Effects of antisense p38 α mitogen-activated protein kinase on myocardial cells exposed to hypoxia and burn serum / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study the effects of antisense p38α mitogen-activated protein kinase (hereinafter referred to as p38α) on myocardial cells exposed to hypoxia and burn serum.</p><p><b>METHODS</b>Thirty adult SD rats were inflicted with 40% TBSA full-thickness burn on the back to obtain burn serum. The myocardial cells were isolated from 80 neonatal SD rats and cultured, then they were divided into 4 groups according to the random number table: normal control group (N, ordinary culture without any treatment), hypoxia+burn serum group (HB, exposed to hypoxia after being treated with 10% burn rat serum), hypoxia+burn serum+infection group (HBI, exposed to hypoxia and 10% burn rat serum after being infected with antisense p38α gene-carrying adenovirus), hypoxia+burn serum+empty vector infection group (exposed to hypoxia and 10% burn rat serum after being infected with adenovirus empty vector). At post hypoxia hour (PHH) 1, 3, 6, and 12, mRNA and protein expression levels of p38α in the latter 3 groups were determined by RT-PCR and Western blotting, cell viability was determined by methylthianolyldiphenyl-tetrazolium bromide assay, and lactate dehydrogenase (LDH) activity was assayed at the same time point. At PHH 1, 6, and 12, apoptosis rate of myocardial cells was assessed by annexin V staining method. The indexes of group N were determined with the methods mentioned-above. Three wells were set at each time point in each group. Data were processed with one-way analysis of variance and LSD- t test.</p><p><b>RESULTS</b>(1) At PHH 1, 3, and 6, the p38α mRNA level was higher in group HB than in group N and group HBI (with t values from 2.725 to 4.375, P values all below 0.05). (2) At PHH 1, 3, and 6, the p38α protein level was higher in group HB than those in group N and group HBI (with t values from 5.351 to 7.981, P values all below 0.01). (3) At PHH 3, 6, and 12, the cell viability in group HB (0.115 ± 0.007, 0.104 ± 0.006, 0.094 ± 0.005) was lower than that in group N (0.141 ± 0.014) and group HBI (0.136 ± 0.009, 0.124 ± 0.010, 0.112 ± 0.007, with t values from 2.357 to 6.812, P values all below 0.05). (4) The LDH activity was up-regulated in group HB as compared with that in group N and group HBI at each time point (with t values from 22.753 to 201.273, P values all below 0.01). (5) At PHH 1, 6, and 12, the apoptosis rate of myocardial cells in group HB [(5.4 ± 0.7)%, (8.7 ± 1.1)%, (13.6 ± 1.7)%] was higher than that of group N [(3.1 ± 0.3)%] and group HBI [(4.3 ± 0.5)%, (5.1 ± 0.7)%, (7.2 ± 0.9)%, with t values from 2.345 to 9.700, P < 0.05 or P < 0.01].</p><p><b>CONCLUSIONS</b>Antisense p38α can protect the myocardial cells from the injury of hypoxia and burn serum.</p>

