Burns

Editorial Board

2010-03-01

Proposed Changes to the Bylaws

2010-03-01

2009 Proposed Revisions. THE INTERNATIONAL SOCIETY FOR BURN INJURIES CONSTITUTION AND BYLAWS

2010-03-01

AWARD OF THE G. WHITAKER INTERNATIONAL BURNS PRIZE FOR 2009 PALERMO, ITALY

2010-03-01

Toxic epidermal necrolysis (Lyell's disease)

Mario Lissia, Pietro Mulas, Antonio Bulla, Corrado Rubino — 2010-03-01

Abstract: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe adverse drug reactions, characterized by a low incidence but high mortality, initially described as separate entities, but today considered variants of the same pathologic process and differing only for severity.The majority of cases appear to be related to idiosyncratic drug reactions. The drugs most commonly involved are: antibiotics such as sulfonamides, β-lactam, tetracyclines and quinolones; anticonvulsants such as phenytoin, phenobarbital and carbamazapine; antiretroviral drugs; nonsteroidal anti-inflammatory drugs, allopurinol.There is common agreement to consider TEN as the manifestation of a disregulated immune reaction against epithelial cells. During the first stages of TEN, apoptosis mediates keratinocyte death and the pivotal role of Fas–FasL pathway activation during TEN is undoubted. T cell cytotoxicity, demonstrated during TEN, has been shown to be mediated by the perforin–granzyme pathway. It seems, also, clear that a peculiar cytokine pattern plays an important role in TEN pathogenesis.The cutaneous findings result in an acute macular erythematous rash with bullae. These lesions rapidly exhibit Nikolsky's sign and a separation of large sheets of epidermis from the dermis and a subsequent localised shedding develops rapidly, which can become very extensive.When feasible, admission in burn or intensive care unit, positioning the patients in air-fluidised beds, is universally considered crucial in TEN treatment.The prompt withdrawal of the suspected drug, fluid and electrolyte replacement and topical wound care are the first line of therapy.The use of corticosteroids has been abandoned and the role of immunosuppressants, despite some success, is not well defined and is not considered as a standard. A trial comparing thalidomide versus placebo in TEN patients was suspended because mortality rate increased in the treated group. Infliximab, a chimeric monoclonal antibody to TNF-α, has been administered to a patient, in single infusion, with a favourable outcome. Plasmapheresis is reported to lead to some success in TEN treatment, with improvement of clinical conditions and high percentage of survival.Different authors reported good results in terms of decreasing mortality and morbidity or improving clinical conditions of the use of human intravenous immunoglobulins (IVIGs). Regardless, the true utility of this treatment remains controversial.In 2005, the authors (ML and RC), dealing with a number of severe TEN cases, proposed a new protocol based on the combination of these last two techniques reporting their preliminary results in the treatment of severe TEN patients.

Burn prevention programs for children in developing countries require urgent attention: A targeted literature review

Asha Parbhoo, Q.A. Louw, K. Grimmer-Somers — 2010-03-01

Abstract: Background: Paediatric burns are a significant international public health problem. Developing and developed countries report similar challenges regarding paediatric burn prevention programs. Paediatric burns requiring healthcare often incur significant health and opportunity costs, death or long-term disability. This paper reviews international burn prevention strategies, and considers implementation of effective prevention strategies in South Africa.Review question: Are there differences between developed and developing countries regarding causes and prevalence of paediatric burns, prevention strategies, and evidence of effectiveness?Review framework: Implementing effective burn prevention strategies in South Africa.Method: This systematic literature review identified, and narratively synthesized information from studies reporting population-based initiatives to prevent paediatric burns. Strategies from developing and developed countries were compared. Common strategies were identified, and evidence of effectiveness described.Findings: 30 studies were included from 16 developed/developing countries, reporting similar prevention strategies. Multi-pronged community-based interventions were most effective. Common elements comprised raising awareness of how burns occur, how burns can be prevented, the speed of sustaining significant injuries, and the short- and long-term effects of burns. Burn prevention strategies relevant to South Africa were provision of education in different formats (written, pictorial and verbal) in places frequented by children and parents, monitoring children more closely in hazardous areas (e.g. kitchens), and better planning of homes to reduce hazards.Conclusion: More work is required to establish effective, sustainable community-wide prevention programs in developed and developing countries. Effective paediatric burn prevention programs for South Africa should acknowledge parent and child literacy, how and where information is best accessed, the need to adapt effective hazard reduction programs to informal settlements, and the importance of legislated minimum safe housing standards. This requires significant commitment from Government, communities and individuals.

