Biodegradable temporising matrix: use of negative pressure wound therapy shows a significantly higher success rate.

OBJECTIVE: The purpose of this case series was to evaluate the efficacy of a synthetic biodegradable temporising matrix (BTM; PolyNovo Biomaterials Pty Ltd, Australia) and compare the outcome of BTM patients with and without negative pressure wound therapy (NPWT). METHOD: A retrospective chart review was conducted on patients admitted with deep full-thickness burns, traumatic or complex wound injuries treated with BTM. Electronic medical records and images were evaluated by a team of clinical professionals. Endpoints included: the measure of successful BTM integration; and comparison between patients treated with and without NPWT. Additional measures were BTM total surface area, BTM sites, timeliness of BTM application and any complications. RESULTS: A total of 28 patients were evaluated and 23 (82.1%) demonstrated overall successful BTM integration. Patients treated with BTM in conjunction with NPWT (n=16) demonstrated a significantly higher (p=0.046) integration rate compared to patients treated without NPWT (n=12) (93.8% versus 58.3%, respectively). Patients treated with BTM with NPWT continued to successfully integrate and sustain favourable outcomes despite the presence of severe infection or the development of haematomas. CONCLUSION: A significantly higher integration rate was demonstrated when BTM was used in conjunction with NPWT. The results of this study further support the efficacy of successful integration of BTM as a replacement for tissue loss in the treatment of deep, full-thickness burns, traumatic and complex wound injuries, and particularly favourable outcomes with the use of NPWT. To the best of our knowledge, this is the first reported case series comparing the clinical outcomes of BTM with and without the use of NPWT.

Physical plasma therapy accelerates wound re-epithelialisation and enhances extracellular matrix formation in cutaneous skin grafts.

Skin grafting is a surgical method of cutaneous reconstruction, which provides volumetric replacement in wounds unable to heal by primary intention. Clinically, full-thickness skin grafts (FTSGs) are placed in aesthetically sensitive and mechanically demanding areas such as the hands, face, and neck. Complete or partial graft failure is the primary complication associated with this surgical procedure. Strategies aimed at improving the rate of skin graft integration will reduce the incidence of graft failure. Cold atmospheric plasma (CAP) is an emerging technology offering innovative clinical applications. The aim of this study was to test the therapeutic potential of CAP to improve wound healing and skin graft integration into the recipient site. In vitro models that mimic wound healing were used to investigate the ability of CAP to enhance cellular migration, a key factor in cutaneous tissue repair. We demonstrated that CAP enhanced the migration of epidermal keratinocytes and dermal fibroblasts. This increased cellular migration was possibly induced by the low dose of reactive oxygen and nitrogen species produced by CAP. Using a mouse model of burn wound reconstructed with a full-thickness skin graft, we showed that wounds treated with CAP healed faster than did control wounds. Immunohistochemical wound analysis showed that CAP treatment enhanced the expression of the dermal-epidermal junction components, which are vital for successful skin graft integration. CAP treatment was characterised by increased levels of Tgfbr1 mRNA and collagen I protein in vivo, suggesting enhanced wound maturity and extracellular matrix deposition. Mechanistically, we show that CAP induced the activation of the canonical SMAD-dependent TGF-ß1 pathway in primary human dermal fibroblasts, which may explain the increased collagen I synthesis in vitro. These studies revealed that CAP improved wound repair and skin graft integration via mechanisms involving extracellular matrix formation. CAP offers a novel approach for treating cutaneous wounds and skin grafts. © 2020 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Cold atmospheric plasma modulates endothelial nitric oxide synthase signalling and enhances burn wound neovascularisation.

