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2018 Vol. 34, No. 12

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Burn Medicine Over the Past 60 Years
The Burn and Plastic Surgery Association of CPLA in thirty years
The Burn and Plastic Surgery Association of CPLA
2018, 34(12): 833-834. doi: 10.3760/cma.j.issn.1009-2587.2018.12.001
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The founding and the development of the Burn and Plastic Surgery Association of the People′s Liberation Army of China (CPLA) were reviewed. It was in 1962 that the Burn Surgery Association of CPLA was founded on the basis of the Burn Collaboration Group of the Army and it was enlarged to become the Burn and Plastic Surgery Association in 1978. Its members consist of the Burn Units of the four Military Medical Universities, all the major hospitals of the Army, Navy and Air Force, and other military medical services. At present an extensive network for academic communications on burn and plastic surgery has been established within the Army. The association has so far sponsored 14 academic conferences, which in fact were nation-wide gatherings since the participants included most of the colleagues and experts of the field no matter they were civilians or in uniform. In recent years, the research on basic sciences related to burn and plastic surgery is very active and has achieved quite remarkable results.In addition, our communications with the colleagues overseas have also been established and several international conferences on the speciality have consecutively been held by the association.
Initiation, development, and achievements of burn rehabilitation therapy in China
Guo Zhenrong, Li Feng, Tu Haixia, Gao Guozhen, Cui Xiaolin, Zhang Bo, Lu Changhong, Zhang Ping
2018, 34(12): 835-839. doi: 10.3760/cma.j.issn.1009-2587.2018.12.002
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Burn rehabilitation in China started from compression therapy in the mid-1970s, which showed the dual effects of prevention and treatment of hypertrophic scars. It not only promoted functional rehabilitation but also strengthened the confidence of patients in rehabilitation treatment. Thereafter, more therapies were brought into practice, such as intra-scar injection of triamcinolone acetonide, application of plastic splints, hydrotherapy, exercises with equipment, skin care, local therapeutic massage, active and passive exercises, as well as external use of drugs for inhibiting scars and pigments. Since the beginning of the 21st century, rehabilitation therapies have been gradually increasing. Psychological rehabilitation, occupational therapy, external use of silicone gel, wax therapy and sound, light, electricity, and radiation therapy have been carried out. Many hospitals have established foundations and held summer camps for children. As far as the whole country is concerned, compared with the huge demand, we still face a number of problems such as shortage of working staff, limited working space, capital chain rupture, lack of multi-disciplinary cooperation, untimely treatment, and incomplete rehabilitation. Nowadays, with increasing knowledge of burn rehabilitation and number of practitioners, improvement of equipment and economic situation, the pace of rehabilitation has accelerated, and the overall implementation of burn rehabilitation therapy has shown great vitality. Patients with burn injury involving over 80% total burn surface area (TBSA) of total burn area or full-thickness burn over 60% TBSA were cured and recovered in different levels of hospitals nationwide, which not only reflects the superb level of burn treatment in China but also reflects the overall improvement of rehabilitation level of the country.
Sixty years′ innovative development of the Department of Burns and Plastic Surgery of the Fourth Medical Center of PLA General Hospital
Shen Chuan′an
2018, 34(12): 840-843. doi: 10.3760/cma.j.issn.1009-2587.2018.12.003
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The Department of Burns and Plastic Surgery of the Fouth Medical Center of PLA General Hospital (the former 304th hospital of PLA) was established in 1958 as one of the earliest specialized burn departments in China. In the pioneering efforts of professor Sheng Zhiyong, an internationally renowned authority in burn surgery and an academician of the Chinese Academy of Engineering, several generations of the department represented by Zhu Zhaoming, GuoZhenrong, Chai Jiake, Yang Hongming, and Shen Chuan′an have worked hard from inheritance to innovation. The Department of Burns and Plastic Surgery has evolved from a simple treatment-oriented department to a military priority built discipline, a military burn research institute, a national key clinical specialty and a national key discipline which integrates treatment, scientific research, achievement transformation, and talent training. At present, our department has 300 beds in total, and we have our own outpatient and emergency service, registration and toll service, 7 operation rooms, medical cosmetics center, hair transplantation center, rehabilitation and physical exercise center, skin care center, and specialized laboratory. In recent years, we have treated more than 70 000 emergency patients and outpatients every year, admitted over 6 500 inpatients annually, and conducted more than 9 000 operations yearly. Our department ranks among the top in the specialized departments with the same size across the country. Our burn cure rate stands at 99.5%, and 50% lethal area is 98% total body surface area, ranking in the international leading level.
