scholarly journals Acanthus ebracteatusVahl. Ethanol Extract Enhancement of the Efficacy of the Collagen Scaffold in Wound Closure: A Study in a Full-Thickness-Wound Mouse Model

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Jutamas Somchaichana ◽  
Tanom Bunaprasert ◽  
Suthiluk Patumraj
Keyword(s):  
Wound Closure ◽  
Total Body Surface Area ◽  
Collagen Scaffold ◽  
Ethanol Extract ◽  
Neutrophil Infiltration ◽  
Skin Incision ◽  
Full Thickness ◽  
Combined Application ◽  
Acanthus Ebracteatus ◽  
Total Body

Acanthus ebracteatusVahl. is a Thai herb that is effective in wound healing. We sought to quantitatively determine whether or not the combined application ofAcanthus ebracteatusVahl. and a collagen scaffold will increase wound closure and angiogenesis. Balb/c mice (body weight: 22–25 g) were anesthetized with sodium thiopental. The dorsal skin incision measuring 1.5 × 1.5 cm was made and then deepened using scissors to produce a full-thickness incision down to the level of the panniculus carnosus. The size of the wound was approximately 10% of the total body surface area. The collagen sheet was implanted onto the wound. Animals were divided into 4 major groups as follows: wound with normal saline (W-NSS), wound treated with 0.3 g/kg BW ofAcanthus ebracteatusVahl. extract (W-AE (0.3 g/kg.bw)), wound implanted with collagen scaffold (W-Coll), and wound implanted with collagen scaffold and treated with 0.3 g/kg BW ofAcanthus ebracteatusVahl. (W-Coll-AE combination). On day 14, the W-Coll-AE group showed decreased wound areas and increased capillary vascularity (CV) when compared to the other 3 groups, W-NSS, W-AE0.3, and W-Coll. In the present study, the combination of AE0.3 with collagen showed the best effect on skin angiogenesis and promoted wound closure with less neutrophil infiltration.

549 Lessons Learned from Two Survivors of Greater Than 90% Total Body Surface Area Full Thickness Burn Injuries Using a Dermal Biodegradable Substitute and Autologous Skin Cell Suspension: A Case Series

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S123-S123
Author(s):  
Aldin Malkoc ◽  
David Wong
Keyword(s):  
Cell Suspension ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Fluid Loss ◽  
Dermal Substitute ◽  
Full Thickness ◽  
Skin Cell ◽  
Thickness Skin ◽  
Total Body ◽  
Skin Coverage

Abstract Introduction Advances in burn injury knowledge, critical care, and pharmacological developments have increased survival rates among extensive burn patients. Survival now dependents not just on skin coverage, but effective control of SIRS response, metabolic derangement, fluid loss and sepsis. Novel synthetic dermal substitutes create robustness, thickness, and pliability of the skin in addition to an improved aesthetic appearance while; point-of-care autologous skin cell harvesting enhances treatment by amplifying small split-thickness skin samples to produce an autologous skin cell suspension (ASCS) to cover a larger burn area. This study reports on two survivors with greater than 90% total body surface area full-thickness burns utilizing a combined treatment of a dermal substitute along with ASCS and traditional burn management strategies. Methods Chart review of two patients with >90% burns and inhalation injury after being trapped in a burning vehicle following a traffic collision occurred. Most of the burns in both patients were “leathery” and consistent with full thickness, sparing only the plantar and dorsal aspect of the feet and bilateral small areas of the hip in Patient 1. Patient 2 had fourth-degree burns in some areas of the chest and flank with only the bilateral groin regions and feet spared. The patients were treated with a multi-step process which included using allograft, dermal substitute, and ASCS with split-thickness skin grafts (STSG) in place of cultured epidermal autograft to achieve coverage of >90% burns with high meshed ratio. Results The dermal substitute was limited to deep burns that penetrated down to fat, muscle, and/or joints. Fluid loss was well controlled by the dermal substitute during initial resuscitation. Post reconstruction, areas covered with the dermal substitute and grafted with autogenous STSG with ASCS exhibited less hypertrophy and contracture bands. The elbow and knee joints showed minimal restriction with passive motion and good skin compliance, but contractures persisted in areas where 4th degree tendon and fascia thermal injury occurred. Areas that showed signs of infection were trimmed or unroofed and allowed to drain while maintaining the remainder of the dermal substitute. Conclusions The use of dermal substitutes and ASCS allowed the care team to achieve SIRS control, improved fluid management, enhanced skin coverage, and reduced hospitalization stay. The process experienced in these cases shows promise for future patients with extensive burns. Both patients were able to survive and show improvement during rehabilitation.

