A Study on the Correlation between Pain and Pain Anxiety during Wound Care in Burn Patients

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Seyed Reza Mazlom

2017-05-01

Full Text Available Background and Objectives: Wound care in burn patients is associated with severe anxiety that is characterized by feeling of fear and prediction of burn dressing pain. The purpose of this study was to determine the correlation between pain and pain anxiety in burn patients. Methods: In this descriptive-analytical study, 60 eligible patients hospitalized in men’s and women’s burn wards of Mashhad Imam Reza Hospital, were selected using available sampling. Pain anxiety and pain severity were measured using self-report pain anxiety questionnaire and visual analog scale, respectively, before and after burn dressing during three weeks (once a week. Data were analyzed by descriptive statistics and Pearson correlation test. Results: In this study, there was a significant linear correlation between pain and pain anxiety in the first week (r=0.512, p<0.001, but there was no significant linear correlation between these variables in the second (r=0.079, p=0.547 and third (r=0.167, p=0.203 weeks. Conclusion: According to the results of this study, assessment and treatment of pain anxiety are essential elements of pain care and management in burn patients.            

Recombinant human erythropoietin improves angiogenesis and wound healing in experimental burn wounds.

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Galeano, Mariarosaria; Altavilla, Domenica; Bitto, Alessandra; Minutoli, Letteria; Calò, Margherita; Lo Cascio, Patrizia; Polito, Francesca; Giugliano, Giovanni; Squadrito, Giovanni; Mioni, Chiara; Giuliani, Daniela; Venuti, Francesco S; Squadrito, Francesco

2006-04-01

Erythropoietin interacts with vascular endothelial growth factor (VEGF) and stimulates endothelial cell mitosis and motility; thus it may be of importance in the complex phenomenon of wound healing. The purpose of this study was to investigate the effect of recombinant human erythropoietin (rHuEPO) on experimental burn wounds. Randomized experiment. Research laboratory. C57BL/6 male mice weighing 25-30 g. Mice were immersed in 80 degrees C water for 10 secs to achieve a deep-dermal second degree burn. Animals were randomized to receive either rHuEPO (400 units/kg/day for 14 days in 100 microL subcutaneously) or its vehicle alone (100 microl/day distilled water for 14 days subcutaneously). On day 14 the animals were killed. Burn areas were used for histologic examination, evaluation of neoangiogenesis by immunohistochemistry, and expression (Western blot) of the specific endothelial marker CD31 as well as quantification of microvessel density, measurement of VEGF wound content (enzyme-linked immunosorbent assay), expression (Western blot) of endothelial and inducible nitric oxide synthases, and determination of wound nitric oxide (NO) products. rHuEPO increased burn wound reepithelialization and reduced the time to final wound closure. These effects were completely abated by a passive immunization with specific antibodies against erythropoietin. rHuEPO improved healing of burn wound through increased epithelial proliferation, maturation of the extracellular matrix, and angiogenesis. The hematopoietic factor augmented neoangiogenesis as suggested by the marked increase in microvessel density and by the robust expression of the specific endothelial marker CD31. Furthermore, rHuEPO enhanced the wound content of VEGF caused a marked expression of endothelial and inducible nitric oxide synthases and increased wound content of nitric oxide products. Our study suggests that rHuEPO may be an effective therapeutic approach to improve clinical outcomes after thermal injury.

Creation of Consistent Burn Wounds: A Rat Model

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Elijah Zhengyang Cai

2014-07-01

Full Text Available Background Burn infliction techniques are poorly described in rat models. An accurate study can only be achieved with wounds that are uniform in size and depth. We describe a simple reproducible method for creating consistent burn wounds in rats. Methods Ten male Sprague-Dawley rats were anesthetized and dorsum shaved. A 100 g cylindrical stainless-steel rod (1 cm diameter was heated to 100℃ in boiling water. Temperature was monitored using a thermocouple. We performed two consecutive toe-pinch tests on different limbs to assess the depth of sedation. Burn infliction was limited to the loin. The skin was pulled upwards, away from the underlying viscera, creating a flat surface. The rod rested on its own weight for 5, 10, and 20 seconds at three different sites on each rat. Wounds were evaluated for size, morphology and depth. Results Average wound size was 0.9957 cm2 (standard deviation [SD] 0.1845 (n=30. Wounds created with duration of 5 seconds were pale, with an indistinct margin of erythema. Wounds of 10 and 20 seconds were well-defined, uniformly brown with a rim of erythema. Average depths of tissue damage were 1.30 mm (SD 0.424, 2.35 mm (SD 0.071, and 2.60 mm (SD 0.283 for duration of 5, 10, 20 seconds respectively. Burn duration of 5 seconds resulted in full-thickness damage. Burn duration of 10 seconds and 20 seconds resulted in full-thickness damage, involving subjacent skeletal muscle. Conclusions This is a simple reproducible method for creating burn wounds consistent in size and depth in a rat burn model.

Dendritic cells modulate burn wound healing by enhancing early proliferation.

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Vinish, Monika; Cui, Weihua; Stafford, Eboni; Bae, Leon; Hawkins, Hal; Cox, Robert; Toliver-Kinsky, Tracy

2016-01-01

Adequate wound healing is vital for burn patients to reduce the risk of infections and prolonged hospitalization. Dendritic cells (DCs) are antigen presenting cells that release cytokines and are central for the activation of innate and acquired immune responses. Studies have showed their presence in human burn wounds; however, their role in burn wound healing remains to be determined. This study investigated the role of DCs in modulating healing responses within the burn wound. A murine model of full-thickness contact burns was used to study wound healing in the absence of DCs (CD11c promoter-driven diphtheria toxin receptor transgenic mice) and in a DC-rich environment (using fms-like tyrosine kinase-3 ligand, FL- a DC growth factor). Wound closure was significantly delayed in DC-deficient mice and was associated with significant suppression of early cellular proliferation, granulation tissue formation, wound levels of TGFβ1 and formation of CD31+ vessels in healing wounds. In contrast, DC enhancement significantly accelerated early wound closure, associated with increased and accelerated cellular proliferation, granulation tissue formation, and increased TGFβ1 levels and CD31+ vessels in healing wounds. We conclude that DCs play an important role in the acceleration of early wound healing events, likely by secreting factors that trigger the proliferation of cells that mediate wound healing. Therefore, pharmacological enhancement of DCs may provide a therapeutic intervention to facilitate healing of burn wounds. © 2016 by the Wound Healing Society.

Efficacy of a children’s procedural preparation and distraction device on healing in acute burn wound care procedures: study protocol for a randomized controlled trial

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Brown Nadia J

2012-12-01

Full Text Available Abstract Background The intense pain and anxiety triggered by burns and their associated wound care procedures are well established in the literature. Non-pharmacological intervention is a critical component of total pain management protocols and is used as an adjunct to pharmacological analgesia. An example is virtual reality, which has been used effectively to dampen pain intensity and unpleasantness. Possible links or causal relationships between pain/anxiety/stress and burn wound healing have previously not been investigated. The purpose of this study is to investigate these relationships, specifically by determining if a newly developed multi-modal procedural preparation and distraction device (Ditto™ used during acute burn wound care procedures will reduce the pain and anxiety of a child and increase the rate of re-epithelialization. Methods/design Children (4 to 12 years with acute burn injuries presenting for their first dressing change will be randomly assigned to either the (1 Control group (standard distraction or (2 Ditto™ intervention group (receiving Ditto™, procedural preparation and Ditto™ distraction. It is intended that a minimum of 29 participants will be recruited for each treatment group. Repeated measures of pain intensity, anxiety, stress and healing will be taken at every dressing change until complete wound re-epithelialization. Further data collection will aid in determining patient satisfaction and cost effectiveness of the Ditto™ intervention, as well as its effect on speed of wound re-epithelialization. Discussion Results of this study will provide data on whether the disease process can be altered by reducing stress, pain and anxiety in the context of acute burn wounds. Trial registration ACTRN12611000913976

Effectiveness of medical hypnosis for pain reduction and faster wound healing in pediatric acute burn injury: study protocol for a randomized controlled trial.

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Chester, Stephen J; Stockton, Kellie; De Young, Alexandra; Kipping, Belinda; Tyack, Zephanie; Griffin, Bronwyn; Chester, Ralph L; Kimble, Roy M

2016-04-29

Burns and the associated wound care procedures can be extremely painful and anxiety-provoking for children. Burn injured children and adolescents are therefore at greater risk of experiencing a range of psychological reactions, in particular posttraumatic stress disorder, which can persist for months to years after the injury. Non-pharmacological intervention is critical for comprehensive pain and anxiety management and is used alongside pharmacological analgesia and anxiolysis. However, effective non-pharmacological pain and anxiety management during pediatric burn procedures is an area still needing improvement. Medical hypnosis has received support as a technique for effectively decreasing pain and anxiety levels in adults undergoing burn wound care and in children during a variety of painful medical procedures (e.g., bone marrow aspirations, lumbar punctures, voiding cystourethrograms, and post-surgical pain). Pain reduction during burn wound care procedures is linked with improved wound healing rates. To date, no randomized controlled trials have investigated the use of medical hypnosis in pediatric burn populations. Therefore this study aims to determine if medical hypnosis decreases pain, anxiety, and biological stress markers during wound care procedures; improves wound healing times; and decreases rates of traumatic stress reactions in pediatric burn patients. This is a single-center, superiority, parallel-group, prospective randomized controlled trial. Children (4 to 16 years, inclusive) with acute burn injuries presenting for their first dressing application or change are randomly assigned to either the (1) intervention group (medical hypnosis) or (2) control group (standard care). A minimum of 33 participants are recruited for each treatment group. Repeated measures of pain, anxiety, stress, and wound healing are taken at every dressing change until ≥95 % wound re-epithelialization. Further data collection assesses impact on posttraumatic stress

Aloe vera and Vitis vinifera improve wound healing in an in vivo rat burn wound model.

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Lin, Li-Xin; Wang, Peng; Wang, Yu-Ting; Huang, Yong; Jiang, Lei; Wang, Xue-Ming

2016-02-01

Aloe vera and Vitis vinifera have been traditionally used as wound healing agents. The present study aimed to investigate the effects of aloe emodin and resveratrol in the burn wound healing procedure. Burn wounds are common in developed and developing countries, however, in developing countries, the incidence of severe complications is higher and financial resources are limited. The results of the present study demonstrated that neither aloe emodin or resveratrol were cytotoxic to THP-1 macrophages at concentrations of 1, 100 and 500 ng/ml. A significant increase in wound-healing activity was observed in mice treated with the aloe emodin and resveratrol, compared with those which received control treatments. The levels of IL-1β in the exudates of the burn wound area of the treated mice increased in a time-dependent manner over 7 days following burn wound injury. At 10 days post-injury, steady and progressive wound healing was observed in the control animals. The present study confirmed that increased wound healing occurs following treatment with aloe emodin,, compared with resveratrol, providing support for the use of Aloe vera plants to improve burn wound healing.

Dual therapeutic functions of F-5 fragment in burn wounds: preventing wound progression and promoting wound healing in pigs

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Bhatia, Ayesha; O'Brien, Kathryn; Chen, Mei; Wong, Alex; Garner, Warren; Woodley, David T.; Li, Wei

2016-01-01

Burn injuries are a leading cause of morbidity including prolonged hospitalization, disfigurement, and disability. Currently there is no Food and Drug Administration-approved burn therapeutics. A clinical distinction of burn injuries from other acute wounds is the event of the so-called secondary burn wound progression within the first week of the injury, in which a burn expands horizontally and vertically from its initial boundary to a larger area. Therefore, an effective therapeutics for bu...

Microbiological Monitoring and Proteolytic Study of Clinical Samples From Burned and Burned Wounded Patients

International Nuclear Information System (INIS)

Toema, M.A.; El-Bazza, Z.E.; El-Hifnawi, H.N.; Abd-El-Hakim, E.E.

2013-01-01

In this study, clinical samples were collected from 100 patients admitted to Burn and Plastic Surgery Department, Faculty of Medicine, Ain Shams University, Egypt, over a period of 12 months. The proteolytic activity of 110 clinical samples taken from surfaces swabs which taken from burned and burned wounded patients with different ages and gender was examined. Screening for the proteolytic activity produced by pathogenic bacteria isolated from burned and burned wounded patients was evaluated as gram positive Bacilli and gram negative bacilli showed high proteolytic activity (46.4%) while 17.9% showed no activity. The isolated bacteria proved to have proteolytic activity were classified into high, moderate and weak. The pathogenic bacteria isolated from burned and burned wounded patients and showing proteolytic activity were identified as Pseudomonas aeruginosa, Proteus mirabilis, Proteus vulgaris, Bacillus megaterium, Bacillus cereus, Staphylococcus aureus, Escherichia coli, Klebsiella ozaeanae, Klebsiella oxytoca, Klebsiella pneumoniae and Pseudomonas fluoresces.

Wound management and outcome of 595 electrical burns in a major burn center.

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Li, Haisheng; Tan, Jianglin; Zhou, Junyi; Yuan, Zhiqiang; Zhang, Jiaping; Peng, Yizhi; Wu, Jun; Luo, Gaoxing

2017-06-15

Electrical burns are important causes of trauma worldwide. This study aims to analyze the clinical characteristics, wound management, and outcome of electric burns. This retrospective study was performed at the Institute of Burn Research of the Third Military Medical University during 2013-2015. Data including the demographics, injury patterns, wound treatment, and outcomes were collected and analyzed. A total of 595 electrical burn patients (93.8% males) were included. The average age was 37.3 ± 14.6 y, and most patients (73.5%) were aged 19∼50 years. Most patients (67.2%) were injured in work-related circumstances. The mean total body surface area was 8.8 ± 11.8% and most wounds (63.5%) were full-thickness burns. Operation times of high-voltage burns and current burns were higher than those of low-voltage burns and arc burns, respectively. Of the 375 operated patients, 83.2% (n = 312) underwent skin autografting and 49.3% (n = 185) required skin flap coverage. Common types of skin flaps were adjacent (50.3%), random (42.2%), and pedicle (35.7%). Amputation was performed in 107 cases (18.0%) and concentrated on the hands (43.9%) and upper limbs (39.3%). The mean length of stay was 42.9 ± 46.3 d and only one death occurred (0.2%). Current burns and higher numbers of operations were major risk factors for amputation and length of stay, respectively. Electrical burns mainly affected adult males with occupational exposures in China. Skin autografts and various skin flaps were commonly used for electric burn wound management. More standardized and effective strategies of treatment and prevention are still needed to decrease amputation rates. Copyright © 2017 Elsevier Inc. All rights reserved.

Prolonged C1 Inhibitor Administration Improves Local Healing of Burn Wounds and Reduces Myocardial Inflammation in a Rat Burn Wound Model

NARCIS (Netherlands)

Begieneman, Mark P. V.; Kubat, Bela; Ulrich, Magda M. W.; Hahn, Nynke E.; Stumpf-Stolker, Yvette; Tempelaars, Miranda; Middelkoop, Esther; Zeerleder, Sacha; Wouters, Diana; van Ham, Marieke S.; Niessen, Hans W. M.; Krijnen, Paul A. J.

2012-01-01

In a previous study, the authors found persistent presence of acute inflammation markers such as C-reactive protein and complement factors locally in burn wounds. This persistence of acute inflammation may not only delay local burn wound healing but also have a systemic effect, for instance on the

Wound healing trajectories in burn patients and their impact on mortality.

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Nitzschke, Stephanie L; Aden, James K; Serio-Melvin, Maria L; Shingleton, Sarah K; Chung, Kevin K; Waters, J A; King, Booker T; Burns, Christopher J; Lundy, Jonathan B; Salinas, José; Wolf, Steven E; Cancio, Leopoldo C

2014-01-01

The rate of wound healing and its effect on mortality has not been well described. The objective of this article is to report wound healing trajectories in burn patients and analyze their effects on in-hospital mortality. The authors used software (WoundFlow) to depict burn wounds, surgical results, and healing progression at multiple time points throughout admission. Data for all patients admitted to the intensive care unit with ≥ 20% TBSA burned were collected retrospectively. The open wound size (OWS), which includes both unhealed burns and unhealed donor sites, was measured. We calculated the rate of wound closure (healing rate), which we defined as the change in OWS/time. We also determined the time delay (DAYS) from day of burn until day on which there was a reduction in OWS healing (H), and 13 did not (NH). H differed from NH on age (38 years [32-57] vs 63 [51-74]), body mass index (27 [21-28] vs 32 [19-52]), 24-hour fluid resuscitation (12 L [10-16] vs 18 [15-20]), pressors during first 48 hours (72% vs 100%), use of renal replacement therapy (32% vs 92%), and mortality (4% vs 100%). Repeated measures analysis of covariance showed a significant difference between survivors and nonsurvivors on OWS as a function of time (Phealing rate (+2%/day) after postburn day 20 had 100% survival whereas those with a negative healing rate (-2%/day) had 100% mortality. For H patients, median DAYS was 41 (28-54); median DAYS/TBSA was 1.3 (1.0-1.9). Survivors had a 0.62% drop in OWS/day, or 4.3%/week. In this cohort of patients with ≥ 20% TBSA, there was a difference in mortality after postburn day 20, between patients with a positive healing rate (+2%/day, 100% survival) and those with a negative healing rate (-2%/day, 100% mortality, P < .05).

Bee Pollen as a Promising Agent in the Burn Wounds Treatment

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Paweł Olczyk

2016-01-01

Full Text Available The aim of the present study was to visualize the benefits and advantages derived from preparations based on extracts of bee pollen as compared to pharmaceuticals commonly used in the treatment of burns. The bee pollen ointment was applied for the first time in topical burn treatment. Experimental burn wounds were inflicted on two white, domestic pigs. Clinical, histopathological, and microbiological assessment of specimens from burn wounds, inflicted on polish domestic pigs, treated with silver sulfadiazine or bee pollen ointment, was done. The comparative material was constituted by either tissues obtained from wounds treated with physiological saline or tissues obtained from wounds which were untreated. Clinical and histopathological evaluation showed that applied apitherapeutic agent reduces the healing time of burn wounds and positively affects the general condition of the animals. Moreover the used natural preparation proved to be highly effective antimicrobial agent, which was reflected in a reduction of the number of microorganisms in quantitative research and bactericidal activity of isolated strains. On the basis of the obtained bacteriological analysis, it may be concluded that the applied bee pollen ointment may affect the wound healing process of burn wounds, preventing infection of the newly formed tissue.

[Clinical effect of three dimensional human body scanning system BurnCalc in the evaluation of burn wound area].

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Lu, J; Wang, L; Zhang, Y C; Tang, H T; Xia, Z F

2017-10-20

Objective: To validate the clinical effect of three dimensional human body scanning system BurnCalc developed by our research team in the evaluation of burn wound area. Methods: A total of 48 burn patients treated in the outpatient department of our unit from January to June 2015, conforming to the study criteria, were enrolled in. For the first 12 patients, one wound on the limbs or torso was selected from each patient. The stability of the system was tested by 3 attending physicians using three dimensional human body scanning system BurnCalc to measure the area of wounds individually. For the following 36 patients, one wound was selected from each patient, including 12 wounds on limbs, front torso, and side torso, respectively. The area of wounds was measured by the same attending physician using transparency tracing method, National Institutes of Health (NIH) Image J method, and three dimensional human body scanning system BurnCalc, respectively. The time for getting information of 36 wounds by three methods was recorded by stopwatch. The stability among the testers was evaluated by the intra-class correlation coefficient (ICC). Data were processed with randomized blocks analysis of variance and Bonferroni test. Results: (1) Wound area of patients measured by three physicians using three dimensional human body scanning system BurnCalc was (122±95), (121±95), and (123±96) cm(2,) respectively, and there was no statistically significant difference among them ( F =1.55, P >0.05). The ICC among 3 physicians was 0.999. (2) The wound area of limbs of patients measured by transparency tracing method, NIH Image J method, and three dimensional human body scanning system BurnCalc was (84±50), (76±46), and (84±49) cm(2,) respectively. There was no statistically significant difference in the wound area of limbs of patients measured by transparency tracing method and three dimensional human body scanning system BurnCalc ( P >0.05). The wound area of limbs of patients

21 CFR 878.4022 - Hydrogel wound dressing and burn dressing.

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2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hydrogel wound dressing and burn dressing. 878.4022 Section 878.4022 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... Hydrogel wound dressing and burn dressing. (a) Identification. A hydrogel wound dressing is a sterile or...

Managing burn wounds with SMARTPORE Technology polyurethane foam: two case reports.

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Imran, Farrah-Hani; Karim, Rahamah; Maat, Noor Hidayah

2016-05-12

Successful wound healing depends on various factors, including exudate control, prevention of microbial contaminants, and moisture balance. We report two cases of managing burn wounds with SMARTPORE Technology polyurethane foam dressing. In Case 1, a 2-year-old Asian girl presented with a delayed (11 days) wound on her right leg. She sustained a thermal injury from a hot iron that was left idle on the floor. Clinical inspection revealed an infected wound with overlying eschar that traversed her knee joint. As her parents refused surgical debridement under general anesthesia, hydrotherapy and wound dressing using SMARTPORE Technology Polyurethane foam were used. Despite the delay in presentation of this linear thermal pediatric burn injury that crossed the knee joint, the patient's response to treatment and its outcome were highly encouraging. She was cooperative and tolerated each dressing change without the need of supplemental analgesia. Her wound was healed by 24 days post-admission. In Case 2, a 25-year-old Asian man presented with a mixed thickness thermal flame burn on his left leg. On examination, the injury was a mix of deep and superficial partial thickness burn, comprising approximately 3% of his total body surface area. SMARTPORE Technology polyurethane foam was used on his wound; his response to the treatment was very encouraging as the dressing facilitated physiotherapy and mobility. The patient rated the pain during dressing change as 2 on a scale of 10 and his pain score remained the same in every subsequent change. His wound showed evidence of epithelialization by day 7 post-burn. There were no adverse events reported. Managing burn wounds with SMARTPORE Technology polyurethane foam resulted in reduced pain during dressing changes and the successful healing of partial and mixed thickness wounds. The use of SMARTPORE Technology polyurethane foam dressings showed encouraging results and requires further research as a desirable management option in

Two stage study of wound microorganisms affecting burns and plastic surgery inpatients.

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Miranda, Benjamin H; Ali, Syed N; Jeffery, Steven L A; Thomas, Sunil S

2008-01-01

This study was designed to identify wound microorganisms and the reasons for differing prevalence between the wards, burns unit and intensive care unit (ICU) in a regional centre for burns and plastic surgery. Antibiotic sensitivities of the 10 most prevalent microorganisms cultured from inpatient wound swabs were also investigated. Inpatient wound swab data were collected retrospectively using notes and departmental database information between January and June 2007. Data were analyzed using chi-squared tests and P-values. Eight hundred five positive wound swabs from 204 swab positive inpatients were analyzed. Stage 1 of this study demonstrated 917 positive swab episodes and 30 varieties of organism. The five most prevalent organisms cultured were Staphylococcus (23.9%), Acinetobacter (21.2%), Methicillin Resistant Staphylococcus aureus (MRSA) (20.8%), Pseudomonas (9.7%) and Enterococcus (5.2%). Stage 2 revealed that Acinetobacter baumanni (ABAU) was significantly more prevalent in military over civilian inpatients (P < .001) and that military inpatients had a significantly greater proportion of ABAU over civilian inpatients within the first 24 hours after admission (P < .001). ABAU episodes were significantly higher on the ICU over the burns unit and on the wards (P < .001). MRSA was significantly more prevalent in military inpatients (P < .001); however, no significant difference was observed within the first 24 hours after admission (P = .440). MRSA was more prevalent on the ICU over the burns unit (P = .023). Pseudomonas aeruginosa (PAER) was significantly more prevalent in military inpatients over civilian inpatients (P < .001), and on the ICU over the burns unit and wards (P = .018). Stage 1 generated a comprehensive, up to date cross section of bacterial flora, with corresponding percentage antibiotic sensitivities, in a regional burns and plastic surgery centre. This will give clinicians a snapshot of organisms affecting inpatient wounds in advance of

Propranolol attenuates hemorrhage and accelerates wound healing in severely burned adults.

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Ali, Arham; Herndon, David N; Mamachen, Ashish; Hasan, Samir; Andersen, Clark R; Grogans, Ro-Jon; Brewer, Jordan L; Lee, Jong O; Heffernan, Jamie; Suman, Oscar E; Finnerty, Celeste C

2015-05-04

Propranolol, a nonselective β-blocker, exerts an indirect effect on the vasculature by leaving α-adrenergic receptors unopposed, resulting in peripheral vasoconstriction. We have previously shown that propranolol diminishes peripheral blood following burn injury by increasing vascular resistance. The purpose of this study was to investigate whether wound healing and perioperative hemodynamics are affected by propranolol administration in severely burned adults. Sixty-nine adult patients with burns covering ≥ 30% of the total body surface area (TBSA) were enrolled in this IRB-approved study. Patients received standard burn care with (n = 35) or without (control, n = 34) propranolol. Propranolol was administered within 48 hours of burns and given throughout hospital discharge to decrease heart rate by approximately 20% from admission levels. Wound healing was determined by comparing the time between grafting procedures. Blood loss was determined by comparing pre- and postoperative hematocrit while factoring in operative graft area. Data were collected between first admission and first discharge. Demographics, burn size, and mortality were comparable in the control and propranolol groups. Patients in the propranolol group received an average propranolol dose of 3.3 ± 3.0 mg/kg/day. Daily average heart rate over the first 30 days was significantly lower in the propranolol group (P operative intervention is optimal.

Noninvasive measurement of burn wound depth applying infrared thermal imaging (Conference Presentation)

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Jaspers, Mariëlle E.; Maltha, Ilse M.; Klaessens, John H.; Vet, Henrica C.; Verdaasdonk, Rudolf M.; Zuijlen, Paul P.

2016-02-01

In burn wounds early discrimination between the different depths plays an important role in the treatment strategy. The remaining vasculature in the wound determines its healing potential. Non-invasive measurement tools that can identify the vascularization are therefore considered to be of high diagnostic importance. Thermography is a non-invasive technique that can accurately measure the temperature distribution over a large skin or tissue area, the temperature is a measure of the perfusion of that area. The aim of this study was to investigate the clinimetric properties (i.e. reliability and validity) of thermography for measuring burn wound depth. In a cross-sectional study with 50 burn wounds of 35 patients, the inter-observer reliability and the validity between thermography and Laser Doppler Imaging were studied. With ROC curve analyses the ΔT cut-off point for different burn wound depths were determined. The inter-observer reliability, expressed by an intra-class correlation coefficient of 0.99, was found to be excellent. In terms of validity, a ΔT cut-off point of 0.96°C (sensitivity 71%; specificity 79%) differentiates between a superficial partial-thickness and deep partial-thickness burn. A ΔT cut-off point of -0.80°C (sensitivity 70%; specificity 74%) could differentiate between a deep partial-thickness and a full-thickness burn wound. This study demonstrates that thermography is a reliable method in the assessment of burn wound depths. In addition, thermography was reasonably able to discriminate among different burn wound depths, indicating its potential use as a diagnostic tool in clinical burn practice.

β-lapachone accelerates the recovery of burn-wound skin.

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Fu, Shih-Chen; Chau, Yat-Pang; Lu, Kuo-Shyan; Kung, Hsiu-Ni

2011-07-01

β-lapachone is a quinone of lapachol extracted from the bark of lapacho tree. Recent findings demonstrated that punched skin wounds of mice healed faster with β-lapachone treatment. The present study investigates the effects of β-lapachone on burn-wound skin of C57BL/6 mice injured by a 100 °C iron stick. Our results indicated that wounds treated with β-lapachone recovered faster than those treated with control ointment containing no β-lapachone. On the third day after burning, the area of β-lapachone treated-wound was 30% smaller than wound treated with control ointment. H&E and immunohistochemistry staining showed that burn-wound skin treated with ointment containing β-lapachone healed faster in its epidermis, dermis, and underlying connective tissues with more macrophages appeared than those treated with control ointment alone. RAW264.7 cell, a macrophage-like cell line derived from BALB/C mice, was used as a model for scrutinizing the effect of β-lapachone on macrophages. We found that the proliferation and the secretion of EGF and VEGF by macrophages were higher in cultures treated with β-lapachone and that ß-lapachone can also increase the release of EGF with TNF-α pretreatment. We conclude that β-lapachone plays an important role in accelerating burn wound healing, and that β-lapachone not only can raise the proliferation of macrophages but also increase the release of VEGF from macrophages.

Gram negative wound infection in hospitalised adult burn patients--systematic review and metanalysis-.

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Azzopardi, Ernest A; Azzopardi, Elayne; Camilleri, Liberato; Villapalos, Jorge; Boyce, Dean E; Dziewulski, Peter; Dickson, William A; Whitaker, Iain S

2014-01-01

Gram negative infection is a major determinant of morbidity and survival. Traditional teaching suggests that burn wound infections in different centres are caused by differing sets of causative organisms. This study established whether Gram-negative burn wound isolates associated to clinical wound infection differ between burn centres. Studies investigating adult hospitalised patients (2000-2010) were critically appraised and qualified to a levels of evidence hierarchy. The contribution of bacterial pathogen type, and burn centre to the variance in standardised incidence of Gram-negative burn wound infection was analysed using two-way analysis of variance. Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumanni, Enterobacter spp., Proteus spp. and Escherichia coli emerged as the commonest Gram-negative burn wound pathogens. Individual pathogens' incidence did not differ significantly between burn centres (F (4, 20) = 1.1, p = 0.3797; r2 = 9.84). Gram-negative infections predominate in burn surgery. This study is the first to establish that burn wound infections do not differ significantly between burn centres. It is the first study to report the pathogens responsible for the majority of Gram-negative infections in these patients. Whilst burn wound infection is not exclusive to these bacteria, it is hoped that reporting the presence of this group of common Gram-negative "target organisms" facilitate clinical practice and target research towards a defined clinical demand.

Stem Cell Therapy to Improve Burn Wound Healing

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2017-03-01

Award Number: W81XWH-13-2-0024 TITLE: Stem Cell Therapy to Improve Burn Wound Healing PRINCIPAL INVESTIGATOR: Carl Schulman, MD, PhD, MSPH...NUMBER Stem Cell Therapy to Improve Burn Wound Healing 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Carl Schulman, MD, PhD, MSPH...treatments, steroid injections, and compression garments. Mesenchymal stem cells (MSC’s) have been used in a variety of clinical applications to repair

Gelam (Melaleuca spp.) Honey-Based Hydrogel as Burn Wound Dressing

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Mohd Zohdi, Rozaini; Abu Bakar Zakaria, Zuki; Yusof, Norimah; Mohamed Mustapha, Noordin; Abdullah, Muhammad Nazrul Hakim

2012-01-01

A novel cross-linked honey hydrogel dressing was developed by incorporating Malaysian honey into hydrogel dressing formulation, cross-linked and sterilized using electron beam irradiation (25 kGy). In this study, the physical properties of the prepared honey hydrogel and its wound healing efficacy on deep partial thickness burn wounds in rats were assessed. Skin samples were taken at 7, 14, 21, and 28 days after burn for histopathological and molecular evaluations. Application of honey hydrogel dressings significantly enhanced (P < 0.05) wound closure and accelerated the rate of re-epithelialization as compared to control hydrogel and OpSite film dressing. A significant decrease in inflammatory response was observed in honey hydrogel treated wounds as early as 7 days after burn (P < 0.05). Semiquantitative analysis using RT-PCR revealed that treatment with honey hydrogel significantly (P < 0.05) suppressed the expression of proinflammatory cytokines (IL-1α, IL-1β, and IL-6). The present study substantiates the potential efficacy of honey hydrogel dressings in accelerating burn wound healing. PMID:21941590

A systematic review of quantitative burn wound microbiology in the management of burns patients.

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Halstead, Fenella D; Lee, Kwang Chear; Kwei, Johnny; Dretzke, Janine; Oppenheim, Beryl A; Moiemen, Naiem S

2018-02-01

The early diagnosis of infection or sepsis in burns are important for patient care. Globally, a large number of burn centres advocate quantitative cultures of wound biopsies for patient management, since there is assumed to be a direct link between the bioburden of a burn wound and the risk of microbial invasion. Given the conflicting study findings in this area, a systematic review was warranted. Bibliographic databases were searched with no language restrictions to August 2015. Study selection, data extraction and risk of bias assessment were performed in duplicate using pre-defined criteria. Substantial heterogeneity precluded quantitative synthesis, and findings were described narratively, sub-grouped by clinical question. Twenty six laboratory and/or clinical studies were included. Substantial heterogeneity hampered comparisons across studies and interpretation of findings. Limited evidence suggests that (i) more than one quantitative microbiology sample is required to obtain reliable estimates of bacterial load; (ii) biopsies are more sensitive than swabs in diagnosing or predicting sepsis; (iii) high bacterial loads may predict worse clinical outcomes, and (iv) both quantitative and semi-quantitative culture reports need to be interpreted with caution and in the context of other clinical risk factors. The evidence base for the utility and reliability of quantitative microbiology for diagnosing or predicting clinical outcomes in burns patients is limited and often poorly reported. Consequently future research is warranted. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Gram negative wound infection in hospitalised adult burn patients--systematic review and metanalysis-.

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Ernest A Azzopardi

Full Text Available BACKGROUND: Gram negative infection is a major determinant of morbidity and survival. Traditional teaching suggests that burn wound infections in different centres are caused by differing sets of causative organisms. This study established whether Gram-negative burn wound isolates associated to clinical wound infection differ between burn centres. METHODS: Studies investigating adult hospitalised patients (2000-2010 were critically appraised and qualified to a levels of evidence hierarchy. The contribution of bacterial pathogen type, and burn centre to the variance in standardised incidence of Gram-negative burn wound infection was analysed using two-way analysis of variance. PRIMARY FINDINGS: Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumanni, Enterobacter spp., Proteus spp. and Escherichia coli emerged as the commonest Gram-negative burn wound pathogens. Individual pathogens' incidence did not differ significantly between burn centres (F (4, 20 = 1.1, p = 0.3797; r2 = 9.84. INTERPRETATION: Gram-negative infections predominate in burn surgery. This study is the first to establish that burn wound infections do not differ significantly between burn centres. It is the first study to report the pathogens responsible for the majority of Gram-negative infections in these patients. Whilst burn wound infection is not exclusive to these bacteria, it is hoped that reporting the presence of this group of common Gram-negative "target organisms" facilitate clinical practice and target research towards a defined clinical demand.

Care of the burn wound: As I do it

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Arvind Madhusudan Vartak

2016-01-01

Full Text Available Skin covers the entire body. It is the most important protective organ. Since the burn injury is most painful of all injuries, dressings play an important part of the management. Dressing of the burn wound is very essential to provide pain relief, to promote early healing, to prevent contractures, and to help early mobilization. Many workers from time immemorial have used different types of dressings so as to provide desired results. I use sterile polyethylene drape as a dressing material after covering it with the first layer of gauze soaked in silver sulfadiazine cream. The results are encouraging as there is near total absence of pain experienced by patients and removal is totally pain-free without any bleeding. There is no need for escharotomies, and there is early removal of the slough with no contracture. The polyethylene drapes are easily available in the market, easy to store, available sterile, and totally cost-effective. They help reduce the hospital stay of the patient. The need of anesthesia for surgeries such as escharotomies and debridement is significantly reduced.

Evaluation of the effects of honey on acute-phase deep burn wounds.

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Nakajima, Yukari; Mukai, Kanae; Nasruddin; Komatsu, Emi; Iuchi, Terumi; Kitayama, Yukie; Sugama, Junko; Nakatani, Toshio

2013-01-01

This study aimed to clarify the effects of honey on acute-phase deep burn wounds. Two deep burn wounds were created on mice which were divided into four groups: no treatment, silver sulfadiazine, manuka honey, and Japanese acacia honey. Wound sizes were calculated as expanded wound areas and sampled 30 minutes and 1-4 days after wounding for histological observation. The wound sections were subjected to hematoxylin and eosin and immunohistological staining to detect necrotic cells, apoptotic cells, neutrophils, and macrophages. The no treatment group formed a scar. The redness around the wound edges in the silver sulfadiazine group was the most intense. All groups exhibited increased wound areas after wounding. The proportions of necrotic cells and the numbers of neutrophils in the manuka and acacia honey groups were lower than those in the no treatment and silver sulfadiazine groups until day 3; however, there were no significant differences between all groups on day 4. These results show that honey treatment on deep burn wounds cannot prevent wound progression. Moreover, comparing our observations with those of Jackson, there are some differences between humans and animals in this regard, and the zone of hyperemia and its surrounding area fall into necrosis, which contributes to burn wound progression.

Evaluation of the Effects of Honey on Acute-Phase Deep Burn Wounds

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Yukari Nakajima

2013-01-01

Full Text Available This study aimed to clarify the effects of honey on acute-phase deep burn wounds. Two deep burn wounds were created on mice which were divided into four groups: no treatment, silver sulfadiazine, manuka honey, and Japanese acacia honey. Wound sizes were calculated as expanded wound areas and sampled 30 minutes and 1–4 days after wounding for histological observation. The wound sections were subjected to hematoxylin and eosin and immunohistological staining to detect necrotic cells, apoptotic cells, neutrophils, and macrophages. The no treatment group formed a scar. The redness around the wound edges in the silver sulfadiazine group was the most intense. All groups exhibited increased wound areas after wounding. The proportions of necrotic cells and the numbers of neutrophils in the manuka and acacia honey groups were lower than those in the no treatment and silver sulfadiazine groups until day 3; however, there were no significant differences between all groups on day 4. These results show that honey treatment on deep burn wounds cannot prevent wound progression. Moreover, comparing our observations with those of Jackson, there are some differences between humans and animals in this regard, and the zone of hyperemia and its surrounding area fall into necrosis, which contributes to burn wound progression.

Nanomedicine and advanced technologies for burns: Preventing infection and facilitating wound healing.

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Mofazzal Jahromi, Mirza Ali; Sahandi Zangabad, Parham; Moosavi Basri, Seyed Masoud; Sahandi Zangabad, Keyvan; Ghamarypour, Ameneh; Aref, Amir R; Karimi, Mahdi; Hamblin, Michael R

2018-01-01

According to the latest report from the World Health Organization, an estimated 265,000 deaths still occur every year as a direct result of burn injuries. A widespread range of these deaths induced by burn wound happens in low- and middle-income countries, where survivors face a lifetime of morbidity. Most of the deaths occur due to infections when a high percentage of the external regions of the body area is affected. Microbial nutrient availability, skin barrier disruption, and vascular supply destruction in burn injuries as well as systemic immunosuppression are important parameters that cause burns to be susceptible to infections. Topical antimicrobials and dressings are generally employed to inhibit burn infections followed by a burn wound therapy, because systemic antibiotics have problems in reaching the infected site, coupled with increasing microbial drug resistance. Nanotechnology has provided a range of molecular designed nanostructures (NS) that can be used in both therapeutic and diagnostic applications in burns. These NSs can be divided into organic and non-organic (such as polymeric nanoparticles (NPs) and silver NPs, respectively), and many have been designed to display multifunctional activity. The present review covers the physiology of skin, burn classification, burn wound pathogenesis, animal models of burn wound infection, and various topical therapeutic approaches designed to combat infection and stimulate healing. These include biological based approaches (e.g. immune-based antimicrobial molecules, therapeutic microorganisms, antimicrobial agents, etc.), antimicrobial photo- and ultrasound-therapy, as well as nanotechnology-based wound healing approaches as a revolutionizing area. Thus, we focus on organic and non-organic NSs designed to deliver growth factors to burned skin, and scaffolds, dressings, etc. for exogenous stem cells to aid skin regeneration. Eventually, recent breakthroughs and technologies with substantial potentials in tissue

Wound care centers

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Pressure ulcer - wound care center; Decubitus ulcer - wound care center; Diabetic ulcer - wound care center; Surgical wound - wound ... Common types of non-healing wounds include: Pressure sores Surgical ... flow, or swollen legs Certain wounds may not heal well due to: ...

Fungal Burn Wound Infection

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1991-01-01

Aspergillus), Blasto- T he use of effective topical chemotherapeutic agents to myces (Candida), and Zygomycetes ( Mucor , Rhizopus).6 reduce...species, 18%; Mucor species and Rhizopus species, acetate in the morning and silver sulfadiazine in the evening. Prophy- 9.1%; and Microspora species and...sensitivity reports, and the patient’s sue, including one patient who required a hip disarticulation response. to control an invasive Mucor burn wound

Ketamine hydrochloride - an adjunct for analgesia in dogs with burn wounds : clinical communication

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K. Joubert

1998-07-01

Full Text Available The management of pain in patients with burn wounds is complex and problematic. Burn-wound pain is severe, inconsistent and underestimated. Patients experience severe pain, especially during procedures, until wound healing has occurred. A multi-modality approach is needed for effective management of pain, which requires an understanding of the mechanisms of pain. Altered pharmacokinetics and pharmacodynamics in burn-wound patients makes drug actions unpredictable. Opioids alone are seldom sufficient for pain control. The multi-modality approach includes the use of opioids and non-steroidal antiinflammatory, anxiolytic and alternative drugs. Ketamine has been found to be a useful agent for analgesia in burn-wound patients; a dose of 10 mg/kg qid per os was found to be an effective adjunct to pain therapy.

Partial-thickness burn wounds healing by topical treatment

OpenAIRE

Saeidinia, Amin; Keihanian, Faeze; Lashkari, Ardalan Pasdaran; Lahiji, Hossein Ghavvami; Mobayyen, Mohammadreza; Heidarzade, Abtin; Golchai, Javad

2017-01-01

Abstract Background: Burns are common event and associated with a high incidence of death, disability, and high costs. Centella asiatica (L.) is a medicinal herb, commonly growing in humid areas in several tropical countries that improve wound healing. On the basis of previous studies, we compared the efficacy of Centiderm versus silver sulfadiazine (SSD) in partial thickness burning patients. Methods: Study population comprised burn victims referred to Velayat Burning Hospital at Rasht, Iran...

Perfusion of burn wounds assessed by Laser Doppler Imaging is related to burn depth and healing time

NARCIS (Netherlands)

Kloppenberg, FWH; Beerthuizen, GIJM; ten Duis, H. J.

Average perfusion in various burn wounds was assessed using Laser Doppler Imaging (LDI). The time necessary for a complete healing of the wound was compared to the results of the LDI measurements. A certain depth of burn was associated with a typical pattern of perfusion in the course of time. There

Otostegia persica extraction on healing process of burn wounds

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Amin Ganjali

2013-06-01

Full Text Available PURPOSE: To investigate if the methanolic extract of the Otostegia persica can accelerating healing process of burn wound because of its anti-inflammatory and antioxidant effects. METHODS:Forty eight male Wistar rats were randomized into three study groups of 16 rats each. Burn wounds were created on dorsal part of shaved rats using a metal rod. In group I the burn wound was left without any treatment. Group was treated with topical silver sulfadiazine pomade. In group III, ointment containing the OP extract was administered. Skin biopsies were harvested from burn area on the 3rd, 5th, 14th and 21st days after burn and examined histologically. RESULTS: Re-epithelialization in the control group and in group II was lower than in group III. Re-epithelialization in groups II and III was significantly different from that in the control group. On the 5th day of the experiment, we assessed lower inflammation in the burn area compared to control group. This means that the inflammation was suppressed by methanolic extract of OP. From day 5 to 14; the fibroblast proliferation peaked and was associated with increased collagen accumulation. It was obvious that angiogenesis improved more in the groups II and III, which facilitated re-epithelialisation. CONCLUSION:Methanolic extract of Otostegia persica exhibited significant healing activity when topically applied on rats. OP is an effective treatment for saving the burn site.

Decontamination of burn wounds using a cold atmospheric pressure plasma jet

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van Gils, Koen; Hofmann, S.; Boekema, B.K.H.L.; Bruggeman, P.J.

2012-01-01

Decontamination of burn wounds using a cold atmospheric pressure plasma jet C.A.J. van Gils, S. Hofmann, B. Boekema and P. Bruggeman Eindhoven University of Technology, Department of Applied Physics, group EPG, P.O. Box 513, 5600 MB Eindhoven In the treatment of burn wounds bacterial infections are

Experimental model of the burn wound topical treatment

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Amra Čabaravdić

2003-11-01

Full Text Available AbstractBACKGROUND AND PURPOSE:Clinical research of drugs is a researching step subsequent to the preclinical studies in experimental animals. The aim of our research was to evaluate animal model of wound healing process after the burninducement and effects of the ointment containing natural plants on the process of burn healing.MATERIAL AND METHODS:Burn wounds were experimentally induced in two species of experimental animals which were treated with topically applied herbal preparation with concomitant monitoring of the healing process. Experimental groups (1 of 15 animals each (mice and rats, while control group (2 of 10 animals each (mice and rats that were not being treated with herbal ointment. After the hair removal, burn was induced on the back of animals by heated brass seal. Different clinical symptoms including oedema of surrounding tissue, redness, exudation, size of the burn surface, histological and microbiological findings were monitored on the days 1, 3, 7, 14 and 21. A statistically significant difference was observed throughout descriptive statistics and paired Student's t-test.CONCLUSION:Physiological healing processes of the acute burn wound following the topical application of herbal preparation can be monitored on the utilized animal model. A three-week treatment resulted in the 90% of completed epithelization in both animal species, indicating the effectiveness of topically applied herbal preparation.

[Effect of insulin on burn wound healing in aging diabetes mellitus rats].

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Wu, Jian; Xue, Xiaodong; Liu, Junling; Si, Xiaoqiang; Yang, Guohu

2009-12-01

To investigate the effect of topical application of insulin on the burn wound healing in aging diabetes mellitus (DM) rats and to explore its mechanism. Seventy-five SPF Wistar rats (female and/or male), aged 12-24 months and weighing 300-350 g, were selected and randomly divided into group A (burn control group, n=25), group B (DM burn control group, n=25), and group C (DM insulin treatment group, n=25). The rats in group B and group C were fed with high-fat, high-protein, and high-sugar forage for 1 month and received intraperitoneal injection of streptozotocin (STZ) to establish experimental model of aging DM. The rats were fed with high-fat, high-protein, and high-sugar forage for another 8 weeks. Then, the deep second-degree burn model was established in the rats of group B and group C. The wounds in group A and B underwent local subcutaneous injection of 2 mL isotonic saline and group C received local subcutaneous injection of 0.1 U insulin. The rate of wound healing was calculated 7, 14, and 21 days after burn injury. At 1, 3, 7, 14, and 21 days after burn injury, HE staining observation, immunohistochemistry staining for CD34, detection of sugar and hydroxyproline (HOP) content in wound tissue, and microvessel density (MVD) calculation were performed. At 7, 14, and 21 days after burn injury, the wound healing rates of group A and group C was significantly higher than that of group B (P 0.05). Histology observation at 21 days after burn injury: in group A, certain degree of epithelization was evident in the wound epithelium; in group B, large quantity of necrotic tissue was evident; in group C, complete epithelization occurred in the wound epithelium with better epithelial cell differentiation and more neonatal collagen. For the sugar content in the wound tissue, group A was significantly lower than group B or group C at 1, 3, 7, 14, and 21 days (P wound tissue and the MVD count, group A or group C was significantly higher than group B (P 0.05). CD34

[Application of a hydrosurgery system in debridement of various types of burn wounds].

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Li, M Y; Mao, Y G; Guo, G H; Liu, D W

2016-09-20

Burn wound healing is closely associated with the depth of wound and early debridement. The traditional ways of debridement have certain limitations and often result in poor appearance and function of repaired area. At present, the hydrosurgery system has been applied clinically in burn field. This paper summarizes advantages and disadvantages of application of the hydrosurgery system in debridement of burn wound with different depths, different periods, extraordinary region, and uncommon agent.

Partial-thickness burn wounds healing by topical treatment

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Saeidinia, Amin; Keihanian, Faeze; Lashkari, Ardalan Pasdaran; Lahiji, Hossein Ghavvami; Mobayyen, Mohammadreza; Heidarzade, Abtin; Golchai, Javad

2017-01-01

Abstract Background: Burns are common event and associated with a high incidence of death, disability, and high costs. Centella asiatica (L.) is a medicinal herb, commonly growing in humid areas in several tropical countries that improve wound healing. On the basis of previous studies, we compared the efficacy of Centiderm versus silver sulfadiazine (SSD) in partial thickness burning patients. Methods: Study population comprised burn victims referred to Velayat Burning Hospital at Rasht, Iran. The intervention group received Centiderm and control group SSD cream. Burn wounds were treated once daily at home. All of the wounds were evaluated till complete healing occurred and at the admission, days 3, 7, 14 objective signs; visual acuity score (VAS) and subjective signs were recorded. Re-epithelialization time and complete healing days were recorded. We used random fixed block for randomization. The randomization sequence was created using the computer. Patients and burning specialist physician were blinded. Results: Seventy-five patients randomized into 2 groups; (40 patients: Centiderm group; 35 patients: SSD group). The mean age of them was 30.67 ± 9.91 years and 19 of them were male (31.7%). Thirty patients in Centiderm and 30 patients in SSD group were analyzed. All of objective and subjective signs and mean of re-epithelialization and complete healing were significantly better in Centiderm group rather than SSD group (P < 0.05). There was no infection in Centiderm group. Conclusions: We showed that use of Centiderm ointment not only improved the objective and subjective signs in less than 3 days, but also the re-epithelialization and complete healing rather than SSD without any infection in the subjects. PMID:28248871

Effect of Malva sylvestris cream on burn injury and wounds in rats

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Ebrahim Nasiri

2015-06-01

Full Text Available Objectives: Burn injury is one of the most health-threatening problems in the world. Malva sylvestris (M. sylvestris flowershave a high mucilage content and are used as a remedy for cut wound and dermal infected wounds in Iranian folklore Medicine. The purpose of this study was to investigate the effect of M. sylvestris cream on the second degree burn injury in rats. Materials and Methods: Five groups of 10 rats per group were burned with hot metal plate. Animals were administrated divided as control, normal saline, standard silver sulfadiazine 1% (SSD, 5% M. sylvestris, and 10% M. sylvestris into separate groups. Wound area, percentage of wound contraction, and histological and bacteriological assessments were evaluated. Results: Wound sizes were not significantly different among groups on 1st and 3rd days after burn injury, while they were significantly different among groups after 7th day post-burn injury. The average areas of wounds on the 15th day were 7.5±2.9, 6.7±2, 10.5±1.6, 4.7±2, and 4.5±2 cm2 for base cream, normal saline, SSD, 5% M. sylvestris, and 10% M. sylvestris, respectively. The results of histology exhibited well-formed horizontally-oriented collagen fibers in MS topical treatment groups. Microorganisms existed in the SSD group were most probably Staphilococcus epidermitis and for NS group were staphylococcus saprophiteccus. Conclusion: M. sylvestris cream improved histological changes of tissue components in the process of healing when compared with SSD cream. Therefore, it can be used as a topical treatment agent for burn wound.

