Studies on systemic absorption of tobramycin in polyethylene glycol ointment applied to wounds of burn patients

The penetration of tobramycin ointment (0.2 per cent) through human burn wounds was studied in two patients with superficial dermal burn (SDB) and deep dermal burn (DDB), two patients with DDB, one patient with full thickness burn (FB) and one patient with burn ulcer (BU). After application of the ointment, the absorption of tobramycin occurred promptly with a peak level at 2-6 h in the sera of patients with SDB + DDB and DDB only. In the BU patient it was found at 2 h; while in the FB, at 10-12 h. The excretion of tobramycin into the urine was also studied. The absorption rate constants (ka) of the two SDB + DDB patients were 0.31 and 0.74, of the two DDB patients, 0.079 and 0.18, and those of the DB and the BU patients, 0.053 and 0.95, respectively. The absorption ratios of tobramycin (amount excreted into the urine during 24 h/applied dose) were different, depending on the condition of the burn wound, and ranged from a low of 10.3 per cent (FB) to a high of 44.0 per cent (BU). These results show that the treatment of burn patients with tobramycin ointment to control burn wound infection should be carefully supervised, especially in the case of BU.     

硝酸银软膏对Ⅱ度烧伤创面治疗作用的多中心临床研究

目的观察硝酸银(AgNO3)软膏对浅Ⅱ、深Ⅱ度烧伤创面的治疗效果,并评价其药物不良反应。方法选择80例浅Ⅱ度和40例深Ⅱ度烧伤患者,进行多中心、随机、阳性药物平行对照和同体试验研究(共4个中心,每个中心30例)。将患者创面按用药不同分为AgNO3组和磺胺嘧啶银(SD-Ag)组,观察各组创面完全愈合时间、指定时相点下创面愈合率、创面细菌培养情况、药物疗效和安全性、药物对创面的刺激性等。结果浅Ⅱ度创面:AgNO3组完全愈合时间为(9．5±2．7)d, SD-Ag组为(10．8±3．4)d,用药后7 d创面愈合率分别为(77．9±20．5)％及(67．3±22．6)％;深Ⅱ度创面:AgNO3组完全愈合时间为(21．5±4．8)d,SD-Ag组为(23．3±6,4)d,用药后20 d创面愈合率分别为(86．6±15．9)％及(78．5±17．7)％。同等深度烧伤创面上述各项数据两组间比较,差异均有统计学意义(P<0．01)。同等深度烧伤创面AgNO3组与SD-Ag组比较,具有同样明显的杀菌作用,但前者对创面的刺激性更小。结论AgNO3软膏是一种可用于浅Ⅱ、深Ⅱ度烧伤创面的有效、安全的外用药。     

The open method of surgical treatment of suppurative wounds

Treatment of purulent wounds by the open method in 280 patients was analysed. It is shown that purposeful use of medicinal agents in accordance with the phases of the wound process is a determinant and influences the duration of treatment. Necrectomy in combination with the topical use of ointments on a water-soluble polyethylene glycol basis (levosin, levomekol, 5% dioxidine ointment, 10% mafenide acetate ointment) produces the most favorable effect on the course of the wound process.     

Polyethylene glycol intoxication in burn patients

Unexplained increases in the anion gaps and serum osmolalities were observed in 3 burn patients who died following treatment with a polyethylene glycol-based burn cream. Toxicity due to absorption of polyethylene glycol was suspected after other causes had been excluded. Ethylene glycol was found in the circulation and the 3 patients died in acute renal failure. All the patients were acidotic with increased anion and osmolat gaps. This syndrome was similar to the more common poisoning with ethylene glycol but also included an increased serum calcium with a concomitant decrease in the ionized calcium. The cause of this high ‘calcium gap’ appeared to be binding of calcium by dicarboxylic acid metabolites of polyethylene glycol. These findings were the same as those found in rabbits treated with polyethylene glycol.     

