Background:There is a lack of rigorous research investigating the factors that influence scar outcome in children. Improved clinical decision-making to reduce the health burden due to post-burn scarring in children wi...Background:There is a lack of rigorous research investigating the factors that influence scar outcome in children. Improved clinical decision-making to reduce the health burden due to post-burn scarring in children will be guided by evidence on risk factors and risk stratification. This study aimed to examine the association between selected patient, injury and clinical factors and the development of raised scar after burn injury. Novel patient factors were investigated including selected immunological co-morbidities (asthma, eczema and diabetes type 1 and type 2) and skin pigmentation (Fitzpatrick skin type). Methods:A prospective case-control study was conducted among 186 children who sustained a burn injury in Western Australia. Logistic regression was used to explore the relationship between explanatory variables and a defined outcome measure:scar height measured by a modified Vancouver Scar Scale (mVSS). Results:The overall correct prediction rate of the model was 80.6%;80.9%for children with raised scars (>1 mm) and 80.4%for children without raised scars (≤1 mm). After adjustment for other variables, each 1%increase in%total body surface area (%TBSA) of burn increased the odds of raised scar by 15.8%(95%CI=4.4-28.5%). Raised scar was also predicted by time to healing of longer than 14 days (OR=11.621;95%CI=3.727-36.234) and multiple surgical procedures (OR=11.521;1.994-66.566). Conclusions:Greater burn surface area, time to healing of longer than 14 days, and multiple operations are independently associated with raised scar in children after burn injury. Scar prevention strategies should be targeted to children with these risk factors.展开更多
Though survival rate following severe thermal injuries has improved,the incidence and treatment of scarring have not improved at the same speed.This review discusses the formation of scars and in particular the format...Though survival rate following severe thermal injuries has improved,the incidence and treatment of scarring have not improved at the same speed.This review discusses the formation of scars and in particular the formation of hypertrophic scars.Further,though there is as yet no gold standard treatment for the prevention or treatment of scarring,a brief overview is included.A number of natural therapeutics have shown beneficial effects both in vivo and in vitro with the potential of becoming clinical therapeutics in the future.These natural therapeutics include both plant-based products such as resveratrol,quercetin and epigallocatechin gallate as examples and includes the non-plant-based therapeutic honey.The review also includes potential mechanism of action for the therapeutics,any recorded adverse events and current administration of the therapeutics used.This review discusses a number of potential'treatments'that may reduce or even prevent scarring particularly hypertrophic scarring,which is associated with thermal injuries without compromising wound repair.展开更多
Burn wound healing involves a complex sequence of processes. Recent studies have revealed that skin reinnervation may have an impact on physiological wound repair. Few studies have addressed the process of reinnervati...Burn wound healing involves a complex sequence of processes. Recent studies have revealed that skin reinnervation may have an impact on physiological wound repair. Few studies have addressed the process of reinnervation and morphological changes in regenerated nerve fibers. The regeneration of neurites during full-thickness burn wound healing was determined by immunofluorescent staining using an anti-neurofilament protein monoclonal antibody, and three-dimensional morphology was observed under a laser scanning confocal microscope. Morphology and the volume fraction of collagen and nerve fibers were measured. Skin reinnervation increased during wound healing, peaked during the proliferative scar stage, and then decreased to lower levels during the maturation period. The results from the skin nerve fibers correlated with those from collagen using semi-quantitative analysis. Disintegration and fragmentation were observed frequently in samples from the proliferative stage, and seldom occurred during the maturation stage. There was a remodeling process of regenerated nerve fibers during wound healing, which comprised changed innervation density and topical morphology. The mechanism of remodeling for nerve fibers requires further investigation.展开更多
