads to the physiological revascularization at 1-3 months. We observed significant elevation of circulating platelets in early stages of engraftment (1-7 days), which normalized over the subsequent 7 and 90 days.

  9. Long-term IgG response to porcine Neu5Gc-antigens without transmission of PERV in burn patients treated with porcine skin xenografts

    PubMed Central

    Scobie, Linda; Padler-Karavani, Vered; Le Bas-Bernardet, Stephanie; Crossan, Claire; Blaha, Josef; Matouskova, Magda; Hector, Ralph D; Cozzi, Emanuele; Vanhove, Bernard; Charreau, Beatrice; Blancho, Gilles; Bourdais, Ludovic; Tallacchini, Mariachiara; Ribes, Juan M; Yu, Hai; Chen, Xi; Kracikova, Jitka; Broz, Ludomir; Hejnar, Jiri; Vesely, Pavel; Takeuchi, Yasuhiro; Varki, Ajit; Soulillou, Jean-Paul

    2013-01-01

    Acellular materials of xenogenic origin are used worldwide as xenografts and Phase I trials of viable pig pancreatic islets are currently being performed. However, limited information is available on transmission of porcine endogenous retrovirus (PERV) after xenotransplantation and on the long-term immune response of recipients to xenoantigens. We analyzed the blood of burn patients who had received living pig skin dressings for up to 8 weeks for the presence of PERV as well as for the level and nature of their long term (maximum 34 years) immune response against pig antigens. Whilst no evidence of PERV genomic material or anti PERV antibody response was found, we observed a moderate increase in anti αGal antibodies and a high and sustained anti non-αGal IgG response in those patients. Antibodies against the non-human sialic acid Neu5Gc constituted the anti non-αGal response with the recognition pattern on a sialogly can array differing from that of burn patients treated without pig skin. These data suggest that anti-Neu5Gc antibodies may represent a barrier for long-term acceptance of porcine xenografts. As anti-Neu5Gc antibodies can promote chronic inflammation, the long-term safety of living and acellular pig tissue implants in recipients warrants further evaluation. PMID:23945141

  10. Differential Response of Human Adipose Tissue-Derived Mesenchymal Stem Cells, Dermal Fibroblasts, and Keratinocytes to Burn Wound Exudates: Potential Role of Skin-Specific Chemokine CCL27

    PubMed Central

    van den Broek, Lenie J.; Kroeze, Kim L.; Waaijman, Taco; Breetveld, Melanie; Sampat-Sardjoepersad, Shakun C.; Niessen, Frank B.; Middelkoop, Esther; Scheper, Rik J.

    2014-01-01

    Many cell-based regenerative medicine strategies toward tissue-engineered constructs are currently being explored. Cell–cell interactions and interactions with different biomaterials are extensively investigated, whereas very few studies address how cultured cells will interact with soluble wound-healing mediators that are present within the wound bed after transplantation. The aim of this study was to determine how adipose tissue-derived mesenchymal stem cells (ASC), dermal fibroblasts, and keratinocytes will react when they come in contact with the deep cutaneous burn wound bed. Burn wound exudates isolated from deep burn wounds were found to contain many cytokines, including chemokines and growth factors related to inflammation and wound healing. Seventeen mediators were identified by ELISA (concentration range 0.0006–9 ng/mg total protein), including the skin-specific chemokine CCL27. Burn wound exudates activated both ASC and dermal fibroblasts, but not keratinocytes, to increase secretion of CXCL1, CXCL8, CCL2, and CCL20. Notably, ASC but not fibroblasts or keratinocytes showed significant increased secretion of vascular endothelial growth factor (5-fold) and interleukin-6 (253-fold), although when the cells were incorporated in bi-layered skin substitute (SS) these differences were less pronounced. A similar discrepancy between ASC and dermal fibroblast mono-cultures was observed when recombinant human-CCL27 was used instead of burn wound exudates. Although CCL27 did not stimulate the secretion of any of the wound-healing mediators by keratinocytes, these cells, in contrast to ASC or dermal fibroblasts, showed increased proliferation and migration. Taken together, these results indicate that on transplantation, keratinocytes are primarily activated to promote wound closure. In contrast, dermal fibroblasts and, in particular, ASC respond vigorously to factors present in the wound bed, leading to increased secretion of angiogenesis/granulation tissue

  11. Differential response of human adipose tissue-derived mesenchymal stem cells, dermal fibroblasts, and keratinocytes to burn wound exudates: potential role of skin-specific chemokine CCL27.

    PubMed

    van den Broek, Lenie J; Kroeze, Kim L; Waaijman, Taco; Breetveld, Melanie; Sampat-Sardjoepersad, Shakun C; Niessen, Frank B; Middelkoop, Esther; Scheper, Rik J; Gibbs, Susan

    2014-01-01

    Many cell-based regenerative medicine strategies toward tissue-engineered constructs are currently being explored. Cell-cell interactions and interactions with different biomaterials are extensively investigated, whereas very few studies address how cultured cells will interact with soluble wound-healing mediators that are present within the wound bed after transplantation. The aim of this study was to determine how adipose tissue-derived mesenchymal stem cells (ASC), dermal fibroblasts, and keratinocytes will react when they come in contact with the deep cutaneous burn wound bed. Burn wound exudates isolated from deep burn wounds were found to contain many cytokines, including chemokines and growth factors related to inflammation and wound healing. Seventeen mediators were identified by ELISA (concentration range 0.0006-9 ng/mg total protein), including the skin-specific chemokine CCL27. Burn wound exudates activated both ASC and dermal fibroblasts, but not keratinocytes, to increase secretion of CXCL1, CXCL8, CCL2, and CCL20. Notably, ASC but not fibroblasts or keratinocytes showed significant increased secretion of vascular endothelial growth factor (5-fold) and interleukin-6 (253-fold), although when the cells were incorporated in bi-layered skin substitute (SS) these differences were less pronounced. A similar discrepancy between ASC and dermal fibroblast mono-cultures was observed when recombinant human-CCL27 was used instead of burn wound exudates. Although CCL27 did not stimulate the secretion of any of the wound-healing mediators by keratinocytes, these cells, in contrast to ASC or dermal fibroblasts, showed increased proliferation and migration. Taken together, these results indicate that on transplantation, keratinocytes are primarily activated to promote wound closure. In contrast, dermal fibroblasts and, in particular, ASC respond vigorously to factors present in the wound bed, leading to increased secretion of angiogenesis/granulation tissue formation

  12. Burn Resuscitation

    DTIC Science & Technology

    2009-01-01

    areas involving large areas of skin the patient is exposed to death first from shock . . .’’ [10]. In describing the pathophysiology leading to the shock...state seen in burns he postulated that various irritants , mental and physical, caused vasomotor paresis leading to accumulation of blood in the...resuscitation volumes. Subsequent studies suggested a decrease in abdominal compartment syndrome (ACS). Oda et al., in 2006, published their experience

  13. Tar burns in the southwest.

    PubMed

    Schiller, W R

    1983-07-01

    The burns which result from contact of human skin with hot tar may be quite serious in proportion to the body surface area involved. Although tending toward partial thickness burns, patchy areas of full thickness skin loss are commonly observed. The use of petrolatum-based ointments on the burn initially to dissolve the tar into the dressings seems like the most efficient and humane method of tar removal. Subsequently, care of the wound is like that of any other burn. Tar burns involving greater than 10 per cent of the body surface area are likely to be the most serious and require intravenous fluid resuscitation. Many tar burns appear to be preventable.

  14. Skin Ph Variations from the Acute Phase to Re-Epithelialization in Burn Patients Treated with New Materials (Burnshield®, Semipermeable Adhesive Film, Dermasilk®, and Hyalomatrix®). Non-Invasive Preliminary Experimental Clinical Trial

    PubMed Central

    Osti, E.

    2008-01-01

    Summary The aim of this trial was to measure the pH value of the skin of burn patients using a non-invasive method, from the acute phase through to complete re-epithelialization. The research was then completed by treating the patients with new materials and innovative methods to verify whether this had an effect on the skin pH and on re-epithelialization time. In this clinical trial, the patients were medicated repeatedly with hydrogel (Burnshield®) kept in place by a transparent, semipermeable adhesive film with a moisture vapour transmission rate equivalent to 1600 until day 5 or 6 post-burn. In one patient, treated silk (DermaSilk®) was applied several times until re-epithelialization; in another patient, synthetic hyaluronic acid (Hyalomatrix®) was applied. Various studies using Dermasilk® have confirmed that the fibroin in silk stimulates re-epithelialization, in addition to keeping the burned skin disinfected, thanks to the antimicrobial agent contained in the treated silk. Hyalomatrix® was used on the other patient, as in other studies, as a temporary substitute for the skin in deep burns. Late complications (keloids and hypertrophic scars) can give rise, even after prolonged periods of time, to Marjolin's ulcer (carcinoma but also melanoma and sarcoma), which can develop in the course of a year. A recent Danish trial affirms that appropriate burn treatment facilitates re-epithelialization and decreases the incidence of Marjolin's ulcer. For the trial, we used a centimetre-wide strip of reactive paper sensitive to pH variations and an acid test (Duotest® kit) as a reference, applied for more than one minute on the patient's burned and slightly damp skin. We performed control procedures on the patient's normal skin, away from the wound site. The pH was measured from day 1 post-burn and every other day thereafter until complete re-epithelialization. We found alkaline pH values for the burned skin from the day of the burn until day 12, with an alkaline p

  15. Skin ph variations from the acute phase to re-epithelialization in burn patients treated with new materials (burnshield®, semipermeable adhesive film, dermasilk®, and hyalomatrix®). Non-invasive preliminary experimental clinical trial.

    PubMed

    Osti, E

    2008-06-30

    The aim of this trial was to measure the pH value of the skin of burn patients using a non-invasive method, from the acute phase through to complete re-epithelialization. The research was then completed by treating the patients with new materials and innovative methods to verify whether this had an effect on the skin pH and on re-epithelialization time. In this clinical trial, the patients were medicated repeatedly with hydrogel (Burnshield®) kept in place by a transparent, semipermeable adhesive film with a moisture vapour transmission rate equivalent to 1600 until day 5 or 6 post-burn. In one patient, treated silk (DermaSilk®) was applied several times until re-epithelialization; in another patient, synthetic hyaluronic acid (Hyalomatrix®) was applied. Various studies using Dermasilk® have confirmed that the fibroin in silk stimulates re-epithelialization, in addition to keeping the burned skin disinfected, thanks to the antimicrobial agent contained in the treated silk. Hyalomatrix® was used on the other patient, as in other studies, as a temporary substitute for the skin in deep burns. Late complications (keloids and hypertrophic scars) can give rise, even after prolonged periods of time, to Marjolin's ulcer (carcinoma but also melanoma and sarcoma), which can develop in the course of a year. A recent Danish trial affirms that appropriate burn treatment facilitates re-epithelialization and decreases the incidence of Marjolin's ulcer. For the trial, we used a centimetre-wide strip of reactive paper sensitive to pH variations and an acid test (Duotest® kit) as a reference, applied for more than one minute on the patient's burned and slightly damp skin. We performed control procedures on the patient's normal skin, away from the wound site. The pH was measured from day 1 post-burn and every other day thereafter until complete re-epithelialization. We found alkaline pH values for the burned skin from the day of the burn until day 12, with an alkaline pH peak

  16. The healing effect of four different silver complexes on full-thickness skin burns in a rat model.

    PubMed

    Gouma, Efthalia; Batistatou, Anna; Verginadis, Ioannis I; Simos, Yannis V; Kyros, Loukas; Hadjikakou, Sotiris K; Karkabounas, Spyridon Ch; Evangelou, Angelos M; Ragos, Vasilios N; Peschos, Dimitrios

    2015-01-01

    This study was carried-out to investigate the effect of four different silver substances (S1, S2, S3, and S4) on burn wound healing in a rat model. One hundred and eighty Wistar rats were used. Animals were randomized into six groups to receive no treatment (CG, control group), and local application of the solvent of silver substances (SG, solvent group), as well as of the four silver substances (EG1-EG4 groups for substances S1-S4, respectively). On days 0, 3, 6, 12, 21, and 31 following burn wound infliction, the size and healing progress of each wound were recorded and evaluated by means of clinical evaluation, planimetry and histological examination. According to our findings lower infection rates, as well as significantly accelerated wound healing and faster re-epithelialization were recorded in EG1, EG2, and EG4 compared to the other groups. The use of S1, S2, and S4 substances proved to be an effective treatment of burn wounds that ensured better outcomes compared to the control and solvent groups, as well as with the use of S3 substance. Nevertheless, they failed to produce short-term healing of the full-thickness burn. Further research is required to examine the possibility of speeding the treatment of full-thickness burns by these complexes in order to reduce healing time to acceptable limits and prevent the need for surgery. Copyright © 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  17. Sterilization of silver acidum pipemedicum skin for the treatment of burns by radioactive cobalt-60-γray

    NASA Astrophysics Data System (ADS)

    Zeng, Defeng; Cao, Fengsheng; Chen, Qinglong; Li, Guohui; Su, Ziyi; Cao, Yong; Wu, Wenqing; Qiu, Zeyi; Chen, Zhanxian

    1995-02-01

    The radiated silver acidum pipemedicum skin (RSAPS) was made of 0.4-0.8 mm laminal skin from healthy white pig, which was infiltrated in norfloxacin and silver nitrate, packed with the film bag of alummium poil and radiated by cobalt-60γ-ray for sterilization at the dosage of 27.92-35.31GY/min for a total dose of 25KGY. RSAPS was very effective in sterilization and had no bad effect on elasticity, adhesion, water permeability, and structure of pig skin. So it is highly appreciated by the patients and medical personnel for its convenience of usage and has gained good social and economic beneficial results.

  18. Your Skin

    MedlinePlus

    ... from getting burned by the sun's ultraviolet, or UV, rays. That's why your skin gets tan if ... Nemours Foundation, iStock, Getty Images, Corbis, Veer, Science Photo Library, Science Source Images, Shutterstock, and Clipart.com

  19. [Treatment of mass burns].

    PubMed

    Zhou, Y

    1999-07-01

    Present paper aims at summing up the experience from 42 cases over a four year period(1993-1997) in ten events of mass burn casualties. 42 cases were analyzed retrospectively, in whom 15 cases sustained III degree burn over 50% TBSA. Among them 7 cases had III degree burn over 70% and 3 cases with III degree burn over 90%. One case (70% TBSA) died of acute respiratory distress syndrome on third postburn day. Another (III degree 70%) died of acute renal failure on seventh postburn day. The remaining 40 cases were successfully cured. Experiences gained in burn care in these ten mass casualties included: sending forward the medical expertise to the site of disaster; airlifting to accelerate transportation, adequate resuscitation in shock stage; early massive excision of eschar and skin grafting; control of burn infection; prevention of Curling ulcer hemorrhage, emphasis on supportive therapy; and the establishment of a skin bank.

  20. Pediatric cutaneous bleach burns.

    PubMed

    Lang, Cathleen; Cox, Matthew

    2013-07-01

    Bleach is a common household product which can cause caustic injuries. Its effects on mucosal tissues and the eye have been well-described in the literature. However, there is little information published regarding the appearance and effect of bleach on a child's skin. We report three children who sustained chemical burns after contact with bleach. All three children sustained accidental bleach burns while at home, and each child had a distinct brown discoloration to the skin from the injury. All three children had treatment and follow-up for their burns. Two of the children sustained more severe burns, which were extensive and required more time to heal. There was also long-term scarring associated with the severe burns. Like most burns, pain control is required until the injury heals. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. Neoadjuvant chemotherapy for radioinduced osteosarcoma of the extremity: The Rizzoli experience in 20 cases

    SciTech Connect

    Bacci, Gaetano . E-mail: gaetano.bacci@ior.it; Longhi, Alessandra; Forni, Cristiana R.N.; Fabbri, Nicola; Briccoli, Antonio; Barbieri, Enza; Mercuri, Mario; Balladelli, Alba B.A.; Ferrari, Stefano; Picci, Piero

    2007-02-01

    Purpose: Evaluate treatment and outcome of 20 patients with radioinduced osteosarcoma (RIO). Because of previous primary tumor treatment, RIO protocols were different from others we used for non-RIO. Patients and Methods: Between 1983 and 1998, we treated 20 RIO patients, ages 4-36 years (mean 16 years), with chemotherapy (two cycles before surgery, three postoperatively). The first preoperative cycle consisted of high-dose Methotrexate (HDMTX)/Cisplatinum (CDP)/Adriamycin (ADM) and the second of HDMTX/CDP/Ifosfamide (IFO). The three postoperative treatments were performed with cycles of MTX/CDP; IFO was used as single agent per cycle repeated three times. Results: Two patients received palliative treatment because their osteosarcoma remained unresectable after preoperative chemotherapy. The remaining 18 patients had surgery (7 amputations, 11 resections); histologic response to preoperative chemotherapy was good in 8 patients, poor in 10. At a mean follow-up of 11 years (range, 7-22 years), 9 patients remained continuously disease-free, 10 died from osteosarcoma and 1 died from a third neoplasm (myeloid acute leukemia). These results are not significantly different from those achieved in 754 patients with conventional osteosarcoma treated in the same period with protocols used for conventional treatment. However, this later group had an 18% 3-year event-free survival after treatment of relapse vs. 0% in the RIO group. Conclusion: Treated with neoadjuvant chemotherapy RIO seem to have an outcome that is not significantly different from that of comparable patients with conventional primary high grade osteosarcoma (5-year event-free survival: 40% vs. 60%, p = NS; 5-year overall survival 40% vs. 67%, p < 0.00008.

  2. Burns - resources

    MedlinePlus

    Resources - burns ... The following organizations are good resources for information on burns : Burns Recovered -- brsg.org Model Systems Knowledge Translation Center - Burn Model Systems -- www.msktc.org/burn

  3. Assessing burn depth in tattooed burn lesions with LASCA Imaging.

    PubMed

    Krezdorn, N; Limbourg, A; Paprottka, F J; Könneker; Ipaktchi, R; Vogt, P M

    2016-09-30

    Tattoos are on the rise, and so are patients with tattooed burn lesions. A proper assessment with regard to burn depth is often impeded by the tattoo dye. Laser speckle contrast analysis (LASCA) is a technique that evaluates burn lesions via relative perfusion analysis. We assessed the effect of tattoo skin pigmentation on LASCA perfusion imaging in a multicolour tattooed patient. Depth of burn lesions in multi-coloured tattooed and untattooed skin was assessed using LASCA. Relative perfusion was measured in perfusion units (PU) and compared to various pigment colours, then correlated with the clinical evaluation of the lesion. Superficial partial thickness burn (SPTB) lesions showed significantly elevated perfusion units (PU) compared to normal skin; deep partial thickness burns showed decreased PU levels. PU of various tattoo pigments to normal skin showed either significantly lower values (blue, red, pink) or significantly increased values (black) whereas orange and yellow pigment showed values comparable to normal skin. In SPTB, black and blue pigment showed reduced perfusion; yellow pigment was similar to normal SPTB burn. Deep partial thickness burn (DPTB) lesions in tattoos did not show significant differences to normal DPTB lesions for black, green and red. Tattoo pigments alter the results of perfusion patterns assessed with LASCA both in normal and burned skin. Yellow pigments do not seem to interfere with LASCA assessment. However proper determination of burn depth both in SPTB and DPTB by LASCA is limited by the heterogenic alterations of the various pigment colours.

  4. Assessing burn depth in tattooed burn lesions with LASCA Imaging

    PubMed Central

    Krezdorn, N.; Limbourg, A.; Paprottka, F.J.; Könneker; Ipaktchi, R.; Vogt, P.M

    2016-01-01

    Summary Tattoos are on the rise, and so are patients with tattooed burn lesions. A proper assessment with regard to burn depth is often impeded by the tattoo dye. Laser speckle contrast analysis (LASCA) is a technique that evaluates burn lesions via relative perfusion analysis. We assessed the effect of tattoo skin pigmentation on LASCA perfusion imaging in a multicolour tattooed patient. Depth of burn lesions in multi-coloured tattooed and untattooed skin was assessed using LASCA. Relative perfusion was measured in perfusion units (PU) and compared to various pigment colours, then correlated with the clinical evaluation of the lesion. Superficial partial thickness burn (SPTB) lesions showed significantly elevated perfusion units (PU) compared to normal skin; deep partial thickness burns showed decreased PU levels. PU of various tattoo pigments to normal skin showed either significantly lower values (blue, red, pink) or significantly increased values (black) whereas orange and yellow pigment showed values comparable to normal skin. In SPTB, black and blue pigment showed reduced perfusion; yellow pigment was similar to normal SPTB burn. Deep partial thickness burn (DPTB) lesions in tattoos did not show significant differences to normal DPTB lesions for black, green and red. Tattoo pigments alter the results of perfusion patterns assessed with LASCA both in normal and burned skin. Yellow pigments do not seem to interfere with LASCA assessment. However proper determination of burn depth both in SPTB and DPTB by LASCA is limited by the heterogenic alterations of the various pigment colours. PMID:28149254

  5. Skin flaps and grafts - self-care

    MedlinePlus

    ... Free flap - self-care; Skin autografting - self-care; Pressure ulcer skin flap self-care; Burns skin flap self- ... skin infection Surgery for skin cancer Venous ulcers , pressure ulcers , or diabetic ulcers that DO NOT heal After ...

  6. Addition of platelet concentrate to Dermo-Epidermal Skin Graft in deep burn trauma reduces scarring and need for revision surgeries

    PubMed Central

    Prochazka, Vaclav; Klosova, Hana; Stetinsky, Jiri; Gumulec, Jaromir; Vitkova, Katerina; Salounova, Dana; Dvorackova, Jana; Bielnikova, Hana; Klement, Petr; Levakova, Veronika; Ocelka, Tomas; Pavliska, Lubomir; Kovanic, Pavel; Klement, Giannoula Lakka

    2017-01-01

    Backround Deep skin burn injuries, especially those on the face, hands, feet, genitalia and perineum represent significant therapeutic challenges. Autologous dermo-epidermal skin grafts (DESG) have become standard of care for treating deep burns. Additionally, human autologous thrombin activated autologous platelet concentrate (APC) has gained acceptance in the setting of wounds. While each of these interventions has been independently shown to accelerate healing, the combination of the two has never been evaluated. We hypothesized that the addition of platelets (source of growth factors and inhibitors necessary for tissue repair) to the DESG (source of progenitor cells and of tissue proteases necessary for spatial and temporal control of growth regulators released from platelets) would create the optimal environment for the reciprocal interaction of cells within the healing tissues. Methods We used clinical examination (digital photography), standardised scales for evaluating pain and scarring, in combination with blood perfusion (laser Doppler imaging), as well as molecular and laboratory analyses. Results We show for the first time that the combination of APC and DESG leads to earlier relief of pain, and decreased use of analgesics, antipruritics and orthotic devices. Most importantly, this treatment is associated with earlier discharges from hospital and significant cost savings. Conclusions Our findings indicate that DESG engraftment is facilitated by the local addition of platelets and by systemic thrombocytosis. This local interaction leads to the physiological revascularization at 1–3 months. We observed significant elevation of circulating platelets in early stages of engraftment (1–7 days), which normalized over the subsequent 7 and 90 days. PMID:24108222

  7. Prospective study on burns treated with Integra®, a cellulose sponge and split thickness skin graft: comparative clinical and histological study--randomized controlled trial.

    PubMed

    Lagus, Heli; Sarlomo-Rikala, Maarit; Böhling, Tom; Vuola, Jyrki

    2013-12-01

    The aim of this study was to compare three different methods to cover excised burn wounds in a randomized controlled trial. Fascially excised burn wounds, measuring 10 cm × 5 cm, were covered with Integra(®), split thickness skin graft (STSG), and a viscose cellulose sponge Cellonex™ in each of ten adult patients. Integra(®) and Cellonex™ treated areas were covered with thin STSG on day 14. Biopsies were taken 3, 7, 14, and 21 days, 3 months, and 12 months after surgery, and samples were subjected to a range of immunohistochemical stains, in addition to hematoxylin and eosin (HE). Scar assessment was performed 3 and 12 months post-operatively with the Vancouver Scar Scale (VSS). Inflammation was not substantial in any of the study areas, but Cellonex™ had the most neutrophils, histiocytes, and lymphocytes with significant differences on days 7 and 14. Complete vascularization of Integra(®) seemed to occur later compared to the other materials. STSG had the most myofibroblasts on day 14 (p = 0.012). In VSS the quality of the scar improved in all materials from 3 to 12 months. The final results for all treatments after 12 months demonstrate equal clinical appearance, as well as histological and immunohistochemical findings. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  8. Medical diagnosis system and method with multispectral imaging. [depth of burns and optical density of the skin

    NASA Technical Reports Server (NTRS)

    Anselmo, V. J.; Reilly, T. H. (Inventor)

    1979-01-01

    A skin diagnosis system includes a scanning and optical arrangement whereby light reflected from each incremental area (pixel) of the skin is directed simultaneously to three separate light filters, e.g., IR, red, and green. As a result, the three devices simultaneously produce three signals which are directly related to the reflectance of light of different wavelengths from the corresponding pixel. These three signals for each pixel after processing are used as inputs to one or more output devices to produce a visual color display and/or a hard copy color print, for one usable as a diagnostic aid by a physician.

  9. In vivo time-lapse imaging of skin burn wound healing using second-harmonic generation microscopy

    NASA Astrophysics Data System (ADS)

    Yasui, Takeshi; Tanaka, Ryosuke; Hase, Eiji; Fukushima, Shu-ichiro; Araki, Tsutomu

    2014-02-01

    Wound healing is a process to repair the damaged tissue caused by thermal burn, incised wound, or stab wound. Although the wound healing has many aspects, it is common for dynamics of collagen fiber, such as decomposition, production, or growth, to be closely related with wound healing. If such the healing process can be visualized as a timelapse image of the collagen fiber in the same subject, one may obtain new findings regarding biological repairing mechanisms in the healing process. In this article, to investigate the temporal modoification of dermal collagen fiber in the burn wound healing, we used second-harmonic-generation (SHG) microscopy, showing high selectivity and good image contrast to collagen molecules as well as high spatial resolution, optical three-dimensional sectioning, minimal invasiveness, deep penetration, the absence of interference from background light, and in vivo measurement without additional staining. Since SHG light arises from a non-centrosymmetric triple helix of three polypeptide chains in the collagen molecule, SHG intensity sensitively reflects the structure maturity of collagen molecule and its aggregates. A series of time-lapse SHG images during the wound healing process of 2 weeks clearly indicated that condensation and melting of dermal collagen fibers by the deep dermal burn, decomposition of the damaged collagen fibers in the inflammation phase, production of new collagen fibers in the proliferation phase, and the growth of the new collagen fibers in the remodeling phase. These results show a high potential of SHG microscopy for optical assessment of the wound healing process in vivo.

  10. Economics of pediatric burns.

    PubMed

    Bass, Michael J; Phillips, Linda G

    2008-07-01

    Sustaining a burn injury sets in motion a cycle of pain, disfigurement, and a search for survival. In pediatric burns, the injury extends to the parents where fear, ignorance, and helplessness forever change their lives. Pediatric burn injuries are caused by fire, hot liquids, clothing irons, hair curlers, caustic substances like drain cleaner, the grounding of an electrical source, and exposure to radiation. Efficiency in the delivery of pediatric burn care is critical. Maximizing resource utilization means continual self-evaluation and economic analysis of therapeutic modalities. Griffiths et al found that most childhood burns are due to scalds, which can be treated for $1061 per percent burn. Paddock et al reduced the cost of treating superficial pediatric burns and reduced the length of stay in hospital using silver-impregnated gauze over traditional methods. Barrett et al found improved cosmesis of skin grafts using cultured epithelial autografts but at a substantially increased cost. Corpron et al showed that pediatric burn units that treat burns >10% total body surface area and operative treatment of pediatric burns regardless of size generate positive revenue. There is a paucity of evidentiary pediatric burn economic data. More research is needed to address areas of pediatric burn care inefficiency. Improving knowledge of cost in all health care endeavors will create competition and drive down expenditures.

  11. The use of non-viable glycerol-preserved cadaver skin combined with widely expanded autografts in the treatment of extensive third-degree burns.

    PubMed

    Kreis, R W; Vloemans, A F; Hoekstra, M J; Mackie, D P; Hermans, R P

    1989-01-01

    Allograft skin lyophilised in 98% glycerol is an effective overlay for widely expanded autografts. The technique was evaluated clinically on a total of 58 sandwich grafting procedures in a group of 39 patients with extensive third-degree burns. Forty-five grafting operations performed within 10 days postburn all resulted in an epithelialisation rate of at least 75% within 5 weeks. Thirty-three of these procedures achieved complete (more than 95%) wound closure. Of 13 operations performed after the 14th postburn day, ten resulted in a wound epithelialisation of at least 75%. Epithelial quality and cosmetic results were good. The mean length of hospitalisation was 56 days. One patient died from unassociated respiratory failure. The absence of allograft viability did not impair its function as an autograft overlay. The apparent attenuation of allograft antigenicity conferred by the action of 98% glycerol may have contributed to the results achieved. The process of cadaver skin preservation in 98% glycerol is simple and inexpensive.

  12. Radio-induced alteration in cordierite - Implications for petrology, gemmology and materials science

    NASA Astrophysics Data System (ADS)

    Krickl, R.; Nasdala, L.; Grambole, D.; Kaindl, R.

    2009-04-01

    Cordierite is a common metamorphic and magmatic mineral, which is used as petrologic tool for reconstructing the history of its host rock. Further applications include cordierite gemstones and the use of synthetic analogs in ceramics. Cordierite is stable over a wide temperature and pressure range and relatively resistant to chemical alteration; however, its properties can be significantly changed upon the impact of external irradiation. In the course of a comprehensive study, natural radiohaloes in cordierite (a widespread feature caused by the impact of alpha-particles originating from radioactive inclusions) as well as artificial analogs produced by implantation of 8.8 MeV He2+ ions were investigated using modern micro-techniques. Additional irradiation experiments were performed using O6+ ions, electrons and gamma-rays. Ion irradiation causes yellow colouration that is strongly pleochroic, and fades at higher doses. The possibility of radiation-treatment for enhancing the quality of gem-cordierite is discussed. While samples remain crystalline up to doses of 1016 He2+/cm2, the same material is fully amorphised when irradiated with the same dose of 30 MeV O6+ ions. These different observations may help to estimate the performance assessment of cordierite-ceramics in radiated environments. A very important result concerning the petrological use of cordierite is the radio-induced transformation of channel constituents: Inside the irradiated areas the vibrational bands of CO2 decrease in intensity, whereas two new bands appear at 2135 cm-1 (both IR- and Raman-active; cf. Nasdala et al., 2006) and 1550 cm-1 (only Raman-activ). They are assigned to stretching vibrations of carbon monoxide and molecular oxygen, respectively, thus indicating a radio-chemical transformation 2CO2 → 2CO + O2 in alpha-irradiated cordierite. This study yields the first spectroscopic evidence for the irradiation-induced formation of molecular oxygen in cordierite. Polarised vibrational

  13. Chemical burn or reaction

    MedlinePlus

    ... this page: //medlineplus.gov/ency/article/000059.htm Chemical burn or reaction To use the sharing features on this page, please enable JavaScript. Chemicals that touch skin can lead to a reaction on the skin, throughout the body, or both. ...

  14. Surgical staple as a transcutaneous transducer for ECG electrodes in burnt skin: safe surgical monitoring in major burns.

    PubMed

    Sofos, Stratos S; Tehrani, Hamid; Shokrollahi, Kayvan; James, M I

    2013-06-01

    It is often difficult to apply traditional ECG electrodes on patients with extensive burns due to a large operative site, compromise of sterility, the fact that traditional placement would be within the operative site or because stick-on pads cannot stick due to prep solution, bleeding and other factors. We present an effective solution based on our experience, of using a common staple or "clip" where the ECG electrode is attached. We can see the patient in the prone position with the back having been debrided and grafted. This technical improvisation gives clinicians the ability to monitor safely and accurately the patients' physiological parameters. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

  15. Chemical and Common Burns in Children.

    PubMed

    Yin, Shan

    2017-05-01

    Burns are a common cause of preventable morbidity and mortality in children. Thermal and chemical burns are the most common types of burns. Their clinical appearance can be similar and the treatment is largely similar. Thermal burns in children occur primarily after exposure to a hot surface or liquid, or contact with fire. Burns are typically classified based on the depth and total body surface area, and the severity and onset of the burn can also depend on the temperature and duration of contact. Chemical burns are caused by chemicals-most commonly acids and alkalis-that can damage the skin on contact. In children, the most common cause of chemical burns is from household products such as toilet bowl cleaners, drain cleaners, detergents, and bleaches. Mild chemical burns generally cause redness and pain and can look similar to other common rashes or skin infections, whereas severe chemical burns are more extreme and may cause redness, blistering, skin peeling, and swelling.

  16. Antimicrobial peptide Epinecidin-1 promotes complete skin regeneration of methicillin-resistant Staphylococcus aureus-infected burn wounds in a swine model.

