RESUMEN
Estimates of percent body surface area (%BSA) burns correlate well with fluid needs, nutritional requirements, and prognosis. Most burn centers rely on the Lund Browder chart and "rule of nines," to calculate the %BSA. Computer-based methods may improve precision and data analysis. We studied two new methods of determining %BSA: a two-dimensional Web-based program (Sage II) and a three-dimensional computer-aided design program (EPRI 3D Burn Vision). Members of our burn team found the Sage II program easy to use and found many of the features useful for patient care. The EPRI program has the advantage of 3D images and different body morphologies but required training to use. Computer-aided methods offer the potential for improved precision and data analysis of %BSA measurements.
Asunto(s)
Superficie Corporal , Quemaduras/patología , Gráficos por Computador , Procesamiento de Imagen Asistido por Computador , Adulto , Simulación por Computador , Estudios de Evaluación como Asunto , Humanos , Imagenología Tridimensional , Grupo de Atención al PacienteRESUMEN
The lips are a complex laminated structure. When lost through injury or disease, they present a complex reconstructive challenge. The facial artery musculomucosal (FAMM) flap is a composite flap with features similar to those of lip tissue. In this article, the anatomy, dissection, and clinical applications for the use of the FAMM flap in lip and vermilion reconstruction are discussed. A series of 16 FAMM flaps in 13 patients is presented. Seven patients had upper-lip reconstruction and six had lower-lip reconstruction. Superiorly based FAMM flaps were used in eight patients, and eight inferiorly based flaps were performed in five patients. Three patients had bilateral, inferiorly based flaps. In summary, the FAMM flap is a local flap that can be used for lip and vermilion reconstruction. Although not identical to the lip, it has many similar features, which make it an excellent option for lip reconstruction.
Asunto(s)
Labio/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Adolescente , Adulto , Malformaciones Arteriovenosas/cirugía , Femenino , Humanos , Labio/irrigación sanguínea , Labio/lesiones , Enfermedades de los Labios/cirugía , Neoplasias de los Labios/cirugía , Masculino , Persona de Mediana Edad , Osteorradionecrosis/cirugía , Colgajos Quirúrgicos/irrigación sanguíneaRESUMEN
Giant congenital pigmented nevi pose a substantial reconstructive challenge for the treating physician. Due to the increased risk of malignant transformation in such lesions, complete excision with tissue expansion or skin grafting is the generally accepted treatment. These modalities can, however, leave the patient with secondary deformities that also require complex reconstructive procedures. The following case details a patient requiring secondary reconstruction with large-volume tissue expansion 12 years after excision of a giant nevus, and split-thickness skin grafting. This patient illustrates a severe secondary deformity and the usefulness of large-volume serial expansion in such patients.
Asunto(s)
Contractura/cirugía , Nevo Pigmentado/cirugía , Complicaciones Posoperatorias , Neoplasias Cutáneas/cirugía , Expansión de Tejido , Niño , Femenino , Humanos , Nevo Pigmentado/congénito , Neoplasias Cutáneas/congénito , Expansión de Tejido/métodosRESUMEN
Degloving injuries range from the occult, easily missed injury to obvious massive tissue damage. The serious nature of these wounds is exacerbated by mismanagement. It is generally accepted that the degloved tissue should be excised, defatted, fenestrated, and reapplied as a full-thickness skin graft. Dressings are required that provide gentle, evenly distributed pressure and avoid shear stress to the newly grafted skin. Numerous types of dressings have been devised but all are cumbersome and time-consuming. We have found the Vacuum-Assisted Closure device to be a rapid, effective, and easy-to-use alternative to traditional methods. The authors examine their experience using a vacuum-assisted closure device to treat nine degloving injuries in 5 patients and discuss the important aspects in using this technique.
