Morphological and pathological changes of larynx after severe laryngeal burn in dogs and their relationship with laryngostenosis / 中华烧伤杂志

Objective@#To investigate the morphological and pathological changes of the larynx after severe laryngeal burn in dogs and their relationship with laryngostenosis.@*Methods@#Eighteen healthy, male beagle dogs were assigned into control group, immediately after injury group, and 2, 4, 6, and 8 weeks after injury groups according to the random number table, with 3 dogs in each group. Dogs of injury group inhaled saturated steam through mouth for 5 seconds to reproduce severe laryngeal burn. Tracheotomy and intubation were performed immediately after injury, and 400 000 U/d penicillin was intravenously infused for 1 week. The feeding, activity, and vocalization of dogs in each group after injury were observed until they were sacrificed. Immediately after injury and 2, 4, 6, and 8 weeks after injury, the laryngeal morphology of the dogs in corresponding time point groups were observed by endoscope. After the observation, the dogs in each injury group were sacrificed, and the laryngeal tissue was taken. The epiglottis, glottis, and cricoid cartilage were collected to make full-thickness tissue slice, respectively, and their pathological changes were observed with hematoxylin and eosin staining. The dogs of control group were not specially treated, and their life activities, laryngeal morphological and pathological changes were observed.@*Results@#(1) The dogs of control group had normal feeding, activities, and vocalization. All the dogs in injury group survived until they were sacrificed, and their feeding, activities, and vocalization were obviously reduced after injury compared with those of control group. The dogs of 2, 4, 6 and 8 weeks after injury groups ate and moved normally 2 weeks after injury but vocalized abnormally in frequency and volume compared with those of control group, which lasted until they were sacrificed. (2) The dog′s laryngeal mucosa in control group was complete and pink, without obvious exudation. The laryngeal mucosa of the dog in immediately after injury group was pale and edematous, with obvious exudation, local ulceration, necrosis, and exfoliation, and dilated microvessels on the surface. The laryngeal mucosa of the dogs in 2 weeks after injury group was pale, edematous, and oozed less than that of immediately after injury group, and the glottis was blocked by an obviously extruding mass. The paleness and edema of laryngeal mucosa were significantly reduced in the dogs of 4 weeks after injury group compared with those of 2 weeks after injury group, without dilated microvessel, and the glottic extruding mass was obviously smaller than that of 2 weeks after injury group. The sizes of glottic mass were similar between the dogs of 6 and 8 weeks after injury groups, which were obviously smaller than that in 4 weeks after injury group. (3) In the dogs of control group, the epithelial cells of epiglottis, glottis, and cricoid cartilage were normal in morphology, the proper glands were visible in the intrinsic layer, and the muscle fibers and the chondrocytes were normal in morphology. In the dogs of immediately after injury group, large sheets of epiglottis epidermis exfoliated, the epithelial cells were swollen and necrotic, the intrinsic glands were atrophic and necrotic, and the chondrocytes were degenerated and necrotic. The epidermis of the glottis partially exfoliated, the epithelial cells were swollen and necrotic, the intrinsic glands were atrophic and necrotic, the muscle fibers were partially atrophic and fractured, and the vacuolar chondrocytes were visible. The cricoid cartilage epidermis was ablated, the epithelial cells were swollen, the intrinsic layer and submucosal layer were slightly edematous, and the morphological structure of glands, chondrocytes, and muscle fibers were normal. In the dogs of 2 weeks after injury group, the epiglottis epidermis was completely restored, a small amount of glands in the intrinsic layer were repaired, and obsolete necrotic chondrocytes and new chondrocytes could be seen. A large number of fibroblasts, new capillaries, and inflammatory cells infiltration were observed in the epidermis of glottis, and intrinsic layer glands were repaired. The cricoid cartilage epidermis was repaired intactly, and there was no edema in the intrinsic layer. In the dogs of 4 weeks after injury group, the epiglottis intrinsic layer glands were further repaired compared with those of 2 weeks after injury group, and new chondrocytes were seen in the submucosa of the glottis. The condition of cricoid cartilage was consistent with that of control group. The dog′s epiglottis, glottis, and cricoid cartilage were similar between the 6 and 8 weeks after injury groups, and no significant change was observed compared with those of 4 weeks after injury group.@*Conclusions@#The morphological changes of larynx after severe laryngeal burn in dogs include mucosa detachment and necrosis, and mass blocking glottis. Pathological changes include epidermis shedding and necrosis, gland atrophy and necrosis, vascular congestion and embolism, chondrocytes degeneration, necrosis and proliferation, even local granulation tissue formation and cartilaginous metaplasia. These results may be the cause of laryngostenosis after laryngeal burn.

