Burns : journal of the International Society for Burn Injuries
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A method was developed to inflict standardized scald burns in the New Yorkshire pig. The tissue damage was compared to a standardized contact burn model. On each flank, six localizations were marked in a symmetrical way. ⋯ The tissue damage in the scalds showed an intermingled pattern of intact and damaged collagen. The more severe scald burns showed a structurally intact superficial vascular plexus, in combination with destruction of the deep vascular plexus. Current and new methods of scald treatment can be classified in this standardized animal model.
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Autologous keratinocytes cultured in vitro from skin biopsies of patients with deep partial and full skin thickness burns were grafted onto nine necrectomized wound surfaces between 17 and 25 days after injury. The cells were applied as nonconfluent single cells suspended in fibrin glue. ⋯ Keratinocyte grafted areas without cadaver skin overgraft showed less mechanical stability than when the keratinocyte-fibrin glue suspension was combined with allogeneic STSG. There is clinical and histological evidence that the allodermis may be partially integrated into the new skin.
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It is not always possible to effect immediate closure of wounds and patients' wounds are therefore exposed to risks of desiccation and infection. In the Plastic Surgery Department, Zuider Ziekenhuis, Rotterdam, we have used glycerolized allogeneic donor as a biological dressing in four patients; a polytrauma patient with a compound fracture of the left lower leg; a diabetic with necrotizing fasciitis; a patient with a cat bite on the lower leg, infected with Pasteurella multocida, and a child with large congenital naevi. On clinical grounds there are suggestions of a correlation between the degree of contamination and vascularization of the wound bed and graft take. Furthermore, our experience with the sandwich technique after excision of a large congenital naevus was positive.
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Cultured epidermal autografts (CEA) have been shown to be an effective permanent skin replacement for major burn injuries, but are more sensitive to adverse conditions than split thickness grafts (Clarke et al., 1988). Cuono et al. (1986, 1987) have described the successful use of engrafted allodermis as a wound bed for cultured grafts. We report on a method of preparing allodermis and grafting CEA in five patients with major burns (48-70 per cent TBSA, average 59.6 per cent). ⋯ Seven to 10 days after surgery, the gauze backings were removed. The average take ranged from 87-100 per cent (average 93.6 per cent). Follow-up for up to 4 years shows supple skin that has been durable, and resistant to trauma and infection.
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Previous clinical observations have suggested that the application of glycerol-preserved donor skin as a temporary wound dressing provokes a weaker rejection reaction than fresh, vital donor skin. Like others, we frequently observed that considerable parts of the allodermis not only remained on the wound for an extended period of time, but even became re-epithelialized in some cases. ⋯ The immunological reaction after grafting vital DA-skin, glycerolized DA-skin onto Lewis rats, and vital as well as glycerolized Lewis-skin onto Lewis rats was compared. The results of these experiments do not support the clinical observations that the glycerolization procedure results in decreased immunogenicity of donor skin.