Skin is the largest organ in human body. It guards the underlying muscles, bones, ligaments, and internal organs. The skin faces the environment, and it is the first line to defend against the assaults of external physical, chemical, and micro-organic factors. The other functions of skin include systemic metabolism, temperature regulation, sensation, and production of vitamin D and folate. Skin injury usually leads to barrier function damage. Extensive skin injury would induce a series of problems such as water-electrolyte disorder, hypoproteinemia, and severe infection. Thus it is important to choose a suitable wound dressing when the skin is severely injured. The characteristics of wound dressings have undergone repeated and noticeable changes over the last several years. Compared with that of the traditional dressing, the ability of new dressings is improved obviously in the properties of wound protection, infection prevention, and wound healing promotion. This article deals with an overview on the characteristics of different wound dressings.
Bandages ; Burns ; surgery ; Humans ; Skin ; injuries ; Skin, Artificial ; Wound Healing

It is important to establish some comprehensive wound healing centers in order to treat those complicated chronic skin wounds. In this paper, I would like to summarize our practices in some hospitals dealing with the construction of wound healing centers and give my suggestions for their future development.
Hospitals, Special ; Humans ; Reconstructive Surgical Procedures ; Skin ; injuries ; Wound Healing

The delayed healing of diabetic ulcer has been haunting the surgeons and researchers for a long time. Although we have been researching and exploring the effective therapies for many years, the progress has been limited. Bone marrow-derived mesenchymal stem cells (BMSCs) have gradually won worldwide attention for their characteristics of differentiating into tissue repair cells and secreting multiple cytokines as well as growth factors. In recent years, the role of BMSCs in the treatment of diabetic ulcer has been drawing more and more attention. This article reviewed the advancement in the research of BMSCs in promoting the healing of diabetic ulcer. Through a discussion of the treatment of diabetic ulcer, the related research in BMSCs, as well as its role in diabetic ulcer treatment, the mechanism of BMSCs in promoting healing of diabetic ulcers is discussed. We expect through further research, unified criteria for the quality of BMSCs, application approach and dosage of BMSCs could be established.
Bone Marrow Cells ; Diabetes Complications ; therapy ; Humans ; Mesenchymal Stromal Cells ; Ulcer ; therapy ; Wound Healing

Platelet-rich plasma (PRP) is the plasma derived from the repeatedly centrifuged whole blood, and it contains high concentration of platelets. The growth factors and concentrated platelets in PRP play important roles in proliferation, division, and differentiation of cells, and wound repair. In the past, PRP was used in the treatment of bone fracture, bone defect, soft tissue injury, and refractory wound. In recent years, it had been used in burn treatment, but it provoked some disputes. This article reviews the advance in the research of PRP in burn treatment and discusses the problems in its clinical application.
Burns ; therapy ; Humans ; Platelet-Rich Plasma

OBJECTIVETo study the role of Wnt/beta-catenin signaling in the phenotype change of normal skin fibroblasts (NFb) into myofibroblasts and the underlying mechanism.

METHODSNFb were isolated by collagenase digestion and cultured. (1) Experiment one. NFb were divided into four groups according to the random number table. Cells in control group were cultured with serum-free DMEM nutrient solution (briefly called nutrient solution). Cells in TGF-beta1 group were cultured with nutrient solution containing 10 ng/mL recombinant human TGF-beta1 (the same concentration for following experiments). Cells in Wnt3a group were cultured with nutrient solution containing 150 ng/mL Wnt3a (the same concentration for following experiments). Cells in TGF-beta1 + Wnt3a group were cultured with nutrient solution containing TGF-beta1 and Wnt3a. The mRNA and protein expression levels of beta-catenin and alpha-smooth muscle actin (alpha-SMA) were determined by real-time fluorescent quantitative PCR and Western blotting at post culture hour (PCH) 48. (2) Experiment two. NFb were divided into four groups according to the random number table. Cells in control group and TGF-beta1 group were treated as those in the corresponding groups in experiment one. Cells in SB415286 (glycogen synthase kinase-3beta inhibitor) group were cultured with nutrient solution containing 10 micromol/L SB415286 (the same concentration for following experiments). Cells in TGF-beta1 + SB415286 group were cultured with nutrient solution containing TGF-beta1 and SB415286. The mRNA and protein expression levels of alpha-SMA were determined by real-time fluorescent quantitative PCR and Western blotting, and the alpha-SMA-positive myofibroblasts were detected by immunofluorescence cytochemical staining at PCH 48. The experiments were all repeated for three times. Data were processed with analysis of variance and LSD- t test.