720 Scalds and Contact Burns: Are They Really Different?

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S191-S191
Author(s):  
Adam Singer ◽  
Evyatar Baer ◽  
Henry Thode
Keyword(s):  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Stepwise Logistic Regression ◽  
Full Thickness ◽  
Chi Square ◽  
Included Patient ◽  
Body Location ◽  
Total Body ◽  
Fire Flame ◽  
Burn Depth

Abstract Introduction Prior studies comparing scalds and contact burns rarely address the affect of burn etiology on burn depth. However, it is commonly believed that scalds tend to heal faster than similarly sized contact and flame burns. As a result, expectant therapy is often preferred after scald injuries. We compared the percentages of full-thickness burns based on burn etiology controlling for burn size, location and patient age. We hypothesized that the percentage of full thickness burns would be lower after scalds compared with contact and flame burns. Methods We performed a retrospective chart review of a prospectively collected burn registry of all patients admitted to a regional burn center between 2000–2010. Data collection included patient and burn characteristics including age, gender, body location, and burn etiology. We compared the percentages of full thickness burns among scald, contact and flame burns using Chi-square tests. Stepwise logistic regression was used to adjust for age, location, and burn size. Results There were 1038 patients in the study with either scald (n=537, 52%), fire/flame (n=434, 42%) or contact (n=67, 6%) burn. Mean (SD) age was 29 (25); 75% were male. Mean (SD) total body surface area (TBSA) was 11 (13)%. Mean (SD) length of stay was 10 (18) days. The percentages of full thickness burns by etiology were scalds 13.1%, fire/flame 34%, and contact burns 45% (P< 0.001). Patients with scalds were younger (22+/-24) than patients with contacts (32+/-28) and fire/flame (38+/-22) burns. Multivariate analysis for predicting full thickness burns found that compared with contact burns, scalds were less likely full thickness (OR 0.23, 95%CI 0.11–0.48) while fire/flame burns were as likely to be full thickness (OR 0.54, 95%CI 0.26–1.15). TBSA and age were also associated with full thickness burns (OR 1.06, 95%CI 1.04–1.09 and OR 1.015, 95%CI 1.007–1.024, respectively). Burns on the head and neck were less likely to be full thickness (OR 0.30, 95%CI, 0.11–0.82). Conclusions Scald burns are significantly less likely to be full thickness than contact or fire/flame burns. Applicability of Research to Practice Based on these results, expectant therapy may be more appropriate for scalds than contact or fire/flame burns.

Complex approach to skin repair in an extensively burned child: a case study

2020 ◽  
Vol 29 (8) ◽  
pp. 458-463
Author(s):  
Robert Zajicek ◽  
Richard Kubok ◽  
Nikola Petrova ◽  
Monika Tokarik ◽  
Eva Matouskova ◽  
...  
Keyword(s):  
Donor Site ◽  
Total Body Surface Area ◽  
Wound Management ◽  
Dermal Substitute ◽  
Full Thickness ◽  
Skin Cells ◽  
Skin Repair ◽  
Thickness Skin ◽  
Complex Approach ◽  
Total Body