Current concepts on burn wound conversion – a review of recent advances in understanding the secondary progressions of burns

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Salibian, Ara A.; Del Rosario, Angelica Tan; De Almeida Moura Severo, Lucio; Nguyen, Long; Banyard, Derek A.; Toranto, Jason D.; Evans, Gregory R.D.; Widgerow, Alan D.

2016-01-01

Burn wound conversion describes the process by which superficial partial thickness burns convert into deeper burns necessitating surgical intervention. Fully understanding and thus controlling this phenomenon continues to defy burn surgeons. However, potentially guiding burn wound progression so as to obviate the need for surgery while still bringing about healing with limited scarring is the major unmet challenge. Comprehending the pathophysiologic background contributing to deeper progression of these burns is an essential prerequisite to planning any intervention. In this study, a review of articles examining burn wound progression over the last five years was conducted to analyze trends in recent burn progression research, determine changes in understanding of the pathogenesis of burn conversion, and subsequently examine the direction for future research in developing therapies. The majority of recent research focuses on applying therapies from other disease processes to common underlying pathogenic mechanisms in burn conversion. While ischemia, inflammation, and free oxygen radicals continue to demonstrate a critical role in secondary necrosis, novel mechanisms such as autophagy have also been shown to contribute affect significantly burn progression significantly. Further research will have to determine whether multiple mechanisms should be targeted when developing clinical therapies. PMID:26787127

The enhanced total body wrap--the new frontier in dressing care for burns.

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Low, O-Wern; Chong, Si Jack; Tan, Bien-Keem

2013-11-01

The management of extensive burns with their associated high fluid exudate following burn excision and skin grafting has always posed a challenge in burn wound care. The ideal dressing should protect the wound from physical damage and micro-organisms; be comfortable and durable; allow high humidity at the wound; and be able to allow maximal activity for wound healing without retarding or inhibiting any stage of the process. The dressing technique described in this paper fulfils all the criteria above and at the same time provides an efficient channel to effectively clear the excessive exudate produced while keeping the wounds moist. Advantages conferred include accurate charting of wound exudate; reduced frequency of dressing changes; lower infection rates through prevention of strike-through; and securing and improving the viability of skin grafts. An enhancement to a technique previously described by us through the use of long thin strips of VAC sponges to transmit negative pressure, the enhanced Total Body Wrap aims to provide ideal conditions to promote healing in burns. Using negative pressure wound therapy (NPWT), this technique is simple and straightforward enough to be applied in majority of tertiary centres around the world. Copyright © 2013. Published by Elsevier Ltd.

Teaching wound care to family medicine residents on a wound care service

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Little SH

2013-08-01

Full Text Available Sahoko H Little,1,2 Sunil S Menawat,1,3 Michael Worzniak,1 Michael D Fetters2 1Oakwood Annapolis Family Medicine Residency, Wayne, Michigan, USA; 2University of Michigan, Department of Family Medicine, Ann Arbor, Michigan, USA; 3Ghent Family Medicine Residency, Eastern Virginia Medical School, Norfolk, Virginia, USA Abstract: Primary care physicians often care for patients with chronic wounds, and they can best serve patients if they have knowledge and proficient skills in chronic wound care, including sharp debridement. The Oakwood Annapolis Family Medicine Residency in Michigan, USA developed a Wound Care Service, incorporating wound care training during the surgical rotation. Effectiveness of the wound care training was evaluated through pre- and posttesting of residents, to assess changes in knowledge and comfort in treating chronic wounds. The results demonstrate significant improvement in residents’ knowledge and comfort in wound care. This innovation demonstrates the feasibility of educating residents in chronic wound care through hands-on experience. Keywords: wound care education, primary care, residency education, surgery rotation, curriculum development

Beneficial effects of hydrogen-rich saline on early burn-wound progression in rats.

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Song Xue Guo

Full Text Available Deep burn wounds undergo a dynamic process known as wound progression that results in a deepening and extension of the initial burn area. The zone of stasis is more likely to develop more severe during wound progression in the presence of hypoperfusion. Hydrogen has been reported to alleviate injury triggered by ischaemia/reperfusion and burns in various organs by selectively quenching oxygen free radicals. The aim of this study was to investigate the possible protective effects of hydrogen against early burn-wound progression.Deep-burn models were established through contact with a boiled, rectangular, brass comb for 20 s. Fifty-six Sprague-Dawley rats were randomly divided into sham, burn plus saline, and burn plus hydrogen-rich saline (HS groups with sacrifice and analysis at various time windows (6 h, 24 h, 48 h post burn. Indexes of oxidative stress, apoptosis and autophagy were measured in each group. The zone of stasis was evaluated using immunofluorescence staining, ELISA, and Western blot to explore the underlying effects and mechanisms post burn.The burn-induced increase in malondialdehyde was markedly reduced with HS, while the activities of endogenous antioxidant enzymes were significantly increased. Moreover, HS treatment attenuated increases in apoptosis and autophagy postburn in wounds, according to the TUNEL staining results and the expression analysis of Bax, Bcl-2, caspase-3, Beclin-1 and Atg-5 proteins. Additionally, HS lowered the level of myeloperoxidase and expression of TNF-α, IL-1β, and IL-6 in the zone of stasis while augmenting IL-10. The elevated levels of Akt phosphorylation and NF-κB p65 expression post burn were also downregulated by HS management.Hydrogen can attenuate early wound progression following deep burn injury. The beneficial effect of hydrogen was mediated by attenuating oxidative stress, which inhibited apoptosis and inflammation, and the Akt/NF-κB signalling pathway may be involved in regulating the

Human umbilical cord mesenchymal stem cells transplantation promotes cutaneous wound healing of severe burned rats.

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Lingying Liu

Full Text Available BACKGROUND: Severe burns are a common and highly lethal trauma. The key step for severe burn therapy is to promote the wound healing as early as possible, and reports indicate that mesenchymal stem cell (MSC therapy contributes to facilitate wound healing. In this study, we investigated effect of human umbilical cord MSCs (hUC-MSCs could on wound healing in a rat model of severe burn and its potential mechanism. METHODS: Adult male Wistar rats were randomly divided into sham, burn, and burn transplanted hUC-MSCs. GFP labeled hUC-MSCs or PBS was intravenous injected into respective groups. The rate of wound closure was evaluated by Image Pro Plus. GFP-labeled hUC-MSCs were tracked by in vivo bioluminescence imaging (BLI, and human-specific DNA expression in wounds was detected by PCR. Inflammatory cells, neutrophils, macrophages, capillaries and collagen types I/III in wounds were evaluated by histochemical staining. Wound blood flow was evaluated by laser Doppler blood flow meter. The levels of proinflammatory and anti-inflammatory factors, VEGF, collagen types I/III in wounds were analyzed using an ELISA. RESULTS: We found that wound healing was significantly accelerated in the hUC-MSC therapy group. The hUC-MSCs migrated into wound and remarkably decreased the quantity of infiltrated inflammatory cells and levels of IL-1, IL-6, TNF-α and increased levels of IL-10 and TSG-6 in wounds. Additionally, the neovascularization and levels of VEGF in wounds in the hUC-MSC therapy group were markedly higher than those in other control groups. The ratio of collagen types I and III in the hUC-MSC therapy group were markedly higher than that in the burn group at indicated time after transplantation. CONCLUSION: The study suggests that hUC-MSCs transplantation can effectively improve wound healing in severe burned rat model. Moreover, these data might provide the theoretical foundation for the further clinical application of hUC-MSC in burn areas.

Protocol for a systematic review of quantitative burn wound microbiology in the management of burns patients.

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Kwei, Johnny; Halstead, Fenella D; Dretzke, Janine; Oppenheim, Beryl A; Moiemen, Naiem S

2015-11-06

Sepsis from burn injuries can result from colonisation of burn wounds, especially in large surface area burns. Reducing bacterial infection will reduce morbidity and mortality, and mortality for severe burns can be as high as 15 %. There are various quantitative and semi-quantitative techniques to monitor bacterial load on wounds. In the UK, burn wounds are typically monitored for the presence or absence of bacteria through the collection and culture of swabs, but no absolute count is obtained. Quantitative burn wound culture provides a measure of bacterial count and is gaining increased popularity in some countries. It is however more resource intensive, and evidence for its utility appears to be inconsistent. This systematic review therefore aims to assess the evidence on the utility and reliability of different quantitative microbiology techniques in terms of diagnosing or predicting clinical outcomes. Standard systematic review methods aimed at minimising bias will be employed for study identification, selection and data extraction. Bibliographic databases and ongoing trial registers will be searched and conference abstracts screened. Studies will be eligible if they are prospective studies or systematic reviews of burn patients (any age) for whom quantitative microbiology has been performed, whether it is compared to another method. Quality assessment will be based on quality assessment tools for diagnostic and prognostic studies and tailored to the review as necessary. Synthesis is likely to be primarily narrative, but meta-analysis may be considered where clinical and methodological homogeneity exists. Given the increasing use of quantitative methods, this is a timely systematic review, which will attempt to clarify the evidence base. As far as the authors are aware, it will be the first to address this topic. PROSPERO, CRD42015023903.

The Burn Medical Assistant: Developing Machine Learning Algorithms to Aid in the Estimation of Burn Wound Size

Science.gov (United States)

2017-10-01

Produce multi-spectral burn wound images and enhanced burn wound diagrams for automated, multi- spectral feature extraction and image segmentation ...Raytheon will not occur, this in conjunction with ARA, we are in the process of market research with currently available Commercial off the Shelf (COTS...thorough market survey of current COTS technology and after review of the technology offered by RVS. This system offers the necessary resolution

Problems of thermal IR-imaging in evaluation of burn wounds

International Nuclear Information System (INIS)

Nowakowski, A.

2009-01-01

Results of the research devoted to application of thermal IR-imaging in diagnostics of burn wounds are discussed. The main aim of the work was to develop an effective method for quantitative evaluation of the depth of a burn wound and for classification of regions for surgical treatment. The criterion of determination the area of the wound to be treated surgically is the time, which should not exceed three weeks for natural healing of a burn wound. Prediction that the healing process may last longer is concluded by immediate surgical intervention. We concentrate on using for this purpose QIRT - NDT TI methods (Quantitative Infra-Red Thermography - Non-Destructive Testing Thermal Imaging); especially - active dynamic thermography - ADT. In this work both, classical thermography using a high quality thermal camera as well as ADT are applied and the results of analysis are joined, allowing multimodality diagnostic approach and improved classification of burns requiring surgical treatment. Now our work in application of thermal imaging in determination of burns is continued for around 10 years, as the first publication showing our methodology was presented in 1999. In 2001, during the Thermosense conference, we have been awarded the Andronicos Kantsios Award for the work on Medical applications of model based dynamic thermography. Important reports of our experience in classical as well as ADT thermography are already published. Now we concentrate on practical aspects of the problem, trying to construct a measuring set to be operative even by not experienced staff and meeting all of necessary requirements for clinical applications. (author)

Effectiveness of Aloe Vera gel compared with 1% silver sulphadiazine cream as burn wound dressing in second degree burns.

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Shahzad, Muhammad Naveed; Ahmed, Naheed

2013-02-01

To assess the efficacy of Aloe Vera gel compared with 1% silver sulfadiazine cream as a burn dressing for the treatment of superficial and partial thickness burns. This Interventional Comparative study was carried out at the Burn unit and Plastic surgery department, Nishtar Hospital Multan, Pakistan from July 2008 to December 2010. A total of 50 patients with superficial and partial thickness burns were divided into two equal groups randomly by consecutive sampling method, one group was dressed with Aloe Vera gel while the other was treated with 1% silversulphadiazine cream, and the results regarding duration of wound epithelialization, pain relief and cost of treatment were compared. In patients treated with Aloe Vera gel, healing of burn wounds were remarkably early than those patients treated with 1% silver sulfadiazine. All the patients of Aloe Vera group were relieved of pain earlier than those patients who were treated with SSD. Thermal burns patients dressed with Aloe Vera gel showed advantage compared to those dressed with SSD regarding early wound epithelialization, earlier pain relief and cost-effectiveness.

Eradication of multidrug-resistant A. baumannii in burn wounds by antiseptic pulsed electric field

Science.gov (United States)

Golberg, Alexander; Broelsch, G. Felix; Vecchio, Daniela; Khan, Saiqa; Hamblin, Michael R.; Austen, William G.; Sheridan, Robert L.; Yarmush, Martin L.

2014-01-01

Emerging bacterial resistance to multiple drugs is an increasing problem in burn wound management. New non-pharmacologic interventions are needed for burn wound disinfection. Here we report on a novel physical method for disinfection: antiseptic pulsed electric field (PEF) applied externally to the infected burns. In a mice model, we show that PEF can reduce the load of multidrug resistant Acinetobacter baumannii present in a full thickness burn wound by more than four orders of magnitude, as detected by bioluminescence imaging. Furthermore, using a finite element numerical model, we demonstrate that PEF provides non-thermal, homogeneous, full thickness treatment for the burn wound, thus, overcoming the limitation of treatment depth for many topical antimicrobials. These modeling tools and our in vivo results will be extremely useful for further translation of the PEF technology to the clinical setting, as they provide the essential elements for planning of electrode design and treatment protocol. PMID:25089285

Early burn wound excision and skin grafting postburn trauma restores in vivo neutrophil delivery to inflammatory lesions

International Nuclear Information System (INIS)

Tchervenkov, J.I.; Epstein, M.D.; Silberstein, E.B.; Alexander, J.W.

1988-01-01

This study assessed the effect of early vs delayed postburn wound excision and skin grafting on the in vivo neutrophil delivery to a delayed-type hypersensitivity (DTH) reaction and a bacterial skin lesion (BSL). Male Lewis rats were presensitized to keyhole-limpet hemocyanin. Group 1 comprised sham controls. Groups 2 through 4 were given a 30% 3 degrees scald burn, but the burn wounds were excised, and skin was grafted on days 1, 3, and 7, respectively, after the burn. Group 5 comprised burn controls. Twelve days after burn trauma, all rats were injected at different intervals (during a 24-hour period) with a trio of intradermal injections of keyhole-limpet hemocyanin, Staphylococcus aureus 502A, and saline at different sites. In vivo neutrophil delivery to these dermal lesions was determined by injecting indium in 111 oxyquinoline-labeled neutrophils isolated from similarly treated groups of rats. Neutrophil delivery to DTH and BSL lesions was restored to normal by excision and skin grafting of the burn wound one day after burn trauma. Waiting three days after burn trauma to excise and skin graft the wound partially, but not completely, restored the in vivo neutrophil delivery to DTH and BSL lesions. Waiting one week to excise and skin graft a burn wound resulted in no improvement in neutrophil delivery to DTH and BSL dermal lesions. It was concluded that burn wound excision and skin grafting immediately after burn trauma restored in vivo neutrophil delivery to a BSL and DTH dermal lesion. This may, in part, explain the beneficial effect of early aggressive burn wound debridement in patients with burn injuries

Modulation of inflammatory and catabolic responses in severely burned children by early burn wound excision in the first 24 hours

NARCIS (Netherlands)

Barret, JP; Herndon, DN

Hypothesis: Early burn wound excision modulates the hypermetabolic response in severe pediatric burn injuries. Design: Before-after trial. Setting: A 30-bed burn referral center in a private, university-affiliated hospital. Methods: We studied 35 severely burned children who were divided into 2

Cost-Effectiveness of a Nonpharmacological Intervention in Pediatric Burn Care.

Science.gov (United States)

Brown, Nadia J; David, Michael; Cuttle, Leila; Kimble, Roy M; Rodger, Sylvia; Higashi, Hideki

2015-07-01

To report the cost-effectiveness of a tailored handheld computerized procedural preparation and distraction intervention (Ditto) used during pediatric burn wound care in comparison to standard practice. An economic evaluation was performed alongside a randomized controlled trial of 75 children aged 4 to 13 years who presented with a burn to the Royal Children's Hospital, Brisbane, Australia. Participants were randomized to either the Ditto intervention (n = 35) or standard practice (n = 40) to measure the effect of the intervention on days taken for burns to re-epithelialize. Direct medical, direct nonmedical, and indirect cost data during burn re-epithelialization were extracted from the randomized controlled trial data and combined with scar management cost data obtained retrospectively from medical charts. Nonparametric bootstrapping was used to estimate statistical uncertainty in cost and effect differences and cost-effectiveness ratios. On average, the Ditto intervention reduced the time to re-epithelialize by 3 days at AU$194 less cost for each patient compared with standard practice. The incremental cost-effectiveness plane showed that 78% of the simulated results were within the more effective and less costly quadrant and 22% were in the more effective and more costly quadrant, suggesting a 78% probability that the Ditto intervention dominates standard practice (i.e., cost-saving). At a willingness-to-pay threshold of AU$120, there is a 95% probability that the Ditto intervention is cost-effective (or cost-saving) against standard care. This economic evaluation showed the Ditto intervention to be highly cost-effective against standard practice at a minimal cost for the significant benefits gained, supporting the implementation of the Ditto intervention during burn wound care. Copyright © 2015. Published by Elsevier Inc.

Human Amniotic Membrane Dressing: an Excellent Method for Outpatient Management of Burn Wounds

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Ali Akbar Mohammadi

2009-03-01

Full Text Available Background: Burns are among the most common traumas indeveloping countries, which consume large amounts of medicalresources. It is important to find an appropriate materialfor dressing of burn wounds that improves healing and is readilyavailable, easily applicable, and economical.Methods: In a single-blind randomized controlled clinicaltrial from March to October 2006, 211 patients with less than20% burn were enrolled into two groups. The first group contained104 patients with average burn of 11.90± 3.80% of totalbody surface area (TBSA for whom amnion dressing wasused. The second group composed of 107 patients with averageburn of 12.30± 4.14% of TBSA treated with routine silversulfadiazine dressing.Results: Amniotic membrane usage was accompanied by accelerationin wound healing, less need for skin graft, and lesspain. The mean healing time in superficial parts of burnwounds in the amnion group was significantly shorter than thecontrol group (9.50±2.13 v 14.30±2.60 days; P value < 0.01.The extent of the wound with granulation tissue which neededskin graft was less in the amnion group (2.10 ± 2.21% v 4.20±1.44%; P value < 0.01.Conclusion: Widespread use of amniotic membrane dressingis recommended for limited burn wound management.

Traditional Herbal Remedies for Burn Wound Healing in Canon of Avicenna

OpenAIRE

Aliasl, Jale; Khoshzaban, Fariba

2013-01-01

Burns are a worldwide problem. The incidence of severe burns has been higher than the combined incidence of tuberculosis and HIV infections. Throughout history there have been many different treatments prescribed for burns. The Canon is the masterpiece of Avicenna’s medical books. The Canon includes a description of 785 simple drugs. Avicenna believed in burn treatment, which follows two goals. The first goal is prevention of blistering and the second goal is treatment of the burn wound after...

Honey for Wound Healing, Ulcers, and Burns; Data Supporting Its Use in Clinical Practice

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Noori Al-Waili

2011-01-01

Full Text Available The widespread existence of unhealed wounds, ulcers, and burns has a great impact on public health and economy. Many interventions, including new medications and technologies, are being used to help achieve significant wound healing and to eliminate infections. Therefore, to find an intervention that has both therapeutic effect on the healing process and the ability to kill microbes is of great value. Honey is a natural product that has been recently introduced in modern medical practice. Honey's antibacterial properties and its effects on wound healing have been thoroughly investigated. Laboratory studies and clinical trials have shown that honey is an effective broad-spectrum antibacterial agent. This paper reviews data that support the effectiveness of natural honey in wound healing and its ability to sterilize infected wounds. Studies on the therapeutic effects of honey collected in different geographical areas on skin wounds, skin and gastric ulcers, and burns are reviewed and mechanisms of action are discussed. (Ulcers and burns are included as an example of challenging wounds. The data show that the wound healing properties of honey include stimulation of tissue growth, enhanced epithelialization, and minimized scar formation. These effects are ascribed to honey's acidity, hydrogen peroxide content, osmotic effect, nutritional and antioxidant contents, stimulation of immunity, and to unidentified compounds. Prostaglandins and nitric oxide play a major role in inflammation, microbial killing, and the healing process. Honey was found to lower prostaglandin levels and elevate nitric oxide end products. These properties might help to explain some biological and therapeutic properties of honey, particularly as an antibacterial agent or wound healer. The data presented here demonstrate that honeys from different geographical areas have considerable therapeutic effects on chronic wounds, ulcers, and burns. The results encourage the use of honey

The effect of a honey based gel and silver sulphadiazine on bacterial infections of in vitro burn wounds

NARCIS (Netherlands)

Boekema, B.K.H.L.; Pool, L.; Ulrich, M.

2013-01-01

Bacterial contamination remains a constant threat in burn wound care. Topical treatments to combat contaminations have good bactericidal effects but can have detrimental effects for the healing process. Treatments with for example silver can increase healing times. Honey based products can be a good

Adenoviral gene delivery to primary human cutaneous cells and burn wounds.

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Hirsch, Tobias; von Peter, Sebastian; Dubin, Grzegorz; Mittler, Dominik; Jacobsen, Frank; Lehnhardt, Markus; Eriksson, Elof; Steinau, Hans-Ulrich; Steinstraesser, Lars

2006-01-01

The adenoviral transfer of therapeutic genes into epidermal and dermal cells is an interesting approach to treat skin diseases and to promote wound healing. The aim of this study was to assess the in vitro and in vivo transfection efficacy in skin and burn wounds after adenoviral gene delivery. Primary keratinocytes (HKC), fibroblasts (HFB), and HaCaT cells were transfected using different concentrations of an adenoviral construct (eGFP). Transfection efficiency and cytotoxicity was determined up to 30 days. Expression was quantified by FACS analysis and fluorimeter. Cytotoxicity was measured using the trypan blue exclusion method. 45 male Sprague Dawley rats received 2x10(8) pfu of Ad5-CMV-LacZ or carrier control intradermally into either superficial partial thickness scald burn or unburned skin. Animals were euthanized after 48 h, 7 or 14 days posttreatment. Transgene expression was assessed using immunohistochemistry and bioluminescent assays. The highest transfection rate was observed 48 h posttransfection: 79% for HKC, 70% for HFB, and 48% for HaCaT. The eGFP expression was detectable in all groups over 30 days (P>0.05). Cytotoxic effects of the adenoviral vector were observed for HFB after 10 days and HaCaT after 30 days. Reporter gene expression in vivo was significantly higher in burned skin compared with unburned skin (P=0,004). Gene expression decreases from 2 to 7 days with no significant expression after 14 days. This study demonstrates that effective adenoviral-mediated gene transfer of epidermal primary cells and cell-lines is feasible. Ex vivo gene transfer in epithelial cells might have promise for the use in severely burned patients who receive autologous keratinocyte sheets. Transient cutaneous gene delivery in burn wounds using adenoviral vectors causes significant concentrations in the wound tissue for at least 1 week. Based on these findings, we hypothesize that transient cutaneous adenoviral gene delivery of wound healing promoting factors has

Reflective THz and MR imaging of burn wounds: a potential clinical validation of THz contrast mechanisms

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Bajwa, Neha; Nowroozi, Bryan; Sung, Shijun; Garritano, James; Maccabi, Ashkan; Tewari, Priyamvada; Culjat, Martin; Singh, Rahul; Alger, Jeffry; Grundfest, Warren; Taylor, Zachary

2012-10-01

Terahertz (THz) imaging is an expanding area of research in the field of medical imaging due to its high sensitivity to changes in tissue water content. Previously reported in vivo rat studies demonstrate that spatially resolved hydration mapping with THz illumination can be used to rapidly and accurately detect fluid shifts following induction of burns and provide highly resolved spatial and temporal characterization of edematous tissue. THz imagery of partial and full thickness burn wounds acquired by our group correlate well with burn severity and suggest that hydration gradients are responsible for the observed contrast. This research aims to confirm the dominant contrast mechanism of THz burn imaging using a clinically accepted diagnostic method that relies on tissue water content for contrast generation to support the translation of this technology to clinical application. The hydration contrast sensing capabilities of magnetic resonance imaging (MRI), specifically T2 relaxation times and proton density values N(H), are well established and provide measures of mobile water content, lending MRI as a suitable method to validate hydration states of skin burns. This paper presents correlational studies performed with MR imaging of ex vivo porcine skin that confirm tissue hydration as the principal sensing mechanism in THz burn imaging. Insights from this preliminary research will be used to lay the groundwork for future, parallel MRI and THz imaging of in vivo rat models to further substantiate the clinical efficacy of reflective THz imaging in burn wound care.

[The Nutrition Care of Severe Burn Patients].

Science.gov (United States)

Hsieh, Yu-Hsiu

2016-02-01

In addition to recent advances in burn patient care techniques such as maintaining warm circumambient temperature, the early excision of wounds, and the use of closed dressing, providing nutrition support through early feeding has proven instrumental in greatly increasing the survival rate of burn patients. Severe burns complicated by many factors initiate tremendous physiological stress that leads to postburn hypermetabolism that includes enhanced tissue catabolism, the loss of muscle mass, and decreases in the body's reservoirs of protein and energy. These problems have become the focus of burn therapy. Treating severe burns aims not only to enhance survival rates but also to restore normal bodily functions as completely as possible. Recent research evaluating the application of anabolic agents and immune-enhance formula for severe burns therapy has generated significant controversy. Inadequate caloric intake is one of the main differences among the related studies, with the effect of many special nutrients such as bran acid amides not taken into consideration. Therefore, considering the sufficiency of caloric and protein intake is critical in assessing effectiveness. Only after patients receive adequate calories and protein may the effect of special nutrients such as glutamine and supplements be evaluated effectively.

Effect of virgin fatty oil of Pistacia lentiscus on experimental burn wound's healing in rabbits.

Science.gov (United States)

Djerrou, Zouhir; Maameri, Z; Hamdi-Pacha, Y; Serakta, M; Riachi, F; Djaalab, H; Boukeloua, A

2010-04-03

This study aimed to assess the efficiency of the virgin fatty oil of Pistacia lentiscus (PLVFO) for burn wounds healing. It was carried out on 6 adult male New Zealand rabbits. Four burn wounds of deep third degree were made on the back of each animal. The first was not treated and served as control (CRL group); the others were covered immediately after burning procedure by 0.5g of one of the following products: Vaseline gel (VAS group), Madecassol(®) cream 1% (MAD group) or 1ml of PLVFO (PLVFO group). The treatments were repeated once daily until complete healing. For four days post burns, the percentage of wound contraction was assessed. Also, the different healing times were noted. The results showed that both PLVFO and Madecassol(®) significantly accelerated wound healing activity compared to wounds dressed with Vaseline and the untreated wounds. However, the level of wound contraction was significantly higher and the healing time was faster in PLVFO group than those of the MAD group, VAS group and CRL group. The different epithelization periods obtained in days were respectively: 30±3.94 (PLVFO group), 33.5±3.78 (MAD group), 34.66±3.88 (VAS group) and 37.16±3.54 (CRL group). We conclude that Pistacia lentiscus virgin fatty oil promotes significantly (p< 0.05) wound contraction and reduces epithelization period in rabbit model.

Antibacterial susceptibility of bacteria isolated from burns and wounds of cancer patients

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Sulaiman A. Alharbi

2014-01-01

Full Text Available In this study 540 burns and wound swabs were collected from cancer patients of some Egyptian hospitals. The single infection was detected from 210, and 70 cases among wounded and burned patients, while mixed infection was 30 and 45, respectively. We recovered where 60 isolates of Pseudomonas aeruginosa, 60 isolates of Staphylococcus aureus, 7 isolates of Staphylococcus epidermidis, 4 isolates of Streptococcus pyogenes, 25 isolates of Escherichia coli, 23 isolates of Klebsiella pneumoniae and 27 isolates of Proteus vulgaris from 355 burn and surgical wound infections . All bacterial isolates showed high resistance to the commonly used β-lactams (amoxycillin, cefaclor, ampicillin, vancomycin, amoxicillin/clavulonic, and low resistance to imepenim and ciprofloxacin. Plasmid analysis of six multidrug resistant and two susceptible bacterial isolates revealed the same plasmid pattern. This indicated that R-factor is not responsible for the resistance phenomenon among the isolated opportunistic bacteria. The effect of ultraviolet radiation on the isolated bacteria was studied.

[Surgical treatment of burns : Special aspects of pediatric burns].

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Bührer, G; Beier, J P; Horch, R E; Arkudas, A

2017-05-01

Treatment of pediatric burn patients is very important because of the sheer frequency of burn wounds and the possible long-term ramifications. Extensive burns need special care and are treated in specialized burn centers. The goal of this work is to present current standards in burn therapy and important innovations in the treatment of burns in children so that the common and small area burn wounds and scalds in pediatric patients in day-to-day dermatological practice can be adequately treated. Analysis of current literature, discussion of reviews, incorporation of current guidelines. Burns in pediatric patients are common. Improvement of survival can be achieved by treatment in burn centers. The assessment of burn depth and area is an important factor for proper treatment. We give an overview for outpatient treatment of partial thickness burns. New methods may result in better long-term outcome. Adequate treatment of burn injuries considering current literature and guidelines improves patient outcome. Rational implementation of new methods is recommended.

Utilisatiion of topical honey In Burns wounds contaminated with ...

African Journals Online (AJOL)

personal

suitable for bacterial infection as a result of low tissue perfusion and high protein content. ... Conclusion:The topical use of honey in deep burn wounds contaminated with pseudomonas ... voiced to Honey bee to lodge in mountains and.

Effect of green tea on the second degree burn wounds in rats

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Mohammad Javad Fatemi

2014-01-01

Full Text Available Background: Various studies indicate that the green tea has anti-inflammatory and anti-oxidative properties. Moreover, a few studies have been carried out that demonstrate beneficial effects of green tea on burned patients. Materials and Methods: In this study, green tea, Vaseline, and silver sulfadiazine dressings were used as first-aid treatment to deep dermal contact burns in rats, compared with a control of nothing. After creating second-degree burn on the dorsum of rats, the treatments were applied for 15 min in four groups. Wound dressing changes were daily. Macroscopic study was performed on days 1, 3, 7, and 14 by using a digital camera and software processing of photos. Microscopic examination was done by pathologic evaluation of skin specimens on day 14. Results: We observed that green tea usage significantly decreased burn size in comparison to the control group (P = 0.004. Conclusion: Green tea is effective on healing process of second degree burn wounds.

Improved wound care product

DEFF Research Database (Denmark)

2012-01-01

The present invention pertains to use of sodium diacetate (NaHAc 2) as an antimicrobial agent against bacteria growing in biofilms. The aspects of the invention include a wound care product comprising sodium diacetate, a kit comprising a wound care product,and a methodof treating an infected wound....

Multispectral imaging burn wound tissue classification system: a comparison of test accuracies between several common machine learning algorithms

Science.gov (United States)

Squiers, John J.; Li, Weizhi; King, Darlene R.; Mo, Weirong; Zhang, Xu; Lu, Yang; Sellke, Eric W.; Fan, Wensheng; DiMaio, J. Michael; Thatcher, Jeffrey E.

2016-03-01

The clinical judgment of expert burn surgeons is currently the standard on which diagnostic and therapeutic decisionmaking regarding burn injuries is based. Multispectral imaging (MSI) has the potential to increase the accuracy of burn depth assessment and the intraoperative identification of viable wound bed during surgical debridement of burn injuries. A highly accurate classification model must be developed using machine-learning techniques in order to translate MSI data into clinically-relevant information. An animal burn model was developed to build an MSI training database and to study the burn tissue classification ability of several models trained via common machine-learning algorithms. The algorithms tested, from least to most complex, were: K-nearest neighbors (KNN), decision tree (DT), linear discriminant analysis (LDA), weighted linear discriminant analysis (W-LDA), quadratic discriminant analysis (QDA), ensemble linear discriminant analysis (EN-LDA), ensemble K-nearest neighbors (EN-KNN), and ensemble decision tree (EN-DT). After the ground-truth database of six tissue types (healthy skin, wound bed, blood, hyperemia, partial injury, full injury) was generated by histopathological analysis, we used 10-fold cross validation to compare the algorithms' performances based on their accuracies in classifying data against the ground truth, and each algorithm was tested 100 times. The mean test accuracy of the algorithms were KNN 68.3%, DT 61.5%, LDA 70.5%, W-LDA 68.1%, QDA 68.9%, EN-LDA 56.8%, EN-KNN 49.7%, and EN-DT 36.5%. LDA had the highest test accuracy, reflecting the bias-variance tradeoff over the range of complexities inherent to the algorithms tested. Several algorithms were able to match the current standard in burn tissue classification, the clinical judgment of expert burn surgeons. These results will guide further development of an MSI burn tissue classification system. Given that there are few surgeons and facilities specializing in burn care

[Clinical study and pathological examination on the treatment of deep partial thickness burn wound with negative charge aerosol].

Science.gov (United States)

Li, Tian-zeng; Xu, Ying-bin; Hu, Xiao-gen; Shen, Rui; Peng, Xiao-dong; Wu, Wei-jiang; Luo, Lan; Dai, Xin-ming; Zou, Yong-tong; Qi, Shao-hai; Wu, Li-ping; Xie, Ju-lin; Deng, Xiao-xin; Chen, E; Zhang, Hui-Zhen

2005-08-01

To investigate the effect of negative charge aerosol (NCA) on the treatment of burn wound. Patients with superficial or deep partial thickness burn only were enrolled in the study, and they were randomly divided into trial group (T, including 180 cases of superficial thickness burn and 100 cases of deep partial thickness burn), control group (C, including 30 cases with superficial thickness burn and 30 with deep partial thickness burn), and self control group (SC, including 10 cases with superficial thickness burn and 10 with deep partial thickness burn). The patients in T and SC groups were treated with NCA for 1.5 hours, 1-2 times a day, from 6 postburn hour (PBH) to 2 postburn day (PBD), while those in C group received conventional treatment. For those in SC group, some of the wounds were covered with sterile schissel, while other wounds without schissel covering. The general changes in the wounds during NCA treatment were observed, and bacterial culture before and after NCA treatment was performed. The healing time was recorded and the blood biochemical parameters were determined. Rat model with deep partial thickness scald was established, and the rats were also divided into T and C groups, and received treatment as in human. Tissue samples were harvested from the wounds of rats in the 2 groups before and 1, 2, 3 weeks after treatment for pathological examination. There was no infection and little exudation in the patients in T group. No bacteria were found in the wound before and after NCA treatment. The healing time of the wounds of patients with superficial and deep partial thickness burn in T group was 6.3 +/- 1.6 d and 15.1 +/- 3.1 d, respectively, which was obviously shorter than those in C group (11.3 +/- 1.4 d and 21.2 +/- 1.4 d, P Negative charge aerosol is safe and effective in promoting wound healing of the patients with partial thickness burns.

The FLIR ONE thermal imager for the assessment of burn wounds: Reliability and validity study.

Science.gov (United States)

Jaspers, M E H; Carrière, M E; Meij-de Vries, A; Klaessens, J H G M; van Zuijlen, P P M

2017-11-01

Objective measurement tools may be of great value to provide early and reliable burn wound assessment. Thermal imaging is an easy, accessible and objective technique, which measures skin temperature as an indicator of tissue perfusion. These thermal images might be helpful in the assessment of burn wounds. However, before implementation of a novel measurement tool into clinical practice is considered, it is appropriate to test its clinimetric properties (i.e. reliability and validity). The objective of this study was to assess the reliability and validity of the recently introduced FLIR ONE thermal imager. Two observers obtained thermal images of burn wounds in adult patients at day 1-3, 4-7 and 8-10 after burn. Subsequently, temperature differences between the burn wound and healthy skin (ΔT) were calculated on an iPad mini containing the FLIR Tools app. To assess reliability, ΔT values of both observers were compared by calculating the intraclass correlation coefficient (ICC) and measurement error parameters. To assess validity, the ΔT values of the first observer were compared to the registered healing time of the burn wounds, which was specified into three categories: (I) ≤14 days, (II) 15-21 days and (III) >21 days. The ability of the FLIR ONE to discriminate between healing ≤21 days and >21 days was evaluated by means of a receiver operating characteristic curve and an optimal ΔT cut-off value. Reliability: ICCs were 0.99 for each time point, indicating excellent reliability up to 10 days after burn. The standard error of measurement varied between 0.17-0.22°C. the area under the curve was calculated at 0.69 (95% CI 0.54-0.84). A cut-off value of -1.15°C shows a moderate discrimination between burn wound healing ≤21 days and >21 days (46% sensitivity; 82% specificity). Our results show that the FLIR ONE thermal imager is highly reliable, but the moderate validity calls for additional research. However, the FLIR ONE is pre-eminently feasible

Wound Care Center of Excellence: A Process for Continuous Monitoring and Improvement of Wound Care Quality.

Science.gov (United States)

Howell, Raelina S; Kohan, Lauren S; Woods, Jon S; Criscitelli, Theresa; Gillette, Brian M; Donovan, Virginia; Gorenstein, Scott

2018-05-01

To provide information about a study using a new process for continuous monitoring to improve chronic wound care quality.This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.After completing this continuing education activity, you should be better able to:1. Recognize problems associated with chronic wound care.2. Identify methods used in this project to improve care.3. Illustrate the findings from this and similar projects and implications for providing improved wound care.Patients with chronic wounds require complex care because of comorbidities that can affect healing. Therefore, the goal of this project was to develop a system of reviewing all hospitalized patients seen by the study authors' wound care service on a weekly basis to decrease readmissions, morbidity, and mortality. Weekly multidisciplinary conferences were conducted to evaluate patient data and systematically assess for adherence to wound care protocols, as well as to create and modify patient care plans. This review of pathology and the performance of root-cause analyses often led to improved patient care.

Spatial frequency domain imaging of burn wounds in a preclinical model of graded burn severity

Science.gov (United States)

Nguyen, John Quan; Crouzet, Christian; Mai, Tuan; Riola, Kathleen; Uchitel, Daniel; Liaw, Lih-Huei; Bernal, Nicole; Ponticorvo, Adrien; Choi, Bernard; Durkin, Anthony J.

2013-06-01

Frequent monitoring of early-stage burns is necessary for deciding optimal treatment and management. Both superficial and full thickness burns are relatively easy to diagnose based on clinical observation. In between these two extremes are superficial-partial thickness and deep-partial thickness burns. These burns, while visually similar, differ dramatically in terms of clinical treatment and are known to progress in severity over time. The objective of this study was to determine the potential of spatial frequency domain imaging (SFDI) for noninvasively mapping quantitative changes in chromophore and optical properties that may be an indicative of burn wound severity. A controlled protocol of graded burn severity was developed and applied to 17 rats. SFDI data was acquired at multiple near-infrared wavelengths over a course of 3 h. Burn severity was verified using hematoxylin and eosin histology. From this study, we found that changes in water concentration (edema), deoxygenated hemoglobin concentration, and optical scattering (tissue denaturation) to be statistically significant at differentiating superficial partial-thickness burns from deep-partial thickness burns.

Potential Use of Essential Oil Isolated from Cleistocalyx operculatus Leaves as a Topical Dermatological Agent for Treatment of Burn Wound.

Science.gov (United States)

Tran, Gia-Buu; Le, Nghia-Thu Tram; Dam, Sao-Mai

2018-01-01

Several herbal remedies have been used as topical agents to cure burn wound, one of the most common injuries in worldwide. In this study, we investigated the potential use of Cleistocalyx operculatus essential oil to treat the burn wound. We identified a total of 13 bioactive compounds of essential oil, several of which exhibited the anti-inflammatory and antimicrobial activities. Furthermore, the essential oil showed the antibacterial effect against S. aureus but not with P. aeruginosa. The supportive effect of essential oil on burn wound healing process also has been proven. Among three groups of mice, wound contraction rate of essential oil treated group (100%) was significantly higher than tamanu oil treated (79%) and control mice (71%) after 20 days (0.22 ± 0.03 versus 0.31 ± 0.02 cm 2 , resp., p essential oil formed a complete epidermal structure, thick and neatly arranged fibers, and scattered immune cells in burn wound. On the contrary, saline treated burn wound formed uneven epidermal layer with necrotic ulcer, infiltration of immune cells, and existence of granulation tissue. This finding demonstrated Cleistocalyx operculatus essential oil as promising topical dermatological agent to treat burn wound.

The Effect of Lithospermum officinale, Silver Sulfadiazine and Alpha Ointments in Healing of Burn Wound Injuries in Rat.

Science.gov (United States)

Mohtasham Amiri, Zahra; Tanideh, Nader; Seddighi, Anahita; Mokhtari, Maral; Amini, Masood; Shakouri Partovi, Alborz; Manafi, Amir; Hashemi, Seyedeh Sara; Mehrabani, Davood

2017-09-01

Burn is the most devastating condition in emergency medicine leading to chronic disabilities. This study aimed to compare the effect of Lithospermum officinale , silver sulfadiazine and alpha ointments on healing of burn wounds in rat. Ninety-five rats were divided into 5 groups. Group 1 just underwent burn injury, and groups 2-5 received alpha ointment, silver sulfadiazine (SSD), gel base and L. officinale extract, respectively. A hot plate was used for induction of a standard 3 rd degree burn wound. Burn wounds were macroscopically and microscopically evaluated on days 7 th , 14 th and 21 st after burn induction. A decrease in the number of inflammatory cells was noted when L. officinale and SSD were applied while the most inflammatory response was seen after administration of alpha ointment. The number of macrophages alone decreased after burn injury, while the frequency was the most when L. officinale and alpha ointment were applied. Re-epithelialization, angiogenesis and formation of granulation tissue were the best in relation to L. officinale and alpha ointment while, the worst results belonged to burn injury group and SSD regarding granulation tissue formation. Considering histological assessment, the best results were observed for scoring of inflammation, re-epithelialization, angiogenesis, formation of granulation tissue and number of macrophage when L. officinale and alpha ointment were used after burn injury. It can be concluded that topical application of L. officinale as a non-toxic, inexpensive and easy to produce herbal can lead to a rapid epithelialization and wound healing and these findings can be added to the literature on burn wound healing.

The bio-positive effects of burned radioactive lantern mantle powder on the wound healing in rats

Energy Technology Data Exchange (ETDEWEB)

Mortazavi, S.M.J.; Rahmani, M.R.; Rahnama, A.; Rashidi-Nejad, H.R.; Ahmadi, J.; Aghaiee, M.M.; Behnejad, B. [Rafsanjan Univ. of Medical Sciences, (Iran, Islamic Republic of)

2006-07-01

Objective: Poor educated people in some parts of Iran use burned mantles as a wound healing powder to prevent the two main threats with the injuries, bleeding and the infection. Some lantern mantles contain low levels of radioactive thorium for maximizing the light output, while non-radioactive mantles contain yttrium. Although radioactive lantern mantles present a minimal radiation health hazard, it is generally believed when inhaled or ingested, thorium containing mantle powder, will be dangerous. To evaluate the effect of burned radioactive lantern mantles on wound healing this study was conducted. Materials and Methods: Twenty rats were divided randomly into two groups of 10 animals each. After inducing general anesthesia, full thickness excision wound was made on the dorsal neck in all animals. The 1. group received topical burned radioactive lantern mantle powder at 1-3 day after making excision wounds. The 2. group received non-radioactive lantern mantle powder at the same days. Accurate blind surface measurement of the wounds by transparency tracing was used for assessment of the wound healing at 1, 3, 7, 10 and 15 days after making wounds. Results: Surface area measurement of the wounds showed a progressive surface reduction in both groups. However, for thorium treated group, the rate of recovery was significantly enhanced compared to that of the control group. Although the wound area in the thorium group was not significantly different from that of the control group at the 3. and 5. days after wounding, a statistically significant difference was observed between the thorium and the control groups at the day 7, day 10 and day 15. The mean wound surface in thorium and control groups were 150.20{+-}15.87 and 186.37{+-}12.68 mm{sup 2} at day 7 (P<0.001), 92.90{+-}15.97 and 134.12{+-}14.19 mm{sup 2} at day 10 (P<0.001), 1.4{+-}0.41 and 8.56{+-}2.04 mm{sup 2} at day 15 after wounding, respectively (P<0.01) Conclusions: These findings suggest that low

Evaluation of phytochemicals, antioxidant and burn wound healing activities of Cucurbita moschata Duchesne fruit peel

Directory of Open Access Journals (Sweden)

Roodabeh Bahramsoltani

2017-07-01

Full Text Available Objective(s: Cucurbita moschata Duchesne (pumpkin is a well-known plant with several pharmacological effects. The aim of the present study was to assess burn wound healing activity of C. moschata peel extract (CE. Also, standardized CE was assessed for antioxidant activity and antibacterial effects against major pathogens of burns. Materials and Methods: Healing properties of topical preparation of 10% and 20% concentrations of CE were assessed on second degree burn in rats during a 14-day period as well as histological studies, total antioxidant power, lipid peroxidation and total thiol content of skin tissue samples. Results: Radical scavenging IC50 and ferric-reducing antioxidant power value were 4.015±0.20 mg/ml and 142.63±2.65 mmol Fe2+/g, respectively. Total mucilage content was 13.8%. The optimal results were obtained by 20% CE that showed 90.80±5.86 % wound closure and tissue repair as well as significant reduction of tissue oxidative stress biomarkers. Histological analyses confirmed wound healing activity of pumpkin peel extract. Conclusion: Considering the high mucilage content of the plant, providing a moist environment for wound, C. moschata peel extract could be a natural remedy for treatment of burns. Further clinical studies are suggested to confirm C. moschata peel extract as a wound healing agent.

Evaluation of phytochemicals, antioxidant and burn wound healing activities of Cucurbita moschata Duchesne fruit peel

Science.gov (United States)

Bahramsoltani, Roodabeh; Farzaei, Mohammad Hosein; Abdolghaffari, Amir Hossein; Rahimi, Roja; Samadi, Nasrin; Heidari, Mohammad; Esfandyari, Mohammadamin; Baeeri, Maryam; Hassanzadeh, Gholamreza; Abdollahi, Mohammad; Soltani, Saba; Pourvaziri, Ali; Amin, Gholamreza

2017-01-01

Objective(s): Cucurbita moschata Duchesne (pumpkin) is a well-known plant with several pharmacological effects. The aim of the present study was to assess burn wound healing activity of C. moschata peel extract (CE). Also, standardized CE was assessed for antioxidant activity and antibacterial effects against major pathogens of burns. Materials and Methods: Healing properties of topical preparation of 10% and 20% concentrations of CE were assessed on second degree burn in rats during a 14-day period as well as histological studies, total antioxidant power, lipid peroxidation and total thiol content of skin tissue samples. Results: Radical scavenging IC50 and ferric-reducing antioxidant power value were 4.015±0.20 mg/ml and 142.63±2.65 mmol Fe2+/g, respectively. Total mucilage content was 13.8%. The optimal results were obtained by 20% CE that showed 90.80±5.86 % wound closure and tissue repair as well as significant reduction of tissue oxidative stress biomarkers. Histological analyses confirmed wound healing activity of pumpkin peel extract. Conclusion: Considering the high mucilage content of the plant, providing a moist environment for wound, C. moschata peel extract could be a natural remedy for treatment of burns. Further clinical studies are suggested to confirm C. moschata peel extract as a wound healing agent. PMID:28852445

Biological Activity of Propolis-Honey Balm in the Treatment of Experimentally-Evoked Burn Wounds

Directory of Open Access Journals (Sweden)

Żaneta Jastrzębska-Stojko

2013-11-01

Full Text Available Medicines of biogenic origin with micro-organic, regenerative and analgesic properties are becoming more and more significant in the treatment of burn wounds. These properties are found in apitherapeutics such as propolis and honey—products collected and processed by a honey bee. Their effect on the course of the healing processes is multidirectional. The aim of the study was a histopathological and biochemical analysis of the processes of scar formation in experimentally evoked burn wounds in white pigs treated with the 1% and 3% Sepropol balms containing standardized extracts of propolis and honey. The results were compared with the therapeutic effects obtained with dermazin cream (1% silver sulfadiazine. The level of collagen was determined in the wounds treated with 1% and 3% Sepropol and compared with the collagen level in healthy skin and wounds treated with dermazin. Granulation and regenerated epithelium formation times were compared, with the 3% Sepropol being by far the most effective. The 3% Sepropol also increased the collagen level to 116% with the control sub-groups scoring between 80% and 98%. The results show the healing process of burn wounds in pigs treated with the Sepropol balm starts earlier and has a faster course than the standard dermazin therapy.

Thermal injury induces impaired function in polymorphonuclear neutrophil granulocytes and reduced control of burn wound infection

DEFF Research Database (Denmark)

Calum, H.; Moser, C.; Jensen, P. O.

