Objective: To analyze the literature published in Chinese Journal of Burns (now Chinese Journal of Burns and Wounds) in the last 22 years, and to explore the development trend of burn discipline. Methods: The relevant clinical and research literature published in Chinese Journal of Burns from January 1, 2000 to December 31, 2021 were retrieved through China National Knowledge Infrastructure database. Bibliometrics was used to classify and analyze the literature by research types, involved research fields, and reported causes of injury, and compare them every 3 years according to the year of publication (with literature published in 2021 being included in the last time period). Keywords of all the literature were retrieved, which were corrected and conversed later. CiteSpace 6.1.R2 software was used to visually cluster the included keywords, count high-frequency and high-centrality keywords, and divide the high-frequency keywords by time as before for segment comparison. Results: A total of 4 485 relevant papers were included, with an average of about 204 papers each year. The research types analysis of literature showed that clinical diagnosis and treatment literature had the highest proportion, reaching 65.3% (2 929/4 485), followed by cell experiment and animal experiment literature, accounting for 18.1% (812/4 485) and 13.2% (591/4 485), respectively. The proportion of various research types of the literature in each time period was basically stable. The analysis of the research fields involved in the literature showed that the literature in the field of systemic treatment of burns accounted for the highest proportion, reaching 60.2% (2 699/4 485), followed by the literature in the fields of acute wounds and plastic surgery, accounting for 20.2% (908/4 485) and 7.3% (326/4 485), respectively. The proportion of the literature in the field of systemic treatment of burns decreased from 84.0% (430/512) in 2000-2002 to 40.3% (373/926) in 2018-2021, with a decreasing proportion of 43.7%. While compared with that in 2000-2002, the proportions of literature in the fields of acute wounds, plastic surgery, chronic wounds, and burn rehabilitation were on the rise, with the proportions in 2018-2021 increased by 11.7%, 9.1%, 10.7%, and 5.5%, respectively. In the first 6 time periods, the number of literature in the field of discipline management was few and remained in single digits, but it increased to 49 in 2018-2021. Among the 1 099 literature in the field of systemic treatment of burns with a clear cause of injury, the literature on thermal burns was the most, accounting for 58.5% (643/1 099), followed by the literature on electrical burns and chemical burns, accounting for 19.8% (218/1 099) and 12.6% (138/1 099), respectively. The comparison by time period showed that the proportion of literature reporting thermal burns showed a significant downward trend, while the proportion of literature reporting other causes of injury did not change significantly. A total of 6 822 keywords from 2 236 literature were included for analysis. Visual cluster analysis showed that relevant studies focused on burns, surgical flaps, scars, and wound healing. The top 3 keywords in frequency were burns, wound healing, and surgical flaps, and the top 3 keywords in centrality were burns, scars, and skin transplantation. The comparison by time period showed that the only keyword with a stable frequency in the top 10 ranks was burns; with the passage of time, some keywords such as endotoxin/endotoxins and fibroblasts gradually dropped out of the top 10 ranks, while keywords such as wounds and injuries, surgical flaps, and negative-pressure wound therapy gradually entered the top 10 ranks. Conclusions: Among the literature published in Chinese Journal of Burns during the last 22 years, the literature on systemic treatment of burns and thermal burns has gradually decreased, while the literature on chronic wounds and burn rehabilitation has increased. Surgical flaps, wound healing, and scar prevention and treatment are the current research hot spots in burn discipline.
Bibliometrics ; Burns, Chemical ; Burns, Electric/therapy* ; China ; Cicatrix ; Humans

OBJECTIVETo study the changes in bulbar conjunctiva microcirculation (BCM) and the therapeutic effect of Pentoxifylline on BCM disturbance after high-voltage electrical burn (HEB) in rabbits.

METHODSForty-five rabbits were divided into control group (C), electrical burn group (EB), and Pentoxifylline treatment group (PT) according to random number table, with 15 rabbits in each group. Model of HEB was reproduced in rabbits from EB and PT groups with voltage regulator and experimental transformer. Rabbits in C group were sham injured with the same devices without electrification. Changes in BCM were observed with microcirculation microscope at 15 minutes before HEB and 5 minutes, 1, 2, 4, 8 hour(s) post HEB (PHM or PHH), including: (1) morphology of microvessels, such as the discernible, diameters of arterioles, venules, and capillaries, the unevenness in caliber, and ischemic area; (2) dynamic changes in microvascular blood flow, such as blood flow speed in arterioles, venules, and capillaries, erythrocyte aggregation, and microthrombi formation; (3) condition of tissues surrounding microvessel, such as bleeding and exudation. Measurement data were processed with t test; enumeration data were processed with Fisher's exact test.

