Inverse relationship between the apoptotic rate and the time elapsed from thermal injuries in deep partial thickness burns

BACKGROUND: The purpose of this article was to further describe apoptotic behaviour in deep partial thickness burns, correlating the apoptotic rate of these lesions with the time elapsed from injury. METHODS: We used TUNEL and Fas immunohistochemistry in serial biopsies of deep partial thickness burns harvested from 1 to 23 days following injury. The apoptotic rate was defined as the number of apoptotic cells out of the total number of nucleated cells. RESULTS: We recruited 25 subjects. Apoptosis was present in all biopsies and showed an inverse relationship with the time elapsed from thermal injury, higher during the first days and lower in the third week (r=-0.518; p=0.008). No significant correlations were demonstrated with age, total burn surface area, deep partial thickness burns area, Baux UBS index. CONCLUSIONS: Our study demonstrates that apoptosis persists in deep partial thickness burns throughout the first 3 weeks and shows an inverse relationship with the time elapsed from injury. It provides, in our opinion, the basis for future investigations regarding correlation with local vascularity and perfusion status and with clinical outcomes of deep partial thickness burns.     

Full-thickness skin columns: A method to reduce healing time and donor site morbidity in deep partial-thickness burns

The current standard of care for the coverage of large wounds often involves split thickness skin grafts (STSGs) which have numerous limitations. One promising technique that has gained traction is fractional autologous skin grafting using full-thickness skin columns (FTSC). Harvesting occurs orthogonally by taking numerous individual skin columns containing the epidermis down through the dermis and transferring them to the wound bed. The purpose of this porcine study was to investigate the efficacy of implanting FTSCs directly into deep partial-thickness burn wounds, as well as examining donor site healing at the maximal harvest density. It was hypothesised that by utilising FTSCs, the rate of healing in deep partial thickness burns can be improved without incurring the donor morbidity seen in other methods of skin grafting. Deep partial-thickness burns were created on the dorsum of female red duroc swine, debrided 3 days later and FTSCs were implanted at varying expansion ratios directly into the burn wounds. At day 14, 1:50 expansion ratio showed significantly faster re-epithelialisation compared to the debrided burn control and 1:200. Donor sites (at 7%–10% harvest density) were 100% re-epithelialised by day 7. Additionally, the maximal harvest density was determined to be 28% in an ex vivo model, which then five donor sites were harvested at 28% density on a red duroc swine and compared to five STSG donor sites. At maximal harvest density, FTSC donor sites were significantly less hypopigmented compared to STSGs, but no significant differences were observed in re-epithelialisation, contraction, blood flow or dermal thickness. In conclusion, implantation directly into deep partial-thickness burns is a viable option for the application of FTSCs, favouring lower expansion ratios like 1:50 or lower. Little difference in donor site morbidity was observed between FTSC at a maximal harvest density of 28% and STSGs, exceeding the optimal harvest density.     

Selective debridement of burn wounds using hydrosurgery system

In recent years, hydrosurgery is a technology that has been applied more and more in debridement procedures. However, the selectivity of hydrosurgery to cutaneous necrotic tissues has not been proved. This study was designed to investigate the possible tissue selectivity of hydrosurgery in the debridement in burn wounds. Deep partial‐thickness burns were produced on the back of porcine, and 48 hours later, both burn wounds and normal skin were debrided using the hydrosurgery system. Then tissue samples were taken, and histological staining was performed and observed under microscope. Burn wound resection rates and the normal skin damaged rates were measured. Our result indicated that the burn wounds were significantly more sensitive than the normal skin when the water pressure produced by the hydrosurgery system was set between 3000 and 5000 psi (pounds per square inch), that is, the necrotic tissue portions were debrided more easily than the normal skin tissue. Based on these data, we suggest that 3000 to 5000 psi of water pressure in the hydrosurgery system has a skin tissue selectivity in burn wounds.     

