Successful Treatment of Lower Limb Burn Wounds With Long-Term Survived Human Skin Allograft in an Immunosuppressed Patient: A Case Report

2020 ◽  
pp. 153473462090456
Author(s):  
Chun-Kai Chang ◽  
Julia Bartkova ◽  
Yi-Shu Liao ◽  
Yuan-Sheng Tzeng
Keyword(s):  
Case Report ◽  
Human Skin ◽  
Lower Limb ◽  
Wound Management ◽  
Immunosuppressed Patient ◽  
Skin Substitutes ◽  
Burn Wound ◽  
Skin Allograft ◽  
Burn Wounds ◽  
Skin Allografts

Early excision and autografting have been the principles in managing acute burn wounds. Despite the known benefits of early autografting, there are situations in which the placement of autograft is unsafe or even unavailable. In these clinical situations, skin substitutes like artificial dressings and human skin allografts are considered as useful for temporary wound coverage. We present an immunosuppressed patient with deep lower limb burn wound who received human skin allograft for wound management. The applied human skin allograft persisted for a longer period without infection or rejection and successfully improved her wound healing. Large and well-designed prospective studies are needed to confirm the encouraging results of the present case report.

Management of the Burn Wound

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

Management of the Burn Wound

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

scholarly journals Deceased donor skin allograft banking: Response and utilization

2010 ◽  
Vol 43 (S 01) ◽  
pp. S114-S120
Author(s):  
Madhuri A. Gore ◽  
Anuradha S. De
Keyword(s):  
Burn Injury ◽  
Deceased Donor ◽  
Indian Society ◽  
Skin Substitutes ◽  
Skin Allograft ◽  
Medical College ◽  
Skin Allografts ◽  
Donor Skin ◽  
Life Saving ◽  
Feasible Option

ABSTRACT Background: In the absence of xenograft and biosynthetic skin substitutes, deceased donor skin allografts is a feasible option for saving life of patient with extensive burn injury in our country. Aims: The first deceased donor skin allograft bank in India became functional at Lokmanya Tilak Municipal (LTM) medical college and hospital on 24th April 2000. The response of Indian society to this new concept of skin donation after death and the pattern of utilization of banked allografts from 2000 to 2010 has been presented in this study. Settings and Design: This allograft skin bank was established by the department of surgery. The departments of surgery and microbiology share the responsibility of smooth functioning of the bank. Materials and Methods: The response in terms of number of donations and the profile of donors was analyzed from records. Pattern and outcome of allograft utilization was studied from specially designed forms. Results: During these ten years, 262 deceased donor skin allograft donations were received. The response showed significant improvement after counselling was extended to the community. Majority of the donors were above 70 years of age and procurement was done at home for most. Skin allografts from 249 donors were used for 165 patients in ten years. The outcome was encouraging with seven deaths in 151 recipients with burn injuries. Conclusions: Our experience shows that the Indian society is ready to accept the concept of skin donation after death. Use of skin allografts is life saving for large burns. We need to prepare guidelines for the establishment of more skin banks in the country.

scholarly journals Active neutrophil responses counteract Candida albicans burn wound infection of ex vivo human skin explants

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Christin von Müller ◽  
Fionnuala Bulman ◽  
Lysett Wagner ◽  
Daniel Rosenberger ◽  
Alessandra Marolda ◽  
...  
Keyword(s):  
Human Skin ◽  
Ex Vivo ◽  
Burn Wound ◽  
Local Immunity ◽  
Fungal Virulence ◽  
Opportunistic Fungi ◽  
Burn Wounds ◽  
Wound Model ◽  
Skin Explants ◽  
Bacteria And Fungi

