Meta-analysis of platelet-rich plasma in repairing burn wounds / 中国组织工程研究

BACKGROUND: At present, platelet-rich plasma has been used in bums, plastic surgery, surgery and orthopedics. However, due to the different standards for platelet-rich plasma preparation, the results of research on bums are controversial. OBJECTIVE: To systematically evaluate the effectiveness of platelet-rich plasma in the repair of burn wounds. METHODS: A computer-based online search of CNKI, VIP, WanFang, CBMdisc, PubMed, Embase, CochraneLibrary, Web of Science databases to retrieve randomized controlled trials regarding platelet-rich plasma repair of bum wounds. In the treatment group, platelet-rich plasma therapy or platelet-rich plasma therapy combined with conventional or other therapies were used. In the control group, conventional therapy, other therapies, or placebo treatment were used. After literature screening, information extraction and quality evaluation, Review Manager 5.3 software was used for meta analysis. RESULTS AND CONCLUSION: Eleven articles were included, involving 837 patients consisting of 420 patients in the treatment group and 417 patients in the control group. Meta analysis results revealed that the wound healing rate in the treatment group was significantly higher than that in the control group [OR=12.61, 95%Cl (6.93,18.29), P<0.000 1], Wound healing time in the treatment group was significantly shorter than that in the control group [OR=-4.64, 95%Cl (-6.21, -3.06), P<0.000 01]. The number of layers of gauze soaked by dressing [OR=-4.01, 95%Cl (-4.91, -3.11), P<0.000 01], the times of changing inner gauze [OR=-3.79, 95%Cl (-5.33, -2.26), P<0.000 01, and the times of dressing change on wound surface [OR=-3.41, 95%Cl (-5.93, -0.88), P=0.008] in the treatment group were significantly less than those in the control group. The positive rate of bacterial culture in wound [OR=0.46, 95%Cl (0.22, 0.94), P=0.03] and the incidence of inflammatory reaction in wound [OR=0.30, 95%Cl (0.17, 0.56), P=0.000 1] in the treatment group were significantly lower than those in the control group. The results suggested that platelet-rich plasma can increase the wound healing rate, shorten wound healing time, reduce the number of layers of gauze soaked by dressing, the times of changing inner gauze, and the times of dressing change on wound surface, and lower the positive rate of bacterial culture and the incidence of inflammatory reaction in wound.

A proline derivative-enriched methanol fraction from Sideroxylon obtusifolium leaves (MFSOL) stimulates human keratinocyte cells and exerts a healing effect in a burn wound model

It was previously demonstrated that the methanol fraction of Sideroxylon obtusifolium (MFSOL) promoted anti-inflammatory and healing activity in excisional wounds. Thus, the present work investigated the healing effects of MFSOL on human keratinocyte cells (HaCaT) and experimental burn model injuries. HaCaT cells were used to study MFSOL's effect on cell migration and proliferation rates. Female Swiss mice were subjected to a second-degree superficial burn protocol and divided into four treatment groups: Vehicle, 1.0% silver sulfadiazine, and 0.5 or 1.0% MFSOL Cream (CrMFSOL). Samples were collected to quantify the inflammatory mediators, and histological analyses were performed after 3, 7, and 14 days. The results showed that MFSOL (50 μg/mL) stimulated HaCaT cells by increasing proliferation and migration rates. Moreover, 0.5% CrMFSOL attenuated myeloperoxidase (MPO) activity and also stimulated the release of interleukin (IL)-1β and IL-10 after 3 days of treatment. CrMFSOL (0.5%) also enhanced wound contraction, promoted improvement of tissue remodeling, and increased collagen production after 7 days and VEGF release after 14 days. Therefore, MFSOL stimulated human keratinocyte (HaCaT) cells and improved wound healing via modulation of inflammatory mediators of burn injuries.