Treatment of full-thickness electric burn of skull combined with cerebral contusion and intracranial infection / 中华烧伤杂志

This article reports the treatment of a patient suffering from full-thickness electric burn of skull combined with cerebral contusion and intracranial infection to provide experience in treating such patients. Based on detailed analysis on patient's condition and CT results, several operations of surgery and anti-infection treatment were performed on the patient. The wounds healed 6 weeks after injury. The skull defect was repaired with three-dimensionally reconstructed titanium mesh of computer-aided design two years after wound healing. The treatment of full-thickness electric burn of skull combined with cerebral contusion was quite difficult. The timing and mode of operation were very important. Perioperative prevention and treatment of intracranial infection were essential to save the life of the patient. In the event of intracranial infection, effective systemic use of antibiotics, cerebrospinal fluid drainage, intrathecal injection of drugs, and the application of other comprehensive measures could ensure the success of treatment.

Lay emphasis on the aesthetic effect of wound repair / 中华烧伤杂志

"Survival first" has been the leading rule in burn surgery for a long time. However, the life quality of patients in future should also be emphasized on the strategic level during the early treatment of patients with massive burn. Aesthetics is also extremely important in wound repair, and it should form a clear conception in the mind of the attending surgeons. Therefore, the aesthetic effect of each surgical intervention should be elaborated with all enough attention. Moreover, we should constantly improve our techniques and skills to obtain presentable postoperative appearance. In addition, we should emphasize the application of new techniques and materials in wound repair, with which to improve aesthetic effect. In conclusion, we should pay more attention to promoting the aesthetic effect in the treatment of burns and traumatic wounds to maintain our superior status in burn treatment in the world.

Repair of deep burn wound of neck with supraclavicular island flap / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the therapeutic effect of supraclavicular island flap in repairing deep burn wound of neck.</p><p><b>METHODS</b>Six patients with deep burn of neck hospitalized from January 2009 to June 2011 were enrolled in the study. Their total burn area ranged from 6% to 22% TBSA, of which full-thickness area ranged from 3% to 22% TBSA. The neck wound ranged from 12 cm x 5 cm to 15 cm x 8 cm in area, and they were all full-thickness in depth. One of the neck wounds was covered with granulation tissue. Patients underwent either debridement and escharectomy or excision of granulation tissue for the neck wound, and they were covered with supraclavicular island flap designed with the size corresponding to that of wound area. Four donor sites were sutured directly. The other two donor sites were covered with free skin graft. Survival of flaps and healing of donor sites were observed. The appearance and function recovery of operative regions were followed up.</p><p><b>RESULTS</b>Supraclavicular island flaps of 6 patients survived as a whole. All the donor sites healed well. Flaps with satisfactory appearance and feeling sensation, accompanied by unlimited extension of neck were observed in the follow-up duration from 6 to 12 months. Scars observed in the flap edge and the donor sites were linear, and they did not affect the overall appearance and function of patients.</p><p><b>CONCLUSIONS</b>Supraclavicular island flap is a good choice for repairing deep burn wound of neck, and it gives a good shape and function recovery of the neck.</p>

Skin irritation and sensitization of swine acellular dermal matrix treated with hyaluronic acid / 中华烧伤杂志

