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>

Effect of lentiviral vector encoding on triggering receptor expressed on myeloid cells 1 on expression of inflammatory cytokine in septic mice infected by Bacteroides fragilis / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the effect of triggering receptor expressed on myeloid cells 1 (TREM-1) vshRNA vector on expression of inflammatory cytokines and survival rate in septic mice infected by Bacteroides fragilis.</p><p><b>METHODS</b>(1) TREM-1 vshRNA vector was constructed. Bacteroides fragilis (2.5 x 10(9) CFU/mL, 0.5 mL) was intraperitoneally injected in each mouse, and septic model was reproduced after 12 hours. (2) One hundred and fifteen mice were divided into healthy control group (n = 3, HC), sepsis group (n = 28, S), TREM-1 vshRNA group (n = 28, T), TREM-1 vshRNA hd group (n = 28, Th), GFP group (n = 28, G) according to random number table. Mice in S, T, Th, G groups were firstly injected with isotonic saline, TREM-1 vshRNA 2 x 10(8) TU, TREM-1 vshRNA 1 x 10(8) TU, GFP siRNA through tail vein, and then sepsis was induced after 1 hour. Mice in HC group were injected with equal volume of isotonic saline through tail vein. Three mice in each group were sacrificed after 12 hours for determination of plasma level of TNF-alpha, IL-1 beta and IL-6, and level of TREM-1mRNA and its protein in hepatic tissue. The survival rate of other mice in each group was monitored for 72 hours. (3) In 125 mice sepsis was reproduced, among them 100 mice were injected with TREM-1 vshRNA 2 x 10(8) TU after 1, 2, 4, 6 hours through tail vein (25 mice at each time point), other 25 mice were injected with equal volume of isotonic saline as control. The survival rate of mice in each group was recorded 72 hours after injection.</p><p><b>RESULTS</b>(1) Compared with those in S group, the plasma level of TNF-alpha, IL-1 beta and IL-6 lowered in T and Th groups (P < 0.05), especially in T group, while those in G group showed no obvious difference (P > 0.05). (2) Compared with those in G group, the level of TREM-1mRNA and its protein in hepatic tissue in T and Th groups decreased (P < 0.01), especially in T group. (3) The survival rate of mice in S and G group was 16%, which was obviously lower than that in T and Th groups (76%, 44%, respectively, P < 0.05 or P < 0.01). (4) The survival rate of mice at 1, 2, 4, 6 hours after injection was 72%, 56%, 40%, 16%, respectively, while all that except at 6 hour after injection were higher significantly than that of control (P < 0.05 or P < 0.01).</p><p><b>CONCLUSIONS</b>The intervention with TREM-1 vshRNA can effectively decrease hepatic level of TREM-1 in septic mice induced by Bacteroides fragilis, inhibit inflammatory response, and improve the survival rate.</p>

Repair of high-voltage electrical burn in the neck / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore methods of repair of high-voltage electrical burn in the neck.</p><p><b>METHODS</b>Thirty-seven patients with high-voltage electrical burn in neck hospitalized since 1985 were enrolled in this study. After debridement, the wounds were repaired with latissimus dorsi myocutaneous flap, trapezius myocutaneous flap, platysma myocutaneous flaps, pectoralis major myocutaneous flap, or latissimus dorsi myocutaneous flap combined with pectoralis major myocutaneous flap.</p><p><b>RESULTS</b>Necrosis occurred at edge of flap (about 1 - 2 cm in breadth) in 3 patients, and the other flaps survived well with perfect appearance and local function.</p><p><b>CONCLUSION</b>To repair with pedicled myocutaneous flaps and combined flaps after early debridement can be safe, effective and reliable in the management of patients with high-voltage electrical burn in the neck.</p>

