Surviving Sepsis After Burn Campaign.

INTRODUCTION: The Surviving Sepsis Campaign was developed to improve outcomes for all patients with sepsis. Despite sepsis being the primary cause of death after thermal injury, burns have always been excluded from the Surviving Sepsis efforts. To improve sepsis outcomes in burn patients, an international group of burn experts developed the Surviving Sepsis After Burn Campaign (SSABC) as a testable guideline to improve burn sepsis outcomes. METHODS: The International Society for Burn Injuries (ISBI) reached out to regional or national burn organizations to recommend members to participate in the program. Two members of the ISBI developed specific "patient/population, intervention, comparison and outcome" (PICO) questions that paralleled the 2021 Surviving Sepsis Campaign [1]. SSABC participants were asked to search the current literature and rate its quality for each topic. At the Congress of the ISBI, in Guadalajara, Mexico, August 28, 2022, a majority of the participants met to create "statements" based on the literature. The "summary statements" were then sent to all members for comment with the hope of developing an 80% consensus. After four reviews, a consensus statement for each topic was created or "no consensus" was reported. RESULTS: The committee developed sixty statements within fourteen topics that provide guidance for the early treatment of sepsis in burn patients. These statements should be used to improve the care of sepsis in burn patients. The statements should not be considered as "static" comments but should rather be used as guidelines for future testing of the best treatments for sepsis in burn patients. They should be updated on a regular basis. CONCLUSION: Members of the burn community from the around the world have developed the Surviving Sepsis After Burn Campaign guidelines with the goal of improving the outcome of sepsis in burn patients.

Evaluating the impact of rehabilitation nursing intervention on quality of life in patients with burn injuries: A protocol for systematic review and meta-analysis.

BACKGROUND: Despite the availability of pharmacological intervention, patients with burn injuries experience pain during the treatment of wounds. Supplementary rehabilitation nursing intervention are required to enhance the wellbeing of patients sustaining injuries from burns. The present study aims to conduct a systematic exploration of the impact of rehabilitation nursing intervention on the wellbeing in patients sustaining burn injuries. METHODS: The electronic databases listed below will be searched systematically: PubMed, EMBASE, CINAHL, Cochrane Library, Web of Science, Scopus, China National Knowledge Infrastructure, and WanFang database. All the databases will be searched from their inauguration to November 2020. There will be no language constraints. Independent undertaking by 2 authors will select studies, extract data from selected studies, and assess the quality of the included studies. All disagreements will be resolved through discussion, or by consulting a third independent author. This study will make use of RevMan 5.3 software to perform statistical analysis. RESULTS: The present protocol summarizes high-quality evidence to assess the impact of rehabilitation nursing intervention on the wellbeing of patients sustaining burn injuries. CONCLUSION: The results of the present protocol has the potential to present evidence to assess whether rehabilitation nursing intervention can enhance the wellbeing of patients sustaining burn injuries. REGISTRATION NUMBER: November 17, 2020.osf.io/t6b8c/. (https://osf.io/t6b8c/).

[Treatment of thoracic and abdominal cavity perforation complicated by Henoch-Schonlein purpura nephritis in a patient with high-voltage electric burn].

A 55-year-old male patient suffered from severe high-voltage electric burn with an area of 20%TBSA full-thickness injury. The injury involved the distal end of left upper limb, right trunk, and whole abdominal wall. Fracture of the 7th-10th ribs was found in the right side of chest, with perforation of abdominal cavity, and bilateral pleural effusion was found. Part of the small intestine was necrotic and exposed. At the early stage, xeno-acellular dermal matrix was grafted after debridement of abdominal wound; peritoneal lavage was performed; negative pressure drainage was performed in orificium fistula of intestine for promoting the adhesion between perforated intestine and abdominal scar. Two orificium fistulas formed after closure of abdominal granulation wound by autologous skin grafting. Eschar of chest wall and denatured ribs were retained. The risk of infection of thoracic cavity was decreased by promoting the adhesion between lung tissue and chest wall. During the treatment, the patient was diagnosed with Henoch-Schonlein purpura nephritis by renal biopsy, with the symptoms of purpura in the lower limbs, heavy proteinuria, severe hypoalbuminemia, edema, etc. After control of kidney damage by immunosuppressive treatment instead of glucocorticoid, alleviation of the levels of proteinuria and blood albumin, free latissimus dorsi myocutaneous flap was excised to repair chest wall, and free skin graft was excised to repair intestinal fistula. After all the wounds were successfully covered, the patient was treated with glucocorticoid combined with immunosuppressants for more than 1 year. The patient was followed up for 3 years, and his renal function was completely recovered with satisfactory clinical outcome.

