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This case report describes the successful wound management of a 19-year-old patient with 76% of his body surface burnt. Due to the severity of the burns and the limited availability of native skin, 63% of the body surface were covered with Integra ( R), a dermis equivalent. This material has been developed for the reconstruction of dermal structures and is designed as a bilayer. It consists...
Dermal collagen displays a random-like structure that has a major role in strength and function of the human integument. It is hypothesised that collagen bundles align in a parallel fashion in the direction of mechanical tension during scarring, which may explain the problematic scar formation that occurs specifically at joints.Scar tissue and normal skin were biopsied from joints and control areas...
Quantifiable prognostic indicators are of considerable practical value following thermal injury. Collagen is a major component of the skin, and is known to undergo denaturation at the elevated temperatures associated with burns. The purpose of this study was to determine whether a recently developed, non-invasive imaging technique could detect and quantify collagen denaturation in burned human skin...
To inhibit surgical scarring by pretreating epidermis at the operation site.Eight patients who were to undergo operation through a modified incision incisions technique and other eight subjects presenting for skin grafting were recruited. For the modified incision patients a method to make the site ‘epidermis-free’ was developed. At the operating site a split thickness rectangular skin flap was raised...
We developed a reproducible model of deep dermal partial thickness burn injury in juvenile Large White pigs. The contact burn is created using water at 92°C for 15s in a bottle with the bottom replaced with plastic wrap. The depth of injury was determined by a histopathologist who examined tissue sections 2 and 6 days after injury in a blinded manner. Upon creation, the circular wound area developed...
Because of the practical importance of acute radiation exposure associated with combined injuries, it is imperative to investigate the efficacy of cost-effective nutritional factors in the reconstruction of irradiated wounds. Therefore, effect of pretreatment of ascorbic acid was studied on the healing of excised wounds in mice exposed to 2, 4, 6 and 8Gy whole body γ-radiation. A full-thickness wound...
Hypertrophic scarring is abnormal proliferation of dermal fibroblasts and excessive deposition of extracellular matrix. To date, despite many studies, treatments have not been satisfactory. Genistein, a potent, specific inhibitor of tyrosine protein kinases (TPKs), has been proved to inhibit many kinds of tumour and some fibrotic diseases. The purpose of this study was to investigate the effects of...
Over production of collagen and its abnormal assembly is the hallmark of abnormal scars such as keloids, a condition which reflects fibrosis of the skin. Fibrotic conditions of organs such as liver, lungs and eyes are characterized by low levels of decorin, a member of the small leucine proteoglycan family, which is an indispensable modulator of collagen assembly. Involvement of decorin in keloids...
Fibroblasts are thought to be partially responsible for the persisting contractile forces that result in burn contractures. Using a monolayer cell culture and fibroblast populated collagen lattice (FPCL) three-dimensional model we subjected hypertrophic scar and non-cicatricial fibroblasts to the antifibrogenic agent pentoxifylline (PTF – 1mg/mL) in order to reduce proliferation, collagen types I...
Burns can result in substantial morbidity through fibroblast proliferation and contracture. Imiquimod (IMQ), an immune response modifier and upregulator of endogenous cytokine expression, has been shown to suppress fibroblast proliferation. It is widely used in the treatment of viral, neoplastic and non-neoplastic skin conditions and has recently been tested in the reduction of hypertrophic scarring...
Dermal substitutes are of major importance in treating full thickness skin defects, both in acute and chronic wounds. In this review we will outline specific requirements of three classes of dermal substitutes:-natural biological materials, with a more or less intact extracellular matrix structure;-constructed biological materials, composed of specific biological components; and-synthetic substitutes,...
This study aims to evaluate percutaneous collagen induction (PCI) in post-burn scarring.Patients with scarring after burn frequently request help in improving the aesthetic appearance of their residual cicatricial deformity. Their scars are generally treated by tissue transfer, W- and Z-plasties, flaps, cortisone injections or ablative procedures that injure or destroy the epidermis and its basement...
Clinical examination alone is not always sufficient to determine which burn wounds will heal spontaneously and which will require surgical intervention for optimal outcome. We present a review of optical modalities currently in clinical use and under development to assist burn surgeons in assessing burn wound severity, including conventional histology/light microscopy, laser Doppler imaging, indocyanine...
Keloids and hypertrophic scars are significant symptomatic clinical problems characterized by the excessive and abnormal deposition of collagen-based extracellular matrix (ECM) components. However, the molecular basis of keloid and hypertrophic scar formation has not been fully elucidated. Here, we demonstrated that down-regulation of the transcription factor Smad interacting protein 1 (SIP1) could...
High-resolution, high-contrast, three-dimensional images of live cell and tissue architecture can be obtained using second harmonic generation (SHG), which comprises non-absorptive frequency changes in an excitation laser line. SHG does not require any exogenous antibody or fluorophore labeling, and can generate images from unstained sections of several key endogenous biomolecules, in a wide variety...
Static splinting therapy is widely considered an essential part in burn rehabilitation to prevent scar contractures in the early phase of wound healing. However, scar contractures are still a common complication. In this article we review the information concerning the incidence of scar contracture, the effectiveness of static splinting therapy in preventing scar contractures, and specifically focus...
The benefits and risks of singular and repetitive microneedling (1mm) have not been thoroughly investigated. The aim of this study was to evaluate the benefits and risks of singular and repetitive skin needling with a microneedling device in an animal model with and without skincare. 30 Sprague Dawley rats were randomized to five groups: control, skin-care only (Vitamin A & C), 1× needling 1mm,...
Oxygen is an essential substance for wound healing. Limited studies have shown that topical oxygen can influence healing. This study evaluated the effects of a Topical Oxygen Emulsion (TOE) on burn wound healing.A porcine second-degree burn wound model was used in the study. Burn wounds were randomly assigned to TOE, vehicle control, and no-treatment (air) groups. Effects of TOE on the granulation...
Current treatment options for severe burn wounds are often insufficient in reconstructing skin and soft tissue defects. Adipose-derived stem cells (ASCs), a readily available source of multipotent stem cells, represent a promising therapy for the treatment of full-thickness burn wounds. Full-thickness burn wounds were created on the paraspinal region of athymic mice. A one-time, sub-eschar injection...
Treatment of full-thickness skin defects with split-thickness skin grafts is generally associated with contraction and scar formation and cellular skin substitutes have been developed to improve skin regeneration. The evaluation of cultured skin substitutes is generally based on qualitative parameters focusing on histology. In this study we focused on quantitative evaluation to provide a template...
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