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| 1 | Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease(2020 edition)显示文摘In recent years,as living standards have continued to improve,the number of diabetes patients in China,along with the incidence of complications associated with the disease,has been increasing.Among these complications,diabetic foot disease is one of the main causes of disability and death in diabetic patients.Due to the differences in economy,culture,religion and level of medical care available across different regions,preventive and treatment methods and curative results for diabetic foot vary greatly.In multidisciplinary models built around diabetic foot,the timely assessment and diagnosis of wounds and appropriate methods of prevention and treatment with internal and external surgery are key to clinical practice for this pathology.In 2019,under the leadership of the Jiangsu Medical Association and Chinese Diabetes Society,the writing group for the Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease(2020 edition)was established with the participation of scholars from the specialist areas of endocrinology,burn injury,vascular surgery,orthopedics,foot and ankle surgery and cardiology.Drawing lessons from diabetic foot guidelines from other countries,this guide analyses clinical practices for diabetic foot,queries the theoretical basis and grades and gives recommendations based on the characteristics of the pathology in China.This paper begins with assessments and diagnoses of diabetic foot,then describes treatments for diabetic foot in detail,and ends with protections for high-risk feet and the prevention of ulcers.This manuscript covers the disciplines of internal medicine,surgical,nursing and rehabilitation and describes a total of 50 recommendations that we hope will provide procedures and protocols for clinicians dealing with diabetic foot. | Aiping Wang Guozhong Lv Xingbo Cheng Xianghua Ma Wei Wang Jianchao Gui JiHu Meng Lu Guoping Chu Jin’an Chen Hao Zhang Yiqiu Jiang Yuedong Chen Wengbo Yang Lin Jiang Houfa Geng Rendong Zheng Yihui Li Wei Feng Boey Johnson Wenjuan Wang Dalong Zhu Yin Hu | 2020 | Burns & Trauma2020，8，1： | 34 |
| 2 | Diagnosis and Treatment of Keloids and Hypertrophic Scars—Japan Scar Workshop Consensus Document 2018显示文摘There has been a long-standing need for guidelines on the diagnosis and treatment of keloids and hypertrophic scars that are based on an understanding of the pathomechanisms that underlie these skin fibrotic diseases.This is particularly true for clinicians who deal with Asian and African patients because these ethnicities are highly prone to these diseases.By contrast,Caucasians are less likely to develop keloids and hypertrophic scars,and if they do,the scars tend not to be severe.This ethnic disparity also means that countries vary in terms of their differential diagnostic algorithms.The lack of clear treatment guidelines also means that primary care physicians are currently applying a hotchpotch of treatments,with uneven outcomes.To overcome these issues,the Japan Scar Workshop(JSW)has created a tool that allows clinicians to objectively diagnose and distinguish between keloids,hypertrophic scars,and mature scars.This tool is called the JSW Scar Scale(JSS)and it involves scoring the risk factors of the individual patients and the affected areas.The tool is simple and easy to use.As a result,even physicians who are not accustomed to keloids and hypertrophic scars can easily diagnose them and judge their severity.The JSW has also established a committee that,in cooperation with outside experts in various fields,has prepared a Consensus Document on keloid and hypertrophic scar treatment guidelines.These guidelines are simple and will allow even inexperienced clinicians to choose the most appropriate treatment strategy.The Consensus Document is provided in this article.It describes(1)the diagnostic algorithm for pathological scars and how to differentiate them from clinically similar benign and malignant tumors,(2)the general treatment algorithms for keloids and hypertrophic scars at different medical facilities,(3)the rationale behind each treatment for keloids and hypertrophic scars,and(4)the body site-specific treatment protocols for these scars.We believe that this Consensus Document will be helpful for physicians from all over the world who treat keloids and hypertrophic scars. | Rei Ogawa Sadanori Akita Satoshi Akaishi Noriko Aramaki-Hattori Teruyuki Dohi Toshihiko Hayashi Kazuo Kishi Taro Kono Hajime Matsumura Gan Muneuchi Naoki Murao Munetomo Nagao Keisuke Okabe Fumiaki Shimizu Mamiko Tosa Yasuyoshi Tosa Satoko Yamawaki Shinichi Ansai Norihisa Inazu Toshiko Kamo Reiko Kazki Shigehiko Kuribayashi | 2019 | Burns & Trauma2019，7，1： | 31 |