[An overview on the establishment of the system of burn prevention and treatment in China by comparing with that of foreign countries].

The number of burn patients in China is still huge because of the demographic and socio-economical reasons. Distinguished achievements have been made in Chinese burn surgery during decades of development, with a generally acknowledged high survival rate of burn victims. However, there are still many problems, including an emphasis on the treatment rather than on prevention, poor pre-hospital care system, unbalanced development of burn centers, shortage of burn rehabilitation and psycho-social support, shortage of financial support, and underdevelopment of social charity for burn patients. Only if the efforts of the burn centers, government, and the whole society join together can the problems be solved and a good system of burn prevention, clinical care, and rehabilitation be established and perfected. The deficiencies in the development of the system in China and the possible solutions are reviewed and discussed in this paper.

[Role of biological protective dressing in microskin grafting in rabbit].

OBJECTIVE: To study the effect of biological protective dressing made from porcine peritoneum in covering wounds with microskin grafts. METHODS: Twenty New Zealand rabbits were divided into ten couples according to the random number table. Rabbits in each couple underwent surgery at the same time. A piece of full-thickness skin of 5 cm in diameter was removed symmetrically from the left and right sides of the back of each rabbit, thus forming two wounds with full-thickness skin defect. One fifth of one piece of skin of one rabbit was cut into tiny pieces of 0.2-0.5 mm in size (microskin). Then the microskin pieces were spread on the two wounds of the donor rabbit with the microskin/wound area ratio 1:10. The two wounds of each rabbit covered with microskin were divided into two groups according to the random number table. One wound was covered with biological protective dressing prepared with porcine peritoneum as experiment group, and the other was covered with the rest allograft in full size obtained from the other rabbit of each couple as control group. The general condition of wound was observed at post operation week (POW) 1-4. Wound healing rate was calculated at POW 3 and 4. Wound healing time was recorded. Specimens were harvested from wounds for histological observation at POW 1-4. Data were processed with paired t test. RESULTS: (1) At POW 1, the biological protective dressings were found to attach firmly to the wounds in experiment group without obvious inflammatory response; the allografts survived well on the wounds in control group. At POW 2, the coverings attached well to the wounds of both groups, but became drier and darker as compared with those at POW 1. At POW 3, some wounds of the two groups healed when the coverings desiccated and separated. At POW 4, all the wounds of both groups healed without obvious difference in appearance. (2) The wound healing rates of the experiment and control groups were respectively (92.8 ± 6.2)% and (91.3 ± 7.3)% (t = 0.54, P > 0.05) at POW 3 and (98.1 ± 2.3)% and (97.0 ± 4.6)% (t = 0.38, P > 0.05) at POW 4. (3) The wound healing time was (25.0 ± 3.9) d in experiment group and (24.8 ± 2.3) d in control group. The difference between them was not statistically significant (t = 0.82, P > 0.05). (4) Histological observation showed that wounds of the two groups were all infiltrated by inflammatory cells, and new blood vessels were observed at POW 1 and 2. The survived microskin proliferated under the coverings. At POW 3 and 4, the coverings on the wounds of two groups were gradually degenerated and became necrotic and separated from the wound beds, while the wounds underneath were re-epithelialized. CONCLUSIONS: The effect of biological protective dressing in covering wounds grafted with microskin is as good as that of the allograft, as they both help the auto-microskin proliferate and repair the wound. It could be considered to be new biological material for clinical application.

[Research into the prevention and treatment of burns due to specific causes should be highly strengthened].

So far there is no clear and accurate definition for burns due to specific causes, though they are encountered sometimes. Burns due to specific causes sometimes are neglected because of their low incidence, and many surgeons, even burn specialists are not familiar with them because of low incidence, thus leading to poor results in the treatment. Burns due to specific causes are often involved in complicated and compound injuries. The treatment is often difficult, leading to delayed wound healing. In this paper, the definition, classification, and clinical characteristics of burns due to specific causes are described. Problems involved in diagnosis and treatment of common ones such as electrical, chemical, and compound burns are discussed. Facing an increase of those burns with specific causes, the author suggests that the research into the prevention and treatment should be highly strengthened.