Expression of myeloid cell triggering receptor-1 in monocytes at early post-burn stage / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the expression of triggering receptor expressed on myeloid cells (TREM-1) in monocytes of burn patients at early post-burn stage, and its significance.</p><p><b>METHODS</b>The monocytes of 8 healthy volunteers (A group), 29 patients with mild and moderate burn (B group), and 9 patients with severe and very serious burns (C group) were isolated from the blood, and the THEM-1 mRNA and protein expression were determined by semi-quantitative RT-PCR and flow cytometry, respectively. The plasma levels of TNF-alpha, IL-1beta were determined by ELISA method.</p><p><b>RESULTS</b>The value of TREM-1 mRNA expression in A, B and C groups were 0.74 +/- 0.13, 1.24 +/- 0.09, and 1.46 +/-0.07, respectively, and the expression rates on cell surface in the 3 groups were (9 +/- 4)%, (51 +/- 6)%, and (71 +/- 7)%, respectively, and there were significant differences among the three groups (P = 0.000). the plasma levels of TNF-alpha and IL-1beta in B and C groups were obviously higher than that in A group (P = 0.000), and they were positively correlated to TREM-1 expression (rs = 0.68, 0.72, P = 0.000).</p><p><b>CONCLUSION</b>Increased expression of TREM-1 in monocytes of burn patients at early post-burn stage is correlated with the release of inflammatory factors, indicating that TREM-1 might contribute to the onset and development of acute inflammatory response after burns.</p>

Repair of skin and soft tissue defect around the malleolus by superior regressive island fasciocutaneous skin flap graft / 中南大学学报(医学版)

OBJECTIVE@#To discuss the repairing procedure of skin and soft tissue defect around the malleolus, achilles tendon exposure, or calcaneus tendon exposure by superior regressive island fasciocutaneous skin flap graft.@*METHODS@#We used the superior regressive island fasciocutaneous skin flaps to repair 13 cases of skin and soft tissue defect or achilles tendon exposure around malleolus after trauma, scar ulcer, tumor, or other occasions. The maximal size of skin and soft tissue defect was 6 cm x 14 cm. The maximal size of calcaneus exposure was 5 cm x 10 cm.@*RESULTS@#Twelve cases obtained complete success with satisfactory results, and 1 case of necrosis delayed wound healing by latissimus dorsal myocutaneous flap graft. The follow-up lasted from 6 months to 4 years with satisfactory results.@*CONCLUSION@#The superior regressive island fasciocutaneous skin flap graft is an effective and convenient method to repair skin and soft tissue defect around the malleolus, achilles tendon exposure, or calcaneus tendon exposure.

Effect of antisense oligonucleotide against Smac/DIABLO on inhibition of hydrogen peroxide induced myocardial apoptosis of neonatal rats / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the effects of antisense phosphorothioate oligonucleotides against Smac/DIABLO (asODN) on hydrogen peroxide (H2O2) induced myocardial apoptosis in neonatal rats.</p><p><b>METHODS</b>Primary myocardial cells from neonatal rats were cultured in vitro, and randomly divided into A (normal control, without transfection), B (with treatment of single liposome), C (with transfection of scrODN), D (with transfection of asODN), E (with H2O2, stimulation), F (with H2O2 stimulation after scrODN transfection), and G (with H2O2 stimulation after asODN transfection) groups. The expression of asODN mRNA and protein were determined with RT-PCR and Western blotting, respectively. The changes in cellular nuclear morphology were observed with 33258 fluorescent staining, and the percentage of nuclear apoptosis was calculated. DNA fragmentation was observed by agarose gel electrophoresis. Activation of caspase-3 and caspase-9 were evaluated by caspase colorimetric analysis kit.</p><p><b>RESULTS</b>The expression of Smac/DIABLO mRNA and protein was obviously inhibited by asODN, which was about 80% percent lower than the protein level in A,B and C groups, but there was no difference noted among A,B and C groups( P > 0.05). Not only the nuclear apoptotic percentage, but also the activity of caspase-3 and caspase-9 in A, C and D groups were in very low levels. But these indices in G group 24 hours after H2O2 stimulation were obviously lower than that in E and F groups [the nuclear apoptotic percentage were (19 +/- 5) %, (52 +/- 3) %, (55 +/- 5) %, respectively, P < 0.01)]. The DNA ladders in G group were also decreased markedly.</p><p><b>CONCLUSION</b>Myocardial apoptosis induced by H2O2 can be inhibited by asODN in rat.</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>

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>

Application of bridged free latissimus dorsi musculo-cutaneous flap on the soft tissue defects in lower extremities / 中华烧伤杂志

