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Rodney K Chan - One of the best experts on this subject based on the ideXlab platform.
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antecedent thermal injury worsens split thickness skin graft quality a clinically relevant porcine model of full thickness Burn Excision and grafting
Burns, 2017Co-Authors: Anders H Carlsson, Lloyd F Rose, John L Fletcher, Kai P Leung, Rodney K ChanAbstract:Current standard of care for full-thickness Burn is Excision followed by autologous split-thickness skin graft placement. Skin grafts are also frequently used to cover surgical wounds not amenable to linear closure. While all grafts have potential to contract, clinical observation suggests that antecedent thermal injury worsens contraction and impairs functional and aesthetic outcomes. This study evaluates the impact of antecedent full-thickness Burn on split-thickness skin graft scar outcomes and the potential mediating factors. Full-thickness contact Burns (100 °C, 30 s) were created on the backs of anesthetized female Yorkshire Pigs. After seven days, Burn eschar was tangentially excised and covered with 12/1000th inch (300 μm) split-thickness skin graft. For comparison, unBurned wounds were created by sharp Excision to fat before graft application. From 7 to 120 days post-grafting, planimetric measurements, digital imaging and biopsies for histology, immunohistochemistry and gene expression were obtained. At 120 days post-grafting, the Observer Scar Assessment Scale, colorimetry, contour analysis and optical graft height assessments were performed. Twenty-nine porcine wounds were analyzed. All measured metrics of clinical skin quality were significantly worse (p < 0.05) in Burn injured wounds. Histological analysis supported objective clinical findings with marked scar-like collagen proliferation within the dermis, increased vascular density, and prolonged and increased cellular infiltration. Observed differences in contracture also correlated with earlier and more prominent myofibroblast differentiation as demonstrated by α-SMA staining. Antecedent thermal injury worsens split-thickness skin graft quality, likely by multiple mechanisms including Burn-related inflammation, microscopically inadequate Excision, and dysregulation of tissue remodeling. A valid, reliable, clinically relevant model of full-thickness Burn, Excision and skin replacement therapy has been demonstrated. Future research to enhance quality of skin replacement therapies should be directed toward modulation of inflammation and assessments for complete Excision.
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Antecedent thermal injury worsens split-thickness skin graft quality: A clinically relevant porcine model of full-thickness Burn, Excision and grafting
Burns : journal of the International Society for Burn Injuries, 2016Co-Authors: Anders H Carlsson, Lloyd F Rose, John L Fletcher, Kai P Leung, Rodney K ChanAbstract:Current standard of care for full-thickness Burn is Excision followed by autologous split-thickness skin graft placement. Skin grafts are also frequently used to cover surgical wounds not amenable to linear closure. While all grafts have potential to contract, clinical observation suggests that antecedent thermal injury worsens contraction and impairs functional and aesthetic outcomes. This study evaluates the impact of antecedent full-thickness Burn on split-thickness skin graft scar outcomes and the potential mediating factors. Full-thickness contact Burns (100 °C, 30 s) were created on the backs of anesthetized female Yorkshire Pigs. After seven days, Burn eschar was tangentially excised and covered with 12/1000th inch (300 μm) split-thickness skin graft. For comparison, unBurned wounds were created by sharp Excision to fat before graft application. From 7 to 120 days post-grafting, planimetric measurements, digital imaging and biopsies for histology, immunohistochemistry and gene expression were obtained. At 120 days post-grafting, the Observer Scar Assessment Scale, colorimetry, contour analysis and optical graft height assessments were performed. Twenty-nine porcine wounds were analyzed. All measured metrics of clinical skin quality were significantly worse (p
Anders H Carlsson - One of the best experts on this subject based on the ideXlab platform.
