11/70. Cryopreserved cultured epidermal allografts achieved early closure of wounds and reduced scar formation in deep partial-thickness burn wounds (DDB) and split-thickness skin donor sites of pediatric patients.Burn treatment in children is associated with several difficulties, e.g. available skin replacement is small, donor area could expand, and subsequent hypertrophic scar and contracture could become larger along with their physical growth. In order to have better clinical results, the authors prepared cryopreserved cultured epidermal allografts from excess epidermal cells of other patients, and applied the epidermal allografts to 55 children, i.e. 43 cases of deep partial-thickness burn wounds (DDB) due to scald burn and 12 cases with split-thickness skin donor sites. In the 43 DDB patients, epithelialization was confirmed 9.1 /-3.6 days (mean /-S.D.) after treatment. In 10 of the 43 patients, epithelialization was comparable between the area which received the epidermal allografts (grafted area) and the area which did not receive the epidermal allografts but was covered with usual wound dressing (non-grafted area). As a result, epithelialization day was 7.9 /-1.7 in grafted areas and 20.5 /-2.3 in non-grafted areas. In the 12 patients with split-thickness skin donor sites, epithelialization was confirmed 6.3 /-0.9 days after treatment. Epithelialization of the grafted and non-grafted areas was comparable in 8 of the 12 patients, and it was 6.5 /-1.1 days and 14.1 /-1.6 days, respectively. In these 10 DDB patients and 8 split-thickness skin donor site patients, redness and scar formation were also milder in the grafted area. The 55 patients have been followed up for 1-8 years (mean, 4.75 years), and scar formation was suppressed in both DDB and split-thickness skin donor sites. These findings showed that cryopreserved cultured epidermal allografts achieve early closure of the wounds and good functional outcomes.- - - - - - - - - - ranking = 1keywords = allograft (Clic here for more details about this article) |
12/70. burns of the perineum and anus.One of the critical sites of the thermal injuries is the region of the perineum. burns of the perineum are relatively frequent, while affections of the anus and sphincters are rare. At the Prague burns Centre, University Hospital Kralovske Vinohrady, two patients were treated with this kind of injury. The site of the burns proved in both instances decisive for treatment and for subsequent prognosis. The surgical procedures (necrectomy and autotransplantation) had to be prepared with regard to the case-histories: in the 11-year-old boy by colostomy and in the adult man suffering from muscular dystrophy by a synthetic low-residue diet.- - - - - - - - - - ranking = 0.033103780864198keywords = transplantation (Clic here for more details about this article) |
13/70. Hematogenous cervical spondylodiscitis after severe burn injury.A 47-year-old man sustained a 31% TBSA burn injury. In spite of early escharectomy and mesh-graft-transplantation the patient suffered a septicaemic phase in the first week, which was treated by a specific antibiotic. Five weeks after the burn injury a cervical spondylodiscitis was diagnosed. Immediate wound debridement, ventral and dorsal spondylodesis with a tricortical bone-graft from the left iliac crest and titanium plates and specific antibiotic therapy led to the stabilization and healing of the cervical spinal column. The spondylodiscitis was microbiologically proved to be hematogenous after spread of staphylococcus aureus from the blood in the early septicaemic phase. Swab culture from the burn surface wound, infected vertebrae and blood during the septicaemic phase revealed coagulase positive S. aureus. The aetiology, predisposing factors and management of this rare, but recognized, complication of major burns are discussed. Case features of this patient are compared with the single site's reported case of hematogenous cervical spondylodiscitis after severe burn injury.- - - - - - - - - - ranking = 0.033103780864198keywords = transplantation (Clic here for more details about this article) |
14/70. Long-term duration of reduced serum complement level following burn injury.We report the case of a boy whose serum CH50 was below the detection limit following burn injury and skin transplantation. The APCH50 level was slightly decreased, although C3, C4, and the other complements were within the normal range. Cold activation was not detected in his plasma. His peripheral blood monocyte ratio slightly elevated to 19% and then decreased to 5.9%. In this case, burn injury caused the depletion of the complement, particularly in the alternative pathway, and resulted in the reduced CH50 level, although C3 did not show the typical pattern of alternative pathway depletion. In previously reported cases of burn injury, the CH50 level returned to the normal range within 2 weeks. In this patient the reduced level of CH50 continued for 4 months. We should consider burn injury one of the causes of complement deficiency even in cases with a duration of more than 1 month.- - - - - - - - - - ranking = 0.033103780864198keywords = transplantation (Clic here for more details about this article) |
