To observe clinical effects of combination of acellular porcine skin with delayed microskin graft on extensively burned patients.
 Methods: Forty extensively burned patients were assigned into a treatment group and a control group. In the treatment group, 20 patients were covered with acellular porcine skin after escharectomy, and the delayed microskin grafting was performed 5 days later. In the control group, 20 patients were covered with allograft skin combined with microskin graft after escharectomy. The cure rate, the graft survival rate, wound healing time and cost per 1% wound were observed.
 Results: The cure rate for the 2 groups was the same (90%), and wound healing time was similar between the two groups (P>0.05). The graft survival rate in the treatment group was higher than that in the control group (P<0.05), and cost per 1% wound in the treatment group was less than that in the control group (P<0.05).
 Conclusion: The combination of acellular porcine skin with delayed microskin graft is an effective method to treat extensively burned patients, and it provides an ideal substitute for allograft skin combined with microskin graft.
Acellular Dermis ; economics ; statistics & numerical data ; Animals ; Biological Dressings ; economics ; statistics & numerical data ; Burns ; therapy ; Cost-Benefit Analysis ; Graft Survival ; Humans ; Skin Transplantation ; economics ; methods ; Swine ; Transplantation, Homologous ; adverse effects ; economics ; methods ; Wound Healing

PURPOSE: To treat burn and burn scar contracture, many types of skin grafts have been developed. Skin allograft is a recently introduced option for reconstruction of skin defects. The science of skin allotransplanation is rooted in progressive thinking by surgeons, fueled by innovative solutions, and aided by understanding the immunology of tolerance and rejection. METHODS: This study assesses the effect of dendritic cell pretreatment in induction of survival increase in a rat skin allograft model. Recipient derived dendritic cells were harvested from rat whole blood and cultured with GM-CSF and IL-4 for 2 weeks. Then donor-specific alloantigen pulsed dendritic cells were reinjected into subdermal tissue before skin graft. Rat left dorsal skin allografts were transplanted in 3 subgroups. Groups: I) untreated, II) FK-506 (2 mg/kg), III) dendritic cell pretreatment and FK-506. Graft appearance and histologic analysis were assessed postoperatively. RESULTS: The group III showed longest graft survival rate than other groups. CONCLUSION: Donor antigen pulsed host dendritic cell combined with short-term immunosuppression prolong skin allograft survival and has potential therapeutic application for induction of tolerance.
Animals ; Burns ; Cicatrix ; Contracture ; Dendritic Cells ; Graft Survival ; Granulocyte-Macrophage Colony-Stimulating Factor ; Humans ; Immunosuppression ; Interleukin-4 ; Isoantigens ; Rats ; Skin ; Tacrolimus ; Thinking ; Tissue Donors ; Transplantation, Homologous ; Transplants

PURPOSE: CryoDerm (CGbio) is derived donated human skin. After removing epidermis and fibroblast of dermal layer, it preserved with cryo-preservation technique using control rate freezer system. To prevent post burn joint contracture in massive burns, we have used CryoDerm in acute stage. METHODS: From January of 2010 to July of 2012, 50 patients who undergone CryoDerm graft with split thickness skin graft were reviewed. The operative method was as follows: 1) Early wound excision and or cadaveric allograft skin coverage was performed within 5 days after burn injury 2) 2~3 weeks after wound excision, split thickness skin graft was performed with CryoDerm graft. Then graft take rate was investigated by inspection. Follow up duration was 3~32 months. RESULTS: Mean age of patients was 42.2 (2~70) years. Mean percentage of total body surface area burned was 27.22% (1~61%). Among 50 patients, 98 joints was operated including 14 hands, 4 wrists, 10 shoulders, 23 elbows, 4 necks, 3 hip joints, 31 knee joints and 9 ankles and feet. Total used graft size of Cryoderm was 10,945 cm2. Average take rate was near 100%. CONCLUSION: Cryoderm graft with split thickness skin graft can be used as a safe and effective operative method for one stage operation in acutely burned patients.
Animals ; Ankle ; Body Surface Area ; Burns ; Cadaver ; Contracture ; Elbow ; Epidermis ; Fibroblasts ; Follow-Up Studies ; Foot ; Hand ; Hip Joint ; Humans ; Joints ; Knee Joint ; Neck ; Shoulder ; Skin ; Transplantation, Homologous ; Transplants ; Wrist

