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systematic literature review of topical local anaesthesia or analgesia to donor site wounds

burns & Trauma 2022年第1期10卷 294-305页

作者： Craig A.McBride Marilyn Wong Bhaveshkumar Patel pegg leditschke children’s burns centre Queensland Children’s HospitalSouth BrisbaneQueenslandAustralia centre for children’s burns and Trauma Research Queensland Children’s Medical Research InstituteUniversity of QueenslandAustralia

Background:Topical local analgesic and anaesthetic agents have been used both pre-and imme-diately post-harvest on split-thickness skin graft(sTsG)donor site wounds(DsW).There is no systematic review of their effectiveness in providing post-harvest analgesia,or of the possible toxic effects of systemic *** study is designed to address the question of which agent,if any,is favoured over the others and whether there are any safety data regarding their ***:systematic literature review of randomised controlled trials of topical agents applied to sTsG DsWs,with a view to providing *** identified via search of Cochrane and EBsCO *** restrictions on language or publication *** outcomes:pain at the time of(awake)sTsG,and post-harvest pain(up to first dressing change).secondary outcome was serum medication levels relative to published data on toxic *** risk of bias assessment tool utilised in assessment of included *** least 2 reviewers screened and reviewed included studies.A narrative review is ***:There were 11 studies meeting inclusion *** methodological quality and patient numbers were *** eutectic mixture of lidocaine and prilocaine pre-harvest affords good local anaesthesia in awake sTsG *** bupivacaine(5 studies)or lidocaine(1 study)gave significantly better post-harvest anaesthesia/analgesia than *** morphine performs no better than *** local anaesthetic agents at reported doses were all well below toxic serum ***:Topical local anaesthetics(lidocaine or bupivacaine)provide good analgesia,both during and after sTsG harvest,at well below toxic serum levels,but there are no good data determining the best local anaesthetic agent to *** is no evidence morphine performs better than placebo.

关键词： Local anaesthetic Donor site wound Topical analgesia Lidocaine Bupivacaine Morphine split-thickness skin graft EMLA

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Epidemiology of isolated foot burns in children presenting to a Queensland paediatric burns centre—a two-year study in warmer climate

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burns & Trauma 2017年第1期5卷 58-63页

作者： Florence Ngu Bhaveshkumar Patel Craig McBride pegg leditschke children’s burns centre Department of Paediatric SurgeryLady Cilento Children’s Hospital501 Stanley StreetSouth Brisbane QLD 4101Australia centre for children’s burns and Trauma Research Queensland Children’s Medical Research InstituteUniversity of QueenslandQueenslandAustralia

Background: European studies of paediatric foot burns report scalds as the leading cause. Mechanisms of injury are different in warmer climates. We sought to characterize the mechanisms and outcomes of isolated foot burns in our population. Methods: Retrospective review of a prospectively collected database of all children aged 0–15 years presenting to a Queensland paediatric burns centre over a 26-month period. Non-parametric analyses such as the Mann-Whitney U and Pearson Chi-square were used. Results: There were 218 children with foot burns treated over a period of 2 years and 2 months of which 214 had complete records. There were significantly more boys than girls (n=134, 62.6% cf. n=80, 37.4%, psm of injury was a contact burn accounting for 63.1% (n=135) followed by scalds (23.8%, n=51). Friction, flame and chemical burns were a minority but were significantly deeper (p=0.03) and significantly more likely to require grafting (p=0.04) and scar management (pscald burns. Conclusions: In our population, contact burns are the most common mechanism of injury causing burns to the feet. The leading aetiology is campfire burns, which account for one-third of all burns to the feet. Prevention campaigns targeted at this population could significantly reduce the burden of morbidity from these burns. Friction, flame and chemical burns constitute a minority of patients but are deeper and more likely to require skin grafting and scar management.

