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

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.

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Longitudinal profiling of the burn patient cutaneous and gastrointestinal microbiota: a pilot study

Scientific Reports ◽

10.1038/s41598-021-89822-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kelly M. Lima ◽

Ryan R. Davis ◽

Stephenie Y. Liu ◽

David G. Greenhalgh ◽

Nam K. Tran

Keyword(s):

Burn Injury ◽

Alpha Diversity ◽

Skin Grafting ◽

Sampling Period ◽

Antibiotic Administration ◽

Gastrointestinal Microbiota ◽

Burn Wound ◽

Burn Care ◽

Increased Risk ◽

Burn Patient

AbstractSepsis is a leading cause of morbidity and mortality in patients that have sustained a severe burn injury. Early detection and treatment of infections improves outcomes and understanding changes in the host microbiome following injury and during treatment may aid in burn care. The loss of functional barriers, systemic inflammation, and commensal community perturbations all contribute to a burn patient’s increased risk of infection. We sampled 10 burn patients to evaluate cutaneous microbial populations on the burn wound and corresponding spared skin on days 0, 3, 7, 14, 21, and 28 post-intensive care unit admission. In addition, skin samples were paired with perianal and rectal locations to evaluate changes in the burn patient gut microbiome following injury and treatment. We found significant (P = 0.011) reduction in alpha diversity on the burn wound compared to spared skin throughout the sampling period as well as reduction in common skin commensal bacteria such as Propionibacterium acnes and Staphylococcus epidermitis. Compared to healthy volunteers (n = 18), the burn patient spared skin also exhibited a significant reduction in alpha diversity (P = 0.001). Treatments such as systemic or topical antibiotic administration, skin grafting, and nutritional formulations also impact diversity and community composition at the sampling locations. When evaluating each subject individually, an increase in relative abundance of taxa isolated clinically by bacterial culture could be seen in 5/9 infections detected among the burn patient cohort.

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Antioxidants Reduce Tissue Necrosis in The Zone of Stasis: Review of Burn Wound Conversion

Jurnal Plastik Rekonstruksi ◽

10.14228/jpr.v7i1.292 ◽

2020 ◽

Vol 7 (1) ◽

pp. 18-28

Author(s):

Aditya Wardhana ◽

Jessica Halim

Keyword(s):

Oxidative Stress ◽

Animal Studies ◽

Burn Injury ◽

Fluid Replacement ◽

Ros Scavenging ◽

Antioxidant Supplementation ◽

Burn Wound ◽

Severe Burns ◽

Burn Depth ◽

Injury Progression

Summary: Severe burns are devastating condition identified by loss of hemodynamic stability and intravascular volume. Adequate fluid replacement, nutritional support, and immediate wound grafting can reduce the risk of infection and mortality. Oxidative stress was shown to have significant role in the burn wound conversion, which happens when the zone of stasis can’t be salvaged and progresses to necrosis. Decreasing the level of oxidative stress early may be fundamental in reducing burn injury progression into deeper tissue. Several animal studies have demonstrated the advance of antioxidant supplementation for burns outcomes. Approach to this salvageable burn tissue is a breakthrough for new directions in burn management. Antioxidant supplementations was proven to prevent burn conversion on the ischemic zone. Administering antioxidant post-burn is linked with less progression of burn depth and inflammatory cytokine release, which alleviates burn-related morbidity and mortality and improves patient’s quality of life. To date, no clinical trials have been done to reproduce similar outcomes of this ROS-scavenging therapy as successfully observed in murine models. Antioxidant supplementation is a promising treatment avenue to halt burn wound conversion following severe burns. Keywords: Burn wound, wound conversion, burn management, antioxidant

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Burn wound dressings

Burns (OSH Surgery) ◽

10.1093/med/9780199699537.003.0017 ◽

2019 ◽

pp. 145-150

Author(s):

Joseph Hardwicke ◽

Naiem Moiemen

Keyword(s):

Wound Healing ◽

Small Area ◽

Burn Injury ◽

Skin Grafting ◽

Wound Dressings ◽

Burn Wound ◽

Regular Monitoring ◽

The Individual ◽

Partial Thickness Burns ◽

Regular Review

The ultimate goal for all burns is to allow the wound to heal with the least amount of scarring, and this is directly related to the depth of burn injury. Superficial partial thickness burns and deeper burns of small area can be treated by suitable dressings alone and this is probably the most widely applied form of treatment for burns. Burns that are selected for treatment by dressings alone, or in combination with surgical debridement and skin grafting, require regular monitoring, both clinically and microbiologically. Modern dressings may allow a longer interval between dressing changes, but this should not be sacrificed in favour of regular review. If wound healing progresses at the expected rate, then the comfort afforded by fewer changes of dressings is advantageous, but the poorly progressing wound should be treated aggressively with a custom-designed dressing which can be tailored for the individual needs of the patient.

