Objective To investigate the effectiveness of autogenous platelet-rich plasma (PRP) gel with acellular xenogeneic dermal matrix in the treatment of deep II degree burns. Methods From January 2007 to December 2009, 30 cases of deep II degree burns were treated. There were 19 males and 11 females with an average age of 42.5 years (range, 32-57 years).The burn area was 10% to 48% of total body surface area. The time from burn to hospitalization was 30 minutes to 8 hours. All patients were treated with tangential excision surgery, one side of the wounds were covered with autogenous PRP gel and acellular xenogeneic dermal matrix (PRP group), the other side of the wounds were covered with acellular xenogeneic dermal matrix only (control group). The heal ing rate, heal ing time, infection condition, and scar formation were observed. Results At 7 days after operation, the infection rate in PRP group (6.7%, 2/30) was significantly lower than that in control group (16.7%, 5/30, P lt; 0.05). The healing times were (18 ± 4) days and (22 ± 4) days respectively in PRP group and control group, showing significant difference (P lt; 0.05). The healing rates at 14 days and 21 days were 75% ± 7% and 88% ± 5% in PRP group, were 62% ± 15% and 73% ± 7% in control group, showing significant difference (P lt; 0.05). RPR group was superior to control group in elasticity, color, appearance, softness, scar formation, and heal ing qual ity. Conclusion Autogenous PRP gel with acellular xenogeneic dermal matrix can accelerate the wound healing of deep II degree burns as well as alleviate the scar proliferation.
Objective To investigate the effectiveness and mechanism of recombinant human granulocyte-macrophage colony-stimulating factor (rhGMCSF) gel on wound debridement and healing of deep II thickness burn. Methods Between December 2008 and December 2010, 58 patients with deep II thickness burn, accorded with the inclusive criteria, were collected. There were 36 males and 22 females with an average age of 32.4 years (range, 12-67 years). The causes were hot liquid in 38 cases and fire in 20 cases. The time from injury to treatment was 1-3 days (mean, 2.1 days). In this randomized, double-blind, and self-control study, all patients were randomly divided into 2 groups, wounds were treated with rhGMCSF gel (test group) or gel matrix (control group). There was no significant difference in wound area between 2 groups (P gt; 0.05). The time of completed removal eschar and the percentage of removal-area of eschar were recorded at 2, 6, 10, 14, and 18 days during healing process. The time of wound healing was also recorded. Results Compared with control group, the necrotic tissues on the burn wound got soft in test group at 4 days after treatment. At 6 days, they loosened and eventually sloughed off. The wound bed presented in red and white, followed by rapidly growing granulation tissues. Except 18 days after treatment, there were significant differences in the percentage of removal-area of eschar between 2 groups (P lt; 0.05). The time of completed removal eschar in test group [(7.71 ± 2.76) days] was significantly shorter than that in control group [(14.71 ± 3.63) days] (t=13.726, P=0.000). The time of wound healing in test group was (18.41 ± 2.47) days, which was significantly shorter than that in control group [(23.58 ± 3.35) days] (t=15.763, P=0.000). Conclusion Compared with the gel matrix, the rhGMCSF gel may promote wound debridement and healing in deep II thickness burn.
Objectives To analyze the effect of improved oven for defluorination in coal-burning endemic fluorosis areas in China, and to provide evidence for the prevention and control of fluorosis. Methods Electronic databases including CNKI, CBM, VIP and CDMD-D (1989 to 2005), were searched. We also checked the reference lists of relevant articles. We selected relevant articles according to the predefined inclusion and exclusion criteria. The methodological quality was assessed . Data on room heat preservation and the effect of improved oven for defluorination were collected in the surveillance spots of Three Gorges Reservoir. Correlation analyses were conducted between the improved oven and its effect parameters. Results Twelve articles of low quality met the selection criteria, of which 9 were graded C and 3 were graded D in terms of the methodological quality. A negative correlation was found between the decreasing rate of normal oven use and the decreasing rate of dental fluorosis as well as of urine fluorine (Pearson correlation coefficient r = – 0.87, – 0.63, Plt;0.01, lt;0.05, respectively). Analysis also revealed a positive correlation between room heat preservation and the decreasing rate of dental fluorosis as well as of normal oven use (the two Spearman correlation coefficients and P values were the same: r = –1.00, Plt;0.01). Conclusion High-quality studies on the effect of improved oven for defluorination in China are not available. Based on the current evidence, the improved oven for defluorination and the correct use, maintenance and house rebuilding for heat preservation may help to prevent fluorosis.
