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Background This systematic review evaluated the efficacy of autologous skin cell suspensions (ASCS) on the re-epithelialization of partial thickness burn injuries and skin graft donor site wounds. Methods Four databases (EMBASE, Google Scholar, MEDLINE, Web of Science), grey literature and select journal hand-searching identified studies from 1975 - 2020. Randomized trials evaluating partial thickness burn management with non-cultured ASCS compared to any other intervention were included. Time to re-epithelialization (TTRE) was the primary outcome. Three independent researchers completed screening, data extraction and certainty of evidence assessment using Cochrane Risk of Bias Tool and Grading of Recommendations Assessment, Development and Evaluation. Results Five trials (n = 347) reported on adults (2 trials) and children (1 trial) with burn wounds, and adults with donor site wounds (2 trials). The effect of ASCS compared to control on TTRE in adult burn wounds was not estimable. TTRE was shorter in pediatric burn wounds (SMD -1.75 [95% CI: -3.45 to -0.05]) and adult donor site wounds (SMD-5.71 [95% CI: -10.61 to-0.81]) treated with ASCS. The certainty of evidence was very low. Conclusion Compared to standard care, ACSC may reduce pediatric partial thickness burn wound and adult split-thickness skin graft donor site TTRE. Registration PROSPERO CRD42019133171

Objectives Split thickness skin graft is an essential component of release of post burn contracture of neck. There are many methods of fixation of skin grafts; however, there is lack of objective comparison between different techniques. This study has been designed to compare three commonly used techniques of split thickness skin graft fixation methods. Surgical time, advantages, cost factor and post-operative outcome have been compared amongst three techniques. Methods A randomized interventional comparative study was conducted to compare three methods of skin graft fixation in patients of 10–50 years age group, with contracture of more than 3 month duration having more than 100 cm2 skin defects after contracture release. Resurfacing of the defects after contracture release was carried out in all the groups using autologous split skin grafts. Patients were included in three groups; Group 1: tie over method, Group 2: skin stapler fixation and Group 3: Cyanoacrylate glue fixation. Results Mean duration of fixation procedure was 34 min in tie over group, in skin stapler group 7 min and in cyanoacrylate group 12 min. Mean cost of fixation material was 10.23 USD in tie-over group, 11.23 USD in stapler group and 40.06 USD in cyanoacrylate group. Mean score of pain/discomfort (visual analog score) on dressing removal in tie-over group was 3, for skin stapler group was 2.9 and that for cyanoacrylate glue group was 1.8. mean graft take was found to be 90.1% in tie-over group, 94.1% in skin stapler group & 93.8% in cyanoacrylate glue group. On logistic regression analysis, keeping all the variables constant in the groups the complications as the outcome variable, three groups are comparable. The need for regrafting remains inconclusive. Conclusions Skin stapler method for skin graft fixation was least time consuming, affordable and highly reliable when graft take success was considered. Cyanoacrylate glue fixation method was least painful and reliable in terms of graft take success though costlier than other two

In burn patients, meshed split thickness skin grafts are commonly used on large and non-flat areas whom immobilization is difficult to achieve. The frequent mobilizations of burn patients can make the graft slip and prevent the revascularization and therefore the taking of the skin graft. In order to prevent this pitfall, we modified and adapted the tie-over dressing procedure. The giant running tie-over dressing enables large skin grafts to be applied to their wound bed and therefore helps revascularization. Some cautions are necessary in order to avoid any infection. This original and easy-to-perform procedure answers to the difficulties of large split-thickness skin grafts in burn patients.