<p><b>OBJECTIVE</b>To evaluate the skin irritation and sensitization potential of the swine acellular dermal matrix treated with hyaluronic acid (SADM-HA).</p><p><b>METHODS</b>(1) Skin irritation test. Twelve New Zealand rabbits were divided into SADM-HA group, allogeneic skin group, and (human) xeno-skin group according to the random number table, with 4 rabbits in each group. Four test sites were designed on the back of each rabbit. Two test sites of each rabbit in the three groups were covered with SADM-HA, allogeneic skin, and xeno-skin, respectively. Another test site was covered with gauze containing 200 g/L sodium dodecyl sulfate solution as positive control. The last test site was covered with gauze containing normal saline as negative control. The primary irritation index and cumulative irritation index of each material were calculated. (2) Skin closed-patch test. Sixty guinea pigs were used. Fifty-four guinea pigs were divided into SADM-HA group, allogeneic skin group, and (human) xeno-skin group according to the random number table, with 18 guinea pigs in each group. Twelve guinea pigs in each of the three groups were correspondingly induced and stimulated by SADM-HA, allogeneic skin, and xeno-skin, with 6 guinea pigs in each group treated with ethanol-soaked gauze to serve as negative control. The remaining 6 guinea pigs were treated with gauze containing 25% α-hexylcinnamaldehyde ethanol solution as positive control. The rating scales of Magnusson and Kligman were used to grade the condition of skin after being treated with above-mentioned materials to evaluate skin sensitivity to them at post stimulation hour 24 and 48. Data were processed with the non-parametric test of independent samples.</p><p><b>RESULTS</b>(1) In the skin irritation test, the primary irritation indexes of the three dressings in SADM-HA group, allogeneic skin group, and xeno-skin group were respectively -0.04, 0.13, and 0.08. The cumulative irritation indexes of the three dressings in SADM-HA group, allogeneic skin group, and xeno-skin group were respectively 0.27, 0.10, and 0.25, which were close to those of negative control within the three groups. The skin irritation of each of the three materials was negligible. (2) In the skin closed-patch test, all scores of the three dressings in SADM-HA group, allogeneic skin group, and xeno-skin group were between 0 and 1. The scores of SADM-HA group and allogeneic skin group were close to those of negative control within the two groups (with U values respectively 188.00 and 90.00, P values both above 0.05). The differences were statistically significant between each material of the three groups and positive control (with U values respectively 19.00, 59.00, 21.50, P values all below 0.01).</p><p><b>CONCLUSIONS</b>The SADM-HA is safe and reliable without skin irritation and sensitization, and it has encouraging prospect in clinical application.</p>

Repair of circumferential wound in the wrist region due to high-voltage electrical burn using combined abdominal axial pattern flaps / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the method for repairing circumferential wound in the wrist region due to high-voltage electrical burn.</p><p><b>METHODS</b>Six patients with circumferential wound in the wrist region after high-voltage electrical burn were admitted to our hospital from January 2009 to December 2011. After debridement, wounds in the wrist were repaired with combined abdominal axial pattern flaps. The wound of wrist on the flexor aspect was repaired with paraumbilical flap carrying a portion of rectus abdominis that filled the wound cavity of the wrist on the flexor aspect. The wound of wrist on the dorsal aspect was repaired with lower abdominal flap. Pedicle division was performed 4 - 5 weeks post surgery. Some donor sites were sutured directly, and the others were closed by skin grafting after the suture of anterior sheath.</p><p><b>RESULTS</b>Three flaps survived. Liquefaction necrosis of tissue was observed under two flaps, and they were healed after debridement. Radial artery embolism of wrist occurred in one flap when pedicle division was performed 5 weeks post surgery, and it was healed by a transplantation of a segment of the great saphenous vein to reconstruct radial artery right after debridement. Patients were followed up for 6 - 12 months, and satisfactory appearance and function of the flaps were observed.</p><p><b>CONCLUSIONS</b>It is a feasible option to repair circumferential wound in the wrist region due to high-voltage electrical burn by using paraumbilical flap carrying a portion of rectus abdominis muscle combined with lower abdominal flap.</p>