Objective To explore the therapeutic effect of recombinant human epidermal growth factor (rhEGF) for burn wounds of degree II in the elderly patients. Methods From February 2003 to October 2008, 80 patientes with burn wounds of degree II were treated and randomly divided into two groups (n=40). In treatment group, there were 24 males and 16 females with an average age of 70 years (60-86 years), including 20 cases of superficial II degree and 20 cases of deep II degree.Burn wounds were caused by flame in 23 cases, by hot l iquid in 16 cases, and by electricity in 1 case. The mean time from injury to hospital ization was (2.87 ± 2.57) hours. The wounds were treated with silver sulfadiazine (SD-Ag) and rhEGF. In control group, there were 18 males and 22 females with an average age of 69 years (61-83 years), including 19 cases of superficial II degree and 21 cases of deep II degree. Burn wounds were caused by flame in 23 cases, by hot l iquid in 14 cases, by electricity in 2 cases, and by chemistry in 1 case. The mean time from injury to hospital ization was (3.39 ± 3.33) hours. The wounds were treated with SD-Ag. The dressing was changed every day until wounds heal ing. There were no significant differences in general data between two groups (P gt; 0.05). Results Wound did not heal in 1 case (deep II degree) of treatment group and in 5 cases (deep II degree) of control group over 40 days and free skin graft was used to repair wound. One case (superficial II degree ) in control group gave up treatment. One case (deep II degree) died of pulmonary infection in treatment group. These cases were excluded and 72 cases were analysed. No other side reactions were observed in teatment group except for flash stabbing pain (4 cases) and pruritus (2 cases). Wound infection occurred in 5 cases of the control group and in 3 cases of the treatment group, and wound healed after symptomatic treatment. The heal ing time of burn wound was (14.30 ± 1.26) days (superficial II degree) and (26.11 ± 2.97) days (deep II degree) in the treatment group, was (16.22 ± 1.40) days (superficial II degree) and (29.13 ± 4.99) days (deep II degree) in control group, showing significant difference between two groups (P lt; 0.05). Conclusion Incombined treatment, rhEGF can promote the heal ing of burn wounds of degree II in the elderly patients.
Abstract Postburn deformities, including hypertrophic scars, scar contracture and defect or deformity of tissue or organ, are the commonest disorders in plastic surgery. It is also difficult to deal with. If the diformity involved multiple organs, oftentimes the teatmentis very difficult because the material for repair is limited and the donorsite usually could not provide adequate amount of skin for repair. Since 1978,2496 cases of various postburn deformities were admitted. In this article, theoptimal time to operate was discussed. The use of flap transfer and soft tissueexpander was described. Prolonged traction in the treatment of severe contracture of large joint was also described.
OBJECTIVE: To evaluate the therapeutic effect of amniotic membrane transplantation(AMT) for ocular burn. METHODS: Twenty patients with ocular burn(28 eyes) were treated with amniotic membrane transplantation. Of them, there were 6 cases of severe alkali burn(10 eyes), 8 cases of severe acid burn(10 eyes), and 6 cases of thermal burn(8 eyes). RESULTS: In 28 eyes, ocular inflammation was controlled after 3-7 days of surgery; no continued dissolution, perforation and iris atrophy were found. There were corneal transparency in 16 eyes, keratoleukoma in 4 eyes, and total corneal opacity in 8 eyes. All eyeballs were saved and had stable ocular surface. There was no allograft immune rejection and secondary infection. CONCLUSION: Amnitic membrane transplantation can relieve the inflammatory reaction, reduce the growth of blood vessel and restrain the proliferation of fibrous tissue. It is an effect surgical method for ocular burn in reconstruction of ocular surface and salvage of eyeball.
OBJECTIVE: To reduce amputation rate of severe electrical burn of wrist and to promote partial recovery of the injuried hand. METHODS: From 1987 to 1999, 44 cases, with 55 limbs of severe electrical burn were classified into 4 types, according to criteria of Dr Shen Zuyao, and were all treated by primary adequate decompression, timely debridement, reconstruction of blood circulation in cases complicated with blood vessel injury, and skin flap grafting from chest, abdomen or inguinal area, followed by treatment of anti-coaggluation and anti-infection. Once the wound healed, auto- or allo-transplantation or transferring of tendons were performed to repair tendon defect, and auto-nerve or fetal nerve transplantation performed for nerve defect. RESULTS: After the primary treatment of the 55 burned limbs, all limbs of type IV were amputated, and most of other 3 types survived. The function, including sensation and movement, of survived hands partially recovered. CONCLUSION: Primary reconstruction of blood circulation, cover of wound with skin flap, and timely repair of sensation and motor function are very crucial approach to reduce amputation rate and to promote the survived hand function of severe electrical burns of wrists.
