Since 1970 surgeons have managed deep burns by surgical debridement and autografting. We tested the hypothesis that enzymatic debridement with NexoBrid would remove the eschar reducing surgery and achieve comparable long-term outcomes as standard of care (SOC). In this Phase 3 trial, we randomly assigned adults with deep burns (covering 3-30% of total body surface area [TBSA]) to NexoBrid, surgical or nonsurgical SOC, or placebo Gel Vehicle (GV) in a 3:3:1 ratio. The primary endpoint was complete eschar removal (ER) at the end of the debridement phase. Secondary outcomes were need for surgery, time to complete ER, and blood loss. Safety endpoints included wound closure and 12 and 24-months cosmesis on the Modified Vancouver Scar Scale. Patients were randomized to NexoBrid (n = 75), SOC (n = 75), and GV (n = 25). Complete ER was higher in the NexoBrid versus the GV group (93% vs 4%; P < .001). Surgical excision was lower in the NexoBrid vs the SOC group (4% vs 72%; P < .001). Median time to ER was 1.0 and 3.8 days for the NexoBrid and SOC respectively (P < .001). ER blood loss was lower in the NexoBrid than the SOC group (14 ± 512 mL vs 814 ± 1020 mL, respectively; P < .0001). MVSS scores at 12 and 24 months were noninferior in the NexoBrid versus SOC groups (3.7 ± 2.1 vs 5.0 ± 3.1 for the 12 months and 3.04 ± 2.2 vs 3.30 ± 2.76 for the 24 months). NexoBrid resulted in early complete ER in >90% of burn patients, reduced surgery and blood loss. NexoBrid was safe and well tolerated without deleterious effects on wound closure and scarring.
Burn injuries are a significant global health concern, with more than 11 million people requiring medical intervention each year and approximately 180,000 deaths annually. Despite progress in health and social care, burn injuries continue to result in socioeconomic burdens for victims and their families. The management of severe burn injuries involves preventing and treating burn shock and promoting skin repair through a two-step procedure of covering and closing the wound. Currently, split-thickness/full-thickness skin autografts are the gold standard for permanent skin substitution. However, deep burns treated with split-thickness skin autografts may contract, leading to functional and appearance issues. Conversely, defects treated with full-thickness skin autografts often result in more satisfactory function and appearance. The development of tissue-engineered dermal templates has further expanded the scope of wound repair, providing scar reductive and regenerative properties that have extended their use to reconstructive surgical interventions. Although their interactions with the wound microenvironment are not fully understood, these templates have shown potential in local infection control. This narrative review discusses the current state of wound repair in burn injuries, focusing on the progress made from wound cover to wound closure and local infection control. Advancements in technology and therapies hold promise for improving the outcomes for burn injury patients. Understanding the underlying mechanisms of wound repair and tissue regeneration may provide new insights for developing more effective treatments in the future.
- MeSH
- hojení ran MeSH
- jizva etiologie prevence a kontrola chirurgie MeSH
- kůže patologie MeSH
- lidé MeSH
- popálení * chirurgie patologie MeSH
- transplantace kůže metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Oddělení plastické chirurgie a léčby popálenin bylo založeno jako součást nově vytvořené II. chirurgické kliniky LF UK a FN Hradec Králové v roce 1985. Přes skromné začátky postupně rozvíjelo činnost v daném oboru a plně pokrývalo potřeby svého regionu s téměř 1 mil. obyvatel. V článku jsou zaznamenány nejdůležitější momenty v jednotlivých etapách vývoje zasahujícího do čtyř dekád. Důraz je položen na personální aspekty, technické a prostorové vybavení pracoviště. Oddělení vždy pracovalo na principu mezioborové spolupráce v rámci kliniky i dalších oborů FN. Za 35 let se oddělení pevně etablovalo do spektra specializovaných činností a plně pokrývá potřeby odborné péče poskytované ve FN Hradec Králové.
Background: The Department of Plastic Surgery and Burns Treatment was established as a part of the newly created 2nd Department of Surgery of Charles University, Medical Faculty and the University Hospital in Hradec Králové in 1985. Through modest beginnings, activities of the Department expanded up to full coverage of specialized care in plastic surgery within the region with almost one million inhabitants. Aim: In this article, the most important events of several historical phases related to almost four decades are described. The aspects of medical personnel, technological and space equipment are especially emphasized. The Department has always been working on the principles of interdisciplinary co-operation within the department itself and other departments within the hospital as well. Over the past 35 years, the Department of Plastic Surgery and Burns Treatment has been firmly entrenched in the spectrum of specialized activities of the University Hospital in Hradec Králové.
