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

In rural places of our country, burns have become frequent accidents due to the use of floor-based stoves & kerosene lamps. Suicides due to burns are also quite usual in our country. The objective of this study is to evaluate the necessity of early excision of the burn wound and skin grafting to decrease the morbidity, mortality, complications of burns and stay at the hospital. Calculate pressure garment efficacy in preventing burn scar and contracture formation. To lay out cost-effective management for patients at rural hospitals. 50 patients were included in this study presenting with burn injuries, admitted in the department of plastic surgery from June 2019 to December 2020. In a recent study, Females (52%) suffered more as compared to males. Scalds were the prime root cause of the burns constituting the 52% of the cases. Infections of Burn wound was seen in 20 patients (40%). Pseudomonas was prime organism isolated. Wound excision was required in 19 patients (38%). Around 6 to 12 days, elapsed between the injury to the surgical excision. 19 patients required (38%) covering of wound permanently with STSG. The mean admission period in hospital for burns of 41-60% was 62 days, 33.4 days for 21-40% burns and 19.6 days for <20%. Amongst 50 patients, 3 died accounting to 6% of overall cases. This study concluded that initiation of resuscitation with untimely wound excision and permanent coverage with grafting can bring significant fall in mortality, painful debridements, limiting complications, decreasing the duration of stay at a hospital, curtailing the cost of health care and time apart from work.

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Management of the Burn Wound

10.2310/ps.2143 ◽

2019 ◽

Author(s):

Nicole S. Gibran ◽

Jose P. Sterling ◽

David M. Heimbach

Keyword(s):

Wound Care ◽

Donor Site ◽

Skin Grafting ◽

Wound Management ◽

Skin Substitutes ◽

Burn Wound ◽

Burn Wounds ◽

Initial Care ◽

Wound Excision ◽

Burn Depth

Current approaches to burn management are based on an understanding of the biology and physiology of human skin and the pathophysiology of the burn wound. The clinical evaluation and initial care of a burn wound is described and includes an assessment of burn depth, determining the need for escharatomy and daily burn wound care. Burns can be topical or surgical. Topical burn wounds require choice in the use of antibiotics. Considerations and techniques for surgical burn wound management are described and include early excision and grafting, wound excision, skin grafting, graft and donor-site dressings, postoperative wound care, biologic dressings and skin substitutes, allograft and xenograft skin, cultured epidermal autografts, and skin substitutes. Figures show the two distinct layers of the skin, various types of burns, and both fascial and tangential excision of burn wounds. This review contains 12 figures, 11 tables, and 61 references. Keywords: Burn wound, graft, partial-thickness, full-thickness, dermis, epidermis, sloughing, dressing

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Management of the Burn Wound

10.2310/surg.2143 ◽

2019 ◽

Author(s):

Nicole S. Gibran ◽

Jose P. Sterling ◽

David M. Heimbach

Keyword(s):

Wound Care ◽

Donor Site ◽

Skin Grafting ◽

Wound Management ◽

Skin Substitutes ◽

Burn Wound ◽

Burn Wounds ◽

Initial Care ◽

Wound Excision ◽

Burn Depth

Current approaches to burn management are based on an understanding of the biology and physiology of human skin and the pathophysiology of the burn wound. The clinical evaluation and initial care of a burn wound is described and includes an assessment of burn depth, determining the need for escharatomy and daily burn wound care. Burns can be topical or surgical. Topical burn wounds require choice in the use of antibiotics. Considerations and techniques for surgical burn wound management are described and include early excision and grafting, wound excision, skin grafting, graft and donor-site dressings, postoperative wound care, biologic dressings and skin substitutes, allograft and xenograft skin, cultured epidermal autografts, and skin substitutes. Figures show the two distinct layers of the skin, various types of burns, and both fascial and tangential excision of burn wounds. This review contains 12 figures, 11 tables, and 61 references. Keywords: Burn wound, graft, partial-thickness, full-thickness, dermis, epidermis, sloughing, dressing

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A Narrative Review of the History of Skin Grafting in Burn Care

Medicina ◽

10.3390/medicina57040380 ◽

2021 ◽

Vol 57 (4) ◽

pp. 380

Author(s):

Deepak K. Ozhathil ◽

Michael W. Tay ◽

Steven E. Wolf ◽

Ludwik K. Branski

Keyword(s):