PURPOSE: To treat burn and burn scar contracture, many types of dermal substitutes have been manufactured and used recently. Allogenic dermis is known to have best cellular affinity to the host, but it is the thinnest product among artificial dermis. Processed thick allogenic dermis (Allocover(R)) has been developed and applied to overcome the problems of preexisting materials as a permanent dermal substitute. METHODS: From June 2007 to May 2009, we have grafted thick acellular human dermal allograft with thin split-thickness skin graft on burn wound and burn scar contracture of feet and legs in 14 patients who had hypertrophic scar, joint contracture and various skin defect areas. Intraoperatively, we fixed spilt thickness skin graft to artificial dermis with suture fixation for avoiding the mobilization between them. RESULTS: Thirteen patients out of 14 patients had no problem. One patient underwent partial skin loss and secondary healing process. During the 18 months of follow up period, no contracture recurrence or skin loss was observed. CONCLUSION: The thick acellular human dermal allograft (Allocover(R)) could be very useful in the management of skin loss and burn scar contractures. Its vascularization has occurred fast enough that wounds can be covered in an adequate layer of dermal augmentation with minimal contracture and good cosmetic results.
Acellular Dermis ; Burns ; Cicatrix ; Cicatrix, Hypertrophic ; Contracture ; Cosmetics ; Dermis ; Follow-Up Studies ; Foot ; Humans ; Joints ; Leg ; Recurrence ; Skin ; Sutures ; Transplantation, Homologous ; Transplants

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 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

Delayed hemolytic transfusion reaction (DHTR) due to multiple red blood cell (RBC) alloantibodies has rarely been reported in Korea. We report a case of DHTR in a patient with anti-c, anti-E, and anti-Jk(b). A 45-year-old man visited the emergency room with flame burn injury over 61% of his entire body. He received six units of packed RBCs and three units of fresh frozen plasma during the operation for excision and glycerol-preserved allografting. His hemoglobin (Hb) level gradually decreased from 13.5 g/dL on the operation day to 7.8 g/dL on the 11th postoperative day in spite of receiving three and two additional units of packed RBCs on the 8th and 9th postoperative days, respectively. His laboratory data was total bilirubin/direct bilirubin 15.9/11.4 mg/dL, lactate dehydrogenase 983 IU/L, haptoglobin 5.93 mg/dL and plasma hemoglobin 8.0 mg/dL. The urinalysis revealed hemoglobinuria, and the peripheral blood film showed moderate spherocytosis. Both the direct and indirect antiglobulin tests were positive, and the follow-up antibody identification test showed anti-c, anti-E, and Jk(b). His Hb levels increased after he was transfused with two units of packed RBCs without c, E, and Jk(b) antigens. This is a case of DHTR due to alloimmunization, which developed within a short interval after the patient had received multiple transfusions.
Bilirubin ; Blood Group Incompatibility ; Burns ; Coombs Test ; Emergencies ; Erythrocytes ; Follow-Up Studies ; Haptoglobins ; Hemoglobins ; Hemoglobinuria ; Humans ; Isoantibodies ; Korea ; L-Lactate Dehydrogenase ; Middle Aged ; Plasma ; Transplantation, Homologous ; Urinalysis

The treatment application of cultured epithelial autograft (CEA) is the only selected treatment method when performing skin graft for treating massive burns over 70 to 80%. Clinically 2 types of CEA, sheet type and suspension type, are currently available in Korea. The sheet type of CEA, Holoderm(R), was commonly used since no other CEA were available. Since the recent introduction of the suspension type, Keraheal(R), the suspension type is also clinically used. Although 2 types are different in type of forms provided but both types are clinically effective for increasing survival rate of massive burn patients. The early treatment method of massive burn is selected based on the rage of burns using Warden or Parkland Formula. The escharectomy is performed within 3 to 7 days of burn then cadaver skin allograft is applied immediately. At this time, the full thickness skin biopsy in the size of 2x3 cm is obtained from non burned area such as axilla, inguinal or abdomen. Then the skin biopsy is sent to the labs. The length of culturing time is less than 3 weeks for Holoderm(R) and around 2 weeks for Keraheal(R). Holoderm(R) is provided as a sheet type. It is simply applied over 1:3~1:6 meshed skin autograft and fixed with staplers together with skin autograft. In the other hand, the suspension type of CEA, Keraheal(R), is provided in a glass vial and sprayed over 1:3~1:6 meshed skin autograft using Tissomat(R). The fibrin sealant is sprayed after application of Keraheal(R) as a fixation of suspension CEA sprayed. Extra wound care is necessary even after both types of CEA are successfully taken since CEA applied regions are much more fragile than those regions applied skin autograft only. The treatment methods of applying cadaver skin allograft and culture epithelial autograft (CEA) are the most advanced treatments available for increasing survival rate of massive burn patients. The sheet type and suspension type of CEA show difference in type of forms provided but they both show successful take rate that enhance the burn treatment. We suspect that both types of CEA still need ongoing efforts and researches to enhance their advantages and eliminate disadvantages to increase the efficacy that can promote wound healing process of massive burn patients.
Abdomen ; Axilla ; Biopsy ; Burns ; Cadaver ; Fibrin Tissue Adhesive ; Glass ; Hand ; Humans ; Korea ; Rage ; Skin ; Survival Rate ; Transplantation, Homologous ; Transplants ; Wound Healing

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 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