摘要:

Myofibroblast anchoring strands (MAS) are extracellular structures that connect the termini of actin bundles within myofibroblasts to collagen fascicles in the extracellular space of wound healing tissues. The strands appear to be primarily comprised of microfibrils of fibronectin 2–5 nm in diameter. They also embody parallel arrays of intermediary sized filaments (ISF) and an amorphous matrix of collagen. The MAS effectively translate the cellular contractile forces required for cell motility into the collagen filament/fiber deformations required for wound contraction. However, the primary function of the strands appears to be the assembly of ISF into collagen fibrils.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Total calcium measurement is less useful clinically than assay of the physiologically active fractions, free and ionized calcium. The latter were measured in burned patients by ultrafiltration and by ion-selective electrode. Hypocalcemia was observed in these patients but it was generally limited to low total calcium. On average, free or ionized calcium were in the normal range. Total and free calcium were weakly correlated with severity of burn injury suggesting a loss of several forms of calcium in severe burn injury. An algorithm was derived to allow calculation of free calcium from total calcium and albumin. Interpatient variables are important, however, so that the algorithm should not be substituted for actual assay of free and ionized alcium.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A number of vasoactive substances, including serotonin, have been implicated in the pathophysiology of burn shock. Ketanserin, a specific serotonin antagonist, was investigated in a porcine burn shock model. Fifteen swine were given a mean 44% total body surface area full-thickness scald burn and received fluid resuscitation with Ringer's lactate for 24 hours postburn. The swine were divided into three groups: Group I (control group) received no ketanserin; Group II received ketanserin as a single intramuscular dose preburn and continuously via intravenous drip postburn; and Group III received ketanserin continuously via intravenous drip postburn only. The ketanserin-treated groups demonstrated improved cardiac index, decreased pulmonary artery pressures, and smaller arteriovenous oxygen content differences compared to the control group in the early postburn period. Ketanserin should be investigated further as a possible adjunctive therapeutic agent during burn shock resuscitation.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Short-term storage of a patient's harvested skin is clinically desirable for numerous reasons. Previous experience in our center using a skin storage solution of saline with a high concentration of antibiotics resulted in poor graft viability and an unsatisfactory clinical outcome. This report defines an improved method of storage which allows longer storage time, yielding viable skin and results in subsequent graft acceptance on the patient.Split-thickness autografts from patients were stored in: 1) saline + 104units/ml penicillin and 0.005 gm/ml streptomycin, or 2) RPMI-1640 + 25 units/ml penicillin and 25 mcg/ml streptomycin, at 4°C. The pH range of the saline solution was 5.90–6.20, compared to 7.20–7.32 for the RPMI-1640 solution. The medium was changed every 3 to 4 days during the storage period. Before graft reapplication the autografts were rinsed with sterile saline.Previous clinical results using the saline-antibiotic storage solution resulted in poor graft viability and no graft survival was noted on patients after 5 days of skin storage. In contrast 11/16 autografts which had been stored in the RPMI-1640 solution for 5 to 22 days (median, 11 days) were successful takes when regrafted to patients. Graft loss was observed in five cases due to the following reasons: inability to immobilize graft (one); poor vascular bed (two); and bacterial infections (two). These data are in agreement with results reported in a separate paper, demonstrating the effectiveness of RPMI-1640 as a storage medium for maintaining viable human skin grafts which were subsequently transplanted to athymic nude mice.Our results indicate that with proper storage techniques viable autografts can be maintained to 22 days without resorting to freezing. The RPMI-1640 solution was clearly superior to the saline solution with medium pH being an important factor in skin storage. Improvements in skin storage at this center have reduced the number of surgical procedures for many patients and have resulted in a shortened time of wound closure in these cases.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Eyelid burns occurred in 67% of the 210 patients with facial burns admitted to the San Diego Regional Burn Center between 1 December 1977 and 30 June 1982. Evaluation of 48 surviving patients with significant eyelid injury demonstrated the safety and effectiveness of early excision and grafting of eyelid burns. Tarsorrhaphies were found not to be useful in preventing ectropion and resulted in deformity of the lid margins. Our technique employing early excision and grafting and reconstruction of eyelid burns is illustrated.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Mafenide acetate is commonly available as a 10% cream and has been shown to be effective in the prevention and control of burn wound sepsis. The high osmolarity of the cream has been implicated in the pain upon application and the neoeschar formation often seen with its use. Mafenide acetate as a 5% solution has a lower osmolarity, and clinical trials with this agent have shown it to be both well accepted by patients and effective in wound preparation. Information concerning its antibacterial efficacy in comparison with other agents, however, has been lacking.Utilizing the Walker burn model, we have found the 5% mafenide acetate solution used as gauze soaks to be equal to mafenide acetate cream and better than silver sulfadiazine in attaining bacterial control of this experimental burn wound in the rat. The 5% solution provided prompt decrease in bacterial counts to less than 105bacteria per gram of tissue in a majority of wounds by 48 hours of treatment. In addition, such wounds showed no evidence of neoeschar formation. In light of the efficient bacterial control and rapid preparation of the wound for grafting seen in this model, more extensive clinical use of the 5% mafenide acetate solution appears justified.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