Asunto(s)
Procedimientos de Cirugía Plástica/instrumentación , Colgajos Quirúrgicos , Heridas y Lesiones/terapia , Adulto , Anciano , Anciano de 80 o más Años , Presión Atmosférica , Vendajes , Desbridamiento , Femenino , Humanos , Masculino , Persona de Mediana Edad , Poliuretanos , Vacio , Cicatrización de Heridas/fisiología , Heridas y Lesiones/fisiopatologíaRESUMEN
In 28 porcine partial thickness excisional wounds, the presence of several growth factors was first studied by enzyme-linked immunoadsorbent assay on wound fluid collected in sealed wound chambers. Basic fibroblast growth factor (bFGF) peaked on day 1 at 31.4 pg/ml; platelet derived growth factor (PDGF)-AB on day 3 reached 45.2 pg/ml, and transforming growth factor-beta (TGF-beta) on day 7 was 726.1 pg/ml. The same chamber system was used in 48 partial thickness excisional wounds for delivery of nanogram doses of bFGF, PDGF-AB, insulin-like growth factor (IGF)-1, epidermal growth factor (EGF), and cholera toxin. PDGF and EGF accelerated healing (1.1 days and 0.3 days, respectively), whereas bFGF and IGF-1 had no effect. Cholera toxin retarded healing by 1.9 days. Furthermore, in 100 excisional wounds EGF in the concentration range of 10 to 1,000 ng/ml had the same stimulating effect on healing. EGF at 10,000 ng/ml significantly delayed healing. The wound chamber model is useful for detecting of endogenous growth factors as well as for delivering exogenous factors.
Asunto(s)
Procedimientos Quirúrgicos Dermatologicos , Sustancias de Crecimiento/farmacología , Cicatrización de Heridas , Animales , Toxina del Cólera/farmacología , Relación Dosis-Respuesta a Droga , Ensayo de Inmunoadsorción Enzimática , Factor de Crecimiento Epidérmico/farmacología , Exudados y Transudados/química , Factor 2 de Crecimiento de Fibroblastos/análisis , Factor 2 de Crecimiento de Fibroblastos/farmacología , Sustancias de Crecimiento/análisis , Factor I del Crecimiento Similar a la Insulina/farmacología , Factor de Crecimiento Derivado de Plaquetas/análisis , Factor de Crecimiento Derivado de Plaquetas/farmacología , Proteínas Recombinantes/farmacología , Regeneración , Piel/patología , Fenómenos Fisiológicos de la Piel , Porcinos , Factor de Crecimiento Transformador beta/análisisRESUMEN
Effects of wet (saline in a vinyl chamber), moist (hydrocolloid dressing), and dry (sterile gauze dressing) environments on wound repair were studied in a porcine partial-thickness wound model. Chambers were exchanged and refilled daily with normal saline containing penicillin G (100 U/ml) and streptomycin (100 micrograms/ml). Hydrocolloid and gauze dressings were kept in place until biopsy of the wound site. Wounds in wet, moist, and dry environments were completely epithelialized on days 6, 7, and 8, respectively. Thickness of the epidermis in wet, moist, and dry wounds was 204 +/- 23, 141 +/- 12, and 129 +/- 18 (mean +/- SEM), respectively. Moist wounds had more subepidermal inflammatory cells than wet wounds. In comparison to dry wounds, the moist or the wet healing environment resulted in less necrosis and faster and better quality of healing in the formation of the newly regenerated epidermis.
Asunto(s)
Vendajes , Coloides , Cloruro de Sodio , Cicatrización de Heridas/fisiología , Animales , Epitelio/patología , Femenino , Necrosis , Penicilina G/administración & dosificación , Regeneración/fisiología , Estreptomicina/administración & dosificación , Porcinos , Cicatrización de Heridas/efectos de los fármacosRESUMEN
Normal and retrovirally transfected keratinocyte suspensions expressing either the beta-galactosidase gene or the human growth hormone (hGH) gene were transplanted into chamber-enclosed skin full-thickness wounds of Yorkshire pigs. Immunostaining of sequential skin biopsies obtained for 4 weeks after transplantation showed survival of the transplanted keratinocytes as well as expression of beta-galactosidase. Transfected keratinocytes were first seen in the neodermal portions of the wounds, then in the regenerating basal epidermal layer, and finally in the terminally differentiating cells of the stratum spinosum. When keratinocytes transfected with the hGH gene were transplanted into similar wounds, hGH was detected for 10 days in wound fluid. In contrast, hGH was detected in vitro for 47 days. Wounds transplanted with either transfected or normal keratinocytes restored the epithelial barrier function significantly faster than nontransplanted controls (P < 0.05). The study confirms the successful transplantation of keratinocyte suspensions, their reconstitution of the epidermis, and their acceleration of repair. Further, this apparently normal incorporation of genetically engineered transplanted keratinocytes expressing either beta-galactosidase or hGH suggests the possibility of introducing other genes expressing therapeutic proteins into wounds to favorably affect healing. Wound fluid detection of the expressed peptide provided early demonstration of successful transfer of the hGH gene.