AbstractBurn wounds are highly susceptible sites for colonization and infection by bacteria and fungi. Large wound surface, impaired local immunity, and broad-spectrum antibiotic therapy support growth of opportunistic fungi such as Candida albicans, which may lead to invasive candidiasis. Currently, it remains unknown whether depressed host defenses or fungal virulence drive the progression of burn wound candidiasis. Here we established an ex vivo burn wound model, where wounds were inflicted by applying preheated soldering iron to human skin explants, resulting in highly reproducible deep second-degree burn wounds. Eschar removal by debridement allowed for deeper C. albicans penetration into the burned tissue associated with prominent filamentation. Active migration of resident tissue neutrophils towards the damaged tissue and release of pro-inflammatory cytokine IL-1β accompanied the burn. The neutrophil recruitment was further increased upon supplementation of the model with fresh immune cells. Wound area and depth decreased over time, indicating healing of the damaged tissue. Importantly, prominent neutrophil presence at the infected site correlated to the limited penetration of C. albicans into the burned tissue. Altogether, we established a reproducible burn wound model of candidiasis using ex vivo human skin explants, where immune responses actively control the progression of infection and promote tissue healing.

70 Chlorhexidine Gluconate for Burn Wound Cleansing: Reduction in Multi-drug Resistant Organism Acquisition

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S45-S46
Author(s):  
Kelsey L Miller-Willis ◽  
Mini Thomas ◽  
Victor C Joe
Keyword(s):  
Wound Care ◽  
Baseline Period ◽  
Chlorhexidine Gluconate ◽  
Wound Management ◽  
Resistant Organism ◽  
Drug Resistant ◽  
Intact Skin ◽  
Burn Wound ◽  
Burn Wounds ◽  
Burn Unit

Abstract Introduction Daily wound care is an important part of burn wound management to help prevent infection. Literature suggests that daily Chlorhexidine Gluconate (CHG) bathing can reduce the risk of acquiring Multi-Drug Resistant Organisms (MDRO). The purpose of this study was to identify change in overall MDRO acquisition in the Burn Unit with the addition of a 1% CHG solution for wound care to the CHG bathing protocol for burn patients. Methods Prior to March 2018, routine bathing and wound care involved use of CHG-incompatible antibacterial soap and water followed by 2% chlorhexidine gluconate cloths to intact skin. In March 2018, the bathing protocol changed, in consultation with the hospital’s infection prevention program, to involve a 1% CHG solution for burn wounds followed by 2% CHG cloths to intact skin in order to prevent the loss of protective residual CHG due to rinsing with CHG-incompatible soap and water. A solution of 1% CHG was chosen by staff as an acceptable concentration for wound bathing. Adherence was measured through review of daily documentation of bathing in the electronic medical record. Incidences of burn unit-attributable hospital-onset MDRO cultures were reviewed for the following periods: Baseline (Aug 2016-Aug 2017), Phase-In (Sept 2017 – Aug 2018) and Post-Implementation (Sept 2018 – Aug 2019). Results Adherence was >85% throughout the intervention period. No adverse events were noted. Incidences of hospital-onset burn unit MDROs during the following time periods were: 22 cases (Baseline), 15 cases (Phase-In), and 10 cases (Post-Implementation). The most common organisms in the baseline period were Extended-Spectrum b-Lactamase (ESBL) Escherichia coli, MRSA, and Multi Drug Resistant Pseudomonas; and post-implementation, the most common organisms were: MRSA and MDR-Pseudomonas. Conclusions A change to a 1% CHG solution for rinsing burn wounds in the setting of 2% CHG cloths to intact skin was well tolerated and associated with a decline in MDRO acquisition attributable to the burn ICU in the one-year post implementation. Applicability of Research to Practice The use of a 1% CHG solution for burn wounds may help prevent MDRO acquisition in the highly susceptible and unique burn population.

scholarly journals Pediatric Thermal Burns and Treatment: A Review of Progress and Future Prospects

2017 ◽  
Author(s):  
Elton Mathias ◽  
Madhu Srinivas Murthy
Keyword(s):  
Wound Repair ◽  
Wound Care ◽  
Point Of View ◽  
Burn Injuries ◽  
Skin Substitute ◽  
Future Prospects ◽  
Skin Substitutes ◽  
Burn Wound ◽  
Burn Wounds ◽  
Basic Care

