Extended Paraumbilical Perforator Flap Pedicled With the Inferior Epigastric Artery for Coverage of Type III Circumferential Electrical Burns of the Wrist.

Type III electrical burns on the wrist are characterized by circumferential wounds, three dimensional with sandwich-like necrosis, and progressive blood circulation disturbances. Limb salvage is challenging, and success in meeting this challenge depends on vascular reconstruction and wound coverage. This article is intended for the following purposes: to investigate the principles of wound debridement, the management of involved blood vessels, and the clinical effects of the extended paraumbilical perforator flap pedicled with the inferior epigastric artery for coverage of type III circumferential electrical burns of the wrist. A total of 13 male patients (age, 20 to 43 years; average, 29 years) were enrolled in the study. After early escharotomy, debridement, and vascular reconstruction, all wounds were repaired with the extended paraumbilical perforator flap pedicled with the inferior epigastric artery. Flap survival was achieved in all 13 patients. Subcutaneous liquefaction necrosis and infection beneath the flap occurred in three patients. Radial or ulnar artery reconstruction via the great saphenous vein (GSV) graft was performed in 12 cases. All patients had a mean follow-up of 6 to 36 months, and the flaps demonstrated satisfactory flexibility and texture. Hand function was preserved in eight patients, and no patients developed abdominal hernia. Thorough debridement, early vascular reestablishment, and wound coverage are essential for the overall limb salvage effort for type III circumferential electrical burns of the wrist. The extended paraumbilical perforator flap may provide a new and appropriate option for the primary repair of extensive soft tissue defects.

Ectopic Implantation Salvage of the Left Thumb to Reconstruct the Right Thumb After Electrical Injury: A Case Report.

The incidence rate of electrical injury has remained stable, while the absolute case number has increased. Amputations, erosions, occlusions, and delayed blood vessel rupture are the common complications. Ectopic implantation salvage has been performed widely in mechanical trauma patients, to preserve viable or possibly viable tissues and organ, without application in the electrical injury patients to the best of our knowledge. Here, we present a case report involving ectopic implantation salvage of the left thumb before contralateral transplantation to the right hand after high-voltage electrical injury. The patient's left thumb remained viable despite necrosis of the left forearm at 3 weeks postinjury. After debridement, we implanted the left thumb to his thigh where it was anastomosed to the lateral circumflex femoral artery's descending branch and great saphenous vein. We replanted the left thumb on the right hand with fixation 6 weeks later. The reassembled right hand remained well-circulated 11 months postreconstruction. We believe this case supports broadening the indication for ectopic implantation salvage surgeries to patients who sustain electrical injuries.

Epidemiology and risk prediction of patients with severe burns admitted to a burn intensive care unit in a burn center in beijing: A 5-year retrospective study.

Objective: This study was performed to describe the epidemiology of patients with severe burns hospitalized in a burn intensive care unit (BICU), explore the risk factors associated with the patients' outcomes and evaluate the ability of prognostic scoring systems as risk prediction of mortality. Methods: The data for this study were derived from patients with severe burns in the BICU of Beijing Jishuitan Hospital from 2015 to 2019. The following epidemiological information and outcomes were collected for retrospective analysis: sex, age, date of injury, etiology of burn, admission time after injury, extent of burn, inhalation injury, length of stay, and outcome. Abbreviated Burn Severity Index (ABSI), prognostic burn index (PBI), the burn index (BI), Belgian Outcome in Burn Injury (BOBI) scores and the revised Baux (rBaux) scores were calculated. Results: Of the 243 patients included in this study, the median age was 41.00 (22.00) years and the male: female ratio was 4.28:1.00. Most of the burns had occurred from March to July. Flame was the main cause of the burns (77.37%), followed by electricity (14.40%). In total, 78.19% of all patients sustained third-degree burns, and the median burn area and third-degree burn area of patients were 40% (53%) and 15.0% (43.0%) of the total body surface area, respectively. The incidence of inhalation injury was 69.14%. Tracheotomy was performed in 53.89% of the patients with inhalation injuries, and the rate of tracheostomy showing a rising trend. The median length of stay was 37 (40) days, and the case fatality rate was 8.64%. Multivariable logistic regression model indicated that age and third-degree burn area were risk factors for death, and the area under the receiver operating characteristic curve for the full prediction model was 0.921 (95% CI = 0.874-0.967). Conclusions: The majority of severe burns are flame-related accidents in middle-aged men. Risk prediction model combining age and third-degree burn area has better mortality predictive value.