A review of the 60 years of Department of Burns and Cutaneous Surgery in Xijing Hospital
Han Juntao, Hu Dahai
2018, 34(12): 844-846. doi: 10.3760/cma.j.issn.1009-2587.2018.12.004
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This article briefly introduces the development history of Department of Burns and Cutaneous Surgery in Xijing Hospital of Air Force Medical University (the former the Fourth Military Medical University) since its establishment more than 60 years ago. The medical staff of the department have been adhering to the treatment concept of the older generation of experts and professors, applying the principles and methods of plastic surgery to the treatment of deep burn wounds. Furthermore, the new techniques in the field of flap surgery, microsurgery, and minimally invasive surgery are applied to repair various complex wounds after burn/trauma and severe scar deformities. Our department has formed our own distinctive technical features and contributed to the development of burn cause in China.
To analyze the past, present, and future of burn medicine from the sixty years of burn surgery in Hubei province
Xie Weiguo
2018, 34(12): 847-851. doi: 10.3760/cma.j.issn.1009-2587.2018.12.005
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By looking back the sixty years′ history of burn surgery in Hubei province, the achievements and experience of the development of burn discipline in the province were summarized, and the problems of development and trends in the future of burn surgery were discussed.
Forward marching Department of Burns of the First Affiliated Hospital of Anhui Medical University
Xu Qinglian, Song Junhui
2018, 34(12): 852-854. doi: 10.3760/cma.j.issn.1009-2587.2018.12.006
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For 60 years, through the continuous efforts, the Department of Burns of the First Affiliated Hospital of Anhui Medical University has made many contributions to the treatment of burns in Chinese and Western medicine during the early phase of the establishment of the department. In recent years, we have also made some achievements in acute and chronic wound repair, burn immunonutrition, burn sepsis, and shock fluid recovery. In the future, we will work harder to make due contributions to the Chinese burn medicine.
Retrospect and prospect of development of Department of Burn Surgery in Guangdong General Hospital
Lai Wen, Sun Chuanwei, Chen Huade
2018, 34(12): 855-858. doi: 10.3760/cma.j.issn.1009-2587.2018.12.007
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Guangdong General Hospital set up burn treatment specialist group in 1960. It was one of the hospitals which set up the department of burns in the early time. In the past 58 years, Department of Burn Surgery in Guangdong General Hospital has treated more than 20 000 burn patients, with overall success rate of 98.58%, standing at the global frontier. In the past 58 years, under the leadership of professors Chen Huade and Lai Wen and through the unremitting efforts of the colleagues, our department has developed from a burn treatment specialist group to the key clinical specialty of Guangdong province, sample unit of hundred level of laminar burn care ward, unit of chairman of the second and third committees of the Burn Branch of Guangdong Medical Association, the base of the National Good Clinical Practice, and has provided high level of burn treatment service for people in South China.
Academician Forum
Establishment of a wound care discipline system in China: the review of the construction of wound care center with Chinese characteristics in 20 years and prospect
Fu Xiaobing
2018, 34(12): 859-863. doi: 10.3760/cma.j.issn.1009-2587.2018.12.008
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The construction of wound treatment specialty (center) with Chinese characteristics began in the early 21st century. Based on my personal experience, this paper systematically reviews the key points and characteristics of the specialty (center) construction of wound treatment with Chinese characteristics and its phased progress. Its future development is also prospected.
Expert Forum
Summary of advances in the research of wound therapy
Han Chunmao, Yu Meirong, Wang Xingang
2018, 34(12): 864-867. doi: 10.3760/cma.j.issn.1009-2587.2018.12.009
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Wound healing is a complex and sequential biological process involving various cells and factors under body′s regulation. Appropriate interventions play positive roles in promoting effective wound healing and improving healing quality. In the clinical practice, there are many new instruments, dressings, and drugs developed for wound care, including antibacterial dressings, wet dressings, precise debridement, negative pressure wound therapy, cytokines/growth factors, and dermal substitutes, which provide revolutionary means for wound treatment. This article summarizes the effective or mature methods in wound care, providing theoretical and practical basis for choosing appropriate treatment methods in different stages of wound.