| 3 | Mesenchymal stromal cells-exosomes:a promising cell-free therapeutic tool for wound healing and cutaneous regeneration显示文摘Cutaneous regeneration at the wound site involves several intricate and dynamic processes which require a series of coordinated interactions implicating various cell types,growth factors,extracellular matrix(ECM),nerves,and blood vessels.Mesenchymal stromal cells(MSCs)take part in all the skin wound healing stages playing active and beneficial roles in animal models and humans.Exosomes,which are among the key products MSCs release,mimic the effects of parental MSCs.They can shuttle various effector proteins,messenger RNA(mRNA)and microRNAs(miRNAs)to modulate the activity of recipient cells,playing important roles in wound healing.Moreover,using exosomes avoids many risks associated with cell transplantation.Therefore,as a novel type of cell-free therapy,MSC-exosome-mediated administration may be safer and more efficient than whole cell.In this review,we provide a comprehensive understanding of the latest studies and observations on the role of MSC-exosome therapy in wound healing and cutaneous regeneration.In addition,we address the hypothesis of MSCs microenvironment extracellular vesicles(MSCs-MEVs)or MSCs microenvironment exosomes(MSCs-MExos)that need to take stock of and solved urgently in the related research about MSC-exosomes therapeutic applications.This review can inspire investigators to explore new research directions of MSC-exosome therapy in cutaneous repair and regeneration. | Peng Hu Qinxin Yang Qi Wang Chenshuo Shi Dali Wang Ubaldo Armato Ilaria Dal Prà Anna Chiarini | 2019 | Burns & Trauma2019，7，1： | 20 |
| 4 | Strategies to prevent hypertrophic scar formation:a review of therapeutic interventions based on molecular evidence显示文摘Once scar tissues mature,it is impossible for the surrounding tissue to regenerate normal dermal tissue.Therefore,it is essential to understand the fundamental mechanisms and establish effective strategies to inhibit aberrant scar formation.Hypertrophic scar formation is considered a result of the imbalance between extracellular matrix synthesis and degradation during wound healing.However,the underlying mechanisms of hypertrophic scar development are poorly understood.The purpose of this review was to outline the management in the early stage after wound healing to prevent hypertrophic scar formation,focusing on strategies excluding therapeutic agents of internal use.Treatment aimed at molecular targets,including cytokines,will be future options to prevent and treat hypertrophic scars.More basic studies and clinical trials,including combination therapy,are required to investigate the mechanisms and prevent hypertrophic scar formation. | Eri Shirakami Sho Yamakawa Kenji Hayashida | 2020 | Burns & Trauma2020，8，1： | 18 |
| 5 | Consensus on the application of negative pressure wound therapy of diabetic foot wounds显示文摘Because China is becoming an aging society,the incidence of diabetes and diabetic foot have been increasing.Diabetic foot has become one of the main health-related killers due to its high disability and mortality rates.Negative pressure wound therapy(NPWT)is one of the most effective techniques for the treatment of diabetic foot wounds and great progress,both in terms of research and its clinical application,has been made in the last 20 years of its development.However,due to the complex pathogenesis and management of diabetic foot,irregular application of NPWT often leads to complications,such as infection,bleeding and necrosis,that seriously affect its treatment outcomes.In 2020,under the