关键词： Epidemiology Foot burns Paediatric scald Australia Campfire

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Prospective randomised controlled trial of Algisite^(TM) M, Cuticerin^(TM), and sorbact■ as donor site dressings in paediatric split-thickness skin grafts

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burns & Trauma 2018年第4期6卷 297-306页

作者： Craig A.McBride Roy M.Kimble Kellie A.stockton pegg leditschke children’s burns centre Queensland Children’s HospitalChildren’s Health Queensland Hospital and Health ServiceSouth BrisbaneQueenslandAustralia centre for children’s burns and Trauma Research Centre for Children’s Health ResearchUniversity of QueenslandSouth BrisbaneAustralia Discipline of Paediatrics and Child Health School of MedicineUniversity of QueenslandSt LuciaQueenslandAustralia

Background:This is a parallel three-arm prospective randomised controlled trial (RCT) comparing Algisite?M, Cuticerin?, and sorbact? as donor site dressings in paediatric split-thickness skin grafts (sTsG). All three were in current use within the pegg leditschke children's Burn centre (PLCBC), the largest paediatric burns centre in Queensland, Australia. Our objective was to find the best performing dressing, following on from previous trials designed to rationalise dressings for the burn wound itself. Methods:All children for sTsG, with thigh donor sites, were considered for enrolment in the trial. Primary outcome measures were days to re-epithelialisation, and pain. secondary measures were cost, itch, and scarring at 3 and 6 months. Patients and parents were blinded to group assignment. Blinding of assessors was possible with the dressing in situ, with partial blinding following first dressing change. Blinded photographic assessments of re-epithelialisation were used. scar assessment was blinded. Covariates for analysis were sex, age, and graft thickness (as measured from a central biopsy). Results:There were 101 patients randomised to the Algisite?M (33), Cuticerin?(32), and sorbact? (36) arms between April 2015 and July 2016. All were analysed for time to re-epithelialisation. Pain scores were not available for all time points in all patients. There were no significant differences between the three arms regarding pain, or time to re-epithelialisation. There were no significant differences for the secondary outcomes of itch, scarring, or cost. Regression analyses demonstrated faster re-epithelialisation in younger patients and decreased donor site scarring at 3 and 6 months with thinner sTsG. There were no adverse effects noted. Conclusions:There are no data supporting a preference for one trial dressing over the others, in donor site wounds (DsW) in children. Thinner skin grafts lead to less donor site scarring in children. Younger patients have faster donor si

关键词： split-thickness skin graft Donor site wound Paediatric burns Alginate Algisite^(TM) M Cuticerin^(TM) sorbact■

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A prospective study of time to healing and hypertrophic scarring in paediatric burns:every day counts

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burns & Trauma 2017年第1期5卷 44-49页

作者： Elizabeth Chipp Lisa Charles Clare Thomas Kate Whiting Naiem Moiemen Yvonne Wilson burns centre Birmingham Children’s HospitalSteelhouse LaneBirminghamUK

Background: It is commonly accepted that burns taking longer than 3 weeks to heal have a much higher rate of hypertrophic scarring than those which heal more quickly. However, some of our patients develop hypertrophic scars despite healing within this 3-week period. Methods: We performed a prospective study of 383 paediatric burns treated non-operatively at a regional burns centre over a 2-year period from May 2011 to April 2013. scar assessment was performed by a senior burns therapist using the Vancouver scar scale. Results: Overall rates of hypertrophic scarring were 17.2%. Time to healing was the strongest predictor of developing hypertrophic scarring, and the earliest hypertrophic scar developed in a patient who was healed after 8 days. The risk of hypertrophic scarring was multiplied by 1.138 for every additional day taken for the burn wound to heal. There was a trend towards higher rates of hypertrophic scarring in non-white skin types but this did not reach statistical significance. Conclusions: The risk of hypertrophic scarring increases with every day and, therefore, every effort should be made to get the wound healed as quickly as possible, even within the traditional 3-week period usually allowed for healing. We believe that the traditional dogma of aiming for healing within 3 weeks is overly simplistic and should be abandoned: in paediatric burns, every day counts.