RESULTS(1) Morphology of microvessel: discernible of microvessels in EB and PT groups was decreased, but that of PT group was better than that of EB group. At PHM 5, diameter of arterioles, venules and capillaries was respectively (7.3+/-2.5), (12.3+/-2.4), (3.5+/-0.7) microm in EB group, all narrower than those of the control group [(14.6+/-3.1), (27.2+/-3.5), (9.0+/-1.4) microm, with t value respectively 5.23, 13.66, 14.04, P values all below 0.05]. Diameters of the microvessels in PT group [(10.2+/-3.8), (21.5+/-3.1), (7.1+/-1.2) microm] were larger than those in EB group (with t value respectively 2.21, 8.99, 10.18, P values all below 0.05). Diameters of arterioles, venules and capillaries in EB and PT groups recovered to the before HEB size at PHH 1. From PHH 2 to 8, arterioles and capillaries decreased gradually in caliber, venules dilated gradually in EB and PT groups, but the changes in PT group were not obvious. Thickness of microvessel was observed uneven in EB group at PHM 5, which lasted until PHH 8. Ischemia of the tissue was observed in EB group at PHM 5, which improved at PHH 2. Situation in PT group was better. (2) Dynamic changes in microvascular blood flow: at PHM 5, blood flow speed in arterioles, venules and capillaries was respectively (202+/-53), (198+/-44), (46+/-12) microm/s in EB group, all slower than those of the control group [(544+/-37), (359+/-32), (220+/-19) microm/s, with t value respectively 20.47, 11.51, 30.02, P values all below 0.05], and those of PT group [(335+/-42), (260+/-35), (119+/-23) microm/s] were faster than those of EB group (with t value respectively 7.55, 4.26, 14.85, P values all below 0.05). Blood flow speed in EB and PT groups recovered to the before HEB level at PHH 1. From PHH 2 to 8, blood flow speed decreased gradually in EB and PT groups, but that of PT group was faster than that of EB group. Erythrocyte aggregation in venules and capillaries was observed in EB group at PHM 5, which eased up at PHH 1, but aggregated at PHH 2, lasting until PHH 8. Obvious microthrombi were observed in EB group at PHH 2, which increased gradually. These changes were less obvious in PT group. (3) Condition of surrounding tissues of microvessel: in EB group, exudation was observed around microvessels at PHH 1, bleeding at PHH 2, with a worsening tendency. Changes in those in PT group were less obvious.

CONCLUSIONSHEB causes disturbance in BCM, but it can be ameliorated by Pentoxifylline.

Animals ; Burns, Electric ; drug therapy ; pathology ; Conjunctiva ; blood supply ; Microcirculation ; Microvessels ; pathology ; Pentoxifylline ; therapeutic use ; Rabbits

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.
Adult ; Brain Abscess ; microbiology ; therapy ; Brain Injuries ; microbiology ; therapy ; Burns, Electric ; microbiology ; therapy ; Humans ; Infection ; therapy ; Male ; Skull ; injuries

OBJECTIVETo explore the optimal method for the treatment of the elbow joint stiffness accompanied with neural injury after electrical injury.

METHODSThirty adult cadaver elbows were fixed and dissected to observe the attachments of the ligaments and the muscles around the joint, and its relationship with the major nerves. Ten patients with electric burns with stiffness of the elbow joint were treated by means of loosening the anterior and posterior fascicles of radial and ulnar collateral ligaments, at the same time down shifting the insertion of flexor muscles, replacing the ulnar nerve anteriorly, in order to reconstruct flexor and extension functions of the elbow. The effect was evaluated with biomechanics criteria.

RESULTSThrough anatomical study, it was revealed that contracture of the posterior fascicles of the radial and ulnar collateral ligaments and triceps brachii muscle would result in stiffness of the elbow joint, and contracture due to disuse of the two anterior fascicles of the radial and ulnar collateral ligaments and M.biceps brachii would produce flexion deformity of the elbow joint. Postoperatively, the functions of the elbow joints of all the 10 patients recovered satisfactorily. Follow-up from 1 to 3 years showed no change in the range of flexion and extension movements of the elbows, and on the contrary, mobility of the elbow joints was improved.