2009-01-01

Severe thermal injury induces immunosuppression, involving all parts of the immune system, especially when large fractions of the total body surface area are affected. An animal model was established to characterize the burn-induced immunosuppression. In our novel mouse model a 6% third-degree burn...... injury was induced in mice with a hot-air blower. The third-degree burn was confirmed histologically. The mice were allocated into five groups: control, shave, burn, infection and burn infection group. At 48 h, a decline in the concentration of peripheral blood leucocytes was observed in the group...... of mice with burn wound. The reduction was ascribed to the decline in concentration of polymorphonuclear neutrophil leucocytes and monocytes. When infecting the skin with Pseudomonas aeruginosa, a dissemination of bacteria was observed only in the burn wound group. Histological characterization...

Effects of Minoxidil Gel on Burn Wound Healing in Rats

OpenAIRE

Khazaeli, Payam; Karamouzian, Mohammad; Rohani, Shohreh; Sadeghirad, Behnam; Ghalekhani, Nima

2014-01-01

Minoxidil has been reported to inhibit in-vitro fibroblast proliferation and lysyl hydroxylase activity, a key enzyme in collagen biosynthesis. These in-vitro effects proposed minoxidil to be a potential antifibrotic agent. The present study aimed to investigate the effects of minoxidil gel on wound healing procedure in a second-degree burn model in rats. Wistar rats were anesthetized and a second-degree burn was induced on the back of Wistar rats using a heated 2 cm diameter metal plate. Exp...

Evolution of Burn Resuscitation in Operation Iraqi Freedom

National Research Council Canada - National Science Library

Chung, Kevin K; Blackbourne, Lorne H; Wolf, Steven E; White, Chrsitopher E; Renz, Evan M; Cancio, Leopoldo C; Holcomb, John B; Barillo, David J

2006-01-01

... of the burn resuscitation. Critical advances in air evacuation of the war wounded, thorough prewar planning, and sustained burn care education of deployed personnel have proven vital in the optimal care of our injured soldiers...

The Healing Effect of Sesame Oil, Camphor and Honey on Second Degree Burn Wounds in Rat.

Science.gov (United States)

Vaghardoost, Reza; Mousavi Majd, Seyed GholamReza; Tebyanian, Hamid; Babavalian, Hamid; Malaei, Leila; Niazi, Mitra; Javdani, Ali

2018-01-01

Many studies were carried out to improve sophisticated dressings to accelerate healing processes and reduce the microbial burden in burn wounds. This study evaluated the healing effect of herbal ointment containing extract of sesame oil, camphor and honey on second degree burn wounds in rats in comparison with daily dressing oil vaseline. Forty rats were randomly assigned to two equal groups. A deep second degree burn was formed on the back of each rat with using a standard burning technique. The burns were dressed daily with herbal ointment containing extract of sesame oil, camphor and honey in group 1, dressing oil vaseline in group 2. The response to treatment was evaluated by digital photography during the treatment on 0, 7, 14, 21, 28 days. Histological scoring was undertaken for scar tissue samples on 0, 7, 14, 21, 28 days. Considerable epithelization in the herbal ointment group vs. the control group over the study period was noted. Neovascularization was significantly higher in herbal ointment treated rats as well. In terms of difference of wound surface area, maximal healing was noticed in herbal ointment extract of sesame oil, camphor and honey group and the minimal repair in the control group. The greatest rate of healing was in the herbal ointment group containing sesame oil, camphor and honey, so the herbal ointment as a suitable substitute for dressing and healing of burn wound injuries is recommended.

[The results of delivering surgical care to the wounded and sick in military medical establishments and impending tasks].

Science.gov (United States)

Briusov, P G; Efimenko, N A

1997-07-01

In article results of activity of the military surgeons on rendering of the surgical care to wounded and sick in 1996 are analyzed. During combat actions in Chechnya despite of severe forms of wounds and significant increase of combined battle traumas lethality among heavy wounded was reduced in 2 times. At common lethality rate in 1.3%, in hospitals from wounds 1.5% of wounded died, from traumas--0.7%, burns--2.9%, frostbitten--0.5%. As to peace time surgery, the analysis of main parameters of surgical work in military medical establishments, structure of diseases of servicemen, surgical activity, average terms of treatment, lethality after operations, defects in rendering of the surgical care is given. In conclusions the authors say about problems, that the military surgeons have today.

Wound-healing Activity of Zanthoxylum bungeanum Maxim Seed Oil on Experimentally Burned Rats.

Science.gov (United States)

Li, Xiao-Qiang; Kang, Rong; Huo, Jun-Cheng; Xie, Yan-Hua; Wang, Si-Wang; Cao, Wei

2017-01-01

The seed oil of Zanthoxylum bungeanum Maxim (ZBSO) is considered to be rich source of fatty acids, mainly oleic and linoleic acids, and has been used for the treatment of burns in Chinese medicine. We evaluated the healing efficacy of ZBSO and explored its possible mechanism on scalded rats. Sprague-Dawley rat models with deep second-degree burns were set up, and ZBSO (500 and 1000 μl/wound) was topically applied twice daily for 7 days and then once daily until wound healing. The therapeutic effects of ZBSO were evaluated by observing wound closure time, decrustation time, wound-healing ratio, and pathological changes. Collagen type-III, matrix metalloproteinase-2 (MMP-2), MMP-9, phospho-nuclear factor-κB (p-NF-κB) p65, inhibitor of NF-κB subunit α p-IκBα, and inhibitor of NF-κB subunit α (IκBα) expression were determined using Western blotting. The ZBSO-treated group showed a higher wound-healing ratio and shorter decrustation and wound closure times than the untreated group. The topical application of ZBSO increased collagen synthesis as evidenced by an increase in hydroxyproline level and upregulated expression of collagen type-III on days 7, 14, and 21 posttreatment. A reduction in MMP-2 and MMP-9 expressions also confirmed the collagen formation efficacy of ZBSO. Furthermore, there was a significant increase in superoxide dismutase levels and a decrease in malondialdehyde levels in ZBSO-treated wounds. ZBSO also decreased tumor necrosis factor alpha, interleukin-1 (IL-1) β, and IL-6 levels in serum, upregulated IκBα, and downregulated p-NF-κB p65 and p-IκBα expression in vivo , indicating the anti-inflammatory action of ZBSO. ZBSO has significant potential to treat burn wounds by accelerating collagen synthesis and the anti-inflammatory cascade of the healing process. The seed oil of Zanthoxylum bungeanum Maxim (ZBSO) is rich of fatty acidsThe healing efficacy of ZBSO on experimentally scalded rats was evaluatedZBSO has significant potential

Adenoviral Gene Delivery to Primary Human Cutaneous Cells and Burn Wounds

OpenAIRE

Hirsch, Tobias; von Peter, Sebastian; Dubin, Grzegorz; Mittler, Dominik; Jacobsen, Frank; Lehnhardt, Markus; Eriksson, Elof; Steinau, Hans-Ulrich; Steinstraesser, Lars

2006-01-01

The adenoviral transfer of therapeutic genes into epidermal and dermal cells is an interesting approach to treat skin diseases and to promote wound healing. The aim of this study was to assess the in vitro and in vivo transfection efficacy in skin and burn wounds after adenoviral gene delivery. Primary keratinocytes (HKC), fibroblasts (HFB), and HaCaT cells were transfected using different concentrations of an adenoviral construct (eGFP). Transfection efficiency and cytotoxicity was determine...

A qualitative exploration of psychosocial specialists' experiences of providing support in UK burn care services.

Science.gov (United States)

Guest, Ella; Griffiths, Catrin; Harcourt, Diana

2018-01-01

A burn can have a significant and long-lasting psychosocial impact on a patient and their family. The National Burn Care Standards (2013) recommend psychosocial support should be available in all UK burn services; however, little is known about how it is provided. The current study aimed to explore experiences of psychosocial specialists working in UK burn care, with a focus on the challenges they experience in their role. Semi-structured telephone interviews with eight psychosocial specialists (two psychotherapists and six clinical psychologists) who worked within UK burn care explored their experiences of providing support to patients and their families. Thematic analysis revealed two main themes: burn service-related experiences and challenges reflected health professionals having little time and resources to support all patients; reduced patient attendance due to them living large distances from service; psychosocial appointments being prioritised below wound-related treatments; and difficulties detecting patient needs with current outcome measures. Therapy-related experiences and challenges outlined the sociocultural and familial factors affecting engagement with support, difficulties treating patients with pre-existing mental health conditions within the burn service and individual differences in the stage at which patients are amenable to support. Findings provide an insight into the experiences of psychosocial specialists working in UK burn care and suggest a number of ways in which psychosocial provision in the NHS burn service could be developed.

An unusual electrical burn caused by alkaline batteries

Directory of Open Access Journals (Sweden)

Tyng-Luen Roan

2015-02-01

Full Text Available Electrical burns caused by low-voltage batteries are rarely reported. We recently encountered a male patient who suffered from a superficial second-degree burn over his left elbow and back. The total body surface area of the burn was estimated to be 6%. After interviewing the patient, the cause was suspected to be related to the explosion of a music player on the left-side of his waist, carried on his belt while he was painting a bathroom wall. Elevated creatine kinase levels and hematuria indicated rhabdomyolysis and suggested an electrical burn. Initial treatment was done in the burn intensive care unit with fluid challenge and wound care. The creatine kinase level decreased gradually and the hematuria was gone after 4 days in the intensive care unit. He was then transferred to the general ward for further wound management and discharged from our burn center after a total of 11 days without surgical intervention.

Quantitative assessment of graded burn wounds using a commercial and research grade laser speckle imaging (LSI) system

Science.gov (United States)

Ponticorvo, A.; Rowland, R.; Yang, B.; Lertsakdadet, B.; Crouzet, C.; Bernal, N.; Choi, B.; Durkin, A. J.

2017-02-01

Burn wounds are often characterized by injury depth, which then dictates wound management strategy. While most superficial burns and full thickness burns can be diagnosed through visual inspection, clinicians experience difficulty with accurate diagnosis of burns that fall between these extremes. Accurately diagnosing burn severity in a timely manner is critical for starting the appropriate treatment plan at the earliest time points to improve patient outcomes. To address this challenge, research groups have studied the use of commercial laser Doppler imaging (LDI) systems to provide objective characterization of burn-wound severity. Despite initial promising findings, LDI systems are not commonplace in part due to long acquisition times that can suffer from artifacts in moving patients. Commercial LDI systems are being phased out in favor of laser speckle imaging (LSI) systems that can provide similar information with faster acquisition speeds. To better understand the accuracy and usefulness of commercial LSI systems in burn-oriented research, we studied the performance of a commercial LSI system in three different sample systems and compared its results to a research-grade LSI system in the same environments. The first sample system involved laboratory measurements of intralipid (1%) flowing through a tissue simulating phantom, the second preclinical measurements in a controlled burn study in which wounds of graded severity were created on a Yorkshire pig, and the third clinical measurements involving a small sample of clinical patients. In addition to the commercial LSI system, a research grade LSI system that was designed and fabricated in our labs was used to quantitatively compare the performance of both systems and also to better understand the "Perfusion Unit" output of commercial systems.

The value of WhatsApp communication in paediatric burn care.

Science.gov (United States)

Martinez, R; Rogers, A D; Numanoglu, A; Rode, H

2018-06-01

Telemedicine is increasingly applied in developed settings to facilitate transfer of information to and from burn surgeons across vast geographic areas. WhatsApp is a widely available and extremely user-friendly encrypted smartphone application that does not require the expensive physical and personnel infrastructure that characterizes many of these telemedicine systems. The aim of this study was to review the use of WhatsApp to facilitate paediatric burn injury consultations to a regional burn centre in a developing country, where burn care continues to be thwarted by administrative apathy, poor resource allocation and lack of attention to medical and nursing education at all levels. A retrospective review was undertaken of all consultations using WhatsApp over an 18-month period, received by the burn centre's two senior medical practitioners. The specific origin and nature of the telemedicine requests for advice, transfer or follow-up were collected, as were data relating to the demographics of the patients, the aetiology, mechanism and extent of the burn injury. The impact of the system of communication in terms of reductions in admissions and clinic visits was assessed, and a cost analysis was undertaken. Feedback was also obtained from those health practitioners regularly using the service. 838 communications occurred during the study period, which included 1562 distinct clinical queries. 486 interactions (58%) originated from within the hospital, the majority of which were initiated by surgeons in training or burn nurse practitioners. 352 (42%) consultations were from outside the hospital. Queries related to the full spectrum of burn care, including emergency management and stabilization, triage and transfer, the need for escharotomy, fluid resuscitation, wound care, the timing and nature of surgical intervention, as well as follow-up and rehabilitation. While no significant changes in the number of surgical interventions or admissions were observed when

Effects of burn wound excision on bacterial colonization and invasion

NARCIS (Netherlands)

Barret, JP; Herndon, DN

Rates of survival after thermal injury have improved in the past two decades, and rates of wound infections and sepsis have decreased during the same period. Early excision has been advocated as one of the major factors, but its safety and efficacy and the exact timing of burn excision are still

The role of PRP and adipose tissue-derived keratinocytes on burn wound healing in diabetic rats.

Science.gov (United States)

Hosseini Mansoub, Navid; Gürdal, Mehmet; Karadadaş, Elif; Kabadayi, Hilal; Vatansever, Seda; Ercan, Gulinnaz

2018-01-01

Introduction: Diabetic burn wounds and ulcers are significant complications of diabetic patients. The aim of this study is to investigate the use of platelet rich-plasma (PRP) and/or keratinocyte-like cells (KLCs) in diabetic thermal wound rat model and to evaluate EGF, FGF-2, TGF-β1, COL1α2, MCP-1 and VEGF-α as wound healing markers at gene expression level. Method: In this study, we used adipose tissue as the source of mesenchymal stem cells (MSCs) and differentiated MSCs into KLCs. KLCs were characterized and transferred to the burn areas on the dorsum of streptozotocine (STZ)-induced diabetic rats. We prepared PRP from rat blood and evaluated its effect alone or in combination with KLCs. On 3 rd , 7 th , 10 th and 14 th days after treatment, wound areas were measured and biopsy samples were excised from the wound areas of the KLCs and/or PRP-treated and untreated diabetic rats to analyze gene expression levels of wound healing markers by qPCR. Results: We observed that, wound contraction started earlier in the PRP and/or KLCs-treated groups in comparison to the control group. However, PRP and KLCs when applied in combination showed additive affect in wound healing. In all groups treated with KLCs and/or PRP, the gene expression levels of evaluated growth factors and COL1α2 increased, while MCP-1 levels decreased when compared to the untreated diabetic rats. In addition, the most prominent difference in qPCR results belongs to combined PRP and KLCs-treated group. Conclusion: We demonstrated that applying PRP and KLCs in combination has a greater potential for treatment of diabetic burn wounds.

Temporal expression of wound healing-related genes in skin burn injury.

Science.gov (United States)

Kubo, Hidemichi; Hayashi, Takahito; Ago, Kazutoshi; Ago, Mihoko; Kanekura, Takuro; Ogata, Mamoru

2014-01-01

Determination of the age of burns, as well as of wounds induced mechanically, is essential in forensic practice, particularly in cases of suspected child abuse. Here, we investigated temporal changes in the expression of 13 genes during wound healing after a burn. The expression of cytokines (IL-1β, IL-6, IL-10, TNF-α, and IFN-γ), chemokines (KC, MCP-1), proliferative factors (TGF-β, VEGF), proteases (MMP-2, 9, 13) and type I collagen in murine skin was examined by real-time PCR at 3, 6, 9, and 12 h and 1, 2, 3, 5, 7, and 14 days after a burn. Based on macroscopic and histological appearance, the healing process of a burn consists of 3 phases: inflammatory (from 3 h to 1 day after the burn), proliferative (from 1 to 7 days), and maturation (from 7 to 14 days). Expression of IL-1β, IL-6, TNF-α, IFN-γ and KC increased significantly in a biphasic pattern from 3 or 6 h to 12 h or 1 day and from 3 or 5 days to 7 days. Expression of MCP-1 increased significantly from 6 h to 5 days. Expression of both IL-10 and TGF-β increased significantly from 12 h to 7 days. Expression of VEGF, MMP-2, MMP-13 and type I collagen increased significantly from 3 days to 7 or 14 days. Expression of MMP-9 increased significantly from 6 h to 14 days. Our results suggest that evaluating the expression of a combination of these genes would enable the exact estimation of the age of a burn. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Superiority of terahertz over infrared transmission through bandages and burn wound ointments

International Nuclear Information System (INIS)

Suen, Jonathan Y.; Padilla, Willie J.

2016-01-01

Terahertz electromagnetic waves have long been proposed to be ideal for spectroscopy and imaging through non-polar dielectric materials that contain no water. Terahertz radiation may thus be useful for monitoring burn and wound injury recovery, as common care treatments involve application of both a clinical dressing and topical ointment. Here, we investigate the optical properties of typical care treatments in the millimeter wave (150–300 GHz), terahertz (0.3–3 THz), and infrared (14.5–0.67 μm) ranges of the electromagnetic spectrum. We find that THz radiation realizes low absorption coefficients and high levels of transmission compared to infrared wavelengths, which were strongly attenuated. Terahertz imaging can enable safe, non-ionizing, noninvasive monitoring of the healing process directly through clinical dressings and recovery ointments, minimizing the frequency of dressing changes and thus increasing the rate of the healing process.

Superiority of terahertz over infrared transmission through bandages and burn wound ointments

Energy Technology Data Exchange (ETDEWEB)

Suen, Jonathan Y., E-mail: j.suen@duke.edu; Padilla, Willie J. [Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina 27708 (United States)

2016-06-06

Terahertz electromagnetic waves have long been proposed to be ideal for spectroscopy and imaging through non-polar dielectric materials that contain no water. Terahertz radiation may thus be useful for monitoring burn and wound injury recovery, as common care treatments involve application of both a clinical dressing and topical ointment. Here, we investigate the optical properties of typical care treatments in the millimeter wave (150–300 GHz), terahertz (0.3–3 THz), and infrared (14.5–0.67 μm) ranges of the electromagnetic spectrum. We find that THz radiation realizes low absorption coefficients and high levels of transmission compared to infrared wavelengths, which were strongly attenuated. Terahertz imaging can enable safe, non-ionizing, noninvasive monitoring of the healing process directly through clinical dressings and recovery ointments, minimizing the frequency of dressing changes and thus increasing the rate of the healing process.

Wound healing and all-cause mortality in 958 wound patients treated in home care

DEFF Research Database (Denmark)

Zarchi, Kian; Martinussen, Torben; Jemec, Gregor B. E.

2015-01-01

to investigate wound healing and all-cause mortality associated with different types of skin wounds. Consecutive skin wound patients who received wound care by home-care nurses from January 2010 to December 2011 in a district in Eastern Denmark were included in this study. Patients were followed until wound...... healing, death, or the end of follow-up on December 2012. In total, 958 consecutive patients received wound care by home-care nurses, corresponding to a 1-year prevalence of 1.2% of the total population in the district. During the study, wound healing was achieved in 511 (53.3%), whereas 90 (9.4%) died...

Comparison of Laser Doppler Imaging (LDI) and clinical assessment in differentiating between superficial and deep partial thickness burn wounds.

Science.gov (United States)

Jan, Saadia Nosheen; Khan, Farid Ahmed; Bashir, Muhammad Mustehsan; Nasir, Muneeb; Ansari, Hamid Hussain; Shami, Hussan Birkhez; Nazir, Umer; Hanif, Asif; Sohail, Muhammad

2018-03-01

To compare the accuracy of Laser Doppler Imaging (LDI) and clinical assessment in differentiating between superficial and deep partial thickness burns to decide whether early tangential excision and grafting or conservative management should be employed to optimize burn and patient management. March 2015 to November 2016. Ninety two wounds in 34 patients reporting within 5days of less than 40% burn surface area were included. Unstable patients, pregnant females and those who expired were excluded. The wounds were clinically assessed and LDI done concomitantly Plastic Surgeons blinded to each other's findings. Wound appearance, color, blanching, pain, hair follicle dislodgement were the clinical parameters that distinguished between superficial and deep partial thickness burns. On day 21, the wounds were again assessed for the presence of healing by the same plastic surgeons. The findings were correlated with the initial findings on LDI and clinical assessment and the results statistically analyzed. The data of 92 burn wounds was analyzed using SPSS (ver. 17). Clinical assessment correctly identified the depth of 75 and LDI 83 wounds, giving diagnostic accuracies of 81.52% and 90.21% respectively. The sensitivity of clinical assessment was 81% and of LDI 92.75%, whereas the specificity was 82% for both. The positive predictive value was 93% for clinical assessment and 94% for LDI while the negative predictive value was 59% and 79% respectively. Predictive accuracy of LDI was found to be better than clinical assessment in the prediction of wound healing, the gold standard for wound healing being 21 days. As such it can prove to be a reliable and viable cost effective alternative per se to clinical assessment. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Wound Healing and Care

Science.gov (United States)

... Safe Videos for Educators Search English Español Wound Healing and Care KidsHealth / For Teens / Wound Healing and ... open to heal through natural scar formation. The Healing Process Before healing begins, the body gears up ...

Role of Daptomycin on Burn Wound Healing in an Animal Methicillin-Resistant Staphylococcus aureus Infection Model.

Science.gov (United States)

Simonetti, Oriana; Lucarini, Guendalina; Orlando, Fiorenza; Pierpaoli, Elisa; Ghiselli, Roberto; Provinciali, Mauro; Castelli, Pamela; Guerrieri, Mario; Di Primio, Roberto; Offidani, Annamaria; Giacometti, Andrea; Cirioni, Oscar

2017-09-01

Prolonged hospitalization and antibiotic therapy are risk factors for the development of methicillin-resistant Staphylococcus aureus (MRSA) infections in thermal burn patients. We used a rat model to study the in vivo efficacy of daptomycin in the treatment of burn wound infections by S. aureus , and we evaluated the wound healing process through morphological and immunohistochemical analysis. A copper bar heated in boiling water was applied on a paraspinal site of each rat, resulting in two full-thickness burns. A small gauze was placed over each burn and inoculated with 5 × 10 7 CFU of S. aureus ATCC 43300. The study included two uninfected control groups with and without daptomycin treatment, an infected control group that did not receive any treatment, and two infected groups treated, respectively, with intraperitoneal daptomycin and teicoplanin. The main outcome measures were quantitative culture, histological evaluation of tissue repair, and immunohistochemical expression of wound healing markers: epidermal growth factor receptor (EGFR) and fibroblast growth factor 2 (FGF-2). The highest inhibition of infection was achieved in the group that received daptomycin, which reduced the bacterial load from 10 7 CFU/ml to about 10 3 CFU/g ( P repair by possibly reducing hypertrophic burn scar formation. Copyright © 2017 American Society for Microbiology.

Therapeutic effects of zerumbone in an alkali-burned corneal wound healing model.

Science.gov (United States)

Kim, Jong Won; Jeong, Hyuneui; Yang, Myeon-Sik; Lim, Chae Woong; Kim, Bumseok

2017-07-01

Cornea is an avascular transparent tissue. Ocular trauma caused by a corneal alkali burn induces corneal neovascularization (CNV), inflammation, and fibrosis, leading to vision loss. The purpose of this study was to examine the effects of Zerumbone (ZER) on corneal wound healing caused by alkali burns in mice. CNV was induced by alkali-burn injury in BALB/C female mice. Topical ZER (three times per day, 3μl each time, at concentrations of 5, 15, and 30μM) was applied to treat alkali-burned mouse corneas for 14 consecutive days. Histopathologically, ZER treatment suppressed alkali burn-induced CNV and decreased corneal epithelial defects induced by alkali burns. Corneal tissue treated with ZER showed reduced mRNA levels of pro-angiogenic genes, including vascular endothelial growth factor, matrix metalloproteinase-2 and 9, and pro-fibrotic factors such as alpha smooth muscle actin and transforming growth factor-1 and 2. Immunohistochemical analysis demonstrated that the infiltration of F4/80 and/or CCR2 positive cells was significantly decreased in ZER-treated corneas. ZER markedly inhibited the mRNA and protein levels of monocyte chemoattractant protein-1 (MCP-1) in human corneal fibroblasts and murine peritoneal macrophages. Immunoblot analysis revealed that ZER decreased the activation of signal transducer and activator of transcription 3 (STAT3), with consequent reduction of MCP-1 production by these cells. In conclusion, topical administration of ZER accelerated corneal wound healing by inhibition of STAT3 and MCP-1 production. Copyright © 2017. Published by Elsevier B.V.

Bioengineering methods employed in the study of wound healing of sulphur mustard burns.

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Graham, John S; Schomacker, Kevin T; Glatter, Robert D; Briscoe, Crystal M; Braue, Ernest H; Squibb, Katherine S

2002-02-01

Sulphur mustard (SM) is a potent incapacitating chemical warfare agent that remains a threat to war fighters and civilians worldwide. SM lesions may require weeks or months to heal, depending upon their severity. This study was undertaken to find a treatment regimen that promotes speedier healing of deep cutaneous SM burns in a weanling pig model. The principal objective of the study was to compare four treatment regimens and establish which achieved the shortest healing time. Twelve Yorkshire Cross weanling pigs were exposed to SM liquid for 2h, generating six large deep dermal/full thickness burns on the ventrum of each animal. Three additional animals served as sham-exposed controls. Surgical intervention occurred at 48 h postexposure. Treatments included: (i) full-thickness debridement of the burns with a computer controlled, raster scanned continuous wave CO2 laser followed by autologous split-thickness skin grafting; (ii) full-thickness sharp surgical tangential excision followed by skin grafting, the 'Gold Standard' used in human deep dermal/full-thickness thermal burns management; (iii) partial-thickness laser ablation with no grafting; and (iv) partial-thickness sharp surgical excision with no grafting. Several non-invasive bioengineering methods were used to monitor the progress of wound healing throughout a 36-day healing period: reflectance colourimetry, evaporimetry, laser Doppler perfusion imaging and ballistometry. Bioengineering methods indicated that laser debridement followed by autologous split-thickness skin grafting was as efficacious in improving the wound healing of deep SM burns in weanling swine as the 'Gold Standard.' Regardless of the method of debridement, barrier function, skin colour and mechanical properties returned to near-normal levels within 15 days of treatment in the grafted sites. Regardless of surgical approach, blood flux levels remained approximately 50-60% of normal tissue throughout the 36-day postsurgical observation

The Future of Data-Driven Wound Care.

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Woods, Jon S; Saxena, Mayur; Nagamine, Tasha; Howell, Raelina S; Criscitelli, Theresa; Gorenstein, Scott; M Gillette, Brian

2018-04-01

Care for patients with chronic wounds can be complex, and the chances of poor outcomes are high if wound care is not optimized through evidence-based protocols. Tracking and managing every variable and comorbidity in patients with wounds is difficult despite the increasing use of wound-specific electronic medical records. Harnessing the power of big data analytics to help nurses and physicians provide optimized care based on the care provided to millions of patients can result in better outcomes. Numerous applications of machine learning toward workflow improvements, inpatient monitoring, outpatient communication, and hospital operations can improve overall efficiency and efficacy of care delivery in and out of the hospital, while reducing adverse events and complications. This article provides an overview of the application of big data analytics and machine learning in health care, highlights important recent advances, and discusses how these technologies may revolutionize advanced wound care. © AORN, Inc, 2018.

Antibacterial properties of tualang honey and its effect in burn wound management: a comparative study

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Nasir Nur-Azida

2010-06-01

Full Text Available Abstract Background The use of honey as a natural product of Apis spp. for burn treatment has been widely applied for centuries. Tualang honey has been reported to have antibacterial properties against various microorganisms, including those from burn-related diagnoses, and is cheaper and easier to be absorbed by Aquacel dressing. The aim of this study is to evaluate the potential antibacterial properties of tualang honey dressing and to determine its effectiveness as a partial thickness burn wound dressing. Methods In order to quantitate the bioburden of the swabs, pour plates were performed to obtain the colony count (CFU/ml. Swabs obtained from burn wounds were streaked on blood agar and MacConkey agar for bacterial isolation and identification. Later, antibacterial activity of Aquacel-tualang honey, Aquacel-Manuka honey, Aquacel-Ag and Aquacel- plain dressings against bacteria isolated from patients were tested (in-vitro to see the effectiveness of those dressings by zone of inhibition assays. Results Seven organisms were isolated. Four types of Gram-negative bacteria, namely Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas spp. and Acinetobacter spp., and three Gram-positive bacteria, namely Staphylococcus aureus, coagulase-negative Staphylococcus aureus (CONS and Streptococcus spp., were isolated. Total bacterial count decreased on day 6 and onwards. In the in-vitro antibacterial study, Aquacel-Ag and Aquacel-Manuka honey dressings gave better zone of inhibition for Gram positive bacteria compared to Aquacel-Tualang honey dressing. However, comparable results were obtained against Gram negative bacteria tested with Aquacel-Manuka honey and Aquacel-Tualang honey dressing. Conclusions Tualang honey has a bactericidal as well as bacteriostatic effect. It is useful as a dressing, as it is easier to apply and is less sticky compared to Manuka honey. However, for Gram positive bacteria, tualang honey is not as effective as usual care

Bacterial isolates from burn wound infections and their antibiograms: A eight-year study

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Mehta Manjula

2007-01-01

Full Text Available Background: Infection is an important cause of mortality in burns. Rapidly emerging nosocomial pathogens and the problem of multi-drug resistance necessitates periodic review of isolation patterns and antibiogram in the burn ward. Aim: Keeping this in mind, the present retrospective study from wounds of patients admitted to burns unit was undertaken to determine the bacteriological profile and the resistance pattern from the burn ward over a period of three years (June 2002 to May 2005 and was compared with the results obtained during the previous five years (June 1997-May 2002, to ascertain any change in the bacteriological profile and antimicrobial resistance pattern. Materials and Methods: Bacterial isolates from 268 wound swabs taken from burn patients were identified by conventional biochemical methods and antimicrobial susceptibility was performed. Statistical comparison of bacterial isolates and their resistance pattern with previous five years data was done using c2 test. Results and Conclusions: During the period from 2002 to 2005 Pseudomonas species was the commonest pathogen isolated (51.5% followed by Acinetobacter species (14.28%, Staph. aureus (11.15%, Klebsiella species (9.23% and Proteus species (2.3%. When compared with the results of the previous five years i.e., 1997 to 2002, Pseudomonas species was still the commonest pathogen in the burns unit. However, the isolation of this organism and other gram-negative organisms had decreased in comparison to previous years. Newer drugs were found to be effective.

Acute pain management in burn patients

DEFF Research Database (Denmark)

Gamst-Jensen, Hejdi; Vedel, Pernille Nygaard; Lindberg-Larsen, Viktoria Oline

2014-01-01

OBJECTIVE: Burn patients suffer excruciating pain due to their injuries and procedures related to surgery, wound care, and mobilization. Acute Stress Disorder, Post-Traumatic Stress Disorder, chronic pain and depression are highly prevalent among survivors of severe burns. Evidence-based pain...... patients. The most highly recommended guidelines provided clear and accurate recommendations for the nursing and medical staff on pain management in burn patients. We recommend the use of a validated appraisal tool such as the AGREE instrument to provide more consistent and evidence-based care to burn...

Body protective compound-157 enhances alkali-burn wound healing in vivo and promotes proliferation, migration, and angiogenesis in vitro

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Huang, Tonglie; Zhang, Kuo; Sun, Lijuan; Xue, Xiaochang; Zhang, Cun; Shu, Zhen; Mu, Nan; Gu, Jintao; Zhang, Wangqian; Wang, Yukun; Zhang, Yingqi; Zhang, Wei

2015-01-01

Chemical burns take up a high proportion of burns admissions and can penetrate deep into tissues. Various reagents have been applied in the treatment of skin chemical burns; however, no optimal reagent for skin chemical burns currently exists. The present study investigated the effect of topical body protective compound (BPC)-157 treatment on skin wound healing, using an alkali burn rat model. Topical treatment with BPC-157 was shown to accelerate wound closure following an alkali burn. Histological examination of skin sections with hematoxylin–eosin and Masson staining showed better granulation tissue formation, reepithelialization, dermal remodeling, and a higher extent of collagen deposition when compared to the model control group on the 18th day postwounding. BPC-157 could promote vascular endothelial growth factor expression in wounded skin tissues. Furthermore, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and cell cycle analysis demonstrated that BPC-157 enhanced the proliferation of human umbilical vein endothelial cells (HUVECs). Transwell assay and wound healing assay showed that BPC-157 significantly promoted migration of HUVECs. We also observed that BPC-157 upregulated the expression of VEGF-a and accelerated vascular tube formation in vitro. Moreover, further studies suggested that BPC-157 regulated the phosphorylation level of extracellular signal-regulated kinases 1 and 2 (ERK1/2) as well as its downstream targets, including c-Fos, c-Jun, and Egr-1, which are key molecules involved in cell growth, migration, and angiogenesis. Altogether, our results indicated that BPC-157 treatment may accelerate wound healing in a model of alkali burn-induced skin injury. The therapeutic mechanism may be associated with accelerated granulation tissue formation, reepithelialization, dermal remodeling, and collagen deposition through ERK1/2 signaling pathway. PMID:25995620

Exploring the concept of a team approach to wound care: Managing wounds as a team.

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Moore, Zena; Butcher, Gillian; Corbett, Lisa Q; McGuiness, William; Snyder, Robert J; van Acker, Kristien

2014-05-01

Background - The growing prevalence and incidence of nonhealing acute and chronic wounds is a worrying concern. A major challenge is the lack of united services aimed at addressing the complex needs of individuals with wounds. However, the WHO argues that interprofessional collaboration in education and practice is key to providing the best patient care, enhancing clinical and health-related outcomes and strengthening the health system. It is based on this background that the team approach to wound care project was conceptualised. The project was jointly initiated and realised by the Association for the Advancement of Wound Care (AAWC-USA), the Australian Wound Management Association (AWMA) and the European Wound Management Association (EWMA). Aim - The aim of this project was to develop a universal model for the adoption of a team approach to wound care. Objective The overarching objective of this project was to provide recommendations for implementing a team approach to wound care within all clinical settings and through this to develop a model for advocating the team approach toward decision makers in national government levels. Method An integrative literature review was conducted. Using this knowledge, the authors arrived at a consensus on the most appropriate model to adopt and realise a team approach to wound care. Results - Eighty four articles met the inclusion criteria. Following data extraction, it was evident that none of the articles provided a definition for the terms multidisciplinary, interdisciplinary or transdisciplinary in the context of wound care. Given this lack of clarity within the wound care literature, the authors have here developed a Universal Model for the Team Approach to Wound Care to fill this gap in our current understanding. Conclusion - We advocate that the patient should be at the heart of all decision-making, as working with the Universal Model for the Team Approach to Wound Care begins with the needs of the patient. To

Improment of process for preparing and testing hydrogels in wound/burn treatment to apply a licence

International Nuclear Information System (INIS)

Doan Thi The; Pham Thi Thu Hong; Doan Binh; Tran Tich Canh; Nguyen Quoc Hien

2007-01-01

Hydrogel based on PVA/PVP/KC/CMC for burn wound dressing has been prepared by cross linking irradiation. The characteristics of the hydrogel such as gel fraction, mechanical properties, the equilibrium swelling degree in water and in pseudo-extra cellular fluid (PECF), and the water vapor transmission rate (WVTR) were measured. The microbe penetration, burn-wound healing effects, skin irritation and sterility level of the hydrogel were tested and analyzed. In addition, a technology system for producing hydrogel in a 500 pieces/batch/4hr scale was designed. (author)

In vitro and in vivo investigation of bacterial cellulose dressing containing uniform silver sulfadiazine nanoparticles for burn wound healing

Directory of Open Access Journals (Sweden)

Xiaoxiao Wen

2015-06-01

Full Text Available Silver sulfadiazine (SSD particles in homogeneous dispersion state were prepared by an ultrasonic method and then nano- and microparticles were separated using centrifugation. SSD particles with narrow size distribution were impregnated with bacterial cellulose (BC to produce BC–SSD composite membrane used as burn wound dressing. A scanning electron microscope (SEM was used to examine the surface morphology of BC–SSD membranes. The incorporation of SSD in BC–SSD was confirmed by X-ray diffraction (XRD. Antimicrobial tests in vitro indicated that BC–SSD showed excellent antibacterial activity against Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli. The effects of BC–SSD on burn wound healing were assessed by rat models. The comparative study confirmed that the wound treated with BC–SSD showed high healing rate. The bacteria count in BC–SSD group was far less than control group. Histological analysis showed that epithelialization progressed better in wound treated with BC–SSD. These values demonstrated that the BC–SSD composite membrane could be a promising wound dressing for burn.

Combination of HIF-1α gene transfection and HIF-1-activated bone marrow-derived angiogenic cell infusion improves burn wound healing in aged mice.

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Du, J; Liu, L; Lay, F; Wang, Q; Dou, C; Zhang, X; Hosseini, S M; Simon, A; Rees, D J; Ahmed, A K; Sebastian, R; Sarkar, K; Milner, S; Marti, G P; Semenza, G L; Harmon, J W

2013-11-01

Impaired burn wound healing in the elderly represents a major clinical problem. Hypoxia-inducible factor-1 (HIF-1) is a transcriptional activator that orchestrates the cellular response to hypoxia. Its actions in dermal wounds promote angiogenesis and improve healing. In a murine burn wound model, aged mice had impaired wound healing associated with reduced levels of HIF-1. When gene therapy with HIF-1 alone did not correct these deficits, we explored the potential benefit of HIF-1 gene therapy combined with the intravenous infusion of bone marrow-derived angiogenic cells (BMDACs) cultured with dimethyloxalylglycine (DMOG). DMOG is known to reduce oxidative degradation of HIF-1. The mice treated with a plasmid DNA construct expressing a stabilized mutant form of HIF-1α (CA5-HIF-1α)+BMDACs had more rapid wound closure. By day 17, there were more mice with completely closed wounds in the treated group (χ(2), P=0.05). The dermal blood flow measured by laser Doppler showed significantly increased wound perfusion on day 11. Homing of BMDACs to the burn wound was dramatically enhanced by CA5-HIF-1α gene therapy. HIF-1α mRNA expression in the burn wound was increased after transfection with CA5-HIF-1α plasmid. Our findings offer insight into the pathophysiology of burns in the elderly and point to potential targets for developing new therapeutic strategies.

Curcumin: a novel therapeutic for burn pain and wound healing

Science.gov (United States)

2013-08-01

given as an adjuvant with the nonsteroidal antiinflammatory drug (NSAID) diclofenac, reduces spontaneous pain behaviors in a formalin-induced orofacial ...R, Hota D, Chakrabarti A. Evaluation of antihyperalgesic effect of curcumin on formalin-induced orofacial pain in rat. Phytother Res 2009;23:507-12...bioavailability 5. Curcumin delivery vehicles 6. Conclusion 7. Expert opinion Review Curcumin: a novel therapeutic for burn pain and wound healing Bopaiah

The evolution of acute burn care - retiring the split skin graft.

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Greenwood, J E

2017-07-01

The skin graft was born in 1869 and since then, surgeons have been using split skin grafts for wound repair. Nevertheless, this asset fails the big burn patient, who deserves an elastic, mobile and robust outcome but who receives the poorest possible outcome based on donor site paucity. Negating the need for the skin graft requires an autologous composite cultured skin and a material capable of temporising the burn wound for four weeks until the composite is produced. A novel, biodegradable polyurethane chemistry has been used to create two such products. This paper describes the design, production, optimisation and evaluation of several iterations of these products. The evaluation has occurred in a variety of models, both in vitro and in vivo, employing Hunterian scientific principles, and embracing Hunter's love and appreciation of comparative anatomy. The process has culminated in significant human experience in complex wounds and extensive burn injury. Used serially, the products offer robust and elastic healing in deep burns of any size within 6 weeks of injury.

Hyperbaric Oxygen Therapy and Oxygen Compatibility of Skin and Wound Care Products.

Science.gov (United States)

Bernatchez, Stéphanie F; Tucker, Joseph; Chiffoleau, Gwenael

2017-11-01

Objective: Use test methods to assess the oxygen compatibility of various wound care products. Approach: There are currently no standard test methods specifically for evaluating the oxygen compatibility and safety of materials under hyperbaric oxygen (HBO) conditions. However, tests such as the oxygen index (OI), oxygen exposure (OE), and autogenous ignition temperature (AIT) can provide useful information. Results: The OI test measures the minimum oxygen concentration that will support candle-like burning, and it was used to test 44 materials. All but two exhibited an OI equal to or greater (safer) than a control material commonly used in HBO. The OE test exposes each material to an oxygen-enriched atmosphere (>99.5% oxygen) to monitor temperature and pressure for an extended duration. The results of the OE testing indicated that none of the 44 articles tested with this method self-ignited within the 60°C, 3 atm pressurized oxygen atmosphere. The AIT test exposes materials to a rapid ramp up in temperature in HBO conditions at 3 atm until ignition occurs. Ten wound care materials and seven materials usually avoided in HBO chambers were tested. The AIT ranged from 138°C to 384°C for wound care products and from 146°C to 420°C for the other materials. Innovation: This work provides useful data and recommendations to help develop a new standard approach for evaluating the HBO compatibility of wound care products to ensure safety for patients and clinicians. Conclusion: The development of an additional test to measure the risk of electrostatic discharge of materials in HBO conditions is needed.

3D photography is a reliable burn wound area assessment tool compared to digital planimetry in very young children.

Science.gov (United States)

Gee Kee, E L; Kimble, R M; Stockton, K A

2015-09-01

Reliability and validity of 3D photography (3D LifeViz™ System) compared to digital planimetry (Visitrak™) has been established in a compliant cohort of children with acute burns. Further research is required to investigate these assessment tools in children representative of the general pediatric burns population, specifically children under the age of three years. To determine if 3D photography is a reliable wound assessment tool compared to Visitrak™ in children of all ages with acute burns ≤10% TBSA. Ninety-six children (median age 1 year 9 months) who presented to the Royal Children's Hospital Brisbane with an acute burn ≤10% TBSA were recruited into the study. Wounds were measured at the first dressing change using the Visitrak™ system and 3D photography. All measurements were completed by one investigator and level of agreement between wound surface area measurements was calculated. Wound surface area measurements were complete (i.e. participants had measurements from both techniques) for 75 participants. Level of agreement between wound surface area measurements calculated using an intra-class correlation coefficient (ICC) was excellent (ICC 0.96, 95% CI 0.93, 0.97). Visitrak™ tracings could not be completed in 19 participants with 16 aged less than two years. 3D photography could not be completed for one participant. Barriers to completing tracings were: excessive movement, pain, young age or wound location (e.g. face or perineum). This study has confirmed 3D photography as a reliable alternative to digital planimetry in children of all ages with acute burns ≤10% TBSA. In addition, 3D photography is more suitable for very young children given its non-invasive nature. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Using wound care algorithms: a content validation study.

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Beitz, J M; van Rijswijk, L

1999-09-01

Valid and reliable heuristic devices facilitating optimal wound care are lacking. The objectives of this study were to establish content validation data for a set of wound care algorithms, to identify their associated strengths and weaknesses, and to gain insight into the wound care decision-making process. Forty-four registered nurse wound care experts were surveyed and interviewed at national and regional educational meetings. Using a cross-sectional study design and an 83-item, 4-point Likert-type scale, this purposive sample was asked to quantify the degree of validity of the algorithms' decisions and components. Participants' comments were tape-recorded, transcribed, and themes were derived. On a scale of 1 to 4, the mean score of the entire instrument was 3.47 (SD +/- 0.87), the instrument's Content Validity Index was 0.86, and the individual Content Validity Index of 34 of 44 participants was > 0.8. Item scores were lower for those related to packing deep wounds (P valid and reliable definitions. The wound care algorithms studied proved valid. However, the lack of valid and reliable wound assessment and care definitions hinders optimal use of these instruments. Further research documenting their clinical use is warranted. Research-based practice recommendations should direct the development of future valid and reliable algorithms designed to help nurses provide optimal wound care.

A comparative study to evaluate the effect of honey dressing and silver sulfadiazene dressing on wound healing in burn patients

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Baghel P

2009-01-01

Full Text Available To compare the effect of honey dressing and silver-sulfadiazene (SSD dressing on wound healing in burn patients. Patients (n=78 of both sexes, with age group between 10 and 50 years and with first and second degree of burn of less than 50% of TBSA (Total body surface area were included in the study, over a period of 2 years (2006-08. After stabilization, patients were randomly attributed into two groups: ′honey group′ and ′SSD group′. Time elapsed since burn was recorded. After washing with normal saline, undiluted pure honey was applied over the wounds of patients in the honey group (n=37 and SSD cream over the wounds of patients in SSD group (n=41, everyday. Wound was dressed with sterile gauze, cotton pads and bandaged. Status of the wound was assessed every third and seventh day and on the day of completion of study. Patients were followed up every fortnight till epithelialization. The bacteriological examination of the wound was done every seventh day. The mean age for case (honey group and control (SSD group was 34.5 years and 28.5 years, respectively. Wound swab culture was positive in 29 out of 36 patients who came within 8 hours of burn and in all patients who came after 24 hours. The average duration of healing in patients treated with honey and SSD dressing at any time of admission was 18.16 and 32.68 days, respectively. Wound of all those patients (100% who reported within 1 hour became sterile with honey dressing in less than 7 days while none with SSD. All of the wounds became sterile in less than 21 days with honey, while tthis was so in only 36.5% with SSD treated wounds. The honey group included 33 patients reported within 24 hour of injury, and 26 out of them had complete outcome at 2 months of follow-up, while numbers for the SSD group were 32 and 12. Complete outcome for any admission point of time after 2 months was noted in 81% and 37% of patients in the honey group and the SSD group. Honey dressing improves wound

In situ deposition of a personalized nanofibrous dressing via a handy electrospinning device for skin wound care

Science.gov (United States)

Dong, Rui-Hua; Jia, Yue-Xiao; Qin, Chong-Chong; Zhan, Lu; Yan, Xu; Cui, Lin; Zhou, Yu; Jiang, Xingyu; Long, Yun-Ze

2016-02-01

Current strategies for wound care provide limited relief to millions of patients who suffer from burns, chronic skin ulcers or surgical-related wounds. The goal of this work is to develop an in situ deposition of a personalized nanofibrous dressing via a handy electrospinning (e-spinning) device and evaluate its properties related to skin wound care. MCM-41 type mesoporous silica nanoparticles decorated with silver nanoparticles (Ag-MSNs) were prepared by a facile and environmentally friendly approach, which possessed long-term antibacterial activity and low cytotoxicity. Poly-ε-caprolactone (PCL) incorporated with Ag-MSNs was successfully electrospun (e-spun) into nanofibrous membranes. These in situ e-spun nanofibrous membranes allowed the continuous release of Ag ions and showed broad-spectrum antimicrobial activity against two common types of pathogens, Staphylococcus aureus and Escherichia coli. In addition, the in vivo studies revealed that these antibacterial nanofibrous membranes could reduce the inflammatory response and accelerate wound healing in Wistar rats. The above results strongly demonstrate that such patient-specific dressings could be broadly applied in emergency medical transport, hospitals, clinics and at the patients' home in the near future.Current strategies for wound care provide limited relief to millions of patients who suffer from burns, chronic skin ulcers or surgical-related wounds. The goal of this work is to develop an in situ deposition of a personalized nanofibrous dressing via a handy electrospinning (e-spinning) device and evaluate its properties related to skin wound care. MCM-41 type mesoporous silica nanoparticles decorated with silver nanoparticles (Ag-MSNs) were prepared by a facile and environmentally friendly approach, which possessed long-term antibacterial activity and low cytotoxicity. Poly-ε-caprolactone (PCL) incorporated with Ag-MSNs was successfully electrospun (e-spun) into nanofibrous membranes. These in situ e

A guide to wound managment in palliative care.

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Naylor, Wayne A

2005-11-01

Wound management in palliative patients is often a very challenging area of care. There are many unique issues that can combine to produce complicated wound management scenarios, including the types of wounds and wound symptoms most commonly affecting palliative care patients, as well as the presence of concurrent disease and associated treatment. Problems exist with the availability of suitable dressings and balancing life expectancy with the goals of wound care. A significant, and possibly under-recognized, issue is the emotional and social distress experienced by these patients, which can be directly attributed to their wound. These problems must all be recognized and addressed in order to manage wounds effectively in this patient population. This article aims to explore these issues and offer advice on the management of wound-related symptoms, with the ultimate goal of improving patients' quality of life.

Optimal treatment of partial thickness burns in children: a systematic review.

Science.gov (United States)

Vloemans, A F P M; Hermans, M H E; van der Wal, M B A; Liebregts, J; Middelkoop, E

2014-03-01

A large part of the patient population of a burn centre consists of children, most of whom are younger than four years. The majority of these young children suffer from superficial and deep partial thickness scald burns that may easily deepen to full thickness burns. A proper wound therapy, that prevents infection and ensures a moist wound condition, might prevent the deterioration of the wound. Therefore, we performed a systematic review of wound management and dressing materials to select the best treatment option for children with burns. A search in Medline and Embase revealed 51 articles for a critical appraisal. The articles were divided into randomized controlled trials, cohort studies and a group of case-reports. Total appraisal did not differ much amongst the groups; the level of evidence was highest in the randomized controlled trials and lowest in the case-reports. In 16 out of 34 comparative studies, silver sulfadiazine or a silver sulfadiazine/chlorhexidine-gluconate combination was the standard of wound care treatment. The competitor dressing was Biobrane(®) in six studies and amnion membrane in three. Tulle gauze, or tulle gauze impregnated with an antibacterial addition were the standard of care treatment in seven studies. In general, membranous dressings like Biobrane(®) and amnion membrane performed better than the standard of care on epithelialization rate, length of hospital stay and pain for treatment of partial thickness burns in children. However, hardly any of the studies investigated long-term results like scar formation. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

Effectiveness of a Glycylcycline Antibiotic for Reducing the Pathogenicity of Superantigen-Producing Methicillin-Resistant Staphylococcus aureus in Burn Wounds.

