中华烧伤与创面修复杂志

Early precise diagnosis and reasonable management of burn wound

Luo Gaoxing

2017, 33(10): 593-596. doi: 10.3760/cma.j.issn.1009-2587.2017.10.001

PDF

Abstract:
Early precise diagnosis and reasonable management of burn wound are the foundation of burn treatment. They determine not only the outcome of the wound but also the prognosis of the burn patient. This article expounds how to diagnose the burn wound objectively and precisely at early stage. On the other hand, the reasonable management such as cooling therapy, escharectomy or tangential excision, and negative pressure wound therapy in the early stage of burn wound is mainly discussed.

Clinical effect of three dimensional human body scanning system BurnCalc in the evaluation of burn wound area

Lu Jin, Wang Liang, Zhang Yongcun, Tang Hongtai, Xia Zhaofan

2017, 33(10): 597-601. doi: 10.3760/cma.j.issn.1009-2587.2017.10.002

Abstract

PDF

Abstract:
Objective To validate the clinical effect of three dimensional human body scanning system BurnCalc developed by our research team in the evaluation of burn wound area. Methods A total of 48 burn patients treated in the outpatient department of our unit from January to June 2015, conforming to the study criteria, were enrolled in. For the first 12 patients, one wound on the limbs or torso was selected from each patient. The stability of the system was tested by 3 attending physicians using three dimensional human body scanning system BurnCalc to measure the area of wounds individually. For the following 36 patients, one wound was selected from each patient, including 12 wounds on limbs, front torso, and side torso, respectively. The area of wounds was measured by the same attending physician using transparency tracing method, National Institutes of Health (NIH) Image J method, and three dimensional human body scanning system BurnCalc, respectively. The time for getting information of 36 wounds by three methods was recorded by stopwatch. The stability among the testers was evaluated by the intra-class correlation coefficient (ICC). Data were processed with randomized blocks analysis of variance and Bonferroni test. Results (1) Wound area of patients measured by three physicians using three dimensional human body scanning system BurnCalc was (122±95), (121±95), and (123±96) cm^2, respectively, and there was no statistically significant difference among them ( F=1.55, P>0.05). The ICC among 3 physicians was 0.999. (2) The wound area of limbs of patients measured by transparency tracing method, NIH Image J method, and three dimensional human body scanning system BurnCalc was (84±50), (76±46), and (84±49) cm^2, respectively. There was no statistically significant difference in the wound area of limbs of patients measured by transparency tracing method and three dimensional human body scanning system BurnCalc (P>0.05). The wound area of limbs of patients measured by NIH Image J method was smaller than that measured by transparency tracing method and three dimensional human body scanning system BurnCalc (with P values below 0.05). There was no statistically significant difference in the wound area of front torso of patients measured by transparency tracing method, NIH Image J method, and three dimensional human body scanning system BurnCalc (F=0.33, P>0.05). The wound area of side torso of patients measured by transparency tracing method, NIH Image J method, and three dimensional human body scanning system BurnCalc was (169±88), (150±80), and (169±86) cm^2, respectively. There was no statistically significant difference in the wound area of side torso of patients measured by transparency tracing method and three dimensional human body scanning system BurnCalc (P>0.05). The wound area of side torso of patients measured by NIH Image J method was smaller than that measured by transparency tracing method and three dimensional human body scanning system BurnCalc (with P values below 0.05). (3) The time for getting information of wounds of patients by transparency tracing method, NIH Image J method, and three dimensional human body scanning system BurnCalc was (77±14), (10±3), and (9±3) s, respectively. The time for getting information of wounds of patients by transparency tracing method was longer than that by NIH Image J method and three dimensional human body scanning system BurnCalc (with P values below 0.05). The time for getting information of wounds of patients by three dimensional human body scanning system BurnCalc was close to that by NIH Image J method (P>0.05). Conclusions The three dimensional human body scanning system BurnCalc is stable and can accurately evaluate the wound area on limbs and torso of burn patients.