Prospective comparison of silver sulfadiazine 1 per cent plus chlorhexidine digluconate 0·2 per cent (Silvazine) and silver sulfadiazine 1 per cent (Flamazine) as prophylaxis against burn wound infection

Patients with fresh full-thickness burn wounds were randomly assigned to receive wound treatment with daily applications of either I per cent silver sulfadiazine plus 0·2 per cent chlorhexidine digluconate cream (Silvazine) or 1 per cent silver sulfadiazine (Flamazine). Fifty-four patients treated with Silvazine were comparable to 67 treated with Flamazine with respect to extent and distribution of burn, age and all aspects of wound and associated treatment. Overall incidence of wound bacterial colonization was less in the Silvazine treated patients (65 per cent versus 88 per cent; P = 0·002). With Silvazine, wound colonization by Staphylococcus aureus was less (41 per cent versus 64 per cent; P = 0·01). Clinical wound infection with Staph. aureus developed in one Silvazine treated patient and five Flamazine treated patients (P = 0·16). Colonization by and infection due to all other organisms did not differ in the two groups. The incidence of graft failure was similar with both agents. In future increasing the concentration of chlorhexidine digluconate above 0·2 per cent might produce an improved prophylactic effect against Gram negative bacteria reported by other authors using the combined agent in in vitro and clinical trials. Silvazine was effective in reducing the incidence of Staph. aureus burn wound colonization without fostering supervening opportunistic infection.     

Moist exposed burn therapy: evaluation of the wound healing process. An experimental model to assess the efficacy of local agents on wound repair in partial- and full-thickness wounds

The porcine model was used to investigate the wound healing process. 116 partial and full-thickness wounds were induced on the back of the animals using the CO₂ Three local dressing agents were tested: Povidone Iodine, Silver Sulphadiazine and MEBO ointments. The following parameters were evaluated: physical examination, photography, pH, transepidermal water loss and moisture of the wound, planimetry and histological assessment of injury. The measurement of different parameters revealed that partial-thickness burn wounds were better assessed using Transepidermal Water Loss (TEWL), while full-thickness ones are better assessed using planimetry, measuring the surface of the wound. MEBO significantly accelerates the wound healing process of partial- (inflicted by CO₂ Laser) and full-thickness excised wounds when compared to other local agents applied on wounds similar in size, extent and cause and the control group.     

Enzymatic wound debridement

BACKGROUND: Clinical experience and existing research strongly support debridement as a necessary component of wound bed preparation when slough or eschar is present. Multiple techniques are available, but the indications for each technique and their efficacy are not clearly established. There is little evidence to guide the clinician in the selection of a safe, effective debridement method for the patient with a chronic wound. OBJECTIVES: We sought to identify evidence related to the efficacy of enzymatic debriding agents collagenase and papain-urea in the removal of necrotic tissue from the wound bed and its impact on wound healing. SEARCH STRATEGY: A systematic review of electronic databases was undertaken using key words: (1) debridement, (2) enzymatic debridement, (3) collagenases, (4) papain, (5) urea, and (6) papain-urea. All prospective and retrospective studies that compared enzymatic debridement using collagenase or papain-urea (with and without chlorophyllin) on pressure ulcers, leg ulcers, or burn wounds were included in the review. All studies that met inclusion criteria and were published between January 1960 and February 2008 were included. RESULTS: Collagenase ointment is more effective than placebo (inactivated ointment or petrolatum ointment) for debridement of necrotic tissue from pressure ulcers, leg ulcers, and partial-thickness burn wounds. Limited evidence suggests that a papain-urea-based ointment removes necrotic material from pressure ulcers more rapidly than collagenase ointment, but progress toward wound healing appears to be equivocal. Limited evidence suggests that treatment of partial-thickness burn wounds in children with collagenase ointment may require an equivocal time to treatment with surgical excision and that combination treatment may reduce the need for surgical excision. Insufficient evidence was found to determine whether collagenase ointment removes necrotic tissue from leg ulcers more or less rapidly than autolytic debridement enhanced by a polyacrylate dressing. IMPLICATIONS FOR PRACTICE: Enzymatic debriding agents are an effective alternative for removing necrotic material from pressure ulcers, leg ulcers, and partial-thickness wounds. They may be used to debride both adherent slough and eschar. Enzymatic agents may be used as the primary technique for debridement in certain cases, especially when alternative methods such as surgical or conservative sharp wound debridement (CSWD) are not feasible owing to bleeding disorders or other considerations. Many clinicians will select enzymes when CSWD is not an option. Clinical experience strongly suggests that combined therapy, such as initial surgical debridement followed by serial debridement using an enzymatic agent or enzymatic debridement along with serial CSWD, is effective for many patients with chronic, indolent, or nonhealing wounds.     