2018, 34(12): 867-867. doi: 10.3760/cma.j.issn.1009-2587.2018.12.101
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2018, 34(12): 906-906. doi: 10.3760/cma.j.issn.1009-2587.2018.12.102
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2018, 34(12): 909-909. doi: 10.3760/cma.j.issn.1009-2587.2018.12.103
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Thoughts of Diagnosis and Treatment
Thoughts and principles of diagnosis and treatment of chronic refractory wounds in China
Dong Wei, Xiao Yurui, Wu Minjie, Jiang Duyin, Nie Lanjun, Liu Yingkai, Tang Jiajun, Tian Ming, Wang Chunlan, Huang Lifang, Dong Jiaoyun, Cao Xiaozan, Song Fei, Ji Xiaoyun, Ma Xian, Kang Yutian, Jin Shuwen, Qing Chun, Lu Shuliang
2018, 34(12): 868-873. doi: 10.3760/cma.j.issn.1009-2587.2018.12.010
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The correct thoughts and principles of diagnosis and treatment of chronic refractory wounds need to be formulated. Through the relevant domestic and international consensus and based on clinical experience, the Thoughts and principles of diagnosis and treatment of chronic refractory wounds in China is proposed. It is considered that in the diagnosis and treatment of chronic refractory wounds, in the case of fully understanding the patient′s medical history, the following thoughts and principles should be complied in order. (1) Pay attention to the cleanliness of the wound after being cleaned. (2) Reasonably perform debridement to avoid being " excessive" or " not thorough". (3) Reasonably perform examination, diagnosis, and differential diagnosis of pathogenic factors. (4) Treat according to etiology. (5) Find comorbidities and prevent adverse outcomes. (6) Select the correct wound treatment method reasonably and timely. When the conservative wound care treatment is considered, pay attention to embodying the concept of etiological treatment, treat the wound according to the principles of safety, phase, selectivity, and effectiveness, and make a reasonable choice of continuing conservative treatment or surgical treatment in time after completing the preparation of the wound bed. When surgical treatment is considered, pay attention to the selection of reasonable surgical method and donor site, pay attention to the healing rate of surgical wound site and the outcome of donor site, and give reasonable protection to the wound site after surgery. (7) Carry out rehabilitation treatment after wound healing and related health education.
Original Article·Wound Repair
Clinical application of computed tomography angiography and three-dimensional reconstruction in repairing high-voltage electrical burn wounds in necks, shoulders, axillas, and upper arms with tissue flaps
Yang Zhibin, Niu Jiandong, Ma Yong, Li Jinning, Shen Jiangyong, Yao Ming
2018, 34(12): 874-880. doi: 10.3760/cma.j.issn.1009-2587.2018.12.011
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Objective To explore the application value of computed tomography angiography (CTA) and three-dimensional reconstruction in repairing high-voltage electrical burn wounds in necks, shoulders, axillas, and upper arms with tissue flaps. Methods From December 2014 to December 2018, 12 patients with high-voltage electrical burns in necks, shoulders, axillas, and upper arms were hospitalized. The size of wounds ranged from 13 cm×10 cm to 32 cm×15 cm after complete debridement. Before tissue flap repair, the subclavian artery-axillary artery-brachial artery and their branches were examined by CTA. The main target vessels and their branches were conducted by three-dimensional reconstruction, and the development of the axis vessels for the tissue flaps planning to dissect and their branches were observed. For wounds in upper arms, amputation stump bone exposed wounds, and wounds in axillas and the anterior, the latissimus dorsi myocutaneous flap is the first choice for repair, if the thoracodorsal artery and internal and external branches are well developed according to CTA examination. Latissimus dorsi myocutaneous flaps were used in 6 patients with the area of myocutaneous flap ranging from 16 cm×12 cm to 32 cm×17 cm. All the donor sites were covered by split-thickness skin graft of thighs. For large wounds in occiputs, necks, and scapulas, the contralateral lower trapezius myocutaneous flap is the first choice for repair, if the superficial descending branch and deep branch of the contralateral transverse cervical artery are well developed according to CTA examination. For small wounds in necks and scapulas, the ipsilateral lower trapezius myocutaneous flap can be used for repair, if the superficial descending branch of the ipsilateral transverse cervical artery is well developed according to CTA examination. Lower trapezius myocutaneous flaps were used in 4 patients with the area of myocutaneous flap ranging from 18 cm×12 cm to 25 cm×17 cm. The donor site of one patient was sutured directly and the donor site of the other 3 patients was covered by split-thickness skin graft of thighs. For wounds in the posteromedial side of upper arms and the anterior side of axillas, the lateral thoracic skin flaps can be used for repair, if the latissimus dorsi myocutaneous flap can not be utilized for reasons of back burn or no muscle is needed for dead space, when the blood supply of side chest skin is reliable according to CTA examination. Lateral thoracic skin flaps were used in 2 patients with the area of skin flap ranging from 16 cm×12 cm to 17 cm×14 cm. The donor site of one patient was sutured directly and the donor site of the other one patient was covered by split-thickness skin graft of thigh. Results During the operation of tissue flap repair in 12 patients, the orientation and starting position of the axis vessels were consistent with those observed by CTA examination before operation. All the tissue flaps survived after operation. During follow-up of 1 to 24 months, the patients were satisfied with no serious scar contracture affecting the function nor secondary infection or chronic ulcer. Conclusions CTA and its three-dimensional reconstruction technique can clearly reconstruct the subclavian artery-axillary artery-brachial artery and their branches before repair of high-voltage burn wounds in necks, shoulders, axillas, and upper arms. It can be used to observe whether the vessels are embolized or not and the starting position and orientation of blood vessels, which can provide an important reference for the selection of tissue flap transplantion.