The limited amount of donor sites and loss of dermis are major challenges in the therapy of extensively burned patients. Here, we present a complex treatment approach of an eight-year-old boy with full-thickness burns on 90% of the total body surface area, using simple and efficient techniques of tissue engineering. To obtain sufficient skin for grafting we repeatedly harvested the same anatomical areas. Acceleration of donor site healing was achieved by treatment with a suspension of noncultured autologous skin cells (NASC) and acellular porcine dermis (Xe-Derma (XD), Czech Republic). Moreover, such wound management allowed up to six reharvestings, compared with one-to-three procedures following routine treatment. Bilayer Integra template (Integra LifeSciences Corp., US) was used as the dermal substitute in over 60% of full-thickness burns. Following successful vascularisation of the neodermis in 3–4 weeks, the templates were covered with meshed split-thickness skin grafts (STSG), or Meek autografts, and facilitated by NASC/XD. We may conclude that such a ‘sandwich’ technique approach, combining four biological covers (Integra, STSG, NASC and XD), significantly contributed to the successful skin repair of the patient.

654 Successful Wound Closure in Patients with Large Total Body Surface Area Calciphylaxis with Aggressive Multi-modal Therapy Including Excision and Skin Grafting

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S184-S185
Author(s):  
Eric Curfman ◽  
Anjay Khandelwal
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Wound Closure ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
Surgical Debridement ◽  
Treatment Modalities ◽  
Total Body ◽  
Tract Infections

Abstract Introduction Calcific Uremic Arteriolopathy (CUA), commonly known as Calciphylaxis, is a rare disorder characterized by ischemic necrosis of the skin and histologically by arteriolar calcification. CUA is most commonly seen in patients with end-stage renal disease (ESRD) but can be seen in other patients as well. CUA carries an extremely high mortality rate, with up to 80% in some studies, even in patients with limited disease. In light of this, many surgeons have adopted a “do-not-touch” practice with these patients. Over the past several years, our institution has seen an increase in referrals for the management of large total-body-surface-area (TBSA) CUA. Methods Retrospective review of all patients with biopsy-proven (by dermatopathology) large TBSA (>=5% TBSA) CUA admitted to a Verified Adult and Pediatric Burn Center from 2015 to present. Demographics, laboratory data, treatment modalities and outcomes including mortality and wound closure were recorded. Results A total of 8 patients with large TBSA CUA were admitted after being transferred from outside hospitals. Average TBSA affected was 13.76% (SD 7.27). 6 of these patients (75%) were noted to have non-uremic calciphylaxis. All patients had positive wound cultures on admission, and 1 patient (12.5%) developed a bacteremia in hospital. There were no central line associated bloodstream infections, catheter associated urinary tract infections or ventilator associated infections. All patients underwent surgical debridement (average 4.125, range 2–5), and 5 patients (62.5%) underwent grafting, (average 1.6, range 2–5) and subsequently proceeded to wound closure. In-hospital mortality was 25% and another patient was referred to a hospice facility after being readmitted with medical complications of her calciphylaxis. Secondary findings included 50% of the patients recently experienced significant weight loss (>100 lbs). On admission, 2 patients (25%) had abnormal serum calcium, 3 patients (37.5%) had abnormal serum PO4, and 4 (50%) patients had abnormal PTH levels. 2 patients (25%) had a recent exposure to warfarin (within 6 months). Conclusions Utilizing a multi-modal management strategy that includes surgical debridement and skin grafting, patients with calciphylaxis can progress to wound closure.

scholarly journals Divulging the Complexities of Deep Partial- and Full-Thickness Burn Wounds Afflicted by Staphylococcus Aureus Biofilms in a Rat Burn Model

2021 ◽  
Vol 2 (3) ◽  
pp. 106-124
Author(s):  
Alan J. Weaver Jr. ◽  
Kenneth S. Brandenburg ◽  
S. L. Rajasekhar Karna ◽  
Christopher Olverson ◽  
Kai P. Leung
Keyword(s):  
Staphylococcus Aureus ◽  
Total Body Surface Area ◽  
Complement C3 ◽  
Full Thickness ◽  
Sprague Dawley ◽  
Burn Wound ◽  
Burn Wounds ◽  
Gm Csf ◽  
Aureus Infection ◽  
Total Body

