Preparation and processing of human allogenic dermal matrix for utilization in reconstructive surgical procedures.

AIM: This article presents the development of a novel preparation and processing method as well as indication for clinical applications of human allogeneic acellular dermal matrix, which was developed originally in the Central Tissue Bank (CTB) for use in burn medicine and reconstructive surgery. METHODS: Acellular dermal matrix (ADM) is a biological material assigned for utilization in several surgical procedures due to its unique structure and advantageous properties. The article focuses on a novel preparation and processing method developed by CTB, which differs in its impact on the structure, biological and biomechanical properties of the final ADM compared to the wide range of commercially available ADM products and currently available ADM products of other tissue banks. RESULTS: The ubiquitous acellular allogeneic dermal collagen matrix is the main substance participating in advantageous properties facilitating the use of ADM in numerous indications from dermal replacement and soft tissue augmentation to more extensive surgical reconstructive procedures. Dermal substitutes play an essential role in the reconstruction of full-thickness skin defects, both in acute and chronic wounds, defects of fasciae, peritoneum, etc., and there is a strong evidence that they can improve the final scar quality as well. Differences in preparation methods of ADMs are recently causing concerns among surgeons utilizing the ADMs. We present three different cases with favourable outcomes by using human acellular ADM grafts. CONCLUSIONS: Although ADMs did not fulfil all of the requirements for an ideal dermal substitute, their applications have been advanced for diverse indications in soft tissue reconstructions and augmentations. Early revascularization of the allografts reduces bacterial contamination. Research and development of new generation of acellular dermal matrices with incorporated autologous in vitro cultured cells will likely yield new products and give new hope for continued improve-ments in functional and cosmetic outcomes (Fig. 9, Ref. 60).

Toxic epidermal necrolysis data from the CELESTE multinational registry. Part II: Specific systemic and local risk factors for the development of infectious complications.

The aim of the study was to identify the most important systemic and local risk factors for the development of infectious complications in patients with toxic epidermal necrolysis (TEN). MATERIAL AND METHODOLOGY: This is a multicentric study that included all patients with TEN who were hospitalized between 2000-2015 in specialized centres in the Czech Republic and Slovakia. The total catchment area included a population of over 12.5 million inhabitants. The actual implementation of the project was carried out using data obtained from the CELESTE (Central European LyEll Syndrome: Therapeutic Evaluation) registry, wherein specific parameters related to epidemiological indicators and infectious complications in patients with TEN were evaluated as a retrospective analysis. RESULTS: A total of 38 patients (97%) of the group were treated with corticosteroids. The comparison of patients with different doses of corticosteroids did not exhibit a statistically significant effect of corticosteroid administration on the development of infectious complications (p=0.421). There was no effect of the extent of the exfoliated area on the development of infectious complications in this area. The average extent of the exfoliated area was 66% TBSA (total body surface area) in patients with reported infectious complications and 71% TBSA (p=0.675) in patients without infectious complications. In the case of the development of an infectious complication in the bloodstream (BSI), the increasing effect of the SCORTEN (SCORe of Toxic Epidermal Necrosis) value was monitored during hospitalization. Within 5days from the beginning of the hospitalization, the average SCORTEN value was 2.7 in 6 patients with BSI and 3.0 in 32 patients without BSI (p=0.588). In the period after the 15th day of hospitalization, 7 patients with BSI had an average SCORTEN value of 3.4, and 16 patients without BSI had an average SCORTEN value of 2.5 (p=0.079). In the case of low respiratory tract infection (LRTI), the effects of the necessity for artificial pulmonary ventilation and the presence of tracheostomy were monitored. The statistically significant effect of mechanical ventilation on the development of LRTI occurred only during the period of 11-15days from the beginning of the hospitalization (p=0.016). The effect of the tracheostomy on the development of LRTI was proven to be more significant. CONCLUSION: We did not find any statistically significant correlation between the nature of immunosuppressive therapy and the risk of developing infectious complications. We failed to identify statistically significant risk factors for the development of BSI. Mechanical ventilation and tracheostomy increase the likelihood of developing LRTIs in patients with TEN.

Toxic epidermal necrolysis data from the CELESTE multinational registry. Part I: Epidemiology and general microbiological characteristics.