Survival and Versatility of the Flow-Through Lateral-Thigh Free Flap in Severe Electrical Injuries to the Wrist.

BACKGROUND: The hand and wrist are most often in contact with electrical currents and thus most vulnerable to severe electrical burns. The treatment of such severe injury via surgical intervention remains a big challenge because of the vast tissue necrosis and the segmental vascular injury. The flow-through lateral-thigh free flap has been used effectively to resurface these defects and to reconstruct segmental vascular defects. METHODS: Between January 2014 and June 2017, 11 male patients aged 19 to 53 years were admitted to the burn unit of our institution. Each presented with severe electrical burns to the wrist with long segmental vascular injury, and 2 cases suffered from electrical burn on both wrists. After radical debridement, the soft-tissue and segmental artery defects were rebuilt through the application of flow-through lateral-thigh free flap for 1 of the ulnar or radial artery injury (7/12). Ulnar artery defects were rebuilt through the application of flow-through lateral-thigh free flap, and radial artery revascularization was done using a greater saphenous vein graft for both ulnar and radial artery injuries (5/12). Vascular condition was closely monitored throughout the treatment period. RESULTS: Forearm amputation was performed in 1 case as a result of distal immediate necrosis postinjury. Successful limb salvage was achieved in the other 12 wrists. Infection beneath the flap occurred in 3 cases but resolved after debridement. Over the course of the 3- to 12-month follow-up period, the free flaps maintained good texture and sharpness, distal circulation of affected limb became well established, and the appearances of the donor sites were acceptable. CONCLUSIONS: High-voltage electrical burns of the wrist are highly destructive, and sophisticated management of damage requires concomitant vascular reconstruction and soft-tissue coverage. The flow-through anterolateral-thigh flap is an optimal solution for this problem. Emphasis must be placed on the affected blood vessel throughout the treatment period.

Protective effects of tiopronin against oxidative stress in severely burned patients.

OBJECTIVE: Tiopronin is an antioxidant. This study investigated the protective effect of tiopronin on oxidative stress in patients with severe burns. METHOD: Patients aged between 16 and 65 years old with >30% body surface area burns admitted to our burn unit from July 2011 to September 2016 were randomly divided into 3 groups: group A treated with tiopronin (15 mg/kg. 24 hrs), group B with vitamin C (792 mg/kg. 24 hrs), the other group with standard treatment (group C). All 3 groups also received standard treatment. Blood superoxide dismutase (SOD), malondialdehyde (MDA), and the biochemical indexes of liver, kidney, and heart were determined before treatment and 24 and 48 hrs after treatment. Samples from 8 normal healthy adult volunteers were also measured. The resuscitation fluid volume requirement for the first 24 hrs was calculated for 3 groups. RESULTS: The serum levels of MDA and the biochemical indexes in severely burned patients were higher than those in healthy volunteers (P<0.01). The serum SOD level of burn patients was lower (P<0.01). After treatment, the levels of SOD increased, the levels of MDA decreased, and the biochemical indexes of heart, liver, and kidney improved; these changes were more obvious in group A and group B compared to group C (P<0.05), and these changes were more obvious in group A compared to group B (P<0.05) at 48 hrs after treatment. There is less resuscitation fluid volume requirement to maintain adequate stable hemodynamic and urine output in the first 24 hrs in group A and group B compared to group C (P<0.05). CONCLUSION: Treatment with tiopronin could exert protective effects against burn-induced oxidative tissue damage and multiple-organ dysfunction, and also could reduce the volume of required fluid resuscitation in severely burned patients.

[Repair of cervical postradiation ulcer following radical mastectomy with lower trapezius myocutaneous flap].