Every year, thousands of soldiers and civilians succumb to burn wound trauma with highly unfavorable outcomes. We previously established a modified Walker-Mason rat scald model exhibiting a P. aeruginosa infection. Here we characterize deep partial- (DPT) and full-thickness (FT) burn wounds inoculated with Staphylococcus aureus. Male Sprague-Dawley rats (350–450 g) inflicted with 10% total body surface area burn inoculated with S. aureus (103–5 CFU/wound) were monitored over an 11-day period. S. aureus rapidly dominated the wound bed, with bacterial loads reaching at least 1 × 109 CFU/g tissue in all wounds. Within 3 days, S. aureus biofilm formation occurred based on genetic transcripts and Giemsa staining of the tissue. S. aureus infection resulted in a slightly faster recruitment of neutrophils in FT wounds, which was related to necrotic neutrophils. The extent of the inflammatory response in S. aureus infected burn wounds correlated with elevated G-CSF, GM-CSF, GRO/KC and/or TNF-α levels, but a majority of pro- and anti-inflammatory cytokines (IL-1β, IL-6, IFN-γ, IL-10, and IL-13) were found to be suppressed, compared to burn-only controls. S. aureus infection resulted in dynamic changes in DAMPs, including elevated HMGB-1 and reduced levels of circulating hyaluronan within FT wounds. S. aureus also reduced complement C3 at all time points in DPT and FT wounds. These changes in DAMPs are believed to be correlated with burn severity and S. aureus specific bioburden. Collectively, this model showcases the evasiveness of S. aureus through dampening the immune response to flourish in the burn wound.

Acute alcohol intoxication increases interleukin-18-mediated neutrophil infiltration and lung inflammation following burn injury in rats

2007 ◽  
Vol 292 (5) ◽  
pp. L1193-L1201 ◽  
Author(s):  
Xiaoling Li ◽  
Elizabeth J. Kovacs ◽  
Martin G. Schwacha ◽  
Irshad H. Chaudry ◽  
Mashkoor A. Choudhry
Keyword(s):  
Lung Tissue ◽  
Lung Inflammation ◽  
Burn Injury ◽  
Alcohol Intoxication ◽  
Total Body Surface Area ◽  
Neutrophil Infiltration ◽  
Male Rats ◽  
Caspase 1 ◽  
Tissue Edema ◽  
Total Body

In this study, we examined whether IL-18 plays a role in lung inflammation following alcohol (EtOH) and burn injury. Male rats (∼250 g) were gavaged with EtOH to achieve a blood EtOH level of ∼100 mg/dl before burn or sham injury (∼12.5% total body surface area). Immediately after injury, rats were treated with vehicle, caspase-1 inhibitor AC-YVAD-CHO to block IL-18 production or with IL-18 neutralizing anti-IL-18 antibodies. In another group, rats were treated with anti-neutrophil antiserum ∼16 h before injury to deplete neutrophils. On day 1 after injury, lung tissue IL-18, neutrophil chemokines (CINC-1/CINC-3), ICAM-1, neutrophil infiltration, MPO activity, and water content (i.e., edema) were significantly increased in rats receiving a combined insult of EtOH and burn injury compared with rats receiving either EtOH intoxication or burn injury alone. Treatment of rats with caspase-1 inhibitor prevented the increase in lung tissue IL-18, CINC-1, CINC-3, ICAM-1, MPO activity, and edema following EtOH and burn injury. The increase in lung IL-18, MPO, and edema was also prevented in rats treated with anti-IL-18 antibodies. Furthermore, administration of anti-neutrophil antiserum also attenuated the increase in lung MPO activity and edema, but did not prevent the increase in IL-18 levels following EtOH and burn injury. These findings suggest that acute EtOH intoxication before burn injury upregulates IL-18, which in turn contributes to increased neutrophil infiltration. Furthermore, the presence of neutrophils appears to be critical for IL-18-meditaed increased lung tissue edema following a combined insult of EtOH and burn injury.

scholarly journals Reperfusion After Severe Frostbite: First Full-Thickness Necrosis After Initial Successful Thrombolysis