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Usage of intermingled skin allografts and autografts in a senior patient with major burn injury

Open Medicine ◽

10.1515/med-2021-0395 ◽

2021 ◽

Vol 16 (1) ◽

pp. 1745-1748

Author(s):

Hongmin Luo ◽

Huining Bian ◽

Chuanwei Sun ◽

Shaoyi Zheng ◽

Bing Xiong ◽

...

Keyword(s):

Burn Injury ◽

Total Body Surface Area ◽

Skin Grafting ◽

Skin Grafts ◽

Burn Wound ◽

Skin Allografts ◽

Economic Method ◽

Major Burn ◽

Gas Flame ◽

Extensive Burn

Abstract Mortality rate in older adults following extensive burn injury is extremely high, and management of these patients is challenging. One of the main problems is that autologous split-thickness skin grafts are scarce and the wounds cannot be covered quickly and effectively. Intermingled skin grafting is a low-tech and economic method, which not only maximizes the use of precious autologous skin but also prevents the wounds from infection and consumption. Herein we present a case of extensive burn injury in a 68-year-old female successfully treated with intermingled skin grafting. The patient was accidentally burned by gas flame, resulting in a major burn injury covering 80% of her total body surface area. Early burn wound excision was performed and the wound was temporarily covered with irradiated porcine skin in the first week after injury. Autologous stamp-like skin grafts were applied to the wound bed 4 weeks after injury. In this operation, the results were not satisfactory. The take rate of the skin grafts is only about 50%. We covered the wounds with intermingled skin allografts and autografts 8 weeks after injury: autografts (0.5 cm × 0.5 cm) + fresh close relative’s allografts (1 cm × 1 cm) + cryopreserved allografts (2 cm × 2 cm).

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524 The Use of Enzymatic Debridement in Large Burns Two Years of Experience

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.154 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S100-S100

Author(s):

Jasminka Minic ◽

Maurizio Governa

Keyword(s):

Inflammatory Response ◽

Gold Standard ◽

Burn Injury ◽

Local Level ◽

Skin Grafting ◽

Positive Outcome ◽

Base System ◽

Burn Wound ◽

Selective Approach ◽

Enzymatic Debridement

Abstract Introduction Modern era of treatment of burn injury stated with revolutionary approach of early surgical debridement followed by autologous skin grafting since early sixties of the last century. For many decades it’s been a gold standard treatment. It’ s considered effective although not selective approach in terms of blood loss and vital tissue preservation. We hypothesized that selective enzymatic debridement could have the positive outcome in terms of local control of wound healing and could decrease systemic inflammatory response. Methods Since February 2017 till February 2019 in our Burn Unit, we treated over 50 cases of partially deep and deep burns. Thirty nine out of 50 was >15% TBSA (15 - 85%). Most of the patients (34 out of 39) was treated in BU or ICU. According to our protocol allograft skin grafting followed enzymatic debridement. Skin biopsy was performed before and after treatment. Three cases died for other complications and comorbidity. Results We respected the gold standard performing complete selective debridement within 1,4 days. Mean age was 54,1ys (1.1–96 ys). No blood transfusion was necessary after enzymatic debridement. Only one procedure was necessary for the majority patients (32 out of 39 pt). Twenty eight out of 39 patients went to OR for skin grafting. For the burn wound completion there was a necessity of average 5,8% autografts. Infection was well controlled with antibiotics therapy. Five cases of sepsis and one case of bacteremia was registered. Conclusions Regardless it a limited number of patient and only one year of experience, obtained results are encouraging. Rapid enzymatic debridement as a minimally invasive tool permitted to control burn wound not only on the local level but it seam like that has improved pro and anti-inflammatory response in terms of better control of the SIRS. Further investigations will be necessary to confirm it. Applicability of Research to Practice This study is applicable inner practice. All the following data were took from our data base system.