Burn resuscitation: The results of the ISBI/ABA survey

David G. Greenhalgh — 2010-03-01

Abstract: Introduction: There are valid concerns that burn shock resuscitation is inadequate; a tendency to over-resuscitate the patient seems to exist which may increase complications such as compartment syndrome. The purpose of this study was to survey members of the ISBI and ABA to determine current practices of burn resuscitation.Methods: A survey asking for practices of burn shock resuscitation was provided to all participants of a recent ABA meeting. Around the same time, the survey was sent to all members of the ISBI through the internet. The results of the 101 respondents (ABA – 59, ISBI – 42, approximately a 15% response rate) are described.Results: Surveys were returned from all the continents except Africa. Respondents included directors (48%), staff physicians (19%), nurses (23%) and others. Most programs admitted adults (87%) and children (75%) with a mean of 289 admissions per year. The cut off to initiate resuscitation was 15% TBSA and most preferred peripheral IVs (70%) and central lines (47.5%). The Parkland formula was preferred (69.3%) while others were used: Brooke – 6.9%, Galveston – 8.9%, Warden – 5.9%, and colloid 11.9%. Lactated Ringer's (LR) was the preferred solution (91.9%), followed by normal saline – 5%, hypertonic saline – 4%, albumin – 20.8%. FFP – 13.9%, and LR/NaHCO3 – 12.9%. Approximately half (49.5%) added colloid before 24h. Urine output is the major indicator of success (94.9%) while 22.7% use other monitors. Most (88.8%) feel their protocols work well with 69.8% feel that it provides the right amount of fluid (24% – too much, 7% – too little). Despite this feeling, they still feel that they give more fluid than the formula in 55.1%, less than formula in 12.4% and the right amount in 32.6%. Approximately 1/3 use an oral resuscitation formula and 81.8% feel that an oral formula works for burns<15% TBSA.Conclusion: Large variations exist in resuscitation protocols but the Parkland formula using LR is still the dominant method. Most feel that their resuscitation protocol works well.

Pre-existing psychiatric disorders, psychological reactions to stress and the recovery of burn survivors

J.A. Wisely, E. Wilson, R.T. Duncan, N. Tarrier — 2010-03-01

Abstract: This study aimed to investigate whether previous findings from a small retrospective study could be replicated prospectively. The previous study showed that patients with an existing diagnosis of psychosis or depression, admitted to a burns service, had longer hospital stays and longer wound healing times when compared with controls matched for burn injury but without a pre-existing psychiatric condition . In this study it was hypothesised that those patients without pre-existing psychiatric diagnosis, but with high levels of psychological distress after burn would also show a similar pattern of delayed recovery to those with a pre-existing psychiatric illness. In addition, we examined potential mechanisms for slowed recovery, including; adherence with treatment; delayed discharge on social grounds and psychological distress. It was hypothesised that patients with pre-existing psychiatric diagnosis would exhibit poorer adherence and delayed placement due to social reasons, compared to patients without pre-existing psychiatric diagnoses.107 consecutive admissions to a burns service over a seven-month period were included in the study. Psychiatric history and level of psychological distress post-burn were collected for all patients as part of routine psychological screening. Patients were compared on the following outcome variables: number of days spent in hospital and number of procedures required.24% (n=27) were found to have a pre-existing psychiatric diagnosis. This group were also found to have significantly longer hospital stays (Mann–Whitney U=585.50, p<0.01) and required more surgical procedures than the group without a psychiatric history (Mann–Whitney U=569.00, p=<0.001). The pattern of results for the group with high psychological distress but without pre-existing psychiatric diagnoses mirrored that of the group with pre-existing psychiatric diagnoses, suggesting that heightened psychological distress alone, has a significant delaying effect upon the rate of recovery (Kruskal–Wallis X=24.75, p<0.01). An exploratory model entering all the variables stepwise at the same stage identified poor adherence and delayed discharge issues as making significant contributions to the final model (r=0.81 adjusted r2=62.9, F (4, 42)=20.48, p<0.001). In conclusion, this study supports the role of psychosocial factors, such as pre-existing psychiatric diagnosis and in hospital psychological distress, in contributing the recovery of survivors of burns. This suggests that identifying and working with these difficulties may impact not only on psychosocial, but also physical aspects of recovery.

