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This report describes the therapeutic course of a case of deep burns caused by friction heat generated over a long contact time by a rotating tractor wheel. The burn was accompanied by a full-thickness defect of the chest wall, which we treated with a combined myocutaneous flap of teres major and latissimus dorsi muscles with a large skin flap. Our therapeutic concept of this case is discussed. Based on the postoperative course of this case, we think a combined myocutaneous flap of teres major and latissimus dorsi muscles with two nourishing vessels as an alternative is a very useful, safe, and secure method for the treatment of cases with axillary damages which require one-stage and stable reconstruction, like our patient.

This report discusses the effectiveness of conservative treatment of burns using applications of prostaglandin E1 (PGE1) containing ointment (PGE1 ointment) to the wound site. Fourteen patients with superficial dermal burns (SDB), deep dermal burns (DDB) and full-thickness dermal burns (DB), who were treated with repeated applications of this ointment, showed rapid epithelialization of the affected tissue. Hypertrophic scarring after epithelialization was less than that expected after other therapies. The degree of scarring was graded as 'none', 'mild', 'moderate' or 'severe'. The results of this therapy revealed no scarring in two sites (8.7 per cent), mild scarring in 16 sites (69.6 per cent), moderate scarring in one site (4.3 per cent) and severe scarring in four sites (17.4 per cent) out of 23 sites distributed among the patients. The application of PGE1 ointment in combination with skin grafting surgery was found to improve functional and aesthetic results in the patients with DDB and DB, by minimizing the area of the donor site; it was especially useful for children with extensive burns because of the shortage of available tissue as donor site material for skin grafting.

This report indicates that retention fluid from blisters of partial skin thickness burns, which contains relatively large amounts of cytokines and growth factors, stimulates the wound healing process. Although epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF) levels were low, relatively large amounts of cytokines including platelet derived growth factor (PDGF), interleukin (IL-6) and transforming growth factor (TGF) alpha were present and these exercised stimulatory effects on wound healing. TGF beta, which plays an important role in collagen metabolism and in scar formation, was also detected. Contrary to our expectations, IL-1 alpha and beta, both of which initiate inflammation, were detected at relatively low levels whereas IL-8 levels were rather high. Various cytokines were shown to coexist in a balanced state in the retention fluids, suggesting that epithelialization might be regulated via a cytokine network operating on the wound surface. The growth of keratinocytes in culture significantly increased with the addition of 1 per cent or more of blister fluid to the medium.

Deep dermal burns covering 30 per cent of the total body surface area were prepared by immersing the backs of rabbits in hot water at 80 degrees C for 20 s, to determine whether platelet activating factor (PAF) was involved in the onset of oedema following burns and to evaluate the effect of TCV-309, a potent PAF antagonist. The PAF antagonist, which was infused soon after the burn, blocked oedema formation in the wound and significantly (P < 0.001) inhibited PAF increase (P < 0.05) in the damaged tissue in a dose-dependent manner. This was confirmed by immunohistochemistry. In contrast, the superoxide dismutase content in the group treated with a high dose of TCV-309 was significantly (P < 0.01) higher than that of the control group. These findings suggest that administration of large doses of a PAF antagonist immediately after injury prevents oedema of burn wounds and the subsequent onset of burn shock by suppressing PAF and superoxide radical formation.

Full skin thickness burns covering 35 per cent of the total body surface of rabbits were followed by measurements of Na-K ATPase and arterial blood gas analyses, before and after the burn injury. Studies of the effects of intravenous fluids with different compositions showed that the active transport of the cell membrane was depressed in vivo immediately after a burn injury, mainly due to acidosis. This phenomenon was not completely corrected by the Baxter formula which uses conventional lactated Ringer's solution. However, an improvement was observed in those groups given the 'Enriched Lactate Solution' (ELS) containing large quantities of lactate as the base source. These results suggest that ELS, which positively corrected acidosis in accordance with its concentration, is very effective and more appropriate than the conventional lactated Ringer's solution for early burn resuscitation.

It is known that the number of platelets decreases after burn injury. However, the mechanism of such a decrease and its influence on systemic organs have not been fully elucidated. In this study, we evaluated the efficacy of OP-41483 (a derivative of the prostaglandin I2 (PGI2) in burned rabbits with special reference to its association with renal function. Full thickness skin loss burns, covering 35 per cent of the total body surface area, were experimentally produced on the back of rabbits. Among the following groups of rabbits (six rabbits each), the time courses of renal function and platelet function were compared; Group I (no treatment), Group II (fluid therapy only), Group III (treated with OP-41483 + fluid therapy; IIIa: 50 ng/kg/min, IIIb: 75 ng/kg/min, IIIc: 100 ng/kg/min). The results show that in Group I, all rabbits died after 8 h. Renal function tests in this group showed a decrease in creatinine clearance and increases in FENa and CH2O. Such changes were improved in Groups IIIb, IIIa and II (in order of the degree of improvement). Group IIIc showed no improvement. As for the platelets the decrease in platelets was the smallest in Group IIIb, where platelets showed no decrease until 8 h after injury and the fibrinogen concentration increased. No improvement was found in Group IIIc by our tests, presumably owing to an overdose of OP-41483. The optimal dose of OP-41483 for improving the renal function of burned rabbits was 75 ng/kg/min in our study.