leadership of Burns,Trauma and Tissue Repair Committee of the Cross-Straits Medicine Exchange Association,the writing group for‘Consensus on the application of negative pressure wound therapy of diabetic foot wounds’was established with the participation of scholars from the specialized areas of burns,endocrinology,vascular surgery,orthopedics and wound repair.Drawing on evidence-based practice suggested by the latest clinical research,this consensus proposes the best clinical practice guidelines for the application and prognostic evaluation of NPWT for diabetic foot.The consensus aims to support the formation of standardized treatment schemes that clinicians can refer to when treating cases of diabetic foot. | Shizhao Ji Xiaobin Liu Jie Huang Junmin Bao Zhaohong Chen Chunmao Han Daifeng Hao Jingsong Hong Dahai Hu Yufeng Jiang Shang Ju Hongye Li Zongyu Li Guangping Liang Yan Liu Gaoxing Luo Guozhong Lv Xingwu Ran Zhongmin Shi Juyu Tang Aiping Wang Guangyi Wang Jiangning Wang Xin Wang Bing Wen Jun Wu Hailin Xu Maojin Xu Xiaofei Ye Liangxi Yuan Yi Zhang Shichu Xiao Zhaofan Xia | 2021 | Burns & Trauma2021，9，1： | 17 |
| 6 | Surgery for scar revision and reduction:from primary closure to flap surgery显示文摘Scars are the final result of the four processes that constitute cutaneous wound healing,namely,coagulation,inflammation,proliferation,and remodeling.Permanent scars are produced if the wounds reach the reticular dermis.The nature of these scars depends on the four wound healing processes.If the remodeling process is excessive,collagen degradation exceeds collagen synthesis and atrophic scars are produced.If the inflammation phase is prolonged and/or more potent for some reason,inflammatory/pathological scars such as keloids or hypertrophic scars can arise.If these pathological scars are located on joints or mobile regions,scar contractures can develop.When used with the appropriate timing and when selected on the basis of individual factors,surgical techniques can improve mature scars.This review paper focuses on the surgical techniques that are used to improve mature scars,burn scars,and scar contractures.Those methods include z-plasties,w-plasties,split-thickness skin grafting,full-thickness skin grafting,local flaps(including the square flap method and the propeller flap),and expanded flaps,distant flaps,regional flaps,and free flaps. | Rei Ogawa | 2019 | Burns & Trauma2019，7，1： | 17 |
| 7 | Intestinal barrier dysfunction in severe burn injury显示文摘Severe burn injury is often accompanied by intestinal barrier dysfunction,which is closely associated with post-burn shock,bacterial translocation,systemic inflammatory response syndrome,hypercatabolism,sepsis,multiple organ dysfunction syndrome,and other complications.The intestinal epithelium forms a physical barrier that separates the intestinal lumen from the internal milieu,in which the tight junction plays a principal role.It has been well documented that after severe burn injury,many factors such as stress,ischemia/hypoxia,proinflammatory cytokines,and endotoxins can induce intestinal barrier dysfunction via multiple signaling pathways.Recent advances have provided new insights into the mechanisms and the therapeutic strategies of intestinal epithelial barrier dysfunction associated with severe burn injury.In this review,we will describe the current knowledge of the mechanisms involved in intestinal barrier dysfunction in response to severe burn injury and the emerging therapies for treating intestinal barrier dysfunction following severe burn injury. | Wen He Yu Wang Pei Wang Fengjun Wang | 2019 | Burns & Trauma2019，7，1： | 17 |