    PubMed

    Huang, Han-Ning; Pan, Chieh-Yu; Wu, Hung-Yi; Chen, Jyh-Yih

    2017-02-03

    This report shows that the antimicrobial peptide (AMP) Epinecidin-1 (Epi-1) efficiently heals MRSA-infected heat burn injuries and provides protection from infection in a pig model. The presence of an optimal level of Epi-1 induces cell proliferation by promoting cell cycle progression through an increase in S-phase cells. Epi-1 also induces proliferation to cover the wounded region in an in vitro cell proliferation assay using immortalized human epithelial HaCaT cells. Next, the in vivo wound healing efficiency of Epi-1 was tested in heat-burned pig skin infected with MRSA under in vivo conditions. Treatment of the injury with Epi-1 for 1 h at six hours post-infection completely healed the wound within 25 days. Conversely, the injury in the untreated control was not healed 25 days post-infection. Histological staining of wound sections with H&E showed that Epi-1 enhanced vascularization and increased epithelial activities in the wound region. Neutrophil recruitment to the wounded region in the Epi-1-treated sections was visualized by Giemsa staining. Additionally, Masson's trichrome staining of wound sections confirmed that Epi-1 enhanced extracellular collagen compound formation. The induction of sepsis-associated blood C-reactive protein (CRP) and the pro-inflammatory cytokine IL-6 in response to MRSA infection was also suppressed in pigs that received Epi-1. Taken together, the results demonstrate that the biomaterial Epi-1 heals wounds through increasing epithelial cell proliferation, vascularization, and the formation of collagen and controls MRSA infection-mediated sepsis in pigs.

  17. Effect of tissue-engineered chitosan-poly(vinyl alcohol) nanofibrous scaffolds on healing of burn wounds of rat skin.

    PubMed

    Gholipour-Kanani, A; Bahrami, S H; Samadi-Kochaksaraie, A; Ahmadi-Tafti, H; Rabbani, S; Kororian, A; Erfani, E

    2012-12-01

    Chitosan-poly(vinyl alcohol) (Cs:PVA) nanofibrous scaffolds were electrospun from 2:3 (wt/wt) Cs:PVA solution dissolved in 80% acetic acid. In vivo study was carried out on the dorsum skin of rat which burnt with a hot brass cylinder. The scaffolds were applied in two forms, that is, acellular (n=6) and cell-seeded with mesenchymal stem cells (n=6). Macroscopic measurements of wound area showed good aspect healing effect of scaffolds in comparison with control wounds specially in 15 days post operating. Pathological studies were done on the wounds to investigate the healing effects. The healing process of the wound covered with Cs/PVA nanofibrous scaffolds was much rapid compared to untreated wounds. However, the presence of stem cells on this scaffolds accelerated the wound healing process owing to their ability of collagen regeneration.

  18. Burns or phytophotodermatitis, abuse or neglect: confusing aspects of skin lesions caused by the superstitious use of fig leaves.

    PubMed

    Abali, Ayse Ebru Sakallioglu; Aka, Mehmet; Aydogan, Cem; Haberal, Mehmet

    2012-01-01

    As a superstition, homemade decoctions are believed to be beneficial for several diseases. This kind of medical therapy, however, can lead to serious adverse effects. In this report, we present three cases from a single family. Each of the family members developed phytophotodermatitis after the application of a fig leaf decoction. The most severe effect was in the case of a 13-year-old boy who had been bathed with the fig leaf decoction; the two other cases were the parents who prepared and applied the medicine to their child's skin to heal the boy's congenital mental-motor retardation. Silver sulfadiazine was used for wound care. The mother was discharged 6 days after admission, the father, after 8 days, and the boy, after 14 days. Burnlike wounds in all three cases healed completely.

  19. Burns and military clothing.

    PubMed

    McLean, A D

    2001-02-01

    Burn injury is a ubiquitous threat in the military environment. The risks during combat are well recognised, but the handling of fuel, oil, munitions and other hot or flammable materials during peacetime deployment and training also imposes an inherent risk of accidental burn injury. Over the last hundred years, the burn threat in combat has ranged from nuclear weapons to small shoulder-launched missiles. Materials such as napalm and white phosphorus plainly present a risk of burn, but the threat extends to encompass personnel in vehicles attacked by anti-armour weapons, large missiles, fuel-air explosives and detonations/conflagrations on weapons platforms such as ships. Large numbers of burn casualties were caused at Pearl Harbor, in Hiroshima and Nagasaki, Vietnam, during the Arab/Israeli Wars and in the Falkland Islands conflict. The threat from burns is unlikely to diminish, indeed new developments in weapons seek to exploit the vulnerability of the serviceman and servicewoman to burns. Clothing can be a barrier to some types of burn--both inherently in the properties of the material, but also by trapping air between clothing layers. Conversely, ignition of the clothing may exacerbate a burn. There is hearsay that burnt clothing products within a wound may complicate the clinical management, or that materials that melt (thermoplastic materials) should not be worn if there is a burn threat. This paper explores the incidence of burn injury, the mechanisms of heat transfer to bare skin and skin covered by materials, and the published evidence for the complication of wound management by materials. Even light-weight combat clothing can offer significant protection to skin from short duration flash burns; the most vulnerable areas are the parts of the body not covered--face and hands. Multilayered combat clothing can offer significant protection for short periods from engulfment by flames; lightweight tropical wear with few layers offers little protection. Under

  20. Efficacy and safety of a fibrin sealant for adherence of autologous skin grafts to burn wounds: results of a phase 3 clinical study.

    PubMed

    Foster, Kevin; Greenhalgh, David; Gamelli, Richard L; Mozingo, David; Gibran, Nicole; Neumeister, Michael; Abrams, Steven Zvi; Hantak, Edith; Grubbs, Lisa; Ploder, Bettina; Schofield, Neil; Riina, Louis H

    2008-01-01

    The objective of this phase 3, multicentered, prospective, randomized, evaluator-blinded, clinical study was to compare skin graft adherence utilizing a fibrin sealant containing 4 IU/ml thrombin (FS 4IU VH S/D [FS 4IU VH S/D will be marketed under the trade name ARTISS upon licensure in the United States]) to graft adherence utilizing staples in burn patients requiring wound excision and skin grafting. FS 4IU VH S/D was compared with staples in 138 patients. Patients had burn wounds measuring < or =40% of total body surface area with two comparable test sites measuring between 1 and 4% total body surface area each. Wound closure at day 28 was assessed using test site planimetry and review of day 28 photographs by three independent blinded evaluators (primary endpoint analysis). Secondary efficacy measures included hematoma/seroma on day 1, engraftment on day 5, and wound closure on day 14. Investigator and patient-reported outcomes were also assessed. The proportion of test sites with complete wound closure at day 28 was 70.3% in FS 4IU VH S/D treated sites and 65.8% in stapled sites, as assessed by planimetry. Blinded review of day 28 photographs confirmed that the rate of complete wound closure was similar between the two treatments, although the overall assessed rates of closure were lower than those determined by planimetry: FS 4IU VH S/D (43.3%) and staples (37.0%). The lower limit of the 97.5% confidence interval of the difference between FS 4IU VH S/D and staples was -0.029, which is above the predefined noninferiority margin of -0.1. Therefore, FS 4IU VH S/D is at least as efficacious as staples at the 97.5% one-sided level for complete wound closure by day 28. Hematoma/seroma on day 1 occurred at significantly (P < .0001) fewer FS 4IU VH S/D-treated sites (29.7% [95% CI 22.2-38.1%]) compared with stapled sites (62.3% [95% CI 53.7-70.4%]). Engraftment on day 5 was deemed to be 100% in 62.3% (95% CI 53.7-70.4%) of the FS 4IU VH S/D-treated sites and 55

  1. Burn Depth Monitor

    NASA Technical Reports Server (NTRS)

    1993-01-01

    Supra Medical Systems is successfully marketing a device that detects the depth of burn wounds in human skin. To develop the product, the company used technology developed by NASA Langley physicists looking for better ultrasonic detection of small air bubbles and cracks in metal. The device is being marketed to burn wound analysis and treatment centers. Through a Space Act agreement, NASA and the company are also working to further develop ultrasonic instruments for new medical applications

  2. Burn Depth Monitor

    NASA Technical Reports Server (NTRS)

    1993-01-01

    Supra Medical Systems is successfully marketing a device that detects the depth of burn wounds in human skin. To develop the product, the companyused technology developed by NASA Langley physicists looking for better ultrasonic detection of small air bubbles and cracks in metal. The device is being marketed to burn wound analysis and treatment centers. Through a Space Act agreement, NASA and the company are also working to further develop ultrasonic instruments for new medical applications.

  3. Burn Depth Monitor

    NASA Technical Reports Server (NTRS)

    1993-01-01

    Supra Medical Systems is successfully marketing a device that detects the depth of burn wounds in human skin. To develop the product, the company used technology developed by NASA Langley physicists looking for better ultrasonic detection of small air bubbles and cracks in metal. The device is being marketed to burn wound analysis and treatment centers. Through a Space Act agreement, NASA and the company are also working to further develop ultrasonic instruments for new medical applications.

  4. Sensitive skin.

    PubMed

    Misery, L; Loser, K; Ständer, S

    2016-02-01

    Sensitive skin is a clinical condition defined by the self-reported facial presence of different sensory perceptions, including tightness, stinging, burning, tingling, pain and pruritus. Sensitive skin may occur in individuals with normal skin, with skin barrier disturbance, or as a part of the symptoms associated with facial dermatoses such as rosacea, atopic dermatitis and psoriasis. Although experimental studies are still pending, the symptoms of sensitive skin suggest the involvement of cutaneous nerve fibres and neuronal, as well as epidermal, thermochannels. Many individuals with sensitive skin report worsening symptoms due to environmental factors. It is thought that this might be attributed to the thermochannel TRPV1, as it typically responds to exogenous, endogenous, physical and chemical stimuli. Barrier disruptions and immune mechanisms may also be involved. This review summarizes current knowledge on the epidemiology, potential mechanisms, clinics and therapy of sensitive skin.

  5. Microsurgical Burn Reconstruction.

    PubMed

    Seth, Akhil K; Friedstat, Jonathan S; Orgill, Dennis P; Pribaz, Julian J; Halvorson, Eric G

    2017-10-01

    The treatment of burn-related wounds requires consideration of several factors, including defect size, available donor sites, exposure of critical structures, and the ultimate functional and aesthetic result of reconstruction. Although skin grafts and locoregional flaps are workhorses in burn reconstruction, they have inherent limitations that can directly impact reconstructive outcomes. Microsurgical free tissue transfer represents a viable option for the reconstruction of burn-related wounds in certain patients. Each anatomic region of the body has unique challenges that must be addressed to achieve a successful reconstruction. Therefore, the choice of free flap must be individualized to the wound and patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Biomass Burning

    Atmospheric Science Data Center

    2015-07-27

    Projects:  Biomass Burning Definition/Description:  Biomass Burning: This data set represents the geographical and temporal distribution of total amount of biomass burned. These data may be used in general circulation models (GCMs) and ...

  7. Burn Institute

    MedlinePlus

    ... a resource to the community. Learn more The Burn Institute reaches thousands of children and adults each year through fire and burn prevention education, burn survivor support programs and the ...

  8. [The role of skin substitutes in the surgical treatment of extensive burns covering more than 60 % of total body surface area. A review of patients over a 10-year period at the Tours University Hospital].

    PubMed

    Lamy, J; Yassine, A-H; Gourari, A; Forme, N; Zakine, G

    2015-04-01

    Progress in intensive care and surgery has made it possible to significantly improve the survival of victims with burns over 60% of total body surface area (TBSA). Coverage of the excised areas of these patients can be difficult when there is a shortage of skin donor sites; then the role of skin substitutes can be important. This retrospective study included patients with burns covering more than 60% TBSA and treated at the Tours University Hospital over a period of 10 years. Patients who died during the first week or who presented superficial burns were excluded. The various substitutions means to temporarily or permanently replace the cutaneous barrier are presented. The biological dressings associated with grafts expanded by six according to the sandwich technique, allografts and xenografts, widely expanded postage stamp skin grafts using a modified Meek technique (Humeca(®)), temporary cutaneous substitutes such as Biobrane(®) and skin substitutes colonized by autologous cells (Integra(®)) are presented. Forty-four patients were admitted. Self-immolations represented 52% of the cases. Twenty-one patients were treated with Integra(®), 5 with Biobrane(®), 17 with sandwich grafts and 4 with postage stamp skin grafts. Integra(®) was widely used when donor sites were insufficient. The mean number of surgical procedures per patient was 8.4. The mean duration of hospitalization was 155 days. Twenty-four patients survived until the end of treatment. Eighteen patients died during the first week before any surgery could be performed. Two patients died at the end of treatment. The overall survival rate was 55%. It was 92% for patients who survived the first week. The principal sequel were functional (hand, cervical, thoracic and axillary contractures) and aesthetic (face and hands). Associated treatments were pressotherapy, physical therapy, ergotherapy and thermal water therapy. By temporarily replacing the cutaneous barrier in the absence of sufficient donor sites

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

    PubMed

    Acar, Ali; Uygur, Fatih; Diktaş, Hüsrev; Evinç, Rahmi; Ulkür, Ersin; Oncül, Oral; Görenek, Levent

    2011-08-01

    In this experimental animal study, the effects of three different topical antimicrobial dressings on Candida albicans contaminated full-thickness burn in rats were analyzed. In total 32 adult Wistar rats (body weight 200-220 g) were used. Silver-coated dressing (Acticoat™®), chlorhexidine acetate 0.5% (Bactigrass®) and Mycostatine (Nystatin®) were compared to assess the antifungal effect of a once-daily application on experimental rat 15% full-skin thickness burn wound seeded 24h earlier with a 10(8) CFU/mL standard strain of C. albicans ATCC 90028. All the animals were sacrificed at post burn day 7. The quantitative counts of seeded organism in burn eschar and subjacent muscle were determined, in addition to the cultures of left ventricle blood and lung biopsies. While there were significant differences between Acticoat™® group (4 ± 10 × 10(4)) and control group (5 ± 6 × 10(6)), and between Nystatin group (4 ± 4 × 10(4)) and control group (P=0.01, P=0.01), there were no significant differences between chlorhexidine acetate 0.5% group (2 ± 3 × 10(4)) and control group (P=0.7) respectively. Acticoat™® and Nystatin were sufficient to prevent to C. albicans from invading to the muscle and from causing systemic infection. The animal data suggest that nystatin is the most effective agents in the treatment of C. albicans-contaminated burn wounds, and Acticoat™® is a choice of treatment on fungal burn wound infection with antibacterial effect and the particular advantage of limiting the frequency of replacement of the dressing. Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.

  10. Musculoskeletal management of the severely burned child.

    PubMed Central

    Birch, J. R.; Eakins, B.; Gosen, J.; Green, S.; Morton, M.

    1976-01-01

    Aggressive management of severe burns minimizes contractures and helps to maintain muscle tone, joint function and psychological well-being. The positioning, activity and exercise programs, splinting and bandaging, and skin care of burned children carried out by the burns team at the Hospital for Sick Children, Toronto is outlined. PMID:782680

  11. Management of burn wounds.

    PubMed

    Schiestl, Clemens; Meuli, Martin; Trop, Marija; Neuhaus, Kathrin

    2013-10-01

    Small and moderate scalds in toddlers are still the most frequent thermal injuries the pediatric surgeons have to face today. Over the last years, surgical treatment of these patients has changed in many aspects. Due to new dressing materials and new surgical treatment strategies that are particularly suitable for children, today, far better functional and aesthetic long-term results are possible. While small and moderate thermal injuries can be treated in most European pediatric surgical departments, the severely burned child must be transferred to a specialized, ideally pediatric, burn center, where a well-trained multidisciplinary team under the leadership of a (ideally pediatric) burn surgeon cares for these highly demanding patients. In future, tissue engineered full thickness skin analogues will most likely play an important role, in pediatric burn as well as postburn reconstructive surgery. Georg Thieme Verlag KG Stuttgart · New York.

  12. Accidental burns during surgery.

    PubMed

    Demir, Erhan; O'Dey, Dan Mon; Pallua, Norbert

    2006-01-01

    The purpose of this report is to increase awareness of intraoperative burns during standard procedures, to discuss their possible causes and warning signs and to provide recommendations for prevention and procedures to follow after their occurrence. A total of 19 patients associated with intraoperative burn accidents were treated surgically and analyzed after a mean follow-up of 5 +/- 3.5 months. Review included retrospective patient chart analysis, clinical examination, and technical device and equipment testing. A total of 15 patients recently underwent cardiac surgery, and 4 pediatric patients recovered after standard surgical procedures. A total of 15 patients had superficial and 4 presented with deep dermal or full-thickness burns. The average injured TBSA was 2.1 +/- 1% (range, 0.5-4%). Delay between primary surgery and consultation of plastic surgeons was 4.5 +/- 3.4 days. A total of 44% required surgery, including débridment, skin grafting or musculocutaneous gluteus maximus flaps, and the remaining patients were treated conservatively. Successful durable soft-tissue coverage of the burn region was achieved in 18 patients, and 1 patient died after a course of pneumonia. Technical analysis demonstrated one malfunctioning electrosurgical device, one incorrect positioned neutral electrode, three incidents occurred after moisture under the negative electrode, eight burns occurred during surgery while fluid or blood created alternate current pathways, five accidents were chemical burns after skin preparation with Betadine solution, and in one case, the cause was not clear. The surgical team should pay more attention to the probability of burns during surgery. Early patient examination and immediate involvement of plastic and burn surgeons may prevent further complications or ease handling after the occurrence.

  13. Novel burn device for rapid, reproducible burn wound generation

    PubMed Central

    Kim, J.Y.; Dunham, D.M.; Supp, D.M.; Sen, C.K.; Powell, H.M.

    2016-01-01

    Introduction Scarring following full thickness burns leads to significant reductions in range of motion and quality of life for burn patients. To effectively study scar development and the efficacy of anti-scarring treatments in a large animal model (female red Duroc pigs), reproducible, uniform, full-thickness, burn wounds are needed to reduce variability in observed results that occur with burn depth. Prior studies have proposed that initial temperature of the burner, contact time with skin, thermal capacity of burner material, and the amount of pressure applied to the skin need to be strictly controlled to ensure reproducibility. The purpose of this study was to develop a new burner that enables temperature and pressure to be digitally controlled and monitored in real-time throughout burn wound creation and compare it to a standard burn device. Methods A custom burn device was manufactured with an electrically heated burn stylus and a temperature control feedback loop via an electronic microstat. Pressure monitoring was controlled by incorporation of a digital scale into the device, which measured downward force. The standard device was comprised of a heat resistant handle with a long rod connected to the burn stylus, which was heated using a hot plate. To quantify skin surface temperature and internal stylus temperature as a function of contact time, the burners were heated to the target temperature (200 ± 5 °C) and pressed into the skin for 40 s to create the thermal injuries. Time to reach target temperature and elapsed time between burns were recorded. In addition, each unit was evaluated for reproducibility within and across three independent users by generating burn wounds at contact times spanning from 5 to 40 s at a constant pressure and at pressures of 1 or 3 lbs with a constant contact time of 40 s. Biopsies were collected for histological analysis and burn depth quantification using digital image analysis (ImageJ). Results The custom burn device

  14. Novel burn device for rapid, reproducible burn wound generation.

    PubMed

    Kim, J Y; Dunham, D M; Supp, D M; Sen, C K; Powell, H M

    2016-03-01

    Scarring following full thickness burns leads to significant reductions in range of motion and quality of life for burn patients. To effectively study scar development and the efficacy of anti-scarring treatments in a large animal model (female red Duroc pigs), reproducible, uniform, full-thickness, burn wounds are needed to reduce variability in observed results that occur with burn depth. Prior studies have proposed that initial temperature of the burner, contact time with skin, thermal capacity of burner material, and the amount of pressure applied to the skin need to be strictly controlled to ensure reproducibility. The purpose of this study was to develop a new burner that enables temperature and pressure to be digitally controlled and monitored in real-time throughout burn wound creation and compare it to a standard burn device. A custom burn device was manufactured with an electrically heated burn stylus and a temperature control feedback loop via an electronic microstat. Pressure monitoring was controlled by incorporation of a digital scale into the device, which measured downward force. The standard device was comprised of a heat resistant handle with a long rod connected to the burn stylus, which was heated using a hot plate. To quantify skin surface temperature and internal stylus temperature as a function of contact time, the burners were heated to the target temperature (200±5°C) and pressed into the skin for 40s to create the thermal injuries. Time to reach target temperature and elapsed time between burns were recorded. In addition, each unit was evaluated for reproducibility within and across three independent users by generating burn wounds at contact times spanning from 5 to 40s at a constant pressure and at pressures of 1 or 3lbs with a constant contact time of 40s. Biopsies were collected for histological analysis and burn depth quantification using digital image analysis (ImageJ). The custom burn device maintained both its internal

  15. Hodgkin’s lymphoma emerging radiation treatment techniques: trade-offs between late radio-induced toxicities and secondary malignant neoplasms

    PubMed Central

    2013-01-01

    Background Purpose of this study is to explore the trade-offs between radio-induced toxicities and second malignant neoplasm (SMN) induction risk of different emerging radiotherapy techniques for Hodgkin’s lymphoma (HL) through a comprehensive dosimetric analysis on a representative clinical model. Methods Three different planning target volume (PTVi) scenarios of a female patient with supradiaphragmatic HL were used as models for the purpose of this study. Five treatment radiation techniques were simulated: an anterior-posterior parallel-opposed (AP-PA), a forward intensity modulated (FIMRT), an inverse intensity modulated (IMRT), a Tomotherapy (TOMO), a proton (PRO) technique. A radiation dose of 30 Gy or CGE was prescribed. Dose-volume histograms of PTVs and organs-at-risk (OARs) were calculated and related to available dose-volume constraints. SMN risk for breasts, thyroid, and lungs was estimated through the Organ Equivalent Dose model considering cell repopulation and inhomogeneous organ doses. Results With similar level of PTVi coverage, IMRT, TOMO and PRO plans generally reduced the OARs’ dose and accordingly the related radio-induced toxicities. However, only TOMO and PRO plans were compliant with all constraints in all scenarios. For the IMRT and TOMO plans an increased risk of development of breast, and lung SMN compared with AP-PA and FIMRT techniques was estimated. Only PRO plans seemed to reduce the risk of predicted SMN compared with AP-PA technique. Conclusions Our model–based study supports the use of advanced RT techniques to successfully spare OARs and to reduce the risk of radio-induced toxicities in HL patients. However, the estimated increase of SMNs’ risk inherent to TOMO and IMRT techniques should be carefully considered in the evaluation of a risk-adapted therapeutic strategy. PMID:23360559

  16. Ionizing radiations and collagen metabolism: from oxygen free radicals to radio-induced late fibrosis

    NASA Astrophysics Data System (ADS)

    Nguyen, Tan Dat; Maquart, François-Xavier; Monboisse, Jean-Claude

    2005-02-01

    Skin fibrosis is one of the most common late adverse effects observed after radiation therapy for cancer. As a dose-limiting factor and hence a major hindrance to increase the amount of radiation delivered to the tumor, this problem can be addressed according to the very early steps of the fibrotic process: the oxygen free radical production. Reactive oxygen species (ROS) generated during radiotherapy result from both inflammatory response and water radiolysis. Many studies have demonstrated that the extracellular matrix molecules are potential targets for ROS, and that collagen metabolism and properties are deeply and permanently modified after irradiation, both in vitro and in vivo. It is therefore possible to design different therapeutic approaches such as the clinical use of liposomal superoxide dismutase able to reverse the imbalance between collagen matrix synthesis and degradation. Finally, the so-called oxidative stress induced by radiation represents a significant parameter leading to fibrosis and will undoubtedly serve to design further experimental and clinical studies.

  17. Burn Wise

    EPA Pesticide Factsheets

    Burn Wise is a partnership program of the U.S. Environmental Protection Agency that emphasizes the importance of burning the right wood, the right way, in the right appliance to protect your home, health, and the air we breathe.

  18. CAD tool for burn diagnosis.

    PubMed

    Acha, Begoña; Serrano, Carmen; Acha, José I; Roa, Laura M

    2003-07-01

    In this paper a new system for burn diagnosis is proposed. The aim of the system is to separate burn wounds from healthy skin, and the different types of burns (burn depths) from each other, identifying each one. The system is based on the colour and texture information, as these are the characteristics observed by physicians in order to give a diagnosis. We use a perceptually uniform colour space (L*u*v*), since Euclidean distances calculated in this space correspond to perceptually colour differences. After the burn is segmented, some colour and texture descriptors are calculated and they are the inputs to a Fuzzy-ARTMAP neural network. The neural network classifies them into three types of bums: superficial dermal, deep dermal and full thickness. Clinical effectiveness of the method was demonstrated on 62 clinical burn wound images obtained from digital colour photographs, yielding an average classification success rate of 82% compared to expert classified images.

  19. Clothing burns in Canadian children

    PubMed Central

    Stanwick, Richard S.

    1985-01-01

    A Canadian survey of 11 tertiary care pediatric centres with specialized burn facilities revealed that an estimated 37 children up to 9 years of age are admitted annually to such hospitals because of clothing burns. Sleepwear accounts for an estimated 21 such burns per year. Girls were found to suffer the most severe burns and represented eight of the nine children in the series who died. Loose and flowing garments dominated the girls' styles. The results of multiple-regression analysis confirmed that style of clothing (loose and flowing as opposed to snug) was the most significant predictor of burn severity, length of hospital stay, the need for skin grafting and survival. The ignition situation (avoidance of parental supervision at the time of injury) was the only other important predictor. The success of regulatory actions in other countries in reducing the incidence of severe clothing burns is reviewed, and preventive strategies for Canada are explored. ImagesFig. 2 PMID:3995433

  20. Rocket plume burn hazard.

    PubMed

    Stoll, A M; Piergallini, J R; Chianta, M A

    1980-05-01

    By use of miniature rocket engines, the burn hazard posed by exposure to ejection seat rocket plume flames was determined in the anaesthetized rat. A reference chart is provided for predicting equivalent effects in human skin based on extrapolation of earlier direct measurements of heat input for rat and human burns. The chart is intended to be used in conjunction with thermocouple temperature measurements of the plume environment for design and modification of escape seat system to avoid thermal injury on ejection from multiplace aircraft.

  1. Longitudinal burn scar quantification.

    PubMed

    Nedelec, Bernadette; Correa, José A; de Oliveira, Ana; LaSalle, Leo; Perrault, Isabelle

    2014-12-01

    Quantitative studies of the clinical recovery of burn scars are currently lacking. Previous reports validate the objective, precise, diagnostic capabilities of high-frequency ultrasound to measure thickness, the Cutometer(®) to measure pliability and the Mexameter(®) to measure erythema and pigmentation of scars. Thus, we prospectively quantified clinical characteristics of patient-matched, after burn hypertrophic scar (HSc), donor site scar (D) and normal skin (N) using these instruments. One investigator measured 3 sites (HSc, D, N) in 46 burn survivors at 3, 6, and 12 months after-burn. A mixed model regression analysis, adjusting p-values for multiplicity of testing, was used to compare means among sites and time points. Participants were 41.2±13.5 years old, 87% males, predominantly Caucasian, with an average of 19.5% body surface area burned. HSc thickness decreased significantly between 3 and 6, 6 and 12, and 3 and 12 months (all p<0.0001), but remained thicker than D and N skin (all p<0.0001). Pliability differed significantly between HSc, D and N sites at all time points (all p<0.0001), with HSc and D increasing between 3 and 12 months (p<0.05) but not reaching normal. HSc and D sites were significantly more erythematous than normal skin (p<0.05) at 3 and 6 months but D sites approached normal by 12 months. The only time points at which pigmentation significantly differed were the HSc and D sites at 6 months. Thickness, pliability, erythema and pigmentation of N skin remained similar over the 12 months. We found that post-burn HSc thickness, pliability and erythema differed significantly from D and N skin at 3, 6, and 12 months and does not return to normal by 12 months after-injury; however, significant improvements towards normal can be expected. Donor sites are redder than normal skin at 3 and 6 months but can be expected to return to normal by 12 months. Although the color of HSc and D sites change markedly with time these color changes are

  2. Incidence and characteristics of chemical burns.

    PubMed

    Koh, Dong-Hee; Lee, Sang-Gil; Kim, Hwan-Cheol

    2017-05-01

    Chemical burns can lead to serious health outcomes. Previous studies about chemical burns have been performed based on burn center data so these studies have provided limited information about the incidence of chemical burns at the national level. The aim of this study was to evaluate the incidence and characteristics of chemical burns using nationwide databases. A cohort representing the Korean population, which was established using a national health insurance database, and a nationwide workers' compensation database were used to evaluate the incidence and characteristics of chemical burns. Characteristics of the affected body region, depth of burns, industry, task, and causative agents were analyzed from two databases. The incidence of chemical burns was calculated according to employment status. The most common regions involving chemical burns with hospital visits were the skin followed by the eyes. For skin lesions, the hands and wrists were the most commonly affected regions. Second degree burns were the most common in terms of depth of skin lesions. The hospital visit incidence was 1.96 per 10,000 person-year in the general population. The compensated chemical burns incidence was 0.17 per 10,000 person-year. Employees and the self-employed showed a significantly increased risk of chemical burns undergoing hospital visits compared to their dependents. Chemical burns on the skin and eyes are almost equally prevalent. The working environment was associated with increased risk of chemical burns. Our results may aid in estimating the size of the problem and prioritizing prevention of chemical burns. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  3. How to Choose the Best Skin Care Products

    MedlinePlus

    ... Surgery Conditions Acne Scars Aging Hands Age Spots Aging Skin Birthmarks Burn Scars Cellulite Crow's Feet Droopy Eyelids ... Surgery Conditions Acne Scars Aging Hands Age Spots Aging Skin Birthmarks Burn Scars Cellulite Crow's Feet Droopy Eyelids ...

  4. MALIGNANT DEGENERATION IN BURN SCARS

    PubMed Central

    Castañares, Salvador

    1961-01-01

    The malignant potential of burn scars has been recognized since Marjolin's classical description of cancer arising in several types of post-traumatic scars. With improved burn therapy since the last war, there has been a higher survival rate of severe burns with proportionate increase in cancer associated with burn scars. This will create increasing problems of permanent disability and compensation. The younger the patient at the time of the burn, the longer the time required for the cancer to develop. Acute cancer development in burn scars has been reported after a four-week interval. Cancer may develop from six weeks to fifty years or more. The etiology of cancer in burn scars is not known. The most important clinical finding is the fact that most of the burn cancers occur in areas which were not grafted. The most common type of cancer encountered in burn scars is squamous cell carcinoma, which forms in Marjolin ulcers. Basal cell carcinoma may develop in the most superficial of burn scars. Treatment should be directed primarily to prompt and adequate skin grafting in all deep burns in order to prevent malignant degeneration of the burn scars. Once it has developed the treatment is the same as for other malignancies which are not associated with burns. Wide surgical excision with block dissection of the regional lymph nodes when they are involved is the treatment of choice. The prognosis of burn scar cancer is poor, once the process has extended because of early and distant metastasis. ImagesFigure 1.Figure 2.Figure 2.Figure 3.Figure 3.Figure 4. PMID:13691372

  5. Burn sepsis and burn toxin

    PubMed Central

    Allgöwer, Martin; Städtler, Karl; Schoenenberger, Guido A

    1974-01-01

    The salient steps of a 20-year programme of research into the nature of burn disease are described. By burn disease we mean the late mortality and morbidity following burns. We have isolated a burn toxin which is derived from a thermal polymerization of cell membrane lipoproteins within the dermis and have studied its influence on the effects of sepsis. We have also used it in the development of active and passive immunization therapy of severe burns. ImagesFig. 2Fig. 5Fig. 6Fig. 7Fig. 8Fig. 9 PMID:4429330

  6. The wound/burn guidelines - 6: Guidelines for the management of burns.

    PubMed

    Yoshino, Yuichiro; Ohtsuka, Mikio; Kawaguchi, Masakazu; Sakai, Keisuke; Hashimoto, Akira; Hayashi, Masahiro; Madokoro, Naoki; Asano, Yoshihide; Abe, Masatoshi; Ishii, Takayuki; Isei, Taiki; Ito, Takaaki; Inoue, Yuji; Imafuku, Shinichi; Irisawa, Ryokichi; Ohtsuka, Masaki; Ogawa, Fumihide; Kadono, Takafumi; Kawakami, Tamihiro; Kukino, Ryuichi; Kono, Takeshi; Kodera, Masanari; Takahara, Masakazu; Tanioka, Miki; Nakanishi, Takeshi; Nakamura, Yasuhiro; Hasegawa, Minoru; Fujimoto, Manabu; Fujiwara, Hiroshi; Maekawa, Takeo; Matsuo, Koma; Yamasaki, Osamu; Le Pavoux, Andres; Tachibana, Takao; Ihn, Hironobu

    2016-09-01

    Burns are a common type of skin injury encountered at all levels of medical facilities from private clinics to core hospitals. Minor burns heal by topical treatment alone, but moderate to severe burns require systemic management, and skin grafting is often necessary also for topical treatment. Inappropriate initial treatment or delay of initial treatment may exert adverse effects on the subsequent treatment and course. Therefore, accurate evaluation of the severity and initiation of appropriate treatment are necessary. The Guidelines for the Management of Burn Injuries were issued in March 2009 from the Japanese Society for Burn Injuries as guidelines concerning burns, but they were focused on the treatment for extensive and severe burns in the acute period. Therefore, we prepared guidelines intended to support the appropriate diagnosis and initial treatment for patients with burns that are commonly encountered including minor as well as moderate and severe cases. Because of this intention of the present guidelines, there is no recommendation of individual surgical procedures.

