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

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.

SURGICAL TREATMENT OF MUCOUS CYSTS ON FINGERS WITHOUT SKIN EXCISION

Mucous cysts on the fingers are commonly treated by excision followed by a rotation flap or skin graft. However, such procedures require skin donors or large incisions. Therefore, a less invasive procedure is needed. Here, we report a surgical treatment method that does not require the excision of the cyst. A skin flap was made around the cyst and raised; the pedicle of the cyst was then electrodesiccated or ligated, and the contents of the cyst were evacuated. If the pedicle could not be clearly identified, the backside of the flap was electrodesiccated to break the connection between the cyst and the distal interphalangeal joint. The skin flap was replaced and sutured. The flaps became almost normal during the follow-up period. No complications or recurrences occurred in any of the six cases that were treated. Our procedure appears to be an effective and less-invasive treatment for mucous cysts of the fingers.

ALLOGENEIC THYMUS GRAFTS AND THE RESTORATION OF IMMUNE FUNCTION IN IRRADIATED THYMECTOMIZED MICE

Irradiated and thymectomized CBA mice are markedly depressed in several immunological parameters (skin homograft rejection, graft-vs.-host activity and hemolytic plaque-forming cells of the spleen, hemolysin and hemagglutinin formation, and peripheral lymphocyte counts). In the present experiments the ability of homografts of neonatal thymus placed beneath the kidney capsule to restore immunological capacity of such animals was studied. Thymus homografts which share the same H-2 locus with the CBA mouse were permanently tolerated and immunological restoration was complete. Skin from the thymus donor was specifically retained, but third party skin with even minor (non-H-2) incompatibility was normally rejected and hemolytic plaque-forming cells of the spleen were restored. Thymus homografts which differ at the H-2 locus were promptly rejected and led to accelerated rejection of skin subsequently grafted from the thymus donor. With such H-2 incompatible thymus grafts, third party skin with minor histo-incompatibility was retained while there was slight to moderate restoration of rejection of skin with major (H-2) incompatibility. Graft-vs.-host activity was restored, but there was no return of plaque-forming spleen cells, hemolysins, hemagglutinins, or peripheral lymphocyte counts. In view of the cross-reactivity at the H-2 locus in CBA mice between thymus and third party skin donors, it was felt that restoration of skin rejection and graft-vs.-host activity could be adequately explained on the basis of immunization by the thymus graft and did not require the postulation of true immune restoration or a thymus hormone.