Umbilical cord-derived mesenchymal stem cells preconditioned with isorhamnetin:potential therapy for burn wounds

BACKGROUND Impaired wound healing can be associated with different pathological states.Burn wounds are the most common and detrimental injuries and remain a major health issue worldwide.Mesenchymal stem cells(MSCs)possess the ability to regenerate tissues by secreting factors involved in promoting cell migration,proliferation and differentiation,while suppressing immune reactions.Preconditioning of MSCs with small molecules having cytoprotective properties can enhance the potential of these cells for their use in cell-based therapeutics.AIM To enhance the therapeutic potential of MSCs by preconditioning them with isorhamnetin for second degree burn wounds in rats.METHODS Human umbilical cord MSCs(hU-MSCs)were isolated and characterized by surface markers,CD105,vimentin and CD90.For preconditioning,hU-MSCs were treated with isorhamnetin after selection of the optimized concentration(5μmol/L)by cytotoxicity analysis.The migration potential of these MSCs was analyzed by the in vitro scratch assay.The healing potential of normal,and preconditioned hU-MSCs was compared by transplanting these MSCs in a rat model of a second degree burn wound.Normal,and preconditioned MSCs(IH+MSCs)were transplanted after 72 h of burn injury and observed for 2 wk.Histological and gene expression analyses were performed on day 7 and 14 after cell transplantation to determine complete wound healing.RESULTS The scratch assay analysis showed a significant reduction in the scratch area in the case of IH+MSCs compared to the normal untreated MSCs at 24 h,while complete closure of the scratch area was observed at 48 h.Histological analysis showed reduced inflammation,completely remodeled epidermis and dermis without scar formation and regeneration of hair follicles in the group that received IH+MSCs.Gene expression analysis was time dependent and more pronounced in the case of IH+MSCs.Interleukin(IL)-1β,IL-6 and Bcl-2 associated X genes showed significant downregulation,while transforming growth factorβ,vascular endothelial growth factor,Bcl-2 and matrix metallopeptidase 9 showed significant upregulation compared to the burn wound,showing increased angiogenesis and reduced inflammation and apoptosis.CONCLUSION Preconditioning of hU-MSCs with isorhamnetin decreases wound progression by reducing inflammation,and improving tissue architecture and wound healing.The study outcome is expected to lead to an improved cell-based therapeutic approach for burn wounds.

The Effect of Oral <i>Melissa officinalis</i>on Serum Oxidative Stress and Second Degree Burn Wounds Healing

For this aim, this study conducted in order to assess the effect of lemon balm as an antioxidant on second degree wound healing and oxidative stress serum of burning patients. To meet the aim, 60 patients with 15 to 50 burn percent with the age range of 18 to 50 were invited after considering to inclusion criteria by the researchers. First they have been put by non-probable method and then random method in two groups of experiment (30 people) and control (30 people). After that, experiment group in addition to ordinary treatment has been used Melissa officinalis (lemon balm) plant two times a day for two weeks (1.5 g in 100 cc). Oxidative stress parameters included serum total antioxidant and the rate of malondialdehyde (MDA) that is one of total production of lipid peroxidation have been measured in patients’ blood sample in first and last parts of the study. The wound position has been studied by using standard wound BATES-JENSEN assessment tool in first, seventh and fifteenth days of study. In order to analyze data, independent sample t-test, paired sample t-test and repeated measurement variance have been used. These results indicated that the state of wound healing in experimental group was better than that in control group. Results indicated that mean of serum total antioxidant had been increased in both groups. The index of lipid peroxidation at the end of period has been increased in experiment group than control group, whether this index is significantly decreased at the end of 15 days in experimental group. According to the results of this study, the effect of Melissa officinalis (lemon balm) plant was effective in increasing lipid peroxideative in better states of second degree burn wound healing.

Temporal analysis of mRNA expression of endogenous TGFβ And its typeⅠ,typeⅡreceptor on burn wounds

Recent studies have shown that application of exogenous transforming growth factor?(TGF?)to a wound has a beneficial effect. However,little is known about the roles of endogenous TGF? and its receptors in the course of wound healing. In the present study, mRNA expression of endogenous TGF? and its type Ⅰ,type Ⅱreceptors on wounds of burned rats was observed by using dot blot hybridization.Thermal injury could induce expression of TGF ?, and its type Ⅰ,type Ⅱ receptor genes, and their expression appeared to be regulated. The expression was the strongest at 5 and 7 d postscalding when the repair of wounds was most active.The study suggests that TGF? plays an important role in epidermis regeneration, and that expression of TGF ? receptors is one of factors regulating wound healing. The expression discrepancy between TGF ? and its type Ⅰ,type Ⅱ receptor genes at the later stages of wound healing implies the presence of a well-controlled mechanism to limit excessive effect of endogenous TGF ? on repair cells.

