Prevalence and Risk Factors for Hypertrophic Scarring of Split Thickness Autograft Donor Sites in a Pediatric Burn Population

TitlePrevalence and Risk Factors for Hypertrophic Scarring of Split Thickness Autograft Donor Sites in a Pediatric Burn Population.ObjectiveThe split-thickness autograft remains a fundamental treatment for burn injuries; however, donor sites may remain hypersensitive, hyperemic, less pliable, and develop hypertrophic scarring. This study sought to assess the long-term scarring of donor sites after pediatric burns.MethodsA retrospective review of pediatric burn patients treated at a single institution (2010–2016) was performed. Primary outcomes were prevalence of donor site hypertrophic scarring, scarring time course, and risk factor assessment.Results237 pediatric burn patients were identified. Mean age at burn was 7 yrs., mean %TBSA was 26% with 17% being Full Thickness. Mean follow-up was 2.4 yrs. Hypertrophic scarring was observed in 152 (64%) patients with 81 (34%) patients having persistent hypertrophic scarring through long-term follow-up. Patient-specific risk factors for hypertrophic scarring were Hispanic ethnicity (P = 0.03), increased %TBSA (P = 0.03), %Full Thickness burn (P = 0.02) and total autograft amount (P = 0.03). Donor site factors for hypertrophic scarring were longer time to epithelialization (P < 0.0001), increased donor site harvest depth (P < 0.0001), autografts harvested in the acute burn setting (P = 0.008), and thigh donor site location (vs. all other sites; P < 0.0001). The scalp, arm, foot, and lower leg donor sites (vs. all other sites) were less likely to develop HTS (P < 0.0001, 0.02, 0.005, 0.002, respectively), along with a history of previous donor site harvest (P = 0.04).ConclusionsHypertrophic scarring is a prominent burden in donor site wounds of pediatric burn patients. Knowledge of pertinent risk factors can assist with guiding management and expectations.     

Biological resurfacing of the knee: a review of surgical management

Lesions of the articular surfaces of the knee have been managed by various techniques over the last 50 years. Surgical management has involved: excising the damaged area, refashioning the underlying bone to produce a fibrous response, and introducing allograft, autograft and synthetic materials to encourage a repair matrix. The techniques and their pitfalls are reviewed and discussed, and suggestions made as to the direction of future studies for the repair of osteochondral lesions in the painful knee.     

Identification of ''short-lived'' and ''long-lived'' patients at presentation of idiopathic myelofibrosis

Mobilization of Philadelphia chromosome (Ph) negative blood progenitors was attempted in 23 newly diagnosed chronic myeloid leukaemia (CML) patients using a regimen of cyclophosphamide (CY) 5 g/m² and rHUG-CSF 150 μg/m² daily. This regimen was well tolerated with no major adverse events reported. More than 2 × 10⁶/kg CD34⁺ cells were collected in 21 patients (91%). Predominantly Ph-negative mobilization (0–25% Ph-positive) was seen in 30% of cases overall and was confined to patients with a Sokal prognostic score < 1 (7/11 with Sokal score <1; 0/12 with Sokal score ≥1). Within the low Sokal index group, a low WBC count pre-mobilization and a low WBC nadir both correlated strongly with Ph-negative mobilization ( P  =0.006 and 0.02 respectively). Five of 19 patients receiving at least 6 months of Roferon A therapy post mobilization achieved a major cytogenetic response; all five patients were Ph-negative mobilizers. Therefore CML patients can be divided into a good-prognosis group in whom predominantly Ph-negative progenitors can be mobilized using a regimen of moderate intensity if haematological control is achieved pre-mobilization, and a poor-prognosis group for whom predominantly Ph-positive cells are mobilized with this regimen regardless of haematological control.     

翼状胬肉患者手术前后泪膜功能的变化

目的通过观察翼状胬肉患者行胬肉切除联合自体角膜缘上皮移植手术前后泪膜功能的变化,分析翼状胬肉及其手术治疗与患者泪膜功能的关系。方法对30例(30眼)翼状胬肉患者行胬肉切除联合自体角膜缘上皮移植术,以对侧健眼为对照,于术前1天、术后2周、4周、8周分别进行泪液分泌(SchirmerⅠ)试验、泪膜破裂时间(breakuptime,BUT)检查;术前1天、术后4周、术后8周行泪液羊齿状物试验(mucusferntest,MFT)检查。结果翼状胬肉眼术前与对侧健眼比较:SchirmerⅠ试验结果差异无显著性(P>0.05);BUT缩短(P<0.05);MFT结果正常的比例减少(P<0.05)。翼状胬肉眼手术前后比较:术前和术后不同时间的SchirmerⅠ试验结果差异无显著性(P>0.05);术后4周、8周BUT值较术前延长(P<0.05);术后4周、8周MFT结果正常的比例较术前增加(P<0.05)。结论翼状胬肉患者泪膜功能明显异常,手术切除胬肉联合自体角膜缘上皮移植术可使患者泪膜功能得到一定程度的改善。     