[Change in expression of vascular endothelial growth factor in serum and wound tissue of rats with electrical burns].

OBJECTIVE: To observe the change in expression of vascular endothelial growth factor (VEGF) in serum and wound tissue of rats with electrical burn (EB), and to explore its regulation mechanism in the pathological changes of EB. METHODS: Sixty-four SD rats were divided into normal control group (n = 8) and EB group (n = 56) according to the random number table. Eight rats in EB group were sacrificed at post injury hour (PIH) 6 and on post injury day (PID) 1, 3, 7, 14, 21, and 28, to collect wound muscle tissue and serum samples. Histopathological changes in wound tissue were observed with HE staining. The serum content of VEGF was determined with double-antibody sandwich enzyme-linked immunosorbent assay. The expression level of VEGF in wound tissue was determined with Western blotting. VEGF expression intensity in wound tissue was observed with immunohistochemical staining. The microvessel density (MVD) was calculated. The correlation between VEGF expression intensity and MVD was analyzed. Muscle tissue of calf and serum of the rats in normal control group without any treatment were collected for above-mentioned observations and determinations. Data were processed with one-way analysis of variance and Spearman hierarchy correlation analysis, and LSD-t test was applied for paired comparison. RESULTS: (1) In EB group, breakage of muscle fiber, heavy infiltration of inflammatory cells, and obvious tissue edema were observed at PIH 6 and on PID 1; new vessels were observed on PID 3; amount of granulation tissue and number of new vessels were found to be increased on PID 7. (2) In EB group, the serum level of VEGF was (43 ± 11) pg/mL at PIH 6, (44 ± 11) pg/mL on PID 1, and (74 ± 27) pg/mL on PID 14, which were all significantly higher than that in normal control group [(15 ± 9) pg/mL, with t values from 4.001 to 5.724, P values all below 0.01]. (3) The protein expression level of VEGF of wound tissue in EB group was higher than that in normal control group (0.21 ± 0.09) at each time point. The protein expression level of VEGF in EB group peaked on PID 7 (0.63 ± 0.13, t = 4.965, P < 0.05). (4) In EB group, strongly positive expression of VEGF was observed in inflammatory cells at early stage and in new vascular endothelial cells at late stage. (5) The expression intensity of VEGF was positively correlated with MVD in wound tissue on PID 3, 7, 14, 21, and 28 in EB group (r(s) = 0.834, P < 0.01). CONCLUSIONS: Different expression levels of VEGF were observed in serum and wound tissue of rats at various stages after EB, and they were closely correlated with different stages of fluid exudation and wound healing process after EB.

[Diagnosis of the deep partial-thickness burn wound of Skh-1 mouse with Optical Coherence Tomography].

OBJECTIVE: To evaluate the application value of Optical Coherence Tomography (OCT) in the diagnosis of the depth of burn wound. METHODS: Deep partial-thickness scald models of Skh-1 mice were reproduced using self-made steam scald appliance. The scald wounds were scanned with OCT 3 hours, or 3 and 8 days after injury respectively. Scanned wound tissue was harvested for histological examination right after each episode of OCT imaging. Normal skin of mice was scanned and examined with the above-mentioned methods at the same time. RESULTS: Compared with those of the normal skin, collagen in the dermis was denatured after steam scald, and it was imaged as vanishing or reduction in birefringence in OCT detection. The structure change intensity was related to the pathological process of the wounds and consistent with the corresponding histological results. CONCLUSIONS: OCT is a noninvasive technique. It can be used to diagnose the depth of burn wound in real time.

[Distribution and vicissitude of drug resistance of Acinetobacter baumannii in burn intensive care unit of Wuhan City Hospital No.3 in three years].