Remodeling of skin nerve fibers during burn wound healing

Burn wound healing involves a complex sequence of processes. Recent studies have revealed that skin reinnervation may have an impact on physiological wound repair. Few studies have addressed the process of reinnervation and morphological changes in regenerated nerve fibers. The regeneration of neurites during full-thickness burn wound healing was determined by immunofluorescent staining using an anti-neurofilament protein monoclonal antibody, and three-dimensional morphology was observed under a laser scanning confocal microscope. Morphology and the volume fraction of collagen and nerve fibers were measured. Skin reinnervation increased during wound healing, peaked during the proliferative scar stage, and then decreased to lower levels during the maturation period. The results from the skin nerve fibers correlated with those from collagen using semi-quantitative analysis. Disintegration and fragmentation were observed frequently in samples from the proliferative stage, and seldom occurred during the maturation stage. There was a remodeling process of regenerated nerve fibers during wound healing, which comprised changed innervation density and topical morphology. The mechanism of remodeling for nerve fibers requires further investigation.

Effect of Phyllanthus niruri.Linn on burn wound in rats

Objective:To evaluate the effect of ethanolic extract of Phyllanthus niruri.Linn(Euphorbiaceae) on experimentally induced burn wound model in rats and to evaluate whether it reverses the wound healing in steroid suppressed rats.Methods:Two models including burn wound model and dexamethasone suppressed bum wound model were used in the study.The formulations of ethanolic extract of Phyllanthus niruri were prepared in gum acacia at 8%and in ointment base at 10%and were administered orally(400 mg/kg) and externally respectively.The parameters studied were the wound contraction and the period of epithelialisation.Results:In bum wound model,oral and topical administration of Phyllanthus niruri did not show any significant effects in wound contraction and period of epithelialisation when compared to control.In dexamethasone suppressed burn wound model,wound contraction rate was increased significantly by topical(P 【 0.001) and oral(P 【 0.001) administrations of Phyllanthus niruri by about 47.57%and 26.16% respectively.Topical administration has shown significant(P 【 0.05) enhancement of wound contraction than oral dosage form.Dexamethasone depressed epithelialisation period was reversed significanUy by topical(P 【 0.0001) and oral(P 【0.001) administrations of Phyllanthus niruri by about 32.5%and 21.3%respectively.Conclusions:Both topical and oral administrations of ethanolic extract of Phyllanthus niruri are found to reverse dexamethasone suppressed burn wound healing.

Effect of vasoactive intestinal peptide on the wound healing of alkali-burned corneas

AIM： To study the effect of vasoactive intestinal peptide （VIP） on wound healing in experimental alkali burns of the cornea. METHODS： Twenty-seven albino rabbits, weighing 3.2 -0.75 kg were used. Alkali burns were induced on corneas by applying 10 mm Whatman paper No：50 soaked in 1 mol/L NaOH. They have further classified into 5 groups as follows： 1） control group given no treatment （n=5）; 2） VIP given subconjunctivally （n=6）; 3） VIP injected into anterior chamber （n=6）; 4） NaCI 0.9% given subconjunctivally （n=5）; 5） NaCI 0.9% given into the anterior chamber （n=5）. All treatment protocols except control group were followed by topical eye drops composed of VIP at two hourly intervals for one week from 8 a.mo to 6 p.m, RESULTS： VIP treated groups of rabbits with alkali burns were found to have better wound healing findings histo-pathologically when compared to those of control group who have received no treatment on day 30. No differences were observed between groups in respect to degree of polymorphonuclear leukocytes （PMNL） infiltration and degree of loss of amorphous substrate on day 15. However, PMNL infiltration and degree of loss of amorphous substrate were lower in Groups 2 and 3 when compared to that of control group on day 30 （P〈0.05）. CONCLUSION： We have shown that VIP has positive effects on alkali induced corneal burns. VIP may inhibit PMNL migration to cornea through an immunomodulatory effect. Inhibition of PMNL migration might reduce the release of collagenaees and this might prevent the extracellular amorphous substance loss.