  7. Burns Caused by Medical Therapy

    DTIC Science & Technology

    2000-05-01

    Insensate skin and chronic medical illness such as diabetes mellitus were common risk factors. The scald potential from hydrotherapy in patients with...anesthetized, unconscious, or immobilized patients by the use of hydrotherapy , heating blankets, hot water bonlcs, or other warm- 272 Bnrillo cr a/ ing de...Hwang JC, Himel HN, Edlich RF. Bilateral amputations foUowing hydrotherapy t:lnk burns in a. paraplegic patient. Burns 1995;21:70-L 53. Simonsen K

  8. Prospective, double-blinded, randomised controlled trial assessing the effect of an Octenidine-based hydrogel on bacterial colonisation and epithelialization of skin graft wounds in burn patients.

    PubMed

    W, Eisenbeiß; F, Siemers; G, Amtsberg; P, Hinz; B, Hartmann; T, Kohlmann; A, Ekkernkamp; U, Albrecht; O, Assadian; A, Kramer

    2012-01-01

    Moist wound treatment improves healing of skin graft donor site wounds. Microbial colonised wounds represent an increased risk of wound infection; while antimicrobially active, topical antiseptics may impair epithelialization. The aim of this prospective randomised controlled clinical trial was to examine the influence of an Octenidine-dihydrochloride (OCT) hydrogel on bacterial colonisation and epithelialization of skin graft donor sites. The study was designed as a randomised, double-blinded, controlled clinical trial. Skin graft donor sites from a total of 61 patients were covered either with 0.05% OCT (n=31) or an OCT-free placebo wound hydrogel (n=30). Potential interaction with wound healing was assessed by measuring the time until 100% re-epithelialization. In addition, microbial wound colonisation was quantitatively determined in all skin graft donor sites. There was no statistically significant difference in the time for complete epithelialization of skin graft donor sites in the OCT and the placebo group (7.3±0.2 vs. 6.9±0.2 days; p=0.236). Microbial wound colonisation was significantly lower in the OCT group than in the placebo group (p=0.014). The OCT-based hydrogel showed no delay in wound epithelialization and demonstrated a significantly lower bacterial colonisation of skin graft donor site wounds.

  9. Prospective, double-blinded, randomised controlled trial assessing the effect of an Octenidine-based hydrogel on bacterial colonisation and epithelialization of skin graft wounds in burn patients

    PubMed Central

    W, Eisenbeiß; F, Siemers; G, Amtsberg; P, Hinz; B, Hartmann; T, Kohlmann; A, Ekkernkamp; U, Albrecht; O, Assadian; A, Kramer

    2012-01-01

    Background: Moist wound treatment improves healing of skin graft donor site wounds. Microbial colonised wounds represent an increased risk of wound infection; while antimicrobially active, topical antiseptics may impair epithelialization. Objectives: The aim of this prospective randomised controlled clinical trial was to examine the influence of an Octenidine-dihydrochloride (OCT) hydrogel on bacterial colonisation and epithelialization of skin graft donor sites. Methods: The study was designed as a randomised, double-blinded, controlled clinical trial. Skin graft donor sites from a total of 61 patients were covered either with 0.05% OCT (n=31) or an OCT-free placebo wound hydrogel (n=30). Potential interaction with wound healing was assessed by measuring the time until 100% re-epithelialization. In addition, microbial wound colonisation was quantitatively determined in all skin graft donor sites. Results: There was no statistically significant difference in the time for complete epithelialization of skin graft donor sites in the OCT and the placebo group (7.3±0.2 vs. 6.9±0.2 days; p=0.236). Microbial wound colonisation was significantly lower in the OCT group than in the placebo group (p=0.014). Conclusions: The OCT-based hydrogel showed no delay in wound epithelialization and demonstrated a significantly lower bacterial colonisation of skin graft donor site wounds. PMID:23071904

  10. The biology of burn injury.

    PubMed

    Evers, Lars H; Bhavsar, Dhaval; Mailänder, Peter

    2010-09-01

    Burn injury is a complex traumatic event with various local and systemic effects, affecting several organ systems beyond the skin. The pathophysiology of the burn patient shows the full spectrum of the complexity of inflammatory response reactions. In the acute phase, inflammation mechanism may have negative effects because of capillary leak, the propagation of inhalation injury and the development of multiple organ failure. Attempts to mediate these processes remain a central subject of burn care research. Conversely, inflammation is a necessary prologue and component in the later-stage processes of wound healing. In this review, we are attempting to present the current science of burn wound pathophysiology and wound healing. We also describe the evolution of innovative strategies for burn management.

  11. Terahertz reflectometry of burn wounds in a rat model

    PubMed Central

    Arbab, M. Hassan; Dickey, Trevor C.; Winebrenner, Dale P.; Chen, Antao; Klein, Mathew B.; Mourad, Pierre D.

    2011-01-01

    We present sub-millimeter wave reflectometry of an experimental rat skin burn model obtained by the Terahertz Time-Domain Spectroscopy (THz-TDS) technique. Full thickness burns, as confirmed by histology, were created on rats (n = 4) euthanized immediately prior to the experiments. Statistical analysis shows that the burned tissue exhibits higher reflectivity compared to normal skin over a frequency range between 0.5 and 0.7 THz (p < 0.05), likely due to post-burn formation of interstitial edema. Furthermore, we demonstrate that a double Debye dielectric relaxation model can be used to explain the terahertz response of both normal and less severely burned rat skin. Finally, our data suggest that the degree of conformation between the experimental burn measurements and the model for normal skin can potentially be used to infer the extent of burn severity. PMID:21833370

  12. Characterization of burn injuries using terahertz time-domain spectroscopy

    NASA Astrophysics Data System (ADS)

    Arbab, M. Hassan; Dickey, Trevor C.; Winebrenner, Dale P.; Chen, Antao; Mourad, Pierre D.

    2011-03-01

    The accuracy rates of the clinical assessment techniques used in grading burn injuries remain significantly low for partial thickness burns. In this paper, we present experimental results from terahertz characterization of 2nd and 3rd degree burn wounds induced on a rat model. Reflection measurements were obtained from the surface of both burned and normal skin using pulsed terahertz spectroscopy. Signal processing techniques are described for interpretation of the acquired terahertz waveform and differentiation of burn wounds. Furthermore, the progression of burn injuries is shown by comparison between acute characterization and 72-hours survival studies. While the water content of healthy and desiccated skin has been considered as a source of terahertz signal contrast, it is demonstrated that other biological effects such as formation of post-burn interstitial edema as well as the density of the discrete scattering structures in the skin (such as hair follicles, sweat glands, etc.) play a significant role in the terahertz response of the burn wounds.

  13. Preparation of Partial-Thickness Burn Wounds in Rodents Using a New Experimental Burning Device.

    PubMed

    Sakamoto, Michiharu; Morimoto, Naoki; Ogino, Shuichi; Jinno, Chizuru; Kawaguchi, Atsushi; Kawai, Katsuya; Suzuki, Shigehiko

    2016-06-01

    The manual application of hot water or hot metal to an animal's skin surface is often used to prepare burn wound models. However, manual burn creation is subject to human variability. We developed a new device that can control the temperature, time, and pressure of contact to produce precise and reproducible animal burn wounds and investigated the conditions required to prepare various burn wounds using our new device. We prepared burn wounds on F344 rats using 3 contact times 2, 4, and 10 seconds using a stamp heated to 80°C. We observed the wound-healing process macroscopically and histologically and evaluated the burn depth using a laser speckle contrast-imaging device, which evaluated the blood flow of the wound. The changes in the burned area over time, tissue perfusion of the burn wounds, histological evaluation of the burn depth by hematoxylin-eosin and azocarmine and aniline blue staining, and the epithelialization rate (the ratio of the epithelialized area to the wound length) were evaluated on histological sections. Results indicated that the burn wounds prepared with contact times of 2, 4, and 10 seconds corresponded to superficial dermal burns, deep dermal burns, and full-thickness burns, respectively. We demonstrated that partial- and full-thickness burn wounds can be precisely and reproducibly created with our new automated burning device.

  14. Animal models in burn research.

    PubMed

    Abdullahi, A; Amini-Nik, S; Jeschke, M G

    2014-09-01

    Burn injury is a severe form of trauma affecting more than 2 million people in North America each year. Burn trauma is not a single pathophysiological event but a devastating injury that causes structural and functional deficits in numerous organ systems. Due to its complexity and the involvement of multiple organs, in vitro experiments cannot capture this complexity nor address the pathophysiology. In the past two decades, a number of burn animal models have been developed to replicate the various aspects of burn injury, to elucidate the pathophysiology, and to explore potential treatment interventions. Understanding the advantages and limitations of these animal models is essential for the design and development of treatments that are clinically relevant to humans. This review aims to highlight the common animal models of burn injury in order to provide investigators with a better understanding of the benefits and limitations of these models for translational applications. While many animal models of burn exist, we limit our discussion to the skin healing of mouse, rat, and pig. Additionally, we briefly explain hypermetabolic characteristics of burn injury and the animal model utilized to study this phenomena. Finally, we discuss the economic costs associated with each of these models in order to guide decisions of choosing the appropriate animal model for burn research.

  15. Animal Models in Burn Research

    PubMed Central

    Abdullahi, A.; Amini-Nik, S.; Jeschke, M.G

    2014-01-01

    Burn injury is a severe form of trauma affecting more than two million people in North America each year. Burn trauma is not a single pathophysiological event but a devastating injury that causes structural and functional deficits in numerous organ systems. Due to its complexity and the involvement of multiple organs, in vitro experiments cannot capture this complexity nor address the pathophysiology. In the past two decades, a number of burn animal models have been developed to replicate the various aspects of burn injury; to elucidate the pathophysiology and explore potential treatment interventions. Understanding the advantages and limitations of these animal models is essential for the design and development of treatments that are clinically relevant to humans. This review paper aims to highlight the common animal models of burn injury in order to provide investigators with a better understanding of the benefits and limitations of these models for translational applications. While many animal models of burn exist, we limit our discussion to the skin healing of mouse, rat, and pig. Additionally, we briefly explain hypermetabolic characteristics of burn injury and the animal model utilized to study this phenomena. Finally, we discuss the economic costs associated with each of these models in order to guide decisions of choosing the appropriate animal model for burn research. PMID:24714880

  16. Techniques for Early Characterization of Burn Injuries.

    DTIC Science & Technology

    1983-12-28

    describing the optical characteristics of thermally injired :;kin and Its changes with burn depth. Part TI: The Doppler Ultrasound Skin Blood Flow... thermal regulation, skin nutrition, and so on. A number of methols; have been developed in an attempt to quantify this parameter: radio- activo isotone...taken only after thermal stability is attained. 11: < . .. References (1] David M. Heimbach, Martin A. Afromowitz, Mark Hoeffner, Mark Burns, and Loren H

  17. Lower-extremity burn reconstruction in the child.

    PubMed

    Barbour, John R; Schweppe, Mark; O, Seung-Jun

    2008-07-01

    Lower-extremity burns in a pediatric patient require special consideration. The management of burn reconstruction in pediatric patients is often complex, requiring multiple reconstructive operations, and the primary intention of the surgeon is to prevent burn scar deformities. Timely management of the burn wound and postburn scars has decreased the incidence of burn scar deformities and contractures of the lower extremity in recent years. We present an overview of the principles of reconstruction techniques using skin grafting and biologic skin substitutes to restore the important barrier lost secondary to burns. In addition, we address methods of repairing scar contracture, a common occurrence in burn patients, at specific locations on the lower extremity. Finally, special scenarios such as burns associated with fractures, burn injury in insensate children, and Marjolin ulcer are discussed.

  18. Chemical Debridement of Burns

    PubMed Central

    Levenson, Stanley M.; Kan, Dorinne; Gruber, Charles; Crowley, Leo V.; Lent, Richard; Watford, Alvin; Seifter, Eli

    1974-01-01

    The development of effective, non-toxic (local and systemic) methods for the rapid chemical (enzymatic and non-enzymatic) debridement of third degree burns would dramatically reduce the morbidity and mortality of severely burned patients. Sepsis is still the major cause of death of patients with extensive deep burns. The removal of the devitalized tissue, without damage to unburned skin or skin only partially injured by burning, and in ways which would permit immediate (or very prompt) skin grafting, would lessen substantially the problems of sepsis, speed convalescence and the return of these individuals to society as effective human beings, and would decrease deaths. The usefulness and limitations of surgical excision for patients with extensive third degree burns are discussed. Chemical debridement lends itself to complementary use with surgical excision and has the potential advantage over surgical excision in not requiring anesthesia or a formal surgical operation. The authors' work with the chemical debridement of burns, in particular the use of Bromelain, indicates that this approach will likely achieve clinical usefulness. The experimental studies indicate that rapid controlled debridement, with minimal local and systemic toxicity, is possible, and that effective chemotherapeutic agents may be combined with the Bromelain without either interfering with the actions of the other. The authors believe that rapid (hours) debridement accomplished by the combined use of chemical debriding and chemotherapeutic agents will obviate the possibility of any increase in infection, caused by the use of chemical agents for debridement, as reported for Paraenzyme21 and Travase.39,48 It is possible that the short term use of systemic antibiotics begun just before and continued during, and for a short time after, the rapid chemical debridement may prove useful for the prevention of infection, as appears to be the case for abdominal operations of the clean-contaminated and

  19. American Burn Association

    MedlinePlus

    ... by burn injury. Donate today The American Burn Association Web site contains general information for burn care ... local burn center or hospital. © 2017 American Burn Association. All rights reserved.

  20. The inner prepuce flap for penile scald burns.

    PubMed

    Fuller, Sam M; Roughton, Michelle C; Gottlieb, Lawrence J

    2014-01-01

    Preputial skin has similar color, texture, and composition to the skin of the penile shaft. The inner preputial skin may be transferred as a flap based upon Dartos fascia to resurface full-thickness burns of the penile shaft, providing a gliding and stretchable surface cover unique to the penis. The advantages of using the inner prepuce skin to resurface full-thickness burns of the penile shaft will be elucidated and the technique will be described. A retrospective chart review was performed of three patients whose penile shaft was resurfaced with inner prepuce flaps after tangential excision of their full-thickness scald burns. Patient 1 was a 9-year-old boy who sustained an 8% TBSA scald burn resulting in a full-thickness burn to the dorsum of his penis. Patient 2 was a 3-year-old boy who sustained a 60% TBSA immersion scald burn as a victim of child abuse, resulting in a circumferential penile burn. Patient 3 was an 8- year-old boy who sustained a 3% TBSA grease burn to the dorsum of his penis. The inner surface of the prepuce of the patients was intact. They were treated with an inner preputial flap. Full-thickness scald burns to the penis are unusual and challenging for the patient, family, and burn surgeon. It is advantageous that inner preputial skin is commonly spared. This specialized thin skin is ideal for resurfacing the penile shaft and should be used when available.

  1. Biomass Burning

    NASA Technical Reports Server (NTRS)

    Levine, Joel S.; Cofer, Wesley R., III; Pinto, Joseph P.

    1993-01-01

    Biomass burning may be the overwhelming regional or continental-scale source of methane (CH4) as in tropical Africa and a significant global source of CH4. Our best estimate of present methane emissions from biomass burning is about 51.9 Tg/yr, or 10% of the annual methane emissions to the atmosphere. Increased frequency of fires that may result as the Earth warms up may result in increases in this source of atmospheric methane.

  2. Efficacy of moist exposed burn ointment on burns.

    PubMed

    Zhang, Hong-Qi; Yip, Tsui-Pik; Hui, Irene; Lai, Vincy; Wong, Ann

    2005-01-01

    In this study, we sought to test the medical efficacy of a Chinese medical herb product, moist exposed burn ointment (MEBO), on wound healing rate and infection control in burn injury. Standardized deep burn wounds were created on the back skin of rats by applying a hot brass bar for 12 to 18 seconds. MEBO was applied four times per day and compared with petroleum jelly, silver sulfadiazine, and dry exposure therapy. Under such a controlled setting, although MEBO had a better wound healing rate than the dry exposure treatment, it did not show the medical advantage statistically, as has been claimed, over the other two treatments (P > .05), either in terms of wound healing rate or bacterial control. We conclude that the MEBO is not suitable for deep burn wound treatment, particularly when infection is a concern.

  3. Treatment of burns in children.

    PubMed

    Herndon, D N; Thompson, P B; Desai, M H; Van Osten, T J

    1985-10-01

    Decreases in mortality from major thermal injury over the last 20 years have been due to advances in resuscitation, control of infection, support of the hypermetabolic response, and early closure of the burn wound. Of these advances in burn care, early wound closure has progressed the most in the last five years. The restoration of the protective functions of the skin is of primary importance to the recovery of the burn patient. Biologic dressings (pigskin, amnion, human skin allograft) when applied to fully debrided, relatively uncontaminated wounds have been shown to adhere to the wound surface, reduce the wound colony counts, limit fluid and protein loss, reduce pain, and increase the rate of epithelialization over that obtained with application of topical antimicrobial agents.

  4. Wound management and outcome of 595 electrical burns in a major burn center.

    PubMed

    Li, Haisheng; Tan, Jianglin; Zhou, Junyi; Yuan, Zhiqiang; Zhang, Jiaping; Peng, Yizhi; Wu, Jun; Luo, Gaoxing

    2017-06-15

    Electrical burns are important causes of trauma worldwide. This study aims to analyze the clinical characteristics, wound management, and outcome of electric burns. This retrospective study was performed at the Institute of Burn Research of the Third Military Medical University during 2013-2015. Data including the demographics, injury patterns, wound treatment, and outcomes were collected and analyzed. A total of 595 electrical burn patients (93.8% males) were included. The average age was 37.3 ± 14.6 y, and most patients (73.5%) were aged 19∼50 years. Most patients (67.2%) were injured in work-related circumstances. The mean total body surface area was 8.8 ± 11.8% and most wounds (63.5%) were full-thickness burns. Operation times of high-voltage burns and current burns were higher than those of low-voltage burns and arc burns, respectively. Of the 375 operated patients, 83.2% (n = 312) underwent skin autografting and 49.3% (n = 185) required skin flap coverage. Common types of skin flaps were adjacent (50.3%), random (42.2%), and pedicle (35.7%). Amputation was performed in 107 cases (18.0%) and concentrated on the hands (43.9%) and upper limbs (39.3%). The mean length of stay was 42.9 ± 46.3 d and only one death occurred (0.2%). Current burns and higher numbers of operations were major risk factors for amputation and length of stay, respectively. Electrical burns mainly affected adult males with occupational exposures in China. Skin autografts and various skin flaps were commonly used for electric burn wound management. More standardized and effective strategies of treatment and prevention are still needed to decrease amputation rates. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Moderate systemic hypothermia decreases burn depth progression.

    PubMed

    Rizzo, Julie A; Burgess, Pamela; Cartie, Richard J; Prasad, Balakrishna M

    2013-05-01

    Therapeutic hypothermia has been proposed to be beneficial in an array of human pathologies including cardiac arrest, stroke, traumatic brain and spinal cord injury, and hemorrhagic shock. Burn depth progression is multifactorial but inflammation plays a large role. Because hypothermia is known to reduce inflammation, we hypothesized that moderate hypothermia will decrease burn depth progression. We used a second-degree 15% total body surface area thermal injury model in rats. Burn depth was assessed by histology of biopsy sections. Moderate hypothermia in the range of 31-33°C was applied for 4h immediately after burn and in a delayed fashion, starting 2h after burn. In order to gain insight into the beneficial effects of hypothermia, we analyzed global gene expression in the burned skin. Immediate hypothermia decreased burn depth progression at 6h post injury, and this protective effect was sustained for at least 24h. Burn depth was 18% lower in rats subjected to immediate hypothermia compared to control rats at both 6 and 24h post injury. Rats in the delayed hypothermia group did not show any significant decrease in burn depth at 6h, but had 23% lower burn depth than controls at 24h. Increased expression of several skin-protective genes such as CCL4, CCL6 and CXCL13 and decreased expression of tissue remodeling genes such as matrix metalloprotease-9 were discovered in the skin biopsy samples of rats subjected to immediate hypothermia. Systemic hypothermia decreases burn depth progression in a rodent model and up-regulation of skin-protective genes and down-regulation of detrimental tissue remodeling genes by hypothermia may contribute to its beneficial effects. Published by Elsevier Ltd.

  6. [Hydrofluoric acid burns].

    PubMed

    Holla, Robin; Gorter, Ramon R; Tenhagen, Mark; Vloemans, A F P M Jos; Breederveld, Roelf S

    2016-01-01

    Hydrofluoric acid is increasingly used as a rust remover and detergent. Dermal contact with hydrofluoric acid results in a chemical burn characterized by severe pain and deep tissue necrosis. It may cause electrolyte imbalances with lethal consequences. It is important to identify high-risk patients. 'High risk' is defined as a total affected body area > 3% or exposure to hydrofluoric acid in a concentration > 50%. We present the cases of three male patients (26, 31, and 39 years old) with hydrofluoric acid burns of varying severity and describe the subsequent treatments. The application of calcium gluconate 2.5% gel to the skin is the cornerstone of the treatment, reducing pain as well as improving wound healing. Nails should be thoroughly inspected and possibly removed if the nail is involved, to ensure proper healing. In high-risk patients, plasma calcium levels should be evaluated and cardiac monitoring is indicated.

  7. Heating-pad burn as a complication of abdominoplasty.

    PubMed

    Ozgenel Ege, G Y; Ozcan, M

    2003-01-01

    As the sensory nerves supplying the abdominal wall are divided during abdominoplasty, sensory changes occur in the abdominal skin after surgery, which are troublesome for some patients. These sensory changes can lead to burn injury in uninformed patients. We report the case of a patient who sustained a second-degree burn to the anterior abdominal skin following the application of a heating pad after an abdominoplasty. This burn healed with conservative treatment. Burn injuries due to sensory loss in the abdominal skin following abdominoplasty must be kept in mind, and patients must be informed about this complication.

  8. Functional Outcomes Following Burn Injury.

    PubMed

    Ryan, Colleen M; Parry, Ingrid; Richard, Reginald

    Major advances in functional recovery following burn injury over the last ten years include the development of conceptual framework for disability assessment and its application burn recovery, the description of the long-term outcomes in the burn population, and progress in basic science research leading to new treatments that improve long-term functional outcomes. Future tasks and challenges include the development of common data elements and standards for burn recovery in order to measure and optimize the path toward functional recovery. The development of patient-reported outcome measures with benchmarks for recovery over time has the potential to improve patient-provider communication and quality of patient-centered care. The study of burn recovery should include an examination of resiliency along with the study of disabilities following burn injury. Better understanding of the mechanisms, impact and modulation of hypermetabolism and inflammation following burn injury is essential to improve functional recovery. Continued basic science and clinical research must focus on scar modulation and skin replacements and address recalcitriant problems such as heterotopic ossification. Health tracking technologies should be leveraged to understand and optimize physical therapy interventions.

  9. Rehabilitation of the burn patient

    PubMed Central

    Procter, Fiona

    2010-01-01

    Rehabilitation is an essential and integral part of burn treatment. It is not something which takes place following healing of skin grafts or discharge from hospital; instead it is a process that starts from day one of admission and continues for months and sometimes years after the initial event. Burns rehabilitation is not something which is completed by one or two individuals but should be a team approach, incorporating the patient and when appropriate, their family. The term ‘Burns Rehabilitation’ incorporates the physical, psychological and social aspects of care and it is common for burn patients to experience difficulties in one or all of these areas following a burn injury. Burns can leave a patient with severely debilitating and deforming contractures, which can lead to significant disability when left untreated. The aims of burn rehabilitation are to minimise the adverse effects caused by the injury in terms of maintaining range of movement, minimising contracture development and impact of scarring, maximising functional ability, maximising psychological wellbeing, maximising social integration PMID:21321643

  10. [Present and future of cell therapy in burns].

    PubMed

    Bargues, L; Prat, M; Leclerc, T; Bey, E; Lataillade, J-J

    2011-06-01

    Severe burned patients need definitive and efficient wound coverage. Outcome of massive burns has been improved by using cultured epithelial autografts (CEA). Despite fragility, percentages of success take, cost of treatment and long-term tendency to contracture, this surgical technique has been developed in few burn centres. First improvements were to combine CEA and dermis-like substitute. Cultured skin substitutes provide earlier skin closure and satisfying functional result. These methods have been used successfully in massive burns. Second improvement was to allow skin regeneration by using epidermal stem cells. Stem cells have capacity to differentiate into keratinocytes, to promote wound repair and to regenerate skin appendages. Human mesenchymal stem cells contribute to wound healing and were evaluated in cutaneous radiation syndrome. Skin regeneration and tissue engineering methods remain a complex challenge and offer the possibility of new treatment for injured and burned patients.

  11. Perineal burn care: French working group recommendations.

    PubMed

    Bordes, Julien; Le Floch, Ronan; Bourdais, Ludovic; Gamelin, Alexandre; Lebreton, Françoise; Perro, Gérard

    2014-06-01

    Burns to the perineum are frequently exposed to faeces. Diverting colostomy is often described to prevent faecal soiling. Because this technique is invasive with frequent complications, use of non-surgical devices including specifically designed faecal management systems has been reported in perineal burns. In order to standardise the faecal management strategy in patients with perineal burns, a group of French experts was assembled. This group first evaluated the ongoing practice in France by analysing a questionnaire sent to every French burn centre. Based on the results of this study and on literature data, the experts proposed recommendations on the management of perineal burns in adults. Specifically designed faecal management systems are the first-line method to divert faeces in perineal burns. The working group proposed recommendations and an algorithm to assist in decisions in the management of perineal burns in four categories of patients, depending on total burn skin area, depth and extent of the perineal burn. In France, non-surgical devices are the leading means of faecal diversion in perineal burns. The proposed algorithm may assist in decisions in the management of perineal burns. The expert group emphasises that large clinical studies are needed to better evaluate these devices. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  12. Topical management of facial burns.

    PubMed

    Leon-Villapalos, Jorge; Jeschke, Marc G; Herndon, David N

    2008-11-01

    The face is the central point of the physical features of the human being. It transmits expressions and emotions, communicates feelings and allows for individual identity. It contains complex musculature and a pliable and unique skin envelope that reacts to the environment through a vast network of nerve endings. The face hosts vital areas that make phonation, feeding, and vision possible. Facial burns disrupt these anatomical and functional structures creating pain, deformity, swelling, and contractures that may lead to lasting physical and psychological sequelae. The management of facial burns may include operative and non-operative treatment or both, depending on the depth and extent of the burn. This paper intends to provide a review of the available options for topical management of facial burns. Topical agents will be defined as any agent applied to the surface of the skin that alters the outcome of the facial burn. Therefore, the classic concept of topical therapy will be expanded and developed within two major stages: acute and rehabilitation. Comparison of the effectiveness of the different treatments and relevant literature will be discussed.

  13. Sensitive skin: an overview.

    PubMed

    Inamadar, Arun C; Palit, Aparna

    2013-01-01

    Sensitive skin is less tolerant to frequent and prolonged use of cosmetics and toiletries. It is self-diagnosed and typically unaccompanied by any obvious physical signs of irritation. With the change in lifestyle and also with increased opportunity to use many new brands of cosmetics and toiletries, there has been an increase in females complaining of unique sensation in their facial skin. Sensitive skin presents as smarting, burning, stinging, itching, and/or tight sensation in their facial skin. The condition is found in more than 50% of women and 40% of men, creating a sizable demand for products designed to minimize skin sensitivity. Good numbers of invasive and non-invasive tests are designed to evaluate and predict the sensitive skin. Management includes guidelines for selecting suitable cosmetics and toiletries in sensitive skin individuals.

  14. Burn Wise - Outreach Materials

    EPA Pesticide Factsheets

    Burn Wise outreach material. Burn Wise is a partnership program of that emphasizes the importance of burning the right wood, the right way, in the right wood-burning appliance to protect your home, health, and the air we breathe.

  15. Burn Wise - Educational Materials

    EPA Pesticide Factsheets

    Burn Wise outreach material. Burn Wise is a partnership program of that emphasizes the importance of burning the right wood, the right way, in the right wood-burning appliance to protect your home, health, and the air we breathe.

  16. Prescribed burning

    Treesearch

    James D. Haywood; Finis Harris

    2002-01-01

    This presentation on prescribed burning is a cooperative effort of the USDA Forest Service, Southern Research Station and Kisatchie National Forest; Louisiana State University Agricultural Center; and the Joint Fire Science Program. The CD includes three methods of delivery: slides, Power Point presentation, and script only.

  17. Burning Man

    ERIC Educational Resources Information Center

    Cech, Scott J.

    2006-01-01

    Former Baltimore cop and teacher Ed Burns isn't a masochist. The writer-producer for "The Wire," a critically applauded HBO series about life and death on the streets of Baltimore, is just feverishly trying to save public schools. He thinks American education is hopelessly screwed up, but that it's also the country's only hope. So it…

  18. Burning Man

    ERIC Educational Resources Information Center

    Cech, Scott J.

    2006-01-01

    Former Baltimore cop and teacher Ed Burns isn't a masochist. The writer-producer for "The Wire," a critically applauded HBO series about life and death on the streets of Baltimore, is just feverishly trying to save public schools. He thinks American education is hopelessly screwed up, but that it's also the country's only hope. So it…

  19. Thigh burn associated with laptop computer use.

    PubMed

    Paulius, Karina; Napoles, Phyllis; Maguina, Pirko

    2008-01-01

    Laptop computers are an uncommon source of burns to the thighs and perineum. Burns can result from the prolonged contact of hot surfaces at the base of the computer with the user's lap. The authors report a case of second-degree burns to the thigh of an otherwise healthy patient that resulted from prolonged use of the laptop. We measured the temperatures of the patient's computer and the temperatures of other popular laptop computers. Laptops can develop temperatures that can pose a risk for burns if the skin is exposed for prolonged periods of time. Patients with impaired lower extremity sensation, altered consciousness, or decreased mobility are at higher risk for laptop burns. To their knowledge, this is the first case report of such a burn injury in the American literature.

  20. Prediction of clinical toxicity in locally advanced head and neck cancer patients by radio-induced apoptosis in peripheral blood lymphocytes (PBLs)

    PubMed Central

    2010-01-01

    Head and neck cancer is treated mainly by surgery and radiotherapy. Normal tissue toxicity due to x-ray exposure is a limiting factor for treatment success. Many efforts have been employed to develop predictive tests applied to clinical practice. Determination of lymphocyte radio-sensitivity by radio-induced apoptosis arises as a possible method to predict tissue toxicity due to radiotherapy. The aim of the present study was to analyze radio-induced apoptosis of peripheral blood lymphocytes in head and neck cancer patients and to explore their role in predicting radiation induced toxicity. Seventy nine consecutive patients suffering from head and neck cancer, diagnosed and treated in our institution, were included in the study. Toxicity was evaluated using the Radiation Therapy Oncology Group scale. Peripheral blood lymphocytes were isolated and irradiated at 0, 1, 2 and 8 Gy during 24 hours. Apoptosis was measured by flow cytometry using annexin V/propidium iodide. Lymphocytes were marked with CD45 APC-conjugated monoclonal antibody. Radiation-induced apoptosis increased in order to radiation dose and fitted to a semi logarithmic model defined by two constants: α and β. α, as the origin of the curve in the Y axis determining the percentage of spontaneous cell death, and β, as the slope of the curve determining the percentage of cell death induced at a determined radiation dose, were obtained. β value was statistically associated to normal tissue toxicity in terms of severe xerostomia, as higher levels of apoptosis were observed in patients with low toxicity (p = 0.035; Exp(B) 0.224, I.C.95% (0.060-0.904)). These data agree with our previous results and suggest that it is possible to estimate the radiosensitivity of peripheral blood lymphocytes from patients determining the radiation induced apoptosis with annexin V/propidium iodide staining. β values observed define an individual radiosensitivity profile that could predict late toxicity due to radiotherapy

  1. Impact of a Newly Implemented Burn Protocol on Surgically Managed Partial Thickness Burns at a Specialized Burns Center in Singapore.

    PubMed

    Tay, Khwee-Soon Vincent; Chong, Si-Jack; Tan, Bien-Keem

    2016-03-01

    This study evaluated the impact of a newly implemented protocol for superficial to mid-dermal partial thickness burns which involves early surgery and rapid coverage with biosynthetic dressing in a specialized national burns center in Singapore. Consecutive patients with 5% or greater total body surface area (TBSA) superficial to mid-dermal partial thickness burns injury admitted to the Burns Centre at the Singapore General Hospital between August and December 2014 for surgery within 48 hours of injury were prospectively recruited into the study to form the protocol group. Comparable historical cases from the year 2013 retrieved from the burns center audit database were used to form the historical control group. Demographics (age, sex), type and depth of burns, %TBSA burnt, number of operative sessions, and length of stay were recorded for each patient of both cohorts. Thirty-nine burns patients managed under the new protocol were compared with historical control (n = 39) comparable in age and extensiveness of burns. A significantly shorter length of stay (P < 0.05) per TBSA burns was observed in the new protocol group (0.74 day/%TBSA) versus historical control (1.55 day/%TBSA). Fewer operative sessions were needed under the new protocol for burns 10% or greater TBSA burns (P < 0.05). The authors report their promising experience with a newly implemented protocol for surgically managed burns patients which involves early surgery and appropriate use of biosynthetic dressing on superficial to mid-dermal partial thickness burns. Clinically, shorter lengths of stay, fewer operative sessions, and decreased need for skin grafting of burns patient were observed.