RESULTS(1) Experiment one. There was no statistically significant difference among four groups in beta-catenin mRNA level (F = 0.302, P = 0.823). There were statistically significant differences among four groups in beta-catenin protein level (F = 16.713, P = 0.001). The protein level of beta-catenin was higher in TGF-beta1 group (0.73 +/- 0.12) and Wnt3a group (0.82 +/- 0.17) than in control group (0.34 +/- 0.11, with t values respectively 3.028, 3.727, P < 0.05 or P < 0.01). The protein level of beta-catenin in TGF-beta1 + Wnt3a group (1.23 +/- 0.21) was higher than that of the other three groups (with t values respectively 6.911, 3.883, 3.184, P values all below 0.01). There were statistically significant differences among four groups in alpha-SMA mRNA level (F = 31.830, P = 0.001). Compared with that of control group, the expression level of alpha-SMA mRNA was up-regulated in TGF-beta1 group and down-regulated in Wnt3a group (with t values respectively 6.759, 2.535, P < 0.05 or P < 0.01). The expression level of alpha-SMA mRNA in TGF-beta1 + Wnt3a group was lower than that of TGF-beta1 group (t = 4.532, P < 0.01). The protein levels of alpha-SMA in control, TGF-beta1, Wnt3a, and TGF-beta1 + Wnt3a groups were respectively 0.83 +/- 0.17, 1.43 +/- 0.20, 0.53 +/- 0.12, and 0.89 +/- 0.14 (F = 16.597, P = 0.001). Compared with that of control group, the protein level of alpha-SMA was up-regulated in TGF-beta1 group and down-regulated in Wnt3a group (with t values respectively 4.582, 2.291, P < 0.05 or P < 0.01). The protein level of alpha-SMA in TGF-beta1 + Wnt3a group was lower than that of TGF-beta1 group (t = 4.123, P < 0.01). (2) Experiment two. There were statistically significant differences among four groups in alpha-SMA mRNA level (F = 34.101, P = 0.001). The alpha-SMA mRNA level in SB415286 group was lower than that of control group (t = 2.511, P < 0.05). The alpha-SMA mRNA level in TGF-beta1 + SB415286 group was lower than that of TGF-beta1 group (t = 3.587, P < 0.01). There were statistically significant differences among four groups in alpha-SMA protein level (F = 11.381, P = 0.003). The alpha-SMA protein level was lower in SB415286 group than in control group (t = 2.364, P < 0.05). The alpha-SMA protein level was down-regulated in SB415286 +TGF-beta1 group as compared with that of TGF-beta1 group (t = 2.556, P < 0.05). There were few alpha-SMA-positive fibroblasts in control group. Compared with that of control group, the expression of alpha-SMA was significantly increased in TGF-beta1 group (t =11.198, P < 0.01), and the expression of alpha-SMA was down-regulated in SB415286 group. Meanwhile, the expression of alpha-SMA in TGF-beta1 + SB415286 group were significantly lower than that of TGF-beta1 group (t = 5.902, P < 0.01).

CONCLUSIONSThe Wnt/beta-catenin signaling might be involved in the fibroblasts-myofibroblasts transition, and it negatively regulate the TGF-beta1 -mediated profibrotic effects.

Cells, Cultured ; Fibroblasts ; cytology ; metabolism ; Humans ; Phenotype ; Transforming Growth Factor beta1 ; metabolism ; Wnt Signaling Pathway ; beta Catenin ; metabolism

OBJECTIVETo study the gene expression of transforming growth factor beta receptor II (TbetaR II) in pathological scar.

METHODSTwenty samples of pathological scar were collected from 20 burn or trauma patients hospitalized in the General Hospital of Ji'nan Military Command from 2007 to 2009. Twenty specimens of epidermal layer were obtained from the middle portion and the edge of pathological scars. Twenty normal skin specimens which were located more than 10 cm away from the lesion sites of 20 patients were collected as self-controls. Serum from 1-2 mL whole blood were obtained from each of the 20 patients for second self-control. Eight normal skin specimens from 8 patients without pathological scar, discarded from un-related operations, were also collected as negative-control. Positive expressions of TbetaR II in three different skin specimens were determined with biotin-streptavidin-peroxidase staining. Gene expressions of TbetaR II in all specimens were compared with PCR-single strand conformation polymorphism analysis and gene sequencing. Data were processed with Fisher's exact test.