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.

Transplantation of human induced pluripotent stem cell derived keratinocytes accelerates deep second-degree burn wound healing

BACKGROUND Current evidence shows that human induced pluripotent stem cells(hiPSCs)can effectively differentiate into keratinocytes(KCs),but its effect on skin burn healing has not been reported.AIM To observe the effects of hiPSCs-derived KCs transplantation on skin burn healing in mice and to preliminarily reveal the underlying mechanisms.METHODS An analysis of differentially expressed genes in burn wounds based on GEO datasets GSE140926,and GSE27186 was established.A differentiation medium containing retinoic acid and bone morphogenetic protein 4 was applied to induce hiPSCs to differentiate into KCs.The expression of KCs marker proteins was detected using immunofluorescence staining.A model of a C57BL/6 mouse with deep cutaneous second-degree burn was created,and then phosphate buffered saline(PBS),hiPSCs-KCs,or hiPSCs-KCs with knockdown of COL7A1 were injected around the wound surface.The wound healing,re-epithelialization,engraftment of hiPSCs-KCs into wounds,proinflammatory factor level,and the NF-κB pathway proteins were assessed by hematoxylin-eosin staining,carboxifluorescein diacetate succinimidyl ester(CFSE)fluorescence staining,enzyme linked immunosorbent assay,and Western blotting on days 3,7,and 14 after the injection,respectively.Moreover,the effects of COL7A1 knockdown on the proliferation and migration of hiPSCs-KCs were confirmed by immunohistochemistry,EdU,Transwell,and damage repair assays.RESULTS HiPSCs-KCs could express the hallmark proteins of KCs.COL7A1 was down-regulated in burn wound tissues and highly expressed in hiPSCs-KCs.Transplantation of hiPSCs-KCs into mice with burn wounds resulted in a significant decrease in wound area,an increase in wound re-epithelialization,a decrease in proinflammatory factors content,and an inhibition of NF-κB pathway activation compared to the PBS group.The in vitro assay showed that COL7A1 knockdown could rescue the inhibition of hiPSCs-KCs proliferation and migration,providing further evidence that COL7A1 speeds up burn wound healing by limiting cell proliferation and migration.CONCLUSION In deep,second-degree burn wounds,COL7A1 can promote KC proliferation and migration while also suppressing the inflammatory response.

Bacteriological profile of burn wound isolates in a burns center of a tertiary hospital

Objective:To determine the bacteriological profile and antimicrobial susceptibility patterns of burn wound isolates.Methods:Swabs were taken from burn wound of patients admitted to Ward D2C and Burns Intensive Care Unit (BICU) from December 2014 to November 2015. Samples were processed at the Microbiology Laboratory for identification and sensitivity. Bacteria isolated were identified using their morphological characteristics, Gram staining reaction and biochemical tests. The antimicrobial susceptibility testing was done using Kirby-Bauer disc diffusion method. Questionnaires were also administered to study participants to obtain information on demography, kind of first aid received, antibiotics received prior to culture and sensitivity.Results:A total of 86 patients comprising 45 patients from Ward D2C and 41 from BICU participated in the study. Males were 51(59.3%) and females 35 (40.7%). Age of participants ranged from 0–56+ years.Pseudomonas aeruginosawas the commonest pathogen isolated 26(30.2%), followed byPseudomonas spp. 21(24.4%),Escherichia coli 17(19.8%),Klebsiellaspp. 12(14.0%). Coagulase negativeStaphylococcusaccounted for 2(2.3%). Overall prevalence of infection in the study was 90.7%.Conclusions: Burn wound infection continues to be a major challenge in burn centers. Regular surveillance of commonly identified pathogens in the ward and their antimicrobial susceptibility will guide proper empiric selection of antibiotics for management of burn wounds.