2020 ◽  
Vol 6 ◽  
pp. 2513826X1989882
Author(s):  
Mohamed Nazhat Al Yafi ◽  
Ali izadpanah ◽  
Michel Alain Danino ◽  
Edouard Coeugniet
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Normal Values ◽  
Total Body Surface Area ◽  
Warm Ischemia ◽  
Full Thickness ◽  
Progressive Necrosis ◽  
Total Body ◽  
Successful Thrombolysis

A 36-year-old male who suffered severe frostbite injuries to both feet presented with an estimated total body surface area at around 4%. These injuries resulted from the patient travelling from his town by foot, with a temperature of −10°C during 4 days. On route, he received rewarming therapy followed by thrombolysis that was initiated as the duration of the warm ischemia period resided under 24 hours. Immediately after the procedure, the feet recovered clinically up to the distal toes. Saturation revealed normal values. Thrombolysis ceased after 9 hours and angiography showed adequate perfusion of the toes. Three hours later, pedal pulses at the toes were lost. Subsequently, the patient developed blisters and progressive necrosis of the toes to midfoot. Both feet were managed expectantly and were dressed, but the conditions of both feet worsened and the tissue turned into full-thickness necrosis. The decision was made to amputate a month after thrombolysis.

538 Successful Wound Closure in Patients with Large Total Body Surface Area (TBSA) Calciphylaxis with Aggressive Medical and Surgical Therapy

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S107-S108
Author(s):  
Eric Curfman ◽  
Anjay Khandelwal
Keyword(s):  
Weight Loss ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Wound Closure ◽  
Total Body Surface Area ◽  
Surgical Debridement ◽  
Significant Weight Loss ◽  
Total Body ◽  
Tract Infections

Abstract Introduction Calcific Uremic Arteriolopathy (CUA), commonly known as Calciphylaxis, is a rare disorder characterized by ischemic necrosis of the skin and histologically by arteriolar calcification. CUA is most commonly seen in patients with end-stage renal disease (ESRD), but can be seen in other patients as well. CUA is an extremely morbid condition and carries a high mortality rate, up to 80% in some studies, even in patients with limited disease. In light of this, many surgeons have adopted a “do-not-touch” approach. Over the past five years, our institution has seen an increase in the referrals of patients with large total-body-surface-area (TBSA) CUA. Methods Retrospective review of all patients with biopsy-proven (by dermatopathology) large, >5% TBSA CUA admitted to a Verified Adult and Pediatric Burn Center from 2015 to present. Demographics, laboratory data, treatment modalities, infectious complications and outcomes, including mortality and wound closure were recorded. Secondary observations included exposure to anticoagulants and recent significant weight loss. Results A total of eight patients with large TBSA CUA were admitted after being transferred from outside hospitals. Average TBSA affected was 13.76% (range 5–27%). Six of these patients (75%) were noted to have non-uremic calciphylaxis. One patient (12.5%) had elevated parathyroid hormone (PTH) levels and hyperphosphatemia while one patient each had isolated hypercalcemia and hyperphosphatemia. All patients had positive wound cultures on admission, and one patient (12.5%) developed a bacteremia in hospital. There were no central line associated bloodstream infections, catheter associated urinary tract infections or ventilator associated infections. All patients underwent surgical debridement (average 4.125, range 2–5), and 5 patients (62.5%) underwent grafting, (average 1.6, range 2–5) and subsequently proceeded to wound closure. In-hospital mortality was 25% and another patient was referred to a hospice facility after being readmitted with medical complications related to her calciphylaxis. Secondary findings included 50% of the patients recently experienced significant weight loss (>100 lbs) and 25% of the patients were taking warfarin within 6 months of presentation. Percent TBSA involvement did not correlate with mortality. Conclusions Utilizing a multi-modal management strategy that includes surgical debridement and skin grafting, patients with large total body surface area calciphylaxis can progress to wound closure. Applicability of Research to Practice Findings may influence surgeons to be aggressive surgically with patients with calciphylaxis leading to improved morbidity and mortality. Improved medical multi-modal therapy has been shown to influence outcomes as well.

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