A retrospective cohort study of Acticoat versus Silvazine in a paediatric population

We wished to determine whether changing our centre's practice of using Acticoat instead of Silvazine as our first-line burns dressing provided a better standard of care in terms of efficacy, cost and ease of use. A retrospective cohort study was performed examining 328 Silvazine treated patients from January 2000 to June 2001 and 241 Acticoat treated patients from July 2002 to July 2003. During those periods the respective dressings were used exclusively. There was no significant difference in age, %BSA and mechanism of burn between the groups. In the Silvazine group, 25.6% of children required grafting compared to 15.4% in the Acticoat group (p=0.001). When patients requiring grafting were excluded, the time taken for re-epithelialisation in the Acticoat group (14.9 days) was significantly less than that for the Silvazine group (18.3 days), p=0.047. There were more wounds requiring long term scar management in the Silvazine group (32.6%) compared to the Acticoat group (29.5%), however this was not significant. There was only one positive blood culture in each group, indicating that both Silvazine and Acticoat are potent antimicrobial agents. The use of Acticoat as our primary burns dressing has dramatically changed our clinical practice. Inpatients are now only 18% of the total admissions, with the vast majority of patients treated on an outpatient basis. In terms of cost, Acticoat was demonstrated to be less expensive over the treatment period than Silvazine . We have concluded that Acticoat is a safe, cost-effective, efficacious dressing that reduces the time for re-epithelialisation and the requirement for grafting and long term scar management, compared to Silvazine.     

Reproducibility of repeated measurements with the Kikuhime pressure sensor under pressure garments in burn scar treatment

This study investigated the reproducibility of repeated measurements with the Kikuhime pressure sensor under two different types of pressure garments used in the treatment and prevention of scars after burns. Also efficiency of garments was assessed in clinical circumstances by assessing pressure loss and residual pressure after 1 month. Intra- and inter-observer reproducibility and repeated measurements with 1-month time lapse were examined on 55 sites in 26 subjects by means of intra-class correlation coefficients and standard error of measurements. Results showed good to excellent ICC and low SEMs in the two conditions. There was a significant difference in pressure after 1 month between elastic tricot and weft knit garments, although evolution of pressure loss after 1 month was similar. Concerning different locations, there was a significant difference in pressure loss after 1 month between gloves and sleeves with the largest pressure loss for sleeves. Considering these results we concluded that the Kikuhime pressure sensor provides valid and reliable information and can be used in comparative clinical trials to evaluate pressure garments used in burn scar treatment. Secondly, elastic tricot garments in our study tended to have higher clinical pressures but both types of garments had similar pressure loss over time.     

Scar Tissue Graft as a Filler for Soft Tissue Augmentation

Soft tissue augmentation with autogenous tissue has been used to correct various defects during aesthetic facial contouring and reconstructive procedures. Although dermal grafts have longer survival rates, fat grafts always have been more popular because of the simple harvesting and grafting methods used. The authors aimed to use existing scar tissue as an injectable graft and to compare its effectiveness as a soft tissue filler substance with that of dermal grafts. In this study, scar tissue was created on 24 male Wistar rats. The created scar and normal healthy skin were removed from the rat dorsal scapular donor site. After depithelialization, the harvested tissues were minced until they were thin enough to pass through a 16-gauge needle. The grafts then were injected into the recipient site between the abdominal muscles. Volumetric analyses and histologic evaluation of the grafts were performed 1, 3, and 5 months after transplantation. The first month after the injection, the amount of remaining dermis graft was more than the scar graft, and this difference was statistically significant. However, at the end of months 3 and 5, there was no marked difference between the groups. The remaining volume of injected scar tissue graft was comparable with that of the dermis graft. The scar grafts were composed mainly of dense connective tissue during all the evaluation periods. In this study, scar tissue provided results comparable with those of dermal grafts up to 5 months when used as a soft tissue filler. It seems that neovascularization of the scar graft may be inadequate for maintenance of graft viability, as compared with dermis grafts. On the other hand, the scar graft formed fibrous tissue, which may be responsible for providing adequate volume as a filler. This may have clinical implications for the patient who needs both scar revision and soft tissue augmentation procedures simultaneously.     