  2. Non-thermic skin affections.

    PubMed

    Broz, L; Kripner, J

    2000-01-01

    The Centre for Burns can help by its means (material, technical and personal) in the treatment of burns with extensive and deep losses of the skin cover and other tissue structures and in some affections with a different etiology (non-thermic affections). Indicated for admission are, in particular, extensive exfoliative affections--Stevens-Johnson's syndrome (SJS), Lyell's syndrome--toxic epidermal necrolysis (TEN) and staphylococcal scalded skin syndrome (SSSS), deep skin and tissue affections associated with fulminant purpura (PF), possibly other affections (epidermolysis bullosa, posttraumatic avulsions etc.). The similarity with burn injuries with loss of the skin cover grade II is typical, in particular in exfoliative affections with a need for adequate fluid replacement in the acute stage and aseptic surgical treatment of the affected area from the onset of the disease. In conditions leading to full thickness skin loss, in addition to general treatment rapid plastic surgical interventions dominate.

  3. The progression of burn depth in experimental burns: a histological and methodological study.

    PubMed

    Papp, A; Kiraly, K; Härmä, M; Lahtinen, T; Uusaro, A; Alhava, E

    2004-11-01

    This study was designed to create a reproducible model for experimental burn wound research in pigs. Previously, the thicker paraspinal skin has been used. We used the more human-like ventral skin to create burns of different depths. Contact burns were created to 11 pigs using a brass plate heated to 100 degrees C in boiling water. Different contact times were used to create burns of different depths. In pigs 1-6, the follow-up time was 72 h and in pigs 7-11 24 h. Burn depth was determined by histology. Histologically, samples were classified into five anatomical layers: epidermis, upper one-third of the dermis, middle third of the dermis, deepest third of the dermis and subcutaneous fat. The location of both thromboses and burn marks were evaluated, respectively. The 1 s contact time lead to a superficial thermal injury, 3 s to a partial thickness and 9 s to a full thickness injury. A progression of burn depth was found until 48 h post-injury. The intra-observer correlation after repeated histological analyses of burn depths by the same histopathologist and the repeatability of burn depth creation yielded kappa coefficients 0.83 and 0.92, respectively. a reproducible burn model for further research purposes was obtained.

  4. Epidemiology and Outcomes of Auricular Burn Injuries.

    PubMed

    Kraenzlin, Franca; Mushin, Oren; Ayazi, Shahin; Loree, John; Bell, Derek E

    2017-05-23

    Auricular burns represent a unique type of injury. The acute management and clinical course of these injuries can be different from other facial burns. There is a paucity of literature pertaining to the epidemiology and acute management of auricular burns. Most studies focus on deformity reconstruction. The aim of this study was to characterize the epidemiology, treatment, and outcomes of auricular burns. Data from all patients presenting to a regional burn center in a 4-year period were reviewed and those with auricular burns were identified. Demographic data, burn mechanism, insurance status, method of treatment, need for skin grafting, percentage graft-take, time to reepithelialization and incidence of deformity were reviewed. During the study period, 593 facial burns were evaluated and 132 (22%) sustained burns to the auricle. The most common mechanisms of injury were flame (65.1%) and scalding (22.5%). Auricular burns were mostly second degree (88%), involved both ears in 44%, and involved only the ventral aspect of the ear in 57%. The majority of patients healed well with conservative management; none suffered from chondritis. Of the 89 patients followed to healing, 1 patient (1.1%) received full-thickness skin grafts to the auricle, resulting in excellent graft-take. All other patients were managed nonoperatively, and none suffered from ear deformities. Auricular burns occur with surprising frequency in patients presenting to burn centers. Careful acute management of these injuries can eliminate development of chondritis and minimize the rate of deformity and need for reconstruction. The majority of wounds heal with conservative management, but time to reepithelialization can be prolonged.

  5. [Burns--risk factors and treatment].

    PubMed

    Perry, Zvi H; Palivatkel, Meirav; Yanculewitch, Noam; Koren, Lior; Rosenberg, Nir

    2009-06-01

    Burn injuries are very frequent and afflict approximately 1% of the population yearly. They are a source of heavy medical burden to medical systems worldwide. In the US alone, about 2 million burns are treated by medical staff yearly, and about 75,000 burns are serious enough to require hospitalization. In the UK, a similar situation is depicted in the statistics--burns constitute 1% of the ER workload, and 0.014% of the hospitalization. Morbidity and mortality from burns is mainly dependent upon: total body surface area (TBSA) that is involved in the burn, the depth of the burn and it's anatomical location, the age of the subject, prior medical history and the severity of adjacent injuries (especially pulmonological injury). TBSA is calculated by age-adjusted tables. There are a number of ways to determine this parameter, the simplest of all is called "the rule of 1/9". Using this technique we divide the body into distinct areas, each equal to 1/9 of the TBSA. The treatment of burn injuries is considered one of the most difficult in the medical profession and some even compare it to the treatment of ICU patients. The primary treatment in burns always involves the removal of the patient from the source of the thermal injury, securing his airway (especially in patients suspected of inhalation injury) and an aggressive fluid resuscitation. Fluid resuscitation is mainly managed using the Parkland equation. The treatment of the burned skin is by one of two regimes--the conservative regime (frequent redressing of the burn site, hygiene and antimicrobial treatment) and the surgical regime (early intervention with debridement, skin implantations etc.). Several different studies have shown a decrease in the mortality rate of severe burn patients who have undergone an early surgical regime in comparison to conservative treatment.

  6. Healing the Burn: Advances in Burn Treatment Technology Aim to Save Lives, Lessen Pain and Scarring.

    PubMed

    Allen, Summer E

    2016-01-01

    When brothers Jamie and Glen Selby, aged 5 and 7, arrived at the Shriners Burns Institute in Denver, Colorado, in July 1983, more than 97% of their skin had been destroyed by a fire they had accidentally started while playing in an abandoned house. The boys were so badly burned that their outlook was grim-a 6-year-old friend who was also in the fire died from his injuries?but Jamie and Glen were lucky. Not only did they survive, but they were also some of the first patients to benefit from a new burn treatment nicknamed test-tube skin.

  7. Burn scar carcinoma.

    PubMed

    Huang, Chun-Yuan; Feng, Chung-Ho; Hsiao, Yen-Chang; Chuang, Shiow Shuh; Yang, Jui-Yung

    2010-11-01

    Since Jean-Nicolas Marjolin reported carcinoma arising in post-traumatic scars in 1828, the term 'Marjolin ulcer' has been applied to malignant changes in burn scars. Although many papers have been published already in this field, there are few reports from Oriental people. From 1989 to 2008, there were 11 cases noted as burn scar carcinoma in Chang Gung Memorial Hospital. Ten were reported as squamous cell carcinoma (SCC) and the one was verrucous carcinoma. Most of the cases occurred in the extremities (10/11). Ten cases underwent an operation initially with wide excision and skin graft or local flap for coverage. Forefoot amputation was performed in one patient. One patient received above-knee amputation and adjuvant therapy because recurrent verrucous carcinoma occurred 2 years later. One patient suffered from a new lesion 8 years later and another case had inguinal lymph node metastasis 8 months later. Five patients were lost to follow-up and six cases were tumor-free during the follow-up period. Most scar malignancies are SCC while other cell types are rarer. The casual association between burn injuries and a later risk of basal cell carcinoma is questionable. Owing to poor prognosis in advanced scar cancer, the best treatment for scar carcinoma is to prevent the scar from developing repeated ulceration by performing aggressive initial burn wound care: early grafting by surgeons and daily scar care with regular follow-up for patients. This may be why a lower incidence has been noted in recent years.

  8. Raman Micro-spectroscopy Study of Healthy and Burned Biological Tissue

    NASA Astrophysics Data System (ADS)

    Zarnani, Faranak; Glosser, Robert; Idris, Ahamed

    2011-10-01

    Burn injuries are a significant medical problem, and need to be treated quickly and precisely. Burned skin needs to be removed early, within hours (less than 24 hrs) of injury, when the margins of the burn are still hard to define. Studies show that treating and excising burn wounds soon after the injury prevents the wound from becoming deeper, reduces the release of proinflammatory mediators, and reduces or prevents the systemic inflammatory reaction syndrome. Also, removing burned skin prepares the affected region for skin grafting. Raman micro-spectroscopy could be used as an objective diagnostic method that will assist burn surgeons in distinguishing unburned from burned areas. As a first step in developing a diagnostic tool, we present Raman micro-spectroscopy information from normal and burned ex vivo rat skin.

  9. Evaporative Water Loss in Superficial to Full Thickness Burns.

    PubMed

    Busche, Marc Nicolai; Roettger, Anne; Herold, Christian; Vogt, Peter Maria; Rennekampff, Hans-Oliver

    2016-10-01

    Increased evaporative water loss (EWL) in burn patients leads to dehydration and hypothermia. Early clinical studies performed with outdated hygrometers suggested a 17 to 75 times increased EWL in burns with contradicting results for the different burn depths.Our study proposals were: (1) obtain reliable data of the EWL of all burn depths, (2) compare these results with findings from earlier studies, (3) evaluate the usefulness of the EWL in differentiating between superficial and deep partial thickness burns, (4) determine the effect of Biobrane on the EWL of superficial partial thickness burns in vivo, and (5) evaluate the effect of the sterile incision foil Opraflex on the EWL in split skin graft donor sites. We measured the EWL of all burn depths in 28 patients under stable and recorded conditions regarding room temperature and humidity with a modern digital evaporimeter (Tewameter TM 300). For the first time in vivo, we also determined the effect of Biobrane on the EWL of burns and evaluated the EWL in split skin graft donor sites covered with Opraflex. The EWL in all burn depths was significantly increased (P < 0.001) compared with unburned skin. There was no significant difference (P > 0.05) in the EWL of superficial compared with deep partial thickness burns, whereas full thickness burns had a significantly lower EWL (P < 0.05) compared with superficial and deep partial thickness burns. Biobrane significantly reduced the EWL (P < 0.05) of superficial partial thickness burns. The EWL of Opraflex covered skin graft donor sites was significantly reduced compared with uncovered donor sites (P < 0.05). Our data suggest that the actual EWL in burns is approximately 3 times higher in full thickness burns and approximately 4 times higher in superficial and deep partial thickness burns compared with normal skin and therefore much lower than suggested previously.Because there was no significant difference in the EWL of superficial compared with deep partial thickness

  10. Burn Resuscitation

    PubMed Central

    2011-01-01

    Fluid resuscitation following burn injury must support organ perfusion with the least amount of fluid necessary and the least physiological cost. Under resuscitation may lead to organ failure and death. With adoption of weight and injury size-based formulas for resuscitation, multiple organ dysfunction and inadequate resuscitation have become uncommon. Instead, administration of fluid volumes well in excess of historic guidelines has been reported. A number of strategies including greater use of colloids and vasoactive drugs are now under investigation to optimize preservation of end organ function while avoiding complications which can include respiratory failure and compartment syndromes. Adjuncts to resuscitation, such as antioxidants, are also being investigated along with parameters beyond urine output and vital signs to identify endpoints of therapy. Here we briefly review the state-of-the-art and provide a sample of protocols now under investigation in North American burn centers. PMID:22078326

  11. Topical Antimicrobials for Burn Wound Infections

    PubMed Central

    Dai, Tianhong; Huang, Ying-Ying; Sharma, Sulbha K.; Hashmi, Javad T.; Kurup, Divya B.; Hamblin, Michael R.

    2010-01-01

    Throughout most of history, serious burns occupying a large percentage of body surface area were an almost certain death sentence because of subsequent infection. A number of factors such as disruption of the skin barrier, ready availability of bacterial nutrients in the burn milieu, destruction of the vascular supply to the burned skin, and systemic disturbances lead to immunosuppression combined together to make burns particularly susceptible to infection. In the 20th century the introduction of antibiotic and antifungal drugs, the use of topical antimicrobials that could be applied to burns, and widespread adoption of early excision and grafting all helped to dramatically increase survival. However the relentless increase in microbial resistance to antibiotics and other antimicrobials has led to a renewed search for alternative approaches to prevent and combat burn infections. This review will cover patented strategies that have been issued or filed with regard to new topical agents, preparations, and methods of combating burn infections. Animal models that are used in preclinical studies are discussed. Various silver preparations (nanocrystalline and slow release) are the mainstay of many approaches but antimicrobial peptides, topical photodynamic therapy, chitosan preparations, new iodine delivery formulations, phage therapy and natural products such as honey and essential oils have all been tested. This active area of research will continue to provide new topical antimicrobials for burns that will battle against growing multi-drug resistance. PMID:20429870

  12. Topical antimicrobials for burn wound infections.

    PubMed

    Dai, T; Huang, Y Y; Sharma, S K; Hashmi, J T; Kurup, D B; Hamblin, M R

    2010-06-01

    Throughout most of history, serious burns occupying a large percentage of body surface area were an almost certain death sentence because of subsequent infection. A number of factors such as disruption of the skin barrier, ready availability of bacterial nutrients in the burn milieu, destruction of the vascular supply to the burned skin, and systemic disturbances lead to immunosuppression combined together to make burns particularly susceptible to infection. In the 20th century the introduction of antibiotic and antifungal drugs, the use of topical antimicrobials that could be applied to burns, and widespread adoption of early excision and grafting all helped to dramatically increase survival. However the relentless increase in microbial resistance to antibiotics and other antimicrobials has led to a renewed search for alternative approaches to prevent and combat burn infections. This review will cover patented strategies that have been issued or filed with regard to new topical agents, preparations, and methods of combating burn infections. Animal models that are used in preclinical studies are discussed. Various silver preparations (nanocrystalline and slow release) are the mainstay of many approaches but antimicrobial peptides, topical photodynamic therapy, chitosan preparations, new iodine delivery formulations, phage therapy and natural products such as honey and essential oils have all been tested. This active area of research will continue to provide new topical antimicrobials for burns that will battle against growing multidrug resistance.

  13. Microvascular transfer of burned tissue for mandibular reconstruction.

    PubMed

    Antonetti, John; Killyon, Garry W; Chang, Peter; McCauley, Robert L

    2009-01-01

    We present a case of mandibular reconstruction using a free-vascularized fibula osteocutaneous flap after invasive infection of the mandible with mucormycosis. Unique to this case is the skin paddle that previously sustained full-thickness burn injury treated with cultured skin substitute (CSS). A 10-year-old boy sustained a 96% total body surface area burn. CSS was used to obtain wound closure. However, he developed invasive mucormycosis of the mandible requiring resection. The best option for mandibular reconstruction was the use of a free-vascularized fibular osteocutaneous flap with CSS as a skin paddle. The reconstruction was performed without complications. To our knowledge this is the first case describing the use of CSS in free tissue transfer. With the improved prognosis in massively burned patients and the increased use of cultured skin for wound coverage, complex reconstruction using previously burned tissue will be required. Previously burned skin including tissue grafted with skin substitutes attains vascularity and healing properties that allow flap elevation for burn reconstruction. Successful utilization of previously burned skin relies on the ability to provide adequate blood supply to the flap by preservation or regeneration of its angiosome.

  14. Biothermomechanics of skin tissues

    NASA Astrophysics Data System (ADS)

    Xu, F.; Lu, T. J.; Seffen, K. A.

    Biothermomechanics of skin is highly interdisciplinary involving bioheat transfer, burn damage, biomechanics and neurophysiology. During heating, thermally induced mechanical stress arises due to the thermal denaturation of collagen, resulting in macroscale shrinkage. Thus, the strain, stress, temperature and thermal pain/damage are highly correlated; in other words, the problem is fully coupled. The aim of this study is to develop a computational approach to examine the heat transfer process and the heat-induced mechanical response, so that the differences among the clinically applied heating modalities can be quantified. Exact solutions for temperature, thermal damage and thermal stress for a single-layer skin model were first derived for different boundary conditions. For multilayer models, numerical simulations using the finite difference method (FDM) and finite element method (FEM) were used to analyze the temperature, burn damage and thermal stress distributions in the skin tissue. The results showed that the thermomechanical behavior of skin tissue is very complex: blood perfusion has little effect on thermal damage but large influence on skin temperature distribution, which, in turn, influences significantly the resulting thermal stress field; the stratum corneum layer, although very thin, has a large effect on the thermomechanical behavior of skin, suggesting that it should be properly accounted for in the modeling of skin thermal stresses; the stress caused by non-uniform temperature distribution in the skin may also contribute to the thermal pain sensation.

  15. Myths on Chemical Burns in the Diaper Area.

    PubMed

    Shah, Kara

    2017-05-01

    Over the past several years, a number of articles and online posts have circulated on the Internet associating use of disposable and cloth diapers with chemical burns on babies' skin. Because both mild chemical burns and diaper dermatitis (diaper rash) can cause skin redness and peeling, it is not surprising that some confusion has arisen regarding the association between these two conditions. However, diapers cannot cause chemical burns because they are made of inert materials. Diaper rash and chemical burns are distinct conditions that require different evaluation and treatment, which is why it is important for pediatricians to help parents understand the difference.

  16. Tweens feel the burn: "salt and ice challenge" burns.

    PubMed

    Roussel, Lauren O; Bell, Derek E

    2016-05-01

    To review our institution's experience with frostbite injury secondary to "salt and ice challenge" (SIC) participation. We conducted a retrospective analysis of intentional freezing burns from 2012 to 2014. Demographics, depth and location of burn, total body surface area of burn, treatment, time to wound healing, length of stay, complications, and motives behind participation were analyzed. Five patients were seen in the emergency department for intentional freezing burns that resulted from SIC (all females; mean age: 12.3 years; range age: 10.0-13.2 years). Mean total body surface area was 0.408%. Salt and ice was in contact with skin for >10 min for two patients, >20 min for two patients, and an unknown duration for one patient. Complications included pain and burn scar dyschromia. Four patients cited peer pressure and desire to replicate SIC as seen on the Internet as their motivation in attempting the challenge. SIC has become a popular, self-harming behavior among youths. Increased public education, and provider and parent awareness of SIC are essential to address this public health concern.

  17. Management of acid burns: experience from Bangladesh.

    PubMed

    Das, Kishore Kumar; Olga, Loren; Peck, Michael; Morselli, Paolo G; Salek, A J M

    2015-05-01

    Acid burn injuries in Bangladesh primarily occur as a result of intentional attacks although there are incidences of accidental acid burns in industry, on the street, and at home. A total of 126 patients with acid burns, 95 from attacks and 31 from accidents, were studied from July 2004 to December 2012. A diagnosis of acid burn was made from history, physical examination and in some cases from chemical analysis of the patients' clothing. Alkali burns were excluded from the study. In the burn unit of Dhaka Medical College Hospital, we applied a slightly different protocol for management of acid burns, beginning with plain water irrigation of the wound, which effectively reduced burn depth and the requirement of surgical treatment. Application of hydrocolloid dressing for 48-72 h helped with the assessment of depth and the course of treatment. Early excision and grafting gives good results but resultant acid trickling creates a marble cake-like appearance of the wound separated by the vital skin. Excision with a scalpel and direct stitching of the wounds are often a good option. Observation of patients on follow-up revealed that wounds showed a tendency for hypertrophy. Application of pressure garments and other scar treatments were given in all cases unless the burn was highly superficial.

  18. Aesthetic septorhinoplasty in the burned nose.

    PubMed

    Hafezi, Farhad; Karimi, Hamid; Nouhi, Amirhosein

    2005-03-01

    Patients who have survived thermal injuries to the face suffer severe disfigurement from the devastating deformities of full-thickness facial burns. The nose is the prominent central organ of the face, which has crucial effect on Aesthetic appearance. The plastic surgeon's role to deal with such cases is to undertake procedures to produce a more pleasant look although the target organ could be the non-burned areas of the face. It is a common belief that surgical intervention under the scarred or grafted nose is risky and may result in skin or covering graft necrosis. For this reason, plastic surgeons are cautious and hesitate to perform Aesthetic surgery on burn scarred tissue. We present 13 cases, 10 women and three men with complete or subtotal nasal burn. Classic Aesthetic Rhinoplasty operations were performed to create a better appearance and correct any internal or external deviations. These procedures are carried out under severely burned skins, or previously grafted and reconstructed noses. Cases were followed for about a one-year period. There was no necrosis in any part of skin after surgery. We believe that Aesthetic rhinoplasty can be done safely in these victims with pleasing outcome. The problems that we encountered in these cases were irregularities of burned alar margins, multiple operations and intractable nasal deviation in severe cases.

  19. Digital imaging in remote diagnosis of burns.

    PubMed

    Roa, L; Gómez-Cía, T; Acha, B; Serrano, C

    1999-11-01

    Images are capable of giving an accurate representation of skin color and have been used extensively in teaching about and researching burn therapy. The advance from analogue to digital imaging allows the remote transmission of the clinical information contained in the digital image of a burn, using a suitable system. The large size of these image files reduces transmission speed and makes data compression desirable. Compression, by means of the JPEG algorithm, of up to 50 times the original size of 38 digital images of burns suffered by 22 consecutive patients did not lessen its great usefulness in determining the depth of burn injuries, according to a group of experts in burn care. The success rate was close to 90%, both for non-compressed images in original BMP format (mean size:1500 Kb) and for compressed images with a Q index of 50 (30 Kb files), when compared with the clinical diagnoses confirmed one week after the accident.

  20. Long hair, smoking, and deep facial burns.

    PubMed

    Koljonen, Virve

    2008-01-01

    The purpose of this article is to describe deep facial burn injuries by cigarette lighters in longhaired adults and to report our experience in their treatment. Eight consecutive cigarette lighter burn victims are treated in the Helsinki Burn Center in the year 2006. Seven of the patients were women; their mean age was 50 years. All were under the influence of alcohol at the time of injury. The mean burnt area was 3.5% TBSA. The burnt areas were primarily forehead, cheek, and ipsilateral ear. After a conservative treatment, all the patients underwent an operation, whereby the nonhealing burns were excised and covered with autologous split thickness skin grafts. Postoperative period was uneventful in all the patients. Besides having severe detrimental effects on general health status and wound healing, smoking is the leading cause of residential and total fire deaths worldwide. The patients in this article suffered deep facial burns because of cigarette lighters.

  1. Marjolin's ulcer and chronic burn scarring.

    PubMed

    Akgüner, M; Barutçu, A; Yilmaz, M; Karataş, O; Vayvada, H

    1998-03-01

    Marjolin's ulcer is a term used to describe squamous cell carcinomas which develop in chronic wounds. These carcinomas may also develop at the site of long-standing irritation, such as unstable burn scars. Development times for burn scar carcinomas of more than 30 years have been noted. This evaluation describes the treatment of 10 patients with burn scar carcinomas who have been treated using wide excision and closure of the defect with skin grafts or flaps, plus regional lymph node dissection if required. Results indicate a mean carcinoma development time of 26 years. Local recurrence occurred in only one patient.

  2. Burn injury caused by laptop computers.

    PubMed

    Sharma, G

    2013-11-01

    Laptop burn is a real condition and medical reports indicate that using a laptop across the legs can indeed cause it. in very rare cases, the condition can cause damage leading to skin cancer. A 24-year-old man presented with an asymptomatic reddish brown pigmentation on the thighs. After an extensive work-up, burning caused by use of a laptop was observed. Burning was induced in 3 days by using laptop for 4 h daily. Laptop should be used in properly ventilated and air-conditioned rooms. The most effective way of preventing erythema is to use the laptop on the table or desk.

  3. Burn Injury Caused by Laptop Computers

    PubMed Central

    Sharma, G

    2013-01-01

    Laptop burn is a real condition and medical reports indicate that using a laptop across the legs can indeed cause it. in very rare cases, the condition can cause damage leading to skin cancer. A 24-year-old man presented with an asymptomatic reddish brown pigmentation on the thighs. After an extensive work-up, burning caused by use of a laptop was observed. Burning was induced in 3 days by using laptop for 4 h daily. Laptop should be used in properly ventilated and air-conditioned rooms. The most effective way of preventing erythema is to use the laptop on the table or desk. PMID:24349844

  4. Burning plasmas

    SciTech Connect

    Furth, H.P.; Goldston, R.J.; Zweben, S.J. . Plasma Physics Lab.); Sigmar, D.J. )

    1990-10-01

    The fraction of fusion-reaction energy that is released in energetic charged ions, such as the alpha particles of the D-T reaction, can be thermalized within the reacting plasma and used to maintain its temperature. This mechanism facilitates the achievement of very high energy-multiplication factors Q, but also raises a number of new issues of confinement physics. To ensure satisfactory reaction operation, three areas of energetic-ion interaction need to be addressed: single-ion transport in imperfectly symmetric magnetic fields or turbulent background plasmas; energetic-ion-driven (or stabilized) collective phenomena; and fusion-heat-driven collective phenomena. The first of these topics is already being explored in a number of tokamak experiments, and the second will begin to be addressed in the D-T-burning phase of TFTR and JET. Exploration of the third topic calls for high-Q operation, which is a goal of proposed next-generation plasma-burning projects. Planning for future experiments must take into consideration the full range of plasma-physics and engineering R D areas that need to be addressed on the way to a fusion power demonstration.

  5. Electrothermal ring burn from a car battery.

    PubMed

    Sibley, Paul A; Godwin, Kenneth A

    2013-08-01

    Despite prevention efforts, burn injuries among auto mechanics are described in the literature. Electrothermal ring burns from car batteries occur by short-circuiting through the ring when it touches the open terminal or metal housing. This article describes a 34-year-old male auto mechanic who was holding a wrench when his gold ring touched the positive terminal of a 12-volt car battery and the wrench touched both his ring and the negative terminal. He felt instant pain and had a deep partial-thickness circumferential burn at the base of his ring finger. No other soft tissues were injured. He was initially managed conservatively, but after minimal healing at 3 weeks, he underwent a full-thickness skin graft. The graft incorporated well and healed by 4 weeks postoperatively. He had full range of motion. The cause of ring burns has been controversial, but based on reports similar to the current patient's mechanism, they are most likely electrothermal burns. Gold, a metal with high thermal conductivity, can heat up to its melting point in a matter of seconds. Many treatments have been described, including local wound care to split- and full-thickness skin grafts. Because most burns are preventable, staff should be warned and trained about the potential risks of contact burns. All jewelry should be removed, and the live battery terminal should be covered while working in the vicinity of the battery. Copyright 2013, SLACK Incorporated.

  6. A model for assessing ignition, flame spread, and burn hazard potential of a multilayered jacket.

    PubMed

    Ezekoye, Ofodike A; Diller, Kenneth R

    2006-01-01

    An analysis is presented of ignition, flame spread, and skin burn associated with the ignition and burning of a multilayered jacket. The important physical processes can all be detailed based on simple thermophysical modeling. The ignition process associated with proximity to a radiant heat source is analyzed to see how a change in external (outer) fabric could have diminished the likelihood of ignition. Once the composite jacket has been ignited, the flame spread process is responsible for the heat transfer to the skin that causes the burn. We analyze the effects of the jacket innermost material on flame spread and on possible burn damage. We show how available thermophysical property data can be used to estimate the effect of inner layer material on burn event duration. Finally, given best-available data on the heat transfer rates between a burning inner layer and skin, we examine the kinetics of skin burn damage to determine the most likely injury that would result.

  7. Ram Burn Observations (RAMBO)

    NASA Technical Reports Server (NTRS)

    2002-01-01

    Ram Burn Observations (RAMBO) is a Department of Defense experiment that observes shuttle Orbital Maneuvering System engine burns for the purpose of improving plume models. On STS-107 the appropriate sensors will observe selected rendezvous and orbit adjust burns.

  8. Is It Time to Tailor the Prediction of Radio-Induced Toxicity in Prostate Cancer Patients? Building the First Set of Nomograms for Late Rectal Syndrome

    SciTech Connect

    Valdagni, Riccardo; Kattan, Michael W.; Rancati, Tiziana; Yu Changhong; Vavassori, Vittorio; Fellin, Giovanni; Cagna, Elena; Gabriele, Pietro; Mauro, Flora Anna; Baccolini, Micaela; Bianchi, Carla; Menegotti, Loris; Monti, Angelo F.; Stasi, Michele; Giganti, Maria Olga; and others

    2012-04-01

    Purpose: Development of user-friendly tools for the prediction of single-patient probability of late rectal toxicity after conformal radiotherapy for prostate cancer. Methods and Materials: This multicenter protocol was characterized by the prospective evaluation of rectal toxicity through self-assessed questionnaires (minimum follow-up, 36 months) by 718 adult men in the AIROPROS 0102 trial. Doses were between 70 and 80 Gy. Nomograms were created based on multivariable logistic regression analysis. Three endpoints were considered: G2 to G3 late rectal bleeding (52/718 events), G3 late rectal bleeding (24/718 events), and G2 to G3 late fecal incontinence (LINC, 19/718 events). Results: Inputs for the nomogram for G2 to G3 late rectal bleeding estimation were as follows: presence of abdominal surgery before RT, percentage volume of rectum receiving >75 Gy (V75Gy), and nomogram-based estimation of the probability of G2 to G3 acute gastrointestinal toxicity (continuous variable, which was estimated using a previously published nomogram). G3 late rectal bleeding estimation was based on abdominal surgery before RT, V75Gy, and NOMACU. Prediction of G2 to G3 late fecal incontinence was based on abdominal surgery before RT, presence of hemorrhoids, use of antihypertensive medications (protective factor), and percentage volume of rectum receiving >40 Gy. Conclusions: We developed and internally validated the first set of nomograms available in the literature for the prediction of radio-induced toxicity in prostate cancer patients. Calculations included dosimetric as well as clinical variables to help radiation oncologists predict late rectal morbidity, thus introducing the possibility of RT plan corrections to better tailor treatment to the patient's characteristics, to avoid unnecessary worsening of quality of life, and to provide support to the patient in selecting the best therapeutic approach.

  9. [Expression of the radio-inducible TK suicide gene controlled by Egr-1 promoter in pancreatic cancer cells: an in vitro experiment].

    PubMed

    Liu, Jin-long; Liu, Xun-liang; Qian, Qing; Du, Qing; Guo, Shi-ying; Li, Chao-jun; Miao, Yi

    2008-07-22

    To investigate the expression of radio-inducible herpes simplex virus thymidine kinase (TK) suicide gene controlled by early growth response-1 (Egr-1) promoter in pancreatic cancer cells. Adenoviral vector pAdEgr-1-TK containing green fluorescent protein (GFP) was constructed. Human pancreatic cancer cells of the line PC-3 were cultured, transfected with pAdEgr-1-TK, and then exposed to 60Co source gamma-radiation at the doses of 0, 5, 7.5, 10, 15, and 20 Gy respectively for 24 hours. RT-PCR and Western blotting were used to detect the TK mRNA and protein expression in the PC3 cells. The TK mRNA expression levels of the PC3 cells exposed to y-radiation at the doses of 0, 5, 7.5, 10, 15, and 20 Gy respectively were (67.3 +/- 2.1)%, (89.3 +/- 1.0)%, (114.7 +/- 5.7)%, (140.5 +/- 3.1)%, (134.5 +/- 4.0)%, and (117.4 +/- 3.4)% respectively. The TK mRNA expression level was markedly increased after exposure to gamma-radiation, especially that t the dose of 10 Gy (all P < 0.01). The TK protein expression levels of the PC3 cells exposed to y-radiation at the doses of 0, 5, 7.5, 10, 15, and 20 Gy were (5.4 +/- 0.7)%, (7.6 +/- 0.9)%, (21.5 +/- 1.5)%, (35.7 +/- l1.4)%, (32.1 +/- 1.2)%, and (28.8 +/- 1.5)% respectively. The Egr-1 promoter causes high expression of TK suicide gene in cancer cells after exposure to 60Co-gamma-radiation. These data provide an experimental basis for gene therapy.

  10. Head and Neck Burns: Acute and Late Reconstruction.Data of Burn Injury Management in 2007

    PubMed Central

    Belba, G.; Gedeshi, I.; Isaraj, S.; Filaj, V.; Kola, N.; Belba, M.

    2008-01-01

    Summary Modern burn care is based on operative wound management. The evidence is clear that prompt excision and closure can be lifesaving for patients even with large burns. Facial burns that are full-thickness need grafting. Deep dermal facial burns need surgery in the third week post-burn. Deep burns to the eyelids should be excised and grafted early in order to prevent cicatricial ectropion and corneal exposure. Following healing from burns, the reconstruction of severe deformities and scars of the face, head, and neck confronts the surgeon with some of the most challenging problems in reconstructive surgery. Our purpose is to provide some retrospective data on acute and late reconstruction of head and neck burns in 2007. Eighty-one patients are considered who were operated on in the Burns and Plastic Surgery Service of the University Hospital Centre in Tirana, Albania, suffering from burns and also from burn deformities in the head and neck regions. A description is given of the different types of operative techniques used for head and neck reconstruction as also of developmental aspects of burned face deformities (physical and psychological) and of their correction. In all, 246 patients with burns and burn deformities were subjected to surgery in 2007. Of these we have extracted 81 cases in which the pathology concerned the head and the neck, including 13 cases of full-thickness facial burns needing excising and grafting. The other 68 cases were burn deformities. This last group of patients included 19 with facial deformities, 14 with perioral deformities, 12 with burn alopecia, ten with upper and lower eyelid deformities, nine with ear deformities, and four with cervical deformities. The operative techniques used were skin grafts (split-thickness or full-thickness), composite grafts, pedicle flaps, and tissue replacement. In burn alopecia cases, we used tissue expansion for the correction. Head and neck burns constitute some of the most challenging problems

  11. Anterior shoulder dislocation as a complication of surgery for burns.

    PubMed

    Hinton, A E; King, D

    1989-08-01

    An example of anterior dislocation of the shoulder resulting from the positioning of a patient for skin grafting of burns is presented. Complications of positioning patients prone and with their arms abducted and practical measures for their avoidance are discussed.

