Application and advances in the research of animal models in burn research / 中华烧伤杂志

The occurrence, development, and prognosis of burn is a complicated pathophysiological process involving many organs and systems. With the development of science and technology and update of treatment concept, more and more new materials, new equipments, and new methods are applied to the diagnosis and treatment of burn. Animals similar to humans in anatomical structure and physiological function are the ideal models for research of burn. Nowadays, animal models of burn have been developed to simulate different aspects of burn. These models provide important essential support for elucidating the pathophysiological mechanism of burns and exploring new therapeutic interventions and materials for human beings. Understanding the advantages and limitations of these animal models is essential for the research of burn.

Investigation of the Result of Massive Pediatric Burn Patients: Early Escharectomy and Allograft

PURPOSE: Massive pediatric burns are subject to progress to wound infection and sepsis at early stage. Early escharectomy and allograft made it safer to treat the pediatric burn patients from this morbidity. The purpose of this study is to analyze the impact of the early escharectomy and temporary wound coverage with allograft on massive pediatric burns. METHODS: From January 1999 to August 2010, 55 pediatric burn patients aged 1 to 10 years whose total burn surface area was over 20% were reviewed. Among them, only 19 patients underwent escharectomy (Pediatric escharectomy group, PEG) and 36 patients underwent escharectomy and allograft (Pediatric allograft group, PAG) And 533 allograft patients (Allograft group, AG) aged over 10 whose total burn surface area were over 20% were reviewed to compare with the pediatric allograft patients. RESULTS: PAG was operated earlier (mean 3.6 days from injury) than PEG (mean 5.9 days). The mortality of PAG (8.3%) was lower than the mortality of PEG (31.6%) significantly. And the PAG were operated earlier than AG (mean 5.8 days from injury). But the difference of mortality was not significant statistically between PAG and AG. CONCLUSION: Early escharectomy and allograft is safe and effective treatment procedure for massive pediatric burn patients by preventing wound sepsis.

The Limited Immune Modulatory Effect of Early Escharectomy on Adhesion Molecules in Major Burn Patients / 대한마취과학회지

BACKGROUND: Early escharectomy has been shown to improve the survival rates and the treatment outcomes of major burn patients. However, its exact mechanism, especially in terms of the human immune system, has not been fully elucidated. This observational study, which placed a focus on adhesion molecules, was conducted to assess changes of soluble intercelluar adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), and E-selectin in major burn patients undergoing early eschar excision. METHODS: Seventeen ASA physical status II or III adult major burn patients, admitted for plastic and reconstructive surgery for burn wound care, were initially recruited. When early escharectomy was scheduled, a series of blood samples were obtained four times at 72 and 24 hours preop and 24 and 72 hours postop, respectively. Changing levels of sICAM-1, sVCAM-1, and E-selectin were measured using quantitative sandwich immunoassay techniques. RESULTS: All patients suffered from major burns. Early escharectomy does not appear to have any significant impact on the levels of sICAM-1 and sVCAM-1. On the other hand, E-selectin levels showed a significant decrease after escharectomy. CONCLUSIONS: Major burn injury certainly induces a systemic inflammatory response. Adhesion molecules behave in such a way that escharectomy has a limited immunomodulatory effect in major burns. This is probably related to the timing and extent of surgery, and the complex nature of burn related inflammation.

The Early Escharectomy in Massive Burns

PURPOSE: Burn wound infection, sepsis and organ failure have been major causes of death in massive burn patient. Because it is difficult to fundamentally prevent bacterial colonization by medical treatment, the need of surgical intervention is advocated by many authors. Therefore the effects of early excision and optimal time were studied. METHODS: Twenty four patients with thermal injuries, on whom early excision of eschar was performed, between June and Aug. 2003, were studied. Fascial excision over third and fourth degree burns and tangential excision over indeterminate areas were performed. Superficial and deep layers of eschar was separated and cultivated, and bacterial colony counts performed. The patients were divided into two groups: a colony count equal or greater than 10(5)/g (group A) and less than 10(5)/g (group B), and studied. The plasma endotoxin levels were assayed and compared. RESULTS: Sepsis occurred at a higher rate when the bacterial colony counts were equal or greater than 10(5)/g at the wound site. Bacterial colonization appears to be greatly increased on the 4th in of escharectomy in superficial layers, and on the 5th in deep layers, in old aged or young child patients tends to occur earlier and with greater severity. The microorganism isolated in all patients was Pseudomonas aeruginosa. There was no statistical difference in the plasma endotoxin levels between groups A and B. CONCLUSION: It is suggested that all massive burn injuries would be better treated with early excision, within 3 days after burns, especially in old aged or young child patients.

The Effect of Early Escharectomy on Pro- and Antiinflammatory Cytokines in Major Burn Patients / 대한마취과학회지

BACKGROUND: Early escharectomy has been shown to improve survival rates and treatment outcomes in major burn patients. However, its mechanism, especially in human immune systems, has not been fully elucidated. This observational study, focusing on cytokines, was conducted to assess changes in the levels of tumor necrosis factor alpha (TNF alpha) and interleukin-10 (IL-10) in major burn patients that underwent early tissue excision. METHODS: Seventeen ASA physical status II or III adults major burn patients, admitted to general surgery for burn wound care, were initially recruited. When early escharectomy was scheduled, a series of blood samples was obtained four times at 72 and 24 hours preop and at 24 and 72 hours postop. Changing levels of TNF alpha and IL-10 were measured by quantitative sandwich immnuoassay. RESULTS: Subjects suffered from 70% TBSA burns. Both cytokines demonstrated a significant tendency to increase in the blood during the study period. Although they temporarily decreased 24 hours after surgery, this effect did not last. CONCLUSIONS: Burn injury certainly increases cytokine response. Early escharectomy appears to decrease the pro and anti-inflammatory cytokines only temporarily. It did not seem to have any long term effect in the human immune system in major burn patients, probably due to the complex nature of the injury.

