中华烧伤与创面修复杂志

Transfer of patients with severe burn injury

Peng Yizhi

2015, 31(4): 241-243. doi: 10.3760/cma.j.issn.1009-2587.2015.04.001

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Transfer of patients with severe burn injury is an important issue during the rescue of mass casualties, as it may give rise to great influence on the prognosis of patients. Timing of transfer, preparation before transfer, and details for attention are elaborated in this article, aiming to further specify the procedures of transfer of patients with burn injury.

Analysis of liver damage and reactivation of hepatitis B virus in hepatitis B surface antigen positive patients after extremely severe burn injury

Bian Huining, Lai Wen, Zheng Shaoyi, Liu Zu'an, Huang Zhifeng, Sun Chuanwei, Ma Lianghua, Li Hanhua, Chen Huade

2015, 31(4): 244-247. doi: 10.3760/cma.j.issn.1009-2587.2015.04.002

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Objective To analyze the development of liver damage and reactivation of hepatitis B virus (HBV) during the treatment of extremely severe burn injury in HBsAg positive patients, in order to provide reference for prevention and treatment of liver damage in patients with HBV infection after extremely severe burn. Methods Medical records of 54 HBsAg positive patients after extremely severe burn injury admitted from January 2004 to December 2014 were retrospectively analyzed. Development of liver damage and HBV reactivation of these patients during the treatment were analyzed according to the classification of their gender, results of hepatitis B e antigen (HBeAg) and HBV DNA examinations on admission, and development of sepsis in the process of treatment. Data were processed with chi-square test. Results (1) The incidence of liver damage in the process of treatment of these patients was 85.2% (46/54). Among all the patients, the proportion of liver damage was 35/38 in male, which was significantly higher than that in female (11/16, χ²=4.867, P<0.05). Liver damage was found in all of 26 patients who were HBeAg positive on admission, 34 patients who were HBV DNA positive on admission, and 36 patients who developed sepsis in the process of treatment; the proportions were significantly higher than those in patients who were HBeAg negative on admission (20/28), patients who were HBV DNA negative on admission (12/20), and patients who did not develop sepsis in the process of treatment (10/18), with χ² values respectively 11.801, 18.384, and 20.574, P values below 0.01. (2) The incidence of HBV reactivation in these patients was 29.6% (16/54). Among all the patients, the proportion of HBV reactivation was 13/38 in male and 3/16 in female, with no statistically significant difference between them (χ²=0.656, P>0.05). The proportions of HBV reactivation in patients who were HBeAg positive on admission, patients who were HBV DNA positive on admission, and patients who developed sepsis in the process of treatment were respectively 13/26, 16/34, and 15/36, and they were significantly higher than those in patients who were HBeAg negative on admission (3/28), patients who were HBV DNA negative on admission (0/20), and patients who did not develop sepsis in the process of treatment (1/18), with χ² values respectively 9.979, 18.615, and 5.873, P<0.05 or P<0.01. Conclusions Patients who are HBsAg positive, HBeAg positive, HBV DNA positive on admission, and develop sepsis in the process of treatment of extremely severe burn injury are more likely to develop liver damage and HBV reactivation. It is necessary to dynamically monitor the changes in HBV DNA and liver function, in order to identity the reactivation of virus.

2015, 31(4): 247-247. doi: 10.3760/cma.j.issn.1009-2587.2015.04.101

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Clinical study on application of intermittent hemofiltration combined with hemoperfusion in the early stage of severe burn in the prevention and treatment of sepsis