  12. Burning Mouth Syndrome and "Burning Mouth Syndrome".

    PubMed

    Rifkind, Jacob Bernard

    2016-03-01

    Burning mouth syndrome is distressing to both the patient and practitioner unable to determine the cause of the patient's symptoms. Burning mouth syndrome is a diagnosis of exclusion, which is used only after nutritional deficiencies, mucosal disease, fungal infections, hormonal disturbances and contact stomatitis have been ruled out. This article will explore the many causes and treatment of patients who present with a chief complaint of "my mouth burns," including symptomatic treatment for those with burning mouth syndrome.

  13. Early dermabrasion of deep dermal burns with sandpaper. Case reports.

    PubMed

    Floccard, B; Tixier, F; Chatot-Henry, D; Lacotte, B; Mehdaoui, H; Drault, J N

    1998-12-01

    Deep dermal burns are initially difficult to evaluate, and they sometimes heal spontaneously. We present our experience of dermabrasion with sandpaper in four patients. It is a useful alternative to early excision of the scar. Skin grafts are not always required and the aesthetic results are excellent. Dermabrasion should be considered routinely for all deep dermal burns and particularly for facial burns and those caused by scalds.

  14. Pathophysiologic Response to Burns in the Elderly.

    PubMed

    Jeschke, Marc G; Patsouris, David; Stanojcic, Mile; Abdullahi, Abdikarim; Rehou, Sarah; Pinto, Ruxandra; Chen, Peter; Burnett, Marjorie; Amini-Nik, Saeid

    2015-10-01

    Over the last decades advancements have improved survival and outcomes of severely burned patients except one population, elderly. The Lethal Dose 50 (LD50) burn size in elderly has remained the same over the past three decades, and so has morbidity and mortality, despite the increased demand for elderly burn care. The objective of this study is to gain insights on why elderly burn patients have had such a poor outcome when compared to adult burn patients. The significance of this project is that to this date, burn care providers recognize the extreme poor outcome of elderly, but the reason remains unclear. In this prospective translational trial, we have determined clinical, metabolic, inflammatory, immune, and skin healing aspects. We found that elderly have a profound increased mortality, more premorbid conditions, and stay at the hospital for longer, p < 0.05. Interestingly, we could not find a higher incidence of infection or sepsis in elderly, p > 0.05, but a significant increased incidence of multi organ failure, p < 0.05. These clinical outcomes were associated with a delayed hypermetabolic response, increased hyperglycemic and hyperlipidemic responses, inversed inflammatory response, immune-compromisation and substantial delay in wound healing predominantly due to alteration in characteristics of progenitor cells, p < 0.05. In summary, elderly have substantially different responses to burns when compared to adults associated with increased morbidity and mortality. This study indicates that these responses are complex and not linear, requiring a multi-modal approach to improve the outcome of severely burned elderly.

  15. Steam vaporizers: A danger for paediatric burns.

    PubMed

    Lonie, Sarah; Baker, Paul; Teixeira, Rodrigo

    2016-12-01

    Steam vaporizers are used to humidify air in dry environments. They are marketed to moisten children's airway secretions and thus to help relieve symptoms associated with upper respiratory tract infections. Unfortunately the steam emitted from the unit can also pose a significant risk of burns to children. Our study aimed to ascertain patterns of injury and treatment outcomes from steam burns resulting from these devices. Potential preventative measures are discussed. Children who had sustained vaporizer scald burns were identified at the outpatient burns clinic over a 10-month period (November 2014-August 2015). Medical records were reviewed retrospectively and data collected on pattern of injury, management and outcomes. Ten children were treated for vaporizer steam burns over the study period. The mean age was 1.6 years and 8 (80%) patients were male. Operative intervention was undergone in 5 (50%) cases; four acutely and one as a secondary reconstructive procedure. Hand burns accounted for 8 (80%) of cases. Steam vaporizers can cause significant burns in the paediatric population. Toddlers were most at risk, frequently sustaining hand burns that underwent skin grafting. Greater public awareness of the danger is indicated and measures to prevent such injuries should be addressed by appropriate authorities. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  16. Increased expression of three types of transient receptor potential channels (TRPA1, TRPV4 and TRPV3) in burn scars with post-burn pruritus.

    PubMed

    Yang, Yoon Seok; Cho, Soo Ick; Choi, Min Gyu; Choi, Young Hee; Kwak, In Suk; Park, Chun Wook; Kim, Hye One

    2015-01-01

    Post-burn pruritus is a common distressing consequence of burn wounds. Empirical treatment often fails to have a satisfactory outcome on post-burn pruritus, as the mechanism of post-burn pruritus has not been fully elucidated. The aim of this study was to evaluate the manifestation of transient receptor potential (TRP) channels in post-burn pruritus. Fifty-one burn patients with (n=33) or without (n=18) pruritus were investigated, including skin biopsies. Not unexpectedly, the scarred body area was larger in the former group. In immunohistochemistry, TPRV3 was significantly elevated in the epidermis of burn scars with pruritus. Furthermore, real time- PCR showed that mRNA of TRPA1 and TRPV4 was increased in itching burn scars. Staining for substance P and CGRP did not differ between the 2 grouped, but the former neuropeptide was increased in burn scars. These results may help determine a specific therapeutic approach for post-burn pruritus.

  17. [Tap-water scald burns].

    PubMed

    Belmonte Torras, J A; Marín de la Cruz, D; Gornés Benajam, María B; Gubern Pi, L; Guinot Madridejos, A

    2004-11-01

    To describe the characteristics of patients with tap-water scalds admitted to our hospital and review current knowledge on their prevention. We performed a retrospective study of admissions for tap-water scalds. The medical records codified as water-tap scalds (MBDS; CIE-9-CM, 940.0-949.5, E.924.0, E.924.2) of patients admitted to our hospital for more than 24 hours from January 1 to December 31, 2003 were reviewed. The following variables were studied: age, sex, mechanism, extent and degree of burn, localization, length of hospital stay, treatment, requirement for skin grafting, mortality, and sequelae. Twenty-nine patients were treated in our hospital. Sixty-two percent were boys. Age ranged from 3 days to 9 years. Six patients (20.6 %) were aged less than 1 year, 19 (63 %) were aged between 1 and 3 years and four (13.8 %) were aged from 3 to 9 years. Body surface area was 10 % or less in 25 patients and more than 20 % in four. Five patients required skin autografting. In two patients, the scald was produced in the neonatal area of our hospital. The mean length of hospital stay was 12 days, ranging from 1 to 38 days. None of the patients died. One patient suffered severe sequelae. Because of the frequency and severity of the burns reported in this study, pediatricians should increase their efforts in educating families about this type of burn. In addition, effective legislation should be implemented in Spain.

  18. Epilepsy and full-thickness burns.

    PubMed

    Botan, A

    2010-06-30

    This paper presents various aspects of severe burns involving epileptic patients, who may suffer dramatic accidents during seizure attacks. Epileptics may fall onto an open fire or hot surface (e.g. a kitchen range) and they may upset containers full of boiling liquids, suffering deep burns and scalds. In our experience in this field, the most commonly affected body areas are the face and hands, the trunk, and the lower limbs. All such injuries are full-thickness burns, owing to the very long contact of the skin surface with the lesional agent. Three cases are presented of epileptics with severe burns who were admitted to the Burn Unit of Targu Mures Teaching Hospital, Romania, where they were hospitalized; conservative debridement using polyurethanefoam (PUR-foam) dressings was the standard procedure, which all the patients received. Split-thickness skin grafting was the final method for closing the granulating bed resulting from the conservative debridement. We have found that conservative debridement using PUR-foam dressings is a cheaper and more reliable alternative than sharp debridement (which may remove healthy tissue at the same time as burn eschars).

  19. Burning mouth syndrome.

    PubMed

    Crow, Heidi C; Gonzalez, Yoly

    2013-02-01

    Pain in the tongue or oral tissues described as "burning" has been referred to by many terms including burning mouth syndrome. When a burning sensation in the mouth is caused by local or systemic factors, it is called secondary burning mouth syndrome and when these factors are treated the pain will resolve. When burning mouth syndrome occurs in the absence of identified risk indicators, the term primary burning mouth syndrome is utilized. This article focuses on descriptions, etiologic theories, and management of primary burning mouth syndrome, a condition for which underlying causative agents have been ruled out.

  20. Dual-imaging system for burn depth diagnosis.

    PubMed

    Ganapathy, Priya; Tamminedi, Tejaswi; Qin, Yi; Nanney, Lillian; Cardwell, Nancy; Pollins, Alonda; Sexton, Kevin; Yadegar, Jacob

    2014-02-01

    Currently, determination of burn depth and healing outcomes has been limited to subjective assessment or a single modality, e.g., laser Doppler imaging. Such measures have proven less than ideal. Recent developments in other non-contact technologies such as optical coherence tomography (OCT) and pulse speckle imaging (PSI) offer the promise that an intelligent fusion of information across these modalities can improve visualization of burn regions thereby increasing the sensitivity of the diagnosis. In this work, we combined OCT and PSI images to classify the degree of burn (superficial, partial-thickness and full-thickness burns). Algorithms were developed to integrate and visualize skin structure (with and without burns) from the two modalities. We have completed the proposed initiatives by employing a porcine burn model and compiled results that attest to the utility of our proposed dual-modal fusion approach. Computer-derived data indicating the varying burn depths were validated through immunohistochemical analysis performed on burned skin tissue. The combined performance of OCT and PSI modalities provided an overall ROC-AUC=0.87 (significant at p<0.001) in classifying different burn types measured after 1-h of creating the burn wounds. Porcine model studies to assess feasibility of this dual-imaging system for wound tracking are underway.

  1. Initial evaluation and management of the critical burn patient.

    PubMed

    Vivó, C; Galeiras, R; del Caz, Ma D P

    2016-01-01

    The major improvement in burn therapy is likely to focus on the early management of hemodynamic and respiratory failures in combination with an aggressive and early surgical excision and skin grafting for full-thickness burns. Immediate burn care by first care providers is important and can vastly alter outcomes, and it can significantly limit burn progression and depth. The goal of prehospital care should be to cease the burning process as well as prevent future complications and secondary injuries for burn shock. Identifying burn patients appropriate for immediate or subacute transfer is an important step in reducing morbidity and mortality. Delays in transport to Burn Unit should be minimized. The emergency management follows the principles of the Advanced Trauma Life Support Guidelines for assessment and stabilization of airway, breathing, circulation, disability, exposure and environment control. All patients with suspected inhalation injury must be removed from the enclosure as soon as possible, and immediately administer high-flow oxygen. Any patient with stridor, shortness of breath, facial burns, singed nasal hairs, cough, soot in the oral cavity, and history of being in a fire in an enclosed space should be strongly considered for early intubation. Fibroscopy may also be useful if airway damage is suspected and to assess known lung damage. Secondary evaluation following admission to the Burn Unit of a burned patient suffering a severe thermal injury includes continuation of respiratory support and management and treatment of inhalation injury, fluid resuscitation and cardiovascular stabilization, pain control and management of burn wound.

  2. A pilot evaluation study of high resolution digital thermal imaging in the assessment of burn depth.

    PubMed

    Hardwicke, Joseph; Thomson, Richard; Bamford, Amy; Moiemen, Naiem

    2013-02-01

    Thermal imaging is a tool that can be used to determine burn depth. We have revisited the use of this technology in the assessment of burns and aim to establish if high resolution, real-time technology can be practically used in conjunction with clinical examination to determine burn depth. 11 patients with burns affecting upper and lower limbs and the anterior and posterior trunk were included in this study. Digital and thermal images were recorded at between 42 h and 5 days post burn. When compared to skin temperature, full thickness burns were significantly cooler (p<0.001), as were deep partial thickness burns (p<0.05). Superficial partial thickness burns were not significantly different in temperature than non-burnt skin (p>0.05). Typically, full thickness burns were 2.3°C cooler than non-burnt skin; deep partial thickness burns were 1.2°C cooler than non-burnt skin; whilst superficial burns were only 0.1°C cooler. Thermal imaging can correctly determine difference in burn depth. The thermal camera produces images of high resolution and is quick and easy to use. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

  3. Circumferential burns to the fingers associated with gold and platinum rings.

    PubMed

    Regan, M W; Moss, A L

    1986-06-01

    Two patients sustained circumferential burns to the fingers associated with metal rings. The first case was caused by molten zinc and was treated by early burn excision and split skin grafting, while the second case was an electrical burn caused by a car battery and was treated conservatively.

  4. [Hand burns in children and Aquacel(®) Burn gloves, an alternative to prolonged hospital stays].

    PubMed

    Ridel, P; Perrot, P; Truffandier, M V; Bellier-Waast, F; Duteille, F

    2015-04-01

    Occlusive dressings for second-degree hand burns in children must prevent infection and promote healing. For good management of analgesia, these treatments often require children to be hospitalized. Our goal was to find an alternative to conventional care protocol that would reduce the number of dressings and therefore the length of hospitalization. We report our experience with the use of Aquacel(®) Burn. Non-randomized monocentric prospective study was conducted from 2012 to 2014. The glove was used in the operating room within 72hours after the burn in children younger than 15 years old with isolated superficial to deep 2nd degree hand burns. Once the glove was perfectly stuck to the burn, the children could go back home. We saw them 10 to 12 days after the accident to be sure there was no indication of skin graft. Twenty gloves were used in 16 children aged from 16 months to 13 years. The average length of stay (ALOS) was five days to put the glove on and one day to remove it. Four hands were grafted. Once we get used to the product, Aquacel(®) Burn gloves have reduced the ALOS before skin graft in cases of isolated hand burns in children. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  5. [Forum on tissue expansion. Repair of sequelae of facial burns by cervical cutaneous expansion].

    PubMed

    Foyatier, J L; Comparin, J P; Latarjet, J; Delay, E; Spitalier, P; Masson, C L

    1993-02-01

    Burn scars of the lower part of the face are a difficult problem in plastic surgery. Full thickness skin graft or local flaps usually give poor cosmetic result. Over the last 5 years, we used 24 skin expanders in the neck area to cover burn scars of the chin and jaw. Discussion of the method and 4 cases are reported.

  6. Topical treatment for facial burns.

    PubMed

    Hoogewerf, Cornelis J; Van Baar, Margriet E; Hop, M Jenda; Nieuwenhuis, Marianne K; Oen, Irma M M H; Middelkoop, Esther

    2013-01-31

    Burn injuries are an important health problem. They occur frequently in the head and neck region - the area central to a person's identity, that provides our most expressive means of communication. Topical interventions are currently the cornerstone of treatment of partial-thickness burns to the face. To assess the effects of topical interventions on wound healing in people with facial burns of any depth. We searched the Cochrane Wounds Group Specialised Register (searched 12 November 2012); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 10); Ovid MEDLINE (1950 to November Week 1 2012); Ovid MEDLINE - In-process & Other Non-Indexed Citations (searched November 12, 2012); Ovid EMBASE (1980 to 2012 Week 45); and EBSCO CINAHL (1982 to 9 November 2012) for relevant trials. We did not apply date or language restrictions. Randomised controlled trials (RCTs) that evaluated the effects of topical treatment for facial burns were eligible for inclusion in this review. Two review authors independently assessed and included the references identified by the search strategy. Included trials were assessed using a risk of bias form, and data were extracted using a standardised data extraction sheet. For dichotomous and continuous outcomes, we calculated risk ratios and mean differences, respectively, both with 95% confidence intervals (CI). We included five RCTs, comprising a total of 119 participants. Two studies compared two different antimicrobial agents and three compared a biological or bioengineered skin substitute with an antimicrobial agent. All studies had small sample sizes and were at high risk of bias. Heterogeneity of interventions and outcomes prevented pooling of data. In three studies time to complete wound healing was significantly shorter for those using a skin substitute than for those using an antibacterial agent, but the quality of the evidence was low. Pain was significantly reduced with the use of skin

  7. Pediatric burn wound impetigo after grafting.

    PubMed

    Aikins, Kimberly; Prasad, Narayan; Menon, Seema; Harvey, John G; Holland, Andrew J A

    2015-01-01

    Modern burn care techniques have reduced the risk of infection of the acute burn wound, resulting in more rapid healing and a lower incidence of graft loss. Secondary breakdown may still occur. The loss of epithelium in association with multifocal superficial abscesses and ulceration has been termed burns impetigo. This may result in considerable morbidity and require prolonged treatment. The events preceding development, the impact on the patient, and the ideal treatment appear unclear and poorly reported. In 5 years, between 2006 and 2011, 406 pediatric burns were treated with skin grafts, with 7% developing burns impetigo. Time to resolution ranged from 5 to 241 days: the mean time to complete healing was greatest with conservative management (96 days), followed by antibacterial dressings (37 days), oral antibiotics (36 days), topical steroids (16 days), and oral antibiotics in combination with topical steroids (13.5 days). Burns impetigo resulted in significant morbidity, requiring multiple visits to the treatment center and prolonged symptoms. Delay in diagnosis and treatment resulted in worse outcomes. Prompt consideration of burns impetigo should occur when postgraft patients present with suggestive clinical signs and treatment with oral antibiotics plus topical steroids should be considered.

  8. Skin graft

    MedlinePlus

    ... that need skin grafts to heal Venous ulcers, pressure ulcers , or diabetic ulcers that do not heal Very ... graft; Full thickness skin graft Patient Instructions Preventing pressure ulcers Surgical wound care - open Images Skin graft Skin ...

  9. Skin Cancer

    MedlinePlus

    ... version of this page please turn Javascript on. Skin Cancer What is Skin Cancer? Skin cancer is the most common type ... of approximately 9,480 Americans in 2013. Can Skin Cancer Be Treated? Most basal cell and squamous ...

  10. Assessment of the effectiveness of silver-coated dressing, chlorhexidine acetate (0.5%), citric acid (3%), and silver sulfadiazine (1%) for topical antibacterial effects against the multi-drug resistant Pseudomonas aeruginosa infecting full-skin thickness burn wounds on rats.

    PubMed

    Yabanoglu, Hakan; Basaran, Ozgur; Aydogan, Cem; Azap, Ozlem Kurt; Karakayali, Feza; Moray, Gokhan

    2013-01-01

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

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

    PubMed Central

    Yabanoglu, Hakan; Basaran, Ozgur; Aydogan, Cem; Azap, Ozlem Kurt; Karakayali, Feza; Moray, Gokhan

    2013-01-01

    The aim of this study was to compare the effects of four different topical antimicrobial dressings on a multi-drug resistant Pseudomonas aeruginosa contaminated full-thickness burn wound rat model. A total of 40 adult male Wistar albino rats were used. The control group (group 1), silver sulfadiazine (1%) group 2, chlorhexidine acetate (0.5%) group 3, citric acid (3%) group 4, and silver-coated dressing group 5 were compared to assess the antibacterial effects of a daily application to a 30% full-skin thickness burn wound seeded 10 minutes earlier with 108 CFU (colony forming unit)/0.5 mL of a multi-drug resistant Pseudomonas aeruginosa strain. Five groups (1 control group and 4 treatment groups) were compared. The administration of third-degree burns to all rats was confirmed based on histopathologic data. The tissue cultures from groups 2 and 5 exhibited significant differences compared to those of the other 3 groups, whereas no significant differences were observed between groups 1, 3, and 4. The effectiveness of the treatments was as follows: 1% silver sulfadiazine > silver-coated dressing > 3% citric acid > 0.5% chlorhexidine acetate > control group. Our results supported the efficacy of topical therapy by silver sulfadiazine and silver-coated dressing on infections caused by multi-drug resistant Pseudomonas spp. PMID:24229034

  12. Skin Diseases: Skin Health and Skin Diseases

    MedlinePlus

    ... and dryness. Sunlight is a major cause of skin aging. ( See "Skin and Sun—Not a Good Mix") . ... person has smoked. Many products claim to revitalize aging skin or reduce wrinkles, but the Food and Drug ...

  13. Stem cells and burns: review and therapeutic implications.

    PubMed

    Butler, Kathryn L; Goverman, Jeremy; Ma, Harry; Fischman, Alan; Yu, Yong-Ming; Bilodeau, Maryelizabeth; Rad, Ali M; Bonab, Ali A; Tompkins, Ronald G; Fagan, Shawn P

    2010-01-01

    Despite significant advances in burn resuscitation and wound care over the past 30 years, morbidity and mortality from thermal injury remain high. Limited donor skin in severely burned patients hinders effective wound excision and closure, leading to infectious complications and prolonged hospitalizations. Even with large-volume fluid resuscitation, the systemic inflammatory response syndrome compromises end-organ perfusion in burn patients, with resultant multiorgan failure. Stem cells, which enhance wound healing and counteract systemic inflammation, now offer potential therapies for these challenges. Through a review of the literature, this article seeks to illustrate applications of stem cell therapy to burn care and to highlight promising areas of research.

  14. Burn Depth Estimation Using Thermal Excitation and Imaging

    SciTech Connect

    Dickey, F.M.; Holswade, S.C.; Yee, M.L.

    1998-12-17

    Accurate estimation of the depth of partial-thickness burns and the early prediction of a need for surgical intervention are difficult. A non-invasive technique utilizing the difference in thermal relaxation time between burned and normal skin may be useful in this regard. In practice, a thermal camera would record the skin's response to heating or cooling by a small amount-roughly 5{degrees} Celsius for a short duration. The thermal stimulus would be provided by a heat lamp, hot or cold air, or other means. Processing of the thermal transients would reveal areas that returned to equilibrium at different rates, which should correspond to different burn depths. In deeper thickness burns, the outside layer of skin is further removed from the constant-temperature region maintained through blood flow. Deeper thickness areas should thus return to equilibrium more slowly than other areas. Since the technique only records changes in the skin's temperature, it is not sensitive to room temperature, the burn's location, or the state of the patient. Preliminary results are presented for analysis of a simulated burn, formed by applying a patch of biosynthetic wound dressing on top of normal skin tissue.

  15. In vivo imaging of human burn injuries with polarization-sensitive optical coherence tomography

    NASA Astrophysics Data System (ADS)

    Kim, Ki Hean; Pierce, Mark C.; Maguluri, Gopi; Park, B. Hyle; Yoon, Sang June; Lydon, Martha; Sheridan, Robert; de Boer, Johannes F.

    2012-06-01

    The accurate determination of burn depth is critical in the clinical management of burn wounds. Polarization-sensitive optical coherence tomography (PS-OCT) has been proposed as a potentially non-invasive method for determining burn depth by measuring thermally induced changes in the structure and birefringence of skin, and has been investigated in pre-clinical burn studies with animal models and ex vivo human skin. In this study, we applied PS-OCT to the in-vivo imaging of two pediatric burn patients. Deep and superficial burned skins along with contralateral controls were imaged in 3D. The imaging size was 8 mm×6 mm×2 mm in width, length, and depth in the air respectively, and the imaging time was approximately 6 s per volume. Superficially burned skins exhibited the same layered structure as the contralateral controls, but more visible vasculature and reduced birefringence compared to the contralateral controls. In contrast, a deeply burned skin showed loss of the layered structure, almost absent vasculature, and smaller birefringence compared to superficial burns. This study suggested the vasculature and birefringence as parameters for characterizing burn wounds.

  16. [Functional reconstruction of multiple severe deformities after extensive deep burn].

    PubMed

    Chen, Bi; Jia, Chi-yu; Hu, Da-hai; Zhu, Xiong-xiang; Han, Jun-tao; Yao, Qing-jun; Xu, Ming-da

    2008-10-01

    To explore new measures for functional reconstruction of multiple severe deformities as a result of extensive deep burn (total burn surface area > or = 90% TBSA, including deep burn > or = 70%TBSA) in late stage. Twelve severe burn patients with above-mentioned deformities were hospitalized in our ward during 1960--2005, the scars resulted from burns were distributed from head to foot with 173 deformities, including 27 scar ulcers. All patients lacked of self-care ability, among them some could not stand. Due to inadequate skin source, deformities were corrected by skin from matured scars expanded with subcutaneous balloon at late postburn stage. Following our former clinical experience, anatomic investigation and experimental research, we chose the following methods to correct deformities and restore functions: application of split-thickness scar skin after expansion (88 wounds); use of scar skin flap/scar-Achilles tendon flaps (59 wounds); combination of thin split-thickness skin grafts from scar and allogeneic acellular dermal matrix (composite skin, 40 wounds). All grafts survived, the appearance and function were improved obviously without complications. Follow-up 1-40 years, all patients could take care themselves with satisfactory function and appearance, and among them 8 patients returned to work (one had worked for 40 years), 2 patients married and had children. The above-mentioned measures are safe, reliable and effective for functional reconstruction of deformities.

  17. Stromal vascular fraction improves deep partial thickness burn wound healing.

    PubMed

    Atalay, Sibel; Coruh, Atilla; Deniz, Kemal

    2014-11-01

    The practice of early burn wound excision and wound closure by immediate autologous skin or skin substitutes is the preferred treatment in extensive deep partial and full-thickness burns. To date there is no proven definite medical treatment to decrease burn wound size and accelerate burn wound healing in modern clinical practice. Stromal vascular fraction is an autologous mixture that has multiple proven beneficial effects on different kinds of wounds. In our study, we investigated the effects of stromal vascular fraction on deep partial-thickness burn wound healing. In this study, 20 Wistar albino rats were used. Inguinal adipose tissue of the rats was surgically removed and stromal vascular fraction was isolated. Thereafter, deep second-degree burns were performed on the back of the rats by hot water. The rats were divided into two groups in a randomized fashion. The therapy group received stromal vascular fraction, whereas the control group received only physiologic serum by intradermal injection. Assessment of the burn wound healing between the groups was carried out by histopathologic and immuno-histochemical data. Stromal vascular fraction increased vascular endothelial growth factor, proliferating cell nuclear antigen index, and reduced inflammation of the burn wound. Furthermore, vascularization and fibroblastic activity were achieved earlier and observed to be at higher levels in the stromal vascular fraction group. Stromal vascular fraction improves burn wound healing by increasing cell proliferation and vascularization, reducing inflammation, and increasing fibroblastic activity. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  18. Sensitive skin: an overview.

    PubMed

    Berardesca, E; Farage, M; Maibach, H

    2013-02-01

    Sensitive skin is a condition of subjective cutaneous hyper-reactivity to environmental factors. Subjects experiencing this condition report exaggerated reactions when their skin is in contact with cosmetics, soaps and sun screens, and they often report worsening after exposure to dry and cold climate. Although no sign of irritation is commonly detected, itching, burning, stinging and a tight sensation are constantly present. Generally substances that are not commonly considered irritants are involved in this abnormal response.Sensitive skin and subjective irritation are widespread but still far from being completely defined and understood. A correlation between sensitive skin and constitutional anomalies and/or other triggering factors such as occupational skin diseases or chronic exposure to irritants has been hypothesized. Recent findings suggest that higher sensitivity can be due to different mechanisms. Hyper-reactors may have a thinner stratum corneum with a reduced corneocyte area causing a higher transcutaneous penetration of water-soluble chemicals. Alterations in vanilloid receptors and changes in neuronal transmission have been described. Monitoring skin parameters such as barrier function, proclivity to irritation, corneocyte size and sensorial transmission can also be useful to identify regional differences in skin sensitivity.

  19. Use of local sliding flaps to manage deep localized burns of the hand.

    PubMed

    Rahoma, Ahmed Hussein

    2011-12-01

    The incidence of hand burns in children is high. In the overall cases of body burns, hand and wrist burns account for about 39%. They may constitute a part of a larger burn of the body, or an isolated injury of the hand and wrist. The choice between early and late escharectomy and skin covering is still a matter of debate. Two cases of deep burns of the hands are presented in this report. The report shows a new way to close the residual wounds of deep burns.

  20. [Application of topical drugs in burn wound].

    PubMed

    Zhang, Guo-an

    2008-10-01

    For burn patients, topical treatment is as important as systemic treatment. Reasonable and timely wound treatment will influence the homeostatic equilibrium, and the progression, the prognosis, and the outcome of the disease. The therapeutic principle should be varied for wounds with different depth of injury. But avoiding or at least alleviating infection, and accelerating healing period, were the common principles. In common, the medication for local wound treatment includes: topical antiseptic, surgical dressing products, artificial skins, and so on. Ideal topical antiseptic should have the following characteristics: the antimicrobial spectrum is broad, including Pseudomonas aeruginosa and MRSA; be able to penetrate necrotic tissue; does not induce drug resistance easily; no local irritating effect and not painful; no side effect to body;can be applied easily; low cost. The functions of surgical dressing include: protect the wounds, keep the microcirculation open, and accelerate wound healing. Artificial skin has been used as the autoskin carrier in skin transplantation operation for large burn area to protect the autoskin grafts, accelerate wound healing, and cover the wounds temporarily. Burns therapy has developed for 50 years in China, the study of local treatment for burn wounds has also experienced a tortuous path of trial and error. This review might contribute some ideas future research.

  1. Burn Wise - Partners

    EPA Pesticide Factsheets

    Within this site you will find information for consumers to make informed decisions about what it means to burn wise. And partners will learn about how they can work with EPA to bring cleaner-burning appliances to market.

  2. First Aid: Burns

    MedlinePlus

    ... MORE ON THIS TOPIC Kitchen: Household Safety Checklist Fireworks Safety First Aid: Sunburn Firesetting Fire Safety Burns ... Being Safe in the Kitchen Finding Out About Fireworks Safety Playing With Fire? Dealing With Burns Fireworks ...

  3. Burning and Burnout.

    ERIC Educational Resources Information Center

    Christensen, Jane

    1981-01-01

    Examines the extended metaphor of "burnout" as it applies to the teaching profession. Examines three ancient Celtic invocations for the better tending of fires, which reveal ways that teachers can burn with enthusiasm without burning out from apathy. (RL)

  4. Burn Wise Funding

    EPA Pesticide Factsheets

    EPA is working with federal, state, tribal and local agencies to find and promote viable funding options to replace wood-burning appliances with cleaner home heating. Includes Guide to Financing Options for Wood-burning Appliance Changeouts.

  5. First Aid: Burns

    MedlinePlus

    ... MORE ON THIS TOPIC Kitchen: Household Safety Checklist Fireworks Safety First Aid: Sunburn Firesetting Fire Safety Burns ... Being Safe in the Kitchen Finding Out About Fireworks Safety Playing With Fire? Dealing With Burns Fireworks ...

  6. American Burn Association

    MedlinePlus

    ... on the Journal's website MONTHLY HEADLINES from MSKTC (Model Systems Knowledge Translation Center) The American Burn Association Web site contains general information for burn care professionals. The ABA Web site is not intended ...

  7. Burning Rate Emulator

    NASA Image and Video Library

    The Burning Rate Emulator is a gas fuel investigation attempting to emulate the burning of solids to improve our understanding of materials''flammability over a wide range of conditions. The approa...

  8. Burns - Multiple Languages

    MedlinePlus

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Burns URL of this page: https://medlineplus.gov/languages/burns.html Other topics A-Z Expand Section ...

  9. Advanced therapies of skin injuries.

    PubMed

    Maver, Tina; Maver, Uroš; Kleinschek, Karin Stana; Raščan, Irena Mlinarič; Smrke, Dragica Maja

    2015-12-01

    The loss of tissue is still one of the most challenging problems in healthcare. Efficient laboratory expansion of skin tissue to reproduce the skins barrier function can make the difference between life and death for patients with extensive full-thickness burns, chronic wounds, or genetic disorders such as bullous conditions. This engineering has been initiated based on the acute need in the 1980s and today, tissue-engineered skin is the reality. The human skin equivalents are available not only as models for permeation and toxicity screening, but are frequently applied in vivo as clinical skin substitutes. This review aims to introduce the most important recent development in the extensive field of tissue engineering and to describe already approved, commercially available skin substitutes in clinical use.

  10. Pathophysiological Study of Sensitive Skin.

    PubMed

    Buhé, Virginie; Vié, Katell; Guéré, Christelle; Natalizio, Audrey; Lhéritier, Céline; Le Gall-Ianotto, Christelle; Huet, Flavien; Talagas, Matthieu; Lebonvallet, Nicolas; Marcorelles, Pascale; Carré, Jean-Luc; Misery, Laurent

    2016-03-01

    Sensitive skin is a clinical syndrome characterized by the occurrence of unpleasant sensations, such as pruritus, burning or pain, in response to various factors, including skincare products, water, cold, heat, or other physical and/or chemical factors. Although these symptoms suggest inflammation and the activation of peripheral innervation, the pathophysiogeny of sensitive skin remains unknown. We systematically analysed cutaneous biopsies from 50 healthy women with non-sensitive or sensitive skin and demonstrated that the intraepidermal nerve fibre density, especially that of peptidergic C-fibres, was lower in the sensitive skin group. These fibres are involved in pain, itching and temperature perception, and their degeneration may promote allodynia and similar symptoms. These results suggest that the pathophysiology of skin sensitivity resembles that of neuropathic pruritus within the context of small fibre neuropathy, and that environmental factors may alter skin innervation.