The inflammatory and fibrous responses to injuries are painful and are inhibitory to the regeneration of specialized cells. The fibrous scarring of skin injuries can also be disfiguring. Cells obtain energy not only f...The inflammatory and fibrous responses to injuries are painful and are inhibitory to the regeneration of specialized cells. The fibrous scarring of skin injuries can also be disfiguring. Cells obtain energy not only from the metabolism of food, but also via the alternative cellular energy (ACE) pathway. The ACE pathway is reflected in a dynamic (kinetic) quality of the body’s fluids. It is postulated to result from the absorption of an environmental force called KELEA (kinetic energy limiting electrostatic attraction). The body’s ACE pathway can be enhanced by the parental administration and even the oral consumption of products comprising KELEA activated water. One of these products, termed Enercel, was originally considered a complex homeopathic remedy. Another product is water containing electrolysis-generated, copper-silver-citrate (CSC) complexes. This product was initially formulated to be bacteriocidal, especially for Gram positive bacteria. This article describes the independent successful use of each of these two products in achieving essentially painless, scar-free healing of skin injuries. The skin injuries were due to a variety of causes including: vascular insufficiency from diabetes;hot water burn;penetrating object;chronic infection;and surgical incision. It is proposed that the ACE pathway increases the resilience of cells of the innate immune system to the triggering of an inflammatory reaction by “danger signals” released from damaged tissues. KELEA activated water should be widely available for the urgent therapy of burns and other traumatic injuries to the skin. ACE pathway enhancing modalities also need to be evaluated in the repair of cellular damage occurring to the heart, brain and other internal organs of the body.展开更多
Background:Patients presenting with large surface area burns are common in our practice;however, patients with a secondary large burn on pre-existing burn scars and grafts are rare and not reported. Case presentation:...Background:Patients presenting with large surface area burns are common in our practice;however, patients with a secondary large burn on pre-existing burn scars and grafts are rare and not reported. Case presentation:We report on an unusual case of a patient sustaining a secondary large burn to areas previously injured by a burn from a different mechanism. We discuss the potential implications when managing a case like this and suggest potential biological reasons why the skin may behave differently. Our patient was a 33-year-old man who presented with a 5%TBSA burn on skin scarred by a previous 40%total body surface area (TBSA) burn and skin grafts. Initially assessed as superficial partial thickness in depth, the wounds were treated conservatively with dressings;however, they failed to heal and became infected requiring surgical management. Conclusions:Burns sustained in areas of previous burn scars and grafts may behave differently to normal patterns of healing, requiring more aggressive management and surgical intervention at an early stage.展开更多
文摘Background:There is a lack of rigorous research investigating the factors that influence scar outcome in children. Improved clinical decision-making to reduce the health burden due to post-burn scarring in children will be guided by evidence on risk factors and risk stratification. This study aimed to examine the association between selected patient, injury and clinical factors and the development of raised scar after burn injury. Novel patient factors were investigated including selected immunological co-morbidities (asthma, eczema and diabetes type 1 and type 2) and skin pigmentation (Fitzpatrick skin type). Methods:A prospective case-control study was conducted among 186 children who sustained a burn injury in Western Australia. Logistic regression was used to explore the relationship between explanatory variables and a defined outcome measure:scar height measured by a modified Vancouver Scar Scale (mVSS). Results:The overall correct prediction rate of the model was 80.6%;80.9%for children with raised scars (>1 mm) and 80.4%for children without raised scars (≤1 mm). After adjustment for other variables, each 1%increase in%total body surface area (%TBSA) of burn increased the odds of raised scar by 15.8%(95%CI=4.4-28.5%). Raised scar was also predicted by time to healing of longer than 14 days (OR=11.621;95%CI=3.727-36.234) and multiple surgical procedures (OR=11.521;1.994-66.566). Conclusions:Greater burn surface area, time to healing of longer than 14 days, and multiple operations are independently associated with raised scar in children after burn injury. Scar prevention strategies should be targeted to children with these risk factors.