关键词： scar Hypertrophic Burn Time to healing Paediatric skin type

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Comparative effectiveness of Biobrane^(■),RECELL^(■)Autologous skin Cell suspension and silver dressings in partial thickness paediatric burns:BRACs randomised trial protocol

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burns & Trauma 2019年第1期7卷 309-320页

作者： Anjana Bairagi Bronwyn Griffin Zephanie Tyack Dimitrios Vagenas steven M.McPhail Roy Kimble centre for children’s burns and Trauma Research Centre for Children’s Health ResearchBrisbaneQueenslandAustralia pegg leditschke children’s burns centre Queensland Children’s HospitalBrisbaneQueenslandAustralia school of Nursing Institute of Health and Biomedical InnovationQueensland University of TechnologyBrisbaneQueenslandAustralia Australian centre for Health services Innovation Institute of Health and Biomedical InnovationSchool of Public Health and Social WorkQueensland University of TechnologyBrisbaneQueenslandAustralia Research Methods Group Institute of Health and Biomedical InnovationQueensland University of TechnologyBrisbaneQueenslandAustralia The University of Queensland BrisbaneQueenslandAustralia centre for Functioning and Health Research Metro South Hospital and Health ServiceBrisbaneQueenslandAustralia

Background:Mixed partial thickness burns are the most common depth of burn injury managed at a large Australian paediatric hospital specialty burns *** time until re-epithelialisation is associated with increased burn depth and scar *** current wound management approaches have benefits such as anti-microbial cover,these are not without inherent limitations including multiple dressing *** Biobrane^(■)RECELL^(■)Autologous skin Cell suspension and silver dressings(BRACs)trial aims to identify the most effective wound management approach for mixed partial thickness injuries in ***:All children presenting with an acute burn injury to the study site will be screened for *** is a single-centre,three-arm,parallel group,randomised *** younger than 16 years,with burns≥5%total body surface area involving any anatomical location,up to 48 h after the burn injury,and of a superficial partial to mid-dermal depth,will be included.A sample size of 84 participants will be randomised to standard silver dressing or a Regenerative Epithelial suspension(REs^(TM))with Biobrane^(■)or Biobrane^(■)*** first dressing will be applied under general anaesthesia and subsequent dressings will be changed every 3 to 5 days until the wound is≥95%re-epithelialised,with re-epithelialisation time the primary *** outcomes of acute pain,acute itch,scar severity,health-related quality of life,treatment satisfaction,dressing application ease and healthcare resource use will be assessed at each dressing change and 3,6 and 12 months post-burn ***:The findings of this study can potentially change the wound management approach for superficial partial to mid-dermal burns in children locally and *** registration:The Australian New Zealand Clinical Trials Registry(ACTRN12618000245291)approved prospective registration on 15 February *** details can be viewed at https://***/T

关键词： Partial thickness burns children Regenerative epidermal suspension Re-epithelialisation Wound healing

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Nanosilver alleviates foreign body reaction and facilitates wound repair by regulating macrophage polarization

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Journal of Zhejiang University-science B(Biomedicine & Biotechnology) 2023年第6期24卷 510-523页

作者： Chuangang YOU Zhikang ZHU shuangshuang WANG Xingang WANG Chunmao HAN Huawei sHAO Department of burns&Wound Care Center the Second Afiliated HospitalZhejiang University School of MedicineHangzhou 310009China Department of burns the First People's Hospital of WenlingWenling 317500China

Foreign body reactions induced by macrophages often cause delay or failure of wound healing in the application of tissue engineering *** study explores the application of nanosilver(NAg)to reduce foreign body reactions during scaffold *** NAg hybrid collagen-chitosan scaffold(NAg-CCs)was prepared using the freeze-drying *** NAg-CCs was implanted on the back of rats to evaluate the effects on foreign body *** tissue samples were collected for histological and immunological evaluation at variable *** pigs were used to assess the effects of NAg on skin wound *** wounds were photographed,and tissue samples were collected for molecular biological analysis at different time points ***-CCs has a porous structure and the results showed that it could release NAg constantly for two *** NAg-CCs group rarely developed a foreign body reaction,while the blank-CCs group showed granulomas or necrosis in the subcutaneous grafting *** matrix metalloproteinase-1(MMP-1)and tissue inhibitor of metalloproteinase-1(TIMP-1)were reduced significantly in the NAg-CCs *** NAg-CCs group had higher interleukin(IL)-10 and lower IL-6 than the blank CCs *** the wound healing study,M1 macrophage activation and inflammatory-related proteins inducible nitric oxide synthase(iNOs),IL-6,and interferon-(IFN-)were inhibited by *** contrast,M2 macrophage activation and proinflammatory proteins(arginase-1),major histocompatibility complex-II(MHC-II),and found in inflammatory zone-1(FIZZ-1)were promoted,and this was responsible for suppressing the foreign body responses and accelerating wound *** conclusion,dermal scaffolds containing NAg suppressed the foreign body reaction by regulating macrophages and the expression of inflammatory cytokines,thereby promoting wound healing.

