Cases reported "Burns"

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21/70. Wound bed preparation: approaches to replacement of dermis.

    Cultured epidermal autograft (CEA) can provide a valuable source of protection in patients with large amounts of skin loss as a result of thermal injury. An unanswered question is: will the long-term outcome be better if a dermis is present? We have approached the problem by attempting to retain the cryopreserved allograft dermis that is originally placed as temporary wound coverage. The retained dermis provides a substantial, uniform, well-vascularized bed that accepts the CEA. The areas that are grafted with CEA have remained durable, and cosmesis is superior to that which results from meshed grafts. We report experience with our technique in three patients with total body surface area burns of 70% to 90% who had cryopreserved meshed (1:1.5) allografts placed immediately after tangential excision of their burns. Excision and application of the allografts were complete by day 14 or 15. CEA was placed on allodermis on days 24, 28, and 35, respectively. patients 1 and 2, who survived and returned to work, had a "take" of at least a 90% of allograft and a permanent coverage CEA take of 88% and 81%, respectively. Patient 3, who died, had an allograft take of only 20% to 30% and a CEA take of less than 10%.
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ranking = 1
keywords = allograft
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22/70. Comparison of cultured epidermal autograft and massive excision with serial autografting plus homograft overlay.

    The chief determinant of mortality in severe burn injuries has been the size and severity of the wound. Early massive excision of the wound has increased the median lethal dose to 98% of total body surface area burn but presents the problem of wound closure. Autograft substitutes must be used for a large burn. We report our experience with early massive excision in the treatment of 47 pediatric patients with burns who had greater than 80% total body surface area burn and greater than 80% full-thickness burn. Four patients died within hours of admission. Fifteen patients died of sepsis and multiorgan failure; the primary source of bacterial contamination was the open wound. The 28 survivors received approximately 2.0 m2 2:1 homograft until autograft became available. A case report of a 10-year-old boy illustrates the use of two types of cultured epidermal autograft, one "homegrown" and one commercially produced.
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ranking = 1.8151880715634
keywords = homograft
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23/70. First experience of the use bone marrow mesenchymal stem cells for the treatment of a patient with deep skin burns.

    female patient with extensive skin burn (I-II-IIIAB skin burn, total area 40%, area of IIIB degree 30%) was treated using transplantation of allogenic fibroblast-like bone marrow mesenchymal stem cells onto the surface of deep thermal burn. The study of wound healing dynamics after transplantation of allogenic fibroblast-like mesenchymal stem cells confirmed high tempo of wound regeneration in the presence of active neoangiogenesis. Due to this, autodermoplasty of burn wounds could be carried out with good results as early as on day 4 after transplantation of fibroblast-like mesenchymal stem cells; this led to more rapid healing of donor zones and accelerated rehabilitation of the patient.
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ranking = 0.17876041666667
keywords = transplantation
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24/70. role of acellular dermal matrix allograft in minimal invasive coverage of deep burn wound with bone exposed--case report and histological evaluation.

    A sandwich graft was applied to the debrided cortical bone layer of the tibia in the case of a 72-year-old male patient with full-thickness necrotic burn injury. The combined graft consisted of a dermal template material and autologous split thickness skin graft. After application, the graft was found totally accepted and provided good functionality with acceptable appearance. Histopathologic evaluation revealed a complete take with revascularisation of the implant. Supporting lamellar bony trabecules were also seen in the deep dermal dermis representing a connection to the underlying bone. The use of the dermal matrix in deep burn exposing the bone provides a satisfactory functional result and good cosmetic appearance.
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ranking = 0.8
keywords = allograft
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25/70. Our experience in the nutritional support of a burned child treated with integra.

    Integra artificial skin was applied on 16% of TBSA after necrectomy on a 7-month-old girl who was scalded on 26% of TBSA by her mother when she was cooking goulash. Nutritional parameters were monitored during the period of 25 days from the 1st necrectomy and application of Integra up to the first autotransplantation--in the period when the other burnt surfaces were almost healed. The average intake of proteins and energy to achieve normal levels of monitored nutritional parameters was lower than that recommended by calculations for similarly burnt children. Our observation is similar to that of King.
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ranking = 0.059586805555556
keywords = transplantation
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26/70. Reconstruction of facial burn sequelae utilizing tissue expanders with embodiment injection site: case report.