Science.gov (United States)

Nosanov, Lauren B; Jo, Daniel Y; Randad, Pranay R; Moffatt, Lauren T; Carney, Bonnie C; Ortiz, Rachel T; Shupp, Jeffrey W

2017-01-01

Objective : Burn-injured patients are highly susceptible to infectious complications, which are often associated with increased morbidity and mortality. Rates of antibiotic resistance have increased, and resistant species such as methicillin-resistant Staphylococcus aureus provide additional challenges in the form of virulence factors. Proteins can disrupt local healing, leading to systemic immune disruption. To optimize outcomes, treatments that reduce pathogenicity must be identified. This study aims to compare a glycylcycline antibiotic-tigecycline-with clindamycin for effectiveness in treating superantigenic methicillin-resistant Staphylococcus aureus in burn wounds. Methods : Sprague-Dawley rats received paired 2 × 2-cm burn wounds, which were subsequently inoculated with known virulence factor-producing methicillin-resistant Staphylococcus aureus or media alone on postinjury day 1. Infected animals received twice-daily tigecycline (high or low dose), twice-daily clindamycin (high or low dose), or saline alone (positive controls). Daily sampling and imaging assessments were performed. Results : Bacterial counts and toxin levels were reduced significantly in antibiotic-treated groups relative to positive controls ( P study supports the use of tigecycline in the treatment of methicillin-resistant Staphylococcus aureus -infected burn wounds. While both protein synthesis inhibitors are effective, tigecycline appears to be superior in controlling toxin levels, enabling better wound healing.

Systemic wound care: a meta-review of cochrane systematic reviews

NARCIS (Netherlands)

Ubbink, Dirk T.; Santema, Trientje B.; Stoekenbroek, Robert M.

2014-01-01

Wound care is a classic example of a surgical realm with a great variation in care. The diversity in wounds and wound treatments, the limited amount of convincing evidence, and the diverging opinions among doctors and nurses involved in wound care contribute to this undesirable variation in care.

Polymeric Films Loaded with Vitamin E and Aloe vera for Topical Application in the Treatment of Burn Wounds

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Gabriela Garrastazu Pereira

2014-01-01

Full Text Available Burns are serious traumas related to skin damage, causing extreme pain and possibly death. Natural drugs such as Aloe vera and vitamin E have been demonstrated to be beneficial in formulations for wound healing. The aim of this work is to develop and evaluate polymeric films containing Aloe vera and vitamin E to treat wounds caused by burns. Polymeric films containing different quantities of sodium alginate and polyvinyl alcohol (PVA were characterized for their mechanical properties and drug release. The polymeric films, which were produced, were thin, flexible, resistant, and suitable for application on damaged skin, such as in burn wounds. Around 30% of vitamin E acetate was released from the polymeric films within 12 hours. The in vivo experiments with tape stripping indicated an effective accumulation in the stratum corneum when compared to a commercial cream containing the same quantity of vitamin E acetate. Vitamin E acetate was found in higher quantities in the deep layers of the stratum corneum when the film formulation was applied. The results obtained show that the bioadhesive films containing vitamin E acetate and Aloe vera could be an innovative therapeutic system for the treatment of burns.

Polymeric films loaded with vitamin E and aloe vera for topical application in the treatment of burn wounds.

Science.gov (United States)

Pereira, Gabriela Garrastazu; Guterres, Sílvia Stanisçuaki; Balducci, Anna Giulia; Colombo, Paolo; Sonvico, Fabio

2014-01-01

Burns are serious traumas related to skin damage, causing extreme pain and possibly death. Natural drugs such as Aloe vera and vitamin E have been demonstrated to be beneficial in formulations for wound healing. The aim of this work is to develop and evaluate polymeric films containing Aloe vera and vitamin E to treat wounds caused by burns. Polymeric films containing different quantities of sodium alginate and polyvinyl alcohol (PVA) were characterized for their mechanical properties and drug release. The polymeric films, which were produced, were thin, flexible, resistant, and suitable for application on damaged skin, such as in burn wounds. Around 30% of vitamin E acetate was released from the polymeric films within 12 hours. The in vivo experiments with tape stripping indicated an effective accumulation in the stratum corneum when compared to a commercial cream containing the same quantity of vitamin E acetate. Vitamin E acetate was found in higher quantities in the deep layers of the stratum corneum when the film formulation was applied. The results obtained show that the bioadhesive films containing vitamin E acetate and Aloe vera could be an innovative therapeutic system for the treatment of burns.

Cost-effectiveness of laser Doppler imaging in burn care in the Netherlands

Directory of Open Access Journals (Sweden)

Hop M Jenda

2013-02-01

Full Text Available Abstract Background Early accurate assessment of burn depth is important to determine the optimal treatment of burns. The method most used to determine burn depth is clinical assessment, which is the least expensive, but not the most accurate. Laser Doppler imaging (LDI is a technique with which a more accurate (>95% estimate of burn depth can be made by measuring the dermal perfusion. The actual effect on therapeutic decisions, clinical outcomes and the costs of the introduction of this device, however, are unknown. Before we decide to implement LDI in Dutch burn care, a study on the effectiveness and cost-effectiveness of LDI is necessary. Methods/design A multicenter randomised controlled trial will be conducted in the Dutch burn centres: Beverwijk, Groningen and Rotterdam. All patients treated as outpatient or admitted to a burn centre within 5 days post burn, with burns of indeterminate depth (burns not obviously superficial or full thickness and a total body surface area burned of ≤ 20% are eligible. A total of 200 patients will be included. Burn depth will be diagnosed by both clinical assessment and laser Doppler imaging between 2–5 days post burn in all patients. Subsequently, patients are randomly divided in two groups: ‘new diagnostic strategy’ versus ‘current diagnostic strategy’. The results of the LDI-scan will only be provided to the treating clinician in the ‘new diagnostic strategy’ group. The main endpoint is the effect of LDI on wound healing time. In addition we measure: a the effect of LDI on other patient outcomes (quality of life, scar quality, b the effect of LDI on diagnostic and therapeutic decisions, and c the effect of LDI on total (medical and non-medical costs and cost-effectiveness. Discussion This trial will contribute to our current knowledge on the use of LDI in burn care and will provide evidence on its cost-effectiveness. Trial registration NCT01489540

Outcome predictors and quality of life of severe burn patients admitted to intensive care unit

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Buoninsegni Laura

2010-04-01

Full Text Available Abstract Background Despite significant medical advances and improvement in overall mortality rate following burn injury, the treatment of patients with extensive burns remains a major challenge for intensivists. We present a study aimed to evaluate the short- and the long-term outcomes of severe burn patients (total body surface area, TBSA > 40% treated in a polyvalent intensive care unit (ICU and to assess the quality of life of survivors, one year after the injury using the EuroQol-5D (EQ-5D questionnaire. Methods A prospective-observational study was performed in an ICU of a University-affiliated hospital. Logistic regression analysis was used to identify the factors predicting in-hospital mortality. The EQ-5D questionnaire was used to asses participant's long term self-reported general health. Results During a period of five years, 50 patients participated in the study. Their mean age was 53.8 ± 19.8; they had a mean of %TBSA burned of 54.5 ± 18.1. 44% and 10% of patients died in the ICU and in the ward after ICU discharge, respectively. Baux index, SAPS II and SOFA on admission to the ICU, infectious and respiratory complications, and time of first burn wound excision were found to have a significant predictive value for hospital mortality. The level of health of all survivors was worse than before the injury. Problems in the five dimensions studied were present as follows: mobility (moderate 68.5%; extreme 0%, self-care (moderate 21%; extreme 36.9%, usual activities (moderate 68.5%; extreme 21%, pain/discomfort (moderate 68.5%; extreme 10.5%, anxiety/depression (moderate 36.9%; extreme 42.1%. Conclusions In severe burn patients, Baux index, severity of illness on admission to the ICU, complications, and time of first burn wound excision were the major contributors to hospital mortality. Quality of life was influenced by consequences of injury both in psychological and physical health.

Comparing the effect of visceral fat and barley seed ash (hordeum vulgare L) with silversulfadiazine on burn wound healing in rats.

Science.gov (United States)

Azadi, Mohammad; Foruozandeh, Hossein; Karami, Leila; Khodayar, Mohammad Javad; Rashidi Nooshabadi, Mohamadreza; Kalantar, Mojtaba; Gudarzi, Mehdi; Pirouzi, Aliyar

2015-02-01

Skin burn is one of the most common complications and remains a major public health issue worldwide. This experiment was conducted to study the effects of traditional medicine (Visceral Fat and Barely Seed Ash) compared with silversulfadiazine (SSD) cream on healing burn wounds in rats. Sixty adult male Wistar rats were randomly divided into four groups of equal numbers; each group consisted of 15 animals. After sedation, type II of skin burn with 1.5 cm diameter circle was created on the back of rats with a heated metal in boiling water. Group one was not treated and considered as control. The burned areas in the second, third and fourth groups were applied twice a day with normal saline, SSD cream and traditional preparation, respectively. Percentage of the burn wound concentration and histopathological examinations were used as parameters of our study on days 4, 9and 14. Obtained data were compared between the groups and days. SSD cream and traditional preparation had better effects on burnt wound healing compared with control group. Furthermore, on the final day of study, the average percentage of wound concentration in traditional medicine group was significantly greater than other groups (P < 0.05). This finding was supported and confirmed by histological examination as well. Traditional preparation significantly decreased inflammation and accelerated wound healing in treated rats. Furthermore, the findings of this study can be applied clinically in the future.

Epidermal growth factor in alkali-burned corneal epithelial wound healing.

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Singh, G; Foster, C S

1987-06-15

We conducted a double-masked study to evaluate the effect of epidermal growth factor on epithelial wound healing and recurrent erosions in alkali-burned rabbit corneas. Epithelial wounds 10 mm in diameter healed completely under the influence of topical epidermal growth factor, whereas the control corneas did not resurface in the center. On reversal of treatment, the previously nonhealing epithelial defects healed when treated with topical epidermal growth factor eyedrops. Conversely, the epidermal growth factor-treated and resurfaced corneas developed epithelial defects when treatment was discontinued. Histopathologic examination disclosed hyperplastic epithelium growing over the damaged stroma laden with polymorphonuclear leukocytes when treated with epidermal growth factor eyedrops, but it did not adhere to the underlying tissue. Hydropic changes were seen intracellularly as well as between the epithelial cells and the stroma.

The healing effect of combined hydroalcoholic extract of Teocurium polium and the seed hull of Quercus brantii on burn wounds in rats

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Mohammadi Jamshid

2016-10-01

Full Text Available Plants and their extracts have considerable potential for wound healing. So, The aim of this study was to evaluate the wound healing effect of combined hydroalcoholic extract of Teocurium Polium (TP and the seed hull of Quercus brantii (Persian oak (QB and comparing with silver sulfadiazine (SSD ointment (1% in rats. Animals were divided into six groups consist of normal (untreated, physiologic serum, TP, seed hulls of Quercus brantii (QB, combination of TP and QB and the other group was SSD. Burn area size, epidermal and dermal diameter, number of hair follicle, histopathology of the burn skin and concentration of plasma malondialdehide (MDA were determined in different groups. Animals treated with QB and TP, SSD and combination of two extracts (QB +TP showed a significant reduction in the burn area. Serum MDA decreased significantly in animals treated with QB, TP and QB+TP. Histological comparison has shown that TP, QB and combination of them significantly increased reepithelialization in burn wounds, as compared to normal group. In conclusion, our results demonstrated that topical application of TP and QB has a significant effect on the burn wound healing.

WOUND CARE DRESSING IN DEVELOPING COUNTRIES: THE ...

African Journals Online (AJOL)

Dr. Ismail Adigun

commonly available to wound care provider are traditional agents such as ... the use of the commonly available products based on the needs of a different .... The cost of care of these patients' wound dressing per ... and haemostatic activity .

Aging influences wound healing in patients with chronic lower extremity wounds treated in a specialized Wound Care Center.

Science.gov (United States)

Wicke, Corinna; Bachinger, Andreas; Coerper, Stephan; Beckert, Stefan; Witte, Maria B; Königsrainer, Alfred

2009-01-01

With the dramatic increase in the aging population, the study and care of wounds in the elderly have become priority topics for both researchers and clinicians. The effects of aging on wound healing in humans have remained controversial. The study was a 5-year epidemiological evaluation of standardized data collected regularly during patients' visits at a specialized Wound Care Center with the aim to determine the key factors influencing the healing of chronic lower extremity wounds. In this analysis of 1,158 chronic wounds, the frequency of wound closure was statistically significantly lower in older patients compared with younger patients. The share of closed wounds decreased by nearly 25% in the elderly patients (>or=70 years). The relationship between the patient's age and the proportion of wound closure was nonlinear. The effect of aging on the frequency of wound closure of chronic wounds became clinically apparent after age 60. The chronicity of the wounds was illustrated by their recurrent nature, their long duration, the presence of multiple wounds, and the frequency of concurrent infection. Comorbidity was documented by the coprevalence of up to three underlying diseases related to impaired wound healing. The present study clearly showed that aging affects chronic wound healing negatively.

Body protective compound-157 enhances alkali-burn wound healing in vivo and promotes proliferation, migration, and angiogenesis in vitro

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Huang T

2015-04-01

Full Text Available Tonglie Huang,1,* Kuo Zhang,2,* Lijuan Sun,3 Xiaochang Xue,1 Cun Zhang,1 Zhen Shu,1 Nan Mu,1 Jintao Gu,1 Wangqian Zhang,1 Yukun Wang,1 Yingqi Zhang,1 Wei Zhang1 1State Key Laboratory of Cancer Biology, Department of Biopharmaceutics, School of Pharmacy, The Fourth Military Medical University, 2National Engineering Research Center for Miniaturized Detection Systems, School of Life Sciences, Northwest University, 3Department of Ophthalmology, Xijing Hospital, The Fourth Military Medical University, Xi’an, People’s Republic of China *These authors contributed equally to this work Abstract: Chemical burns take up a high proportion of burns admissions and can penetrate deep into tissues. Various reagents have been applied in the treatment of skin chemical burns; however, no optimal reagent for skin chemical burns currently exists. The present study investigated the effect of topical body protective compound (BPC-157 treatment on skin wound healing, using an alkali burn rat model. Topical treatment with BPC-157 was shown to accelerate wound closure following an alkali burn. Histological examination of skin sections with hematoxylin–eosin and Masson staining showed better granulation tissue formation, reepithelialization, dermal remodeling, and a higher extent of collagen deposition when compared to the model control group on the 18th day postwounding. BPC-157 could promote vascular endothelial growth factor expression in wounded skin tissues. Furthermore, 3-(4,5-dimethylthiazol-2-yl-2,5-diphenyltetrazolium bromide and cell cycle analysis demonstrated that BPC-157 enhanced the proliferation of human umbilical vein endothelial cells (HUVECs. Transwell assay and wound healing assay showed that BPC-157 significantly promoted migration of HUVECs. We also observed that BPC-157 upregulated the expression of VEGF-a and accelerated vascular tube formation in vitro. Moreover, further studies suggested that BPC-157 regulated the phosphorylation level of

A Smartphone App and Cloud-Based Consultation System for Burn Injury Emergency Care.

Directory of Open Access Journals (Sweden)

Lee A Wallis

Full Text Available Each year more than 10 million people worldwide are burned severely enough to require medical attention, with clinical outcomes noticeably worse in resource poor settings. Expert clinical advice on acute injuries can play a determinant role and there is a need for novel approaches that allow for timely access to advice. We developed an interactive mobile phone application that enables transfer of both patient data and pictures of a wound from the point-of-care to a remote burns expert who, in turn, provides advice back.The application is an integrated clinical decision support system that includes a mobile phone application and server software running in a cloud environment. The client application is installed on a smartphone and structured patient data and photographs can be captured in a protocol driven manner. The user can indicate the specific injured body surface(s through a touchscreen interface and an integrated calculator estimates the total body surface area that the burn injury affects. Predefined standardised care advice including total fluid requirement is provided immediately by the software and the case data are relayed to a cloud server. A text message is automatically sent to a burn expert on call who then can access the cloud server with the smartphone app or a web browser, review the case and pictures, and respond with both structured and personalized advice to the health care professional at the point-of-care.In this article, we present the design of the smartphone and the server application alongside the type of structured patient data collected together with the pictures taken at point-of-care. We report on how the application will be introduced at point-of-care and how its clinical impact will be evaluated prior to roll out. Challenges, strengths and limitations of the system are identified that may help materialising or hinder the expected outcome to provide a solution for remote consultation on burns that can be

A Smartphone App and Cloud-Based Consultation System for Burn Injury Emergency Care.

Science.gov (United States)

Wallis, Lee A; Fleming, Julian; Hasselberg, Marie; Laflamme, Lucie; Lundin, Johan

2016-01-01

Each year more than 10 million people worldwide are burned severely enough to require medical attention, with clinical outcomes noticeably worse in resource poor settings. Expert clinical advice on acute injuries can play a determinant role and there is a need for novel approaches that allow for timely access to advice. We developed an interactive mobile phone application that enables transfer of both patient data and pictures of a wound from the point-of-care to a remote burns expert who, in turn, provides advice back. The application is an integrated clinical decision support system that includes a mobile phone application and server software running in a cloud environment. The client application is installed on a smartphone and structured patient data and photographs can be captured in a protocol driven manner. The user can indicate the specific injured body surface(s) through a touchscreen interface and an integrated calculator estimates the total body surface area that the burn injury affects. Predefined standardised care advice including total fluid requirement is provided immediately by the software and the case data are relayed to a cloud server. A text message is automatically sent to a burn expert on call who then can access the cloud server with the smartphone app or a web browser, review the case and pictures, and respond with both structured and personalized advice to the health care professional at the point-of-care. In this article, we present the design of the smartphone and the server application alongside the type of structured patient data collected together with the pictures taken at point-of-care. We report on how the application will be introduced at point-of-care and how its clinical impact will be evaluated prior to roll out. Challenges, strengths and limitations of the system are identified that may help materialising or hinder the expected outcome to provide a solution for remote consultation on burns that can be integrated into routine

Partial-thickness burn wounds healing by topical treatment: A randomized controlled comparison between silver sulfadiazine and centiderm.

Science.gov (United States)

Saeidinia, Amin; Keihanian, Faeze; Lashkari, Ardalan Pasdaran; Lahiji, Hossein Ghavvami; Mobayyen, Mohammadreza; Heidarzade, Abtin; Golchai, Javad

2017-03-01

Burns are common event and associated with a high incidence of death, disability, and high costs. Centella asiatica (L.) is a medicinal herb, commonly growing in humid areas in several tropical countries that improve wound healing. On the basis of previous studies, we compared the efficacy of Centiderm versus silver sulfadiazine (SSD) in partial thickness burning patients. Study population comprised burn victims referred to Velayat Burning Hospital at Rasht, Iran. The intervention group received Centiderm and control group SSD cream. Burn wounds were treated once daily at home. All of the wounds were evaluated till complete healing occurred and at the admission, days 3, 7, 14 objective signs; visual acuity score (VAS) and subjective signs were recorded. Re-epithelialization time and complete healing days were recorded. We used random fixed block for randomization. The randomization sequence was created using the computer. Patients and burning specialist physician were blinded. Seventy-five patients randomized into 2 groups; (40 patients: Centiderm group; 35 patients: SSD group). The mean age of them was 30.67 ± 9.91 years and 19 of them were male (31.7%). Thirty patients in Centiderm and 30 patients in SSD group were analyzed. All of objective and subjective signs and mean of re-epithelialization and complete healing were significantly better in Centiderm group rather than SSD group (P < 0.05). There was no infection in Centiderm group. We showed that use of Centiderm ointment not only improved the objective and subjective signs in less than 3 days, but also the re-epithelialization and complete healing rather than SSD without any infection in the subjects.

How wounds heal

Science.gov (United States)

... How puncture wounds heal; How burns heal; How pressure sores heal; How lacerations heal ... bleed. For example, burns, some puncture wounds, and pressure sores do not bleed. Once the scab forms, your ...

Probing Endogenous Collagen by Laser Induced Autofluorescence in Burn Wound Biopsies- A Pilot Study.

Science.gov (United States)

Prabhu, Vijendra; Acharya, Anusha; Rao, Bola Sadashiva Satish; Rathnakar, Bharath; Kumar, Pramod; Guddattu, Vasudeva; Mahato, Krishna Kishore

2018-04-19

The focus of the current study was to interrogate the predictive potential of laser-induced autofluorescence (LIAF) by objectively assessing collagen synthesis in burn wound granulation tissues ex vivo. Prior grafting, granulation tissues (20 samples) following burn injury were collected from 17 subjects of age range 18- 60 years with patient/donor consent and the corresponding autofluorescence spectra were recorded at 325 nm He-Cd laser (≈ 2 mW) excitations. The resulting endogenous collagen intensity from the above tissue samples was computed by normalizing the NADH levels. In addition, the hydroxyproline content was also estimated biochemically from the same granulation tissues. A comparative assessment of both LIAF and biochemical estimations for endogenous collagen by hydroxyproline resulted in strong positive correlation among them. The above relevant observations suggest that LIAF is equally informative as that of biochemical estimations, in evaluating endogenous collagen content in wound granulation tissues. Thus, it can be concluded that LIAF has the predictive potential, as a non-invasive objective tool to measure the endogenous collagen levels in wound biopsy tissues and provide complementary data conducive for making clinical decisions. This article is protected by copyright. All rights reserved.

Expression and activity levels of chymase in mast cells of burn wound tissues increase during the healing process in a hamster model.

Science.gov (United States)

Dong, Xianglin; Xu, Tao; Ma, Shaolin; Wen, Hao

2015-06-01

The present study aimed to investigate the changes in the expression levels and activity of mast cell chymase in the process of burn wound healing in a hamster model of deep second-degree burn. The hamster model was established by exposing a ~3 cm diameter area of bare skin to hot water (75°C) for 0, 6, 8, 10 or 12 sec. Tissue specimens were collected 24 h after burning and histological analysis revealed that hot water contact for 12 sec was required to produce a deep second-degree burn. Quantitative polymerase chain reaction and a radioimmunoassay were used to the determine changes in chymase mRNA expression levels and activity. The mRNA expression levels and activity of chymase were increased in the burn wound tissues when compared with the normal skin. However, no statistically significant differences were observed in mast cell chymase activity amongst the various post-burn stages. Chymase mRNA expression levels peaked at day 1 post-burn, subsequently decreasing at days 3 and 7 post-burn and finally increasing again at day 14 post-burn. In summary, a hamster model of deep second-degree burn can be created by bringing the skin into contact with water at 75°C for 12 sec. Furthermore, the mRNA expression levels and activity of chymase in the burn wound tissues increased when compared with those in normal skin tissues.

Pediatric wound care and management in the emergency department [digest].

Science.gov (United States)

Sanders, Jennifer E; Pade, Kathryn H

2017-10-23

Traumatic wounds and lacerations are common pediatric presenting complaints to emergency departments. Although there is a large body of literature on wound care, many emergency clinicians base management of wounds on theories and techniques that have been passed down over time. Therefore, controversial, conflicting, and unfounded recommendations are prevalent. This issue reviews evidence-based recommendations for wound care and management, including wound cleansing and irrigation, anxiolysis/sedation techniques, closure methods, and post-repair wound care. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

Competencies of specialised wound care nurses: a European Delphi study.

Science.gov (United States)

Eskes, Anne M; Maaskant, Jolanda M; Holloway, Samantha; van Dijk, Nynke; Alves, Paulo; Legemate, Dink A; Ubbink, Dirk T; Vermeulen, Hester

2014-12-01

Health care professionals responsible for patients with complex wounds need a particular level of expertise and education to ensure optimum wound care. However, uniform education for those working as wound care nurses is lacking. We aimed to reach consensus among experts from six European countries as to the competencies for specialised wound care nurses that meet international professional expectations and educational systems. Wound care experts including doctors, wound care nurses, lecturers, managers and head nurses were invited to contribute to an e-Delphi study. They completed online questionnaires based on the Canadian Medical Education Directives for Specialists framework. Suggested competencies were rated on a 9-point Likert scale. Consensus was defined as an agreement of at least 75% for each competence. Response rates ranged from 62% (round 1) to 86% (rounds 2 and 3). The experts reached consensus on 77 (80%) competences. Most competencies chosen belonged to the domain 'scholar' (n = 19), whereas few addressed those associated with being a 'health advocate' (n = 7). Competencies related to professional knowledge and expertise, ethical integrity and patient commitment were considered most important. This consensus on core competencies for specialised wound care nurses may help achieve a more uniform definition and education for specialised wound care nurses. © 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Healing potential of Iranian traditional medicinal plants on burn wounds in alloxan-induced diabetic rats

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A Ghasemi Pirbalouti

2011-10-01

Full Text Available Malva sylvestris, Punica granatum, Amygdalus communis, Arnebia euchroma and Scrophularia deserti are important medicinal plants in Iranian traditional medicine (Unani whose have been used as remedy against edema, burn, and wound and for their carminative, antimicrobial and anti-inflammatory activities. The ethanol extracts of M. sylvestris and P. granatum flowers, A. communis leaves, A. euchroma roots and S. deserti stems were used to evaluate the burn healing activity in alloxan-induced diabetic rats. Burns were induced in Wistar rats divided into nine groups as following; Group-I: normal rats were treated with simple ointment base (control, Group-II: diabetic rats were treated with simple ointment base (control, Groups-III and -VII: diabetic rats were treated with simple ointment base containing of extracts (diabetic animals, Groups VIII: diabetic rats were treated with simple ointment base containing of mixed extracts, Group-IX: diabetic rats received the standard drug (Silver Sulfadiazine. The efficacy of treatments was evaluated based on wound area, epithelialization time and histopathological characteristics. Wound contraction showed that there is high significant difference between the different groups (p<0.001. At the 18th day, A. euchroma, S. deserti, A. communis and mixed extract ointment treated groups healed 80-90%. At the 9th and 18th days the experiment, the best results were obtained with A. communis and standard drug, when compared to the other groups as well as to the controls. It may be concluded that almond leaves (sweet and bitter formulated in the simple ointment base is effective in the treatment of burns and thus supports its traditional use.

Community health nursing, wound care, and...ethics?

Science.gov (United States)

Bell, Sue Ellen

2003-09-01

Because of changing demographics and other factors, patients receiving care for wounds, ostomies, or incontinence are being referred in increasing numbers to community health nursing organizations for initial or continued care. As home-based wound care becomes big business, little discussion is being focused on the moral and ethical issues likely to arise in the high-tech home setting. Progressively more complex and expensive home care relies on family members to take on complicated care regimens in the face of decreasing numbers of allowable skilled nursing home visits. A framework and a principle-based theory for reflection on the character and content of moral and ethical conflicts are provided to encourage informed and competent care of patients in the home. Common moral and ethical conflicts for WOC nurses in the United States are presented. These conflicts include issues of wound care supply procurement; use of documentation to maximize care or profit; problems of quality, care consistency, and caregiver consent; and dilemmas of tiered health care options. The advantages of a framework to address ethical conflicts are discussed.

Cutaneous wound healing: Current concepts and advances in wound care

Directory of Open Access Journals (Sweden)

Kenneth C Klein

2014-01-01

Full Text Available A non-healing wound is defined as showing no measurable signs of healing for at least 30 consecutive treatments with standard wound care. [1] It is a snapshot of a patient′s total health as well as the ongoing battle between noxious factors and the restoration of optimal macro and micro circulation, oxygenation and nutrition. In practice, standard therapies for non-healing cutaneous wounds include application of appropriate dressings, periodic debridement and eliminating causative factors. [2] The vast majority of wounds would heal by such approach with variable degrees of residual morbidity, disability and even mortality. Globally, beyond the above therapies, newer tools of healing are selectively accessible to caregivers, for various logistical or financial reasons. Our review will focus on the use of hyperbaric oxygen therapy (HBOT, as used at our institution (CAMC, and some other modalities that are relatively accessible to patients. HBOT is a relatively safe and technologically simpler way to deliver care worldwide. However, the expense for including HBOT as standard of care for recognized indications per UHMS(Undersea and Hyperbaric Medical Society may vary widely from country to country and payment system. [3] In the USA, CMS (Centers for Medicare and Medicaid Services approved indications for HBOT vary from that of the UHMS for logistical reasons. [1] We shall also briefly look into other newer therapies per current clinical usage and general acceptance by the medical community. Admittedly, there would be other novel tools with variable success in wound healing worldwide, but it would be difficult to include all in this treatise.

Cutaneous wound healing: Current concepts and advances in wound care

Science.gov (United States)

Klein, Kenneth C; Guha, Somes Chandra

2014-01-01

A non-healing wound is defined as showing no measurable signs of healing for at least 30 consecutive treatments with standard wound care.[1] It is a snapshot of a patient's total health as well as the ongoing battle between noxious factors and the restoration of optimal macro and micro circulation, oxygenation and nutrition. In practice, standard therapies for non-healing cutaneous wounds include application of appropriate dressings, periodic debridement and eliminating causative factors.[2] The vast majority of wounds would heal by such approach with variable degrees of residual morbidity, disability and even mortality. Globally, beyond the above therapies, newer tools of healing are selectively accessible to caregivers, for various logistical or financial reasons. Our review will focus on the use of hyperbaric oxygen therapy (HBOT), as used at our institution (CAMC), and some other modalities that are relatively accessible to patients. HBOT is a relatively safe and technologically simpler way to deliver care worldwide. However, the expense for including HBOT as standard of care for recognized indications per UHMS(Undersea and Hyperbaric Medical Society) may vary widely from country to country and payment system.[3] In the USA, CMS (Centers for Medicare and Medicaid Services) approved indications for HBOT vary from that of the UHMS for logistical reasons.[1] We shall also briefly look into other newer therapies per current clinical usage and general acceptance by the medical community. Admittedly, there would be other novel tools with variable success in wound healing worldwide, but it would be difficult to include all in this treatise. PMID:25593414

Acute pavement burns: a unique subset of burn injuries: a five-year review of resource use and cost impact.

Science.gov (United States)

Silver, Andrew G; Dunford, Gerrit M; Zamboni, William A; Baynosa, Richard C

2015-01-01

This study focuses on the hospital care of a rare subset of burn injuries caused by contact with environmentally heated pavement, to further understand the required use of resources. This article aims to show that pavement burns are typically more severe than their flame/scald counterparts. A retrospective review of patients admitted to the burn center with injuries suffered from contact with hot pavement was performed. Patients were stratified on the presence or absence of altered mental status (AMS) and additional inciting factors. A representative sample of similarly sized flame and scald wounds treated in the same time period was compiled for comparison. Those with pavement burns had a significantly greater requirement for operative intervention, repetitive debridements, overall cost/percent burned, and lengthier hospital stays than those with flame/scald burns. Pavement burn victims with AMS were significantly more likely to require an operation, a greater cost/percent burned, and longer hospital stays than those without AMS. Pavement burns are significantly worse than similarly sized scald/flame burns with regards to length of stay and total hospital costs, and the necessity of initial and repetitive operative intervention. These discrepancies are even greater in patients with AMS as a concomitant inciting factor. It is apparent that these wounds often continue to deepen during a patient's stay, likely because of continued pressure on the wounds while recumbent. As such, this article highly recommends pressure off-loading beds and more aggressive debridement in the treatment of these unique injuries.

An assessment of burn care professionals' attitudes to major burn.

LENUS (Irish Health Repository)

Murphy, A D

2008-06-01

The resuscitation of severe burn remains a controversial area within the burn care profession. There is ongoing debate as to what percentage burn is associated with a sufficient quality of life to support initial resuscitation efforts. We conducted a survey of delegates at the 39th Annual Meeting of the British Burns Association (2005), regarding attitudes towards resuscitation following major burns. Respondents were asked the maximum percentage total body surface area (TBSA) burn beyond which they would not wish to be resuscitated. They were also asked what maximum TBSA they perceived to be commensurate with an acceptable quality of life (QOL). One hundred and forty three of 300 delegates responded to the questionnaire. Thirty three percent of respondents would not wish to be resuscitated with 50-75% TBSA burns or greater. A further 35% would not wish to have life-sustaining intervention with 75-95% TBSA burns or greater. The remaining 32% indicated that they would not want resuscitation with TBSA burns>95%. Regardless of TBSA affected, 16% would not wish resuscitation if they had full thickness facial burns, a further 10% did not want resuscitation if both their hands and faces were affected. Our survey demonstrates the diversity of personal preference amongst burn care professionals. This would suggest that a unifying philosophy regarding the resuscitation of extensive burns will remain elusive.

The Wound CARE Instrument: the process for developing standards for wound management education and programming.

Science.gov (United States)

Orsted, Heather L; Woodbury, M Gail; Stevenson, Kimberly

2012-06-01

This article describes the collaborative process undertaken by the Canadian Association for Enterostomal Therapy and the Canadian Association of Wound Care in an effort to improve the quality of wound prevention and management education and programming. The end result of this process is the Wound CARE Instrument which promotes an interprofessional, collaborative appraisal process to support the development, adoption or adaption of wound management educational events and programs. © 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

Competencies of specialised wound care nurses : a European Delphi study

NARCIS (Netherlands)

Eskes, Anne M; Maaskant, Jolanda M; Holloway, Samantha; van Dijk, Nynke; Alves, Paulo; Legemate, Dink A; Ubbink, Dirk T; Vermeulen, Hester

2014-01-01

Health care professionals responsible for patients with complex wounds need a particular level of expertise and education to ensure optimum wound care. However, uniform education for those working as wound care nurses is lacking. We aimed to reach consensus among experts from six European countries

Competencies of specialised wound care nurses: a European Delphi study

NARCIS (Netherlands)

Eskes, Anne M.; Maaskant, Jolanda M.; Holloway, Samantha; van Dijk, Nynke; Alves, Paulo; Legemate, Dink A.; Ubbink, Dirk T.; Vermeulen, Hester

2014-01-01

Health care professionals responsible for patients with complex wounds need a particular level of expertise and education to ensure optimum wound care. However, uniform education for those working as wound care nurses is lacking. We aimed to reach consensus among experts from six European countries

Skin substitutes for management of thermal burns in the event of a nuclear detonation

International Nuclear Information System (INIS)

Singh, Rita

2014-01-01

Skin substitutes can play a potential role in the treatment of burn injuries in a nuclear scenario. Defence Laboratory, Jodhpur is involved in the development of various types of skin substitutes for use in burn injuries. Amniotic membranes collected from placentae are processed as biological dressings and sterilized by gamma radiation. Multi-centric clinical trials have demonstrated the functional and clinical efficacy of radiation sterilized biological dressings in burn wound care. Chitin-nanosilver membranes and hydrogels have also been developed and characterized for use as burn wound dressing

The impact of the types of microorganisms isolated from blood and wounds on the results of treatment in burn patients with sepsis.

Science.gov (United States)

Glik, Justyna; Kawecki, Marek; Gaździk, Tadeusz; Nowak, Mariusz

2012-01-01

Despite development of combustiology, infections continue to be the most important cause of death among patients with burns. Sepsis is the most severe clinical presentation of infection in patients after thermal injuries who require immediate treatment. Early diagnosis and proper treatment of sepsis are important in the clinical management that is often hampered for multiple reasons, e.g. impaired patient immunity, problems with microorganisms with multi-antibacterial drug resistance. The aim of the study was to assess effect of type of a microorganism isolated from blood and wound on results of treatment of sepsis in patients with burns. Effect of type of microorganisms isolated from blood and wound on the result of treatment of sepsis was studied in 338 patients hospitalized immediately after an injury in Centre for Burn Treatment in Siemianowice Śląskie in years 2003 - 2004 (at the age of 18 - 96 years, 66 women and 272 men). Clinical symptoms of generalized infection were found in all study subjects. The study group was divided into two subgroups: cured patients and patients who died of sepsis. The following parameters were assessed in both subgroups: type of microorganism isolated from blood, type of microorganism isolated from wound as well as occurrence of the same and different infections of blood and burn wound. positive blood cultures were found in 165 patients (48.8%), 106 (64.2%) were cured, 59 (35.8%) died. The most commonly isolated microorganisms in cured patients were Gram(+) Staphylococcus epidermidis MRSE (19.81%) and Staphylococcus aureus MRSA (18.87%). Gram(-) intestinal rods were least commonly isolated from this group. The most commonly isolated microorganisms from blood of patients who were to die, included non-fermenting Gram(-) rods Acinetobacter baumannii (35.59%) and Pseudomonas aeruginosa (22.03%). Mixed bacterial flora was found in the blood of 22.03% patients. Among patients who were to die, the same microorganisms were found in the

Emergency department management of patients with thermal burns [digest].

Science.gov (United States)

Tolles, Juliana; Gupta, Nachi; Nusbaum, Jeffrey

2018-02-01

Thermal burn injuries are a significant cause of morbidity and mortality worldwide. In addition to treatment of the burns, emergency clinicians must assess for inhalation injury, exposure to toxic gases, and related traumatic injuries. Priorities for emergency resuscitation include stabilization of airway and breathing, intravenous fluid administration, pain control, and local wound care. Special populations, including children and pregnant women, require additional treatment considerations. Referral to specialized burn care for select patients is necessary to improve long-term outcomes. This article reviews thermal burn classification and evidence-based treatment strategies. [Points & Pearls is a digest of Emergency Medicine Practice.].

Isolation and identification of burn wound superbugs by molecular technique and their susceptibility to silver nanoparticles

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Mala, R.; Celsia, A. S. Ruby

2018-02-01

Burn wound is a global problem affecting millions of people. It is the major cause of mortality and morbidity. This study was aimed to isolate and identify the wound isolates by 16S rRNA and to assess their susceptibility to antibiotics and silver nanoparticles. Silver nanoparticles were synthesized using aqueous extract of A.indica. The silver nanoparticles were characterized by FESEM, XRD, FTIR and DSC. Antibacterial susceptibility of the isolates was assessed by well diffusion method. The wound isolates were identified as S.aureus and E.coli. Both isolates were resistant to β lactum antibiotics, aminoglycoside, quinolones and macrolides. The inhibition zone exhibited by all antibiotics against both organisms was less than 5 mm. The size of silver nanoparticles were recorded as 55 nm. XRD confirmed the crystalline nature of the nanoparticles. TGA and DSC of silver nanoparticles showed the loss of weight and the melting point of silver nanoparticles was recorded at 871.3°C. Silver nano particles inhibited S.aureus and E.coli with an inhibition zone of 27 mm and 32 mm respectively. Therefore the study demonstrated that only silver containing dressings can be used in burn wounds infected by multi drug resistant super bugs.

Topical oxygenation therapy in wound care: are patients getting enough?

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Hunt, Sharon

2017-08-10

Wound management is a major burden on today's healthcare provider, both clinically with regard to available resources and financially. Most importantly, it has a significant impact on the patient's quality of life and experience. Within the field of wound care these pressures, alongside an ageing population, multiple comorbidities, disease processes and negative lifestyle choices, increase incidences of reduced skin integrity and challenging wounds. In an attempt to meet these challenges alternative, innovative therapies are being explored to support the wound healing process. Wound care experts are now exploring the scientific, biological aspects of wound healing at a cellular level. They are taking wound care back to basics with the identification of elements that, if introduced as an 'adjunct' or as a stand-alone device alongside gold-standard regimens, can positively impact the static or problematic wounds that pose the most challenges to clinicians on a daily basis. This article explores the phenomenon of oxygen, its place in tissue formation and the effect of depletion on the wound healing process and highlights ways in which patients may receive benefit from non-invasive intervention to improve wound care outcomes.

Comparison of three different dressings for partial thickness burns in children: study protocol for a randomised controlled trial.

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Gee Kee, Emma; Kimble, Roy M; Cuttle, Leila; Stockton, Kellie

2013-11-25

In the paediatric population, pain and distress associated with burn injuries during wound care procedures remain a constant challenge. Although silver dressings are the gold standard for burn care in Australasia, very few high-level trials have been conducted that compare silver dressings to determine which will provide the best level of care clinically. Therefore, for paediatric patients in particular, identifying silver dressings that are associated with lower levels of pain and rapid wound re-epithelialisation is imperative. This study will determine whether there is a difference in time to re-epithelialisation and pain and distress experienced during wound care procedures among Acticoat™, Acticoat™ combined with Mepitel™ and Mepilex Ag™ dressings for acute, paediatric partial thickness burns. Children aged 0 to 15 years with an acute partial thickness (superficial partial to deep partial thickness inclusive) burn injury and a burn total body surface area of ≤ 10% will be eligible for the trial. Patients will be randomised to one of the three dressing groups: (1) Acticoat™ or (2) Acticoat™ combined with Mepitel™ or (3) Mepilex Ag™. A minimum of 28 participants will be recruited for each treatment group. Primary measures of pain, distress and healing will be repeated at each dressing change until complete wound re-epithelialisation occurs or skin grafting is required. Additional data collected will include infection status at each dressing change, physical function, scar outcome and scar management requirements, cost effectiveness of each dressing and staff perspectives of the dressings. The results of this study will determine the effects of three commonly used silver and silicone burn dressing combinations on the rate of wound re-epithelialisation and pain experienced during dressing procedures in acute, paediatric partial thickness burn injuries. Australian New Zealand Clinical Trials Registry ACTRN12613000105741.

Burn mouse models

DEFF Research Database (Denmark)

Calum, Henrik; Høiby, Niels; Moser, Claus

2014-01-01

Severe thermal injury induces immunosuppression, involving all parts of the immune system, especially when large fractions of the total body surface area are affected. An animal model was established to characterize the burn-induced immunosuppression. In our novel mouse model a 6 % third-degree b......Severe thermal injury induces immunosuppression, involving all parts of the immune system, especially when large fractions of the total body surface area are affected. An animal model was established to characterize the burn-induced immunosuppression. In our novel mouse model a 6 % third...... with infected burn wound compared with the burn wound only group. The burn mouse model resembles the clinical situation and provides an opportunity to examine or develop new strategies like new antibiotics and immune therapy, in handling burn wound victims much....

Comparison of two silver dressings for wound management in pediatric burns.

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Jester, Ingo; Bohn, Ingo; Hannmann, Thorsten; Waag, Karl-Ludwig; Loff, Steffan

2008-11-01

Purpose. Silver wound dressings are widely used in the treatment of burns. Dressings differ in material characteristics, various antimicrobial activities, and ease of use. The purpose of this study was to evaluate both dressing performance and amount of pain during the dressing changes of 2 silver dressings Urgotul SSD® (Laboratoires Urgo, Chenove, France), and Contreet Ag® (Coloplast, Minneapolis, MN) in children. A retrospective cohort study was performed with 2 groups of 20 burns treated with Urgotul SSD and Contreet Ag until the wounds were healed or grafted. Seventy dressing changes in the Contreet Ag group and 67 dressing changes in the Urgotul group were evaluated. Every dressing change was assessed regarding the dressing performance (exudate, adherence, bleeding, and dressing application/removal), and pain. Pain was "absent or slight" in 61 (92%) dressing changes with Urgotul SSD, and in 60 (85%) of the dressing changes with Contreet Ag. Dressing application in the Urgotul group was more often "very easy" (n = 33; 49%) or "easy" (n = 32; 48%) than in the Contreet Ag group, "very easy" (n = 25; 35%), and "easy" (n = 42; 60%). Contreet Ag had a greater ability to absorb exudate ("very good" n = 60; 85%, and "good" n = 11; 15%) than Urgotul SSD ("very good" n = 34; 51%, and "good" n = 13; 19%). Urgotul SSD and Contreet Ag are comparable regarding pain during dressing change. The dressings differ in their ability to absorb exudate and ease of application. Both dressings provided nearly painless wound management, and therefore were highly accepted by the nurses and especially the children being treated.

Identifying an Education Gap in Wound Care Training in United States Dermatology.

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Ruiz, Emily Stamell; Ingram, Amber; Landriscina, Angelo; Tian, Jiaying; Kirsner, Robert S; Friedman, Adam

2015-07-01

As restoration of the integument is paramount to wound healing, dermatologists should be central to managing wounds; yet this is often not the case. If a training gap exists during residency training, this may account for the observed discrepancy. To identify United States (US) dermatology residents' impressions regarding their preparedness to care for wounds, and to assess the amount and type of training devoted to wound care during residency. An online survey among current US dermatology residents enrolled in a residency training program. The primary goal was to determine whether dermatology residents believe more wound care education is needed, evaluate preparedness to care for wounds, and identify future plans to manage wounds. Responses were received from 175 of 517 (33.8%) US Dermatology residents contacted. The majority of residents did not feel prepared to manage acute (78.3%) and chronic (84.6%) wounds. Over three quarters (77.1%) felt that more education is needed. Fewer than half (49.1% and 35.4%) of residents planned to care for acute and chronic wounds, respectively, when in practice. There is a gap in wound care education in US dermatology residency training. This translates to a low percentage of dermatology residents planning to care for wounds in future practice. Dermatology residents need to receive focused wound care training in order to translate the underpinnings of wound healing biology and ultimately better serve patients.

Wound care matrices for chronic leg ulcers: role in therapy

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Sano H

2015-07-01

Full Text Available Hitomi Sano,1 Sachio Kouraba,2 Rei Ogawa11Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan; 2Sapporo Wound Care and Anti-Aging Laboratory, Sapporo, JapanAbstract: Chronic leg ulcers are a significant health care concern. Although deep wounds are usually treated by flap transfers, the operation is invasive and associates with serious complications. Skin grafts may be a less invasive means of covering wounds. However, skin grafts cannot survive on deep defects unless high-quality granulation tissue can first be generated in the defects. Technologies that generate high-quality granulation tissue are needed. One possibility is to use wound care matrices, which are bioengineered skin and soft tissue substitutes. Because they all support the healing process by providing a premade extracellular matrix material, these matrices can be termed “extracellular matrix replacement therapies”. The matrix promotes wound healing by acting as a scaffold for regeneration, attracting host cytokines to the wound, stimulating wound epithelialization and angiogenesis, and providing the wound bed with bioactive components. This therapy has lasting benefits as it not only helps large skin defects to be closed with thin skin grafts or patch grafts but also restores cosmetic appearance and proper function. In particular, since it acts as a layer that slides over the subcutaneous fascia, it provides skin elasticity, tear resistance, and texture. Several therapies and products employing wound care matrices for wound management have been developed recently. Some of these can be applied in combination with negative pressure wound therapy or beneficial materials that promote wound healing and can be incorporated into the matrix. To date, the clinical studies on these approaches suggest that wound care matrices promote spontaneous wound healing or can be used to facilitate skin grafting, thereby avoiding the need to use

Comparative effectiveness of different wound dressings for patients with partial-thickness burns: study protocol of a systematic review and a Bayesian framework network meta-analysis.

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Jiang, Qiong; Chen, Zhao-Hong; Wang, Shun-Bin; Chen, Xiao-Dong

2017-03-22

Selecting a suitable wound dressing for patients with partial-thickness burns (PTBs) is important in wound care. However, the comparative effectiveness of different dressings has not been studied. We report the protocol of a network meta-analysis designed to combine direct and indirect evidence of wound dressings in the management of PTB. We will search for randomised controlled trials (RCTs) evaluating the wound-healing effect of a wound dressing in the management of PTB. Searches will be conducted in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Wounds Group Specialised Register and CINAHL. A comprehensive search strategy is developed to retrieve articles reporting potentially eligible RCTs. Besides, we will contact the experts in the field and review the conference proceedings to locate non-published studies. The reference lists of articles will be reviewed for any candidate studies. Two independent reviewers will screen titles and abstracts of the candidate articles. All eligible RCTs will be obtained in full text to perform a review. Disagreement on eligibility of an RCT will be solved by group discussion. The information of participants, interventions, comparisons and outcomes from included RCTs will be recorded and summarised. The primary outcome is time to complete wound healing. Secondary outcomes include the proportion of burns completely healed at the end of treatment, change in wound surface area at the end of treatment, incidence of adverse events, etc. The result of this review will provide evidence for the comparative effectiveness of different wound dressings in the management of PTB. It will also facilitate decision-making in choosing a suitable wound dressing. We will disseminate the review through a peer-review journal and conference abstracts or posters. PROSPERO CRD42016041574; Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please

Care for the Critically Injured Burn Patient Modulation of Burn Scars Through Laser Deliver of Stem Cells

Science.gov (United States)

2013-10-01

Miller School of Medicine and the USAISR. To obtain ADSCs, a sample of adipose tissue was surgically removed from the back (front shoulder) region... center of the animal and resulted in better overall similarity in clinical scar morphology. Histologic evaluation of wounds 70 days after burn...isolate and grow tissue fibroblast from the treated and control burn scars. Tissue samples (3 per time point) were decontaminated using several

Citation classics in the burn literature during the past 55 years.

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Nam, Jason J; Chung, Kevin K; King, Booker T; Jones, John A; Cancio, Leopoldo C; Baer, David G; Renz, Evan M; Blackbourne, Lorne H; Orman, Jean A

2014-01-01

The objective of this study was to identify the 100 most cited, peer-reviewed burn-related articles over the past half century. Burn care presents ongoing challenges to both U.S. civilian and military healthcare personnel. Improvements in burn survival and quality of life are the result of advances in burn research. The Web of Science (including Science Citation Index) was searched for the most cited articles related to burn care, published from 1955 to the present. The most cited article was "Permanent coverage of large burn wounds with autologous cultured human epithelium," by G.G. Gallico et al, New England Journal of Medicine, 1984 (711 citations). Between the 1970s and the 1990s, there was a near doubling of the number of highly cited publications with each subsequent decade. A total of 85% of the articles were on the topics of pathophysiology (37%), wounds, tissue, or dressings (31%), or organ failure/sepsis (17%). B.A. Pruitt Jr. (2320 citations), D.N. Herndon (1972 citations), and A.D. Mason Jr. (1435 citations) were the most cited authors. This study identified some of the most important contributions to burn research and the areas of greatest scientific interest to the specialty during the past five decades, and highlights key research that has contributed to the evolution of modern burn care.