INTRODUCTION: Toxic epidermal necrolysis (TEN) is a rare, life-threatening autoimmune disease predominantly manifested in the skin and mucous membranes. Today, infectious complications have the dominant share in mortality of TEN patients. Due to the nature of the therapy and administration of immunosuppressive medications, a wide range of potentially pathogenic microorganisms, which cause infectious complications in different compartments in these patients, is not surprising. MATERIAL AND METHODOLOGY: This is a multicentric study, which included all patients with TEN hospitalized between 2000-2015 in specialized centres in the Czech Republic and Slovakia. The total catchment area was over 12.5 million inhabitants. The actual implementation of the project was carried out using data obtained from the registry CELESTE (Central European LyEll Syndrome: Therapeutic Evaluation), when specific parameters relating to epidemiological indicators and infectious complications in patients with TEN were evaluated in the form of a retrospective analysis. RESULTS: In total, 39 patients with TEN were included in the study (12 patients died, mortality was 31%), who were hospitalized in the monitored period. The median age of patients in the group was 63 years (the range was 4-83 years, the mean was 51 years), the median of the exfoliated area was 70% TBSA (total body surface area) (range 30-100%, mean 67%). SCORTEN was calculated for 38 patients on the day of admission. Its median in all patients was 3 (range 1-6; mean 3). Any kind of infectious complication in the study group was recorded in 33 patients in total (85%). In total, 30 patients (77%) were infected with gram-positive cocci, 27 patients (69%) with gram-negative rods, and yeast cells or fibrous sponge were cultivated in 12 patients (31%). A total of 32 patients (82%) were found to have infectious complications in the exfoliated area, 15 patients (39%) had lower respiratory tract infections, 18 patients (46%) urinary tract infections and 15 patients (39%) an infection in the bloodstream. The most common potentially pathogenic microorganism isolated in our study group was coagulase neg. Staphylococcus, which caused infectious complications in 24 patients. Enterococcus faecalis/faecium (19 patients), Pseudomonas aeruginosa (17 patients), Staphylococcus aureus (11 patients) and Escherichia coli (11 patients) were other most frequently isolated micro-organisms. CONCLUSION: The published data were obtained from the unique registry of TEN patients in Central Europe. In the first part, we have succeeded in defining the basic epidemiological indicators in the group of patients anonymously included in this registry. The study clearly confirms that infectious complications currently play an essential role in TEN patients, often limiting the chances of survival. The study also shows a high prevalence of these complications in the period after 15days from the start of hospitalization, when most patients already have completely regenerated skin cover.

COMPLICATIONS OF LOWER EXTREMITY HEMATOMAS IN PATIENTS WITH PRE-INJURY WARFARINE USE.

INTRODUCTION: The aim of this paper is to ascertain the number of patients with pre-injury warfarin use who developed lower extremity hematomas treated in our facility, to analyse the data, used treatment methods and outcomes in these patients. PATIENTS AND METHODS: We performed a retrospective review, identifying all the patients with pre-injury Warfarin use admitted with hematoma or full-thickness skin loss in the ten years period from January 2006 to December 2015. RESULTS: Overall 9 women and 2 men with mean age of 72 years were identified. All the injuries were sustained in a domestic setting. Except of one female patient primarily admitted to our department, all patients had been hospitalized primarily in local/regional hospitals for an average period of 32.6 days. All the patients transferred to our department required surgical wound closure. The mean wound surface area was 136.3cm² (range 45-525). The duration of hospital stay was 15 days in average. DISCUSSION: The data obtained were compared with the results and findings of similar studies and were discussed. CONCLUSION: The results achieved in the present study showed the beneficial effect of used treatment methods based on the surgical wound closure techniques during hospital stay of the patients. Clinicians, first contact physicians, and also patients alone need to be aware of the vulnerability of this group of patients. The consequences of even minor lower extremity trauma can be serious, with development of a very complex chronic wound that is difficult to manage.

Epileptics and burns.

BACKGROUND: The aim of this paper is to ascertain the number of patients with a burn injury sustained during an epileptic seizure treated in our facility, to identify the characteristics of these types of injuries and to suggest preventive measures, which could reduce the frequency and morbidity of such injuries. PATIENTS AND METHODS: We performed a retrospective study, identifying all patients admitted with burns sustained during an epileptic seizure within a period of six years. RESULTS: Totally 7 women with an average age of 45 years were enrolled in this retrospective study. Mean BSAB was 2.4% (range 0.5-6). All burns occurred in a domestic setting during household activities (cooking, ironing). Thermal injury included contact burn (6 patients with deep burns), followed by scald (one patient with superficial burns). 6 of 7 patients (85%) required excision of deep burns and skin grafting procedure. The average duration of hospital stay was 13 days. Collected data were compared with the results and findings of similar studies and analysed. A list of preventive measures is included. CONCLUSION: Patients with epilepsy should be informed about all potential threats at the time of neurological diagnosis including also the risk of serious burn injury, which should be emphasised.

Cultured keratinocytes and their possible applications.