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antecedent thermal injury worsens split thickness skin graft quality a clinically relevant porcine model of full thickness Burn Excision and grafting
Burns, 2017Co-Authors: Anders H Carlsson, Lloyd F Rose, John L Fletcher, Kai P Leung, Rodney K ChanAbstract:Current standard of care for full-thickness Burn is Excision followed by autologous split-thickness skin graft placement. Skin grafts are also frequently used to cover surgical wounds not amenable to linear closure. While all grafts have potential to contract, clinical observation suggests that antecedent thermal injury worsens contraction and impairs functional and aesthetic outcomes. This study evaluates the impact of antecedent full-thickness Burn on split-thickness skin graft scar outcomes and the potential mediating factors. Full-thickness contact Burns (100 °C, 30 s) were created on the backs of anesthetized female Yorkshire Pigs. After seven days, Burn eschar was tangentially excised and covered with 12/1000th inch (300 μm) split-thickness skin graft. For comparison, unBurned wounds were created by sharp Excision to fat before graft application. From 7 to 120 days post-grafting, planimetric measurements, digital imaging and biopsies for histology, immunohistochemistry and gene expression were obtained. At 120 days post-grafting, the Observer Scar Assessment Scale, colorimetry, contour analysis and optical graft height assessments were performed. Twenty-nine porcine wounds were analyzed. All measured metrics of clinical skin quality were significantly worse (p < 0.05) in Burn injured wounds. Histological analysis supported objective clinical findings with marked scar-like collagen proliferation within the dermis, increased vascular density, and prolonged and increased cellular infiltration. Observed differences in contracture also correlated with earlier and more prominent myofibroblast differentiation as demonstrated by α-SMA staining. Antecedent thermal injury worsens split-thickness skin graft quality, likely by multiple mechanisms including Burn-related inflammation, microscopically inadequate Excision, and dysregulation of tissue remodeling. A valid, reliable, clinically relevant model of full-thickness Burn, Excision and skin replacement therapy has been demonstrated. Future research to enhance quality of skin replacement therapies should be directed toward modulation of inflammation and assessments for complete Excision.
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Antecedent thermal injury worsens split-thickness skin graft quality: A clinically relevant porcine model of full-thickness Burn, Excision and grafting
Burns : journal of the International Society for Burn Injuries, 2016Co-Authors: Anders H Carlsson, Lloyd F Rose, John L Fletcher, Kai P Leung, Rodney K ChanAbstract:Current standard of care for full-thickness Burn is Excision followed by autologous split-thickness skin graft placement. Skin grafts are also frequently used to cover surgical wounds not amenable to linear closure. While all grafts have potential to contract, clinical observation suggests that antecedent thermal injury worsens contraction and impairs functional and aesthetic outcomes. This study evaluates the impact of antecedent full-thickness Burn on split-thickness skin graft scar outcomes and the potential mediating factors. Full-thickness contact Burns (100 °C, 30 s) were created on the backs of anesthetized female Yorkshire Pigs. After seven days, Burn eschar was tangentially excised and covered with 12/1000th inch (300 μm) split-thickness skin graft. For comparison, unBurned wounds were created by sharp Excision to fat before graft application. From 7 to 120 days post-grafting, planimetric measurements, digital imaging and biopsies for histology, immunohistochemistry and gene expression were obtained. At 120 days post-grafting, the Observer Scar Assessment Scale, colorimetry, contour analysis and optical graft height assessments were performed. Twenty-nine porcine wounds were analyzed. All measured metrics of clinical skin quality were significantly worse (p
David N. Herndon - One of the best experts on this subject based on the ideXlab platform.