Burns is a pervasive and oppressive basic care issue. In children, burn injuries are a major reason for bleakness and mortality. The quirks in the physiology of liquid and electrolyte taking care of, the vital necessity and the distinctions in the different body extends in children direct that the pediatric wounds administration ought to be brought with an alternate point of view than for adults. Notwithstanding, for the intensivist, challenges regularly exist that muddle quiet help and adjustment. Moreover, burn injuries are mind-boggling and can show exceptional challenges that require deep-rooted recovery. Investigation in burn wound care has yielded progressions that will keep on improving practical recuperation. What's more, pain management all through this period is essential. Managing these wounds requires escalated therapeutic treatment for multi-organ dysfunction, and forceful surgical treatment to forestall sepsis and other inconveniences. The biological therapeutic bilayered skin substitutes with a long shelf life that recapitulates the normal barrier function of the intact human skin and stimulate wound repair and skin regeneration. A definitive objective is to accomplish a perfect skin substitute that gives a successful and without scar wound recuperating. This review article features the headway in pediatric burn wounds with an emphasis on the pathophysiology and treatment of burn wounds.

scholarly journals Evaluation of the Biocompatibility of a Bilayer Chitosan Skin Regenerating Template, Human Skin Allograft, and Integra Implants in Rats

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Shah Jumaat Mohd Yussof ◽  
Ahmad Sukari Halim ◽  
Arman Zaharil Mat Saad ◽  
Hasnan Jaafar
Keyword(s):  
Human Skin ◽  
Inflammatory Reaction ◽  
Gold Standard ◽  
Tissue Response ◽  
Regeneration System ◽  
Skin Allograft ◽  
Skin Cells ◽  
Skin Allografts ◽  
Tissue Responses

Introduction. Chitosan is a nontoxic, biocompatible, and biodegradable polymer obtained from chitin by N-deacetylation using strong alkali. Chitosan in a form of a bilayer skin regenerating template can act as a scaffold for regeneration. Integra is a two-layer skin regeneration system, constructed of a matrix of crosslinked fibers that acts as a scaffold for regenerating dermal skin cells. Human skin allografts (HSAs) are the “gold standard” for temporary coverage of clean burn wounds. Objectives. The objective of this study was to conduct in-vivo, preclinical biocompatibility evaluations of Integra, HSA, and Chitosan skin regenerating template (SRT). Methods. Paravertebral subcutaneous pockets were created for the implantation of test materials. Implants were retrieved after 4, 7, 14, 21, and 28 days. Slides of sections through the implants were examined to determine biocompatibility. Results. Chitosan SRT and Integra showed similar inflammatory patterns. HSA showed a higher inflammatory reaction initially which then reduced to levels similar to Integra and Chitosan SRT. Chitosan SRT and Integra also shared similar angiogenesis levels. Towards the end, all implants were degraded with decreased tissue response. Conclusion. Integra, Chitosan SRT, and HSA have been shown to be biocompatible. Integra and Chitosan SRT seem to illicit similar tissue responses.

537 Transplantation of Fresh Scalp Allograft in Repairing Extensive Deep Burn Wounds in Children

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S107-S107
Author(s):  
Chuanan Shen ◽  
Tianjun Sun ◽  
Huping Deng ◽  
Yuezeng Niu
Keyword(s):  
High Efficiency ◽  
Healing Time ◽  
High Ratio ◽  
Scar Formation ◽  
Burn Wound ◽  
Burn Wounds ◽  
Skin Allografts ◽  
Post Operation ◽  
Healthy Relative ◽  
Skin Donors

