BACKGROUND Toxic epidermal necrolysis(TEN)is often associated with skin wounds affecting large areas.Healing of this type of wound is difficult because of pressure,infection and other factors.It can increase the lengt...BACKGROUND Toxic epidermal necrolysis(TEN)is often associated with skin wounds affecting large areas.Healing of this type of wound is difficult because of pressure,infection and other factors.It can increase the length of hospital stay and result in wound sepsis and even death.CASE SUMMARY A 49-year-old woman developed a skin lesion covering 80%of the total body surface area after using a kind of Chinese medicinal ointment on a burn wound on her back;she developed life-threatening wound sepsis and septic shock.Methicillin-resistant Staphylococcus aureus,carbapenem-resistant Acinetobacter baumannii,carbapenem-resistant Pseudomonas aeruginosa and other bacteria were cultured from wound tissue,deep venous catheter and blood samples.Imipenem cilastatin sodium,tigecycline and teicoplanin were used for anti-infection therapy.Finally,the patient was transferred to the burn department because of severe wound sepsis.In the burn intensive care unit,pain-free dressing changes and autologous scalp skin grafting were performed to heal the wound in addition to reasonable and effective antibacterial treatment according to microbial susceptibility test results.After three operations within 2 wk,the wound healed and sepsis resolved.CONCLUSION TEN patients with large areas of skin injury may develop wound infection and life-threatening wound sepsis.Autologous scalp skin grafting may be beneficial for rapid wound healing and reducing the risk of sepsis in TEN patients,and it leaves no scar at the donor site.展开更多
Background:Staged excision and grafting with viable cryopreserved alloskin or fresh pigskin at an early stage is a main strategy for wound management in massive burns.Alloskin is the gold standard of a biological temp...Background:Staged excision and grafting with viable cryopreserved alloskin or fresh pigskin at an early stage is a main strategy for wound management in massive burns.Alloskin is the gold standard of a biological temporary skin substitute,and the main drawback to its wider use is the limited number of donors.In this paper,we compare the use of fresh pigskins to cryopreserved alloskins as temporary skin substitutes on subcutaneous tissue wounds after tangential excision by observing the clinical performances of these grafts in cases of a massive burn.Methods:We selected six adult massive burn patients undergoing tangential excision and skin grafting on subcutaneous tissue wounds(TESGSTW)at our burn center from January 1,2003 to December 31,2013.The general clinical data and survival percentage of skins at postoperative weeks(POWs)1,2,and 3 were analyzed.In our clinical practice,we also observed the phenomenon that several viable cryopreserved alloskin or fresh pigskin grafts used as temporary coverage on subcutaneous tissue wounds had long-term survival after repeated desquamation.The macroscopic and histological results of one typical case were also analyzed.Results:In this study,the first three TESGSTW operations were performed at 2–3,5–8,and 11–16 days post-injury.The operation areas were 30.3±7.9%total body surface area(TBSA),19.0±6.0%TBSA,and 12.0±1.7%TBSA,respectively.The survival percentage of the cryopreserved alloskins or fresh pigskins at POWs 1,2,and 3 were 80.0±10.0%vs 75.7±5.3%(t=1.01,P=0.16),71.2±10.6%vs 66.4±6.2%(t=1.09,P=0.30),and 48.7±2.5%vs 35.0±7.0%(t=3.83,P=0.03),respectively.The microscopic observation of the survival of alloskins or pigskins in one typical case showed rete ridges and a basilar membrane at the joint of the epidermis and dermis at an early stage;these structures disappeared with extended time post-operation.Conclusions:From the clinical observations,fresh pigskin and cryopreserved alloskins could be used with equal effectiveness at an early stage(within 2 weeks post-operation)as temporary coverage on massive burns after TESGSTW.After engraftment,several cryopreserved alloskins or fresh pigskins could co-survive in a massive burn patient for an extended amount of time.The co-survival of alloskin and pigskin will provide clues for further research into skin transplantation.展开更多
