Cultured skin cells, artificial dermis join in race against time to cover burn wound

Article Abstract:

Infection control, nutritional support, and better techniques for removing burned skin have all contributed to higher survival rates among burn patients. However, with more patients who have burns covering 80 percent or more of their bodies surviving, survival now depends on wound closure. If the wound does not close, patients with burns over 85 to 90 percent of their bodies typically run out of metabolic fuel after two or three months, or they die of infections, especially pneumonia. Culturing skin from patients who have so little skin left is very difficult. Graft tissue can be expanded by cutting it to look like mesh, but it can be expanded only so far before both the cosmetic and medical results are unacceptable. Cadaver grafts and other foreign tissue grafts can be used, but there is danger of disease transmission and rejection of the graft by the patient's immune system. Researchers are developing an artificial dermis, as well as methods to culture skin from biopsies of the patient's own skin. The artificial dermis is a porous, collagen-based mat that promotes the growth of blood vessels. Blood vessels usually grow into the mat in about two weeks, and then an extremely thin layer of surface skin in placed over it. The harvested skin is substantially thinner, so that the donor site heals faster and can be used again if necessary. Drawbacks are that the artificial dermis provides little infection resistance, and requires two operations. Cultured skin is a promising technique, but so far has been difficult to use. (Consumer Summary produced by Reliance Medical Information, Inc.)

Innovations, Skin-grafting, Skin grafts

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Army center helps severely burned patients push survival 'envelope'

Article Abstract:

The burn unit at the United States Army Institute for Surgical Research (USAISR) at Fort Sam Houston in Texas is the world's largest institute for burn research. Burns are among the most difficult wounds to treat because all systems of the body are involved, and the immune system is greatly depressed, leaving the patient vulnerable to infection. Infection control is one of the major advances that has led to improved survival of burn patients. The discovery of two effective topical anti-infective agents, and the new single-bed, isolated intensive care units have led to the near disappearance of infection by Pseudomonas aeruginosa and Providencia stuartii. Pneumonia is still the most common cause of death in the burn unit, especially when the burn involves inhalation injury. Sophisticated techniques for diagnosis of inhalation injury have become available, but there has been little that could be done to treat it. Newer types of ventilators may help improve the survival rate for these patients. Since the 1960s, the use of silver has been standard for the topical treatment of burns, but it did not penetrate the wound well. Researchers are now exploring the use of electricity to push the silver ions into the wound. Silver nylon, with or without electric current, has been shown to be an effective barrier to microbial infection in rats and may turn out to be a useful therapy in humans, not only for burns, but for all kinds of wounds. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Pseudomonas aeruginosa infections

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Burn patients confront pain, fear, loss of control

Article Abstract:

Burn patients have constant pain, with moments of more intense pain when a breeze or the touch of a sheet excites the exposed nerves. In addition to the physical pain, there is also psychological pain, caused not only by the burns themselves, but also the sudden transformation of an independent person into a person who is totally dependent on others for everything. Patients often react inappropriately to this loss of control by refusing to eat, trying to get out of bed, or otherwise attempting to regain some control over their lives. Patients are given as much autonomy as possible at the United States Army Institute of Surgical Research (USAISR), which employs a full-time psychiatric nurse. What and when they want to eat are decisions that patients can make that give them a feeling of control over some part of their lives. In addition to the patient, the family must be considered. Families become anxious and demanding if their needs are not met, thereby increasing the nurses' workload. The USAISR has begun a 10-center study to assess the family's needs during the patient's hospitalization. The goal is to find out what these families need, rather than what nurses think they need. Other studies have shown differences between what heath care workers think the families need and what the families actually do want. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Hospital patients, Family

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