In recent years, negative pressure wound therapy (NPWT) technique has been widely used in burn surgery, including wound repair, skin grafting, and cosmetic procedures, showing promising clinical results. Based on the literature and clinical experience, the mechanism of NPWT and its clinical application in burn surgery are briefly iterated herewith.
Burns ; surgery ; Humans ; Negative-Pressure Wound Therapy ; Skin ; Skin Transplantation ; Wound Healing

Objective To study the effects of tumor necrosis factord (TNF ?)on degradation of long lived protein in cultured myotubes, myoblasts were proliferated in tissue block culture and fused into myotubes. Methods Then the protein in myotubes was radiolabelled with L [3,5 3 H] tyrosine. Myotubes were either cultured with TNF ? 2000U/mL or without TNF ?, and 12h, 24h, 36h, 48h later, the amounts of L [3,5 3 H] tyrosine in culture medium and cells were determined, and the degradation rates of long lived protein were calculated. Other myotubes were cultured either with 50?mol/mL proteasome inhibitor MG132 or 50?mol/mL MG132 and TNF ? 2000U/mL, and long lived proteolytic rates were calculated by the same method after 24h culture. Results The long lived proteolytic rates in myotubes cultured with TNF ? were increased significantly at all time points compared with control group ( P

Objective To study the protein metabolism in rat myocardium after burn injury with sepsis, the mRNA expressions of ubiquitin were determined. Methods Wistar rats were subjected to a 30% full thickness burn and endotoxin (6mg/kg) was immediately injected into the peritoneal cavity. They were randomly divided into 2 and 6 hour groups and a normal control group, with 9 rats in each group. The cardiac muscle was taken to assay the mRNA expressions of ubiquitin during postinjury period. Results The expressions of the ubiquitin mRNA (2 4kb and 1 2kb), especially the 2 4kb stripe, in cardiac muscle of burn sepsis rats were significantly higher than that of normal control ( P

Objective To observe the effect of recombinant human growth hormone(rhGH)combined with intensive insulin therapy on the metabolism in severely burned patients.Methods From March 2001 to October 2007,15 severely burned patients were enrolled in the study,and they were categorized as rhGH combined with intensive insulin group(group I,n=6)and rhGH with insulin in ordinary dose group(group R,n=9).The excised burn wounds were closed with microautograft and allograft skin within 4 days after burn injury.Postoperatively,all patients received rhGH every night for 14 days.In group R,insulin in ordinary dose was added to glucose infusion,and in group I,an insulin pump was used to control blood glucose at 4-8mmol/L.Blood samples were collected for determination of blood glucose,K+,serum amino acid profile,and proalbumin,and urinary 3-MH were also measured.Results The concentration of blood glucose,K+,blood amino acids and urinary 3-MH in group I became lower than that in group R 3 days after surgery(P

Objective To study the emergency treatment,diagnosis and integrative treatment for the patients with severe burn injury combined with inhalation injury.Methods Thirty-five burn victims in a mass casualty were airlifted to our Burns Institute from a remote area on second day post-burn,including 14 patients who had received emergent tracheostomy for inhalation injury.After hospitalization,bronchoscopic examinations were done for further evaluating the inhalation injury,and timely locating and removing of sputum crust and necrotic mucosa from the airway in patients with signs of dyspnea,and helping decide the opportune time of removing the tracheostomy tube.The "artificial nose" and intratracheal instillation and lavage were used for humidifying the mucosa of the tracheobronchial tree.The stryker frame,vibrator and expectorant were also used to facilitate expectoration.Epidermis growth factor was topically used for promoting the restoration of the injured endotracheal mucosa.Results The degree of inhalation injury in fourteen patients with tracheostomy was identified through bronchoscopy as moderate(3 cases),severe(8 cases),and very severe(3 cases).The tracheostomy tubes were removed within one week in seven patients(50.0%),and during the second week post-burn in six patients(43%).The removal of tube was delayed in the remaining patients until 42nd day post-burn because of multiple organ dysfunction syndrome.Pulmonary infection occurred in two patients on the 10th day post-burn,and pathogens were found in tracheo-bronchial discharge in three patients.Conclusion Emergent tracheostomy should be performed the earlier the better for severe inhalation injury,and bronchoscopy was desirable for distinct diagnosis and treatment,especially for estimating the repair of tracheal mucosa and deciding the time for removal of the tracheostomy tube.Moistening the tracheo-bronchial tree through instillation of fluid with drugs and "artificial nose",and the use of Stryker frame,vibrator and expectorant were effective in facilitating expectoration and preventing lung infection.Topical use of epidermis growth factor may be helpful for the repair of injured tracheal mucosa.