  11. The effect of burn rehabilitation massage therapy on hypertrophic scar after burn: a randomized controlled trial.

    PubMed

    Cho, Yoon Soo; Jeon, Jong Hyun; Hong, Aram; Yang, Hyeong Tae; Yim, Haejun; Cho, Yong Suk; Kim, Do-Hern; Hur, Jun; Kim, Jong Hyun; Chun, Wook; Lee, Boung Chul; Seo, Cheong Hoon

    2014-12-01

    To evaluate the effect of burn rehabilitation massage therapy on hypertrophic scar after burn. One hundred and forty-six burn patients with hypertrophic scar(s) were randomly divided into an experimental group and a control group. All patients received standard rehabilitation therapy for hypertrophic scars and 76 patients (massage group) additionally received burn scar rehabilitation massage therapy. Both before and after the treatment, we determined the scores of visual analog scale (VAS) and itching scale and assessed the scar characteristics of thickness, melanin, erythema, transepidermal water loss (TEWL), sebum, and elasticity by using ultrasonography, Mexameter(®), Tewameter(®), Sebumeter(®), and Cutometer(®), respectively. The scores of both VAS and itching scale decreased significantly in both groups, indicating a significant intragroup difference. With regard to the scar characteristics, the massage group showed a significant decrease after treatment in scar thickness, melanin, erythema, TEWL and a significant intergroup difference. In terms of scar elasticity, a significant intergroup difference was noted in immediate distension and gross skin elasticity, while the massage group significant improvement in skin distensibility, immediate distension, immediate retraction, and delayed distension. Our results suggest that burn rehabilitation massage therapy is effective in improving pain, pruritus, and scar characteristics in hypertrophic scars after burn. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  12. Skin analysis following dermal exposure to kerosene in rats: the effects of postmortem exposure and fire.

    PubMed

    Hieda, Yoko; Tsujino, Yoshio; Xue, Yuying; Takayama, Koji; Fujihara, Junko; Kimura, Kojiro; Dekio, Satoshi

    2004-02-01

    To evaluate the usefulness of skin analysis for the forensic examination of cases involving postmortem dermal exposure to kerosene and/or fire, an experimental study using rats was performed. Rats received dermal exposure to kerosene before or after death, and the effect of fire was determined by burning an area of exposed skin after death. Kerosene concentrations in skin and blood were determined by gas chromatography-mass spectrometry and microscopic observation was performed for skin samples. No differences were observed in skin kerosene levels between antemortem and postmortem exposure. Kerosene concentrations in mildly burned skin where the stratum corneum (SC) was retained were approximately 84% compared to those in non-burned exposed skin, whereas concentrations in severely burned skin where the SC was almost completely burned off were 28% of non-burned skin. Even in non-exposed control skin 14% of the original kerosene concentrations could be detected, which was considered to be caused by contamination during the experimental protocol combined with kerosene's property of a high affinity for the SC. These results suggest that (1) skin analysis is useful in estimating the type of petroleum product involved in crimes or accidents even for postmortem exposure, (2) whether the SC is retained or not primarily determined the kerosene levels in burned skin, and (3) attention must be paid to evaluate the results obtained from skin samples in the light of the circumstances surrounding the case.

  13. Feet sunk in molten aluminium: The burn and its prevention.

    PubMed

    Alonso-Peña, David; Arnáiz-García, María Elena; Valero-Gasalla, Javier Luis; Arnáiz-García, Ana María; Campillo-Campaña, Ramón; Alonso-Peña, Javier; González-Santos, Jose María; Fernández-Díaz, Alaska Leonor; Arnáiz, Javier

    2015-08-01

    Nowadays, despite improvements in safety rules and inspections in the metal industry, foundry workers are not free from burn accidents. Injuries caused by molten metals include burns secondary to molten iron, aluminium, zinc, copper, brass, bronze, manganese, lead and steel. Molten aluminium is one of the most common causative agents of burns (60%); however, only a few publications exist concerning injuries from molten aluminium. The main mechanisms of lesion from molten aluminium include direct contact of the molten metal with the skin or through safety apparel, or when the metal splash burns through the pants and rolls downward along the leg. Herein, we report three cases of deep dermal burns after 'soaking' the foot in liquid aluminium and its evolutive features. This paper aims to show our experience in the management of burns due to molten aluminium. We describe the current management principles and the key features of injury prevention. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  14. Healing burns using atmospheric pressure plasma irradiation

    NASA Astrophysics Data System (ADS)

    Hirata, Takamichi; Kishimoto, Takumi; Tsutsui, Chihiro; Kanai, Takao; Mori, Akira

    2014-01-01

    An experiment testing the effects of plasma irradiation with an atmospheric-pressure plasma (APP) reactor on rats given burns showed no evidence of electric shock injuries upon pathology inspection of the irradiated skin surface. In fact, the observed evidence of healing and improvement of the burns suggested healing effects from plasma irradiation. The quantities of neovascular vessels in the living tissues at 7 days were 9.2 ± 0.77 mm-2 without treatment and 18.4 ± 2.9 mm-2 after plasma irradiation.

  15. Filigree burn of lightning: two case reports.

    PubMed

    Kumar, Virendra

    2007-04-01

    Lightning is a powerful natural electrostatic discharge produced during a thunderstorm. The electric current passing through the discharge channels is direct with a potential of 1000 million volts or more. Lightning can kill or injure a person by a direct strike, a side-flash, or conduction through another object. Lightning can cause a variety of injuries in the skin and the cardiovascular, neurological and ophthalmic systems. Filigree burn of lightning is a superficial burn and very rare. Two cases of death from lightning which have this rare finding are reported and discussed.

  16. [Plastic reconstructive surgery for burn injuries].

    PubMed

    Niederbichler, A D; Vogt, P M

    2009-06-01

    The stage-adjusted therapy of thermal injuries is based on pathophysiologic mechanisms as well as functional and aesthetic requirements. Plastic reconstructive surgical approaches are highly important in the prevention of the frequent grave sequelae of thermal trauma and to achieve optimal functional rehabilitation and favourable outcome. In reconstructive surgery of burns operative goals are subdivided into acute, secondary reconstructive, functional and aesthetic indications. The achievement of early wound closure to preserve functional skin and soft tissue components is an essential part of acute reconstructive procedures. Functional reconstructive and aesthetic procedures supplement the conservative treatment modalities of the secondary phase of burn care with physical therapy, ergotherapy and psychological support.

  17. Optimization of burn referrals.

    PubMed

    Reiband, Hanna K; Lundin, Kira; Alsbjørn, Bjarne; Sørensen, Anne Marie; Rasmussen, Lars S

    2014-05-01

    Correct estimation of the severity of burns is important to obtain the right treatment of the patient and to avoid over- and undertriage. In this study we aimed to assess how often the guidelines for referral of burn injured patients are met at the national burn centre (NBC), Denmark. We included burn patients referred to the NBC in a three-months period. Patient records were systematically analyzed and compared with the national guidelines for referral of burn injured patients. A total of 97 burn injured patients were transferred for treatment at the NBC and the most common reason for referral was partial thickness burn exceeding 3% estimated area of burn (55% of the patients) while facial burns (32%) and inhalational injury (25%) were other common reasons. We found that 29 (30%) of the referrals were considered potentially unnecessary according to the guidelines. The overtriage was highest among patients suffering of burns due to scalding and these were mostly children below 2 years of age. An overtriage of referred burn injured patient was found and 30% of the referred patients were treated as outpatients. A telemedicine solution may be useful in the evaluation of burn injured patients before transfer. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  18. California Burn Scars

    Atmospheric Science Data Center

    2014-05-15

    article title:  Burn Scars Across Southern California     ... California between October 21 and November 18, 2003. Burn scars and vegetation changes wrought by the fires are illustrated in these ... and Nov 18, 2003 Images:  California Burn Scars location:  United States region:  ...

  19. Trout Creek 1999 Burn

    Treesearch

    Sherel Goodrich

    2008-01-01

    A small prescribed fire near the mouth of Trout Creek in Strawberry Valley, Wasatch County, Utah, on the Uinta National Forest provided an opportunity to compare production and vascular plant composition in unburned and burned areas. At four years post burn, production of herbaceous plants was about four times greater in the burned area than in the unburned area. Most...

  20. Biologic and synthetic skin substitutes: An overview.

    PubMed

    Halim, Ahmad Sukari; Khoo, Teng Lye; Mohd Yussof, Shah Jumaat

    2010-09-01

    The current trend of burn wound care has shifted to more holistic approach of improvement in the long-term form and function of the healed burn wounds and quality of life. This has demanded the emergence of various skin substitutes in the management of acute burn injury as well as post burn reconstructions. Skin substitutes have important roles in the treatment of deep dermal and full thickness wounds of various aetiologies. At present, there is no ideal substitute in the market. Skin substitutes can be divided into two main classes, namely, biological and synthetic substitutes. The biological skin substitutes have a more intact extracellular matrix structure, while the synthetic skin substitutes can be synthesised on demand and can be modulated for specific purposes. Each class has its advantages and disadvantages. The biological skin substitutes may allow the construction of a more natural new dermis and allow excellent re-epithelialisation characteristics due to the presence of a basement membrane. Synthetic skin substitutes demonstrate the advantages of increase control over scaffold composition. The ultimate goal is to achieve an ideal skin substitute that provides an effective and scar-free wound healing.

  1. Biologic and synthetic skin substitutes: An overview

    PubMed Central

    Halim, Ahmad Sukari; Khoo, Teng Lye; Mohd. Yussof, Shah Jumaat

    2010-01-01

    The current trend of burn wound care has shifted to more holistic approach of improvement in the long-term form and function of the healed burn wounds and quality of life. This has demanded the emergence of various skin substitutes in the management of acute burn injury as well as post burn reconstructions. Skin substitutes have important roles in the treatment of deep dermal and full thickness wounds of various aetiologies. At present, there is no ideal substitute in the market. Skin substitutes can be divided into two main classes, namely, biological and synthetic substitutes. The biological skin substitutes have a more intact extracellular matrix structure, while the synthetic skin substitutes can be synthesised on demand and can be modulated for specific purposes. Each class has its advantages and disadvantages. The biological skin substitutes may allow the construction of a more natural new dermis and allow excellent re-epithelialisation characteristics due to the presence of a basement membrane. Synthetic skin substitutes demonstrate the advantages of increase control over scaffold composition. The ultimate goal is to achieve an ideal skin substitute that provides an effective and scar-free wound healing. PMID:21321652

  2. Epidemiology and outcome of burns: early experience at the country's first national burns centre.

    PubMed

    Iqbal, Tariq; Saaiq, Muhammad; Ali, Zahid

    2013-03-01

    This study aims to document the epidemiologic pattern and outcome of burn injuries in the country's first national burn centre. This case series study was conducted over a 2-year period at Burns Care Centre (BCC), Pakistan Institute of Medical Sciences (PIMS), Islamabad. The study included all burn injury patients who primarily presented to and were managed at the centre. Those patients who presented more than 24 h after injury or those who were initially managed at some other hospital were excluded from the study. Initial assessment and diagnosis was made by thorough history, physical examination and necessary investigations. Patients with major burns, high voltage electric burns and those needing any surgical interventions were admitted for indoor management. Patients with minor burns were discharged home after necessary emergency management, home medication and follow-up advice. The sociodemographic profile of the patients, site of sustaining burn injury, type and extent (total body surface area (TBSA), skin thickness involved and associated inhalational injury) of burn and outcome in terms of survival or mortality, etc., were all recorded on a proforma. The data were subjected to statistical analysis. Out of a total of 13,295 patients, there were 7503 (56.43%) males and 5792 (43.56%) females. The mean age for adults was 33.63±10.76 years and for children it was 6.71±3.47 years. The household environment constituted the commonest site of burns (68%). Among all age groups and both genders, scalds were the commonest burns (42.48%), followed by flame burns (39%) and electrical burns (9.96%). The affected mean TBSA was 10.64±11.45% overall, while for the hospitalised subset of patients the mean TBSA was 38.04±15.18%. Most of the burns were partial thickness (67%). Inhalation injury was found among 149 (1.12%) patients. Most of the burns were non-intentional and only 96 (0.72%) were intentional. A total of 1405 patients (10.58%) were admitted while the remainder

  3. [Invasive yeast infections in severely burned patients].

    PubMed

    Renau, Ana Isabel; García-Vidal, Carolina; Salavert, Miguel

    2016-01-01

    Currently, there are few studies on candidaemia in the severely burned patient. These patients share the same risk factors for invasive fungal infections as other critically ill patients, but have certain characteristics that make them particularly susceptible. These include the loss of skin barrier due to extensive burns, fungal colonisation of the latter, and the use of hydrotherapy or other topical therapies (occasionally with antimicrobials). In addition, the increased survival rate achieved in recent decades in critically burned patients due to the advances in treatment has led to the increase of invasive Candida infections. This explains the growing interest in making an earlier and more accurate diagnosis, as well as more effective treatments to reduce morbidity and mortality of candidaemia in severe burned patients. A review is presented on all aspects of the burned patient, including the predisposition and risk factors for invasive candidiasis, pathogenesis of candidaemia, underlying immunodeficiency, local epidemiology and antifungal susceptibility, evolution and prognostic factors, as well as other non-Candida yeast infections. Finally, we include specific data on our local experience in the management of candidaemia in severe burned patients, which may serve to quantify the problem, place it in context, and offer a realistic perspective. Copyright © 2016 Asociación Española de Micología. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Pediatric Treadmill Burns: Assessing the effectiveness of prevention strategies.

    PubMed

    Goltsman, David; Li, Zhe; Connolly, Siobhan; Meyerowitz-Katz, Daniel; Allan, James; Maitz, Peter K M

    2016-11-01

    Legislative changes in 2008 in Australia mandated that all new treadmills display a warning sticker about the risk of friction burns in children. This was accompanied by a health promotion campaign advising of the risks of treadmills to children. Analyses of pediatric burns data identified all cases of treadmill burns occurring between 2005 and 2014. The incidence of treadmill burns, associations with age and gender, characteristics of the burns and the adequacy of first aid provided immediately after the burn was examined. There were 298 cases of treadmill burns over the 10-year period (3.5% of all pediatric burns). The incidence rose until the introduction of legislation and health promotion in 2008, and then declined over the remaining study period. The majority of treadmill burns in children were inflicted on the upper limbs (91%), and 93% involved the hands. Most burns were full thickness (62%, n=182) and 49% (n=148) required skin grafts. Approximately one-third of treadmill burns (35%, n=105) occurred while someone else was using the treadmill. In the vast majority of treadmill burn injuries (74%, n=223), there was either no first aid or inadequate first aid provided immediately after the injury. A significant number of treadmill burns occur in children, and these often result in serious injuries that are not treated with appropriate first aid. A reduction in the incidence of these burns was associated with the introduction of legislation and health promotion targeted at child safety around treadmills. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  5. Hot soup! Correlating the severity of liquid scald burns to fluid and biomedical properties.

    PubMed

    Loller, Cameron; Buxton, Gavin A; Kerzmann, Tony L

    2016-05-01

    Burns caused by hot drinks and soups can be both debilitating and costly, especially to pediatric and geriatric patients. This research is aimed at better understanding the fluid properties that can influence the severity of skin burns. We use a standard model which combines heat transfer and biomedical equations to predict burn severity. In particular, experimental data from a physical model serves as the input to our numerical model to determine the severity of scald burns as a consequence of actual fluid flows. This technique enables us to numerically predict the heat transfer from the hot soup into the skin, without the need to numerically estimate the complex fluid mechanics and thermodynamics of the potentially highly viscous and heterogeneous soup. While the temperature of the soup is obviously is the most important fact in determining the degree of burn, we also find that more viscous fluids result in more severe burns, as the slower flowing thicker fluids remain in contact with the skin for longer. Furthermore, other factors can also increase the severity of burn such as a higher initial fluid temperature, a greater fluid thermal conductivity, or a higher thermal capacity of the fluid. Our combined experimental and numerical investigation finds that for average skin properties a very viscous fluid at 100°C, the fluid must be in contact with the skin for around 15-20s to cause second degree burns, and more than 80s to cause a third degree burn.

  6. Role of epidermal stem cells in repair of partial-thickness burn injury after using Moist Exposed Burn Ointment (MEBO(®)) histological and immunohistochemical study.

    PubMed

    El-Hadidy, M R; El-Hadidy, A R; Bhaa, A; Asker, S A; Mazroa, S A

    2014-04-01

    Moist Exposed Burn Ointment (MEBO(®)) is widely used topical agent applied on skin burn. This study investigated the effect of MEBO topical application on activation and proliferation of epidermal stem cells through the immunohistochemical localization of cytokeratin 19 (CK19) as a known marker expressed in epidermal stem cells. Biopsies from normal skin and burn wounds were taken from 21 patients with partial thickness burn 1, 4, 7, 14, 21, and 28 days after treatment with MEBO. Tissue sections were prepared for histological study and for CK19 immunohistochemical localization. In control skin, only few cells showed a positive CK19 immune-reaction. Burned skin showed necrosis of full thickness epidermis that extended to dermis. Gradual regeneration of skin accompanied with an enhancement in CK19 immune-reactivity was noted 4, 7, 14 and 21 days after treatment with MEBO. On day 28, a complete regeneration of skin was observed with a return of CK19 immune-reactivity to the basal pattern again. In conclusion, the enhancement of epidermal stem cell marker CK19 after treatment of partial thickness burn injuries with MEBO suggested the role of MEBO in promoting epidermal stem cell activation and proliferation during burn wound healing. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Development of an in vitro burn wound model.

    PubMed

    Coolen, Neeltje A; Vlig, Marcel; van den Bogaerdt, Antoon J; Middelkoop, Esther; Ulrich, Magda M W

    2008-01-01

    Healing of a deeper burn wound is a complex process that often leads to scar formation. Skin wound model systems are important for the development of treatments preventing scarring. The aim of this study is to develop a standardized in vitro burn wound model that resembles the in vivo situation. A burn wound (10 x 2 mm) was made in ex vivo skin and the skin samples were cultured at the air-liquid interface for 7, 14, and 21 days. Cells in the skin biopsies maintained their viability during the 21-day culture period. During culture, reepithelialization of the wound took place from the surrounding tissue and fibroblasts migrated into the wound area. Cells of the epithelial tongue and fibroblasts near the wound margin were proliferating. During culture, skin-derived antileukoproteinase and keratin 17 were expressed only in the epithelial tongue. Both collagen type IV and laminin were present underneath the newly formed epidermis, indicating that the basement membrane was restored. These results show that the burn wound model has many similarities to in vivo wound healing. This burn wound model may be useful to study different aspects of wound healing and testing pharmaceuticals and cosmetics on, e.g., migration and reepithelialization.

  8. Candidemia in major burns patients.

    PubMed

    Renau Escrig, Ana I; Salavert, Miguel; Vivó, Carmen; Cantón, Emilia; Pérez Del Caz, M Dolores; Pemán, Javier

    2016-06-01

    Major burn patients have characteristics that make them especially susceptible to candidemia, but few studies focused on this have been published. The objectives were to evaluate the epidemiological, microbiological and clinical aspects of candidemia in major burn patients, determining factors associated with a poorer prognosis and mortality. We conducted a retrospective observational study of candidemia between 1996 and 2012 in major burn patients admitted to the La Fe University Hospital, Valencia, Spain. The study included 36 episodes of candidemia in the same number of patients, 55.6% men, mean age 37.33 years and low associated comorbidity. The incidence of candidemia varied between 0.26 and 6.09 episodes/1000 days stay in the different years studied. Candida albicans was the most common species (61.1%) followed by Candida parapsilosis (27.8%). Candidemia by C. krusei, C. glabrata or C. tropicalis were all identified after 2004. Central vascular catheter (CVC) was established as a potential source of candidemia in 36.1%, followed by skin and soft tissues of thermal injury (22.2%) and urinary tract (8.3%). Fluconazole was used in 19 patients (52.7%) and its in vitro resistance rate was 13.9%. The overall mortality was 47.2%, and mortality related to candidemia was 30.6%. Factors associated with increased mortality were those related to severe infection and shock. CVC was the most usual focus of candidemia. Fluconazole was the most common antifungal drug administered. The management of candidemia in major burn patients is still a challenge. © 2016 Blackwell Verlag GmbH.

  9. Aging Skin

    MedlinePlus

    ... email address Submit Home > Healthy Aging > Wellness Healthy Aging Aging skin More information on aging skin When it ... treated early. Return to top More information on Aging skin Read more from womenshealth.gov Varicose Veins ...

  10. Burn wound healing: present concepts, treatment strategies and future directions.

    PubMed

    Oryan, A; Alemzadeh, E; Moshiri, A

    2017-01-02

    Burns are the most extensive forms of soft tissue injuries occasionally resulting in extensive and deep wounds and death. Burns can lead to severe mental and emotional distress, because of excessive scarring and skin contractures. Treatment of burns has always been a difficult medical problem and many different methods have been used to treat such injuries, locally. Biofilms are a collection of microorganisms that delay wound healing. One of the new methods of prevention and treatment of burn wound infections is application of antimicrobials, which act on biofilms and prevent the wound infection. Biofilm initiates a persistent, low-grade, inflammatory response, impairing both the epithelialisation and granulation tissue formation. Skin grafts have been shown to dramatically reduce deaths from infection. However, grafting has considerable limitations. Such injuries are long-lasting and many patients suffer from chronic pain for a long time. Tissue engineering is a new approach in reducing the limitations of conventional treatments and producing a supply of immunologically tolerant artificial tissue, leading to a permanent solution for damaged tissues; such criteria make it a cost-effective and reliable treatment modality. To overcome the present limitations of burn wound healing, knowledge about the latest findings regarding healing mechanisms is important. Here the authors discuss the most important events regarding burn wound healing and review the latest treatment strategies that have been used for burn wounds from in vitro to clinical levels. Finally, we discuss the role of tissue engineering and regenerative medicine in the future of burn wound healing, modelling and remodelling.

  11. History of burns: The past, present and the future.

    PubMed

    Lee, Kwang Chear; Joory, Kavita; Moiemen, Naiem S

    2014-01-01

    Burn injuries are one of the most common and devastating afflictions on the human body. In this article we look back at how the treatment of burns has evolved over the centuries from a primarily topical therapy consisting of weird and wonderful topical concoctions in ancient times to one that spans multiple scientific fields of topical therapy, antibiotics, fluid resuscitation, skin excision and grafting, respiratory and metabolic care and nutrition. Most major advances in burn care occurred in the last 50 years, spurred on by wars and great fires. The use of systemic antibiotics and topical silver therapy greatly reduced sepsis related mortality. This along with the advent of antiseptic surgical techniques, burn depth classification and skin grafting allowed the excision and coverage of full-thickness burns which resulted in greatly improved survival rates. Advancements in the methods of assessing the surface area of burns paved way for more accurate fluid resuscitation, minimising the effects of shock and avoiding fluid over-loading. The introduction of metabolic care, nutritional support and care of inhalational injuries further improved the outcome of burn patients. We also briefly discuss some future directions in burn care such as the use of cell and pharmalogical therapies.

  12. Pathophysiologic Response to Burns in the Elderly☆

    PubMed Central

    Jeschke, Marc G.; Patsouris, David; Stanojcic, Mile; Abdullahi, Abdikarim; Rehou, Sarah; Pinto, Ruxandra; Chen, Peter; Burnett, Marjorie; Amini-Nik, Saeid

    2015-01-01

    Over the last decades advancements have improved survival and outcomes of severely burned patients except one population, elderly. The Lethal Dose 50 (LD50) burn size in elderly has remained the same over the past three decades, and so has morbidity and mortality, despite the increased demand for elderly burn care. The objective of this study is to gain insights on why elderly burn patients have had such a poor outcome when compared to adult burn patients. The significance of this project is that to this date, burn care providers recognize the extreme poor outcome of elderly, but the reason remains unclear. In this prospective translational trial, we have determined clinical, metabolic, inflammatory, immune, and skin healing aspects. We found that elderly have a profound increased mortality, more premorbid conditions, and stay at the hospital for longer, p < 0.05. Interestingly, we could not find a higher incidence of infection or sepsis in elderly, p > 0.05, but a significant increased incidence of multi organ failure, p < 0.05. These clinical outcomes were associated with a delayed hypermetabolic response, increased hyperglycemic and hyperlipidemic responses, inversed inflammatory response, immune-compromisation and substantial delay in wound healing predominantly due to alteration in characteristics of progenitor cells, p < 0.05. In summary, elderly have substantially different responses to burns when compared to adults associated with increased morbidity and mortality. This study indicates that these responses are complex and not linear, requiring a multi-modal approach to improve the outcome of severely burned elderly. PMID:26629550

  13. [The clinical use of cryopreserved human skin allografts for transplantation].

    PubMed

    Martínez-Flores, Francisco; Chacón-Gómez, María; Madinaveitia-Villanueva, Juan Antonio; Barrera-Lopez, Araceli; Aguirre-Cruz, Lucinda; Querevalu-Murillo, Walter

    2015-01-01

    The biological recovery of human skin allografts is the gold standard for preservation in Skin Banks. However, there is no worldwide consensus about specific allocation criteria for preserved human skin allografts with living cells. A report is presented on the results of 5 years of experience of using human skin allografts in burned patient in the Skin and Tissue Bank at the "Instituto Nacional de Rehabilitacion" The human skin allografts were obtained from multi-organ donors. processed and preserved at -80 °C for 12 months. Allocation criteria were performed according to blood type match, clinical history, and burned body surface. Up to now, the Skin and Tissue Bank at 'Instituto Nacional de Rehabilitacion" has processed and recovered 125,000 cm(2) of human skin allografts. It has performed 34 surgical implants on 21 burned patients. The average of burn body surface was 59.2%. More than two-thirds (67.7%) of recipients of skin allografts were matched of the same to type blood of the donor, and 66.6% survived after 126 days hospital stay. It is proposed to consider recipient's blood group as allocation criteria to assign tissue; and use human skin allografts on patiens affected with burns over 30% of body surface (according the "rule of the 9"). Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  14. Cold burn injuries in the UK: the 11-year experience of a tertiary burns centre.

    PubMed

    Nizamoglu, Metin; Tan, Alethea; Vickers, Tobias; Segaren, Nicholas; Barnes, David; Dziewulski, Peter

    2016-01-01

    Guidance for the management of thermal injuries has evolved with improved understanding of burn pathophysiology. Guidance for the management of cold burn injuries is not widely available. The management of these burns differs from the standard management of thermal injuries. This study aimed to review the etiology and management of all cold burns presenting to a large regional burn centre in the UK and to provide a simplified management pathway for cold burns. An 11-year retrospective  analysis (1 January 2003-31 December 2014)  of all cold injuries presenting to a regional burns centre in the UK was conducted. Patient case notes were reviewed for injury mechanism, first aid administered, treatment outcomes and time to healing. An anonymized nationwide survey on aspects of management of cold burns was disseminated between 13 July 2015-5 October 2015 to British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) and Plastic Surgery Trainees Association (PLASTA) members in the UK. Electronic searches of MEDLINE, EMBASE and the Cochrane Library were performed to identify relevant literature to provide evidence for a management pathway for cold burn injuries. Twenty-three patients were identified. Age range was 8 months-69 years. Total body surface area (TBSA) burn ranged from 0.25 to 5 %. Twenty cases involved peripheral limbs. Seventeen (73.9 %)cases were accidental, with the remaining six (26.1 %) cases being deliberate self-inflicted injuries. Only eight patients received first aid. All except one patient were managed conservatively. One case required skin graft application due to delayed healing. We received 52 responses from a total of 200 questionaires. Ninety percent of responders think clearer guidelines should exist. We present a simplified management pathway based on evidence identified in our literature search. Cold burns are uncommon in comparison to other types of burn injuries. In the UK, a disproportionate number of cold

  15. Efficacy of propranolol in wound healing for hospitalized burn patients.

    PubMed

    Mohammadi, Ali Akbar; Bakhshaeekia, Alireza; Alibeigi, Peyman; Hasheminasab, Mohammad Jalal; Tolide-ei, Hamid Reza; Tavakkolian, Ahmad Reza; Mohammadi, Mohammad Kazem

    2009-01-01

    Burn patients have the highest metabolic rate among critically ill or injured patients. Because propranolol decreases energy expenditure and muscle protein catabolism, in this study, we hypothesized that propranolol would improve healing process and decrease wound-healing time. This study was a double-blind randomized clinical trial; a total of 79 burn patients who referred to this center from January 2006 to January 2007 fulfilled the inclusion criteria. Thirty-seven patients were randomly placed in propranolol group and 42 in control group. The propranolol group received propranolol orally with the dose of 1 mg/kg/d and maximum dose of 1.98 mg/kg/d given in six divided doses. This dose was adjusted to decrease the resting heart rate by 20% from each patient's baseline value. The control group received placebo. The most common cause of burn in both groups was flame followed by flash. Patients with superficial burns in the propranolol group needed less time to heal for acceptable wound healing in superficial burns (16.13+/-7.40 days vs 21.52+/-7.94 days; P=.004). We also found that patients with deep burn injury needed less time to be ready for skin graft (28.23+/-8.43 days vs 33.46+/-9.17 days; P=.007) when compared to that of the control group. The use of propranolol decreased the size of the burn wound that finally needed skin graft. Patients in the propranolol group with an average burn size of 31.42% TBSA finally needed 13.75% of TBSA skin graft compared with that of control patients with an average burn size of 33.61% TBSA who needed 18.72% of TBSA skin graft, and patients in the control group with an average burn size of 33.61% TBSA finally needed 18.72% of TBSA skin graft (P=.006). Patients in the propranolol group had a shorter hospital stay period than the control group (30.95+/-8.44 days vs 24.41+/-8.11 days; P=.05). Administration of propranolol, improved burn wound healing, and decreased healing time and hospital stay period. The use of propranolol

  16. Burning mouth syndrome and secondary oral burning.

    PubMed

    Minor, Jacob S; Epstein, Joel B

    2011-02-01

    Burning mouth syndrome is a complex disorder of unclear etiology that is most prevalent in perimenopausal women. It is often accompanied by dysguesia and subjective xerostomia. Recent evidence implicates both central and peripheral neuropathies, possibly representing a phantom pain syndrome in some patients. Ensuring that the patient's oral burning is not secondary to some other local or systemic factor is central to appropriate management. Current standard therapies include clonazepam, paroxetine, and cognitive behavioral therapy, and several promising new alternatives are described.

  17. 14 CFR 25.1193 - Cowling and nacelle skin.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Cowling and nacelle skin. 25.1193 Section... and nacelle skin. (a) Each cowling must be constructed and supported so that it can resist any... openings or by burning through external skin, any other zone or region where it would create...

  18. 14 CFR 25.1193 - Cowling and nacelle skin.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Cowling and nacelle skin. 25.1193 Section... and nacelle skin. (a) Each cowling must be constructed and supported so that it can resist any... openings or by burning through external skin, any other zone or region where it would create...

  19. 14 CFR 25.1193 - Cowling and nacelle skin.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Cowling and nacelle skin. 25.1193 Section... and nacelle skin. (a) Each cowling must be constructed and supported so that it can resist any... openings or by burning through external skin, any other zone or region where it would create...

  20. 14 CFR 25.1193 - Cowling and nacelle skin.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Cowling and nacelle skin. 25.1193 Section... and nacelle skin. (a) Each cowling must be constructed and supported so that it can resist any... openings or by burning through external skin, any other zone or region where it would create...

  1. 14 CFR 25.1193 - Cowling and nacelle skin.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Cowling and nacelle skin. 25.1193 Section... and nacelle skin. (a) Each cowling must be constructed and supported so that it can resist any... openings or by burning through external skin, any other zone or region where it would create additional...

  2. Identification of cutaneous functional units related to burn scar contracture development.

    PubMed

    Richard, Reginald L; Lester, Mark E; Miller, Sidney F; Bailey, J Kevin; Hedman, Travis L; Dewey, William S; Greer, Michelle; Renz, Evan M; Wolf, Steven E; Blackbourne, Lorne H

    2009-01-01

    The development of burn scar contractures is due in part to the replacement of naturally pliable skin with an inadequate quantity and quality of extensible scar tissue. Predilected skin surface areas associated with limb range of motion (ROM) have a tendency to develop burn scar contractures that prevent full joint ROM leading to deformity, impairment, and disability. Previous study has documented forearm skin movement associated with wrist extension. The purpose of this study was to expand the identification of skin movement associated with ROM to all joint surface areas that have a tendency to develop burn scar contractures. Twenty male subjects without burns had anthropometric measurements recorded and skin marks placed on their torsos and dominant extremities. Each subject performed ranges of motion of nine common burn scar contracture sites with the markers photographed at the beginning and end of motion. The area of skin movement associated with joint ROM was recorded, normalized, and quantified as a percentage of total area. On average, subjects recruited 83% of available skin from a prescribed area to complete movement across all joints of interest (range, 18-100%). Recruitment of skin during wrist flexion demonstrated the greatest amount of variability between subjects, whereas recruitment of skin during knee extension demonstrated the most consistency. No association of skin movement was found related to percent body fat or body mass index. Skin recruitment was positively correlated with joint ROM. Fields of skin associated with normal ROM were identified and subsequently labeled as cutaneous functional units. The amount of skin involved in joint movement extended far beyond the immediate proximity of the joint skin creases themselves. This information may impact the design of rehabilitation programs for patients with severe burns.

  3. Bizarre paediatric facial burns.

    PubMed

    Ho, W S; Ying, S Y; Wong, T W

    2000-08-01

    Child abuse and neglect account for a significant number of paediatric burn injuries. It is of great importance because of the high mortality, high frequency of repeated abuse, as well as the physical, psychological and social sequelae that it causes. Burn abuse is often under-recognized and under-reported because it is difficult to define non-accidental injury. On the other hand, false accusation of burn abuse is extremely damaging to the family. Bizarre and unusual burn injuries can be caused by accident and should not automatically be assumed to be deliberate injury. Three boys of age 1-7 years with bizarre facial burns were admitted to the Burns Unit at the Prince of Wales Hospital between February 1995 and July 1999. One was burned by his baby-sitter with hot water steam and the other two were burned by their mothers with hot boiled eggs. The unusual causes of their burns raised the suspicion of child abuse and formal investigations were carried out by the Social Services Department. Detail assessment including a developmental history of the child and the psychosocial assessment of the family revealed that these three boys were burned because of poor medical advice and innocent cultural belief.

