168 research outputs found
The efficacy of Aloe vera, tea tree oil and saliva as first aid treatment for partial thickness burn injuries
No full textMany alternative therapies are used as first aid treatment for burns, despite limited evidence supporting their use. In this study, Aloe vera, saliva and a tea tree oil impregnated dressing (Burnaid) were applied as first aid to a porcine deep dermal contact burn, compared to a control of nothing. After burn creation, the treatments were applied for 20 min and the wounds observed at weekly dressing changes for 6 weeks. Results showed that the alternative treatments did significantly decrease subdermal temperature within the skin during the treatment period. However, they did not decrease the microflora or improve re-epithelialisation, scar strength, scar depth or cosmetic appearance of the scar and cannot be recommended for the first aid treatment of partial thickness burns.Leila Cuttle, Margit Kempf, Olena Kravchuk, Narelle George, Pei-Yun Liu, Hong-En Chang, Julie Mill, Xue-Qing Wang and Roy M. Kimbl
Burn healing is dependent on burn site: a quantitative analysis from a porcine burn model
No full textThis retrospective review examines healing in different sites on a porcine burn model; 24 pairs of burns on 18 pigs from other animal trials were selected for analysis. Each pair of burns was located on the either the cranial or the caudal part of the thoracic ribs region, on the same side of the animal. The burns were 40–50 cm2 in size and of uniform deep-dermal partial thickness. Caudal burns healed significantly better than cranial burns, demonstrated by earlier closure of wounds, less scar formation and better cosmesis. To our knowledge, this is the first detailed study reporting that burn healing is affected by location on a porcine burn model. We recommend that similar symmetrical burns should be used for future comparative assessments of burn healing.Xue-Qing Wang, Pei-Yun Liu, Margit Kempf, Leila Cuttle, Allen Hong-En Chang, Michael Wong, Olena Kravchuk, Julie Mill, Roy M. Kimbl
Conservative surgical debridement as a burn treatment: supporting evidence from a porcine burn model
No full textIn thermal deep-dermal burns, surgical debridement is normally used in conjunction with skin grafting or skin substitutes and debridement alone as a burn treatment is not usually practiced. The current study addresses whether or not debridement alone would enhance burn wound healing on small deep-dermal-partial thickness burns. This was a prospective and blinded experimental trial using a porcine deep-dermal-partial thickness burn model. Four burns, approximately 50 cm2 in size, were created on each of eight pigs. Two burns from each pig were immediately surgically debrided and the other two were not debrided as the internal control. Hydrate gel together with paraffin gauze were used to cover the burns for four pigs and silver dressings for the other four. Clinical assessment of wound healing was conducted over a 6-week period. Skin samples were collected at the end of the experiment and histopathological evaluation was performed. The results show thinner scar formation and lower scar height in the debrided compared with nondebrided wounds in the hydrate gel/paraffin gauze groups. There were no statistically significant differences in wound healing assessment between the debrided and nondebrided wounds dressed with silver dressings. This study provides supporting evidence that immediate debridement with an appropriate dressing and without skin grafting may promote wound healing, suggesting its potential benefit for clinical patients.Xue-Qing Wang, Margit Kempf, Pei-Yun Liu, Leila Cuttle, Hong-En Chang, Olena Kravchuk, Julie Mill, Gael E Phillips, Roy M. Kimbl
Silver deposits in cutaneous burn scar tissue is a common phenomenon following application of a silver dressing
No full textBackground: Silver dressings have been widely and successfully used to prevent cutaneous wounds, including burns, chronic ulcers, dermatitis and other cutaneous conditions, from infection. However, in a few cases, skin discolouration or argyria-like appearances have been reported. This study investigated the level of silver in scar tissue post-burn injury following application of Acticoat™, a silver dressing. Methods: A porcine deep dermal partial thickness burn model was used. Burn wounds were treated with this silver dressing until completion of re-epithelialization, and silver levels were measured in a total of 160 scars and normal tissues. Results: The mean level of silver in scar tissue covered with silver dressings was 136 μg/g, while the silver level in normal skin was less than 0.747 μg/g. A number of wounds had a slate-grey appearance, and dissection of the scars revealed brown-black pigment mostly in the middle and deep dermis within the scar. The level of silver and the severity of the slate-grey discolouration were correlated with the length of time of the silver dressing application. Conclusions: These results show that silver deposition in cutaneous scar tissue is a common phenomenon, and higher levels of silver deposits and severe skin discolouration are correlated with an increase in the duration of this silver dressing application.Xue-Qing Wang, Hong-En Chang, Rod Francis, Henry Olszowy, Pei-Yun Liu, Margit Kempf, Leila Cuttle, Olena Kravchuk, Gael E. Phillips and Roy M. Kimbl