Effects of flap or myocutaneous flap combined with fascia lata or composite mesh on repairing severe high-voltage electrical burn wounds in abdomen of patients

Zhang Cong, Hu Xiaohua, Chen Hui, Ma Chunxu, Qin Fengjun, Wen Chunquan, Shen Yuming

2017, 33(10): 602-606. doi: 10.3760/cma.j.issn.1009-2587.2017.10.003

Abstract

PDF

Abstract:
Objective To investigate the effects of flap or myocutaneous flap combined with fascia lata or composite mesh on repairing wounds in abdomen of patients with severe high-voltage electrical burn. Methods From January 2010 to May 2017, 11 patients with severe high-voltage electrical burn in abdomen were hospitalized in our burn wards. In 3 hours to 7 days after burn, operation was performed when patients were in stable condition. After debridement, intestines with necrosis or perforation in 4 patients with peritoneal defects were resected and intestinal anastomosis was performed. The size of abdominal wounds after debridement ranged from 13 cm×9 cm to 41 cm×32 cm. Five patients were treated with rectus abdominis myocutaneous flap and size of which ranged from 14 cm×10 cm to 30 cm×17 cm. Among the above 5 patients, 4 patients with peritoneal defects used composite mesh of 25 cm×20 cm to enhance abdominal wall. Three patients were treated with tensor fascia lata myocutaneous flap, and size of the flap ranged from 24 cm×10 cm to 27 cm×13 cm. Three patients were treated with anterolateral thigh flap with fascia lata, and one of them was treated with the lobulated flap; size of the flap ranged from 18 cm×13 cm to 25 cm×15 cm. The later 6 patients used fascia lata of flap to enhance abdominal wall. The donor sites were sutured directly or repaired with intermediate split-thickness skin graft of thigh. Results After operation, flaps or myocutaneous flaps of patients were survived, and strength of abdominal wall recovered. During follow-up of 6 month to 1 year, flaps or myocutaneous flaps were in good appearance, with no ankylenteron or abdominal wall hernia. Conclusions Flap or myocutaneous flap combined with fascia lata or composite mesh can achieve good effects on repairing severe high-voltage electrical burn wounds in abdomen.

Clinical effects of middle and low peroneal artery perforator flap with pedicle on repairing skin and soft tissue defects of ankle

Li Hai, Zhang Cheng, Deng Chengliang, Tang Xiujun, Nie Kaiyu, Wei Zairong

2017, 33(10): 607-610. doi: 10.3760/cma.j.issn.1009-2587.2017.10.004

Abstract

PDF

Abstract:
Objective To investigate clinical effects of middle and low peroneal artery perforator flap with pedicle on repairing skin and soft tissue defects of ankle. Methods Twenty patients with skin and soft tissue defects of ankle and exposure of tendon and bone were admitted in our burn wards from April 2012 to December 2015. The size of skin and soft tissue defects ranged from 5 cm×4 cm to 23 cm×10 cm. Patients were treated with debridement and vacuum sealing drainage (VSD) after admission. After VSD treatment for 1 week, flap transplantation operation was performed. Middle and low perforating branches of peroneal artery were detected by portable Doppler blood flow meter before the operation. Flaps were designed and resected according wounds during the operation, with 1 or 2 middle and low perforating branches of peroneal artery in flaps. Seventeen patients were treated with middle and low peroneal artery perforator flap. Larger wounds with exposure of tendon and bone were repaired with middle and low peroneal artery perforator flap, and the other wounds were repaired with intermediate split-thickness skin graft of thigh on the same side in three patients. The size of flap ranged from 6 cm×5 cm to 25 cm×12 cm. The donor sites were sutured directly or repaired with intermediate split-thickness skin graft of thigh on the same side. Results After operation, 1 patient with partial skin necrosis at the distal of the flap because of disorder of venous circulation healed after dressing change and physiotherapy, and flaps of the other 19 patients survived well. During follow-up of 3 to 36 months, flaps of all patients were in good appearance, with no obvious cicatrix, and the affected limbs and ankle joints functioned well. Conclusions Middle and low peroneal artery perforator flap with advantages of stable perforating branch, reliable blood supply, and large resected size, can repair skin and soft tissue defects of ankle.

Effects of improved V-Y advancement flap with major artery perforator on repairing skin and soft tissue defects

