Journal of burns and wounds最新文献

Background: Dermal skin substitutes have become a standard of care in burn treatment.

Objective: To compare and assess wound contracture reduction and histologic incorporation into the wound, dermal substitutes were implanted into full-thickness skin wounds in nude mice.

Materials and methods: Thirty-seven mice received a full-thickness 2 x 2 cm dorsal skin wound, and were either implanted with an acellular dermal matrix, Alloderm, Dermagraft-TC, Dermalogen, or Integra or assigned to the control group (with no dermal substitute). At 28 days postsurgery, the wounds were assessed for contraction, epithelialization, and other histological characteristics.

Results: Each dermal substitute decreased wound contracture, but Alloderm and the acellular dermal matrix did so significantly compared to the control (P < .01 and P < .03, respectively). Within-group and control comparisons showed no significant differences with respect to the presence of dystrophic calcification, squamous hyperplasia, infiltration of neutrophils, fibroblasts, and macrophages, epidermal keratinocyte stratification, or collagen fiber configuration.

Conclusions: Integra elicited the greatest foreign body response. Although the Dermalogen group had the thickest elastin fiber fragments, Dermagraft may have initiated the earliest elastin fiber formation in the wounds. While all dermal substitutes were incorporated into the wound bed and wound contracture was decreased, acellular dermal matrix and Alloderm, both human skin-derived products, produced less contraction and the thickest new "dermis" in the healed wounds compared to the control or synthetic dermal substitutes.

Background: The recent report of high numbers of Acinetobacter baumannii bloodstream infections among service members injured in Iraq and Afghanistan during the period January 2002 through August 2004 has prompted an investigation into their etiology. A review of the current guidelines for open combat casualty wounds as part of this broad investigation was not mentioned in the report.

Objective: The objective of this study was 2-fold: to ascertain the susceptibility of A. baumannii to currently available topical antibacterial agents and (2) to propose an alternative, effective treatment protocol for contaminated combat-related wounds so as to reduce or eliminate the likelihood of the wound serving as the source of A. baumannii infection or septicemia.

Methods: A standardized antimicrobial susceptibility study of 43 strains of A. baumannii collected from a tertiary care burn center was conducted using 2 commonly used topical antibacterial agents, 1% silver sulfadiazine cream (Silvadene) and 5% mafenide acetate solution (5% Sulfamylon Solution).

Results: Both were effective, but 5% Sulfamylon Solution demonstrated significantly greater antibacterial activity.

Conclusion: Five percent Sulfamylon Solution, initially developed for wartime use, and currently limited by the Food and Drug Administration to soaks following meshed split-thickness autografts following excision of second-degree and third-degree burns, has a broad spectrum of antibacterial activity and extensive off-label applicability. It is an ideal agent for use in the treatment of war wounds, and should be considered as a superior replacement for normal saline in the current guidelines for open combat casualty wounds.

Objective: The purpose of this paper is to present an overview of the interrelationship between hormones, nutrition, and wound healing.

Methods: The data on various hormones and their effects on specific elements of nutrition and wound healing are reviewed.

Results: The key anabolic hormones are human growth hormone, insulin-like growth factor-1, insulin, and testosterone and its analogs. Although each has specific metabolic actions, there is also a very important hormone-hormone interaction. A deficiency of these hormones occurs in acute and chronic catabolic states, resulting in lean mass loss and impairing the healing process.

Conclusion: There is a well-recognized interrelationship between hormones, nutrition, and wound healing. The anabolic process of protein synthesis, with new tissue formation, requires the action of anabolic hormones. Exogenous administration of these agents has been shown to maintain or increase lean body mass as well as directly stimulate the healing process through their anabolic and anticatabolic actions.

Sulfur mustard is an alkylating chemical warfare agent that primarily affects the eyes, skin, and airways. Sulfur mustard injuries can take several months to heal, necessitate lengthy hospitalizations, and result in significant cosmetic and/or functional deficits. Historically, blister aspiration and/or deroofing (epidermal removal), physical debridement, irrigation, topical antibiotics, and sterile dressings have been the main courses of action in the medical management of cutaneous sulfur mustard injuries. Current treatment strategy consists of symptomatic management and is designed to relieve symptoms, prevent infections, and promote healing. There are currently no standardized or optimized methods of casualty management that prevent or minimize deficits and provide for speedy wound healing. Several laboratories are actively searching for improved therapies for cutaneous vesicant injury, with the aim of returning damaged skin to optimal appearance and normal function in the shortest time. Improved treatment will result in a better cosmetic and functional outcome for the patient, and will enable the casualty to return to normal activities sooner. This editorial gives brief overviews of sulfur mustard use, its toxicity, concepts for medical countermeasures, current treatments, and strategies for the development of improved therapies.