OBJECTIVE: To study the clinical distribution characteristics and vicissitude of antibiotic resistance of Acinetobacter baumannii (AB), and to look for the risk factors of AB infection in order to provide reasonable reference for the prevention and treatment of its infection. METHODS: Specimens of blood, venous catheters, sputum, wound exudates and pharyngeal swabs from 156 patients hospitalized in our burn ICU from January 2006 to December 2008 were collected and cultured. The clinical distribution and antibiotic resistance of AB were determined and analyzed. The risk factors related to AB infection were analyzed. Drug resistance rate data were processed with WHONET 5.3 software; the other data were processed with chi-square test and Logistic regression analysis. RESULTS: Ninety-two strains of AB were identified during the three years from different kinds of specimens, with 41 (44.6%) from wound exudates, 14 (15.2%) from pharyngeal swabs and sputum respectively, 13 (14.1%) from blood, and 10 (10.9%) from venous catheters. AB accounted for 23.1% (30/130), 27.5% (25/91), 28.2% (37/131) respectively among the strains detected in 2006, 2007, and 2008. During the three years, except for imipenem and cefoperazone/sulbactam, the average resistance rates of AB to other ten commonly used antibiotics were all above 50.0%. Burn area (χ(2) = 24.374, P = 0.000), mechanical ventilation (χ(2) = 8.968, P = 0.003), duration of use of antibiotics (χ(2) = 3.981, P = 0.046), and deep venous catheterization (χ(2) = 9.170, P = 0.002) were the risk factors of AB infection, and the former two were independent risk factors. CONCLUSIONS: There is a pan-drug resistance tendency of AB in our burn ICU, and the positive culture rates are increasing in recent years. Disinfection and isolation measures, appropriate use of antibiotics, avoidance of invasive performances such as deep venous catheterization and tracheostomy, or shortening their duration are important means to prevent and control infection of AB.

[Repair of electrical burns on hands with flaps].

OBJECTIVE: To summarize the experiences and shortcomings of repair of wounds on hands due to electrical burns with flaps, aiming at further improvement. METHODS: Clinical data of 425 patients with electrical burn of hands admitted to Burn Institute of Wuhan, City Hospital NO. 3 & Tongren Hospital of Wuhan University from January 2000 to December 2006 were collected and summarized. Therapeutic methods and outcomes of all patients were statistically analyzed. Flap types, complications after surgery and problems existed in patients having undergone flap transplantation were summarized. Patients were divided into surgery within 7days post burn (PBD) group (SW) and surgery after PBD 7 group (SA) according to the timing of surgery. Survival rate of flaps and incidence of complications in patients of two groups were compared. RESULTS: Out of the 425 patients, 348 (90.2%) patients underwent surgery, among which 248 flaps of different types were transplanted in 209 patients, including 202 (81.5%) distant pedicle flaps, 19 (7.7%) local flaps, 12 (4.8%) free flaps, and 15 (6.0%) other kinds of tissue flaps. Five flaps failed because of necrosis of torn off, and the resulting wounds were treated with other methods. Eight flaps showed necrosis of distal margin, and the wound healed with dressing changing or skin grafting. All the remaining flaps survived with satisfactory cosmetic and functional results. In SW group (n = 170) and SA group (n = 78), survival rate of flaps was respectively 98.8% (168/170) and 96.2% (75/78), incidence of complications was respectively 10.6% (18/170) and 12.8% (10/78). There was no statistical difference between above two sets of data (with chi(2) value respectively 0.81 and 0.27, and P values both above 0.05). CONCLUSIONS: There are many types of flaps that can be used to repair electric burn wounds on hands. Appropriate choice and design of flaps, skillful operation, and careful post-operation observation and treatment are key points for good therapeutic effect.

[Burn rehabilitation and community reintegration-new challenge to burn surgery in China].

Burn patients often have severe disfigurement, dysfunction, and psychological disorder after discharge, which may last for a long time, even for a whole life. These problems may prevent patients from returning to normal life and re-entering society. Because of demographic and socioeconomic reasons, the number of burn patients in China is huge. The rising cure rate further increases the number of patients that need rehabilitation treatment. However, the level of burn rehabilitation in China is relatively low as compared with that in the developed countries. Along with the social and economical development, it is no longer satisfied to just save the life of patient. Improving the quality of wound healing, avoiding or decreasing disfigurement, dysfunction, and psychological disorder, and finally helping patients re-enter society is the ultimate goal of burn treatment. Modern concept of rehabilitation is to restore health or normal life for patients by medical, psychosocial, educational and occupational methods. Although increasing attention has been paid to burn rehabilitation in China recently, so far it is mainly focused on the fields of improving patients' appearance and body function, whereas the importance of psychosocial, educational, occupational, and social rehabilitation has still not been realized. Some fields of burn rehabilitation have not been well established and many are not carried out by professionals. The model of multidisciplinary team in burn centers of developed countries including surgeons and nurses, as well as allied professionals such as psychologists, physical and occupational therapists, dietitians, anesthesiologists and social workers has seldom been introduced into China. In most burn centers in China, psychological support is mainly given by nurses in their spare time of nursing. Burn treatment used to be divided into the early stage of life saving and wound repair, and the late stage of rehabilitation. It has not been realized until recent years that rehabilitation measurements should be carried out through the whole process of burn treatment. Organizations of burn survivors and summer camps for burnt children proved to be helpful for the patients' self-confidence and community integration have hardly been established in China. Lack of funding is one of the main reasons for the lagging behind in burn rehabilitation in China. According the experiences of other countries, raising money from donation through burn foundation may be a useful way to support burn rehabilitation. Solving the above problems and improving the burn rehabilitation will be a new challenge to burn surgery in China.

