Abordaje de la mano con quemaduras en una unidad de grandes quemados / Management of burned hand in a critical care burn unit

Introducción y Objetivo. Las quemaduras en las manos suponen un volumen total muy importante en la atención sanitaria. Prácticamente la totalidad de la población ha sufrido o sufrirá a lo largo de su vida una quemadura en sus manos. Afortunadamente, la inmensa mayoría no requerirá una atención especializada por parte de un cirujano plástico. Aun así, el impacto de los que sí precisan dicha atención es importante y debemos tener siempre planificado cómo actuar en cada situación. La función final que se obtenga de una mano quemada será de vital importancia, tanto si es la única zona del cuerpo afectada, como si entra en el contexto del gran quemado, y más en estos casos puesto que tendrá una gran repercusión positiva en su calidad de vida si se logra un resultado óptimo y/o funcional. El objetivo de este artículo es revisar nuestra experiencia como Unidad de Quemados en el tratamiento de la mano quemada y mostrar una serie de ejemplos de abordaje de las secuelas de quemaduras en manos que permita al paciente reincorporarse de forma completa a su actividad habitual. Material y Método. Revisamos los pacientes atendidos en nuestra Unidad entre 2012 y 2014, la afectación en manos, su epidemiología, distribución por variables, y revisamos varios casos de secuelas, algunos típicos y otros menos frecuentes. Resultados. Atendimos a un total de 307 pacientes, de los cuales 68 sufrieron quemaduras en 1 mano y 113 en las 2, requiriendo finalmente cirugía 155 manos. Del total, 39 pacientes provenían del ámbito laboral, de los cuales sufrieron quemaduras en manos 20, siendo en estos casos más frecuente la afectación de ambas manos que en los pacientes que no sufrieron accidentes laborales (4 afectados en una sola mano y 20 en ambas manos). Conclusiones. Nuestros pilares básicos se centran en: un diagnóstico preciso y precoz de profundidad, extensión y repercusiones; un tratamiento quirúrgico temprano y adecuado; un manejo rehabilitador continuo; y un seguimiento detallado de las posibles secuelas para poder tratarlas con la mejor indicación y en el momento preciso (AU)

Background and Objective. Hand burns have a very important total volume in healthcare. Virtually all of the population has suffered or will suffer throughout the life a burn on hands. Fortunately, the vast majority do not require a specialized attention by a plastic surgeon. Still, the impact of those who need such specialist attention is important and we must always plan what to do in every situation. The final function that is obtained from a burned hand will be vital whether it is the only area affected as if within the context of a critical burn patient, and more so in these cases as it will have a positive impact on their quality of life if results achieved are optimal and/or functional. The aim of this study is to present our experience as Burns Unit in the treatment of burned hands, and to review some examples of management of burns sequels in hands in order to get a complete reintegration of patients to their usual activities. Methods. We reviewed patients at our Unit involvement in hands, epidemiology, distribution in variables, and reviewed several cases, some typical and others less frequent. Results. We attended a total of 307 patients, 68 of them with burns in 1 hand, and 113 in both hands, finally needing surgery 155 hands. From the total, 39 patients came from the laboral ambient, 20 with hand burns, being both hands burns more frequent in those cases than in those who didn't suffered laboral accidents (4 burns in only 1 hand and 20 in both hands). Conclusions. Our cornerstones are: an accurate and early diagnosis of depth, extent and impact; an early and appropriate surgical treatment; continuous rehabilitation management; and a close follow up of the possible sequelae to treat them with the best indication and at the right time (AU)

The use of adipose mesenchymal stem cells and human umbilical vascular endothelial cells on a fibrin matrix for endothelialized skin substitute.

In recent years, the reconstruction of human skin by tissue engineering represents a clinical challenge and has offered a therapeutic alternative. Avascular engineered skin equivalents have been available for several years and used to treat wounds due to burns, nonhealing ulcers, and surgical excisions. They are constituted by different types of cultured cells included in a three-dimensional structure that permits cellular proliferation to create tissue substitutes. The major drawback of these artificial skin substitutes is their lack of blood supply, since the endurance and cell proliferation of the substitute depend on an adequate oxygen and nutrient supply and on toxin removal. These functions are served by the vascular system. We have produced a new model of endothelialized skin substitute that promotes the formation of capillary-like structures by seeding human umbilical vein endothelial cells (HUVECs) with dermal fibroblasts and human adipose-derived mesenchymal stem cells (hADMSCs) in a fibrin matrix. Dermal fibroblasts and hADMSCs produce extracellular matrix that stimulates cellular growth and proliferation. hADMSCs secrete significant quantities of angiogenic and antiapoptotic factors (vascular endothelial growth factor and hepatocyte growth factor), which induce in vitro differentiation of these cells into endothelial cells promoting angiogenesis and participating in tissue repair and skin regeneration processes. We obtained the artificial skin substitute with similar structure to native skin, including dermis and epidermis. We demonstrated that endothelial cells (CD31 and von Willebrand factor positive) proliferated and organized themselves into capillary-like structures within the fibrin matrix. The epidermis showed a complete epithelization by squamous cells (AE1/AE3 cytokeratin positive) with intracytoplasmic keratohyalin granules, hyperkeratosis, and parakeratosis. We have established a novel artificial skin substitute that facilitates the formation of capillary-like structures that may provide a novel therapeutic approach to different skin defects and prove to be a useful tool for regenerative medicine.