Animals ; Burns ; complications ; Cicatrix ; etiology ; physiopathology ; Fetus ; physiopathology ; Humans ; Wound Healing

Parkland formula is the most widely used resuscitation formula in burn care. However, a growing number of disputes have been raised along with the development of medical technology, among which its total volume and composition of the fluid are the two foci. Firstly, Parkland formula may lead to an untoward phenomenon nicknamed "fluid creep", which may lead to complications such as abdominal compartment syndrome. Secondly, along with the deeper understanding of how permeability of blood vessels changes after burn injury, colloid is recommended to be given after the third 8 h post-burn. Additionally, controversy exists in the choice of different colloid solutions. The safety of different colloid solutions remains to be further elucidated. This article will deal with all of the above-mentioned problems.
Burns ; physiopathology ; therapy ; Fluid Therapy ; methods ; Humans ; Isotonic Solutions ; therapeutic use ; Resuscitation ; methods ; Treatment Outcome

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 analyze the changes in bacteria constitution in severe burn wounds in different stages so as to provide reference for clinical prevention and treatment.METHODS A total of 36 casualties with severe burn injuries(≥50.0% total burn surface area) and hospitalized within 5 days post-burns from 2004 to 2006 were enrolled in the study.Samples were collected in the burn wounds from the first day to two months post-burns.RESULTS Totally 476 bacterial strains were isolated and Gram-negative bacteria accounted for 64.1%.However,in term of the single bacterial strain,Staphylococcus aureus(SAU) ranked first and the follows were Pseudomonas aeruginosa(PAE) and Acinetobacter baumannii(ABA).During the first week and the six weeks to 2 months post-burns,Gram-positive bacteria were dominant and SAU ranked first.From the second week to the fifth week,Gram-negative bacteria were dominant,PAE and ABA were the main bacteria.Even though Gram-negative bacteria dominated in these periods,SAU still ranked the first or the second in terms of single bacterial strain.CONCLUSIONS Bacteria constitution in burn wounds differs in different stages.It must be stressed to prevent infections of SAU regardless of any stages,as well as ABA infections since the percentage of ABA has increased markedly in recent years.

The present article summarized briefly the experiences and lessons learned in the management of mass burn casualties,and also gave a brief account of the present status of the system of emergency care of mass casualties in our country.The authors proposed herewith an organizational system conforming to the status quo of our country.It was suggested that through learning from attending seminars and training in specialty centers,devotion to intensive research of relevant problems and constant interchange of experiences and ideas,the ability of professional staff to meet the needs of urgent and heavy duty could be raised in salvaging mass casualties both in peace time and war.

It is well known that in patients with severe burn, especially when complicated by sepsis, the breakdown of body proteins is acceleraled, producing a hypercalabolic response. Negative nitrogen balance and malnutrition will develop rapidly, predisposing to various complications. High calori intake and enhancement of anabolic process might fail to improve the patient′s nutritional condition. A skeletal muscles account for over 50% of body cell dry weight, their catabolism exerts profound effect on whole body metabolism. By using modern molecular biology techniques, one of the mechanisms underlying skeletal muscle proteolysis is shown to be activation of the ubiquitin proteasome pathway. The role of its possible modulating factors in inducing muscle protein breakdown after burn injury was explored in rat models of burn injury with or without sepsis. Muscle spesimens obtained from severely burned patient with sepsis was also collected for study.The results were as follows. (1)The total and myofibrillar proteolytic rate in extensor digitorum longus (EDL) muscle was increased markedly, especially the expressions of ubiquitin, and mRNA of subunit RC2(the largest subunit of 20s proteasome) were prominantly increased in EDL muscle. There was a significant positive correlation between the proteolytic rate and the expression of mRNA of ubiquitin, or mRNA of subunit RC2, after the stimulation of burn injury. On the other hand, there was no significant change in proteolytic rate and transcription of ubiquitin in soleus (SOL) muscle. (2)The myofibrillar proteolytic rate and the ubiquitin proteasome component were significantly enhanced in rats with sepsis compared with control group. There were significant positive correlations among plasma concentration of endotoxin, TNF ?, cortisol and respective values of myofibrillar proteolytic rate, and ubiquitin proteasome component. (3)There were significant positive correlations between the urinary output of 3 methylhistidine (3 MH)in 24h urine and respective values of plasma concentration of cortisol, TNF ?, and endotoxin in severely burned patients with sepsis. The expressions of ubiquitin mRNA 2 4 kilobase pair (?B), 1.2kb, C 2 subunit mRNA and the protein expressions of ubiquitin in quadriceps femoris muscle were significantly increased compared with the control group. (4)Muscle proteolytic rate was markedly enhanced when myotube was cultured with TNF ?. However, by using the ubiquitin proteasome inhibitor mG132, significant decrease in the muscle proteolyitc rate was observed. (5)Glucocorticoid could increase the skeletal muscle proteolytic rate, especially the myofibrillar proteolytic rate, through activating the ubiquitin proteasome system at gene level. However, this effect could be greatly bluned by glucocorticoid receptor antagonist RU38486. (6)NF ?B activity in skeletal muscle of burned rat with sepsis was markedly increased. However, by using inhibitor of NF ?B, the NF ?B activity was down regwlated in the muscle, and a decrease in the total and myofibrillar proteolytic rate was observed. (7)Decrease in transcriptional expression of ubiquitin and reduction in the skeletal muscle proteolytic rate were found when escharectomy was performed during early stage of burn injury. The results suggested that the treatment strategies for prevention of skeletal muscle proteolysis of postburn sepsis should firstly be aimed at eradication of devitalized tissues, i.e. prevention of sepsis by reonoval of the primary injury. Secondly, attention should be paid to modulating or controlling the process of ubiquitin proteasome pathway in response to burn injury, and this might provide an effective way to reduce skeletal muscle protein wasting by specifically inhibiting the specific enzymes or subunits involved in the enhancement of the activity of ubiquitin proteasome pathway after burn injury. However, more studies in the ubiquitin proteasome proteolytic pathway in severe burn injury are necessary to confirm this assertion.