Preservation of human amniotic membrane (HAM) in glycerol 85% has been used clinically but the use of glycerol 98% can give the maximum virucidal activity and increases the safety of HAM.To determine the degree of clinical efficacy of HAM preserved in glycerol 98% as a biological dressing in management of donor site of split thickness skin graft (STSG).40 subjects were enrolled in this randomized, controlled study conducted in Al-Azhar University Hospitals from August 2013 to June 2014. We compared HAM preserved in glycerol 98% to vaseline gauze. Patients were randomly allocated to STSG donor site dressing with one of these materials. Outcome measures included pain scores at postoperative days 2, 6 and 10, time to re-epithelialization, and incidence of infection.Both groups were homogenous regarding age, gender, cause of burn and size. The HAM group showed significantly less pain on postoperative days 2 and 6 (4 and 2.7 vs. 5.6 and 4.2 respectively with p value0.05). Shorter time to re-epithelialization was also found in the HAM group (11.7 vs. 15.4 with p value0.05). No significant difference was found between both groups in the incidence of infection.HAM preserved in glycerol 98% is clinically effective as a biological dressing. The higher glycerol concentration increases the safety of HAM with retaining the clinical effect at the same time.

Choice of the donor site for a split thickness skin graft depends on skin availability, possible complications and anticipated esthetic results. We selected the scalp to be the primary donor site at our institution. During a period of ten years (1998–2008), a group of 123 pediatric patients aged 4 months to 15 years (65% were below the age of 2; mean age 2.98 years) underwent skin grafting from this particular site. In 2 cases the same area was re-harvested. All donor sites healed by the 10th post-operative day. Donor site complications included: 2 microalopecia regions, 5 pressure sores in a close proximity, 1 hypertrophic scar and 1 visible mark on the forehead due to technical mistake in graft harvesting. All children started scar management of the recipient site with contact therapy using adhesive tape Hypafix (BSN Medical); subsequently moving on to silicone sheets or gel in selected refractory cases. We present results for 68 scars in 41 patients with the longest follow-up period. Scar quality was evaluated after minimum of 10 years and scored according to the Vancouver Scar Assessment Scale. Very good and good results were obtained in 55 scars (80.9%), satisfactory in 11 scars (16.2%) and unsatisfactory in 2 scars (2.9%). Conclusions Our results confirm, that the scalp is a reliable donor site in children and contact therapy is an adequate form of scar prevention/treatment of the recipient site.

The standard of care for deep burns is autologous split thickness skin grafting. Although adequate to resurface a deep wound, the resulting skin is chronically abnormal. The purpose of this study was to describe the experience of patients with split thickness skin grafts to help guide future investigations related to skin regeneration. In this study, an interpretive description qualitative methodology was employed. Subjects participated in a two-part single patient interview that was recorded and transcribed. A nurse with experience in clinical burn care coded and interpreted the data. Participants were recruited through presentation to a university based outpatient burn clinic for follow up from autologous split thickness skin grafting. Eight male patients and four female patients 20-62 years old ranging 2-29 months post-skin grafting were enrolled in the study. The most significant concerns voiced by patients were identified and organized into five themes: (1) a new normal, (2) split thickness skin graft symptoms, (3) appearance of new skin, (4) coping, and (5) participation in future clinical trials. Participants reported that the abnormalities related to their split thickness skin grafts were significant enough that they would be willing to participate in a future clinical trial investigating new cell-based therapies.

One of the consequences of face burn is upper lip deformation with philtrum injury. The philtrum's absence poses severe cosmetic defects. A literature review shows no effective developed technique which allows the surgeon to restore the upper lip and the philtrum in a single-stage procedure. The article presents a new method for burn-damaged philtrum restoration. Two scar stripes are deliberately left in place above the upper lip where the normal philtral ridges should be. The width of these two stripes (ridges) should be around 4 mm. The upper lip scars, lateral both ridges and between them, are excised forming the philtral dimple. The wound is covered with a split thickness skin graft. Two U-shaped sutures are led through the skin graft, both scar stripes and deeper through the underlying tissues between stripes. A bolster is plunged between the ridges in order to fill the dimple and is fixed by the tie-over dressing with tension. The skin transplant lying laterally to the ridges is covered with a separate tie-over dressing. The bolster is being kept in place for the duration of 7 days. As a result, the scar ridges preserve their height and the dimple keeps its depth. Good long-time follow-up results (up to 7 years) were observed in all 18 patients. In most cases the dimple can be slightly smoothed with time. The suggested method of philtrum restoration is an important component of the burned upper lip reconstruction as part of the post-burn facial resurfacing.