Healing of partial thickness porcine skin wounds in a liquid environment.

This study employs a liquid-tight vinyl chamber for the topical fluid-phase treatment of experimental wounds in pigs. Continuous treatment with normal saline significantly reduced the early progression of tissue destruction in partial thickness burns. Uncovered burns formed a deep layer of necrosis (0.49 +/- 0.004 mm, mean +/- SD) although burn wounds covered with empty chambers demonstrated less necrosis (0.14 +/- 0.01 mm), fluid-treated wounds formed no eschar, and little tissue necrosis could be detected (less than 0.005 mm). Topical treatment with hypertonic dextran increased water flux across burn wounds by 0.24 ml/cm2/24 hr (mean, n = 95) over saline-treated wounds during the first 5 days after wounding. When partial thickness burn and excisional wounds were immersed in isotonic saline until healed, the daily efflux of water, protein, electrolytes, and glucose across the wound surface declined during healing to baseline values found in controls (saline-covered unwounded skin). The declining protein permeability was used as a reproducible, noninvasive, endogenous marker for the return of epithelial barrier function. Saline-treated excisional wounds healed within 8.6 +/- 0.6 days (mean +/- SD, n = 27) and burn wounds within 12.1 +/- 1.4 days (mean +/- SD, n = 15). Healing of fluid-treated wounds occurred without tissue maceration and showed less inflammation and less scar formation than healing of air exposed wounds (no attempt was made to compare rates of healing between air- and fluid-exposed wounds). We consider the fluid-filled chamber a potentially very useful diagnostic, monitoring, and delivery system for wound-healing research and for human wound therapy.     

A randomised clinical trial comparing a hydrocolloid-derived dressing and glycerol preserved allograft skin in the management of partial thickness burns

Membranous dressings for the treatment of partial and mixed thickness burns are among the most innovative and promising new developments of the last years. In this study, we present data of a randomised prospective comparative study on a carboxymethylcellulose based dressing, Hydrofibre((R)) and glycerolized human allograft skin.In a 2 year period, 80 patients (40 for each material) were enrolled in the trial. Study wounds (<10% TBSA) that had not re-epithelialised after 14+/-3 days were debrided and grafted or, if small enough, managed with a topical antimicrobial agent. Mean total TBSA was 8.3+/-5.2%, study burn 3.7+/-2.0% for the Hydrofibre((R)) group and 7.3+/-4.3% total, 3.4+/-2.1% study burn for the allograft skin group (n.s. Wilcoxon rank sum test). No significant differences between groups were established in number of patients with superficial/deep burns.In both groups about 2/3 of the patients healed completely with the dressings applied (24/40 versus 27/40 for Hydrofibre((R)) versus allograft skin, respectively). However, a higher incidence of post-study excision and grafting was found in the Hydrofibre((R)) group (45% versus 15% in the allograft skin group, P=0.004, Mann-Whitney). At 10 weeks follow-up no significant differences were seen in scar colour, pigmentation, pliability, height or itching (Vancouver Scar Scale). Skin elasticity, measured by the Cutometer((R)), was significantly better for the allograft group (P=0.010, Wilcoxon). These differences were no longer found at 6 months and 1 year follow-up. Incidence of hypertrophy after 6 months was higher, but not significantly, in the Hydrofibre((R)) compared to the allograft skin group (52.5% versus 30%, P=0.09, chi-square).In view of the results from our comparative study on Hydrofibre((R)) versus allograft skin, we prefer the use of allograft skin for the category of larger burns of mixed depth, usually presented to burn centres. However, for partial thickness and small burns Hydrofibre((R)) can be the first choice in treatment.     