Zhou Situo, Huang Mitao, Zeng Jizhang, Liang Pengfei, Zhang Minghua

2017, 33(10): 611-615. doi: 10.3760/cma.j.issn.1009-2587.2017.10.005

Abstract

PDF

Abstract:
Objective To explore the effect of improved V-Y advancement flap with major artery perforator on repairing several skin and soft tissue defects in whole body. Methods From March 2015 to June 2017, 4 cases with pressure ulcer in sacrococcygeal region, 4 cases with pressure ulcer at ischial tuberosity, 2 cases with scalp and skull defects at occiput, 1 case with secondary wound after tumor resection in axillary region, and 2 cases with skin and soft tissue defects caused by other trauma were hospitalized, with disease duration ranging from 1 week to 6 months. Bones, blood vessels, or nerves were exposed in wounds of 11 cases. After debridement, wounds with area ranging from 5 cm×4 cm to 15 cm×12 cm were repaired by improved V-Y advancement flap with major artery perforator including occipital artery perforator, arteria glutaea perforator, intercostal artery perforator, and peroneal artery perforator, and the area of flap ranged from 11 cm×5 cm to 35 cm×20 cm. Distal end of flaps additionally carried 1 major artery perforator in 4 cases. Results All flaps survived well without hemodynamic disorder, and wounds and donor sites healed well. During the follow-up for 3 to 18 months, the flaps were good in appearance with similar color and texture to normal skin around wound and without recurrence of rupture. Conclusions Compared with traditional V-Y advancement flap, the improved V-Y advancement flap with major artery perforator has the advantages of larger repair area, longer advance distance without tension, simple operation, and good appearance after operation, which is beneficial to clinical application.

Advances in the research of effects of regulation of cell autophagy on wound healing

Li Min, Liu Dewu

2017, 33(10): 625-628. doi: 10.3760/cma.j.issn.1009-2587.2017.10.009

Abstract

PDF

Abstract:
As one of the self-protection mechanism, autophagy widely exists in eukaryotic cells. It plays an important role in maintaining cells survival, update, material recycling, and tissue homeostasis. A series of researches discovered that autophagy played dual function in fibrotic diseases. The induction of autophagy can promote the degradation of collagen on one hand, on the other hand, the regulation of autophagy through microRNA, transforming growth factor β, and other factors can promote the occurrence of fibrosis. In wound healing, autophagy may participate in the pathophysiological processes of inflammation, reepithlialization, and wound remodeling. The regulation of cell autophagy may become an effective way and the new target for treatment of wound and pathological scar.

2017, 33(10): 610-610. doi: 10.3760/cma.j.issn.1009-2587.2017.10.101

Abstract

Abstract:

2017, 33(10): 616-618. doi: 10.3760/cma.j.issn.1009-2587.2017.10.006

Abstract

PDF

Abstract:

2017, 33(10): 619-622. doi: 10.3760/cma.j.issn.1009-2587.2017.10.007

Abstract

PDF

Abstract:

2017, 33(10): 623-624. doi: 10.3760/cma.j.issn.1009-2587.2017.10.008

Abstract

PDF

Abstract:

2017, 33(10): 638-638. doi: 10.3760/cma.j.issn.1009-2587.2017.10.102

Abstract

Abstract:

2017, 33(10): 643-643. doi: 10.3760/cma.j.issn.1009-2587.2017.10.103

Abstract

Abstract:

2017, 33(10): 644-645. doi: 10.3760/cma.j.issn.1009-2587.2017.10.013

Abstract

PDF

Abstract:

2017, 33(10): 646-647. doi: 10.3760/cma.j.issn.1009-2587.2017.10.014

Abstract

PDF

Abstract:

2017, 33(10): 648-649. doi: 10.3760/cma.j.issn.1009-2587.2017.10.015

Abstract

PDF

Abstract:

Analysis on on-site rescue and traumatic features of victims involved in gas explosion accident in Hangzhou

