An Open-Label Study of Low-Level Laser Therapy Followed by Autologous Fibroblast Transplantation for Healing Grade 3 Burn Wounds in Diabetic Patients

Objective: This case series describes successful management grade 3 burn ulcers in 10 diabetic patients using Autologous Fibroblast Transplantation along with Low-Level Laser Therapy.Background: Low Level Laser Therapy (LLLT) has been used as an effective therapeutic modality since the mid sixties. Although there are several clinical studies using LLLT in wound healing especially diabetic, pressure and venous ulcers, but there are rare reports of using this technique in burn ulcers. In this study for the first time we used LLLT along with antilogous fibroblast skin transplantation to treat grade 3 burn ulcers in diabetic patients.Materials and Methods: Ten diabetic patients with grade 3 burn ulcer, candidate for skin graft surgery entered the study. 1 Cm2 was biopsied using punch. Fibroblasts were extracted and cultured in-vitro. Patients were treated using LLLT in 3-4 weeks that took time that fibroblast cultures become ready to use. Laser irradiation was done using red red light, 650 nm, 150 mW, 1 J/ cm2  for the bed of the ulcer and infra red light 808 nm, 200 mW, 6 J/ cm2 for the margins every other day for 10 sessions. Then a thin layer of fibroblast suspension was applied to the base of ulcer using sterile sampler and its surface was covered by Vaseline gauze.Result: All patients healed completely in 10-12 weeks. No adverse effects were reported.Conclusion: We conclude that this method can be used as an effective method for treating large wounds especially in complicated patients including diabetics

Autologous cricoid cartilage as a graft for airway reconstruction in an emergent technique - A case report

Introduction: Laryngotracheal stenosis can be caused after traumatic injuries to the neck from the subglottic larynx to the trachea. Patients with laryngotracheal stenosis often need a tracheotomy and occasionally may become tracheotomy dependent. Different procedures have been described for the management of these lesions. Management options include techniques of endoscopic dilation, laser resection, laryngo-fissure, and an innovative array of plastic reconstructions with or without the use of stents. Case Report: This paper presents airway reconstruction in a young patient with severe subglottic stenosis due to a blunt trauma to the neck, who was treated using particles of an autologous fractured cricoid cartilage as the source for airway augmentation. An incision was made in the anterior midline of the cricoid lamina and deepened through the scar tissue to the posterior cricoid lamina. Then two lateral incisions (right&left) were made in the cricoid lamina and fractured cartilage particles and the scar tissue were removed via these two lateral incisions. The mucosal lining at the right and left of the midline incision, after debulking, were sutured to a lateral position. Thereafter three cartilage particles were used to reconstruct the anterior cricoid lamina and augment the lumen. Conclusion: It is worth to mention that an autologus cartilage graft can be used for certain cases with traumatic airway stenosis. Further follow up and more patients are needed to approve this method of reconstructive surgery in emergent situations

Evaluation of the Effects of Low Level Laser Therapy on the Healing Process After Skin Graft Surgery in Burned Patients (A Randomized Clinical Trial)

Background: Skin graft is standard therapeutic technique in patients with deep ulcers but as every surgical procedure has complications. Although several modern dressings are available to enhance comfort of donor site, using techniques that accelerate wound healing may enhance patient’s satisfaction.Low Level Laser Therapy (LLLT) has been used in several medical fields, especially for wound healing but for treating large ulcers, it may last several months to heal completely.Materials and Methods: The protocols and informed consent were reviewed according to Medical Ethics Board of Shahid Beheshti University of Medical Sciences (IR.SBMU.REC.1394.363) and Iranian Registry of Clinical Trials (IRCT2016020226069N2). Nine patients with bilateral similar grade 3 burn ulcer in both hands or both feet, candidate for Split Thickness Skin Graft (STSG) were selected. One side was selected for laser irradiation and the other side as control, randomly. Laser area was irradiated by red, 655 nm laser light, 150 mW, 2 J/Cm2 for the bed of the ulcer and infra red 808 nm laser light, 200 mW for the margins, every day for 7 days.Results: The rate of wound dehiscence after skin graft surgery was significantly lower in laser treated group in comparison to control group which received only classic dressing (P=0.019).Discussion: In the present study for the first time we evaluate the effects of LLLT on the healing process of skin grafted area in burn patients. The results showed LLLT is a safe effective method which improves graft survival and wound healing process and decreases the rate of wound dehiscence in patients with deep burn ulcer

Retrospective epidemiological study of burn injuries in 1717 pediatric patients: 10 years analysis of hospital data in Iran