Introduction:Erosive pustular dermatosis of the scalp(EPDS)is an uncommon condition with unknown etiology.The clinical exclusive diagnosis needs to be differentiated from similar diseases.Case presentation:A 68-year-o...Introduction:Erosive pustular dermatosis of the scalp(EPDS)is an uncommon condition with unknown etiology.The clinical exclusive diagnosis needs to be differentiated from similar diseases.Case presentation:A 68-year-old woman presented with an eight-month history of a chronic scalp eruption.She had been diagnosed as squamous cell carcinoma by biopsy nine months ago,and had been treated by surgical excision and skin grafting.One month later,she was referred for evaluation of the newly enlarged lesion which was observed at the skin grafting site.She was diagnosed of EPDS based on characteristics of lesions,clinicopathological findings and laboratory data.The condition had clinically improved with systemic steroid therapy and topical tacrolimus for two weeks.Relapses occurred after complete withdrawal of both treatments.After repeating the above therapy and applying topical tacrolimus as maintenance therapy,the condition was well controlled at the one-year follow-up.Discussion:EPDS is an uncommon inflammatory dermatosis with main incidence rate of elderly patients and female predominance.The diagnosis of EPDS cant be made only by histopathological examination,which is helpful for differential diagnosis.Microbiological investigations commonly remain negative.For the high risk of relapse,it is important for clinicians to be aware of maintenance treatment and a long-term management.Conclusion:It should be recognized by clinicians that EPDS is an uncommon and relapse disease,leading to serious cosmetic problems.The treatment lacks evidence-based medicine data,clinician should choose the appropriate therapy according to the condition of patients.展开更多
Current advances in basic stem cell research and tissue engineering augur well for the development of improved cultured skin tissue substitutes:a class of products that is still fraught with limitations for clinical u...Current advances in basic stem cell research and tissue engineering augur well for the development of improved cultured skin tissue substitutes:a class of products that is still fraught with limitations for clinical use.Although the ability to grow autologous keratinocytes in-vitro from a small skin biopsy into sheets of stratified epithelium(within 3 to 4 weeks)helped alleviate the problem of insufficient donor site for extensive burn,many burn units still have to grapple with insufficient skin allografts which are used as intermediate wound coverage after burn excision.Alternatives offered by tissue-engineered skin dermal replacements to meet emergency demand have been used fairly successfully.Despite the availability of these commercial products,they all suffer from the same problems of extremely high cost,sub-normal skin microstructure and inconsistent engraftment,especially in full thickness burns.Clinical practice for severe burn treatment has since evolved to incorporate these tissue-engineered skin substitutes,usually as an adjunct to speed up epithelization for wound closure and/or to improve quality of life by improving the functional and cosmetic results long-term.This review seeks to bring the reader through the beginnings of skin tissue engineering,the utilization of some of the key products developed for the treatment of severe burns and the hope of harnessing stem cells to improve on current practice.展开更多
基金The State Key Laboratory of Trauma,Burns and Combined Injury,No.SKLJYJF18the First Affiliated Hospital,Army Medical University,No.SWH2019QNLC-04.
文摘BACKGROUND Toxic epidermal necrolysis(TEN)is often associated with skin wounds affecting large areas.Healing of this type of wound is difficult because of pressure,infection and other factors.It can increase the length of hospital stay and result in wound sepsis and even death.CASE SUMMARY A 49-year-old woman developed a skin lesion covering 80%of the total body surface area after using a kind of Chinese medicinal ointment on a burn wound on her back;she developed life-threatening wound sepsis and septic shock.Methicillin-resistant Staphylococcus aureus,carbapenem-resistant Acinetobacter baumannii,carbapenem-resistant Pseudomonas aeruginosa and other bacteria were cultured from wound tissue,deep venous catheter and blood samples.Imipenem cilastatin sodium,tigecycline and teicoplanin were used for anti-infection therapy.Finally,the patient was transferred to the burn department because of severe wound sepsis.In the burn intensive care unit,pain-free dressing changes and autologous scalp skin grafting were performed to heal the wound in addition to reasonable and effective antibacterial treatment according to microbial susceptibility test results.After three operations within 2 wk,the wound healed and sepsis resolved.CONCLUSION TEN patients with large areas of skin injury may develop wound infection and life-threatening wound sepsis.Autologous scalp skin grafting may be beneficial for rapid wound healing and reducing the risk of sepsis in TEN patients,and it leaves no scar at the donor site.
