Use of human keratinocytes cultured on fibrin glue in the treatment of burn wounds.

Keratinocytes isolated from a small skin biopsy and cultured according to the method of Rheinwald and Green (Cell 1975, 6: 331) are able to undergo rapid expansion in vitro and have been used successfully in the treatment of burn wounds. One of the inconveniences of this method involves the transfer of the epidermal sheet from the culture flask onto the wound bed. One way to facilitate this process is to use fibrin glue (Biocol) as a culture bed for the keratinocytes. Burns are then grafted by simply placing the sheet of fibrin glue and keratinocytes onto the wound bed. This process has been successful in two patients, permanently covering areas of 720 cm2 and 5342 cm2. The newly formed epidermis was fully differentiated and histologically normal after 1 year. The efficiency of this improved, faster procedure could lead to a new approach in the treatment of extensive burn wounds.

Precise diagnosis of infection in burn wound biopsy specimens. Combination of histologic technique, acridine orange staining, and culture.

This study developed a rapid manual histologic technique on burn wound biopsy specimens for an early diagnosis of infection. A total of 86 biopsy specimens were processed using this rapid manual method, acridine orange fluorescent staining for the detection of microorganisms, and a quantitative culture for the identification and counting of bacteria in adjacent homogenized biopsy specimens. Use of these three techniques has shown their complementarity for the evaluation of sepsis in burn wound patients. The histologic study allowed a classification of the depth of bacterial involvement 4 hours after specimen collection, whereas the acridine orange fluorescent staining was useful for quantitative evaluation of infection in the same delay. Thus a rapid therapeutic decision can be made while waiting for the results of quantitative culture and sensitivity tests, which require 24 to 48 hours. We propose routine monitoring of burned patients consisting of these three tests performed simultaneously on each biopsy specimen.

[Comparative trial of propofol and ketamine in anesthesia for the baths of severely burnt patients]. / Essai comparatif du propofol et de la kétamine au cours de l'anesthésie pour bain des grands brûlés.

Ketamine was the normal anaesthetic drug for carrying out the baths of severely burnt patients. It was compared with propofol in a study of 50 patients (greater than 50 UBS) randomly assigned to two groups: 2.5 mg . kg-1 propofol and 2 mg . kg-1 ketamine. The speed of induction was the same for both groups, surgery beginning within the same time intervals. In the propofol group, however, apnoea was seen more often and lasted longer (p less than 0.05) than in the ketamine group. The times between repeat injections were short (about 5 min) and constant with propofol, whereas they were larger and irregular with ketamine; this was due to the shorter distribution half-life and lack of accumulation of propofol. During anaesthesia with propofol, haemodynamic parameters remained steady after an initial period of cardiovascular depression. Respiratory rate increased, because of the lack of analgesia. Recovery was very quick, complete and with no bothersome adverse effects in the propofol group. These hypercatabolic patients could therefore be fed early postoperatively; also, there was no deleterious psychological interference in these deeply disturbed patients.

[A method of bacterial count by epifluorescence with acridine orange. Application to skin biopsies performed in burnt patients]. / Etude d'une méthode de dénombrement des bactéries par épifluorescence à l'acridine orange. Application aux biopsies de peau effectuées chez les brûlés.

Acridine orange was used for staining and counting micro-organisms obtained from 136 skin biopsies performed in burned patients. The number of organisms per gram of tissue was compared to the number of colony-forming-units (CFU) calculated from cultures of the same biopsies. The staining method was positive in 97 per cent of septic samples, and in 25 per cent of these it proved more sensitive than bacterial cultures, with a 100 to 1000-fold greater number of pathogens detected. Acridine orange also demonstrated bacteria in 69 biopsies which remained sterile after culture. In some cases, the same bacterial species was found in other samples taken a few days later.

[Course of plasma fibronectin in burn patients. Its variations during septic episodes]. / Evolution de la fibronectine plasmatique chez le brûlé. Ses variations lors d'épisodes septiques.

The time course of plasma fibronectin (FNp) was evaluated following burn injury in 62 patients during 30 days. Those patients were divided into three groups: A: 36 non septic survivors, B: 7 septic survivors, C: 19 dead patients. Those groups were statistically different if either age or total body surface area burnt (TBSA), or unit burnt standard (UBS) or the percentage or third degree burnt area were considered. The relationship between FNp, UBS or sepsis was studied. No correlation was found between FNp levels and TBSA or UBS for the first three days. After acute depletion on day 2, the FNp level returned to initial values on day 3. That depletion was probably a consequence of resuscitation since both falls in plasma FNp and haematocrit were parallel from day 1 to day 2. When the patients became septic, there was always a drop in FNp level. The depleted level of FNp remained low in the patients who finally died, whereas in those who survived that level had returned to normal. The observation of FNp level could therefore be useful in determining how serious a sepsis is.