CONCLUSIONLoosening of the anterior and posterior fascicles of the two collateral ligaments and replacement of insertions of biceps and triceps are pivotal in the treatment of stiffness of the elbow joint. Meanwhile lowering the origins of forearm flexor muscles on epicondylus and replacing anteriorly the ulnar nerve can further improve the flexion, function of the joint and relieve compression of the nerve.

Adult ; Ankylosis ; etiology ; pathology ; therapy ; Burns, Electric ; complications ; pathology ; therapy ; Elbow Joint ; anatomy & histology ; pathology ; Humans ; Male ; Middle Aged

OBJECTIVETo explore the pathogenic characteristics and management of brain injury in patients injured by high voltage electricity.

METHODSOne hundred and thirty eight patients injured by electricity were enrolled in this study. Postburn brain injury was diagnosed by clinical sighs and imaging analysis. The brain injury was graded as mild, moderate, severe and most severe. The relationships among the inlet of the electric current and the electric voltage and the degree of brain injury were analyzed, and the causes and pathogenesis of the brain injury were suggested. Treatment modality was optimized for the patients according to the diagnostic data.

RESULTSIn this group of patients, brain injury was identified in 106 cases, mostly rated as mild and moderate. Only 4 cases were ranked as severe degree with positive imaging findings. The electric voltage seemed to be not correlated with the incidence of postburn brain injury. But the intensity of electric current and the locations of electrical current inlet and outlet were closely related to the degree of brain injury. Among all the patients in this group, 131 survived and 7 died after treatment. But there was no death due directly to brain injury.

CONCLUSIONThere was high incidence of postburn brain injury in patients injured by high voltage electricity. The injury might be related to the direct effect of electrical current on the brain tissue, to mechanical injury, to the cardio-pulmonary lesions caused by electrical current, or to massive skin burn. Early and accurate diagnosis of the injury was of key importance for lowering both mortality and disability.

Adolescent ; Adult ; Aged ; Brain Injuries ; diagnosis ; etiology ; therapy ; Burns, Electric ; complications ; diagnosis ; therapy ; Child ; Child, Preschool ; Female ; Humans ; Injury Severity Score ; Male ; Middle Aged ; Young Adult

OBJECTIVETo summarize the experience of early treatment of high-voltage electric burn wounds in the limbs.

METHODSFifty-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.

RESULTSWounds 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.

CONCLUSIONSEarly 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.

Adolescent ; Adult ; Burns, Electric ; therapy ; Child ; Extremities ; injuries ; surgery ; Female ; Humans ; Male ; Middle Aged ; Skin Care ; Surgical Flaps ; Wound Healing ; Young Adult

OBJECTIVETo investigate the influence of aerosols on the expression of cyclin B(1), cyclin C and proliferating cell nuclear antigen (PCNA) in wound tissue healing of burned rat models.

METHODSSprague Dawley (SD) rats were inflicted as the deep partial thickness burn models. Rats were randomly divided into experimental group and control group. The experimental group were treated with aerosols. Samples were collected in 1 approximately 10 postburn days. Immunohistochemistry and image analysis methods were conducted to examine the expression of cyclin B(1), cyclin C and PCNA in both experimental and control groups.

RESULTSThe expression of cyclin C in experimental group was detected in nucleus of skin basal cell on the second postburn day, increased evidently at the fifth days and sustained at high expression level up to the tenth days after treatment. The expression of cyclin C in experimental group was significantly higher than control group (P < 0.05). The expression of PCNA was first observed in skin basal cell nucleus and hair follicle cell nucleus in both experimental and control group on the third postburn day. The expression of PCNA increased evidently at the fifth days in experimental after treatment and that increased evidently at the seventh days in control group, which showed there were lots of active proliferation cell. And the difference of the expression of PCNA between experimental and control group was significant (P < 0.01). The expression of cyclin B(1) was detected in nucleus and cytoplasm of skin basal cell in both groups on the third postburn day, and no difference between the experimental and control group (P > 0.05).

CONCLUSIONSAerosols can up-regulate the expression of cyclin C and PCNA in skin basal cell nucleus. Therefore the aerosols can accelerate wound tissue healing.