Investigating the effects of walnut ointment on non-healing burn wounds

Effective treatments for non-healing burn wounds are an unmet need for 95% of burn sufferers. Approaches currently available to treat non-healing burn wounds are not satisfactory due to undesirable side-effects or expense. The anti-oxidation and antibacterial activities of walnuts are recommended for treating chronic diseases. Walnut ointment has been developed and successfully applied to treat non-healing burn wounds in our hospital for decades. We report herein a detailed retrospective case review examining patients’ response to the walnut ointment. The walnut ointment has shortened healing time of non-healing burn wounds and improved clinical outcomes. In order to investigate the mechanism of action, walnut ointment has been applied on wounds of porcine full-thickness burn wound models. Histological and immunohistochemical analysis indicated our walnut ointment supports wound healing through promoting keratinocyte proliferation and differentiation. Taken together, we recommend the walnut ointment offers an effective and economical treatment for patients presenting with non-healing burn wounds.     

The effect of henna and linseed herbal ointment blend on wound healing in rats with second-degree burns

The treatment of skin burns is one of the most important challenge in medical science. The aim of this study is evaluation of the efficacy of Artaderm herbal ointment containing the Henna (Lawsonia inermis) extract, Linseed (Linum usitatissimum) oil, and Honey Wax on wound healing in the rat with second-degree burn wounds. The Artaderm ointment had an effective role in controlling burn wound infections due to its antimicrobial and anti-inflammatory properties. In this study, 64 male Wistar rats were randomly divided into 8 groups (n = 8). Four groups received Artaderm, 1% Silver Sulfadiazine (SSD 1%), Cod Liver Oil and Fundermol (Alpha) ointments which used in common practices for burn injuries. Another three groups received Henna, Linseed, and Honey Wax alone and a control group that just underwent a second-degree burn injury without any treatments. A second-degree burn was formed on the back of each rat and dressed daily with one of the agents. Burn wounds were macroscopically and microscopically evaluated on the 7th, 14th, and 21st day after burn induction. Rats treated with the Artaderm ointment had significantly faster wound contraction as well as shorter healing time than the rest groups. No scar was observed in rats treated with the Artaderm ointment on the 21st day, while this level of improvement was not observed in other groups at the same time. More than 90% of wounds were healed after on the 14th day in rats treated with Artaderm (94.10 ± 0.18) and Alpha (92.05 ± 0.23) ointments. According to these findings, it can be concluded that Artaderm herbal ointment can be used as a proper alternative for healing of wounds in second-degree burns.     

Moist exposed therapy of partial-thickness burn wounds. A multi-center study

Summary In laser-induced partial-thickness burns of pig skin, moist exposed burn ointment (MEBO) produces a moist environment, allows drainage of exudates, reduces eschar formation, and accelerates debridement and wound healing. A prospective multi-center study was conducted to evaluate the effect of MEBO on the healing of partial-thickness burn wounds. We included 52 patients with 100 burn sites ranging from 0.5% to 15% total body surface area in the study. Treatment efficacy was assessed on physical examination of the wound, the course of time of trans-epidermal water loss (TEWL) and moisture values, bacterial wound colonization and the degree of pain experienced by patients during and between dressing changes. Using the Visual Analogue Thermometer device (VAT) a progressive decrease of pain was found throughout the treatment which was statistically significant at 6, 9 and 12 post-burn days. TEWL, as an indicator of re-epithelialization, demonstrated a decreasing trend on day 3, and the reduction became significant from the 6th post-burn day. Moisture was significantly decreased during the first 5 post-burn days. As re-epithelialization progressed there was a net decrease in moisture paralleling TEWL. After 1 week of MEBO treatment, bacterial wound colonization decreased to 10% in the immediate group and to 61% in the late group of application. By the second week, colonization dropped to 5% and 23% respectively. Topical ointment application contributed to the debridement of the wound bed facilitating rapid epithelialization within 2–6 days, depending on the burn depth. MEBO is an ointment that can effectively produce a moist and wet environment for optimal healing of partial-thickness burns.     

