Clinical effects of in situ perforation of preserved split scar matrix in combination with scalp transplantation and vacuum sealing drainage in the treatment of hypertrophic scar in non-functional sites after burns / 中华烧伤杂志

Objective: To investigate the clinical effects of in situ perforation of preserved split scar matrix in combination with scalp transplantation and vacuum sealing drainage in the treatment of hypertrophic scar in non-functional sites after burns. Methods: A retrospective observational study was used. From June 2017 to June 2019, 33 patients (24 males and 9 females, aged 8-50 years) who met the inclusion criteria with hypertrophic scars in non-functional sites outside the face after burns were treated in General Hospital of TISCO (the Sixth Hospital of Shanxi Medical University). All patients underwent scalp transplantation after perforation of retained split scar matrix in situ (with scar thinning area of 90-500 cm2), and then the vacuum sealing drainage was performed. The hematoma and infection of wounds were observed on the 7th day after operation. At the same time, the survival rate of skin grafting was observed and calculated. The flatness and thickness of the scar in the operative area were observed in 12 months after operation, and the itching and pain of the patients were recorded. Vancouver Scar Scale was used to score the scar of patients before operation and at 3, 6 and 12 months after operation. The healing time and hair growth of donor site were observed. Data were statistically analyzed with repeated analysis of variance, paired sample t test and bonferroni correction. Results: On the 7th day after operation, local subcutaneous hematoma appeared in the wound of 2 patients, which healed after dressing change; no infection occurred. On the 7th day after operation, the survival rate of skin grafting of patients was 94.6%-99.0%(96.8±1.2)%. Scar flatness was well, the thickness of scar was not significantly higher than that of normal skin in 12 months after operation, and the symptoms of itching pain of patients disappeared or significantly relieved. Vancouver Scar Scale scores of patients before operation and at 3, 6, and 12 months after operation were 12.1±2.8, 8.5±1.5, 7.6±1.6, 6.7±1.3, respectively, and the scores of 3, 6, and 12 months after operation were all significantly lower than that before operation (with t values of 4.48, 4.06, and 3.97, respectively, P<0.01). All the donor sites of the head healed well in 4-7 days after operation. By 3-6 months after operation, all patients had good hair growth in the donor site and achieved no scar healing. Conclusions: The treatment of hypertrophic scar in non-functional sites outside the face after burns by in situ perforation of preserved split scar matrix in combination with scalp transplantation and vacuum sealing drainage can effectively improve the appearance of hypertrophic scar in non-functional areas after burn and reduce its degree of hyperplasia, with scar-free donor site healing.

Influence of rhubarb on gastrointestinal motility and intestinal mucosal barrier in patients with severe burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the influence of rhubarb on gastrointestinal motility and intestinal mucosal barrier in patients with severe burn.</p><p><b>METHODS</b>Thirty patients with severe burn admitted to our burn wards within 48 hours after burn injury from December 2009 to December 2010 were divided into therapeutic group (T, treated with 10 g rhubarb by nasal feeding and 5 g L-glutamine by oral administration beginning from 6 hours after admission, three times per day, and also given enteral nutrition beginning from 24 hours after admission, n = 16) and control group (C, received the same treatment as used in T group but without rhubarb, n = 14) according to the random number table. Gastrointestinal function indexes including restoration of bowel sound within 24 hours, abdominal distension, tolerance to enteral nutrition, and defecation were observed after treatment. The serum samples were harvested on post burn day (PBD) 3, 7, 14 for determination of the levels of gastrin (GAS) by radioimmunoassay, motilin (MTL) by enzyme-linked immunosorbent assay, diamine oxidase (DAO) by enzyme spectrophotometry, and endotoxin (ET) by kinetic turbidimetric assay with TAL. Data were processed with t test and chi-square test.</p><p><b>RESULTS</b>Compared with those in C group, the numbers of patients with restoration of bowel sound within 24 hours and tolerance to enteral nutrition in T group were increased (with chi2 value respectively 5.01, 4.84, P values all below 0.05), the number of patients with abdominal distension was decreased (chi2 = 4.84, P = 0.025). Compared with those of C group, defecation time was earlier, number of bowel movement was increased with soft feces in patients of T group. The serum levels of GAS in T group on PBD 3, 7, 14 [ (92 +/- 26), (95 +/- 16), (98 +/- 18) ng/L] were significantly higher than those in C group [(80 +/- 15), (75 +/- 17), (79 +/- 13) ng/L, with t value respectively 15.352, 22.951, 19.263, P values all below 0.01]. The serum levels of MTL in T group on PBD 3, 7, 14 [(246 +/- 80), (299 +/- 76), (300 +/- 100) ng/L] were significantly higher than those in C group [(189 +/- 44), (203 +/- 64), (200 +/- 67) ng/L, with t value respectively 14.173, 19.294, 26.298, P values all below 0.01]. The serum levels of ET in T group on PBD 3, 7, 14 [(0.398 +/- 0.035), (0.373 +/- 0.005), (0.238 +/- 0.019) EU/mL] were significantly lower than those in C group [(0.493 +/- 0.043), (0.501 +/- 0.045), (0.423 +/- 0.099) EU/mL, with t value respectively 6.213, 9.153, 15.134, P < 0.05 or P < 0.01]. The serum levels of DAO in T group on PBD 3, 7 [ (3.0 +/- 0.4), (2.9 +/- 0.5) U/mL] were significantly lower than those in C group [(3.9 +/- 0.5), (3.6 +/- 0.6) U/mL, with t value respectively 3.982, 4.236, P values all below 0.05], and there was no obvious difference between T and C groups on PBD 14 (t = 1.762, P > 0.05).</p><p><b>CONCLUSIONS</b>Rhubarb can protect intestinal mucosal barrier in patients with severe burn through increasing secretion of gastrointestinal hormones and promoting restoration of gastrointestinal motility.</p>