Donor Site ◽

Subsequent Development ◽

Skin Grafting ◽

Human Condition ◽

Surgical Instruments ◽

Wound Management ◽

Burn Wound ◽

Medical Progress ◽

Burn Care ◽

History Of

Thermal injuries have been a phenomenon intertwined with the human condition since the dawn of our species. Autologous skin translocation, also known as skin grafting, has played an important role in burn wound management and has a rich history of its own. In fact, some of the oldest known medical texts describe ancient methods of skin translocation. In this article, we examine how skin grafting has evolved from its origins of necessity in the ancient world to the well-calibrated tool utilized in modern medicine. The popularity of skin grafting has ebbed and flowed multiple times throughout history, often suppressed for cultural, religious, pseudo-scientific, or anecdotal reasons. It was not until the 1800s, that skin grafting was widely accepted as a safe and effective treatment for wound management, and shortly thereafter for burn injuries. In the nineteenth and twentieth centuries skin grafting advanced considerably, accelerated by exponential medical progress and the occurrence of man-made disasters and global warfare. The introduction of surgical instruments specifically designed for skin grafting gave surgeons more control over the depth and consistency of harvested tissues, vastly improving outcomes. The invention of powered surgical instruments, such as the electric dermatome, reduced technical barriers for many surgeons, allowing the practice of skin grafting to be extended ubiquitously from a small group of technically gifted reconstructive surgeons to nearly all interested sub-specialists. The subsequent development of biologic and synthetic skin substitutes have been spurred onward by the clinical challenges unique to burn care: recurrent graft failure, microbial wound colonization, and limited donor site availability. These improvements have laid the framework for more advanced forms of tissue engineering including micrografts, cultured skin grafts, aerosolized skin cell application, and stem-cell impregnated dermal matrices. In this article, we will explore the convoluted journey that modern skin grafting has taken and potential future directions the procedure may yet go.

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Arginine Is a Critical Substrate for the Pathogenesis of Pseudomonas aeruginosa in Burn Wound Infections

mBio ◽

10.1128/mbio.02160-16 ◽

2017 ◽

Vol 8 (2) ◽

Cited By ~ 16

Author(s):

Jake Everett ◽

Keith Turner ◽

Qiuxian Cai ◽

Vernita Gordon ◽

Marvin Whiteley ◽

...

Keyword(s):

Antimicrobial Agents ◽

Hospital Setting ◽

Multidrug Resistant ◽

Burn Patients ◽

Burn Wound ◽

Burn Wounds ◽

Resistant Strains ◽

High Doses ◽

Ubiquitous Presence

ABSTRACT Environmental conditions affect bacterial behavior and can greatly influence the course of an infection. However, the environmental cues that elicit bacterial responses in specific infection sites are relatively unknown. Pseudomonas aeruginosa is ubiquitous in nature and typically innocuous. However, it is also one of the most prevalent causes of fatal sepsis in burn wound patients. The aim of this study was to determine the impact of environmental factors, specifically the availability of arginine, on the pathogenesis of P. aeruginosa in burn wound infections. Comparison of burned versus noninjured tissue revealed that l-arginine (l-Arg) was significantly depleted in burn wounds as a consequence of elevated arginase produced by myeloid-derived suppressor cells. We also observed that l-Arg was a potent chemoattractant for P. aeruginosa, and while low concentrations of l-Arg increased P. aeruginosa’s swimming motility, high concentrations resulted in diminished swimming. Based on these observations, we tested whether the administration of exogenous l-Arg into the burn wound could attenuate the virulence of P. aeruginosa in thermally injured mice. Administration of l-Arg resulted in decreased P. aeruginosa spread and sepsis and increased animal survival. Taken together, these data demonstrate that the availability of environmental arginine greatly influences the virulence of P. aeruginosa in vivo and may represent a promising phenotype-modulating tool for future therapeutic avenues. IMPORTANCE Despite our growing understanding of the pathophysiology of burn wounds and the evolution of techniques and practices to manage infections, sepsis remains a significant medical concern for burn patients. P. aeruginosa continues to be a leader among all causes of bacteremic infections due to its tendency to cause complications in immunocompromised patients and its ubiquitous presence in the hospital setting. With the unforgiving emergence of multidrug-resistant strains, it is critical that alternative strategies to control or prevent septic infections in burn patients be developed in parallel with novel antimicrobial agents. In this study, we observed that administration of l-Arg significantly reduced bacterial spread and sepsis in burned mice infected with P. aeruginosa. Given the safety of l-Arg in high doses and its potential wound-healing benefits, this conditionally essential amino acid may represent a useful tool to modulate bacterial behavior in vivo and prevent sepsis in burn patients. IMPORTANCE Despite our growing understanding of the pathophysiology of burn wounds and the evolution of techniques and practices to manage infections, sepsis remains a significant medical concern for burn patients. P. aeruginosa continues to be a leader among all causes of bacteremic infections due to its tendency to cause complications in immunocompromised patients and its ubiquitous presence in the hospital setting. With the unforgiving emergence of multidrug-resistant strains, it is critical that alternative strategies to control or prevent septic infections in burn patients be developed in parallel with novel antimicrobial agents. In this study, we observed that administration of l-Arg significantly reduced bacterial spread and sepsis in burned mice infected with P. aeruginosa. Given the safety of l-Arg in high doses and its potential wound-healing benefits, this conditionally essential amino acid may represent a useful tool to modulate bacterial behavior in vivo and prevent sepsis in burn patients.