ObjectiveTo prepare adipose-derived stem cells (ADSCs) and chitosan chloride (CSCl) gel complex to study the biocompatibility and the feasibility of repairing the wounds of deep partial thickness scald in rats. MethodsADSCs were prepared by enzymogen digestion and differential adherence method from the subcutaneous adipose tissue of SPF grade 6-week-old male Sprague Dawley (SD) rats. Temperature sensitive CSCl gel was prepared by mixing CSCl, β glycerol phosphate, and hydroxyethyl cellulose in 8∶2∶2.5 ratio. The proliferation of ADSCs was measured by cell counting kit 8 (CCK-8) assay and the survival of ADSCs was detected by the Live/Dead flurescent staining in vitro. A deep partial thickness burn animal model was made on the back of 72 SPF grade 6-week-old male SD rats by boiled water contact method and randomly divided into 3 groups (n=24). Group A was blank control group, group B was CSCl hydrogel group, group C was ADSCs/CSCl gel group. The wound closure rate at 3, 7, 14, 21 days was observed after operation. The number of inflammatory cells at 7 days and epidermal thickness at 21 days were observed by HE staining after operation. The angiogenesis at 7 days was evaluated by immunohistochemistry staining with CD31 expression. ResultsCSCl had a temperature sensitivity, at 4℃, the temperature-responsive hydrogel was liquid and became solid at 37℃. The CCK-8 assay and Live/Dead flurescent staining confirmed that ADSCs could grow and proliferate in the ADSCs/CSCl hydrogel complex. General observation showed the wound closure ratio in group C was superior to groups A and B after operation (P<0.05). HE staining showed that at 7 days after operation, the wound healing of the three groups entered fibrous proliferation stage. Collagen deposition and inflammatory cell infiltration were observed in the dermis of each group. The proportion of inflammatory cells in group C was significantly lower than that in groups A and B, and in group B than in group A (P<0.01). At 21 days after operation, the fibrous connective tissues of neoepithelium and dermis in groups B and C were arranged neatly, and fibroblasts and neocapillaries could be seen. In group A, neoepidermis could also be seen, but the fibrous connective tissues in dermis were arranged disorderly and sporadic capillaries could be seen. The thickness of neonatal epidermis in group C was significantly larger than that in groups A and B, and in group B than in group A (P<0.01). CD31 immunohistochemistry staining showed that the neovascularization could be seen in all groups. The number of neovascularization in group C was significantly higher than that in groups A and B, and in group B than in group A (P<0.05). ConclusionThe ADSCs/CSCl hydrogel complex has a good biocompatibility and possessed positive effects on promoting the deep partial thickness scald wound repairing in rats.
ObjectiveTo investigate the feasibil ity and effectiveness of using scar spl it thickness skin grafts combined with acellular allogeneic dermis in the treatment of large deep Ⅱ degree burn scar. MethodsBetween January 2013 and December 2013, 20 cases of large deep Ⅱ degree burn scar undergoing plastic operation were enrolled. There were 14 males and 6 females, aged 4 to 60 years (mean, 40 years). Burn reasons included hydrothermal burns in 10 cases, flame burns in 9 cases, and lime burns in 1 case. The burn area accounted for 70% to 96% total body surface area (TBSA) with an average of 79% TBSA. The time from wound healing to scar repair was 3 months to 2 years (mean, 7 months). Based on self-control, 0.7 mm scar spl it thickness skin graft was used to repair the wound at the right side of joints after scar resection (control group, n=35), 0.5 mm scar spl it thickness skin graft combined with acellular allogeneic dermis at the left side of joints (trial group, n=30). Difference was not statistically significant in the scar sites between 2 groups (Z=-1.152, P=0.249). After grafting, negative pressure drainage was given for 10 days; plaster was used for immobilization till wound heal ing; and all patients underwent regular rehabil itation exercises. ResultsNo significant difference was found in wound heal ing, infection, and healing time between 2 groups (P>0.05). All patients were followed up for 6 months. According to the Vancouver Scar Scale (VSS), the score was 5.23±1.41 in trial group and was 10.17±2.26 in control group, showing significant difference (t=8.925, P=0.000). Referring to Activities of Daily Living (ADL) grading standards to assess joint function, the results were excellent in 8 cases, good in 20 cases, fair in 1 case, and poor in 1 case in trial group; the results were excellent in 3 cases, good in 5 cases, fair in 22 cases, and poor in 5 cases in control group; and difference was statistically significant (Z=-4.894, P=0.000). ConclusionA combination of scar spl it thickness skin graft and acellular allogeneic dermis in the treatment of large deep Ⅱ degree burn scar is feasible and can become one of solution to the problem of skin source tension.
Objective To study the preventive measure of the subambient temperature burn by analysing the pathogenesis feature. Methods The cl inical data were analysed from 351 cases of subambient temperature burn between February 2004 and February 2009, including age, sex, burn season, burn factors, burn position, burn area, burn degree, treatment way, and wound heal ing. Results Subambient temperature burn occurred in every age stage. The susceptible age stages included infant, children, and the elderly. Female patients were more than male patients. The common burn reasons werehot-water bottle burn, honey warm keeper burn, and heating device burn. The peak season was winter. Lower l imb was the most common site of the subambient temperature burn. The deep II degree to III degree were the most common level, and the burn area was always small, often 1% of total body surface area. Most of patients were treated with changing dressings at cl inic and few patients needed hospital ization. Though the surface of wound could heal finally, and the wound healed well with no obvious scar in patients who received operation. Conclusion Subambient temperature burn is the frequently encountered disease in winter. Use of the warming articles should be cautious, at the same time safety awareness should be strengthened so as to decrease the incidence rate of subambient temperature burn and the injury degree.