Anna Chrapusta

Levels of plasma matrix metalloproteinases (MMP-2 and MMP-9) in response to INTEGRA® dermal regeneration template implantation

Background Cutaneous wound healing results in scar formation. Matrix metalloproteinases (MMP) transform extracellular matrix proteins and modulate inflammation and cell signaling, thus determining scar outcome. To provide rapid wound closure and reduced scarring, dermal scaffolds were introduced. Little is known about the influence of these materials on MMPs levels. Material/Methods In this in vivo study the levels of MMP-2, MMP-9, and mediators of inflammation and fibrosis (IL-4 and TGF-β1) in patients treated with Integra® dermal regeneration template (IDRT) were investigated. In the group of 11 pediatric patients treated with IDRT, levels of selected molecules were analyzed before surgery and at day 1, 7, and 25 after scaffold implantation. Results The mean IDRT take rate was 89.5±4.7% with 4 patients (36%) who developed local infection. Patients were divided into 2 groups according to presence of infection (1 group with complications and 1 group without complications). In the group with complications, the IDRT take rate was significantly reduced compared to the group without complications (71.5±5.4 vs. 100±0.1; p<0.005). Plasma levels of MMP-2 were significantly (p<0.05) elevated in both groups on day 7 after the scaffold placement compared to baseline. Positive correlations between IL-4 and MMP-2 (p=0.01) in the group with complications and TGF-β1 and MMP-9 (p=0.012) in both groups were observed. Conclusions These findings suggest that Integra® scaffold degradation is mainly caused by MMP-2, whereas inflammation associated with local infection increases levels of this molecule and it is not associated with elevation of MMP-9. This shows that dermal regeneration with Integra® uses molecular mechanisms other than scar formation during dermal wound healing.

A comparative analysis of advanced techniques for skin reconstruction with autologous keratinocyte culture in severely burned children: own experience

Introduction The local treatment in burns larger than 50% of total body surface area is still the great challenge for surgeons. Aim This paper presents a review of different solutions for deep burn wound healing in children and the early outcomes of treatment with combined autologous cell culture technique. Material and methods For this study, 20 children aged between 4 and 12 years with 55–65% of TBSA III grade burn injury were analyzed. A skin sample, 1 cm × 1 cm in size, for keratinocyte cultivation, was taken on the day of the burn. After necrotic tissue excision, the covering of the burned area with an isolated meshed skin graft was carried out between day 4 and 7. After 7 days of keratinocyte cultivation, the mentioned areas were covered with cells from the culture. We divided the burned regions, according to the way of wound closure, into 3 groups each consisting of 15 treated regions of the body. We used meshed split thickness skin grafts (SSG group), cultured autologous keratinocytes (CAC group), and both techniques applied in one stage (SSG + CAC group). Results In the SSG group, the mean time for complete closure of wounds was 12.7 days. Wounds treated with CAC only needed a non-significantly longer time to heal – 14.2 days (p = 0.056) when compared to SSG. The shortest time to heal was observed in the group treated with SSG + CAC – 8.5 days, and it was significantly shorter when compared to the SSG and CAC groups (p < 0.001). Conclusions This study suggests that cultured keratinocytes obtained after short-time multiplication, combined with meshed autologous split thickness skin grafts, constitute the optimal wound closure in burned children.

Hyperbaric oxygen therapy as additional treatment in deep sternal wound infections – a single center’s experience

Introduction Deep sternal wound infection (DSWI) is one of the most serious complications after cardiac surgery procedures, observed in 5% of patients. Current standard medical therapy for DSWI includes antibiotics, surgical debridement, resuturing or negative pressure wound therapy (NPWT). Unfortunately, in some cases these methods are insufficient, and additional therapeutic options are needed. Aim To assess the effects and usefulness of additional hyperbaric oxygen therapy (HBO2) in patients with DSWI after cardiac surgery procedures. Material and methods A retrospective analysis of 10 patients after cardiac surgery who developed DSWI in the period 2010–2012 was performed. After 3 months of ineffective conventional therapy including targeted antibiotic, surgical sternal debridement and NPWT, patients were qualified for additional HBO2 therapy. A total of 20 sessions of HBO2 therapy were performed, each 92 minutes long. Results After 4 weeks of HBO2 treatment, 7 patients presented complete wound healing with fibrous scar formation. One patient was qualified for the another cycle of HBO2 therapy with 20 additional sessions, and complete wound healing was observed. In 2 cases, after 5 and 19 sessions, HBO2 was interrupted because of improper qualifications. Conclusions The HBO2 as an additional therapy in DSWI was successful in 80% of cases, and no complications were observed. However, due to the small number of published studies with a small number of patients, randomized, clinical trials are needed to assess the clinical results of HBO2 in DSWI after cardiac surgery procedures.

Treatment of frostbites – effectiveness of dermal substitute application on frostbite wounds – a case report)

Exposure to cold can produce: localized injury (frostnip, chilblain, immersion foot and frostbite), generalized cooling of the entire body (systemic hypothermia) and a combination of both. Frostbite refers to the clinical situation in which water molecules freeze and crystallize within biologic tissue, resulting in cellular and tissue death. Frostbite injury have been divided into four classic stages (first, second, third, fourth). The staging has limited clinical usefulness, because no direct correlation to survival or tissue loss exists with prognosis based on early staging. Some experts describe frostbite injury as: superficial and deep. This allows for a better correlation between degrees and final outcome. In center it was treated 26 cases of frostbite since September 2009 (2 in 2009, 7 in 2010, 5 in 2011 and 12 in 2012). It was presented four of them that were found as clinically deep frostbites: 1. 17-years-old male with I/II Wschodnie Centrum Leczenia Oparzeń i Chirurgii Rekonstrukcyjnej w Łęcznej RYSZARD MĄDRY Wschodnie Centrum Leczenia Oparzeń i Chirurgii Rekonstrukcyjnej w Łęcznej, ul. Krasnystawska 52, 21-010 Łęczna, Tel.: (81) 752 65 38, Fax: (81) 752 65 39, e-mail: ryszard.madry@icloud.com Wpłynęło: 20.02.2014 Zaakceptowano: 05.03.2014 DOI: dx.doi.org/10.15374/ChPiO2014007 Artykuł jest dostępny na zasadzie dozwolonego użytku osobistego. Dalsze rozpowszechnianie (w tym umieszczanie w sieci) jest zabronione i stanowi poważne naruszenie przepisów prawa autorskiego oraz grozi sankcjami prawnymi. !