Wang Xin′gang, Jin Ronghua, Liu Fengping, Han Chunmao

2017, 33(10): 629-633. doi: 10.3760/cma.j.issn.1009-2587.2017.10.010

Abstract

PDF

Abstract:
Objective To investigate the situations of on-site rescue and traumatic features of victims involved in gas explosion accident in Hangzhou, so as to provide more data support for emergency medical rescues of the similar incidents of massive casualty. Methods Two medical workers with a certain clinical experience were sent to Hangzhou 120 emergency medical centers to collect data of the on-site rescue on 21st July, 2017, including ambulance call-outs, on-site command and traffic conditions, and on-site triage and evacuation of the victims. They were then sent to the hospitals receiving the victims to investigate the situations of these victims including the general information (such as gender, age, admitted hospitals, and number of admission, discharge, and transferring in the first two weeks after the accident) and injury assessment [such as injury position and type, injury severity evaluation by New Injury Severity Scoring (NISS), and burn severity evaluation for victims with burns]. Results (1) A total of 15 ambulances reached the accident site for rescue. The traffic and transportation were jammed and interrupted after this accident. On-site triage and distribution were disorderly conducted. (2) Clinical data of 53 victims were collected, including 24 males and 29 females, with the age of 8 to 70 (34±14) years old. They were sent into 6 hospitals in Hangzhou. Two victims died on the day of accident. Up to two weeks after this accident, 28 (52.8%) victims were discharged from the hospitals and received follow-up in outpatient department. Five victims with severe injuries were transferred to the other hospitals. (3) Based on the results of NISS, the injury severities were mild in 29 (54.7%) cases, moderate in 9 (17.0%) cases, serious in 3 (5.7%) cases, and severe in 12 (22.6%) cases. Those 2 dead victims were classified into the severe category due to the highest NISS score of 75. For all of the victims, skin and soft tissue defects were most common. Six (11.3%) victims were combined with burns. According to the classification of burn severity, there were one case of mild, one case of serious, and 4 cases of severe. Conclusions The gas explosion accident in Hangzhou caused massive casualties with complex injuries. The local emergency medical rescue responded quickly, but during the rescue process, lots of aspects should be further improved.

The expression of SnoN in human hypertrophic scar fibroblasts and the mechanism of its participation in hypertrophic scar formation

Kuang Fang, Zhang Zhi, Chen Bin, Liu Changling, Zhao Yuanyuan, Xu Zhirong, Li Xiaojian

2017, 33(10): 634-638. doi: 10.3760/cma.j.issn.1009-2587.2017.10.011

Abstract

PDF

Abstract:
Objective To investigate the expression of SnoN in human hypertrophic scar fibroblasts and the mechanism of its participation in hypertrophic scar formation. Methods Eight patients with hypertrophic scar after burn in need of surgery were admitted in our unit from January to October 2013, and then hypertrophic scar tissue and normal skin tissue of full-thickness skin donor site resected by surgery of the patients were collected. Hypertrophic scar fibroblasts and normal skin fibroblasts of patients were isolated with method of explant culture and then sub-cultured. Cells of the third to fifth passage were used in the following experiments. (1) The protein expressions of SnoN of hypertrophic scar fibroblasts and normal skin fibroblasts were assessed with Western blotting. (2) The mRNA expressions of SnoN of another batch of hypertrophic scar fibroblasts and normal skin fibroblasts were determined with reverse transcription polymerase chain reaction. (3) Another batch of hypertrophic scar fibroblasts and normal skin fibroblasts were treated with 10 ng/mL transforming growth factor beta1 (TGF-β₁) for 30 min, 1 h, 2 h, and 6 h, respectively, and then the protein expressions and mRNA expressions of SnoN of untreated cells and treated cells were detected as above. Data were processed with one way analysis of variance and independent sample t test. Results (1) The protein expression of SnoN of hypertrophic scar fibroblasts was 0.020±0.003, significantly lower than that of normal skin fibroblasts (0.032±0.005, t=7.19, P<0.05). (2) The mRNA expression of SnoN of hypertrophic scar fibroblasts was 0.407±0.157, with no significant difference from that of normal skin fibroblasts (0.339±0.095, t=-1.29, P>0.05). (3) The protein expression of SnoN of normal skin fibroblasts was increased in a time-dependent fashion with the TGF-β₁ stimulation, and the protein expressions of SnoN of cells treated with TGF-β₁ for 30 min, 1 h, 2 h, and 6 h were significantly higher than those of untreated cells (with t values from 2.27 to 27.89, P values below 0.05). The protein expression of SnoN of hypertrophic scar fibroblasts was decreased in a time-dependent fashion with the TGF-β₁ stimulation, and the protein expressions of SnoN of cells treated with TGF-β₁ for 30 min, 1 h, 2 h, and 6 h were obviously lower than those of untreated cells (with t values from 10.80 to 13.85, P values below 0.05). (4) The mRNA expressions of SnoN of normal skin fibroblasts and hypertrophic scar fibroblasts were both increased in a time-dependent fashion with the TGF-β₁ stimulation, and the mRNA expressions of SnoN of the two types of cells treated with TGF-β₁ for 30 min, 1 h, 2 h, and 6 h were both significantly higher than those of untreated cells (with t values from 18.16 to 58.22, P values below 0.05). Conclusions The protein expression of SnoN in hypertrophic scar fibroblasts is reduced, which weakens its inhibitory effect on TGF-β₁ signal, thus amplifying the TGF-β₁ signal, and it may participate in the formation of hypertrophic scar.