[Treatment of facial pigmentation after burns with traditional Chinese medicine mask and skin care].

OBJECTIVE: To observe the effects of traditional Chinese medicine mask combined with skin care in the treatment of facial pigmentation after burns. METHODS: Forty-one patients with facial pigmentation after burns hospitalized from January 2009 to June 2010 were enrolled and divided into treatment group (n = 26, odd number) and control group (n = 15, even number) according to the visiting order. After cleaning, massaging, and steam spraying to faces, patients in treatment and control groups were respectively treated with traditional Chinese medicine mask developed by physicians in our hospital and common commercial beauty mask. Masks were removed when they became completely dry. The treatment was repeated every other day. Ten times made up a course of treatment. Three consecutive courses were carried out on each patient. Before treatment and at the end of each course, the skin color differences were measured with Vancouver Pigmented Scar Scale; image gray scale value of pigmented skin was measured with image analysis technique. Satisfaction degree acknowledged by both patients and physicians were recorded at the end of each course; adverse effects were recorded; and the overall efficacy between two groups was compared. Data were processed with chi-square test or t test. RESULTS: Skin color differences, image gray scale value of patients in treatment group were close to those in control group before treatment (with t value respectively 0.800 and 0.694, P values all above 0.05). Skin color differences, image gray scale value, and satisfaction degree acknowledged by both patients and physicians in treatment group were better than those in control group at the end of each course. At the end of the third course of treatment, the skin color differences in treatment and control groups scored 0.5 ± 0.4 and 1.1 ± 0.6, respectively, with image gray scale value of 55 ± 5 and 66 ± 6, respectively, which were statistically different from each other (with t value respectively 3.389 and 5.102, P values all below 0.01). The overall efficacy of the treatment group was 92.3%, which was much better than that of the control group (53.3%, χ(2) = 6.31, P < 0.05). No allergy caused by the traditional Chinese medicine mask was observed during the treatment. CONCLUSIONS: The traditional Chinese medicine mask combined with skin care is effective for the treatment of facial pigmentation after burns.

[Repair and reconstruction of penile defects due to devastating deep burn].

OBJECTIVE: To summarize the experience of repair and reconstruction of penile defects as a result of devastating deep burn. METHODS: Twenty-four patients with penile defects in early or late (a half year after wound healed, the same below) stage after burn were involved. Their suspensory ligaments of penis were dissected to lengthen the penis after escharotomy with the necrotic distal part removed. The wounds formed after lengthening were covered with lower abdominal skin flap, scrotal or internal pudendal artery flap. Ten patients underwent surgery within 30 days after burn; the other 14 patients underwent surgery in the late stage. The condition of flaps and complications after surgery were observed. The lengths of penis of patients in flaccid and erection state were measured before surgery and at follow-up period. The sensory function of penile skin, the erectile function of the penis, and sexual intercourse activity of patients were followed up. RESULTS: All the flaps survived except two, in whom areas of 1.0 cm x 0.5 cm and 1.5 cm x 1.0 cm of necrosis at distal parts were found, and they healed after dressing changes. Patients were followed up for 2 to 5 years. The length of penis in flaccid state was (7.4 +/- 1.6) cm, which was (5.3 +/- 1.4) cm longer than that before surgery (P < 0.01). The length of penis in erection state was (9.7 +/- 1.2) cm. The sensory function of penis recovered gradually about half year after surgery with well preserved erectile function. Except one who did not try to have sexual intercourse again, all the other married patients and their spouses were satisfied or quite satisfied with sexual intercourse activity. CONCLUSIONS: Penis elongation combined with skin flap grafting is a good method for the treatment of penile defects due to devastating deep burn. Suitable length and erectile function of penis can be preserved with this method.