Objective To introduce the successful experiences in treating 35 burned victims transferred from a remote area.Methods Thirty-five burned casualties were transferred to our burns institute from a remote area on the post-burn day 2,May 28,2006.All of them were males,age ranged from 17 to 46 years with mean of 22.4?8.7 years.The mean total burned area was 13.6%?12.9% TBSA(ranged from 4% to 75%).Among them,32 patients also manifested the signs of severe inhalation injury.In all of the patients,heart function,pulmonary function,liver function,renal function,and coagulation function were abnormal.Therefore,they were in critical condition with multiple complications,demanding most meticulous care.On this occasion,our strategies consisted of dispatching experienced surgeons and nurses to the referring hospitals and the airport to accept the patients to give appropriate care to them during the journey.The medical staff was well organized to insure that each of them was ordained specific duty.The conditions of patients were evaluated immediately and appropriate treatment was expeditiously started to arrest those lethal complications on arrival.Timely and exact comprehensive treatments were prerequisite to save the patients' life.Adequate metabolic support should be emphasized,and either coagulant or anticoagulant treatment should be given when indicated.Results All of the patients survived.Conclusion In dealing with mass burn casualties,organizational work is essential to prevent any untoward complications during the transportation,and the staff of the receiving hospital sheald also be organized to treat any life-threatening conditions on arrival of the palients.Meticulous care should be given to all the patients,and fatal complications are expeditionsly treated in order to achieve a satisfactory result.

PurposeTo optimize the imaging parameters of clinical MRI scanner in rat pancreas imaging to improve the image quality and to provide better MRI image quality and more economical research method for imaging study of rat pancreas. Materials and Methods Twenty-four healthy male Wistar rats were randomly divided into the conventional sequence (CS) group, the adjustment sequence (AS) group and the optimization sequence (OS) group, with 8 rats in each group. The rats in the CS group were scanned with conventional parameters using a clinical MRI scanner. The principle of parameter adjustment was: parameters associated with T1WI or T2WI imaging quality (TR, TE, slice thickness, NEX, FOV and matrix) was set with four changes, and only one of the six parameters was changed in each scan, image quality was evaluated by two senior radiologists, the parameter corresponded the best image quality evaluated consistently by two radiologists were selected as the optimal imaging parameter, all the optimized parameters were set up step by step in this way which formed the imaging parameters in OS group. The pancreatic signal intensity and signal to noise ratio was compared between CS group and OS group after imaging.Results The optimized sequence parameters in clinical MRI scanner were listed below: T1WI sequence (M3D/FSPGR/15): TR 6 ms, TE 2.5 ms, slice thickness 2.0 mm, NEX 8, FOV 7 cm×7 cm, Matrix 120×120; T2WI sequence (FSE-XL/90): TR 4000 ms, TE 71 ms, slice thickness 2.0 mm, NEX 1, FOV 8 cm×8 cm, Matrix 192×160. The pancreatic SI in T1WI and T2WI sequence of the OS group were significantly higher than those in the CS group (t=5.16 and 3.80,P<0.01), while the pancreatic SNR in T1WI and T2WI sequence of the OS group were significantly higher than those in the CS group (t=5.65 and 3.26,P<0.01).Conclusion The optimized parameters can improve the imaging quality of rat pancreas MRI significantly, thus provide a reference for the related experimental study.

0.05). Yet, the activity of NF-?B (female: 12.10?2.89; male: 19.53? 2.12) and the level of TNF-? female: (4.10?0.72) ng/ml; male: (6.37?1.29) ng/ml were significantly increased after injection of lipopolysaccharide (P

OBJECTIVETo study the application of VSD in the treatment of severe necrotizing fasciitis in extremities of patients.

