Study on 17 pediatric patients aged from 1 to 12 years of old, 14 boys and 3 girls. Burn-caused agents were dry heat, wet-heat and chemicals. Patients were divided randomly into 2 groups: Group A (Study group) involved 10 patients with mean age of 5 years, average common burn area was 41% of body area and deep burn area was 35% of body area. Group B (control group) included 7 patients with mean age of 6 years. The average common burn area of these patients was 48% of body area and the deep burn area was 34%. In group A, the bacterial infection incidence was lower markedly than group B (p<0.05). P. aeruginosa caused sepsis had highest incidence (66.6%) in patients with positive culture. Skin implantation produced good and moderate results in group A. 10 patients received skin allograft in 16 operations. Mean time survival of skin grafts is 14.92 days.
burns, (Transplantation, Homologous)

PURPOSE: Massive pediatric burns are subject to progress to wound infection and sepsis at early stage. Early escharectomy and allograft made it safer to treat the pediatric burn patients from this morbidity. The purpose of this study is to analyze the impact of the early escharectomy and temporary wound coverage with allograft on massive pediatric burns. METHODS: From January 1999 to August 2010, 55 pediatric burn patients aged 1 to 10 years whose total burn surface area was over 20% were reviewed. Among them, only 19 patients underwent escharectomy (Pediatric escharectomy group, PEG) and 36 patients underwent escharectomy and allograft (Pediatric allograft group, PAG) And 533 allograft patients (Allograft group, AG) aged over 10 whose total burn surface area were over 20% were reviewed to compare with the pediatric allograft patients. RESULTS: PAG was operated earlier (mean 3.6 days from injury) than PEG (mean 5.9 days). The mortality of PAG (8.3%) was lower than the mortality of PEG (31.6%) significantly. And the PAG were operated earlier than AG (mean 5.8 days from injury). But the difference of mortality was not significant statistically between PAG and AG. CONCLUSION: Early escharectomy and allograft is safe and effective treatment procedure for massive pediatric burn patients by preventing wound sepsis.
Aged ; Burns ; Humans ; Sepsis ; Transplantation, Homologous ; Wound Infection

OBJECTIVETo observe the effects of autologous fat granules in mixed grafting microskin grafts on repair of extensive deep burn wounds in patients.

METHODSTwenty patients hospitalized in our ward were enrolled for autogenous self-control test in wounds on both or symmetrical parts of wounds of the trunk, and they were randomly divided into experimental (E) trol (C) groups, the wounds in E group were repaired with autologous fat granules together with microskin in mixed grafting (volume ratio 1 : 1), and in C group only autologous microskin grafting was given. Wound healing rate was measured on 30th, 45th, and 60th day after operation. Wound specimens harvested for HE staining and PCNA immunohistochemistry examination on 7th, 14th, 21st, and after operation.

RESULTS(1) The mean wound healing rate on 30th, 45th, and 60th day after E group was (56.3 +/- 3.1)%, (76.4 +/-6.1)%, (96.2 +/- 1.5)%, which were respectively higher C group [(28.3 +/-2.0)%, (47.3 +/-4.8)%, (85.4 +/- 2.2)%, P < 0.01]. HE staining showed epithelization in E group was earlier than that in C group, with regular arrangement of collagen fibers. The quantity NA positive cells in E group were larger than that in C group, and PCNA was mainly expressed cells of basal layer .

CONCLUSIONAutologous fat granules in mixed grafting with autologous microskin promote wound healing.

Adipose Tissue ; transplantation ; Adult ; Burns ; surgery ; Female ; Humans ; Male ; Skin Transplantation ; methods ; Transplantation, Autologous ; Transplantation, Homologous ; Wound Healing

OBJECTIVETo investigate the immunologic reaction difference between xenogeneic and allogeneic acellular dermal matrix (ADM) grafting.