OBJECTIVE: To explore the clinical effects of ipsilateral lower trapezius myocutaneous flap for repairing cervical ulcer as a result of radiotherapy after radical mastectomy. METHODS: Six patients with cervical ulcers as a result of radiotherapy after radical mastectomy were hospitalized from March 2010 to February 2015, suffering from persistent pain in different degrees. The wound area ranged from 6 cm × 4 cm to 10 cm × 6 cm before debridement, 8 cm × 5 cm to 16 cm × 10 cm after debridement. Ipsilateral lower trapezius myocutaneous flap was used to repair the wound after thorough debridement, with the area ranging from 10 cm × 7 cm to 20 cm × 13 cm. The donor sites were sutured directly or covered with medium-thickness skin graft obtained from the back. RESULTS: Pain was obviously relieved in all the patients 2 days after surgery. The wounds in five patients were healed, while necrosis of superficial skin approximately 1 cm in diameter appeared at the distal end of one myocutaneous flap, and it healed after dressing change. During the follow-up period of 3 to 18 months, no recurrence of ulcer was found, the texture of the myocutaneous flaps was soft with good appearance, and the donor sites healed well. CONCLUSIONS: On the basis of thorough debridement, it is feasible to repair the cervical ulcer as a result of radiotherapy after radical mastectomy with the ipsilateral lower trapezius myocutaneous flap.

[Management of skin necrosis around incision following total knee arthroplasty].

OBJECTIVE: To investigate the risk factors of skin necrosis around incision after total knee arthroplasty (TKA), and explore the measures of prevention and treatment. METHODS: Between June 2007 and June 2013,7 patients with skin necrosis around incision after TKA were treated. There were 5 males and 2 females with an average age of 69 years (range, 59-78 years), including osteoarthritis in 4 cases, traumatic arthritis in 2 cases, and rheumatoid arthritis in 1 case. Two cases complicated by diabetes, and 2 cases by hypertension; 1 case received long-term hormone therapy; and 2 cases had a history of smoking. Scar was seen near knee joint in 2 cases. The skin necrosis ranged from 10 cm x 2 cm to 13 cm x 8 cm. The time from TKA to debridement was 7-15 days (mean, 12 days). After thorough debridement, the saphenous artery skin flap, medial head of gastrocnemius muscle flap, lateral head of gastrocnemius muscle flap were used in 4 cases, 2 cases, and 1 case respectively; reconstruction of patellar ligament was performed in 2 cases. Donor sites were repaired by split-thickness skin graft. RESULTS: All the flaps and myocutaneous flaps survived well, and all wounds healed by first intention. At donor site, the grafted skins survived and wounds healed by first intention. No early complication occurred. All cases were followed up 6-12 months (mean, 7.8 months). The flaps and myocutaneous flaps had good texture and appearance; no prosthetic loosening and displacement happened, no secondary infection was observed after operation. The knee range of motion was 45-110 degrees (mean, 85 degrees) at 6 months after operation. According to the Knee Society Score (KSS), the results were excellent in 3 cases, good in 2 cases, general in 1 case, and poor in 1 case at 6 months after operation. CONCLUSION: Early discovery, thoroughly debridement, and timely repair with axial pattern flap or myocutaneous flap are the key factors to treat skin necrosis around incision after TKA and save the artificial prosthesis.

[Treatment of post-traumatic chronic calcaneal osteomyelitis and soft tissue defect by using combined muscle and skin flaps of calf].

OBJECTIVE: To investigate the effectiveness of distally pedicled peroneus brevis muscle flaps and reverse sural neurovascular island flaps for post-traumatic chronic calcaneal osteomyelitis and soft tissue defects. METHODS: Between January 2008 and January 2012, 9 patients suffering from post-traumatic chronic calcaneal osteomyelitis and soft tissue defects were treated, including 8 males and 1 female with an average age of 33 years (range, 18-46 years). The left heel was involved in 4 cases, and right heel in 5 cases. Infection occurred after reduction and internal fixation of closed fractures of the calcaneus in 7 cases, and open calcaneal fracture and soft tissue defect in 2 cases. The disease duration was 2 months to 3 years (mean, 5 months). Purulent secretion, tissue necrosis, or sinus formation was observed in all wounds. The results of bacterial culture were positive. X-ray and CT examination showed uneven density of calcaneus and bone cavity or dead bone formation. After thorough debridement, the size of bone defect ranged from 3 cm x 3 cm x 3 cm to 6 cm x 4 cm x 3 cm; the size of soft tissue defect ranged from 7 cm x 3 cm to 12 cm x 7 cm. The distally pedicled peroneus brevis muscle flaps (11 cm x 3 cm-16 cm x 4 cm) were used for bone defect repair, and reverse sural neurovascular island flaps (8 cm x 4 cm-14 cm x 8 cm) for soft tissue defect. The donor site was directly sutured in 6 cases and repaired by skin graft in 3 cases. RESULTS: After operation, reverse sural neurovascular island flaps survived in 9 cases, and all wounds healed by first intention. No necrosis or liquefaction of distally pedicled peroneus brevis muscle flaps was observed. Incision at donor site healed by first intention, and skin grafts at donor site survived. All cases were followed up 6-24 months (mean, 13.5 months). The flaps had good texture. No recurrence of osteomyelitis was observed. Basic weight-bearing walking function was restorated. No obvious calcaneal collapse happened. CONCLUSION: The distally pedicled peroneus brevis muscle flap combined with reverse sural neurovascular island flap is one of the effective methods to treat post-traumatic chronic calcaneal osteomyelitis with soft tissue defect, with the advantages of simple operation and good blood supply.