Telemedicine in wound care.

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Chanussot-Deprez, Caroline; Contreras-Ruiz, José

2008-12-01

Telemedical wound care is one of the applications of teledermatology. We present our experience using telemedicine in the successful assessment and treatment of three patients with hard-to-heal ulcers. Three patients were seen at the PEMEX General Hospital in Veracruz, Mexico. The first patient was a 53-year-old man with hypertension, morbid obesity, chronic venous insufficiency, recurrent erysipelas, leg ulcers and lymphoedema. There was one ulcer on his left lower leg (20 x 10 cm) and one on his right leg (9 x 7 cm). The second patient was a 73-year-old woman with class III obesity and ulcers in her right leg, secondary to surgical debridement of bullous erysipelas. The third patient was a 51-year-old female with rheumatoid arthritis with one ulcer on each leg and chronic lymphostasis. Photographs with a digital camera were taken and sent weekly via email to a wound care specialist in Mexico City. The photographs allowed the expert to diagnose and evaluate the chronic wounds periodically. In the present cases, telemedicine allowed us to have a rapid evaluation, diagnosis and treatment. The images were of enough quality to be useful and small enough to be sent via regular email to the remote physician who immediately gave his feedback. The expert was confident to give therapeutic recommendations in this way, and we considered this method to be very cost-effective, saving the patient and the health care system, especially in transportation.

Synthesis and characterization of biosheet impregnated with Macrotyloma uniflorum extract for burn/wound dressings.

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Muthukumar, Thangavelu; Senthil, Rethinam; Sastry, Thotapalli Parvathaleswara

2013-02-01

Developing biomaterials having wound healing properties within the search of a common man is the need of hour, particularly in developing and third world countries. Keeping this objective in view we have developed a wound dressing material, in sheet form, containing fish scale collagen (FSC) and physiologically clotted fibrin (PCF), both are by products of aqua food and meat industries respectively. To impart antimicrobial properties to the composite sheet, it was incorporated with Macrotyloma uniflorum plant extract (MPE). SEM pictures have shown that FSC:PCF:MPE composite has fibrous and porous surface which helps in transportation of oxygen as well as absorbing wound fluids and their evaporation. The biomaterials have shown 100% biocompatibility and the percentage cell viability was found to be above 89%. The FSC:PCF:MPE biocomposite film with required mechanical strength, biocompatibility and antimicrobial properties can be tried as a burn/wound dressing material. Copyright © 2012 Elsevier B.V. All rights reserved.

Wound care in the geriatric client

Directory of Open Access Journals (Sweden)

Steve Gist

2009-06-01

Full Text Available Steve Gist, Iris Tio-Matos, Sharon Falzgraf, Shirley Cameron, Michael BeebeGeriatrics and Extended Care, Programs, VA Puget Sound Health Care Systems, American Lake Division, Tacoma, WA, USAAbstract: With our aging population, chronic diseases that compromise skin integrity such as diabetes, peripheral vascular disease (venous hypertension, arterial insufficiency are becoming increasingly common. Skin breakdown with ulcer and chronic wound formation is a frequent consequence of these diseases. Types of ulcers include pressure ulcers, vascular ulcers (arterial and venous hypertension, and neuropathic ulcers. Treatment of these ulcers involves recognizing the four stages of healing: coagulation, inflammation, proliferation, and maturation. Chronic wounds are frequently stalled in the inflammatory stage. Moving past the inflammation stage requires considering the bacterial burden, necrotic tissue, and moisture balance of the wound being treated. Bacterial overgrowth or infection needs to be treated with topical or systemic agents. In most cases, necrotic tissue needs to be debrided and moisture balance needs to be addressed by wetting dry tissue and drying wet tissue. Special dressings have been developed to accomplish these tasks. They include films, hydrocolloids, hydrogel dressings, foams, hydro-fibers, composite and alginate dressings.Keywords: wound care, pressure ulcers, vascular ulcers, diabetic ulcers, debridement, elderly

Recent advances in topical wound care

Directory of Open Access Journals (Sweden)

Sujata Sarabahi

2012-01-01

Full Text Available There are a wide variety of dressing techniques and materials available for management of both acute wounds and chronic non-healing wounds. The primary objective in both the cases is to achieve a healed closed wound. However, in a chronic wound the dressing may be required for preparing the wound bed for further operative procedures such as skin grafting. An ideal dressing material should not only accelerate wound healing but also reduce loss of protein, electrolytes and fluid from the wound, and help to minimize pain and infection. The present dictum is to promote the concept of moist wound healing. This is in sharp contrast to the earlier practice of exposure method of wound management wherein the wound was allowed to dry. It can be quite a challenge for any physician to choose an appropriate dressing material when faced with a wound. Since wound care is undergoing a constant change and new products are being introduced into the market frequently, one needs to keep abreast of their effect on wound healing. This article emphasizes on the importance of assessment of the wound bed, the amount of drainage, depth of damage, presence of infection and location of wound. These characteristics will help any clinician decide on which product to use and where,in order to get optimal wound healing. However, there are no ′magical dressings′. Dressings are one important aspect that promotes wound healing apart from treating the underlying cause and other supportive measures like nutrition and systemic antibiotics need to be given equal attention.

Preliminary results in single-step wound closure procedure of full-thickness facial burns in children by using the collagen-elastin matrix and review of pediatric facial burns.

Science.gov (United States)

Demircan, Mehmet; Cicek, Tugrul; Yetis, Muhammed Ikbal

2015-09-01

Management of full-thickness facial burns remains one of the greatest challenges. Controversy exists among surgeons regarding the use of early excision for facial burns. Unfortunately, delayed excision of deeper burns often results in more scarring and subsequent reconstruction becomes more difficult. A collagen-elastin matrix is used to improve the quality of the reconstructed skin, to reduce scarring and to prevent wound contraction. It serves as a foundation for split thickness skin graft and enhances short and long-term results. We report the usage of a collagen-elastin matrix during single-step wound closure technique of severe full-thickness facial burns in 15 children with large burned body surface area, and also we review the literature about pediatric facial burns. There were 15 pediatric patients with severe facial burns, 8 girls and 7 boys ranging in age from 10 months to 12 years, mean age 7 years and 6 months old. The facial burn surface area (FBSA) among the patients includes seven patients with 100%, five with 75%, and three with 50%. The average total body surface area (TBSA) for the patients was 72%, ranging between 50 and 90%. 5 of the patients' admissions were late, more than four days after burns while the rest of the patients were admitted within the first four days (acute admission time). The burns were caused by flame in eight of the patients, bomb blast in four, and scalding in three. All patients were treated by the simultaneous application of the collagen-elastin matrix and an unmeshed split thickness skin graft at Turgut Özal Medical Center, Pediatric Burn Center, Malatya, Turkey. After the treatment only two patients needed a second operation for revision of the grafts. All grafts transplanted to the face survived. The average Vancouver scar scales (VSS) were 2.55±1.42, ranging between one and six, in the first 10 of 15 patients at the end of 6 months postoperatively. VSS measurements of the last 5 patients were not taken since the 6

SELECTIVE INTESTINAL DECONTAMINATION FOR PREVENTION OF WOUND COLONIZATION IN SEVERELY BURNED PATIENTS - A RETROSPECTIVE ANALYSIS

NARCIS (Netherlands)

MANSON, WL; KLASEN, HJ; SAUER, EW; OLIEMAN, A

In this study the effect of selective intestinal decontamination of the digestive tract (SDD) on wound colonization was investigated. Ninety-one patients with at least 25 per cent total burned surface area (TBSA) were included in this study. All patients received oral polymyxin. In 63 patients oral

Leptospermum Honey for Wound Care in an Extremely Premature Infant.

Science.gov (United States)

Esser, Media

2017-02-01

Neonatal wound care is challenging due to the fragility and vulnerable skin structure. Neonates are often left susceptible to the forces of their environment, leaving them open to infection when skin injury occurs. Leptospermum honey has been used successfully in adult patients, with evidence lacking in the neonatal population. This case demonstrates the management of a difficult-to-heal wound in a 23-week gestation infant. Selecting the proper treatment and products for wound healing is challenging, with little evidence-based research available for the treatment of neonatal wounds. Leptospermum honey and other adult-driven dressings have been used for neonatal wound care as well as other adult-driven dressings. This case demonstrates the benefits of Leptospermum honey as an option for neonatal wounds. This case presents the treatment and healing of an extensive wound of a 23-week gestation neonate using a hydrogel product initially and then transitioning to a Leptospermum honey dressing due to suboptimal healing. Results of this treatment included quick healing time, little to no scarring, and no loss of movement or function to the affected extremities. The incorporation of Leptospermum honey for wound care has the potential to promote faster wound healing, with less scarring in the neonatal population. Adult wound care principles have been applied in the face of a weak evidence base relating to neonatal-specific cases. There is a need for continued research related to moist wound healing in the neonatal population, with resulting product and practice recommendations.

78 FR 49528 - Consolidation of Wound Care Products Containing Live Cells

Science.gov (United States)

2013-08-14

...] Consolidation of Wound Care Products Containing Live Cells AGENCY: Food and Drug Administration, HHS. ACTION... certain wound care products containing live cells from the Center for Devices and Radiological Health... CDRH and CBER. FDA believes that as more wound care products containing live cells are developed such...

Do systematic reviews address community healthcare professionals' wound care uncertainties? Results from evidence mapping in wound care.

Science.gov (United States)

Christie, Janice; Gray, Trish A; Dumville, Jo C; Cullum, Nicky A

2018-01-01

Complex wounds such as leg and foot ulcers are common, resource intensive and have negative impacts on patients' wellbeing. Evidence-based decision-making, substantiated by high quality evidence such as from systematic reviews, is widely advocated for improving patient care and healthcare efficiency. Consequently, we set out to classify and map the extent to which up-to-date systematic reviews containing robust evidence exist for wound care uncertainties prioritised by community-based healthcare professionals. We asked healthcare professionals to prioritise uncertainties based on complex wound care decisions, and then classified 28 uncertainties according to the type and level of decision. For each uncertainty, we searched for relevant systematic reviews. Two independent reviewers screened abstracts and full texts of reviews against the following criteria: meeting an a priori definition of a systematic review, sufficiently addressing the uncertainty, published during or after 2012, and identifying high quality research evidence. The most common uncertainty type was 'interventions' 24/28 (85%); the majority concerned wound level decisions 15/28 (53%) however, service delivery level decisions (10/28) were given highest priority. Overall, we found 162 potentially relevant reviews of which 57 (35%) were not systematic reviews. Of 106 systematic reviews, only 28 were relevant to an uncertainty and 18 of these were published within the preceding five years; none identified high quality research evidence. Despite the growing volume of published primary research, healthcare professionals delivering wound care have important clinical uncertainties which are not addressed by up-to-date systematic reviews containing high certainty evidence. These are high priority topics requiring new research and systematic reviews which are regularly updated. To reduce clinical and research waste, we recommend systematic reviewers and researchers make greater efforts to ensure that research

Surgical treatment and management of the severely burn patient: Review and update.

Science.gov (United States)

Gacto-Sanchez, P

Since one of the main challenges in treating acute burn injuries is preventing infection, early excising of the eschar and covering of the wound becomes critical. Non-viable tissue is removed by initial aggressive surgical debridement. Many surgical options for covering the wound bed have been described, although split-thickness skin grafts remain the standard for the rapid and permanent closure of full-thickness burns. Significant advances made in the past decades have greatly improved burns patient care, as such that major future improvements in survival rates seem to be more difficult. Research into stem cells, grafting, biomarkers, inflammation control, and rehabilitation will continue to improve individualized care and create new treatment options for these patients. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

Advanced skin, scar and wound care centre for children: A new era of care

Directory of Open Access Journals (Sweden)

Andrew Burd

2012-01-01

Full Text Available Advanced wound care centres are now a well established response to the growing epidemic of chronic wounds in the adult population. Is the concept transferable to children? Whilst there is not the same prevalence of chronic wounds in children there are conditions affecting the integumentary system that do have a profound effect on the quality of life of both children and their families. We have identified conditions involving the skin, scars and wounds which contribute to a critical number of potential patients that can justify the setting up of an advanced skin, scar and wound care centre for children. The management of conditions such as giant naevi, extensive scarring and epidermolysis bullosa challenge medical professionals and lead to new and novel treatments to be developed. The variation between and within such conditions calls for a customizing of individual patient care that involves a close relationship between research scientists and clinicians. This is translational medicine of its best and we predict that this is the future of wound care particularly and specifically in children.

Cryopreserved cadaveric skin allograft for cover of excised burns wounds: early clinical experience in Singapore

International Nuclear Information System (INIS)

See, P.; Chua, J.J.; Phua, T.T.; Song, C.; Tan, K.C.; Foo, C.L.; Lee, S.T.; Ngim, R.

1999-01-01

Human cadaveric skin allograft is widely and effectively used in the treatment of extensive burns. A Skin Bank was established in Singapore National Burns Centre in late 1992 to cater to this need. Due to the shortage of skin donors, it was not until early 1998 that the Skin Bank began to store cadaveric skin harvested from consent donors under the Medical Therapy, Education and Research Act. Cadaveric skin has significant clinical usefulness particularly in the treatment of severe burns. The National Burns Centre admits on the average 300 patients a year, and about 25% of which have sustained major burns (total bum area in excess of 30% BSA or full thickness in excess of 20% BSA). In many cases, the bums are too extensive for autologous skin grafts. The pivotal role of the Skin Bank allows temporary coverage of the entire open bum wound following desloughing or bum wound excision. To date six skin donations have been dealt with. The national tissue transplant team coordinated the selection and screening of these donors. The skin harvested is cryopreserved with 10% dimethyl sulphoxide (DMSO) or glycerol in DMEM. Supplementation with antibiotics is important. Storage temperature is set at -150 degree C. The procurement, processing, preservation and storage of skin allografts were according to guidelines issued by the American Association of Tissue Banks.Three patients with extensive bums (45% mean body surface area) have benefited from this stored cadaveric skin as temporary biological dressings. The technique is by no means novel but the usage of cadaveric skin represents a further treatment milestone for the severe bum injury patients at our centre

Rapid research and implementation priority setting for wound care uncertainties.

Directory of Open Access Journals (Sweden)

Trish A Gray

Full Text Available People with complex wounds are more likely to be elderly, living with multimorbidity and wound related symptoms. A variety of products are available for managing complex wounds and a range of healthcare professionals are involved in wound care, yet there is a lack of good evidence to guide practice and services. These factors create uncertainty for those who deliver and those who manage wound care. Formal priority setting for research and implementation topics is needed to more accurately target the gaps in treatment and services. We solicited practitioner and manager uncertainties in wound care and held a priority setting workshop to facilitate a collaborative approach to prioritising wound care-related uncertainties.We recruited healthcare professionals who regularly cared for patients with complex wounds, were wound care specialists or managed wound care services. Participants submitted up to five wound care uncertainties in consultation with their colleagues, via an on-line survey and attended a priority setting workshop. Submitted uncertainties were collated, sorted and categorised according professional group. On the day of the workshop, participants were divided into four groups depending on their profession. Uncertainties submitted by their professional group were viewed, discussed and amended, prior to the first of three individual voting rounds. Participants cast up to ten votes for the uncertainties they judged as being high priority. Continuing in the professional groups, the top 10 uncertainties from each group were displayed, and the process was repeated. Groups were then brought together for a plenary session in which the final priorities were individually scored on a scale of 0-10 by participants. Priorities were ranked and results presented. Nominal group technique was used for generating the final uncertainties, voting and discussions.Thirty-three participants attended the workshop comprising; 10 specialist nurses, 10 district

Rapid research and implementation priority setting for wound care uncertainties

Science.gov (United States)

Dumville, Jo C.; Christie, Janice; Cullum, Nicky A.

2017-01-01

Introduction People with complex wounds are more likely to be elderly, living with multimorbidity and wound related symptoms. A variety of products are available for managing complex wounds and a range of healthcare professionals are involved in wound care, yet there is a lack of good evidence to guide practice and services. These factors create uncertainty for those who deliver and those who manage wound care. Formal priority setting for research and implementation topics is needed to more accurately target the gaps in treatment and services. We solicited practitioner and manager uncertainties in wound care and held a priority setting workshop to facilitate a collaborative approach to prioritising wound care-related uncertainties. Methods We recruited healthcare professionals who regularly cared for patients with complex wounds, were wound care specialists or managed wound care services. Participants submitted up to five wound care uncertainties in consultation with their colleagues, via an on-line survey and attended a priority setting workshop. Submitted uncertainties were collated, sorted and categorised according professional group. On the day of the workshop, participants were divided into four groups depending on their profession. Uncertainties submitted by their professional group were viewed, discussed and amended, prior to the first of three individual voting rounds. Participants cast up to ten votes for the uncertainties they judged as being high priority. Continuing in the professional groups, the top 10 uncertainties from each group were displayed, and the process was repeated. Groups were then brought together for a plenary session in which the final priorities were individually scored on a scale of 0–10 by participants. Priorities were ranked and results presented. Nominal group technique was used for generating the final uncertainties, voting and discussions. Results Thirty-three participants attended the workshop comprising; 10 specialist nurses

Accessing wound-care information on the Internet: the implications for patients.

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Bovill, E S; Hormbrey, E; Gillespie, P H; Banwell, P E

2001-02-01

The Internet and the World Wide Web have revolutionised communication and provide a unique forum for the exchange of information. It has been proposed that the Internet has given the public more access to medical information resources and improved patient education. This study assessed the impact of the Internet on the availability of information on wound care management. The search phrases 'wound care', 'wound healing' and 'wounds' were analysed using a powerful Metacrawler search engine (www.go2net.com). Web site access was classified according to the target audience (wound-care specialists, other health professionals, patients) and the author (societies, institutions or commercial companies). The largest proportion of web sites were commercially based (32%). Of the total number, 23% specifically targeted patients, mostly by advertising. Only 20% were aimed at wound specialists. Extensive surfing was required to obtain wound-care information, and objective information sites were under-represented. Regulated, easily accessible, objective information sites on wound-healing topics are needed for improved patient education and to balance the existing commercial bias.

Skin graft fixation in severe burns: use of topical negative pressure.

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Kamolz, L P; Lumenta, D B; Parvizi, D; Wiedner, M; Justich, I; Keck, M; Pfurtscheller, K; Schintler, M

2014-09-30

Over the last 50 years, the evolution of burn care has led to a significant decrease in mortality. The biggest impact on survival has been the change in the approach to burn surgery. Early excision and grafting has become a standard of care for the majority of patients with deep burns; the survival of a given patient suffering from major burns is invariably linked to the take rate and survival of skin grafts. The application of topical negative pressure (TNP) therapy devices has demonstrated improved graft take in comparison to conventional dressing methods alone. The aim of this study was to analyze the impact of TNP therapy on skin graft fixation in large burns. In all patients, we applied TNP dressings covering a %TBSA of >25. The following parameters were recorded and documented using BurnCase 3D: age, gender, %TBSA, burn depth, hospital length-of-stay, Baux score, survival, as well as duration and incidence of TNP dressings. After a burn depth adapted wound debridement, coverage was simultaneously performed using split-thickness skin grafts, which were fixed with staples and covered with fatty gauzes and TNP foam. The TNP foam was again fixed with staples to prevent displacement and finally covered with the supplied transparent adhesive film. A continuous subatmospheric pressure between 75-120 mm Hg was applied (VAC®, KCI, Vienna, Austria). The first dressing change was performed on day 4. Thirty-six out of 37 patients, suffering from full thickness burns, were discharged with complete wound closure; only one patient succumbed to their injuries. The overall skin graft take rate was over 95%. In conclusion, we consider that split thickness skin graft fixation by TNP is an efficient method in major burns, notably in areas with irregular wound surfaces or subject to movement (e.g. joint proximity), and is worth considering for the treatment of aged patients.

The resource impact of wounds on health-care providers in Europe.

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Posnett, J; Gottrup, F; Lundgren, H; Saal, G

2009-04-01

Most of the literature focuses on the resources required to manage particular wound types, rather than the cost of wounds to health-care organisations. Until this information is available, wound care is unlikely to be a management priority.

The treatment of extensively burned patents and β irradiational injury skin burn patients with irradiated pigskin

International Nuclear Information System (INIS)

Tang Zhongyi; Lu Xingan; Jing Ling; Qi Qiang

1994-01-01

Obvious therapeutic effects achieved by the covering of irradiation sterilized pigskin on burn wounds, escarectomized 3rd degree burn wounds β injured burns are discussed. The article also describes the manufacture processes of irradiated pigskins and the selection of surgical treatments of various burns. 5 refs., 1 tab., 4 figs

Amniotic membrane seeded with mesenchymal adipose-derived stem cell for coverage of wound in third degree burn: An experimental study

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Mohammad Javad Fatemi

2014-09-01

Conclusion: Acellular amnion seeded with adipose-derived stem cell can result in faster wound healing and better histopathology characteristic. The amnion as a scaffold and the fat derived stem cells as healing accelerator are recommended for coverage of the 3rd degree burn wounds after excision and it may reduce the need for skin graft.

Topical Erythropoietin Treatment Accelerates the Healing of Cutaneous Burn Wounds in Diabetic Pigs Through an Aquaporin-3-Dependent Mechanism.

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Hamed, Saher; Ullmann, Yehuda; Egozi, Dana; Keren, Aviad; Daod, Essam; Anis, Omer; Kabha, Hoda; Belokopytov, Mark; Ashkar, Manal; Shofti, Rona; Zaretsky, Asaph; Schlesinger, Michal; Teot, Luc; Liu, Paul Y

2017-08-01

We have previously reported that the topical application of erythropoietin (EPO) to cutaneous wounds in rats and mice with experimentally induced diabetes accelerates their healing by stimulating angiogenesis, reepithelialization, and collagen deposition, and by suppressing the inflammatory response and apoptosis. Aquaporins (AQPs) are integral membrane proteins whose function is to regulate intracellular fluid hemostasis by enabling the transport of water and glycerol. AQP3 is the AQP that is expressed in the skin where it facilitates cell migration and proliferation and re-epithelialization during wound healing. In this report, we provide the results of an investigation that examined the contribution of AQP3 to the mechanism of EPO action on the healing of burn wounds in the skin of pigs with experimentally induced type 1 diabetes. We found that topical EPO treatment of the burns accelerated their healing through an AQP3-dependent mechanism that activates angiogenesis, triggers collagen and hyaluronic acid synthesis and the formation of the extracellular matrix (ECM), and stimulates reepithelialization by keratinocytes. We also found that incorporating fibronectin, a crucial constituent of the ECM, into the topical EPO-containing gel, can potentiate the accelerating action of EPO on the healing of the burn injury. © 2017 by the American Diabetes Association.

Buruli ulcer: wound care and rehabilitation

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Frimpong M

2016-06-01

Full Text Available Michael Frimpong,1 Fred Stephen Sarfo,2 Mabel Sarpong Duah,1 Mark Wansbrough-Jones,3 Richard O Phillips2 1Kumasi Centre for Collaborative Research in Tropical Medicine, 2Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; 3Institute for Infection and Immunity, St George’s University of London, London, UK Abstract: Buruli ulcer caused by Mycobacterium ulcerans is a neglected tropical disease characterized by extensive ulceration involving predominantly the upper and lower limbs of patients. The disease is common in rural tropical communities in West and Central Africa, where access to proper health care is limited. Pathogenesis of the characteristic painless ulcers is linked to the elaboration by M. ulcerans of a lipid toxin called mycolactone that has potent cytopathic, immunosuppressive, and analgesic effects on a host of cells in cutaneous tissues. Mycolactone is known to profoundly inhibit secretion of a plethora of proteins that are essential for wound healing. Even though a combination antibacterial therapy of streptomycin and rifampicin for 8 weeks is effective for treatment, it relies on good and appropriate wound management to prevent secondary bacterial infections and improve healing. Evidence-based interventions for wound care in Buruli ulcer disease are often lacking and have relied on expert advice and recommendations. Surgical interventions are limited to debridement of necrotic tissue and grafting of extensive ulcers, usually after antibiotic therapy. Patients’ rehabilitation is an important component of care to reduce disabilities associated with the disease and proper integration into the community after treatment. Keywords: Buruli ulcer, Mycobacterium ulcerans disease, Mycobacterium ulcerans, wound care, rehabilitation, disability

A comparative study of histopathological effects of aqueous extract of cinnamon and honey with sulfadiazine on skin burn wound healing in rats infected with Pseudomonas aeuroginosa

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Mohammadreza Valilou

2017-11-01

Full Text Available Pseudomonas aeruginosa, a ubiquitous opportunistic pathogen, is the most common infective agent of burn wounds. The aim of this study was to compare the histopathological effect of a mixture of aqueous extract of cinnamon and honey with silver sulfadiazine on the healing of Pseudomonas aeruginosa infected second grade skin burn wounds in rats. To this end, 60 male rats were randomly assigned to four experimental groups (15 rats in each group. After inducing anesthesia, second grade burn wound with the diameter of 12 mm was created in the dorsal region of rats. Then, 1.5×108 cfu/ml P. aeruginosa PA01was equally bestrewed on the wound of all rats. Every 12 hours, silver sulfadiazine (group 1, honey (group 2 and aqueous extract of cinnamon and honey (group 3 were applied to the wounds and group 4 was kept as control. On days 7, 14, and 21, five rats were selected from each group at each time point and after inducing anesthesia and measuring the diameter of the wound by coliseum, microbial and histopathological samples were taken from the wounds. Microbial studies showed that in all groups except the control group, the growth of the microbe was stopped. Histopathological observations regarding wound healing and diameter showed that there was a significant difference between treatment groups and the control group on days 7, 14 and 21 (p

Wound Documentation by Using 3G Mobile as Acquisition Terminal: An Appropriate Proposal for Community Wound Care.

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Ge, Kui; Wu, Minjie; Liu, Hu; Gong, Jiahong; Zhang, Yi; Hu, Qiang; Fang, Min; Tao, Yanping; Cai, Minqiang; Chen, Hua; Wang, Jianbo; Xie, Ting; Lu, Shuliang

2015-06-01

The increasing numbers of cases of wound disease are now posing a big challenge in China. For more convenience of wound patients, wound management in community health care centers under the supervision of a specialist at general hospitals is an ideal solution. To ensure an accurate diagnosis in community health clinics, it is important that "the same language" for wound description, which may be composed of unified format description, including wound image, must be achieved. We developed a wound information management system that was built up by acquisition terminal, wound description, data bank, and related software. In this system, a 3G mobile phone was applied as acquisition terminal, which could be used to access to the data bank. This documentation system was thought to be an appropriate proposal for community wound care because of its objectivity, uniformity, and facilitation. It also provides possibility for epidemiological study in the future. © The Author(s) 2014.

Pediatric Thermal Burns and Treatment: A Review of Progress and Future Prospects

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Elton Mathias

2017-12-01

Full Text Available Burn injuries are a devastating critical care problem. In children, burns continue to be a major epidemiologic problem around the globe resulting in significant morbidity and death. Apparently, treating these burn injuries in children and adults remains similar, but there are significant physiological and psychological differences. The dermal layer of the skin is generally thinner in neonates, infants, and children than in adults. Enhanced evaporative loss and need for isotonic fluids increases the risk of hypothermia in the pediatric population. The pain management of the children with major burns challenges the skills of the personnel of every unit. Managing these wounds requires intensive therapeutic treatment for multi-organ dysfunction, and surgical treatment to prevent sepsis and other complications that further delay wound closure. Alternatives to the practice of donor site harvest and autografting for the treatment of severe burns and other complex skin defects are urgently needed for both adult and pediatric populations. This review article focuses on thermal burn pathophysiology and pain management and provides an overview of currently approved products used for the treatment of pediatric burn wounds. A new promising approach has been presented as a first-line therapy in the treatment of burns to reduce surgical autografting in pediatric patients.

PMN Leukocytes and Fibroblasts Numbers on Wound Burn Healing on the Skin of White Rat after Administration of Ambonese Plantain Banana

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Juniarti

2012-04-01

Full Text Available A study of ambonese plantain banana (Musa paradisiaca var sapientum Lamb treatment in burn wound healing on the skin of white rats (Rattus novergicus has been conducted. The wound healing of burn injuries was evaluated by counting the number of PMN leukocytes and fibroblasts at the 7th, 14th, and 21st days following the treatment. The study showed that the decrease in number of PMN leukocytes of subjects treated with ambonese plantain banana was relatively more significant compared to both negative and positive control (Bioplacenton ®. In contrast, an increasing number of fibroblasts was significantly demonstrated at the 14th and 21st days after treatment. In conclusion, ambonese plantain banana treatment in burn injuries will provide better results compared to both positive and negative controls.

A clinician's guide to the treatment of foot burns occurring in diabetic patients.

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Jones, Larry M; Coffey, Rebecca; Khandelwal, Sorabh; Atway, Said; Gordillo, Gayle; Murphy, Claire; Fries, Jody A; Dungan, Kathleen

2014-12-01

Diabetes mellitus affects 25.8 million Americans and is predicted to almost double by 2050. The presence of diabetes complicates hospital courses because of the microvascular complications associated with disease progression. Patients with diabetes represent 18.3% of annual burn admissions to our unit and 27% have burns to the feet. The purpose of this project was to develop an evidence-based guideline for care of the patient with diabetes and foot burns A multidisciplinary group was charged with developing an evidence-based guideline for the treatment of foot burns in patients with diabetes. Evidence was evaluated in the areas of diabetes, burn care, hyperbaric medicine, care of diabetic foot wounds and physical therapy. After guideline development and approval, key aspects were incorporated into order sets. Key aspects of this guideline are the ability to identify patients with undiagnosed diabetes, assess diabetic control, optimize glycemic and metabolic control, optimize burn wound management, treat microvascular disease, and provide education and a discharge plan. Evaluated outcomes are glycemic control, length of stay, complication rates, amputation rates, infection rates and the use of hyperbaric oxygen. Best outcomes for this high risk population will be attainable with an evidence based guideline. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Comparative effectiveness of the SNaP™ Wound Care System.

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Hutton, David W; Sheehan, Peter

2011-04-01

Diabetic lower extremity wounds cause substantial burden to healthcare systems, costing tens of thousands of dollars per episode. Negative pressure wound therapy (NPWT) devices have been shown to be cost-effective at treating these wounds, but the traditional devices use bulky electrical pumps that require a durable medical equipment rental-based procurement process. The Spiracur SNaP™ Wound Care System is an ultraportable NPWT system that does not use an electric pump and is fully disposable. It has superior healing compared to standard of care with modern dressings and comparable healing to traditional NPWT devices while giving patients greater mobility and giving clinicians a simpler procurement process. We used a mathematical model to analyse the costs of the SNaP™ system and compare them to standard of care and electrically powered NPWT devices. When compared to standard of care, the SNaP™ system saves over $9000 per wound treated and more than doubles the number of patients healed. The SNaP system has similar healing time to powered NPWT devices, but saves $2300 in Medicare payments or $2800 for private payers per wound treated. Our analysis shows that the SNaP™ system could save substantial treatment costs in addition to allowing patients greater freedom and mobility. © 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

Consensus principles for wound care research obtained using a Delphi process.

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Serena, Thomas; Bates-Jensen, Barbara; Carter, Marissa J; Cordrey, Renee; Driver, Vickie; Fife, Caroline E; Haser, Paul B; Krasner, Diane; Nusgart, Marcia; Smith, Adrianne P S; Snyder, Robert J

2012-01-01

Too many wound care research studies are poorly designed, badly executed, and missing crucial data. The objective of this study is to create a series of principles for all stakeholders involved in clinical or comparative effectiveness research in wound healing. The Delphi approach was used to reach consensus, using a web-based survey for survey participants and face-to-face conferences for expert panel members. Expert panel (11 members) and 115 wound care researchers (respondents) drawn from 15 different organizations. Principles were rated for validity using 5-point Likert scales and comments. A 66% response rate was achieved in the first Delphi round from the 173 invited survey participants. The response rate for the second Delphi round was 46%. The most common wound care researcher profile was age 46-55 years, a wound care clinic setting, and >10 years' wound care research and clinical experience. Of the initial 17 principles created by the panel, only four principles were not endorsed in Delphi round 1 with another four not requiring revision. Of the 14 principles assessed by respondents in the second Delphi round, only one principle was not endorsed and it was revised; four other principles also needed revision based on the use of specific words or contextual use. Of the 19 final principles, three included detailed numbered lists. With the wide variation in design, conduct, and reporting of wound care research studies, it is hoped that these principles will improve the standard and practice of care in this field. © 2012 by the Wound Healing Society.

Second Annual Meeting of the International Society of Pediatric Wound Care.

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Keswani, Sundeep G

2015-10-01

The overarching goals of the International Society of Pediatric Wound Care (ISPeW) are to (1) set global standards for the assessment and treatment of pediatric wounds of varying etiologies; (2) provide a forum for international interprofessional collaboration among healthcare professionals, researchers, educators, and industry leaders dedicated to the care of pediatric wounds; (3) promote and support clinical research focused on the prevention, assessment, and treatment of pediatric wounds; (4) collaborate with wound care organizations worldwide on pediatric wound care issues; and (5) provide evidence-based pediatric wound care education to healthcare professionals, parents, and lay caregivers. This edition of Advances in Wound Care includes some of the work that was presented at the 2014 ISPeW meeting in Rome. The first article by Dr. Romanelli, is an in-depth description of the progression of skin physiology throughout its maturational stages and clinical implication. A cutting edge article by Dr. Timothy King then follows, with regard to scar prevention in postnatal tissues. This is followed by a comprehensive look at debridement techniques in pediatric trauma by Dr. Ankush Gosain. Next, is a cautionary article by Dr. Luca Spazzapan that examines the prevalence of diabetic foot ulcers in children and the potential for an epidemic. The last article in this series is from the keynote speaker, Dr. Amit Geffen, who eloquently examines the use of biomaterials to offload and prevent pediatric pressure ulcers.

Wound and soft tissue infections of Serratia marcescens in patients receiving wound care: A health care-associated outbreak.

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Us, Ebru; Kutlu, Huseyin H; Tekeli, Alper; Ocal, Duygu; Cirpan, Sevilay; Memikoglu, Kemal O

2017-04-01

We described a health care-associated Serratia marcescens outbreak of wound and soft tissue infection lasting approximately 11 months at Ankara University Ibni Sina Hospital. After identification of S marcescens strains from the clinical and environmental samples, and their susceptibility testing to antimicrobial agents, pulsed-field gel electrophoresis (PFGE) was performed to detect molecular epidemiologic relationships among these isolates. The strains which were isolated from the saline bottles used for wound cleansing in the wound care unit were found to be 100% interrelated by PFGE to the strains from the samples of the outbreak patients. Reuse of the emptied bottles has no longer been allowed since the outbreak occurred. Besides, more efficient and frequent infection control training for hospital staff has been conducted. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Accelerated re-epithelialization of partial-thickness skin wounds by a topical betulin gel: Results of a randomized phase III clinical trials program.

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Barret, Juan P; Podmelle, Fred; Lipový, Břetislav; Rennekampff, Hans-Oliver; Schumann, Hauke; Schwieger-Briel, Agnes; Zahn, Tobias R; Metelmann, Hans-Robert

2017-09-01

The clinical significance of timely re-epithelialization is obvious in burn care, since delayed wound closure is enhancing the risk of wound site infection and extensive scarring. Topical treatments that accelerate wound healing are urgently needed to reduce these sequelae. Evidence from preliminary studies suggests that betulin can accelerate the healing of different types of wounds, including second degree burns and split-thickness skin graft wounds. The goal of this combined study program consisting of two randomized phase III clinical trials in parallel is to evaluate whether a topical betulin gel (TBG) is accelerating re-epithelialization of split-thickness skin graft (STSG) donor site wounds compared to standard of care. Two parallel blindly evaluated, randomised, controlled, multicentre phase III clinical trials were performed in adults undergoing STSG surgery (EudraCT nos. 2012-003390-26 and 2012-000777-23). Donor site wounds were split into two equal halves and randomized 1:1 to standard of care (a non-adhesive moist wound dressing) or standard of care plus TBG consisting of 10% birch bark extract and 90% sunflower oil (Episalvan, Birken AG, Niefern-Oeschelbronn, Germany). The primary efficacy assessment was the intra-individual difference in time to wound closure assessed from digital photographs by three blinded experts. A total of 219 patients were included and treated in the two trials. Wounds closed faster with TBG than without it (15.3 vs. 16.5 days; mean intra-individual difference=-1.1 days [95% CI, -1.5 to -0.7]; p<0.0001). This agreed with unblinded direct clinical assessment (difference=-2.1 days [95% CI, -2.7 to -1.5]; p<0.0001). Adverse events possibly related to treatment were mild or moderate and mostly at the application site. TBG accelerates re-epithelialization of partial thickness wounds compared to the current standard of care, providing a well-tolerated contribution to burn care in practice. Copyright © 2017 The Authors. Published by

Role of Mesenchymal Stem Cells on Cornea Wound Healing Induced by Acute Alkali Burn

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Yao, Lin; Li, Zhan-rong; Su, Wen-ru; Li, Yong-ping; Lin, Miao-li; Zhang, Wen-xin; Liu, Yi; Wan, Qian; Liang, Dan

2012-01-01

The aim of this study was to investigate the effects of subconjunctivally administered mesenchymal stem cells (MSCs) on corneal wound healing in the acute stage of an alkali burn. A corneal alkali burn model was generated by placing a piece of 3-mm diameter filter paper soaked in NaOH on the right eye of 48 Sprague-Dawley female rats. 24 rats were administered a subconjunctival injection of a suspension of 2×106 MSCs in 0.1 ml phosphate-buffered saline (PBS) on day 0 and day 3 after the corneal alkali burn. The other 24 rats were administered a subconjunctival injection of an equal amount of PBS as a control. Deficiencies of the corneal epithelium and the area of corneal neovascularization (CNV) were evaluated on days 3 and 7 after the corneal alkali burn. Infiltrated CD68+ cells were detected by immunofluorescence staining. The mRNA expression levels of macrophage inflammatory protein-1 alpha (MIP-1α), tumor necrosis factor-alpha (TNF-α), monocyte chemotactic protein-1 (MCP-1) and vascular endothelial growth factor (VEGF) were analyzed using real-time polymerase chain reaction (real-time PCR). In addition, VEGF protein levels were analyzed using an enzyme-linked immunosorbent assay (ELISA). MSCs significantly enhanced the recovery of the corneal epithelium and decreased the CNV area compared with the control group. On day 7, the quantity of infiltrated CD68+ cells was significantly lower in the MSC group and the mRNA levels of MIP-1α, TNF-α, and VEGF and the protein levels of VEGF were also down-regulated. However, the expression of MCP-1 was not different between the two groups. Our results suggest that subconjunctival injection of MSCs significantly accelerates corneal wound healing, attenuates inflammation and reduces CNV in alkaline-burned corneas; these effects were found to be related to a reduction of infiltrated CD68+ cells and the down-regulation of MIP-1α, TNF-α and VEGF. PMID:22363499

Evaluation of the efficacy of cell and micrograft transplantation for full-thickness wound healing

DEFF Research Database (Denmark)

Kruse, Carla R.; Sakthivel, Dharaniya; Sinha, Indranil

2018-01-01

Background: Skin grafting is the current standard of care in the treatment of full-thickness burns and other wounds. It is sometimes associated with substantial problems, such as poor quality of the healed skin, scarring, and lack of donor-site skin in large burns. To overcome these problems...

Using portable negative pressure wound therapy devices in the home care setting

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Burke JR

2014-12-01

Full Text Available Joshua R Burke, Rachael Morley, Mustafa Khanbhai Academic Surgery Unit, Education and Research Centre, University Hospital of South Manchester, Manchester, UK Abstract: Negative pressure wound therapy (NPWT is the continuous or intermittent application of subatmospheric pressure to the surface of a wound that improves the wound environment, accelerates healing, and reduces wound closure time. Since its first documented use, this technology has lent itself to a number of adaptations, most notably, the development of portable devices facilitating treatment in the home care setting. With advancing surgical standards, wound healing is an important rate-limiting factor in early patient discharge and often a major cost of inpatient treatment. The efficacy of NPWT in the home care setting has been investigated through rate of wound closure, time in care, and patient experience. Rate of wound closure is the most appropriate primary end point. Much can be gleaned from patient experience, but the future success of portable NPWT will be measured on time in care and therefore cost effectiveness. However, there is a lack of level 1a evidence demonstrating increased efficacy of portable over inpatient NPWT. The development of portable NPWT is an encouraging innovation in wound care technology, and extending the benefits to the home care setting is both possible and potentially more beneficial. Keywords: portable, negative pressure wound therapy, vacuum-assisted closure, topical negative pressure therapy

Bacterial infections in burn patients at a burn hospital in Iran.

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Ekrami, Alireza; Kalantar, Enayat

2007-12-01

The major challenge for a burn team is nosocomial infection in burn patients, which is known to cause over 50% of burn deaths. Most studies on infection in burn patients focus on burn wound infection, whereas other nosocomial infections in these patients are not well described. We undertook this study to determine three types of nosocomial infections viz., burn wound infection, urinary tract infection, and blood stream infection in burn patients in a burn hospital in Iran. During the one year period (May 2003 to April 2004), 182 patients were included in this study. Blood, urine and wound biopsy samples were taken 7 and 14 days after admission to Taleghani Burn hospital. Isolation and identification of microorganisms was done using the standard procedure. Disk diffusion test were performed for all the isolates for antimicrobial susceptibility. Of the 182 patients, 140 (76.9%) acquired at least one type of infection of the 140, 116 patients (82.8%) were culture positive on day 7 while 24 (17.2%) on 14 days after admission. Primary wound infection was most common (72.5%), followed by blood stream (18.6%) and urinary tract infections (8.9 %). The microorganisms causing infections were Pseudomonas aeruginosa (37.5%), Staphylococcus aureus (20.2%), and Acinetobacter baumanni (10.4%). Among these isolates P. aeruginosa was found to be 100 per cent resistant to amikacin, gentamicin , carbenicillin, ciprofloxacin, tobramycin and ceftazidime; 58 per cent of S. aureus and 60 per cent of coagulase negative Staphylococcus were methicillin resistant. High prevalence of nosocomial infections and the presence of multidrug resistant bacteria, and methicillin resistant S. aureus in patients at Taleghani Burn Hospital suggest continuous surveillance of burn infections and develop strategies for antimicrobial resistance control and treatment of infectious complications.

The evidence-based topical therapies for management of minor burns in outpatient clinic

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Siphora Dien

2015-08-01

Full Text Available Burns are often seen in clinics or hospitals. Majority of burns are minor burns, which can be managed in outpatient setting with satisfactory result. The healing outcome depends on physician’s knowledge and competencies in burn pathogenesis and basic principles of burn care. Initial treatment of burns consists of emergency evaluation, assessment of depth and severity of burns and considerations for referral. The principles of minor wound therapy include cooling, cleansing, pain management, and topical therapy. Recently, many topical agents are available and indicated for first to second degree burn. Silver sulfadiazine (SSD is the standard treatment; however, it has some limitations. Scientific evidences showed that topical antibiotics do not reduce the incidence of local infection, invasive infection, and mortality of infection. Burns heal faster with hydrogel dressings and some other dressings compared to SSD. There are insufficient evidences to support the use of aloe vera, honey, and negative pressure wound therapy in burns. Moist exposed burn ointment (MEBO® has been demonstrated to have equal efficacy to SSD.

In vitro cytotoxity of silver: implication for clinical wound care.

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Poon, Vincent K M; Burd, Andrew

2004-03-01

In this study, we look at the cytotoxic effects of silver on keratinocytes and fibroblasts. We have assessed the viability of monolayer cultures using the MTT and BrdU assays. The composition of the culture medium and also the culture technique were modified to assess the effects of culture 'environment' on the susceptibility of the cells to the toxic action of silver. Further in vitro, experiments were performed using tissue culture models to allow cellular behavior in three dimensional planes which more closely simulated in vivo behavior. The silver source was both silver released from silver nitrate solution but also nanocrystalline silver released from a commercially available dressing. The results show that silver is highly toxic to both keratinocytes and fibroblasts in monolayer culture. When using optimized and individualized culture the fibroblasts appear to be more sensitive to silver than keratinocytes. However, when both cell types were grown in the same medium their viability was the same. Using tissue culture models again indicated an 'environmental effect' with decreased sensitivity of the cells to the cytotoxic effects of the silver. Nevertheless in these studies the toxic dose of skin cells ranging from 7 x 10(-4) to 55 x 10(-4)% was similar to that of bacteria. These results suggest that consideration of the cytotoxic effects of silver and silver-based products should be taken when deciding on dressings for specific wound care strategies. This is important when using keratinocyte culture, in situ, which is playing an increasing role in contemporary wound and burn care.

[Burns, new challenges to take on].

Science.gov (United States)

Galí-Llàcer, Rosa; Sena-Fernández, Beatriz; Leyva-Moral, Juan Manuel

2009-04-01

This article concerns a transversal descriptive study which shows the characteristics of burns treated in a Primary Health Care Center in an urban environment in Barcelona from 19 July 2005 unti 11 August 2007 (N=93). Patients younger than 15 were excluded from this study. 88% (82; CI of 95% 81,47-94,59) of the burns treated were caused by a thermal agent. Kitchen cooking oil ranks first as the cause of burns (24; 27%, CI of 95% 17,99-36,01). 70% of the burns studied had signs of superficial skin damage (65, CI of 95% 60,70-79,30). 61% (57; CI of 95% 51,70-70,30) of these burns were located on upper extremities The average recorded body surface burned was 0.0076% (median = 0,005%, range = 0,0001-0,5000%). The greatest number of wounds were observed among men aged 31 to 45 (17%; 16; CI of 95% 9,38-24,62). Educational health programs which focus on prevention of, and first aid care for, burns are needed. Studies like this one may prove useful when starting preventive or educational strategies.

The Effect of Massage on Anticipatory Anxiety and Procedural Pain in Patients with Burn Injury.

Science.gov (United States)

Najafi Ghezeljeh, Tahereh; Mohades Ardebili, Fatimah; Rafii, Forough; Manafi, Farzad

2017-01-01

Pain related to burn injuries is one of the most troublesome pain intensity. This study aimed to investigate the effect of massage on anticipatory anxiety, procedural pain intensity, vital signs and relaxation level of patients with burn injury. In this quasi-experimental study, through convenience sampling, 60 hospitalized adult burn patients were selected from a specialized burn and reconstructive hospital. Subjects were assigned to massage and control groups through simple randomization. Massage was offered by using non aromatic oil about 10-15 minutes before wound care on intact part of the body once a day for 20 minutes on patients' bedside for 3 consecutive days. In the 3 days, the control group did not received any massage and were asked to stay at bed. Demographic and clinical characteristics and vital signs, Visual Analogue Scale and the Persian version of Burn Specific Pain Anxiety Scale were used to determine baseline and procedural pain, anxiety and relaxation levels and anticipatory anxiety. No significant difference was noted between mean score of pain intensity, anxiety and relaxation level, and vital signs in massage and control groups after intervention following wound care. In massage and control groups, there was no significant differences between mean scores of anticipatory anxiety before and after intervention. There was no significant difference between the mean scores of anticipatory anxiety in massage and control groups after intervention prior wound care. Massage was shown not to have any effect on anticipatory anxiety and procedural pain.

Improving wound and pressure area care in a nursing home.

Science.gov (United States)

Sprakes, Kate; Tyrer, Julie

Wound and pressure ulcer prevention are key quality indicators of nursing care. This article describes a collaborative project between a community skin care service and a nursing home. The aim of the project was to establish whether the implementation of a wound and pressure ulcer management competency framework within a nursing home would improve patient outcomes and reduce the severity and number of wounds and pressure ulcers. Following the project's implementation, there was a reduction in the number of wounds and pressure ulcers, hospital admissions and district nursing visits. Nursing home staff also reported an increase in their knowledge and skills.

Radiosterilization of freeze-dried human amniotic Membrane and its use in the treatment of burn wound. Algerian experience

International Nuclear Information System (INIS)

Djefal, A.; Mahlous, M.; Nacer Khodja, A.; Larbi, M.; Larbi Daho Bachir, M.

2001-01-01

The present study evaluates the usefulness of human amniotic membrane as biological dressing and its efficacy in the treatment of burns comparatively to the conventional dressing. We reported the practical methods of preparation, preservation and radiation sterilisation of amnion, and the clinical results of its successful use in the treatment of 80 cases of superficial and intermediate depth dermal burns. The increased rate of healing, pain relief, good adhesion to the bed wound and absence of infection were observed

A comparative study to evaluate the effect of honey dressing and silver sulfadiazene dressing on wound healing in burn patients

OpenAIRE

Baghel, P. S.; Shukla, S.; Mathur, R. K.; Randa, R.

2009-01-01

To compare the effect of honey dressing and silver-sulfadiazene (SSD) dressing on wound healing in burn patients. Patients (n=78) of both sexes, with age group between 10 and 50 years and with first and second degree of burn of less than 50% of TBSA (Total body surface area) were included in the study, over a period of 2 years (2006-08). After stabilization, patients were randomly attributed into two groups: ?honey group? and ?SSD group?. Time elapsed since burn was recorded. After washing wi...

Regenerative Medicine Applications in Wound Care.

