[Inspiration from the research advances in microcirculatory dysfunction to the treatment of burn shock and burn septic shock].

Microcirculatory dysfunction is an important pathophysiological change of shock. In the last decade, many researches on the mechanism of microcirculatory dysfunction have been involved in areas such as the glycocalyx damage of vascular endothelial cells, macrocirculation- microcirculation discoupling, vascular hyporeactivity, and microcirculation monitoring. Accordingly, this paper discussed how these research findings can be applied to burn patients, with the aim of alerting the clinicians to improving microcirculation, and maintaining hemodynamic coordination during the treatment of burn shock and burn septic shock. In addition, with the development of accurate and reliable microcirculation monitoring techniques, it is necessary to carry out multi-center clinical trials to reveal the clinical significance of target-oriented shock resuscitation protocol combining macrocirculatory and microcirculatory parameters.

[Controlling excessive fluid resuscitation in massive burn patients to prevent complications].

Excessive fluid resuscitation in massive burn patients is a common phenomenon in burn management, and the reasons are mostly related with administering resuscitation of crystalloid alone and pursuing a goal-directed resuscitation with targeting normal hemodynamic parameters in the first 24 h post burn. Tissue edema caused by excessive fluid resuscitation is a vital factor that induces complications including respiratory compromise, abdominal compartment syndrome, and so on. Therefore, in order to control excessive fluid resuscitation and prevent its subsequent complications in massive burn patients, it is necessary to determine the optimal resuscitation regime, set appropriate resuscitation endpoints, and implement precise management of fluid resuscitation.

[Observation on the clinical effect of self-designed modified rhomboid skin flap in facial wound repair].

Objective: To investigate the clinical effect of self-designed modified rhomboid flap in repairing rhomboid, round, and teardrop-shaped wounds on the face. Methods: A retrospective observational study was conducted. From August 2018 to April 2020, 30 patients with facial lesions admitted into Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the People's Hospital of Jianchuan County in Yunnan province met the inclusion criteria, including 16 males and 14 females, aged 23 to 88 years. The wound area ranged from 1.0 cm×1.0 cm to 7.0 cm×5.0 cm, with 10 cases of rhomboid wounds, 12 cases of round wounds, and 8 cases of teardrop-shaped wounds. The self-designed modified rhomboid flaps were applied to repair the wounds and after that, the patients were followed up for 1 to 18 months to record the survival of flaps, wound tension, scar formation and complications after surgery. Results: No necrosis or blackening was observed at the tip of the flaps after surgery. All the flaps survived and the wounds healed well with little tension, minimal scars, and no complications. Conclusions: The self-designed modified rhomboid flap is especially suitable for facial wounds with multiple important organs, multiple anatomical subunits, and areas with large changes in soft tissue tension, which can reduce not only the rotation of the flap, but also unnecessary excision of normal skin and soft tissue.

[Developing trend of wound dressing].

The ideal wound dressing should have the functions of keeping wound moist and warm, preventing and treating wound infection, promoting wound healing, and so on; However there is no such ideal wound dressing in clinic. Dressings are likely to capable application to different kinds of wounds with multi-functions in the future. For the purpose of good tissue compatibility and permanent wound cover, auto- or allo- skin living cells should be integrated with biological dressings as real artificial skin by employing tissue engineering technology. Clinical application of smart dressings can enable wound management more personalized, effective, optimized, and convenient.

[Reconsideration of burn scar treatment].

Since the mechanisms of scar formation are not fully understood, at least to date, there is no ideal method to prevent and treat scar after burn. In recent years, on the basis of conventional treatments, such as pressure therapy, external use of silicone gel, and intralesional injections of corticosteroids, the therapeutic approaches of fractional carbon dioxide laser treatment, injection of anti-vascular endothelial growth factor antibody, autologous fat transplantation, injection of botulinum toxin A, radiation therapy etc., have been gradually applied to treat burn scars. It is very important to select various methods individually and comprehensively according to the specific conditions of patients and scars. Meanwhile, it is necessary to continue to study and explore the possibility of targeted therapy in scar management.

