Journal Of Burns And Wounds[JOURNAL]
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34 papers
Setting science free.
Milner SM
J Burns Wounds · 2006 Oct · PMID 17091132
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Burn-induced bone loss: importance, mechanisms, and management.
Klein GL
J Burns Wounds · 2006 Aug · PMID 16921418
OBJECTIVE: The purpose of this article is to familiarize the reader with the issue of bone loss that accompanies severe burn injury. Why is this important? How does it happen? How can we treat it? METHODS: The published...
OBJECTIVE: The purpose of this article is to familiarize the reader with the issue of bone loss that accompanies severe burn injury. Why is this important? How does it happen? How can we treat it? METHODS: The published findings on this subject are reviewed and integrated into a conceptual framework. RESULTS: Bone loss occurs quickly following a severe burn, is sustained, and increases the risk of postburn fracture. The likely mechanisms responsible are the increase in endogenous glucocorticoid production resulting from the stress response and resorptive cytokines resulting from the systemic inflammatory response and likely aggravated by progressive vitamin D deficiency. Calcium metabolism is also disrupted as the patients develop hypocalcemic hypoparathyroidism likely due to an upregulation of the parathyroid calcium-sensing receptor, possibly due to inflammatory cytokine stimulation. Treatment is achieved by use of anabolic agents and vitamin D supplementation. Studies of acute administration of the antiresorptive agent pamidronate are also promising. CONCLUSION: Postburn bone loss should be looked for in patients with a burn injury of 40% or greater total body surface area. The cause is inherent to the adaptive mechanisms following burn injury. Methods are available to treat this condition.
Comparative evaluation of transdermal formulations of norfloxacin with silver sulfadiazine cream, USP, for burn wound healing property.
Malipeddi VR, Dua K, Sara UV … +2 more , Malipeddi H, Agrawal A
J Burns Wounds · 2006 Jun · PMID 16921417
OBJECTIVE: In an attempt to find a better treatment for bacterial infections and burn wounds, various semisolid formulations containing 5% w/w of norfloxacin were prepared and evaluated for physicochemical parameters, in...
OBJECTIVE: In an attempt to find a better treatment for bacterial infections and burn wounds, various semisolid formulations containing 5% w/w of norfloxacin were prepared and evaluated for physicochemical parameters, in vitro drug release through cellophane membrane, antimicrobial activity, and burn wound healing properties. The prepared formulations were compared with silver sulfadiazine 1% cream, USP. METHODS: Various semisolid formulations were prepared with different bases like Carbopol, polyethylene glycol, and hydroxypropylmethyl cellulose, using standard procedures. The antimicrobial activity of these semisolid norfloxacin formulations, against various strains of aerobic and anaerobic microorganisms, was evaluated by using a standard cup-plate method. The wound healing property was evaluated by measuring the wound contraction and expressed as percentage of contraction of original wound size for each animal group. RESULTS: Antimicrobial activity of norfloxacin semisolid formulations was found to be equally effective against both aerobic and anaerobic bacteria in comparison to a formulation of silver sulfadiazine 1% cream, USP, available on the market. CONCLUSION: The burn wound healing property of the prepared norfloxacin semisolid formulations was found to be in good agreement with silver sulfadiazine 1% cream, USP, available on the market.
Effect of a simple versus a complex matrix on the polarity of cardiomyocytes in culture.
Davis RA, van Winkle WB, Buja LM … +2 more , Poindexter BJ, Bick RJ
J Burns Wounds · 2006 Mar · PMID 16921416
OBJECTIVE: The objective of this study was to observe the effects of cell culture on cellular polarity in cardiomyocytes as influenced by cytoskeletal proteins. METHODS: Cardiomyocytes from adult and neonatal rats were i...