关键词： Nanosilver Macrophages Implants Foreign body reaction Wound repair

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Netrin-1 co-cross-linked hydrogel accelerates diabetic wound healing in situ by modulating macrophage heterogeneity and promoting angiogenesis

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Bioactive Materials 2024年第9期39卷 302-316页

作者： Futing shu Hongchao Huang shichu Xiao Zhaofan Xia Yongjun Zheng Department of Burn surgery The First Affiliated Hospital of Naval Medical UniversityShanghai200433People’s Republic of China Research Unit of Key Techniques for Treatment of burns and Combined burns and Trauma Injury Chinese Academy of Medical SciencesShanghai200433People’s Republic of China

Diabetic wounds,characterized by prolonged inflammation and impaired vascularization,are a serious complication of *** study aimed to design a gelatin methacrylate(GelMA)hydrogel for the sustained release of netrin-1 and evaluate its potential as a scaffold to promote diabetic wound *** results showed that netrin-1 was highly expressed during the inflammation and proliferation phases of normal wounds,whereas it synchronously exhibited aberrantly low expression in diabetic *** of netrin-1 inhibited normal wound healing,and the topical application of netrin-1 accelerated diabetic wound *** studies demonstrated that netrin-1 regulated macrophage heterogeneity via the A2bR/sTAT/PPARγsignaling pathway and promoted the function of endothelial cells,thus accelerating diabetic wound *** data suggest that netrin-1 is a potential therapeutic target for diabetic wounds.

关键词： Netrin-1 GelMA hydrogel Diabetic wound healing Angiogenesis Macrophage heterogeneity

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substance P combined with epidermal stem cells promotes wound healing and nerve regeneration in diabetes mellitus

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Neural Regeneration Research 2016年第3期11卷 493-501页

作者： Fei-bin Zhu Xiang-jing Fang De-wu Liu Ying shao Hong-yan Zhang Yan Peng Qing-ling Zhong Yong-tie Li De-ming Liu burns Institute the First Affiliated Hospital of Nanchang University Nanchang Jiangxi Province China Department of burns Huizhou Central People's Hospital Huizhou Guangdong Province China Medical College of Nanchang University Nanchang Jiangxi Province China

Exogenous substance P accelerates wound healing in diabetes,but the mechanism remains poorly ***,we established a rat model by intraperitoneally injecting *** wounds（1.8 cm diameter） were drilled using a self-made punch onto the back,bilateral to the vertebral column,and then treated using amniotic membrane with epidermal stem cells and/or substance P around and in the middle of the *** the combined treatment the wound-healing rate was 100% at 14 *** prolonged time,type I collagen content gradually increased,yet type III collagen content gradually *** protein gene product 9.5-and substance P-immunoreactive nerve fibers *** nerve fiber endings extended to the *** therapeutic effects of combined substance P and epidermal stem cells were better than with amniotic membrane and either factor *** results suggest that the combination of substance P and epidermal stem cells effectively contributes to nerve regeneration and wound healing in diabetic rats.

关键词： nerve regeneration diabetes substance P epidermal stem cells sensory nerve wound healing collagen neural regeneration

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用多感官型分心装置缓解患儿伤口处理时疼痛的研究

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中华烧伤杂志 2009年第5期25卷 352-356页

作者： Kate Miller sylvia Rodger sam Bucolo Xue-Qing Wang Roy M Kimble 4029 stuart pegg Paediatric burns centre Royal Children's Hospital Brisbane Australia Bums Research Group Department of Paediatrics & Child Health The School of Medicine The University of Queensland Brisbane Australia Department of Occupational Therapy The School of Health and Rehabilitation Sciences The University of Queensland Brisbane Australia Department of Design Queensland University of Technology Brisbane Australia

目的设计多感官型分心装置（MMD），观察其在烧伤换药和其他医疗过程中减轻患儿焦虑和疼痛的效果。方法设计3项前瞻性、随机对照临床试验。选择澳大利亚布里斯班皇家儿童医院烧伤中心和骨折整形外科患儿182例，共计354个医疗过程，分别... 详细信息

