Peter Mailänder

The biology of burn injury

Please cite this paper as: The biology of burn injury. Experimental Dermatology 2010; 19: 777–783.

A rare vasoproliferative lesion: angiolymphoid hyperplasia with eosinophilia of the hand

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare vasoproliferative lesion of uncertain aetiology, involving the skin and subcutaneous tissue. The predilection of the tumour-like lesion is for the head and neck region. Radical surgical excision is still regarded as the most effective treatment. We present the case of a 33-year-old female with ALHE of the right hand. Preoperative MRI and angiography demonstrated involvement of the fourth and fifth rays, with complete occlusion of the ulnar artery, and a small lesion at the level of the metacarpophalangeal joint of the index finger. Complete tumour excision could not be achieved without resection of the fourth and fifth rays. One year postoperatively, there were no clinical signs of recurrence. The patient refused any further invasive diagnostic and follow-up examinations. Angiolymphoid hyperplasia of the hand is a rare disease, and patients should undergo early surgical treatment to achieve complete excision of the lesion.

Adder bite: an uncommon cause of compartment syndrome in northern hemisphere

Snakebite envenomation is an uncommon condition in the northern hemisphere, but requires high vigilance with regard to both the systemic effects of the venom and the locoregional impact on the soft tissues. Bites from the adder, Vipera Berus, may have serious clinical consequences due to systemic effects. A case of a 44-year-old man is reported. The patient was bitten in the right hand. He developed fasciotomy-requiring compartment syndrome of the upper limb. Recognition of this most seldom complication of an adder bite is vital to save the limb. We recommend that the classical signs and symptoms of compartment syndrome serve as indication for surgical decompression.

Remote effects of extracorporeal shock wave therapy on cutaneous microcirculation.

BACKGROUNDnExtracorporeal shock wave treatment (ESWT) has proven its clinical benefits in different fields of medicine. Tissue regeneration and healing is improved after shock wave treatment. Even in the case of burn wounds angiogenesis and re-epithelialization is accelerated, but ESWT in extensive burn wounds is impracticable.nnnHYPOTHESISnHigh energy ESWT influences cutaneous microcirculation at body regions remote from application site.nnnMETHODSnEighteen Sprague Dawley rats were randomly assigned to two groups and received either high energy ESWT (Group A: total 1000 impulses, 10xa0J) or placebo shock wave treatment (Group B: 0 impulses, 0xa0J), applied to the dorsal lower leg of the hind limb. Ten minutes later microcirculatory effects were assessed at the contralateral lower leg of the hind limb (remote body region) by combined Laser-Doppler-Imaging and Photospectrometry.nnnRESULTSnIn Group A cutaneous capillary blood velocity was significantly increased by 152.8% vs. placebo ESWT at the remote body location (pxa0=xa00.01). Postcapillary venous filling pressure remained statistically unchanged (pxa0>xa00.05), while cutaneous tissue oxygen saturation increased by 12.7% in Group A (pxa0=xa00.220).nnnCONCLUSIONnHigh energy ESWT affects cutaneous hemodynamics in body regions remote from application site in a standard rat model. The results of this preliminary study indicate that ESWT might be beneficial even in disseminated and extensive burn wounds by remote shock wave effects and should therefore be subject to further scientific evaluation.

Failure in developing a model for complete vascular thrombosis in the common iliac artery in the rat.

The purpose of this study was to develop a model for complete arterial thrombosis proximal to the rat cremaster flap for subsequent fibrinolytic studies at the microcirculatory level. We divided 20 male Sprague‐Dawley rats into four experimental groups of five animals each. We assigned each group to an established thrombosis model using crush and standard microsurgical anastomosis, crush and intimal abrasion, inverted arterial suture, and intravascular silk sutures combined with microsurgical anastomosis at the common iliac artery. Vessel patency was examined using the milking test 30, 60, 90, and 120 min after the thrombogenic insults. The model of perpendicular silk sutures and anastomosis caused complete arterial thrombosis in one animal over 120 min. The other models failed in all animals. In conclusion, the thrombogenic models used in this study are not capable of creating a reliable complete arterial thrombosis in the common iliac artery of the rat.

Arterial crush injury causes decrease in tissue perfusion at the level of the microcirculation in skeletal muscle flap.

This study was designed to evaluate the effects of crush injuries to the feeding arteries of a muscle flap on microcirculatory haemodynamics. Eighteen male Sprague‐ Dawley rats were divided into three experimental groups for intravital microscopy of the cremaster muscle flap. Group 1 served as control. In group 2 the common iliac artery and in group 3 additionally the lower abdominal aorta was crushed with a Kocher clamp (17.4 N) over 5 min. Microcirculatory parameters (red blood cell velocity, vessel diameter, and capillary perfusion) were monitored before and 2 h after crush. In the one‐level crush group, red blood cell velocities significantly decreased by 39.17% (P=0.046) in first order arterioles and by 32.91% (P=0.0106) in second order arterioles. In capillary perfusion, a drop of 48.02% (P=0.0039) was noted. In the two‐level crush group, red blood cell velocities significantly dropped over 32.06% (P=0.0250) in first order arterioles, 35.91% (P=0.0065) in second order arterioles, and 45.69% (P=0.0782) in first order venules. Capillary perfusion was reduced by 20.16% (P=0.374). Arterial crush injuries as possible thrombogenic insults may result in a significant decrease in skeletal muscle perfusion although the blood supply through the crushed supplying vessel is maintained.