Aerosols ; Animals ; Burns ; metabolism ; therapy ; Cyclin B ; biosynthesis ; Cyclin B1 ; Cyclin C ; Cyclins ; biosynthesis ; Disease Models, Animal ; Electric Stimulation Therapy ; methods ; Female ; Proliferating Cell Nuclear Antigen ; biosynthesis ; Rats ; Rats, Sprague-Dawley ; Wound Healing ; physiology

OBJECTIVETo observe the effects of low molecular weight heparin (LMWH) on the inflammatory response and vascular injury in rat after electric burn.

METHODSA homemade regulator and transformer apparatus was used to reproduce the model of electric burn (0.5 cm×0.5 cm in size) with depth from full-thickness to full-thickness skin plus muscle and bone on the middle of the inside of right hind limb in 60 Wistar rats. The open wounds were covered with 20 g/L sulfadiazine silver paste immediately after injury. The wound condition was observed every day. The injured rats were divided into group LMWH and control group (C) according to the random number table, with 30 rats in each group. Rats in group LMWH were given subcutaneous injection of LMWH (1 U/g) in abdominal wall, 2 times a day. No other treatment was given in rats in group C. On post burn day (PBD) 3, 5, and 10, 10 rats respectively of two groups were sacrificed. The damaged tissue of wound and that around the wound (1.0 cm×0.5 cm in size) were excised, and heart blood was obtained. The pathological changes and thrombosis in damaged tissue were observed with HE, Masson, and aldehyde fuchsin staining, and the thrombosis rate was calculated. Serum contents of TNF-α and endothelin-1 were determined with ELISA. The mRNA expression of TNF-α in damaged tissue was detected with RT-PCR. Data were processed with Levene homogeneity test, analysis of variance of factorial design, LSD- t test, SNK- q test, and Friedman M nonparametric test.

RESULTS(1) The injured limb of rats was obviously swollen after electric burn, which reached deeply to the muscle and bone. Compared with those of group C, the swelling of rats subsided slightly faster and the inflammatory response was lighter in group LMWH at each time point. (2) The necrosis of damaged tissue and profuse infiltration of inflammatory cells were observed. Dilatation of blood vessels, congestion and thrombosis, and swelling, necrosis, and desquamation of vascular endothelial cells were observed in the damaged tissue. Damaged blood vessel wall, ruptured elastic fiber, loss of internal elastic membrane, and other pathological changes were observed in the damaged tissue of rats in the two groups. Above lesions were improved gradually along with the passage of time, and the improvement was more obvious in rats of group LMWH compared with that of group C on PBD 5 and 10. (3) The thrombosis rates of rats in group LMWH were obviously lower than those of rats in group C (F = 4.921, P < 0.05). The thrombosis rates of rats in group LMWH on PBD 3 and 10 were respectively (0.07 ± 0.11)% and (0.03 ± 0.05)%, which were significantly lower than those of rats in group C [(0.16 ± 0.15)% and (0.13 ± 0.18)%, with t values respectively 2.17 and 2.07, P values below 0.05]. In group LMWH, the thrombosis rate of rats on PBD 10 was obviously lower than that on PBD 3 (t = 3.61, P < 0.05). (4) The serum contents of TNF-α and endothelin-1 of rats in group LMWH were significantly lower than those of rats in group C (F = 47.161, χ(2) = 81.46, P values below 0.01). In group LMWH, TNF-α contents were respectively (71 ± 24), (74 ± 14), (72 ± 20) pg/mL, and endothelin-1 contents were respectively (20.9 ± 3.2), (19.8 ± 5.2), (18.6 ± 1.1) ng/mL on PBD 3, 5, and 10, and they were significantly lower than those of rats in group C [(195 ± 148), (96 ± 20), (159 ± 46) pg/mL and (38.8 ± 15.4), (27.9 ± 3.6), (25.6 ± 7.6) ng/mL, with t values from 3.81 to 8.05, q values from 4.41 to 7.85, P < 0.05 or P < 0.01]. (5) The mRNA expression levels of TNF-α in damaged tissue of rats in group LMWH were significantly lower than those of rats in group C (F = 199.113, P < 0.01). The mRNA expression levels of TNF-α of rats in group LMWH were respectively 0.93 ± 0.10, 1.15 ± 0.12, 1.21 ± 0.11 on PBD 3, 5, and 10, and they were significantly lower than those of group C (1.68 ± 0.15, 1.43 ± 0.12, 1.50 ± 0.13, with t values from 3.75 to 6.12, P < 0.05 or P < 0.01). In group LMWH, the mRNA expression level of TNF-α of rats on PBD 10 was obviously higher than that on PBD 3 (t = 3.61, P < 0.05).

