Clinical Effect of Comprehensive Rehabilitation Treatment for Deep Burns in Different Functional Joint Areas

Objective:To analyse the clinical effect of comprehensive rehabilitation therapy in patients with deep burns at different functional joint areas.Methods:Eighty-one patients with deep burns with different functional joint areas from April 2018 to April 2019 were divided into the conventional and rehabilitation groupings.The conventional group(n=40)received routine treatment and rehabilitation while the rehabilitation group(n=41)was given comprehensive rehabilitation treatment.Thereafter,the recovery of joint function in patients with deep burns in different areas,the combined value of clinical long-term treatment,the recovery of joint function and the score of daily living ability were calculated.Results:The total long-term effective rate of treatment,the recovery of the joint function,and the score of daily living ability of the patients with deep burns in the rehabilitation group were more favourable than those of the conventional group as demonstrated by P<0.05,the index data indicating statistical significance.Conclusion:Comprehensive rehabilitation therapy can reduce complications and improve the quality of life in patients with deep burns in different functional joint areas.

Treatment of Post Burn Scar Extended Deformity of the Toes IV Degree and Using Bridge Cellular Cutaneous Flap

Post burn dorsal foot contractures of the toes of the IV degree cause functional limitations of all lower extremities, which creates a serious cosmetic defect, and therefore, needs surgical reconstruction. The series of 11 patients (7 men and 4 women) with extended contracture of the 4th degree of toes after burn were operated upon by using the new method with the flap including subcutaneous tissue (bridge-like stem), and the operations were performed at Samarkand Burn Center, Samarkand, Uzbekistan. We observed a good result with no complications. The flap was viable, and its sensibility was preserved. No marginal necrosis was noticed. As a result, the use of this method allowed achieving normal aesthetic outlines. The flap acquired the properties of the healthy skin without contracture. For the whole operated feet, it is important to wear pressure socks as soon as the wounds are fully healed and to continue this pressing therapy until the edema and recurrence of contracture are no longer being the problems. This usually means a period of 6 to 9 months.

Clinical Safety and Efficacy of Platelet-Rich Plasma in Wound Healing

Background: Platelet-rich plasma has been extensively used in several clinical settings. However, there still a lack of conclusive evidence concerning the benefits of platelet-rich plasma in the field of wound healing. We aimed to evaluate the safety and the efficacy of autologous platelet-rich plasma in acute wound healing. Methods: This prospective study enrolled forty adult patients of both sexes and aged between 18 - 50 years. All patients in need for split-thickness skin graft were included in our study. The donor sites were randomly divided into two equal halves: the platelet-rich plasma side, which was injected with recently activated platelet-rich plasma;and the control side, in which the conventional method of dressing was used. Measurement of the platelet count and transforming growth factor-B1 concentration in each platelet-rich plasma preparation and the whole blood was done for all patients. Clinical monitoring of the donor sites was done every 7 days for 3 weeks, regarding pain perception, epithelialization surface area and possible side effects of the platelet-rich plasma. Histopathological monitoring was done on the 7th postoperative day. Results: The platelet count was increased about 3.5 folds and transforming growth factor-B1 was increased 2.4 folds in the platelet-rich plasma compared to the patients’ blood. The platelet-rich plasma side had significantly lower pain scores at day 7 (4.8 ± 0.18 vs 5.9 ± 0.07) and day 14 (1.4 ± 0.11 vs 1.9 ± 0.09) postoperative (p = 0.002 and p = 0.004, respectively) and had significantly higher rate of epithelialization at day 7 (9.8 ± 0.35 cm2 vs 7.5 ± 0.32 cm2) and day 14 (38.4 ± 0.36 cm2 vs 36.9 ± 0.42 cm2) postoperative (p p = 0.039, respectively), while at day 21 postoperative, there was no significant difference between both sides. There was no significant difference between both sides regarding the incidence of complications. The platelet-rich plasma side showed intact epithelium, differentiation of the cells in stratum spongiosum and stratum granulosum, neovascularization and earlier collagen deposition. Conclusion: The platelet-rich plasma is safe and effective adjuvant in the management of acute wounds. However, we recommend for larger clinical trials for standardized method for PRP preparation and better understanding of the efficacy of this blood product.

Management of facial burns

Burns to the face affect a part of the body that cannot be hidden and thus exposes potentially major changes in appearance to society.Therefore,it is incumbent upon the caregiver to optimize healing and minimize scarring.The goal for partial-thickness burns is to have them heal within 2–3 weeks to minimize healing time.For full-thickness burns there needs to be strategies to optimize the outcomes for skin grafting and minimize scarring.The goal of this review is to discuss the best way to improve the outcomes of these devastating injuries.