Burn injury causes dynamic alterations in the coagulation and fibrinolysis, and so-called DIC often occurs in burned patients. In this study the clinical significance of heparin therapy combined with antithrombin III concentrate in animal experiments and clinical experiences were discussed. The changes in blood coagulation, fibrinolysis and kidney function and the effect of anticoagulation therapy using heparin were investigated in rabbits with third degree burn covering 35% of the total body surface area. The animals were subjected to determinations for various kidney function tests, blood coagulation and fibrinolysis tests, blood viscosity and hematocrit value before induction of the burn and after 8 and 24 hours respectively. Thirty rabbits were divided into a non-therapy group, an intravenous infusion group, a heparin group, an antithrombin III group, and an antithrombin III plus heparin group and the results were compared among them. Oliguria and a disturbance of kidney function were noted even at hour 8 after burn in the non-therapy group. In the intravenous infusion group urine volume was maintained well although the early stage of non-oliguric renal insufficiency was noted. The changes noted in the intravenous infusion group were prevented almost completely in the heparin group at hour 8, but FENa and CH2O were elevated at hour 24 probably because antithrombin III activity was depressed markedly. In the antithrombin III group and the antithrombin III plus heparin group, however, creatinine clearance was moderately elevated while FENa and CH2O remained unchanged as compared with the values before the burn. The antithrombin III plus heparin group showed slightly better results than the antithrombin III group in Ucr/Pcr ratio, creatinine clearance and CH2O. The results of the present study indicate that it is extremely effective to initiate appropriate fluid infusion therapy immediately after a burn and administer antithrombin III concentrate in combination with or without heparin for the prevention of acute renal insufficiency in patient with a severe burn. The effects of antithrombin III concentrate when used clinically were also discussed.

Platelet reduction and renal dysfunction may occur after major thermal injury and be causally related to changes in the arachidonate cascade. In this article two new drugs, prostaglandin I2 analog OP-41483 (Venopirin) and thromboxane synthetase inhibitor OKY-046 (Cataclot), were tested in addition to aspirin in animal experiments with rabbits. The rabbits were divided into five groups and measurements made before and 8 and 24 hours after burn injury. The results indicate that platelet reduction and renal dysfunction occur within 8 hours after thermal injury in the no-therapy group and renal dysfunction could not be prevented completely even by adequate infusion therapy, but treatment with OP-41483 proved to suppress platelet reduction and improve renal function. Improvement in renal function was also noted in animals treated with aspirin or OKY-046, but platelet reduction could not be prevented by these drugs. Analysis of the time course of changes in thromboxane B2 level and 6-keto prostaglandin F1 alpha level disclosed that animals treated by infusion showed an elevation in thromboxane B2 and a significant elevation in the thromboxane B2/6-keto prostaglandin F1 alpha ratio, whereas animals treated with these three drugs showed a reduction in the thromboxane B2/6-keto prostglandin F1 alpha ratio. These results indicate that an effective measure for prevention of dysfunction of the organs after thermal injury is treatment with drugs that can modify the arachidonate cascade and cause an absolute or relative reduction in TXA2.

The changes in blood coagulation, fibrinolysis and kidney function and the effect of anticoagulation therapy using herapin were investigated in rabbits with full thickness skin loss burns covering 35 per cent of the total body surface area. Determinations of various kidney function tests, blood coagulation and fibrinolysis tests, blood viscosity and haematocrit values were made before burning and after 8 and 24h. Thirty rabbits were divided into a non-therapy group, an intravenous infusion group, a heparin group, an antithrombin III group and an antithrombin III plus heparin group and the results were compared. Oliguria and a disturbance of kidney function were noted 8 h after the burn in the non-therapy group. In the intravenous infusion group urine volume was well maintained although the early stage of non-oliguric renal insufficiency was noted. The changes noted in the intravenous infusion group were prevented almost completely in the heparin group but FENa and CH2O were elevated at 24h probably because antithrombin III activity was markedly depressed. In the antithrombin III group and the antithrombin III plus heparin group, however, creatinine clearance (Clcr) was moderately elevated while FENa and CH2O remained unchanged as compared with the values before the burn. The antithrombin III plus heparin group showed slightly better results than the antithrombin III group in Ucr/Pcr ratio, Clcr and CH2O. The results of the present study indicate that it is extremely effective to initiate appropriate fluid therapy immediately after a burn and to administer antithrombin III concentrate in combination with or without heparin for the prevention of acute renal insufficiency in patients with a severe burn.

A full skin thickness burn covering 35 per cent of the total body surface area was inflected on the back of rabbits. The animals were divided into seven groups and the effectiveness of OP-41483, aspirin (ASA), OKY-046 and CV-3988 was studied. All rabbits died between 8 and 24 h after injury in the no therapy group. Renal function tests in this group showed a decrease in Cler and an increase in FENa and CH2O. Such changes were improved slightly with infusion therapy. On the contrary, with OP-41483, OKY-046 and ASA, distinct improvements were observed (in order of extent of improvement), but with CV-3988 the improvements were rather small. As a result these drugs may also be effective in preventing organ failure after burn injury, but as such changes presumably occur immediately after the burn it is considered that a fast-acting agent such as OP-41483 is the most effective form of treatment.