Repair of wound on hand or foot due to electrical burn using free lateral upper arm perforator flap / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the effect of free lateral upper arm perforator flap in repairing wound on hand or foot due to electrical burn.</p><p><b>METHODS</b>Six patients with full-thickness wounds on hand or foot resulting from electrical burn were hospitalized from June 2010 to June 2013. The wounds ranged from 6.0 cm ×4.0 cm to 8.5 cm×7.5 cm in area. Free lateral upper arm perforator flaps were used to repair these defects, with flap area ranging from 9 cm ×4 cm to 12 cm × 9 cm. The donor sites in five cases were closed by suturing; the other one donor site was closed by transplantation of full-thickness skin from abdomen.</p><p><b>RESULTS</b>One flap used to repair the wound in middle finger failed due to failure of venous return, and it was repaired with full-thickness skin harvested from abdomen after dressing change. The other five flaps survived resulting in good elasticity and matched appearance of the recipient area without obvious bulkiness. Patients were followed up for 6 to 24 months. The function of the injured hands or feet recovered well, and the results of function evaluation of five hands were excellent in 2 cases, good in 2 cases, and poor in 1 case. Little scar formation with no contraction or function impairment was observed on donor site, and the result was satisfactory.</p><p><b>CONCLUSIONS</b>Free lateral upper arm perforator flap, with long vessel and less adipose tissue, is suitable for repairing small but deep wound on hand or foot due to electrical burn.</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>

Proteomic change in lymphocytes of scalded rabbits caused by Staphylococcus aureus invasion / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study the proteomic change in lymphocytes of rabbits with scald injury and Staphylococcus aureus (SA) invasion.</p><p><b>METHODS</b>Twenty-four rabbits were divided into four groups as follows: control group, scald group, scald with SA invasion 2 hs group, and scald with SA invasion 6 hs group, according to random number table, with 6 rabbits in each group. Except for rabbits in control group (sham scald at 37 degrees C), rabbits in the other 3 groups were subjected to 30% TBSA full-thickness scald. Rabbits in SA invasion 2 and 6 hs groups were injected with 2 mL (1.0 x 10(8) CFU/mL) SA suspension, which was in the log growth phase, via auricle vein 18 hs and 22 hs after injury. Whole blood samples were collected from carotid artery of rabbits in 4 groups 24 hs after scald. Lymphocytes were isolated and its extracted proteins were analyzed by two-dimensional gel electrophoresis coupled with mass spectroscopy.</p><p><b>RESULTS</b>About 1030 protein spots of lymphocytes were detected in each group. Compared with that of control group, 19 protein spots were found to be differentially expressed in the other 3 groups, and 11 spots (10 proteins) were identified. Expression levels of cofilin, cyclophilin A, ubiquitin, nucleoside diphosphate kinase, glutamate dehydrogenase and annexin 1 were down-regulated, but expression level of peroxiredoxin was up-regulated obviously.</p><p><b>CONCLUSIONS</b>There is obvious proteomic change in lymphocytes of scalded rabbits or of scalded rabbits invaded by SA, and it may relate to immune suppression and sepsis after injury.</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>

The use of composite sodium lactate and sorbitol composition in fluid resuscitation for shock in patients with major burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of the use of sodium lactate and sorbitol (CISS) in the fluid resuscitation for shock in patients with major burns.</p><p><b>METHODS</b>Fifty - three adult patients with major burns (hospitalized within 6 hours after burns) were randomly divided into A (n = 24, with i.v. infusion of 50 g/L CISS, 2 000 ml per day) and B (n = 29, with i. v. infusion of 50 g/L glucose, 2 000 ml per day) groups. The amount of electrolytes and colloid as the main resuscitation fluids was calculated according to the formula in both groups. Meanwhile, additional electrolytes and insulin were supplemented to the patients in the B group. The result of combating shock, energy supply, and side effects in the two groups were observed. The changes in hepatic and renal function, and the changes in electrolytes were monitored. The amount of fluid supplementation and urinary volume were recorded. The level of blood glucose of each patient was determined at the admission time and 24, 48, and 72 hours after injury.</p><p><b>RESULTS</b>No obvious difference was found in control of shock and energy supply between A and B group. There was no side effects or damage to hepatic and renal function related to infused fluids in A group. But the patients of the B group required supplementation of exra electrolytes and insulin during the fluid resuscitation period in order to maintain the normal levels of electrolytes and blood glucose, and this was not necessary in group A. The diuretic effect in group A was better than that in group B (average urinary volume in the first two 24 hours: group A: 1.9 +/- 0.6 and 3.3 +/- 0.8 L; group B:1.0 +/- 0.5 and 2.3 +/- 0.8 L).</p><p><b>CONCLUSION</b>The use of CISS during shock stage of the patients with major burns could be beneficial to the replenishment of blood volume, control of shock, promotion of diuresis and subsidence of edema. It could also provide electrolytes and energy, without the influence on the level of blood glucose.</p>

Long-term result of repair of deeply burned hands with large sheet of split-thickness autoskin grafting with the preservation of denatured dermis / 中华烧伤杂志

<p><b>OBJECTIVE</b>To evaluate the long-term results of repair of burn hands with large sheet of split-thickness autoskin grafting with the preservation of denatured dermis.</p><p><b>METHODS</b>One hundred and fifty-two hands in 86 burn patients with deep partial thickness and full thickness burn were enrolled in the study. The burned hands were treated by tangential excision and grafted with large sheet of split-thickness autoskin with the preservation of denatured dermis. The patients were followed-up from 3 months to 3 years. The skin color, elasticity, degree of contracture and the functional grading of the operated hands were observed.</p><p><b>RESULTS</b>Good function was found in one hundred and forty-one out of the 152 burn hands (92.8%). For the rest 11 hands, pigmentation was found in 4, poor appearance in 4, and 3 hands with both poor appearance and function.</p><p><b>CONCLUSION</b>Large sheet of split-thickness autoskin grafting with the preservation of denatured dermis could be an optimal choice for the management of hands with deep partial thickness burn, and it could restore the appearance and function of the hands satisfactorily.</p>