Objective To investigate the relationship between antibiotic administration and the changes in constituent ratios of preponderant pathogens in infection of burn wounds in our burn unit. Methods The consumption of different kinds of antibiotics [expressed as the number of defined daily doses (DDD)/100 patient-day], as well as the constituent ratio of Staphylococcus aureus and Pseudomonas aeruginosa, and percentage of methicillin-resistant S. aureus (MRSA) among all positive cultures of S. aureus were calculated from 1995 to 2004, and their correlation was analyzed. Results Within this period, it was found that the consumption of first and second-generation cephalosporins and aminoglycosides, including cefazolin and amikacin, was decreased remarkably, while the consumption of antibiotics combined with lactamase inhibitor, third-generation cephalosporins, quinolones, including ceftazidime, levofloxacin and fosfomycin, was increased significantly. At the same time, the constituent ratio of P. aeruginosa declined to certain extent, while the constituent ratio of S. aureus gradually rase, but no increase was found in percentage of MRSA in S. aureus. The constituent ratios of S. aureus and P. aeruginosa were correlated to consumption of more than ten kinds of antibiotics or antimicrobial agents. Conclusions The results suggested that more cefazolin or amikacin and less antibiotics with lactamase inhibitor or third generation cephalosporins were used in the treatment of burn infection might help decrease the infection caused by S. aureus, and that when more carbopenem or cefoperazone/sulbactam were used there might be a tendency of declination of P. aeruginosa infection.

Objective To investigate the influence of composite transplantation of two kinds of acellular xeno-dermis (pigskin) and micro-autograft on wound healing. Methods Seventy-two Sprague-Dawley rats with full-thickness skin defect on the back were randomly divided into three groups, and then compositt skin I(acellular dermal xeno-matrix+autologous particulate skin +selective acellular xeno-dermis) was adopted to cover the skin defect in the experimental group I, composite skin II(acellular dermal xeno-matrix+autologous particulate skin + glutaraldehyde xeno-skin) was adopted to cover the skin defect in the experimental group II, and auto-particulate skin was adopted in the control group. The area of wound healing and the rates of wound contraction were calculated.Tissue samples were harvested and examined by means of histology, immunohistochemistry and electron microscopy. Results There were continuous epidermis and basement membrane, and the dermal matrix was a kind of matrix with normal structure and organization of collagen and without any cellular components in selective acellular xeno-dermis. There was full differentiation of epithelium, orderly collagen arrange and basal membrane of the skin could be identified by immunohistochemical stain in compound skin grafting group I. The healing effect of compound skin grafting group I was better than compound skin grafting group II and auto-particulate skin grafting group. Conclusion The composite grafts constructed by selective acellular xeno-dermis (pigskin) could be a potential new type of composite skin substitute for the repair of full-thickness skin defect.

Objective To observe the effect of low molecular weight heparin(LMWH)on hypercoagulability in extensive severe burn patients.Methods 9 patients were assigned as LMWH treatment group(TG),and another 12 burn patients with the similar extent of burn injury admitted in the same period were assigned as routine treatment group(RTG).All the treatments were the same except 5000U LMWH was given via subcutaneous injection per 12 or 6 hours to the TG group for 3-7days.The patients in normal control group(NCG)consisted of patients receiving plastic surgery.The following coagulation parameters were determined before and after the heparin treatment:prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT),international normalized ratio(INR),fibrinogen(Fib)and platelet(PLT).Results INR,APTT and PLT in both TG and RTG groups were significantly lower compared with that in NCG before treatment,and Fib in two former groups were higher than that in NCG.Compared with those values before treatment,Fib decreased and PLT increased significantly after LMWH treatment in TG.However,there were no significant changes in other parameters in TG after LMWH treatment.Severe side effects such as haemorrhage were not found in patients in TG.Conclusion LMWH could ameliorate hypercoagulability following severe burns.

Objective To repair and reconstruct severe burn wounds on face,hands and joints with the principles and techniques of plastic and aesthetic surgery.Methods Twenty three burn victims in a single batch were transferred from a remote area to our Burns Institute on post burn day 2,June 28,2006.All the patients were males aged from 17 to 46 years,with a mean of 24.4?6.3 years,the mean total burn area was 15.7%?13.9% TBSA(ranged from 6% to 75%),with moderate to severe inhalation injury,and fourteen of them had received tracheostomy.The burn areas on face ranged from 0.5% to 3% TBSA,and all of them were deep second or third degree burn.The burn areas on hands ranged from 1% to 4% TBSA of deep second or third degree.On post burn day 3,the patients received escharectomy or tangential excision of eschar on hands followed by split thickness skin grafting with the principles and techniques of plastic and aesthetic surgery.During post burn week 2 to 3,the eschar on the faces were peeled off,followed by split-thickness skin grafting according to the principles and techniques of plastic and aesthetic surgery.Results All the wounds on the face and joints were repaired successfully,the configuration and functions were satisfactory.Conclusion It is feasible to repair the burn wounds on face and joints with the principles and techniques of plastic and aesthetic surgery for the burn patients of mass fire catastrophe.