目的设计多感官型分心装置（MMD），观察其在烧伤换药和其他医疗过程中减轻患儿焦虑和疼痛的效果。方法设计3项前瞻性、随机对照临床试验。选择澳大利亚布里斯班皇家儿童医院烧伤中心和骨折整形外科患儿182例，共计354个医疗过程，分别应用标准分心法、手握电子游戏机和MMD（前MMD—D型、MMD-D型及MMD-PP型）。采用改良面部表情评分法、面部疼痛评分法、视觉模拟评分法及Wong，Baker面部表情疼痛评分法，记录患儿报告的疼痛分数、父母和护理人员报告的患儿焦虑和疼痛分数以及换药时间。结果与标准分心法组和电子游戏机组[（3．60±O．25）、（3．83±1．49）分]比较，MMD—D组与MMD—PP组患儿首次换药时的疼痛分数[（2．13±0．23）、（2．15±0．17）分]显著降低（P〈0．01），换药时间明显缩短（P〈0．01），且MMD在连续3次换药过程中均能发挥缓解疼痛的作用。此外，MMD-PP组患儿在换药前由焦虑引起的疼痛分数也较其他组显著降低（P〈0．01）。结论MMD较标准分心法和手握电子游戏机更能有效减轻患儿伤口处理过程中的焦虑和疼痛。该装置仍在临床试验中，且继续显示其有效性。

关键词：镇痛儿童分心法虚拟现实

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Prospective study and validation of early warning marker discovery based on integrating multi-omics analysis in severe burn patients with sepsis

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burns & Trauma 2023年第1期11卷 15-31页

作者： Jiamin Huang Yi Chen Zaiwen Guo Yanzhen Yu Yi Zhang Pingsong Li Lei shi Guozhong Lv Bingwei sun Department of burns and Plastic surgery Affiliated Suzhou Hospital of Nanjing Medical UniversitySuzhou 215002Jiangsu ProvinceChina Department of burns and Plastic surgery Affiliated Hospital of Nantong UniversityNantong 226000JiangsuChina Department of burns and Plastic surgery Northern Jiangsu People’s HospitalYangzhou 225001JiangsuChina Department of burns and Plastic surgery Affiliated Hospital of Jiangsu UniversityZhenjiang 212001JiangsuChina Department of burns and Plastic surgery Affiliated Hospital of Jiangnan Uni-versityWuxi 214041JiangsuChina Department of burns and Plastic surgery Affiliated Huaian No.1 People’s Hospital of Nanjing Medical UniversityHuaian 223300JiangsuChina

Background:Early detection,timely diagnosis and rapid response are essential for case management and precautions of burn-associated ***,studies on indicators for early warning and intervention have rarely been *** study was performed to better understand the pathophysiological changes and targets for prevention of severe burn ***:We conducted a multi-center,prospective multi-omics study,including genomics,microRNAomics,proteomics and single-cell transcriptomics,in 60 patients with severe burn injuries.A mouse model of severe burn injuries was also constructed to verify the early warning ability and therapeutic effects of potential ***:Through genomic analysis,we identified seven important susceptibility genes(DNAH11,LAMA2,ABCA2,ZFAND4,CEP290,MUC20 and ENTPD1)in patients with severe burn injuries complicated with *** plasma miRNAomics studies,we identified four miRNAs(hsamiR-16-5p,hsa-miR-185-5p,hsa-miR-451a and hsa-miR-423-5p)that may serve as early warning markers of burn-associated sepsis.A proteomic study indicated the changes in abundance of major proteins at different time points after severe burn injury and revealed the candidate early warning markers s100A8 and *** addition,the proteomic analysis indicated that neutrophils play an important role in the pathogenesis of severe burn injuries,as also supported by findings from single-cell transcriptome sequencing of *** further studies on severely burned mice,we determined that s100A8 is also a potential early therapeutic target for severe burn injuries,beyond being an early warning ***:Our multi-omics study identified seven susceptibility genes,four miRNAs and two proteins as early warning markers for severe burn-associated *** severe burn-associated sepsis,the protein s100A8 has both warning and therapeutic effects.

关键词： Early warning Marker Integrating multi-omics analysis severe burn sepsis

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