RESULTSPositive expression of TbetaR II in pathological scar epidermis was lower than that in normal skin specimen of patients with pathological scar or normal skin specimen of patients without pathological scar, and TbetaR II was mainly located in the basal layer of epidermis. Positive expressions of TbetaR II were seldom found in acanthocytes, granular cells, and cuticle or even non-existing. No abnormality of TbetaR II was found in normal skin epidermis or serum samples of pathological scar patients or normal skin epidermis of patients without pathological scar. TbetaR II expressing in 8 specimens of epidermis of pathological scar showed abnormal electrophoresis pattern at poly A fragments hand and loss of one A base in DNA fragment (P = 0.044).

CONCLUSIONSThere may he abnormal gene expression of TbetaR II in pathological scar epidermis. Replantation of epidermis of scar may increase the risk of scar recurrence, while replantation of normal skin of patients with scar on wound may not increase the risk of scar recurrence.

Adolescent ; Adult ; Child ; Child, Preschool ; Cicatrix ; metabolism ; pathology ; Epidermis ; metabolism ; Female ; Gene Expression ; Humans ; Male ; Middle Aged ; Protein-Serine-Threonine Kinases ; genetics ; metabolism ; Receptors, Transforming Growth Factor beta ; genetics ; metabolism ; Young Adult

OBJECTIVETo investigate the feasibility of differentiation of human induced pluripotent stem cells (iPSCs) into epidermal-like stem cells.

METHODS(1) Human strain of iPSCs were plated on-to trophoblast of inactivated Fb strain of mouse embryos and cultured in complete medium of embryonic stem cells, iPSCs were subcultured by collagenase IV digestion method. The morphology and growth of iPSCs were observed under inverted phase contrast microscope, and the cells were stained with alkaline phosphatase (AKP). iPSCs were cultured in incomplete medium of embryonic stem cells to observe the ability of embryoid body formation. (2) Human iPSCs were inoculated onto 6-well plate covered with human amniotic membrane to culture as induction group. Other iPSCs were cultured on 6-well plate without human amniotic membrane as control group. Morphological changes in iPSCs in two groups were observed. Expressions of integrin beta1 and CK19 of iPSCs in two groups were determined by immunocytochemical staining.

RESULTSHuman iPSCs showed a typical stem cell clone-like growth with a clear boundary, and they proliferated vigorously in complete medium of embryonic stem cells. These cells were AKP-positive. iPSCs formed embryoid body in trophoblast-free and suspension culture conditions. After 4 days of co-culture, stem cell clones were formed on the surface of amniotic membrane in induction group, and part of the cells were integrin beta1 and CK19 positive. Most of the cells died, and no integrin beta1 and CK19 positive cells were found in control group.

CONCLUSIONSHuman iPSCs can be differentiated into epidermal-like stem cells by amniotic membrane induction, and it lays an experimental basis for providing new source of seed cells of skin tissue engineering.

Animals ; Cell Culture Techniques ; Cell Differentiation ; Cells, Cultured ; Epidermis ; cytology ; Humans ; Induced Pluripotent Stem Cells ; cytology ; Mice

OBJECTIVETo observe the therapeutic effect of repairing cervical scar contracture using flaps carrying cervical cutaneous branch of the transverse cervical artery.

METHODSSixty-six patients with scar contracture after burn in anterior region of neck hospitalized from 1988 to 2011. The scars were excised and repaired with flaps containing the cervical cutaneous branch of transverse cervical artery. They included 55 island flaps (with 9 flaps pre-expanded) and 11 non-island flaps (with 1 flap pre-expanded). After removing the scar and releasing the contracture, flaps with the cervical cutaneous branch of transverse cervical artery were designed and raised in the supraclavicular and infraclavicular regions and the anterior thoracic region. The axial vessel of the flap was the cutaneous artery, which perforated in the crossing area of sternocleidomastoid muscle and omohyoid muscle and originated from the transverse cervical artery. The posterior borderline of the flap reached the anterior border of the trapezius muscle. Its exterior borderline reached the middle part of deltoid muscle, and its interior borderline ended at the midsternal line. The lower borderline was located 3.0-4.0 cm below the nipple. The incisions at the interior, lower, and exterior borders of the flap were first made. Then after sharp dissection to the clavicle, blunt dissection was performed to the pedicle to allow the flaps to be able to cover the wound after rotation without undue tension. The pre-expanded donor sites were sutured directly, while the un-expanded ones were covered with skin graft.