Large-area burns with pandrug-resistant Pseudomonas aeruginosa infection and respiratory failure / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Infection due to pandrug-resistant Pseudomonas aeruginosa (PDRPA) has become a challenge in clinical practice. The aim of this research was to summarize the treatment of large-area burns (60% - 80%) with PDRPA infection and respiratory failure in our hospital over the last two years, and to explore a feasible treatment protocol for such patients.</p><p><b>METHODS</b>We retrospectively analyzed the treatment of five patients with large-area burns accompanied by PDRPA infection and respiratory failure transferred to our hospital from burn units in hospitals in other Chinese cities from January 2008 to February 2010. Before PDRPA infection occurred, all five patients had open wounds with large areas of granulation because of the failure of surgery and dissolving of scar tissue; they had also undergone long-term administration of carbapenems. This therapy included ventilatory support, rigorous repair of wounds, and combined antibiotic therapy targeted at drug-resistance mechanisms, including carbapenems, ciprofloxacin, macrolide antibiotics and β-lactamase inhibitors.</p><p><b>RESULTS</b>Four patients recovered from burns and one died after therapy.</p><p><b>CONCLUSIONS</b>First, compromised immunity caused by delayed healing of burn wounds in patients with large-area burns and long-term administration of carbapenems may be the important factors in the initiation and progression of PDRPA infection. Second, if targeted at drug-resistance mechanisms, combined antibiotic therapy using carbapenems, ciprofloxacin, macrolide antibiotics and β-lactamase inhibitors could effectively control PDRPA infection. Third, although patients with large-area burns suffered respiratory failure and had high risks from anesthesia and surgery, only aggressive skin grafting with ventilatory support could control the infection and save lives. Patients may not be able to tolerate a long surgical procedure, so the duration of surgery should be minimized, and the frequency of surgery increased.</p>

Early treatment of high-voltage electric burn wound in the limbs / 中华烧伤杂志

<p><b>OBJECTIVE</b>To summarize the experience of early treatment of high-voltage electric burn wounds in the limbs.</p><p><b>METHODS</b>Fifty-four patients (50 males and 4 females, aged from 10 to 56 years) with high-voltage electric burn wounds in 97 limbs (67 upper limbs and 30 lower limbs) were hospitalized in our burn wards from January 2003 to December 2010. A total of 119 burn wounds in wrist-forearm, forearm-elbow-upper arm, shoulder-axillary region, ankle-foot, lower leg, around the knee, thigh-inguinal region were treated with incision for decompression within 10 days after burn. Under the premise of relatively stable systemic condition of the patients, certain surgical operations were performed as follows. (1) Sixteen limbs with 16 wounds were amputated, among them forearm amputation was performed for 5 upper limbs with necrosis, with preservation of elbow joints, and the residual wounds of the elbow and upper arm were repaired with pedicled latissimus dorsi musculo-cutaneous flaps; 1 upper limb with upper arm amputated, with preservation of shoulder joint, was repaired with pedicled latissimus dorsi musculo-cutaneous flap. (2) Ninety-five wounds were covered with various tissue flaps with abundant blood supply after early debridement, in which 3 brachial arteries, 1 vein, 1 brachial artery and vein were reconstructed in 5 wrist wounds, artery reconstruction was performed in elbow wound of 1 case with injured brachial artery. (3) Eight wounds were treated with free skin grafting. Wound healing conditions were observed and followed up.</p><p><b>RESULTS</b>Wounds in 16 limbs healed after amputation and repair. Blood supply and (or) venous return of hands were restored in 5 wrist wounds after vessel reconstruction. After artery reconstruction, abundant blood supply was observed in 1 case with injured brachial artery and amputation was avoided. Necrosis occurred in distal parts of tissue flaps in 5 wounds after grafting, in which 2 wounds healed after removal of necrotic tissue followed by closure with suture, and 3 wounds healed after debridement and free skin grafting. Tissue flap infection occurred in wrist (5 wounds), elbow (1 wound), ankle-foot (2 wounds), and healed after debridement and suture. The other tissue flaps survived after grafting. Six wounds healed after skin grafting. Partial necrosis occurred in 2 wounds after skin grafting, and they were healed after second skin grafting. Thirty-seven patients were followed up for 6 to 12 months, the skin flaps survived with satisfactory appearance and texture.</p><p><b>CONCLUSIONS</b>Early extensive compartment release through fasciectomies and escharectomies, early debridement, early vascular grafting, early wound coverage with contemporary reparative and reconstructive surgical techniques are rational options for the treatment of high-voltage electric burns in the limbs.</p>

Lay emphasis on research into prevention and treatment of complications of burns / 中华烧伤杂志

The prevention and treatment of complications are very important aspects in burn treatment. We should pay attention to the fundamental research, clinical prevention and treatment of complications. We have had good grasp of the subjects by fundamental research such as MODS. We must keep complications in mind when signs, symptoms, monitoring index and laboratory reports are inconsistent to the usual course of the injury, and we must guard against the occurrence of complications in the whole course of burn treatment. Consideration must be given to the treatment of both complications and the primary disease in order to slow down deterioration of patient, and guarantee the curative effect. There are still many unknown areas of burn complications for us to explore and discover.