基金This study was supported in part by grants from Building Project on National Clinical Key Specialty of China(2012649)Science and Technology Development Project of Shandong Province(2013GSF11870)+2 种基金Science and Technology Development Project of Shandong Province Health and Medicine(2011HZ008)Business Project of Study Abroad Returnees in Jinan(20080405)Natural Science Foundation of Shandong Province(ZR2014HP016)
文摘Background:Staged excision and grafting with viable cryopreserved alloskin or fresh pigskin at an early stage is a main strategy for wound management in massive burns.Alloskin is the gold standard of a biological temporary skin substitute,and the main drawback to its wider use is the limited number of donors.In this paper,we compare the use of fresh pigskins to cryopreserved alloskins as temporary skin substitutes on subcutaneous tissue wounds after tangential excision by observing the clinical performances of these grafts in cases of a massive burn.Methods:We selected six adult massive burn patients undergoing tangential excision and skin grafting on subcutaneous tissue wounds(TESGSTW)at our burn center from January 1,2003 to December 31,2013.The general clinical data and survival percentage of skins at postoperative weeks(POWs)1,2,and 3 were analyzed.In our clinical practice,we also observed the phenomenon that several viable cryopreserved alloskin or fresh pigskin grafts used as temporary coverage on subcutaneous tissue wounds had long-term survival after repeated desquamation.The macroscopic and histological results of one typical case were also analyzed.Results:In this study,the first three TESGSTW operations were performed at 2–3,5–8,and 11–16 days post-injury.The operation areas were 30.3±7.9%total body surface area(TBSA),19.0±6.0%TBSA,and 12.0±1.7%TBSA,respectively.The survival percentage of the cryopreserved alloskins or fresh pigskins at POWs 1,2,and 3 were 80.0±10.0%vs 75.7±5.3%(t=1.01,P=0.16),71.2±10.6%vs 66.4±6.2%(t=1.09,P=0.30),and 48.7±2.5%vs 35.0±7.0%(t=3.83,P=0.03),respectively.The microscopic observation of the survival of alloskins or pigskins in one typical case showed rete ridges and a basilar membrane at the joint of the epidermis and dermis at an early stage;these structures disappeared with extended time post-operation.Conclusions:From the clinical observations,fresh pigskin and cryopreserved alloskins could be used with equal effectiveness at an early stage(within 2 weeks post-operation)as temporary coverage on massive burns after TESGSTW.After engraftment,several cryopreserved alloskins or fresh pigskins could co-survive in a massive burn patient for an extended amount of time.The co-survival of alloskin and pigskin will provide clues for further research into skin transplantation.
文摘Introduction:Erosive pustular dermatosis of the scalp(EPDS)is an uncommon condition with unknown etiology.The clinical exclusive diagnosis needs to be differentiated from similar diseases.Case presentation:A 68-year-old woman presented with an eight-month history of a chronic scalp eruption.She had been diagnosed as squamous cell carcinoma by biopsy nine months ago,and had been treated by surgical excision and skin grafting.One month later,she was referred for evaluation of the newly enlarged lesion which was observed at the skin grafting site.She was diagnosed of EPDS based on characteristics of lesions,clinicopathological findings and laboratory data.The condition had clinically improved with systemic steroid therapy and topical tacrolimus for two weeks.Relapses occurred after complete withdrawal of both treatments.After repeating the above therapy and applying topical tacrolimus as maintenance therapy,the condition was well controlled at the one-year follow-up.Discussion:EPDS is an uncommon inflammatory dermatosis with main incidence rate of elderly patients and female predominance.The diagnosis of EPDS cant be made only by histopathological examination,which is helpful for differential diagnosis.Microbiological investigations commonly remain negative.For the high risk of relapse,it is important for clinicians to be aware of maintenance treatment and a long-term management.Conclusion:It should be recognized by clinicians that EPDS is an uncommon and relapse disease,leading to serious cosmetic problems.The treatment lacks evidence-based medicine data,clinician should choose the appropriate therapy according to the condition of patients.
基金The authors are deeply saddened by the recent passing(2nd November 2015)of Professor Howard Greenthe pioneer of cultured skin cell therapy.The authors are always grateful to him for his help and the gift of 3T3-J2 which made possible the use of cultured epithelial autografts to treat severe burn injuries in Singapore
文摘Current advances in basic stem cell research and tissue engineering augur well for the development of improved cultured skin tissue substitutes:a class of products that is still fraught with limitations for clinical use.Although the ability to grow autologous keratinocytes in-vitro from a small skin biopsy into sheets of stratified epithelium(within 3 to 4 weeks)helped alleviate the problem of insufficient donor site for extensive burn,many burn units still have to grapple with insufficient skin allografts which are used as intermediate wound coverage after burn excision.Alternatives offered by tissue-engineered skin dermal replacements to meet emergency demand have been used fairly successfully.Despite the availability of these commercial products,they all suffer from the same problems of extremely high cost,sub-normal skin microstructure and inconsistent engraftment,especially in full thickness burns.Clinical practice for severe burn treatment has since evolved to incorporate these tissue-engineered skin substitutes,usually as an adjunct to speed up epithelization for wound closure and/or to improve quality of life by improving the functional and cosmetic results long-term.This review seeks to bring the reader through the beginnings of skin tissue engineering,the utilization of some of the key products developed for the treatment of severe burns and the hope of harnessing stem cells to improve on current practice.