Cryopreserved cadaveric allografts for treatment of unexcised partial thickness flame burns: clinical experience with 12 patients

Partial thickness burns (PTB) usually heal within 3 weeks. Prevention of infection and desiccation of the wounds are crucial for optimal healing. Early tangential excision of the burn eschar and allografting prevent deepening of the burns, and are therefore advocated for treatment with the best functional and aesthetic results. For superficial partial thickness burns (SPTB) conservative use of topical antimicrobial agents with frequent dressing changes are implemented. We compared the conservarive treatment for PTBs and SPTBs to grafting cryopreserved cadaveric allografts with no prior excision.

Twelve patients with flame PTB areas were allografted after mechanical debridement without excision of the burn wounds. The allografts were cadaveric skin cryopreserved by programmed freezing and stored at −180°C for 30–48 months. Matching burns for depth and area were treated with silver sulfadiazine (SSD) one to two times daily until healing or debridement and grafting were required.

It was found that 80 per cent of the cryopreserved allografts adhered well and 76 per cent of the treated areas healed within 21 days, whereas only 40 per cent of the SSD-treated burns healed within 21 days.

Partial thickness burns can be treated successfully with viable human allografts (cryopreserved cadaveric skin) with no prior surgical excision. The burn wounds heal well within 3 weeks. For deep partial thickness burns (DPTB) treatment with allografts has no advantage if they have not been previously excised.     

异种脱细胞真皮和自体刃厚皮片复合移植修复关节部位深度烧伤创面

目的探讨异种脱细胞真皮(s-ADM)与自体刃厚皮片(auto-OTS)复合移植修复关节部位深度烧伤创面的效果.方法1999年5月～2000年4月共16例患者19个关节部位,烧伤总面积2%～48%,其中Ⅲ°烧伤面积1%～35%.均于伤后1～5天切痂,应用s-ADM和auto-OTS复合移植,使用面积25～150cm2,观察治疗效果.结果术后复合皮片的成活率为(90.80±18.34)%,优于邻近微粒皮移植区(P＜0.05),与邻近邮票状植皮区相似(P＞0.05);复合移植区局部光滑柔软,关节功能活动恢复良好.病理学检查提示复合移植区有正常细胞长入s-ADM中,胶原纤维排列较为整齐.结论s-ADM与auto-OTS复合移植对烧伤创面修复和预防瘢痕增生是有效而价廉的.     

荷负电气溶胶治疗Ⅱ度烧伤创面的临床效果及病理学观察

目的观察荷负电气溶胶(下称气溶胶)治疗Ⅱ度烧伤创面的效果。方法选择单纯浅Ⅱ、深Ⅱ度烧伤患者,随机分为:(1)气溶胶组:浅Ⅱ度180例、深Ⅱ度100例,伤后6h~2d开始用气溶胶治疗创面,l~2次/d,1.5h/次。(2)对照组:浅Ⅱ、深Ⅱ度患者各30例,常规治疗。(3)自身对照组:浅Ⅱ、深Ⅱ度患者各10例,同上用气溶胶治疗,但同一患者部分创面覆盖无菌金属片屏蔽气溶胶(屏蔽组),部分创面不屏蔽(非屏蔽组)。观察气溶胶治疗过程中患者创面的大体变化,治疗前后进行创面细菌培养,并监测其肝、肾功能及血生化指标有无改变。记录各组患者创面愈合时间。另制作深Ⅱ度烫伤大鼠模型,同前分为气溶胶组和对照组并治疗。取两组大鼠治疗前及治疗后1、2、3周的创面组织标本,作病理学观察。结果气溶胶治疗后患者创面渗出少,治疗前后均无细菌生长。总体来讲,气溶胶治疗前后患者肝、肾功能及血生化指标无明显改变。气溶胶组患者浅Ⅱ度创面伤后(6.3±1.6)d愈合,深Ⅱ度创面(15.1±3.1)d愈合,明显短于对照组相同深度创面[(11.3±1.4)、(21.2±1.4)d,P<0.01]。自身对照组中,相同烧伤深度的非屏蔽组与屏蔽组比较,创面愈合时间也明显缩短(P<0.01)。病理学检查显示,气溶胶组大鼠治疗后第3周皮肤结构已基本恢复正常,而对照组此时恢复较差。结论气溶胶能有效促进Ⅱ度烧伤创面的愈合且使用安全。     