Evaluation of the cytotoxicity of cell free dermal substitutes using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide method / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The cytotoxicity of dermal substitutes may be increased by the very processes used to deplete the cells. The present research aimed to investigate the method for monitoring the cytotoxicity of cell-free dermal substitutes using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) method.</p><p><b>METHODS</b>The cytotoxicity of four dermal substitutes was evaluated using the MTT method according to the standards set by the Chinese State Food and Drug Administration (SFDA). Swine acellular dermal matrix (SADM) and goat acellular dermal matrix (GADM) were produced using a repeated freeze-thaw method. Human dermal matrix glutaraldehyde composite (HADM-G) and SADM cross-linked with glutaraldehyde (SADM-G) were produced using conventional methods.</p><p><b>RESULTS</b>The cytotoxicity of all dermal substitutes ranged from Grade 0 to Grade 1, meeting the standards of the Chinese FDA. The OD(490) of both SADM and GADM was higher than that of either HADM-G or SADM-G (P < 0.05).</p><p><b>CONCLUSION</b>Dermal substitutes produced by the freeze-thaw method are less cytotoxic than those produced using conventional methods.</p>

Repair of cicatricial contracture in face and neck regions with expanded skin flap / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the result of repairing deformity due to cicatricial contracture in face and neck regions with expanded skin flap.</p><p><b>METHODS</b>Eighty-three skin expanders with volume ranging from 100 to 600 mL were implanted into 38 patients with scars in face and neck regions after burn. The expansion time ranged from 3 to 5 months. Most expanders were implanted under normal skin. Ten expanders were implanted under stable integrated scars after healing of burn, and flaps therefrom were transplanted; 3 expanders were implanted into deep fascia layer of trapezius, and remote expanded skin flaps with deep branch of transverse cervical artery as the pedicle were formed and transplanted.</p><p><b>RESULTS</b>All flaps survived in 38 cases with satisfactory results. Complications including hematoma and infection after surgery occurred in 8 cases, but they did not affect therapeutic effect after treatment. Thirty patients were followed up for 3 to 24 months. It was found that the color and texture of skin flaps were good; appearance and function were obviously improved.</p><p><b>CONCLUSIONS</b>Expanded skin flap is the best flap for repairing cicatricial deformity in face and neck regions after burn. Expanded cicatricial skin and expanded skin of remote region are good choices when normal skin is not available nearby.</p>

Repair non-healing wound with artificial dermis and autologous skin graft / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the feasibility of repairing non-healing wound with artificial dermis and autologous skin graft, and to evaluate its efficacy.</p><p><b>METHODS</b>Twenty in-patients with 25 non-healing wounds lasting more than 8 weeks were divided into chronic ulcer group (9 patients with 11 ulcerating scars after trauma and burn), and bone exposing group (11 patients with 14 wounds with exposed bone ranging from 0.8 - 77.0 cm(2) in size, the largest 22.0 cm x 3.5 cm). Wounds were debrided and repaired with artificial dermis in the first stage. Autologous split-thickness skin was grafted in the II stage when the wounds were well vascularized locally and exposed bone and tendon were covered with dermis-like tissue within 2 - 6 weeks.</p><p><b>RESULTS</b>In chronic ulcer group, 9 of the 11 wounds healed well, the other 2 healed after routine dressing change. In bone exposing group, 12 of the 14 wounds healed well and the exposed bone was effectively covered; artificial dermis on the other 2 wounds failed to survive due to infection, and they were repaired with skin flap later. Patients were followed up for 5 - 24 months. Wounds healed with satisfactory appearance and no recurrence of wound or obvious hyperplasic scar was observed; no obvious scar was observed in the donor site.</p><p><b>CONCLUSIONS</b>The method of repairing non-healing wound with artificial dermis combining with autologous skin graft is simple; and it results in healing of wounds with high quality and little damage to the donor site. It provides a new choice for repairing non-healing wound.</p>