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effects of early Excision and aggressive enteral feeding on hypermetabolism catabolism and sepsis after severe Burn
Journal of Trauma-injury Infection and Critical Care, 2003Co-Authors: David W. Hart, Steven E. Wolf, Robert B. Beauford, David L. Chinkes, David N. Herndon, Ronald P Mlcak, John P Heggers, Robert R Wolfe, David R Hoyt, Basil A PruittAbstract:Background Severe Burn induces a systemic hypermetabolic response, which includes increased energy expenditure, protein catabolism, and diminished immunity. We hypothesized that early Burn Excision and aggressive enteral feeding diminish hypermetabolism.Methods Forty-six Burned children were enrolle
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effects of Burn wound Excision on bacterial colonization and invasion
Plastic and Reconstructive Surgery, 2003Co-Authors: Juan P. Barret, David N. HerndonAbstract:Rates of survival after thermal injury have improved in the past two decades, and rates of wound infections and sepsis have decreased during the same period. Early Excision has been advocated as one of the major factors, but its safety and efficacy and the exact timing of Burn Excision are still under debate. It was hypothesized that acute Burn wound Excision (in the first 24 hours after Burning) would be superior to conservative treatment and delayed Excision in preventing bacterial colonization and invasion.,juries were Twenty consecutive patients with thermal injuries were studied. Twelve patients underwent acute Burn wound Excision, and eight patients underwent conservative treatment and delayed Excision. The second group of patients received topical treatments in another facility and underwent delayed Excision after transfer to our set-vice, on postBurn day 6. Quantitative bacteriological assessments of the excised wound and biopsy samples of the wound bed, obtained before autografting and/or homografting, were performed. The effects of time on bacterial counts, differences between superficial and deep biopsy samples, and the effects of early versus late debridement were studied. Patients admitted early exhibited bacterial counts of less than 105 bacteria per grain of tissue. Patients in this group did not experience infection or graft loss. Patients admitted late exhibited counts of more than 105 bacteria (p = 0.001, compared with early admission). Three patients in the late Excision group experienced infection and graft loss (p <0.05, compared with the early Excision group). Burn wound Excision significantly decreased bacterial colonization for all patients (p <0.001). Greater bacterial colonization and higher rates of infection were correlated with topical treatment and late Excision (p <0.001). It is concluded that Burn wound Excision significantly reduces bacterial colonization. Patients who undergo topical treatment and delayed Burn wound Excision exhibit greater bacterial colonization and increased rates of infection. Acute Burn wound Excision should be considered for all full-thickness Burns.
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Determinants of blood loss during primary Burn Excision.
Surgery, 2001Co-Authors: David W. Hart, Steven E. Wolf, Robert B. Beauford, Sofia O. Lal, David L. Chinkes, David N. HerndonAbstract:Abstract Background. Excisional therapy for Burn wounds is frequently associated with large operative blood losses. Our objective was to identify patient and operative factors that affect surgical blood loss and determine strategies to minimize hemorrhage. Methods. Data from 92 consecutive pediatric patients with severe Burns (>40% total body surface area) were evaluated. Patient demographics, Burn characteristics, operative factors, and clinical course variables were correlated with blood loss. Blood loss at the time of initial total Burn Excision was determined by a standardized, previously validated method. Data were analyzed sequentially and cumulatively through univariate and cross-sectional multivariate linear regression. Results. Demographic factors that correlated with increased blood loss were older age, male sex, and larger body size. Area of full-thickness (third-degree) Burn correlated with blood loss, whereas total Burn size did not. High wound bacteria counts (derived from quantitative tissue cultures), total wound area excised, and operative time were the strongest predictors of the volume of operative hemorrhage. Blood loss increased with delay to primary Burn Excision at a maximum at 5 to 12 days after Burn injury. Conclusions. Early definitive surgical therapy before extensive bacterial colonization and rapid operative Excision is a strategy that may decrease operative hemorrhage and transfusion requirements during Burn surgical procedures. (Surgery 2001;130:396-402.)
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β-Adrenergic Desensitization after Burn Excision Not Affected by the Use of Epinephrine to Limit Blood Loss
Anesthesiology, 2000Co-Authors: Christopher K. Mcquitty, David N. Herndon, Jeffrey M. Berman, Joaquin Cortiella, Mali MathruAbstract:BackgroundBurn patients have impaired myocardial function and decreased β-adrenergic responsiveness. Further β-adrenergic dysfunction from systemic absorption of topically administered epinephrine that is given to limit blood loss during Burn Excision could affect perioperative management. The autho
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Massive transfusion of reconstituted whole blood is well tolerated in pediatric Burn surgery.
