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Blome-Eberwein SA, Schwartz A, Ferdock M, Starner S, Gogal C. Minimally invasive burn reconstruction with subcutaneous scar contracture release. Burns 2024; 50:1597-1604. [PMID: 38609745 DOI: 10.1016/j.burns.2024.03.023] [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: 03/13/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Scar contracture bands after burns are frequent problems that cause discomfort and physical limitation. This study investigates the efficacy of a minimally invasive contracture band release technique (MICBR) inspired by closed platysmotomy. METHODS Patients with burn scars treated with MICBR in our center were included retrospectively. Our routine scar and contracture treatments (non-invasive and invasive) were utilized prior to undergoing MICBR. Range of motion (ROM) and Vancouver Scar Scale was measured before and after the procedure when feasible. RESULTS Forty-five patients were included, with 97 total contracture sites treated all over the body. An average of 1.6 sites were treated per patient, with a maximum of six. Patients age was 6-68 years; total burn surface area ranged from 0.5% to 85%. 24% were performed under local anesthesia. 84% were in originally skin grafted areas. We found significant improvements in ROM and VSS. 84% of patients surveyed were "satisfied" or "very satisfied". 95% reported improved mobility. No significant adverse events occurred. CONCLUSION This MICBR technique is a versatile, safe, and well-tolerated adjunct procedure that can help patients regain mobility after a burn injury.
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Affiliation(s)
- Sigrid A Blome-Eberwein
- Department of Surgery, Division of Burn Surgery, Lehigh Valley Health Network, Allentown, PA, USA.
| | - Adam Schwartz
- Department of Surgery, Division of Burn Surgery, Lehigh Valley Health Network, Allentown, PA, USA
| | | | - Sophia Starner
- Department of Surgery, Division of Burn Surgery, Lehigh Valley Health Network, Allentown, PA, USA
| | - Christina Gogal
- Network Office of Research and Innovation, Lehigh Valley Health Network, Allentown, PA, USA
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Blome-Eberwein SA. Emerging Technologies. Clin Plast Surg 2024; 51:355-363. [PMID: 38789145 DOI: 10.1016/j.cps.2024.02.002] [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] [Indexed: 05/26/2024]
Abstract
In this article, an array of new developments in burn care, from diagnosis to post-burn reconstruction and re-integration, will be discussed. Multidisciplinary advances have allowed the implementation of technologies that provide more accurate assessments of burn depth, improved outcomes when treating full-thickness burns, and enhanced scar tissue management. Incorporating these new treatment modalities into current practice is essential to improving the standard of burn care and developing the next generation of burn wound management methodologies.
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Affiliation(s)
- Sigrid A Blome-Eberwein
- Department of Burn Surgery, University of South Florida Morsani College of Medicine, Lehigh Valley Health Network, 1200 S Cedar Crest Boulevard, Allentown, PA 18103, USA.
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Alvedro-Ruiz P, Díaz-Ros N, García-García M, Merino-Romero M, Heredia-Alcalde I, Andresen-Lorca B, Pérez-Plaza A, Pérez-Del-Caz MD. Occipito-Cervico-Dorsal Flap for Neck Reconstruction After Postburn Contractures: A Case Report and Literature Review. PLASTIC AND AESTHETIC NURSING 2024; 44:124-127. [PMID: 38639969 DOI: 10.1097/psn.0000000000000552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Because the head and neck are one of the most frequent locations of burns, it is of paramount importance that plastic surgeons and plastic surgical nurses understand the most effective surgical methods for treating neck contractures and the reconstructive technique required for each case. We introduce the case of a 42-year-old woman who presented with a severe postburn neck contracture that was reconstructed with a pedicled occipito-cervico-dorsal flap. We closed the donor-site wound primarily and completely covered the defect with good results. In addition to conventional skin grafts, dermal matrices, and microsurgical techniques, using an occipito-cervico-dorsal flap should be considered for reconstructing postburn neck contractures as it offers good aesthetic and functional outcomes, provides enough tissue and pliable skin, and results in minimal donor-site morbidity.