Repair of tissue defect of lower leg and foot with reverse island skin flaps with sural nerve and blood supplying vessels / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the clinical effect of reverse island skin flaps with sural nerve and blood supplying vessels on repair of tissue defect of lower leg and foot.</p><p><b>METHODS</b>Fifty-six patients with lower leg and foot tissue defects were hospitalized from June 1997 to August 2007. Among them, 10 patients suffered from soft tissue defect of lower leg; 38 patients suffered from wound infection, exposure of fracture of tibia and fibula, and osteonecrosis; 8 patients suffered from heelstick tissue defect, bone adhering scar, and osteomyelitis. The defects were repaired with sural nerve and blood vessel nourished reverse island skin flaps (46 cases) and myocutaneous flaps (10 cases). The size of flaps ranged from 5 cm x 4 cm to 22 cm x 16 cm. Flap donor sites were closed by direct suture or free skin grafting.</p><p><b>RESULTS</b>Flaps in 55 cases survived. Patients were followed up 3-6 months, there was no complication, and they were healed with satisfactory texture and appearance. The patients could walk normally, but with unsatisfactory sensory recovery. In one patient, the flap was broken and ulcerated 1 month after operation on account of leaving behind necrotic tibia. It was healed after second operation.</p><p><b>CONCLUSIONS</b>Sural nerve and blood vessel nourished reverse island skin flap or myocutaneous flap transplantation is an effective treatment for repair of soft tissue defect of lower leg and foot.</p>

Application of topical drugs in burn wound / 中华烧伤杂志

For burn patients, topical treatment is as important as systemic treatment. Reasonable and timely wound treatment will influence the homeostatic equilibrium, and the progression, the prognosis, and the outcome of the disease. The therapeutic principle should be varied for wounds with different depth of injury. But avoiding or at least alleviating infection, and accelerating healing period, were the common principles. In common, the medication for local wound treatment includes: topical antiseptic, surgical dressing products, artificial skins, and so on. Ideal topical antiseptic should have the following characteristics: the antimicrobial spectrum is broad, including Pseudomonas aeruginosa and MRSA; be able to penetrate necrotic tissue; does not induce drug resistance easily; no local irritating effect and not painful; no side effect to body;can be applied easily; low cost. The functions of surgical dressing include: protect the wounds, keep the microcirculation open, and accelerate wound healing. Artificial skin has been used as the autoskin carrier in skin transplantation operation for large burn area to protect the autoskin grafts, accelerate wound healing, and cover the wounds temporarily. Burns therapy has developed for 50 years in China, the study of local treatment for burn wounds has also experienced a tortuous path of trial and error. This review might contribute some ideas future research.

Treatment of burn cicatricial foot drop with Ilizarov fixator / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the efficacy of Ilizarov fixator on cicatricial foot drop after burn.</p><p><b>METHODS</b>Six patients with cicatricial foot drop after burn were treated with Ilizarov fixator during June 2004 approximately October 2007, the fixator was set on the leg and foot by fixed bone needles. Nuts on the threaded rod were turned from 3 post operation day, 2 approximately 4 rounds per time and 4 times per day in the first week, then 1 approximately 2 rounds per time and 4 times a day, which corrected the deformity of talipes equinus by shortening or lengthening the thread rod in the front and at the back. Ankle joint was maintained in neutral position for 2 approximately 3 months after effective correction. Weight carrying for patients was increased gradually after removal of fixator. Ankle joint was maintained in neutral position with fixator at least three months. Patients were followed up 5 approximately 10 months.</p><p><b>RESULTS</b>Ankle joints from all patients were restored to neutral position after application with fixator for 4 approximately 6 weeks. All patients achieved 0 degrees dorsiflexion in weight carrying for whole planta pedis after use of fixator for 12 approximately 15 weeks with good locomotion function.</p><p><b>CONCLUSION</b>Ilizarov fixator is safe and mini-injury, which is an effective method for treatment of cicatricial foot drop.</p>