Atypical Increases of BIS according to Effect Site Concentration of Propofol in Severely Burn Patients Undergoing Early Escharectomy / 대한마취과학회지

BACKGROUND: This bispectral index, which is used for intravenous anesthetics and inhalation anesthesia, is a scale of sedation and hypnotic effect, which is widely used in clinics. Atypical changes in BIS are expected due to increased cardiac output, decreased blood albumin concentrations and renal function in severe burn patients undergoing early escharectomy. The aim of this study was to compare BIS according to effected site concentrations of propofol during anesthetic induction using propofol TCI in severe burn and nonburn patients. METHODS: Forty patients were classified as twenty nonburn elective surgical patients (group 1) and twenty burn patients scheduled for escharectomy (group 2). For induction, a propofol TCI device incorporating a prefilled syringe was adjusted to a target concentration of 6mug/ml in flash mode. The bispectral index was checked before induction and at each effect site concentration of propofol (0.5mug/ml interval) until an effect site concentration of 4.5mug/ml. Other suspected contributory factors such as cardiac index, creatinine clearance and albumin were checked simultaneously. The unpaired t-test and repeated measures ANOVA were performed for the statistical analysis. RESULTS: Below an effect site concentration of propofol of 3mug/ml, no BIS difference was evident between group 1 and group 2. However, at 3.5mug/ml, group 1 was 41.1+/-13.5 and group 2 was 54.7+/-16.6 and at 4mug/ml, group 1 was 40.1+/-2.6 and group 2 was 50.1+/-13.1. Among the suspected contributing factors, cardiac index and albumin showed significant differences between groups 1 and 2 (cardiac index: 3.4+/-0.5 L/min/m2 vs 2.7+/-0.3 L/min/m2, albumin: 4.1+/-0.3 g/dl vs 2.6+/-0.3 g/dl, P<0.05). Creatinine clearance showed no significant difference between the groups. CONCLUSIONS: Severe burn patients who are expecting early escharectomy had higher BIS values than nonburn patients from an effect site concentration of propofol of 3.5mug/ml. This study suggest that cardiac index should be considered as a factor that influences propofol.

Management of Scalp and Facial Burns by Sulphuric Acid With Early Escharectomy or/and Peeling of Eschar and Zoning Skin Grafting / 中国医师杂志

Objective To explore optimal methods and an opportunity of the management of scalp and facial burns caused by sulphuric acid,so as to prevent the development of facial hypertrophic scar and deformity. Methods Early zoning management were carried out in burn patients by sulphuric acid : ⑴Early (postburn 1～4 days) escharectomy and full or split thickness skin grafting were carried out in up-facial( forehead,temporal and up eyelid) ; ⑵Early(postburn 9～12 days) peeling of eschar and split thickness skin grafting were applied in cheek. ⑶Scalp expansion or skin grafting in granulation laterly in scalp wound according its shape and area.Results The wounds in 6 cases had healed comfortably ,hypertrophic scar and facial deformity were not occurred during the followed-up.3 cases of scalp burns scarring baldness were avoided.Conclusion Scalp and facial burns by sulphuric acid could be managed as early escharectomy and peeling of eschar and zoning skin grafting.As result,facial scar hypertrophy and deformity could be avoided.

THE EFFECTS OF ESCHARECTOMY DURING BURN SHOCK STAGE ON THE mRNA EXPRESSION OF INTERCELLULAR ADHESION MOLECULE-1 AND TUMOR NECROSIS FACTOR-? IN RAT LIVER / 解放军医学杂志

To investigate the changes in the expression of intercellular adhesion molecule 1(ICAM 1) ,tumor necrosis factor ?(TNF ?) mRNA and MPO activity in rat liver after burns and the effects of escharectomy during burn shock stage on the expression of these parameters. One hundred and seventy six Wistar rats with 30% TBSA full thickness thermal injury were used. The mRNA expression of ICAM 1 and TNF ? were detected by reverse transcription polymerase chain reaction(RT PCR) in liver tissues at various intervals after burns with or without escharectomy during shock stage. Both expression of ICAM 1 and TNF ?mRNA in rat liver after burns began to increase at 4h postburn and peaked at 12h and 24h, respectively. Afterwards in groups of escharectomy at 8h and 24h postburn, the expressions of both ICAM 1 and TNF ? increased again, though the expression values were lower than the first peak values, and they returned to normal range at 96h postburn. But in groups of burn control and escharectomy at 96h postburn, their expressions still remained high on 7d postburn. In addition, MPO activity returned to normal levels at 96h postburn in groups with escharectomy during shock stage, while in groups burn control and escharectomy at 96h postburn, a high value of MPO activity persisted till 7d postburn. Our findings suggest that eschar could induce the production of inflammatory mediators such as ICAM 1 and TNF ? which damaged endothelial cells. Therefore, escharectomy as early as possible may play an important role in preventing the expression and release of adhesion molecules and the development of systemsc lnflammatory response syndrome.

The clinical study of escharectomy in shock phase in coping with burn complications / 临床外科杂志

Objective To study the availability of escharectomy in shock phase and its role in preventing complications.Methods To make an analysis between the escharectomies and skin grafting of 79 cases in or beyond shock phase in the incidence of sepsis,visceral complications,MODS,mortality,healing time and the expenditure.Result The cases of the early operations revealed much better consequences than those performed beyond shock phase.Conclusion The escharectomy in shock phase proves to be available and significant in reducing post burn complications.