Treatment with cold atmospheric plasma (CAP) has been reported to promote wound healing in animals. However, how this process is mediated remains unclear. In this study we examined the mechanisms which underlie the improved wound healing effects of CAP and the roles of associated reactive oxygen and nitrogen species (RONS), which are generated by plasma. By using in vitro models which mimicked various steps of angiogenesis, we demonstrated that CAP triggered the production of nitric oxide (NO), and enhanced cell migration and the assembly of endothelial cells into vessel-like structures. These are both hallmarks of the proliferative phase of wound healing. Using a mouse model of a third-degree burn wound, we went on to show that CAP treatment was associated with enhanced angiogenesis, characterised by accelerated in vivo wound healing and increased cellular proliferation. Here, CAP significantly increased the in vivo production of endothelial NO synthase (eNOS), an enzyme that catalyses NO synthesis in endothelial cells, and significantly increased the expression of pro-angiogenic PDGFRß and CD31 markers in mouse wounds. Mechanistically, we showed that CAP induced eNOS phosphorylation and activation, thereby increasing the levels of endogenous NO in endothelial cells. Increased NO generation facilitated by CAP further stimulated important pro-angiogenic VEGFA/VEGFR2 signalling in vitro. This proof-of-concept study may guide future efforts aimed at addressing the use of physical plasma and its therapeutic applications in a variety of pathological scenarios. © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Effect of collagenase ointment versus moist exposed burn ointment on healing of full-thickness burns in mice by removing of necrotic tissue.

The presence of necrotic tissue is one of the major problems that affect healing of burn wounds. The present study was designed to find the effectiveness of collagenase versus moist exposed burn ointment (MEBO) on removal of necrotic tissue of burns. Twenty mice randomly assigned and divided into four groups. For Group 1, burn wounds were treated with collagenase ointment only, Group 2 burn wounds were treated with MEBO, Group 3 burn wounds were treated with white vaseline alone, and Group 4 burn wounds were considered as control and left without treatment. In each group, the time of treatment was considered. The results indicated that the removal time of necrotic tissue and healing process was better in the case of using collagenase than using MEBO for treatment of burns.

Benefits of cryopreserved human amniotic membranes in association with conventional treatments in the management of full-thickness burns.

The use of split-thickness skin autografts (STSA) with dermal substitutes is the gold standard treatment for third-degree burn patients. In this article, we tested whether cryopreserved amniotic membranes could be beneficial to the current treatments for full-thickness burns. Swines were subjected to standardised full-thickness burn injuries, and then were randomly assigned to treatments: (a) STSA alone; (b) STSA associated with the dermal substitute, Matriderm; (c) STSA plus human amniotic membrane (HAM); and (d) STSA associated with Matriderm plus HAM. Clinical and histological assessments were performed over time. We also reported the clinical use of HAM in one patient. The addition of HAM to classic treatments reduced scar contraction. In the presence of HAM, skin wound healing displayed high elasticity and histological examination showed a dense network of long elastic fibres. The presence of HAM increased dermal neovascularization, but no effect was observed on the recruitment of inflammatory cells to the wound. Moreover, the use of HAM with classical treatments in one human patient revealed a clear benefit in terms of elasticity. These results give initial evidence to consider the clinical application of HAM to avoid post-burn contractures and therefore facilitate functional recovery after deep burn injury.

Pedicled abdominal skin flap technique for fingers salvaging and reconstruction in a complex palmar hand burn injury: A case report.

INTRODUCTION AND IMPORTANCE: The only treatment option for full-thickness burn injury is surgical management, either skin grafting or a skin flap. Treatment may be challenging due to the multiple procedures that need to be performed and multiple factors that can affect treatment outcomes especially to do fingers reconstruction. CASE PRESENTATION: A 25-years-old man was admitted because of a burn injury on the palm of his left hand. There are waxy and leathery appearances of burn injuries on the palm and 2nd to 5th digits of the left hand and diagnosed with a full-thickness contact burn injury and compartment syndrome. The patient underwent a pedicled abdominal skin flap followed by necrotomy, flap thinning, and digit separation as a reconstruction management. CLINICAL DISCUSSION: Pedicled abdominal skin flap is one of the best surgical techniques available for full thickness burn injury reconstruction because it is believed to regain the closest natural-looking appearance and extremity functions. Abdominal flap as random flap is safe to be divided into small part to cover the fingers. CONCLUSION: Thorough examinations and appropriate management such as pedicled abdominal skin flaps are important to perform in patients with full-thickness burn injuries.

Crocin-1 laden thermosensitive chitosan-based hydrogel with smart anti-inflammatory performance for severe full-thickness burn wound therapeutics.

