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

Medicina ◽  
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.

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

Plastic chronic wound management with Cellutome

Phlebologie ◽  
2016 ◽  
Vol 45 (02) ◽  
pp. 100-105
Author(s):  
G. U. Seip
Keyword(s):  
Health Care Providers ◽  
Chronic Wounds ◽  
Donor Site ◽  
Skin Grafting ◽  
Minimal Invasive ◽  
Wound Management ◽  
Wound Treatment ◽  
Care Providers ◽  
Patients With Diabetes ◽  
Chronic Wound Management

SummaryChronic wounds continue to present a significant challenge to health-care providers around the globe. Unlike acute wounds, chronic wounds do not proceed through an orderly process of repair. In recent years many new modalities of modern wound treatment systems have been promoted. However, until recently there were few modalities designed to promote epithelialisation of a fully granulated wound. Mesh graft procedures have long been the gold standard for the management of acute wounds and chronic wounds but have also many disadvantages like discomfort associated with the donor site and the creation of a second painful wound (donor site).The increase of chronical wounds in Germany due to the average age of patients, the aggressiveness of medical treatment and increase of numbers of patients with diabetes and severe polymorbidity requires specialized wound treatment and plastic surgery. Since 2014 there was a new innovative system introduced in the market called Cellutome epidermal harvesting system. The Cellutome system is a epidermal harvesting system for skin grafting and can replace in many cases the traditional meshgraft procedure with a classic dermatoma. The skin donor section on the patient`s thigh heals within days without scarring. The system offers a precise, simplified and minimal invasive option for skin grafting in the treatment of especially chronic wounds.

scholarly journals The evolution of acute burn care – retiring the split skin graft

2017 ◽  
Vol 99 (6) ◽  
pp. 432-438 ◽  
Author(s):  
JE Greenwood
Keyword(s):  
Skin Graft ◽  
Wound Repair ◽  
Burn Injury ◽  
Comparative Anatomy ◽  
Donor Site ◽  
Burn Wound ◽  
Burn Care ◽  
Split Skin

The skin graft was born in 1869 and since then, surgeons have been using split skin grafts for wound repair. Nevertheless, this asset fails the big burn patient, who deserves an elastic, mobile and robust outcome but who receives the poorest possible outcome based on donor site paucity. Negating the need for the skin graft requires an autologous composite cultured skin and a material capable of temporising the burn wound for four weeks until the composite is produced. A novel, biodegradable polyurethane chemistry has been used to create two such products. This paper describes the design, production, optimisation and evaluation of several iterations of these products. The evaluation has occurred in a variety of models, both in vitro and in vivo, employing Hunterian scientific principles, and embracing Hunter’s love and appreciation of comparative anatomy. The process has culminated in significant human experience in complex wounds and extensive burn injury. Used serially, the products offer robust and elastic healing in deep burns of any size within 6 weeks of injury.

scholarly journals Retrospective Evaluation of Progenitor Biological Bandage Use: A Complementary and Safe Therapeutic Management Option for Prevention of Hypertrophic Scarring in Pediatric Burn Care

2021 ◽  
Vol 14 (3) ◽  
pp. 201
Author(s):  
Karim Al-Dourobi ◽  
Alexis Laurent ◽  
Lina Deghayli ◽  
Marjorie Flahaut ◽  
Philippe Abdel-Sayed ◽  
...  
Keyword(s):  
Donor Site ◽  
Skin Grafting ◽  
Specific Cell ◽  
Hypertrophic Scarring ◽  
Retrospective Case ◽  
Clinical Safety ◽  
Cell Therapies ◽  
Burn Care ◽  
Advanced Therapy ◽  
Second Degree

Progenitor Biological Bandages (PBB) have been continuously applied clinically in the Lausanne Burn Center for over two decades. Vast translational experience and hindsight have been gathered, specifically for cutaneous healing promotion of donor-site grafts and second-degree pediatric burns. PBBs constitute combined Advanced Therapy Medicinal Products, containing viable cultured allogeneic fetal dermal progenitor fibroblasts. Such constructs may partly favor repair and regeneration of functional cutaneous tissues by releasing cytokines and growth factors, potentially negating the need for subsequent skin grafting, while reducing the formation of hypertrophic scar tissues. This retrospective case-control study (2010–2018) of pediatric second-degree burn patients comprehensively compared two initial wound treatment options (i.e., PBBs versus Aquacel® Ag, applied during ten to twelve days post-trauma). Results confirmed clinical safety of PBBs with regard to morbidity, mortality, and overall complications. No difference was detected between groups for length of hospitalization or initial relative burn surface decreasing rates. Nevertheless, a trend was observed in younger patients treated with PBBs, requiring fewer corrective interventions or subsequent skin grafting. Importantly, significant improvements were observed in the PBB group regarding hypertrophic scarring (i.e., reduced number of scar complications and related corrective interventions). Such results establish evidence of clinical benefits yielded by the Swiss fetal progenitor cell transplantation program and favor further implementation of specific cell therapies in highly specialized regenerative medicine.