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Affiliation(s)
- Pedro Alvedro-Ruiz
- Pedro Alvedro-Ruiz, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Nerea Díaz-Ros, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María García-García, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Mar Merino-Romero, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Iván Heredia-Alcalde, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Belén Andresen-Lorca, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Aranzazu Pérez-Plaza, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María Dolores Pérez-Del-Caz, MD, PhD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Nerea Díaz-Ros
- Pedro Alvedro-Ruiz, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Nerea Díaz-Ros, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María García-García, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Mar Merino-Romero, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Iván Heredia-Alcalde, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Belén Andresen-Lorca, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Aranzazu Pérez-Plaza, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María Dolores Pérez-Del-Caz, MD, PhD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - María García-García
- Pedro Alvedro-Ruiz, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Nerea Díaz-Ros, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María García-García, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Mar Merino-Romero, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Iván Heredia-Alcalde, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Belén Andresen-Lorca, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Aranzazu Pérez-Plaza, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María Dolores Pérez-Del-Caz, MD, PhD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Mar Merino-Romero
- Pedro Alvedro-Ruiz, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Nerea Díaz-Ros, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María García-García, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Mar Merino-Romero, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Iván Heredia-Alcalde, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Belén Andresen-Lorca, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Aranzazu Pérez-Plaza, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María Dolores Pérez-Del-Caz, MD, PhD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Iván Heredia-Alcalde
- Pedro Alvedro-Ruiz, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Nerea Díaz-Ros, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María García-García, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Mar Merino-Romero, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Iván Heredia-Alcalde, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Belén Andresen-Lorca, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Aranzazu Pérez-Plaza, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María Dolores Pérez-Del-Caz, MD, PhD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Belén Andresen-Lorca
- Pedro Alvedro-Ruiz, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Nerea Díaz-Ros, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María García-García, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Mar Merino-Romero, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Iván Heredia-Alcalde, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Belén Andresen-Lorca, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Aranzazu Pérez-Plaza, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María Dolores Pérez-Del-Caz, MD, PhD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Aranzazu Pérez-Plaza
- Pedro Alvedro-Ruiz, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Nerea Díaz-Ros, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María García-García, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Mar Merino-Romero, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Iván Heredia-Alcalde, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Belén Andresen-Lorca, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Aranzazu Pérez-Plaza, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María Dolores Pérez-Del-Caz, MD, PhD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - María Dolores Pérez-Del-Caz
- Pedro Alvedro-Ruiz, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Nerea Díaz-Ros, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María García-García, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Mar Merino-Romero, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Iván Heredia-Alcalde, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Belén Andresen-Lorca, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Aranzazu Pérez-Plaza, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María Dolores Pérez-Del-Caz, MD, PhD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
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Lapthorn AR, Ilg MM, Dziewulski P, Cellek S. Hydroxypyridone anti-fungals selectively induce myofibroblast apoptosis in an in vitro model of hypertrophic scars. Eur J Pharmacol 2024; 967:176369. [PMID: 38325796 DOI: 10.1016/j.ejphar.2024.176369] [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: 09/05/2023] [Revised: 01/19/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
Hypertrophic scars are a common complication of burn injuries, yet there are no medications to prevent their formation. During scar formation, resident fibroblasts are transformed to myofibroblasts which become resistant to apoptosis. Previously, we have shown that hydroxypyridone anti-fungals can inhibit transformation of fibroblasts, isolated from hypertrophic scars, to myofibroblasts. This study aimed to investigate if these drugs can also target myofibroblast persistence. Primary human dermal fibroblasts, derived from burn scar tissue, were exposed to transforming growth factor beta-1 (TGF-β1) for 72 h to induce myofibroblast transformation. The cells were then incubated with three hydroxypyridone anti-fungals (ciclopirox, ciclopirox ethanolamine and piroctone olamine; 0.03-300 μM) for a further 72 h. The In-Cell ELISA method was utilised to quantify myofibroblast transformation by measuring alpha-smooth muscle actin (α-SMA) expression and DRAQ5 staining, to measure cell viability. TUNEL staining was utilised to assess if the drugs could induce apoptosis. When given to established myofibroblasts, the three hydroxypyridones did not reverse myofibroblast transformation, but instead elicited a concentration-dependent decrease in cell viability. TUNEL staining confirmed that the hydroxypyridone anti-fungals induced apoptosis in established myofibroblasts. This is the first study to show that hydroxypyridone anti-fungals are capable of inducing apoptosis in established myofibroblasts. Together with our previous results, we suggest that hydroxypyridone anti-fungals can prevent scar formation by preventing the formation of new myofibroblasts and by reducing the number of existing myofibroblasts.
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Affiliation(s)
- Alice Ruth Lapthorn
- Fibrosis Research Group, Medical Technology Research Centre, School of Allied Health, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK.