[Rescue and treatment for the mass burn casualties of yellow phosphorus explosion].

OBJECTIVE: To summarize the characteristics and treatment of burn casualties of yellow phosphorus explosion, so as to share the experiences in emergency treatment. METHODS: By analyzing the data related to this accident, the characteristics of the injury and experiences of treatment for mass burn casualties from yellow phosphorous explosion were summarized. RESULTS: Eighty-one patients, 72 males and 9 females, were injured in a yellow phosphorus explosion. The mean age of the patients was 24 +/- 13 years old (5-42 y). The mean total burn surface area was (9 +/- 11)% [(0.4% - 70.0%))] TBSA, and the mean burn surface area of III degrees/IV degrees was (7 +/- 10)% [(0.4% - 60.0%)] TBSA. Most of the patients showed the symptoms and signs of phosphorus poisoning. Among all the patients, 27 cases (33.3%) showed hepatic dysfunction, 15 cases (18.5%) had renal dysfunction, 42cases (51.9%) showed electrolytes disorders. Among the 8 patients with burn surface area over 10% TBSA and less than 20% TBSA, high levels of cardiac enzymes were found in 6 cases, anaemia in 7 cases (3 with progressive anaemia), asphyxia occurred in 1 case 48 hours after burn, and in 1 case complicated with stress ulcer. Escharectomy and skin grafting were performed within four days after burn in 72 patients. All the patients survived, some of them showed impaired hand function and hypertrophic scar, and partial finger amputation was done in 3 patients. CONCLUSION: Yellow phosphorus explosion produces deep burn injuries in surrounding people especially in exposed parts such as head, hand and so on. Adequate organization of medical resources for emergency treatment, early debridement, and accelerating excretion of phosphorus are the key points for the successful rescue of mass casualties.

[Subarea ostectomy of mandible for lower face re-shaping].

OBJECTIVE: Dividing the mandible into lower part of mandibular ramus, mandibular angle, mandibular body, chin, we designed subarea ostectomy for reduce the width of anterior, body, posterior part of of the lower face. METHODS: Combide with splitting ostectomy of the out layer of mandible, ostectomy of inferior border of mandible and augmentation of the chin, re-shape the mandibular angle, body, and chin, corrected the un-beauty of the lower face and side-face. RESULTS: From May 2003 to August 2005 , a total of twenty-three patients have been operated on by this method with satisfactory results. CONCLUSIONS: Subarea ostectomy of mandible is more effective in re-shaping the whole lower face.

[Application of reverse island flaps pedicled with cutaneous nerve nutrient vessels to repair defect on distal parts of extremities].

OBJECTIVE: To analyze the feasibility of reverse island flaps pedicled with cutaneous nerve nutrient vessels in repairing the defect on distal parts of extremities. METHODS: Thirty patients with tissue defect in distal extremities, complicated by exposed vessels, nerve, tendons, and/or bones ,were repaired with island flaps pedicled with neurocutaneous nutrient vessel. Among them, five cases were grafted with flaps with external forearm cutaneous nerve vessels, eleven cases were grafted with flap containing sural neural nutrient vessels in its pedicle,and 14 cases with saphenous nerve nutrient vessels in the pedicles. RESULTS: The flaps of 28 cases survived with perfect appearance and function. In one case partial necrosis occurred because of compression on the pedicle, but the patient healed after dressing, and another case with necrosis of the edge of the flap due to infection, but also healed after skin grafting. CONCLUSION: The reverse island flaps pedicled with cutaneous nerve nutrient vessels which are constant in anatomy, with reliable blood supply, can be recommended because its simple operative technique, non-injurious to main blood vessels and muscles, the repair of distal defects of the extremities.

[Improvement of reduction of prominent malar complex through an intraoral incision].

OBJECTIVE: To improve the technique of prominent malar complex reduction. METHODS: The improvements of the operation procedure included double-oblique osteotomy of the prominent malar complex, accessorial tiny preauricular incision and the way that the complex was moved upward, inward or posteriorly. The zygomatic body was fixed with microplate screw or steelwire. The jugal soft tissue was lifted to prevent facial slack. The method was used in 17 cases from June 2000 to April 2004. RESULTS: Postoperative follow up for 4 approximately 24 months showed satisfactory result in all the cases. CONCLUSIONS: This modified method resolved some problems in reduction malarplasty through an intraoral approach.