A microarray analysis of temporal gene expression profiles in thermally injured human skin

J.A. Greco, A.C. Pollins, B.E. Boone, S.E. Levy, L.B. Nanney — 2010-03-01

Abstract: Partial-thickness burns incite a multitude of responses which eventually culminate in cutaneous wound repair. We hypothesized that these events would evoke extensive alterations in gene expression thereby orchestrating the complexity of spatial and temporal events that characterize “normal” human wound healing. In the present study, gene expression from partial-thickness areas at defined temporal periods (1–3 days, 4–6 days, and 7–18 days) after injury were compared to normal non-wounded skin. Gene alterations proved extensive (2286 genes). Statistically significant alterations were noted among increased and decreased genes expressed in the three different temporal groupings. Our foundational data (based on samples from 45 individuals) provide a comprehensive molecular gene expression portrait of the cutaneous reparative responses that are initiated during the first 17 days after injury. Our efforts also represent an initial endeavor to move beyond the historically defined “morphological phases” of wound repair toward reporting molecular clues that define the temporal sequence of healing in human subjects. Further analysis of genes that are either affected or remain not affected following injury to normal skin is expected to identify potential targets for therapeutic augmentation or silencing.

Acute kidney injury in critically ill burn patients. Risk factors, progression and impact on mortality

Tina Palmieri, Athina Lavrentieva, David G. Greenhalgh — 2010-03-01

Abstract: Introduction: The aim of this study was to apply the RIFLE [risk (R), injury (I), failure (F), loss (L) and end-stage kidney disease (E)] criteria in burn ICU patients, to identify the risk factors for occurrence of acute kidney injury (AKI), as well as to analyze the progression between stages (classes) of RIFLE classification, and the impact of progression of AKI on morbidity and mortality.Design: Retrospective, descriptive cohort study.Setting: Single-center, 8 bed burn ICU facility.Patients: All consecutive patients aged >18 years with a burn injury of 20% or more of a total body surface area percent (TBSA%) admitted during a 2-year-period were included in the study.Interventions: None.Measurements and results: Data of 60 patients were studied. AKI occurred in 32 (53.3%) of patients with severe burns with the maximum RIFLE category: Risk in 9 (28.1%), Injury in 6 (18.8%) and Failure 17 (53.1%). Patients with AKI had a mortality rate of 34.4%. None of patients who did not develop AKI during ICU stay died. Thirteen patients progressed to higher RIFLE I class of AKI. Patients who progressed to higher RIFLE class had higher mortality rate (46%) compared to those who remained at the same (Risk or Injury) RIFLE class (7.7%). The progression to higher RIFLE class was associated with the higher extrarenal SOFA and the higher SOFA at maximum RIFLE class, the use of nephrotoxic drugs, the number of operations, the cumulative fluid balance prior the maximum RIFLE and the presence of sepsis. Logistic regression analysis indicated that maximum SOFA score, presence of sepsis and Failure class of AKI (p=0.033) were the independent risk factors for mortality.Conclusion: This study demonstrated (a) the high incidence of AKI in patients with severe burns; (b) the number of predisposing to progression of AKI factors (severity of organ failure, presence of sepsis, use of nephrotoxic drugs, number of previous surgical operations, cumulative fluid balance); (c) the association of Failure class of acute kidney injury with high mortality.