Background: Burn injuries are considered an important preventable cause of injuries in children, and it still produces significant death in Iran. This study investigated the causes and severity of burns in patients. Methods: This study was retrospective descriptive study of children-burn injury in a referral Burn Care Center in Tehran, Iran during a ten-year period since 2005 to 2014. Data collection have been facilitated by using a specially designed checklist. The subjects included 1717 consecutive patients with various causes of burn injury. Data were analyzed applying descriptive statistics, one-way ANOVA, Chi-square. P-values less than 0.05 were considered significant. Results: The patients� mean age was 4.11 ± 3.42 yr. The mean hospitalization period was 11.15 ± 8.37 d. The grade of burn was 2 in 1292 (75.2) patients. Among the children-burn patients, 59.9 suffered from <20 of total body surface area burn. Most affected part of the body was trunk 762 (44.4). Overall, 1256 patients (73.2) suffered from hot liquid burns. Burns mortality rate for this study was identified 8.1 (N=3). Conclusion: The majority of the patients were male with a male to female ratio of 1.7:1. Most patients were in the 2-4 yr age group, with most of the injuries occurring in boys under the age of 5 yr old. It is the child's natural curiosity and inability to understand that special things are dangerous to them, which leads to burning injury. Most affected part of the body was trunk and 1256 patients (73.2) suffered from hot liquid burns. © 2018, Iranian Journal of Public Health. All rights reserved

Meta-analysis and systematic review of skin graft donor-site dressings with future guidelines.

Background: Many types of split-thickness skin graft (STSG) donor-site dressings are available with little consensus from the literature on the optimal dressing type. The purpose of this systematic review was to analyze the most recent outcomes regarding moist and nonmoist dressings for STSG donor sites. Methods: A comprehensive systematic review was conducted across PubMed/MEDLINE, EMBASE, and Cochrane Library databases to search for comparative studies evaluating different STSG donor-site dressings in adult subjects published between 2008 and 2017. The quality of randomized controlled trials was assessed using the Jadad scale. Data were collected on donor-site pain, rate of epithelialization, infection rate, cosmetic appearance, and cost. Meta-analysis was performed for reported pain scores. Results: A total of 41 articles were included comparing 44 dressings. Selected studies included analysis of donor-site pain (36 of 41 articles), rate of epithelialization (38 of 41), infection rate (25 of 41), cosmetic appearance (20 of 41), and cost (10 of 41). Meta-analysis revealed moist dressings result in lower pain (pooled effect size = 1.44). A majority of articles (73%) reported better reepithelialization rates with moist dressings. Conclusion: The literature on STSG donor-site dressings has not yet identified an ideal dressing. Although moist dressings provide superior outcomes with regard to pain control and wound healing, there continues to be a lack of standardization. The increasing commercial availability and marketing of novel dressings necessitates the development of standardized research protocols to design better comparison studies and assess true efficacy.R01 EB021308 - NIBIB NIH HHSPublished versio

The effect of a hydrolyzed collagen-based supplement on wound healing in patients with burn: A randomized double-blind pilot clinical trial

Introduction: Burn is among the most severe forms of critical illness, associated with extensive and prolonged physical, metabolic and mental disorders. The aim of this study was to assess the effect of an oral, low-cost, and accessible collagen-based supplement on wound healing in patients with burn. Methods: In this randomized double-blind controlled pilot clinical trial, 31 men, 18�60 years, with 20�30 total body surface area burn were studied. Patients were randomly assigned to receive either a collagen-based supplement (1000 kcal) or an isocaloric placebo, for 4 weeks. Serum pre-albumin, rate of wound healing, length of hospital stay, and anthropometries were assessed at baseline, and the end of week 2 and 4. Results: Serum pre-albumin was significantly higher at week 2 (29.7 ± 13.6 vs. 17.8 ± 7.5 mg/dL, P = 0.006) and week 4 (35.1 ± 7.6 vs. 28.3 ± 8.2 mg/dL, P = 0.023) in collagen than control group. Changes in pre-albumin concentration were also significantly higher in collagen group at week 2 (13.9 ± 9.8 vs. �1.9 ± 10.3 mg/dL, P < 0.001) and week 4 (19.2 ± 7.5 vs. 8.5 ± 10.1 mg/dL, P = 0.002). The Hazard ratio of wound healing was 3.7 times in collagen compared to control group (95 CI: 1.434�9.519, P = 0.007). Hospital stay was clinically, but not statistically, lower in collagen than control group (9.4 ± 4.6 vs. 13.5 ± 7 days, P = 0.063). There were no significant differences in weight, body mass index, dietary energy and protein intakes between the two groups. Conclusion: The findings showed that a hydrolyzed collagen-based supplement could significantly improve wound healing and circulating pre-albumin, and clinically reduce hospital stay in patients with 20�30 burn. © 2019 Elsevier Ltd and ISB

Retrospective epidemiological study of burn injuries in 1717 pediatric patients: 10 years analysis of hospital data in Iran