Combined rectus abdominis muscle/paraumbilical flap and lower abdominal flap for the treatment of type III circumferential electrical burns of the wrist.

BACKGROUND: Type III circumferential electrical burns of the wrist are one of the most severe electrical injuries, involving rather extensive necrosis, progressive blood circulatory embarrassment and a high amputation rate. This injury poses a challenge for vascular reconstruction and wound coverage. The purpose of this study was to evaluate the effectiveness of the combined rectus abdominis muscle/paraumbilical flap and lower abdominal flap for the treatment of type III circumferential electrical burns of the wrist. METHODS: Six men (age, 19-32 years; average, 21 years) with type III circumferential electrical burns of the wrist were included. After thorough debridement, the volar wound was repaired with a partial rectus abdominis muscle/paraumbilical flap and the dorsal wound was repaired with a lower abdominal flap. RESULTS: Flap survival was complete in all six patients. During a follow-up of 6-12 months, the flaps showed good texture and shape. No abdominal hernia occurred in any patients. The scar on the abdominal wall was acceptable. CONCLUSION: The combined rectus abdominis muscle/paraumbilical flap and lower abdominal flap has large wound coverage potential and offers a new, easy, safe option for the treatment of type III circumferential electrical burns of wrist.

[Treatment of full-thickness electric burn of skull combined with cerebral contusion and intracranial infection].

This article reports the treatment of a patient suffering from full-thickness electric burn of skull combined with cerebral contusion and intracranial infection to provide experience in treating such patients. Based on detailed analysis on patient's condition and CT results, several operations of surgery and anti-infection treatment were performed on the patient. The wounds healed 6 weeks after injury. The skull defect was repaired with three-dimensionally reconstructed titanium mesh of computer-aided design two years after wound healing. The treatment of full-thickness electric burn of skull combined with cerebral contusion was quite difficult. The timing and mode of operation were very important. Perioperative prevention and treatment of intracranial infection were essential to save the life of the patient. In the event of intracranial infection, effective systemic use of antibiotics, cerebrospinal fluid drainage, intrathecal injection of drugs, and the application of other comprehensive measures could ensure the success of treatment.

Repairing proximal and middle lower-leg wounds with retrograde sartorius myocutaneous flap pedicled by perforating branches of medial inferior genicular artery or posterior tibial artery.

BACKGROUND AND OBJECTIVES: The blood supply of the lower one-third of the sartorius muscle is mainly provided by the descending genicular artery (saphenous artery). The terminal branches of the saphenous artery, together with the perforators of the posterior tibial artery and medial inferior genicular artery, form a stable and rich anastomotic network in the genus inferior medialis. Based on this anatomy, we designed a retrograde sartorius myocutaneous flap to repair wounds in the proximal and middle thirds of the lower leg. METHODS: A sartorius myocutaneous flap with the posterior tibial (or medial inferior genicular) artery perforators as the pedicle was designed. The flap was based on a retrograde flow route: medial inferior genicular and posterior tibial artery perforators, the vascular network at the inferomedial knee, the saphenous artery, saphenous artery perforators, to the sartorius muscle. With this design, the flap can be transferred to the middle and proximal tibia. Between January 2007 and June 2010, 12 patients with middle/proximal lower-leg wounds were successfully treated with this method. RESULTS: Ten of 12 myocutaneous flaps survived with primary healing of wounds. Two cases developed a small degree of distal superficial skin necrosis but with normal muscular blood supply and healed after conservative treatment. CONCLUSION: Retrograde sartorius myocutaneous pedicle flaps from the perforating branches of the medial inferior genicular artery or posterior tibial artery have advantages in terms of reliable blood supply, ease of operation and minimal amount of damage, and can be used to repair proximal and middle lower-leg wounds. They are especially applicable when lower-leg flaps are unavailable due to poor soft-tissue conditions following trauma or multiple operations. However, the safety flap size needs to be determined in future studies.