Guo Wanli, Lei Jin, Duan Peng, Ma Xiaoming

2015, 31(4): 248-253. doi: 10.3760/cma.j.issn.1009-2587.2015.04.003

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Objective To investigate the effects of application of intermittent hemofiltration combined with hemoperfusion (HP) in the early stage of severe burn in the prevention and treatment of sepsis. Methods Forty severely burned patients, admitted to our burn ward from June 2011 to March 2013, conforming to the study criteria, were divided into conventional treatment group (CT, n=20) and blood purification group (BP, n=20) according to the random number table. Patients in group CT received CT according to the accepted principles of treatment for a severe burn. Patients in group BP received CT and intermittent hemofiltration combined with HP once respectively on post injury day (PID) 3, 5, and 7, spanning 6 to 8 hours for each treatment. On PID 3, 5, 7, 10, and 14, body temperature, heart rate, and respiratory rate were recorded; white blood cell count (WBC), neutrophil granulocytes, blood urea nitrogen (BUN), and creatinine were determined; levels of IL–1, IL–6, TNF–α, and high–mobility group box 1 (HMGB1) in serum were determined by ELISA; level of LPS in serum was determined with the chromogenic substrate limulus amebocyte lysate method; level of procalcitonin (PCT) in serum was determined by double antibody sandwich immune chemiluminescence method. The symptoms and signs of sepsis were observed during the treatment. Data were processed with Fisher's exact test, chi–square test, analysis of variance for repeated measurement, and LSD–t test. Results (1) Except for that on PID 5, the mean body temperature of patients in group BP was significantly lower than that of group CT at each of the rest time points (with t values from 1.87 to 2.97, P values below 0.05). The heart rate was significantly slower in patients of group BP than in group CT from PID 3 to 14 (with t values from 1.78 to 3.59, P values below 0.05). Except for that on PID 3, the respiratory rate of patients in group BP was significantly slower than that of group CT at each of the rest time points (with t values from 1.93 to 2.85, P values below 0.05). (2) The levels of WBC, neutrophil granulocytes, BUN, and creatinine of patients in group BP were significantly lower than those of group CT (with t values from 1.78 to 4.23, P values below 0.05). (3) Except for that on PID 3, the level of IL–1 of patients in group BP was significantly lower than that of group CT at each of the rest time points (with t values from 1.97 to 4.16, P values below 0.05). Except for that on PID 7, the level of IL–6 of patients in group BP was significantly lower than that of group CT at each of the rest time points (with t values from 2.11 to 6.34, P values below 0.05). The levels of TNF–α and HMGB1 of patients in group BP were significantly lower than those of group CT from PID 3 to 14 (with t values from 1.98 to 5.29, P values below 0.05). (4) On PID 3, 5, 7, 10, and 14, the levels of LPS and PCT of patients in group BP were respectively (0.23±0.07), (0.27±0.09), (0.22±0.06), (0.20±0.08), (0.15±0.07) EU/mL, and (0.44±0.12), (0.67±0.13), (0.74±0.13), (0.64±0.12), (0.71±0.10) ng/mL, and they were lower than those of group CT [(0.37±0.08), (0.45±0.09), (0.56±0.09), (0.48±0.08), (0.40±0.08) EU/mL, and (0.74±0.11), (1.16±0.12), (1.40±0.13), (1.55±0.15), (1.49±0.14) ng/mL, with t values from 1.88 to 3.43, P values below 0.05]. (5) The incidence of sepsis of patients in group BP was obviously lower than that of group CT (χ²=6.94, P<0.01). Conclusions Intermittent hemofiltration combined with HP can effectively improve blood biochemical indexes and vital signs and reduce the occurrence of burn sepsis by decreasing the levels of proinflammatory cytokines, LPS, and PCT.

Effects of unified surgical scheme for wounds on the treatment outcome of patients with extensive deep burn

Tang Wenbin, Li Xiaojian, Deng Zhongyuan, Zhang Zhi, Zhang Xuhui, Zhang Tao, Zhong Xiaomin, Chen Bin, Liu Changling