Effects of skin-resident regulatory T cells on wound healing after burn injury / 解放军医学杂志

Objective: To investigate the effect of skin-resident regulatory T cells (Tregs) on wound healing after burn injury. Methods: 60 Foxp3DTR mice and 60 wild-type C57BL/6 mice were included in the present study. The Foxp3DTRdiphtheria toxin (DT) injection group (F-DT group) and the wild-type DT injection group (C-DT group) were further divided into early (n=9) and late (n=9) groups according to the random number table method. In the early group, mice were injected intraperitoneally with DT during the early stage (-1, 0 and 3rd days ofter injury) after burns, while in the late group, mice were injected at the late stage (5th, 7th and 9th days after injury). We took photos of mouse wounds at different time points, and measured the wound area to assess wound healing rate. After HE staining, re-epithelialization of the wound was observed under light microscope. In addition, flow cytometry was used to analyze changes in local infiltration and functional expression of Tregs in skin of wild-type mice at different time points after burns. Results: Compared with the C-DT group, the rate of burn wound healing in the F-DT early group was significantly reduced (P0.05). In comparison to the C-DT group, HE staining in the F-DT early group revealed slower wound closure process and slower scar formation and crusting process, together with faster granulation tissue formation and obvious slower angiogenesis and re-epithelialization. Using flow cytometry to analyzing the infiltration of skin Tregs, CD4+Foxp3+T cells were significantly increased after burns, and gradually returned to basal level after reaching peak on day 5 (P<0.05). While CD25+Treg cells were markedly decreased to baselines after peaking on day 3 (P<0.05). In addition, CTLA- 4 expressions of skin Tregs was significantly enhanced after burns, and peaked on day 3 after burns, then gradually decreased to baseline values (P<0.05), while ICOS reached peak on day 5 postburn, and gradually decreased to normal range on day 11 (P<0.05). Conclusion: The skin Tregs appear to be infiltrated into the wounds during the early stage after injury, which might contributes to promoting wound healing following burns.

Effects of Coriaria Sinica Maxim's extract on microcirculation and oxidative stress of wounds in rats with deep second-degree burn / 中国应用生理学杂志

OBJECTIVE@#To investigate the effects of Coriaria Sinica Maxim's extract(CSME) on microcirculation and oxidative stress of wounds in rats with deep second-degree burn.@*METHODS@#One hundred and eighty rats were randomly divided into normal saline group(NS), white petroleum group(WPL), silver sulfadiazine group (SSD), Coriariasinica Maxim's extract group which were divided into low dose(CSME-L),middle dose(CSME-M) and high dose(CSME-H). After anesthesia with burn instrument to burn the hair removal area of rats, these wounds were confirmed by pathological results with deep second degree burns.And then,those drugs were applied respectively on the wounds,such as NS、WPL、SSD and different concentrations of CSME. After injury at 48 h, 7 d, 14 d and 21 d,the healing rate(HR) of wound was measured, and the microvessel density (MVD), tissue moisture (TM), vascular endothelial growth factor (VEGF), model driven architecture (MDA), superoxide dismutase(SOD) and hydroxyproline(HYP) were detected, too. All pathological sections of the wound tissue were observed.@*RESULTS@#The HR of CSME groups were obviously increased with a dose-dependent manner, which was significantly higher than that of NS and WPL (<0.05); On the 21 day, the diameter, number, distribution of the vessels and and the TM were less than other groups with a dose-dependent manner; On the 7 and 14 day after injury, CSME groups were significantly higher than the NS, WPL and SSD with a dose-dependent manner (<0.05), but, on the 21 day after injury, they were lower than NS, WPL and SSD with a dose-dependent (<0.05) manner. The levels of SOD, HYP, NO and ET in CSME groups were higher than those in other groups with dose-dependent on SOD activity, HYP, NO and ET content (<0.05), while MDA activity was weaker than other groups (<0.05). Similarly, pathological findings were also shown that CSME groups were better than other groups with a dose-dependent manner in decrease decreasing of wound repair time and hyperplasia of scar tissue.@*CONCLUSIONS@#CSME can relieve tissue edema, promote wound contraction, speed up the formation of eschar and accelerate the proliferation of granulation tissue, which are beneficial to the wound healing in the early stages. But, it can inhibit the hyperplasia of granulation tissue to prevent the excessive scar hyperplasia of burn wound in the later stages. Its mechanism is related to regulation what microcirculation, oxidativestress, NO and VEGF.