- MeSH
- chirurgická centra dějiny MeSH
- dějiny 20. století MeSH
- dějiny 21. století MeSH
- lidé MeSH
- nemocnice univerzitní MeSH
- nemocniční oddělení * dějiny MeSH
- plastická chirurgie * MeSH
- popálení chirurgie MeSH
- zákroky plastické chirurgie * MeSH
- Check Tag
- dějiny 20. století MeSH
- dějiny 21. století MeSH
- lidé MeSH
- Publikační typ
- historické články MeSH
- Geografické názvy
- Česká republika MeSH
Úvod: Hypertrofické jizvy jsou nechtěným a mutilujícím následkem hlubokých popálenin, dále vystupňovány jsou u rozsáhlých popáleninových úrazů. Frakční CO2 laserová terapie je jednou z metod komplexní léčby hypertrofických jizev a používá se od roku 2007. Přestože její účinnost byla v klinické praxi objektivně prokázána, nebyly stanoveny optimální parametry nastavení. Pro hodnocení účinku laserové terapie se používají dříve navržené hodnotící nástroje, které dobře postihují kvalitu jizev, ale nedokáží postihnout specifické změny pro provedené laserové terapii. Materiál a metody: Frakční CO2 laserová terapie hypertrofických jizev je na Oddělení plastické a estetické chirurgie FN Olomouc prováděna od roku 2017; systematická studie účinků probíhala v letech 2019–2020. Celkem bylo léčeno 25 hypertrofických jizev u 13 pacientů, každá z jizev byla frakční CO2 laser terapií ošetřena více než jednou. Výsledky: Statistickou analýzou dat bylo detekováno statisticky významné zlepšení textury jizev a zlepšení celkového funkčního a estetického výsledku. U jizev, jejichž výška byla před zahájením laserové terapie vyšší než 2 mm, došlo k signifikantní redukci výšky pod 2 mm (62,5 % jizev). Korelační analýzou byla detekována statisticky signifikantní pozitivní korelace mezi energií laserového paprsku a redukcí rozsahu jizev prominujících nad nivó zdravého okolí. Frakční CO2 laserová terapie ukázala statisticky významnou účinnost při redukci rizik spojených s plnoformátovou CO2 laserovou terapií. Frakční ošetření bylo pacienty velmi dobře tolerováno, topická anestezie 5% gelem lidokainu byla dostatečná u 24 z 25 pacientů. Následné hojení probíhalo u všech pacientů bez komplikací. Závěr: Frakční CO2 laserovou terapií bylo dosaženo statisticky významného zlepšení textury a redukce výšky hypertrofických jizev a zlepšení celkového funkčního i estetického výsledku.
Introduction: Hypertrophic scars are an unwanted and mutilating consequence of deep burns, and are further exacerbated by extensive burn injuries. Fractional CO2 laser therapy is one of the methods for complex treatment of hypertrophic scars, it has been used since 2007 [1]. Although its effectiveness has been objectively proven in clinical practice, the optimal settings parameters have not been determined. To evaluate the effect of laser therapy, previously designed evaluation tools are used, which evaluate the quality of scars well, but fail to capture specific changes for the performed laser therapy. Material and methods: Fractional CO2 laser therapy of hypertrophic scars is performed at the Department of Plastic and Esthetic Surgery, University Hospital Olomouc, since 2017 and the systematic study took place in 2019–2020. In common, 25 hypertrophic scars were treated in 13 patients; each scar was treated by fractional CO2 laser therapy more than once. Results: Statistical analysis detected statistically significant improvement of the texture of the scars and the improvement of overall functional and esthetic result. We found significant reduction of the height under 2 mm (62,5% of scars) in scars with the height > 2 mm before the initiation of laser therapy. Correlation analysis detected a statistically significant positive correlation between the energy of laser beam and the reduction volume of the scar protruding above the niveau of healthy surrounding tissue. Fractional CO2 laser therapy showed statistically significant efficacy in the reduction of the risks associated with full-format CO2 laser-therapy. Fractional treatment was very well tolerated by the patients. Topical 5% lidocaine gel was effective in 24 out of 25 patients. Further healing was without complications in all patients. Conclusion: Fractional CO2 laser therapy has achieved statistically significant improvement of the texture and reduction of hypertrophic scars and overall improvement of functional and esthetic result in our study.
