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Jiang Y, Zhou P, Liu AY, Liu S, Chen XL, Wang F. Efficacy of hydrosurgical eschar excision following MEEK microskin grafting in patients with massive burns: A retrospective study of a single center. Burns 2024; 50:1223-1231. [PMID: 38490834 DOI: 10.1016/j.burns.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/31/2024] [Accepted: 02/27/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION One of the most common traumatic injuries, burn injuries lead to at least 180,000 deaths each year worldwide. Massive burns result in severe tissue loss and increase the rate of infection. Eschar excision with skin grafting is the gold standard of treatments for massive burns. Retaining dermis tissue is the key to ensuring the survival of skin grafts and rapidly closing exposed tissues. Traditional eschar excision with Humby or Weck knife controls the depth of excision until the dermis, but ensuring the accuracy of excision is challenging. Hydrosurgery minimizes damage to uninjured tissues during the removal of necrotic tissues. A foot pedal is used to adjust debridement depth for precise debridement. To figure out the clinical advantages and risks of using hydrosurgery in treating massive burns, this study has been conducted. METHOD Forty-two patients with massive burns and total body surface area (TBSA) of > 30% were treated at the First Affiliated Hospital of Anhui Medical University from May 2020 to January 2023. They underwent hydrosurgical eschar excision with MEEK microskin graft (n = 23) or tangential excision with MEEK microskin graft (n = 19). RESULT No statistically significant differences (p > 0.05) in the following demographics were found between the two groups: age, weight, TBSA, deep-partial-thickness burn, gender, inhalation injury, shock, excision area, and MEEK ratio. By contrast, statistically significant differences in per unit area of operation time, per unit area of operation spending, hospitalization cost, hospitalization duration, wound-healing time, skin graft survival, and scar quality were found between hydrosurgical excision group with MEEK microskin graft and conventional excision group with MEEK microskin graft. CONCLUSION The hydrosurgical excision system showed better clinical effects for patients with massive burns.
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Affiliation(s)
- Yan Jiang
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China
| | - Ping Zhou
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China
| | - Ao-Ya Liu
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China
| | - Sheng Liu
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China
| | - Xu-Lin Chen
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China
| | - Fei Wang
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China.
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Hachicha S, Mokline A, Ghedira S, Rahmouni M, Fraj H, Ben Saad M, Messadi AA. [Burns and Diabetes Mellitus: Epidemiology, Clinical Presentation and Prognosis]. ANNALS OF BURNS AND FIRE DISASTERS 2024; 37:23-27. [PMID: 38680838 PMCID: PMC11041885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/22/2023] [Indexed: 05/01/2024]
Abstract
Burns in diabetics are quite frequent and serious in relation to diabetic neuropathy, which is common in this population, delaying healing and predisposing to the risk of infection. The objective of this study was to describe the characteristics of burns in diabetics hospitalized at the CTB of Tunis over 18 months. During the study period, 891 patients were hospitalized, including 43 diabetics (5%). The average age of our patients was 57 years old with a male predominance (65%). Type 2 diabetes was present in 86% of cases and type 1 diabetes in 14% of cases. Degenerative complications were reported in 10 cases (23%), such as diabetic retinopathy (n=6), diabetic nephropathy (n=4) and diabetic neuropathy (n=6). The circumstances of burns were related to a domestic accident in 2/3 of the cases (76.7%). Thermal burns were involved in 83.7% of cases. 86% of the patients had decompensated their diabetes during their hospitalization. Sepsis marked the evolution of the patients in 55.8% of cases. In our study, poor prognostic factors were: a glycosylated haemoglobin > 13%, an extent of burns greater than 20%, and a delay in consultation greater than 6 hours. The mortality rate was 18.6%.