METHODSSplit thick skin samples harvested from healthy piglets and human volunteers who underwent losing-weight operation were processed to be xeno-ADM and allo-ADM. The ADMs overlapped with ultrathin auto-skin were employed to immediately cover the wound after escharectomy in deep burn patients. The patients were correspondingly set to be Xeno (26 cases) and Allo (10 cases) groups. Another 8 cases with deep burn wounds were grafted with only split thick autoskin (TTS) after escharectomy as control group. The tissue samples from grafted area were observed by immunohistochemistry after the grafting. The typing of immune cells in peripheral blood and grafted tissue was determined.

RESULTS(1) The CD4(+), CD45RO(+) and CD4(+)/CD8(+) cell ratios in peripheral blood in Xeno group increased slightly after the skin grafting when comparing to those in control group (P > 0.05). (2) There existed lasting inflammatory and immunological reaction in the local site of grafts in Xeno group. In addition, more than 80% of the inflammatory cells could be found to be CD3(+)/CD4(+), CD45RO(+). But CD8(+), Vs8C(+) plasmocytes and CD57(+) NK cells were found less. Furthermore, eosinophil and CD68(+)/CD4(+) foreign body megalocyte reactions could also be identified, especially in Xeno-ADM before rejection (P < 0.05 - 0.001). There was only mild inflammatory and immunological reaction during early grafting stage (within 8 post-operational weeks) in Allo-group.

CONCLUSIONThe specific immunologic reaction of human host to ADM might be participated by mononuclear cells and macrophages and presented mainly as cellular immune reaction induced by CD4(+) T lymphocytes. Furthermore, the foreign body megalocyte constructed by help T cell and macrophage might play important roles in the reaction.

Animals ; Burns ; immunology ; surgery ; Dermis ; transplantation ; Graft Rejection ; Humans ; Skin Transplantation ; immunology ; methods ; Swine ; Transplantation, Heterologous ; Transplantation, Homologous

OBJECTIVETo present the clinical application of composite graft of acellular allo-dermis matrix (ADM) with thin auto-microskin on burn wound.

METHODS8 inpatients with 18 full thickness skin burn wounds were transplanted with allo-ADM after eschar was excised, then the auto-microskin and allo-human skin were covered on the area of the matrix, the wound where no allo-ADM grafting were covered as control groups only with auto-microskin and allo-human skin. The area of donor to wound is 1:5 - 1:8.

RESULTSSurvived rate of 18 pieces composite skin that allo-ADM with auto-microskin were grafted were 94%. After following up for 3 to 13 months, the skins of complex grifting had well elastic and smooth texture compared to auto-microskin grafted, they appeared less cicatrisation and ulceration. 3 months after operation, it was indicated by histological examination that tightknit the epithelial-dermal conjunction and epidermal papilla structure could be identified in the allo-ADM skin and there were orderly collagenous fibres, but scar skin structure was observed in that auto-microskin grifted area.

CONCLUSIONThe graft effectiveness of allo-ADM and auto-microskin was better than that of auto-microskin, and this method could be used on major deep burn wound healing.

Adult ; Burns ; surgery ; Female ; Humans ; Male ; Middle Aged ; Skin Transplantation ; methods ; Tissue Donors ; Transplantation, Autologous ; Transplantation, Homologous ; Treatment Outcome

OBJECTIVETo evaluate the effect of mixed composite skin graft on the deep partial thickness burn wounds after tangential excision in burn patients.

METHODSTangential excision was performed in 30 extremities of 23 burn patients within 3 postburn days (PBDs). Then large pieces of homologous acellular dermal matrix were grafted onto the superficial fascia with razor thin autoskin on top of them. The survival rate of skin grafts, the appearance and the functional recovery of the extremities were observed on 10 to 12 post operative day (POD). Skin samples from a healed wound of a patient were harvested three months after the injury for pathologic examination.