  4. Burn mortality in Iraq.

    PubMed

    Qader, Ari Raheem

    2012-08-01

    Mortality rates are important outcome parameters after burn, and can serve as objective end points for quality control. Causes of death after severe burn have changed over time. In a prospective study, eight hundred and eighty-four burn patients were admitted to the Burns and Plastic surgery Hospital in Sulaimani-Kurdistan region of Iraq in 2009. Age, gender, nationality, cause of burn, extent of injury, cause of death and mortality rate were tabulated and analyzed, 338 (38.2%) were male and 546 (61.8%) were female. The highest number of cases occurred in January, with the highest short period incidence occurring in April. Out of 884 cases, 260 persons died. Burn injuries were more frequent and larger with higher mortality in females than in males. Flame was the major cause of burns. Self-inflicted burns were noted mainly in young women. A large number of burns which affect children and females, occur in the domestic setting and could have been prevented. Therefore, it is necessary to implement programs for health education relating to prevention of burn injuries focusing on the domestic setting. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

  5. Burns in pregnancy.

    PubMed

    Maghsoudi, Hemmat; Samnia, Roya; Garadaghi, Abasad; Kianvar, Hadi

    2006-03-01

    A 9-year prospective study of burns in pregnant women hospitalized at the Sina hospital burn center was conducted to determine the etiology and outcome of pregnant patients. Fifty-one patients (27.45% self-inflicted, 72.55% unintentional) were identified and stratified by age, burn size, presence or absence of inhalation injury, trimester of pregnancy, maternal and fetal mortality, and cause of burn. The mean patient age was 24.2 years. There were 20 maternal deaths and 23 fetal deaths. The majority of which (maternal: 13 and fetal: 13) were among self-inflicted burned pregnant women. The mean burn size was 37.7%, and was significantly larger for nonsurvivors of mother than survivors (68.8% versus 17.6%; p<0.001). In the 51 pregnant women, as the total burned body surface area exceeds 40%, both maternal and fetal mortality reaches 100%. Inhalation injuries were strongly associated with large burns, and were presents in all suicide patients. Kerosene ignition (68.6% of all patients, 100% of self-inflicted patients) was the most common type of burn. Large burn size was the strongest predictor of mortality of mother and fetus followed by the presence of inhalation injury.

  6. [The pain from burns].

    PubMed

    Latarjet, J

    2002-03-01

    The painful events associated with the treatment of a severe burn can, because of their long-lasting and repetitive characteristics, be one of the most excruciating experiences in clinical practice. Moreover, burn pain has been shown to be detrimental to burn patients. Although nociception and peripheral hyperalgesia are considered the major causes of burn pain, the study of more hypothetical mechanisms like central hyperalgesia and neuropathic pain may lead to a better understanding of burn pain symptoms and to new therapeutic approaches. Continuous pain and intermittent pain due to therapeutic procedures are two distinct components of burn pain. They have to be evaluated and managed separately. Although continuous pain is by far less severe than intermittent pain, the treatment is, in both cases, essentially pharmacological relying basically on opioids. Because of wide intra- and inter-individual variations, protocols will have to leave large possibilities of adaptation for each case, systematic pain evaluation being mandatory to achieve the best risk/benefit ratio. Surprisingly, the dose of medication decreases only slowly with time, a burn often remaining painful for long periods after healing. Non pharmacological treatments are often useful and sometimes indispensable adjuncts; but their rationale and their feasibility depends entirely on previous optimal pharmacological control of burn pain. Several recent studies show that burn pain management is inadequate in most burn centres.

  7. Maintaining a glycerolized skin bank--a practical approach.

    PubMed

    Vuola, J; Pipping, D

    2002-10-01

    The Helsinki Burn Unit admits around 120-140 patients a year and, of these, 20-30 need intensive care. Before 1995, fresh, non-tested cadaver skin was used to cover widely meshed autografts in large burns. In 1995, we founded a skin bank to avoid the problems encountered in the use of fresh cadaver skin: contamination by viruses or bacteria, shortage of available skin, the occasionally poor quality of the cadaver skin, and the inconvenience of harvesting skin in the mortuary. Crucial to the work of the Skin Bank has been cooperation with the Transplantation Unit of our hospital. This reduces paperwork and guarantees the quality of the donors. It also enables us to harvest skin only from tested multiorgan donors in an operating theater setting. Also important is a well organized team to ensure the procurement of a sufficient amount of good-quality allografts. This requirement raises the otherwise low costs of a glycerolized skin bank.

  8. Compensation for occupational skin diseases.

    PubMed

    Song, Han-Soo; Ryou, Hyun-chul

    2014-06-01

    The Korean list of occupational skin diseases was amended in July 2013. The past list was constructed according to the causative agent and the target organ, and the items of that list had not been reviewed for a long period. The revised list was reconstructed to include diseases classified by the International Classification of Diseases (10th version). Therefore, the items of compensable occupational skin diseases in the amended list in Korea comprise contact dermatitis; chemical burns; Stevens-Johnson syndrome; tar-related skin diseases; infectious skin diseases; skin injury-induced cellulitis; and skin conditions resulting from physical factors such as heat, cold, sun exposure, and ionized radiation. This list will be more practical and convenient for physicians and workers because it follows a disease-based approach. The revised list is in accordance with the International Labor Organization list and is refined according to Korean worker's compensation and the actual occurrence of occupational skin diseases. However, this revised list does not perfectly reflect the actual status of skin diseases because of the few cases of occupational skin diseases, incomplete statistics of skin diseases, and insufficient scientific evidence. Thus, the list of occupational diseases should be modified periodically on the basis of recent evidence and statistics.

  9. Epidermal aquaporin-3 is increased in the cutaneous burn wound.

    PubMed

    Sebastian, R; Chau, E; Fillmore, P; Matthews, J; Price, L A; Sidhaye, V; Milner, S M

    2015-06-01

    Aquaporins (AQP) are a family of transmembrane proteins that transport water and small solutes such as glycerol across cell membranes. It is a mediator of transcellular water flow and plays an important role in maintaining intra/extracellular fluid homeostasis by facilitating water transport in response to changing osmotic gradients. In the skin, AQPs permit rapid, regulated, and selective water permeability and have been demonstrated to play a role in skin hydration, cell proliferation, migration, immunity, and wound healing. However, the expression of AQP-3 in the cutaneous burn wound has never been elucidated. We sought to assess the expression of AQP-3 in patients with burn wounds. A fresh full thickness biopsy sample was taken from the center of the burn wound, the burn wound edge, and the graft donor site in 7 patients (n=21), approximately 3-7 days post injury. Fixed, paraffin embedded sections were stained using AQP-3 specific antibody and examined by immunofluorescence. Fresh samples were processed to quantify AQP-3 protein expression with Western blot analysis. The central portion of the burn wound revealed destruction of the epidermis and dermis with no AQP-3 present. Along the burn wound edge where the epidermal architecture was disrupted, there was robust AQP-3 staining. Western blot analysis demonstrated deeper staining along the burn wound edge compared to unburned skin (control). Quantification of the protein shows a significant amount of AQP-3 expression along the burn wound edge (3.6±0.34) compared to unburned skin (2.1±0.28, N=7, *p<0.05). There is no AQP-3 expression in the burn wound center. AQP-3 expression is increased in the burn wound following injury. While its role in wound healing has been defined, we report for the first time the effect of cutaneous burns on AQP-3 expression. Our data provides the first step in determining its functional role in burn wounds. We hypothesize that development of AQP3 targeted therapies may improve burn

  10. [Freon gas frostbite: an unusual burn evolving in two stages].

    PubMed

    Chaput, B; Eburdery, H; Courtade-Saïdi, M; De Bonnecaze, G; Grolleau, J-L; Garrido, I

    2012-06-01

    Freon gas is a halogenated derivative widely used in refrigeration and air conditioning. It is maintained at a temperature below -41°C and its contact with skin may cause very serious burns. This is usually an accident at work and the burns affect the hands of patients first. Unfortunately, early clinical presentation is often reassuring and does not reflect the actual depth of the injury. Few cases of this injury are reported and no treatment protocol is established at this time. We present two cases of frostbite by freon gas, initially evaluated at a stage of superficial burns and evolved spontaneously in a few days to full thickness burns necessitating surgical treatment by excision and skin grafting. This evolution in two phases has never been described and could help to better understand the pathophysiology of this frostbite and the possibilities of management. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  11. [Tactics of treatment for extended burns of various affection depth].

    PubMed

    Kovalenko, O M

    2012-02-01

    Investigation was based on analysis of the treatment results of 75 children, suffering extended superficial and deep skin burns squared 15-30% of body surface. There was proved, that sequence of excision of superficial and deep necrotic scab influences the burn disease course. There was elaborated algorithm of sequence of the operative treatment stages in patients, suffering extended superficial skin burns, coexisting with deep burns, the superficial necrotic scab definitely, was excised after trauma and a deep one--in the second stage. The superficial and deep necrotic scab excision before 7-9th day after trauma have promoted significant reduction of the intoxication syndrome severity, the middle molecular mass peptides, indices of peroxidal oxidization of lipids, oxidizing modification of proteins, clinical signs of SIRS, rate of septic complications in 1.75 times, the stationary treatment time of severely ill patients by (7.2 +/- 1.5) days.

  12. Burn care standards in Israel: lack of consensus.

    PubMed

    Haik, J; Ashkenazy, O; Sinai, S; Tessone, A; Barda, Y; Winkler, E; Orenstein, A; Mendes, D

    2005-11-01

    In recent years, the need for a national burn center based on ABA guidelines has emerged in Israel. The formation of such a center is now underway in the Chaim Sheba Medical Center. As a first step in the standardization of burn care in Israel, we have conducted a nation-wide survey among burn care personnel (physicians, nurses and other burn team members), regarding different aspects of the treatment of burn patients. A questionnaire comprised of 30 questions regarding the severity of burns admitted, the site of initial management, wound care (both burn/skin-graft sites and donor sites), dressing changes protocols, sterility precautions, hydrotherapy, and pressure dressings was presented to 70 health-care professionals involved in the treatment of burns. Seventy-seven percent of interviewed personnel participated in the survey. Consensus was found regarding most local (topical) wound care, (SSD for clean non-facial burns, Sulfamylon (mafenide-acetate) for contaminated non-facial burns, Threolone (chloramphenicol 3% and prednisolone 0.5%) or Bacitracin for facial burns, Paraffin gauzes with or without Sulfamylon for donor and graft sites). Dressing changes regimes were also agreed upon generally. However, there was no consensus regarding the ideal time for the removal of donor site dressings and this issue will need to be resolved. Other important findings are that both Edinborough University Solution of Lime (EUSOL), which has been deemed unsuitable for burn treatment due to toxic effects, and hydrotherapy, which has been proposed as a source of infection and contamination, are still widely used. We anticipate that these issues will be settled in our unified national burn care protocols (which are currently under development and revision).

  13. Burns at KCMC: epidemiology, presentation, management and treatment outcome.

    PubMed

    Ringo, Y; Chilonga, K

    2014-08-01

    About 90% of the global burden of burns occurs in the low and middle income countries. In Africa it is estimated that between 17,000 and 30,000 children under five die each year due to burns. In Tanzania there are no specialized burn centers. Burn patients are often managed in the general surgical wards in most hospitals. Kilimanjaro Christian Medical Centre is one of the four tertiary referral hospitals in Tanzania. This study aimed to review the epidemiology presentation management and outcome of burn patients in this challenging environment. A cross-sectional prospective study involving 41 patients was undertaken from October 2011 to April 2012. 65.9% were males. The largest age group was below 5 years (36.6%). 19.5% were epileptic. More than half of the burns were due to open flame. 80.5% had second degree burns. 56.1% had a BSA of 15% or less and 56.1% had an APACHE score of 10 or less. It was found that 73.2% of burns occurred at home. The commonest prehospital first aid applied was honey. Only 41.5% arrived in hospital within the first 24h after burn. Among the 14.6% who had skin grafting, none had early excision of burn wound. 53.7% developed wound sepsis while 24.4% developed contractures. The mortality rate was 26.8%. Children under five are the worst affected by burns. Most patients had second degree burn wounds. Inappropriate management of the burn wound started just after injury and continued even in hospital. Mortality and complication rates are high. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  14. Sensitive skin: mechanisms and diagnosis.

    PubMed

    Primavera, G; Berardesca, E

    2005-02-01

    Sensitive skin is a condition of subjective cutaneous hyperreactivity to environmental factors. Subjects experiencing this condition report exaggerated reactions when their skin is in contact with cosmetics, soaps and sunscreens, and they often report worsening after exposure to dry and cold climate. Although no sign of irritation is commonly detected, itching, burning, stinging and a tight sensation are constantly present. Generally substances that are not commonly considered irritants are involved in this abnormal response. They include many ingredients of cosmetics such as: dimethyl sulfoxide, benzoyl peroxide preparations, salicylic acid, propylene glycol, amyldimethylaminobenzoic acid and 2-ethoxyethyl methoxycinnamate. Sensitive skin and subjective irritation are widespread but still far from being completely defined and understood. The aim of this paper is to summarize the relevant literature in order to elucidate the underlying mechanisms of sensitive skin and the best testing methodologies for investigation of sensitive skin.

  15. Burns associated with fondues.

    PubMed Central

    Laliberté, D; Beaucage, C; Watts, N

    1992-01-01

    OBJECTIVE: To describe the causes of burns associated with fondues. DESIGN: Descriptive case series. PATIENTS: All 17 patients admitted to a burn centre between Apr. 1, 1985, and Mar. 31, 1990, whose burns were associated with fondue. Eleven agreed to complete a telephone interview. RESULTS: The age of the 17 patients varied from 2 to 56 (mean 27) years. Two causes were identified: spilling of the contents of the fondue pot and explosion of the fondue fuel when added to the burner during a meal. The telephone interview revealed that eight people other than the respondents were burned during the same accidents. CONCLUSION: Although we identified only badly burned patients the problem may be more extensive. The knowledge of specific causes of burns from handling fondue equipment indicates that preventive action should be undertaken. More epidemiologic information is needed to obtain a precise estimate of the magnitude of this public health problem. PMID:1393897

  16. Burns associated with fondues.

    PubMed

    Laliberté, D; Beaucage, C; Watts, N

    1992-10-01

    To describe the causes of burns associated with fondues. Descriptive case series. All 17 patients admitted to a burn centre between Apr. 1, 1985, and Mar. 31, 1990, whose burns were associated with fondue. Eleven agreed to complete a telephone interview. The age of the 17 patients varied from 2 to 56 (mean 27) years. Two causes were identified: spilling of the contents of the fondue pot and explosion of the fondue fuel when added to the burner during a meal. The telephone interview revealed that eight people other than the respondents were burned during the same accidents. Although we identified only badly burned patients the problem may be more extensive. The knowledge of specific causes of burns from handling fondue equipment indicates that preventive action should be undertaken. More epidemiologic information is needed to obtain a precise estimate of the magnitude of this public health problem.

  17. Financial burden of burn injuries in iran: a report from the burn registry program

    PubMed Central

    Karimi, H.; Motevalian, S.A.; Momeni, M.; Ghadarjani, M.

    2015-01-01

    Summary Understanding the cost of burn treatment is very important for patients, their families, governmental authorities and insurance companies. It alleviates patient and familial stress, provides a framework for better use of resources, and facilitates better performance between burn centers. Hospital burn costs can provide a basis for authorities to budget for acute burn treatment, for further management of chronic complications, and for planning prevention and public educational programs in Iran. To identify costs we used data from our burn registry program. Over the two-year assessment period, we treated roughly 28,700 burn patients, 1,721 of whom were admitted, with a mortality rate of 5.9%. The male to female ratio was 1.7:1 (63% male; 37% female). Flame burns were most frequent (49.8%) followed by scalds (35.7%). Mean hospital stay was 14.41 days (range 0-64 days). Mean TBSA was 17.39%. Skin grafts were carried out in 65.4% of the patients, with a mean of 5.2 surgeries per patient. The total cost of all patient admissions over the two years was US$ 4,835,000. The maximum treatment cost for one patient was US$ 91,000. The mean cost per patient was US$ 2,810 (29,500,000 Rials). The mean cost for each percent of burn was US$ 162. The mean cost for a one-day stay in hospital was US$ 195. The mean cost of each operation was US$ 540. Patients who contracted infections endured longer hospital stays, meaning increased costs of US$ 195 per day. With comparable outcome and results, the cost of burn treatment in Iran is cheaper than in the US and Europe PMID:27777552

  18. Financial burden of burn injuries in iran: a report from the burn registry program.

    PubMed

    Karimi, H; Motevalian, S A; Momeni, M; Ghadarjani, M

    2015-12-31

    Understanding the cost of burn treatment is very important for patients, their families, governmental authorities and insurance companies. It alleviates patient and familial stress, provides a framework for better use of resources, and facilitates better performance between burn centers. Hospital burn costs can provide a basis for authorities to budget for acute burn treatment, for further management of chronic complications, and for planning prevention and public educational programs in Iran. To identify costs we used data from our burn registry program. Over the two-year assessment period, we treated roughly 28,700 burn patients, 1,721 of whom were admitted, with a mortality rate of 5.9%. The male to female ratio was 1.7:1 (63% male; 37% female). Flame burns were most frequent (49.8%) followed by scalds (35.7%). Mean hospital stay was 14.41 days (range 0-64 days). Mean TBSA was 17.39%. Skin grafts were carried out in 65.4% of the patients, with a mean of 5.2 surgeries per patient. The total cost of all patient admissions over the two years was US$ 4,835,000. The maximum treatment cost for one patient was US$ 91,000. The mean cost per patient was US$ 2,810 (29,500,000 Rials). The mean cost for each percent of burn was US$ 162. The mean cost for a one-day stay in hospital was US$ 195. The mean cost of each operation was US$ 540. Patients who contracted infections endured longer hospital stays, meaning increased costs of US$ 195 per day. With comparable outcome and results, the cost of burn treatment in Iran is cheaper than in the US and Europe.

  19. The Burns Registry of Australia and New Zealand: progressing the evidence base for burn care.

    PubMed

    Cleland, Heather; Greenwood, John E; Wood, Fiona M; Read, David J; Wong She, Richard; Maitz, Peter; Castley, Andrew; Vandervord, John G; Simcock, Jeremy; Adams, Christopher D; Gabbe, Belinda J

    2016-03-21

    Analysis of data from the Burns Registry of Australia and New Zealand (BRANZ) to determine the extent of variation between participating units in treatment and in specific outcomes during the first 4 years of its operation. BRANZ, an initiative of the Australian and New Zealand Burn Association, is a clinical quality registry developed in accordance with the Australian Commission on Safety and Quality in Healthcare national operating principles. Patients with burn injury who fulfil pre-defined criteria are transferred to and managed in designated burn units. There are 17 adult and paediatric units in Australia and New Zealand that manage almost all patients with significant burn injury. Twelve of these units treat adult patients. Data on 7184 adult cases were contributed by ten acute adult burn units to the registry between July 2010 and June 2014.Major outcomes: In-hospital mortality, hospital length of stay, skin grafting rates, and rates of admission to intensive care units. Considerable variations in unit profiles (including numbers of patients treated), in treatment and in outcomes were identified. Despite the highly centralised delivery of care to patients with severe or complex burn injury, and the relatively small number of specialist burn units, we found significant variation between units in clinical management and in outcomes. BRANZ data from its first 4 years of operation support its feasibility and the value of further development of the registry. Based on these results, the focus of ongoing research is to improve understanding of the reasons for variations in practice and of their effect on outcomes for patients, and to develop evidence-informed clinical guidelines for burn management in Australia and New Zealand.

  20. One Burn, One Standard

    DTIC Science & Technology

    2014-09-01

    for supporting burn treatment has induced a rethinking of current medical documentation processes of burns, especially with respect to the Lund...Browder burn diagram. In the past, the lack of comparability, scientific evalu- ation possibilities, and as a consequence, missing medical evidence in...to interested parties after registration. To that end, a protected (everyone is able to read the content, one has to register to edit) wiki (www

  1. Skin Biomes.

    PubMed

    Fyhrquist, N; Salava, A; Auvinen, P; Lauerma, A

    2016-05-01

    The cutaneous microbiome has been investigated broadly in recent years and some traditional perspectives are beginning to change. A diverse microbiome exists on human skin and has a potential to influence pathogenic microbes and modulate the course of skin disorders, e.g. atopic dermatitis. In addition to the known dysfunctions in barrier function of the skin and immunologic disturbances, evidence is rising that frequent skin disorders, e.g. atopic dermatitis, might be connected to a dysbiosis of the microbial community and changes in the skin microbiome. As a future perspective, examining the skin microbiome could be seen as a potential new diagnostic and therapeutic target in inflammatory skin disorders.

  2. Burn Wound Infections

    PubMed Central

    Church, Deirdre; Elsayed, Sameer; Reid, Owen; Winston, Brent; Lindsay, Robert

    2006-01-01

    Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices. PMID:16614255

  3. Burn wound infections.

    PubMed

    Church, Deirdre; Elsayed, Sameer; Reid, Owen; Winston, Brent; Lindsay, Robert

    2006-04-01

    Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices.

  4. Choosing Wood Burning Appliances

    EPA Pesticide Factsheets

    Information to assist consumers in choosing a wood burning appliance, including types of appliances, the differences between certified and non-certified appliances, and alternative wood heating options.

  5. Perturbed mononuclear phagocyte system in severely burned and septic patients

    PubMed Central

    Xiu, Fangming; Jeschke, Marc G.

    2013-01-01

    Burn is one of the most common and devastating forms of trauma. Major burn injury disturbs the immune system, resulting in marked alterations in bone marrow hematopoiesis and a progressive suppression of the immune response, which are thought to contribute to increased susceptibility to secondary infections and the development of sepsis. Immunosuppression in severely burned and septic patients leads to high morbidity and mortality in these patients. Mononuclear Phagocytes System (MPS) is a critical component of the innate immune response and play key roles in burn immunity. These phagocytes are the first cellular responders to severe burn injury after acute disruption of the skin barrier. They are not only able to internalize and digest bacteria and dead cells and scavenge toxic compounds produced by metabolism, but also able to initiate an adaptive immune response. Severe burn and sepsis profoundly inhibit the functions of DC, monocyte and macrophage. Adoptive transfer of MPS or stem cells to severely burned and septic patients that aim to restore MPS function is promising. A better understanding of the roles played by MPS in the pathophysiology of severe burn and sepsis will guarantee a more rational and effective immunotherapy of severely burned and septic patients. PMID:23860581

  6. [Reconstruction of the ear in the burns patient].

    PubMed

    Carrillo-Córdova, Jorge Raúl; Jiménez Murat, Yusef; Apellaniz-Campo, Armando; Bracho-Olvera, Hazel; Carrillo Esper, Raúl

    2017-03-06

    Face burns are a singular pathology with great functional and psychological impact in the patients suffering them. The ears play a fundamental role in personal interactions and damage to this organ results in physical and emotional distress. The reconstructive treatment of the burned ear is a challenge. Multiple procedures have been described to achieve success in the reconstruction of the burned ear; immediate reconstruction with autologous rib cartilage, secondary reconstruction, alloplastic material reconstruction, tissue expansion, skin grafts and also microvascular flaps are some of the most common procedures used in this patients. All these techniques focus on giving a natural appearance to the patient. Burns to the ears affect 30% of the patients with facial burns, they require an excellent treatment given by a multidisciplinary team.

  7. Rehabilitation of burn injured patients following lightning and electrical trauma.

    PubMed

    Selvaggi, Gennaro; Monstrey, Stan; Van Landuyt, Koen; Hamdi, Moustapha; Blondeel, Phillip

    2005-01-01

    Electrical burn injuries are complicated because of damage to many structures including: blood vessels, muscles, nerves, tendons, bone and skin. Surgeons must confront many problems such as wound healing coverage, scarring, loss of nerve and tendons, progressive joint stiffness and amputation. The goals of burn therapists are to achieve wound healing, functional recovery, and good cosmetic results. Rehabilitation is both preventive and therapeutic and is a fundamental part of managing these patients. In this article, rehabilitation is discussed with emphasis on the following: pain management, wound coverage, positioning, splinting, and exercises (range-of-motion and ambulation). The treatment and prevention of hypertrophic scarring is evaluated. Finally, the use of engineering and assistive technologies for rehabilitation of the electrical burn injured patient is discussed. Successful management of electrical burn injured patients involves communication among the different burn specialists, such as surgeons, anesthesiologists, neurologists, nurses, and kinesitherapists; engineers from the garments/prostheses companies; psychologists; and the patient him/herself.

  8. A review of negative-pressure wound therapy in the management of burn wounds.

    PubMed

    Kantak, Neelesh A; Mistry, Riyam; Halvorson, Eric G

    2016-12-01

    Negative pressure has been employed in various aspects of burn care and the aim of this study was to evaluate the evidence for each of those uses. The PubMed and Cochrane CENTRAL databases were queried for articles in the following areas: negative pressure as a dressing for acute burns, intermediate treatment prior to skin grafting, bolster for skin autografts, dressing for integration of dermal substitutes, dressing for skin graft donor sites, and integrated dressing in large burns. Fifteen studies met our inclusion criteria. One study showed negative pressure wound therapy improved perfusion in acute partial-thickness burns, 8 out of 9 studies showed benefits when used as a skin graft bolster dressing, 1 out of 2 studies showed improved rate of revascularization when used over dermal substitutes, and 1 study showed increased rate of re-epithelialization when used over skin graft donor sites. Negative pressure can improve autograft take when used as a bolster dressing. There is limited data to suggest that it may also improve the rate of revascularization of dermal substitutes and promote re-epithelialization of skin graft donor sites. Other uses suggested by studies that did not meet our inclusion criteria include improving vascularity in acute partial-thickness burns and as an integrated dressing for the management of large burns. Further studies are warranted for most clinical applications to establish negative pressure as an effective adjunct in burn wound care. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  9. Treatment of Burn and Surgical Wounds With Recombinant Human Tropoelastin Produces New Elastin Fibers in Scars.

    PubMed

    Xie, Hua; Lucchesi, Lisa; Zheng, Bo; Ladich, Elena; Pineda, Teresa; Merten, Rose; Gregory, Cynthia; Rutten, Michael; Gregory, Kenton

    2017-02-15

    Tropoelastin (TE), the soluble precursor of insoluble elastin fibers, is produced in minimal amounts in adults. Burn injuries result in inflexible collagen-rich scars because of lack of elastin fiber formation. We studied the feasibility of using recombinant human tropoelastin to enable elastin fiber production in burn and surgical scars to improve skin flexibility. In a swine hypertrophic burn scar model, normal skin and 3 × 3-cm partial thickness thermal burns underwent dermatome resection at 1 week post burn and randomized to four subcutaneous injections of saline or TE (either 0.5, 5, or 10 mg/ml) spaced 3 days apart. Two burn sites received TE injections after wound closure (0.5 or 10 mg/ml). At 90 days, skin hardness, flexibility, and histology were evaluated. All injury sites developed hypertrophic scars. New elastin fibers were found in burn scars in all injuries injected after skin closure with low (5/5) and high (6/6) TE doses (P < .05). No elastin fibers were observed without TE treatment. No significant differences in skin hardness, flexibility, or inflammation were observed. This is the first report demonstrating that subcutaneous injections of TE into surgical and burn injuries can safely produce new elastin fibers in scars. Despite the development of new elastin fibers, skin flexibility was not improved, possibly because of insufficient elastin fiber maturation or the hypertrophic model used. The ability to restore elastin fiber formation in adult skin after burns, trauma, and surgery may improve skin regeneration and reduce disabling complications of scar formation.

  10. Segmentation and classification of burn images by color and texture information.

    PubMed

    Acha, Begoña; Serrano, Carmen; Acha, José I; Roa, Laura M

    2005-01-01

    In this paper, a burn color image segmentation and classification system is proposed. The aim of the system is to separate burn wounds from healthy skin, and to distinguish among the different types of burns (burn depths). Digital color photographs are used as inputs to the system. The system is based on color and texture information, since these are the characteristics observed by physicians in order to form a diagnosis. A perceptually uniform color space (L*u*v*) was used, since Euclidean distances calculated in this space correspond to perceptual color differences. After the burn is segmented, a set of color and texture features is calculated that serves as the input to a Fuzzy-ARTMAP neural network. The neural network classifies burns into three types of burn depths: superficial dermal, deep dermal, and full thickness. Clinical effectiveness of the method was demonstrated on 62 clinical burn wound images, yielding an average classification success rate of 82%.

  11. Hot bitumen burns: 92 hospitalized patients.

    PubMed

    Baruchin, A M; Schraf, S; Rosenberg, L; Sagi, A A

    1997-08-01

    Bitumen burns while comprising a small percentage of all types of burns are troublesome. They affect persons engaged in gainful employment which the burns then curtail, as well as requiring special attention because the substance adheres to the skin and is therefore difficult to remove. Ninety-two consecutive patients with such burns who were admitted as in-patients over a 10-year period (1985-1995) have been reviewed. Most of the burns occurred on a worksite and involved active young persons (mean age 29.6 years) the mean size of the burn was 3.87 per cent TBSA, mainly affecting the upper extremities and hands. Mean hospitalization time was 10.6 days. Bitumen burns are fully predictable and can easily be prevented by avoiding unsafe practice and/or equipment. Bitumen is a general term for petroleum-derived substances ranging from true petroleum through so-called mineral tars, to asphalt. Asphalt (Asphaltum) is a semi-solid mixture of several hydrocarbons probably formed by the evaporation of the lighter or more volatile constituents. It is amorphous of low specific gravity, 1-2, with a black or brownish black colour and pitchy lustre. At room temperature it is solid becoming molten and spreadable when heated to 93 degrees C and over. Roofing tars and asphalts are usually heated to temperatures of 232 degrees C to achieve desirable viscosities (e.g. for spraying), whereas lower temperatures are required for the manageable form to pave roads. Notable localities for asphaltum are the island of Trinidad and the Dead Sea region where lake asphaltums were long known to the ancient. Ironically, none of the 92 patients who were treated for bitumen injuries in the 'Soroka' (Beer-Sheba, Israel) and 'Barzilai' (Ashkelon, Israel) Medical Centres (80 and 150 km from the lake respectively) had anything to do with the Dead Sea area.

  12. Mafenide acetate solution dressings: an adjunct in burn wound care.

    PubMed

    Shuck, J M; Thorne, L W; Cooper, C G

    1975-07-01

    A continuation of the study of 5% aqueous Sulfamylon solution dressings in burned patients was analyzed in 150 consecutive cases. The rate of invasive infection and mortality was not excessive. Dressings were used as an adjunct to other topical chemotherapeutic agents as well as homo/heterograft skin in the overall burn care program. Sulfamylon soaks were shown to be effective for debridement, granulation tissue protection and preparation, and bacterial control. The dressings were comfortable when in place and the wounds appeared clean. Epithelialization was not hampered so that the dressings could be utilized in partial thickness wounds as well as for mesh autografts on extensive burn surfaces=

  13. Quantitative assessments of burn degree by high-frequency ultrasonic backscattering and statistical model

    NASA Astrophysics Data System (ADS)

    Lin, Yi-Hsun; Huang, Chih-Chung; Wang, Shyh-Hau

    2011-02-01

    An accurate and quantitative modality to assess the burn degree is crucial for determining further treatments to be properly applied to burn injury patients. Ultrasounds with frequencies higher than 20 MHz have been applied to dermatological diagnosis due to its high resolution and noninvasive capability. Yet, it is still lacking a substantial means to sensitively correlate the burn degree and ultrasonic measurements quantitatively. Thus, a 50 MHz ultrasound system was developed and implemented to measure ultrasonic signals backscattered from the burned skin tissues. Various burn degrees were achieved by placing a 100 °C brass plate onto the dorsal skins of anesthetized rats for various durations ranged from 5 to 20 s. The burn degrees were correlated with ultrasonic parameters, including integrated backscatter (IB) and Nakagami parameter (m) calculated from ultrasonic signals acquired from the burned tissues of a 5 × 1.4 mm (width × depth) area. Results demonstrated that both IB and m decreased exponentially with the increase of burn degree. Specifically, an IB of -79.0 ± 2.4 (mean ± standard deviation) dB for normal skin tissues tended to decrease to -94.0 ± 1.3 dB for those burned for 20 s, while the corresponding Nakagami parameters tended to decrease from 0.76 ± 0.08 to 0.45 ± 0.04. The variation of both IB and m was partially associated with the change of properties of collagen fibers from the burned tissues verified by samples of tissue histological sections. Particularly, the m parameter may be more sensitive to differentiate burned skin due to the fact that it has a greater rate of change with respect to different burn durations. These ultrasonic parameters in conjunction with high-frequency B-mode and Nakagami images could have the potential to assess the burn degree quantitatively.

  14. Radiation sterilization of skin allograft

    NASA Astrophysics Data System (ADS)

    Kairiyama, E.; Horak, C.; Spinosa, M.; Pachado, J.; Schwint, O.

    2009-07-01

    In the treatment of burns or accidental loss of skin, cadaveric skin allografts provide an alternative to temporarily cover a wounded area. The skin bank facility is indispensable for burn care. The first human skin bank was established in Argentina in 1989; later, 3 more banks were established. A careful donor selection is carried out according to the national regulation in order to prevent transmissible diseases. As cadaveric human skin is naturally highly contaminated, a final sterilization is necessary to reach a sterility assurance level (SAL) of 10 -6. The sterilization dose for 106 batches of processed human skin was determined on the basis of the Code of Practice for the Radiation Sterilization of Tissue Allografts: Requirements for Validation and Routine Control (2004) and ISO 11137-2 (2006). They ranged from 17.6 to 33.4 kGy for bioburdens of >10-162.700 CFU/100 cm 2. The presence of Gram negative bacteria was checked for each produced batch. From the analysis of the experimental results, it was observed that the bioburden range was very wide and consequently the estimated sterilization doses too. If this is the case, the determination of a tissue-specific dose per production batch is necessary to achieve a specified requirement of SAL. Otherwise if the dose of 25 kGy is preselected, a standardized method for substantiation of this dose should be done to confirm the radiation sterilization process.