| | - Marcus Maximillian Ilg
- Fibrosis Research Group, Medical Technology Research Centre, School of Allied Health, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK
| | - Peter Dziewulski
- Fibrosis Research Group, Medical Technology Research Centre, School of Allied Health, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK; St. Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK; St Andrew's Anglia Ruskin Research Group (StAAR), Chelmsford, UK
| | - Selim Cellek
- Fibrosis Research Group, Medical Technology Research Centre, School of Allied Health, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK
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Aleman Paredes K, Selaya Rojas JC, Flores Valdés JR, Castillo JL, Montelongo Quevedo M, Mijangos Delgado FJ, de la Cruz Durán HA, Nolasco Mendoza CL, Nuñez Vazquez EJ. A Comparative Analysis of the Outcomes of Various Graft Types in Burn Reconstruction Over the Past 24 Years: A Systematic Review. Cureus 2024; 16:e54277. [PMID: 38496152 PMCID: PMC10944562 DOI: 10.7759/cureus.54277] [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] [Accepted: 02/15/2024] [Indexed: 03/19/2024] Open
Abstract
Burn injuries, a major global health concern, result in an estimated 180,000 fatalities annually. Despite tremendous progress in treatment methods over the years, the morbidity and mortality associated with burns remain significant. Autologous skin grafting, particularly split-thickness skin grafting (STSG), has been a cornerstone in burn reconstruction, and it has facilitated survival and functional recovery for total body surface area (TBSA) significantly. However, the requirement for primary closure at the donor site due to the constraints of full-thickness donor harvesting continues to pose challenges. The introduction of dermal regenerative templates (DRT) in the late 1970s marked a substantial step forward in tissue engineering, addressing the inadequacy of dermal replacement with STSGs. This systematic review aimed to compare the outcomes of different graft types - bioengineered, autografts, allografts, and xenografts - in burn reconstruction over the last 24 years. The review focused on the pros and cons of each graft type, offering clinical insights grounded in experience and evidence. The approach involved a systematic review of studies published in English from January 2000 to January 2024, covering randomized controlled trials (RCTs), cohort studies, case-control studies, and case series. The participants comprised individuals of all ages who underwent burn reconstruction with skin grafts, specifically split-thickness grafts, full-thickness grafts, composite grafts, and epidermal grafts (autografts, allografts, and xenografts) and bioengineered grafts. The primary outcomes were functional and cosmetic results, patient satisfaction, graft survival, and complications. The risk of bias was evaluated using the Cochrane risk-of-bias tool for randomized trials version 2 (RoB 2), the Newcastle-Ottawa Scale (NOS) for non-randomized studies, and the Canada Institute for Health Economics (IHE) quality appraisal tool for case series. Our initial search yielded a total of 1,995 articles, out of which 10 studies were selected for final analysis. Among the four clinical trials assessed, 75% showed a high risk of bias. The studies reviewed involved various graft types, with six studies (60%) concentrating on allografts, three (30%) on autografts, and one (10%) on bioengineered skin grafts. The outcomes were varied, underlining the intricate nature of burn wound management. Our evaluation revealed promising results for autologous-engineered skin substitutes and allografts but also highlighted methodological disparities among the studies included. The dominance of observational studies and the diversity of outcome measures present obstacles to direct comparisons. Future research should address these limitations, employing well-structured RCTs, standardized outcome measures, and exploring long-term outcomes and patient-specific factors. The rapidly evolving field of regenerative medicine offers great potential for novel grafting methods. This systematic review provides valuable insights into the diverse outcomes of burn reconstruction using different graft types. Autologous-engineered skin substitutes and allografts seem to hold significant promise, suggesting a possible shift in grafting techniques. However, methodological inconsistencies and the lack of high-quality evidence underscore the necessity for further research to fine-tune burn care approaches.
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Affiliation(s)
| | - Julio C Selaya Rojas
- Plastic and Reconstructive Surgery, Hospital General Regional No. 220 ¨José Vicente Villada¨, Toluca, MEX
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Zhang M, Fang Y, Li H, Shi S, Chen J, Tang F, Li X, Jiang M, Wang S, Li S, Zhou J. Prognostic Analysis of Skin Scar Loosening and Tissue-Expansive Autologous Skin Grafting in the Treatment of Skin Postburn Scars. J Craniofac Surg 2023; 34:e411-e415. [PMID: 36534028 DOI: 10.1097/scs.0000000000009149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND This study aims to observe and investigate the clinical value of scar loosening and tissue-expansive autologous skin grafting in the treatment of postburn scars and independent risk characteristics for surgery-related complications. METHODS We retrospectively analyzed 94 cases with postburn scars, and all patients were treated with scar loosening and autologous skin grafting. Overall therapeutic effects were evaluated using the standard of cure and improvement of clinical diseases. Burn Specific Health Scale-brief was used to analyze patients' quality of life. The visual analog scale scores were used to analyze esthetic satisfaction. Surgery-related complications were recorded, and logistic regression model was used to analyze independent factors affecting surgery-related complications. RESULTS As for overall efficacy evaluation, 50 cases were cured, 19 cases were markedly improved, 17 cases improved, and 8 cases were detected and tested, and the overall effective rate was 91.4%. The Burn Specific Health Scale-brief and visual analog scale score showed a trend of increasing gradually. It indicated that the patients were satisfied with the operation and their quality of life was improved. The logistic regression model showed that history of skin disease (OR=1.53 (1.08-2.16), P =0.02) and skin area (OR=2.50 (1.22-4.50), P <0.01) were significantly associated with surgery-related complications. CONCLUSIONS Scar loosening and autologous skin grafting is a safe and effective treatment. The history of skin disease and skin area was the independent factors for surgery-related complications.