Clinical efficacy observation on combination of narrow-spectrum medium-wave ultraviolet, red light, and low power He-Ne laser in treating post-burn eczema
Zhao Haiyang, Wang Hongtao, Zhu Chan, Dang Rui, Liang Min, Qi Zongshi, Hu Dahai
2018, 34(12): 881-886. doi: 10.3760/cma.j.issn.1009-2587.2018.12.012
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Objective To investigate the clinical effects of combined utilization of narrow-spectrum medium-wave ultraviolet, red light, and low power He-Ne laser on treatment of post-burn eczema. Methods From July 2014 to July 2017, 80 patients with post-burn eczema who met the study inclusion criteria were treated in our burn rehabilitation center, and their clinical data were analyzed retrospectively. Patients were divided into ultraviolet treatment group, red light treatment group, laser treatment group, and combination treatment group according to the utilized treatment methods, with 20 cases in each group. Patients in ultraviolet treatment group were treated with narrow-spectrum medium-wave ultraviolet once every other day for 10 minutes each time. Patients in red light treatment group and laser treatment group were treated with red-light and low power He-Ne laser respectively once a day for 10 minutes each time. Patients in combination treatment group were treated with combination of the above three methods without sequence or interval time, and the treatment time and interval time were the same as the previously described. All patients were treated for four weeks since the time of admission. The itching degree, surface area of the affected body, degree of keratosis, and degree of cracking of target tissue were evaluated using Eczema Area and Severity Index (EASI) scoring method after each treatment. Eczema improvement rate was calculated according to the total score of EASI to determine the curative effect. The therapeutic effective time was recorded. The therapeutic effective rate was calculated according to the total scores of EASI before treatment for the first time and 4 weeks after treatment. Besides, the adverse reactions of patients were also observed and recorded. Data were analyzed by Chi-square test, Kruskal-Wallis rank sum test, Wilcoxon signed rank sum test, one-way analysis of variance, Least Significant Difference-t test, and Bonferroni correction. Results Therapeutic effective times of eczema of patients in ultraviolet treatment group, red light treatment group, and laser treatment group were similar, respectively (13.7±1.3), (16.4±1.6), and (15.1±1.7) d (t=0.32, 0.58, 0.74, P>0.05). The therapeutic effective time of combination treatment group was (6.3±0.9) d, significantly shorter than that of ultraviolet treatment group, red light treatment group, or laser treatment group (t=5.62, 4.72, 4.61, P<0.05 or P<0.01). Compared with those before treatment for the first time, eczema itching degree, surface area of affected body, degree of keratosis, degree of cracking, and total score of EASI of patients in ultraviolet treatment group, red light treatment group, laser treatment group, and combination treatment group showed obvious improvement in 4 weeks after treatment (Z=5.372, 4.392, 4.284, 3.998, 4.092, 3.904, 4.042, 4.216, 3.684, 3.890, 5.081, 4.794, 4.094, 3.493, 3.995, 5.084, 4.903, 4.384, 3.995, 4.063, P<0.05 or P<0.01). Each item score and total score of EASI of eczema of patients in the first three groups were close (P>0.05), while each item score and total score of EASI of eczema of patients in combination treatment group was significantly better than those of ultraviolet treatment group, red light treatment group, and laser treatment group (H=2.482, 2.491, 3.583, 3.462, 6.025, 2.492, 3.693, 3.085, 3.482, 6.042, 5.831, 5.831, 4.893, 4.092, 6.931, P<0.05). Therapeutic effective rates of eczema of patients in ultraviolet treatment group, red light treatment group, and laser treatment group were close, respectively 60%, 60%, and 55% (χ2=1.46, 1.63, 0.97, P>0.05). The therapeutic effective rate of eczema of patients in combination treatment group was 90%, significantly higher than that of ultraviolet treatment group, red light treatment group, or laser treatment group (χ2=3.43, 4.15, 2.97, P<0.05 or P<0.01). There were no serious adverse reactions appeared in patients of all the four groups after treatment. Three patients in ultraviolet treatment group had local skin erythema, which was alleviated after symptomatic treatment. Conclusions Combination of narrow-spectrum medium-wave ultraviolet, red light, and low power He-Ne laser in treating post-burn eczema is superior to single therapy in terms of clinical effective time and efficacy, which has no obvious adverse reaction and is worthy of promotion.
