Reconstructive surgery after burns: A 10-year follow-up study

Hop, M.J.; Langenberg, Lisette C; Hiddingh, J.; Stekelenburg, Carlijn M.; Wal, Martijn B. A. van der; Hoogewerf, Cornelis J; Köppen, M.; Polinder, Suzanne; Zuijlen, Paul P. M. van; Baar, Margriet E. van; Middelkoop, Esther

doi:10.1016/j.burns.2014.04.014

Cited by 45 publications

(20 citation statements)

References 24 publications

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“…Deep partial and full thickness burn wounds often result in hypertrophic scars as a result of a derailment of the healing process. Scars, especially located at joints, are a burden for patients due to functional limitations in joint mobility, and they often need multiple reconstructive surgeries [1]. …”

Section: Introductionmentioning

confidence: 99%

Differential effects of Losartan and Atorvastatin in partial and full thickness burn wounds

et al. 2017

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Healing of burn wounds is often associated with scar formation due to excessive inflammation and delayed wound closure. To date, no effective treatment is available to prevent the fibrotic process. The Renin Angiotensin System (RAS) was shown to be involved in fibrosis in various organs. Statins (e.g. Atorvastatin), Angiotensin receptor antagonists (e.g. Losartan) and the combination of these drugs are able to reduce the local RAS activation, and reduced fibrosis in other organs. We investigated whether inhibition of the RAS could improve healing of burn wounds by treatment with Atorvastatin, Losartan or the combination of both drugs. Therefore, full and partial thickness burn wounds were inflicted on both flanks of Yorkshire pigs. Oral administration of Atorvastatin, Losartan or the combination was started at post-burn day 1 and continued for 28 days. Full thickness wounds were excised and transplanted with an autologous meshed split-thickness skin graft at post-burn day 14. Partial thickness wounds received conservative treatment. Atorvastatin treatment resulted in enhanced graft take and wound closure of the full thickness wounds, faster resolution of neutrophils compared to all treatments and reduced alpha-smooth muscle actin positive cells compared to control treatment. Treatment with Losartan and to a lesser extent the combination therapy resulted in diminished graft take, increased wound contraction and poorer scar outcome. In contrast, Losartan treatment in partial thickness wounds decreased the alpha-smooth muscle actin+ fibroblasts and contraction. In conclusion, we showed differential effects of Losartan and Atorvastatin in full and partial thickness wounds. The extensive graft loss seen in Losartan treated wounds is most likely responsible for the poor clinical outcome of these full thickness burn wounds. Therefore, Losartan treatment should not be started before transplantation in order to prevent graft loss. Atorvastatin seems to accelerate the healing process in full thickness wounds possibly by dampening the pro-inflammatory response.

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Section: Introductionmentioning

confidence: 99%

Differential effects of Losartan and Atorvastatin in partial and full thickness burn wounds

et al. 2017

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“…After surviving the initial injury, reconstructive surgery (RS), such as skin grafts, dermal regenerative grafts, and flaps are common procedures performed to repair extensive burn wounds. 1,2 In this study, predictors for the use of these surgeries in burn injury were evaluated.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Reconstructive Surgery Among Burn Patients

Soleimani¹,

Evans²,

Sood³

et al. 2015

Plastic and Reconstructive Surgery

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Patient demographics and rates of plastic surgery consultations were evaluated to assess the frequency of breast reconstruction. RESULTS:Overall, 676 out of 1475 patients (45.8%) underwent reconstruction after mastectomy with the majority undergoing autologous tissue reconstruction compared to implant reconstruction. The rates of breast reconstruction and plastic surgery referrals increased dramatically from 53.1% to 75.4% and from 53.8% to 93.8% respectively during the study period. Advanced age and stage of disease were significant predictors for not undergoing evaluation or reconstruction. Ethnicity was also a negative predictor for reconstruction during the study period. There were significant racial disparities during the first half of the study period with Caucasian (11.0%) and Asian (23.1%) women being more likely to undergo autologous tissue reconstruction compared to African-American (2.7%) or Hispanic (0%) women. These differences were no longer evident during the second half of the study. Referral to the plastic and reconstructive surgery service did not result in any significant delays in cancer treatment. CONCLUSION:Comprehensive breast cancer treatment should include evaluation for reconstruction. Plastic surgery consultations for breast reconstruction are critical to optimize care without causing delays in overall cancer care. Implementation of programs to include plastic surgical evaluation provides additional avenues for improvement in order to increase rates of breast reconstruction to all patients. REFERENCES: 1. Kaufman CS, Connolly J. NAPBC Standards Manual 2014 Edition. Chicago, Illinois: American College of Surgeons; 2014. 2. Alderman AK, Hawley ST, Waljee J, Mujahid M, Morrow M, Katz SJ. Understanding the impact of breast reconstruction on the surgical decision-making process for breast reconstruction.

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“…For each patient, information on reconstructive surgery, use of blood products, pressure clothes and silicone therapy were recorded prospectively during hospital admission and the follow‐up period up to 12 months postburn. The unit price for the reconstructive surgery was derived from a previous Dutch study on this subject . Unit prices of blood products, pressure clothes, and silicone therapy were derived from the financial department and supplier.…”

Section: Methodsmentioning

confidence: 99%

Long‐term quality of life and cost‐effectiveness of treatment of partial thickness burns: A randomized controlled trial comparing enzyme alginogel vs silver sulfadiazine (FLAM study)

Rashaan

Krijnen

Kwa

et al. 2020

Wound Repair Regeneration

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The clinical effectiveness and scar quality of the randomized controlled trial comparing enzyme alginogel with silver sulfadiazine (SSD) for treatment of partial thickness burns were previously reported. Enzyme alginogel did not lead to faster wound healing (primary outcome) or less scar formation. In the current study, the healthrelated quality of life (HRQoL), costs, and cost-effectiveness of enzyme alginogel compared with SSD in the treatment of partial thickness burns were studied. HRQoL was evaluated using the Burn Specific Health Scale-Brief (BSHS-B) and the EQ-5D-5L questionnaire 1 week before discharge and at 3, 6, and 12 months postburn. Costs were studied from a societal perspective (health care and nonhealth-care costs) for a follow-up period of 1 year. A cost-effectiveness analysis was performed using costeffectiveness acceptability curves and comparing differences in societal costs and Quality Adjusted Life Years (QALYs) at 1 year postburn. Forty-one patients were analyzed in the enzyme alginogel group and 48 patients in the SSD group. None of the domains of BSHS-B showed a statistically significant difference between the treatment groups. Also, no statistically significant difference in QALYs was found between enzyme alginogel and SSD (difference −0.03; 95% confidence interval [CI], −0.09 to 0.03; P = .30). From both the health care and the societal perspective, the difference Abbreviation: BSHS-B, Burn Specific Health Scale-Brief; HRQoL, Health-related quality of life; ICER, incremental cost-effectiveness ratio; SSD, silver sulfadiazine; TBSA, total body surface area;QALYs, quality adjusted life years; VAT, Visual Analogue Thermometer.

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Reconstructive surgery after burns: A 10-year follow-up study

Cited by 45 publications

References 24 publications

Differential effects of Losartan and Atorvastatin in partial and full thickness burn wounds

Differential effects of Losartan and Atorvastatin in partial and full thickness burn wounds

Predictors of Reconstructive Surgery Among Burn Patients

Long‐term quality of life and cost‐effectiveness of treatment of partial thickness burns: A randomized controlled trial comparing enzyme alginogel vs silver sulfadiazine (FLAM study)

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