OBJECTIVE: The objective of this study was to observe the effects of cell culture on cellular polarity in cardiomyocytes as influenced by cytoskeletal proteins. METHODS: Cardiomyocytes from adult and neonatal rats were isolated and grown on 2 different extracellular matrices--laminin and a complex, fibroblast-derived extracellular matrix, cardiogel. The location of a number of proteins was visualized by means of fluorescence deconvolution microscopy, using specific fluorescent probes for alpha-adrenergic receptors, beta-adrenergic receptors, the sarcolemmal L-type calcium channel, and the sodium + potassium adenosine triphosphatase pump protein. Intracellular migration of these proteins during the first 4 days of culture was followed and microscopic stacked images were reconstructed. A fluorescein isothiocyanate-labeled probe for actin was used to ensure that cardiomyocytes were being examined, based on protein patterns. RESULTS: We examined 2 types of myocyte: freshly isolated neonates and cultured adult cardiomyocytes that undergo dedifferentiation. Initial, perinuclear clumping (endoplasmic reticulum/Golgi-associated) of the probes with an ensuing spread to the cytoplasm and periphery, accompanied by a better organization and more rapid response to biochemical stimuli, was seen on the complex matrix. CONCLUSIONS: A complex matrix overcomes cell polarity at a faster rate than myocytes cultured on a simple matrix, although both culture matrices were able to support cell growth and differentiation, and single-layer cultures are a good method by which structural and biochemical data can be obtained. The use of a native, complex matrix is preferable to employing a simple, single protein, although temporal aspects of cell growth must be considered regarding the particular aspect of the cell structure development/biochemical pathways that the researcher intends focusing on.
Modalities for the assessment of burn wound depth.
Devgan L, Bhat S, Aylward S … +1 more , Spence RJ
J Burns Wounds · 2006 Feb · PMID 16921415
OBJECTIVE: Burn wound depth is a significant determinant of patient treatment and morbidity. While superficial partial-thickness burns generally heal by re-epithelialization with minimal scarring, deeper wounds can form...
OBJECTIVE: Burn wound depth is a significant determinant of patient treatment and morbidity. While superficial partial-thickness burns generally heal by re-epithelialization with minimal scarring, deeper wounds can form hypertrophic or contracted scars, often requiring surgical excision and grafting to prevent a suboptimal result. In addition, without timely intervention, more superficial burn wounds can convert to deeper wounds. As such, the rapid and accurate assessment of burn wound depth is a priority in treating burn-injured patients. The object of this article is to review current research on modalities useful in the assessment of burn wound depth with emphasis on the relative costs and benefits of each technique. METHODS: PubMed and Cochrane computerized databases were used for data retrieval, using the search terms "burns," "burn wounds," "burn depth," "burn depth measurement," and "burn depth progression." In addition, bibliographic references from prior reviews of burn depth were reviewed. All peer-reviewed, English-language articles relevant to the topic of burn depth measurement were reviewed, including those focusing on animal and human populations. Where appropriate, conclusions drawn from review articles and expert analyses were included. RESULTS: Although bedside evaluation remains the most common modality of diagnosing the depth of burn wounds, recent technological advances have broadened the scope of depth assessment modalities available to clinicians. Other depth assessment techniques include biopsy and histology, and perfusion measurements techniques such as thermography, vital dyes, indocyanine green video angiography, and laser Doppler techniques. CONCLUSION: Of the depth assessment modalities currently used in clinical practice, LDI and ICG video angiography offer the best data-supported estimates of accuracy. Until the future of new modalities unfolds, a combination of clinical evaluation and another modality--thermography, biopsy, or, ideally, ICG video angiography or LDI--is advised to best assess the depth of acute burn wounds.
Severe desquamating disorder after liver transplant: toxic epidermal necrolysis or graft versus host disease?
Schulz JT, Sheridan RL
J Burns Wounds · 2006 Jan · PMID 16921414
OBJECTIVE: The objective of this article is to present and discuss the clinical characteristics of TEN (Toxic Epidermal Necrolysis) and GVHD (Graft Versus Host Disease) following orthotopic liver transplantation. METHODS...
OBJECTIVE: The objective of this article is to present and discuss the clinical characteristics of TEN (Toxic Epidermal Necrolysis) and GVHD (Graft Versus Host Disease) following orthotopic liver transplantation. METHODS: Recent experience with a patient who suffered a fatal desquamation syndrome within weeks of liver transplantation provides the basis for a discussion of differential diagnosis of these two conditions. RESULTS: TEN and GVHD demonstrate similar clinical presentations as well as etiology (CD8+ lymphocyte attack on epithelial surfaces). This case demonstrates the difficulty in distinguishing between these two conditions in this particular patient. CONCLUSIONS: Advances in the understanding and treatment of one of these disease states may provide therapeutic insights into the other.
Collagenase promotes the cellular responses to injury and wound healing in vivo.
Riley KN, Herman IM
J Burns Wounds · 2005 May · PMID 16921413
OBJECTIVE: This study focuses on the growth-promoting and migration-enhancing role that Clostridial collagenase plays in vitro and in vivo. METHODS: For in vitro studies, biosynthesized extracellular matrices were treate...