Burns are the fourth most common type of civilian trauma worldwide, and the management of severe irregular scald wounds remains a significant challenge. Herein, crocin-1 laden hydroxybutyl chitosan (CRO-HBC) thermosensitive hydrogel with smart anti-inflammatory performance was developed for accelerating full-thickness burn healing. The injectable and shape adaptability of the CRO-HBC gel make it a promising candidate for effectively filling scald wounds with irregular shapes, while simultaneously providing protection against external pathogens. The CRO-HBC gel network formed by hydrophobic interactions exhibited an initial burst release of crocin-1, followed by a gradual and sustained release over time. The excessive release of ROS and pro-inflammatory cytokines should be effectively regulated in the early stage of wound healing. The controlled release of crocin-1 from the CRO-HBC gel adequately addresses this requirement for wound healing. The CRO-HBC hydrogel also exhibited an excellent biocompatibility, an appropriate biodegradability, keratinocyte migration facilitation properties, and a reactive oxygen species scavenging capability. The composite CRO-HBC hydrogel intelligently mitigated inflammatory responses, promoted angiogenesis, and exhibited a commendable efficacy for tissue regeneration in a full-thickness scalding model. Overall, this innovative temperature-sensitive CRO-HBC injectable hydrogel dressing with smart anti-inflammatory performance has enormous potential for managing severe scald wounds.

The Combination of Stromal Vascular Fraction Cells and Platelet-Rich Plasma Increases Fibroblast Growth Factor 2 and Insulin-Like Growth Factor 1 in Full-Thickness Burns in Animal Model.

The previous study on the injection of SVFs in combination with PRP showed positive effect on the healing of deep dermal burns. We now seek to understand the effect on full thickness burns, as assessed by changes in serum FGF2, IGF1, epithelialization, and fibroblast count. Forty-eight Wistar rats were randomly divided into four groups: (1) rats with full thickness burns given a local injection of combined SVFs and PRP; (2) rats with burns given topical Vaseline; (3) rats with burns given a local injection of placebo; and (4) rats without burns. Primary data were measured according to the time of euthanasia (at the 8th hour, 4th day, 7th day, 14th day or 21st day). One-way ANOVA test followed by post hoc test were used. Epithelialization in rats who received SVFs and PRP was superior on days 7, 14 and 21 when compared to the other groups. The fibroblast count in rats who received SVFs and PRP showed significant difference on days 7 (p=0.022). Significant differences in serum FGF2 were observed on days 4, 7, 14 and 21 (p=0.003, p=0.001, p=0.024, p=0.038, respectively). A significant difference was also observed in serum IGF1 levels on days 7, 14 and 21 (p=0.043, p=0.003, p=0.045, respectively), and the combination of SVFs and PRP showed superior results compared to other groups. Injection of combined SVFs and PRP increases FGF2, IGF1, fibroblast count, and epithelialization.

Nous avons montré dans une étude précédente que l'injection combinée de cellules stromales vasculaires (CSV) et de plasma riche en plaquettes (PRP) promeut la guérison des brûlures intermédiaires. Dans cette étude, nous évaluons les effets de cette même combinaison sur les brûlures profondes en mesurant les variations du facteur 2 de croissance fibroblastique (F2CF) comme du facteur de croissance insuline-like 1 (FCIL1), l'épithélialisation et le nombre de fibroblastes. Quarante- huit rats Wistar ont été répartis au hasard en 4 groupes : 1- Brûlure profonde et injection de CSV + PRP ; 2- Brûlure profonde et pansement vaseliné ; 3- Brûlure profonde et injection de placebo ; 4- Rats sains. Les données ont été recueillies au moment de leur sacrifice : h8, J4, J7, J14 et J21). Un test ANOVA a précédé les analyses adaptées. L'épithélialisation était supérieure, à J7, J14 et J21 chez les rats du groupe 1. Le nombre de fibroblastes était significativement plus élevé à J7 (p= 0,022). Les concentrations sériques de F2CF étaient significativement plus élevées à J4, J7, J14 et J21 (p= 0,003 ; 0,001 ; 0,024 et 0,038 respectivement). En ce qui concerne FCIL1, les concentrations sériques étaient plus élevées dans le groupe 1 à J7, J14 et J21 (p= 0,043 ; 0,003 et 0,045). L'injection combinée de CSV et de PRP augmente F2CF et FCIL1, le nombre de fibroblastes et l'épithélialisation.

Injectable hydrogel based on silk fibroin/carboxymethyl cellulose/agarose containing polydopamine functionalized graphene oxide with conductivity, hemostasis, antibacterial, and anti-oxidant properties for full-thickness burn healing.