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Affiliation(s)
- Mengyao Zhang
- Department of Plastic Surgery, The Third Xiangya Hospital, Central South University, Hunan Province
| | - Yuan Fang
- Department of Plastic Surgery, The Third Xiangya Hospital, Central South University, Hunan Province
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Haibo Li
- Department of Plastic Surgery, The Third Xiangya Hospital, Central South University, Hunan Province
| | - Shupeng Shi
- Department of Plastic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Anhui Province
| | - Jia Chen
- Department of Plastic Surgery, The Third Xiangya Hospital, Central South University, Hunan Province
| | - Fengjie Tang
- Department of Plastic Surgery, The Third Xiangya Hospital, Central South University, Hunan Province
| | - Xu Li
- Department of Plastic Surgery, The Third Xiangya Hospital, Central South University, Hunan Province
| | - Ming Jiang
- Neihuang Chinese Medicine Hospital, Anyang, Henan, China
| | - Shoubao Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Shengli Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Jianda Zhou
- Department of Plastic Surgery, The Third Xiangya Hospital, Central South University, Hunan Province
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Farzaneh SB, Devetzis K, Kamyab AA, Sousi S, Zargaran A, Zargaran D. Emergency burn education: Evaluating a surgical simulation-based intervention. J Plast Reconstr Aesthet Surg 2023; 82:137-140. [PMID: 37167714 DOI: 10.1016/j.bjps.2023.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/15/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Medical simulation has provided favorable outcomes in the improvement of clinical competence at both the undergraduate and postgraduate levels. The recall of information demonstrably increases when it has been taught in environments similar to the workplace. This study aimed to evaluate the role of a one-day burn simulation session in improving students' knowledge of burn management and interest in plastic surgery as a specialty. METHOD A one-day course was designed to deliver multiple lectures covering surgical topics such as the classification and management of burns, followed by a series of practical workshops. Participants were instructed to undergo a pre-course knowledge assessment and a survey focusing on interest in plastic surgery. Students were subsequently instructed to complete a post-course assessment and a survey of knowledge and confidence in managing burns as well as interest in plastic surgery both immediately and 6 weeks post-course. RESULTS The students' knowledge demonstrated a 54.2% increase in the post-course assessment (p < 0.01). 27% of participants (n = 14) participated in a 6-week post-course quiz. The knowledge assessment of these participants at 6 weeks post-course also demonstrated a sustained increase of 61.0% (p < 0.01). Interest in plastic surgery was increased by 31.4% post-course (p < 0.01). At 6 weeks post-course, a sustained increase of 14.7% was demonstrated in comparison to pre-course data (p = 0.03). CONCLUSION Simulation teaching provides good outcomes in both information retention and interest in plastic surgery as a specialty. Therefore, medical school curriculums may benefit from including burn simulations.
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Affiliation(s)
| | | | - Arya Anthony Kamyab
- St George's University of London, Cranmer Terrace, Tooting, SW17 0RE London, UK
| | - Sara Sousi
- Department of Surgery and Cancer, Imperial College London, W12 0NN London, UK; King's College London, London SE1 1UL, Greater London, UK
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Abstract
This chapter highlights the importance of a comprehensive burn scar treatment plan in approaching a burn survivor. General concepts of burn scar physiology and a practical system to describe burn scars based on cause, biology, and symptoms are presented. Common scar management modalities including nonsurgical, surgical, and adjuvant therapies are further discussed.
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Affiliation(s)
- Noor Obaidi
- The Metis Foundation, 84 NorthEast 410 Loop, STE 325, San Antonio, TX 78216, USA
| | - Corey Keenan
- The Metis Foundation, 84 NorthEast 410 Loop, STE 325, San Antonio, TX 78216, USA
| | - Rodney K Chan
- The Metis Foundation, 84 NorthEast 410 Loop, STE 325, San Antonio, TX 78216, USA; United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA.
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9
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Żwierełło W, Piorun K, Skórka-Majewicz M, Maruszewska A, Antoniewski J, Gutowska I. Burns: Classification, Pathophysiology, and Treatment: A Review. Int J Mol Sci 2023; 24:ijms24043749. [PMID: 36835171 PMCID: PMC9959609 DOI: 10.3390/ijms24043749] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/05/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Burns and their treatment are a significant medical problem. The loss of the physical barrier function of the skin opens the door to microbial invasion and can lead to infection. The repair process of the damage caused by the burn is impaired due to the enhanced loss of fluids and minerals through the burn wound, the onset of hypermetabolism with the concomitant disruption of nutrient supply, and derangements in the endocrine system. In addition, the initiated inflammatory and free radical processes drive the progression of oxidative stress, the inhibition of which largely depends on an adequate supply of antioxidants and minerals. Clinical experience and research provide more and more data to make the treatment of patients with thermal injury increasingly effective. The publication discusses disorders occurring in patients after thermal injury and the methods used at various stages of treatment.
