OBJECTIVETo investigate the influence of early tangential excision within 24 postburn hours on local wound inflammatory response and tissue injury in patients with deep partial thickness burn.

METHODSTwelve patients with deep partial thickness burn were enrolled in the study. Tangential excision was performed within 24 postburn hours. The same wound of a patient was divided into three areas for harvesting tissue samples, i.e. pre-operation, post-operation and non-operation areas. For each patient, the biopsies from the pre-operation area were harvested before tangential excision, while those from post-operation and non-operation areas were harvested during 5 to 7 postburn days (PBDs). The contents of IL-8, MPO and MDA in wound tissue were determined by tissue culture and chemical colorimetry, respectively. HE and Mason's staining were employed to assess the degree of necrosis of the wound tissue.

RESULTSThe IL-8, MPO and MDA contents in the local wound tissue after tangential excision were 6.83 +/- 1.85 microg/L, 4.07 +/- 0.87 U/g, and 8.94 +/- 5.66 micromol/g, respectively, which were significantly lower than those from non-operation area (P < 0.01). The inflammatory response in the non-operative wound area was distinct with expansion of necrotic tissue area. In contrast, the local inflammatory response of the wound after tangential excision was ameliorated without the enlargement of necrotic tissue area.

CONCLUSIONTangential excision within 24 postburn hours could be beneficial in ameliorating local inflammatory response, and in preventing progressive deepening of the burn wounds, thus it could accelerate wound healing in patients with deep partial thickness burn.

Adult ; Burns ; metabolism ; pathology ; surgery ; Female ; Humans ; Inflammation ; Interleukin-8 ; metabolism ; Male ; Malondialdehyde ; metabolism ; Middle Aged ; Peroxidase ; metabolism ; Surgical Wound Infection ; Wound Healing

OBJECTIVETo explore the different expression of TGF-beta1 and collagen during the healing process of wound infected by Pseudomonas aeruginosa (PAO1).

METHODS24 female Wistar rats were randomly divided into pure wound group (group A) and wound + PAO1 group (group B). The re-epithelial rate, shrinkage rate and neutrophils number on the wounds were observed on the 1st, 3rd, 7th and 10th day after operation. The expression of TGF-beta1 and collage I, Ill was also detected.

RESULTSOn the 7th day, the re-epithelial rate in group A was higher than that in group B, while the shrinkage rate in group A was lower than that in group B. The neutrophils number increased to peak on the 1st day in group B, but on the 3rd day in group A. The TGF-beta1 expression increased after operation in both groups, but it decreased in group B on the 3rd day and re-increased after that. The TGF-beta1 expression was significantly different between the two groups on the 7th day (P < 0.05). The expression of collagen I and III decreased during healing. The expression of collagen III in group A was higher on the 3rd day and was lower on the 7th and 10th day than that in group B, showing a significant difference (P < 0.05).

CONCLUSIONSPAO1 infection could delay the expression of TGF-beta1 and collagen I, III on wound, which may interfere the healing process of wound.

Animals ; Collagen Type I ; metabolism ; Collagen Type III ; metabolism ; Female ; Pseudomonas Infections ; pathology ; Pseudomonas aeruginosa ; Rats ; Rats, Wistar ; Skin Transplantation ; Surgical Wound Infection ; metabolism ; microbiology ; Transforming Growth Factor beta1 ; metabolism ; Wound Healing

BACKGROUND: Inflammation related hematological parameters vary greatly depending on patients. It is not well known how much increase of which parameter warrants suspicion of postoperative infection. This study proposes to identify the normal range and the predictive factors for postoperative infection by conducting a time series analysis of the hematological parameters of patients after the spinal posterior fusion. METHODS: A retrospective study was done with 608 patients who underwent spinal posterior fusion with pedicle screw fixation. Laboratory assessment including the leucocyte, neutrophil, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) of patients for 2 weeks after operation. The patients were divided into the one-level fusion group (group I), the two-level fusion group (group II), the three or multi-level fusion or reoperation group (group III), and the postoperative infection group (group IV). Blood was drawn before breakfast prior to the operation, and then 2-3 days, 4-7 days, 8-11 days, and 12-14 days after the operation. The leucocyte count, neutrophil count, CRP, and ESR were measured. RESULTS: From 4-7 days after the operation, the CRP and neutrophil count of group IV were significantly higher than those of group I and II, and from 8-11 days after operation, the CRP and neutrophil counts were significantly higher than those of all groups. Twelve to fourteen days after the operation, the neutrophil count of group IV was significantly higher than that of group I and II, while the neutrophil count of group III was also higher than that of group I. The lower limit of the 95% confidence interval (CI) of the CRP and neutrophil count group IV was greater than the upper limit of the 95% CI of group I and II. The ESR of group IV was significantly higher than that of group I and III. CONCLUSIONS: If the postoperative CRP and neutrophil counts are high, or if the CRP begins to rise again 8 days after the operation, the likelihood of infection increases, but caution must be exercised in interpreting the results. If the hematological parameters are higher than the lower limit of the 95% CI of the postoperative infection group, infection must be strongly suspected.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Analysis of Variance ; Blood Sedimentation ; C-Reactive Protein/metabolism ; Child ; Female ; Humans ; Inflammation/*blood ; Leukocyte Count ; Male ; Middle Aged ; Predictive Value of Tests ; Retrospective Studies ; Spinal Fusion/*methods ; Surgical Wound Infection/*blood/diagnosis

BACKGROUND: The authors examined whether poor preoperative glucose control, as indicated by the hemoglobin A1c (HbA1c) level of more than 8%, is associated with postoperative wound and infectious complications in diabetic patients that have undergone total knee arthroplasty (TKA). METHODS: One hundred and sixty-seven TKAs performed in 115 patients with type 2 diabetes mellitus, from January 2001 through March 2007, were retrospectively reviewed. Logistic regression was used to identify the variables that had a significant effect on the risk of wound complications or early deep infection. The variables considered were age, gender, body mass index, comorbidities, operation time, antibiotic-impregnated cement use, amount of blood transfusion, close suction drain use, duration of diabetes, method of diabetes treatment, diabetes complications, and preoperative HbA1c level. RESULTS: The overall incidence of wound complications was 6.6% (n = 11) and there were seven cases (4.2%) of early postoperative deep infection. Logistic regression revealed that the independent risk factors of wound complications were preoperative HbA1C > or = 8% (odds ratio [OR], 6.07; 95% confidence interval [CI], 1.12 to 33.0) and operation time (OR, 1.01; 95% CI, 1.00 to 1.03). No variable examined was found to be significantly associated with the risk of early postoperative deep infection. CONCLUSIONS: Poorly controlled hyperglycemia before surgery may increase the incidence of wound complications among diabetic patients after TKA.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee/*adverse effects ; Blood Glucose/metabolism ; Diabetes Mellitus, Type 2/blood/drug therapy/*metabolism ; Female ; Glucose/*metabolism ; Hemoglobin A, Glycosylated/metabolism ; Humans ; Hypoglycemic Agents/therapeutic use ; Incidence ; Insulin/therapeutic use ; Logistic Models ; Male ; Middle Aged ; Retrospective Studies ; Surgical Wound Infection/*metabolism