Effects of human adipose-derived mesenchymal stem cells and platelet-rich plasma on healing of wounds with full-thickness skin defects in mice
Lei Xiaoxuan, Xu Pengcheng, Zhang Lei, Pang Mengru, Tian Ju, Cheng Biao
2018, 34(12): 887-894. doi: 10.3760/cma.j.issn.1009-2587.2018.12.013
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Objective To investigate the effects of human adipose-derived mesenchymal stem cells (ADSCs) and platelet-rich plasma (PRP) on healing of wounds with full-thickness skin defects in mice. Methods ADSCs were isolated from the lumbar and abdominal fat donated voluntarily by a healthy woman undergoing liposuction in the Department of Plastic Surgery of Guangzhou General Hospital of Guangzhou Military Area Command, and the cells were cultured and identified. ADSCs of the second passage were used in the following experiments. The venous blood of the volunteer was taken, and PRP was obtained by secondary centrifugation. Thirty-six C57BL/6 mice were divided into simple injury group (n=12), simple ADSCs treatment group (n=12), and ADSCs+ PRP treatment group (n=12) according to the random number table. Each mouse was inflicted with a 1 cm×1 cm wound with full-thickness skin defect on the back. Immediately after injury, the wounds of mice in simple injury group were subcutaneously injected with 1 mL normal saline, the wounds of mice in simple ADSCs treatment group were subcutaneously injected with 1 mL phosphate buffer solution-blended ADSCs suspension (with concentration of 5×105 /mL, the same below), and the wounds of mice in ADSCs+ PRP treatment group were subcutaneously injected with 1 mL mixture of PRP and ADSCs (1∶2 volume ratio). Three mice in each group were taken on post injury day (PID) 3, 5, 7, and 14 to observe the gross condition of wound, and the wound healing rate was calculated. On PID 3, 5, and 7, the non-healing wound tissue and 0.5 cm normal skin tissue around the wound margin were taken after gross observation. The inflammation, re-epithelialization, and angiogenesis of tissue were observed by hematoxylin and eosin staining, and the re-epithelialization rate was calculated. The collagen synthesis of tissue was observed by masson staining. Immunohistochemistry was used to observe the expression of macrophages of tissue samples collected on PID 3 and 5. Data were processed with analysis of variance of factorial design and Least-Significant Difference test. Results (1) On PID 3, the wounds of mice in ADSCs+ PRP treatment group were with granulation tissue regeneration, redness, and swelling, and the wounds of mice in the other two groups were ruddy and with effusion. On PID 5, the wounds of mice in ADSCs+ PRP treatment group had less redness and swelling, which were dry with obvious scab, and wounds of mice in the other two groups were obviously red and swollen. On PID 7, scab formed basically on wounds of mice in the three groups. On PID 14, the wounds of mice in the three groups basically healed, and their crusts were off. On PID 3, 5, 7, and 14, the wound healing rates of mice in ADSCs+ PRP treatment group were obviously higher than those of the other two groups (P<0.05 or P<0.01). On PID 5 and 7, the wound healing rates of mice in simple ADSCs treatment group were obviously higher than those of simple injury group (P<0.01). (2) On PID 3, granulation tissue regeneration of wounds in ADSCs+ PRP treatment group was more than that in the other two groups. On PID 5, inflammatory reaction of wounds of mice was mild in ADSCs+ PRP treatment group, which was severe in the other two groups. On PID 7, the re-epithelialization process of wounds of mice was almost completed in ADSCs+ PRP treatment group, and the number of new vessels was more in ADSCs+ PRP treatment group than in the other two groups. The migration distance of regenerated epithelia around the wound edge in simple injury group and simple ADSCs treatment group was short. On PID 3, 5, and 7, the re-epithelialization rates of wounds of mice in ADSCs+ PRP treatment group were (37.6±4.5)%, (59.1±1.3)%, and (89.2±4.3)%, respectively, significantly higher than (25.7±1.5)%, (34.5±4.4)%, and (50.8±2.7)% in simple injury group and (29.1±0.8)%, (42.6±2.9)%, and (72.9±3.0)% in simple ADSCs treatment group (P<0.01). On PID 5 and 7, the re-epithelialization rates of wounds of mice in simple ADSCs treatment group were significantly higher than those in simple injury group (P<0.05 or P<0.01). (3) On PID 3 and 5, a quite large number of new collagen fibers appeared in granulation tissue of wounds of ADSCs+ PRP treatment group, while the collagen fibers in the other two groups were less. On PID 7, the granulation tissue of mice in ADSCs+ PRP treatment group decreased, and a large number of new collagen fibers appeared. The collagen fibers in wounds tissue of mice in simple ADSCs treatment group increased, while the collagen fibers deposited in wounds tissue of mice in simple injury group was still less. (4) On PID 3 and 5, the numbers of macrophages in wounds tissue of mice in simple ADSCs treatment group were 4.7±0.6 and 5.3±0.6 respectively, obviously lower than 6.3±0.6 and 7.7±0.6 in injury group (P<0.05 or P<0.01); the numbers of macrophages in wounds tissue of mice in ADSCs+ PRP treatment group were 3.0±1.1 and 2.7±0.5, significantly lower than those in the other two groups (P<0.05 or P<0.01). Conclusions Human PRP and ADSCs are involved in the early inflammation, metaphase of tissue proliferation, and re-epithelialization and shaping process of late stage of wounds with full-thickness skin defects in mice. The combination of ADSCs and PRP may be a comparatively good combination to improve the speed and quality of wound healing.