15/70. Permanent restoration of human skin treated with cultured epithelium grafting--wound healing by stem cell based tissue engineering--.The technique of epidermal cell culture developed by Green and colleagues made a breakthrough in the treatment of massive wounds in vivo with grown cells in vitro. In the past two decades, progress of culture methods and clinical practice have been made and now it is possible to treat extensive skin defect with large amounts of cultured epithelium. Since 1985, we have been successfully used cultured epidermis as autografts for the permanent coverage of full-thickness burn wounds or excised burn scars, giant nevi, tattoos and so on. Furthermore, cultured epidermis has been available as allografts to promote the healing of chronic skin ulcers or deep dermal burn. In this paper we describe our clinical experience of cultured epithelium grafting for the treatment of wounds and predict new trial of wound management and regeneration based on tissue engineering concept.- - - - - - - - - - ranking = 0.11111111111111keywords = allograft (Clic here for more details about this article) |
16/70. cytomegalovirus infection in a cyclosporine-treated burn patient: case report.We report the case of a 45-year-old burned man (55% total body surface area full-thickness burn) who developed symptomatic cytomegalovirus infection during cyclosporine (CSA) therapy (3 mg/kg orally) for skin transplantation. During the sixth hospital week the patient developed signs compatible with CMV infection, and CMV was recovered from the urine and sputum. Examination of skin biopsy specimens from the transplanted cadaver allograft revealed inclusion bodies compatible with CMV infection, and CMV antigens were detected by immunohistochemical testing. The CMV infection of the skin was confirmed by recovery of infectious virus and by detection of CMV nucleic acids using in situ hybridization with a biotinylated HCMV dna probe. Restriction enzyme analysis of a urine CMV isolate and two isolates from skin demonstrated differences in dna patterns, suggesting that the patient was infected simultaneously with two different CMV strains.- - - - - - - - - - ranking = 0.14421489197531keywords = allograft, transplantation (Clic here for more details about this article) |
17/70. Repair and reconstruction of massively damaged burn wounds.OBJECTIVE: To report repair and reconstruction of massively damaged burn wounds under unusual condition. methods: One hundred forty-eight patients with deep burn tissue defects admitted from January 1993 through December 2000 were analyzed, among them 96 patients suffered from electrical injury which constituted 65.3% of all cases, 18 patients with hot press injury, 18 cases with deep burns as a result of CO poisoning or epileptic seizure, accounting for 12.2 and 12.2%, respectively, 6 cases with radiation injury, comprising 4.0% of all cases, 2 cases with explosive injury, 2 cases with chemical burn and 6 cases caused by erosive chemicals and wound infection. One hundred seventy-six flaps were transferred with mostly local flaps to repair deep burn wounds in 148 patients with tissue defects, in which necrotic tendons were replaced by acellular allogeneic tendons simultaneously in seven cases. Sixty-one iliolumbar arterial axial skin flaps for coverage of soft-tissue defects in hands or wrists were transplanted. Technical innovations to repair large soft-tissue defects of temporal region and ear, chin and lip, and dorso-lateral aspect of foot due to deep burn were explored. New technics to define necrotic tissue and vascular damage as a result of electrical injury were developed. RESULTS: The biggest dimension of flaps in this group was 22cmx30cm. The survival rate of flap was 96.5%, while necrosis of the tip of flap occurred in 3.5%. The function and configuration were satisfactory after 4 months to 8 years follow-up. The technique of 99Tcm-methylene di-phosphonate (99Tcm-MDP) scintigraphy helped identify necrotic tissue before operation, and with the help of digital subtraction arteriogram (DSA) arterial injury could be identified. B-mode ultrasound was helpful to show the extent of endothelial injury, and Colour Doppler was useful to show luminal blood flow signal and filling defect in the injured artery. CONCLUSIONS: Repair and reconstruction of massively damaged burn wound at early stage could be achieved. Techniques which helped define the extent of damage to the soft tissues, including arteries and tendons were essential preoperatively for successful reconstruction. Functional and aesthetic reconstruction, as well as the general condition of the patients, could thus be significantly improved early after the devastating injuries. Further innovations of operative technics would benefit more patients with such injuries.- - - - - - - - - - ranking = 0.016339992108102keywords = allogeneic (Clic here for more details about this article) |