Magnetic resonance imaging of artificial lumbar disks： safety and metal artifacts

Background This study was to investigate the safety of two types of commercially available lumbar artificial discs （CHARITE and PRODISC-L） during a magnetic resonance imaging （MRI） procedure in a 1.5-Tesla MR system, and to evaluate the size of metal artifacts on the MR image for different sequences. Methods A 1.5-Tesla clinical MR imaging system was used. The degree of deflection of the endplates of two artificial discs was evaluated by an angle-measurement instrument at the portals of the MRI scanner. The heating effect of the radio frequency （RF） magnetic field was evaluated by using ＂worst-case＂ imaging sequences on a human cadaver implanted with an artificial lumbar disc at the L5/S1 intervertebral disc location. The temperatures of the tissue adjacent to the implant, and of the L4/L5 intervertebral disc （used as a control） were measured, respectively, using a digital probe thermometer before and after the MRI scan sequence. A rectangular water phantom was designed to evaluate the metal artifacts of these two artificial discs under different MR imaging sequences. Results The maximal deflection angle of the endplate of the implants under a static MR field was 7.5 and 6.0 degrees, for the CHARITE and PRODISC-L, respectively. The difference between temperature rise of tissue adjacent to the two types of artificial discs and the temperature rise of the L4/L5 control location was 0.4 and 0.6℃, respectively. The size of metal artifacts on images of TSE （T1/T2 -weighted）, STIR and Turbo Dark Fluid sequences were relatively less than those of TSE fat saturation, Flash and SE （Tl-weighted） sequences. Conclusions The CHARITE and the PRODISC-L artificial disc do not present an additional hazard or risk to a patient undergoing an MRI procedure using a scanner operating with a static magnetic field of 1.5T or lower. Image artifacts from the implants may present problems if the anatomical region of interest is in or near the area where these implants are located （e.g., vertebral canal at affected segment）.

Evaluation of the cytotoxicity of cell free dermal substitutes using the 3-（4,5-dimethylthiazol-2-yl）-2,5-diphenyl tetrazolium bromide method

Background The cytotoxicity of dermal substitutes may be increased by the very processes used to deplete the cells. The present research aimed to investigate the method for monitoring the cytotoxicity of cell-free dermal substitutes using 3-（4,5-dimethylthiazol-2-yl）-2,5-diphenyl tetrazolium bromide （MI-I-） method. Methods The cytotoxicity of four dermal substitutes was evaluated using the MIF method according to the standards set by the Chinese State Food and Drug Administration （SFDA）. Swine acellular dermal matrix （SADM） and goat acellular dermal matrix （GADM） were produced using a repeated freeze-thaw method. Human dermal matrix glutaraldehyde composite （HADM-G） and SADM cross-linked with glutaraldehyde （SADM-G） were produced using conventional methods. Results The cytotoxicity of all dermal substitutes ranged from Grade 0 to Grade 1, meeting the standards of the Chinese FDA. The OD490 of both SADM and GADM was higher than that of either HADM-G or SADM-G （P 〈0.05）. Conclusion Dermal substitutes produced by the freeze-thaw method are less cytotoxic than those produced using conventional methods.

Consensus on the application of negative pressure wound therapy of diabetic foot wounds

Because China is becoming an aging society,the incidence of diabetes and diabetic foot have been increasing.Diabetic foot has become one of the main health-related killers due to its high disability and mortality rates.Negative pressure wound therapy(NPWT)is one of the most effective techniques for the treatment of diabetic foot wounds and great progress,both in terms of research and its clinical application,has been made in the last 20 years of its development.However,due to the complex pathogenesis and management of diabetic foot,irregular application of NPWT often leads to complications,such as infection,bleeding and necrosis,that seriously affect its treatment outcomes.In 2020,under the leadership of Burns,Trauma and Tissue Repair Committee of the Cross-Straits Medicine Exchange Association,the writing group for‘Consensus on the application of negative pressure wound therapy of diabetic foot wounds’was established with the participation of scholars from the specialized areas of burns,endocrinology,vascular surgery,orthopedics and wound repair.Drawing on evidence-based practice suggested by the latest clinical research,this consensus proposes the best clinical practice guidelines for the application and prognostic evaluation of NPWT for diabetic foot.The consensus aims to support the formation of standardized treatment schemes that clinicians can refer to when treating cases of diabetic foot.