[Further understanding of infection of carbapenems-resistant Klebsiella pneumoniae among burn patients and the related strategies for antimicrobial treatment].

The prevalence of carbapenems-resistant Klebsiella pneumoniae (CRKP ) in burn wards has become one of the most troublesome issues in current management of bacterial infections. It is necessary for us to reconsider the epidemiology, risk factors and clinical characteristics of CRKP infection as well as therapeutic options. Formulating the principles of antimicrobial therapy of CRKP infection and combined antibiotics therapy and implementing appropriate dosage regimens designed by pharmacokinetic and pharmacodynamic profiles will be of importance. Common antimicrobial agents for the treatment of CRKP infection include polymyxins, tigecycline, fosfomycin, and carbapenems. Infection control measures such as contact isolation, active screening, and environmental surface disinfection must be integrated with antimicrobial stewardship to effectively curb and prevent the spread of CRKP.

[Recognizing prevention and treatment of burn sepsis with the concept of holistic integrative medicine].

Sepsis remains a major cause of death in severe burns. The effect of sepsis management is influenced by its complicated pathophysiologic changes. In order to improve the outcome of burn sepsis, the predisposing factor of sepsis after burn analyzed by advanced technology, the early prevention, antibiotics therapy, and combined treatment in severe burns with sepsis are discussed using the concept of holistic integrative medicine.

[Treatment strategies of sequelae following burn wound].

Burn patients are facing not only their physical recovery but also some complex problems caused by the injury, including pruritus, sleep disorders, pain, and psychological disorders. These problems may bring about challenges for survivors and burn treatment team members who work with them. The purpose of this paper is to improve the understanding and knowledge of these occult problems for clinicians in this field.

[Topical use of lysostaphin for Staphylococcus aureus infection of burn wounds in mice].

The effect of lysostaphin on the burn wounds infected with Staphylococcus aureus was studied in mice. The results showed that the mortality and incidence of bacterial isolation in wounds were 17.2% and 8.3%, respectively, in mice treated by lysostaphin, and the figures were significantly lower than that treated by SD-Ag (40.6% and 100%) or base (44.1% and 94.7%). In lysostaphin group the bacterial count of subeschar tissue was 1325 cfu/g, compared with more than 10(9) cfu/g in both SD-Ag and base groups. The results demonstrate that lysostaphin has powerful killing effect on S. aureus, and may be used as atopical antimicrobial to control burn wound infection with S. aureus.

[Topical fibronectin for enhancement of burn healing].

The effects of fibronectin (Fn) on burn healing were observed in mice. A split thickness burn covered 7% approximately 8% TBSA was created on the back of mouse. Experimentally 0.05ml of Fn (0.5mg/ml) was topically applied daily. Wound healing time and healing rate were determined. On 5 and 10 postburn days, biopsy sample of wound tissue was obtained. Total protein, DNA, and hydroxyproline contents were measured according to Bradford method, Hoechest 33258 dye fluorometry, and routine measure respectively. The mean wound healing time in mice treated with Fn was 18.67 +/- 4.50 days compared to 22.89 +/- 2.85 days in the controls. The wound healing rate was significantly higher in the Fn-treated mice. The contents of wound tissue DNA and hydroxyproline in Fn group were significantly increased on day 5, and total protein was significantly increased on day 10. This study indicated that topical application of Fn is beneficial to wound healing.

[Methicillin-resistant Staphylococcus aureus infection and its treatment in burned patients].

Burn wound and systemic infections caused by methicillin-resistant Staphylococcus aureus (MRSA) were analysed in 95 patients. Results showed that both 95 (92.2%) out of 103 strains of Staphylococcus aureus isolated from burn wound and all 17 strains from blood were MRSA. Wound MRSA infection could be found in patients with variety of severity and in any kind of wound, while systemic MRSA infection was often occurred in extensive burn patients. The isolated MRSA were most resistant to cephalosporins and sensitive to vancomycin. In order to control wound MRSA infection, Lysostaphin which is active against these organisms could be used as a topical antimicrobial.