Science.gov (United States)

Nilforoushzadeh, Mohammad Ali; Sisakht, Mahsa Mollapour; Seifalian, Alexander Marcus; Amirkhani, Mohammad Amir; Banafshe, Hamid Reza; Verdi, Javad; Sharifzad, Farzaneh; Taghiabadi, Ehsan

2017-01-01

During the last two decades, a number of studies have been carried out on the application of regenerative medicine in the field of dermatology. The aim of this research was to critically review the application of regenerative medicine in the field of dermatology. The next aim was to look in depth to see whether regenerative medicine strategies have a place in the future of wound healing in a clinical setting. More specifically, to see if these strategies would apply for burns and non-healing diabetic wounds. Billions of dollars have been spent worldwide on research in wound treatment and skin regeneration. Although a high number of clinical trials show promising results, there is still no commercially available treatment for use. In addition, the outcome data from the clinical trials, taking place throughout the world, are not published in a standardized manner. Standardization within clinical trials is required for: protocols, outcome, endpoint values, and length of follow-up. The lack of standardization makes it much more difficult to compare the data collected and the different types of treatment. Despite several promising results from research and early phase clinical studies, the treatment for wounds as well as skin regeneration is still considered as an unmet clinical need. However, in the past three years, more promising research has been approaching clinical trials; this could be the solution that clinicians have been waiting for. This is a multibillion dollar industry for which there should be enough incentive for researchers and industry to seek the solution. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Gold standards for primary care of burn management

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Fatih Zor

2009-01-01

Full Text Available Every year, about 2.5 million people are affected from burns in the world. In our country there is no reliable database related to this subject. There are ongoing studies about the epidemiology of burns in Turkey. After burn injury had represent many various complications, such as myocardial infarction, cardiac deficiency, acute hypertension, endocarditis, thromboembolism, pulmonary edema, pneumonia, respiratuar failure, renal failure, gastric ulcus, ileus, sepsis, coagulopathy and anemia. Such complications can preventable or treatable. In this respect, preventive management in the first step burn treatment had very importantly in burn cases. Skin is a barrier which protects evaporative heat loss. In cases of acute burn, hypothermia occurs related to skin loss. For these cases, care must be taken to keep the patient warm. In addition fluid resuscitation is very important in these cases. Furthermore, the damaged tissues are highly susceptible to infection in burned patients. Burn care and rehabilitation includes challenging and complex procedures. Briefly, treatments of burn cases require a multidisciplinary and meticulous approach.

TeleWound care – providing remote wound assessment and treatment in the home care setting: current status and future directions

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Santamaria N

2013-11-01

Full Text Available Nick Santamaria,1 Suzanne Kapp2 1University of Melbourne and Melbourne Health, Royal Melbourne Hospital, Melbourne, VIC, Australia; 2Royal District Nursing Service Institute, Melbourne, VIC, Australia Abstract: The use of wound telemedicine systems in the home care environment has been expanding for the last decade. These systems can generally be grouped into two main types: store and forward systems and video conference type systems; additionally, there are also hybrid systems available that include elements of both. Evidence to date suggests that these systems provide significant benefits to patients, clinicians, and to the health care system generally. Reductions in resource use, visit substitution, costs, and high patient and clinician satisfaction have been reported; however, there is a lack of integration with existing health care technology and no clearly defined technical or clinical standards as yet. Similarly, the legalities associated with wound telemedicine and remote consultation remain unclear. As wound telemedicine systems continue to evolve and be deployed in different locations, there remains significant potential to harness their power to benefit patients being treated at home. Keywords: telemedicine, home care, e-health

Biomaterials and Nanotherapeutics for Enhancing Skin Wound Healing

Science.gov (United States)

Das, Subhamoy; Baker, Aaron B.

2016-01-01

Wound healing is an intricate process that requires complex coordination between many cell types and an appropriate extracellular microenvironment. Chronic wounds often suffer from high protease activity, persistent infection, excess inflammation, and hypoxia. While there has been intense investigation to find new methods to improve cutaneous wound care, the management of chronic wounds, burns, and skin wound infection remain challenging clinical problems. Ideally, advanced wound dressings can provide enhanced healing and bridge the gaps in the healing processes that prevent chronic wounds from healing. These technologies have great potential for improving outcomes in patients with poorly healing wounds but face significant barriers in addressing the heterogeneity and clinical complexity of chronic or severe wounds. Active wound dressings aim to enhance the natural healing process and work to counter many aspects that plague poorly healing wounds, including excessive inflammation, ischemia, scarring, and wound infection. This review paper discusses recent advances in the development of biomaterials and nanoparticle therapeutics to enhance wound healing. In particular, this review focuses on the novel cutaneous wound treatments that have undergone significant preclinical development or are currently used in clinical practice. PMID:27843895

Biomaterials and Nanotherapeutics for Enhancing Skin Wound Healing

Directory of Open Access Journals (Sweden)

Subhamoy Das

2016-10-01

Full Text Available Wound healing is an intricate process that requires complex coordination between many cells and an appropriate extracellular microenvironment. Chronic wounds often suffer from high protease activity, persistent infection, excess inflammation, and hypoxia. While there has been intense investigation to find new methods to improve cutaneous wound care; the management of chronic wounds, burns, and skin wound infection remain challenging clinical problems. Ideally, advanced wound dressings can provide enhanced healing and bridge the gaps in the healing processes that prevent chronic wounds from healing. These technologies have great potential for improving outcomes in patients with poorly healing wounds but face significant barriers in addressing the heterogeneity and clinical complexity of chronic or severe wounds. Active wound dressings aim to enhance the natural healing process and work to counter many aspects that plague poorly healing wounds including excessive inflammation, ischemia, scarring and wound infection. This review paper discusses recent advances in the development of biomaterials and nanoparticle therapeutics to enhance wound healing. In particular, this review focuses on the novel cutaneous wound treatments that have undergone significant preclinical development or currently used in clinical practice.

Prehospital treatment of burns: a qualitative study of experiences, perceptions and reactions of victims.

Science.gov (United States)

Sadeghi Bazargani, H; Fouladi, N; Alimohammadi, H; Sadeghieh Ahari, S; Agamohammadi, M; Mohamadi, R

2013-08-01

The manner in which burns are initially managed, at an incident scene, can affect the extent and depth of burn wounds and their final prognosis. The aim of this study was to understand people's experiences, perceptions and reactions towards the initial management of burns and fire accidents in Ardabil Province, Iran. In a qualitative study, 48 burn victims accompanied by their caregivers were enrolled. Focus group discussion (FGD) was used to collect data. All the interviews were recorded, transcribed and analysed using content analysis method. Four categories of information were retrieved in this study, including fire control, scald and burn wound management, seeking medical consultation and severity indicators. Uncertainty regarding what to do when someone catches fire was an evident finding that was explored through the discussions. The results revealed that transferring the patient to the hospital most often takes place after initial treatments administered at home. People believed that cooling a burn wound for a time longer than a few seconds may harm the wound. A strong belief in the efficacy of traditional remedies was disclosed when the statements of participants revealed that traditional or home-made remedies were widely used either to control pain immediately after burn and later during the wound repair process to accelerate the repair or to control the infection and prevent oedema and scar. Among these remedies, pennyroyal and grated potatoes seemed to be the most popular ones. Pennyroyal was thought to prevent infection and potatoes were used to relieve pain. People doubted the capability of health-care workers who work in rural health houses. People considered electrical burns and burns on the chest to be the most severe types of burns. Inappropriate perceptions regarding initial management of burns existed among the participants that should be addressed in future quantitative research or through developing programmes on secondary prevention of burns

Fundamentals of pain management in wound care.

Science.gov (United States)

Coulling, Sarah

Under-treated pain can result in a number of potentially serious sequelae (Australian and New Zealand College of Anaesthetists, 2006), including delayed mobilization and recovery, cardiac complications, thromboses, pulmonary complications, delayed healing, psychosocial problems and chronic pain syndromes. This article considers pain management in the context of painful wounds. An international comparative survey on wound pain (European Wound Management Association, 2002) found that practitioners in the wound care community tend to focus on healing processes rather than the patient's total pain experience involving an accurate pain assessment and selection of an appropriate pain management strategy. Procedural pain with dressing removal and cleansing caused the greatest concerns. An overview of simple, evidence-based drug and non-drug techniques is offered as potential strategies to help minimize the experience of pain.

Nurses' emotional experience of caring for children with burns.

LENUS (Irish Health Repository)

Hilliard, Carol

2012-02-01

AIMS AND OBJECTIVES: The aim of this phenomenological study was to explore the emotions experienced by children\\'s nurses when caring for children with burns, in addition to ascertaining how the nurses dealt with these emotions. BACKGROUND: The nature of nursing practice is such that it inevitably generates some form of emotional response in nurses. The literature reveals that the manner nurses deal with their emotional experiences can impact on their nursing care. DESIGN: The study used Husserlian phenomenology to explore the emotional experiences of eight purposively selected children\\'s nurses who have worked on the burns unit of an Irish paediatric hospital. METHODS: Data were collected using in-depth, unstructured interviews and analysed using Colaizzi\\'s seven stage framework. RESULTS: The phenomenon of participants\\' emotional experiences is captured in four themes: (1) caring for children with burns, (2) supporting parents, (3) sustaining nurses\\' emotional well-being, and (4) learning to be a burns nurse. Nursing children with burns generated a myriad of emotions for participants. Burns dressing-changes, managing burn-related pain, supporting parents and the impact of busy workloads on the emotional care of children and their parents emerged as the most emotionally challenging aspects of participants\\' role. Participants recognised the need to manage their emotional responses and spoke of the benefits of a supportive nursing team. CONCLUSIONS: The findings offer insights into both the rewarding and challenging aspects of nursing children with burns. Nurses in this environment must be supported to recognise and manage their emotional responses to their work. RELEVANCE TO CLINICAL PRACTICE: Helping nurses to manage the emotional consequences of their work will help to sustain their emotional well-being, enhance the care received by children and also enable nurses to support parents in their role as partners in care.

[Burns care following a nuclear incident].

Science.gov (United States)

Bargues, L; Donat, N; Jault, P; Leclerc, T

2010-09-30

Radiation injuries are usually caused by radioactive isotopes in industry. Detonations of nuclear reactors, the use of military nuclear weapons, and terrorist attacks represent a risk of mass burn casualties. Ionizing radiation creates thermal burns, acute radiation syndrome with pancytopenia, and a delayed cutaneous syndrome. After a latency period, skin symptoms appear and the depth of tissue damages increase with dose exposure. The usual burn resuscitation protocols have to be applied. Care of these victims also requires assessment of the level of radiation, plus decontamination by an experienced team. In nuclear disasters, the priority is to optimize the available resources and reserve treatment to patients with the highest probability of survival. After localized nuclear injury, assessment of burn depth and surgical techniques of skin coverage are the main difficulties in a burn centre. Training in medical facilities and burn centres is necessary in the preparation for management of the different types of burn injuries.

Biofilm inhibitory and eradicating activity of wound care products against Staphylococcus aureus and Staphylococcus epidermidis biofilms in an in vitro chronic wound model.

Science.gov (United States)

Brackman, G; De Meyer, L; Nelis, H J; Coenye, T

2013-06-01

Although several factors contribute to wound healing, bacterial infections and the presence of biofilm can significantly affect healing. Despite that this clearly indicates that therapies should address biofilm in wounds, only few wound care products have been evaluated for their antibiofilm effect. For this reason, we developed a rapid quantification approach to investigate the efficacy of wound care products on wounds infected with Staphylococcus spp. An in vitro chronic wound infection model was used in which a fluorescent Staph. aureus strain was used to allow the rapid quantification of the bacterial burden after treatment. A good correlation was observed between the fluorescence signal and the bacterial counts. When evaluated in this model, several commonly used wound dressings and wound care products inhibited biofilm formation resulting in a decrease between one and seven log CFU per biofilm compared with biofilm formed in the absence of products. In contrast, most dressings only moderately affected mature biofilms. Our model allowed the rapid quantification of the bacterial burden after treatment. However, the efficacy of treatment varied between the different types of dressings and/or wound care products. Our model can be used to compare the efficacy of wound care products to inhibit biofilm formation and/or eradicate mature biofilms. In addition, the results indicate that treatment of infected wounds should be started as soon as possible and that novel products with more potent antibiofilm activity are needed. © 2013 The Society for Applied Microbiology.

Towards more efficient burn care: Identifying factors associated with good quality of life post-burn.

Science.gov (United States)

Finlay, V; Phillips, M; Allison, G T; Wood, F M; Ching, D; Wicaksono, D; Plowman, S; Hendrie, D; Edgar, D W

2015-11-01

As minor burn patients constitute the vast majority of a developed nation case-mix, streamlining care for this group can promote efficiency from a service-wide perspective. This study tested the hypothesis that a predictive nomogram model that estimates likelihood of good long-term quality of life (QoL) post-burn is a valid way to optimise patient selection and risk management when applying a streamlined model of care. A sample of 224 burn patients managed by the Burn Service of Western Australia who provided both short and long-term outcomes was used to estimate the probability of achieving a good QoL defined as 150 out of a possible 160 points on the Burn Specific Health Scale-Brief (BSHS-B) at least six months from injury. A multivariate logistic regression analysis produced a predictive model provisioned as a nomogram for clinical application. A second, independent cohort of consecutive patients (n=106) was used to validate the predictive merit of the nomogram. Male gender (p=0.02), conservative management (p=0.03), upper limb burn (p=0.04) and high BSHS-B score within one month of burn (pburns were excluded due to loss to follow up. For clinicians managing comparable burn populations, the BSWA burns nomogram is an effective tool to assist the selection of patients to a streamlined care pathway with the aim of improving efficiency of service delivery. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

In view of standardization Part 2: Management of challenges in the initial treatment of burn patients in Burn Centers in Germany, Austria and Switzerland.

Science.gov (United States)

Ziegler, Benjamin; Hirche, Christoph; Horter, Johannes; Kiefer, Jurij; Grützner, Paul Alfred; Kremer, Thomas; Kneser, Ulrich; Münzberg, Matthias

2017-03-01

Initial therapy of severe burns in specialized burn trauma centers is a challenging task faced by the treating multi-professional and interdisciplinary team. A lack of consistent operating procedures and varying structural conditions was recently demonstrated in preliminary data of our group. These results raised the question on how specific treatment measures in acute burn care are met in the absence of standardized guidelines. A specific questionnaire containing 57 multiple-choice questions was sent to all 22 major burn centers in Germany, Austria and Switzerland. The survey included standards of airway management and ventilation, fluid management and circulation, body temperature monitoring and management, topical burn wound treatment and a microbiological surveillance. Additionally, the distribution of standardized course systems was covered. 17 out of 22 questionnaires (77%) were returned completed. Regarding volume resuscitation, results showed a similar approach in estimating initial fluid while discrepancies persisted in the use of colloidal fluid and human albumin. Elective tracheostomy and the need for bronchoscopy with suspected inhalation injury were the most controversial issues revealed by the survey. Topical treatment of burned body surface also followed different principles regarding the use of synthetic epidermal skin substitutes or enzymatic wound debridement. Less discrepancy was found in basic diagnostic measures, body temperature management, estimation of the extent of burns and microbiological surveillance. While many burn-related issues are clearly not questionable and managed in a similar way in most participating facilities, we were able to show that the most contentious issues in burn trauma management involve initial volume resuscitation, management of inhalation trauma and topical burn wound treatment. Further research is required to address these topics and evaluate a potential superiority of a regime in order to increase the level of

Foot burns: epidemiology and management.

Science.gov (United States)

Hemington-Gorse, S; Pellard, S; Wilson-Jones, N; Potokar, T

2007-12-01

This is a retrospective study of the epidemiology and management of isolated foot burns presenting to the Welsh Centre for Burns from January 1998 to December 2002. A total of 289 were treated of which 233 were included in this study. Approximately 40% were in the paediatric age group and the gender distribution varied dramatically for adults and children. In the adult group the male:female ratio was 3.5:1, however in the paediatric group the male:female ratio was more equal (1.6:1). Scald burns (65%) formed the largest group in children and scald (35%) and chemical burns (32%) in adults. Foot burns have a complication rate of 18% and prolonged hospital stay. Complications include hypertrophic scarring, graft loss/delayed healing and wound infection. Although isolated foot burns represent a small body surface area, over half require treatment as in patients to allow for initial aggressive conservative management of elevation and regular wound cleansing to avoid complications. This study suggests a protocol for the initial acute management of foot burns. This protocol states immediate referral of all foot burns to a burn centre, admission of these burns for 24-48 h for elevation, regular wound cleansing with change of dressings and prophylactic antibiotics.

The prevalence, aetiology and management of wounds in a community care area in Ireland.

LENUS (Irish Health Repository)

Skerritt, Louise

2014-06-01

This study aimed to establish the prevalence and aetiology of wounds, allowing an insight into the management of wound care, the use of dressings and the nursing time allocated to the provision of wound care in a community setting in Ireland. A cross-sectional survey was used, with data collected on all clients in the community who received treatment from public health nurses or community registered general nurses for wound care over a 1-week period in April 2013. A 98.9% response rate was realised, and 188 people were identified as having wounds, equating to a crude prevalence of 5% of the active community nursing caseload. A total of 60% (n=112) had leg ulcers, 22% (n=42) had pressure ulcers, 16% (n=30) had an acute wound (surgical or traumatic wounds), 1% (n=2) had a diabetic foot wound and a further 1% (n=2) had wounds of other aetiologies. The mean duration of wounds was 5.41 months. A total of 18% of wounds were identified as infected; however, 60% (n=112) of wounds had antimicrobial products in use as either a primary or secondary dressing. The study established that there is a significant prevalence of wounds in this community care area. There was absence of a clinical diagnosis in many cases, and evidence of inappropriate dressing use, risking an increase in costs and a decrease in good clinical outcomes. It also highlighted the importance of ongoing education and auditing in the provision of wound care.

Wound-care teams for preventing and treating pressure ulcers.

Science.gov (United States)

Moore, Zena E H; Webster, Joan; Samuriwo, Ray

2015-09-16

Pressure ulcers, which are localised injury to the skin or underlying tissue, or both, occur when people are unable to reposition themselves to relieve pressure on bony prominences. Pressure ulcers are often difficult to heal, painful and impact negatively on the individual's quality of life. The cost implications of pressure ulcer treatment are considerable, compounding the challenges in providing cost effective, efficient health service delivery. International guidelines suggest that to prevent and manage pressure ulcers successfully a team approach is required. Therefore, this review has been conducted to clarify the role of wound-care teams in the prevention and management of pressure ulcers. To assess the impact of wound-care teams in preventing and treating pressure ulcers in people of any age, nursed in any healthcare setting. In April 2015 we searched: The Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. There were no restrictions with respect to language, date of publication or study setting. We considered RCTs that evaluated the effect of any configuration of wound-care teams in the treatment or prevention of pressure ulcers. Two review authors independently assessed titles and, where available, abstracts of the studies identified by the search strategy for their eligibility. We obtained full versions of potentially relevant studies and two review authors independently screened these against the inclusion criteria. We identified no studies that met the inclusion criteria. We set out to evaluate the RCT evidence pertaining to the impact of wound-care teams on the prevention and management of pressure ulcers. However, no studies met the inclusion criteria. There is a lack of evidence concerning whether wound-care teams make a difference to the incidence or healing of pressure

Application of Numerical Analysis of the Shape of Electron Paramagnetic Resonance Spectra for Determination of the Number of Different Groups of Radicals in the Burn Wounds

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Paweł Olczyk

2017-01-01

Full Text Available Background. The evidence exists that radicals are crucial agents necessary for the wound regeneration helping to enhance the repair process. Materials and methods. The lineshape of the electron paramagnetic resonance (EPR spectra of the burn wounds measured with the low microwave power (2.2 mW was numerically analyzed. The experimental spectra were fitted by the sum of two and three lines. Results. The number of the lines in the EPR spectrum corresponded to the number of different groups of radicals in the natural samples after thermal treatment. The component lines were described by Gaussian and Lorentzian functions. The spectra of the burn wounds were superposition of three lines different in shape and in linewidths. The best fitting was obtained for the sum of broad Gaussian, broad Lorentzian, and narrow Lorentzian lines. Dipolar interactions between the unpaired electrons widened the broad Gaussian and broad Lorentzian lines. Radicals with the narrow Lorentzian lines existed mainly in the tested samples. Conclusions. The spectral shape analysis may be proposed as a useful method for determining the number of different groups of radicals in the burn wounds.

Fabrication and evaluation of auto-stripped tri-layer wound dressing for extensive burn injury

International Nuclear Information System (INIS)

Lin, F.-H.; Tsai, J.-C.; Chen, T.-M.; Chen, K.-S.; Yang, J.-M.; Kang, P.-L.; Wu, T-H.

2007-01-01

In the study, we are going to develop a tri-layer membrane as the artificial skin for extensive burn injury. The first layer is a three-dimensional tri-copolymer sponge of gelatin/hyaluronan/chodroitin-6-sulfate with 70% in porosity and 20-100 μm in pore size. The layer is constructed as a dermis analogous layer to stimulate capillaries penetration, to promote dermal fibroblast migration and to induce the secretion of extra-cellular matrix, which provides a better physiological environment for burn patient recovery. The second layer is as so called auto-stripped layer composed by poly-N-isopropyacrylamide (PNIPAAm). The layer will be automatically peeled off from the tri-copolymer layer once the wound site closed and recovered. The third layer is composed by polypropylene (PP) non-woven fabric, which provides an open structure for exudates drainage out that will reduce the risk of second infection. The tri-layer wound dressing has been successfully prepared by subsequently high-energy plasma treatment, γ-ray irradiation, UV light exposure, and lyophilized process. From the results of MTT, IL-8, IL-1α, IL-6, and TNF-α measurement, the developed material will not induce tissue inflammatory or immune response. The dermal fibroblasts showed initial contact with the material surface through the radial extension of filopodia followed by cytoplasmic webbing that could be examined by SEM. Dermal fibroblasts subsequently flattened for further proliferation and extra-cellular matrix secretion. Dermal analog layer provides a three-dimensional architecture for normal dermis regeneration. The layer can be completely biodegraded within 4 weeks post-operation. After served as a scaffold for the ingrowth of self-fibroblasts, a normal dermis like layer will be regenerated. The dressing will fall off automatically without any damage once the wound site healed completely

eHealth in Wound Care,- overview and key issues to consider before implementation

DEFF Research Database (Denmark)

Moore, Zena; Angel, Donna; Bjerregaard, Julie

2015-01-01

Purpose This document aims to provide wound care clinicians with a rapid and structured overview of the key issues related to use of eHealth applications (telemedicine and telehealth) within wound care. This includes: • An overview of terminology and available literature • Guidance on the methodo......Purpose This document aims to provide wound care clinicians with a rapid and structured overview of the key issues related to use of eHealth applications (telemedicine and telehealth) within wound care. This includes: • An overview of terminology and available literature • Guidance...... on the methodology for evaluation of eHealth solutions • An introduction to and discussion of the potential benefits of eHealth technologies in wound care, and the possible barriers to their implementation • Recommendations for ensuring a good implementation process and supporting involvement of wound care...... professionals in safeguarding that eHealth solutions meet the needs of the patients. Methodology The document sections lean on the structure and focus areas of the Model for ASsessment of Telemedicine (MAST) which defines crucial items to evaluate an eHealth application. The content of the document is developed...

Patients' and clinicians' experiences of wound care in Canada: a descriptive qualitative study.

Science.gov (United States)

Woo, K Y; Wong, J; Rice, K; Coelho, S; Haratsidis, E; Teague, L; Rac, V E; Krahn, M

2017-07-01

This study sought to explore patients' and clinicians' perceptions and experiences with the provision of standard care by a home care nurse alone or by a multidisciplinary wound care team. The interviews were conducted using an in-depth semi structured format; following a funnel idea of starting out broad and narrowing down, ensuring that all the necessary topics were covered by the end of the interview. A purposive sample of 16 patients with different wound types were interviewed to ensure that the data would reflect the range and diversity of treatment and care experience. To reflect the diversity of experiences 12 clinicians from various clinical backgrounds were interviewed. Based on the analysis of the interviews, there are four overarching themes: wound care expertise is required across health-care sectors, psychosocial needs of patients with chronic wounds are key barriers to treatment concordance, structured training, and a well-coordinated multidisciplinary team approach. Results of this qualitative study identified different barriers and facilitators that affect the experiences of community-based wound care.

[Analysis of projects received and funded in fields of emergency and intensive care medicine/trauma/burns/plastic surgery from National Natural Science Foundation of China during 2010-2013].

Science.gov (United States)

Xiong, Kun; Wang, Linlin; Chen, Xulin; Cao, Yongqian; Xiang, Chuan; Xue, Lixiang; Yan, Zhangcai

2014-01-01

To summarized the projects received and funded in the fields of emergency and intensive care medicine/trauma/burns/plastic surgery from National Natural Science Foundation of China (NSFC) during 2010-2013, put forward the thinking and perspective of this future trend in these fields. The number of the funded project and total funding in the fields of emergency and intensive care medicine/trauma/burns/plastic surgery from NSFC during 2010-2013 had been statistical analyzed, in the meantime, the overview situation of various branches in basic research and further preliminary analysis the research frontier and hot issues have been analyzed. (1) The number of funded project were 581 in H15 of NSFC during 2010-2013, total funding reached to 277.13 million RMB, including 117 projects in H1511 (emergency and intensive care medicine/trauma/burns/plastic surgery and other science issue), 96 projects in H1507 (wound healing and scar), 88 projects in H1502 (multi-organ failure), 71 projects in H1505 (burn), 61 projects in H1504 (trauma). (2) The top 10 working unit for project funding in the field of emergency and intensive care medicine/trauma/burns/plastic surgery present as Third Military Medical University (70), Shanghai Jiao tong University (69), Second Military Medical University (40), Chinese PLA General Hospital (36), Forth Military Medical University (35), Zhejiang University (22), Sun Yat-Sen University (18), Southern Medical University (14), China Medical University (11), Capital Medical University (11) respectively, the number of funded project positive correlated with funding. (3) The funded research field in H15 covered almost all important organs and system injury or repair research, our scientists reached a fairly high level in some research field, for example, sepsis, trauma, repair, et al. "Sepsis" was funded 112 projects in H15 for 4 years, the growth rate became rapid and stable comparing to shock, burns and cardiopulmonary resuscitation funded projects

Pirfenidone nanoparticles improve corneal wound healing and prevent scarring following alkali burn.

Directory of Open Access Journals (Sweden)

Sushovan Chowdhury

Full Text Available To evaluate the effects of pirfenidone nanoparticles on corneal re-epithelialization and scarring, major clinical challenges after alkali burn.Effect of pirfenidone on collagen I and α-smooth muscle actin (α-SMA synthesis by TGFβ induced primary corneal fibroblast cells was evaluated by immunoblotting and immunocytochemistry. Pirfenidone loaded poly (lactide-co-glycolide (PLGA nanoparticles were prepared, characterized and their cellular entry was examined in primary corneal fibroblast cells by fluorescence microscopy. Alkali burn was induced in one eye of Sprague Dawley rats followed by daily topical treatment with free pirfenidone, pirfenidone nanoparticles or vehicle. Corneal re-epithelialization was assessed daily by flourescein dye test; absence of stained area indicated complete re-epithelialization and the time for complete re-epithelialization was determined. Corneal haze was assessed daily for 7 days under slit lamp microscope and graded using a standard method. After 7 days, collagen I deposition in the superficial layer of cornea was examined by immunohistochemistry.Pirfenidone prevented (P<0.05 increase in TGF β induced collagen I and α-SMA synthesis by corneal fibroblasts in a dose dependent manner. Pirfenidone could be loaded successfully within PLGA nanoparticles, which entered the corneal fibroblasts within 5 minutes. Pirfenidone nanoparticles but not free pirfenidone significantly (P<0.05 reduced collagen I level, corneal haze and the time for corneal re-epithelialization following alkali burn.Pirfenidone decreases collagen synthesis and prevents myofibroblast formation. Pirfenidone nanoparticles improve corneal wound healing and prevent fibrosis. Pirfenidone nanoparticles are of potential value in treating corneal chemical burns and other corneal fibrotic diseases.

Assessment of the relation between prealbumin serum level and healing of skin-grafted burn wounds.

Science.gov (United States)

Moghazy, A M; Adly, O A; Abbas, A H; Moati, T A; Ali, O S; Mohamed, B A

2010-06-01

Nutritional status is an important factor in graft healing. Prealbumin (transthyretin) is a better nutritional marker than the widely used albumin serum level. Prealbumin serum levels were estimated in an endeavour to correlate them to graft healing and to serve as a predictor of graft healing in burn wounds. Fifty burned patients undergoing graft in the Suez Canal University Hospital Burn Unit were subjected to this cross-sectional study. Prealbumin levels were assessed on preoperative day and on the fourth postoperative day. Graft healing was considered complete when the take was 90% or more of the grafted area. The most significantly correlated factor to graft healing was serum prealbumin. Serum albumin levels were not in significant correlation with graft healing or prealbumin levels. In addition, serum prealbumin levels were significantly higher in the younger age group and significantly lower in patients with chronic diseases. Serum prealbumin level is a sensitive tool in predicting graft take in burned patients when all local conditions are favourable and optimised. Nevertheless, it seems less sensitive in the prediction of graft healing in small raw areas less than 5% of total body surface area (TBSA). (c) 2009 Elsevier Ltd and ISBI. All rights reserved.

Improving mortality outcomes of Stevens Johnson syndrome/toxic epidermal necrolysis: A regional burns centre experience.

Science.gov (United States)

Nizamoglu, M; Ward, J A; Frew, Q; Gerrish, H; Martin, N; Shaw, A; Barnes, D; Shelly, O; Philp, B; El-Muttardi, N; Dziewulski, P

2018-05-01

Stevens Johnson Syndrome/toxic epidermal necrolysis (SJS/TEN) are rare, potentially fatal desquamative disorders characterised by large areas of partial thickness skin and mucosal loss. The degree of epidermal detachment that occurs has led to SJS/TEN being described as a burn-like condition. These patients benefit from judicious critical care, early debridement and meticulous wound care. This is best undertaken within a multidisciplinary setting led by clinicians experienced in the management of massive skin loss and its sequelae. In this study, we examined the clinical outcomes of SJS/TEN overlap & TEN patients managed by our regional burns service over a 12-year period. We present our treatment model for other burn centres treating SJS/TEN patients. A retrospective case review was performed for all patients with a clinical diagnosis of TEN or SJS/TEN overlap admitted to our paediatric and adult burns centre between June 2004 and December 2016. Patient demographics, percentage total body surface area (%TBSA), mucosal involvement, causation, severity of illness score (SCORTEN), length of stay and survival were appraised with appropriate statistical analysis performed using Graph Pad Prism 7.02 Software. During the study period, 42 patients (M26; F: 16) with TEN (n=32) and SJS/TEN overlap (n=10) were managed within our burns service. Mean %TBSA of cutaneous involvement was 57% (range 10-100%) and mean length of stay (LOS) was 27 days (range 1-144 days). We observed 4 deaths in our series compared to 16 predicted by SCORTEN giving a standardised mortality ratio (SMR) of 24%. Management in our burns service with an aggressive wound care protocol involving debridement of blistered epidermis and wound closure with synthetic and biological dressings seems to have produced benefits in mortality when compared to predicted outcomes. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Reduced need for grafting and low incidence of hypertrophic scarring in burns after enzymatic debridement

OpenAIRE

Corrales-Benítez, Carlos; Martínez-Méndez, José Ramón; González-Miranda, Álvaro; Serrano-Alonso, Maite; Casado-Pérez, César

2016-01-01

Background and Objective. Early burn scar removal is the standard of care for burn patients; excisional debridement, however, often leads to excision of dermal remnants, making autografting unavoidable. Enzymatic debridement with proteolytic enzymes enriched in Bromelain (Nexobrid®) leaves these dermal remnants to allow spontaneous healing of partial thickness burns. This study evaluates if Nexobrid® (MediWound Ltd., Israel) reduces the need for surgery and autografting in intermediate and de...

Use of telemedicine to improve burn care in Ukraine.

Science.gov (United States)

Fuzaylov, Gennadiy; Knittel, Justin; Driscoll, Daniel N

2013-01-01

Global burn injuries have been described as the "forgotten public health crises" by the World Health Organization. Nearly 11 million people a year suffer burns severe enough to require medical attention; more people are burned each year than are infected with human immunodeficiency virus/acquired immunodeficiency syndrome and tuberculosis combined. Telemedicine has the potential to link experts in specialized fields, such as burn care, to regions of the world that have limited or no access to such specialized care. A multilevel telemedicine program was developed between Massachusetts General Hospital/Shriners Hospital in Boston, Massachusetts, and City Hospital #8 in Lviv, Ukraine. The program should lead to a sustainable improvement in the care of burn victims in Ukraine. The authors helped establish a Learning Center at City Hospital #8 in Lviv, Ukraine, through which they were able to consult from Shriners Hospital in Boston, on a total of 14 acute burn patients in Ukraine. This article discusses two case reports with the use of telemedicine and how it has allowed the authors to provide not only acute care consultation on an international scale, but also to arrange for direct expert examination and international transport to their specialized burn center in the United States. The authors have established a program through doctors from Massachusetts General Hospital/Shriner's Hospital in Boston, which works with a hospital in Ukraine and has provided acute consultation, as well as patient transportation to the United States for treatment and direct assessment.

Improved Clinical Efficacy with Wound Support Network Between Hospital and Home Care Service.

Science.gov (United States)

Bergersen, Tone Kristin; Storheim, Elisabeth; Gundersen, Stina; Kleven, Linn; Johnson, Maria; Sandvik, Leiv; Kvaerner, Kari Jorunn; Ørjasæter, Nils-Otto

2016-11-01

The aim of this study was to test the efficacy of a wound support network model between the primary home care service and the hospital. The impact on wound healing rate, cost benefit, and transfer of knowledge was investigated. The intervention group was exposed to a wound support network (n = 32), and the control group continued standard organization of treatment (n = 21). Nonrandomized controlled study; observations were made before (baseline) and after the implementation of the intervention (12 weeks). Patients with chronic wounds (lasting >6 weeks and with wound area >1 cm) in Oslo, Norway. Closure of the observation wound; wound size; total number of wounds; presence of eczema, edema, and pain; number of dressings per week; time spent per dressing; and number of control appointments at the hospital. The economic impact is calculated for the hospital and for the community of Oslo, Norway. The number of control appointments (t = 3.80, P home care service and the hospital is cost-effective, improves clinical efficacy of the home care services' work, and reduces the need for consultations at the hospital.

Fusarium spp infections in a pediatric burn unit: nine years of experience.

Science.gov (United States)

Rosanova, María Teresa; Brizuela, Martín; Villasboas, Mabel; Guarracino, Fabian; Alvarez, Veronica; Santos, Patricia; Finquelievich, Jorge

2016-01-01

Fusarium spp are ubiquitous fungi recognized as opportunistic agents of human infections, and can produce severe infections in burn patients. The literature on Fusarium spp infections in pediatric burn patients is scarce. To describe the clinical and epidemiological features as well as outcome of Fusarium spp infections in pediatric burn patients. Retrospective, descriptive study of Fusarium spp infections in a specialized intensive care burn unit. In 15 patients Fusarium spp infections were diagnosed. Median age was 48 months. Direct fire injury was observed in ten patients. The median affected burn surface area was 45%. Twelve patients had a full thickness burn. Fourteen patients had a Garces Index ≥3. Fungal infection developed at a median of 11 days after burn injury. Fungi were isolated from burn wound in 14 patients and from the bone in one patient. Amphotericin B was the drug of choice for treatment followed by voriconazole. Median time of treatment completion was 23 days. One patient (7%) died of fungal infection-related causes. In our series Fusarium spp was an uncommon pathogen in severely burnt patients. The burn wound was the most common site of infection and mortality was low. Copyright © 2016 Elsevier Editora Ltda. All rights reserved.

Management of acid burns: experience from Bangladesh.

Science.gov (United States)

Das, Kishore Kumar; Olga, Loren; Peck, Michael; Morselli, Paolo G; Salek, A J M

2015-05-01

Acid burn injuries in Bangladesh primarily occur as a result of intentional attacks although there are incidences of accidental acid burns in industry, on the street, and at home. A total of 126 patients with acid burns, 95 from attacks and 31 from accidents, were studied from July 2004 to December 2012. A diagnosis of acid burn was made from history, physical examination and in some cases from chemical analysis of the patients' clothing. Alkali burns were excluded from the study. In the burn unit of Dhaka Medical College Hospital, we applied a slightly different protocol for management of acid burns, beginning with plain water irrigation of the wound, which effectively reduced burn depth and the requirement of surgical treatment. Application of hydrocolloid dressing for 48-72 h helped with the assessment of depth and the course of treatment. Early excision and grafting gives good results but resultant acid trickling creates a marble cake-like appearance of the wound separated by the vital skin. Excision with a scalpel and direct stitching of the wounds are often a good option. Observation of patients on follow-up revealed that wounds showed a tendency for hypertrophy. Application of pressure garments and other scar treatments were given in all cases unless the burn was highly superficial. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Burns injury in children: Is antibiotic prophylaxis recommended?

Directory of Open Access Journals (Sweden)

Jamila Chahed

2014-01-01

Full Text Available Background: Wound infection is the most frequent complication in burn patients. There is a lack of guidelines on the use of systemic antibiotics in children to prevent this complication. Patients and Methods: A prospective study is carried out on 80 patients to evaluate the role of antibiotic prophylaxis in the control of infections. Results: The mean age was 34 months (9 months to 8 years. There was a male predominance with sex ratio of 1.66. The mean burn surface size burn was 26.5% with total burn surface area ranging from 5% to 33%, respectively. According to American Burn Association 37% (30/80 were severe burns with second and third degree burns >10% of the total surface body area in children aged <10 years old. Scalds represented 76.2% (61/80 of the burns. Burns by hot oil were 11 cases (13.7%, while 8 cases (10% were flame burns. The random distribution of the groups was as follow: Group A (amoxicilline + clavulanic acid = 25 cases, Group B (oxacilline = 20 cases and Group C (no antibiotics = 35 cases. Total infection rate was 20% (16/80, distributed as follow: 8 cases (50% in Group C, 5 cases (31.2% in Group A and 3 cases in Group B (18.7%. Infection rate in each individual group was: 22.9% (8 cases/35 in Group C, 20% (5 cases/25 in Group A and 15% (3 cases/20 in Group B (P = 0.7. They were distributed as follow: Septicaemia 12 cases/16 (75%, wound infection 4 cases/16 (25%. Bacteria isolated were with a decreasing order: Staphylococcus aureus (36.3%, Pseudomonas (27.2%, Escherichia coli (18.1%, Klebsiella (9% and Enterobacteria (9%. There is a tendency to a delayed cicatrisation (P = 0.07 in case of hot oil burns (65.18 ± 120 days than by flame (54.33 ± 19.8 days than by hot water (29.55 ± 26.2 days. Otherwise no toxic shock syndrome was recorded in this study. Conclusion: It is concluded that adequate and careful nursing of burn wounds seems to be sufficient to prevent complications and to obtain cicatrisation. Antibiotics are

Antimicrobial activity of silver nanoparticles synthesized using honey and gamma radiation against silver-resistant bacteria from wounds and burns

Science.gov (United States)

Hosny, A. M. S.; Kashef, M. T.; Rasmy, S. A.; Aboul-Magd, D. S.; El-Bazza, Z. E.

2017-12-01

Silver nanoparticles (AgNPs) are promising antimicrobial agents for treatment of wounds and burns. We synthesized AgNPs using honey at different pH values or with different gamma irradiation doses. The resulting nanoparticles were characterized by UV-vis spectroscopy, TEM, DLS and FTIR. Their antimicrobial activity, against standard bacterial strains and silver-resistant clinical isolates from infected wounds and burns, was evaluated in vitro through determination of their minimum inhibitory concentration (MIC). AgNPs prepared using 30 g of honey exposed to 5 kGy gamma radiation had the best physical characters regarding stability and uniformity of particle size and shape. They recorded the lowest MIC values against both the standard and silver-resistant isolates. In conclusion, honey and gamma radiation can be used in synthesis of highly stable pure AgNPs, without affecting the physico-chemical and antimicrobial activity of honey. This offered an advantage in terms of inhibition of silver-resistant bacteria isolates.

Effect of piracetam and nimodipine on full-thickness skin burns in rabbits.

Science.gov (United States)

Sari, Elif; Dincel, Gungor C

2016-08-01

The potential of several drugs for full-thickness skin burns has been investigated, but the treatment of such burns remains a challenge in plastic surgery. The present study was designed to determine the effect of systemic and topical administration of piracetam and nimodipine on full-thickness skin burn wound healing. A total of 36 New Zealand male rabbits were divided into six groups. Full-thickness skin burns were produced in all the groups, except the control group. Piracetam was administered systemically (piracetam-IV) and topically (piracetam-C) for 14 days, and nimodipine was administered systemically (nimodipine-IV) and topically (nimodipine-C) over the burn wounds for 14 days. The sham group underwent burn injury but was not administered any drug. After 21 days, gross examination and histopathological analysis were performed and the results were compared statistically. Nimodipine-C and nimodipine-IV had no effect on burn wound healing. However, both piracetam-IV and piracetam-C significantly enhanced the healing of the full-thickness skin burn wounds, although the latter was more effective, useful and practical in burn wound healing. The histopathological features of the wounds in the piracetam-C group were closer to those of the control group than those of the other groups. Piracetam-C rather than piracetam-IV may promote full-thickness burn wound healing in rabbits. © 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Characterization of care for patients with wounds in Primary Care

Directory of Open Access Journals (Sweden)

Isabel Cristina Ramos Vieira Santos

2014-10-01

Full Text Available This study aimed to describe the treatment of patients with wounds in the Primary Health Care. A descriptive research with quantitative approach. Ninety-three Family Health Units of the city of Recife-PE, Brazil, were selected, and 112 nurses were interviewed from July to December 2011. The record book of bandages and procedures and the dressing form were used as an additional source of data. Frequencies, measures of central tendency and dispersion, prevalence and, for continuous variables, the analysis of variance were estimated. The prevalence of patients with wounds was 1.9% of the estimated covered population. Vascular ulcers accounted for 74.1% of the treated wounds. The dressing was predominantly performed by Nursing technicians, and the products available for this procedure did not match the current technological development.

A survey of wound care knowledge in South Africa

African Journals Online (AJOL)

2010-12-09

Dec 9, 2010 ... to manage pressure ulcers, suggesting that they do not receive enough training in this disorder.6 Canadian nurses express little confidence in the knowledge of physicians who supervise treatment of chronic wounds.7. In South Africa, chronic wound care is often left to unsupervised nursing personnel, who ...

Fish scale collagen sponge incorporated with Macrotyloma uniflorum plant extract as a possible wound/burn dressing material.

Science.gov (United States)

Muthukumar, Thangavelu; Prabu, P; Ghosh, Kausik; Sastry, Thotapalli Parvathaleswara

2014-01-01

Application of plant extracts for the burn/wound treatment is followed over the decades as a common practice and it is an important aspect in clinical management. In this study porous collagen sponges (CS) were prepared using fish scales and were incorporated with mupirocin (CSM) and extracts of Macrotyloma uniflorum (CSPE) separately to impart antimicrobial activity to the sponges. The results showed that the addition of plant extract increased the tensile strength of CSPE and stability against collagenase enzyme. FTIR studies have shown the incorporation of plant extract in CSPE, SEM studies have revealed the porous nature of the sponges and XRD patterns have shown the retention of collagen triple helical structure even after the addition of plant extract. CSPE and CSM have exhibited antimicrobial properties. The sponges prepared were analysed for their in vitro biocompatibility studies using fibroblasts and keratinocyte cell lines and the results have shown their biocompatible nature. Based on the results obtained, CS, CSM and CSPE may be tried as a burn/wound dressing materials, initially, in small animals in vivo. Copyright © 2013 Elsevier B.V. All rights reserved.

Evaluation of protocol change in burn-care management using the Cox proportional hazards model with time-dependent covariates.

Science.gov (United States)

Ichida, J M; Wassell, J T; Keller, M D; Ayers, L W

1993-02-01

Survival analysis methods are valuable for detecting intervention effects because detailed information from patient records and sensitive outcome measures are used. The burn unit at a large university hospital replaced routine bathing with total body bathing using chlorhexidine gluconate for antimicrobial effect. A Cox proportional hazards model was used to analyse time from admission until either infection with Staphylococcus aureus or discharge for 155 patients, controlling for burn severity and two time-dependent covariates: days until first wound excision and days until first administration of prophylactic antibiotics. The risk of infection was 55 per cent higher in the historical control group, although not statistically significant. There was also some indication that early wound excision may be important as an infection-control measure for burn patients.

Rethinking burns for low & middle-income countries: Differing patterns of burn epidemiology, care seeking behavior, and outcomes across four countries.

Science.gov (United States)

Davé, Dattesh R; Nagarjan, Neeraja; Canner, Joseph K; Kushner, Adam L; Stewart, Barclay T

2018-02-20

Low-and middle-income (LMIC) countries account for 90% of all reported burns, nevertheless there is a paucity of providers to treat burns. Current studies on burns in LMICs have not evaluated the gap between care seeking and receiving. This study explores this gap across socioeconomically similar populations in a multi-country population based assessment to inform burn care strategies. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) instrument is a cross sectional national, cluster random sampling survey administered in Nepal, Rwanda, Sierra Leone, and Uganda from 2011 to 2014. The survey identifies burn etiology, demographics, timing, disability, and barriers to receiving care. Among 13,763 individuals surveyed, 896 burns were identified. Rwanda had the highest proportion of individuals seeking and receiving care (91.6% vs 88.5%) while Sierra Leone reported the fewest (79.3% vs 70.3%). Rwanda reported the largest disability while Nepal reported the highest proportion with no disability (47.5% vs 76.2%). Lack of money, healthcare providers, and rural living reduce the odds of receiving care by 68% and 85% respectively. Despite similar country socioeconomic characteristics there was significant variability in burn demographics, timing, and disability. Nevertheless, being geographically and economically disadvantaged predict lack of access to burn care. Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.

Negative pressure wound therapy versus standard wound care on quality of life: a systematic review.

Science.gov (United States)

Janssen, A H J; Mommers, E H H; Notter, J; de Vries Reilingh, T S; Wegdam, J A

2016-03-01

Negative pressure wound therapy (NPWT) is a widely accepted treatment modality for open or infected wounds. Premature ending of NPWT occasionally occurs due to negative effects on the quality of life (QoL), however, the actual impact on QoL is unknown. The aim of this review is to analyse the effect of NPWT versus standard wound care (SWC) on QoL when used for the treatment of open or infected wounds. A systematic literature search in a range of databases (PubMed, CINAHL, Medline, Web of Science, Science Direct Freedom Collection, SwetsWise, PSYCArticles and Infrotrac Custom Journals) using the following search terms; 'standard wound care', 'wound dressing', 'dressing', 'treatment', OR 'negative pressure wound therapy [MESH]', OR 'vacuum assisted closure' AND 'quality of life [MESH]', 'patient-satisfaction', OR 'experiences' was performed. Methodological quality was assessed using the methodological index for non-randomised studies (MINORS) checklist. There were 42 studies identified, five matched the inclusion criteria: two randomised clinical trials (RCTs), one clinical comparative study, one exploratory prospective cohort study and one quasi experimental pilot study. Median MINORS-score was 75% (58%-96%). There were seven different questionnaires used to measure QoL or a subsidiary outcome. QoL in the NPWT group was lower in the first week, though no difference in QoL was observed thereafter. This systematic review observed that QoL improved at the end of therapy independent of which therapy was used. NPWT led to a lower QoL during the first week of treatment, possible due to aniexty, after which a similar or better QoL was reported when compared with SWC. It could be suggested that NPWT might be associated with increased anxiety. All authors of this publication have received no financial support or have personal interests conflicting with the objectivity of this manuscript.

Training and burn care in rural India

Directory of Open Access Journals (Sweden)

Chamania Shobha

2010-10-01

Full Text Available Burn care is a huge challenge in India, having the highest female mortality globally due to flame burns. Burns can happen anywhere, but are more common in the rural region, affecting the poor. Most common cause is flame burns, the culprit being kerosene and flammable flowing garments worn by the women. The infrastructure of healthcare network is good but there is a severe resource crunch. In order to bring a positive change, there will have to be more trained personnel willing to work in the rural areas. Strategies for prevention and training of burn team are discussed along with suggestions on making the career package attractive and satisfying. This will positively translate into improved outcomes in the burns managed in the rural region and quick transfer to appropriate facility for those requiring specialised attention.

The SNaP™ Wound Care System: A Case Series Using a Novel Ultraportable Negative Pressure Wound Therapy Device for the Treatment of Diabetic Lower Extremity Wounds

Science.gov (United States)

Lerman, Bruce; Oldenbrook, Leslie; Ryu, Justin; Fong, Kenton D.; Schubart, Peter J.