几种深Ⅱ度烧伤创面处理方法的回顾及改善创面微循环的初步实验研究

目的回顾性分析几种深Ⅱ度烧伤创面的修复方法,探讨改善创面微循环对创面愈合的意义. 方法 (1)对于笔者单位烧伤患者的深Ⅱ度创面,应用削痂疗法治疗614例、磨痂疗法治疗32例、清创后异体皮覆盖86例、外用磺胺嘧啶银后创面暴露1 836例、外用中药京万红烫伤膏包扎治疗408例.统计、分析各种疗法的治疗效果.(2)制作大鼠深Ⅱ度烫伤模型.伤后5 min内分别由其尾静脉注入等渗盐水(对照组,10只)、巴曲酶(治疗组,10只),创面均外用磺胺嘧啶银.测定两组大鼠伤前及伤后0.5-72.0 h的创面皮肤血流灌注单位,计算其伤后14、18 d的创面愈合率、收缩率及创面愈合时间.用组织学方法观察两组大鼠创面愈合后的皮肤毛囊数. 结果 (1)削痂疗法术后2-3周创面愈合,其中烧伤总面积50%～79%TBSA的患者治愈率94.8%,总面积80%～98%TBSA者治愈率93.4%.磨痂疗法磨痂+异体皮覆盖术后(13.8±2.1)d创面愈合,无瘢痕形成.清创后异体皮覆盖其中82例患者术后(18.0±2.3)d创面愈合.外用磺胺嘧啶银后暴露其中1 658例患者用药后(26.0±3.2)d痂下愈合.外用京万红烫伤膏后包扎患者多有细菌感染,其中下肢创面愈合时间为(26.0±2.8)d.(2)治疗组大鼠伤后2.0-72.0 h创面局部血流灌注单位均明显高于对照组(P<0.01).伤后14、18 d,治疗组创面愈合率明显高于对照组(P<0.01),但两组创面收缩率接近(P>0.05).治疗组创面愈合时间短于对照组(P<0.01).伤后30 d,对照组大鼠真皮层中残存少量毛囊,数量明显少于治疗组(P<0.01). 结论深Ⅱ度烧伤后早期采用削痂、磨痂或清创后覆盖异体皮的方法处理创面,可减轻感染、缩短疗程、提高治愈率和愈合质量.使用巴曲酶可改善深Ⅱ度烧伤创面微循环,加快愈合速度.     

Treatment of second degree facial burns with allografts--preliminary results

Facial burns are very common and have significant clinical impact. However, the treatment regimen for superficial to deep facial burns is not well defined. The purpose of this study was to investigate the effects of cadaver skin grafting in deep partial thickness facial burns in comparison to standard care. In a prospective open study design severely injured patients with superficial and deep partial thickness burns were randomized into the group receiving open treatment with silversulfadiazine (standard n=5) or into the group receiving early superficial debridement followed by coverage with glycerolized cadaver skin (n=5). The outcome measures were time and quality of wound healing, and incidence of hypertrophic scarring at 3 and 6 months post burn. There were no significant differences in demographics between groups. In the group treated with the allogenic material time to reepithelialization was 10.5 days, while it was 12.4 days in the silversulfadiazine group (p<0.05). Scar quality was found to be significantly improved in the allogenic treatment group. Three and 6 months postburn there were no patients with significant hypertrophic scarring in the allogenic group while there were two patients who developed hypertrophic scars in the silversulfadiazine group (p<0.05). In this study, we demonstrated that glyzerolized cadaver allograft skin represents a superior biological dressing for shallow and deep partial thickness facial burns. This is in concordance with other reports on scalds. It would be worthwhile to perform more clinical studies with a larger number of patients to further evaluate the effect and function of allogenic skin for facial burns.     