RESULTSThe survival rate of the composite skin grafts was 93%. Necrosis was encountered in 7% of the grafts in the lower extremities due to the poor fixation of the grafts leading to separation of autologous skin and the dermal template, and also due to infection resulting in lysis of the grafts. The grafted skin was excellent in the appearance and elasticity, and function of the injured extremities recovered well after grafting after 3 - 6 months of follow-up. Epidermal and dermal texture was also good as shown by pathologic examination.

CONCLUSIONMixed composite skin grafting after early tangential excision might be an ideal and effective method in the management of deep partial thickness burn wounds.

Adult ; Burns ; surgery ; Dermis ; transplantation ; Female ; Follow-Up Studies ; Graft Survival ; Humans ; Male ; Skin Transplantation ; methods ; Transplantation, Homologous ; Wound Healing

OBJECTIVETo observe the influence of mixed grafting of autologous and allogeneic microskin on burn wound healing.

METHODSAutologous microskin grafting (expansion rate 5:1) was employed as control. Autologous microskin mixed with the allogeneic microskin with the thickness of 0.3 mm and 0.6 mm, respectively, were designated as experimental groups 1 and 2 (EP1 and EP2). The wound healing rate, wound contraction rate, and histological changes were observed on the 2nd, 3rd and 4th weeks after the grafting.

RESULTSThe wound healing rate in two experimental groups (94.58 +/- 3.99)% in EP1, and (95.28 +/- 1.93)% in EP2 was significantly higher than that in the control group (88.28 +/- 6.85)% at the end of the 2nd week after the grafting (P < 0.05) The wound healing rate in experimental group 2 (94.55 +/- 3.47)% was obviously higher than that in control (88.51 +/- 5.59)% and experimental group 1 (89.51 +/- 4.70)% at the end of the 3rd week after grafting (P < 0.05). There was no obvious difference in wound healing rate among the three groups at the end of the 4th week after grafting. Obvious lymphocytic infiltration was observed by histological examination between epidermis and dermis in the two experimental groups at the end of the 2nd week after grafting. But there was no obvious difference among the three groups 4 weeks after grafting.

CONCLUSIONThe wound healing could be improved by mixed skin grafting with appropriate quantity of allogeneic and autologous microskin. Furthermore, the wound contraction could be ameliorated if the thickness of allogeneic dermis was increased in the mixed grafting even with the same proportion of allogeneic to autologous microskin.

Animals ; Burns ; surgery ; Female ; Male ; Rats ; Rats, Sprague-Dawley ; Rats, Wistar ; Skin Transplantation ; methods ; Transplantation, Autologous ; Transplantation, Homologous ; Wound Healing

OBJECTIVETo explore an ideal skin substitute with its appearance and texture similar to normal skin, to repair wounds with full-thickness skin defect.

METHODSComposite skin (CS) in question was composed of allo/xenogeneic acellular dermal matrix (ADM) and razor thin autoskin. One step skin grafting was employed in the experimental study and clinical trial. Razor thin autoskin alone was used as the control in the study. Changes in the antigenicity of ADM and the reformation of basement membrane (BM) structure at epidermis-dermis junction (EDJ) of ADMs were studied at designated time points after the grafting with biochemical and immunohistochemical methods. Fifty-three patients with full thickness skin defects due to various causes, including scar excision were grafted with CS, and survival rate and long-term result were observed.

RESULTSThe grafted CS survived satisfactory. The reformation of the basement membrane structure was clearly observed at the 28th post-graft week. The basement membrane cells grew with polarization in an undulating arrangement. There was reformation of dermal papillae and ridges. The antigenicity of allo-ADM was obviously lower than that of xeno-ADM. Sixty-five out of 70 pieces of CS grafting (92.9%) survived totally, two of them survived partially, and three failed due to infection. The longest follow-up period was 8 and a half years. The grafted CS appeared similar to the normal skin in regard to the texture and color, especially allo-ADM, and no evident rejection reaction was seen.

CONCLUSIONADM possessed very low antigenicity, thus serving a lasting framework after grafting. In addition, it could serve as a "dermal template" for the induction of tissue regeneration.