CONCLUSIONSLMWH intervention can ameliorate vascular injury and inflammatory response of electrically burned wounds in rats, and it decreases thrombosis rate in the vessels of injured limb.

Animals ; Anticoagulants ; administration & dosage ; Burns, Electric ; blood ; complications ; therapy ; Endothelin-1 ; Heparin, Low-Molecular-Weight ; administration & dosage ; Male ; Rats ; Rats, Wistar ; Serum ; metabolism ; Treatment Outcome ; Tumor Necrosis Factor-alpha ; blood ; Vascular System Injuries ; therapy

PURPOSE: Endovascular procedures are being used with increasing frequency for the treatment of patients with peripheral vascular disease. Vascular surgeons must adapt to this rapid change in treatment modalities toward less invasive procedures. These procedures require that the individual be familiar with intravascular catheter techniques. Therefore, the vascular surgeon should acquire endovascular treatment skills. The purpose of this study was to report the early experience of a vascular surgeon-handed digital subtraction angiography (DSA) and endovascular procedures. METHOD: From March 2006 to October 2007, 104 patients (male 83, female 21, mean age 56.5+/-17.2, range 16~94) underwent DSA or endovascular procedures. One vascular surgeon performed all of the procedures. The procedures were performed in the angiography suite equipped with INTEGRIS Allura 15 (Philips Medical Systems, DA Best, Netherlands). RESULT: Seventy-seven patients (74.0%) underwent diagnostic DSA during the period. The indications for DSA were limb ischemia in 34 patients, electric burn in 26 patients, and a non-healing wound of the extremity in 10 patients. Ascending venography was performed in nine patients (8.6%) with deep vein thrombosis, 1 patient with venous ulcer and in 1 patient with suspicious for venous thoracic outlet syndrome. Sixteen patients (15.3%) underwent endovascular treatment. Among them, 14 patients with critical limb ischemia received percutaneous balloon angioplasty and/or stent insertion and two patients with deep vein thrombosis received catheter-directed thrombolytic therapy. The technical success rate was 100%. After the procedures, one patient had a puncture site hematoma and two patients had contrast-agent allergic reactions. CONCLUSION: Surgeon-handed DSA and intervention showed a good success rate and reasonable complication rate.
Angiography* ; Angiography, Digital Subtraction ; Angioplasty, Balloon ; Burns, Electric ; Catheters ; Endovascular Procedures ; Extremities ; Female ; Hematoma ; Humans ; Hypersensitivity ; Ischemia ; Peripheral Vascular Diseases ; Phlebography ; Punctures ; Stents ; Thoracic Outlet Syndrome ; Thrombolytic Therapy ; Varicose Ulcer ; Venous Thrombosis ; Wounds and Injuries

OBJECTIVETo investigate the influence of recombinant human growth hormone (rhGH) on body fluid compartments and water-sodium retention in severe burn patients.

METHODSThirty adult patients with severe burn were divided into treatment (T) and control (C) groups by block randomized design. Patients in both groups were subcutaneously injected with same amount of rhGH (12 IU/d) or isotonic saline during 7 - 21 post burn day (PBD). The total body water (TBW), intracellular water (ICW), extracellular water (ECW) were measured by bioelectrical impedance analysis (BIA) on 7, 14, 21 PBD. The 24 h urinary output of Na+ was determined by ion selective electrode method (ISE).

RESULTSThere were no significant difference in levels of TBW, ICW, ECW and 24 h urinary output of Na+ between two groups on 7, 14, 21 PBD (P > 0.05). No difference in results was found between groups at different time points (P > 0.05). After the data were analyzed, the level of TBW (36 +/- 6 L), ICW (21 +/- 4 L) on 21 PBD were evidently lower than those on 7 PBD (38 +/- 6 L, 23 +/- 7 L, P < 0.01).

CONCLUSIONThe level of ICW and TBW in severe burn patients decreased along with the time. Proper dosage of rhGH has no significant effect on body fluid compartments and water-sodium retention.

Adolescent ; Adult ; Aged ; Body Fluid Compartments ; Body Water ; Burns ; metabolism ; physiopathology ; therapy ; Edema ; etiology ; Electric Impedance ; Extracellular Space ; Female ; Human Growth Hormone ; therapeutic use ; Humans ; Male ; Middle Aged ; Sodium ; metabolism ; Young Adult