OBJECTIVE: This study focuses on the growth-promoting and migration-enhancing role that Clostridial collagenase plays in vitro and in vivo. METHODS: For in vitro studies, biosynthesized extracellular matrices were treated with purified Clostridial collagenase, nonspecific proteases, or buffer controls. Keratinocytes were subsequently plated upon these matrices in the presence or absence of Clostridial collagenase and/or heparin-binding epidermal-like growth factor, and cell proliferation and migration were quantified. To examine the effects of Clostridial collagenase in vivo, we performed a double-blind study of full-thickness wounds on the backs of Yucatan Micropigs, testing the effects of purified Clostridial collagenase, Regranex (PDGF-BB), and Solosite (carboxymethyl cellulose) on wound healing. IN VITRO STUDIES: Matrix pretreatment with Clostridial collagenase stimulates a 2-fold increase in proliferation and postinjury migration; when Clostridial collagenase and/or heparin-binding epidermal-like growth factor are added to the growth media, there is an additional doubling of growth and migration, yielding approximately 5-fold enhancement of keratinocyte proliferation and migration. Papain-urea treatment under similar conditions results in a 50% decrease in cell number over a 1-week time course. In vivo studies: By all parameters measured, including granulation tissue formation, inflammation, re-epithelization, and time to wound closure, purified Clostridial collagenase was superior (analysis of variance, P > .05) to other treatments tested. CONCLUSION: On the basis of these findings, we concluded that Clostridial collagenase stimulates keratinocyte cellular responses to injury in vitro and may represent a novel therapeutic approach for promotion of wound healing in vivo.
Immunofluorescence deconvolution microscopy and image reconstruction of human defensins in normal and burned skin.
Poindexter BJ
J Burns Wounds · 2005 Apr · PMID 16921412
OBJECTIVE: The aim of this study was visualization and localization of the human antimicrobials human beta defensins 1, 2, and 3, neutrophil defensin alpha (human neutrophil peptide), and the cathelicidin LL-37 in normal...
OBJECTIVE: The aim of this study was visualization and localization of the human antimicrobials human beta defensins 1, 2, and 3, neutrophil defensin alpha (human neutrophil peptide), and the cathelicidin LL-37 in normal and burned skin, and determination of the cell types in which these antimicrobials were localized. METHODS: Tissue sections were probed with antimicrobial antibodies, tagged with fluorescently labeled secondary antibodies, and subjected to fluorescence deconvolution microscopy and image reconstruction. Images were generated by stacking multiple-section scans, which were then volume rendered by rotating stacks 360 degrees about an axis, or modeled in 3 dimensions. RESULTS: This technique yields a definitive image, providing a rapid basis for further quantification and manipulation from a full 3-dimensional aspect. In normal skin, human beta defensin-1 was localized to the perinuclear region of keratinocytes; human beta defensin-2 was primarily localized to the stratum germinativum; human beta defensin-3 was found in dendritic cells of the stratum spinosum; human neutrophil peptide was randomly distributed in the papillary dermis; and LL-37 was concentrated in the stratum corneum and along ducts. In burned skin, in which keratinocytes are lost or destroyed, human beta defensin-1 was present in dermal glandular structures including hair shafts; human beta defensin-2 and human beta defensin-3 were found in the remaining keratin layers and glands of the lower dermis; human neutrophil peptide was primarily localized to hair shafts, though visible in residual keratin layers; and LL-37 was evident in very high concentrations in the epithelium of sweat ducts. CONCLUSION: We conclude via this technique that cells in the lower dermal and subdermal regions of burned skin synthesize antimicrobials after burn injury, and maintain something of a barrier against infection. This methodology is discussed and explained in this article.
Case studies: Use of salicylic acid (Avosil) and hydrogel (Avogel) in limiting scar formation.
Danielson JR, Walter RJ
J Burns Wounds · 2005 Mar · PMID 16921411
OBJECTIVE: The purpose of this report is to present the results of a preliminary treatment regimen for hypertrophic scars combining topical 2% salicylic acid cream (Avosil) with an overlay of hydrogel dressing (Avogel)....