A retrospective analysis of ambulatory burn patients: focus on wound dressings and healing times

INTRODUCTION

In this study, we retrospectively analysed healing times of ambulatory burn patients after silver-based dressings were introduced in late December 2005, and compared the results with those obtained before.

PATIENTS AND METHODS

Data were collected in November–December 2005 and in January–February 2006. We excluded from the study: (i) admitted patients; (ii) patients with mixed superficial partial thickness and deep partial thickness burns; (iii) patients with full-thickness burns; and (iv) operated patients that came for follow-up. We recorded the age, sex, cause (flame vs scald), burn depth, dressings used and healing times.

RESULTS

We selected 347 patients corresponding to 455 burned areas (64.4% superficial and 35.6% deep; 47.7% treated in 2005 and 52.3% in 2006). During the years 2005 and 2006, there was an increase in the use of silver-based dressings (2005, 9.7%; 2006, 38.7%; chi-squared test, P < 0.001) and a decrease in the use of paraffin gauzes (2005, 66.4%; 2006, 40.3%; chi-squared test, P < 0.001). The healing time of overall burns and of superficial burns showed no significant differences between 2005 and 2006. However, in deep partial thickness burns, a significant reduction was present (2006, 19; 2005, 29 days; Student''s t-test, P < 0.01). Among all dressings, paraffin gauzes had the shortest healing times in superficial burns (5 days); with silver-based dressings in deep burns, the healing times were nanocrystalline silver (16 days) and silver carboxymethylcellulose (21 days).

CONCLUSIONS

Results of our retrospective study would suggest that paraffin gauzes are a valuable option in superficial burns, while silver-based dressings are preferable in deep burns.     

Influence of a temporary synthetic skin substitute on capillary stasis in burns

The prognosis of deep partial thickness burns depends on several factors e.g. infection, wound dehydration, mechanical trauma etc. As shown by Zawacki years ago, the prognosis can be influenced by immediate post-burn application of various dressings. Appropriate dressings can cause early reversal of the capillary “stasis zone”, improving the prognosis. In his study, Zawacki showed that he could achieve the best results by using porcine skin grafts. In our study, we repeated Zawacki’s experimental model, replacing porcine skin graft with a temporary synthetic skin substitute, Omiderm^?. Deep partial thickness burns were inflicted on guinea pigs, who were then divided into three groups and treated as follows: removal of burn blister, burn blister left intact and removal of burn blister which was then replaced by Omiderm. At various times the animals were sacrificed and perfusion with India ink was performed in order to evaluate capillary stasis and its reversal. Upon statistical analysis of results we found that by using Omiderm we achieved early reversal of the stasis zone, as compared to the other groups. It seems to us that appropriate early treatment of deep partial thickness burns can make a significant difference to the prognosis of the burn wound.     

Early excision of major burns in children: effect on morbidity and mortality

The advantage of early excision and grafting in the treatment of limited full-thickness burns has been clearly established. The goal of the present study was to evaluate the role of early burn wound excision in major pediatric burns. Of the 470 pediatric burn admissions between 1979 and 1984 that were reviewed, 53 patients met the criteria of deep second or third degree burns greater than 25% total body surface area (TBSA). Of these, 20 had burn wound excision within 7 days (Early) and 33 had delayed excision and grafting (Late). The Early group, despite having greater transfusion requirements (69.4 v 36.2 cc/kg), had shorter hospital stays (35.3 v 49.1 d, P less than 0.05), fewer metabolic complications (20% v 79%, P less than 0.001), and less burn wound contamination (55% v 90%, P less than 0.01) than the Late group. Mortality was lower in the Early group (0% v 12%), but this was not statistically significant. Early excision and grafting are therefore recommended in the care of major burns in children.     

Burn wound assessment in porcine skin using indocyanine green fluorescence.