2015, 31(4): 254-258. doi: 10.3760/cma.j.issn.1009-2587.2015.04.004

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Objective To investigate the effects of unified surgical scheme for wounds on the outcome of patients with extensive deep partial–thickness to full–thickness (briefly referred to as deep) burn. Methods One hundred and thirty–seven patients with extensive deep burn hospitalized from July 2007 to November 2012 underwent unified surgery according to area of deep wound (unified scheme group, US). Among them, 57 patients with deep wound area less than 51% TBSA received escharectomy or tangential excision by stages followed by autologous mesh skin grafting; 52 patients with deep wound area from 51% to 80% TBSA underwent escharectomy or tangential excision by stages followed by autologous mesh skin grafting and/or small skin grafting, or escharectomy or tangential excision followed by large sheet of allogeneic skin covering plus autologous mesh skin grafting and/or small skin grafting after the removal of allogeneic skin; 28 patients with deep wound area larger than 80% TBSA received escharectomy or tangential excision by stages followed by autologous microskin grafting plus coverage of large sheet of allogeneic skin, or escharectomy or tangential excision followed by small autologous skin grafting and/or intermingled grafting with small autologous and/or allogeneic skin. Another 120 patients with extensive deep burn hospitalized from January 2002 to June 2007 who did not receive unified surgical scheme were included as control group (C). Except for the surgical methods in group US, in 53 patients with deep wound area less than 51% TBSA in group C escharectomy or tangential excision was performed followed by autologous small skin grafting; in 40 patients with deep wound area from 51% to 80% TBSA in group C escharectomy or tangential excision was performed followed by autologous microskin grafting plus large sheet of allogeneic skin covering, or escharectomy or tangential excision followed by large sheet of allogeneic skin embedded with stamp–like autologous skin; in 27 patients with deep wound area larger than 80% TBSA in group C escharectomy or tangential excision was performed followed by covering with large sheet of allogeneic skin embedded with stamp–like autologous skin without intermingled grafting with small autologous and allogeneic skin in group US. In group US, escharectomy of full–thickness wound in extremities was performed with the use of tourniquet in every patient; saline containing adrenaline was subcutaneously injected when performing escharectomy or tangential excision over the trunk and skin excision; normal skin and healed superficial–thickness wound were used as donor sites for several times of skin excision. The baseline condition of patients and their treatment in the aspects of fluid resuscitation, nutrition support, anti–inflammation, and organ function support were similar between the two groups. The mortality and incidence of complications of all patients and wound healing time and times of surgery of healed patients were compared between the two groups. Data were processed with independent sample t test, Mann–Whitney U test, and Fisher's exact test. Results (1) Both the mortality and the incidence of complications of patients with deep wound area less than 51% TBSA in group US were 0, which were close to those of group C (with P values above 0.05). The number of times of surgery of healed patients with deep wound area less than 51% TBSA in group US was 2.4±0.9, which was obviously fewer than that of group C (3.5±1.8, U=–5.085, P<0.001), but with wound healing time close to that of group C (U=–1.480, P>0.05). (2) Both the mortality and the incidence of complications of patients with deep wound area from 51% to 80% TBSA in group US were 0, which were significantly lower than those of group C [both as 20.0% (8/40), with P values below 0.01]. The number of times of surgery and wound healing time of healed patients with deep wound area from 51% to 80% TBSA in group US were respectively 3.0±1.0 and (43±13) d, which were obviously fewer or shorter than those in group C [4.2±2.3 and (61±34) d, with U values respectively –2.491 and –2.186, P values below 0.05]. (3) Both the mortality and the incidence of complications of patients with deep wound area larger than 80% TBSA in group US were 25.0% (7/28), which were close to those of group C [both as 25.9% (7/27), with P values above 0.05]. The number of times of surgery and wound healing time of healed patients with deep wound area larger than 80% TBSA in group US were close to those of group C (with U values respectively –0.276 and –0.369, P values above 0.05). Conclusions Unified surgical scheme can indirectly decrease the mortality and the incidence of complications of burn patients with deep wound area from 51% to 80% TBSA; it can reduce times of surgery of healed patients of this type and shorten their wound healing time.