RESULTSOut of the 66 flaps, 64 flaps survived. Two flaps showed partial necrosis at the distal end due to sub-flap hematoma, and they healed after skin grafting. All the donor sites healed. The color and texture of all flaps matched well with the surrounding skin tissue. The flaps regained sensation pertaining to the chest in the early stage, and complete sensation pertaining to the neck appeared 6 months after surgery.

CONCLUSIONSThe flap containing cervical cutaneous branch of the transverse cervical artery is a good choice for repairing severe cervical scar contracture for its simple harvest, reliable blood supply, and similar color and texture to the skin of cervical region.

Adolescent ; Adult ; Carotid Arteries ; Child ; Child, Preschool ; Cicatrix ; surgery ; Contracture ; surgery ; Female ; Humans ; Male ; Middle Aged ; Neck ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Surgical Flaps ; blood supply ; Young Adult

OBJECTIVETo observe the therapeutic effect of supraclavicular island flap in repairing deep burn wound of neck.

METHODSSix patients with deep burn of neck hospitalized from January 2009 to June 2011 were enrolled in the study. Their total burn area ranged from 6% to 22% TBSA, of which full-thickness area ranged from 3% to 22% TBSA. The neck wound ranged from 12 cm x 5 cm to 15 cm x 8 cm in area, and they were all full-thickness in depth. One of the neck wounds was covered with granulation tissue. Patients underwent either debridement and escharectomy or excision of granulation tissue for the neck wound, and they were covered with supraclavicular island flap designed with the size corresponding to that of wound area. Four donor sites were sutured directly. The other two donor sites were covered with free skin graft. Survival of flaps and healing of donor sites were observed. The appearance and function recovery of operative regions were followed up.

RESULTSSupraclavicular island flaps of 6 patients survived as a whole. All the donor sites healed well. Flaps with satisfactory appearance and feeling sensation, accompanied by unlimited extension of neck were observed in the follow-up duration from 6 to 12 months. Scars observed in the flap edge and the donor sites were linear, and they did not affect the overall appearance and function of patients.

CONCLUSIONSSupraclavicular island flap is a good choice for repairing deep burn wound of neck, and it gives a good shape and function recovery of the neck.

Adult ; Burns ; surgery ; Female ; Humans ; Male ; Middle Aged ; Neck Injuries ; surgery ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Soft Tissue Injuries ; surgery ; Surgical Flaps

OBJECTIVETo investigate the aesthetic effect of wound repair with flaps.

METHODSOne thousand nine hundred and ninety-six patients with 2082 wounds hospitalized from January 2004 to December 2011. These wounds included 503 deep burn wounds, 268 pressure sores, 392 soft tissue defects caused by trauma, 479 soft tissue defects due to resection of skin cancer and mole removal, 314 soft tissue defects caused by scar excision, and 126 other wounds. Wound area ranged from 1.5 cm x 1.0 cm to 30.0 cm x 22.0 cm. Sliding flaps, expanded flaps, pedicle flaps, and free flaps were used to repair the wounds in accordance with the principle and timing of wound repair with flaps.

RESULTSFive flaps showed venous congestion within 48 hours post-operation, 2 flaps of them improved after local massage. One flap survived after local heparin wet packing and venous bloodletting. One flap survived after emergency surgical embolectomy and bridging with saphenous vein graft. One flap showed partial necrosis and healed after skin grafting. The other flaps survived well. One thousand three hundred and twenty-one patients were followed up for 3 months to 2 years, and flaps of them were satisfactory in shape, color, and elasticity, similar to that of normal skin. Some patients underwent scar revision later with good results.

CONCLUSIONSApplication of suitable flaps in wound repair will result in quick wound healing, good function recovery, and satisfactory aesthetic effect.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Burns ; surgery ; Child ; Child, Preschool ; Esthetics ; Female ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; Wound Healing ; Young Adult