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

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.

scholarly journals Historical Evolution of Skin Grafting—A Journey through Time

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 348
Author(s):  
Michael Kohlhauser ◽  
Hanna Luze ◽  
Sebastian Philipp Nischwitz ◽  
Lars Peter Kamolz
Keyword(s):  
20Th Century ◽  
Gold Standard ◽  
Skin Grafting ◽  
Historical Evolution ◽  
Burn Wound ◽  
Wound Coverage ◽  
Burn Care ◽  
19Th And 20Th Century

Autologous skin grafting was developed more than 3500 years ago. Several approaches and techniques have been discovered and established in burn care since then. Great achievements were made during the 19th and 20th century. Many of these techniques are still part of the surgical burn care. Today, autologous skin grafting is still considered to be the gold standard for burn wound coverage. The present paper gives an overview about the evolution of skin grafting and its usage in burn care nowadays.

527 Eschar Removal by Bromelain Based Enzymatic Debridement in Burns: European Consensus Guidelines Update

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S101-S102
Author(s):  
Christoph R Hirche ◽  
Benjamin Ziegler ◽  
Ulrich Kneser
Keyword(s):  
Skin Grafting ◽  
Wound Management ◽  
Consensus Guidelines ◽  
Burn Care ◽  
Number Of Patients ◽  
Consensus Statements ◽  
The Impact ◽  
And Training ◽  
Enzymatic Debridement

Abstract Introduction Bromelain based Enzymatic Debridement (ED) has been introduced as an additional concept to the burn surgeon’s armamentarium, and is best indicated for mid-to deep dermal burns with mixed patterns. Increasing evidence has been published on special regions and settings, adressing success and limitations of ED for improved patient care. To better guide ED in view of the increasing experience, there is a need to publish updated consensus guidelines with user-orientated recommendations. Methods A multiprofessional expert panel of plastic surgeons and burn care specialists from 10 European countries was convened, to assist in developing current recommendations for best practices with use of ED. Consensus statements were based on peer-reviewed publications and clinical relevance. For consensus agreement, the methodology employed was an agreement algorithm based on a modification of the Willy and Stellar method. For this study on ED, consensus was considered when there was at least 80 % agreement to each statement. Results The updated consensus guidelines from 2019 refer to a diversity of experience and practice patterns of 1232 summarized patient cases in Europe (2017: 500 cases), reflecting the impact of the published recommendations. Forty-three statements were formulated, addressing the following topics: indications, pain management and anesthesia, large surface indication, timing of application for various indications, preparation and application, post-interventional wound management, skin grafting, outcome, scar and revision management, cost-effectiveness, patient′s perspective, logistic aspects and training strategies. The degree of consensus was remarkably high, with consensus in 42 of 43 statements (97.7%), while no consensus was achieved on the role of outpatient treatment/ED as day cases in minor burns in experienced burn centers. A classifications with regard to timing of application for ED was introduced, with „immediate/ very early“(≤12h), early (12-72h) or delayed (>72h) treatment. All further recommendations are addressed in the presentation. Conclusions The updated guidelines in this paper represent further refinement of the recommended indication, application and post-interventional management for the use of ED. The published statements contain detailed, user-orientated recommendations aiming to align current and future users and prevent unnecessary pitfalls. The significance of this work is reflected by the magnitude of patient experience behind it, larger than the total number of patients treated in all published ED clinical trials. Applicability of Research to Practice These consensus guidelines may serve as refined user-orientated recommendations for implementation and successful application of ED in further countries (e.g. USA) based on the evidence and experience of 1232 summarized patient cases.

scholarly journals Calcium Homeostasis Comparison in Thermal Burn Patients–Early Tangential Excision and Grafting versus Conservative Management

2020 ◽  
Vol 53 (03) ◽  
pp. 381-386
Author(s):  
Sonika Jha ◽  
Parul Goyal ◽  
Sameek Bhattacharya ◽  
Shilpi Baranwal
Keyword(s):  
Calcium Homeostasis ◽  
Conservative Management ◽  
Bone Mineralization ◽  
Skin Grafting ◽  
Urinary Calcium ◽  
Wound Management ◽  
Categorical Variables ◽  
P Value ◽  
Burn Wound ◽  
Thermal Burn

Abstract Introduction With the advent of better burn wound management protocols, early excision and grafting, increased number of burns patients are surviving and entering the struggle of prolonged rehabilitation. Calcium homeostasis and its influence on bone mineralization plays an important role, but it is adversely influenced by the proinflammatory state in burns, leading to hypocalcemia and paradoxical hypercalciuria which, in turn, leads to excessive bony resorption and pathological fractures. The role of early excision in the overall metabolism of calcium is being investigated in the study. Method This study was undertaken in a tertiary level government-run hospital from February 2018 to August 2019. A total of 28 patients with second degree thermal burns were included. For all patients, fasting serum parathormone levels along with various serum electrolytes like Ca2+,Mg2+, PO4 3- and urinary calcium levels were serially measured from day of admission to 2 months. The first group of 14 patients (Group A) underwent early tangential excision and skin grafting, whereas another 14 patients (Group B) underwent conservative management. All categorical variables were analyzed with the help of Chi square test. A p value of < 0.05 was considered statistically significant. Result There was a statistically significant improvement in serum parathormone and other electrolytes’ levels in the tangential excision group. Similarly, urinary excretion of calcium also showed favorable results in the group. Conclusion Early tangential excision and grafting in burns plays an important role in maintaining serum parathormone and calcium levels, leading to prevention of hypercalciuria and optimization of other factors affecting calcium homeostasis.

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