BACKGROUND: An accurate assessment of deep dermal burns within the first week after burn is still an unresolved clinical problem. Infrared-excited fluorescence of indocyanine green was examined as a method of early determination of burn depth. METHODS: Burns of varying depths were placed on the paraspinal region, flank, and abdomen of swine using a heated brass block. Fluorescence images of the burns were recorded 1, 24, 48, and 72 hours later. RESULTS: The ratio of fluorescence in 64 burn wounds relative to adjacent normal tissue identified wounds that healed and did not heal within 21 days with an accuracy of 100%, after accounting for the age of the burn. Higher fluorescence ratios were observed in newly placed burns relative to older burns having comparable depths. CONCLUSION: Deep partial-thickness burns were differentiated from deep dermal full-thickness burns in a porcine skin burn model independent of body location. Diagnosis was possible between 1 and 72 hours after injury.     

A pilot evaluation study of high resolution digital thermal imaging in the assessment of burn depth

Thermal imaging is a tool that can be used to determine burn depth. We have revisited the use of this technology in the assessment of burns and aim to establish if high resolution, real-time technology can be practically used in conjunction with clinical examination to determine burn depth. 11 patients with burns affecting upper and lower limbs and the anterior and posterior trunk were included in this study. Digital and thermal images were recorded at between 42 h and 5 days post burn. When compared to skin temperature, full thickness burns were significantly cooler (p < 0.001), as were deep partial thickness burns (p < 0.05). Superficial partial thickness burns were not significantly different in temperature than non-burnt skin (p > 0.05). Typically, full thickness burns were 2.3 °C cooler than non-burnt skin; deep partial thickness burns were 1.2 °C cooler than non-burnt skin; whilst superficial burns were only 0.1 °C cooler. Thermal imaging can correctly determine difference in burn depth. The thermal camera produces images of high resolution and is quick and easy to use.     

大鼠深Ⅱ度烧伤创面保留变性真皮并覆盖自体皮疗效观察

目的为探讨自体皮覆盖变性真皮修复深Ⅱ度烧伤创面的可行性提供实验依据。方法在大鼠背部造成直径3.5cm深Ⅱ度烧伤创面。伤后2—5d行创面浅层削痂保留变性真皮,同时在局部移植大张自体断层皮片。移植前和移植后不同时相点分别切取植皮区全层皮肤,光镜下观察其形态学及胶原纤维变化,并检测其生物力学改变。取移植大鼠同体背部正常皮肤作为对照指标。结果(1)保留的变性真皮为玻璃样变性。(2)大鼠自体皮移植术后7d,皮片与创面融合无法分离,光镜下可见真皮乳头及网状层。术后21d移植部位皮肤厚度、结构、形态与正常组织相似,有萎缩毛囊,胶原纤维条索密度逐渐增大接近融合。(3)鼠皮抗拉强度、最大应变值在术后逐渐增大,至60d时接近正常。结论将自体皮覆盖于变性真皮上用以修复深Ⅱ度烧伤创面,变性真皮能够逐渐复苏,使其结构、形态接近正常。     

烧伤后24 h内削痂防治深Ⅱ度创面进行性加深的组织学观察

目的　探讨烧伤后 2 4h内行削痂手术 ,对深Ⅱ度烧伤创面进行性加深的防治作用。方法　选择 12例深Ⅱ度烧伤患者 ,在伤后 2 4h内进行创面削痂手术。分别从手术前、手术后 (伤后 5～7d)和未手术创面 (伤后 5～ 7d)获取标本。采用HE染色、Masson′s染色和免疫组化技术标记Vi mentin抗原阳性细胞的方法 ,对创面组织标本进行组织学观察。　结果　随病程演进 ,未手术创面炎性反应程度明显加重 ,组织坏死范围扩大 ,原来残存的皮肤附件因炎症加重而消失 ;Masson′s染色棕红色范围扩大 ,亮绿色范围缩小 ;Vimentin抗原阳性细胞数量明显减少。伤后 2 4h内削痂创面局部炎症反应较未削痂创面明显减轻 ,可见新鲜肉芽形成和部分上皮修复 ,组织坏死范围未见进一步扩大 ,与未手术区比较差异有显著性意义 (P <0 .0 5 ) ;Masson′s染色亮绿色范围无明显缩小 ;Vimentin抗原阳性细胞数量明显多于未手术区 (P <0 .0 5 )。　结论　烧伤后 2 4h内削痂 ,能适时去除创面坏死组织、阻断组织变质性损害的加剧 ,从而有效改善深Ⅱ度创面的进行性加深现象 ,对创面愈合具有促进作用。     