Vitronectin: growth factor complexes hold potential as a wound therapy approach
No full textTopical administration of growth factors has displayed some potential in wound healing, but variable efficacy, high doses, and costs have hampered their implementation. Moreover, this approach ignores the fact that wound repair is driven by interactions between multiple growth factors and extracellular matrix (ECM) proteins. We report herein that complexes comprising IGF and IGF-binding proteins bound to the ECM protein vitronectin (VN) significantly enhance cellular functions relevant to wound repair in human skin keratinocytes in two- and three-dimensional in vitro cell models and are active, even in the presence of wound fluid. Moreover, these responses require activation of both the IGF receptor and the VN-binding av integrins. Further, we assessed the complexes as a topical agent in the treatment of deep dermal partial thickness burns in a porcine model. This pilot study revealed that the complexes may hold promise as a wound healing therapy. Critically, the significant responses observed in vitro and the encouraging preliminary data in vivo were obtained with nanogram doses of growth factors. This suggests that coupling delivery of growth factors to ECM proteins such as VN may ultimately prove to be a more effective strategy for developing a wound healing therapy.Zee Upton, Leila Cuttle, Anthony Noble, Margit Kempf, Gemma Topping, Jos Malda, Yan Xie, Julie Mill, Damien G Harkin, Olena Kravchuk, David I Leavesley and Roy M Kimbl
The evaluation of a clinical scar scale for porcine burn scars
No full textThis study describes the evaluation of a clinical scar scale for our porcine burn scars, which includes scar cosmetic outcome, colour, height and hair, supplemented with reference porcine scar photographs representing each scar outcome and scar colour scores. A total of 72 porcine burn scars at week 6 after burn were rated in vivo and/or on photographs. Good agreements were achieved for both intra-rater reliability (correlation is 0.86-0.98) and inter-rater reliability (ICC=80-85%). The results showed statistically significant correlations for each pair in this clinical scar scale (p<0.01), with the best correlation found between scar cosmetic outcome and scar colour. A multivariate principle components analysis revealed that this clinical scar assessment was highly correlated with scar histology, wound size, and re-epithelialisation data (p<0.001). More severe scars are clinically characterised by darker purple colouration, more elevation, no presence of hair, histologically by thicker scar tissue, thinner remaining normal dermis, are more likely to have worse contraction, and slower re-epithelialisation. This study demonstrates that our clinical scar scale is a reliable, independent and valuable tool for assessing porcine burn outcome and truthfully reflects scar appearance and function. To our knowledge, this is the first study demonstrating a high correlation between clinical scar assessment and scar histology, wound contraction and re-epithelialisation data on porcine burn scars. We believe that the successful use of porcine scar scales is invaluable for assessing potential human burn treatments.Xue-Qing Wang, Olena Kravchuk, Pei-Yun Liu, Margit Kempf, Carolina V.D. Boogaard, Peter Lau, Leila Cuttle, Julie Mill and Roy M. Kimblehttp://www.elsevier.com/wps/find/journaldescription.cws_home/30394/description#descriptio
The optimal duration and delay of first aid treatment for deep partial thickness burn injuries
No full textUsing our porcine model of deep dermal partial thickness burn injury, various durations (10min, 20min, 30min or 1h) and delays (immediate, 10min, 1h, 3h) of 15 degrees C running water first aid were applied to burns and compared to untreated controls. The subdermal temperatures were monitored during the treatment and wounds observed weekly for 6 weeks, for re-epithelialisation, wound surface area and cosmetic appearance. At 6 weeks after the burn, tissue biopsies were taken of the scar for histological analysis. Results showed that immediate application of cold running water for 20min duration is associated with an improvement in re-epithelialisation over the first 2 weeks post-burn and decreased scar tissue at 6 weeks. First aid application of cold water for as little as 10min duration or up to 1h delay still provides benefit.Leila Cuttle, Margit Kempf, Pei-Yun Liu, Olena Kravchuk, Roy M. Kimbl
Cytotoxicity testing of silver-containing burn treatments using primary and immortal skin cells