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Affiliation(s)
- S. Hachicha
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
| | - A. Mokline
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
- Service de Réanimation des Brûlés, Centre de Traumatologie et des Grands Brûlés, Tunis, Tunisie
| | - S. Ghedira
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
| | - M. Rahmouni
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
| | - H. Fraj
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
- Service de Réanimation des Brûlés, Centre de Traumatologie et des Grands Brûlés, Tunis, Tunisie
| | - M. Ben Saad
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
- Service de Réanimation des Brûlés, Centre de Traumatologie et des Grands Brûlés, Tunis, Tunisie
| | - A-A. Messadi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
- Service de Réanimation des Brûlés, Centre de Traumatologie et des Grands Brûlés, Tunis, Tunisie
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Li S, Wang Y, Wang S, Xie J, Fu T, Li S. In situ gelling hydrogel loaded with berberine liposome for the treatment of biofilm-infected wounds. Front Bioeng Biotechnol 2023; 11:1189010. [PMID: 37324421 PMCID: PMC10266532 DOI: 10.3389/fbioe.2023.1189010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/22/2023] [Indexed: 06/17/2023] Open
Abstract
Background: In recent years, the impact of bacterial biofilms on traumatic wounds and the means to combat them have become a major research topic in the field of medicine. The eradication of biofilms formed by bacterial infections in wounds has always been a huge challenge. Herein, we developed a hydrogel with the active ingredient berberine hydrochloride liposomes to disrupt the biofilm and thereby accelerate the healing of infected wounds in mice. Methods: We determined the ability of berberine hydrochloride liposomes to eradicate the biofilm by means of studies such as crystalline violet staining, measuring the inhibition circle, and dilution coating plate method. Encouraged by the in vitro efficacy, we chose to coat the berberine hydrochloride liposomes on the Poloxamer range of in-situ thermosensitive hydrogels to allow fuller contact with the wound surface and sustained efficacy. Eventually, relevant pathological and immunological analyses were carried out on wound tissue from mice treated for 14 days. Results: The final results show that the number of wound tissue biofilms decreases abruptly after treatment and that the various inflammatory factors in them are significantly reduced within a short period. In the meantime, the number of collagen fibers in the treated wound tissue, as well as the proteins involved in healing in the wound tissue, showed significant differences compared to the model group. Conclusion: From the results, we found that berberine liposome gel can accelerate wound healing in Staphylococcus aureus infections by inhibiting the inflammatory response and promoting re-epithelialization as well as vascular regeneration. Our work exemplifies the efficacy of liposomal isolation of toxins. This innovative antimicrobial strategy opens up new perspectives for tackling drug resistance and fighting wound infections.
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Affiliation(s)
- Sipan Li
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yongan Wang
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Siting Wang
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jianjun Xie
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Tingming Fu
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Shaoguang Li
- Microsurgery Department of Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
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Yin X, Hong J, Tang HB, Liu M, Li YS. Enhanced healing of oral chemical burn by inhibiting inflammatory factors with an oral administration of shengFu oil. Front Pharmacol 2022; 13:913098. [PMID: 36034877 PMCID: PMC9403317 DOI: 10.3389/fphar.2022.913098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/11/2022] [Indexed: 11/18/2022] Open
Abstract
ShengFu oil is a compounded Chinese medicinal prescription, and provides antibacterial, anti-inflammatory, and analgesic effects, favoring burn wound repair. In this study, we aimed at investigating the effects of topical applications of ShengFu oil and its active ingredients in oral chemical burns and elucidating its regulatory effects on β-catenin, COX-2, and MMP-9 expression caused by exposure to acid or alkaline agents. ShengFu oil contains 16 components, such as Frankincense, Radix Scutellariae and Radix Rehmanniae, and the main active ingredients from Frankincense are α-pinene, linalool, and n-octanol. Mouse models of oral chemical burns were induced by using glacial acetic acid or sodium hydroxide. Hematoxylin and eosin staining and immunohistochemical staining were used to detect the protein expressions of β-catenin, COX-2, and MMP-9 in wound tissues. They were further quantified by multispectral imaging analysis to clarify the effective mechanism of ShengFu oil for intervening inflammatory factors and active components. Our results indicated that the application of ShengFu oil on oral chemical burns effectively stopped the oral burn bleeding and reduced the inflammatory reaction in the damaged tissues, demonstrating that ShengFu oil can promote wound tissue repair in burns caused by heat, acids, and alkalis. The immunohistochemical staining results illustrated that ShengFu oil and its active ingredients significantly reversed the abnormal changes in inflammation-related proteins in mouse tongue tissues that were caused by chemical burns. Regarding long-term toxic effects of ShengFu oil on the gastrointestinal tract, liver, and kidney system, the results of hematoxylin and eosin staining experiments depicted that ShengFu oil was safe and effective for liver, kidney, intestine, esophagus, and tongue. All of these demonstrated that ShengFu oil and its active ingredients are effective and safe in preventing and treating oral chemical burns by interfering with the inflammatory microenvironment.