Analysis of predominant bacteria of burn infection and their resistance to antibiotics in recent years / 中华烧伤杂志

<p><b>OBJECTIVE</b>To analyze the strains of bacteria in burn infection and their resistance to antibiotics in our burn unit in the recent years.</p><p><b>METHODS</b>Bacteria were isolated from specimens from the wounds, venous lines, blood, urine and feces of the hospitalized burn patients from January 2003 to December 2005 to analyze the vicissitude of bacteria and their drug resistance.</p><p><b>RESULTS</b>The number of Gram-negative bacteria (372 strains) was larger than Gram-positive ones (292 strains). Staphylococcus aureus (accounting for 16.7%) was predominant among Gram-positive bacteria, among which methicillin resistant staphylococcus aureus (MRSA) accounted for 82.5%. Among the Gram-negative bacteria, Pseudomonas aeruginosa accounted for 12.5%, and Escherichia coli accounted for 11.1%. The drug resistant ESPL-producing strains of Escherichia coli and Klebsiella pneumoniae accounted for 60.8% and 42.9%, respectively.</p><p><b>CONCLUSION</b>Drug resistance to antibiotics is a serious problem in a burn unit, calling for monitoring the vicissitude of bacteria strains and antibiotics sensitivity in order to control bacterial infection and dissemination.</p>

Study on the relationship between the human leucocyte antigen-DR expression on CD14+ monocytes and sepsis / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the changes in the expression of HLA-DR on CD14+ monocytes of burn patients with delayed resuscitation, and to analyze the relationship between it and sepsis.</p><p><b>METHODS</b>Twenty-five patients with total burn surface area over 30% TBSA and delayed resuscitation were enrolled in the study, among which 7 were complicated by sepsis during hospitalization. Peripheral blood was collected on 1, 3, 7, 14 and 28 post-burn days (PBD), and the blood of the patients with sepsis were also collected on the 1 and 2 days after the occurrence of sepsis. Twenty healthy volunteers were enrolled as controls. Expression rate of HLA-DR on CD14+ monocytes was determined by flow cytometry. The level of TNF-alpha and IL-10 were measured by ELISA.</p><p><b>RESULTS</b>Expression rate of HLA-DR antigen on CD14+ monocytes in burn patients without sepsis on 1, 3, 7, 14, 28 PBD were (15 +/- 6)%, (7 +/- 5)%, (26 +/- 17)%, (28 +/- 16)% and (47 +/- 16)%, respectively, which were obviously lower than that of healthy people [(92 +/- 10)%, P < 0.01], and it was also markedly lower on 1 and 2 days after the occurrence of sepsis than that of controls and those of patients without sepsis on 1, 7, 14, 28 PBD (P < 0.01). The positive rate and concentration of TNF-alpha in patients with sepsis were obviously higher than that of healthy people and patients without sepsis (P < 0.05 or P < 0.01). There was a negative correlation between the expression rate of HLA-DR on CD14+ monocytes and IL-10 levels, and it showed significant difference on 1, 7, and 28 PBD (r = -0.9963, -0.7459, -0.8474, respectively, P < 0.01).</p><p><b>CONCLUSION</b>Immune function is suppressed and proinflammatory mediators are excessively released in severely burn patients after delayed resuscitation, especially when complicated with sepsis. Expression of HLA-DR on CD14+ monocytes may be an useful parameter for monitoring the immune function of burn patients.</p>

Pathogenic bacteria distribution and drug resistance analysis in burns department / 中华外科杂志