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Longitudinal Profiling Of The Burn Patient Cutaneous And Gastrointestinal Microbiota

10.21203/rs.3.rs-240723/v1 ◽

2021 ◽

Author(s):

Kelly Lima ◽

Ryan Davis ◽

Stephenie Liu ◽

David Greenhalgh ◽

Nam Tran

Keyword(s):

Burn Injury ◽

Alpha Diversity ◽

Skin Grafting ◽

Sampling Period ◽

Antibiotic Administration ◽

Gastrointestinal Microbiota ◽

Burn Wound ◽

Burn Care ◽

Increased Risk ◽

Burn Patient

Abstract Sepsis is a leading cause of morbidity and mortality in patients that have sustained a severe burn injury. Early detection and treatment of infections improves outcomes and understanding changes in the host microbiome following injury and during treatment may aid in burn care. The loss of functional barriers, systemic inflammation, and commensal community dysbiosis all contribute to a burn patient’s increased risk of infection. We sampled 10 burn patients to evaluate cutaneous microbial populations on the burn wound and corresponding spared skin on days 0, 3, 7, 14, 21, and 28 post-intensive care unit admission. In addition, skin samples were paired with perianal and rectal locations to evaluate changes in the burn patient gut microbiome following injury and treatment. We found significant (P = 0.011) reduction in alpha diversity on the burn wound compared to spared skin throughout the sampling period as well as reduction in common skin commensal bacteria such as Propionibacterium acnes and Staphylococcus epidermitis. Compared to healthy volunteers (n = 18), the burn patient spared skin also exhibited a significant reduction in diversity (P = 0.001). Treatments such as systemic or topical antibiotic administration, skin grafting, and nutritional formulations also impact diversity and community composition at the sampling locations. When evaluating each subject individually, an increase in relative abundance of a clinically isolated bacteria could be seen in 5/9 infections detected among the burn patient cohort.

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531 The Effect of Burn Wound Size on Caloric Requirements: A Correlation of Nutritional Changes to the Clinical State

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.181 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S113-S114

Author(s):

Marc R Matthews ◽

Sara Calder ◽

Areta Kowal-Vern ◽

Philomene Spadafore ◽

Karen J Richey ◽

...

Keyword(s):

Injury Severity ◽

Burn Injury ◽

Recovery Period ◽

Total Body Surface Area ◽

Caloric Intake ◽

Retrospective Chart Review ◽

Clinical State ◽

Apache Score ◽

Burn Wound ◽

Caloric Requirements

Abstract Introduction Caloric intake has been a vital component for burn wound healing and recovery. The hypothesis was that caloric requirements are based on injury severity & post-burn week as predicated by indirect calorimetry (IC)/predictive equations. Methods This was a retrospective chart review of 115 burn patients (2012–2017). Caloric requirements were determined by the Curreri equation [which includes % total body surface area (TBSA)] and IC for a 5-week period provided mainly by enteral nutrition. Patients received supplements and total parenteral nutrition as needed. Results The mean ±sd age was 43±18 years, 41±18 % TBSA, Body Mass Index of 28±7 kg/m2, and mortality of 26 (23%). The major mechanisms of injury were flame/flash/explosions. There were 59 (51%) of patients with < 40 % TBSA burns, [median Injury Severity Score (ISS) 9; Apache score 14], and 56 (49%) with ≥40 % TBSA (median ISS 25; Apache score 21), p < .0001. The Respiratory Quotient (RQ) had a median of 0.94 (range 0.79 to 1.02). The median number of surgeries for the < 40 % TBSA group was 5 versus 12 for the ≥40 % TBSA, p < .0001. The Injury Factor did not differ from weeks 1–5 (1.8 for < 40 % TBSA and 2.0 for the ≥ 40 % TBSA). The Curreri equation calculation for this study was a median 3640 (range 2161–5950) calories. The Curreri equation resulted in significantly increased caloric recommendations for the ≥ 40 %TBSA compared to the < 40 %TBSA patients, p < .0001. The < 40 %TBSA group had caloric requirements ranging between 1500- 2700 calories compared to the ≥ 40 %TBSA group, whose calories ranged between 2000–3700. The total daily caloric recommendations were also significantly increased in the ≥40 %TBSA compared to the < 40 %TBSA patients. The maximum levels of resting energy expenditure (REE) from IC, total daily calories recommended by the dietitian and average calories ranged between 3000–4500 in the < 40 %TBSA group and 3600–6700 in the ≥ 40 %TBSA group. The caloric recommendations increased for all patients from week 1 to week 3 and leveled off during weeks 4–5. Conclusions Patient caloric requirements were dependent not only on the severity of the burn injury but also the post-burn hospitalization during which surgeries, debridement/grafting, and infectious complications occurred. They increased until the third week post-burn and leveled off in the recovery period. The study caloric recommendations and requirements were consistent with the REE and Curreri equation assessments.

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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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668 Fixation of Split-Thickness Skin Grafts with Liquid Adhesive and Fibrin Glue in Place of Staples

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.314 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S190-S191

Author(s):

Joshua Frost ◽

Nathan Hallier ◽

Tanir Moreno ◽

Jared Covell ◽

Ryan Keck ◽

...