Human beta defensin is absent in burn blister fluid

Defensins are a family of cationic antimicrobial peptides that participate in innate host defence. Human beta defensin-2 (HBD-2) is produced by human keratinocytes, and has a potent bactericidal activity against a wide spectrum of microorganisms. We have recently shown that expression of HBD-2 is present in normal skin and lost in the full-thickness burn wound. Defensins have been found in the blister fluid of chronic wounds. Our study was designed to examine blister fluid from partial-thickness burns for defensin content. Fluid from five patients was collected from partial-thickness burn blisters, and then analysed by sandwich Enzyme-Linked Immunosorbent Assay (ELISA) with a monoclonal antibody and rabbit polyclonal antibody to HBD-2. The assay was validated against a Western blot assay for HBD-2 in samples of bronchoalveolar lavage fluid from patients with inflammatory lung disease. No HBD-2 was detectable in any of the burn blister fluids analysed. HBD-2 is lost in the full-thickness burn wound, and we have now demonstrated its absence in burn blister fluid. This finding represents evidence of a host defence defect within the burn wound and suggests a possible therapeutic role for antimicrobial peptides in the management of burn wounds.     

Efficacy of hydrosurgical excision combined with skin grafting in the treatment of deep partial-thickness and full-thickness burns: A two-year retrospective study

IntroductionDeep partial-thickness and full-thickness burn wounds often undergo tangential excision or escharectomy to expose healthy tissue, combined with skin grafting to promote wound healing. However, conventional tangential excision with the humby knife leads to inevitable damage to the dermis while excising burn tissue due to the lack of precision. Indeed, the preservation of dermal tissue is a key factor in determining wound healing and scar quality. The precision and tissue selectivity of the Versajet Hydrosurgical System has been established for excising burn tissue while preserving dermal tissue. In this study, we retrospectively compared the efficacy of "Hydrosurgical excision combined with skin grafting" and "Conventional tangential excision combined with skin grafting" in treating deep partial-thickness and full-thickness burn wounds to demonstrate that hydrosurgery improved the treatment of deep partial-thickness and full-thickness burns.MethodsA total of 86 patients with deep partial-thickness and/or full-thickness burns with a total burn surface area (TBSA) ≤ 25% from July 2018 to July 2020 were included in this study and were divided into experimental (hydrosurgical excision combined with skin grafting, n = 43) and control (conventional tangential excision combined with skin grafting, n = 43) groups. Parameters were analyzed, including the intraoperative blood loss volume per unit area of grafted skin, surgery duration, wound healing time, skin graft survival, and the treatment costs per unit of burned area. Scar assessment was performed at 1 year with the modified Vancouver Scar Scale linked with TBSA (mVSS-TBSA).ResultNo significant difference was found in male to female ratio, age, weight, TBSA, burn depth, skin grafting area (SKA), skin grafting methods, cases treated with carbon dioxide fractional laser or incidence of inhalation injury, and the incidence of hypovolemic shock between two groups(p > 0.05). Compared with the control group, patients treated with hydrosurgical excision combined with skin grafting experienced less intraoperative blood loss volume per unit area of grafted skin (p < 0.05). The mVSS-TBSA of patients that underwent hydrosurgical excision combined with skin grafting was significantly improved in comparison to the control group (p < 0.01). No significant difference was found in surgery duration, wound healing time, skin graft survival and treatment costs per unit of burned area between the two groups (p > 0.05).ConclusionHydrosurgical excision combined with skin grafting reduced intraoperative blood loss volume per unit area of grafted skin, improved scarring 1-year after injury, and did not increase the treatment costs per unit of burned area. This technique provides a novel alternative for managing deep partial-thickness and full-thickness burn wounds.     