Effects of high frequency oscillatory ventilation combined with incremental positive end-expiratory pressure on myocardial ischemia and hypoxia and apoptosis of cardiomyocytes in dogs with smoke inhalation injury

Luo Jie, Guo Guanghua, Zhu Feng, Fu Zhonghua, Liao Xincheng, Liu Mingzhuo

2015, 31(4): 259-263. doi: 10.3760/cma.j.issn.1009-2587.2015.04.005

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Objective To compare the effects of high frequency oscillatory ventilation (HFOV) combined with incremental positive end-expiratory pressure (IP) and those of pure HFOV on myocardial ischemia and hypoxia and apoptosis of cardiomyocytes in dogs with smoke inhalation injury. Methods Twelve healthy male dogs were divided into group HFOV and group HFOV+ IP according to the random number table, with 6 dogs in each group. After being treated with conventional mechanical ventilation, dogs in both groups were inflicted with severe smoke inhalation injury, and then they received corresponding ventilation for 8 hours respectively. After treatment, the blood samples were collected from heart to determine the activity of creatine kinase-MB (CK-MB) and lactate dehydrogenase 1 (LDH1) in plasma. The dogs were sacrificed later. Myocardium was obtained for determination of content of TNF-α per gram myocardium by ELISA, apoptotic rate of cardiomyocytes by flow cytometer, degree of hypoxia with HE staining, and qualitative and quantitative expression of actin (denoted as integral absorbance value) with streptavidin-biotin-peroxidase staining. Data were processed with t test. The relationship between the content of TNF-α per gram myocardium and the apoptotic rate of cardiomyocytes was assessed by Spearman linear correlation analysis. Results (1) After treatment for 8 h, the values of activity of CK-MB and LDH1 in plasma of dogs in group HFOV+ IP were respectively (734±70) and (182±15) U/L, which were both lower than those in group HFOV [(831±79) and (203±16) U/L, with t values respectively 2.25 and 2.35, P values below 0.05]. (2) Compared with that in group HFOV [(0.060±0.018) μg], the content of TNF-α per gram myocardium of dogs in group HFOV+ IP after treatment for 8 h was decreased significantly [(0.040±0.011) μg, t=2.32, P<0.05]. (3) Compared with that in group HFOV [(33.4±2.2)%], the apoptotic rate of cardiomyocytes of dogs in group HFOV+ IP after treatment for 8 h was significantly decreased [(28.2±3.4)%, t=3.15, P<0.05]. There was a positive correlation between the content of TNF-α per gram myocardium and the apoptotic rate of cardiomyocytes (r=0.677, P<0.05). (4) HE staining showed that myocardial fibers of dogs in both groups were arranged in wave shape in different degrees, indicating there was myocardial hypoxia in different degrees. Compared with that of group HFOV, the degree of hypoxia in group HFOV+ IP was slighter. (5) The results of immunohistochemical staining showed that there was less loss of actin in myocardial fibers of dogs in group HFOV+ IP than in group HFOV. The expression level of actin in myocardium of dogs in group HFOV+ IP after treatment for 8 h (194.7±3.1) was obviously higher than that in group HFOV (172.9±2.6, t=13.20, P<0.01). Conclusions Compared with pure HFOV, HFOV combined with IP can alleviate the inflammatory reaction in myocardium of dogs, reduce the apoptosis of cardiomyocytes, and ameliorate the myocardial damage due to ischemia and hypoxia.

2015, 31(4): 264-266. doi: 10.3760/cma.j.issn.1009-2587.2015.04.006

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2015, 31(4): 266-266. doi: 10.3760/cma.j.issn.1009-2587.2015.04.103

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2015, 31(4): 267-270. doi: 10.3760/cma.j.issn.1009-2587.2015.04.007

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2015, 31(4): 270-273. doi: 10.3760/cma.j.issn.1009-2587.2015.04.008

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2015, 31(4): 274-276. doi: 10.3760/cma.j.issn.1009-2587.2015.04.009

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2015, 31(4): 277-278. doi: 10.3760/cma.j.issn.1009-2587.2015.04.010

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2015, 31(4): 278-279. doi: 10.3760/cma.j.issn.1009-2587.2015.04.011

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2015, 31(4): 279-279. doi: 10.3760/cma.j.issn.1009-2587.2015.04.102

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2015, 31(4): 290-292. doi: 10.3760/cma.j.issn.1009-2587.2015.04.014