[Managements of open wounds from an earthquake].

OBJECTIVE: To explore the surgical managements of open wounds from 5·12 Wenchuan Earthquake. METHODS: In this report, fifty one patients with open wounds were treated after transported into West China Hospital from May 12 to 26 in 2008 after 5·12 Wenchuan Earthquake. Among 51 cases, open wounds were due to open fractures (n = 8), fasciotomy (n = 6), exposed bone (n = 8) and defects of skin and soft tissue (n = 29). All cases had wound infections. Sixty operations were performed, including muscle and myocutaneous flap (n = 4), skin grafting (n = 30), NPWT (negative pressure wound therapy) (n = 2) and debridement (n = 24). RESULTS: Four cases of muscle and myocutaneous flaps survived with an excellent blood circulation. And 30 cases of skin grafting had a survival rate of over 90%, 2 cases of NPWT and 24 cases of debridement required further treatment. CONCLUSION: With adequate surgical managements, open wound healing from an earthquake may be accelerated and the functions maximally preserved.

[Repair of circumferential wound in the wrist region due to high-voltage electrical burn using combined abdominal axial pattern flaps].

OBJECTIVE: To explore the method for repairing circumferential wound in the wrist region due to high-voltage electrical burn. METHODS: Six patients with circumferential wound in the wrist region after high-voltage electrical burn were admitted to our hospital from January 2009 to December 2011. After debridement, wounds in the wrist were repaired with combined abdominal axial pattern flaps. The wound of wrist on the flexor aspect was repaired with paraumbilical flap carrying a portion of rectus abdominis that filled the wound cavity of the wrist on the flexor aspect. The wound of wrist on the dorsal aspect was repaired with lower abdominal flap. Pedicle division was performed 4 - 5 weeks post surgery. Some donor sites were sutured directly, and the others were closed by skin grafting after the suture of anterior sheath. RESULTS: Three flaps survived. Liquefaction necrosis of tissue was observed under two flaps, and they were healed after debridement. Radial artery embolism of wrist occurred in one flap when pedicle division was performed 5 weeks post surgery, and it was healed by a transplantation of a segment of the great saphenous vein to reconstruct radial artery right after debridement. Patients were followed up for 6 - 12 months, and satisfactory appearance and function of the flaps were observed. CONCLUSIONS: It is a feasible option to repair circumferential wound in the wrist region due to high-voltage electrical burn by using paraumbilical flap carrying a portion of rectus abdominis muscle combined with lower abdominal flap.

[Early treatment of high-voltage electric burn wound in the limbs].