Long-term experience with 1 per cent topical silver sulphadiazine cream in the management of burn wounds

Three hundred and forty-two patients with 10–50 per cent body surface area burns were studied prospectively over the 5-year period from 1982 to 1986 for the effectiveness of topical 1 per cent silver sulphadiazine. Various parameters were studied including: (i) healing time of deep partial skin thickness burns, (ii) eschar separation time, (iii) conversion rate of deep dermal burns to full skin thickness burns, (iv) burn wound surface bacterial flora and their changing pattern over the years, (v) incidence of invasive sepsis and (vi) overall mortality. There was a remarkable decrease in the time taken for the healing of deep dermal burns, and the conversion rate of deep dermal burns to full skin thickness was significantly reduced. Eschar separation was delayed considerably. There was a total change in the predominent surface micro-organisms from Staph. aureus, which was predominant in 1982, to pseudomonas species and klebsiella in 1986. Moreover, there was the emergence of a new variety of micro-organism within the last 2 years. The incidence of invasive infection and overall mortality was significantly reduced.     

锌-金属硫蛋白对大鼠皮肤烫伤创面的影响

目的研究Ｗｉｓｔａｒ大鼠深Ⅱ度烧伤后皮肤活力的下降与脂质过氧化反应的关系。方法以氧耗量、琥珀酸脱氢酶、Ｓｃｈｉｆ’ｓ碱及创面愈合时间为指标,以金属硫蛋白作为保护剂外用于烫伤创面,分别采用空白对照及５×１０－６ｍｏｌ／Ｌ,１×１０－５ｍｏｌ／Ｌ两种浓度,测定伤后８,２４,４８ｈ各项指标的变化。结果皮肤氧耗量、琥珀酸脱氢酶活性下降,Ｓｃｈｉｆｓ碱含量明显升高。应用金属硫蛋白保护后,皮肤活性（氧耗及琥珀酸脱氢酶含量）均显著高于对照组（Ｐ＜０．０５或Ｐ＜０．０１）,同时Ｓｃｈｉｆ’ｓ碱含量下降（Ｐ＜０．０５或Ｐ＜０．０１）,创面愈合时间平均提前２天。结论烫伤组织损伤与脂质过氧化反应有一定的关系,而金属硫蛋白有一定保护作用。     

Laser Doppler imaging prediction of burn wound outcome in children

The ability of laser Doppler imaging (LDI) to evaluate burn depth in children was investigated. Fifty-seven patients were prospectively studied over a 10-month period. Each patient was clinically assessed, photographed and independently scanned between 36 and 72 h of the burn. Patients were reviewed until wound healing had occurred within 12 days or skin grafting had been performed. The median age was 1 year and 10 months (range 5 months to 15 years and 8 months). The median body surface area burnt was 7.0% (range 0.5-30%). In 30 patients, the burn did not heal within 12 days, 17 of which were grafted. Clinical examination correctly determined 66% of deep partial or full thickness burns between 36 and 72 h of injury compared to 90% using LDI. The LDI was also more specific; correctly diagnosing 96% of superficial partial thickness burns as opposed to 71% on clinical examination. Moderate degrees of movement did not appear to limit the accuracy of the scan.