The Journal of trauma, 1999Co-Authors: Juan P. Barret, Manubhai H. Desai, David N. HerndonAbstract:Background: Massive transfusions can produce cardiovascular instability, metabolic abnormalities, dilutional coagulopathy, and pulmonary dysfunction. They also have been related to a higher incidence of infections. The purpose of this study was to assess the safety of massive transfusion of reconstituted whole blood. Methods: Twenty consecutive severely Burned pediatric patients underwent near-total Burn Excision on admission and blood transfusion with reconstituted whole blood. Patients were studied for coagulopathies and postoperative complications related to massive transfusion. Results: Only one patient presented with postoperative bleeding related to acute renal failure. No other complications occurred. There were no septic episodes or pulmonary dysfunction. The amount of massive blood transfusion did not correlate with any laboratory or clinical disturbance. Conclusion: Massive transfusion of reconstituted whole blood in severely Burned pediatric patients is safe; it does not compromise hemostasis nor is it associated with an increased rate of septic episodes or pulmonary complications. A prospective randomized clinical trial comparing its effectiveness versus packed red cells is necessary.
Lloyd F Rose - One of the best experts on this subject based on the ideXlab platform.
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antecedent thermal injury worsens split thickness skin graft quality a clinically relevant porcine model of full thickness Burn Excision and grafting
Burns, 2017Co-Authors: Anders H Carlsson, Lloyd F Rose, John L Fletcher, Kai P Leung, Rodney K ChanAbstract:Current standard of care for full-thickness Burn is Excision followed by autologous split-thickness skin graft placement. Skin grafts are also frequently used to cover surgical wounds not amenable to linear closure. While all grafts have potential to contract, clinical observation suggests that antecedent thermal injury worsens contraction and impairs functional and aesthetic outcomes. This study evaluates the impact of antecedent full-thickness Burn on split-thickness skin graft scar outcomes and the potential mediating factors. Full-thickness contact Burns (100 °C, 30 s) were created on the backs of anesthetized female Yorkshire Pigs. After seven days, Burn eschar was tangentially excised and covered with 12/1000th inch (300 μm) split-thickness skin graft. For comparison, unBurned wounds were created by sharp Excision to fat before graft application. From 7 to 120 days post-grafting, planimetric measurements, digital imaging and biopsies for histology, immunohistochemistry and gene expression were obtained. At 120 days post-grafting, the Observer Scar Assessment Scale, colorimetry, contour analysis and optical graft height assessments were performed. Twenty-nine porcine wounds were analyzed. All measured metrics of clinical skin quality were significantly worse (p < 0.05) in Burn injured wounds. Histological analysis supported objective clinical findings with marked scar-like collagen proliferation within the dermis, increased vascular density, and prolonged and increased cellular infiltration. Observed differences in contracture also correlated with earlier and more prominent myofibroblast differentiation as demonstrated by α-SMA staining. Antecedent thermal injury worsens split-thickness skin graft quality, likely by multiple mechanisms including Burn-related inflammation, microscopically inadequate Excision, and dysregulation of tissue remodeling. A valid, reliable, clinically relevant model of full-thickness Burn, Excision and skin replacement therapy has been demonstrated. Future research to enhance quality of skin replacement therapies should be directed toward modulation of inflammation and assessments for complete Excision.
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Antecedent thermal injury worsens split-thickness skin graft quality: A clinically relevant porcine model of full-thickness Burn, Excision and grafting
Burns : journal of the International Society for Burn Injuries, 2016Co-Authors: Anders H Carlsson, Lloyd F Rose, John L Fletcher, Kai P Leung, Rodney K ChanAbstract:Current standard of care for full-thickness Burn is Excision followed by autologous split-thickness skin graft placement. Skin grafts are also frequently used to cover surgical wounds not amenable to linear closure. While all grafts have potential to contract, clinical observation suggests that antecedent thermal injury worsens contraction and impairs functional and aesthetic outcomes. This study evaluates the impact of antecedent full-thickness Burn on split-thickness skin graft scar outcomes and the potential mediating factors. Full-thickness contact Burns (100 °C, 30 s) were created on the backs of anesthetized female Yorkshire Pigs. After seven days, Burn eschar was tangentially excised and covered with 12/1000th inch (300 μm) split-thickness skin graft. For comparison, unBurned wounds were created by sharp Excision to fat before graft application. From 7 to 120 days post-grafting, planimetric measurements, digital imaging and biopsies for histology, immunohistochemistry and gene expression were obtained. At 120 days post-grafting, the Observer Scar Assessment Scale, colorimetry, contour analysis and optical graft height assessments were performed. Twenty-nine porcine wounds were analyzed. All measured metrics of clinical skin quality were significantly worse (p
Kai P Leung - One of the best experts on this subject based on the ideXlab platform.