Anatomic basis of the accompanying pattern of the superficial temporal arterial branches and veins and its clinical application / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study the course of branches of the superficial temporal artery (BSTA) and the accompanying pattern of their veins in order to provide anatomic basis for flap design.</p><p><b>METHODS</b>Head and facial part of ten adult corpses (19 sides) were dissected and photographed. The coordinate system was set up with external auditory foramen as the point of origin, aided by the graph analysis software Digimizer. The course of the frontal branch and parietal branch of the superficial temporal artery (STA), and the accompanying pattern between the BSTA and the veins were measured and analyzed. The STA and its branches were located by Ultrasonic Doppler, and the corresponding branches of the superficial temporal vein (BSTV) were disclosed by bowing patient's head with breath holding or cerclaging the basement of the patient's skull. And then 10 sides of transposition (fascia) flaps with axis at the angular bisector between BSTA and BSTV were devised to repair wounds of 9 patients that hospitalized from February 2008 to December 2009. Data were processed with test of variance homogeneity.</p><p><b>RESULTS</b>Frontal BSTV absence was found in 6 head sides, and the maximum distance between artery and vein was (2.1 ± 1.2) cm. Parietal BSTV absence was found in 3 head sides, and the maximum distance was (1.4 ± 0.7) cm. The distance between frontal BSTA and BSTV was larger than that between parietal BSTA and BSTV, and the dispersion degree of the former was higher than that of the latter (F = 0.0404, P = 0.0475). All the (fascia) flaps survived without congestion or necrosis.</p><p><b>CONCLUSIONS</b>When branch of the superficial temporal vessel was selected as the axial vessel of flap, the flap design shall depend on the accompanying pattern of BSTV to avoid the flap necrosis due to poor venous return after surgery. The superficial temporal vein and its branches can be well disclosed by bowing head or cerclaging skull. The approach is simple, useful, safe, and reliable.</p>

Repair of nose and adjacent tissue defect deformities after burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To look for the best method of repairing nose and adjacent tissue defect after burn and observe the effect.</p><p><b>METHODS</b>Twelve patients with post-burn nose and adjacent tissue defect deformities hospitalized from January 1999 to December 2008 were repaired with expanded forehead flap, pedicled upper-arm flap, axial post-auricular reversed flow island flap, and nasolabial groove flap. Among them, 4 cases with total nasal defect, 8 cases with partial nasal defect; and 3 cases were accompanied with scars on cheek, 5 cases accompanied with scars on forehead, 5 cases accompanied with upper lip ectropion and subtotal upper lip defect. The skin flap size ranged from 3.0 cm x 1.5 cm to 10.0 cm x 8.0 cm.</p><p><b>RESULTS</b>Five cases were repaired with expanded forehead flap, 3 cases with pedicled upper-arm flap, 1 case with axial post-auricular reversed flow island flap, and 3 cases with nasolabial groove flap respectively. All the 12 flaps survived. Patients were followed up for 1 to 7 years, and nasal function and appearance were obviously improved.</p><p><b>CONCLUSIONS</b>Optimal repairing method shall be chosen to repair nasal defect after burn according to its extent, and forehead flap is preferred. Pedicled upper-arm flap and reversed flow axial post-auricular island flap can be employed if local flap and ortho-position skin flap are unavailable when obvious scar is present on face as a result of severe burn.</p>

Application of latissimus dorsi flap in different forms in repair of skin and soft tissue defects in lower extremities / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore repair methods of skin and soft tissue defects in lower extremities with free latissimus dorsi flaps.</p><p><b>METHODS</b>Forty-two patients with wounds and soft tissue defects in lower extremities, including 4 cases on knee, 22 cases on leg, 15 cases on ankle and foot, 1 case with extensive avulsion from knee to dorsum of foot, were hospitalized in our unit from February 1996 to February 2008. Wounds or soft tissue defects were respectively repaired with latissimus dorsi musculocutaneous flaps, latissimus dorsi muscle flaps, latissimus dorsi perforator flaps with preserved vascular sleeves, 2 double-leaf segmental latissimus dorsi compound flaps after debridement. The flaps ranged from 18 cm x 8 cm to 40 cm x 18 cm in size. The donor sites were covered by skin grafting in 19 cases.</p><p><b>RESULTS</b>All wounds were healed primarily except vascular crisis occurred in 3 cases, partial necrosis of skin at donor site in 2 cases, and graft site (1 case). Follow-up for 3 to 24 months of 31 patients showed: six cases received two-stage plastic operation on account of bulkiness with trouble in wearing shoes, and mild contraction of muscular flap in 3 cases.</p><p><b>CONCLUSIONS</b>Latissimus dorsi flap in various forms can be satisfactory for repair of large skin and soft tissue defects in lower extremities.</p>

Pathological experimental study of autologous skin transplant on retained denatured dermis / 中南大学学报(医学版)