Keyword(s):

Fibrin Glue ◽

Skin Grafting ◽

Skin Grafts ◽

Inclusion Criteria ◽

Intact Skin ◽

Body Area ◽

Wound Site ◽

Graft Take ◽

Thickness Skin ◽

Split Thickness Skin Grafting

Abstract Introduction A critical component of split-thickness skin grafting is the fixation of the skin graft to the wound site. Graft displacement can result in graft failure, especially during the initial 48–72 hours following application. The most common method of securing grafts is with the use of staples, sometimes with the addition of fibrin glue in order to aid both graft adhesion and homeostasis. The use of staples, however, is associated with significant levels of patient discomfort, especially during staple removal. A possible alternative to staples is the use of liquid adhesives, in combination with steri-strips, to anchor the edges of skin grafts to intact skin. Certain liquid adhesives, such as gum-based resins, are cheaper to use than staples and offer the potential to secure small split-thickness skin grafts without the associated pain of staples. In this pilot study, we examined the effectiveness of using a combination of gum-based resin (Gum Mastic-Storax-Msal-Alcohol), fibrin glue, and steri-strips to secure partial-thickness grafts in 8 patients without the use of staples or sutures. Methods Patients were included in the study who required split-thickness skin grafts to treat wounds involving less than or equal to 15% total surface body area and whose wounds were not located in areas prone to graft displacement, such as the axilla and groin. For each patient, skin grafts were secured using fibrin glue (sprayed over the entire wound), and a combination of liquid adhesive and steri-strips applied around the wound perimeter. The success of each graft was determined by the percentage of graft take. Results From January 1st, 2020 to April 30th, 2020, 8 patients were identified who fit the inclusion criteria. Five of the patients received grafts to their lower extremities, two patients received grafts to their upper extremities, and one of the patients received a graft to the torso. The average wound site that was grafted was 116.7 cm2. Average graft take among the 8 patients was 96.9%, with a range of 90%-100%. No complications at the graft site were noted, such as hematomas or any other event that resulted in graft displacement or failure. Conclusions The results of the study demonstrate that a combination of liquid adhesive, fibrin glue, and steri-strips, can be used as an effective alternative to staples in small split-thickness skin grafts. The use of liquid adhesive in place of staples was advantageous because it eliminated to need for staple removal, which resulted in less discomfort for the patient and less work for the nursing staff.

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The Role of Immunohistochemical Markers for the Diagnosis and Prognosis of Adrenocortical Neoplasms

Journal of Personalized Medicine ◽

10.3390/jpm11030208 ◽

2021 ◽

Vol 11 (3) ◽

pp. 208

Author(s):

Anna Angelousi ◽

Georgios Kyriakopoulos ◽

Fani Athanasouli ◽

Anastasia Dimitriadi ◽

Eva Kassi ◽

...

Keyword(s):

Transcriptome Analysis ◽

Cox Regression ◽

P53 Protein ◽

Immunohistochemical Analysis ◽

Ki 67 ◽

Diagnosis And Prognosis ◽

Immunohistochemical Markers ◽

Small Series ◽

Morphological Criteria ◽

Survival And Development

Adrenal cortical carcinoma (ACC) is a rare cancer with poor prognosis that needs to be distinguished from adrenocortical adenomas (ACAs). Although, the recently developed transcriptome analysis seems to be a reliable tool for the differential diagnosis of adrenocortical neoplasms, it is not widely available in clinical practice. We aim to evaluate histological and immunohistochemical markers for the distinction of ACCs from ACAs along with assessing their prognostic role. Clinical data were retrospectively analyzed from 37 patients; 24 archived, formalin-fixed, and paraffin-embedded ACC samples underwent histochemical analysis of reticulin and immunohistochemical analysis of p27, p53, Ki-67 markers and were compared with 13 ACA samples. Weiss and Helsinki scores were also considered. Kaplan−Meier and univariate Cox regression methods were implemented to identify prognostic effects. Altered reticulin pattern, Ki-67% labelling index and overexpression of p53 protein were found to be useful histopathological markers for distinguishing ACAs from ACCs. Among the studied markers, only pathological p53 nuclear protein expression was found to reach statistically significant association with poor survival and development of metastases, although in a small series of patients. In conclusion, altered reticulin pattern and p53/Ki-67 expression are useful markers for distinguishing ACCs from ACAs. Immunohistopathology alone cannot discriminate ACCs with different prognosis and it should be combined with morphological criteria and transcriptome analysis.

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