Asunto(s)
Trasplante de Células , Epidermis/fisiología , Hormona del Crecimiento/biosíntesis , Queratinocitos/fisiología , Trasplante Heterólogo , Cicatrización de Heridas , Heridas y Lesiones/fisiopatología , beta-Galactosidasa/biosíntesis , Animales , Células Cultivadas , Epidermis/patología , Femenino , Hormona del Crecimiento/análisis , Humanos , Cinética , Porcinos , Factores de Tiempo , Transfección , Heridas y Lesiones/patología , beta-Galactosidasa/análisisRESUMEN
Wound fluid was obtained from porcine partial-thickness excisional wounds and analyzed for heparin-binding growth factors. Two heparin-binding growth factor activities were detected, a relatively minor one that was eluted from a heparin affinity column with 0.65 M NaCl and a major one that was eluted with 1.1 M NaCl. These activities were not present in wound fluid 1 hr after injury but appeared 1 day after injury, were maximal 2-3 days after injury, and were not detectable by 8 days after injury. The heparin-binding growth factor eluted with 0.65 M NaCl was identified as a platelet-derived growth factor (PDGF)-like activity by the use of specific anti-PDGF neutralizing antibodies. The heparin-binding growth factor eluted with 1.1 M NaCl was shown to be structurally related to heparin-binding epidermal growth factor (EGF)-like growth factor (HB-EGF) by several criteria, including binding to heparin affinity columns and elution with 1.1 M NaCl, competition with the binding of 125I-EGF to the EGF receptor, triggering phosphorylation of the EGF receptor, immunodetection on a Western blot, and stimulation of fibroblast and keratinocyte growth. It was concluded that HB-EGF is a major growth factor component of wound fluid and, since it is mitogenic for fibroblasts and keratinocytes, that it might play an important role in wound healing.
Asunto(s)
Endotelio Vascular/citología , Factor de Crecimiento Epidérmico/metabolismo , Sustancias de Crecimiento/metabolismo , Heparina/metabolismo , Queratinocitos/citología , Heridas y Lesiones/fisiopatología , Células 3T3 , Secuencia de Aminoácidos , Animales , Western Blotting , Capilares , Bovinos , División Celular/efectos de los fármacos , Células Cultivadas , Cromatografía de Afinidad , Replicación del ADN/efectos de los fármacos , Endotelio Vascular/efectos de los fármacos , Factor de Crecimiento Epidérmico/aislamiento & purificación , Factor de Crecimiento Epidérmico/farmacología , Receptores ErbB/metabolismo , Sustancias de Crecimiento/aislamiento & purificación , Sustancias de Crecimiento/farmacología , Humanos , Queratinocitos/efectos de los fármacos , Cinética , Ratones , Ratones Endogámicos , Datos de Secuencia Molecular , Péptidos/síntesis química , Péptidos/inmunología , Fosforilación , Porcinos , Células Tumorales CultivadasRESUMEN
This study employs a liquid-tight vinyl chamber for the topical fluid-phase treatment of experimental wounds in pigs. Continuous treatment with normal saline significantly reduced the early progression of tissue destruction in partial thickness burns. Uncovered burns formed a deep layer of necrosis (0.49 +/- 0.004 mm, mean +/- SD) although burn wounds covered with empty chambers demonstrated less necrosis (0.14 +/- 0.01 mm), fluid-treated wounds formed no eschar, and little tissue necrosis could be detected (less than 0.005 mm). Topical treatment with hypertonic dextran increased water flux across burn wounds by 0.24 ml/cm2/24 hr (mean, n = 95) over saline-treated wounds during the first 5 days after wounding. When partial thickness burn and excisional wounds were immersed in isotonic saline until healed, the daily efflux of water, protein, electrolytes, and glucose across the wound surface declined during healing to baseline values found in controls (saline-covered unwounded skin). The declining protein permeability was used as a reproducible, noninvasive, endogenous marker for the return of epithelial barrier function. Saline-treated excisional wounds healed within 8.6 +/- 0.6 days (mean +/- SD, n = 27) and burn wounds within 12.1 +/- 1.4 days (mean +/- SD, n = 15). Healing of fluid-treated wounds occurred without tissue maceration and showed less inflammation and less scar formation than healing of air exposed wounds (no attempt was made to compare rates of healing between air- and fluid-exposed wounds). We consider the fluid-filled chamber a potentially very useful diagnostic, monitoring, and delivery system for wound-healing research and for human wound therapy.