MEBO治疗烧伤瘢痕溃疡82例体会

目的：探讨湿润烧伤膏（MEBO）在烧伤瘢痕溃疡中的应用。方法：用MEBO采用不同方法对82例不同部位、面积、病程的烧伤瘢痕溃疡的治疗效果进行分析。结果：全部瘢痕溃疡面愈合，功能良好。结论：MEBO是目前治疗烧伤瘢痕溃疡疗效较为理想的药物。     

美宝疤痕平临床应用与疗效评价

目的：通过临床正确应用美宝疤痕平，预防和治疗增生性瘢痕病人，验证疗程的合理性及疗效的可靠性。方法：对临床316例不同部位的深度烧伤后期病人，按瘢痕预防性治疗3个月，瘢痕治疗6个月-8个月的疗程计算，正确用药。结果：美宝疤痕平可使绝大部分深度烧伤病人恢复正常的皮肤弹性和色泽，使增生性瘢痕消退或明显缩小范围，降低手术率和病人致残率。结论：美宝疤痕平能有效地预防和治疗增生性瘢痕。     

湿润烧伤膏对豚鼠免疫功能作用的研究

目的：观察湿润烧伤膏（MEBO）对豚鼠免疫功能的影响。方法：用MTT比色法检测了MEBO对豚鼠血清白细胞介素－1含量及吞噬功能和血清溶菌酶功能的影响。结果：以上免疫学指标均有明显增强作用。与对照组相比，IL－1有显性差异（P＜0．05），其余两项有非常显性差异（P＜0．01）。结论：MEBO有明显提高豚鼠血清IL－1的含量和吞噬细胞吞噬功能及溶菌酶的非特异性免疫功能的作用。以上研究为MEBO的临床应用丰富了理论依据。     

Burn scar assessment: A systematic review of objective scar assessment tools

Purpose

All deep second and third degree burns are at risk to develop hypertrophic scars which can severely undermine the quality of survival. To assess the severity of scarring, several technical devices or tools have been introduced to evaluate one or more aspects of the scar, enabling comparison of different treatment protocols and allowing an objective follow-up. The objective of this study was to review which tools can be used in objective burn scar assessment.

Basic procedures

The Systematic literature search involving PubMed, the Web of Science (incl. Science Citation Index).

Main findings

51 articles with burn scar assessment as main topic were found. Several characteristics of the scar can be assessed, such as color, metric features and elasticity, but none of the available tools covers the whole aspect of the scar. Especially subjective factors such as pain and itching cannot be assessed with those tools, in spite of their great impact on the patient's quality of life.

Conclusions

Scar tools enable objective and reproducible evaluation of scars, which is essential for scientific studies and medico-legal purposes, and in selected cases for the clinical follow-up of an individual patient. Further studies to evaluate these tools on scars are nevertheless required.     

食管腐蚀伤后瘢痕狭窄的预防与治疗

目的：报告我科预防及治疗１０２例食管腐蚀伤后瘢痕狭窄的经验。方法及结果：早期入院行预防性手术３０例，包括改良食管腔内置管１８例，１５例成功，３例失败；食管腔内加压置管７例及循环式扩张５例均治愈；已形成瘢痕狭窄或结肠重建食管术后吻合口狭窄７８例，手术方法有结肠代食管４５例，切除瘢痕段食管行食管胃吻合１１例，颈阔肌皮瓣修复狭窄１３例，背阔肌岛状皮瓣１例，其他类型手术５例。结论：腐蚀伤早期采用食管腔内置管，可预防大多数病例后期发生瘢痕狭窄。已形成广泛瘢痕狭窄而病变在主动脉弓下缘以下者，可切除瘢痕段食管，行食管胃吻合术；高于主动脉弓以上者，可行瘢痕段食管旷置，用结肠重建食管；局限于颈部的狭窄或吻合口狭窄难以用形成手术修复者，采用颈阔肌皮瓣修复是值得推广使用的方法。     

止血生肌膏外敷治疗指、趾端损伤的实验研究

采用离断法造成家兔趾开放损伤。分止血生肌膏组，烧伤宁组，对照组进行实验观察。结果表明：止血生肌膏有较好的止血作用。能显著地缩小创面（P＜0．01）。用药第一周显著特点为问质中中性白细胞浸润较多，第二、三周显著特点为肉芽组织增生明显伴表皮组织增生，第三，四周显著特点为上皮组织高度增生且完善。经急性毒性试验及急性皮肤过敏试验证实无毒性作用，无不良反应。     

邻近皮肤扩张修复面部瘢痕术

目的：面部瘢痕手术修复的最佳方法，方法：设计面部瘢痕面周围正常皮肤下植入扩张器，皮肤扩张后再切除瘢痕组织，用扩张皮瓣修复，结果：面部瘢痕被扩张后的皮瓣修复，供瓣区刀口直接缝合。结论：以扩张的皮瓣修复面部瘢痕具有供受区邻近，皮瓣转移方便，血运可靠，颜色质地面部正常皮肤且平整，以及刀口均无张力缝合，瘢痕细小等特点。