Overcoming bacterial infections and promoting wound healing are significant challenges in clinical practice and fundamental research. This study developed a series of enzymatic crosslinking injectable hydrogels based on silk fibroin (SF), carboxymethyl cellulose (CMC), and agarose, with the addition of polydopamine functionalized graphene oxide (GO@PDA) to endow the hydrogel with suitable conductivity and antimicrobial activity. The hydrogels exhibited suitable gelation time, stable mechanical and rheological properties, high water absorbency, and hemostatic properties. Biocompatibility was also confirmed through various assays. After loading the antibiotic vancomycin hydrochloride, the hydrogels showed sustained release and good antibacterial activity against methicillin-resistant Staphylococcus aureus (MRSA). The fast gelation time and desirable tissue-covering ability of the hydrogels allowed for a good hemostatic effect in a rat liver trauma model. In a rat full-thickness burn wound model, the hydrogels exhibited an excellent treatment effect, leading to significantly enhanced wound closure, collagen deposition, and granulation tissue formation, as well as neovascularization and anti-inflammatory effects. In conclusion, the antibacterial electroactive injectable hydrogel dressing, with its multifunctional properties, significantly promoted the in vivo wound healing process, making it an excellent candidate for full-thickness skin wound healing.

Experiences of frostbite injury from recreational use of nitrous oxide canisters in a UK burns center: Not a laughing matter.

Nitrous oxide is used as a recreational drug. Contact frostbite injury from compressed gas canisters has previously been described in the literature, but an increased number of such cases has been noted in our busy regional burns center in the UK. A single-center prospective case series of all patients referred and treated for frostbite injury secondary to misuse of nitrous oxide compressed gas canisters between January and December 2022 is presented. Data collection was performed through a referral database and patient case notes. Sixteen patients, of which 7 were male and 9 were female, satisfied the inclusion criteria. Mean patient age was 22.5 years. The median TBSA was 1%. In total, 50% of patients in the cohort had a delayed initial presentation to A&E of greater than 5 days. Eleven patients were reviewed at our burns center for further assessment and management. In total, 11 patients had bilateral inner thigh frostbite injuries, of which 8 had necrotic full-thickness injury, including subcutaneous fat. Seven patients were reviewed at our burns center and offered excision and split-thickness skin graft. Four patients presented with contact frostbite injury to the hand and one patient to the lower lip. This subgroup was managed successfully with conservative management alone. The reproducible pattern of frostbite injury secondary to the abuse of nitrous oxide compressed gas canisters is demonstrated in our case series. The distinct pattern of injury, patient cohort, and anatomical area affected presents an opportunity for targeted public health intervention in this group.

Effects of Platelet-Rich Plasma (Prp) and Stromal Vascular Fraction (Svf) Addition on Epidermal Growth Factor (Egf) Serum Levels in Full-Thickness Burn Healing in Rats.

Platelet-rich plasma (PRP) and stromal vascular fraction (SVF) cells are clinically proven to aid in cellular regeneration and accelerate wound healing. The healing effect can be measured by epidermal growth factor (EGF) levels. This study aims to determine the effect of a combination of PRP and SVF injections on EGF levels during the healing of full-thickness burns in Wistar rats. Forty-eight adult Wistar rats were divided into 4 groups. Group A consisted of healthy rats. Groups B, C and D underwent modified full-thickness dermal burns. Group B was treated with local injections of PRP and SVF, Group C was treated with topical Vaseline, and Group D was treated with local injections of sterile water. EGF levels were subsequently assessed on days 1, 4, 7, 14 and 21 post-burn. EGF levels were generally increased in all groups, with the largest increase observed in the PRP and SVF injection group. A one-way ANOVA showed a significant increase in EGF levels on all days (p = <0.05). Based on the results of the linear regression test, local injection of PRP and SVF after full-thickness burns increases EGF levels by 27.3%. Combination PRP and SVF injections can increase EGF levels during the healing process of full-thickness burns. EGF is a critical growth factor in accelerating the healing process of full-thickness burns.