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670 Delayed Enzymatic Debridement of Burn Wounds using the Proteolytic Gel SN514

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.316 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S191-S192

Author(s):

Angela R Jockheck-Clark ◽

Randolph Stone ◽

Michelle Holik ◽

Lucy Schaffer ◽

Shanmugasundaram Natesan ◽

...

Keyword(s):

Burn Injury ◽

Vehicle Control ◽

Surrounding Tissue ◽

Burn Wound ◽

Burn Wounds ◽

Delayed Treatment ◽

Medical Evacuation ◽

Contamination Levels

Abstract Introduction Thermal burns account for 5–10% of casualties sustained in present-day conflicts and are expected to be one of the most common wounds to occur in future conflicts. In prolonged field care (PFC) situations, medical evacuation could be delayed for days. During this time, burn wounds can become infected, detrimentally impact neighboring tissue, and cause systemic immune responses. Therefore, it is essential to test and evaluate non-surgical debridement agents that could be implemented prior to reaching a Role 3 military treatment facility. This work details how the proprietary proteolytic gel SN514 impacts burn debridement when applied within a PFC-like timeline. SN514 contains an enzyme formulation that is thermostable, easy to apply, and selectively degrades non-viable tissue in vitro and in vivo. Methods Deep-partial thickness contact burns were created using an established porcine model and covered with gauze or an antimicrobial incise drape. Four days later, the burns were treated with one of five treatments: 0.2% SN514, 0.8% SN514, a vehicle control, gauze, or an antimicrobial silver dressing. Treatments were re-applied every 24 hours for 72 to 96 hours. The effects of the treatment regiments were compared histologically. Biopsies were also taken to monitor bacterial contamination levels. Results Burns treated with SN514 were partially debrided and visually distinct from those treated with gauze, the silver dressing, or the vehicle control. Preliminary analyses suggest that SN514-treated burns that had been covered with “dry” gauze had a much lower debridement efficiency than those treated with the incise drape. This suggests that SN514 debridement efficiency may depend on the presence of a moist eschar. Preliminary analyses also suggest that there was little difference in burn wound bacterial counts among the five treatment groups. Conclusions SN514 is able to debride burns that experienced delayed treatment, without any evidence of harm to the surrounding tissue or evidence of exacerbating the original burn injury. SN514-treated wounds displayed little to no blood loss and did not increase burn wound infection levels compared to wounds treated with gauze or an antimicrobial silver dressing.

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A novel design of wound bandage using heparin-polyvinylpyrrolidone/TiO2 nanocomposite to improved antibacterial treatment and burn wound healing effect: In vitro and in vivo evaluation

Materials Express ◽

10.1166/mex.2021.1877 ◽

2021 ◽

Vol 11 (11) ◽

pp. 1808-1818

Author(s):

Xiuli Li ◽

Jigang Wang ◽

Xin Li ◽

Xiaoqian Hou ◽

Hao Wang ◽

...

Keyword(s):

Electron Microscope ◽

Dermal Fibroblast ◽

Synergistic Effects ◽

Bacterial Species ◽

Human Dermal Fibroblast ◽

Burn Wound ◽

In Vivo Evaluation ◽

Closure Rate

In our current study, porous heparin-polyvinylpyrrolidone/TiO2 nanocomposite (HpPVP/TiO2) bandage were prepared via the incorporation of TiO2 into HpPVP hydrogels for biomedical applications such as burn infection. The effect of the HpPVP hydrogels and the nanoparticles of TiO2 composition on the functional group and the surface properties of the as-fabricated bandages were characterized by Fourier transform infrared spectroscopy (FTIR) and X-ray diffractometry (XRD). The presence of TiO2 nanoparticles created the internal structure of the HpPVP hydrogel that aids in a homogeneous porous structure, as indicated by the scanning electron microscope (SEM). The size distribution of the TiO2 nanoparticles was measured using a transmission electron microscope (TEM). The studies on the mechanical properties of the HpPVP hydrogel indicate that the addition of TiO2 nanoparticles increases its strength. The prepared HpPVP/TiO2 nanocomposite dressing has excellent antimicrobial activity were tested against bacterial species (Staphylococcus aureus and Escherichia coli) and has good biocompatibility against human dermal fibroblast cells (HFFF2) for biological applications. In addition, in vivo evaluations in Kunming mice exposed that the as-fabricated HpPVP/TiO2 nanocomposite bandages increased the wound curing and facilitated accelerate skin cell construction along with collagen development. The synergistic effects of the HpPVP/TiO2 nanocomposite hydrogel dressing material, such as its excellent hydrophilic nature, good bactericidal activity, biocompatibility and wound closure rate through in vivo test makes it a suitable candidate for burn infections.