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Affiliation(s)
- Wojciech Żwierełło
- Department of Medical Chemistry, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Krzysztof Piorun
- West Pomeranian Center for Treating Severe Burns and Plastic Surgery, 72-300 Gryfice, Poland
| | - Marta Skórka-Majewicz
- Department of Medical Chemistry, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Agnieszka Maruszewska
- Department of Physiology and Biochemistry, Institute of Biology, University of Szczecin, 71-412 Szczecin, Poland
| | - Jacek Antoniewski
- Department of Medical Chemistry, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Izabela Gutowska
- Department of Medical Chemistry, Pomeranian Medical University, 70-204 Szczecin, Poland
- Correspondence:
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Sabapathy SR, Shanmugakrishnan RR, Ramkumar S, Muthukumar V, Senthilkumaran M, Bharathi RR. Postburn Reconstruction of the Face and Neck. Plast Reconstr Surg 2022; 150:1326e-1339e. [DOI: 10.1097/prs.0000000000009690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Ponomarenko OV, Serhieieva LN, Parkhomenko KY. Surgical treatment results in patients with defects of the integumentary tissues of the trunk and limbs of mechanical origin. J Med Life 2022; 15:1358-1364. [PMID: 36567839 PMCID: PMC9762375 DOI: 10.25122/jml-2022-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 09/13/2022] [Indexed: 01/03/2023] Open
Abstract
This study aimed to develop and implement a universal method for the quantitative assessment of treatment effectiveness in patients with skin and underlying soft tissue defects of the trunk and extremities. The study involved 242 patients, including 46 patients with upper extremity injuries, 179 with lesions of lower extremity tissues, and 17 patients with defects of the integumentary tissues of the trunk. The greatest treatment effectiveness was observed in patients with upper limb injury: excellent result - 60.0%, good - 33.3%, unsatisfactory - 6.7% of patients. In the group of patients with lower extremity injuries, an excellent result was recorded in 19.6% of cases, good (58.1%), satisfactory (15.1%), and unsatisfactory in 7.2% of patients. In patients with trunk injuries, an excellent treatment result was obtained in 23.5%, good - 35.5%, satisfactory - 23.5%, and unsatisfactory - 17.6%. The universal quantitative method for evaluating treatment effectiveness in patients with various types of damage to the trunk and extremities tissues was proposed. This method makes it possible to objectively determine the level of medical service provided to each patient, which is of great importance in the context of medical service reorganization in the state.
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Affiliation(s)
- Olena Vasylivna Ponomarenko
- Department of Medicine of Catastrophes, Military Medicine and Neurosurgery, Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine,Corresponding Author: Olena Vasylivna Ponomarenko, Department of Medicine of Catastrophes, Military Medicine and Neurosurgery, Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine E-mail:
| | - Ludmila Nylsivna Serhieieva
- Department of Medical Physics, Biophysics and Higher Mathematics, Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine
| | - Kyrylo Yuriiovych Parkhomenko
- Department of General Practice Family Medicine and Internal Medicine, Kharkiv National Medical University, Kharkiv, Ukraine
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12
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Release of Severe Postburn Contracture of Index Finger with Two-stage Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4335. [PMID: 35620487 PMCID: PMC9119636 DOI: 10.1097/gox.0000000000004335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/24/2022] [Indexed: 11/30/2022]
Abstract
Postburn contractures are the result of deep burns that are not treated properly and promptly. Severe contractures require more than one surgery to be completely relieved. Their surgical treatment is very difficult and challenging for reconstructive surgeons. The author presents a case with severe postburn contracture of the index finger especially at the DIP joint with an angle of 110 degrees, which was released with a full skin graft in two stages of reconstruction. The application of this procedure enables the complete release of severe contractures and protects the fingers from their loss as a result of the shortening of vascular structures.
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Issa M, Badawi M, Bisheet G, Makram M, Elgadi A, Abdelaziz A, Noureldin K. Skin Graft Versus Local Flaps in Management of Post-burn Elbow Contracture. Cureus 2021; 13:e20768. [PMID: 35111453 PMCID: PMC8792479 DOI: 10.7759/cureus.20768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Contracture is a pathological scar tissue resulting from local skin tissue damage, secondary to different local factors. It can restrict joint mobility, resulting in deformity and disability. This study aimed to investigate the outcomes of skin grafts compared to local flaps to reconstruct post-burn elbow contractures. These parameters included regaining function, range of movement, recurrence, and local wound complications. Methodology A retrospective study reviewed 21 patients for elbow reconstruction over 12 months. Only patients with post-burn elbow contracture were included. Other causes, including previous corrective surgery, associated elbow stiffness, and patients who opted out of post-operative physiotherapy, were excluded. Patients were categorized according to the method of coverage into three groups: graft alone (G1), local flap (G2), or combined approach (G3). Results Females were three times at higher risk to suffer a burn injury, while almost half of the cases were children. Scald injury represented 81% of burn causes. G1,2,3 were used in 47.6%, 42.9% and 9.5% of cases retrospectively. The overall rate of infection was 28.6%. Hundred percent graft taken was recorded in 83.3 % of cases; however, flap take was 91.1%. After 12 months of follow-up, re-contracture was 60% and 22.8% in G1 and G2; however, the satisfaction rate was 70% and 100% in both groups retrospectively. The overall satisfaction was 85.7% in all groups. Conclusion Grafts and local flaps are reasonable options for post contracture release; however, flaps are superior. Coverage selection depends on the lost tissue area and exposure of underlying deep structures. Physiotherapy and patient satisfaction are crucial in the outcomes.
