Review of burn injury research for the year 2009

Maintaining Inducibility of Dermal Follicle Cells on Silk Fibroin/Sodium Alginate Scaffold for Enhanced Hair Follicle Regeneration

The extracellular matrix (ECM) is important for maintaining cell phenotype and promoting cell proliferation and differentiation. In order to better solve the problem of skin appendage regeneration, a combination of mechanical/enzymatic digestion methods was used to self-extract dermal papilla cells (DPCs), which were seeded on silk fibroin/sodium alginate scaffolds as seed cells to evaluate the possibility of skin regeneration/regeneration of accessory organs. Scanning electron microscopy (SEM) graphs showed that the interconnected pores inside the scaffold had a pore diameter in the range of 153-311 μm and a porosity of 41-82%. Immunofluorescence (IF) staining and cell morphological staining proved that the extracted cells were DPCs. The results of a Cell Counting Kit-8 (CCK-8) and Calcein-AM/PI live-dead cell staining showed that the DPCs grew well in the composite scaffold extract. Normal cell morphology and characteristics of aggregation growth were maintained during the 3-day culture, which showed that the silk fibroin/sodium alginate (SF/SA) composite scaffold had good cell-compatibility. Hematoxylin-eosin (H&E) staining of tissue sections further proved that the cells adhered closely and aggregated to the pore wall of the scaffold, and retained the ability to induce differentiation of hair follicles. All these results indicate that, compared with a pure scaffold, the composite scaffold promotes the adhesion and growth of DPCs. We transplanted the SF/SA scaffolds into the back wounds of SD rats, and evaluated the damage model constructed in vivo. The results showed that the scaffold inoculated with DPCs could accelerate the repair of the skin and promote the regeneration of the hair follicle structure.

An injectable aldehyded 1-amino-3,3-diethoxy-propane hyaluronic acid–chitosan hydrogel as a carrier of adipose derived stem cells to enhance angiogenesis and promote skin regeneration

We report an injectable aldehyded 1-amino-3,3-diethoxy-propane (ADEP)–hyaluronic acid (AHA)–chitosan (CS) hydrogel.

Injectable polysaccharide hybrid hydrogels as scaffolds for burn wound healing

In this study, the polysaccharide-based hydrogels were prepared by Schiff base reaction. Then, the hydrogels were applied to a burn wound model of rats, following by skin regeneration.

Perioperative anesthesia management of the burn patient

Burn patients provide numerous challenges to the anesthesiologist. It is important to understand the multiple physiologic disruptions that follow a burn injury as well as the alterations in pharmacokinetics and pharmacodynamics of commonly used anesthetics. Thought must be given to surgery during initial fluid resuscitation and the airway challenges many of these patients present. Finally, the central role of pain management through all phases of care is a constant concern.

Guidelines for vocational evaluation following burns: integrated review of relevant process and factors

PURPOSE

A systematic literature review was undertaken to gather evidence to develop a guideline for vocational evaluation following burn injuries (BI). This review aimed to identify the key processes evaluators should follow and the key factors they should consider when completing such evaluations.

METHODS

Steps outlined in Cochrane Handbook of Systematic Review were followed including: development of review question; search strategies and selection criteria; quality appraisal; data extraction; analysis & synthesis; drawing conclusions. Four databases (Pubmed, Medline, CINHAL, PsycINFO) and 14 websites were searched for relevant articles and studies (quantitative, qualitative), reviews and guidelines. Two reviewers independently completed reviews, performed quality assessments and extracted data into evidence tables. Using the ICF model and directed content analysis, key processes and factors were analyzed and synthesized across the evidence.

RESULTS

A total of 138 articles were identified using the key words (e.g. burns, work). Studies, reviews and guidelines were retrieved if they focused on adults and discussed the processes relevant to vocational evaluation and/or factors associated with successful return to work (RTW) following a BI. Items were excluded if they did not address adults who had suffered a burn, the process of work or RTW, or challenges related to work after a BI. Using the above criteria 76 items were retrieved for full review. Fifty-six items remained after the quality appraisal. Results were integrated to develop the Evidence-based Framework for Vocational Evaluation Following Burn Injury.

CONCLUSIONS

This framework outlines 7 key processes relevant to vocational evaluation following burn injuries.

Risk factors of burns among children in Mongolia

Burn is one of the leading causes of under-5 childhood injuries. Identification of risk factors and awareness level of caregivers could help reduction of burn-related morbidity. The objectives of this study were to identify general perceptions of risk factors of childhood burns, prevalence of burns among under-five Mongolian children, and to assess knowledge and practice of burn care and care seeking behaviors for care givers of those children. A household-based cross-sectional survey was conducted from September to October 2010 including 865 households with 1154 under-5 children. Data were collected by face-to-face interview using semi-structured questionnaire. Of total 1154 children, 291 (25.2%) had burn injury in their life-time. Above half of them had suffered a scald. Majority of burns occurred at home and urban children were at higher risk. The age up to 36 months, boys, and fewer children (<3) in the household were found as significant risk factors for childhood burns. Caregivers' knowledge and practices on childhood burns were generally insufficient; most of them indicated the importance of physical environment at home. We concluded that burns were common among under-5 children, and caregivers' knowledge and practices on burns was inadequate. Specific interventions like "Caregivers education program" encouraging safe domestic environmental conditions should be undertaken to increase their awareness on burn-related issues to reduce childhood burns in Mongolia.

Dextran hydrogel scaffolds enhance angiogenic responses and promote complete skin regeneration during burn wound healing

Neovascularization is a critical determinant of wound-healing outcomes for deep burn injuries. We hypothesize that dextran-based hydrogels can serve as instructive scaffolds to promote neovascularization and skin regeneration in third-degree burn wounds. Dextran hydrogels are soft and pliable, offering opportunities to improve the management of burn wound treatment. We first developed a procedure to treat burn wounds on mice with dextran hydrogels. In this procedure, we followed clinical practice of wound excision to remove full-thickness burned skin, and then covered the wound with the dextran hydrogel and a dressing layer. Our procedure allows the hydrogel to remain intact and securely in place during the entire healing period, thus offering opportunities to simplify the management of burn wound treatment. A 3-week comparative study indicated that dextran hydrogel promoted dermal regeneration with complete skin appendages. The hydrogel scaffold facilitated early inflammatory cell infiltration that led to its rapid degradation, promoting the infiltration of angiogenic cells into the healing wounds. Endothelial cells homed into the hydrogel scaffolds to enable neovascularization by day 7, resulting in an increased blood flow significantly greater than treated and untreated controls. By day 21, burn wounds treated with hydrogel developed a mature epithelial structure with hair follicles and sebaceous glands. After 5 weeks of treatment, the hydrogel scaffolds promoted new hair growth and epidermal morphology and thickness similar to normal mouse skin. Collectively, our evidence shows that customized dextran-based hydrogel alone, with no additional growth factors, cytokines, or cells, promoted remarkable neovascularization and skin regeneration and may lead to novel treatments for dermal wounds.