Negative Pressure Wound Therapy—An Effective, Minimally Invasive Therapeutic Modality in Burn Wound Management

Despite the advancement in burn therapy in the last decades the treatment of burn wounds still remains a challenging task. Infection is still a common complication;while sepsis remains the leading cause of death in severe burns. The research guided integration of new and effective techniques in burn wound management is mandatory. Negative pressure wound therapy (NPWT) is an effective and widely used technique in the management of problematic wounds. Previously existing indications include soft tissue traumas and chronic wounds such as diabetic, arterial, venous and pressure ulcers. The characteristics and challenges of these wounds have a lot in common with burns. Since the early 2000’s there are experiences with the use of NPWT for the healing of second degree burn wounds. Our clinical experience shows that it is a minimally invasive and effective way of improving burn wound management. In this article we give a review of the literature showing the mechanisms, unmapped future opportunities, financial issues, and possible adverse effects of NPWT in burn therapy.

The effect of Xuebijing on burn patients and its effect on pain and wound healing

Objective:To explore the therapeutic effect of Xuebijing on burn patients and its effect on pain and wound healing.Methods:The burn patients treated in our hospital were selected and divided into two groups according to single and double numbers.The first group,the conventional treatment group(CT group):take conventional treatment to treat this group of burn patients;the second group,Xuebijing group(BWN group):take the CT group+Xuebijing combination treatment of this group of burn patients,37 cases in each group.There was no difference in general data between CT group and BWN group.To explore the differences between prothrombin time(PT),thrombin time(TT),fibrinogen(FIB),pain,secondary effects,and wound healing in CT group and BWN group The therapeutic effect of the patient and its effect on pain and wound healing.Results:Examination showed that the coagulation indexes of patients in CT group were 26.34±4.25,17.69±4.12,2.01±0.78,the coagulation indexes of patients in BWN group were 17.49±3.56,11.07±2.39,3.56±1.14,compared with CT group and BWN group In the CT group,the prothrombin time(PT)and thrombin time(TT)indicators were higher than those in the BWN group,but fibrinogen(FIB)was significantly lower than that in the BWN group(p<0.05).It can be seen from the table that before treatment,the visual analogue scoring(VAS)scores of patients in CT group and BWN group were 6.64±1.12 and 6.98±1.08,respectively,with a small difference(p>0.05).After treatment,CT group and BWN group scores They were 4.56±1.16 and 2.12±0.97 respectively.Compared with CT group and BWN group,the VAS score of CT group was significantly higher than that of BWN group(p<0.05).After treatment,the number of wound healing days in the BWN group(20.68±3.14d)was less than that in the CT group(32.89±4.25d)(P<0.05),but the wound healing rate(96.48±6.89%)was significantly higher than the CT group(81.17±5.74%)(P<0.05).In the CT group,3 patients had blood accumulation,2 infections,and 3 effusions.In the BWN group,there were 0 blood accumulations,1 infection,and 2 effusions.Compared with the CT group and the BWN group,the number and incidence of the BWN group(8.12%)Are less than CT group(21.62%)(p<0.05).The patient's leg suffered third-degree burns.After 5 weeks of treatment,the edge of the allogeneic skin on the CT group began to peel off and the epidermis fell off.Rejection.Conclusion:Conventional treatment+Xuebijing treatment,its curative effect is significant,can significantly accelerate the wound healing rate,and at the same time,reduce the incidence of secondary effects.

The Treatment of Partial-Thickness Burns with a Hydroconductive Wound Dressing: Clinical and Mechanistic Effects

Objectives: Edema in partial-thickness burn wounds can decrease tissue perfusion, increase tissue ischemia, and deepen the burn injury. We report the results of a clinical trial comparing the effectiveness of a hydro-conductive dressing to our standard burn dressing at removing edema fluid from partial-thickness burns and present the proposed mechanisms of action of the hydroconductive dressing. Methods: An internally controlled comparison of two wound dressings was performed on 10 patients with non-contiguous partial-thickness burns. Each patient served as his/her own control. One burn was treated with our standard burn dressing and the other with hydroconductive dressing. Dressings were weighed prior to application, removed at 24 and 48 hours, weighed, and new pre-weighed dressings applied. Weight gain of each dressing at 24 and 48 hours was determined. Statistics were applied using the Student’s paired T-test. The VAS pain scale was measured prior to, during, and after each dressing change. Results: At 24 hours, the hydroconductive dressing had increased 85.6% ± 29.3% in weight compared with 61.3% ± 32.7% for the control (P = 0.053). For the second 24 hour period, the respective numbers were statistically significantly different at 59.7% ± 23.4% vs. 34.2% ± 19.1% (P = 0.038). Averaging the weight gain over the two dressing periods demonstrated that the differences were highly statistically significant as the hydroconductive dressing increased in weight by 71.0% ± 20.3% compared with 44.5% ± 17.4% for the gauze dressing (P = 0.005). VAS scores revealed no statistical differences. Mechanisms of action included capillary, hydroconductive, and electrostatic actions. Conclusions: A hydroconductive dressing designed to draw off excessive wound fluid removes more wound edema fluid than standard burn gauze dressings.