Le PRP et les cellules de FSV ont prouvé leur intérêt dans la régénération cellulaire, promouvant ainsi la cicatrisation. Cet effet cicatrisant peut être évalué par les taux de FCE. Cette étude a pour but de mesurer les taux sériques de FCE après l'injection, à des rats Wistar en phase de cicatrisation de brûlure profonde, d'un mélange de PRP et de FSV. Quarante- huit rats Wistar adultes ont été répartis en 4 groupes : A- contrôle sain, B- brûlure profonde et injections locales de PRP+FSV, C- brûlure profonde et vaseline topique, D- brûlure profonde et injections locale d'eau stérile. Les taux de FCE ont été mesurés à J1, 4, 7, 14 et 21. Ils étaient augmentés dans tous les groupes, singulièrement le groupe B. En ANOVA unilatérale, cette augmentation était significative sur tous les prélèvements (p<0,05). En effectuant un test de régression linéaire, on évalue l'augmentation des taux de FCE sous PRP/FSV à 27,3%. L'injection de PRP+FSV est donc à même d'augmenter les taux de FCE, facteur clé de la cicatrisation, après brûlure profonde.

Prompt Management of Airbag Burn Injuries Leads to Optimized Patient Outcomes: A Pilot Study.

BACKGROUND: Dual airbags are required to be installed and available for use in all motor vehicles since 1997. The National Highway Traffic Safety Administration reported that 50,457 lives were saved by airbags from 1987 to 2017; however, airbag deployment can cause injuries, including thermal and chemical burns, hyperpigmentation, and dysaesthesia. There is little information available in the literature regarding differences in outcomes between promptly visiting a plastic surgeon and waiting for treatment, especially as an injury may not be immediately apparent or patients may not know that airbag burn injuries may be delayed in presenting. METHODS: This is a retrospective cohort pilot study conducted among 14 patients who presented to a plastic surgeon between January 1, 2019 and June 30, 2022 owing to injuries from airbag deployment. An early visit was considered ≤30 days, and a late visit was >30 days. Other variables collected included age, sex, Fitzpatrick skin type, smoking status, comorbidities, type of injury, injury site, pain status, hyper/hypopigmentation, dysaesthesia, epithelialization, and improvements in pain, pigmentation, and dysaesthesia from treatment. RESULTS: The mean age was 36.0 years (standard deviation (SD) 17.9). The majority were female (85.7%), non-smokers (87.5%), and not diabetic (75.0%). Only six patients (42.9%) visited their doctor within one month of injury. Most patients experienced dysaesthesia (85.7%) and pain (71.4%). Thirteen of the 14 patients had hyperpigmentation or hyperemia, and one had hypopigmentation. Full or slight epithelialization was seen in 35.7%, and nine of the 14 patients had no epithelialization. Ongoing issues were a factor for 64.3% of these patients; 42.9% had ongoing issues with hyperpigmentation. A full recovery was seen in 28.6% of the patients. The patients who saw the plastic surgeon by day 30 or less (early) from the time of injury had a 66.7% improvement in pigmentation and 33.3% resolution in pain. Of those who went to the surgeon beyond 30 days (late), 25% had improvement in pigmentation and 37.5% had resolution of pain. Improvement in dysaesthesia occurred in both groups, but those who saw the plastic surgeon early had 33.3% resolution, while 37.5% of those who went late improved. Of those who went late to the surgeon, only 12.5% had epithelialization, while 66.7% of those who went within 30 days showed signs of (full or slight) epithelialization. CONCLUSION: Patients involved in motor vehicle collisions (MVCs) should be informed of the delayed fashion in which airbag burns can develop. An ostensibly mild burn may portend long-term consequences, especially if such injuries are not addressed in a prompt manner. Our study demonstrates how airbag burn injuries and their sequelae are best addressed with early care.

The Silent Threat-Alkali Foot Burn: A Case Report.