不同直径自体神经移植效果的比较研究

目的　建立不同直径鼠自体神经移植模型,探讨在自体神经移植中神经直径对移植效果的影响。方法　将4 0只SD大鼠随机分成A、B、C、D 4组,均造成右侧坐骨神经缺损模型,分别用自体坐骨神经、桡神经、正中神经、尺神经进行修复。术后4周、6周,各组分别取5只动物观察足部溃疡情况,记录运动神经传导速度,取神经组织镜下观察神经再生情况。结果　术后6周神经再生较术后4周好(P <0 .0 1) ,而A、B、C、D各组间无显著性差异(P >0 .0 5 )。术后的时间与移植神经的直径之间无交互作用(P >0 .0 5 )。结论　粗神经移植在神经冲动的电传导上占优势,而细神经移植段能够优先获得良好的血供,并不能简单地认为越粗越好或越细越好,临床上应根据具体病情来选择供体神经的粗细。     

羊膜移植与自体角膜缘移植治疗翼状胬肉的初步疗效对照

目的 比较评价新鲜羊膜移植与自体角膜缘移植在翼状胬肉治疗中的效果。方法 翼状胬肉患者42例48眼。分为羊膜移植组及角膜缘移植组，每组24眼。分别行翼状胬肉切除联合新鲜羊膜移植和自体角膜缘移植。术后随访12～19个月，观察翼状胬肉复发率。结果 羊膜移植组6眼（26％）复发，角膜缘移植组3例（13．6％）复发。在初发性胬肉治疗中两组分别有3眼（20％）、2眼（14％）复发；在复发性胬肉治疗中两组分别有3眼（37％）、1眼（12．5％）复发。结论 在防止胬肉复发方面，羊膜移植与角膜缘移植在治疗初发性胬肉中疗效相当；角膜缘移植治疗复发性胬肉疗效优于羊膜移植。     

Displacement of the incisive foramen in conjunction with implant placement in the anterior maxilla without jeopardizing vitality of nasopalatine nerve and vessels: a novel surgical approach

Accurate implant placement in the anterior maxilla is essential in achieving optimal prosthetic rehabilitation with proper function and acceptable esthetic and phonetic demands. One of the preferable prosthetic solutions to restore a missing maxillary incisor in young adults is by an implant-supported crown. Bone resorption together with an enlarged incisive foramen, challenge proper implant placement. A simultaneous procedure where the implant osteotomy site penetrated the incisive canal is presented. A configurated cortico-cancellous block graft core was adjusted to fit the foramen while its soft tissue content was pushed back posteriorly but not removed. This procedure was followed by an immediate implant placement. Re-entry at 9 months revealed solid bone support embracing the implant body. Although the size of the incisive foramen diminished significantly, the nasopalatine branches were still evident. No complications and/or loss of sensation were observed.     

自体骨用于脊柱后路植骨融合中BMP-2、BMP-7的表达

目的:观察自体骨用于脊柱后路融合过程中骨形态发生蛋白2-7(BMP-2、BMP-7)的表达,并探讨其在脊柱融合过程中的作用机制。方法:成年雄性新西兰大白兔36只,随机分为2组,每组18只,在兔腰椎5、6横突植入自体骨(自体骨组)、异体骨(异体骨组)制作腰椎后路融合模型。分别于第2、4、7、14、27、35天处死兔,取其融合节段标本,显微镜下观察,并用图文分析软件计算软骨生成面积和BMP-2、BMP-7阳性细胞数。结果:在脊柱后路融合模型中自体骨组、异体骨组软骨生成面积分别为(51±4)%、(40±5)%,自体骨组明显大于异体骨组(P<0.05)。脊柱融合过程中,各时间点自体骨组BMP-2、BMP-7表达均高于异体骨组,差异有统计学意义(P<0.05)。第14~27天表达达到高峰。结论:在脊柱后路植骨融合中,自体骨植骨融合质量优于异体骨,在脊柱融合异位成骨的过程中,自体骨BMP-2、BMP-7起到关键性作用。     

A morphological comparison of interposed freeze-thawed skeletal muscle autografts and interposed nerve autografts in the repair of the rat facial nerve

Freeze-thawed co-axially aligned skeletal muscle autografts provide new concept in peripheral nerve repair, and are being investigated in the repair of mixed motor/sensory nerves. These grafts provide an orientated matrix of large basement membrane tubes through which regenerating axons can migrate and reinnervate the distal nerve. Using the buccal branch of the rat facial nerve as a model, we compared five freeze-thawed muscle autografts with five interposed nerve autografts. Some 300 days after grafting, the morphology of the distal nerve was evaluated. When the two groups were assessed morphometrically, it was found that nerve grafts showed a small but significant improvement over muscle grafts in respect of indices of the fibre maturation.     

洛沙坦对兔自体静脉移植物平滑肌细胞增殖的影响

目的　探讨洛沙坦对自体静脉移植物平滑肌细胞增殖的影响 ,寻找防止静脉移植物内膜增生的合理、有效的途径。方法　 4 8只新西兰大白兔随机分为治疗组和对照组 ,每组各 2 4只 ,分别于自体静脉移植术后1、3、5、7d ,每组处死 6只动物 ,取移植物行免疫组织化学染色 ,对增殖细胞核抗原阳性 (PCNA)的平滑肌细胞进行定性、定量观察。结果　术后第 1天PCNA即呈阳性反应。术后第 5天细胞增殖达到高峰 ,对照组PCNA阳性细胞数为 2 4 31± 4 0 9,明显高于治疗组 (1372± 2 6 3) ,两者相差异有显著性 (P <0 .0 1) ;对照组增殖指数为 89± 3,显著高于治疗组 (5 1± 4 ,P <0 .0 1)。结论　洛沙坦可抑制自体静脉移植物的平滑肌细胞增殖 ,对预防冠状动脉旁路移植术后静脉桥狭窄可能有一定的临床意义。