Mode of debridement, negative-pressure therapy combined with tissue transplantation for treatment of complicated and refractory wounds / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe therapeutic effect of negative-pressure treatment combined with tissue transplantation on complicated and refractory wounds after debridement.</p><p><b>METHODS</b>After debridement, 20 patients with 20 complicated and refractory wounds hospitalized in our burn wards from May 2008 to June 2010 were randomly divided into treatment group (T, treated with negative-pressure from -19 kPa to -8 kPa, n = 10) and control group (C, covered with petrolatum gauze overlaid with saline gauze and dry gauze, n = 10) according to alternating method. On post treatment day (PTD) 4, 7, and 14, granulation tissues of wound surface in size of 4 mm × 3 mm × 2 mm were harvested for histopathological observation (including capillary growth, inflammatory cells, and collagen arrangement) with HE staining, and the numbers of vascular endothelial cells (VEC, with addition of rabbit anti-human coagulation factor VIII related antigen polyclonal antibody) and proliferation period cells (with addition of mouse anti-human Ki-67 monoclonal antibody) were counted by immunohistochemical staining. Data were processed with t test. Another 59 patients harboring 62 complicated and refractory wounds admitted to our burn ward at the same period were treated with the same mode of debridement, negative-pressure therapy, followed by timely skin or skin flap grafting.</p><p><b>RESULTS</b>(1) Granulation tissue in T group grew more rapidly than that in C group. More capillaries and less inflammatory cells were observed in T group on PTD 7 as compared with those in C group. Collagen in T group on PTD 14 was more regular in arrangement than that in C group. The number of VEC per 400 times visual field in T group on PTD 4, 7, and 14 was respectively higher than that in C group (108.7 ± 11.2 vs. 31.0 ± 3.6, 138.0 ± 14.7 vs. 34.6 ± 4.5, 68.7 ± 6.9 vs. 55.1 ± 6.5, with t values from 4.62 to 30.28, P values all equal to 0.01). The number of proliferation period cell per 400 times visual field in T group on PTD 4 and 7 was respectively higher than that in C group (88.9 ± 5.9 vs. 16.6 ± 3.3, 128.1 ± 13.0 vs. 110.1 ± 8.9, with t value respectively 19.89, 3.33, P values all below 0.05). The number of proliferation period cell per 400 times visual field in T group on PTD 14 was obviously lower than that in C group (26.7 ± 5.1 vs. 59.7 ± 4.5, t = -12.43, P = 0.01). (2) After being treated with above therapeutic mode, necrotic tissues were removed completely and granulation tissue grew rapidly in 62 complicated and refractory wounds with high survival rate of skin grafts or skin flaps with good repair effect.</p><p><b>CONCLUSIONS</b>Negative-pressure therapy can accelerate VEC formation and stimulate cell proliferation after debridement. Debridement, negative-pressure therapy, and timely skins/skin flaps grafting can effectively increase healing rate of complicated and refractory wounds.</p>

Correction of claw hand deformity after burns by elastic traction / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate a new method for correction of claw hand deformity after burns.</p><p><b>METHODS</b>From May 2006 to Jul. 2010, 12 patients with claw hands deformities after burns were treated with skin grafts (11 hands) and skin flap (1 hand) with unsatisfactory results. Then elastic traction (skin traction or skeletal traction) were performed with individual functional brace.</p><p><b>RESULTS</b>All patients were followed up for 0.5 to 2 years. Elastic traction was effective in the correction of metacarpophalangeal joint deformity, buttonhole deformity, thumb-in-palm deformity, scar contracture, and palmar arch deformity.</p><p><b>CONCLUSIONS</b>Elastic traction is a simple and effective way for the correction of claw hand deformity after burns with less morbidity and stable results.</p>

Analysis of the proteomic changes of the serum of the Smad3 targeted deficient mice / 生物工程学报

We have studied the proteomic changes of the serum of the Smad3 targeted deficient mice using 2-DE and PMF approaches. 7 proteins expressed at different level in wild type mice and the Smad3 deficient mice were identified. These results would benefit the research on diagnosis and therapy of osteoarthritis and provided clues to studying the important function of Smad3 mediated TGF-beta signals during the skeletal development.