Asunto(s)
Piel/lesiones , Cicatrización de Heridas , Animales , Quemaduras/patología , Quemaduras/fisiopatología , Calcio/metabolismo , Células Epiteliales , Potasio/metabolismo , Proteínas/metabolismo , Piel/patología , Piel/fisiopatología , Cloruro de Sodio , Porcinos , Equilibrio HidroelectrolíticoRESUMEN
Between 1975 and 1985 37 patients (23 men, 14 women, 34.3-88 years, mean age 59.5 years) with a primary tumor of the small intestine (7 benign, 8 carcinoids, 22 malign neoplasms) were operated. Preoperative diagnosis could be improved by sonography and computed tomography. In dubious cases explorative laparotomy is recommended. 1 patient died postoperatively. During the mean follow-up period of 32.7 months 19 patients (57%) died with a mean survival time of 19.7 month. An improvement of prognosis of small intestinal tumors may be possible by an early diagnosis and a radical surgical approach, according to the health status of the patient.
Asunto(s)
Neoplasias Intestinales/cirugía , Intestino Delgado/cirugía , Adulto , Anciano , Neoplasias Duodenales/cirugía , Femenino , Estudios de Seguimiento , Humanos , Neoplasias del Íleon/cirugía , Neoplasias Intestinales/diagnóstico , Neoplasias del Yeyuno/cirugía , Espectroscopía de Resonancia Magnética , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
1 The free fraction of azapropazone in the plasma of 37 healthy volunteers ranged from 0.0027 to 0.0070 (0.0044 +/- 0.0009, mean +/- s.d.). The principal binding protein was found to be albumin. 2 In 27 patients with various degrees of renal failure the free fraction values of azapropazone were markedly enhanced (0.0260 +/- 0.0239, mean +/- s.d.) and increased more than tenfold in some patients. There was a weak correlation (r = 0.46, P less than 0.05) between the free fraction and the clearance of endogenous creatinine. Such correlation was not found for serum creatinine, serum albumin, serum uric acid and serum urea nitrogen. 3 In 32 patients with chronic liver disease the free fraction values of azapropazone were also markedly higher (0.0210 +/- 0.0242, mean +/- s.d.) than in healthy subjects. There were statistical significant correlation between free fraction values and the prothrombin complex activity in the plasma (r = 0.40, P less than 0.05) and the total bilirubin concentration in the plasma (r = 0.90, P less than 0.001), respectively. Such correlation was not found for serum albumin, serum glutamic oxalacetic transaminase, serum gamma-glutamyl transpeptidase and serum alkaline phosphatase. 4 In patients with kidney and liver disease the free fraction values of azapropazone correlated well with those of the anticoagulant drug phenprocoumon (r = 0.93, P less than 0.001). However, the binding of the latter drug was less impaired. Bilirubin, when added in vitro, displaced both drugs from plasma proteins but this displacing effect was much smaller than the binding changes observed in patients with liver disease. 5 Kidney and liver disease caused a marked impairment of the plasma protein binding of azapropazone. In patients with kidney disease the degree of impairment of azapropazone binding cannot or only poorly (creatinine clearance) be predicted from the biochemical parameters of kidney function whereas in patients with chronic liver disease the total bilirubin concentration in the plasma may serve as an index of the binding defect.
Asunto(s)
Apazona/sangre , Proteínas Sanguíneas/metabolismo , Fallo Renal Crónico/sangre , Hepatopatías/sangre , Unión Proteica/efectos de los fármacos , Triazinas/sangre , Adolescente , Adulto , Anciano , Bilirrubina/farmacología , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The pharmacokinetics of azapropazone (Prolixan) was studied in 7 healthy volunters following single oral and i.v. doses of 600 mg. After i.v. injection plasma concentration declined biexponentially with time. The half-life of the beta-phase was 13.6 +/- 2.6 h (mean +/- SD), the apparent volume of distribution 11.9 +/- 3.5 l, and the total clearance 10.1 +/- 2.1 ml . min-1. Following oral administration peak plasma concentrations occurred between 3 and 6 h and declined with a beta-phase half-life of 14.3 +/- 2.8 h. The binding of azapropazone to plasma proteins was high (ranging from 99.52 to 99.67% at a total plasma concentration of 75 micrograms/ml). The bioavailability of azapropazone when administered as capsules was 83 +/- 19%.