Bromelain-based enzymatic debridement as a treatment of choice in high-risk patient with deep facial burns, a case report.

INTRODUCTION: Deep facial burns are often combined with inhalation injury that could lead to patient destabilization. Accurate timing of surgical debridement of deep burns in a critical patient is the real medical art. Especially in patients with deep burned face and hands, in whom early debridement promises better functional and aesthetic results. CASE PRESENTATION: A fifty-three-year-old woman sustained burns of 16% TBSA including face area. The treatment of the burn injury was complicated by severe inhalation trauma, which led to patient destabilization shortly after admission. Standard surgical debridement was risky at the time. We used a new enzymatic agent for early burn eschar necrolysis instead. All the debrided areas were temporarily covered with porcine xenografts. The facial burns healed spontaneously without the need for a skin transplant. Definitive surgery treatment of full-thickness burns was postponed until the patient´s stabilization. DISCUSSION: The new enzymatic debridement is minimally invasive and can be applied bedside without the need for general anesthesia. All advantages of the new enzymatic debridement had led to extend its use at the face area, although it was not tested in this area during pre-registration studies. Especially in facial area high selectivity and significant reduction of skin grafting expect a better aesthetic and functional outcome. CONCLUSION: Bromelain-based enzymatic debridement proved to be safe and effective on the face in a very high-risk patient with unstable circulation and severe inhalation injury as an alternative to tangential excision.

Deep frozen amniotic membrane used as a scaffold and/or carrier for different cell types.

Amniotic membrane is a biological material widely used in plastic and reconstructive surgery and in ophthalmology. Due to its excellent biocompatibility and strength we tried to use it as a scaffold for the in vitro cultivation of different cell types, especially keratinocytes and limbal stem cells. It was possible to cultivate limbal stem cells and keratinocytes without using 3T3 mouse fibroblast feeder cells on deep frozen amniotic membranes. The amniotic membrane can also be used as a carrier for suspensions of different types of cells, allowing a substantial reduction of the cultivation time needed to prepare cell cultures for clinical application to burn patients. Our results show that the amniotic membrane seems not only to be an excellent carrier for human keratinocytes and corneal limbal stem cells, but also for other cell types, including dermal fibroblasts, adipose tissue-derived mesenchymal stem cells and chondrocytes.

[Employment of current results of tissue engineering in the development of skin substitutes]. / Vyuzívanie súcasných poznatkov tkanivového inzinierstva pri príprave kozných náhrad.

Substitution of skin, particularly in extensive burns, is one of the key points for patients mortality reduction. In addition to the use of allogeneic and autologous skin substitutes, new developments in tissue engineering would enable the use biosynthetic and combined skin substitutes, which could mimic the structure and functions of normal skin. Several such types of substitutes like cultured allogeneic and autologous keratinocytes, allogeneic/autologous composites, acellular matrices, matrices based on biological substances such as collagen/hyaluronic acid, and matrices seeded by different cell types (keratinocytes, dermal fibroblasts, stem cells) already exist. Recent development in skin substitutes research aims gradually to establish a fully functional skin substitute which could mimic skin not only by its structure, but which could be capable to assure also its revascularization, reinnervations, and replacement of skin appendages (hair follicles, sebaceous glands etc.) as well. Creation of such a skin substitute will require collaboration of a wide range of research specialists including molecular biology, material sciences, genetic and tissue engineering, computer sciences, and, of course, clinical specialists in the field of plastic surgery and burn medicine. Recent advances in this field are promising and give hope that in the near future such a fully functional skin substitute would become a reality. This article aims to give information on the available skin substitutes at the present time.