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antecedent thermal injury worsens split thickness skin graft quality a clinically relevant porcine model of full thickness Burn Excision and grafting
Burns, 2017Co-Authors: Anders H Carlsson, Lloyd F Rose, John L Fletcher, Kai P Leung, Rodney K ChanAbstract:Current standard of care for full-thickness Burn is Excision followed by autologous split-thickness skin graft placement. Skin grafts are also frequently used to cover surgical wounds not amenable to linear closure. While all grafts have potential to contract, clinical observation suggests that antecedent thermal injury worsens contraction and impairs functional and aesthetic outcomes. This study evaluates the impact of antecedent full-thickness Burn on split-thickness skin graft scar outcomes and the potential mediating factors. Full-thickness contact Burns (100 °C, 30 s) were created on the backs of anesthetized female Yorkshire Pigs. After seven days, Burn eschar was tangentially excised and covered with 12/1000th inch (300 μm) split-thickness skin graft. For comparison, unBurned wounds were created by sharp Excision to fat before graft application. From 7 to 120 days post-grafting, planimetric measurements, digital imaging and biopsies for histology, immunohistochemistry and gene expression were obtained. At 120 days post-grafting, the Observer Scar Assessment Scale, colorimetry, contour analysis and optical graft height assessments were performed. Twenty-nine porcine wounds were analyzed. All measured metrics of clinical skin quality were significantly worse (p < 0.05) in Burn injured wounds. Histological analysis supported objective clinical findings with marked scar-like collagen proliferation within the dermis, increased vascular density, and prolonged and increased cellular infiltration. Observed differences in contracture also correlated with earlier and more prominent myofibroblast differentiation as demonstrated by α-SMA staining. Antecedent thermal injury worsens split-thickness skin graft quality, likely by multiple mechanisms including Burn-related inflammation, microscopically inadequate Excision, and dysregulation of tissue remodeling. A valid, reliable, clinically relevant model of full-thickness Burn, Excision and skin replacement therapy has been demonstrated. Future research to enhance quality of skin replacement therapies should be directed toward modulation of inflammation and assessments for complete Excision.
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Antecedent thermal injury worsens split-thickness skin graft quality: A clinically relevant porcine model of full-thickness Burn, Excision and grafting
Burns : journal of the International Society for Burn Injuries, 2016Co-Authors: Anders H Carlsson, Lloyd F Rose, John L Fletcher, Kai P Leung, Rodney K ChanAbstract:Current standard of care for full-thickness Burn is Excision followed by autologous split-thickness skin graft placement. Skin grafts are also frequently used to cover surgical wounds not amenable to linear closure. While all grafts have potential to contract, clinical observation suggests that antecedent thermal injury worsens contraction and impairs functional and aesthetic outcomes. This study evaluates the impact of antecedent full-thickness Burn on split-thickness skin graft scar outcomes and the potential mediating factors. Full-thickness contact Burns (100 °C, 30 s) were created on the backs of anesthetized female Yorkshire Pigs. After seven days, Burn eschar was tangentially excised and covered with 12/1000th inch (300 μm) split-thickness skin graft. For comparison, unBurned wounds were created by sharp Excision to fat before graft application. From 7 to 120 days post-grafting, planimetric measurements, digital imaging and biopsies for histology, immunohistochemistry and gene expression were obtained. At 120 days post-grafting, the Observer Scar Assessment Scale, colorimetry, contour analysis and optical graft height assessments were performed. Twenty-nine porcine wounds were analyzed. All measured metrics of clinical skin quality were significantly worse (p