文摘Though survival rate following severe thermal injuries has improved,the incidence and treatment of scarring have not improved at the same speed.This review discusses the formation of scars and in particular the formation of hypertrophic scars.Further,though there is as yet no gold standard treatment for the prevention or treatment of scarring,a brief overview is included.A number of natural therapeutics have shown beneficial effects both in vivo and in vitro with the potential of becoming clinical therapeutics in the future.These natural therapeutics include both plant-based products such as resveratrol,quercetin and epigallocatechin gallate as examples and includes the non-plant-based therapeutic honey.The review also includes potential mechanism of action for the therapeutics,any recorded adverse events and current administration of the therapeutics used.This review discusses a number of potential'treatments'that may reduce or even prevent scarring particularly hypertrophic scarring,which is associated with thermal injuries without compromising wound repair.
基金the Natural Science Foundation of Shandong Province, No.Y2002C29
文摘Burn wound healing involves a complex sequence of processes. Recent studies have revealed that skin reinnervation may have an impact on physiological wound repair. Few studies have addressed the process of reinnervation and morphological changes in regenerated nerve fibers. The regeneration of neurites during full-thickness burn wound healing was determined by immunofluorescent staining using an anti-neurofilament protein monoclonal antibody, and three-dimensional morphology was observed under a laser scanning confocal microscope. Morphology and the volume fraction of collagen and nerve fibers were measured. Skin reinnervation increased during wound healing, peaked during the proliferative scar stage, and then decreased to lower levels during the maturation period. The results from the skin nerve fibers correlated with those from collagen using semi-quantitative analysis. Disintegration and fragmentation were observed frequently in samples from the proliferative stage, and seldom occurred during the maturation stage. There was a remodeling process of regenerated nerve fibers during wound healing, which comprised changed innervation density and topical morphology. The mechanism of remodeling for nerve fibers requires further investigation.
文摘The inflammatory and fibrous responses to injuries are painful and are inhibitory to the regeneration of specialized cells. The fibrous scarring of skin injuries can also be disfiguring. Cells obtain energy not only from the metabolism of food, but also via the alternative cellular energy (ACE) pathway. The ACE pathway is reflected in a dynamic (kinetic) quality of the body’s fluids. It is postulated to result from the absorption of an environmental force called KELEA (kinetic energy limiting electrostatic attraction). The body’s ACE pathway can be enhanced by the parental administration and even the oral consumption of products comprising KELEA activated water. One of these products, termed Enercel, was originally considered a complex homeopathic remedy. Another product is water containing electrolysis-generated, copper-silver-citrate (CSC) complexes. This product was initially formulated to be bacteriocidal, especially for Gram positive bacteria. This article describes the independent successful use of each of these two products in achieving essentially painless, scar-free healing of skin injuries. The skin injuries were due to a variety of causes including: vascular insufficiency from diabetes;hot water burn;penetrating object;chronic infection;and surgical incision. It is proposed that the ACE pathway increases the resilience of cells of the innate immune system to the triggering of an inflammatory reaction by “danger signals” released from damaged tissues. KELEA activated water should be widely available for the urgent therapy of burns and other traumatic injuries to the skin. ACE pathway enhancing modalities also need to be evaluated in the repair of cellular damage occurring to the heart, brain and other internal organs of the body.
文摘Background:Patients presenting with large surface area burns are common in our practice;however, patients with a secondary large burn on pre-existing burn scars and grafts are rare and not reported. Case presentation:We report on an unusual case of a patient sustaining a secondary large burn to areas previously injured by a burn from a different mechanism. We discuss the potential implications when managing a case like this and suggest potential biological reasons why the skin may behave differently. Our patient was a 33-year-old man who presented with a 5%TBSA burn on skin scarred by a previous 40%total body surface area (TBSA) burn and skin grafts. Initially assessed as superficial partial thickness in depth, the wounds were treated conservatively with dressings;however, they failed to heal and became infected requiring surgical management. Conclusions:Burns sustained in areas of previous burn scars and grafts may behave differently to normal patterns of healing, requiring more aggressive management and surgical intervention at an early stage.