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Antimicrobial and anti-biofilm potencies of dermcidin-derived peptide DCD-1L against Acinetobacter baumannii: an in vivo wound healing model

BMC Microbiology ◽

10.1186/s12866-022-02439-8 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Zahra Farshadzadeh ◽

Maryam Pourhajibagher ◽

Behrouz Taheri ◽

Alireza Ekrami ◽

Mohammad Hossein Modarressi ◽

...

Keyword(s):

Wound Healing ◽

Acinetobacter Baumannii ◽

Biofilm Formation ◽

Histopathological Examination ◽

Inhibitory Effect ◽

Bacterial Attachment ◽

Burn Wound ◽

Conventional Antibiotics

Abstract Background The global emergence of Acinetobacter baumannii resistance to most conventional antibiotics presents a major therapeutic challenge and necessitates the discovery of new antibacterial agents. The purpose of this study was to investigate in vitro and in vivo anti-biofilm potency of dermcidin-1L (DCD-1L) against extensively drug-resistant (XDR)-, pandrug-resistant (PDR)-, and ATCC19606-A. baumannii. Methods After determination of minimum inhibitory concentration (MIC) of DCD-1L, in vitro anti-adhesive and anti-biofilm activities of DCD-1L were evaluated. Cytotoxicity, hemolytic activity, and the effect of DCD-1L treatment on the expression of various biofilm-associated genes were determined. The inhibitory effect of DCD-1L on biofilm formation in the model of catheter-associated infection, as well as, histopathological examination of the burn wound sites of mice treated with DCD-1L were assessed. Results The bacterial adhesion and biofilm formation in all A. baumannii isolates were inhibited at 2 × , 4 × , and 8 × MIC of DCD-1L, while only 8 × MIC of DCD-1L was able to destroy the pre-formed biofilm in vitro. Also, reduce the expression of genes involved in biofilm formation was observed following DCD-1L treatment. DCD-1L without cytotoxic and hemolytic activities significantly reduced the biofilm formation in the model of catheter-associated infection. In vivo results showed that the count of A. baumannii in infected wounds was significantly decreased and the promotion in wound healing by the acceleration of skin re-epithelialization in mice was observed following treatment with 8 × MIC of DCD-1L. Conclusions Results of this study demonstrated that DCD-1L can inhibit bacterial attachment and biofilm formation and prevent the onset of infection. Taking these properties together, DCD-1L appears as a promising candidate for antimicrobial and anti-biofilm drug development.

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Stimulation of wound healing process through ROS/RNS signals indirectly generated by N2/Ar micro-plasma - in vitro and in vivo studies

Science and Technology Development Journal ◽

10.32508/stdj.v18i2.1069 ◽

2015 ◽

Vol 18 (2) ◽

pp. 29-37

Author(s):

Hien Thi Minh Ngo ◽

Linh Quang Huynh ◽

Liao Jiunn Der ◽

Thuy Ngu Son Nguyen

Keyword(s):

Healing Process ◽

In Vivo Studies ◽

Wound Healing Process ◽

Fibroblast Cells ◽

Plasma Exposure ◽

Burn Wound ◽

Degree Burn ◽

Plasma Exposure Time

In this work, non-thermal N2/Ar micro-plasma was applied to fibroblast cells and second degree burn in mice to investigate the bio-safety and bioefficiency of micro-plasma device for studying wound healing process. The chosen parameters of the device were the addition of 0.5% N2 in argon plasma and RF supplied power of 17 W and 13 W in vitro and in vivo studies, respectively. Firstly, micro-plasma was applied to fibroblast cells and the induced biological effect was studied in vitro. The result showed that cells number increased three folds for plasma exposure time of 5 or 10 sec, followed by cell culture for 48 hrs. The cell coverage rate rose 20% for the same plasma exposure time, followed by cell culture for 6 or 12 hrs. Secondly, micro-plasma was applied to the second degree burn wound mice, followed by related ex vivo and in vivo assessments. For the former, 0.5% N2/Ar micro-plasma was competent to generate ROS/RNS signals for advancing healing process by the increase of ROS/RNS concentration around the plasma-exposed wound bed. The induced effect is most probably correlated with the angiogenesis and epithelialization processes of the burn wound on mice.

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