Donor site management after split-thickness skin graft applications can have problems such as late healing and pain. Many dressing methods and medical applications are reported to solve these problems but none of them were ideal. In this study we aimed to promote epithelisation and remove pain earlier with using lyophilized bovine collagen (gelfix spray). According to our results, epithelisation time for the gelfix group was earlier than control group (9.09 days mean and 11.2 days mean for control group (p

Honey has been used for medicinal purposes since ancient times. Its antibacterial effects have been established during the past few decades. Still, modern medical practitioners hesitate to apply honey for local treatment of wounds. This may be because of the expected messiness of such local application. Hence, if honey is to be used for medicinal purposes, it has to meet certain criteria. The authors evaluated its use for the split thickness skin graft fixation because of its adhesive and other beneficial effects in 11 patients. No complications such as graft loss, infection, and graft rejection were seen. Based on these results, the authors advised honey as a new agent for split thickness skin graft fixation. In recent years there has been a renewed interest in honey wound management. There are a range of regulated wound care products that contain honey available on the Drug Tariff. This article addresses key issues associated with the use of honey, outlining how it may be best used, in which methods of split thickness skin graft fixations it may be used, and what clinical outcomes may be anticipated. For this reason, 11 patients who underwent different diagnosis were included in this study. In all the patients same medical honey was used for the fixation of the skin graft. No graft loss was seen during both the first dressing and the last view of the grafted areas. As a result, it has been shown that honey is also a very effective agent for split thickness skin graft fixations. Because it is a natural agent, it can be easily used in all skin graft operation for the fixation of the split thickness skin grafts.

A multi-centre, open, within-patient controlled study was performed on 23 adult burnt patients to investigate the effectiveness, safety and tolerability of Veloderm in comparison with Algisite M and Jaloskin in split-thickness skin graft donor site care. The areas dressed with Veloderm completely healed within 10-13 days in a significant higher proportion than the other two dressings (47.6% for Veloderm versus 26.3% for Algisite M and 10% for Jaloskin, P

WOS: 000376886300043, PubMed ID: 26899599, Skin graft studies in rats constitute a valuable adjunct to scientific human experimentations, however the harvesting of split thickness skin graft poses a challenge to the researcher due to the presence of panniculus carnosus tissue in rat skin. This striated muscle tissue renders significant laxity and mobility to the skin layer, greatly interfering with the process of skin graft harvest. In order to fixate the rat skin and limit its flexibility various techniques and modifications have been described, which mostly rely on the use of subdermal implanted templates. These methods are therefore time consuming, with an additional exposure to surgical stress and wounds. A new and simple technique is presented which offers a rapid and reliable alternative to the existing methods of split thickness skin graft harvesting without any additional invasive procedure or extra instruments other than the researchers hands and a dermatome. (C) 2015 Elsevier Ltd and ISBI. All rights reserved.

This report presents a case of post-burn palmar contracture with flexion contracture of thumb of 20-year duration. The contracture was released and the raw area was covered with split thickness skin graft. Only one 'K' wire in soft tissue was needed to keep all the fingers straight and immobilized, suggestive of intermetacarpal ligamentous contracture. A static night splint was given to maintain the correction. Complete range of movement was achieved in a month with the combination of dynamic splinting and physiotherapy. It was interesting to note that even 20 years of contracted position did not render the metacarpophalangeal joints completely stiff and useless. Probable reasons are discussed.

Split-thickness skin grafts (STSGs) from the scalp have been used in large burns. The donor site wounds are usually covered using occlusive dressings, such as film dressings because they contribute to reduce donor site pain and infection under exudative crust and to enhance re-epithelialization. However, it is not always easy to fix such film dressings to the scalp because of the presence of hair. In this paper, we report the use of skin staplers to fix the film dressings. Eight donor sites in four patients were dressed in this way. The patients had 50-78% of the body burned, all of them survived. The mean healing time for the donor sites was 6.8 days. Three patients had their scalps re-harvested several times (range two to three times). There were no infections nor secondary skin ulcers at the donor sites. The technique of this dressing is very simple and speedy, thus we recommend the use of skin staplers to fix the film dressing to scalp donor wounds in patients with burns.

