Treatment of burns and donor sites with human allogeneic keratinocytes grown on acellular pig dermis.

The absence of a dermal component predisposes cultured epidermal sheets to instability, contractibility, and makes them difficult to handle. In order to overcome these drawbacks, we developed recombined human/pig skin (RHPS) composed of human keratinocytes cultured on cell-free pig dermis. The original intention to prepare a permanent skin substitute composed of xenodermis and autologous epidermis was not achieved, but it has been proved that RHPS can serve as an effective, ready to use keratinocyte delivery system when applied 'upside-down', i.e. with epidermal cells facing the wound surface. The keratinocyte layer establishes a direct contact with the wound bed, while the dermal layer mechanically protects the wound. Twenty deep dermal burns were grafted with RHPS: 13 (65%) healed completely in 4-14 days, three (15%) healed partially and four (20%) did not heal. Of five full thickness burn wounds only one healed after repeated RHPS grafting within 18 days. Thirty-one (100%) donor sites treated with any of the three forms of RHPS, subconfluent, confluent meshed or confluent unmeshed, healed within 6-8 days compared with 14-18 days in control sites. Seven donor sites (100%) of immunodeficient patients with prolonged wound healing epithelialized in 7-10 days under RHPS compared with 32-90 days in areas treated with tulle gras and dry gauze.

The primary treatment of severe burn hand by flap plastic.

The author has summed up the experience from the treatment of severely burn hand. A deep burn of the hand is always a severe injury since it may be the cause of partial or full disability. Over the last 12 years (between April 1983 and March 1995) the Prague Burn Centre hospitalized altogether 182 cases of severe burn hands aged between 3 and 74 years. In all injuries an early necrectomy was carried out and the surface was covered with temporary cover. The depths of the injury is properly treated, becomes usually obvious after 4 days after the injury and then it is possible to cover the necrectomised areas with various types of flap plastics. The aim is the greatest possible return of the useful function and a satisfactory cosmetic result.

Emergency care of severe burn children (an experience of Prague Burn Centre).

The control of a shock associated with burns has marked effects on the further course of burn injuries. In spite of the steadily increasing improvement of intensive care of severe burn children sometimes are not applied essential recommended procedures which are necessary during the first aid and the transport of burn cases to a burn centre. These procedures are determined by the assessment of a lot factors. A misinterpretation of these factors can lead to an insufficient or to an excessively aggressive therapy with their sequelae. This holds true both for a local and for a systemic therapy of severe burn children. The most important problems are documented by 2 case reports.

Inhalation injury by paraffin flames (an African experience).

The paraffin flames predominate over all the aethiological agents of inhalation injury in South Africa. During the period of 16 months (from April 1992 to July 1993) we admitted 104 patients with inhalation injury by paraffin flames and we classified this type of injury into four main categories: a) patients with definite smoke inhalation injury but showing no respiratory insufficiency within the first 24 hours post burn, b) patients with developing respiratory insufficiency within the first 24 hours post burn, c) patients presenting intense symptoms on arrival, d) patients dying on arrival or very soon after. Tracheostomy was done if it was not possible to extubate within a period of 6 days after the injury. Bronchoscopy as well as chest X-ray examination, blood gases analysis, histological and cytological findings of sputum were performed in all patients. Authors evaluate also first experience with Bivona Fome Cuf Silicone Tracheostomy Tube.

[FSH, LH, prolactin, estradiol and progesterone after burn injuries in premenopausal and postmenopausal women]. / FSH, LH, prolaktin, estradiol a progesteron po popáleninovém traumatu u premenopauzálních a postmenopauzálních zen.

The authors examined 49 women who suffered severe burns and had to be hospitalized. Thirteen of these women were postmenopausal, 35 premenopausal and in one women, incipient pregnancy was revealed. In 14 women repeatedly FSH, LH oestradiol, progesterone and prolactin were assessed in serum by RIA. The group of premenopausal and postmenopausal women did not differ as to the levels of oestradiol, progesterone and prolactin. The gonadotropin levels in postmenopausal women were somewhat higher but the difference was significant only in FSH. The mean levels of the investigated hormones in premenopausal and postmenopausal women were: FSH 7.98 and 21.56 mIU/ml resp. oestradiol 151.88 and 183 micrograms/ml) resp. These differences cannot be explained by possible differences in the extent of burns or the time when the serum sample was taken. The authors interpret the results to the effect that the adrenals and steroid hormones produced by them resp. have a central position in the dysfunction of the pituitary-ovarian axis. These hormones influence by a backfeed mechanism the secretion of pituitary gonadotropins. This is consistent with data in the literature dealing with burns in men.