Skin grafting in severe burns

Abstract Background Burns are common injuries associated with high disability and mortality. In recent years, Meek micrografting technique has been gradually applied for the wound treatment of severe burns. However, the efficacy of two-stage Meek micrografting in patients with severe burns keeps unclear. Methods The data of eligible patients with severe burns who were admitted to Southwest Hospital of the Third Military Medical University from January 2013 to December 2019 were retrospectively analysed. The patients were divided into two groups according to the Meek micrografting method: one-stage skin grafting (group A) and two-stage skin grafting (group B). The baseline data, survival rate of skin graft, length of hospital stay, treatment costs, laboratory data and cumulative survival were statistically analysed. Results 127 patients (91 in group A and 36 in group B) were included in the study. There were no significant difference in the baseline data, the length of hospital stay and treatment costs between the two groups. The survival rate of skin graft was higher in group B. Total protein and albumin level, platelet count in group B were superior to those in group A, while there were no difference in other laboratory data (prealbumin, serum creatinine, urea nitrogen, cystatin C, blood cultures, wound exudate cultures) and cumulative survival between the two groups. Conclusion Our results demonstrated that staged Meek micrografting could improve the survival rate of skin graft, by reducing the risks of hypoproteinaemia, hypoalbuminemia and low platelet counts after adequate resuscitation.

Download Full-text

EXTERNAL FIXATION OF ENDOTRACHEAL TUBES WHILE SKIN GRAFTING SEVERE BURNS OF THE FACE

Plastic & Reconstructive Surgery ◽

10.1097/00006534-197811000-00025 ◽

1978 ◽

Vol 62 (5) ◽

pp. 776

Author(s):

Reid H. Hansen ◽

John P. Remensnyder ◽

Stephen R. Lewis

Keyword(s):

External Fixation ◽

Skin Grafting ◽

Endotracheal Tubes ◽

Severe Burns ◽

The Face

Download Full-text

OPTIMIZATION OF SURGICAL APPROACH OF TREATMENT IN PATIENTS WITH FULL-THICKNESS THERMAL BURNS

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2017-176-2-45-50 ◽

2017 ◽

Vol 176 (2) ◽

pp. 45-50 ◽

Cited By ~ 1

Author(s):

I. V. Reva ◽

I. A. Odintsova ◽

V. V. Usov ◽

T. N. Obydennikova ◽

G. V. Reva

Keyword(s):

Immune Cells ◽

Burn Injury ◽

Skin Grafting ◽

Intact Skin ◽

Burn Wound ◽

Ki 67 ◽

Severe Burns ◽

Morphological Criteria ◽

The Moment ◽

Immunohistochemical Techniques

OBJECTIVE. The study investigated methods of improving the results of active surgical treatment of patients with severe burns and at the same time the possibility of determination of optimal terms of autografting and shortening the terms of hospital stay. MATERIALS AND METHODS. Researches were carried out in patients aged from 18 to 60 at the period from 2007 to 2015. Immunohistochemical techniques were used to detect an expression of Ki-67 gene and localization of immune cells in dynamics. RESULTS. The authors have obtained the morphological criteria of readiness of burned wound to autografting with following prediction of results. The graft healing processes depended on angiogenesis activity and quantity of functioning blood vessels in the burn wound and at its border of intact skin. The regenerative potential of tissue structures in the burn area and at its border was determined by the expression of Ki67gene. These data allowed the authors to forecast the outcome of skin grafting. CONCLUSIONS. The optimal ratio of immune cells in burn wound at its border with intact skin is a criterion of readiness for autodermoplasty. Autodermoplasty should have been performed in terms of 9 days since the moment of burn injury in order to have a significant advantage compared with subsequent terms of grafting.