OBJECTIVE@#To identify the pathological character of denatured dermis,and its turnover after autologous skin transplant.@*METHODS@#Deep partial thickness burn wounds whose diameter was 2.5 cm were produced on the back of Sprague-Dawley (SD) rats. After simple debriding,xenogenic skin was transplanted. Superficial tangential excision was performed on the burn wounds on 48 hours postburn with the preservation of denatured dermis. Split thickness autologous skin was grafted on the wounds immediately. Tissue samples of whole layer of the skin were harvested from the grafted sites at different time points after the skin grafting. Pathological observation on the denatured skin and the transplanted skin was carried out with HE and Massonos trichrome blue.@*RESULTS@#The superficial cells of the denatured dermis necrotized largely with few cells alive,collagen denatured,and many inflammatory cells infiltrating. Necrosis tissue and inflammatory cells could be found in the denatured skin in the early period after the skin transplant. There were infiltrated inflammatory cells in the transplanted skin 3 days after the skin transplant. On the 10th day,the necrotized tissue diminished markedly,and red cells were found in its upper stratum. On the 21st day, the morphology and structure of the transplanted skin were similar to those of the normal skin.@*CONCLUSION@#The retained denatured dermis has little effect on the survival of the transplanted skin. The necrosis components can be absorbed and replaced by the tissue alive after the autologous skin is transplanted.

Repair of claw hand deformity after burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To summarize methods for repair of claw hand deformity after burn.</p><p><b>METHODS</b>Ninety-seven patients with 136 claw hands after burn hospitalized from May 1992 to May 2007 were repaired with skin grafting (104 hands) and transposition of skin flap (32 hands), among which 21 hands were minor-grade, 92 hands moderate, 23 hands severe. The metacarpophalangeal joint was repaired after scar release in dorsum of hand with manual extraction reduction, release of collateral ligament and joint capsula, separation of adhesion in joint, tendon lengthening for obvious contracture. Restitution of finger flexion deformity, lysis of adhesion and grafting among first web and finger webs, repair of central slip extensor tendon or phalangeal arthrodesis were performed according to the abnormal condition after lysis of dorsal scar of hand. The metacarpophalangeal joint from 31 patients were not repaired with above methods for severe finger flexion deformity, their palmar scar were loosened and transplanted firstly, then scar in dorsum of hand were loosened, metacarpophalangeal joint were repaired, flap or skin were transferred or transplanted. General rehabilitation were performed routinely after operation.</p><p><b>RESULTS</b>The ending of flaps (4 hands) due to the scar were necrosis after transposition and healed through dressing change, other skins or flaps all survived. Most articular deformities were corrected completely or basically. Functions including palmar opposition, grasp were also recovered with satisfactory results.</p><p><b>CONCLUSION</b>Skin transplantation and transferring of skin flap with overall planning and individual isatin are the key points for repair of claw hand after burn.</p>

Repair of the scar in the midface by skin expansion with parallel juxtaposed skin expanders / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore a new method for the repair of the scar in the midface.</p><p><b>METHODS</b>Parallel juxtaposed expansion of the skin and soft-tissue of jaw, face, neck and posterior aspect of auricle was performed to repair the scar in the midface of 15 patients. The operation consisted of two steps. In the first step, two expanders were placed subcutaneously under the subskin of jaw, face, neck and posterior aspect of the auricle, respectively, and they were expanded timely to create adequate superfluous skin and soft tissue. In the second step, the expanded skin flap was rotated and advanced to repair the the scar in the midface.</p><p><b>RESULTS</b>Parallel juxtaposed expansion was performed to repair the scar in the midface of 15 patients. The incision was comparatively concealed, the colour and elasticity of the skin transplant, and the facial contours were satisfactory.</p><p><b>CONCLUSION</b>Parallel juxtaposed expansion of the skin soft-tissue of jaw, face, neck and posterior auricular is beneficial for the repair of the scar in the midface.</p>