In a controlled, prospective study, calcium sodium alginate and porcine xenograft were compared in the treatment of split-thickness skin graft donor sites on 20 patients. Half of each donor site was dressed with each material. Time to complete healing, quality of regenerated skin and patient comfort were assessed. Time to healing was 8.1 days with alginate and 11.3 days with porcine xenograft (P less than 0.001). Quality of healed skin was consistently good with the alginate, and better than under the xenograft in 95 per cent of patients (P less than 0.001). Hypertrophic scarring was not observed under alginate dressings but occurred in 25 per cent of xenograft-dressed sites (P less than 0.01). In addition, evidence was found that allergic reactions to porcine xenograft could occur. Alginate was preferred by 75 per cent of patients and none preferred porcine xenograft (P less than 0.01); the remainder had no preference. It was concluded that porcine xenograft is inferior to calcium sodium alginate as a dressing for split-thickness skin donor sites.

Cellophane paper has been used as a dressing for split-thickness skin graft donor sites in 251 patients between October 1985 and December 1989. Twelve donor sites in 10 patients were observed in detail to assess the usefulness of this material. The results of the study are presented and the merits and disadvantages of this dressing material have been discussed. In the opinion of the authors the cellophane paper dressing was found to be most satisfactory. It is also cheaper than the newly available dressing materials for the skin donor area.

Argon beam coagulation (ABC) uses argon gas to evacuate blood in an operative field and simultaneously to transport a coagulating electric current to bleeding sites. This allows a 'no touch' method of coagulation which is faster, more precise, and less destructive than conventional electrocautery. The technique has been used to reduce blood loss in liver surgery, trauma surgery and neck dissections. In this study, the effect of ABC treatment of the recipient graft beds on the survival of split thickness skin grafts was assessed in pigs, testing the hypothesis that ABC treatment of the recipient bed would have no adverse effect on skin graft survival. Nine 20 kg mixed breed pigs had split thickness skin grafts raised on each side of the paraspinous area. The graft beds on one side were prepared using ABC and the contralateral side served as controls. The percentage of graft survival on the ABC treated sides was compared to control graft survival on the other side at 12 days postsurgery. Our results confirm the hypothesis that treatment of the recipient bed with ABC does not adversely affect the survival of split thickness skin grafts.

This study was designed to evaluate the epidemiology and outcome of burn injuries due to paint thinner in a local burn center. During a 10-year period, 32 patients were admitted to our Burn Unit for paint thinner thermal burn. Patients were reviewed regarding the age, sex, etiologic factors, extent and localization of burn, treatment methods, length of hospitalization, and results. There were 30 males and 2 females. The mean age of patients was 25.9 +/- 11 years. The most common etiologic factor was kindling a fire with paint thinner. The mean extent of burn was 33.6 +/- 24% of the total body surface area. All patients sustained burn injury on the face, arms, and hands and five patients among them had extended burn areas on the trunk and/or lower extremity. The mean length of hospitalization for the survivors was 34.5 +/- 21.6 days. Twenty-eight patients were treated by early excision and split-thickness skin grafting. In four patients, burn wounds were healed by conservative management. Five patients with burn size of over 75% of the total body surface area died. In conclusion, paint thinner may be the cause of a catastrophic thermal injury and should not be used for the purpose of kindling fire.

The cost analysis undertaken by Schwarze et al. [1] to compare treatment costs between Jelonet and Suprathel appears to be flawed. Fig. 3 in their text indicates that the nursing care for Jelonet was charged at 15 euros per hour whereas nursing care for Suprathel was charged at 10 euros per hour. Likewise it appears that physicians were paid 5 euros less per hour in the Suprathel group. However, the hourly salary for nurses should be the same in both groups, and similarly for physicians.