Guidelines for burn rehabilitation in China.

Quality of life and functional recovery after burn injury is the final goal of burn care, especially as most of burn patients survive the injury due to advanced medical science. However, dysfunction, disfigurement, contractures, psychological problems and other discomforts due to burns and the consequent scars are common, and physical therapy and occupational therapy provide alternative treatments for these problems of burn patients. This guideline, organized by the Chinese Burn Association and Chinese Association of Burn Surgeons aims to emphasize the importance of team work in burn care and provide a brief introduction of the outlines of physical and occupational therapies during burn treatment, which is suitable for the current medical circumstances of China. It can be used as the start of the tools for burn rehabilitation.

[Comparison of the clinical effect of complex transplantation with heterogenetic acellular dermal M(ADM) AND allogeneic ADM].

OBJECTIVE: To explore the short-term clinical effects of complex transplantation among the acellular dermal matrix(ADM) of heterogenic or allogeneic and autogenic split on the burnt wound as to find out a permanent substitution for the treatment on full skin thickness defect without scar. METHODS: Two kinds of ADM were used on the 18 patients with full thickness burn wound through complex transplantation with autogenic splits. The patients with medial-thickness autograft was used as control group. Survival rate was obtained 2 weeks after operation; contraction rate and the scores of Vancouver burn scale were obtained 8 weeks after operation. RESULTS: No significant difference was observed in survival rate among the three groups 2 weeks after operation(P > 0. 05); no significant difference was observed in contraction rate of autografts and scores of Vancouver burn scale among the three groups 8 weeks after operation (P > 0. 05). CONCLUSION ADM of heterogenic and ADM of allogeneic have similar effect on the reconstruction of skin, so the piglet ADM made in this way could be used as a substitution.

The effects of inhaled nitric oxide on cardiac pathology and energy metabolism in a canine model of smoke inhalation injury.

OBJECTIVE: The effects of inhaled nitric oxide (NO) on cardiac pathology and energy metabolism were studied in a canine model of smoke inhalation injury. MATERIAL AND METHOD: Twenty-one dogs were randomly divided into three groups: four dogs constituted the normal control group (group N), eight dogs subjected to smoke inhalation followed by O(2) inhalation (FiO(2)=0.45) constituted the injury control group (group C), and nine dogs inhaling a mixture of O(2) and 45ppm nitric oxide after smoke exposure served as the treatment group (group T). Myocardial zymograms were continuously measured, and ventricular muscles were examined for histopathology in the end of the experiment. RESULTS: Lactate dehydrogenase (LDH), alpha-hydroxybutyrate dehydrogenase (alpha-HBD), creatine kinase (CK) and glutamic oxalacetic transaminase (GOT) in group T were less than those in group C(P<0.05, or P<0.01). ATP content and energy charge (EC) in group T were higher significantly than those in group C(P<0.01). Light microscopy and electron microscopy indicated that the ventricular pathologic changes in group T were milder than in control group. CONCLUSION: Nitric oxide inhalation relieved myocardial damage and improved energy metabolism.

[Comparison of composite grafting of autoskin with acellular dermal matrix from different sources].

OBJECTIVE: To compare the composite grafts of acellular dermal matrix (ADM) from different sources with autoskin. METHODS: Six local white mini pigs were employed for the experiment. The pigs were randomly divided into four groups according to different skin grafts, i.e. A (human ADM with razor thin autoskin), B (porcine ADM with razor thin autoskin), C (razor thin autoskin only), and D (split thickness autoskin) as control. The survival rate, the contraction degree of the grafts, and the histological changes in grafting area were observed at 2, 4, 8, 12 and 24 hours after the operation. RESULTS: The grafted area in both A and B groups appeared smooth and elastic with satisfactory graft survival. The in growth of the host reparative cells such as fibroblast and vascular endothelium could be induced by composite grafts of different ADMs with skin grafting. The contraction areas in A and B groups seemed bigger than those in C and D groups. The tissue structure of grafting areas was similar to that of split thickness skin grafting area at 24 post-operation weeks. CONCLUSION: Combination of the homogenous and heterogeneous ADMs with autografts exhibited similar biological function during the observation period (24 weeks after operation). Xenogenous ADMs might have broader clinical applications.

Cardiac contraction and calcium transport function after severe burn injury in rats.

OBJECTIVE: To examine the function change of myocardial calcium transports and determined what role the change plays in cardiac dysfunction after severe burn injury in rats. METHODS: The contraction and relaxation properties of the left ventricle (LV) were studied in the isolated hearts preparations of Wistar rats at 3, 8, and 24 h after a 30% TBSA (total body surface area) full-thickness burn. The calcium transport function of the sarcoplasmic reticulum (SR) was measured by the millipore filtration technique. RESULTS: The maximal rate of LV pressure (plus minusdp/dtmax) of the burn group was significantly lower than that of the control group (P<0.01). In addition, the calcium-dependent ATPase activity and the coupling ratio of SR were also markedly depressed. CONCLUSIONS: It indicates that the decrease in the SR calcium transport function is one of the important mechanisms for the cardiac contractile dysfunction after severe burn injury.