Assessing the severity of inhalation injuries in adults

Z. Hassan, J.K. Wong, J. Bush, A. Bayat, K.W. Dunn — 2010-03-01

Abstract: Inhalation injury is a major cause of morbidity and mortality in thermally injured patients but is difficult to quantify. A number of parameters can be useful evaluating inhalation injury including bronchoscopy, PaO2/FiO2 (P/F) ratio, and carboxyhaemaglobin (COHb) levels. Identification of markers that permit early detection of the degree of damage caused by inhalation injury is important to predict patient survival. In this retrospective study we evaluated the potential of using the P/F ratio, bronchoscopic findings and the COHb level to assess the severity of the inhalation injury in adults.A retrospective review of all patients admitted with inhalation injuries to the intensive care unit (ICU) from January 1995 to December 2002 was conducted and of the 110 patients 105 Casenotes were obtained and investigated.The total burn surface area (TBSA), age and bronchoscopic findings showed a positive correlation with mortality. There was no significant correlation between COHb levels and mortality, but there was a significant correlation between P/F ratio and mortality in adults. Logistic regression indicated that the combination of TBSA, age and P/F ratio was highly predictive of mortality following major burns.This study supports the predictive nature of the P/F ratio in relation to survival in adults. Larger prospective studies using bronchoscopic findings and P/F ratio would give us a better indication as to the value of a scoring system in adults that are admitted with inhalation injuries.

Involving burn survivors in agenda setting on burn research: An added value?

2010-03-01

Abstract: Background and aim: The role of burn survivors in burn research is usually restricted to being objects of study and beneficiaries of research results, while decision-making on research is traditionally the domain of a small group of experts, mainly scientists. In this article we compare the research priorities of burn survivors and professionals and investigate to what extent it is possible to come to a joint research agenda.Methodology: The project followed the Dialogue Model for research agenda setting. Initially burn survivors and professionals were consulted separately and group-specific lists of research priorities were established, using a literature survey, exploratory interviews (n=10), focus groups (n=58), a questionnaire (n=224) and Delphi rounds (n=12). Subsequently, in a dialogue meeting burn survivors and professionals presented and discussed their priorities, developed one integrated list, and prioritized the 15 most important topics on this list.Results: Considerable overlap was observed between the research priorities of burn survivors and professionals, particularly with respect to biomedical and clinical research on wound healing and scar management. However, differences were also observed, e.g. treatment of itching and oedema on scars and donor places.Conclusion: The model proved useful in eliciting research priorities from both professionals and burn survivors, and in stimulating a meaningful dialogue between these groups. The involvement of burn survivors identified burn research areas that are currently not the focus of research in The Netherlands.

Age-dependent differences of interleukin-6 activity in cardiac function after burn complicated by sepsis

2010-03-01

Abstract: Interleukin (IL)-6 is a pleiotropic cytokine that is activated after acute injuries, and plays an important role during aging. We aim to define the role of IL-6 on myocardial dysfunction following a 40% total body surface area burn followed by late (7 days) Streptococcus pneumoniae sepsis (burn plus sepsis) in 2- and 14-month-old wild type and IL-6−/− mice. We measured global hemodynamic and cardiac contractile function with left ventricular pressure–volume analysis 24h after sepsis induction, and measured phosphorylated signal transducer and activator of transcription 3 (p-STAT-3), tumor necrosis factor (TNF)-α, and IL-1β in the heart with Western blot analysis. We also measured mRNA expression of IL-6, TNF-α, and IL-1β. Sham injured mice did not manifest any appreciable level of p-STAT-3 or functional deficiencies regardless of age or presence of the IL-6 gene. Burn plus sepsis injury was associated with a significant deterioration of global hemodynamic and cardiac contractile function in WT mice in both age groups. This dysfunction was attenuated by IL-6 deficiency at age 2 months, but accentuated at age 14 months. Aging was associated with an increase in mRNA expression of IL-6 (WT mice), TNF-α, and IL-1β (all mice). At age 14 months, IL-6 deficient mice exhibited a greater TNF-α mRNA expression than the wild type mice. We conclude aging is associated with changed cytokine gene transcription, and burn plus sepsis injury further intensifies such gene responses. IL-6 deficiency does not abrogate STAT-3 phosphorylation and it may enhance expression of other inflammatory cytokines. The differential effects of IL-6 deficiency on the cardiac function in young and aging mice cannot be explained by cytokine gene expression alone, and require further studies.