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14
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Jiang Y, Guo R, Zhou S, Wang B, Sun W. Functional and aesthetic reconstruction of digital flexion contractures with full-thickness plantar skin grafts in children. Dermatol Ther 2020; 33:e14466. [PMID: 33112495 DOI: 10.1111/dth.14466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/15/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Abstract
Hand burns are frequently seen in children, often resulting in digital flexion contractures. Traditional split-thickness or full-thickness skin grafts leave notably different skin texture and hyperpigmentation. The purpose of this study was to describe our operation for treating digital flexion contractures with full-thickness plantar skin grafts, and to evaluate the appearance and function outcomes. Hematoxylin and eosin staining, Masson trichrome staining and Melan A (marker of melanocyte) staining were used to evaluate palmar skin, plantar skin, groin skin and burn scars. Full-thickness plantar skin grafts were performed between 2008 and 2015 in 24 hand burn patients with digital flexion contracture. The average age at the time of surgery was 39.3 months and the average follow-up period was 5.5 years. The functional and cosmetic results were assessed. Plantar skin shared similar attributes with palmar skin histologically. Both plantar skin and palmar skin did not express melan A. All of the skin grafts survived well without hematoma, infection and necrosis. The grafts resembled the adjacent normal skin in regards to appearance and texture. The average TAM (total active movement) degree for the fingers was improved from 152.3° to 238.5°. The average VSS (Vancouver Scar Scale) score decreased dramatically from 10.4 to 1.1. Twenty one of twenty four patients (21/24, 87.5%) were very satisfied with function and appearance, and three in twenty four (3/24, 12.5%) were somewhat satisfied. This study indicates that full-thickness plantar skin grafts can achieve a satisfactory appearance and good function for hand burn child patients with digital flexion contractures.
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Affiliation(s)
- Yongkang Jiang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ruiji Guo
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shengbo Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bin Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wenhai Sun
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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15
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A novel technique of reducing full-thickness skin graft contraction using a dermal substitute: an animal model study. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-020-01661-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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The Effectiveness of Burn Scar Contracture Release Surgery in Low- and Middle-income Countries. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2907. [PMID: 32802643 PMCID: PMC7413812 DOI: 10.1097/gox.0000000000002907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/15/2020] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Worldwide, many scar contracture release surgeries are performed to improve range of motion (ROM) after a burn injury. There is a particular need in low- and middle-income countries (LMICs) for such procedures. However, well-designed longitudinal studies on this topic are lacking globally. The present study therefore aimed to evaluate the long-term effectiveness of contracture release surgery performed in an LMIC.
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17
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Al-Qattan MM, AlMutairi MH. Reconstruction of severe burn contractures of the upper lip in males using a pedicled superficial temporal artery hair-bearing flap. Two case reports. Int J Surg Case Rep 2020; 72:309-312. [PMID: 32563092 PMCID: PMC7305348 DOI: 10.1016/j.ijscr.2020.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/26/2020] [Accepted: 06/03/2020] [Indexed: 11/05/2022] Open
Abstract
The use of the superficial temporal artery free flap has been described for upper lip burn contractures. However, the pedicled superficial temporal artery flap is much simpler to execute than free flaps. The main concern with the use of the pedicled superficial temporal artery flap in these cases is regarding the viability of the distal end of the flap. We demonstrate this in two case reports.
Introduction Severe burn contractures of the upper lip are usually treated either with full thickness skin grafts or flaps. Most authors recommend the free radial forearm flap as the flap of choice. In males, another free flap option is the use of the superficial temporal artery hair-bearing free flap. Case reports In this report, we demonstrate that the superficial temporal artery hair-bearing flap may be used as a pedicle flap (rather than a free flap) for the reconstruction of severe upper lip burn contractures in males. We show our method of flap delay and design to ensure that the distal part of the flap will survive; and this will be demonstrated in two case reports. Discussion The pedicled superficial temporal artery flap is much simpler to execute than free flaps. Conclusions Severe post burn contractures of the upper lip in males may be reconstructed using the pedicled superficial temporal artery hair-bearing flap. In order for the flap to reach the contralateral side of the lip, it will have to cross the midline in the scalp. We demonstrate our method of flap delay and design to ensure flap safety and viability. We also show that concurrent burn deformities in close proximity of the upper lip should be treated prior to upper lip reconstruction. Finally, we stress on the principle of reconstructing the entire skin of the upper lip as one aesthetic unit.
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Affiliation(s)
- Mohammad M Al-Qattan
- Department of Surgery, King Saud University, P.O. Box 18097, Riyadh, 11415, Saudi Arabia.
| | - Musa H AlMutairi
- Department of Plastic Surgery at Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
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18
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Yamakawa S, Hayashida K. Advances in surgical applications of growth factors for wound healing. BURNS & TRAUMA 2019; 7:10. [PMID: 30993143 PMCID: PMC6450003 DOI: 10.1186/s41038-019-0148-1] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/13/2019] [Indexed: 12/15/2022]
Abstract
Growth factors have recently gained clinical importance for wound management. Application of recombinant growth factors has been shown to mimic cell migration, proliferation, and differentiation in vivo, allowing for external modulation of the healing process. Perioperative drug delivery systems can enhance the biological activity of these growth factors, which have a very short in vivo half-life after topical administration. Although the basic mechanisms of these growth factors are well understood, most have yet to demonstrate a significant impact in animal studies or small-sized clinical trials. In this review, we emphasized currently approved growth factor therapies, including a sustained release system for growth factors, emerging therapies, and future research possibilities combined with surgical procedures. Approaches seeking to understand wound healing at a systemic level are currently ongoing. However, further research and consideration in surgery will be needed to provide definitive confirmation of the efficacy of growth factor therapies for intractable wounds.