Role of histamine receptors in the regulation of edema and circulation postburn

Despite histamine being a potent endogenous vasoactive agent released in increasing amounts postburn, its role in postburn oedema formation has been controversial and its effect on burn circulation poorly investigated. The present study investigated the involvement of H₁, H₂ and H₃ receptors in postburn edema in rats exposed to skin and muscle burns and their influence on skin circulation postburn. We used the selective antagonists clemastine (H₁), ranitidine (H₂), thioperamide (H₃) and the selective H₃ receptor agonist, imetit. Results showed that none of the antagonists or the H₃ agonist had significant effect on postburn edema measured by quantitative spectrophotometric analysis of extravasated Evans blue-albumin in the full-thickness burned skin or muscle. Clemastine and thioperamide failed to induce significant effect on blood flow in the partial- or full-thickness skin burn injury as measured by laser Doppler flowmetry, while ranitidine significantly (P<0.01) reduced blood flow in the full-thickness burn. In contrast, the H₃ receptor agonist, imetit, significantly increased blood flow, both in the partial-thickness burn injury (P<0.05) and in the full-thickness burn (P<0.01). Moreover, imetit significantly (P<0.01) increased mean arterial pressure while thioperamide significantly (P<0.01) reduced systemic pressure. In conclusion, H₁, H₂ and H₃ receptors are not important actors in the regulation of vascular patency permeability, whereas H₃ receptors play an important role by increasing skin circulation postburn, presumably by relaxation of vascular smooth muscle and/or by interacting with other inflammatory neurotransmitters. Data also suggest that H₂ receptor blockers may not be best choice for stress ulcer prophylaxis in burn patients.     

Effectiveness of four topical treatment methods in a rat model of superficial partial-thickness burn injury: the advantages of combining zinc-hyaluronan gel with silver foam dressing

BackgroundThere are several options available for conservative treatment of partial-thickness burns, however, reliable, affordable, and easily obtainable animal testing models are hard to find for the comparison of the different treatment methods. We aimed at developing a preclinical testing model and at comparing four treatment methods for superficial partial-thickness burns.MethodsBurn injury was induced in 90 adult male Wistar rats by placing the 130°C hot tip of a commercially obtainable soldering device for 30 s on the clipped skin of the interscapular region at a steady pressure. Skin histology was studied on days 5, 10, and 22 after the induction of the burn injury, on which days, respectively, the ratio of the not epithelialized wound (%), the extent of re-epithelialization (score), and the scar thickness (µm) were assessed. We compared 4 groups: silver-sulfadiazine cream, zinc-hyaluronan gel, silver foam dressing, and the combination of zinc-hyaluronan gel with a silver foam dressing.ResultsOn day 5, the induction of superficial partial-thickness burn injury was confirmed histologically in the rats. The zinc-hyaluronan gel and the combination treatment resulted in a markedly smaller ratio of the non-epithelialized area (29 ± 10% and 28 ± 13%, respectively) than silver-sulfadiazine cream (69 ± 4%; p < 0.01). On day 10, the extent of re-epithelialization was the lowest (～0.2) in the silver-sulfadiazine cream group, while the other 3 treatments performed significantly better. The combination treatment lead to the maximal score of 2 in all rats, which was higher than in the other 3 treatment groups. On day 22, the scar thickness was the smallest in the combination treatment group (560 ± 42 µm), which was significantly less than in the silver-sulfadiazine cream group (712 ± 38 µm; p < 0.05).ConclusionsWe designed and histologically confirmed a reproducible method for induction of superficial partial-thickness burns in rats for preclinical testing. In our model, the combination of zinc-hyaluronan gel with silver foam dressing was more effective than either of its components alone or than silver-sulfadiazine cream.     

A silver-impregnated antimicrobial dressing reduces hospital costs for pediatric burn patients

Purpose

Since using a novel silver-impregnated antimicrobial dressing (Aquacel Ag, ConvaTec, Princeton, NJ) in our pediatric patients with partial-thickness burns, hospital LOS has been significantly reduced. Here we investigated whether there was concomitant cost-effectiveness of this approach.