Time Course of Histomorphologic Features during Chronic Burn Wound Healing

In forensic pathology, it is always indispensable to determine burn wound vitality or age to accurately assess the relationship between death and any burn wounds. Subsequently, the determination of wound age is a definitive and still cutting-edge subject in forensic pathology. Therefore, deep second-degree burn injuries were induced in a group of mice. At 7, 12, 17, 21 and 28 days post-burn, burn wound specimens were histomorphologically differentiated and compared with normal intact skin using H&E stain. The study revealed that the burn wound during healing process was usually incorporated of infiltration of inflammatory cells, granulation tissue formation and epithelialization within 7 - 12 days post-burn. Then, the surface of burn wound was partially ulcerated in association with epidermal necrosis, dermal disorganization and degeneration of the sebaceous gland 17 - 21 days post-burn. Finally, the regenerated skin retained the structure of normal skin at 28th day post-burn. Our study demonstrated that the histopathological changes of burn wounds involved deep dermis, and the pathological changes occurred at distinctive time phases were almost different in comparing to regular intact skin. Such age estimation of burn wounds is important when a cadaver or a burnt body has many burns of diverse times, especially in criminal cases.

Clinical characteristics and treatment of burn wound sepsis in extensive burn patients: successful experience with eight cases

Eight burn wound sepsis patients, in which 6 cases were diagnosed as MODS and two as septic shock, were treated consecutively in our hospital from September 1997 to October 1998. The plasma concentration of IL-6, IL-8, TNFα and LPS were assayed before and after surgical intervention, as well as when the patients vital signs became stable. The results showed: ①The patients' conditions abruptly deteriorated when the burn wound sepsis emerged.

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...

Injectable chitosan hydrogels loaded with antioxidant agent as first-aid dressings for second-degree burn wounds

Burn wounds are destructive skin traumas typically of irregular shape and large area. Prone to infection, they require frequent dressing replacement, and painless removal of dressings from burn wounds remains a major challenge. This study focuses on the dynamic characteristics and treatment difficulty of burn wounds. Hydrogel dressings based on glycol chitosan and propionaldehyde-or benzaldehyde-terminated 4-arm poly(ethylene glycol) were designed on the basis of Schiff base cross-linking networks. The hydrogels exhibited shape-adaptability, self-healing and fast-degradation properties, which makes these hydrogels suitable for burn wounds. Salvianolic acid B(SaB)-loaded hydrogel exhibited good antioxidant properties in vitro. In a rat model of deep second-degree burn wounds, the SaB-loaded hydrogel could quickly reduce wound temperature, regulate wound oxidant microenvironment, promote angiogenesis, and accelerate wound healing. Thus, the drug-loaded hydrogel shows significant potential as a first-aid dressing for treatment of burn wounds.

Click-hydrogel delivered aggregation-induced emissive nanovesicles for simultaneous remodeling and antibiosis of deep burn wounds

As a high-risk trauma,deep burns are always hindered in their repair process by decreased tissue regeneration capacity and persistent infections.In this study,we developed a simultaneous strategy for deep burn wounds treatment using functional nanovesicles with antibacterial and tissue remodeling properties,delivered via a click-chemistry hydrogel.An aggregation-induced emission photosensitizer of 4-(2-(5-(4-(diphenylamino)phenyl)thiophen-2-yl)vinyl)-1-(2-hydroxyethyl)pyridin-1-ium bromide(THB)with excellent photodynamic properties was first prepared,and then combined with readily accessible adipose stem cells-derived nanovesicles to generate the THB functionalized nanovesicles(THB@ANVs).The THB@ANVs showed strong antibacterial activity against Gram-positive bacteria(up to 100%killing rate),and also beneficial effects on tissue remodeling,including promoting cell migration,cell proliferation,and regulating immunity.In addition,we prepared a click-hydrogel of carboxymethyl chitosan for effective delivery of THB@ANVs on wounds.This hydrogel could be injected to conform to the wound morphology while responding to the acidic microenvironment.In vivo evaluations of wound healing revealed that the THB@ANVs hydrogel dressing efficiently accelerated the healing of second-degree burn wounds by reducing bacterial growth,regulating inflammation,promoting early angiogenesis,and collagen deposition.This study provides a promising candidate of wound dressing with diverse functions for deep burn wound repair.