OBJECTIVE: The purpose of this report is to present the results of a preliminary treatment regimen for hypertrophic scars combining topical 2% salicylic acid cream (Avosil) with an overlay of hydrogel dressing (Avogel). METHODS: The study group consisted of 3 patients with symptomatic hypertrophic scars: 2 presternal and 1 on the inner thigh. Scars were divided into 3 equal-size areas: (1) untreated control, (2) hydrogel alone, and (3) 2% salicylic acid with hydrogel cover. Treatments were applied every 8 to 12 hours and a Velcro appliance was employed to cover the area during treatment. The total length of treatment was 60 days. RESULTS: At the end of the 60-day treatment protocol, the area treated with 2% salicylic acid and hydrogel was asymptomatic. In contrast, the hydrogel-treated and untreated control areas remained erythematous and symptomatic for burning pain and pruritus. CONCLUSION: This small study suggests the efficacy of combined salicylic acid and hydrogel therapy in the treatment of hypertrophic scars. More extensive studies of scar treatment with salicylic acid and hydrogel are needed. These studies must be larger in scope to carefully document the spectrum of patient responses and should include methods for evaluating alterations in the levels of different inflammatory mediators.
Management of an acute thermal injury with subatmospheric pressure.
Molnar JA, Simpson JL, Voignier DM … +2 more , Morykwas MJ, Argenta LC
J Burns Wounds · 2005 Mar · PMID 16921410
OBJECTIVE: This article reports the first application of subatmospheric pressure management to a deep, partial-thickness human thermal burn. METHODS: After cleaning the wound, the decision was made to treat the hand and...
OBJECTIVE: This article reports the first application of subatmospheric pressure management to a deep, partial-thickness human thermal burn. METHODS: After cleaning the wound, the decision was made to treat the hand and distal forearm with subatmospheric pressure (V.A.C., KCI, Inc, San Antonio, Tex). The sponge was applied directly to the burned skin without additional interface at approximately 6 hours after injury. The dressing was maintained at a continuous negative pressure of 125 mm Hg over the next 40 hours, with interruption only for routine clinical evaluation at 5, 16, and 24 hours after initiation of treatment. This was accomplished by opening the dressing without completely changing it. The treatment was tolerated well by the patient, requiring no excessive pain medication. After the subatmospheric pressure treatment was stopped, the wound appeared to be of indeterminate depth and the patient was started on twice daily applications of silver sulfadiazine. RESULTS: The clinical impression at this time was that the hand burn had not progressed but had stabilized and had minimal edema. He was followed as an outpatient and returned to work by 8 weeks. At approximately 4 weeks postinjury, his skin not only was functional but also appeared more normal, with less hyperemia than adjacent areas treated with topical antibacterials. CONCLUSION: The present case does not prove that subatmospheric pressure treatment prevents burn wound progression. However, when combined with the previously reported laboratory studies it suggests the need for further research. Currently, a prospective, randomized, blinded, controlled multicenter trial is underway to evaluate the clinical importance of these observations.
Comparison of dermal substitutes in wound healing utilizing a nude mouse model.
Truong AT, Kowal-Vern A, Latenser BA … +2 more , Wiley DE, Walter RJ
J Burns Wounds · 2005 Mar · PMID 16921409
BACKGROUND: Dermal skin substitutes have become a standard of care in burn treatment. OBJECTIVE: To compare and assess wound contracture reduction and histologic incorporation into the wound, dermal substitutes were impl...
BACKGROUND: Dermal skin substitutes have become a standard of care in burn treatment. OBJECTIVE: To compare and assess wound contracture reduction and histologic incorporation into the wound, dermal substitutes were implanted into full-thickness skin wounds in nude mice. MATERIALS AND METHODS: Thirty-seven mice received a full-thickness 2 x 2 cm dorsal skin wound, and were either implanted with an acellular dermal matrix, Alloderm, Dermagraft-TC, Dermalogen, or Integra or assigned to the control group (with no dermal substitute). At 28 days postsurgery, the wounds were assessed for contraction, epithelialization, and other histological characteristics. RESULTS: Each dermal substitute decreased wound contracture, but Alloderm and the acellular dermal matrix did so significantly compared to the control (P < .01 and P < .03, respectively). Within-group and control comparisons showed no significant differences with respect to the presence of dystrophic calcification, squamous hyperplasia, infiltration of neutrophils, fibroblasts, and macrophages, epidermal keratinocyte stratification, or collagen fiber configuration. CONCLUSIONS: Integra elicited the greatest foreign body response. Although the Dermalogen group had the thickest elastin fiber fragments, Dermagraft may have initiated the earliest elastin fiber formation in the wounds. While all dermal substitutes were incorporated into the wound bed and wound contracture was decreased, acellular dermal matrix and Alloderm, both human skin-derived products, produced less contraction and the thickest new "dermis" in the healed wounds compared to the control or synthetic dermal substitutes.