Methods

We retrospectively reviewed Burn Registry Data from a large Children's Hospital Burn Unit from January 2005 through August 2005 for inpatients with partial-thickness burns treated with Aquacel Ag. A comparison group was composed of patients from the same period the previous year treated with silver sulfadiazine cream (SSD, Par Pharmaceuticals, Woodcliff, NJ) and matched for age and %TBSA burned. Patients with inhalation injury or full-thickness burns were excluded. Intent-to-treat analysis was limited to patients with less than 22% TBSA burn. Direct costs and total charges were compared statistically after log transformation due to the skewedness of the data.

Results

Total charges and direct costs were significantly lower for Aquacel Ag-treated patients (n = 38) than for SSD-treated patients (n = 39) (P = .004 and P < .001, respectively). In addition, Aquacel Ag-treated patients had a shorter LOS than SSD-treated patients.

Discussion

These data strongly support our findings that the application of Aquacel Ag reduces hospital LOS which results in a significant cost savings in the care of pediatric patients with partial-thickness burns.     

Removal of necrotic tissue with an ananain-based enzyme-debriding preparation

An enzymatic debriding preparation was formulated with purified enzyme derived from a crude pineapple stem extract. The primary component of this preparation was the sulfhydryl protease ananain which represented >/=85% of the proteolytic activity. The remaining proteolytic activity in the preparation was contributed by a co-purifying homologous cysteine protease comosain. Taken together these two proteases provided a protein purity of greater than 95% as judged by sodium dodecyl sulfate polyacrylamide gel electrophoresis. This ananain-based enzyme preparation exhibited both gelatinolytic and fibrinolytic activity in vitro. Ananain-based enzyme preparation was formulated in a hydrophilic cream vehicle at concentrations ranging from 115 to 260 U/gm vehicle. Ananain-based enzyme preparation formulated in this fashion is referred to as Vianain debriding agent. Vianain was applied to partial-thickness cutaneous burn wounds produced in the skin of domestic pigs. A maximum of two 4-hour applications of Vianain provided complete debridement of eschar from the partial-thickness burn wounds as judged by light and electron microscopic analyses of biopsy specimens harvested before and after debridement. Wounds debrided with Vianain exhibited more rapid reepithelialization as compared with wounds that were not debrided. Wounds on pigs that were hyperimmunized to ananain-based enzyme preparation before burning and debridement with Vianain exhibited a similar enhancement in reepithelialization as compared with wounds treated with vehicle alone. The capacity of Vianain to debride necrotic tissue was also evaluated in a guinea pig ischemic ulcer model. Full-thickness ischemic lesions were created on the back of guinea pigs. Vianain was applied to the hardened necrotic tissue for 6 hours per day for up to a maximum of 5 days. Complete debridement of these wounds was accomplished within 4 to 5 days. Treatment of ischemic cutaneous ulcerations in this animal model with two commercially available enzyme-debriding agents provided little or no debridement of the necrotic tissue. In vitro, Vianain treatment of surgically debrided human tissue samples, obtained from patients with burn injury or cutaneous ulcers, showed that the protease preparation was effective in rapidly digesting these necrotic tissues.     