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Affiliation(s)
- Sho Yamakawa
- Division of Plastic and Reconstructive Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Kenji Hayashida
- Division of Plastic and Reconstructive Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501 Japan
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19
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Zhang A, Kuc A, Tung L, King K, Dayicioglu D. Expanded Latissimus Dorsi Myocutaneous Flap for Burn Scar Reconstruction. EPLASTY 2018; 18:ic13. [PMID: 30046368 PMCID: PMC6050535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Angie Zhang
- aUniversity of South Florida Morsani College of Medicine, Tampa,Correspondence:
| | - Amra Kuc
- aUniversity of South Florida Morsani College of Medicine, Tampa
| | - Lillian Tung
- aUniversity of South Florida Morsani College of Medicine, Tampa
| | - Kathryn S. King
- bDepartment of Plastic Surgery, University of South Florida Morsani College of Medicine, Tampa
| | - Deniz Dayicioglu
- bDepartment of Plastic Surgery, University of South Florida Morsani College of Medicine, Tampa
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20
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Stone Ii R, Natesan S, Kowalczewski CJ, Mangum LH, Clay NE, Clohessy RM, Carlsson AH, Tassin DH, Chan RK, Rizzo JA, Christy RJ. Advancements in Regenerative Strategies Through the Continuum of Burn Care. Front Pharmacol 2018; 9:672. [PMID: 30038569 PMCID: PMC6046385 DOI: 10.3389/fphar.2018.00672] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/05/2018] [Indexed: 01/09/2023] Open
Abstract
Burns are caused by several mechanisms including flame, scald, chemical, electrical, and ionizing and non-ionizing radiation. Approximately half a million burn cases are registered annually, of which 40 thousand patients are hospitalized and receive definitive treatment. Burn care is very resource intensive as the treatment regimens and length of hospitalization are substantial. Burn wounds are classified based on depth as superficial (first degree), partial-thickness (second degree), or full-thickness (third degree), which determines the treatment necessary for successful healing. The goal of burn wound care is to fully restore the barrier function of the tissue as quickly as possible while minimizing infection, scarring, and contracture. The aim of this review is to highlight how tissue engineering and regenerative medicine strategies are being used to address the unique challenges of burn wound healing and define the current gaps in care for both partial- and full-thickness burn injuries. This review will present the current standard of care (SOC) and provide information on various treatment options that have been tested pre-clinically or are currently in clinical trials. Due to the complexity of burn wound healing compared to other skin injuries, burn specific treatment regimens must be developed. Recently, tissue engineering and regenerative medicine strategies have been developed to improve skin regeneration that can restore normal skin physiology and limit adverse outcomes, such as infection, delayed re-epithelialization, and scarring. Our emphasis will be centered on how current clinical and pre-clinical research of pharmacological agents, biomaterials, and cellular-based therapies can be applied throughout the continuum of burn care by targeting the stages of wound healing: hemostasis, inflammation, cell proliferation, and matrix remodeling.
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Affiliation(s)
- Randolph Stone Ii
- Combat Trauma and Burn Injury Research, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Shanmugasundaram Natesan
- Combat Trauma and Burn Injury Research, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Christine J Kowalczewski
- Combat Trauma and Burn Injury Research, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Lauren H Mangum
- Combat Trauma and Burn Injury Research, US Army Institute of Surgical Research San Antonio, TX, United States.,Extremity Trauma and Regenerative Medicine, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Nicholas E Clay
- Combat Trauma and Burn Injury Research, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Ryan M Clohessy
- Combat Trauma and Burn Injury Research, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Anders H Carlsson
- Dental and Craniofacial Trauma Research, US Army Institute of Surgical Research San Antonio, TX, United States
| | - David H Tassin
- Dental and Craniofacial Trauma Research, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Rodney K Chan
- Dental and Craniofacial Trauma Research, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Julie A Rizzo
- Burn Flight Team, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Robert J Christy
- Combat Trauma and Burn Injury Research, US Army Institute of Surgical Research San Antonio, TX, United States
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21
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Deng X, Chen Q, Qiang L, Chi M, Xie N, Wu Y, Yao M, Zhao D, Ma J, Zhang N, Xie Y. Development of a Porcine Full-Thickness Burn Hypertrophic Scar Model and Investigation of the Effects of Shikonin on Hypertrophic Scar Remediation. Front Pharmacol 2018; 9:590. [PMID: 29922164 PMCID: PMC5996232 DOI: 10.3389/fphar.2018.00590] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/17/2018] [Indexed: 01/10/2023] Open
Abstract