Despite current workplace protection measures, chemical burn accidents are not uncommon. Among these, alkali burn is the most challenging due to its silent behaviour and aggressive mechanism. Characterized by its initial painless onset, allowing a prolonged exposure, it tends to result in deeper and more destructive burns, creating major reconstructive and therapeutic challenges. This case concerns a 53-year-old male who sustained a full thickness burn of his left instep foot after prolonged contact with an alkali substance. The wound was submitted to several surgical debridement procedures, with preservation of the major tendinous and vascular-nervous structures. The skin defect was then repaired with skin graft. Early recognition and prompt management with copious and prolonged wound irrigation is paramount. As in this type of burn it is difficult to initially assess its true depth, even after initial surgical debridement, a more cautious approach is recommended. Chronic pain is associated with chemical burns and it should be treated early in the process with the use of multimodal analgesia in order to prevent future complications. No matter the absence of major complaints in the 4 week-postoperative evaluation, the possible long-term consequences are still unknown. Despite the prolonged exposure time and the initial presentation with a deep burn, after several surgical debridement procedures, preservation of major tendon and neurovascular structures was assured, which allowed a plain approach for reconstruction of the wound with a skin graft. The case illustrates different challenges associated with evaluation and treatment of patients with deep alkali burns. Also, usage auditing and awareness of regular users appear to be essential.

Les brûlures chimiques au travail restent relativement fréquentes malgré les mesures de protection. Les atteintes par agent alcalin sont particulièrement problématiques car elles sont insidieuses bien que très destructrices. Le temps de contact est prolongé et les destructions sont majeures, posant de difficiles problèmes de reconstruction, en raison de leur caractère initialement indolore. Nous présentons le cas d'un homme de 53 ans victime d'une brûlure du cou de pied gauche après contact prolongé avec un agent alcalin. Les excisions successives ont permis de préserver les éléments nobles et de greffer secondairement la zone touchée. Il est indispensable de diagnostiquer précisément l'atteinte et de laver la région atteinte à grande eau. La profondeur réelle est difficile à apprécier initialement si bien que les excisions doivent être prudentes. Les douleurs chroniques ne sont pas rares dans ces cas et peuvent être prévenues par la qualité de l'analgésie initiale, multimodale. A un mois, le patient ne se plaint de rien, ce qui ne préjuge pas de complications plus tardives. Malgré un temps de contact prolongé et un aspect initial profond, les éléments nobles on pu être préservés, permettant une couverture par simple greffe. Ce cas illustre les difficultés dans le diagnostic et le traitement des brûlures profondes par base. Il est essentiel d'éduquer et surveiller les usagers réguliers de ces produits.

Efficacy of hydrosurgical excision combined with skin grafting in the treatment of deep partial-thickness and full-thickness burns: A two-year retrospective study.

INTRODUCTION: Deep partial-thickness and full-thickness burn wounds often undergo tangential excision or escharectomy to expose healthy tissue, combined with skin grafting to promote wound healing. However, conventional tangential excision with the humby knife leads to inevitable damage to the dermis while excising burn tissue due to the lack of precision. Indeed, the preservation of dermal tissue is a key factor in determining wound healing and scar quality. The precision and tissue selectivity of the Versajet Hydrosurgical System has been established for excising burn tissue while preserving dermal tissue. In this study, we retrospectively compared the efficacy of "Hydrosurgical excision combined with skin grafting" and "Conventional tangential excision combined with skin grafting" in treating deep partial-thickness and full-thickness burn wounds to demonstrate that hydrosurgery improved the treatment of deep partial-thickness and full-thickness burns. METHODS: A total of 86 patients with deep partial-thickness and/or full-thickness burns with a total burn surface area (TBSA) ≤ 25% from July 2018 to July 2020 were included in this study and were divided into experimental (hydrosurgical excision combined with skin grafting, n = 43) and control (conventional tangential excision combined with skin grafting, n = 43) groups. Parameters were analyzed, including the intraoperative blood loss volume per unit area of grafted skin, surgery duration, wound healing time, skin graft survival, and the treatment costs per unit of burned area. Scar assessment was performed at 1 year with the modified Vancouver Scar Scale linked with TBSA (mVSS-TBSA). RESULT: No significant difference was found in male to female ratio, age, weight, TBSA, burn depth, skin grafting area (SKA), skin grafting methods, cases treated with carbon dioxide fractional laser or incidence of inhalation injury, and the incidence of hypovolemic shock between two groups(p > 0.05). Compared with the control group, patients treated with hydrosurgical excision combined with skin grafting experienced less intraoperative blood loss volume per unit area of grafted skin (p < 0.05). The mVSS-TBSA of patients that underwent hydrosurgical excision combined with skin grafting was significantly improved in comparison to the control group (p < 0.01). No significant difference was found in surgery duration, wound healing time, skin graft survival and treatment costs per unit of burned area between the two groups (p > 0.05). CONCLUSION: Hydrosurgical excision combined with skin grafting reduced intraoperative blood loss volume per unit area of grafted skin, improved scarring 1-year after injury, and did not increase the treatment costs per unit of burned area. This technique provides a novel alternative for managing deep partial-thickness and full-thickness burn wounds.