[Influence of vascular endothelial growth factor gene modification on skin substitute grafted on nude mice].

OBJECTIVE: To investigate the influence of vascular endothelial growth factor (VEGF) gene modification on skin substitute grafted on nude mice. METHODS: Human fibroblasts were transfected with VEGF adenovirus vector. Then the genetic modified fibroblasts were seeded on patches of Integra artificial skin. Twenty-four hours later, the Integra patches were grafted onto full-thickness skin defects on nude mice. Seventy-two nude mice were divided into experiment (n = 18, E, with fibroblasts seeded on Integra which were transfected by adenovirus containing VEGF in advance), GFP control (n = 18, the fibroblasts were transfected with adenovirus containing labelled GFP segment as same as that in E group, but containing no VEGF gene), Fb control (n = 18, without gene transfection), and control (n = 18, no fibroblast was seeded on Integra) groups. The survival rate, the revascularization process and the histological changes in the grafts in gene modified group (experimental group) and control groups were observed and analyzed. RESULTS: The revascularization condition in the experimental group was much better than that in the control group. The grafts adhered firmly to the wound during early postoperation stage, and were more prone to bleed when separated from the wound. The survival rate was obviously higher, while the infection rate was much lower in experimental group (100.0%) compared with the control groups (83.3%, 75.0%, 77.8%, respectively) (P < 0.05). CONCLUSION: High expression of VEGF by gene modification can promote the vascularization process of skin substitute, hence improve the grafting result.

[Diagnosis and treatment of penetrating injury to the left ventricle].

OBJECTIVE: To review our experiences with diagnosis and treatment of 6 cases of penetrating injury to the left ventricle. METHODS: Six patients were admitted to the emergency department 0.5 to 3 h after the injury, all with shock and 3 with obvious pericardiac tamponade. All the patients received immediate thoracotomy for repairing the ruptured left ventricle, sub-pericardial window and pericardiocentesis, with also blood autotransfusion. RESULTS: All patients survived the operations. One patient required reexploration because of hemorrhage in the chest and two presented ST-segment changes in postoperative ECG, and one had nonspecific intraventricular conduction delay with T-wave inversion. CONCLUSIONS: Penetrating injury to the left ventricle is manifested by low blood pressure and signs of pericardial tamponade. Immediate thoracotomy to relieve the tamponade and effective hemostasis can be critical for management of such patients.

[The histological changes and the revascularization process in the grafted dermal substitutes].

OBJECTIVE: To observe the revascularization process and histological changes in the dermal substitutes after grafting. METHODS: Twenty-one SD rats were enrolled in the study and were randomly divided into swine acellular dermal matrix (sADM), human acellular dermal matrix (hADM), and artificial dermal equivalent (Integra) groups according to different dermal substitutes grafted underneath the skin of SD rats. The gross appearance of the grafts was observed, and the tissue biopsies were harvested at 2, 3, 4, 7, 10, 14, 21, 30, 60, 90, 120, 150, 180 post grafting day (PGD) for the observation of the revascularization process and their histological changes. RESULTS: Gross observation: The incision in each group healed well without local swelling and inflammatory response after grafting. The grafts had a compact contact with the wounds. The texture of the grafted dermis in each group was soft and could not be felt from the surface of the body on 90 PGD. The presence of the grafts could be discerned on 180 PGD in all the groups, but some of them became smaller in size and thinner, even hard to identify in a few. Fibroblasts, neutrophils and lymphocytes migrated into the grafts from 2PGD on. New capillary sprouts from the receiving beds could be observed after 3PGD. Affluent capillary nets formed in the grafts during 30 to 60 PGD. The structure of the grafts became nearly unidentifiable from the native dermis after 150 PGDs. Absorption and degradation to various degrees occurred in some of the grafts after 180 PGD. CONCLUSION: The revascularization of the three dermal substitutes could begin shortly after grafting. The sponge-like structure of the substitutes was advantageous for the migration of the host fibroblast into the substitute and for the secretion of the new extra-cellular matrix. The dermal substitutes could last in the wound for a long time with partial absorption and degeneration.