Preparation of bioactive denatured acellular dermal matrix from burn mice riched in mice bone marrow mesenchymal stem cells
Qi Yongjun, Wang Xiao, Jiao Ya, Gong Hongmin, Pan Yi, Jiang Duyin
2018, 34(12): 895-900. doi: 10.3760/cma.j.issn.1009-2587.2018.12.014
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Objective To investigate the preparation of bioactive denatured acellular dermal matrix (DADM) from burn mice riched in mice bone marrow mesenchymal stem cells. Methods Twelve BALB/c mice were collected and 20% total body surface area scalds (hereinafter referred to as burns) with deep partial thickness were inflicted on the back skin of each mouse. After removing epidermis, the burned skin were collected and divided into Triton X-100 group and elhylene diamine tetraacetic acid (EDTA) group according to the random number table, with 15 samples in each group. Samples in Triton X-100 group and EDTA group were respectively placed in mixture of 2.5 g/L Triton X-100 and 2.5 g/L trypsin solution and mixture of 0.2 g/L EDTA and 2.5 g/L trypsin solution for sustained vibration and elution for 24 hours to make mice DADM. The general appearance of DADM was observed. The structure and arrangement of collagen fibers of DADM were observed by scanning electron microscope and tissue structure of DADM were observed by fluorescence microscope. Bone marrow mesenchymal stem cells (BMSCs) from mice were transplanted in mice DADM in the two groups with concentration of 2×105 cells per well to prepare bioactive mice DADM. After cultured for 3 days, tissue structure of bioactive mice DADM was observed by hematoxylin and eosin staining, distribution and number of BMSCs of bioactive mice DADM were observed by immunofluorescence staining. Proliferation of BMSCs of bioactive mice DADM after cultured for 2 h, 1 d, 3 d, and 5 d was detected by cell count kit-8. Data were processed with analysis of variance for repeated measurement and t test. Results (1) Mice DADM in the two groups were white in appearance with certain tenacity and elasticity. Mice DADM in the two groups maintained good three-dimensional porous network structure. Collagen fibers of mice DADM in EDTA group were with good continuity, and collagen fibers of mice DADM in Triton X-100 group were fractured in varying degrees. Mice DADM in the two groups were decellularized completely, and the collagen fibers were loose and arranged disorderly. The continuity of tissue structure of mice DADM in EDTA group was better than that of mice DADM in Triton X-100 group. (2) After cultured for 3 days, the BMSCs in bioactive mice DADM in the two groups were evenly distributed. The number of bioactive BMSCs in mice DADM in EDTA group was 37±7, which was significantly more than that of mice DADM in Triton X-100 group (25±8, t=0.128, P<0.05). The proliferation of bioactive BMSCs in mice DADM in Triton X-100 group and EDTA group was similar at 2 hours and on day 1 after cultured (t=1.292, 0.656, P>0.05). On 3, 5 days after cultured, the proliferation of bioactive BMSCs in mice DADM in EDTA group was significantly higher than that of mice DADM in Triton X-100 group (t=2.309, 14.128, P<0.05 or P<0.01). Conclusions Mice DADM prepared by decellularization of EDTA has better three-dimensional porous network structure and good continuity of collagen fiber. The BMSCs in bioactive DADM from burn mice prepared by transplanting BMSCs are evenly distributed with large quantity and strong proliferative capacity, which has the potential to be good autologous dermal substitute.
