SUMMARY -Th e purpose of this study was to create a fi brin-based human skin substitute in vitro with epidermal and dermal component and to assess its healing potential in deep partial and full thickness burns. Fibrin scaff olds were prepared from commercial fi brin glue kits. Human fi broblasts were cultured in fi brin gel. Human keratinocytes were seeded on the top of the gel. Viability of cells was determined fl uorimetrically. Scanning electron microscope and immunocytochemistry analysis of cultured cells were performed. After hydrosurgical preparation of deep burn necrotic tissue, wound bed was prepared for skin substitutes. Progress of healing was documented using visual estimation and photos. Scanning electron microscope images showed good cell attachment and colony spreading of keratinocytes and fi broblasts on fi brin scaff old. Immunofl uorescent staining of cell cultures on fi brin scaff old showed expression of vimentin, a marker of fi broblast cells, cytokeratin 19, a marker of epithelial stem cells, as well as involucrin, a marker of diff erentiated keratinocytes. Clinical results clearly showed that appearance of the skin did not diff er signifi cantly from the areas of transplanted skin using split-thickness skin graft techniques. In conclusion, using these fi brin-cultured autografts on massive full-thickness burn resulted in good healing.
AimTo assess the efficacy of the procedural consolidation concept (PCC) at reducing the number of sessions of general anesthesia necessary for treating children with epidermolysis bullosa (EB).MethodsWe examined the records of children treated at Children's Hospital of Zagreb between April 1999 and December 2007. Children treated before the introduction of PCC in January 2005 (n = 39) and after (n = 48) were analyzed in order to determine the effect of PCC on the occurrence of complications, days of hospitalization, and number of hospitalizations.ResultsDuring the study period, 53 patients underwent 220 sessions of general anesthesia for a total of 743 surgical interventions per session. Before the introduction of PCC (n = 39 patients, 83 sessions), the median number of interventions per session was 2 (range 1-5), and after the introduction of PCC (n = 48 patients, 137 sessions) it was 4 (range 3-7, P < 0.001). After the introduction of PCC, the median number of complications per anesthesia session increased from 2 (range 0-10) to 3 (range 0-10) (P = 0.027), but the median number of complications per surgical procedure decreased from 1 (range 0-10) to 0.6 (range 0-2.5) (P < 0.001). PCC lengthened each anesthesia session from a median of 65 minutes (range 35-655) to 95 minutes (range 50-405), (P < 0.001). Total length of hospitalization was similar before (median 1, range 1-4) and after (median 1, range 1-3) introduction of PCC (P = 0.169). The number of hospitalization days per procedure was 3 times lower after the introduction of PCC (median 0.3, range 0.2-3) than before (median 1, range 0.75-1.7) (P < 0.001).ConclusionPCC should be considered an option in the surgical treatment of children with EB.
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