Differential expression of microRNAs in serum of severe burn patients and analysis of the signaling pathway at early stage

Wang Shan, Ruan Qiongfang, Xie Weiguo, Chen Lan, Jiang Meijun, Ruan jingjing, Ye Ziqing

2017, 33(10): 639-643. doi: 10.3760/cma.j.issn.1009-2587.2017.10.012

Abstract

PDF

Abstract:
Objective To explore differential expression of microRNAs in serum of patients with severe burn and analysis of the signaling pathway at early stage. Methods In this study, we included three healthy adult volunteers and three patients with severe burn, conforming to the inclusion criteria and hospitalized in Tongren Hospital of Wuhan University & Wuhan Third Hospital in July 2015. Venous whole blood of 6 mL of each burn patient and healthy volunteer was collected at 24 to 48 h post injury of burn patients. The whole blood was divided into burn group and healthy control group. Whole blood of 2 mL of each one was used to determine white blood cell count and neutrophile granulocyte content. Serum was separated from the other whole blood of 4 mL of each one. Half of serum was used to determine content of blood glucose, total protein, and albumin; another half of serum was used to extract total RNA with Trizol method. The differentially expressed microRNA, with differential expression ratio larger than or equal to 1.500 between 2 groups, were screened by microRNA chip technique. Then cluster analysis and functional enrichment analysis of Kyoto encyclopedia of genes and genomes (KEGG) signaling pathway were performed on the differentially expressed microRNAs. Data were processed with t test. Results (1) Content of white blood cell count, neutrophile granulocyte of whole blood, and blood glucose of serum of patients in burn group was obviously higher than that in healthy control group (with t values from 4.27 to 7.83, P<0.05 or P<0.01). Content of total protein and albumin of serum of patients in burn group was significantly lower than that in healthy control group (with t values respectively -12.80 and -12.36, P values below 0.01). (2)Compared with those in serum of healthy control group, differential expression ratios of 48 microRNAs in serum of burn group were larger than 1.500, with 22 up-regulated microRNAs and 26 down-regulated microRNAs. MicroRNA expression profile in serum of burn group was different from that of healthy control group. (3)Functional enrichment analysis of KEGG signaling pathway showed that compared with those in serum of healthy control group, microRNAs of differential expression in serum of burn group took part in tumor transcription misregulation signaling pathway, tumor proteoglycan signaling pathway, long-term potentiation signaling pathway, tumor associated microRNAs signaling pathway, citrate cycle signaling pathway, tumor necrosis factor signaling pathway, focal adhesion signaling pathway, endocytosis signaling pathway, insulin secretion signaling pathway, and estrogen signaling pathway. Conclusions MicroRNA expression profile in serum of patients with severe burn is different from that in serum of healthy adults. MicroRNAs of differential expression may take part in important pathophysiological process of energy metabolism, inflammatory response, and regulation of blood glucose at early stage of severe burn.

Application advances of three-dimensional bioprinting in burn and plastic surgery field

Li Rubing, Li Minxiong, Guo Guanghua, Zhang Hongyan

2017, 33(10): 650-652. doi: 10.3760/cma.j.issn.1009-2587.2017.10.016

Abstract

PDF

Abstract:
Three-dimensional bioprinting is one of the latest and fastest growing technologies in the medical field. It has been implemented to print part of the transplantable tissues and organs, such as skin, ear, and bone. This paper introduces the application status, challenges, and application prospect of three-dimensional bioprinting in burn and plastic surgery field.

Advances in the research of treatment of angiogenesis inhibitor on pathological scars

Dong Liang, Fang Yong

2017, 33(10): 653-656. doi: 10.3760/cma.j.issn.1009-2587.2017.10.017

Abstract

PDF

Abstract:
Angiogenesis inhibitors are a class of agents that prevent the angiogenesis by inhibiting the activation, migration, and proliferation of endothelial cells. In recent years, studies have found that there was a close relationship between the occurrence of pathological scars and angiogenesis. The vascular density in pathological scars is significantly higher than that in normal skin and scars. Neovascularization supports the fibroblasts growth and collagen production, which contribute to the development of pathological scars. Therefore, the angiogenesis inhibitor may become a possible agent for prevention and treatment of pathological scars. This review explores the relationship between pathological scars and angiogenesis inhibitor.

2017 Vol. 33, No. 10

Guidelines and Consensus>>

Notice>>