No full textA novel burn wound hydrogel dressing has been previously developed which is composed of 2-acrylamido-2-methylpropane sulfonic acid sodium salt with silver nanoparticles (silver AMPS). This study compared the cytotoxicity of this dressing to the commercially available silver products; Acticoat™, PolyMem Silver® and Flamazine™ cream. Human keratinocytes (HaCaT and primary HEK) and normal human fibroblasts (NHF) were exposed to dressings incubated on Nunc™ polycarbonate inserts for 24, 48 and 72h. Four different cytotoxicity assays were performed including; Trypan Blue cell count, MTT, Celltiter-Blue™ and Toluidine Blue surface area assays. The results were expressed as relative cell viability compared to an untreated control. The cytotoxic effects of Acticoat™ and Flamazine™ cream were dependent on exposure time and cell type. After 24h exposure, Acticoat™ and Flamazine™ cream were toxic to all tested cell lines. Surprisingly, HaCaTs treated with Acticoat™ and Flamazine™ had an improved ability to survive at 48 and 72h while HEKs and NHFs had no improvement in survival with any treatment. The novel silver hydrogel and PolyMem Silver® showed low cytotoxicity to all tested cell lines at every time interval and these results support the possibility of using the novel silver hydrogel as a burn wound dressing. Researchers who rely on HaCaT cells as an accurate keratinocyte model should be aware that they can respond differently to primary skin cells
Silver absorption on burns after application of Acticoat(TM): data from pediatric patients and a porcine burn model
No full textSilver dressings have been widely used to successfully prevent burn wound infection and sepsis. However, a few case studies have reported the functional abnormality and failure of vital organs, possibly caused by silver deposits. The aim of this study was to investigate the serum silver level in the pediatric burn population and also in several internal organs in a porcine burn model after the application of Acticoat. A total of 125 blood samples were collected from 46 pediatric burn patients. Thirty-six patients with a mean of 13.4% TBSA burns had a mean peak serum silver level of 114 microg/L, whereas 10 patients with a mean of 1.85% TBSA burns had an undetectable level of silver (<5.4 microg/L). Overall, serum silver levels were closely related to burn sizes. However, the highest serum silver was 735 microg/L in a 15-month-old toddler with 10% TBSA burns and the second highest was 367 microg/L in a 3-year old with 28% TBSA burns. In a porcine model with 2% TBSA burns, the mean peak silver level was 38 microg/L at 2 to 3 weeks after application of Acticoat and was then significantly reduced to an almost undetectable level at 6 weeks. Of a total of four pigs, silver was detected in all four livers (1.413 microg/g) and all four hearts (0.342 microg/g), three of four kidneys (1.113 microg/g), and two of four brains (0.402 microg/g). This result demonstrated that although variable, the level of serum silver was positively associated with the size of burns, and significant amounts of silver were deposited in internal organs in pigs with only 2% TBSA burns, after application of Acticoat.Xue-Qing Wang, Margit Kempf, Jonathon Mott, Hong-En Chang, Rod Francis, Pei-Yun Liu, Leila Cuttle, Henry Olszowy, Olena Kravchuk, Julie Mill, Roy M. Kimbl
The poor penetration of topical burn agent through burn eschar on a porcine burn model
No full textWe read with great interest the article entitled “Enhancing drugs absorption through third-degree previous termburnnext term wound eschar” by Manafi et al. [1]. The authors addressed the concern of previous termpoor penetrationnext term of topically applied anti-microbials through previous termburnnext term eschar and detailed the improvement of this previous termpenetrationnext term by previous termpenetrationnext term enhancers. Here, we would like to report the previous termpoor penetrationnext term of a previous termtopicalnext term agent into the viable deep dermal layer under previous termburnnext term eschar on a porcine previous termburnnext term model [2] L. Cuttle, M. Kempf, G.E. Phillips, J. Mill, M.T. Hayes and J.F. Fraser et al., A porcine deep dermal partial thickness previous termburnnext term model with hypertrophic scarring, previous termBurnsnext term 32 (2006), pp. 806–820. Article | PDF (1332 K) | View Record in Scopus | Cited By in Scopus (18)[2]. In previous termburnnext term treatment, a common practice is the previous termtopicalnext term application of either anti-microbial products or wound enhancing agents. While the activity of anti-microbial products is designed to fight against microbes on the wound surface but with the least toxicity to viable tissue, wound enhancing agents need to reach the viable tissue layer under the previous termburnnext term eschar. Many studies have reported the accelerated healing of superficial previous termburnnext term wounds and skin graft donor sites by the previous termtopicalnext term application of exogeneous growth factors [3]. It is well known that the efficacy of the previous termpenetrationnext term of a previous termtopicalnext term agent on intact skin mostly depends on the molecular size of the product [4] and [5]. While previous termburnnext term injury destroys this epidermal physiological barrier, the coagulated previous termburnnext term tissue layer on the previous termburnnext term wound surface makes it difficult for previous termtopicalnext term agents to reach viable tissue
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