Hypertrophic scars formed after burns remain a challenge in clinical practice. Development of effective scar therapies relies on validated animal models that mimic human hypertrophic scars. A consistent porcine full-thickness burn hypertrophic scar model has yet to be developed. We have previously reported that Shikonin induces apoptosis and reduces collagen production in hypertrophic scar fibroblasts in vitro and may therefore hold potential as a novel scar remediation therapy. In this study, we aimed to validate the potential of Shikonin on scar remediation in vivo. A novel porcine hypertrophic scar model was created after full-thickness burn wounds, and the effect of Shikonin on scar remediation was investigated. Clinical scar assessments, histology, and immunohistochemistry were used to evaluate scar appearance, morphology, and protein expression. Eight weeks after scar formation, clinical scar assessment indicated that the score of hypertrophic scars treated with Shikonin was significantly lower than that of the control group. Hypertrophic scars treated with Shikonin appeared flat, pink, and pliable. In addition, histological analysis indicated that hypertrophic scars treated with Shikonin exhibited reduced thickness of the epidermis and dermis, thin and even epithelial layers, reduced numbers of keratinocytes, uniform distribution of fibroblasts, and a parallel and loose arrangement of collagen fibers in the dermis. Moreover, immunohistochemical analysis indicated that Shikonin inhibited the expression of p63, cytokeratin 10, alpha-smooth muscle actin, transforming growth factor-beta 1, and collagen I, which play important roles in hypertrophic scar formation. Based on these results, we conclude that Shikonin has potential as a novel scar therapy.
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Affiliation(s)
- Xingwang Deng
- College of Clinical Medicine, Ningxia Medical University, Yinchuan, China
| | - Qian Chen
- Department of Burns and Plastic Surgery, Xinyang Central Hospital, Xinyang, China
| | - Lijuan Qiang
- College of Clinical Medicine, Ningxia Medical University, Yinchuan, China
| | - Mingwei Chi
- Medical Department, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Nan Xie
- Tissue Organ Bank & Tissue Engineering Centre, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yinsheng Wu
- Department of Burns and Plastic Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Ming Yao
- Department of Burns and Plastic Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Dan Zhao
- Tissue Organ Bank & Tissue Engineering Centre, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jiaxiang Ma
- Tissue Organ Bank & Tissue Engineering Centre, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Ning Zhang
- Department of Pathology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yan Xie
- Tissue Organ Bank & Tissue Engineering Centre, General Hospital of Ningxia Medical University, Yinchuan, China.,Clinical Medical School, Ningxia Medical University, Yinchuan, China.,School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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22
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Yoshino Y, Kubomura K, Ueda H, Tsuge T, Ogawa R. Extension of flaps associated with burn scar reconstruction: A key difference between island and skin-pedicled flaps. Burns 2017; 44:683-691. [PMID: 29089205 DOI: 10.1016/j.burns.2017.09.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/05/2017] [Accepted: 09/17/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The choice between local flap designs for burn reconstruction is largely shaped by aesthetic, vascularity, procedural complexity, and wound-closure considerations. However, another key consideration is how well specific local flap designs release post-burn scar contractures. This is because constant tension on wound edges can generate pathological scarring. However, the ability of specific local flap to release post-burn scar contractures is poorly understood. This question was addressed by this study of patients who underwent local flap surgery to release post-burn scar contractures. METHODS The flap type, its original size, and the degree to which the flap extended 6 months after surgery were recorded. RESULTS Of the 40 patients enrolled, 20 received an island flap and 20 received a skin-pedicled flap. The scars were most commonly located on the anterior chest, axilla, and cubital fossa, followed by the lateral chest, abdomen, thigh, and popliteal fossa. Six months after surgery, the skin-pedicled and island flaps had extended on average by 1.53- and 1.28-fold, respectively. CONCLUSIONS While it was technically easier to transfer island flaps to the recipient site, they released contractures less effectively than skin-pedicled flaps. The postoperative extensibility of flaps should be considered when determining which flap design is optimal for the individual patient.
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Affiliation(s)
- Yukiko Yoshino
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School Hospital, Tokyo, Japan.
| | - Ken Kubomura
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Hyakuzoh Ueda
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Takuya Tsuge
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Rei Ogawa
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School Hospital, Tokyo, Japan
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23
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Singh S, Narang P, Sood A, Mittal V. Not all is lost: journey of a deep periorbital burn. BMJ Case Rep 2017; 2017:bcr-2017-221565. [PMID: 29079673 DOI: 10.1136/bcr-2017-221565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Swati Singh
- Ophthalmic Plastics Surgery and Cornea Services, LJ Eye Institute, Ambala, Haryana, India
| | - Purvasha Narang
- Ophthalmic Plastics Surgery and Cornea Services, LJ Eye Institute, Ambala, Haryana, India
| | - Ankur Sood
- Plastics Surgery, Tricity Institute of Plastics Surgery, Chandigarh, India
| | - Vikas Mittal
- Ophthalmic Plastics Surgery and Cornea Services, LJ Eye Institute, Ambala, Haryana, India
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