The potential benefit of 5% Sulfamylon Solution in the treatment of Acinetobacter baumannii-contaminated traumatic war wounds.
Kucan JO, Heggers JP
J Burns Wounds · 2005 Feb · PMID 16921408
BACKGROUND: The recent report of high numbers of Acinetobacter baumannii bloodstream infections among service members injured in Iraq and Afghanistan during the period January 2002 through August 2004 has prompted an inv...
BACKGROUND: The recent report of high numbers of Acinetobacter baumannii bloodstream infections among service members injured in Iraq and Afghanistan during the period January 2002 through August 2004 has prompted an investigation into their etiology. A review of the current guidelines for open combat casualty wounds as part of this broad investigation was not mentioned in the report. OBJECTIVE: The objective of this study was 2-fold: to ascertain the susceptibility of A. baumannii to currently available topical antibacterial agents and (2) to propose an alternative, effective treatment protocol for contaminated combat-related wounds so as to reduce or eliminate the likelihood of the wound serving as the source of A. baumannii infection or septicemia. METHODS: A standardized antimicrobial susceptibility study of 43 strains of A. baumannii collected from a tertiary care burn center was conducted using 2 commonly used topical antibacterial agents, 1% silver sulfadiazine cream (Silvadene) and 5% mafenide acetate solution (5% Sulfamylon Solution). RESULTS: Both were effective, but 5% Sulfamylon Solution demonstrated significantly greater antibacterial activity. CONCLUSION: Five percent Sulfamylon Solution, initially developed for wartime use, and currently limited by the Food and Drug Administration to soaks following meshed split-thickness autografts following excision of second-degree and third-degree burns, has a broad spectrum of antibacterial activity and extensive off-label applicability. It is an ideal agent for use in the treatment of war wounds, and should be considered as a superior replacement for normal saline in the current guidelines for open combat casualty wounds.
The role of anabolic hormones for wound healing in catabolic states.
Demling RH
J Burns Wounds · 2005 Jan · PMID 16921407
OBJECTIVE: The purpose of this paper is to present an overview of the interrelationship between hormones, nutrition, and wound healing. METHODS: The data on various hormones and their effects on specific elements of nutr...
OBJECTIVE: The purpose of this paper is to present an overview of the interrelationship between hormones, nutrition, and wound healing. METHODS: The data on various hormones and their effects on specific elements of nutrition and wound healing are reviewed. RESULTS: The key anabolic hormones are human growth hormone, insulin-like growth factor-1, insulin, and testosterone and its analogs. Although each has specific metabolic actions, there is also a very important hormone-hormone interaction. A deficiency of these hormones occurs in acute and chronic catabolic states, resulting in lean mass loss and impairing the healing process. CONCLUSION: There is a well-recognized interrelationship between hormones, nutrition, and wound healing. The anabolic process of protein synthesis, with new tissue formation, requires the action of anabolic hormones. Exogenous administration of these agents has been shown to maintain or increase lean body mass as well as directly stimulate the healing process through their anabolic and anticatabolic actions.
Wound healing of cutaneous sulfur mustard injuries: strategies for the development of improved therapies.
Graham JS, Chilcott RP, Rice P … +3 more , Milner SM, Hurst CG, Maliner BI
J Burns Wounds · 2005 Jan · PMID 16921406
Sulfur mustard is an alkylating chemical warfare agent that primarily affects the eyes, skin, and airways. Sulfur mustard injuries can take several months to heal, necessitate lengthy hospitalizations, and result in sign...
Sulfur mustard is an alkylating chemical warfare agent that primarily affects the eyes, skin, and airways. Sulfur mustard injuries can take several months to heal, necessitate lengthy hospitalizations, and result in significant cosmetic and/or functional deficits. Historically, blister aspiration and/or deroofing (epidermal removal), physical debridement, irrigation, topical antibiotics, and sterile dressings have been the main courses of action in the medical management of cutaneous sulfur mustard injuries. Current treatment strategy consists of symptomatic management and is designed to relieve symptoms, prevent infections, and promote healing. There are currently no standardized or optimized methods of casualty management that prevent or minimize deficits and provide for speedy wound healing. Several laboratories are actively searching for improved therapies for cutaneous vesicant injury, with the aim of returning damaged skin to optimal appearance and normal function in the shortest time. Improved treatment will result in a better cosmetic and functional outcome for the patient, and will enable the casualty to return to normal activities sooner. This editorial gives brief overviews of sulfur mustard use, its toxicity, concepts for medical countermeasures, current treatments, and strategies for the development of improved therapies.
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