Abstract Introduction It is difficult to treat pediatric extensive burns, which contribute to high mortality rates, partly because of the lack of large allogeneic skin to close wound in China. Therefore, we innovatively used fresh scalp as thin split thickness skin allografts to cover the burn wounds of pediatric patients. Methods Fresh scalp allografts were harvested from voluntary donors who were patients’ relatives. The median total burn area in the major burns was of 40% TBSA, in depth of deep second to third degree. The fresh scalp allografts were transplanted on the wounds post tangential excision or escharectomy in the way of mere fresh scalp allografts coverage or mixed coverage with autografts and fresh scalp allografts. Results All the patients survived without serious complications during the treatment period. The median healing time was 47 days; the average healing time of the donors’ scalps was (7.6±1.08) days with no scar formation, alopecia areata or folliculitis post operation. Conclusions The use of fresh scalp allografts in the treatment of pediatric major burns is an effective and feasible method in protecting wounds and promoting wound healing as well as in reducing scar formation in the donor sites of burned children. The high ratio of fresh scalp areas to pediatric burn wound areas ensures high efficiency of wound coverage; and healthy relative skin donors have more initiatives and favorable healing results. Applicability of Research to Practice This is a clinical research which is highly applicable in practice.

scholarly journals Modelling early thermal injury using an ex vivo human skin model of contact burns

2020 ◽  
Author(s):  
Aiping Liu ◽  
Edgar Ocotl ◽  
Aos Karim ◽  
Josiah J. Wolf ◽  
Benjamin L. Cox ◽  
...  
Keyword(s):  
Wound Healing ◽  
Human Skin ◽  
Tissue Injury ◽  
Ex Vivo ◽  
Individual Variability ◽  
Dependent Manner ◽  
Preclinical Research ◽  
Burn Wound ◽  
Burn Wounds ◽  
Significant Difference

AbstractBackgroundEarly mechanisms underlying the progressive tissue death and the regenerative capability of burn wounds are understudied in human skin. A clinically relevant, reproducible model for human burn wound healing is needed to elucidate the early changes in the human burn wound environment. This study reports a reproducible contact burn model on human skin that explores the extent of tissue injury and healing over time, and defines the inter-individual variability in human skin to enable use in mechanistic studies on burn wound progression and healing.MethodsUsing a customized burn device, contact burns of various depths were created on human skin by two operators and were evaluated for histologic depth by three raters to determine reproducibility. Early burn wound progression and wound healing were also evaluated histologically after the thermally injured human skin was cultured ex vivo for up to 14 days.ResultsBurn depths were reproducibly generated on human skin in a temperature- or time-dependent manner. No significant difference in operator-created or rater-determined depth was observed within each patient sample. However, significant inter-individual variation was identified in burn depth in ten patient samples. Burn-injured ex vivo human skin placed into culture demonstrated differential progression of cell death and collagen denaturation for high and low temperature contact burns, while re-epithelialization was observed in superficial burn wounds over a period of 14 days.ConclusionThis model represents an invaluable tool to evaluate the inter-individual variability in early burn wound progression and wound healing to complement current animal models and enhance the translation of preclinical research to improvements in patient care.

Acute limb ischemia in a patient with pre-fibrotic myelofibrosis complicated by heparin-induced thrombocytopenia and thrombosis – case report and systematic review of dabigatran use

VASA ◽  
2020 ◽  
pp. 1-6 ◽  
Author(s):  
Marina Di Pilla ◽  
Stefano Barco ◽  
Clara Sacco ◽  
Giovanni Barosi ◽  
Corrado Lodigiani
Keyword(s):  
Systematic Review ◽  
Case Report ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Review Of The Literature ◽  
Heparin Induced Thrombocytopenia ◽  
Lower Limb Ischemia ◽  
Vein Thrombosis ◽  
Left Lower Limb

Summary: A 49-year-old man was diagnosed with pre-fibrotic myelofibrosis after acute left lower-limb ischemia requiring amputation and portal vein thrombosis. After surgery he developed heparin-induced thrombocytopenia (HIT) with venous thromboembolism, successfully treated with argatroban followed by dabigatran. Our systematic review of the literature supports the use of dabigatran for suspected HIT.

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