重组人表皮生长因子软膏对烧伤创面修复的促进作用

目的　探讨重组人表皮生长因子 (rh EGF)软膏治疗烧伤的有效浓度 ,并观察对创面愈合的促进作用。方法　将 12 0例烧伤患者分为两部分 ,第一部分选择 15例浅 °烧伤患者 ,采用开放实验 ,分三组每组 5例 ,进行三种不同浓度 rh EGF软膏 (0 .5 μg/ g,10 μg/ g,5 0 μg/ g)的疗效比较 ,确定临床使用浓度。第二部分 ,选择浅 °和深 °烧伤患者10 5例为试验对象 ,在第一部分研究的基础上选取最适药浓度 ,进行多中心随机双盲实验 ,所有患者均采用自身对照。以创面愈合为指标 ,判断创面愈合时间 ,并观察创面动态愈合率及不良反应。结果　第一部分患者 10 μg/ g和 5 0 μg/ g组的创面愈合时间差异不显著但较 0 .5 μg/ g组明显缩短 ,有统计学意义 (P<0 .0 1)。第二部分选用 10 μg/ g浓度的 rh EGF软膏与水溶性软膏基质进行随机双盲研究。浅 °创面用药组愈合时间为 (8.39± 2 .2 5 )天 ,空白对照组为 (9.5 2± 2 .5 6 )天 ,组间比较具有统计学意义 (P<0 .0 1) ;用药组不同时间内的愈合率较对照组明显提高 ;深 °创面愈合时间用药组、对照组分别为 (16 .80± 2 .99)天 ,(18.2 7± 3.17)天 ,组间比较有统计学意义 (P<0 .0 1)。结论　rh EGF软膏对烧伤创面有明显的促进修复作用 ,且 10 μg/ g的浓度较为理想     

Evaluation of the burn wound with perfusion fluorometry

Determination of depth of burn injury using vital dyes has been unsatisfactory. The present study evaluated the ability of the fiberoptic perfusion fluorometer to assess the depth of burn in the early postburn period. Sixty-three burns were examined with the fluorometer after intravenous administration of sodium fluorescein. The fluorescein kinetics were monitored for 1 hour within the first 48 hours and again between the third and sixth days postburn. The rate of fluorescein uptake and burn wound fluorescence was determined and compared to that of normal unburned skin. Depth of burn was confirmed by biopsy and healing characteristics. Fluorometric analysis during both study periods consistently distinguished between partial-thickness and full-thickness burns. Partial-thickness burns uniformly exhibited fluorescence within 10 minutes; full-thickness burns showed nil fluorescence. None of the patients experienced a change in skin color or complications from the small dose of fluorescein given.     

The fate of the dorsal metacarpal arterial system following thermal injury to the dorsal hand: A Doppler sonographic study

Hands are involved in over 70% of all serious burns. This study comprised 80 hands in 41 patients with burns of the dorsum of the hand. Eighty percent of the hands in our study had deep partial-thickness and full-thickness burns that had to be grafted. This study was performed to evaluate the patency of the dorsal metacarpal artery (DMCA) system in burn-injured hands. Sixteen hands healed spontaneously; 62 had to be excised and grafted. Doppler mapping of the dorsum of the hand was completed using an 8-MHz probe. Patent vessels were found in a pattern similar to that of a normal population in spontaneously healed and grafted partial-thickness burns. The incidence of dorsal arteries decreased from 100% for the first DMCA to 80% for the DMCA in the fourth web space. In full-thickness burns the correlation of burned hands to normal volunteers was only 80%. It can be concluded from the data that the DMCA system is not damaged by deep partial-thickness burns that are excised and grafted. The DMCA system is still intact in 80% of patients with full-thickness burns. The potential for elevating a DMCA flap is therefore preserved after burn excision and grafting. Preoperative Doppler examinations are recommended before planning the flaps.     

湿润烧伤膏抗感染作用的实验研究

我们采用大鼠２０％Ⅲ度烫伤创面接种绿脓杆菌ＡＴＣＣ－２７８５３作为实验治疗模型，旨在评价湿润烧伤膏外用治疗烧伤的防治感染功效。于接种绿脓杆菌后１０分钟、８小时、２４小时和４８小时开始外用湿润烧伤膏治疗，并以１％的Ａｇ－ＳＤ霜，１．２％的Ａｇ－ＦＬＸ霜和基础霜剂作为对照。治疗４８小时后送血培养，痂下细菌计数及组织病理学检查，以此作为评价指标。４种外用药物在体外对绿脓杆菌，大肠杆菌和金黄色葡萄球菌做抑菌试验，结果表明，Ａｇ－ＦＬＸ抗菌作用和疗效最强，Ａｇ－ＳＤ次之，而湿润烧伤膏的各项指标和基础霜剂间差异无显著意义（Ｐ＞０．０５）。说明湿润烧伤膏在防治烧伤感染方面几乎没有作用。