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2015, 31(4): 293-294. doi: 10.3760/cma.j.issn.1009-2587.2015.04.015

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2015, 31(4): 295-297. doi: 10.3760/cma.j.issn.1009-2587.2015.04.016

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2015, 31(4): 297-300. doi: 10.3760/cma.j.issn.1009-2587.2015.04.017

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2015, 31(4): 300-303. doi: 10.3760/cma.j.issn.1009-2587.2015.04.018

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2015, 31(4): 304-305. doi: 10.3760/cma.j.issn.1009-2587.2015.04.019

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2015, 31(4): 306-307. doi: 10.3760/cma.j.issn.1009-2587.2015.04.020

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2015, 31(4): 308-310. doi: 10.3760/cma.j.issn.1009-2587.2015.04.021

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2015, 31(4): 310-311. doi: 10.3760/cma.j.issn.1009-2587.2015.04.022

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2015, 31(4): 312-314. doi: 10.3760/cma.j.issn.1009-2587.2015.04.023

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2015, 31(4): 318-319. doi: 10.3760/cma.j.issn.1009-2587.2015.04.025

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2015, 31(4): 320-320. doi: 10.3760/cma.j.issn.1009-2587.2015.04.026

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Surgical strategy for postburn cervical scar contracture

Feng Shaoqing, Su Weijie, Xi Wenjing, Min Peiru, Pu Zheming, Zhang Yan, Zhang Yixin

2015, 31(4): 280-284. doi: 10.3760/cma.j.issn.1009-2587.2015.04.012

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Objective To explore the surgical strategy for postburn cervical scar contracture. Methods Sixty–five patients with scar contracture as a result of burn injury in the neck were hospitalized from July 2013 to July 2014. Release of cervical scar contracture was conducted according to different demands of the 3 anatomic subunits of neck, i. e. lower lip vermilion border–supramaxillary region, submaxillary region, and anterior region of neck. After release of contracture, platysma was released. For some cases with chin retrusion, genioplasty with horizontal osteotomy was performed. The coverage of wound followed the principle of similarity, i. e. the skin tissue covering the wound in the neck should be similar to the characters of skin around the wound in terms of color, texture, and thickness. Based on this principle, except for the preschool children in whom skin grafting was performed, the wounds of the other patients were covered by local skin flaps, adjacent skin flaps, or free skin flaps. Results All patients underwent release of scar and platysma, while 9 patients underwent genioplasty with horizontal osteotomy. Wounds were covered with local skin flaps in 32 patients, with adjacent skin flaps in 7 patients, with free skin flaps in 11 patients, and with skin grafts in 15 patients. All skin grafts and flaps survived. Good range of motion was achieved in the neck of all patients, with the cervicomental angle after reconstruction ranging from 90 to 120°. All patients were followed up for 6 to 24 months. Six patients who had undergone skin grafting were found to have some degrees of skin contracture, while none of the patients who had undergone flap coverage showed any signs of contracture recurrence. Conclusions Restoration of the cervicomental angle is critical in the treatment of postburn cervical scar contracture, and the release of scar contracture should conform to the subunit principle. The coverage of wound should be based on the principle of similarity, with repair by skin flaps as the first choice, and skin grafting as the second choice. Satisfactory effect of repair would be achieved by following the above surgical principles.

Effects of inhibitory peptide of Staphylococcus epidermidis biofilm on adhesion and biofilm formation of this bacterium