AIM: Skin is the largest organ, providing an outer layer of the body and thus creating a barrier against the surrounding environment. It possesses many important functions and can be damaged by various mechanisms. The substitution of damaged skin, mainly in the treatment of deep extensive burns, represents a key challenge. Damaged skin can be replaced permanently by skin autografts, cultured autogenous and allogenic keratinocytes or by the combination of skin substitutes with in vitro cultured autologous keratinocytes. In this article the preparation method and the possible applications of cultured autologous and allogeneic keratinocytes are described; we have long experience of this issue at the Department of Burns and Reconstructive Surgery in the University Hospital Bratislava.

Treatment of partial-thickness scalds by skin xenografts--a retrospective study of 109 cases in a three-year period.

BACKGROUND: The purpose of the present study was to confirm the clinical expediency of using a particular type of biological skin substitute--porcine skin xenograft--in the treatment of partial-thickness scald burns. MATERIAL AND METHODS: Over a period of three years (from the beginning of the 2005 to the end of the 2007) 109 admitted patients with partial-thickness scald burns were treated with skin xenografts. The mean age of the patients was 7.6 years (S.D.: 15.3), while mean TBSA was 13% (S.D.: 8.2). RESULTS: The number of patients healed by the 14th day postburn or sooner and their mean healing time, the mean healing time for all 109 patients, mean hospital stay and number of patients undergoing surgery were all evaluated. Of the 109 patients, 78 (71%) healed within 14 days with a mean time of 9.6 days (S.D.: 3.2). One sample t-test which compared mean healing times achieved within 14 days with the value of 14 days established a significant difference (p = 0.0001). For all 109 cases the mean healing time was 15.1 days (S.D.: 11.6), with no significant difference between mean healing times and the value of 14 days (p = 0.3). The mean hospital stay was up to 10 days (S.D.: 6.7). Four patients (3.6%) received split thickness skin grafts with an average extent of 4.5% TBSA. The data obtained were compared with similar studies and other treatment options for this indication and were discussed. CONCLUSION: This retrospective study proves the clinical efficiency of using skin xenografts for the treatment of partial-thickness scald burns. Skin xenografts showed good adherence on the wound surfaces, decreased the amount of exudate and reduced pain. In addition, the risk of hypertrophic scar formation was lower when wound healing was achieved within 14 days.

Enzymatic necrolysis of acute deep burns--report of preliminary results with 22 patients.

Enzymatic debridement by the use of a proteolytic enzyme complex derived, isolated and purified from pineapple stems proves to be an innovative, rapid, effective, selective and safe method of postburn necrotic skin removal. The major advantages of the procedure include minimal invasivity, rapidity, effectiveness, possibility to perform the debridement at the bedside, minimal or no loss of blood and minimal interference with natural wound healing processes. Our preliminary experience with this treatment method showed that in most of the cases treated the debridement was excellent, safe and rapid. The average duration of the debridement was less than 4 hours. The debridement was accompanied by minor to moderate pain which could be treated by analgetic medications. No serious adverse events or reactions have been observed during the study. The time for healing was comparable with the standard of care methods. The second randomized multicenter study is still in progress and has not yet been finished.

Analysis of 1119 burn injuries treated at the Bratislava Burn Department during a five-year period.

The Bratislava Burn Department was founded and started its activity 5 years ago. The department serves an area with 2.5 million of inhabitants with mixed both urban and rural population. We tried to analyze epidemiological data of 1119 acute burn injuries treated at the Department during a five-year period. All the data were compiled from statistical burn charts of in-patients. The average annual number of acute burn admissions including referrals was approximately 200 patients. We could see a distinct male predominance in almost all of the age groups with an average male to female ratio of 2.1:1. Children represented 38.1% of all the treated burn patients. The age group with the highest number of patients was in children 0-3 years with 237 patients (21.1%), and in adults 16-30 years with 197 patients (17.6%). The extent of burns varied between 1 and 99% of the BSA. The mean burn size was 15.7% of the BSA. The majority of the accidents were caused by hot liquids, followed closely by flame and/or explosion--they represented 43% and 36%, respectively. Concerning the place and/or cause of the accidents, the majority of burns occurred at homes, they represent 81.5% of the cases. Only 18.5% occurred at work, mostly in industry. Almost all of the injuries were caused by negligence. The rate of suicides by our patients was very low, less than 1%. 83 patients died, only 3 of them were children. The overall mortality rate was 7.3%. The mortality rate in children was as low as 0.7%. We compared our data with similar studies done in Kosice (Slovakia), Spain, and Brazil.(ABSTRACT TRUNCATED AT 250 WORDS)