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

To study the effects of TNF ? on the protein metabolism and the ubiquitin system gene expression in isolated skeletal muscles, after dissecting and isolating the extensor digitorium longus (EDL) muscles, the in vitro oxygen rich muscle incubation system and as high performance liquid chromatography were used to assess proteolytic rate of the samples. The EDL muscles in study group were incubated with media containing 6 000 U/ml recombinant rat TNF ?. In control group, the media were of the same composition as that of the study group except recombinant rat TNF ?. The expressions of ubiquitin mRNA and C 2 mRNA in rat EDL muscles were determined by Northern blot analysis. No notable difference was observed in the total and myofibrillar proteolytic rate in EDL muscles between the two groups. The expressions of ubiquitin mRNA(2 4kb) and C2 mRNA of EDL muscle incubated with medium containing TNF ? were increased by 151% and 56%, respectively, as compared with those in control group. TNF ? could directly strengthen the function of ubiquitin dependent proteolytic system, but further studies are necessay to elucidate whether TNF ? could directly increase the proteolytic rate in skeletal muscle.

To study the changes of skeletal muscle proteolysis in severely burned patients with sepsis and analyze its possible mechanism, the blood, 24h urine and quadriceps femoris muscle samples were collected from nine severely burned patients with sepsis (the burn sepsis group) and nine patients with plastic operation (the control group). The plasma concentrations of cortisol and TNF ? were determined with radioimmunoassay. The urinary output of 3 methylhistidine (3 MH) in 24h urine were assessed with high performance liquid chromatography. The expressions of ubiquitin mRNA and C 2 mRNA in quadriceps femoris muscle were determined by Northern blot analysis. The protein expressions of ubiquitin in quadriceps femoris muscle were determined by immunopathology. The results showed that the plasma concentrations of cortisol and TNF ? in burn sepsis group were significantly higher than those of the control group ( P

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.

Objective To study the resuscitative effect of hypertonic electrolyte glucose solution (HEGS) on the haemodynamics pa-rameters in enteral resuscitation of burn shock. Methods Eighteen beagle dogs with 35% TBSA third degree burned were used in this stud-y. They were random divided into no-resuscitation group (NR group), enteral resuscitation with HEGS group (EH group) and intravenous resuscitation with isotonic electrolyte glucose solution (lEGS) group (Ⅱ group). The fluid resuscitation was given from half an hour after TBSA). The haemodynamics parameters (cardiac index, mean arterial pressure, intrathoracic blood volume index, and systemic vascular re-sistance index) were continuously assessed by PICCO. Result The cardiac output index reduced markedly after bum in the three groups, and then returned after 2h in two resuscitation groups, which were higher than that in the NR group( P<0.05). The mean arterial pressure reduced in the three groups, which was higher in the two resuscitation groups than that in NR group(P < 0.05). The intrathoracic blood volume index was rapidly reduced in the three groups. It returned in EH group from 2 hours after burned, which was still higher than that in the other two groups (P < 0.05). Meanwhile the systemic vascular resistance index was increased quickly. It was reduced in EH group from 2 hours after burned, which was lower than that in the other two groups (P < 0.05). Conclusion The results show that it was feasible for 35% TBSAⅢ° burn-injury dogs to be resuscitated with 1.8% hypertonic electrolyte-glucose solution by enteral, which can markedly reduce liquid quantity needed.

OBJECTIVETo study the effects of glucocorticoid on skeletal muscle protein metabolism in burn sepsis and its possible mechanism.

METHODSThe rats were randomly divided into four groups with 15 rats in each group. Group B, 30% TBSA full-thickness burn was produced on the back and endotoxin (6 mg/kg bw) was given intraperitoneally after the injury to simulate burn sepsis. Groups C and D, glucocorticoid receptor antagonist RU38486 (10 mg/kg bw) was given by gavage 2 hours before or 2 hours after burn with endotoxin, respectively. Group A, the rats received only normal saline in same volume as endotoxin. Plasma levels of cortisol were determined with standard procedure. Extensor digitorium longus muscles (EDL) were procured from both legs 12 hours after the injury. After weighing, the proteolytic rate was determined in vitro in an incubation system with oxygen rich environment by high performance liquid chromatography. The gene expressions of ubiquitin, E(2)-14kDa and C2 in the muscles were determined by Northern blot analysis.

RESULTSThe weight of EDL was significantly lower in group B than in group A (t = 9.03, P < 0.01). Although the weight of EDL muscles was also lower in groups C and D than in group A, it was significantly higher than in group B (t = 2.26, 6.42, P < 0.05 or P < 0.01). The concentrations of plasma cortisol were markedly higher in groups B, C and D than in group A (t = 9.03 - 22.94, P < 0.01). A 58.8% (210/357) of the total and 335.5% (4.16/1.24) of myofibrillar proteolytic rate in group B was higher than in group A (t = 36.99 and t = 46.19, P < 0.01), respectively. The total and myofibrillar proteolytic rate in group D was 28.3% (161/567) and 49.6% (2.68/5.40) and in group C 18.9% (108/567) and 23.2% (1.25/5.40), which were lower than those in group B (t = 5.34 approximately 34.68, P < 0.01), respectively. Although the expressions of ubiquitin mRNA (2.4 kb), E(2)-14 kDa mRNA (1.2 kb) and C2 mRNA in groups C and D were significantly higher than in group A, all the values were lower than those in group B (t = 3.22, 11.32, P < 0.01), especially in group C.

CONCLUSIONSThe proteolytic rate of skeletal muscle, especially the myofibrillar proteolytic rate, was enhanced during burn with sepsis. Hypersecretion of glucocorticoid could upgrade the gene expression of ubiquitin system, resulting in hyperdegradation of skeletal muscle protein during burn with sepsis. Glucocorticoid receptor antagonist RU38486 could decrease the hyperdegradation of skeletal muscle during burn with sepsis.

Animals ; Burns ; metabolism ; Gene Expression Regulation ; Glucocorticoids ; physiology ; Hydrocortisone ; blood ; Male ; Mifepristone ; pharmacology ; Muscle Proteins ; metabolism ; Muscle, Skeletal ; metabolism ; Rats ; Rats, Wistar ; Sepsis ; metabolism ; Ubiquitin ; metabolism