Download Full-text

Experience of using vacuum therapy in the burn department

Medico-Biological and Socio-Psychological Problems of Safety in Emergency Situations ◽

10.25016/2541-7487-2021-0-3-26-34 ◽

2021 ◽

pp. 26-34

Author(s):

D. O. Vagner ◽

E. V. Zinoviev ◽

V. V. Soloshenko ◽

S. G. Shapovalov

Keyword(s):

Negative Pressure ◽

Clinical Guidelines ◽

Cognitive Disorders ◽

Skin Grafting ◽

Vacuum Therapy ◽

Multicenter Studies ◽

Petersburg Institute ◽

Burn Treatment ◽

Severe Burns ◽

Microsoft Office

Relevance. Indications, application techniques and contraindications for the use of vacuum therapy in surgery and orthopedics are formulated in clinical guidelines and are generally available. Indications for the use of a vacuum in patients with severe burns are scattered and depend on personal experience and preferences of the medical staff, and not on objective reasons.Intention. To analyze the results of using Negative Pressure Wound Therapy (NPWT) in patients of burn departments.Methodology. The study included 56 patients treated with local negative pressure in the Department of thermal injuries of the Saint-Petersburg institute of emergency care named after I.I. Dzhanelidze in 2017–2020. Statistical data processing was performed using Microsoft Office Excel 2007 and IBM SPSS 20.0 using descriptive and non-parametric statistics.Results and their Discussion. The frequency of using VAC-therapy in patients with burn injuries was 0.8 % (56 of 6764). The most common reasons for hospitalization of patients were contact injuries – 20 (36 %) and flame burns – 18 (32 %). The main indications for NPWT were stimulation of granulation formation – 21 (38 %), control of wound infection – 20 (36 %), and temporary wound closure after early excisions or atypical amputations – 11 (20 %). The main contraindications to the use of the method were cognitive disorders or impaired consciousness. The primary complication was the depressurization of the dressings, which we encountered in 9 cases (16 %). The expected results of vacuum therapy were achieved in 49 patients (88 %).Conclusion. Local negative pressure is relatively rarely used in burn treatment. A positive effect from the use of NPWT can be expected in the control of wound infections and in the preparation of wounds for skin grafting. The prospects for the introduction of the method can be considered its application in the treatment of partial-thickness burns and additional fixation of skin grafts. To objectify the choice of modes and duration of vacuum therapy in burned patients, it is necessary to conduct further multicenter studies with the preparation of clinical guidelines.

Download Full-text

EXTERNAL FIXATION OF ENDOTRACHEAL TUBES WHILE SKIN GRAFTING SEVERE BURNS OF THE FACE

Plastic & Reconstructive Surgery ◽

10.1097/00006534-197810000-00033 ◽

1978 ◽

Vol 62 (4) ◽

pp. 628-629 ◽

Cited By ~ 6

Author(s):

REID H. HANSEN ◽

JOHN P. REMENSNYDER

Keyword(s):

External Fixation ◽

Skin Grafting ◽

Endotracheal Tubes ◽

Severe Burns ◽

The Face

Download Full-text

Reconstruction of Major Burns With Stevens–Johnson Syndrome: A Case Report and Literature Review

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa183 ◽

2020 ◽

Author(s):

Xiaojing Ge ◽

Yute Sun ◽

Xin Su ◽

Fang Zhou ◽

Gang Yao

Keyword(s):

Donor Site ◽

Skin Grafting ◽

Multiple Organ ◽

Lower Limbs ◽

Stevens Johnson Syndrome ◽

Burn Wounds ◽

Severe Burns ◽

Drug Eruptions ◽

Johnson Syndrome ◽

Serious Infections

Abstract Stevens–Johnson syndrome (SJS) is a severe type of pleomorphic erythema and a rare disorder of the skin and mucous membranes, which can lead to serious infections, pulmonary embolism, acute respiratory distress syndrome, multiple organ dysfunction syndrome, and other serious consequences. Patients with SJS are usually treated in burn centers. SJS complicated by severe burns is very rare, and this is associated with a high risk of infection and other more serious complications. With SJS, the availability of donor sites is compromised given the lack of healthy epidermis, and this makes it more difficult to treat. The patient was a 52-year-old man with 45% TBSA burns with 40% TBSA full-thickness burns on both lower limbs. During treatment, his condition was complicated by SJS, renal failure, and respiratory failure. After 31 days, he was transferred to our department. On the 22nd day, the patient recovered from SJS, and after undergoing four skin grafting procedures, the burn wounds healed, and the donor site had healed spontaneously. He was discharged after 86 days of treatment in our department. In conclusion, major burns complicated with SJS are rare clinical presentations. The skin affected by the drug eruptions can be used as a donor site for transplantation to the burn wounds, and this donor area can also heal.

Download Full-text