The Combination of Stromal Vascular Fraction Cells and Platelet-Rich Plasma Increases Fibroblast Growth Factor 7 and Promotes Angiogenesis in Full Thickness Burn Injury: Rat Experimental Study.

Our previous study on how the combination of stromal vascular fraction cells (SVFs) and platelet-rich plasma (PRP) affect deep dermal burn healing showed promising results. In this study, we assessed the effect on full-thickness burns by evaluating FGF7 serum level and capillary count. Forty-eight Wistar rats were divided into four major groups: (1) locally injected with combined SVFs and PRP; (2) topically applied Vaseline; (3) locally injected with placebo; (4) and rats without burns. These groups were divided further into smaller groups based on the day of euthanasia (8th hour, 4th day, 7th day, 14th day, and 21st day). FGF7 serum level was measured using ELISA, and capillaries were counted using a microscope. A one-way ANOVA test, post hoc, and regression tests were used. On day 4, both FGF7 and capillary counts showed significant differences between groups (p=0.000 and 0.048, respectively). On day 7, only FGF7 result showed a significant difference (p=0.000). On day 14, FGF7 and capillary counts showed significant differences (p=0.000, 0.018 respectively). The SVFs and PRP-treated groups showed superior results compared to other groups. The injection of combined SVFs and PRP increased FGF7 and capillary counts.

Notre précédente étude sur les effets de la combinaison de cFVS et de PRP sur la cicatrisation des brûlures, nous avons étudié les effets de cette même combinaison sur les brûlures profondes, en évaluant les niveaux de F7CF et le nombre de capillaires (NbC). Quarante-huit rats Wistar ont été répartis en 4 groupes : G1 = injection locale de cFVS et PRP ; G2 = vaseline topique ; G3 = injection locale de placebo ; G4 = rats sains. Ces groupes ont ensuite été subdivisés selon la date de sacrifice (8ème heure, 4ème, 7ème, 14ème et 21ème jours). F7CF a été mesuré par ELISA et les capillaires ont été comptés sous microscopie. Les analyses ont été effectuées par ANOVA unilatérale post hoc suivie de tests de régression. À J4, on constate une différence significative entre les groupes, tant pour F7CF (p= 0,000) que pour NbC (p= 0,048). À J7, la différence n'est significative que pour F7CF (p= 0,000). À J14, on retrouve une différence significative pour les 2 variables à l'étude (p= 0,000 et p= 0,018). Le groupe cFVS+PRP a des résultats meilleurs que les autres, cette injection augmentant F7CF et NbC.

Prediction of Mortality in Acute Thermal Burn Patients Using the Abbreviated Burn Severity Index Score: A Single-Center Experience.

Background Burn injuries are highly variable and dynamic. The outcome of patients is influenced by various factors and requires prompt therapeutic interventions, including fluid resuscitation, for a favorable result. Although having varying shortcomings, many scoring indexes are developed and validated in Western countries to predict mortality in a burn patient. The Abbreviated Burn Severity Index (ABSI) estimates survival expectancy in a burn patient via various negative prognostic factors. This study describes the pattern of burn injuries to validate the ABSI as an outcome predictor in burnt patients. Methodology From January to December 2018, 100 patients participated in this observational research conducted in the Department of Surgery at Mahatma Gandhi Hospital's Burn Ward, a part of Dr. Sampurnanand Medical College, Jodhpur. Risk factors for death from a burn were patients' age and gender, the depth of the burn, the inhalation burn, and the total burned body surface area (TBSA). The area under the receiver operating curve (AUROC) was used to determine how well it could predict burn deaths. Results This study included 100 patients (69 men and 31 women, with a ratio of 2.22:1). In total, 73 patients survived, and 27 died (a mortality rate of 27%). The fatality rate increased with increased burn surface area, reaching 100% in patients with >80% burns (p < 0.0001). Additionally, those with an ABSI of >11 expressed 100% mortality rate (p < 0.0001). Conclusions In this study, older age, high burned surface area, concomitant inhalational burns, full-thickness burns, and a higher ABSI were found to be significant predictors of mortality.