Accelerated healing of skin burns by anti-Gal/α-gal liposomes interaction

Uri Galili, Kim Wigglesworth, Ussama M. Abdel-Motal — 2010-03-01

Abstract: Topical application of α-gal liposomes on burns results in rapid local recruitment of neutrophils and macrophages. Recruited macrophages are pivotal for healing of burns because they secrete cytokines/growth factors that induce epidermis regeneration and tissue repair. α-Gal liposomes have glycolipids with α-gal epitopes (Galα1-3Galβ1-4GlcNAc-R) which bind anti-Gal, the most abundant natural antibody in humans constituting ∼1% of immunoglobulins. Interaction of α-gal liposomes with anti-Gal within the fluid film formed on burns, activates complement and generates chemotactic complement cleavage peptides which effectively recruit neutrophils and macrophages. Anti-Gal IgG coating α-gal liposomes further binds to Fcγ receptors on macrophages and activates them to secrete cytokines/growth factors. Efficacy of α-gal liposomes treatment in accelerating burn healing is demonstrated in the experimental model of α1,3galactosyltransferase knockout mice. These mice are the only available nonprimate mammals that can produce anti-Gal in titers similar to those in humans. Pairs of burns in mice were covered either with a spot bandage coated with 10mg α-gal liposomes, or with a control spot bandage coated with saline. On Day 3 post-treatment, the α-gal liposomes treated burns contained ∼5-fold as many neutrophils as control burns, whereas macrophages were found only in α-gal liposomes treated burns. On Day 6, 50–100% of the surface area of α-gal liposomes treated burns were covered with regenerating epidermis (re-epithelialization), whereas almost no epidermis was found in control burns. The extensive recruitment of macrophages by anti-Gal/α-gal liposomes interaction was further demonstrated in vivo with polyvinyl alcohol (PVA) sponge discs containing α-gal liposomes, implanted subcutaneously. Since anti-Gal is abundant in all humans, it is suggested that treatment with α-gal liposomes will be effective also in patients with burns and other skin wounds.

The use of “composite dressing” for covering split-thickness skin graft donor sites

Tien-Hsiang Wang, Hsu Ma, Fa-Lai Yeh, Jin-Teh Lin, Bing-Hwei Shen — 2010-03-01

Abstract: To evaluate the effect of a new dressing method for clean wound coverage, two kinds of dressing materials are combined together to cover nine wounds in nine patients. All the wounds are split-thickness skin graft donor sites located in the anterior thighs. The size of the wounds ranges from 6cm×4cm to 10cm×8cm (42cm2 on average). A central fenestration is created in the polyurethane film layer for draining the wound discharge, and a piece of 2.5cm×2.5cm carboxymethyl cellulose dressing is fixed on top of the fenestration for protecting the underlying wound. Dry gauze is used to cover the composite dressing, which is replaced daily. The wound condition is checked and recorded everyday until the patient is discharged. Further management and follow-up for the wound is performed at the outpatient department or by telephone. All wounds healed smoothly on the postoperative 6th to 7th day. No wound infection was noted, including one patient who had diabetes mellitus. Five patients responded to follow-up for at least 5 months and no hypertrophy scar formation was noted. From clinical experiences, we know that this new method is practical and cost-effective for covering small-sized, split-thickness skin graft donor-site wounds.

Reconstruction of large hypertrophic scar on trunk and thigh by means of liposuction technique

Gui-er Ma, Hua Lei, Jian Chen, Zhen-jun Liu — 2010-03-01

Abstract: Objective: Hypertrophic scars on trunk and thigh are less important in function and appearance than those on face, neck, hand, foot and joint. However, patients suffer itching, pain and disfiguration. Thus far, neither non-surgical nor surgical methods treat these scars perfectly. This study reports on the application of liposuction technique to reconstruct these scars and reviews the outcomes.Method: Between March 2000 and March 2008, we treated 26 hypertrophic scars on trunk and thigh (20 patients) using liposuction. Tumescent liquids were infiltrated and liposuction was performed in the areas of trunk and thigh where the scars located. Following scar excision, defects were covered by sliding flap created by liposuction. Incisions were closed without tension.Results: Twenty-six hypertrophic scars were reconstructed in one stage by flaps of similar texture and colour in areas around the scars without wound dehiscence, infection, skin necrosis, sensory deficit, haematoma and seroma. The contours of liposuction areas were natural and even.Conclusion: Large hypertrophic scar at sites rich in subcutaneous fat such as trunk and thigh can be reconstructed in one stage by liposuction technique, which is easy, safe, effective and economic. Although indications of liposuction scar reconstruction are strict, it is indeed a better option for appropriate cases.

