The role of skin bank in the treatment of severely burnt patients.

The accessibility of suitable temporary covers plays the key role in the treatment of severe skin losses. Biological covers have got the longest tradition in the wound healing. Skin banks are engaged in their production and distribution. Already in 1973 J. Moserová developed the methodology of harvesting pig xenografts. Later on, the short-term and the long-term method of storage were verified (Böhm, Konícková, Vogtová). In 1986, the Skin Bank in the Prague Burn Centre was established. In Prague Burn Centre the allografts are used very rarely, usually from the living donors, family members of the patients. Therefore, in our bank, we specialized in harvesting porcine xenografts. They are produced in three different forms--fresh, deep frozen in vapours of liquid nitrogen, and glycerolized. Porcine xenografts serve as a biological cover; they make barrier against infection and evaporation and protect the wound against desiccation. They are used namely for the treatment of superficial burn wounds, as a temporary coverage of excised wounds and as a dressing on release incision. Every year more than 10,000 strips have been used in our Burn Centre, it represents the area 200 m2. Since 1991 cultivation laboratory has been a part of our Skin Bank. We are interested in cultivation of human epidermal cells--keratinocytes. Cultured epidermal grafts became the first human in vitro prepared tissue, which was successfully transplanted to the patient. For the treatment of deep dermal skin losses we use either autologous keratinocytes, which can create permanent cover, or allogeneic cells, which stimulate spontaneous healing. Cultured keratinocytes are used in the treatment of burnt patients as well as in the trophic defects.

Therapeutical aspects of using citalopram in burns.

CONCLUSION OF THE ICU: Preliminary results from this stage of our study demonstrate a significant decrease of the duration of oedema, probably due to the effects of the inhibition of vascular hyperpermeability. This means that patients under Citalopram therapy can undergo surgical procedures such as necrectomies and autografts sooner because they are stabilized as early as the beginning of their treatment. Particularly the patients with burned faces and deep dermal burns have a better prognoses in respect to cosmetics. CONCLUSION OF THE PSYCHOLOGIST: From the beginning of the study to the present time, no patient experienced PTSD. The compared group of out-patients had been treated on average of 3 months when the first signs of a reduction in the clinical symptoms of PTSD was registered. The clinical onset of the therapeutical effect--on average in the third week--is comparable with references from anxiety or inhibitory depression treatment by using Citalopram. We suggest, at present, that the above-mentioned, preliminary results of our study have shown that Citalopram treatment has a beneficial effect on emotional disturbances in severely burned patients. CONCLUSION OF THE SCAR SPECIALIST: Seropram is a very useful preparation in burn praxis. When we apply it as a bolus 40 mg i.v. immediately after admission to the ICU, the scarring process is very good and hypertrophic scars are not seen. When we apply Seropram in the form of a continual infusion, using the injectomat during a 24-hour period, scarring is better than in the control group, but hypertrophic scarring is not out of the question.

Cultivation and grafting of human keratinocytes on a poly(hydroxyethyl methacrylate) support to the wound bed: a clinical study.

Cultured epithelial sheets on a textile support are used for the treatment of seriously burned patients. In this study we demonstrate a new procedure for the grafting of keratinocytes directly on a polymer cultivation support. This procedure is much easier in comparison with classical techniques, and encouraging results of clinical trials demonstrate the improved healing of the wound bed after the use of this procedure. There is no difference in the cytokeratine pattern (LP-34, cytokeratin-10) of the reconstructed epidermis and normal human skin.

Combined technique of anesthesia in early and late neck reconstruction.

Once the notion of the "quality of life" has been used in deliberations about straight-forward cases, it may be given wider application. It may be invoked in intensive care, in care of the handicapped and in any of medicine's specialist areas. In severe burns to keep the patient alive occurs at the cost of a degree of discomfort and disability caused by scar formation and following deformities. Severe anterior neck burn scar contracture issues in serious functional embarrassment, requiring early neck reconstruction based on three principles: releasing shrinked area, restoring contour of the mento-collical angle and preventing recurrence. Performing the surgical procedure demands endotracheal intubation which is impossible to accomplish because of chin adherent to jugulum. Combined technique of anesthesia using intravenous introduction (Ketalar) with or without local infiltration of the anterior neck scarring and immediate cutting through to the healthy muscle layer is necessary. Then follows insertion of endotracheal tube. The interval between incision and insertion may be rather crucial, as will be demonstrated in one of the cases treated in the Prague Burn Center during the last two decades.

Reconstruction of a devastating electric injury: case-report.

In the submitted case-report the authors describe a combination of a reconstruction operation with an orthopaedic approach to a devastating injury of the shoulder and elbow in a 26-year-old patient after an electric current injury. The total extent of the skin damage was 13% T.B.S.A. with localization on the right side of the chest, right arm, left elbow and shoulder. After fascial excisions the proximal part of the humerus was amputated with fixation by means of cerclage to the scapula. This defect was covered with the musculus latissimus dorsi flap and the defect on the elbow was covered by a tube pedicle flap.

First experiences with clinical application of cultured auto-epithelium grafts.

A modified method of in vitro cultivation of human keratinocytes was used to grow epidermal grafts. Grafts were applied to four patients, onto different types of wound: xenograft pretreated wounds, fresh donor sites, granulating wounds, and allogenic dermis left in place after removal of allogenic epidermis at the stage of starting rejection. Except for hypertropic granulating wounds in one patient all the other applications were successful.