Effects of allogeneic mouse adipose-derived mesenchymal stem cell-microporous sheep acellular dermal matrix on healing of wound with full-thickness skin defect in mouse and the related mechanism
Cao Shengjun, Wang Lingfeng, Ba Te, Fu Xue, Li Fang, Hao Chunguang
2018, 34(12): 901-906. doi: 10.3760/cma.j.issn.1009-2587.2018.12.015
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Objective To explore the allogeneic mouse adipose-derived mesenchymal stem cell (ADSC)-microporous sheep acellular dermal matrix (ADM) on healing of wound with full-thickness skin defect in mouse and the related mechanism. Methods One Kunming mouse was sacrificed by cervical dislocation to collect adipose tissue from inguinal region. Mouse ADSCs were isolated from the adipose tissue and cultured in vitro. Cells of the third passage were identified by cell adipogenic and osteogenic differentiation. The expressions of CD73, CD90, CD105, and CD34 were analyzed by flow cytometry. After one sheep was sacrificed, microporous sheep ADM was prepared from sheep back using decellularization method and freezing-thawing method. A 12 mm diameter, round, full-thickness skin defect wound was made on the back of each one of 36 Kunming mice. The wounds were covered by microporous sheep ADM. The mice were divided into group ADSC and control (C) group with 18 mice in each group according to the random number table after surgery. A volume of 0.2 mL DMEM/F12 culture medium containing 1×106 ADSCs was injected between microporous sheep ADM and wound of mice in group ADSC. While 0.2 mL DMEM/F12 culture medium was injected between microporous sheep ADM and wound of mice in group C. On post surgery day (PSD) 12 and 17, wound healing rates of mice in the 2 groups were calculated. On PSD 7, 12, and 17, wound vascularization of mice in the 2 groups was observed under reverse irradiation of backlight. On PSD 7, 12, and 17, the wound granulation tissue of mice in group ADSC was observed by hematoxylin and eosin staining. On PSD 7, the thicknesses of granulation tissue of mice in the 2 groups was measured. On PSD 12 and 17, expressions of VEGF in wounds of mice in the 2 groups were detected by immunohistochemical method. The sample number was 6 in each group at each time point in the above experiments. Data were processed with t test and analysis of variance of factorial design. Results (1) After 7 days of adipogenic induction, lipid droplet was observed in cytoplasm using oil red O staining. After 21 days of osteogenic induction, black deposits of calcium salts were detected using silver nitrate staining. Expression rates of CD73, CD90, CD105, and CD34 in cells were 97.82%, 99.32%, 97.35%, and 5.88% respectively. The cells were identified as ADSCs. (2) The wound healing rates of mice in group ADSC on PSD 12 and 17 [(78±6)%, (98±3)%] were significantly higher than those in group C [(60±9)%, (90±4)%, t=4.26, 4.46, P<0.01]. (3) On PSD 7, no vessel obviously grew into the center of wounds of mice in the 2 groups, while the granulation tissue has covered the wounds of mice in group ADSC. On PSD 12, the vessels were more abundant in wounds of mice in group ADSC than those in group C. On PSD 17, big vessels crossing the whole wounds was observed in wounds of mice in group ADSC, while big vessels were observed without crossing the whole wounds in wounds of mice in group C. (4) The wounds were covered with thin granulation tissue on PSD 7, and the granulation tissue began to thicken on PSD 12 and were covered by epidermis on PSD 17 in wounds of mice in group ADSC. On PSD 7, the granulation tissue in wounds of mice in group ADSC [(0.62±0.05) mm] was significantly thicker than that in group C [ (0.31±0.04) mm, t=12.27, P<0.01]. (5) On PSD 12 and 17, expressions of VEGF in wounds of mice in group ADSC [(80.7±2.2), (0.98±0.03)/mm2] were significantly than those in group C [(59.5±2.4), (81.5±2.6)/mm2,t=15.95, 14.14, P<0.01]. Conclusions Allogeneic mouse ADSC-microporous sheep ADM can accelerate angiogenesis and growth of granulation tissue, thus promoting wound healing, which may be due to the increase of expression of VEGF.