The limited amount of donor sites and loss of dermis are major challenges in the therapy of extensively burned patients. Here, we present a complex treatment approach of an eight-year-old boy with full-thickness burns on 90% of the total body surface area, using simple and efficient techniques of tissue engineering. To obtain sufficient skin for grafting we repeatedly harvested the same anatomical areas. Acceleration of donor site healing was achieved by treatment with a suspension of noncultured autologous skin cells (NASC) and acellular porcine dermis (Xe-Derma (XD), Czech Republic). Moreover, such wound management allowed up to six reharvestings, compared with one-to-three procedures following routine treatment. Bilayer Integra template (Integra LifeSciences Corp., US) was used as the dermal substitute in over 60% of full-thickness burns. Following successful vascularisation of the neodermis in 3-4 weeks, the templates were covered with meshed split-thickness skin grafts (STSG), or Meek autografts, and facilitated by NASC/XD. We may conclude that such a 'sandwich' technique approach, combining four biological covers (Integra, STSG, NASC and XD), significantly contributed to the successful skin repair of the patient.
- MeSH
- dítě MeSH
- hojení ran fyziologie MeSH
- lidé MeSH
- popálení chirurgie MeSH
- prasata MeSH
- transplantace kůže * MeSH
- umělá kůže * MeSH
- výsledek terapie MeSH
- zvířata MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- Geografické názvy
- Česká republika MeSH
Rapid wound closure in extensively burned patients has remained one of the major unresolved issues of medicine. Integra® is the most widely established artificial skin, which is composed of a porous matrix of cross-linked bovine collagen and chondroitin 6-sulphate covered by a semi-permeable silicone layer. We present here a (immuno)histological study of a severely burned patient with a full-thickness burn treated with a tissue-engineered dermal template (Integra®) and split-thickness skin graft-based protocol. Immunohistochemical investigation of the artificial dermis revealed that immune cell infiltration reached its peak on day 10. Tissue immunophenotyping found an increase in CD3+ cells over the course of the study as well as CD4 and CD8 positivity on day 40, indicating remaining T-cell subpopulations. We observed weak/no infiltration of NK cells (CD56+). In conclusion, the use of bi-layer Integra® represents a feasible and safe procedure resulting in formation of non-irritating dermal substitutes.
- MeSH
- chondroitin sulfáty MeSH
- hojení ran MeSH
- lidé MeSH
- popálení * chirurgie MeSH
- skot MeSH
- transplantace kůže MeSH
- umělá kůže * MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- skot MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Third degree burn trauma of the head and neck requires an interdisciplinary approach. After emergency care and hemodynamic stabilization of the patient the focus lies on the reconstruction of the damaged tissue. The options of reconstruction are influenced by the general condition of the patient and by the condition of the surrounding tissues. The deep defects of the head are dangerous for a high risk of wound infection and possible fatal complications. In particular cases the first methods of choice for closure of the defect may be ineffective and a free flap transfer should be considered. We present a case report of a 62-year-old woman who suffered third degree burn trauma of the head and neck leading to a deep defect of the forehead reaching behind the hairline. On the bottom there was an exposed bone with no healing tendency. Due to surrounding fragile scarred tissue we chose a free flap transfer using serratus anterior muscle as a method of closure. The flap was fully healed and provided good aesthetic and functional outcome.
- MeSH
- lidé středního věku MeSH
- lidé MeSH
- popálení * chirurgie MeSH
- volné tkáňové laloky MeSH
- výsledek terapie MeSH
- zákroky plastické chirurgie metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
INTRODUCTION: Artificial skin has become the treatment of choice in extensive, full-thickness thermal injuries. The longest follow-up of the healing process in burn sites covered with the Integra Bilayer Matrix Wound Dressing onto the wound published to date was at around five years after application. In our case report, we describe the clinical and histological analysis of an extensive, full-thickness thermal injury 14 years on from treatment with the bilayer matrix wound dressing. CASE STUDY: A nine-year-old boy suffered a full-thickness skin loss over 85% of his body surface area following a fire accident. The bilayer matrix wound dressing was used on both legs and covered almost 30% of his body surface area. Cosmetic and functional results were satisfactory. Histological analysis performed nine years after the application of the bilayer matrix wound dressing onto the wound showed a double-layered skin composition with changes in the fibrous component of the dermis. CONCLUSION: Despite satisfactory short- and long-term clinical results from applications of the bilayer matrix wound dressing, we found important differences in microstructure when compared with the physiological condition.