  15. Propolis and amnion reepithelialise second-degree burns in rats.

    PubMed

    Pessolato, Alicia Greyce Turatti; Martins, Daniele dos Santos; Ambrósio, Carlos Eduardo; Mançanares, Celina Almeida Furlanetto; de Carvalho, Ana Flávia

    2011-11-01

    Burns are serious consequences of trauma in terms of both imminent mortality and prolonged periods of morbidity. They are often accompanied by unsatisfactory cosmetic as well as functional and psychological outcomes. These complications emphasise the need for stronger efforts in achieving greater diversity and effectiveness in the treatment of skin burns. This study aimed to verify the effectiveness of gross and microscopic epidermal and dermal responses in the process of regenerative repair or healing of burns in rats that were treated either daily with 5% propolis ointment or by autologous amnion graft. Second-degree burns were inflicted in the neck region of female rats by contact with a hot metal (at 130 °C) for 5 s. Propolis treatment accelerated the process of tissue repair and led to decreased local inflammation, which indicates that treatment with propolis was successful in the initial period (7 days) and stimulated the production of collagen fibre (assessed by morphometry) in all the periods evaluated (14 and 21 days). Amnion treatment inhibited local inflammation (assessed macroscopically), stimulated local epithelial regeneration (assessed microscopically) and stimulated the production of collagen fibre (assessed by morphometry) in the days following burn. These treatments offer new therapeutic strategies for treating severe skin burns; these strategies may allow the minimisation of scar formation, a more rapid return of function and, ultimately, a better quality of life for burn patients.

  16. Zinc burns: a rare burn injury.

    PubMed

    de Juan, A; Ramon, P; Santoyo, F; Alonso, S

    2000-08-01

    A patient was presented with significant burns resulting from a workplace accident in a zinc production unit. This occurred as a result of the spontaneous combustion of zinc bleed under high pressure. The patient sustained burns to the face, body, and hands and suffered significant injury to the left cornea. Computed imaging revealed solid particles in the ethmoid sinus and also in the right nasal fossa, dissecting the right lacrimal duct. Photographic documentation is presented. This injury was potentially preventable and resulted from poor observance of safety procedures.

  17. Jewelry Ring-Associated Electrothermal Burn Injuries: A Nine-Patient Case Series.

    PubMed

    Mushin, Oren P; Bogue, Jarrod T; Pencek, Megan E; Bell, Derek E

    Ring-associated burns are infrequent, comprising only a small fraction of burn consults and admissions. However, because of the location of these burns and the propensity for circumferential wounds, small burn size may belie the severity of resultant injuries. Herein, the authors present their experience with this potentially severe type of burn. Records from a regional burn center were retrospectively analyzed during a 36-month period. All patients who sustained ring burns were included. Data points included demographics, burn location, need for surgical intervention, grafted area, hospital days (length of stay), percent graft take, complications, and time to re-epithelialization. Nine patients sustained ring-associated burns during the study period, accounting for 1.4% of all patients with burns seen during the same period. Average age was 41 years (range: 29-52 years). Seven (77%) ring-associated burns involved contact with a battery. All injuries were circumferential. Average burn TBSA was 0.07%. Two patients (22%) had third-degree injuries, both of which received split-thickness skin grafts. Grafted area was 4 and 5 cm, respectively. Average length of stay was 2.8 days. Mean graft take was 99.5 ± 1.5%. Average time to complete re-epithelialization was 12 days. One patient suffered temporary disability. No patients suffered from compartment syndrome. Ring-associated burns are an uncommon source of injury in the burn population. Despite small burn TBSA, these patients are more likely to require split-thickness skin grafts and suffer dysfunction compared with similarly-sized burns in other body regions. Expedient treatment and coordination with occupational therapy should be undertaken to achieve optimal outcomes.

  18. A new apparatus for standardization of experimental burn models.

    PubMed

    Arda, Mehmet Surhan; Koçman, Atacan Emre; Söztutar, Erdem; Baksan, Bedri; Çetin, Cengiz

    2017-09-01

    Burns have severe economic burden for families and countries therefore its treatment modalities have utmost importance. Several study both experimental or clinic has been reported accordingly. Although contact burns were frequently used models, most of them were manually designed. The elapsed time was recorded only. However, the real time contact surface temperature (T) and weight force (WF) were fundamental characteristics of a burn model. The aim of this study is to create a standard burn model with recording real time variables on behalf of custom designed apparatus. A custom designed apparatus was manufactured in which the variables of real time T, WF and elapsed time could be set and record. A vertical angle was provided to ensure the applied WF. And hence, Sprague-Dawley rats were randomly divided into four groups: (1) Burned at 60±1°C with low WF(G60WFL), (2) Burned at 60±1°C with high WF(G60WFH), (3) Burned at 80±1°C with low WF(G80WFL), (4) Burned at 80±1°C with high WF(G80WFH). The healthy skin thickness and burn depth were measured. The percentage of burn depth to healthy skin was used for statistical analysis. Constant variables T and WF were achieved. The pressure applied on skin was not significant between low [G60WFL vs G80WFL, (p=0.1704)] and high [G60WFH vs G80WFH (p=0.2369)] WF groups. However the percentage of burn depth was increasing owing to applied WF in 60°C group [G60WFL vs G60WFH, (p=0.0125)] and in 80°C group [G80WFL vs G80WFH (p<0.0001)]. And also the percentage was significantly increasing owing to set T, in low WF group [G60WFL vs G80WFL (p<0.0001)] and high WF group [G60WFH vs G80WFH (p<0.0001)]. Besides neither T nor WF has priority. Without recording the real time T and WF, it is infeasible to achieve a standard burn model. For a standard depth of burn, variables should be under control, as if our custom designed apparatus. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  19. A major burn injury in a liver transplant patient

    PubMed Central

    Delikonstantinou, I.; Philp, B.; Kamel, D.; Barnes, D.; Dziewulski, P.

    2016-01-01

    Summary Immunosuppressive therapy may aggravate the clinical course of a burned patient, primarily affecting wound healing and thus complicating permanent wound coverage. We hereby present the successful management of a 48-year-old female liver transplant recipient with a major burn injury, aiming to elucidate the effects of the patient’s immunosuppression on surgical treatment. After admission to the Burns ITU, the patient underwent serial debridement of the burn and coverage with cryopreserved allografts. Despite immunosuppression, no prolonged survival of the allo-epidermis was documented. Nevertheless, a variable degree of vascularized allo-dermis was clinically identified. She subsequently underwent skin autografting and was discharged home with most of the wounds healed. Although there are isolated reports of survival of skin allografts in immunocompromised patients, in our case the allografted skin did not provide permanent wound coverage. However, it permitted a staged surgical management, allowing the immunosuppressive regime to change, the skin donor sites to heal and it also provided a dermal scaffold for successful skin autografting. PMID:28149251

  20. Nutrition of burned patients.

    PubMed

    Gudaviciene, Daiva; Rimdeika, Rytis; Adamonis, Kestutis

    2004-01-01

    Burns form 5-12% of all traumas. About 2,200 of patients are annually hospitalized in Lithuania. In most cases people of the employable age get burned. The treatment is often long-lasting, and afterwards recovered patients often have invalidity from burn sequels. The mortality of hospitalized burned patients is about 10%. The most common causes of death are pulmonary edema, pneumonia, sepsis and multiorgan failure. All these complications are related with insufficient nutrition. These complications are extremely frequent and dangerous for patients with more than 20% of body burned. The nutritional support of burned patient gives a possibility to increase the survival probability, to decrease complication rate and hospitalization time. Currently in Lithuania there are no standards for burned patient nutrition. More attention is given to strategy of surgical strategy and techniques, as well as antibiotic therapy. This article is the review of the different aspects of artificial nutrition of burned patient: indications, modes of nutrition, mixtures and terms of nutritional support.

  1. Pain in burn patients.

    PubMed

    Latarjet, J; Choinère, M

    1995-08-01

    While severe pain is a constant component of the burn injury, inadequate pain management has been shown to be detrimental to burn patients. Pain-generating mechanisms in burns include nociception, primary and secondary hyperalgesia and neuropathy. The clinical studies of burn pain characteristics reveal very clear-cut differences between continuous pain and pain due to therapeutic procedures which have to be treated separately. Some of the main features of burn pain are: (1) its long-lasting course, often exceeding healing time, (2) the repetition of highly nociceptive procedures which can lead to severe psychological disturbances if pain control is inappropriate. Pharmaco-therapy with opioids is the mainstay for analgesia in burned patients, but non-pharmacological techniques may be useful adjuncts. Routine pain evaluation is mandatory for efficient and safe analgesia. Special attention must be given to pain in burned children which remains too often underestimated and undertreated. More educational efforts from physicians and nursing staff are necessary to improve pain management in burned patients.

  2. Burning Mouth Syndrome.

    PubMed

    Kamala, K A; Sankethguddad, S; Sujith, S G; Tantradi, Praveena

    2016-01-01

    Burning mouth syndrome (BMS) is multifactorial in origin which is typically characterized by burning and painful sensation in an oral cavity demonstrating clinically normal mucosa. Although the cause of BMS is not known, a complex association of biological and psychological factors has been identified, suggesting the existence of a multifactorial etiology. As the symptom of oral burning is seen in various pathological conditions, it is essential for a clinician to be aware of how to differentiate between symptom of oral burning and BMS. An interdisciplinary and systematic approach is required for better patient management. The purpose of this study was to provide the practitioner with an understanding of the local, systemic, and psychosocial factors which may be responsible for oral burning associated with BMS, and review of treatment modalities, therefore providing a foundation for diagnosis and treatment of BMS.

  3. [Chickenpox, burns and grafts].

    PubMed

    Rojas Zegers, J; Fidel Avendaño, L

    1979-01-01

    An outbreak of chickenpox that occurred at the Burns Repair Surgery Unit, Department of Children's Surgery, Hospital R. del Río, between June and November, 1975, is reported. 27 cases of burned children were studied, including analysis of correlations of the stages and outcome of the disease (varicela), the trauma (burns) and the graft (repair surgery). As a result, the authors emphasize the following findings: 1. Burns and their repair are not aggravating factors for varicella. In a small number of cases the exanthema looked more confluent in the graft surgical areas and in the first degree burns healing spontaneously. 2. Usually there was an uneventful outcome of graft repair surgery on a varicella patient, either during the incubation period, the acme or the convalescence. 3. The fact that the outmost intensity of secondary viremia of varicella occurs before the onset of exanthemia, that is, during the late incubation period, is confirmed.

  4. Burning mouth syndrome.

    PubMed

    Nasri-Heir, Cibele

    2012-01-01

    According to the International Association for the Study of Pain, burning mouth Syndrome (BMS) is defined as a burning pain in the tongue or other oral mucous membrane in the absence of clinical signs or laboratory findings. The etiology is unknown and presents a challenge for both researchers and clinicians. The management of BMS is still not satisfactory. The prognosis is poor and the burning sensation can last for many years causing a dramatic impact on the patient's quality of life. It is important to distinguish between true BMS and symptomatic burning sensation which occurs when the burning sensation is secondary to a local or systemic pathologic condition. Currently, there are no defined diagnostic criteria for BMS. A diagnosis is usually reached by exclusion of other diseases. This may lead to misdiagnoses, presenting an obstacle to successful treatment.

  5. Tissue engineering of cultured skin substitutes.

    PubMed

    Horch, Raymund E; Kopp, Jürgen; Kneser, Ulrich; Beier, Justus; Bach, Alexander D

    2005-01-01

    Skin replacement has been a challenging task for surgeons ever since the introduction of skin grafts by Reverdin in 1871. Recently, skin grafting has evolved from the initial autograft and allograft preparations to biosynthetic and tissue-engineered living skin replacements. This has been fostered by the dramatically improved survival rates of major burns where the availability of autologous normal skin for grafting has become one of the limiting factors. The ideal properties of a temporary and a permanent skin substitute have been well defined. Tissue-engineered skin replacements: cultured autologous keratinocyte grafts, cultured allogeneic keratinocyte grafts, autologous/allogeneic composites, acellular biological matrices, and cellular matrices including such biological substances as fibrin sealant and various types of collagen, hyaluronic acid etc. have opened new horizons to deal with such massive skin loss. In extensive burns it has been shown that skin substitution with cultured grafts can be a life-saving measure where few alternatives exist. Future research will aim to create skin substitutes with cultured epidermis that under appropriate circumstances may provide a wound cover that could be just as durable and esthetically acceptable as conventional split-thickness skin grafts. Genetic manipulation may in addition enhance the performance of such cultured skin substitutes. If cell science, molecular biology, genetic engineering, material science and clinical expertise join their efforts to develop optimized cell culture techniques and synthetic or biological matrices then further technical advances might well lead to the production of almost skin like new tissue-engineered human skin products resembling natural human skin.

  6. Burn Scar Biomechanics Following Pressure Garment Therapy

    PubMed Central

    Kim, Jayne Y.; Willard, James J.; Supp, Dorothy M.; Roy, Sashwati; Gordillo, Gayle M.; Sen, Chandan K.; Powell, Heather M.

    2015-01-01

    Background The current standard of care for the prevention and treatment of scarring following burn injury is pressure garment therapy (PGT). Although this therapy has been used clinically for many years, controversy remains regarding its efficacy. The purpose of this study was to evaluate the efficacy of PGT in a female Red Duroc pig (fRDP) burn model where wound depth could be tightly controlled. Methods Full-thickness burn wounds were generated on fRDPs. At day 28 post-burn, PGT was applied to half of the wounds (10 mmHg), with control wounds covered with garments exerting no compression. Scar area, perfusion, hardness, and elasticity were quantified at days 0, 28, 42, 56, and 72 using computerized planimetry, Laser Doppler and torsional ballistometry. Scar morphology was assessed at days 28, 56 and 76 using histology, immunohistochemistry and transmission electron microscopy. Results Pressure garment therapy significantly hindered scar contraction with control scars contracting to 64.6 + 13.9% original area at day 72 while PGT scars contracted to 82.7 + 17.9% original area. PGT significantly reduced skin hardness and increased skin strength by 1.3X. No difference in perfusion or blood vessel density was observed. Average collagen fiber diameter was greater in control burns than PGT. Conclusions PGT was effective at reducing scar contraction and improving biomechanics compared to control scars. These results confirm the efficacy of pressure garments and highlight the need to further investigate the role of pressure magnitude and time of therapy application to enhance their efficacy for optimal biomechanics and patient mobility. PMID:25989300

  7. Morphological study of burn wound healing with the use of collagen-chitosan wound dressing.

    PubMed

    Kirichenko, A K; Bolshakov, I N; Ali-Riza, A E; Vlasov, A A

    2013-03-01

    Experiments on the model of thermal skin burn in rats showed that the use of wound dressing based on collagen-chitosan complex Kollakhit-Bol in local treatment of grade IIIb skin burns increased healing rate by accelerating the formation of granulation and fibrous connective tissues and reducing crust thickness in comparison with Kollakhit coating. Kollakhit-Bol provided targeted stimulation of reparative processes in the treatment of grade IIIb burns by creating favorable conditions for grafting full thickness skin transplant or dermal-epidermal skin equivalent. In the topical treatment of thermal burn, Kollakhit-Bol application shortened the phases of alteration and exudation and accelerated transition to the productive phase of the inflammatory process with phagocytosis and neoangiogenesis activation.

  8. Enhancing the clinical utility of the burn specific health scale-brief: not just for major burns.

    PubMed

    Finlay, V; Phillips, M; Wood, F; Hendrie, D; Allison, G T; Edgar, D

    2014-03-01

    Like many other Western burn services, the proportion of major to minor burns managed at Royal Perth Hospital (RPH) is in the order of 1:10. The Burn Specific Health Scale-Brief (BSHS-B) is an established measure of recovery after major burn, however its performance and validity in a population with a high volume of minor burns is uncertain. Utilizing the tool across burns of all sizes would be useful in service wide clinical practice. This study was designed to examine the reliability and validity of the BSHS-B across a sample of mostly minor burn patients. BSHS-B scores of patients, obtained between January 2006 and February 2013 and stored on a secure hospital database were collated and analyzed Cronbach's alpha, factor analysis, logistic regression and longitudinal regression were used to examine reliability and validity of the BSHS-B. Data from 927 burn patients (2031 surveys) with a mean % total burn surface area (TBSA) of 6.7 (SD 10.0) were available for analysis. The BSHS-B demonstrated excellent reliability with a Cronbach's alpha of 0.95. First and second order factor analyses reduced the 40 item scale to four domains: Work; Affect and Relations; Physical Function; Skin Involvement, as per the established construct. TBSA, length of stay and burn surgery all predicted burn specific health in the first three months of injury (p<0.001, p<0.001, p=0.03). BSHS-B whole scale and domain scores showed significant improvement over 24 months from burn (p<0.001). The results from this study show that the structure and performance of the BSHS-B in a burn population consisting of 90% minor burns is consistent with that demonstrated in major burns. The BSHS-B can be employed to track and predict recovery after burns of all sizes to assist the provision of targeted burn care. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  9. Temperature Responses during Exercise in a Hot Environment in Severely Burned Children

    PubMed Central

    McEntire, Serina J.; Chinkes, David L.; Herndon, David N.; Suman, Oscar E.

    2014-01-01

    Objective We have previously described thermoregulatory responses of severely burned children during submaximal exercise in a thermoneutral environment. However, the thermoregulatory response of burned children to exercise in the heat is not well understood and could have important safety implications for rehabilitation. Study design Children (n=10) with >40% total body surface area burns and non-burned children (n=10) performed a 30 minute bout of treadmill exercise at 75% of their peak aerobic power in a heated environment. Intestinal temperature, burned and unburned skin temperature, and heart rate were recorded pre-exercise, every 2 minutes during exercise, and during recovery. Results Three of the 10 burned children completed the exercise bout in the heat; however, all of the non-burned children completed the 30 minute bout. One burned child reached a core body temperature > 39°C at minute 23. Burned children had a significantly higher core body temperature thru the first 12 minutes of exercise compared to non-burned children. However, 9 of 10 (90%) burned children did not become hyperthermic during exercise in the heat. Conclusion Specific to this study, hyperthermia did not typically occur in burned children, relative to non-burned children. Whether this is due to an intolerance to exercise in the heat or to an inability to generate sufficient heat during exercise needs to be explored further. PMID:20616652

  10. Prevention of Infections Associated with Combat-Related Burn Injuries

    DTIC Science & Technology

    2011-08-01

    microbial flora.19–22 Gram-positive skin flora such as Streptococcus pyogenes and Staphylococcus aureus reside deep within skin appendages and colonize...such as Pseudomonas aeruginosa, Klebsiella pneumoniae , and Escherichia coli, colonize the wound within the first 48 hours to 72 hours after injury.19,20...bacterial microorganisms that colonize the burn wound surface after injury, S. aureus, P. aeruginosa, and K. pneumoniae are the most likely to result

  11. Deodorant spray: a newly identified cause of cold burn.

    PubMed

    May, Ulrich; Stirner, Karl-Heinz; Lauener, Roger; Ring, Johannes; Möhrenschlager, Matthias

    2010-09-01

    Two patients encountered a first-degree cold burn after use of a deodorant spray. The spray-nozzle to skin-surface distance was approximately 5 cm, and the spraying lasted approximately 15 seconds. Under laboratory conditions, the deodorant in use was able to induce a decline in temperature of >60 degrees C. These 2 cases highlight a little-known potential for skin damage by deodorant sprays if used improperly.

  12. Skin Infections

    MedlinePlus

    ... to the touch may have yellow drainage Of cellulitis: a red, inflamed area on the skin that is tender to the touch may occur in an area of a scratch or cut redness often spreads rapidly over the skin's surface ...

  13. Skin Aging

    MedlinePlus

    ... heal, too. Sunlight is a major cause of skin aging. You can protect yourself by staying out of ... person has smoked. Many products claim to revitalize aging skin or reduce wrinkles, but the Food and Drug ...

  14. Skin Complications

    MedlinePlus

    ... drugs that can help clear up this condition. Day-to-Day Skin Care See our tips for daily skin ... Better Breakfast Ensure a healthy start to your day with this guide. » « Connect With Us Register for ...

  15. [Whole esophagus deep burns with a metal foreign body in the stomach: a case report].

    PubMed

    Yang, Yan; Xiao, Nengkan; Xie, Hanqiu; Tang, Zhongming

    2014-04-01

    Whole esophagus deep burn is an extremely rare upper gastrointestinal tract disease. We report a case of severe burns of involving extensive body skin, eyes, throat, and esophagus. Endoscopic examination revealed acute necrotizing esophagitis and detected a metal foreign body in the stomach. The patient underwent burn wound debridement with analgesia, anti-shock rehydration, anti-infection, and symptomatic treatments, which failed to improve the conditions. The patient died of respiratory and circulatory failure secondary to serious sepsis.

  16. Microwave oven burns to children: an unusual manifestation of child abuse.

    PubMed

    Alexander, R C; Surrell, J A; Cohle, S D

    1987-02-01

    Two children sustained full-thickness burns as a result of being placed in microwave ovens. Well demarcated burns occurred on the skin surfaces closest to the microwave-emitting devices. Morbidity was limited to complications of direct thermal effects. One of the children sustained a distinctive pattern of relative sparing of tissue layers without electrical burn features, such as nuclear streaming and charring, at the entrance site. In both instances eventual identification of this unusual etiology was initiated by child abuse concerns.

  17. A Literature Review of Burns in Reconstructed Breasts After Mastectomy.

    PubMed

    Jaeger, Marie; Wagman, Yonathan; Liran, Alon; Harats, Moti; Winkler, Eyal; Haik, Josef; Tessone, Ariel

    2016-12-01

    The goal of this literature review is to review and combine case studies of accidental burns to the breast, following mastectomy and immediate breast reconstruction with autologous tissue, implants, or tissue expanders. The authors searched PubMed and Cochrane Library and reviewed cases of burns of reconstructed breasts after mastectomy from July 1985 to May 2015. Only studies in the English language were included in their search. They also report 5 new cases of burns in patients with burns to the breast, which were either reconstructed with implants or tissue expanders at Sheba Medical Center (Ramat Gan, Israel). The authors found 21 publications regarding burns after breast reconstruction dating from 1985 to 2014, which equaled 59 cases of reported burns in the 21 included publications. The most common causes of burns were due to heat conduction (37/59) followed by solar radiation (19/59) and heat convection (3/59). The majority of the cases were treated by a conservative approach. The 5 new cases added were all due to thermal radiation (5/5). Two of these cases were treated conservatively (2/5), and 3 underwent surgery (3/5). The removal of thermoregulatory capabilities of the skin and the thickness of the remaining tissue in the mastectomy procedure are key to understanding the cause of burns to reconstructed breasts.

  18. Analytical solution of the Pennes equation for burn-depth determination from infrared thermographs.

    PubMed

    Romero-Méndez, Ricardo; Jiménez-Lozano, Joel N; Sen, Mihir; González, F Javier

    2010-03-01

    A serious problem in emergency medicine is the correct evaluation of skin burn depth to make the appropriate choice of treatment. In clinical practice, there is no difficulty in classifying first- and third-degree burns correctly. However, differentiation between the IIa (superficial dermal) and IIb (deep dermal) wounds is problematic even for experienced practitioners. In this work, the use of surface skin temperature for the determination of the depth of second-degree burns is explored. An analytical solution of the 3D Pennes steady-state equation is obtained assuming that the ratio between burn depth and the burn size is small. The inverse problem is posed in a search space consisting of geometrical parameters associated with the burned region. This space is searched to minimize the error between the analytical and experimental skin surface temperatures. The technique is greatly improved by using local one-dimensionality to provide the shape of the burned region. The feasibility of using this technique and thermography to determine skin burn depth is discussed.

  19. Use of the Mayfield horseshoe headrest for management of burns of the neck.

    PubMed

    Balakrishnan, Chenicheri; Pane, Thomas A

    2005-01-01

    Proper positioning of a patient facilitates access and decreases frustration during surgical debridement of circumferential burns of the neck. The Mayfield swivel horseshoe headrest (Integra, USA) provides cranial support in either the supine or prone position for excision and skin grafting of the circumferential burns of the neck. This headrest can also be used during reconstruction of the neck.

  20. Improving burn care and preventing burns by establishing a burn database in Ukraine.

    PubMed

    Fuzaylov, Gennadiy; Murthy, Sushila; Dunaev, Alexander; Savchyn, Vasyl; Knittel, Justin; Zabolotina, Olga; Dylewski, Maggie L; Driscoll, Daniel N

    2014-08-01

    Burns are a challenge for trauma care and a contribution to the surgical burden. The former Soviet republic of Ukraine has a foundation for burn care; however data concerning burns in Ukraine has historically been scant. The objective of this paper was to compare a new burn database to identify problems and implement improvements in burn care and prevention in this country. Retrospective analyses of demographic and clinical data of burn patients including Tukey's post hoc test, analysis of variance, and chi square analyses, and Fisher's exact test were used. Data were compared to the American Burn Association (ABA) burn repository. This study included 1752 thermally injured patients treated in 20 hospitals including Specialized Burn Unit in Municipal Hospital #8 Lviv, Lviv province in Ukraine. Scald burns were the primary etiology of burns injuries (70%) and burns were more common among children less than five years of age (34%). Length of stay, mechanical ventilation use, infection rates, and morbidity increased with greater burn size. Mortality was significantly related to burn size, inhalation injury, age, and length of stay. Wound infections were associated with burn size and older age. Compared to ABA data, Ukrainian patients had double the length of stay and a higher rate of wound infections (16% vs. 2.4%). We created one of the first burn databases from a region of the former Soviet Union in an effort to bring attention to burn injury and improve burn care. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  1. [The intermingled transplantation used in severe burn patients after eschar excision].

    PubMed

    Liao, Zhen-jiang

    2008-10-01

    In the early developing stage of burn surgery, severe burn patients with large and deep burn wound often died of complications because of shortage of auto-skin. The method of intermingled transplantation composed of a large sheet of partial thickness allo-skin with punched holes for in laying small pieces of partial thickness auto-skin was first advocated by Chinese doctors (Ruijin Hospital) in 1960's. This intermingled transplantation method has saved many severe burn patients with extensive full-thickness burn wound. The mortality rate of severe burn patients has decreased and the survival rate has increased remarkably since the intermingled transplantation treatment method used in the burn units. In this paper we review the process of formation of intermingled transplantation and the mechanisms of success of this Chinese method in repairing the large wound surface area after eschar excision. We will focus our discussion on the low systemic immunological reaction, the effect of auto-skin islet, local immunological tolerance induced by in layed auto skin, the balance of Th1 and Th2 cells and the effects of some cytokines such as IL-10 in local immunological tolerance and etc. after intermingled transplantation.

  2. Hypercoagulability after burn injury.

    PubMed

    Van Haren, Robert M; Thorson, Chad M; Valle, Evan J; Busko, Alexander M; Guarch, Gerardo A; Andrews, David M; Pizano, Louis R; Schulman, Carl I; Namias, Nicholas; Proctor, Kenneth G

    2013-07-01

    Hypercoagulability is a homeostatic response to trauma, but relatively little information is available about coagulation changes after burn injury. Therefore, we tested the hypothesis that burn patients are hypercoagulable at admission and/or during recovery. A prospective observational trial was conducted at an American Burn Association verified Burn Center. Thromboelastography (TEG) was performed on blood drawn from indwelling catheters upon admission and weekly for those who remained hospitalized. Routine and special coagulation tests were performed on stored samples. Data are expressed as median (interquartile range). Twenty-four patients (88% male) were enrolled, with a median age of 49 (20) years and a median total body surface area burn of 29% (23%); 21 experienced thermal burns (4 inhalational injuries), and 3 had electrical burns. There were no significant differences in TEG or coagulation assays between patients with thermal versus electrical burn injury, but there were significant differences between men versus women and between those with or without inhalational injury. Sixteen patients had repeat samples 1 week after intensive care unit admission. The repeat TEG was more hypercoagulable (all p < 0.05). Fibrinogen and natural anticoagulation proteins (protein C, protein S, and antithrombin III) were also increased (all p < 0.05). Two patients (8%) developed venous thromboembolism (VTE); TEG reaction time, fibrinogen, and partial thromboplastin time were decreased (all p < 0.05) at admission compared with those with no VTE. All changes occurred despite pharmacologic thromboprophylaxis. There was no significant correlation between TEG and total body surface area or between TEG and fluid balance. In general, burn patients have normal coagulation parameters at admission but become hypercoagulable during recovery. However, those who are hypercoagulable at admission may have an increased risk of VTE. Additional monitoring and/or thromboprophylaxis may be

  3. Heparin Reduced Mortality and Sepsis in Severely Burned Children

    PubMed Central

    Zayas, G.J.; Bonilla, A.M.; Saliba, M.J

    2007-01-01

    between 1998 and 1999 was significant (p < 0.008). The survivors had notably smooth skin. Conclusions. The use of heparin in this study relieved burn pain, significantly reduced mortality and sepsis with fewer procedures, and discernibly improved cosmetic results. PMID:21991064

  4. Paediatric ICU burns in Finland 1994-2004.

    PubMed

    Papp, Anthony; Rytkönen, Tanja; Koljonen, Virve; Vuola, Jyrki

    2008-05-01

    The paediatric burn population requiring intensive care in Finland has never been examined before. The aim of this study was firstly to determine the aetiology, incidence and prognosis of paediatric burns requiring intensive care in Finland and secondly to compare the possible differences between the two national burn centres. All burn patients' charts were retrospectively reviewed in two national burn centres from an 11-year-period. Patients whose ICU stay was more than 48h, were included. Forty-five children who were hospitalized in the two burn centres during the study period met the inclusion criteria. They represent 2.4% (45/1898) of all burns victims hospitalized in these burn centres during that time giving an incidence of 0.1/100,000 per year in Finland. The median age was 5 years, every third patient was 0-2 years old and 75.6% were male. Most burns were scalds (42.2%), which caused all burns (100%) in age group 0-2 years. Flame burns were most frequent (83%) in the age group 6-10 years. In the 11-16 years old patients, high voltage/electric burns caused 50% of all burns and flame the other 50%. The overall median TBSA in all burns was 26%. The median (range) hospital stay was 12 days (2-193) (0.88 days/% burned) and the median (range) ICU days was 7 (2-64) (0.29 days/%). Intubation and respirator therapy was needed in 31 (46%) patients. There were no patients who needed haemofiltration or haemodialysis and no mortality. Only six patients (13%) were treated conservatively and 39 (87%) surgically. Dressing changes under general anaesthesia were preferred in Helsinki (37 times) and especially in the paediatric hospital (32 times) compared to Kuopio (7 times). Allografts were used only in Helsinki in 4 patients whereas artificial skin was used only in Kuopio in 15 patients. The overall cost of care was very similar in both centres being 1292-1425 euros per hospital day. There were some small differences between the two burn centres in treatment policies. Most

  5. Burn encephalopathy in children.

    PubMed

    Mohnot, D; Snead, O C; Benton, J W

    1982-07-01

    Among 287 children with burns treated over a recent two-year period, 13 (5%) showed evidence of encephalopathy. The major clinical symptoms were an altered sensorium and seizures. The majority of symptoms began later than 48 hours after the burn and were accompanied by multiple metabolic aberrations including hypocalcemia. Three children had a relapsing course, and 1 had temporarily enlarged cerebral ventricles. Eleven children improved to normal. In the majority of instances, burn encephalopathy probably reflects central nervous system dysfunction resulting from complex metabolic, hematological, and hemodynamic abnormalities rather than from a single metabolic abnormality.

  6. Bioengineered Self-assembled Skin as an Alternative to Skin Grafts

    PubMed Central

    Climov, Mihail; Medeiros, Erika; Farkash, Evan A.; Qiao, Jizeng; Rousseau, Cecile F.; Dong, Shumin; Zawadzka, Agatha; Racki, Waldemar J.; Al-Musa, Ahmad; Sachs, David H.; Randolph, Mark A.

    2016-01-01

    For patients with extensive burns or donor site scarring, the limited availability of autologous and the inevitable rejection of allogeneic skin drive the need for new alternatives. Existing engineered biologic and synthetic skin analogs serve as temporary coverage until sufficient autologous skin is available. Here we report successful engraftment of a self-assembled bilayered skin construct derived from autologous skin punch biopsies in a porcine model. Dermal fibroblasts were stimulated to produce an extracellular matrix and were then seeded with epidermal progenitor cells to generate an epidermis. Autologous constructs were grafted onto partial- and full-thickness wounds. By gross examination and histology, skin construct vascularization and healing were comparable to autologous skin grafts and were superior to an autologous bilayered living cellular construct fabricated with fibroblasts cast in bovine collagen. This is the first demonstration of spontaneous vascularization and permanent engraftment of a self-assembled bilayered bioengineered skin that could supplement existing methods of reconstruction. PMID:27482479

  7. [Severe burns related to steam inhalation therapy].

    PubMed

    Belmonte, J A; Domínguez-Sampedro, P; Pérez, E; Suelves, J M; Collado, J M

    2015-02-01