A COMBINATION OF HERPES VIRUS INFECTION (HSV-1, HHV-6) AND MULTI-RESISTANT BACTERIAL INFECTION IN A SEVERELY BURNED PEDIATRIC PATIENT - A CASE REPORT.

Serious burn trauma is associated with changes of the immune system, and immunosuppression induced by burn trauma can lead to reactivation of latent infections. Herpetic viruses are known for their lifelong persistence after primary infection and ability to reactivate. Their reactivation in the setting of burn trauma or primary infection can cause serious complications for a weakened burn patient. Presented is a case of a toddler who sustained second-degree scald burns over 20% of his body surface area. The injury was complicated by a multi-resistant bacterial infection in addition to reactivation of a latent HHV-6 infection concurrently with a primary HSV-1 infection. Described further are basic diagnostics, local and systemic treatment strategies, and other complications due to disseminated herpetic infections. To date, HHV-6 reactivation has not been described in conjunction with burn injury.

DERMAL REPLACEMENT WITH MATRIDERM - FIRST EXPERIENCE AT THE PRAGUE BURN CENTRE.

INTRODUCTION: The quality of resulting scar tissue plays an important role in patients return to normal life and full functioning in society. The use of artificial skin substitutes in clinical practice improves functional and cosmetic outcomes. This is true for any patient, and not only those suffering from burns. MATERIAL AND METHODS: The collagen elastin dermal substitute Matriderm® allows for immediate application of a dermal substitute together with a skin graft. The authors present a group of 10 patients representing their first experience in utilizing Matriderm® as a dermal substitute in the treatment of skin losses due to various etiologies. RESULTS: The average healing time in the group was 19.6 days. Healing took place without serious infectious complications and with good functional results. CONCLUSION: Matriderm® can be utilized as an alternative to the most commonly used dermal substitute so far, Integra®, in the treatment of acute skin loss due to various etiologies and in reconstructive surgery.

Early Changes during Skin Repair Using Tissue-Engineered Dermal Template in a Full-Thickness Burn.

Rapid wound closure in extensively burned patients has remained one of the major unresolved issues of medicine. Integra® is the most widely established artificial skin, which is composed of a porous matrix of cross-linked bovine collagen and chondroitin 6-sulphate covered by a semi-permeable silicone layer. We present here a (immuno)histological study of a severely burned patient with a full-thickness burn treated with a tissue-engineered dermal template (Integra®) and split-thickness skin graft-based protocol. Immunohistochemical investigation of the artificial dermis revealed that immune cell infiltration reached its peak on day 10. Tissue immunophenotyping found an increase in CD3+ cells over the course of the study as well as CD4 and CD8 positivity on day 40, indicating remaining T-cell subpopulations. We observed weak/no infiltration of NK cells (CD56+). In conclusion, the use of bi-layer Integra® represents a feasible and safe procedure resulting in formation of non-irritating dermal substitutes.

EXPERIENCE WITH INTEGRA® AT THE PRAGUE BURNS CENTRE 2002-2016.

INTRODUCTION: Integra® dermal replacement has a wide spectrum of use both in burn medicine as well as in reconstructive plastic surgery and traumatology. Since 2002, it has been a part of surgical treatment of patients at Prague Burns Centre of the Královské Vinohrady Teaching Hospital. STUDY GROUP: Integra® was used in 47 patients in total between years 2002 and 2016. In this group there were 28 paediatric patients and 19 adult patients. Eleven children were operated during the reconstructive period, 8 children had an acute injury. There were 11 adult patients with Integra® applied within the trauma treatment, another 9 during reconstructive surgery. In 2016, we examined 11 patients treated by Integra®, at least 2 years ago. The average time since the application was 9 years. All examined patients had Integra® primarily applied to treat an acute injury. METHOD: Scars after the application of Integra® were compared with scars after dermoepidermal grafts (DE) in respective patients. Evaluation was performed on the basis of subjective and objective assessment by means of the modified Vancouver Scale (VSS). Samples were submitted for a histological and immunohistochemical analysis. RESULTS: Areas with Integra® coverage scored 1.4 points on average on the VSS. The scars after dermoepidermal graft scored 4 points on the same scale. Subjective assessment of functional and cosmetic quality of scars by patients was better in all cases in comparison to DE grafting. Notable differences were found between scars following Integra® application and those after DE grafting on histological assessment, namely in the organization and quality of collagen and elastin fibres as well as in tissue revascularization. CONCLUSION: The Integra® artificial skin replacement is a part of surgical strategy in management of extensive burn trauma and plays an important role in reconstructive surgery. The resulting scar quality when using Integra® seems to be better than in DE grafting both from an objective and subjective points of view..

MICRONEEDLING - A FORM OF COLLAGEN INDUCTION THERAPY - OUR FIRST EXPERIENCES.

INTRODUCTION: Microneedling (percutaneous collagen induction therapy) is a new promising miniinvasive therapeutic method for the treatment of skin alterations of different aetiology, including burn scars. Since 2016, it is also available at our department. The microtraumatization of scars with the Dermaroller® leads to an activation of the healing cascade, activation of growth factors, which activate cell proliferation in the wound, increased synthesis and deposit of collagen - elastin complex with successive transformation of collagen III to collagen I, to neoangiogenesis and thus to accelerated scar remodelling. MATERIAL AND METHODS: In the pilot study conducted in 2016, the microneedling method with Dermaroller® with 2.5 mm needles was used in six patients (two males, four females; age 25-73 years) with stabilized scars after previous application of split thickness skin graft due to thermal injury. We repeated the microneedling procedure in three intervals approximately 6 to 8 weeks apart, with the use of topical anaesthesia. RESULTS: Preliminary results showed a subjective improvement of the scars. Objective evaluation with the Vancouver Scar Score showed an improvement of an average of two points before and after treatment. CONCLUSION: Our first clinical experience show that microneedling appears to be a suitable microinvasive method for the improvement of scar quality after burn trauma.

[Delayed liver hematoma development following deceleration injury]. / Pozdní vznik hematomu jater po deceleracním traumatu.

Our report presents the case of a young woman who suffered liver trauma after electrical current injury and ensuing fall from an electricity pylon. The resulting intrahepatic hematoma manifested after a time interval of 48 hours following the injury, with initially negative CT scan.Key words: liver hematoma electrical current - polytrauma burns.

Toxic epidermal necrolysis and Stevens-Johnson syndrome at the Prague Burn Centre 1998-2008.

BACKGROUND: Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are skin disorders characterized by extensive necrosis of the mucous membranes and the epidermis caused by an autoimmune response. OBJECTIVES: To present experience of treating TEN and SJS at the Prague Burn Centre (PBC) 1998-2008. METHODS: 22 patients with the diagnosis TEN or SJS were enrolled. We collected data including the extent of the skin involvement, the ratio of men:women, the average age, the mortality rate, presence of comorbidities, the length of hospital stay, the period from the first symptoms to the admission to the PBC, corticosteroids administration prior to admission. RESULTS: 82% patients had injuries larger than 30% of body surface area. The ratio of men:women was 1 : 1.5; the average age was 48.4 years; the mortality was 32%. Significant comorbidities were present in 41% of the cases. The average length of hospital stay was 12.9 days. The period from the first symptoms to the admission to the PBC was 9.6 days; corticosteroids were administered to 68% of the cases. CONCLUSION: Treatment strategies at the PBC are based upon a multidisciplinary approach and focus on the general principles of treating patients with extensive skin loss. Corticosteroids must be avoided, antibiotics are not indicated and intravenous immunoglobulins are not justified in the standard therapy. Early diagnosis, prompt transport to a burn center are essential for patients outcomes. The medical community should be informed about these rare but potentially life threatening diseases.