Background: Burn injuries are considered an important preventable cause of injuries in children, and it still produces significant death in Iran. This study investigated the causes and severity of burns in patients. Methods: This study was retrospective descriptive study of children-burn injury in a referral Burn Care Center in Tehran, Iran during a ten-year period since 2005 to 2014. Data collection have been facilitated by using a specially designed checklist. The subjects included 1717 consecutive patients with various causes of burn injury. Data were analyzed applying descriptive statistics, one-way ANOVA, Chi-square. P-values less than 0.05 were considered significant. Results: The patients� mean age was 4.11 ± 3.42 yr. The mean hospitalization period was 11.15 ± 8.37 d. The grade of burn was 2 in 1292 (75.2) patients. Among the children-burn patients, 59.9 suffered from <20 of total body surface area burn. Most affected part of the body was trunk 762 (44.4). Overall, 1256 patients (73.2) suffered from hot liquid burns. Burns mortality rate for this study was identified 8.1 (N=3). Conclusion: The majority of the patients were male with a male to female ratio of 1.7:1. Most patients were in the 2-4 yr age group, with most of the injuries occurring in boys under the age of 5 yr old. It is the child's natural curiosity and inability to understand that special things are dangerous to them, which leads to burning injury. Most affected part of the body was trunk and 1256 patients (73.2) suffered from hot liquid burns. © 2018, Iranian Journal of Public Health. All rights reserved

Epidemiology of burns during pregnancy in Tehran, Iran

Objective The purpose of this study was to determine the epidemiological factors of burns in pregnant women admitted to Motahari hospital in Tehran during a 7-year period. Study design This retrospective descriptive study was carried out for a 7-year period. Researchers examined the medical records and documents of all 38 pregnant women admitted to Motahari hospital. The required data including age, days of hospitalization, burn percentage, cause of the burn, extent and severity of the burn, burn involved member, gestational age, and fetal and maternal outcomes were collected using check lists. The collected data were analyzed using statistical package using social sciences (SPSS) software version 20. Results During this 7-year period, 38 pregnant women with burns in different parts of their body were admitted to Motahari hospital in Tehran. Regarding burn frequency in the trimesters of pregnancy, the highest frequency was found in the second trimester (73.7), and the frequency in the first and the third trimesters were 7.9 and 18.4, respectively. Maternal mortality rate in the third trimester (57.1) was higher than in the second (46.4) and the first (33.3) trimesters; however, fetal mortality rate was the highest in the first trimester (66.7) followed by the third trimester (57.1). Overall, fetal death occurred in half of the patients. Conclusion The results of this study showed high maternal and fetal mortality rates in pregnant women with burns. This issue indicates that planning and implementing supportive and therapeutic protocols in these patients are of utmost importance and should be carried out by maintaining the health of mother and fetus immediately after patient hospitalization. © 2016 Elsevier Ltd and ISBI. All rights reserved

Embolectomy For Acute Lower Limb Ischemia

In this prospective descriptive study, all patients with acute lower limb ischemia who presented to Shohada Tajrish Hospital (STH) between July 2001 and July 2003 were analyzed and followed for 6 months. The total population of 109 patients, with no significant difference in sexual distribution had a mean age of 64±16 years. 23% had AF and 31% had a history of MI, but in the ECG of 30%, no pathologic finding had been detected. Pain and coolness were the two most prevalent symptoms. Only one-third of the patients had normal sensory and motor examination in their limb and the rest had different degrees of impairment. More than 70% of the patients arrived here after 12 hours from the onset of the symptoms. Fasciotomy was done in 29%, and amputation in 23.5%. The mortality rate was 12.2%. Surgical site infection occurred in 11% and 14.1% underwent re-embolectomy. There was no pseudoaneurysms. The time interval from the onset, sensory and motor findings, and calf tenderness a! ffected the prognosis. Prognosis was better in smokers. The iatrogenic group which consisted of 13.7% of our patient population had the best prognosis (no mortality or morbidity). 4% of the patients who had first undergone embolectomy in other centers, all lost their limbs. In cases of late embolectomies, venotomy and heparin flush has lowered the amputation level without increasing mortality. Early referral by a cardiologist, receiving heparin rapidly and smoking are among the factors which improve prognosis

Candidemia in pediatric burn patients: Risk factors and outcomes in a retrospective cohort study

Background and Purpose: Despite advances in burn care and management, infections are still a major contributor to morbidity and mortality rates in patients with burn injuries. Regarding this, the present study was conducted to investigate the prevalence and importance of candidemia in pediatric burn patients. Materials and Methods: Blood samples were collected from the patients and cultured in an automated blood culture system. Candida species were identified using specific culture media. The relationship between candidemia and possible risk factors was evaluated and compared to a control group. Results: A total of 71 patients with the mean age of 4.52±3.63 years were included in the study. Blood cultures showed candidemia in 19 (27) patients. Based on the results, C. albicans was the most common fungus among patients with and without candidemia. The results of statistical analysis also showed that candidemia was significantly correlated with total body surface area (TBSA), mechanical ventilation, duration of total parenteral nutrition, length of intensive care unit (ICU) stay, presence of neutropenia, and R-Baux score (all P�0.001). In this regard, TBSA, length of ICU stay, R-Baux score, and Candida score were identified as the determinant factors for mortality due to candidemia. Conclusion: Candidemia increases the mortality and morbidity rates associated with burn injuries. Prompt diagnostic and prevention measures can reduce the unfortunate outcomes via controlling the possible risk factors. Copyright © 2020, Published by Mazandaran University of Medical Sciences on behalf of Iranian Society of Medical Mycology and Invasive Fungi Research Center