METHODSEight patients, suffering from severe necrotizing fasciitis, who had been traditionally treated with iodophor-soaked gauze for 21 to 365 days in other hospitals, were transferred to our institute because of the nonhealing wounds and systemic toxic symptoms induced by infection, from January 2011 to August 2013. After admission, surgical debridement was performed timely, and the necrotic tissue was collected during the operation for pathological observation after HE staining. After the operation, VSD was started with negative pressure ranging from -100 to -80 kPa, and the furacilin solution (0.2 g/L) and oxygen (2 L/min) were continuously infused into the wound during the treatment. Surgical debridement was performed repeatedly according to the wound condition followed by change of VSD dressings to continue VSD treatment. The wounds were closed by suturing or with autologous skin grafts after being covered by fresh granulation tissue. The times of surgical debridement, times of change of VSD materials, wound healing status, and length of stay in our institute were recorded. All patients were followed up for a long time. Results HE staining showed that there were diffuse necrotic adipose and fibrous connective tissues in the necrotic tissue, and the normal tissue structure disappeared accompanied by significant infiltration of inflammatory cells. The number of surgical debridement was 2 to 10 (3.9 +/- 2.8) times. The number of VSD materials change was 2 to 10 (4.0 +/- 2.9) times. Wounds were closed by suturing and healed in two patients; wounds in the other six patients were partially sutured, their residual wounds were healed by autologous skin grafting. The length of stay in our institute was 20 to 49 (33 +/- 10) days. All patients were discharged after recovery. Patients were followed up for 2 to 24 months, and their wounds were found to be in good condition without ulceration or recurrence.

CONCLUSIONSVSD can effectively remove the necrotic tissues and exudates from the fascial spaces and promote proliferation of granulation tissue. Therefore it serves as an effective approach to the treatment of severe necrotizing fasciitis in extremities.

Debridement ; Drainage ; Extremities ; surgery ; Fasciitis, Necrotizing ; surgery ; Granulation Tissue ; Humans ; Negative-Pressure Wound Therapy ; Oxygen ; Pressure ; Skin ; Skin Transplantation ; Ulcer ; Vacuum

OBJECTIVETo explore the effects of recombinant human growth hormone (rhGH) when applied postoperatively on the metabolism of branch chain amino acid in severely burned patients.

METHODSFifty burn patients, aged 12 - 50 years and inflicted by more than 30% TBSA with 10% or more of III degree burn and admitted from the January of 1999 to the January of 2001 were enrolled in the study. The patients were randomly divided into rhGH treating (rhGH group) and control groups. Escharectomy was performed within 3 postburn day (PBDs). rhGH (0.3 IU/kg) was injected percutaneously every evening for ten days since the 1st postoperative day (POD). The changes of the plasma levels of GH and branch chain amino acid and the urine level of 3-methyl histidine (3-MH) were observed in the morning in the patients from the two groups.

RESULTSThe plasma GH level before operation decreased obviously in two groups of patients when comparing with normal value (P < 0.05). The plasma GH level in rhGH group was evidently higher than that in control group since the 3rd POD (P < 0.05). There was significant increase of the output amount of urine 3-MH in all patients, but which was obviously higher in control group than that in rhGH group (P < 0.05). The plasma levels of branch chain amino acid in burn patients before and one day after operation were lower than normal levels. The plasma levels of valine, isoleucine and leucine increased to peak values at POD 3 in rhGH group and at POD 7 in control group and decreased thereafter. The plasma branch chain amino acid level in rhGH group was evidently lower than that in control group since POD 7 (P < 0.05). The plasma GH level in rhGH group was negatively and significantly correlated with the urine output amount of 3-MH (P < 0.01).

CONCLUSIONPostoperative application of rhGH in major burn patients might be beneficial to the protein synthesis from amino acids by skeletal muscles and to the decrease of muscle protein degrading rate.

Adolescent ; Adult ; Amino Acids ; metabolism ; urine ; Burns ; blood ; metabolism ; urine ; Child ; Female ; Human Growth Hormone ; blood ; pharmacology ; Humans ; Male ; Middle Aged ; Muscle, Skeletal ; drug effects ; metabolism ; Recombinant Proteins ; blood ; pharmacology