- MeSH
- chondroitin sulfáty * MeSH
- dítě MeSH
- hojení ran MeSH
- kolagen * MeSH
- lidé MeSH
- popálení patologie chirurgie MeSH
- umělá kůže * MeSH
- zákroky plastické chirurgie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Východiska: Předpokladem úspěšné léčby rozsáhlého popáleninového úrazu je časná nekrektomie a kožní autotransplantace, limitujícím faktorem je nedostatek odběrových ploch. Možným řešením se jeví metoda Meek mikrograftingu, kterou v roce 1958 publikoval americký lékař C. P. Meek. Kožní štěpy jsou prokrájeny na mikrografty a expandovány v poměru 1:3, 1:4, 1:6 nebo 1:9. I při malém rozsahu odběrových ploch je tak možné transplantovat rozsáhlé plochy po nekrektomii. Materiál a metody: Meek mikrografting byl na Popáleninovém centru FN Ostrava poprvé použit v roce 2013. Dosud jsme takto provedli 14 operací u 4 pacientů s rozsáhlým popáleninovým traumatem. Pooperačně bylo sledováno přihojení mikrograftů, rychlost hojení a následné jizvení se zaměřením na vznik jizevnatých kontraktur. Výsledky: Průměrná úspěšnost zhojení ploch transplantovaných mikrografty byla 86,5 %. Nejlépe se hojily plochy transplantované odloženě po nekrektomii. K rozvoji jizevnaté hypertrofie došlo na plochách transplantovaných mikrografty i meshovanými štěpy. V oblastech mikrograftingu nedošlo ke vzniku jizevnatých kontraktur s nutností operačního řešení. U jednoho pacienta bylo nutné operační uvolnění jizevnatých kontraktur v oblasti transplantace meshovanými štěpy. Diskuse: Meek mikrografting osvědčil svoje výhody. K přípravě mikrograftů lze využít i velmi malé kožní štěpy, u nichž je meshování nemožné. Při expanzi meshovaných štěpů 1:3 a vyšší je tyto třeba krýt xenotransplantáty či allotransplantáty. U mikrograftů není sandwichové krytí dle našich zkušeností nutné ani při expanzi 1:6. V oblastech mikrograftingu nedošlo ke vzniku závažných jizevnatých kontraktur, lze spekulovat o možné menší rizikovosti Meek mikrograftů oproti meshovaným štěpům. Nevýhodou meek mikrograftingu je vyšší ekonomická náročnost. Závěr: Meek mikrografting potvrdil svoji efektivitu pro operační léčbu hlubokých popálenin u rozsáhlých termických úrazů spojených s nedostatkem odběrových ploch.
Background: Early necrectomy and skin autotransplantation are prerequisites for successful treatment of extensive burns. Insufficient autograft donor site availability is a limiting factor. The Meek micrografting technique, published by C. P. Meek in 1958, appears to be a potential solution. Skin grafts are cut into micrografts and expanded at a ratio of 1:3, 1:4, 1:6 or 1:9. Thus, even in cases with limited donor site availability, it is possible to cover large areas after necrectomy. Material and Methods: Meek micrografting was first used at the University Hospital Ostrava Burns Centre in 2013. To date, 14 operations have been performed in 4 patients with extensive burn trauma. Engraftment, healing rate, and subsequent scarring (with a particular focus on scar contracture formation) were observed postoperatively. Results: The average micrograft success rate was 86.5%. The best success rates were observed in areas with deferred transplantation after necrectomy. Hypertrophic scarring occurred in both Meek and meshed transplant areas. No scar contractures requiring surgical management developed in micrografted areas. Surgical scar contracture release was required in 1 patient who underwent meshed graft transplantation. Discussion: The Meek technique demonstrated significant advantages. Micrografts can be prepared with very small skin grafts, which is impossible with the mesh technique. Meshed grafts with expansion ratios of 1:3 or higher require allograft or xenograft coverage. In our experience, overlays were not necessary for micrografts with a 1:6 expansion ratio. Given that no serious scar contractures developed in micrografted areas, we speculate that micrografts may pose a lower risk for their development when compared to meshed grafts. The disadvantage of the Meek technique is greater economic demands. Conclusion: Meek micrografting is effective in the surgical management of deep burns in extensive thermal injuries with limited donor site availability...
- Klíčová slova
- Meek mikrografting,
- MeSH
- autologní transplantace MeSH
- délka pobytu MeSH
- dospělí MeSH
- expanze tkáně * MeSH
- hojení ran MeSH
- jizva hypertrofická MeSH
- jizva MeSH
- lidé MeSH
- popálení * chirurgie MeSH
- transplantace kůže * metody MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