2010-01-01

Although there is significant evidence supporting the use of negative pressure wound therapy (NPWT) for the treatment of lower extremity diabetic ulcers, currently available electrically powered NPWT systems are not ideally suited for treating smaller diabetic foot ulcers. The Smart Negative Pressure (SNaP™) Wound Care System is a novel, ultraportable device that delivers NPWT without the use of an electrically powered pump. It was specifically designed to meet the wound care needs of patients with diabetes. The SNaP System is compact, silent, mobile, easy-to-use, and available off-the-shelf. It is fully disposable and may offer other important benefits over electrically powered systems to both the clinician and patient. We review the evidence for use of NPWT for the treatment of diabetic wounds and discuss the potential benefits of this new NPWT technology for patients with diabetes. We also present a case series of four difficult lower extremity diabetic ulcers that were successfully treated with the SNaP System. This study suggests that the SNaP System may be a useful addition to the armamentarium of the diabetic wound care clinician. PMID:20663444

Effect of auto-skin grafting on bacterial infection of wound in rats inflicted with combined radiation-burn injury

International Nuclear Information System (INIS)

Ran Xinze; Yan Yongtang; Wei Shuqing

1992-01-01

Rats were exposed to 6 Gy whole body γ-ray irradiation from a 60 Co source followed by light radiation burn (15% TBSA, full thickness burn) from a 5 kw bromo-tungsten lamp. The effect of auto-skin grafting on invasive bacterial infection of wound in the rats with combined radiation-burn injury was studied, In the control group inflicted with combined radiation-burn injury but without skin grafting, bacteria were found on and in the eschars at 24th hour after injury, and in the subeschar tissue on 3rd day. Tremendous bacterial multiplication occurred from 7th to 15th day, and the amount of bacteria in the internal organs increased along with the increase of subeschar infection. At the same time, no bacterial infection was found in internal organs in auto-skin grafted group at 24th hour after injury. The results show that skin grafting can decrease or prevent bacterial infection in both subeschar tissue and internal organs

The Ability of Tissue Engineered Skin Accelerating the Closure of Different Wound

Institute of Scientific and Technical Information of China (English)

无

2005-01-01

1 IntroductionIn the past several decades, a number of reseacher have described the principal efficacy of tissue engineered skin to promote wound healing of venous and diabetic ulcers. But the true value of tissue-engineered skin products in different wound care remains yet to be more clearly defined. In this trial, we analysis the effective of tissue-engineered skin (ActivSkin) in the management of burns, donor sites and ulcers, which were also the frequently injury caused with warfare, disaster and terror...

Wound care guidelines and formulary for community nurses.

Science.gov (United States)

Baeyens, T A

2000-03-01

Community nursing is experiencing significant change as a result of developments such as improved technology, care in the community and earlier discharge of patients from hospital. Because of this, increasingly complex clinical care is required in the community, and it has been noted that community nurses are 'under considerable pressure' and show 'evidence of high stress and low morale'. Wound care is one area in which community nurses constantly battle to keep abreast of continual change. Growing product availability and diversity of use, changes in dressing techniques and the ever-increasing costs associated with wound care mean decision-making in wound care is often a complex task. In the Grampian region, a handbook of evidence-based practice guidelines with a product formulary was developed and distributed to all community nurses. The handbook was designed to ease the decision-making process by evaluating evidence-based practice and local preferences to recommend and guide nurses towards effective clinical practice and cost efficiency. All grades of district nurse in the region have been issued with their own copy of the handbook. It is presented in an A5 ring-binder format to make it easy to carry and to facilitate updating using loose-leaf inserts. The use of logos, extra information boxes and colour coding makes it easy for users to find specific areas of interest in the handbook. The success of the handbook has led to debate on the potential for development of a similar resource for use by practice nurses and in local community hospitals.

Video-Enhanced Telemedicine Improves the Care of Acutely Injured Burn Patients in a Rural State.

Science.gov (United States)

Wibbenmeyer, Lucy; Kluesner, Karen; Wu, Hongqian; Eid, Anas; Heard, Jason; Mann, Benjamin; Pauley, Alison; Peek-Asa, Corrine

The acute care of burn patients is critical and can be a daunting experience for emergency personnel because of the scarcity of burn injuries. Telemedicine that incorporates a visual component can provide immediate expertise in the treatment and management of these injuries. The authors sought to evaluate the addition of video telemedicine to our current telephone burn transfer program. During a 2-year period, 282 patients, 59.4% of all burn patients transferred from outside hospitals, were enrolled in the study. In addition to the scripted call with the charge nurse (ChargeRN) and the accepting physician, nine hospitals also transmitted video images of the wounds before transfer as part of a store and forward telemedicine transfer program (77, 27.6%). The accuracy of burn size estimations (BSA burned) and management changes (fluid requirements, transfer mode, and final disposition) were analyzed between the telephones-only sites (T only) and the video-enhanced sites. Referringstaff participating in video-enhanced telemedicine were sent a Google survey assessing their experience the following day. The referring staff (Referringstaff) was correct in their burn assessment 20% of the time. Video assessment improved the ChargeRN BSA burned and resulted in more accurate fluid resuscitation (P = .030), changes in both transportation mode (P = .042), and disposition decisions (P = .20). The majority of the Referringstaff found that video-enhanced telemedicine helped them communicate with the burn staff more effectively (3.4 ± 0.37, scale 1-4). This study reports the successful implementation of video-enhanced telemedicine pilot project in a rural state. Video-enhanced telemedicine using a store and forward process improved burn size estimation and facilitated management changes. Although not quantitatively assessed, the low cost of the system coupled with the changes in transportation and disposition strongly suggests a decrease in healthcare costs associated with

Identification and content validation of wound therapy clinical endpoints relevant to clinical practice and patient values for FDA approval. Part 1. Survey of the wound care community.

Science.gov (United States)

Driver, Vickie R; Gould, Lisa J; Dotson, Peggy; Gibbons, Gary W; Li, William W; Ennis, William J; Kirsner, Robert S; Eaglstein, William H; Bolton, Laura L; Carter, Marissa J

2017-05-01

Wounds that exhibit delayed healing add extraordinary clinical, economic, and personal burdens to patients, as well as to increasing financial costs to health systems. New interventions designed to ease such burdens for patients with cancer, renal, or ophthalmologic conditions are often cleared for approval by the U.S. Food and Drug Administration (FDA) using multiple endpoints but the requirement of complete healing as a primary endpoint for wound products impedes FDA clearance of interventions that can provide other clinical or patient-centered benefits for persons with wounds. A multidisciplinary group of wound experts undertook an initiative, in collaboration with the FDA, to identify and content validate supporting FDA criteria for qualifying wound endpoints relevant to clinical practice (CP) and patient-centered outcomes (PCO) as primary outcomes in clinical trials. As part of the initiative, a research study was conducted involving 628 multidisciplinary expert wound clinicians and researchers from 4 different groups: the interdisciplinary core advisory team; attendees of the Spring 2015 Symposium on Advanced Wound Care (SAWC); clinicians employed by a national network of specialty clinics focused on comprehensive wound care; and Association for the Advancement of Wound Care (AAWC) and Wound Healing Society (WHS) members who had not previously completed the survey. The online survey assessed 28 literature-based wound care endpoints for their relevance and importance to clinical practice and clinical research. Fifteen of the endpoints were evaluated for their relevance to improving quality of life. Twenty-two endpoints had content validity indexes (CVI) ≥ 0.75, and 15 were selected as meriting potential inclusion as additional endpoints for FDA approval of future wound care interventions. This study represents an important first step in identifying and validating new measurable wound care endpoints for clinical research and practice and for regulatory

Outcome after burns: an observational study on burn scar maturation and predictors for severe scarring.

Science.gov (United States)

van der Wal, Martijn B A; Vloemans, Jos F P M; Tuinebreijer, Wim E; van de Ven, Peter; van Unen, Ella; van Zuijlen, Paul P M; Middelkoop, Esther

2012-01-01

Long-term outcome of burn scars as well as the relation with clinically relevant parameters has not been studied quantitatively. Therefore, we conducted a detailed analysis on the clinical changes of burn scars in a longitudinal setup. In addition, we focused on the differences in scar quality in relation to the depth, etiology of the burn wound and age of the patient. Burn scars of 474 patients were subjected to a scar assessment protocol 3, 6, and 12 months postburn. Three different age groups were defined (≤5, 5-18, and ≥18 years). The observer part of the patient and observer scar assessment scale revealed a significant (p burned (p  0.230) have no significant influence on scar quality when corrected for sex, total body surface area burned, time, and age or etiology, respectively. © 2012 by the Wound Healing Society.

Prevention of Infections Associated with Combat-Related Burn Injuries

Science.gov (United States)

2011-08-01

microbial flora and wound colonization in burned patients. Burns. 2004;30:357–361. 20. Barret JP, Herndron DN. Effects of burn wound excision on bacterial...Biobrane versus 1% silver sulfadiazine. Ann Emerg Med. 1990;19:121–124. 57. Barret JP, Dziewulski P, Ramzy PI, Wolf SE, Desai MH, Herndon DN

Open-to-Air Is a Viable Option for Initial Wound Care in Necrotizing Soft Tissue Infection that Allows Early Detection of Recurrence without Need for Painful Dressing Changes or Return to Operating Room.

Science.gov (United States)

Yang, Derek; Davies, April; Burge, Bailey; Watkins, Phillip; Dissanaike, Sharmila

2018-01-01

The standard treatment of necrotizing soft tissue infection (NSTI) includes extensive surgical debridement. Care of these debridements is challenging because of the size of the wound and associated pain. A potential solution is to leave the wounds open-to-air in the period after the initial debridement, allowing for regular inspection at bedside while reducing pain associated with frequent dressing changes. We evaluated the feasibility of this approach from a pain control standpoint. An audit of wound care modalities used on adult patients with NSTI admitted to a regional burn center between January 2009 and May 2014 was performed. Patients with at least one operation were included. Those opting for palliative care were excluded. Wound care was divided into four categories: open-to-air (OTA), negative-pressure wound therapy (NPWT), packing, and ointment. Wound care, pain score, pain medication use, and number of operations were collected for the first seven days after initial debridement. Pain management was assessed by pain scores. Analgesic use was measured and compared using conversion to morphine milligram equivalents (MME). Ninety-six patients were included; 67% were men with average age of 50 years, resulting in a total of 672 days of wound care evaluated: 69 days of OTA, 127 days of NPWT, 200 days of packing, and 126 days of ointment (150 days were undocumented). Average daily pain score from all wound care modalities was 2.00. Negative pressure wound therapy had the highest reported daily pain score (2.18, p = 0.034), whereas OTA had the lowest pain score (1.63, p < 0.05). Mortality was lower in the OTA cohort but was not statistically significant; there were no other differences in long-term outcome. Leaving wounds OTA is a safe and viable option in the immediate post-debridement period of NSTI to reduce pain, while permitting frequent re-evaluation for quick recognition of disease progression and repeat operative debridement if necessary.

New strategies in clinical care of skin wound healing.

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Günter, C I; Machens, H-G

2012-01-01

The prevalence of chronic wounds is closely correlated to the aging population and so-called civilizational diseases. Therefore, they are causing morbidity and mortality of millions of patients worldwide, with an unbroken upward trend. As a consequence, chronic wounds induce enormous and rapidly growing costs for our health care systems and society in general. Thus, medically effective and cost-efficient treatment methods are urgently needed. Methods of 'regenerative medicine' might offer innovative scientific solutions, including the use of stem cells, growth factors and new bioactive materials. These tools are experimentally well described but clinically poorly performed. The main reasons for this are both legislative and economic. This review describes state-of-the-art techniques, up-to-date research projects, innovative preclinical and clinical approaches in wound care, and activities to translate these innovative techniques into clinical routine. Copyright © 2012 S. Karger AG, Basel.

Aquacel(®) Ag dressing versus Acticoat™ dressing in partial thickness burns: a prospective, randomized, controlled study in 100 patients. Part 1: burn wound healing.

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Verbelen, Jozef; Hoeksema, Henk; Heyneman, Alexander; Pirayesh, Ali; Monstrey, Stan

2014-05-01

Studies comparing contemporary silver dressings in burns are scarce. In a prospective, randomized, controlled study, counting 50 patients/research group, we compared two frequently used silver dressings, Acticoat™ and Aquacel(®) Ag, in the management of partial thickness burns with a predicted healing time between 7 and 21 days as assessed by laser Doppler imaging between 48 and 72h after burn. Variables investigated were related to baseline research group characteristics, wound healing, bacteriology, economics, nurse, and patient experience. Both research groups were comparably composed taking into account gender, age and burn characteristics. Similar results were obtained as to healing time and bacterial control with both silver dressings. A statistically significant difference in favor of the Aquacel(®) Ag dressing was found for average ease of use (p<0.001), average ease of application (p=0.001), patient pain (p<0.001), patient comfort with the dressing (p=0.017), silver staining (p<0.001), and cost effectiveness (p<0.001). Both silver dressings resulted in comparable healing times and bacterial control but the Aquacel(®) Ag dressing significantly increased comfort for patients as well as nurses and was significantly more cost-effective than the Acticoat™ dressing for the given indication. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

In-vitro- and in-vivo-studies on the application of an innovative wound healing system for burn patients on the basis of a spray-transplantation of primary isolated skin cells and an active wound dressing made of hollow fiber capillaries

OpenAIRE

Plettig, Jörn

2016-01-01

The treatment of acute burns, especially for patients with 2b degree wounds, is not resolved satisfactorily. The thesis evaluates an innovative therapeutic concept based on a primary skin cell isolation from fetal or adult tissue, an autologous spray-transplantation and a temporary wound supply via an active wound dressing based on hollow fiber capillaries. The aim is to increase the yield of regenerative basal keratinocyte precursor cells through a gentle isolation technique and to distribut...

Epidemiology, etiology and outcomes of burn patients in a Referral Burn Hospital, Tehran

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Mohammad Mehdi Soltan Dallal

2016-08-01

Full Text Available Background: Burns and its complications are regarded as a major problem in the society. Skin injuries resulted from ultraviolet radiation, radioactivity, electricity or chemicals as well as respiratory damage from smoke inhalation are considered burns. This study aimed to determine the epidemiology and outcome of burn patients admitted to Motahari Hospital, Tehran, Iran. Methods: Two hundred patients with second-degree burns admitted to Motahari Referral Center of Burn in Tehran, Iran. They were studied during a period of 12 months from May 2012 to May 2013. During the first week of treatment swabs were collected from the burn wounds after cleaning the site with sterile normal saline. Samples were inoculated in blood agar and McConkey agar, then incubation at 37 C for 48 hours. Identification was carried out according to standard conventional biochemical tests. Treatment continued up to epithelial formation and wound healing. Results of microbial culture for each patient was recorded. Healing time of the burn wounds in patients was recorded in log books. Chi-square test and SPSS Software v.19 (IBM, NY, USA were used for data analysis. Results: Our findings indicate that the most causes of burns are hot liquids in 57% of cases and flammable liquid in 21% of cases. The most cases of burns were found to be in the range of 21 to 30 percent with 17.5% and 7% in male and female respectively. Gram-negative bacteria were dominated in 85.7% and among them pseudomonas spp. with 37.5% were the most common cause of infected burns, followed by Enterobacter, Escherichia coli, Staphylococcus aureus, Acinetobacter and Klebsiella spp. Conclusion: The results of this study showed that the most cause of burns in both sex is hot liquid. Men were more expose to burn than women and this might be due to the fact that men are involved in more dangerous jobs than female. Pseudomonas aeruginosa was the most common organism encountered in burn infection.

Initial evaluation and management of the critical burn patient.

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Vivó, C; Galeiras, R; del Caz, Ma D P

2016-01-01

The major improvement in burn therapy is likely to focus on the early management of hemodynamic and respiratory failures in combination with an aggressive and early surgical excision and skin grafting for full-thickness burns. Immediate burn care by first care providers is important and can vastly alter outcomes, and it can significantly limit burn progression and depth. The goal of prehospital care should be to cease the burning process as well as prevent future complications and secondary injuries for burn shock. Identifying burn patients appropriate for immediate or subacute transfer is an important step in reducing morbidity and mortality. Delays in transport to Burn Unit should be minimized. The emergency management follows the principles of the Advanced Trauma Life Support Guidelines for assessment and stabilization of airway, breathing, circulation, disability, exposure and environment control. All patients with suspected inhalation injury must be removed from the enclosure as soon as possible, and immediately administer high-flow oxygen. Any patient with stridor, shortness of breath, facial burns, singed nasal hairs, cough, soot in the oral cavity, and history of being in a fire in an enclosed space should be strongly considered for early intubation. Fibroscopy may also be useful if airway damage is suspected and to assess known lung damage. Secondary evaluation following admission to the Burn Unit of a burned patient suffering a severe thermal injury includes continuation of respiratory support and management and treatment of inhalation injury, fluid resuscitation and cardiovascular stabilization, pain control and management of burn wound. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

Biodegradable soy wound dressings with controlled release of antibiotics: Results from a guinea pig burn model.

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Egozi, Dana; Baranes-Zeevi, Maya; Ullmann, Yehuda; Gilhar, Amos; Keren, Aviad; Matanes, Elias; Berdicevsky, Israela; Krivoy, Norberto; Zilberman, Meital

2015-11-01

There is growing interest in the development of biodegradable materials from renewable biopolymers, such as soy protein, for biomedical applications. Soy protein is a major fraction of natural soybean and has the advantages of being economically competitive, biodegradable and biocompatible. It presents good water resistance as well as storage stability. In the current study, homogenous antibiotic-loaded soy protein films were cast from aqueous solutions. The antibiotic drug gentamicin was incorporated into the films in order to inhibit bacterial growth, and thus prevent or combat infection, upon its controlled release to the surrounding tissue. The current in vivo study of the dressing material in contaminated deep second-degree burn wounds in guinea pigs (n=20) demonstrated its ability to accelerate epithelialization with 71% epithelial coverage compared to an unloaded format of the soy material (62%) and a significant improved epithelial coverage as compared to the conventional dressing material (55%). Our new platform of antibiotic-eluting wound dressings is advantageous over currently used popular dressing materials that provide controlled release of silver ions, due to its gentamicin release profile, which is safer. Another advantage of our novel concept is that it is based on a biodegradable natural polymer and therefore does not require bandage changes and offers a potentially valuable and economic approach for treating burn-related infections. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Pathophysiologic Response to Burns in the Elderly

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Marc G. Jeschke

2015-10-01

Full Text Available Over the last decades advancements have improved survival and outcomes of severely burned patients except one population, elderly. The Lethal Dose 50 (LD50 burn size in elderly has remained the same over the past three decades, and so has morbidity and mortality, despite the increased demand for elderly burn care. The objective of this study is to gain insights on why elderly burn patients have had such a poor outcome when compared to adult burn patients. The significance of this project is that to this date, burn care providers recognize the extreme poor outcome of elderly, but the reason remains unclear. In this prospective translational trial, we have determined clinical, metabolic, inflammatory, immune, and skin healing aspects. We found that elderly have a profound increased mortality, more premorbid conditions, and stay at the hospital for longer, p  0.05, but a significant increased incidence of multi organ failure, p < 0.05. These clinical outcomes were associated with a delayed hypermetabolic response, increased hyperglycemic and hyperlipidemic responses, inversed inflammatory response, immune-compromisation and substantial delay in wound healing predominantly due to alteration in characteristics of progenitor cells, p < 0.05. In summary, elderly have substantially different responses to burns when compared to adults associated with increased morbidity and mortality. This study indicates that these responses are complex and not linear, requiring a multi-modal approach to improve the outcome of severely burned elderly.

Honey as a topical treatment for wounds.

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Jull, Andrew B; Cullum, Nicky; Dumville, Jo C; Westby, Maggie J; Deshpande, Sohan; Walker, Natalie

2015-03-06

Honey is a viscous, supersaturated sugar solution derived from nectar gathered and modified by the honeybee, Apis mellifera. Honey has been used since ancient times as a remedy in wound care. Evidence from animal studies and some trials has suggested that honey may accelerate wound healing. The objective of this review was to assess the effects of honey compared with alternative wound dressings and topical treatments on the of healing of acute (e.g. burns, lacerations) and/or chronic (e.g. venous ulcers) wounds. For this update of the review we searched the Cochrane Wounds Group Specialised Register (searched 15 October 2014); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 9); Ovid MEDLINE (1946 to October Week 1 2014); Ovid MEDLINE (In-Process & Other Non-Indexed Citations 13 October 2014); Ovid EMBASE (1974 to 13 October 2014); and EBSCO CINAHL (1982 to 15 October 2014). Randomised and quasi-randomised trials that evaluated honey as a treatment for any sort of acute or chronic wound were sought. There was no restriction in terms of source, date of publication or language. Wound healing was the primary endpoint. Data from eligible trials were extracted and summarised by one review author, using a data extraction sheet, and independently verified by a second review author. All data have been subsequently checked by two more authors. We identified 26 eligible trials (total of 3011 participants). Three trials evaluated the effects of honey in minor acute wounds, 11 trials evaluated honey in burns, 10 trials recruited people with different chronic wounds including two in people with venous leg ulcers, two trials in people with diabetic foot ulcers and single trials in infected post-operative wounds, pressure injuries, cutaneous Leishmaniasis and Fournier's gangrene. Two trials recruited a mixed population of people with acute and chronic wounds. The quality of the evidence varied between different comparisons and

Epidemiology of Burn Injury and Demography of Burn Care Facilities

Science.gov (United States)

1990-06-01

epidemiologic surveillance, vide the nursing care required by an exten- microbiology support is required for diagno-v sively burned patient is one of the...MA. Pittsburgh bur study. 28. Purdue GF, Hunt JL, Prescott PR. Child abuse bynig an iandnci o, suspiciro JA Traumarg 1988 t Pittsburgh and Allegheny

A modern method of treatment: The role of silver dressings in promoting healing and preventing pathological scarring in patients with burn wounds

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Munteanu, A; Florescu, IP; Nitescu, C

2016-01-01

Burn wounds are a global public health problem, which affects all countries, no matter the development stage and occurs in all age groups, from toddlers to elderly. In spite of burns being the cause of numerous household and work accidents, there are still no clear stated unanimous rules for their treatment. Every day new products appear on the market, each of them trying to prove more effective. Since ancient times, silver has been known for its antimicrobial properties, so it has been used for a long time in the treatment of burns and other types of wounds. One of the relatively modern methods of treatment is applying silver sheets on the scald lesions. In this paper, which was part of a larger study (research for a PhD thesis), concerning prevention and treatment of the post-burn pathological scars, the cases of some patients with burns, who were treated by using the above mentioned method were presented and analyzed. The results obtained by applying silver sheets were then commented and interpreted, pointing out the advantages and disadvantages compared to silver sulfadiazine creams and ointments, which have already been used at a large scale. The prevention and treatment of post-burn pathological (hypertrophic and keloid) scars is a field in which still little is known and in which there are also no clearly set therapy plans. We hope that through this research and the following ones we will manage to establish some major guidelines concerning the prevention of pathological scars, which are not only disabling, but also a major aesthetic issue for any patient, in order to obtain better outcomes. PMID:27974941

Effects of plasma treatment on wounds

NARCIS (Netherlands)

Tipa, R.S.; Stoffels - Adamowicz, E.; Lim, C.T.; Goh, J.C.H.

2009-01-01

Cold plasma treatment of wounds is gaining much interest, because it will offer a non-contact, painless and harmless therapy to manage large-area lesions (burn wounds, chronic ulcerations). One of the important issues in plasma wound healing is the safety of the method. In this work we study in

Pediatric burns: Kids' Inpatient Database vs the National Burn Repository.

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Soleimani, Tahereh; Evans, Tyler A; Sood, Rajiv; Hartman, Brett C; Hadad, Ivan; Tholpady, Sunil S

2016-04-01

Burn injuries are one of the leading causes of morbidity and mortality in young children. The Kids' Inpatient Database (KID) and National Burn Repository (NBR) are two large national databases that can be used to evaluate outcomes and help quality improvement in burn care. Differences in the design of the KID and NBR could lead to differing results affecting resultant conclusions and quality improvement programs. This study was designed to validate the use of KID for burn epidemiologic studies, as an adjunct to the NBR. Using the KID (2003, 2006, and 2009), a total of 17,300 nonelective burn patients younger than 20 y old were identified. Data from 13,828 similar patients were collected from the NBR. Outcome variables were compared between the two databases. Comparisons revealed similar patient distribution by gender, race, and burn size. Inhalation injury was more common among the NBR patients and was associated with increased mortality. The rates of respiratory failure, wound infection, cellulitis, sepsis, and urinary tract infection were higher in the KID. Multiple regression analysis adjusting for potential confounders demonstrated similar mortality rate but significantly longer length of stay for patients in the NBR. Despite differences in the design and sampling of the KID and NBR, the overall demographic and mortality results are similar. The differences in complication rate and length of stay should be explored by further studies to clarify underlying causes. Investigations into these differences should also better inform strategies to improve burn prevention and treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

Mouse Model of Burn Wound and Infection

DEFF Research Database (Denmark)

Calum, Henrik; Høiby, Niels; Moser, Claus

2017-01-01

The immunosuppression induced by thermal injury renders the burned victim susceptible to infection. A mouse model was developed to examine the immunosuppression, which was possible to induce even at a minor thermal insult of 6% total body surface area. After induction of the burn (48 hr) a depres......The immunosuppression induced by thermal injury renders the burned victim susceptible to infection. A mouse model was developed to examine the immunosuppression, which was possible to induce even at a minor thermal insult of 6% total body surface area. After induction of the burn (48 hr...

The Burns Registry of Australia and New Zealand: progressing the evidence base for burn care.

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Cleland, Heather; Greenwood, John E; Wood, Fiona M; Read, David J; Wong She, Richard; Maitz, Peter; Castley, Andrew; Vandervord, John G; Simcock, Jeremy; Adams, Christopher D; Gabbe, Belinda J

2016-03-21

Analysis of data from the Burns Registry of Australia and New Zealand (BRANZ) to determine the extent of variation between participating units in treatment and in specific outcomes during the first 4 years of its operation. BRANZ, an initiative of the Australian and New Zealand Burn Association, is a clinical quality registry developed in accordance with the Australian Commission on Safety and Quality in Healthcare national operating principles. Patients with burn injury who fulfil pre-defined criteria are transferred to and managed in designated burn units. There are 17 adult and paediatric units in Australia and New Zealand that manage almost all patients with significant burn injury. Twelve of these units treat adult patients. Data on 7184 adult cases were contributed by ten acute adult burn units to the registry between July 2010 and June 2014.Major outcomes: In-hospital mortality, hospital length of stay, skin grafting rates, and rates of admission to intensive care units. Considerable variations in unit profiles (including numbers of patients treated), in treatment and in outcomes were identified. Despite the highly centralised delivery of care to patients with severe or complex burn injury, and the relatively small number of specialist burn units, we found significant variation between units in clinical management and in outcomes. BRANZ data from its first 4 years of operation support its feasibility and the value of further development of the registry. Based on these results, the focus of ongoing research is to improve understanding of the reasons for variations in practice and of their effect on outcomes for patients, and to develop evidence-informed clinical guidelines for burn management in Australia and New Zealand.

[Continuous medical education of general practitioners/family doctors in chronic wound care].

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Sinozić, Tamara; Kovacević, Jadranka

2014-10-01

A number of healthcare professionals, specialists in different fields and with different levels of education, as well as non-healthcare professionals, are involved in the care of chronic wound patients, thus forming a multidisciplinary team that is not only responsible for the course and outcome of treatment, but also for the patient quality of life. Family doctor is also member of the team the task of which is to prevent, diagnose, monitor and anticipate complications and relapses, as well as complete recovery of chronic wound patients, with the overall care continuing even after the wound has healed, or is involved in palliative care. A family medicine practitioner with specialized education and their team of associates in the primary health care, along with material conditions and equipment improvement, can provide quality care for patients with peripheral cardiovascular diseases and chronic wounds, organized according to the holistic approach. It is essential that all professional associations of family medicine as well as professional associations of other specialties - fields that are involved in wound prevention and treatment - be included in developing the continuous medical education program. The benefits of modern information technology should be used to good advantage. The education should be adapted to the needs of family practitioners in terms of the form, place, time, volume, financial affordability and choice of topic. The interest shown in team education should be transformed into specialized programs in the creation of which it is essential to include both physicians and nurses and their respective professional associations. Special attention should be paid to education and training of young doctors/nurses, those with less work experience, those that have not yet been part of such education, those that lack experience in working with wound patients, those whose teams deal mostly with elderly patients, and also residents in family medicine and

Systematic review of the use of honey as a wound dressing

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Moore, Owen A; Smith, Lesley A; Campbell, Fiona; Seers, Kate; McQuay, Henry J; Moore, R Andrew

2001-01-01

Objective To investigate topical honey in superficial burns and wounds though a systematic review of randomised controlled trials. Data sources Cochrane Library, MEDLINE, EMBASE, PubMed, reference lists and databases were used to seek randomised controlled trials. Seven randomised trials involved superficial burns, partial thickness burns, moderate to severe burns that included full thickness injury, and infected postoperative wounds. Review methods Studies were randomised trials using honey, published papers, with a comparator. Main outcomes were relative benefit and number-needed-to-treat to prevent an outcome relating to wound healing time or infection rate. Results One study in infected postoperative wounds compared honey with antiseptics plus systemic antibiotics. The number needed to treat with honey for good wound healing compared with antiseptic was 2.9 (95% confidence interval 1.7 to 9.7). Five studies in patients with partial thickness or superficial burns involved less than 40% of the body surface. Comparators were polyurethane film, amniotic membrane, potato peel and silver sulphadiazine. The number needed to treat for seven days with honey to produce one patient with a healed burn was 2.6 (2.1 to 3.4) compared with any other treatment and 2.7 (2.0 to 4.1) compared with potato and amniotic membrane. For some or all outcomes honey was superior to all these treatments. Time for healing was significantly shorter for honey than all these treatments. The quality of studies was low. Conclusion Confidence in a conclusion that honey is a useful treatment for superficial wounds or burns is low. There is biological plausibility. PMID:11405898

Systematic review of the use of honey as a wound dressing

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McQuay Henry J

2001-06-01

Full Text Available Abstract Objective To investigate topical honey in superficial burns and wounds though a systematic review of randomised controlled trials. Data sources Cochrane Library, MEDLINE, EMBASE, PubMed, reference lists and databases were used to seek randomised controlled trials. Seven randomised trials involved superficial burns, partial thickness burns, moderate to severe burns that included full thickness injury, and infected postoperative wounds. Review methods Studies were randomised trials using honey, published papers, with a comparator. Main outcomes were relative benefit and number-needed-to-treat to prevent an outcome relating to wound healing time or infection rate. Results One study in infected postoperative wounds compared honey with antiseptics plus systemic antibiotics. The number needed to treat with honey for good wound healing compared with antiseptic was 2.9 (95% confidence interval 1.7 to 9.7. Five studies in patients with partial thickness or superficial burns involved less than 40% of the body surface. Comparators were polyurethane film, amniotic membrane, potato peel and silver sulphadiazine. The number needed to treat for seven days with honey to produce one patient with a healed burn was 2.6 (2.1 to 3.4 compared with any other treatment and 2.7 (2.0 to 4.1 compared with potato and amniotic membrane. For some or all outcomes honey was superior to all these treatments. Time for healing was significantly shorter for honey than all these treatments. The quality of studies was low. Conclusion Confidence in a conclusion that honey is a useful treatment for superficial wounds or burns is low. There is biological plausibility.

Potentials of leaves of Aspilia africana (Compositae in wound care: an experimental evaluation

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Akah PA

2007-07-01

Full Text Available Abstract Background The potentials of the leaves of the haemorrhage plant, Aspilia africana C. D Adams (Compositae in wound care was evaluated using experimental models. A. africana, which is widespread in Africa, is used in traditional medicine to stop bleeding from wounds, clean the surfaces of sores, in the treatment of rheumatic pains, bee and scorpion stings and for removal of opacities and foreign bodies from the eyes. The present study was undertaken to evaluate the potentials for use of leaves of this plant in wound care. Methods The effect of the methanol extract (ME and the hexane (HF and methanol (MF fractions (obtained by cold maceration and graded solvent extraction respectively on bleeding/clotting time of fresh experimentally-induced wounds in rats, coagulation time of whole rat blood, growth of microbial wound contaminants and rate of healing of experimentally-induced wounds in rats were studied as well as the acute toxicity and lethality (LD50 of the methanol extract and phytochemical analysis of the extract and fractions. Results The extract and fractions significantly (P ME>HF. Also, the extract and fractions caused varying degrees of inhibition of the growth of clinical isolates of Pseudomonas fluorescens and Staphylococcus aureus, as well as typed strains of Ps. aeruginosa (ATCC 10145 and Staph. aureus (ATCC 12600, and reduced epithelialisation period of wounds experimentally-induced in rats. Acute toxicity and lethality (LD50 test in mice established an i.p LD50 of 894 mg/kg for the methanol extract (ME. Phytochemical analysis revealed the presence of alkaloids, saponins, tannins, flavonoids, resins, sterols, terpenoids and carbohydrates. Conclusion The leaves of A. africana possess constituents capable of arresting wound bleeding, inhibiting the growth of microbial wound contaminants and accelerating wound healing which suggest good potentials for use in wound care.

How is research evidence used to support claims made in advertisements for wound care products?

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Dumville, Jo C; Petherick, Emily S; O'Meara, Susan; Raynor, Pauline; Cullum, Nicky

2009-05-01

To investigate the amount, type and accuracy of citations use in support of product related claims from advertisements of wound care products. Although articles submitted to most medical journals are subjected to peer review, such scrutiny is often not required for the content of advertisements. A contents survey of advertisements from two wound care journals (Journal of Wound Care and Ostomy Wound Management) from 2002-2003 and the British Medical Journal, 2002-2003. Data collected from advertisements included identification of product related claims made and any corresponding citations. Where journal articles were cited to support claims, the articles were obtained. Where data on file were cited, this material was requested. In each case the accuracy of claims in relation to the content of the supporting citation was assessed. The use of citations to support product related claims was infrequent in advertisements from wound care journals, where 35% of advertisements containing a product related claim also contained at least one citation, compared with 63% of advertisements from the British Medical Journal. Of citations that were supplied, journal articles were less common in the wound journals (40% vs. 73% in the British Medical Journal) and data on file more common (38% vs. 6% in the British Medical Journal). Where journal articles were obtained, 56% of claims in the wound care journals advertisements were not supported by the cited article, compared with 12% of claims in the British Medical Journal. The wound journals advertised predominantly medical devices. The use and accuracy of referencing in advertisements from wound care journals was poor. Nurses have increasing responsibilities for the prescribing of both drugs and devices, which must be accompanied by the ability to interpret marketing materials and research evidence critically. Nurse educators must ensure that nurse education generally and nurse prescriber training particularly, builds skills of

Fifty Years of Burn Care at Shriners Hospitals for Children, Galveston.

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Čapek, Karel D; Culnan, Derek M; Desai, Manubhai H; Herndon, David N

2018-03-01

More than 50 years ago, Shriners Hospitals for Children expanded their philanthropy to include care for burned children. In so doing, the effects of their work weightily expanded from rehabilitation and quality of life outcomes to include survival proper. As the first facility dedicated to the care of burned children, originally designated the Shriners Burn Institute, the Galveston hospital remains the cornerstone of this endeavor. Shriners maintains charitable pediatric hospitals, provide care irrespective of the patient's or the family's ability to pay, and promote research. The sole criterion for admission at Shriners Hospitals for Children is the determination by a surgeon at a Shriners hospital that "the child's trouble may be corrected or improved." This philanthropic effort to provide medical care for children is one expression of the human commonality recognized by Shriners. In this article, we provide some background information on how this hospital came into existence as well as a global summary of its interventions toward greater survival and more complete rehabilitation of burned children. Based on the findings presented herein, we assert that there is less suffering and less loss of life due to childhood burns today than in previous years. We attribute much of this improvement to the simple voluntary collective decision by Shriners to provide alms for burned children.

Burns at KCMC: epidemiology, presentation, management and treatment outcome.

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Ringo, Y; Chilonga, K

2014-08-01

About 90% of the global burden of burns occurs in the low and middle income countries. In Africa it is estimated that between 17,000 and 30,000 children under five die each year due to burns. In Tanzania there are no specialized burn centers. Burn patients are often managed in the general surgical wards in most hospitals. Kilimanjaro Christian Medical Centre is one of the four tertiary referral hospitals in Tanzania. This study aimed to review the epidemiology presentation management and outcome of burn patients in this challenging environment. A cross-sectional prospective study involving 41 patients was undertaken from October 2011 to April 2012. 65.9% were males. The largest age group was below 5 years (36.6%). 19.5% were epileptic. More than half of the burns were due to open flame. 80.5% had second degree burns. 56.1% had a BSA of 15% or less and 56.1% had an APACHE score of 10 or less. It was found that 73.2% of burns occurred at home. The commonest prehospital first aid applied was honey. Only 41.5% arrived in hospital within the first 24h after burn. Among the 14.6% who had skin grafting, none had early excision of burn wound. 53.7% developed wound sepsis while 24.4% developed contractures. The mortality rate was 26.8%. Children under five are the worst affected by burns. Most patients had second degree burn wounds. Inappropriate management of the burn wound started just after injury and continued even in hospital. Mortality and complication rates are high. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Telemedicine for wound management

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Ravi K Chittoria

2012-01-01

Full Text Available The escalating physiological, psychological, social and financial burdens of wounds and wound care on patients, families and society demand the immediate attention of the health care sector. Many forces are affecting the changes in health care provision for patients with chronic wounds, including managed care, the limited number of wound care therapists, an increasingly ageing and disabled population, regulatory and malpractice issues, and compromised care. The physician is also faced with a number of difficult issues when caring for chronic wound patients because their conditions are time consuming and high risk, represent an unprofitable part of care practice and raise issues of liability. Telemedicine enhances communication with the surgical wound care specialist. Digital image for skin lesions is a safe, accurate and cost-effective referral pathway. The two basic modes of telemedicine applications, store and forward (asynchronous transfer and real-time transmission (synchronous transfer, e.g. video conference, are utilized in the wound care setting. Telemedicine technology in the hands of an experienced physician can streamline management of a problem wound. Although there is always an element of anxiety related to technical change, the evolution of wound care telemedicine technology has demonstrated a predictable maturation process.

Traditional burn care in sub-Saharan Africa: a long history with wide acceptance.

Science.gov (United States)

Albertyn, R; Berg, A; Numanoglu, A; Rode, H

2015-03-01

Burns are very common in sub-Saharan Africa and are considered to be a major health care problem. The management of burns in many African countries is challenged by limited financial resources, inaccessible health care facilities, lack of trained professionals and superstition. These limitations are related to the many burned patients seeking treatment from traditional healers. The use of traditional remedies, plant and animal products are seen as an important aspect of burn management as it is both an affordable and respected treatment modality. Despite its popularity, the use of traditional burn care remedies is faced with many challenges as little research has been done on its effectiveness, dosage and adverse reactions. This paper reviewed the traditions and customs associated with traditional burn care as well as the use of plant, animal and mineral products used by traditional healers. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

BurnCase 3D software validation study: Burn size measurement accuracy and inter-rater reliability.

Science.gov (United States)

Parvizi, Daryousch; Giretzlehner, Michael; Wurzer, Paul; Klein, Limor Dinur; Shoham, Yaron; Bohanon, Fredrick J; Haller, Herbert L; Tuca, Alexandru; Branski, Ludwik K; Lumenta, David B; Herndon, David N; Kamolz, Lars-P

2016-03-01

The aim of this study was to compare the accuracy of burn size estimation using the computer-assisted software BurnCase 3D (RISC Software GmbH, Hagenberg, Austria) with that using a 2D scan, considered to be the actual burn size. Thirty artificial burn areas were pre planned and prepared on three mannequins (one child, one female, and one male). Five trained physicians (raters) were asked to assess the size of all wound areas using BurnCase 3D software. The results were then compared with the real wound areas, as determined by 2D planimetry imaging. To examine inter-rater reliability, we performed an intraclass correlation analysis with a 95% confidence interval. The mean wound area estimations of the five raters using BurnCase 3D were in total 20.7±0.9% for the child, 27.2±1.5% for the female and 16.5±0.1% for the male mannequin. Our analysis showed relative overestimations of 0.4%, 2.8% and 1.5% for the child, female and male mannequins respectively, compared to the 2D scan. The intraclass correlation between the single raters for mean percentage of the artificial burn areas was 98.6%. There was also a high intraclass correlation between the single raters and the 2D Scan visible. BurnCase 3D is a valid and reliable tool for the determination of total body surface area burned in standard models. Further clinical studies including different pediatric and overweight adult mannequins are warranted. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Analysis of antibiotic consumption in burn patients

Directory of Open Access Journals (Sweden)

Soleymanzadeh-Moghadam, Somayeh

2015-06-01

Full Text Available Infection control is very important in burn care units, because burn wound infection is one of the main causes of morbidity and mortality among burn patients. Thus, the appropriate prescription of antibiotics can be helpful, but unreasonable prescription can have detrimental consequences, including greater expenses to patients and community alike. The aim of this study was to determine the effect of antibiotic therapy on the emergence of antibiotic-resistant bacteria. 525 strains of and were isolated from 335 hospitalized burn patients. Antibiotic susceptibility tests were performed after identification the strains. The records of patients were audited to find the antibiotic used.The results indicated that is the most prevalent Gram-negative bacteria. Further, it showed a relation between abuse of antibiotics and emergence of antibiotic resistance. Control of resistance to antibiotics by appropriate prescription practices not only facilitates prevention of infection caused by multi-drug resistant (MDR microorganisms, but it can also decrease the cost of treatment.

Optimizing Wound Bed Preparation With Collagenase Enzymatic Debridement

Science.gov (United States)

McCallon, Stanley K.; Weir, Dorothy; Lantis, John C.

2015-01-01

Difficult-to-heal and chronic wounds affect tens of millions of people worldwide. In the U.S. alone, the direct cost for their treatment exceeds $25 billion. Yet despite advances in wound research and treatment that have markedly improved patient care, wound healing is often delayed for weeks or months. For venous and diabetic ulcers, complete wound closure is achieved in as few as 25%–50% of chronic or hard-to-heal wounds. Wound bed preparation and the consistent application of appropriate and effective debridement techniques are recommended for the optimized treatment of chronic wounds. The TIME paradigm (Tissue, Inflammation/infection, Moisture balance and Edge of wound) provides a model to remove barriers to healing and optimize the healing process. While we often think of debridement as an episodic event that occurs in specific care giver/patient interface. There is the possibility of a maintenance debridement in which the chronic application of a medication can assist in both the macroscopic and microscopic debridement of a wound. We review the various debridement therapies available to clinicians in the United States, and explore the characteristics and capabilities of clostridial collagenase ointment (CCO), a type of enzymatic debridement, that potentially allows for epithelialization while debriding. It appears that in the case of CCO it may exert this influences by removal of the necrotic plug while promoting granulation and sustaining epithelialization. It is also easily combined with other methods of debridement, is selective to necrotic tissue, and has been safely used in various populations. We review the body of evidence has indicated that this concept of maintenance debridement, especially when combined episodic debridement may add a cost an efficacious, safe and cost-effective choice for debridement of cutaneous ulcers and burn wounds and it will likely play an expanding role in all phases of wound bed preparation. PMID:26442207

Spray-on-skin cells in burns: a common practice with no agreed protocol.

Science.gov (United States)

Allouni, Ammar; Papini, Remo; Lewis, Darren

2013-11-01

Cultured epithelial autograft (CEA) has been used for skin coverage after burn wound excision since 1981. It is used in burn units and centres throughout the U.K.; however, there appears to be no agreed standards of practice. We aimed to investigate the experience and current practice with its usage in the management of acute burn injury. An online survey was sent to twenty-five burns consultants in the U.K., who are members of the British Burn Association. We received 14 responses. Rarely have the responders agreed to the same practice in most of the questions. Different choices were given by responders with regards the indications for cell culture, techniques used, primary and secondary dressings used, first wound review timing, and measures used to evaluate outcomes. In the current economic environment, the NHS needs to rationalize services on the basis of cost effectiveness. CEA is an expensive procedure that requires an adequately sterile laboratory, special equipments and highly experienced dedicated staff. When dealing with expensive management options, it is important to have an agreed protocol that can form the standard that can be referred to when auditing practices and results to improve burn management and patients' care. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

Scar formation following excisional and burn injuries in a red Duroc pig model.

Science.gov (United States)

Blackstone, Britani N; Kim, Jayne Y; McFarland, Kevin L; Sen, Chandan K; Supp, Dorothy M; Bailey, J Kevin; Powell, Heather M

2017-08-01

Scar research is challenging because rodents do not naturally form excessive scars, and burn depth, size, and location cannot be controlled in human longitudinal studies. The female, red Duroc pig model has been shown to form robust scars with biological and anatomical similarities to human hypertrophic scars. To more closely mimic the mode of injury, recreate the complex chemical milieu of the burn wound environment and enhance scar development, an animal model of excessive burn-induced scarring was developed and compared with the more commonly used model, which involves excisional wounds created via dermatome. Standardized, full-thickness thermal wounds were created on the dorsum of female, red Duroc pigs. Wounds for the dermatome model were created using two different total dermatome settings: ∼1.5 mm and ≥ 1.9 mm. Results from analysis over 150 days showed that burn wounds healed at much slower rate and contracted more significantly than dermatome wounds of both settings. The burn scars were hairless, had mixed pigmentation, and displayed fourfold and twofold greater excess erythema values, respectively, compared with ∼1.5 mm and ≥ 1.9 mm deep dermatome injuries. Burn scars were less elastic, less pliable, and weaker than scars resulting from excisional injuries. Decorin and versican gene expression levels were elevated in the burn group at day 150 compared with both dermatome groups. In addition, transforming growth factor-beta 1 was significantly up-regulated in the burn group vs. the ∼1.5 mm deep dermatome group at all time points, and expression remained significantly elevated vs. both dermatome groups at day 150. Compared with scars from dermatome wounds, the burn scar model described here demonstrates greater similarity to human hypertrophic scar. Thus, this burn scar model may provide an improved platform for studying the pathophysiology of burn-related hypertrophic scarring, investigating current anti-scar therapies, and development of

Fabrication and characterization of ovalbumin films for wound dressing applications

International Nuclear Information System (INIS)

Shojaee, Mozhgan; Navaee, Fatemeh; Jalili–Firoozinezhad, Sasan; Faturechi, Rahim; Majidi, Mohammad; Bonakdar, Shahin

2015-01-01

A great number of people suffer from burning injuries all around the world each year. Applying an appropriate wound dressing can promote new tissue formation, prevent losing water and inhibit invasion of infectious organisms. In this study, egg white with a long standing history, as a homemade remedy, was fabricated as a wound dressing for burn injuries. For this reason, ovalbumin films were cross-linked by 1-ethyl-3-3-dimethyl aminopropyl carbodiimide hydrochloride (EDC) with different concentrations (1, 5 and 10 mM) using three concentrations of ethanol. Physical–chemical characterizations including Fourier transform infrared spectroscopy (FTIR), gas transmission rate (GTR), tensile mechanical tests, water uptake and degradation rate were performed on the samples. The sample with 5 mM crosslinking agent at 70% ethanol was considered as the optimized one with 417 kPa of ultimate tensile strength, 64% elongation at break and 230% water uptake. In addition, biological evaluations conducted by MTT and live/dead assay indicated no sign of cyto-toxicity for all the samples. Moreover, scanning electron microscopy (SEM) showed that the fibroblast cells were well spread on the sample with the formation of filopodia. In conclusion, modified ovalbumin can be applied as the base material for fabrication of wound dressing and skin care products. - Highlights: • Ovalbumin films were cross-linked by EDC with different concentrations. • Physical–chemical characterizations were performed on the samples. • Biological evaluations indicated no sign of cyto-toxicity for all the samples. • The optimized sample was considered with 5 mM crosslinking agent at 70% ethanol. • Modified ovalbumin can be applied as wound dressings and skin care products

Fabrication and characterization of ovalbumin films for wound dressing applications

Energy Technology Data Exchange (ETDEWEB)

Shojaee, Mozhgan; Navaee, Fatemeh [Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran (Iran, Islamic Republic of); Jalili–Firoozinezhad, Sasan [Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran (Iran, Islamic Republic of); Departments of Biomedicine and Surgery, University Hospital Basel, University of Basel, 4031 Basel (Switzerland); Faturechi, Rahim [Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran (Iran, Islamic Republic of); Majidi, Mohammad [National Cell Bank of Iran, Pasteur Institute of Iran, Tehran (Iran, Islamic Republic of); Bonakdar, Shahin, E-mail: sh_bonakdar@pasteur.ac.ir [National Cell Bank of Iran, Pasteur Institute of Iran, Tehran (Iran, Islamic Republic of)

2015-03-01

A great number of people suffer from burning injuries all around the world each year. Applying an appropriate wound dressing can promote new tissue formation, prevent losing water and inhibit invasion of infectious organisms. In this study, egg white with a long standing history, as a homemade remedy, was fabricated as a wound dressing for burn injuries. For this reason, ovalbumin films were cross-linked by 1-ethyl-3-3-dimethyl aminopropyl carbodiimide hydrochloride (EDC) with different concentrations (1, 5 and 10 mM) using three concentrations of ethanol. Physical–chemical characterizations including Fourier transform infrared spectroscopy (FTIR), gas transmission rate (GTR), tensile mechanical tests, water uptake and degradation rate were performed on the samples. The sample with 5 mM crosslinking agent at 70% ethanol was considered as the optimized one with 417 kPa of ultimate tensile strength, 64% elongation at break and 230% water uptake. In addition, biological evaluations conducted by MTT and live/dead assay indicated no sign of cyto-toxicity for all the samples. Moreover, scanning electron microscopy (SEM) showed that the fibroblast cells were well spread on the sample with the formation of filopodia. In conclusion, modified ovalbumin can be applied as the base material for fabrication of wound dressing and skin care products. - Highlights: • Ovalbumin films were cross-linked by EDC with different concentrations. • Physical–chemical characterizations were performed on the samples. • Biological evaluations indicated no sign of cyto-toxicity for all the samples. • The optimized sample was considered with 5 mM crosslinking agent at 70% ethanol. • Modified ovalbumin can be applied as wound dressings and skin care products.

Treadmills: a preventable source of pediatric friction burn injuries.

Science.gov (United States)

Maguiña, Pirko; Palmieri, Tina L; Greenhalgh, David G

2004-01-01

Treadmills are a burn risk for children. A child's hand can get trapped in the conveyor belt, causing friction burns to the underlying tissue. The purpose of this retrospective study was to review the characteristics and treatment of treadmill-related burns in children from 1998 to 2002. Ten patients, at a mean age of 3.4 years, sustained injuries associated with treadmill use. Trapping of the hand between the conveyor belt and the base was the most frequent injury mechanism. Burn location was predominantly on fingers and palms. Four patients required operative intervention. All patients required specialized wound care as well as scar management and occupational therapy. Treadmills pose a danger to children. Current safety devices are ineffective for preventing serious hand injuries in children. New design modifications and public awareness are needed to improve child safety.