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Affiliation(s)
- Xin Yin
- Lab of Hepatopharmacology and Ethnopharmacology, School of Pharmaceutical Sciences, South-Central Minzu University, Wuhan, China
| | - Jing Hong
- Lab of Hepatopharmacology and Ethnopharmacology, School of Pharmaceutical Sciences, South-Central Minzu University, Wuhan, China
| | - He-Bin Tang
- Lab of Hepatopharmacology and Ethnopharmacology, School of Pharmaceutical Sciences, South-Central Minzu University, Wuhan, China
| | - Min Liu
- Chongqing Center for Drug Evaluation and Inspection, Chongqing, China
| | - Yu-Sang Li
- Lab of Hepatopharmacology and Ethnopharmacology, School of Pharmaceutical Sciences, South-Central Minzu University, Wuhan, China
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Kokoska RE, Szeto MD, Sivesind TE, Dellavalle RP, Wormald JCR. From the Cochrane Library: Hydrosurgical Debridement Versus Conventional Surgical Debridement for Acute Partial-Thickness Burns. JMIR DERMATOLOGY 2022; 5:e37030. [PMID: 37632860 PMCID: PMC10334889 DOI: 10.2196/37030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/29/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ryan E Kokoska
- School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Mindy D Szeto
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Torunn E Sivesind
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Justin C R Wormald
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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Legemate CM, Kwa KAA, Goei H, Pijpe A, Middelkoop E, van Zuijlen PPM, Beerthuizen GIJM, Nieuwenhuis MK, van Baar ME, van der Vlies CH. Hydrosurgical and conventional debridement of burns: randomized clinical trial. Br J Surg 2022; 109:332-339. [PMID: 35237788 PMCID: PMC10364696 DOI: 10.1093/bjs/znab470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/06/2021] [Accepted: 12/18/2021] [Indexed: 08/02/2023]
Abstract
BACKGROUND Tangential excision of burned tissue followed by skin grafting is the cornerstone of burn surgery. Hydrosurgery has become popular for tangential excision, with the hypothesis that enhanced preservation of vital dermal tissue reduces scarring. The aim of this trial was to compare scar quality after hydrosurgical versus conventional debridement before split-skin grafting. METHODS A double-blind randomized within-patient multicentre controlled trial was conducted in patients with burns that required split-skin grafting. One wound area was randomized to hydrosurgical debridement and the other to Weck knife debridement. The primary outcome was scar quality at 12 months, assessed with the observer part of the Patient and Observer Scar Assessment Scale (POSAS). Secondary outcomes included complications, scar quality, colour, pliability, and histological dermal preservation. RESULTS Some 137 patients were randomized. At 12 months, scars of the hydrosurgical debrided wounds had a lower POSAS observer total item score (mean 2.42 (95 per cent c.i. 2.26 to 2.59) versus 2.54 (95 per cent c.i. 2.36 to 2.72; P = 0.023)) and overall opinion score (mean 3.08 (95 per cent c.i. 2.88 to 3.28) versus 3.30 (95 per cent c.i. 3.09-3.51); P = 0.006). Patient-reported scar quality and pliability measurements were significantly better for the hydrosurgically debrided wounds. Complication rates did not differ between both treatments. Histologically, significantly more dermis was preserved with hydrosurgery (P < 0.001). CONCLUSION One year after surgery scar quality and pliability was better for hydrosurgically debrided burns, probably owing to enhanced histological preservation of dermis. REGISTRATION NUMBER Trial NL6085 (NTR6232 (http://www.trialregister.nl)).