Thiamine supplementation increases serum thiamine and reduces pyruvate and lactate levels in burn patients

2010-03-01

Abstract: The importance of vitamins for optimal metabolism is well established. However, currently little is known about the optimal vitamin levels required for burn patients. As a consequence, current practice both for macronutrient supplementation and vitamin supplementation varies widely between burn units. A better understanding of the effects of vitamins on metabolism may lead to better nutrition and subsequently improved outcomes for burn patients.Thiamine is an important co-factor required for multiple enzymes involved in carbohydrate metabolism. We have examined the levels of thiamine (B1) in burn patients as well as the effects of thiamine supplementation on the levels of serum thiamine, pyruvate and lactate.Twenty patients had blood samples taken on the day of admission, then on days 1, 3, and 7 post-admission and weekly thereafter until discharge. Of these, nine received enteral feeding. Six patients received thiamine supplementation. Serum thiamine, pyruvate and lactate levels were measured at each time point.Serum thiamine levels increased significantly with thiamine supplementation (p<0.001). Serum thiamine levels also increased with time of supplementation (p<0.001). Serum thiamine level was closely associated with pyruvate and lactate levels, with a decrease in both pyruvate and lactate associated with increased serum thiamine. Lastly, pyruvate and lactate levels appear closely associated in a linear relationship.This study suggests thiamine supplementation increases serum thiamine and that this increase is associated with a decrease in pyruvate and lactate levels. Further study of changes in metabolic flux associated with thiamine supplementation and a randomised control trial of thiamine supplementation are required to establish whether thiamine supplementation is beneficial to burn patients’ metabolism and recovery.

The effect of epidural anaesthesia on the reverse-flow fasciocutaneous flap: An experimental study in rabbits

Fatih Uygur, Hüseyin Şen, Nurettin Noyan, Cihan Şahin — 2010-03-01

Abstract: Background: The reverse-flow fasciocutaneous flap has been popularised as a feasible alternative to reconstruction of the post-burn contractures around lower-extremity joints. The effect of epidural anaesthesia (EA) on the haemodynamics of reverse-flow fasciocutaneous flap (RFFF) has not yet been investigated. Therefore, it was our primary objective to determine how EA impacts on vascular haemodynamics and tissue perfusion. Materials and methods: This study included 30 New Zealand white rabbits. The reverse-flow saphenous fasciocutaneous island flap in rabbit model was used. In group I (n=10), epidural catheterisation of the rabbits were performed and they received an epidural infusion of 0.1mlkg−1 0.125% bupivacaine 12-h periods until the 10th day. In group II (n=10), epidural catheterisation of the rabbits was performed and they received an epidural infusion of 0.1mlkg−1 isotonic sodium chloride solution. In group III (n=10), epidural catheterisation of the rabbits was not performed. Intra-arterial blood pressure (IABP) and intravenous blood pressure (IVBP) was recorded at time intervals of 5, 15, 30 and 60min, respectively, after tourniquet release on the first and 10th day. Microcirculatory flow was measured by laser Doppler flowmetry at 2, 4, 6, 8 and 10 days in all the groups. Results: Throughout the experiment, the flaps showed complete survival. A significant difference was noted in the microcirculatory flow measurements in the flap surfaces between group I and groups II–III throughout the experiment (p<0.05). A significant difference was noted in IVBP and IABP between group I and groups II–III (p<0.05). On the first and the 10th day, however, there were no significant differences between groups II and III (p>0.05). Conclusion: EA improves blood flow to RFFF and prevents the progression of venous congestion.