The danger of DIY Do-It-Yourself related full thickness burn injury: Case report during COVID-19 lockdown in Ireland.

DIY injuries are a common cause of presentation to hospital around the world. During the COVID19 Pandemic there was a significant increase in the number of household injuries. Many of these injuries occur commonly in the home and they presented in increased proportions due to lockdown measures. However during lockdowns people also undertook activities they would normally outsource to skilled professionals which resulted in unique mechanisms of injury. We present the case of a young woman with a delayed presentation of a full thickness burn following the use of an at home laser hair removal device. We will discuss the recent literature on the effects of the pandemic on presentations to emergency services, the surgical management of this injury and its' reconstruction with biodegradable temporising matrix.

Preparation, Characterization, and Biological Evaluation of Transparent Thin Carboxymethyl-Chitosan/Oxidized Carboxymethyl Cellulose Films as New Wound Dressings.

Full thickness burns in which the damage penetrates deep into the skin layers and reaches underneath the muscle, compel the need for more effective cure. Herein, cross-linked carboxymethyl-chitosan (CM-chitosan) films, prepared by Schiff base association with oxidized carboxymethyl cellulose (OCMC), are investigated regarding the wound healing capacity on full thickness burn injuries in vivo. Transparent thin CM-chitosan/OCMC films are obtained with tensile strength reaching 6.11 MPa, elongation at break above 27%, and water absorption more than 800%, which operates in favor of absorbing excess exudate and monitoring the wound status. Furthermore, the nonadherent CM-chitosan/OCMC films, with satisfactory biodegradability, cell, and tissue compatibility, are readily used to the wound sites and easily removed following therapy on scalded tissue so as to alleviate the suffering from burn. The films efficiently promote epithelial and dermal regeneration compared to the control, achieving 75.9% and 94.4% wound closure, respectively, after 14 and 27 days. More importantly, CM-chitosan/OCMC films accelerate wound healing with natural mechanisms which include controlling inflammatory response, reducing apoptosis, promoting fibroblast cell proliferation, and collagen formation. In conclusion, the CM-chitosan/OCMC films elevate the repair ratio of burn injuries and have great potential for facilitating the healing process on full-thickness exuding wounds.

Investigating the effects of walnut ointment on non-healing burn wounds.

Effective treatments for non-healing burn wounds are an unmet need for 95% of burn sufferers. Approaches currently available to treat non-healing burn wounds are not satisfactory due to undesirable side-effects or expense. The anti-oxidation and antibacterial activities of walnuts are recommended for treating chronic diseases. Walnut ointment has been developed and successfully applied to treat non-healing burn wounds in our hospital for decades. We report herein a detailed retrospective case review examining patients' response to the walnut ointment. The walnut ointment has shortened healing time of non-healing burn wounds and improved clinical outcomes. In order to investigate the mechanism of action, walnut ointment has been applied on wounds of porcine full-thickness burn wound models. Histological and immunohistochemical analysis indicated our walnut ointment supports wound healing through promoting keratinocyte proliferation and differentiation. Taken together, we recommend the walnut ointment offers an effective and economical treatment for patients presenting with non-healing burn wounds.

An Application of a Negative-Pressure Wound Dressing for Partial- or Full-Thickness Burn Wounds.

Negative-pressure wound therapy is widely used in burn populations. Traditionally, negative-pressure devices use persistent vacuum suction, requiring a longer hospital stay. In this study, we applied a novel negative-pressure wound dressing for burn wounds, which eliminates the hospital stay. The medical records of 39 patients with partial-/full-thickness burns treated by negative-pressure wound dressing were retrospectively analyzed. The average burn area, burn degree, healing duration, cost, and incidents during treatment were determined and compared with previous data for conventional therapies. In conclusion, for patients diagnosed with partial-thickness or full-thickness burns and a burn area <34.6 ± 2.21 cm2, the negative-pressure wound dressing is a reliable option, especially for burnt children. Moreover, the negative-pressure wound dressing treatment was not only much cheaper than conventional therapies, but also eliminated hospital stay in patients with small-area deep burn wounds.