Brief Original Article
Clinical effects of adjacent fasciocutaneous flaps in repairing small wounds with bone or steel plate exposure in anterior tibia
Zhang Yonghong, Shen Guoliang, Zhao Xiaoyu, Qian Hangen, Huang Chunhui, Xu Jun, Fan Shuwen
2018, 34(12): 907-909. doi: 10.3760/cma.j.issn.1009-2587.2018.12.016
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Objective To explore the clinical effects of adjacent fasciocutaneous flaps in repairing small wounds with bone or steel plate exposure in anterior tibia. Methods Twelve patients with small wounds of bone or steel plate exposure in anterior tibia covering area of 2 cm×2 cm to 5 cm×3 cm were admitted to our unit from January 2014 to December 2016. A circular or elliptical adjacent fasciocutaneous flap was designed on the normal skin located at the inside or outside of the wound according to the size of wound after thorough debridement. The pedicle of the flap was located at the proximal end and transferred through the subcutaneous tunnel to cover the wound. The sizes of flaps were 3 cm×3 cm to 6 cm×4 cm. Flaps were fixed with interrupted sutures and drainage rubber sheets were placed under the flaps. The drainage rubber sheets were removed within 24 to 48 hours. The donor area was repaired by medium-thickness skin graft collected from homolateral outer thigh. Results All the flaps of 9 patients survived. Two patients had necrosis at the distal end of the flaps and were cured by changing dressing. One patient had tension blisters on the flap and was cured by removing blisters and improving microcirculation. All patients were followed up for 3 months, and the flaps were good in blood supply, appearance, and color, with hypaesthesia. Conclusions Repair of small wounds with bone or steel plate exposure in anterior tibia by adjacent fasciocutaneous flap is simple in surgical procedure and does not damage the well-known blood vessels, and the appearance, texture, and thickness of flaps are close to the skin of anterior tibia region. It is a good choice for repairing this kind of wounds and worth promoting in clinic.
Review
Advances in the research of effects of autologous platelet-rich plasma on the treatment of burn wounds
Yang Sisi, Xiao Chengzhi
2018, 34(12): 910-913. doi: 10.3760/cma.j.issn.1009-2587.2018.12.017
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Autologous platelet-rich plasma (PRP) is plasma with high concentration of platelet extracted from autologous blood. After activation, growth factors involved in wound healing are released from PRP. Current clinical investigations have demonstrated that the application of PRP seems to enhance the clinical outcome of plastic surgery, oral implantology, maxillofacial region and bone repair, and cardio-thoracic surgery. PRP can stimulate angiogenesis and promote fibroblast proliferation, therefore the application of PRP has shown good results in wound healing. However, up to date there is few current clinical researches on application of PRP on wound healing in burn patients. The application of PRP is not currently standardized, and the effects in burn wounds are poorly understood. This review is to determine if the application of PRP can enhance the clinical outcome of burns and scar formation.
Academic Information
Summary of the 2018 Academic Annual Meeting of the Chinese Burn Association
Li Shaohui, Zhong Ning, Shu Bin, Guan Hao
2018, 34(12): 914-916. doi: 10.3760/cma.j.issn.1009-2587.2018.12.018
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The 2018 Academic Annual Meeting of the Chinese Burn Association, sponsored by the Chinese Medical Association and the Chinese Burn Association, was successfully held in Fuzhou, Fujian Province, from October 24th to 27th. The theme of this conference is " One China, One Standard". A total of 1, 798 submissions were received, and 1, 060 registered representatives, more than 2, 000 representatives from 9 countries and regions attended the meeting. Focusing on the theme of " One China, One Standard" , the conference adopted a variety of innovative forms such as academic debate, live surgery, BBS on both sides of the straits, award selection, and so on to provide participants with multiple ways for exchange on the professional hot issues in the key areas of burns. The atmosphere of the conference was warm. The 2019 annual academic conference is scheduled to be held in Zhuhai, China.
Summary of the 2018 Academic Annual Meeting of the Society of Burn Surgery of Chinese Medical Doctor Association
Chen Bin, Li Xiaojian, Zhang Zhi
2018, 34(12): 917-918. doi: 10.3760/cma.j.issn.1009-2587.2018.12.019
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The 2018 Academic Annual Meeting of the Society of Burn Surgery of Chinese Medical Doctor Association, sponsored by the Chinese Medical Doctor Association, was successfully held in Guangzhou, Guangdong province from November 16th to 18th, 2018. More than 300 representatives of burn surgery attended the meeting. The content of the meeting included academician lectures, special reports, seminar, difficult and complex case discussions, which were closely related to clinical needs. In response to the development status and challenges of burn specialty and the status and problems of the training of burn specialist in China, special experts were invited to make special reports and discussions. During the meeting, a general election meeting of the Society of Burn Surgery of Chinese Medical Doctor Association was held, the fourth committee was elected, and professor Peng Yizhi was elected as the president.

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