Wound-healing activity of a proteolytic fraction from Carica candamarcensis on experimentally induced burn

2010-03-01

Abstract: Carica candamarcensis is a species from the Caricaceae family whose immature fruit contains latex with large amounts of cysteine proteinases. In prior studies, we isolated two of these enzymes displaying mitogenic activity when incubated with L929 fibroblastic cells. One of the fractions containing these enzymes (P1G10) was shown to enhance wound healing of skin and to accelerate healing of chemically induced gastric ulcer.In this study we evaluate the effect of P1G10 on heat-induced, third-degree burn using a rodent model. The results show that 0.1% P1G10 accelerates epithelisation while the effect of 1% or 0.01% P1G10 is not significantly different to 1% silver sulphadiazine, 2% papain or the hydrosoluble vehicle used as control. In a double-blind randomised experiment comparing the healing response of 0.1%, 1% and the vehicle alone, we confirmed the enhanced healing property of P1G10. Histological analysis of burn-tissue sections following treatment with P1G10 support these observations. These results extend the healing properties of these groups of enzymes to a different type of trauma and open the way to future clinical applications.

The involvement of alpha-melanocyte-stimulating hormone in the hyperpigmentation of human skin autografts

Chun-Yu Xue, Li Li, Ling-Li Guo, Jun-Hui Li, Xin Xing — 2010-03-01

Abstract: Hyperpigmentation occurs frequently in human skin autografts, resulting in an unsatisfactory appearance.Objective: This study aims to elucidate the role of α-melanocyte-stimulating hormone (α-MSH) in the hyperpigmentation process of skin autografts by analysing the expression of α-MSH and the amount of melanin in human autografted skin and normal skin.Methods: Immunohistochemistry and reverse transcription-polymerase chain reaction methods were carried out to detect the expression and distribution of α-MSH and pro-opiomelanocortin (POMC) in skin autografts, including full-thickness skin autografts, split-thickness skin autografts and normal skin. The Fontana–Masson stain was used to detect the amount of melanin in all the skin specimens.Results: The level of α-MSH and POMC expression in autografted skin was much higher than that of control normal skin, and thinner split-thickness skin autografts expressed higher levels of POMC mRNA and α-MSH protein. The amount of melanin in skin autografts was significantly higher compared with normal skin. The expression of α-MSH correlated well with the amount of melanin in skin autograft epidermis.Conclusions: These results indicate that the function of melanogenesis, transfer of melanin in melanocytes, was dramatically enhanced in skin autografts by α-MSH. The over-expression of α-MSH may play an important role in the hyperpigmentation process of skin autografts and provide a novel mechanism of this process.

Burn injuries due to Christian religious customs

Andreas Gohritz, Marc Busche, Matthias Aust, Peter M. Vogt, Merlin Guggenheim — 2010-03-01

Sir, With great interest we read the paper by Al-Qattan and Al-Zahrani K, “A review of burns related to traditions, social habits, religious activities, festivals and traditional medical practices”, which summarizes thermal injuries related to specific social and cultural customs and practices from Jewish, Muslim, Indian and Buddhist religions , but none related to Christian customs. We would like to take the opportunity to draw attention to typical burn injury patterns due to Christian religious practice.

Re: Burn injuries due to Christian religious customs

M.M. Al-Qattan — 2010-03-01

Reply, We would like to thank the authors for their useful contribution. We missed their article because we only reviewed the English literature. Once again, their comments confirm the importance of burns related to traditions, social habits, and religious activities .

Mast cells in wound-healing cholestatic liver response

Maria-Angeles Aller, Jose García-Domínguez, Patri Vergara, Jaime Arias — 2010-03-01

We read the very interesting Review by Van der Veer et al, published in one of the recent issues of the journal . Among the potential cellular and molecular causes of hypertrophic scar formation, the authors mention mast cells and some of their mediators, in particular TNF-α and IL-4 .

Response to Letter to the Editor: Mast cells in wound-healing cholestatic liver response

Frank B. Niessen, Willem M. van der Veer — 2010-03-01

We are very pleased that our review about potential cellular and molecular causes of hypertrophic scar formation in the skin induces discussion and will bring up new hypotheses regarding excess scar formation.