Ouyang Jing, Xiong Lirong, Feng Wei, Sun Fengjun, Chen Yongchuan

2015, 31(4): 285-289. doi: 10.3760/cma.j.issn.1009-2587.2015.04.013

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Objective To study the effects of inhibitory peptide of Staphylococcus epidermidis (SE) biofilm (briefly referred to as inhibitory peptide) on adhesion and biofilm formation of SE at early stage. Methods By using peptide synthesizer, the inhibitory peptide was synthesized with purity of 96.8% and relative molecular mass of 874.4. (1) Solution of SE ATCC 35984 (the same below) was cultivated with inhibitory peptide in the final concentrations of 1–256 μg/mL, and the M-H broth without bacteria solution was used as blank control. The MIC of the inhibitory peptide against SE was determined (n=3). (2) Solution of SE was cultivated with trypticase soy broth (TSB) culture solution containing inhibitory peptide in the final concentrations of 16, 32, 64, 128, and 256 μg/mL (set as inhibitory peptide groups in corresponding concentration), and solution of SE being cultivated with TSB culture medium was used as negative control group. Growth of SE was observed every one hour from immediately after cultivation (denoted as absorbance value), and the growth curve of SE during the 24 hours of cultivation was drawn, with 3 samples in each group at each time point. (3) Solution of SE was cultivated with TSB culture solution containing inhibitory peptide in the final concentrations of 16, 32, 64, 128, and 256 μg/mL (set as inhibitory peptide groups in corresponding concentration), and solution of SE being cultivated with TSB culture medium was used as negative control group. Adhesive property of SE was observed after cultivation for 4 hours (denoted as absorbance value, n=10); biofilm formation of SE was observed after cultivation for 20 hours (denoted as absorbance value, n=10). (4) Solution of SE was cultivated with TSB culture solution containing inhibitory peptide in the final concentration of 128 μg/mL (set as 128 μg/mL inhibitory peptide group), and solution of SE being cultivated with TSB culture medium was used as negative control group. Adhesive property of SE and its biofilm formation were observed with confocal laser scanning microscope (CLSM), and the sample numbers were both 3. Data were processed with one-way analysis of variance, LSD test, and Dunnett T3 test. Results (1) The MIC of inhibitory peptide against SE exceeded 256 μg/mL. (2) There was no significant difference in the growth curve of SE between inhibitory peptide groups in different concentrations and negative control group. (3) After 4 hours of cultivation, the absorbance values of adhesive property of SE in 256, 128, 64, and 32 μg/mL inhibitory peptide groups were respectively 0.20±0.04, 0.27±0.03, 0.35±0.04, and 0.40±0.04, which were significantly lower than the absorbance value in negative control group (0.53±0.10, P<0.05 or P<0.01); the absorbance value of adhesive property of SE in 16 μg/mL inhibitory peptide group was 0.47±0.09, which was close to the absorbance value in negative control group (P>0.05). After 20 hours of cultivation, the absorbance values of biofilm formation of SE in 256, 128, and 64 μg/mL inhibitory peptide groups were respectively 0.49±0.10, 0.68±0.06, and 0.93±0.13, which were significantly less than the absorbance value in negative control group (1.21±0.18, P<0.05 or P<0.01); the absorbance values of biofilm formation in 32 and 16 μg/mL inhibitory peptide groups were respectively 1.18±0.22 and 1.15±0.26, which were close to the absorbance value in negative control group (with P values above 0.05). (4) CLSM showed that more adhering bacteria and compact structure of biofilm were observed in negative control group, but less adhering bacteria and loose structure of biofilm were observed in 128 μg/mL inhibitory peptide group. Conclusions The inhibitory peptide can inhibit adhesion and biofilm formation of SE at early stage, but its structure still needs to be further modified.

Advances in the research of mechanism of enhancement of wound healing with extracorporeal shock wave therapy

Zhao Jingchun, Xue Yan, Yu Jiaao, Shi Kai, Xian Chunjing, Zhou Xin

2015, 31(4): 315-317. doi: 10.3760/cma.j.issn.1009-2587.2015.04.024

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The vast majority of the published papers dealing with the treatment of wounds in the past few decades reported that extracorporeal shock wave therapy (ESWT) used in wound repair is easy in manipulation, noninvasive, safe, effective, and well tolerated by patients. However, little is known about the mechanism of ESWT in wound healing to date. In this article, we reviewed the literature to identify the potential cellular and molecular mechanisms of ESWT in the process of wound healing, and the results of the literature showed that the mechanism of ESWT in promoting wound healing is the result of heterogeneous biological effects.

2015 Vol. 31, No. 4

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