Development and validation of an online interactive, multimedia wound care algorithms program.

Science.gov (United States)

Beitz, Janice M; van Rijswijk, Lia

2012-01-01

To provide education based on evidence-based and validated wound care algorithms we designed and implemented an interactive, Web-based learning program for teaching wound care. A mixed methods quantitative pilot study design with qualitative components was used to test and ascertain the ease of use, validity, and reliability of the online program. A convenience sample of 56 RN wound experts (formally educated, certified in wound care, or both) participated. The interactive, online program consists of a user introduction, interactive assessment of 15 acute and chronic wound photos, user feedback about the percentage correct, partially correct, or incorrect algorithm and dressing choices and a user survey. After giving consent, participants accessed the online program, provided answers to the demographic survey, and completed the assessment module and photographic test, along with a posttest survey. The construct validity of the online interactive program was strong. Eighty-five percent (85%) of algorithm and 87% of dressing choices were fully correct even though some programming design issues were identified. Online study results were consistently better than previously conducted comparable paper-pencil study results. Using a 5-point Likert-type scale, participants rated the program's value and ease of use as 3.88 (valuable to very valuable) and 3.97 (easy to very easy), respectively. Similarly the research process was described qualitatively as "enjoyable" and "exciting." This digital program was well received indicating its "perceived benefits" for nonexpert users, which may help reduce barriers to implementing safe, evidence-based care. Ongoing research using larger sample sizes may help refine the program or algorithms while identifying clinician educational needs. Initial design imperfections and programming problems identified also underscored the importance of testing all paper and Web-based programs designed to educate health care professionals or guide

[Deep alkali burns: Evaluation of a two-step surgical strategy].

Science.gov (United States)

Devinck, F; Deveaux, C; Bennis, Y; Deken-Delannoy, V; Jeanne, M; Martinot-Duquennoy, V; Guerreschi, P; Pasquesoone, L

2018-04-10

Chemical burns are rare but often lead to deep cutaneous lesions. Alkali agents have a deep and long lasting penetrating power, causing burns that evolve over several days. The local treatment for these patients is excision of the wound and split thickness skin graft. Early excision and immediate skin grafting of alkali burns are more likely to be complicated by graft failure and delayed wound healing. We propose a two-step method that delays skin grafting until two-three days after burn wound excision. Our population included 25 controls and 16 cases. Men were predominant with a mean age of 41.9 years. In 78% of cases, burns were located on the lower limbs. The mean delay between the burn and excision was 16.5 days. In cases, the skin graft was performed at a mean of 11.3 days after the initial excision. We did not unveil any significant difference between both groups for the total skin surface affected, topography of the burns and the causal agent. Wound healing was significantly shorter in cases vs controls (37.5 days vs 50.3 days; P<0.025). Furthermore, we observed a decreased number of graft failures in cases vs controls (13.3% vs 46.7%; P=0.059). Our study shows the relevance of a two-step surgical strategy in patients with alkali chemical burns. Early excision followed by interval skin grafting is associated with quicker wound healing and decreased rate of graft failure. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Chapter 2 evolution of burn management in the u.s. Military: impact on nursing.

Science.gov (United States)

Schmidt, Patricia; Mann-Salinas, Elizabeth A

2014-01-01

As the only burn center in the Department of Defense, the U.S. Army Institute of Surgical Research is the primary location for care of service members with burn injuries. The combat operations in Iraq and Afghanistan during the past decade have caused an increase in burn patients. As a result of this increased need, advancements in care were developed. The speed and precision of transporting patients from the battlefield to the burn center has improved over previous conflicts. Technological advancements to support treating complications of burn wound healing were leveraged and are now integrated into daily practice. Clinical decision support systems were developed and deployed at the burn center as well as to combat support hospitals in combat zones. Technology advancements in rehabilitation have allowed more service members to return to active duty or live productive civilian lives. All of these advancements were developed in a patient-centered, interdisciplinary environment where the nurses are integrated throughout the research process and clinical practice with the end goal of healing combat burns in mind.

Care Wounds: Precarious Vulnerability and the Potential of Exposure.

Science.gov (United States)

Cubellis, Lauren

2018-04-07

What does it mean to offer care when the act of caring is wounding to its giver? For peer specialists-individuals with lived experience as patients in the psychiatric system-this question shapes how they use their own histories to provide support for individuals experiencing psychiatric crisis. Peer support is unique in the way it draws on empathetic resonance and depends on carefully deployed vulnerability; where one connects with others through the recognition of shared experience and mutual hurt. For peers, care works when this guidance, reassurance, and "being with"-all of which draw upon their own stories of traumatic history and variegated suffering-mitigate the present crisis being experienced by another. Drawing on twenty-eight months of fieldwork with a peer-staffed crisis respite center in the eastern United States, I argue that the peer specialist becomes the embodiment of a novel intersection of intimacy and compensation; one that poses vulnerability not as a consequence, casualty, or risk factor in the commodification of care, but as its principle vector of resonance and the assumption on which it is based. For peers, care that works-in that it creates a mutual resonance for the recipient-becomes simultaneously care that wounds its giver.

Development of clinical process measures for pediatric burn care: Understanding variation in practice patterns.

Science.gov (United States)

Kazis, Lewis E; Sheridan, Robert L; Shapiro, Gabriel D; Lee, Austin F; Liang, Matthew H; Ryan, Colleen M; Schneider, Jeffrey C; Lydon, Martha; Soley-Bori, Marina; Sonis, Lily A; Dore, Emily C; Palmieri, Tina; Herndon, David; Meyer, Walter; Warner, Petra; Kagan, Richard; Stoddard, Frederick J; Murphy, Michael; Tompkins, Ronald G

2018-04-01

There has been little systematic examination of variation in pediatric burn care clinical practices and its effect on outcomes. As a first step, current clinical care processes need to be operationally defined. The highly specialized burn care units of the Shriners Hospitals for Children system present an opportunity to describe the processes of care. The aim of this study was to develop a set of process-based measures for pediatric burn care and examine adherence to them by providers in a cohort of pediatric burn patients. We conducted a systematic literature review to compile a set of process-based indicators. These measures were refined by an expert panel of burn care providers, yielding 36 process-based indicators in four clinical areas: initial evaluation and resuscitation, acute excisional surgery and critical care, psychosocial and pain control, and reconstruction and aftercare. We assessed variability in adherence to the indicators in a cohort of 1,076 children with burns at four regional pediatric burn programs in the Shriners Hospital system. The percentages of the cohort at each of the four sites were as follows: Boston, 20.8%; Cincinnati, 21.1%; Galveston, 36.0%; and Sacramento, 22.1%. The cohort included children who received care between 2006 and 2010. Adherence to the process indicators varied both across sites and by clinical area. Adherence was lowest for the clinical areas of acute excisional surgery and critical care, with a range of 35% to 48% across sites, followed by initial evaluation and resuscitation (range, 34%-60%). In contrast, the clinical areas of psychosocial and pain control and reconstruction and aftercare had relatively high adherence across sites, with ranges of 62% to 93% and 71% to 87%, respectively. Of the 36 process indicators, 89% differed significantly in adherence between clinical sites (p measures represents an important step in the assessment of clinical practice in pediatric burn care. Substantial variation was observed

Five years' experience of the modified Meek technique in the management of extensive burns.

Science.gov (United States)

Hsieh, Chun-Sheng; Schuong, Jen-Yu; Huang, W S; Huang, Ted T

2008-05-01

The Meek technique of skin expansion is useful for covering a large open wound with a small piece of skin graft, but requires a carefully followed protocol. Over the past 5 years, a skin graft expansion technique following the Meek principle was used to treat 37 individuals who had sustained third degree burns involving more than 40% of the body surface. A scheme was devised whereby the body was divided into six areas, in order to clarify the optimal order of wound debridements and skin grafting procedures as well as the regimen of aftercare. The mean body surface involvement was 72.9% and the mean area of third degree burns was 41%. The average number of operations required was 1.84. There were four deaths among in this group of patients. The Meek technique of skin expansion and the suggested protocol are together efficient and effective in covering an open wound, particularly where there is a paucity of skin graft donor sites.

Skin bioengineering and stem cells for severe burn treatment

International Nuclear Information System (INIS)

Lataillade, J.J.; Trouillas, M.; Alexaline, M.; Brachet, M.; Bey, E.; Duhamel, P.; Leclerc, T.; Bargues, L.

2015-01-01

Severely burned patients need definitive and efficient wound coverage. The outcome of massive burns has improved with cultured epithelial auto-grafts (CEA). In spite of its fragility, percentage of success, cost of treatment and long-term tendency to contracture, this surgical technique has been developed in some burn centres. The first improvements involved combining CEA and dermis-like substitutes. Cultured skin substitutes provide faster skin closure and satisfying functional results. These methods have been used successfully in massive burns. A second improvement was to enable skin regeneration by using epidermal stem cells. Stem cells can differentiate into keratinocytes, to promote wound repair and to regenerate skin appendages. Human mesenchymal stem cells foster wound healing and were used in cutaneous radiation syndrome. Skin regeneration and tissue engineering methods remain a complex challenge and offer the possibility of new treatment for injured and burned patients. (authors)

21 CFR 880.5180 - Burn sheet.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Burn sheet. 880.5180 Section 880.5180 Food and... Burn sheet. (a) Identification. A burn sheet is a device made of a porous material that is wrapped aroung a burn victim to retain body heat, to absorb wound exudate, and to serve as a barrier against...

A Soft Casting Technique for Managing Pediatric Hand and Foot Burns.

Science.gov (United States)

Choi, Young Mee; Nederveld, Cindy; Campbell, Kristen; Moulton, Steven

2018-04-04

Hand and foot burns in children are difficult to dress. The authors have developed a soft casting technique to manage burns to these areas. The aim of this study is to report the outcomes using weekly dressing changes with a soft casting technique to manage pediatric hand and foot burns in the outpatient setting. A retrospective chart review was performed on children with burns to the hands or feet, who underwent dressing changes with a soft casting technique at the Children's Hospital Colorado Burn Center. Soft casting was performed by placing antibiotic ointment-impregnated nonadherent gauze over the burn wound(s), wrapping the extremity using rolled gauze, applying soft cast pad, plaster, soft cast tape, and an elastic bandage. This was changed weekly. Two hundred ninety-eight children with hand burns had a mean age of 16.8 ± 2 months. Two hundred forty-eight children had partial thickness burn injuries (83%), 50 had full thickness burn injuries (17%), and the mean total body surface area (TBSA) was 1 ± 2.4%. The mean time to heal was 10.1 ± 1.7 days for all subjects. Sixty-six children with foot burns were identified with a mean age of 24 ± 2.6 months. Forty-six children had partial thickness injuries (70%), 20 had full thickness burn injuries (30%), and the mean TBSA was 2.3 ± 2.9%. The mean time to heal was 14.1 ± 2.2 days for all subjects. Weekly dressing changes using a soft casting technique are effective for the outpatient management of pediatric hand and foot burns. This method avoids costly inpatient hospital care, reduces the number of painful dressing changes, and allows children to heal in their own environment.

Burn patient care lost in good manufacturing practices?

Science.gov (United States)

Dimitropoulos, G.; Jafari, P.; de Buys Roessingh, A.; Hirt-Burri, N.; Raffoul, W.; Applegate, L.A.

2016-01-01

Summary Application of cell therapies in burn care started in the early 80s in specialized hospital centers world-wide. Since 2007, cell therapies have been considered as “Advanced Therapy Medicinal Products” (ATMP), so classified by European Directives along with associated Regulations by the European Parliament. Consequently, regulatory changes have transformed the standard linear clinical care pathway into a more complex one. It is important to ensure the safety of cellular therapies used for burn patients and to standardize as much as possible the cell sources and products developed using cell culture procedures. However, we can definitely affirm that concentrating the bulk of energy and resources on the implementation of Good Manufacturing Practice (GMP) alone will have a major negative impact on the care of severely burned patients world-wide. Developing fully accredited infrastructures and training personnel (required by the new directives), along with obtaining approval for clinical trials to go ahead, can be a lengthy process.We discuss whether or not these patients could benefit from cell therapies provided by standard in-hospital laboratories, thus avoiding having to meet rigid regulations concerning the use of industrial pharmaceutical products. “Hospital Exemption” could be a preferred means to offer burn patients a customized and safe product, as many adaptations may be required throughout their treatment pathway. Patients who are in need of rapid treatment will be the ones to suffer the most from regulations intended to help them. PMID:28149232

From Baghdad to Boston: International Transfer of Burned Children in Time of War

Science.gov (United States)

2014-10-01

Afghani- stan.1 At the busiest CSH in Iraq, located at Ibn Sina Hospital in Baghdad, many of these burned children underwent wound care and discharge...Iraq by a commercial airline, again funded by the Iraqi Children’s Project. The patients followed up with U.S. Army personnel at Ibn Sina Hospital

Biobrane versus 1% silver sulfadiazine in second-degree pediatric burns

NARCIS (Netherlands)

Barret, JP; Dziewulski, P; Ramzy, PI; Wolf, SE; Desai, MH; Herndon, DN

Partial-thickness burns in children have been treated for many years by daily, painful rubbing, washing, and cleansing of the burn wound, followed by topical application of antimicrobial creams. Pain and impaired wound healing are the main problems. We hypothesized that the treatment of

Fundamentals of randomized clinical trials in wound care

DEFF Research Database (Denmark)

Brölmann, Fleur E; Eskes, Anne M; Sumpio, Bauer E

2013-01-01

In wound care research, available high-level evidence according to the evidence pyramid is rare, and is threatened by a poor study design and reporting. Without comprehensive and transparent reporting, readers will not be able to assess the strengths and limitations of the research performed...

Pediatric scalds: do cooking-related burns have a higher injury burden?

Science.gov (United States)

Bachier, Marielena; Hammond, Sarah E; Williams, Regan; Jancelewicz, Timothy; Feliz, Alexander

2015-11-01

Pediatric scald burns result in frequent emergency room visits and hospitalizations. We investigated whether cooking-related burns produce greater morbidity requiring more extensive care than noncooking burns. We performed a 6-y review at our free-standing children's hospital. Children aged cooking versus noncooking burns. The Mann-Whitney U test, a chi-square test, and the negative binomial were used to compare continuous, categorical, and count data between groups. Bivariate analysis was performed to identify risk factors among patients with adverse outcomes. We identified 308 patients; 262 (85%) cooking and 46 (15%) noncooking burns. Most patients were African-American males, with public insurance, and a median age of 2 y. Cooking burns preferentially occurred over the head, neck, and upper body; noncooking burns were distributed over the lower body (P  0.11). In subgroup analysis, semisolid and grease burns resulted in increased rates of wound contractures and/or limited mobility when compared with noncooking burns (P = 0.05 and P = 0.008, respectively). Patients with complications were more likely to have third degree burns and required more consults, longer hospitalization, and more surgical debridements and clinic visits. Most accidental scald burns occurred in young children during food preparation. Greater long-term morbidity was found in patients with semisolid and grease burns. This subset of children has a higher injury burden and requires extensive care in the acute and long-term setting. Copyright © 2015 Elsevier Inc. All rights reserved.

Electrical burns in sports fishing: a case report.

Science.gov (United States)

Valença-Filipe, R; Egipto, P; Horta, R; Braga, J M; Costa, J; Silva, A

2014-11-01

Electrical burns are among the most devastating types of burns, with wide-ranging injuries. They can sometimes occur in the context of fishing, usually involving high voltages. The authors present the case of a 59-year-old-man who suffered a sports accident during a fishing competition, with the formation of an electrical arc due to proximity of the fishing rod and high voltage cables. He presented burns affecting 3% of TBSA, third degree deep burns on trunk and left hand; no signs of cardiac injury. He was admitted to our Burn Unit for monitoring, care dressing and surgical treatment; complete wound healing was achieved after 24 days. Due to its relatively small share among burns, published data on electrical injuries and fishing remain scarce, and differ in patient collectives due to infrastructural or environmental differences. The authors are not aware of published specific reports on electrical burns in sports fishing practice, like the case here presented. The authors want to alert for potential medical, social and economic consequences of this type of sports accidents that could be entirely avoidable with some preventive measures. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Hypoperfusion and Wound Healing: Another Dimension of Wound Assessment.

Science.gov (United States)

Smollock, Wendy; Montenegro, Paul; Czenis, Amy; He, Yuan

2018-02-01

To examine the correlation between mean arterial pressure (MAP) and wound healing indices and describe an analytical process that can be used accurately and prospectively when evaluating all types of skin ulcerations. A correlational study in a long-term-care facility.Participants (N = 230) were adults residing in a long-term-care facility with an average age of 77.8 years (range, 35-105). Assessment through both an index of wound healing and wound surface area. Signs of wound healing included a reduction of surface area and surface necrosis and increased granulation or epithelialization. Aggregate analyses for all wound locations revealed a positive correlation between the MAP and index of wound healing (r = 0.86, n = 501, P wound healing was noted for all wound locations in this data set when MAP values were 80 mm Hg or less (r = 0.95, n = 141, P wounds and MAP of less than 80 mm Hg yielded a very strong positive correlation. The data indicated that as perfusion decreased, wounds within the sample population declined (r = 0.93, n = 102, P wound healing or worsened wounds. A predictability of wounds stalling or declining related to the MAP was observed, regardless of topical treatment or standard-of-care interventions. Therefore, the data also suggest that remediating states of low perfusion should take precedence in making treatment decisions.

Translational systems biology: introduction of an engineering approach to the pathophysiology of the burn patient.

Science.gov (United States)

An, Gary; Faeder, James; Vodovotz, Yoram

2008-01-01

The pathophysiology of the burn patient manifests the full spectrum of the complexity of the inflammatory response. In the acute phase, inflammation may have negative effects via capillary leak, the propagation of inhalation injury, and development of multiple organ failure. Attempts to mediate these processes remain a central subject of burn care research. Conversely, inflammation is a necessary prologue and component in the later stage processes of wound healing. Despite the volume of information concerning the cellular and molecular processes involved in inflammation, there exists a significant gap between the knowledge of mechanistic pathophysiology and the development of effective clinical therapeutic regimens. Translational systems biology (TSB) is the application of dynamic mathematical modeling and certain engineering principles to biological systems to integrate mechanism with phenomenon and, importantly, to revise clinical practice. This study will review the existing applications of TSB in the areas of inflammation and wound healing, relate them to specific areas of interest to the burn community, and present an integrated framework that links TSB with traditional burn research.

Treatment of acute burn blisters in unscheduled care settings.

Science.gov (United States)

Payne, Sarah; Cole, Elaine

2012-09-01

Many patients with minor burns present at emergency departments and urgent care centres, where their management is often undertaken by experienced nurses rather than experts in treating burns. This article describes a small study of the clinical decision making that underpins nurses' management of minor burns in these non-specialist settings. The results suggest that, due to a lack of relevant research, nurses base their decisions on previous experience or expert colleagues' opinions and advice rather than on the evidence.

Wound healing activity of Sida cordifolia Linn. in rats.

Science.gov (United States)

Pawar, Rajesh S; Chaurasiya, Pradeep K; Rajak, Harish; Singour, Pradeep K; Toppo, Fedelic Ashish; Jain, Ankit

2013-01-01

The present study provides a scientific evaluation for the wound healing potential of ethanolic (EtOH) extract of Sida cordifolia Linn. (SCL) plant. Excision, incision and burn wounds were inflicted upon three groups of six rats each. Group I was assigned as control (ointment base). Group II was treated with 10% EtOH extract ointment. Group III was treated with standard silver sulfadiazine (0.01%) cream. The parameters observed were percentage of wound contraction, epithelialization period, hydroxyproline content, tensile strength including histopathological studies. It was noted that the effect produced by the ethanolic extract of SCL ointment showed significant (P < 0.01) healing in all wound models when compared with the control group. All parameters such as wound contraction, epithelialization period, hydroxyproline content, tensile strength and histopathological studies showed significant (P < 0.01) changes when compared with the control. The ethanolic extract ointment of SCL effectively stimulates wound contraction; increases tensile strength of excision, incision and burn wounds.

Preclinical Evaluation of Tegaderm™ Supported Nanofibrous Wound Matrix Dressing on Porcine Wound Healing Model.

Science.gov (United States)

Ong, Chee Tian; Zhang, Yanzhong; Lim, Raymond; Samsonraj, Rebekah; Masilamani, Jeyakumar; Phan, Tran Hong Ha; Ramakrishna, Seeram; Lim, Ivor; Kee, Irene; Fahamy, Mohammad; Templonuevo, Vilma; Lim, Chwee Teck; Phan, Toan Thang

2015-02-01

Objective: Nanofibers for tissue scaffolding and wound dressings hold great potential in realizing enhanced healing of wounds in comparison with conventional counterparts. Previously, we demonstrated good fibroblast adherence and growth on a newly developed scaffold, Tegaderm™-Nanofiber (TG-NF), made from poly ɛ-caprolactone (PCL)/gelatin nanofibers electrospun onto Tegaderm (TG). The purpose of this study is to evaluate the performance and safety of TG-NF dressings in partial-thickness wound in a pig healing model. Approach: To evaluate the rate of reepithelialization, control TG, human dermal fibroblast-seeded TG-NF(+) and -unseeded TG-NF(-) were randomly dressed onto 80 partial-thickness burns created on four female and four male pigs. Wound inspections and dressings were done after burns on day 7, 14, 21, and 28. On day 28, full-thickness biopsies were taken for histopathological evaluation by Masson-Trichrome staining for collagen and hematoxylin-eosin staining for cell counting. Results: No infection and severe inflammation were recorded. Wounds treated with TG-NF(+) reepithelialized significantly faster than TG-NF(-) and control. Wound site inflammatory responses to study groups were similar as total cell counts on granulation tissues show no significant differences. Most of the wounds completely reepithelialized by day 28, except for two wounds in control and TG-NF(-). A higher collagen coverage was also recorded in the granulation tissues treated with TG-NF(+). Innovation and Conclusion: With better reepithelialization achieved by TG-NF(+) and similar rates of wound closure by TG-NF(-) and control, and the absence of elevated inflammatory responses to TG-NF constructs, TG-NF constructs are safe and demonstrated good healing potentials that are comparable to Tegaderm.

[Qualified and emergency specialized surgical care for those with wounds to the extremities].

Science.gov (United States)

Iurkevich, V V; Fidarov, E Z; Bauér, V A

1997-06-01

Experience of organization of the surgical care in the military hospital to 438 wounded in extremities during armed conflict in Republic of Chechnya is generalized. Maximum reduction of stages of medical evacuation of the wounded in extremities, approaching of the qualified and urgent specialized surgical care directly to the region of battle actions, use of opportunities for it one-moment rendering corresponded to principles of the modern military-medical doctrine. Due to realization of the requirements of the doctrine life of many wounded ++ was saved, terms of treatment, medical and social rehabilitation are reduced. Besides lethality, treatment cost and numbers of transferring to the reserve from the Armed Forces were reduced.

Physical functional outcome assessment of patients with major burns admitted to a UK Burn Intensive Care Unit.

Science.gov (United States)

Smailes, Sarah T; Engelsman, Kayleen; Dziewulski, Peter

2013-02-01

Determining the discharge outcome of burn patients can be challenging and therefore a validated objective measure of functional independence would assist with this process. We developed the Functional Assessment for Burns (FAB) score to measure burn patients' functional independence. FAB scores were taken on discharge from ICU (FAB 1) and on discharge from inpatient burn care (FAB 2) in 56 patients meeting the American Burn Association criteria for major burn. We retrospectively analysed prospectively collected data to measure the progress of patients' physical functional outcomes and to evaluate the predictive validity of the FAB score for discharge outcome. Mean age was 38.6 years and median burn size 35%. Significant improvements were made in the physical functional outcomes between FAB 1 and FAB 2 scores (pburn patients. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

[Wound healing is still a game of " blind men and an elephant"].

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Han, C M

2016-10-20

The wound healing includes non-healing and overhealing of the wounds. The results of wound healing are well known by people such as non-healing of the diabetic ulcer or hypertrophic scar after deep burn. In this issue, three papers involve in wound healing, one about autologous adipose-derived mesenchymal stem cells injected into wound or scar of rabbit ear, one about severe hypoxia and hypoalbuminemia inducing human hypertrophic scar derived fibroblast apoptosis in vitro, and another about the dysfunction of protein kinase B/mammalian target of rapamycin signaling pathway contributing to the pathophysiological characteristics of diabetic skin and non-healing wound. The basic problem of hypertrophic scar study is lacking an ideal animal model. Although rabbit ear model or red Duroc pig model has been used widely for study on hypertrophic scar, they can not fully represent human dermal fibrosis after deep trauma on the skin. I recommend A novel nude mouse model of hypertrophic scarring using scratched full thickness human skin grafts recently published in Advances in Wound Care to the readers. The author emphasizes that the wound healing study is still in the situation like the game of " blind men and an elephant" .

Burns education for non-burn specialist clinicians in Western Australia.

Science.gov (United States)

McWilliams, Tania; Hendricks, Joyce; Twigg, Di; Wood, Fiona

2015-03-01

Burn patients often receive their initial care by non-burn specialist clinicians, with increasingly collaborative burn models of care. The provision of relevant and accessible education for these clinicians is therefore vital for optimal patient care. A two phase design was used. A state-wide survey of multidisciplinary non-burn specialist clinicians throughout Western Australia identified learning needs related to paediatric burn care. A targeted education programme was developed and delivered live via videoconference. Pre-post-test analysis evaluated changes in knowledge as a result of attendance at each education session. Non-burn specialist clinicians identified numerous areas of burn care relevant to their practice. Statistically significant differences between perceived relevance of care and confidence in care provision were reported for aspects of acute burn care. Following attendance at the education sessions, statistically significant increases in knowledge were noted for most areas of acute burn care. Identification of learning needs facilitated the development of a targeted education programme for non-burn specialist clinicians. Increased non-burn specialist clinician knowledge following attendance at most education sessions supports the use of videoconferencing as an acceptable and effective method of delivering burns education in Western Australia. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Apyrase Elicits Host Antimicrobial Responses and Resolves Infection in Burns.

Science.gov (United States)

Bayliss, Jill M; Levi, Benjamin; Wu, Jianfeng; Wang, Stewart C; Su, Grace L; Xi, Chuanwu

The authors previously reported that adenosine triphosphate (ATP) stimulates biofilm formation and removal of the ATP could reduce biofilm formation. The main objective of this study was to evaluate the effects of the ATP-hydrolyzing enzyme, apyrase, on control of Acinetabacter baumannii infection in the burn wound as well as to assess host skin antimicrobial responses. The authors found that apyrase stimulated nitric oxide formation at the wound site and reduced CD55 expression, thereby inducing the assembly of membrane attack complexes. Apyrase treatment nearly eradicated multidrug-resistant A. baumannii from burn wounds in the absence of antibiotics. Apyrase may be an effective therapy against antibiotic-resistant bacterial infections in burns.

Epidermal-dermal crosstalk during burn wound scar maturation

NARCIS (Netherlands)

T.E. Hakvoort (Eveline)

1999-01-01

textabstractBurn injuries arc among the worst traumas which can happen to man. The larger a burn injury, the more severe the consequences and the highcr the chance of an adverse outcome or even death. In The Netherlands each year 40,000 people visit a general practitioner for treatment of a burn

Caring for Wounded Veterans: A Strategy in the GWOT

National Research Council Canada - National Science Library

Talley, Steve

2007-01-01

... and physical well-being of its veterans. This project examines what needs to be done to ensure that the United States Government provides immediate and long-term care and support to America's wounded veterans, regardless of their physical...

Economic burden of burn injuries in the Netherlands: A 3 months follow-up study.

Science.gov (United States)

Hop, M Jenda; Wijnen, Ben F M; Nieuwenhuis, Marianne K; Dokter, Jan; Middelkoop, Esther; Polinder, Suzanne; van Baar, Margriet E

2016-01-01

Burn care has rapidly improved in the past decades. However, healthcare innovations can be expensive, demanding careful choices on their implementation. Obtaining knowledge on the extent of the costs of burn injuries is an essential first step for economic evaluations within burn care. The objective of this study was to determine the economic burden of patients with burns admitted to a burn centre and to identify important cost categories until 3 months post-burn. A prospective cohort study was conducted in the burn centre of Maasstad Hospital Rotterdam, the Netherlands, including all patients with acute burn related injuries from August 2011 until July 2012. Total costs were calculated from a societal perspective, until 3 months post injury. Subgroup analyses were performed to examine whether the mean total costs per patient differed by age, aetiology or percentage total body surface area (TBSA) burned. In our population, with a mean burn size of 8%, mean total costs were €26,540 per patient varying from €742 to €235,557. Most important cost categories were burn centre days (62%), surgical interventions (5%) and work absence (20%). Flame burns were significantly more costly than other types of burns, adult patients were significantly more costly than children and adolescents and a higher percentage TBSA burned also corresponded to significantly higher costs. Mean total costs of burn care in the first 3 months post injury were estimated at €26,540 and depended on age, aetiology and TBSA. Mean total costs in our population probably apply to other high-income countries as well, although we should realise that patients with burn injuries are diverse and represent a broad range of total costs. To reduce costs of burn care, future intervention studies should focus on a timely wound healing, reducing length of stay and enabling an early return to work. Copyright © 2015 Elsevier Ltd. All rights reserved.

Epoetin Alpha and Epoetin Zeta: A Comparative Study on Stimulation of Angiogenesis and Wound Repair in an Experimental Model of Burn Injury.

Science.gov (United States)

Irrera, Natasha; Bitto, Alessandra; Pizzino, Gabriele; Vaccaro, Mario; Squadrito, Francesco; Galeano, Mariarosaria; Stagno d'Alcontres, Francesco; Stagno d'Alcontres, Ferdinando; Buemi, Michele; Minutoli, Letteria; Colonna, Michele Rosario; Altavilla, Domenica

2015-01-01

Deep second-degree burns are characterized by delayed formation of granulation tissue and impaired angiogenesis. Erythropoietin (EPO) is able to stimulate angiogenesis and mitosis, activating vascularization and cell cycle. The aim of our study was to investigate whether two biosimilar recombinant human erythropoietins, EPO-α and EPO-Z, may promote these processes in an experimental model of burn injury. A total of 84 mice were used and a scald burn was produced on the back after shaving, in 80°C water for 10 seconds. Mice were then randomized to receive EPO-α (400 units/kg/day/sc) or EPO-Z (400 units/kg/day/sc) or their vehicle (100 μL/day/sc 0.9% NaCl solution). After 12 days, both EPO-α and EPO-Z increased VEGF protein expression. EPO-α caused an increased cyclin D1/CDK6 and cyclin E/CDK2 expression compared with vehicle and EPO-Z (p<0.001). Our study showed that EPO-α and EPO-Z accelerated wound closure and angiogenesis; however EPO-α resulted more effectively in achieving complete skin regeneration. Our data suggest that EPO-α and EPO-Z are not biosimilars for the wound healing effects. The higher efficacy of EPO-α might be likely due to its different conformational structure leading to a more efficient cell proliferation and skin remodelling.

Medical response to the radioinduced burns

International Nuclear Information System (INIS)

Portas, Mercedes

2001-01-01

For over two years the Hospital for Burns in Buenos Aires has been studying the burns caused by radiation, in accordance to an agreement with the Nuclear Regulatory Authority (ARN) of Argentina. The analysis of each case showed the importance of the differential diagnosis from conventional injuries, of this early diagnosis depends the possibility of treatment from the 0 (zero) hour (time at which the accident took place) and achieve the wound healing with the best possible treatment, weather it is medical or surgical in nature. The Hospital's medical staff has developed the necessary skills to recognize this type of burns from an early stage. Most patients arrive to the consultation on their own accord due to the general practitioners inability to correctly diagnose the wounds appeared after radiotherapy has been applied. In this article, we present the general guidelines that the doctors of the Hospital for Burns follow in the presence of radio inducted injuries, objectifying the ethiopathogenic differences of the various burns. (author)

Development of a wound healing index for patients with chronic wounds.

Science.gov (United States)

Horn, Susan D; Fife, Caroline E; Smout, Randall J; Barrett, Ryan S; Thomson, Brett

2013-01-01

Randomized controlled trials in wound care generalize poorly because they exclude patients with significant comorbid conditions. Research using real-world wound care patients is hindered by lack of validated methods to stratify patients according to severity of underlying illnesses. We developed a comprehensive stratification system for patients with wounds that predicts healing likelihood. Complete medical record data on 50,967 wounds from the United States Wound Registry were assigned a clear outcome (healed, amputated, etc.). Factors known to be associated with healing were evaluated using logistic regression models. Significant variables (p healing for each wound type. Some variables predicted significantly in nearly all models: wound size, wound age, number of wounds, evidence of bioburden, tissue type exposed (Wagner grade or stage), being nonambulatory, and requiring hospitalization during the course of care. Variables significant in some models included renal failure, renal transplant, malnutrition, autoimmune disease, and cardiovascular disease. All models validated well when applied to the holdout sample. The "Wound Healing Index" can validly predict likelihood of wound healing among real-world patients and can facilitate comparative effectiveness research to identify patients needing advanced therapeutics. © 2013 by the Wound Healing Society.

Stem Cells in Burn Eschar

NARCIS (Netherlands)

van der Veen, V. C.; Vlig, M.; van Milligen-Kummer, F.J.; de Vries, S.I.; Middelkoop, E.; Ulrich, M.

2012-01-01

This study compares mesenchymal cells isolated from excised burn wound eschar with adipose-derived stem cells (ASCs) and dermal fibroblasts in their ability to conform to the requirements for multipotent mesenchymal stem cells (MSCs). A population of multipotent stem cells in burn eschar could be an

Assessing the feasibility of implementing low-cost virtual reality therapy during routine burn care.

Science.gov (United States)

Ford, Cameron G; Manegold, Ellen M; Randall, Cameron L; Aballay, Ariel M; Duncan, Christina L

2018-06-01

Burn care often involves procedures that result in significant pain experiences for patients which, in turn, can lead to poorer physical and psychological health outcomes. Distraction and virtual reality (VR) are an effective adjunct to pharmacological interventions in reducing pain. Much of the research that has demonstrated efficacy for VR in burn care has involved expensive and extensive technology. Thus, identifying cost-effective, feasible, acceptable, and effective approaches to apply distraction within routine burn care is important. The objective of this mixed-methods study was to evaluate key stakeholder (i.e., patients, providers) perceptions of feasibility, acceptability, and effectiveness for the use of low-cost VR technology during routine burn care with adult patients. Ten adult patients used VR during burn care dressing changes in an outpatient clinic setting, after which they completed a satisfaction survey and individual qualitative interview. Providers also completed a satisfaction/perception survey after each participant's care. Quantitative and qualitative results from both patient and provider perspectives consistently supported the feasibility and utility of applying low-cost VR technology in this outpatient burn clinic setting. Special considerations (e.g., aspects to consider when choosing an apparatus or application) stemming from stakeholder feedback are discussed. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

The management of perineal wounds

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Ramesh k Sharma

2012-01-01

Full Text Available Management of perineal wounds can be very frustrating as these invariably get contaminated from the ano-genital tracts. Moreover, the apparent skin defect may be associated with a significant three dimensional dead space in the pelvic region. Such wounds are likely to become chronic and recalcitrant if appropriate wound management is not instituted in a timely manner. These wounds usually result after tumor excision, following trauma or as a result of infective pathologies like hideradenitis suppurativa or following thermal burns. Many options are available for management of perineal wounds and these have been discussed with illustrative case examples. A review of literature has been done for listing commonly instituted options for management of the wounds in perineum.

Biological function evaluation and effects of laser micro-pore burn-denatured acellular dermal matrix.

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Zhang, Youlai; Zeng, Yuanlin; Xin, Guohua; Zou, Lijin; Ding, Yuewei; Duyin, Jiang

2018-03-01

In the field of burns repairs, many problems exist in the shortage of donor skin, the expense of allograft or xenograft skin, temporary substitution and unsatisfactory extremity function after wound healing. Previous studies showed that burn-denatured skin could return to normal dermis formation and function. This study investigates the application of laser micro-pore burn-denatured acellular dermis matrix (DADM) from an escharotomy in the repair of burn wounds and evaluates the biological properties and wound repair effects of DADM in implantation experiments in Kunming mice. Specific-pathogen-free (SPF) Kunming mice were used in this study. A deep II° burn wound was created on the dorsum of the mice by an electric heated water bath. The full-thickness wound tissue was harvested. The necrotic tissue and subcutaneous tissue were removed. The denatured dermis was preserved and treated with 0.25% trypsin, 0.5% Triton X-100. The DADM was drilled by laser micro-pore. The biological properties and grafting effects of laser micro-pore burn-DADM were evaluated by morphology, cytokine expression levels and subcutaneous implantation experiments in Kunming mice. We found statistical significance (Ppore burn-DADM (experimental group) compared to the control group (no laser micro-pore burn-DADM). Cytokine expression level was different in the dermal matrixes harvested at various time points after burn (24h, 48h, 72h and infected wound group). Comparing the dermal matrix from 24h burn tissue to infected wound tissue, the expression level of IL-6, MMP-24, VE-cadherin and VEGF were decreased. We found no inflammatory cells infiltration in the dermal matrix were observed in both experimental and control groups (24h burn group), while the obviously vascular infiltration and fiber fusion were observed in the experimental group after subcutaneous implantation experiments. There was better bio-performance, low immunogenicity and better dermal incorporation after treated by laser

Wound healing in animal models: review article

Directory of Open Access Journals (Sweden)

Fariba Jaffary

2017-10-01

Full Text Available Wound healing and reduction of its recovery time is one of the most important issues in medicine. Wound is defined as disruption of anatomy and function of normal skin. This injury could be the result of physical elements such as  surgical incision, hit or pressure cut of the skin and gunshot wound. Chemical or caustic burn is another category of wound causes that can be induced by acid or base contact irritation. Healing is a process of cellular and extracellular matrix interactions that occur in the damaged tissue. Wound healing consists of several stages including hemostasis, inflammatory phase, proliferative phase and new tissue formation which reconstructs by new collagen formation. Wounds are divided into acute and chronic types based on their healing time. Acute wounds have sudden onset and in normal individuals usually have healing process of less than 4 weeks without any residual side effects. In contrast, chronic wounds have gradual onset. Their inflammatory phase is prolonged and the healing process is stopped due to some background factors like diabetes, ischemia or local pressure. If the healing process lasts more than 4 weeks it will be classified as chronic wound. Despite major advances in the treatment of wounds, still finding effective modalities for healing wounds in the shortest possible time with the fewest side effects is a current challenge. In this review different phases of wound healing and clinical types of wound such as venous leg ulcer, diabetic foot ulcer and pressure ulcer are discussed. Also acute wound models (i.e burn wounds or incisional wound and chronic wound models (such as venous leg ulcers, diabetic foot ulcer, pressure ulcers or bedsore in laboratory animals are presented. This summary can be considered as a preliminary step to facilitate designing of more targeted and applied research in this area.

Survey of the Statewide Impact of Payer Source on Referral of Small Burns to Burn Centers.

Science.gov (United States)

Penny, Rachel; Coffey, Rebecca; Jones, Larry; Bailey, J Kevin

It is generally agreed that patients with large burns will be referred to organized burn centers, however, the referral of patients with smaller burns is less certain. A two-part survey was conducted to identify referral patterns for burn patients that meet American Burn Association referral criteria, and any effect insurance type might have on the referral patterns. The emergency departments of our state hospital association's member hospitals were contacted seeking a referral for a fictitious patient with a third-degree scald of the dominant hand. The referral sites were contacted twice, first stating that the patient had commercial insurance, next stating that the patient had Medicaid. Data collected included wait time for an appointment or reasons for denial of an appointment. Of 218 hospitals, 46 were excluded because they did not offer emergency care, and eight because they were listed as burn centers on the American Burn Association website. Of the remaining 164, 119 (73%) would refer to a burn center, 21 (13%) to a plastic surgeon, 10 (6%) to a hand surgeon, 7 (4%) to a wound center, 7 (4%) to another nonburn physician resource. There was no difference in wait time to the first available appointment with regards to insurance type (6.56 ± 4.68 vs 6.53 ± 5.05 days). Our state's referral pattern gives us insight into the regional referral pattern. This information will be used to guide a focused education and communication program to provide better service for the burn victims of our state.

LED phototherapy in full-thickness burns induced by CO2 laser in rats skin.

Science.gov (United States)

da Silva Melo, Milene; Alves, Leandro Procópio; Fernandes, Adriana Barrinha; Carvalho, Henrique Cunha; de Lima, Carlos José; Munin, Egberto; Gomes, Mônica Fernandes; Salgado, Miguel Angel Castillo; Zângaro, Renato Amaro

2018-04-27

Many studies have been conducted on the treatment of burns because they are important in morbidity and mortality. These studies are mainly focused on improving care and quality of life of patients. The aim of this study was evaluate the LED phototherapy effects in rats skin full-thickness burns induced by CO 2 laser. The animals were divided in NT group that did not received any treatment and LED group that received LED irradiation at 685 nm, 220 mW, and 4.5 J/cm 2 during 40 s by burned area. Biopsies were obtained after 7, 14, and 21 days of treatment and submitted to histological and immunohistochemical analysis. The LED phototherapy shows anti-inflammatory effects, improves angiogenesis, and stimulates the migration and proliferation of fibroblasts. The T CD8+ lymphocytes were more common in burned areas compared to T CD4+ lymphocytes since statistically significant differences were observed in the LED group compared to the NT group after 7 days of treatment. These results showed that LED phototherapy performs positive influence in full-thickness burns repair from the healing process modulated by cellular immune response. The obtained results allowed inferring that burns exhibit a characteristic cell immune response and this cannot be extrapolated to other wounds such as incision and wounds induced by punch, among others.

Knowledge of nursing students about the care provided to people with neoplastic wounds

Directory of Open Access Journals (Sweden)

Roseane Ferreira Gomes

2017-05-01

Full Text Available Objective: To investigate the knowledge of nursing students about the care provided to patients with neoplastic wound. Method: This is an exploratory research of a qualitative nature, which was attended by 15 students of the Bachelor's Degree in Nursing from the Center of Education and Health of the Federal University of Campina Grande, campus Cuité - PB, in the period from October to November 2015. For data collection, we used a form for an interview. The data were analyzed through the Technique of Thematic Analysis of Minayo. Results: From the analysis of the empirical material emerged the following thematic categories: Category 1 - Defining neoplastic wounds; Category 2 - Knowledge incipient on ‘neoplastic wounds’ for academic and professional practice; Category 3 - Envisioning the theme "neoplastic wound" in the Academy; Category 4 - Knowledge about methods of evaluation of neoplastic wounds and Category 5 - Knowledge of therapeutic modalities of neoplastic wounds. Conclusions: The academics know the evaluative method of a patient with neoplastic wound as integralizadora unit of care process; recognize palliative care as the best therapeutic modality for these customers, especially when they are in completion and indicate the products contraindicated in the treatment of these lesions; however, do not mention the covers and recommended substances for the control of the signs and symptoms of these injuries. In this context, it is believed that the creation of academic projects of extension, with the aim of creating opportunities for integration between theory and practice, is one of the ways to improve the knowledge.   Keywords: Knowledge; Students of Nursing; Skin Neoplasms.

The process of implementing a rural VA wound care program for diabetic foot ulcer patients.

Science.gov (United States)

Reiber, Gayle E; Raugi, Gregory J; Rowberg, Donald

2007-10-01

Delivering and documenting evidence-based treatment to all Department of Veterans Affairs (VA) foot ulcer patients has wide appeal. However, primary and secondary care medical centers where 52% of these patients receive care are at a disadvantage given the frequent absence of trained specialists to manage diabetic foot ulcers. A retrospective review of diabetic foot ulcer patient records and a provider survey were conducted to document the foot ulcer problem and to assess practitioner needs. Results showed of the 125 persons with foot ulcers identified through administrative data, only, 21% of diabetic foot patients were correctly coded. Chronic Care and Microsystem models were used to prepare a tailored intervention in a VA primary care medical center. The site Principal Investigators, a multidisciplinary site wound care team, and study investigators jointly implemented a diabetic foot ulcer program. Intervention components include wound care team education and training, standardized good wound care practices based on strong scientific evidence, and a wound care template embedded in the electronic medical record to facilitate data collection, clinical decision making, patient ordering, and coding. A strategy for delivering offloading pressure devices, regular case management support, and 24/7 emergency assistance also was developed. It took 9 months to implement the model. Patients were enrolled and followed for 1 year. Process and outcome evaluations are on-going.

Eschar removal by bromelain based enzymatic debridement (Nexobrid®) in burns: An European consensus.

Science.gov (United States)

Hirche, Christoph; Citterio, Antonella; Hoeksema, Henk; Koller, Ján; Lehner, Martina; Martinez, José Ramón; Monstrey, Stan; Murray, Alexandra; Plock, Jan A; Sander, Frank; Schulz, Alexandra; Ziegler, Benjamin; Kneser, Ulrich

2017-12-01

Early debridement and/or eschar removal is regarded as a significant step in the treatment of deep partial and full thickness burns. It aims to control wound bioburden and allows early wound closure by conservative treatment or skin grafting. Preservation of viable dermis accompanied by early wound closure, is regarded as a necessary step to reduce scar related complication, e.g. functional limitations and/or unaesthetic scar formation. Aside from the classical techniques of surgical excision as tangential excision for eschar removal, hydro-surgery, maggot therapy, laser, enzymatic debridement have been described as additional techniques in the burn surgeon's armamentarium. It is widely accepted that early eschar removal within 72h improves the outcome of burn wound treatment by reducing bacterial wound colonization, infection and length of hospital stay. In contrast, the right technique for eschar removal is still a matter of debate. There is increasing evidence that enzymatic debridement is a powerful tool to remove eschar in burn wounds, reducing blood loss, the need for autologous skin grafting and the number of wounds requiring surgical excision. In order to assess the role and clinical advantages of enzymatic debridement by a mixture of proteolytic enzymes enriched in Bromelain (Nexobrid ® ) beyond the scope of the literature and in view of users' experience, a European Consensus Meeting was scheduled. The aim was to provide statements for application, based on the mutual experience of applying enzymatic debridement in more than 500 adult and pediatric patients by the consensus panelists. Issues to be addressed were: indications, pain management and anesthesia, timing of application, technique of application, after-intervention care, skin grafting after enzymatic debridement, blood loss, training strategies and learning curve and areas of future research needs. Sixty-eight (68) consensus statements were provided for the use of enzymatic debridement. The

Marjolin’s ulcer in chronic wounds – review of available literature

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Dariusz Bazaliński

2017-09-01

Full Text Available Marjolin’s ulcer is a rare, aggressive skin cancer developing in scar tissue, chronic ulcers and areas affected by inflammations. Its incidence is estimated to range from 1% to 2% of all burn scars. It most frequently takes the form of squamous cell carcinoma which sometimes is diagnosed during examination of lesions developing in scars and hard-to-heal chronic wounds (pressure sores, leg ulcers. Therapeutic management of Marjolin’s ulcer requires well-designed treatment plan to ensure optimal medical care and good quality of life for the patient. The high risk of metastases and damage to the structure of vitally important organs determines the need for early diagnosis and prompt surgical intervention with supplementary therapy. The purpose of the study was to examine etiopathogenesis of Marjolin’s ulcer and principles of its treatment. The authors focused on the aspect of malignant degeneration in chronic wounds (leg ulcers, pressure sores as a very rare, aggressive form of Marjolin’s ulcer. A review of the available literature on the issue of Marjolin ulcers was conducted using the key words; Marjolin ulcers, pressure sore, chronic wound. Malignant degeneration in chronic wounds is a very rare aggressive form of Marjolin ulcer. Increased oncological alertness should be displayed by nursing and medical personnel taking care of patients with chronic wounds.

Surgical management and hypermetabolic modulation of pediatric burns

NARCIS (Netherlands)

Barret Nerín, Juan Pedro

2002-01-01

The purpose of the present thesis is to test the hypothesis that immediate burn wound excision of massive pediatric burns is safe and efficacious, presenting with negligible postoperative complications and with salutary effects on the inflammatory and catabolic response after burn injury.

Treatment and follow-up results of children with electrical burn who observed in burn intensive care unit

Directory of Open Access Journals (Sweden)

Çiğdem Aliosmanoğlu

2011-06-01

Full Text Available Electrical burns are infrequent relative to other injuries, but they are associated with high morbidity and mortality. The aim of this study was to assess management and follow-up results of pediatric patients’ who observed in intensive care unit and also review the precautions for preventing electrical burns.Materials and methods: Totally 22 patients aged under 17 years who were observed in the burn intensive care unit of Şanlıurfa Education and Research Hospital during the period between July 2009-October 2010. Cases were investigated retrospectively. The patients’ age, gender, total burn surface area, length of stay in hospital, musculo-skeletal system complication, cardiovascular system complication, kidney damage and attempts were recorded.Results: Of the 22 cases, 19 (86.3% were male and 3 (13.7% were female. The mean age of the patients was 11.5 years. In 10 (45.4% children burns were occurred in workplace and working area and 12 (54.6% were occurred in the home environment. Depth of burns were third degree in 10 (45.4% children and second degree in 12 (54.6%. The mean percentage of burn surface area was 25.9%. The mean length of stay in hospital was 17 days. Debridement and grafting were performed to 12 (54.6% cases and 10 (45.4% children were treated with dressings. No patient had increased creatinine kinase levels, oliguria, myoglobuinuria and arrhythmia. The mean hospitalization time was 17 days.Conclusion: Nearly half of patients underwent debridement plus grafting. None of our patients developed renal failure other severe system dysfunction.