Marjolin's ulcers in the post-burned lesions and scars

Marjolin's ulcer(MU) represents malignant degeneration that typically ensues over a period of time in the post-burned lesions and scars or any other chronic wound. This review highlights various facets of the presentation and management of MUs that originate from post-burned lesions. The incidence of MUs in such lesions is reported to be 0.77%-2%. This malignancy characteristically develops in the areas of full thickness skin burns that had been allowed for weeks to months to heal spontaneously by secondary intention, or burn wounds which never healed completely over years and the unstable post-burned scars. In the majority of cases, the MU is a squamous cell carcinoma(SCC). The MUs contribute to an overall 2% of all SCCs and 0.03% of all basal cell carcinomas of the skin. Clinically MUs present in two major morphologic forms. The commoner form is the flat, indurated, ulcerative variety while the less common form is the exophytic papillary variety. Lower limbs represent the most frequently affected body parts. Surgical resection of the primary tumor with 2-4 cm horizontal clearance margin, nodal clearance and radiotherapy constitute the cornerstones of effective oncologic management. Despite best efforts, the overall mortality is reported to be 21%.

Infection control in severely burned patients

In the last two decades, much progress has been made in the control of burn wound infection and nasocomial infections(NI) in severely burned patients. The continiually changing epidemiology is partially related to greater understanding of and improved techniques for burn patient management as well as effective hospital infection control measures. With the advent of antimicrobial chemotherapeutic agents, infection of the wound site is now not as common as, for example, urinary and blood stream infections. Universal application of early excision of burned tissues has made a substantial improvement in the control of wound-related infections in burns. Additionally, the development of new technologies in wound care have helped to decrease morbidity and mortality in severe burn victims. Many examples can be given of the successful control of wound infection, such as the application of an appropriate antibiotic solution to invasive wound infection sites with simultaneous vacuum-assisted closure, optimal preservation of viable tissues with waterjet debridement systems, edema and exudate controlling dressings impregnated with Ag(Silvercel, Aquacell-Ag). The burned patient is at high risk for NI. Invasive interventions including intravenous and urinary chateterization, and entubation pose a further risk of NIs. The use of newly designed antimicrobial impregnated chateters or silicone devices may help thecontrol of infection in these immunocomprimised patients. Strict infection control practices(physical isolation in a private room, use of gloves and gowns during patient contact) and appropriate empirical antimicrobial therapy guided by laboratory surveillance culture as well as routine microbial burn wound culture are essential to help reduce the incidance of infections due to antibiotic resistant microorganisms.

Effective administration of cranial drilling therapy in the treatment of fourth degree temporal,facial and upper limb burns at high altitude:A case report

BACKGROUND Fourth degree burns damage the full thickness of the skin and affect underlying tissues.Skin grafting after debridement is often used to cover the wounds of salvageable severe burns.A granulation wound can be formed by drilling the skull to the barrier layer to solve the problem of skull exposure.Low oxygen levels present at high altitudes aggravate ischemia and hypoxia which can negatively impact wound healing.The impaired healing in such cases can be ameliorated by hyperbaric oxygen therapy.CASE SUMMARY We describe a patient who presented with fourth degree burns to the left temporal and facial regions upon admission in December 2018.The periosteum of the skull and the deep fascia of the face were exposed.After the first stage of debridement and skin grafting,the temporal skin did not survive well.Granulation was induced by cranial drilling,and then a local flap was transferred to cover the wound.The left temporal and facial wounds were completely covered and the patient recovered well.CONCLUSION Skin grafting and flap transfer after early debridement to cover the wound and control infection were of great significance.In the later stages of the patient's treatment,survival of the skin graft and skin flap was observed.The second stage repair was performed to achieve successful skin grafting by cranial granulation.Granulation was formed by drilling the skull,and then the wound was closed,which is suitable for cases with skull exposure and wounds with poor blood supply.We consider that hyperbaric oxygen treatment and improving tissue oxygen supply were beneficial in this patient.