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Affiliation(s)
- Catherine M. Legemate
- Burn Centre, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Movement Sciences, Vrije Univeristeit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Kelly A. A. Kwa
- Burn Centre, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
- Department of Traumasurgery, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
| | - Harold Goei
- Burn Centre, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
- Department of Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Univeristeit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Anouk Pijpe
- Burn Centre, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
- Association of Dutch Burn Centres, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
| | - Esther Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Movement Sciences, Vrije Univeristeit Amsterdam, 1081 HV Amsterdam, The Netherlands
- Association of Dutch Burn Centres, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
| | - Paul P. M. van Zuijlen
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Movement Sciences, Vrije Univeristeit Amsterdam, 1081 HV Amsterdam, The Netherlands
- Burn Centre, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
- Pediatric Surgical Centre, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, 1105 AZ Amsterdam, The Netherlands
| | | | - Marianne K. Nieuwenhuis
- Association of Dutch Burn Centres, Martini Hospital, 9728 NT Groningen, The Netherlands
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, 9747 AS Groningen, The Netherlands
- Department for Human Movement Sciences, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Margriet E. van Baar
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands
- Association of Dutch Burn Centres, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
| | - Cornelis H. van der Vlies
- Burn Centre, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands
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Li R, Panxianzhi N, Ye S, Yuan T, Fan Y, Zhang X. A simple, safe and easily accessible polyvinyl alcohol hydrogel for wound cleaning. J Biomater Appl 2022; 36:1737-1747. [PMID: 35244481 DOI: 10.1177/08853282211058944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute wounds are often contaminated by some kind of filth, and fluids are usually used to wash away the dirt, but the force of the fluid may cause secondary injury at the wound site or even increase the risk of infection. Hydrogels have several advantages over liquid scouring since they are less intense, more portable, and easier to control. In this study, poly(vinyl alcohol) was used to prepared a series of hydrogels, which were tested in terms of their properties and abilities to clean simulated dirty wounds. Simulated dirt and bacterial (Serratia marcescens) adhesion experiments demonstrated that they could effectively adhere to a certain amount of dirt or bacteria to achieve the purpose of wound cleaning. In addition to the bacterial adhesion, the antibacterial experiments also proved that the hydrogels have a certain inhibitory effect on the proliferation of E.coli and S.aureus. The hydrogels could change shape freely and exhibited excellent biocompatibility, ductility, and self-healing capabilities, which increase their service life and make them more suitable for treating wounds or acting as protection buffers. Based on all these characteristics, the developed hydrogel may be a potentially valuable material for wound cleaning.
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Affiliation(s)
- Renpeng Li
- 12530National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, Sichuan, China
| | - Ni Panxianzhi
- 12530National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, Sichuan, China
| | - Sheng Ye
- 12530National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, Sichuan, China
| | - Tun Yuan
- 12530National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, Sichuan, China
| | - Yujiang Fan
- 12530National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, Sichuan, China
| | - XingDong Zhang
- 12530National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, Sichuan, China
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Early non-excisional debridement of paediatric burns under general anaesthesia reduces time to re-epithelialisation and risk of skin graft. Sci Rep 2021; 11:23753. [PMID: 34887486 PMCID: PMC8660833 DOI: 10.1038/s41598-021-03141-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/23/2021] [Indexed: 11/21/2022] Open
Abstract
Reported advantages of early excision for larger burn injuries include reduced morbidity, mortality, and hospital length of stay for adult burn patients. However, a paucity of evidence supports the best option for paediatric burns and the advantages of non-excisional (mechanical) debridement. Procedural sedation and analgesia in the emergency department is a popular alternative to debridement in operating theatres under general anaesthesia. This study aims to evaluate the association between early (< 24 h post-injury) non-excisional debridement under general anaesthesia with burn wound re-epithelialisation time and skin graft requirements. Cohort study of children younger than 17 years who presented with burns of five percent total body surface area or greater. Data from January 2013 to December 2019 were extracted from a prospectively collected state-wide paediatric burns' registry. Time to re-epithelialisation was tested using survival analysis, and binary logistic regression for odds of skin graft requirementto analyse effects of early non-excisional debridement in the operating theatre. Overall, 292 children met eligibility (males 55.5%). Early non-excisional debridement under general anaesthesia in the operating theatre, significantly reduced the time to re-epithelialisation (14 days versus 21 days, p = 0.029)) and the odds of requiring a skin graft in comparison to paediatric patients debrided in the emergency department under Ketamine sedation (OR: 6.97 (2.14-22.67), p < 0.001. This study is the first to demonstrate that early non-excisional debridement under general anaesthesia in the operating theatre significantly reduces wound re-epithelialisation time and subsequent need for a skin graft in paediatric burn patients. Analysis suggests that ketamine procedural sedation and analgesia in the emergency department used for burn wound debridement is not an effective substitute for debridement in the operating theatre.
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