OBJECTIVE: To summarize the experience of early treatment of high-voltage electric burn wounds in the limbs. METHODS: Fifty-four patients (50 males and 4 females, aged from 10 to 56 years) with high-voltage electric burn wounds in 97 limbs (67 upper limbs and 30 lower limbs) were hospitalized in our burn wards from January 2003 to December 2010. A total of 119 burn wounds in wrist-forearm, forearm-elbow-upper arm, shoulder-axillary region, ankle-foot, lower leg, around the knee, thigh-inguinal region were treated with incision for decompression within 10 days after burn. Under the premise of relatively stable systemic condition of the patients, certain surgical operations were performed as follows. (1) Sixteen limbs with 16 wounds were amputated, among them forearm amputation was performed for 5 upper limbs with necrosis, with preservation of elbow joints, and the residual wounds of the elbow and upper arm were repaired with pedicled latissimus dorsi musculo-cutaneous flaps; 1 upper limb with upper arm amputated, with preservation of shoulder joint, was repaired with pedicled latissimus dorsi musculo-cutaneous flap. (2) Ninety-five wounds were covered with various tissue flaps with abundant blood supply after early debridement, in which 3 brachial arteries, 1 vein, 1 brachial artery and vein were reconstructed in 5 wrist wounds, artery reconstruction was performed in elbow wound of 1 case with injured brachial artery. (3) Eight wounds were treated with free skin grafting. Wound healing conditions were observed and followed up. RESULTS: Wounds in 16 limbs healed after amputation and repair. Blood supply and (or) venous return of hands were restored in 5 wrist wounds after vessel reconstruction. After artery reconstruction, abundant blood supply was observed in 1 case with injured brachial artery and amputation was avoided. Necrosis occurred in distal parts of tissue flaps in 5 wounds after grafting, in which 2 wounds healed after removal of necrotic tissue followed by closure with suture, and 3 wounds healed after debridement and free skin grafting. Tissue flap infection occurred in wrist (5 wounds), elbow (1 wound), ankle-foot (2 wounds), and healed after debridement and suture. The other tissue flaps survived after grafting. Six wounds healed after skin grafting. Partial necrosis occurred in 2 wounds after skin grafting, and they were healed after second skin grafting. Thirty-seven patients were followed up for 6 to 12 months, the skin flaps survived with satisfactory appearance and texture. CONCLUSIONS: Early extensive compartment release through fasciectomies and escharectomies, early debridement, early vascular grafting, early wound coverage with contemporary reparative and reconstructive surgical techniques are rational options for the treatment of high-voltage electric burns in the limbs.

[Repair of tissue defect of lower leg and foot with reverse island skin flaps with sural nerve and blood supplying vessels].

OBJECTIVE: To observe the clinical effect of reverse island skin flaps with sural nerve and blood supplying vessels on repair of tissue defect of lower leg and foot. METHODS: Fifty-six patients with lower leg and foot tissue defects were hospitalized from June 1997 to August 2007. Among them, 10 patients suffered from soft tissue defect of lower leg; 38 patients suffered from wound infection, exposure of fracture of tibia and fibula, and osteonecrosis; 8 patients suffered from heelstick tissue defect, bone adhering scar, and osteomyelitis. The defects were repaired with sural nerve and blood vessel nourished reverse island skin flaps (46 cases) and myocutaneous flaps (10 cases). The size of flaps ranged from 5 cm x 4 cm to 22 cm x 16 cm. Flap donor sites were closed by direct suture or free skin grafting. RESULTS: Flaps in 55 cases survived. Patients were followed up 3-6 months, there was no complication, and they were healed with satisfactory texture and appearance. The patients could walk normally, but with unsatisfactory sensory recovery. In one patient, the flap was broken and ulcerated 1 month after operation on account of leaving behind necrotic tibia. It was healed after second operation. CONCLUSIONS: Sural nerve and blood vessel nourished reverse island skin flap or myocutaneous flap transplantation is an effective treatment for repair of soft tissue defect of lower leg and foot.

[Characterization and biological significance of peripheral blood dendritic cell subsets in patients with severe burn].

OBJECTIVE: To investigate the characteristics of dendritic cells (DCs) in patients with severe burn. METHODS: Peripheral blood samples were obtained from 12 patients with severe burn 1, 2, 3, and 4 weeks after burn, and from 10 healthy donors as controls. Mononuclear cells were isolated, and GM-CSF 1000 and IL-4 were used to induce the transformation of DCs. Mature DCs were harvested and underwent flow cytometry to detect the expression of HLA-DR, CD80, CD83, CD86, CD14, and CD11c. RESULT: 1, 2, 3, and 4 weeks after burn, the expression levels of HLA-DR were 62.1% +/- 8.4%, 65.0% +/- 6.2%, 68.4% +/- 5.7%, and 75.4% +/- 8.4% respectively; the expression levels of CD80 were 12.9% +/- 3.7%, 14.7% +/- 2.5%, 16.1% +/- 4.2%, and 16.2% +/- 4.8%; the expression levels of CD83 were 15.1% +/- 4.2%, 15.1% +/- 4.0%, 22.2% +/- 7.7%, and 21.3% +/- 7.0% respectively; the expression levels of CD86 were 69.2% +/- 7.1%, 70.5% +/- 5.4%, 75.1% +/- 6.1%, and 79.6% +/- 6.4% respectively, all significantly lower than that of the control group (84.3% +/- 8.2%, all P < 0.001). 1, 2, 3, and 4 weeks after burn, the expression levels of CD14 in the DCs of the severe burn patients were 12.7% +/- 1.9%, 12.0% +/- 1.5%, 11.3% +/- 1.3%, and 9.3% +/- 1.7% respectively, all significantly higher than that of the control group (7.3% +/- 1.5%, P < 0.001). 1, 2, 3, and 4 weeks after burn, the expression levels of CD11c in the DCs of the severe burn patients were 86.8% +/- 6.1%, 89.5% +/- 5.1%, 91.3% +/- 2.8%, and 89.4% +/- 4.0% respectively, a little lower than that of the control group, however, without significant difference (92.6% +/- 3.8%, P > 0.05). CONCLUSION: The functions of DCs in the patients with severe burn are declined, which may partly contribute to infection after burn.