In a study of 27 thermally burned patients (mean TBSA, 58%; range, 32–96%) serum fibronectin levels were decreased with parallel decreased oxygen consumption of stimulated peripheral blood phagocytes and decreased EGTA-blocked burn serum opsonizing activity which correlated with serum fibronectin changes postburn. Normal and burn sera fibronectin content also correlated with the opsonizing times for zymosan andStaphylococcus aureusbut not forEnterobacteriaceae.Although in vivo 14 cases showed circulating fibronectin 140 μg/ml or lower and a marked decrease inStaphylococcus aureusopsonization, only two patients from this group revealed positiveStaphylococcus aureusblood cultures and serum fibronectin levels were higher in patients withStaphylococcus aureussepsis than in patients withEnterobacteriaceaesepsis. Supplementary experiments on leukocyte oxidative response after zymosan stimulation in normal, fibronectin-depleted, and fibronectin-reconstituted serum demonstrated that the lag period of oxygen burst is a fibronectin-dependent reaction.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Forty-nine consecutive burned patients over the age of 50 years treated with an early surgical protocol of wound closure were studied prospectively to determine if early surgery had a beneficial effect on total hospitalization time or mortality. Surgery was performed within the first 72 to 96 hours postburn. Twenty-six patients (Group I) had burns less than 20% of the TBSA, range, 3 to 18%, with 0 to 10% full thickness. Seventeen (66%) of these patients had surgical closure of the wound. The mean hospitalization time was 16.3 days. Twenty-three patients (Group II) had burns greater than 20% TBSA, range, 20 to 81%, with 0 to 68% full thickness. Eight (35%) of these patients died and five of the deaths were due to cardiovascular collapse during the initial resuscitative phase. Fourteen patients had 37 operative procedures performed to close the burn wound. Twelve (86%) of these 14 patients survived and the mean hospitalization time of the surviving patients was 44 days. No anesthetic complications occurred in either group.Results of this study indicate that an early surgical approach to wound closure resulted in a greater than 25% reduction in total hospitalization time, and further, that this early surgical approach was not associated with any increase in mortality, but instead, appeared to be associated with a reduction in mortality (x2=8.10;p<0.01).

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A major problem in patients surviving thermal injury is the development of hypertrophic burn scars. The current study was performed to determine the factors associated with an increased risk of the development of hypertrophic burn scars.Fifty-nine children (mean age, 3 years; mean TBSA, 14%) and 41 adults (mean age, 37; mean TBSA, 21%) followed from 9 to 18 months formed the study group. The location as well as time required for the burns to heal were recorded in addition to the age and race of the patients. Sixty-three (26%) of the 245 burn areas, in these 100 patients, became hypertrophic. No correlation between patient age and the development of wound problems was found. Blacks had more wound problems than others, if the burn wound took longer than 10 to 14 days to heal. The most important indicator of whether wound problems would occur, in our series, was the time required for the burn to heal. If the burn wound healed between 14 and 21 days then one third of the anatomic sites became hypertrophic; if the burn wound healed after 21 days then 78% of the burn sites developed hypertrophic scars.Based upon these results we have developed a selective, individualized protocol for the use of prophylactic pressure therapy in patients with spontaneously healing burn wounds.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Transmembrane potential difference (PD) is a reliable indicator of cellular function. Decreased PD in hepatocytes in hemorrhagic shock occurred concomitant with decreased adenosine triphosphate (ATP), suggesting energy depletion as the mechanism of cell dysfunction. This study correlates changes in liver and muscle PD with hepatocyte ATP, glucose-6-phosphate (G-6-P), and lactate levels in burn shock and resuscitation. Six adult female baboons were subjected to 52.4 ± 6.3% body surface area third-degree scald burns. The animals were resuscitated using the Parkland formula, after the muscle PD had fallen to −70 mV. Liver PD decreased from 46.2 ± 2.4 mV to 22.4 ± 3.8 mV in burn shock. The PD recovered toward normal with resuscitation. ATP and G-6-P contents did not change significantly, while lactate rose threefold in burn shock. A severe cellular derangement was indicated by this marked hepatocyte depolarization. Maintenance of normal intracellular ATP excludes energy depletion as the mechanism of this cell dysfunction. These findings are consistent with failure of active ion transport or changes in cell membrane permeability which were partially recovered during fluid resuscitation.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID