Early burn wound excision in mass casualty events

Dear Editor,The aim of the letter is to stress the need of creating unified recommendations concerning early burn wound excision in cases of mass casualty burns exclusively.There are several triage methods,both for civilian and military circumstances,that govern burn casualty triage and evacuation from the incident site,as well as hospital referral up to 120 h from the disaster.

Keladi candik(Alocasia longiloba Miq.) petiole extracts promote wound healing in a full thickness excision wound model in rats

Objective: To investigate the wound-healing effect of Alocasia longiloba(A. longiloba) petiole extract on wounds in rats.Methods: Twenty-two male Sprague-dawley rats were randomly assigned to receive 10% solcoseryl gel, phosphate buffer saline, 50% ethanol, 95% ethanol and hexane extracts of A. longiloba at 1.5%, 3% and 6% doses, respectively. A full thicknesses wound(6 mm) was created on the dorsal of the rat; and all rats were applied with the extract solutions, 10% solcoseryl gel and phosphate buffer saline once a day topically until day 12. The wound was photographed on day 1, 6 and 12, and the percentage of wound contraction was calculated. On day 12, rats were sacrificed and histological examination of granulation tissue was carried out using haematoxylin & eosin and Masson's Trichrome stain to determine the wound healing effect.Results: In this study, 6% of 50% and 95% ethanol extracts of A. longiloba showed 82.50% and 82.32% wound contraction, respectively, and were comparable with 10% solcoseryl gel(82.30%). Meanwhile, phosphate buffer saline treated group showed the lowest wound contraction(69.86%). Histological assessment of wound treated with 6% of 95% ethanol extract of A. longiloba showed distinct epidermal and dermal layer, higher proliferation of fibroblast and more angiogenesis with collagen compared to other wound treated groups.Conclusions: A. longiloba petiole extracts have a wound healing potential and 6% of 95% ethanol extract of A. longiloba is more effective. Further studies are required to understand the wound healing mechanism of action of the extract.

Preliminary Investigation of Formulated Herbal Ointment Demonstrates Amelioration of Excision Wound in Experimental Rabbit Model Compared with Silver Sulfadiazine

In light of the use of Lannea barteri in the management of diverse illnesses and treatment of wounds in traditional medicine, the current study was conducted to assess the wound-healing efficacy of crude aqueous extract of the stem bark of Lannea barteri and its shea butter formulated ointment using an excision wound model in the rabbit. The herbal ointment (5%, w/w) exhibited a significant wound healing activity, showing 99.9% ± 0.3% wound contraction at the end of the experiment (24th day). There was no significant difference (p > 0.05) between the 5% (w/w) herbal ointment compared with Silver Sulphadiazine cream (positive control), which showed a 97.8% ± 1.0% rate of excision wound contraction on day 24. Compared with the negative control group (administered with only shea butter), the wound healing activity of the ointment was significant (p Lannea barteri for the treatment of wounds and demonstrates that shea butter usage as a base in formulating an herbal ointment might aid in topical application for wound repair and regeneration, as well as the potential for enhanced wound healing.

The effect of extensive excision of burn wound with invasive infection on hypermetabolism in burn patients with sepsis

To evaluate the effect of extensive excision of invasive burn wound infection on hypermeta-bolic response in burn patients with sepsis. Methods:Eight patients with major burn, complicated by invasive burn wound infection and sepsis were consecutively admitted to our hospital from September 1997 to October 1998. REEs were monitored by means of Cardiorespiratory Diagnostic System (Medical Graphics Corporation, USA) at patients bedside. Plasma concentration of IL-6、IL-8、TNF-α and LPS were assayed before an...

The Use of Zigs and Zags to Reduce Scarring over “Keloid Triangles” during Excisional Surgery: Biomechanics, Review and Recommendations

Aim: The sternal region, cervico-mandibular region and the intra-mammary region have been the bane of many cutaneous surgeons, with a higher propensity for poor scarring and wound complications. In this article, the author undertakes a review of different methods of breaking up scars by utilizing zigs and zags, and conducts a pigskin study to measure the reduction in tension that can be achieved by using a simple zigzag technique while performing excisions. Methods: A pigskin study conducted into the use of the simple zigzag to reduce the tension (and thereby scarring) of surgical wounds is reported here, and comparison and review is undertaken of the biomechanics of elliptical excisions and traditional Z-plasties. Results: Using a simple zigzag reduces tension across the midpoint of the scar more effectively than a Z-plasty or a simple elliptical excision. Conclusion: The techniques of breaking up a scar or incision line by using zigs and zags, in a means to reduce scarring, are not new. However, each of these techniques has specific advantages and disadvantages that need consideration by the surgeon. In this paper, a pigskin study is conducted into the use of the simple zigzag to reduce the tension (and thereby reduce the risk of poor scarring) of surgical wounds.

地奥司明片对改良肛裂切除术后患者的影响

目的:探讨地奥司明片对改良肛裂切除术后患者的影响。方法:选取2019年1—11月于北京市肛肠医院肛肠科治疗的改良肛裂切除术后患者84例为研究对象,随机分为对照组和观察组,各42例。对照组采用头孢西丁钠、消毒创面等常规治疗,在此基础上,观察组采用地奥司明片治疗。比较两组临床疗效、疼痛及水肿评分、创面愈合指标、炎性因子水平。结果:观察组总有效率高于对照组,差异有统计学意义(P=0.007);观察组视觉模拟评分法、创面水肿评分低于对照组,差异有统计学意义(P<0.001);观察组术后便血次数少于对照组,肉芽组织生长时间、创面愈合时间短于对照组,差异有统计学意义(P<0.001);术后3d,两组白细胞介素-6、肿瘤坏死因子-α、γ干扰素水平低于术前,观察组低于对照组,差异有统计学意义(P<0.05)。结论:地奥司明片可减轻改良肛裂切除术后患者疼痛、水肿症状,促进创面愈合,减轻炎性反应,临床疗效显著。

Wound healing activity of aqueous extract of Crotalaria verrucosa in Wistar albino rats

Objective:To evaluate the wound healing effect of aqueous extract of Crotalaria verrucosa(C. verrucosa) in rats.Methods:Three wound models including incision,excision and dead space wounds were used in this study.The parameters studied were breaking strength in incision models,granulation tissue dry weight,breaking strength and hydroxyproline content in dead space wounds,percentage of wound contraction and period of epithelialization in excision wound model.Results:Two doses of the extract with and without dexamethasone showed significant increases in mean hydroxyproline,total protein content and dry weight of granulation tissue but it was higher with dose 800 mg/kg comparing with the control.The dexamethasone treated group showed a significant(P【0.001) reduction in the wound breaking strength when compared to control group in incision type of wound model.Coadministration of C.verrucosa with dexamethasone significantly(P【0.001) increased the breaking strength compared to the dexamethasone treated only group.In excision wound model,the percentage of the wound contraction was significantly(P【0.01) increased by two doses of test extract on all the days except the lower dose which exhibited only on 12th,16th days of drug treatment and it also reversed the dexamethasone suppressed wound contraction.It significantly(P【0.001) reduced the time required for epithelialization and reversed the epithelialization delaying effect of dexamethasone (P【0.001).Conclusions:C.verrucosa was found to possess significant wound healing property. This was evident by decrease in the period of epithelialization,increase in the rate of wound contraction,skin breaking strength,and granulation tissue dry weight content.Hence C. verrucosa could be a good wound healing agent.

Preliminary pharmacological evaluation of Martynia annua Linn leaves for wound healing

Objective:To evaluate the wound healing potential of fractions from ethanol extract of Martynin annua(M.annua) Linn leaves.Methods:Ethanol extract of Af.annua Linn leaves was fractionate into three different fractions(MAF-A,MAF-B and MAF-C) which were screened for wound healing potential using two models:excision and incision on rats.The thin layer chromatography(TLC) profile of all fractions were analysed and TLC of luteolin was also done.The PovidoneIodine Ointment was used as reference for comparision.Excision and incision wounds were created on dorsal portion of rats for study.Wound contraction,biochemical parameters(protein level and hydroxyproline level) and histopathological study were performed in excision wound model whereas incision model was used for determination of tensile strength.Results:The wound contraction and tensile strength of skin tissues were observed significantly greater in MAF-C fraction treated group than other two fractions(P<0.01).In excision wound method(on day 18) protein content and hydroxyproline were found significantly higher in MAF-C group than control group(P<0.01).Histopathological study also showed better angiogenesis,matured collagen fibres and fibroblast cells as compared with the control group.Conclusions:In conclusion, our findings suggest that fiaction MAF-C from ethanol extract of M.annua leaves is found most effective in wound healing.

Pharmacological studies on Buchanania lanzan Spreng.-A focus on wound healing with particular reference to anti-biofilm properties

Objective:To evaluate the wound healing activity of the methanolic root extract of Buchanania lanzan Spreng.(B.lanzan),with a focus on antimicrobial and anti-biofilm properties.Methods:The extract was evaluated for its wound healing properties(excision and incision models)as evident from the analysis of tensile strength and wound contraction.The extract was also screened for antibacterial properties against different Cram positive and Gram negative bacterial strains.B.lanzan was also studied for its effect on biofilm formation and disruption of preformed biofilms.The synergistic effect of B.lanzan was determined in combination with gentamicin.Results:Topical application of B.lanzan(10%w/w ointment)significantly increased(40.84%)the tensile strength in the incision wound model.B.lanzan also showed significant wound healing activity in excision model and such significant activity was observed from the 9th day.Whereas Soframycin displayed significant wound healing activity from the 6th day.It was found that root extracts of B.lanzan revealed significant inhibition against all tested pathogens.B.lanzan displayed antimicrobial activity against Cram positive(MIC 0.625 mg/mL)and Cram negative(MIC0.625-1.25 mg/mL).B.lanzan was able to reduce biofilm formation and also caused disruption of preformed biofilms in a manner similar to ciprofloxacin.However,gentamicin was found to be ineffective against biofilms formed by Gram negative organism.According to the fractional inhibitory concentration index,B.lanzan displayed synergistic activity when it was combined with gentamicin.Conclusions:From this study it may be concluded that the root extract of B.lanzan revealed significant wound healing potential,which was supported and well correlated with pronounced antibacterial activity of the tested plant parts.

Comparative Efficacy of <i>Tagetes erecta</i>and <i>Centella asiatica</i>Extracts on Wound Healing in Albino Rats

The study was undertaken to evaluate the comparative efficacy of hydroalcoholic extracts of leaves of Tagetes erecta (T. erecta) and aerial parts of Centella asiatica (C. asiatica) on Excision, Incision and Dead space wound models in albino rats. Extract of T. erecta and C. asiatica (P T. erecta extract (250 and 500 mg/kg) showed significantly increased the wound breaking strength in incision wound model and wet and dry granulation tissue weights, breaking strength in a dead space wound model compare to control and C. asiatica treated group (P T. erecta extract showed potent wound healing activity then the reported C. asiatica in different wound parameters.

Antioxidant,Antimicrobial and Wound Healing Potential of Helicteres isora Linn.Leaf Extracts

Objective To investigate the antioxidant,antimicrobial and wound healing potential of Helicteres isora Linn.leaf extracts.Methods The petroleum ether,chloroform,acetone,ethanol and hydroalcoholic extracts of leaves were screened for phytochemicals.The 1,1-diphenyl-2-picrylhydrazyl(DPPH),nitric oxide(NO)radical scavenging tests and reducing power assays were performed to measure antioxidant activity;disc diffusion methods were used to evaluate antimicrobial potential.Wound healing activity was evaluated by incision and excision wound rat models.Results The extracts contained mainly sterols and flavonoids.The hydroalcoholic extract showed remarkable antioxidant and antimicrobial potential and significant(P<0.05)wound healing activity.Conclusions The identified activities of the hydroalcoholic extract may be attributable to its constituent phytochemicals.

保留变性真皮二期植皮法治疗四肢关节部位深Ⅱ度烧伤的临床效果

目的探讨四肢关节部位深Ⅱ度烧伤早期削痂、保留变性真皮联合负压封闭引流(VSD)治疗后二期移植刃厚皮片的临床疗效。方法采用回顾性研究,选择2018年1月至2021年3月浙江省中医药大学附属嘉兴中医院收治的26例四肢关节部位深Ⅱ度烧伤患者(共31个创面),受伤至入院时间(7.3±3.1)h,烧伤面积1%~7%总体表面积(TBSA)。早期削痂保留变性真皮联合VSD治疗4~5 d,二期行刃厚皮片移植术。观察保留变性真皮VSD治疗前后组织病理学结果,观察治疗期间植皮区有无积液、血肿、感染及皮片坏死情况,记录供植皮区完全由上皮组织覆盖、无渗液的愈合时间。随访半年,观察植皮区有无附件炎发生,采用温哥华瘢痕评定量表(VSS)、患者与观察者瘢痕评估量表(POSAS)对供植皮区瘢痕情况进行评分。结果保留变性真皮联合VSD治疗前真皮层少量胶原纤维玻璃样变性,可见炎症细胞浸润带,治疗后真皮层胶原纤维增生并玻璃样变性、炎症细胞浸润带基本消失。26个供皮区创面均一期愈合,愈合时间为(9.61±1.83)d。31个植皮区创面愈合时间为(13.35±1.56)d,无血肿、感染、皮片坏死发生,其中29个创面一期愈合,2个创面出现皮下积液,经引流换药愈合。随访6个月,26个供皮区VSS评分为1(1,2)分,患者对供皮区瘢痕总体评价为2.00(1.00,2.25)分;31个植皮区瘢痕无附件炎发生,VSS评分为(3.39±2.28)分,医生对植皮区瘢痕总体评价为(3.48±1.20)分,无因功能活动受限而行瘢痕整形手术发生。结论早期削痂保留变性真皮联合VSD治疗后二期行刃厚皮片移植应用于四肢关节部位深Ⅱ度烧伤,能有效保护间生态组织、减轻进行性损伤,保证关节部位愈合质量的同时减少供区损伤,具有临床推广应用价值。

EXTENSIVE WOUND EXCISION IN SHOCK STAGE INPATIENTS WITH MAJOR BURNS

To stop excessive plasma loss,alleviate noxious effcets of devitalized tissues on the body and shorten the hospitalization time,we performed extensive escharectomy during the shock period in extensively burned patients.

削痂对深Ⅱ度烧伤局部生长因子释放及愈合的影响

为探讨削痂手术对深Ⅱ度烧伤创面局部生长因子水平及创面愈合的影响，对7例烧伤患者深Ⅱ度创面中削痂手术前、手术后和未手术之创面组织在体外组织培养中释放EGF、bFGF、PDGF－AB水平进行检测和病理学观察。研究发现，削痂手术后创面组织释放EGF、bFGF、PDGF－AB水平较手术前和未手术创面有显著升高；局部组织病理学观察显示，手术后创面新鲜肉芽形成和表皮修复程度较手术前和未手术创面显著。实验提示，削痂手术可以增加创面局部组织释放EGF、bFGF、PDGF－AB，对深Ⅱ度烧伤创面愈合有促进作用。

火器伤初期外科处理的病理学研究

对犬火器伤模型分别采用传统的切除失活组织（切除）和现代的仅强调减压、引流（切开）的初期外科处理方法，对其病理形态学及细菌学等资料作了系统观察。结果发现：两种方法对感染等并发症的防治效果没有显著性差异，而在对创伤修复的影响方面，切开法明显较切除法优越。

深二度烧伤创面伤后24h内削痂的临床研究

目的 探讨深二度烧伤创面伤后24 h内削痂的可行性及其促进创面愈合的临床效果。方法19例烧伤总面积在200％～40％、以深二度为主的住院病人在伤后24 h内削痂;39例烧伤严重程度相似的病人在伤后3～5 d削痂作为对照。观察病人休克期的补液量、尿量、休克征象,回吸收期体温和心率,创面愈合时间以及并发症情况;同时对两组创面活检取材,进行组织学观察。结果 两组烧伤病人休克期补液量、尿量的比较均无差异(P>0.05);休克期后第1、2 d,对照组体温高于试验组(P<0.05);伤后24 h内削痂病人创面平均愈合时间(24.67±3.38)d,与对照组创面平均愈合时间(29.77±8.28)d比较明显缩短(P<0.05);组织学观察显示,经伤后24 h内削痂后,创面局部的炎症反应较对照创面明显减轻,创面组织未见进一步损害。结论烧伤后24 h内削痂对烧伤总面积在20％～40％、以深二度为主的成年病人是安全的,能通过改善局部过强的炎症反应而促进创面的愈合。

微生物谷氨酰胺转胺酶对大鼠创伤愈合作用研究

研究了微生物谷氨酰胺转胺酶对大鼠创伤的促愈合作用。建立大鼠背部刀割伤模型，用创面照像、透明膜描记扫描记录伤后第5、10、15、20d的创面面积，计算创伤愈合率；并用注水法测量伤腔容积，同时观测肉芽组织再生及其总蛋白、氨基已糖和己糖醛酸的含量变化情况。结果实验组创面愈合时间平均为18．1d，较对照组平均缩短了2—3d（P〈0．05）；创伤愈合率显著提高（P〈0．05或P〈0．01）；伤腔容积明显缩小（P〈0．05）；实验组肉芽干湿重较对照组显著增加（P〈0．05），肉芽中蛋白质、氨基已糖和己糖醛酸含量增加显著（P〈0．05）。结果显示谷氨酰胺转胺酶具有促进大鼠皮肤创伤愈合的作用，其作用机理可能是与促进肉芽组织中蛋白质，氨基多糖和胶原的合成有关。

伤后24h内削痂对深二度烧伤创面生长因子释放的影响

目的 探讨伤后24 h内削痂手术对深二度烧伤创面局部表皮生长因子(EGF)、碱性成纤维细胞生长因子(bFGF)和血小板衍生生长因子(PDGF)释放的影响。方法 12例深二度烧伤患者,伤后24 h内实施削痂手术。削痂术前先切取手术前实验区组织标本。术中部分创面保留不予手术,作为未手术实验区。伤后5～7 d行再次手术,分别切取经削痂处理和未手术区的创面组织,作为手术后和未手术实验区标本。分别检测创面组织释放生长因子EGF、FGF-2和PDGF-AB的含量,并进行组织学观察和新生肉芽形成半定量分析。结果 削痂手术创面组织局部释放EGF、FGF-2和PDGF-AB的水平较手术前和未手术创面有显著升高(P<0.05);组织形态学观察显示,削痂手术后创面新鲜肉芽组织形成较手术前和未手术创面显著(P<0.05)。结论 伤后24 h内削痂手术可以促进局部创面组织释放EGF、FGF-2和PDGF-AB,促进新生肉芽形成,有利于深二度烧伤创面愈合。

大鼠烧伤休克期切痂对烧伤后炎症反应的影响

目的了解烧伤后一些细胞因子的变化 ,以探讨休克期手术对炎症反应的影响。 方法 4 2只Ⅲ度烧伤30 %总体表面积大鼠 ,随机分成对照组、烧伤手术组和烧伤未手术组。在烧伤后 4h ,切除大鼠烧伤创面 ,以辐照猪皮覆盖 ;伤后 3、6、10d测定烧伤手术组和未手术组TNF -α、IL - 2、IL - 6和IL - 10。 结果IL - 2水平 ,手术组伤后 3d和6d明显下降 ,伤后 10d时继续下降 ;血清IL - 6 ,烧伤手术组和未手术组伤后 3d较对照组显著增高 ;血清TNF -α ,烧伤手术组在伤后 3d显著降低 ,伤后 6d和 10d较对照组显著增高 ;烧伤后 3、6、10d时 ,烧伤手术组和未手术组IL - 10均有显著上升 ,其中未手术组上升更明显。 结论烧伤休克期手术去除创面坏死组织 ,在烧伤回吸收期炎症反应得到明显抑制 ,机体的免疫力恢复明显 。

0.1%碘伏与生理盐水在清创术中冲洗的疗效对比

目的总结0.1%碘伏在清创术中冲洗伤口的临床疗效。方法 2004年1月~2012年12月,182例皮肤软组织挫裂伤患者,随机分为实验组101例与对照组81例,实验组采用＂0.1%碘伏冲洗伤口＂,对照组采用＂生理盐水冲洗伤口＂。记录实验组和对照组患者术区有无红肿热痛等炎症反应。结果实验组101例患者中伤口均未出现红肿热痛等炎症反应,伤口全部甲级愈合。对照组81例患者中有11例伤口出现不同程度的红肿热痛等炎症反应,经换药后愈合。结论 ＂0.1%碘伏清创术中冲洗伤口＂是一种简单、经济、有效的方法,能有效避免清创伤口的感染。