[Protective effects of ulinastatin against multiple organic damage after severe burn injury: experimental and clinic studies].

OBJECTIVE: To study the protective effects of ulinastatin (UTI), a human trypsin inhibitor, on the damage to the functions of multiple organs at the early stage of severe burn. METHODS: (1) Twelve male mini-pigs, inflicted with III degrees burn with 35% total body surface area (TBSA), were randomly divided into two equal groups: Group A (control group, treated with fluid resuscitation immediately after injury and normal saline by intravenous drip tid) and Group B (UTI-treated group, in addition to fluid resuscitation UTI 5000 U/kg was given one hour after injury, 3 times/day). Blood samples were taken for the determination of serum TNF-alpha, IL-6, malonyldiadehyde (MDA), superoxide dismutase (SOD), alanine transaminase (ALT), aspartate transaminase (AST), creatine kinase (CK), MB isoenzyme of CK (CK-MB), blood urea nitrogen (BUN), creatinine (Cr), diamine oxidase (DAO), and D-lactate before and 6, 24, 48, and 72 hours after injury. (2) Forty hospitalized patients with 50%-70% TBSA partial and full thickness burn, 28 males and 12 females, aged 18-60, were randomly divided into routine treatment group (n = 16, receiving routine fluid resuscitation and wound management and normal saline IV drop bid for 7 days) and UTI treatment group (n = 24, in addition to the routine treatment UTI 400,000 U was given IV drop bid for 7 days). Sixteen healthy volunteers served as controls to undergo blood examination. The average body temperature (T), respiratory rate (R), systole blood pressure (BP) were detected 48 hours after burn. Blood samples were taken to determine the plasma lipopolysaccharide (LPS), and serum TNF-alpha, norepinephrine (NE), myeloperoxidase (MPO), ALT, AST, CK, CK-MB, lactic dehydrogenase (LDH), BUN, and Cr 1, 3, and 7 days after burn. RESULTS: (1) The serum TNF-alpha, IL-6, and MDA levels significantly increased, and the serum SOD level significantly decreased 6 hours after burn in the mini-pings in both groups (all P < 0.05), and the changes in Group A were more significant than in Group B (all P < 0.05). The serum AST, CK, CK-MB, BUN, Cr, DAO, and D-lactate levels increased in the mini-pigs of both groups after severe burn in comparison with those before burn (all P < 0.05), especially in Group A in comparison with Group B (all P < 0.05). However, the serum levels of ALT and LDH of Group B did not increase significantly in comparison with those before burn. (2) The serum LPS, TNF-alpha, NE, ALT, AST, CK, CKMB, LDH, BUN, Cr, and MPO significantly increased after burn and began to decrease since the 7th day after burn, and the decrease levels in the UTI group were more significant than in the routine treatment group (all P < 0.05). In the routine treatment group 2 cases of sepsis were found and one case died of multiple organ failure; no complication was found in the UTI treatment group. CONCLUSION: UTI can significantly lessen the production of inflammatory mediators and oxygen free radical and protect the functions of multiple organs after severe burn.

Effect of Zn7-metallothionein on oxidative stress in liver of rats with severe thermal injury.

AIM: Using the model of burned animal with delayed resuscitation to study antagonistic effect of Zn7-metallothionein (Zn7-MT) on oxidative stress in the liver of rats suffered from severe thermal injury on skin. METHODS: To compare the changes in antioxidant concentrations and antioxidative enzyme activities in the liver or plasma of burned rats with or without Zn7-MT in resuscitation fluid by biochemical assay. RESULTS: After injury, glutathione concentration was progressively decreased with time. At 24 h after injury, activities of glutathione reductase and glutathione peroxidase in the liver of burned rats were increased and then decreased at 48 h postburn. Alpha-tocopherol in plasma was reduced at 24 h and malondialdehyde in the liver was increased significantly postburn. MT and MT-1 mRNA expression in burned rats were activated. Taken together, oxidative stress in the liver of burned rats occurred. Exogenous Zn7-MT attenuated the changes in antioxidant concentrations and antioxidative enzyme activities in the liver or plasma of burned rats. The effect of Zn7-MT was in a concentration-dependent manner and the concentration of 10 micromol/L was the most effective. Exogenous Zn7-MT also inhibited MT-1 mRNA overexpression and increased MT protein concentration. CONCLUSION: Zn7-MT effectively antagonized oxidative stress in the liver of rats with severe thermal injury.

[An observation of the effects of Tiopronin on the oxygen free radicals in severely scalded rats receiving delayed fluid resuscitation].

OBJECTIVE: To observe the harmful effects of oxygen free radicals and the protective roles of Tiopronin in severely scalded rats after delayed fluid resuscitation. METHODS: Rats inflicted with 30% III degree scald on the back were employed as the model. They were divided into delayed resuscitation (D) and Tiopronin treatment (T) groups. The changes in superoxide dismutase (SOD) and malonyldialdehyde (MDA) in plasma and subeschar fluid were determined at 24 to 48 postburn hours (PBHs) by means of electron spin resonance (ESR) technique and other routine methods. And the pathomorphological changes in the heart, liver, kidneys and small intestine, and changes in the blood biochemical indices were simultaneously determined. Normal rats were taken as control group (N). RESULTS: The plasma SOD level was was lower than that in N group, while the MDA content in plasma and subeschar fluid in D group was much higher than that in N group. Changes in all the blood biochemical and internal organ pathomorphology were more obvious in the D group. on the other hand, the rat plasma SOD level in T group increased obviously (P < 0.01) while the MDA contents was decreased in T group (P < 0.05) when compared with those rats of D group. In addition, the internal organ pathomorphology and blood biochemical indices were improved evidently in T group. CONCLUSION: Oxidative stress injury was evoked in severely scalded rats after delayed fluid resuscitation, and it could be protected to some extent by Tiopronin.

[Protective effects of Zn-metallothionein on erythrocyte membrane of rats with severe scalding after delayed resuscitation].

OBJECTIVE: To study the antagonism of Zn-metallothionein (Zn-MT) to oxidative stress of rats with severe scalding after delayed resuscitation. METHODS: 27 Wistar rats were randomly divided into three groups: normal control; burn with delayed fluid resuscitation group; and Zn-MT protected group. The rats were scalded with 30% total body surface area (TBSA) third degree burn. Four hours after injury, they were resuscitated, but Zn-MT (1 x 10(-5) mol/L) was given in the third group rats. 24 hours after they were scalded, blood was taken, RBCs were separated and labeled with electron spin resonance (ESR) spin label 3-maleimido-proxy l to detect membrane protein conformation. The serum was collected and added into the reaction system of xanthine, xanthine oxidase and ESR spin trap 5, 5-dimethylpyroline-N-oxide to assay the levels of superoxide dismutase (SOD) by ESR. RESULTS: The ratios of strong solidity and weak solidity of RBC membrane proteins in the three groups were 0.352 +/- 0.043, 0.409 +/- 0.027, and 0.386 +/- 0.062 respectively, and the revolved times of membrane proteins were 1.300 +/- 0.210, 1.576 +/- 0.190 and 1.381 +/- 0.210 seconds respectively. Compared to the first group, the membrane protein conformation in the second group was changed remarkably, and the speed of membrane protein movement decreased significantly. However, those changes were alleviated obviously by Zn-MT. The SOD levels in serum of the three groups rats were 73.2% +/- 1.4%, 48.8% +/- 3.8% and 66.8% +/- 3.2% respectively. Compared to the normal control group, the SOD levels in serum of the second group decreased obviously. However, an excess of oxygen free radicals produced after injury could be scavenged by Zn-MT. CONCLUSION: RBC membrane proteins of rats with severe scalding after delayed resuscitation were injured by oxygen free radicals produced after injury, and Zn-MT could alleviate this injury.