<p><b>OBJECTIVE</b>To evaluate the effect of bridged free latissimus dorsi musculo-cutaneous flap on repairing of soft tissue defect in the lower extremity.</p><p><b>METHODS</b>Seven patients with extensive soft tissue defects in the lower extremities were enrolled in the clinical investigation. The defects were all repaired with bridged free latissimus dorsi musculo-cutaneous flaps. The condition of the blood vessels in the flaps and the healthy extremities was examined with ultrasound Doppler before the operation to assure the blood circulation of grafted flap. After debridement, the flap was designed in accordance with the size and the depth of the wound. Then the transplantation of the flaps were done. The operative indication and points for attention were summarized thereafter.</p><p><b>RESULTS</b>All the 7 flaps survived. All patients recovered well with satisfactory function and external appearance, except flap reduction was done in 2 patients due to undue thickness of the flaps. Indications for operation: (1) Patients with anterior or posterior tibial artery injury in the injured lower extremity in which arterial transplantation was not possible to allow the free transplantation of a skin flap. (2) The injury was extensive and deep, with the injurious condition of the blood vessels indeterminable and no healthy artery could be found for anastomosis with a donor artery. (3) No vascular injury could be identified in the contralateral healthy extremity. Points for attention included that the blood supply of the flap to be transferred should be adequate, and the survival of the flap after division of the pedicle should be assured. The length of the flap to be transferred should be longer by 10% than the distance between the site of transplantation in the lower extremities and the donor area; and the donor area should be larger by 20% than the recipient area. The skin area of the flap to be transferred should be broad enough avoid tension so that there would be no pressure on the blood vessels. Pay attention to the blood supply of the flap after operation, and the recipient limb should be properly immobilized.</p><p><b>CONCLUSION</b>The repair of extensive soft tissue defect in the lower extremity with bridged free latissimus dorsi musculo-cutaneous flap could be satisfactory. Proper wound management, broad flap, stable immobilization were the pivotal points for the success of the operation.</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>

Repair of the penial injury in patients inflicted by high-voltage electrical injury / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the repair and reconstruction of penial defect in patients inflicted by high-voltage electrical injury.</p><p><b>METHODS</b>Among one hundred and fifty three patients inflicted with high-voltage electrical injury, 6 suffered from penial injury (including 3 with necrosis of whole penis, 1 with partial necrosis of penis, 1 with partial necrosis of penial shin and 1 with necrosis of entire skin of penis) were enrolled in the study. The penis was repaired by direct suture of the residual skin following excision of necrotic skin in one case, by skin grafting in two case, by scrotum skin flap transplantation in 3 cases.</p><p><b>RESULTS</b>The appearance and function of the penis in three cases were satisfactory, and the result was also satisfactory in one patient who underwent reconstructive operation at late post injury stage. The penis was totally lost in 2 patients.</p><p><b>CONCLUSION</b>The skin necrosis of penis after high-voltage injury could be repaired with scrotum skin flap. Total necrosis of the penis could be reconstructed with abdominal skin flap.</p>

An experimental study on the repair of the necrotic tubular bone with pedicled vascular periosteum grafting in rabbits / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the mechanism of the repair of the necrotic tubular bone with pedicled vascular periosteum grafting in rabbits.</p><p><b>METHODS</b>Twenty mature New Zealand rabbits aged 8 months were randomly divided into test and control groups by placebo-controlled protocol. A segment of radius measuring 1.2 cm in length with pedicled vascular periosteum of the rabbits in the test group was obtained from the middle distal part of the bone, and boiled for 30 minutes. The cooled bone was then re-grafted and wrapped with vascularized periosteum and immobilized, while those in the control group, no periosteal grafting was done. X-ray examinations of the bones were carried out at 2, 4, 6, 8 approximately 10 post operation weeks (POWs). Meanwhile 4-5 rabbits were sacrificed for the harvesting of the radius on both sides for histological examination.</p><p><b>RESULTS</b>It was revealed by X-ray and histological study that the periosteal hyperplasia could be observed 2-4 weeks after operation in the test group. The sign of union of the fracture and the formation and reconstitution of the trabeculae could be observed 6-8 weeks after operation. The reconstitution of reticulated bone, the formation of the lamellar bone and new haversian system could be observed during 8-10 POW. The structure of the new formed bones became more mature and the fracture healed at 12 POW. In contrast, there was no changes in the necrotic bones in the control group at 2 POW and no signs of fracture healing at 4-6 POW, and the defect of the bones could be observed at 8 POW. The necrotic bones were totally dissolved and absorbed, and the bone defects could be observed clearly filled with fibrotic tissues at 12 POW.</p><p><b>CONCLUSION</b>The necrotic bones could be replaced by regeneration of new bone originated from the pedicled vascular periosteum, so that the necrotic tubular bones could be repaired. But the necrotic bones in the control group were eventually absorbed, resulting in bone defects.</p>