The efficacy of recombinant human activated protein C (rhAPC) vs antithrombin III (at III) vs heparin, in the healing process of partial-thickness burns: a comparative study.

This is an experimental study regarding the positive effect of recombinant human activated protein C (rhAPC) in the healing process of partial-thickness burns, in comparison to antithrombin III and heparin. On a porcine model we induced superficial partial-thickness and deep partial-thickness burns and performed intravenous administration of the elements of study during the first 48 h. The progress of the condition of the injured tissues was evaluated by histopathological examination at specific time intervals. The results showed an improved healing response of the specimens treated with rhAPC compared to those treated with antithrombin III, heparin, and placebo.

The use of artificial skin in plastic surgery and burns.

The use of artificial skin restores the depth and the elasticity of the skin, through restoration of the dermis, with no significant morbidity. Thus we have permanent release of contractures and a pleasing contour with satisfactory functional and cosmetic results. Still, these advantages must be weighed against the necessity for meticulous surgical technique and intensive post-operative care, the waiting period and the cost of the product.

Surfactant administration in severe inhalation injury: case report.

Inhalation injury is one of the main causes of death in patients with severe burns. Administration of exogenous surfactant appears promising for the treatment of acute respiratory failure. We report our clinical experience with this approach. A 35 yr-old man was admitted to our burns unit after an industrial accident. He had sustained a 60% total body surface area full-thickness burn combined with severe inhalation injury. Fiberoptic bronchoscopy confirmed the diagnosis, demonstrating severe blisters and ulcers of the bronchial mucosa. Refractory hypoxaemia (PaO (2)/FiO (2)56 mm Hg, where PaO (2)is oxygen tension in arterial blood and FiO (2)is the fraction of inspired oxygen) was treated with optimal mechanical ventilatory support; additionally, an initial dose of natural bovine surfactant (Alveofact) of 50 mg/kg body weight was administered by intrabronchial instillation on day 3 postburn. A significant improvement in oxygenation was observed 12 h after administration (from 56 mm Hg initially to 194 mm Hg), followed by an improvement in dynamic compliance (from 26 ml/cm H (2)O initially to 41 ml/cm H (2)O) and inspiratory resistance (from 14 cm H (2)O/lps initially to 11 cm H (2)O/lps). The same dose of surfactant was repeated 48 h later to prevent potential deterioration, resulting in maintenance of gas exchange and lung mechanics at the above levels. No complication associated with the surfactant administration was observed. However, the patient died on day 9 post-burn owing to extrapulmonary causes. Our results demonstrate a significant improvement in gas exchange and lung mechanics in a burn patient with severe inhalation injury after repeated administration of exogenous surfactant. Further study is needed in order to elucidate the clinical impact of surfactant administration and the complications associated with its use in cases of inhalation injury.