<p><b>OBJECTIVE</b>To study the distribution and drug resistance of pathogenic bacterium and find the proper measures of infection control.</p><p><b>METHODS</b>Six hundred and eighty-two pathogenic bacteria strains were isolated and cultured from samples collected from January 2003 to December 2005. The pathogenic bacterium distribution and antibiotic resistance were analyzed.</p><p><b>RESULTS</b>The detection rate of gram-negative bacteria was higher than gram-positive ones. The gram-positive bacteria accounted for 292 strains (42.8%), in which the detection rate of staphylococcus aureus is highest (16.7% of total) and the detection rate of methicillin-resistant staphylococcus aureus accounted for 82.5% in staphylococcus aureus strains. Among 372 gram-negative bacteria strains (54.5%), the detection rate of bacillus aeruginosa, escherichia coli, baumannii and enterobacter cloacae were 12.5%, 11.1%, 9.1% and 8.2% respectively; extended-spectrum beta-lactamases (ESBLs) were detected in 45 (60.8%) escherichia coli and 9 (42.9%) klebsiella pneumoniae strains. Eighteen strains of fungus were found, and it decreased in last 2 years. The detection rate of opportunistic pathogenic bacteria and the antibiotic resistant strains kept increasing in the 3 years.</p><p><b>CONCLUSIONS</b>Drug resistance of pathogenic bacterium is very serious in burns department. The irrational use of broad-spectrum antibiotics and the antibiotic detection of pathogenic bacterium are all contributed to the drug resistance. It is important to enhance the asepsis, prevent hospital infection, detect the pathogenic bacteria and use antibiotics rationally in burns department.</p>

Multi-center clinical study of acticoat (nanocrystalline silver dressing) for the management of residual burn wounds / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the clinical efficacy and safety of Acticoat (nanocrystalline silver dressing) for the treatment of residual burn wounds.</p><p><b>METHODS</b>Ninety-eight patients with 166 residual burn wounds were enrolled in the multi-center randomized clinical trials. In addition to the routine treatment, Acticoat was applied onto the wounds of the trial group once a day if there was much exudation from the wound, or the dressing change was made every other two days when the wounds were clean. Silver sulfadiazine (SD-Ag) was used in the control group of patients. The healing time was observed up to 20 days. The healing rate on the 15th day after treatment was taken as the percentage of healing.</p><p><b>RESULTS</b>The average healing time was (12 +/- 5) days after the application of Acticoat, which was significantly shorter than that in control wounds with SD-Ag (16 +/- 6) days, (P = 0.005 < 0.01). The total effective rate of the wounds for trial was 97.05%, which was higher than that in control (94.17%) group, but there was no statistically significant difference. The bacterial clearing rate of the Acticoat group on the 6th and 12th post treatment day was 21.7% and 43.5% respectively, which was significantly higher than that in control group. No side-effect was observed in the two groups during the study.</p><p><b>CONCLUSION</b>Acticoat with nanocrystalline silver can promote the healing of residual burn wounds effectively.</p>

Influence of intravenous infusion of D-fructose on post-operative blood glucose level in burn patients / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the influence of intravenous infusion of 50 g/L fructose on post-operative blood glucose level in burn patients, and to evaluate its therapeutic value and safety.</p><p><b>METHODS</b>A prospective, randomized, double blinded clinical trial was conducted. Forty-one burn patients with burn area ranging between 10% -30% of total body surface (TBSA) and third degree burns ranging between 1% -10% TBSA were enrolled in the study and randomized into experiment group (E, n = 21, with intravenous infusion of 500 ml of 50 g/L fructose daily for 3 days after escharectomy) and control group ( C, n = 20, with intravenous infusion of glucose 1 day after escharectomy for 3 days). Intravenous infusion of other carbohydrate liquids or oral intake of sugar was withhold within 4 hours of fructose or glucose infusion. Physical signs and side effects were observed during the administration. The plasma glucose contents before operation and on 1, 2 and 3 post-operation day( POD) were measured. The serum content of lactic acid, uric acid, hepatic and renal function were determined before operation and on 4 POD.</p><p><b>RESULTS</b>Physical signs before and after drug administration, and plasma glucose content before operation, as well as before and after fructose administration in 3 POD exhibited no obvious difference between the two groups ( P > 0. 05 ). The plasma glucose content was increased 3 days after operation in the control group, and it reached the peak on 3 POD [ (8. 4+/-3. 5) mmol/L] , which was markedly higher than that before glucose administration [ (6. 4+/-2.4) mmol/L, P <0. 01) ]. The plasma contents of lactic acid and uric acid showed no obvious difference ( P >0.05) between the two groups, and also no difference before and after operation ( P > 0. 05). No changes were observed in hepatic and renal functions.</p><p><b>CONCLUSION</b>Intravenous infusion of 50 g/L D-fructose is safe because it exerts little influence on blood glucose level.</p>