Animals ; Burns ; surgery ; Dermis ; transplantation ; Follow-Up Studies ; Graft Survival ; Humans ; Male ; Rabbits ; Skin Transplantation ; methods ; Swine ; Transplantation, Autologous ; Transplantation, Heterologous ; Transplantation, Homologous ; Treatment Outcome ; Wound Healing

OBJECTIVETo review the long-term clinical effect of composite transplantation of allogeneic acellular dermal matrix (ADM) and split thickness skin autograft (STSG).

METHODSNineteen patients with 34 wounds transplanted with allogeneic ADM combined with STSG who were hospitalized from March 2001 to October 2008 were enrolled as composite transplantation group (CT). Another 9 patients with 11 wounds transplanted with STSG admitted within the same time frame were enrolled as control group (C). All patients were followed up for longer than 2 years. Color, evenness, texture, contracture, sensation, and complications of transplanted skin were assessed using a modified Manchester Scar Scale (1-4 scores, the higher the score, the poorer the situation). The scar formation on skin donor sites was assessed by the Vancouver Scar Scale. Patients' degree of satisfaction and health status during the transplantation period were investigated in the form of questionnaire. The skin tissue structure of 4 patients was observed with histological method. The joint range of motion was assessed by the neutral position before and after operation and at follow-up. Data were processed with nonparametric test, chi-square test or t test.

RESULTS(1) The evenness, contracture, and texture of transplanted skin in CT group scored (1.6 ± 0.5), (1.8 ± 0.8), and (1.5 ± 0.8), respectively, which were significantly lower than those in C group [(2.0 ± 0.7), (2.2 ± 0.9), and (2.3 ± 0.7), with Z value respectively -2.058, -2.220, -2.323, P values all below 0.05]. Scores of color, sensation, and complications of transplanted skin in two groups were close to each other (with Z value respectively -0.628, -0.428, -2.520, P values all above 0.05). (2) Mild scar formation was observed in one of the skin donor sites in CT group. (3) Information as obtained from questionnaire showed no statistical difference between two groups in pinching, itching, and satisfaction degree (with χ(2) value respectively 0.187, 0.019, 2.628, P values all above 0.05). (4) Nerve fibers were seen in hand tissue 2 years after operation. ADM did not induce severe inflammatory responses in the site of grafting. (5) Eleven joints in CT group recovered or improved in function; while the other two joints required secondary surgery. Obvious contracture was observed in the two joints in C group.

CONCLUSIONSAllogeneic ADM combined with STSG transplantation prevents scar contracture and has obvious effect in improving function and appearance. There is no problem in regard to safety for its existence in either adult or children.

Adolescent ; Adult ; Burns ; surgery ; Child ; Child, Preschool ; Dermis ; transplantation ; Female ; Follow-Up Studies ; Humans ; Male ; Skin Transplantation ; methods ; Skin, Artificial ; Time ; Transplantation, Autologous ; Transplantation, Homologous ; Young Adult

OBJECTIVETo discuss the clinical application of Meek skin grafting technique.

METHODSSixteen patients with TBSA>30% were treated by Meek grafting technique, and the results were compared with a control group treated with traditional stamp skin grafting. The skin expanding rate, graft survival, operating time, medical expense, and skin scar formation were evaluated and compared between the two groups.

RESULTSIn the 16 cases managed with Meek grafting technique, the graft survival rate was above 95%, and there were significant differences in all the observed indices between Meek grafting group and the control group (P<0.01).

CONCLUSIONMeek skin grafting technique possesses the advantages of more economic donor skin use, shorter operating time and hospital stay with reduced cost, and provides a good option for management of severely burned patients.

Adolescent ; Adult ; Burns ; physiopathology ; surgery ; Female ; Graft Survival ; Humans ; Male ; Middle Aged ; Skin Transplantation ; instrumentation ; methods ; Surgical Mesh ; Transplantation, Autologous ; Transplantation, Homologous