Effects of minimally invasive tangential excision in treating deep partial-thickness burn wounds on trunk and limbs in pediatric patients in the early stage post burn / 中华烧伤杂志

Objective@#To observe the effects of minimally invasive tangential excision in treating deep partial-thickness burn wounds on trunk and limbs in pediatric patients in the early stage post burn.@*Methods@#Clinical data of 40 children with deep partial-thickness burn wounds on trunk and limbs, admitted to our burn ward from January 2016 to June 2017, conforming to the study criteria, were retrospectively analyzed. They were divided into conventional treatment group (CT, n=19) and minimally invasive tangential excision group (MITE, n=21) according to the different treatments. The patients in group CT were treated with eschar-reserving therapy firstly. When tangential excision was performed, the roller knife was used, and no necrotic tissue left on the wound bed was considered the proper depth of excision. Razor-thickness skin grafting was performed to cover the wound when adipose tissue exposed markedly after tangential excision. Dressing change was performed within 48 h after the operation and repeated every 2 days. Unhealed wounds were covered by razor-thickness skin grafting. The patients in group MITE were treated with tangential excision in the early stage post burn. The tangential excision was operated with electric dermatome, and the thickness was set at 0.1 mm to excise the surface of eschar until the sporadic punctate hemorrhage on wound surface was observed and some necrotic tissue was left on the wound bed. Porcine acellular dermal matrix was applied after tangential excision. The first dressing change was often performed about 1 week after the operation. Razor-thickness skin grafting was performed to cover the unhealed wounds. The length of wound healing, high fever, antibiotic usage, and hospital stay, times of later operation, and hospitalization expenses of patients in the 2 groups were recorded. The excisional eschar and wound bed tissue of patients in group MITE were harvested for pathological observation. Data were processed with t test and Fisher′s exact probability test.@*Results@#(1) There were no statistically significant differences in length of high fever and length of hospital stay and hospitalization expenses between patients in the 2 groups (t=-1.67, -1.93, 0.31, P>0.05). The lengths of wound healing [(24.8±2.5) d] and antibiotic usage [(4.4±0.7) d] of patients in group MITE were significantly shorter than those in group CT [(33.3±2.5) and (7.0±0.7) d, t=-2.44, -2.44, P<0.05], and times of later operation of patients in group MITE [(0.29±0.14) times] were significantly less than those in group CT [(0.79±0.21) times, t=-2.03, P<0.05]. (2) The thickness of the excisional eschar of patients in group MITE was about 150 μm. The eschar has epidermis and upper dermis. Some necrotic tissue was left on the wound bed.@*Conclusions@#The treatment for pediatric deep partial-thickness burn wounds on trunk and limbs with minimally invasive tangential excision using electric dermatome in the early stage post burn can accelerate wound healing, shorten length of antibiotic usage, and reduce times of later operations.

Treatment of Partial Thickness Burn Wounds with Cultured Epidermal Homografts

PURPOSE: Since Rheinwald and Green laid the foundation of epidermal cell culture technology in 1975, many clinicians and scientists have attempted to prove the effectiveness of cultured epidermal autologous(CEA) or homogenetic(CEH) grafts in the wound healing process. In contrast to CEA which cultured from a patient's skin on demand, Cultured Epidermal Homograft (CEH) can be readily available to use on cleaned wounds. In this study, we conducted a controlled clinical trial in order to confirm the effectiveness of CEH in treating partial-thickness 2nd degree burn wounds. METHODS: From July 2003 to January 2004 at Hangang Sacred Heart Hospital, we performed a clinical trial in which 35 patients who suffered from 2nd degree burns were enrolled. Wounds were randomly divided into two parts, control and test sites. Test sites were treated with allogeneic keratinocyte sheets (Kaloderm(R), Tegoscience Inc.), a CEH commercialized in Korea. RESULTS: All wounds healed completely without any major complication. The complete healing took 8.3+/- 2.8(mean+/-S.D.) days in the test sites as opposed to 11.7+/-3.3 days in the control sites. CONCLUSION: Based on these results, we concluded that CEH accelerates re-epithelialization of partial thickness burn wounds and CEH can be an safe alternative to skin grafts for 2nd degree burns.