    Although highly specialized burn centers have significantly reduced mortality rates following extensive total body surface area burns, survivors are often left with grotesque facial disfigurement. Hypertrophic scars and tissue defects are the most common cause of functional and aesthetic problems in the head and neck region. Plastic surgeons use full-thickness or split-thickness skin grafts, pedicled flaps, free flaps, transplantation of bone or cartilage and tissue expansion. The authors present a case of a patient who suffered from third-degree flame burns to the face. Prior skin grafting procedures left him with severe scar deformity of the face. The patient was treated utilizing multiple tissue expansion. Facial animation has retained and facial integrity has been aesthetically restored and, with the use of make-up, it is near normal in social settings at conversational distances. The tissue expansion technique is advantageous in facial reconstruction because it makes it possible to resurface even wider defects with neighboring skin, similar in colour and texture, and superior to skin obtained elsewhere.
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ranking = 0.059586805555556
keywords = transplantation
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27/70. Erythropoietic protoporphyria: unusual skin and neurological problems after liver transplantation.

    The case of a woman with protoporphyria who developed liver failure and underwent liver transplantation is described. During the pretransplant episode of liver failure she developed quadriparesis that rapidly progressed after transplantation to a severe polyneuropathy. Following transplantation she also developed a second-degree burn of the light-exposed abdominal wall. The neuropathy resembled that observed in other forms of porphyria, and it is proposed that the extreme disturbance of protoporphyrin levels associated with protoporphyrin-induced liver failure caused this neuropathy. Such a neuropathy has not previously been described in protoporphyria. Erythrocyte protoporphyrin levels remain high and fecal levels normal, although results of liver tests are normal. She remains photosensitive, which emphasizes that although liver transplantation may be lifesaving in this disorder, it is not curative, and care must be taken to prevent photosensitive damage to skin and light-exposed internal organs.
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ranking = 0.47669444444444
keywords = transplantation
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28/70. Successful treatment of a 95 per cent body surface area burn.

    survival after sustaining a 95 per cent body surface area burn is uncommon. We report the successful treatment of a 21-year-old patient who sustained such an extensive burn injury. This report stresses the importance of early aggressive excision of the burn eschar and early coverage with allografts (homografts) and later coverage with autogenous keratinocytes.
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ranking = 0.56303761431267
keywords = homograft, allograft
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29/70. cyclosporine A for prolonging allograft survival in patients with massive burns.

    cyclosporine A (CsA) immunosuppression was used in three patients with massive burns to prolong skin allograft survival. cyclosporine A kinetic studies in patients with burns revealed markedly accelerated blood clearance and high variability in drug absorption when compared with studies in renal transplantation patients. Doses required to maintain therapeutic levels varied widely. While patients were receiving adequate maintenance therapy with CsA immunosuppression the allograft was tightly adherent without gross or microscopic rejection and was indistinguishable from autograft. Ultimately, patients' wounds were permanently covered with sequential autografts by recropping limited donor sites. There were not unusual septic complications, although prophylaxis for opportunistic infections was used. The disadvantage of allograft use is its early rejection and obligatory replacement until permanent coverage with autograft can be accomplished. cyclosporine A can prolong allograft survival and allow autograft coverage from limited donor sites in a sequential fashion. This may lead to increased survival in patients with massive burns.
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ranking = 1.6595868055556
keywords = allograft, transplantation
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30/70. The use of cultured autologous epidermis in the treatment of extensive burn wounds.

    Seventeen patients with deep second- and third-degree burn wounds have been grafted with cultured autologous epidermis. These epidermal cell sheets were cultivated according to the feeder layer technique as described by Rheinwald and Green. After dispase treatment and detachment from the culture vessel, the cell sheets, mounted on a polyamide mesh, were ready for grafting. patients with wounds excised at an early stage, prepared with human cadaver allografts or synthetic dressings, showed a significantly better graft take than nonexcised, chronic granulating wounds which were grafted at a later stage (47% versus 15%; p less than 0.002). Sandwich treatment of expanded mesh autografts and cultured autograft overlay did not improve the graft take, although in some cases wound healing was accelerated. The graft take was inversely correlated with the age of the patient (p = 0.01), and showed a weak inverse correlation with the day of first (and subsequent) culture grafting (p = 0.07). wound infection was the main cause of graft failure. Up to 4 years after grafting, the grafted areas showed continued stability and the regenerated skin became supple, smooth, and pliable. Hypertrophic scar formation was less than observed in comparable areas treated with meshed grafts. Wound contraction occurred approximately to the same extent as in split-thickness skin grafts. We emphasize that by a better control of wound infection the graft take, also in secondary-stage procedures, can significantly improve.
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ranking = 0.2
keywords = allograft
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