18/70. Human plasma as a dermal scaffold for the generation of a completely autologous bioengineered skin.BACKGROUND: Keratinocyte cultures have been used for the treatment of severe burn patients. Here, we describe a new cultured bioengineered skin based on (1) keratinocytes and fibroblasts obtained from a single skin biopsy and (2) a dermal matrix based on human plasma. A high expansion capacity achieved by keratinocytes grown on this plasma-based matrix is reported. In addition, the results of successful preclinical and clinical tests are presented. methods: keratinocytes and fibroblasts were obtained by a double enzymatic digestion (trypsin and collagenase, respectively). In this setting, human fibroblasts are embedded in a clotted plasma-based matrix that serves as a three-dimensional scaffold. Human keratinocytes are seeded on the plasma-based scaffold to form the epidermal component of the skin construct. regeneration performance of the plasma-based bioengineered skin was tested on immunodeficient mice as a preclinical approach. Finally, this skin equivalent was grafted on two severely burned patients. RESULTS: keratinocytes seeded on the plasma-based scaffold grew to confluence, allowing a 1,000-fold cultured-area expansion after 24 to 26 days of culture. Experimental transplantation of human keratinocytes expanded on the engineered plasma scaffold yielded optimum epidermal architecture and phenotype, including the expression of structural intracellular proteins and basement-membrane components. In addition, we report here the successful engraftment and stable skin regeneration in two severely burned patients at 1 and 2 years follow-up. CONCLUSIONS: Our data demonstrate that this new dermal equivalent allows for (1) generation of large bioengineered skin surfaces, (2) restoration of both the epidermal and dermal skin compartments, and (3) functional epidermal stem-cell preservation.- - - - - - - - - - ranking = 0.033103780864198keywords = transplantation (Clic here for more details about this article) |
19/70. Trapezius musculocutaneous flap in severe shoulder and neck burn.Scarring of the neck produces problems with function and appearance. The highly mobile anterior neck with its thin skin cover is particularly prone to flexion contractures that can range from minimally restrictive to crippling mentosternal synechiae. The trapezius muscle is the basis for muscle and musculocutaneous flaps that are of great usefulness in reconstructing defects of the head and neck and the upper back specially when there are no other regional flaps available. Use of trapezius musculocutaneous flap in the treatment of cicatricial contracture deformity of neck results in satisfactory function and external appearance and is a good method for the repair of soft tissue defects of the neck with the advantage of invariable blood supply. There is no deformation in the donor region which is hidden posteriorly. Its blood supply is rich enough to avoid any local necrosis after transplantation. Up to the present time this flap has been used to cover defects following excision of tumors in the head and upper parts of neck. Use of the trapezius musculocutaneous flap in seven patients who suffered from severe scarring in anterior neck and shoulder due to burn during an 8-year period (1995-2003) is described with good results achieved.- - - - - - - - - - ranking = 0.033103780864198keywords = transplantation (Clic here for more details about this article) |
20/70. Major full thickness skin burn injuries in premature neonate twins.burns in neonates have been reported following the use of pulse oximeters, various electrodes, chemical disinfecting agents and phototherapy blankets. Burn injuries in premature neonates are very rare and there have been no reports on major full skin thickness injuries. This case reports on preterm neonate male twins delivered at a Community Hospital. After the delivery they were placed on water warmers for 15-20 min and then transported into incubators. Burn injuries were noticed 1h after the delivery. infant One, weight 1500 g, had an injury of 20% TBSA on his dorsum, waist and buttocks. The other infant, weight 1835 g, had an injury of 14% TBSA on the same areas. The infants were transported to the University Hospital. At the seventh day after the injury they recovered from respiratory distress and surgical procedures started. The eschar was excised deep to fascia and wounds were grafted with 0.1mm thickness skin grafts harvested from the thigh and cut into islets. autografts were protected by overlay with fresh allograft harvested from the twins' father. Surgery procedures were performed in two steps, each second day, not exceeding 10% of total body area during excision. Donor sites healed at the eighth day after the surgery. Burn wounds healed gradually by way of spontaneous replacement of allograft and wound closure by spontaneous epithelization from the autograft islets. Eighteen days after the surgery all the grafted wounds were found epithelized. We conclude that in premature neonates relatively low temperatures may cause deep burn injuries. We recommend the delivery of preterm childbirths at well equipped facilities with staff qualified in nursing of premature neonates.- - - - - - - - - - ranking = 0.22222222222222keywords = allograft (Clic here for more details about this article) |
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