| 8 | Exosomes derived from human amniotic epithelial cells accelerate diabetic wound healing via PI3K-AKT-mTOR-mediated promotion in angiogenesis and fibroblast function显示文摘Background:Diabetic wounds are one of the most common and serious complications of diabetes mellitus,characterized by the dysfunction of wound-healing-related cells in quantity and quality.Our previous studies revealed that human amniotic epithelial cells(hAECs)could promote diabetic wound healing by paracrine action.Interestingly,numerous studies demonstrated that exosomes derived from stem cells are the critical paracrine vehicles for stem cell therapy.However,whether exosomes derived from hAECs(hAECs-Exos)mediate the effects of hAECs on diabetic wound healing remains unclear.This study aimed to investigate the biological effects of hAECs-Exos on diabetic wound healing and preliminarily elucidate the underlying mechanism.Methods:hAECs-Exos were isolated by ultracentrifugation and identified by transmission electron microscopy,dynamic light scattering and flow cytometry.A series of in vitro functional analyses were performed to assess the regulatory effects of hAECs-Exos on human fibroblasts(HFBs)and human umbilical vein endothelial cells(HUVECs)in a high-glycemic microenvironment.Highthroughput sequencing and bioinformatics analyses were conducted to speculate the related mechanisms of actions of hAECs-Exos on HFBs and HUVECs.Subsequently,the role of the candidate signaling pathway of hAECs-Exos in regulating the function of HUVECs and HFBs,as well as in diabetic wound healing,was assessed.Results:hAECs-Exos presented a cup-or sphere-shaped morphology with a mean diameter of 105.89±10.36 nm,were positive for CD63 and TSG101 and could be internalized by HFBs and HUVECs.After that,hAECs-Exos not only significantly promoted the proliferation and migration of HFBs,but also facilitated the angiogenic activity of HUVECs in vitro.High-throughput sequencing revealed enriched miRNAs of hAECs-Exos involved in wound healing.Kyoto Encyclopedia of Genes and Genomes and Gene Ontology analyses have shown that the target genes of the top 15 miRNAs were highly enriched in the PI3K-AKT pathway.Further functional studies demonstrated that the PI3K-AKT-mTOR pathway was necessary for the induced biological effects of hAECs-Exos on HFBs and HUVECs,as well as on wound healing,in diabetic mice.Conclusions:Our findings demonstrated that hAECs-Exos represent a promising,novel strategy for diabetic wound healing by promoting angiogenesis and fibroblast function via activation of the PI3K-AKT-mTOR pathway. | Pei Wei Chenjian Zhong Xiaolan Yang Futing Shu Shichu Xiao Teng Gong Pengfei Luo Li Li Zhaohong Chen Yongjun Zheng Zhaofan Xia | 2020 | Burns & Trauma2020，8，1： | 12 |
| 9 | Advances in the treatment of traumatic scars with laser,intense pulsed light,radiofrequency,and ultrasound显示文摘Traumatic scarring is one of the most common complications after soft tissue injury caused by burns and trauma,which affects tens of millions of people worldwide every year.Traumatic scars diminish the quality of life due to disfigurement,symptoms of pain and itch,and restricted motion.The pathogenesis and pathophysiology of traumatic scar remain elusive.The management for traumatic scars is comprised of surgical and non-surgical interventions such as pressure therapy,silicone,corticosteroid,and radiotherapy,which are chosen by clinicians based on the physical examinations of scars.Recently,great progress in treating traumatic scars has been achieved by the development of novel technologies including laser,intense pulsed light(IPL),radiofrequency,and ultrasound.The aim of this review article was to summarize the advances of these technologies for traumatic scars intervention. | Xiujun Fu Jiying Dong Shen Wang Min Yan Min Yao | 2019 | Burns & Trauma2019，7，1： | 12 |
| 10 | Advances in surgical applications of growth factors for wound healing显示文摘Growth factors have recently gained clinical importance for wound management.Application of recombinant growth factors has been shown to mimic cellmigration,proliferation,and differentiation in vivo,allowing for external modulation of the healing process.Perioperative drug delivery systems can enhance the biological activity of these growth factors,which have a very short in vivo half-life after topical administration.Although the basic mechanisms of these growth factors are well understood,most have yet to demonstrate a significant impact in animal studies or small-sized clinical trials.In this review,we emphasized currently approved growth factor therapies,including a sustained release system for growth factors,emerging therapies,and future research possibilities combined with surgical procedures.Approaches seeking to understand wound healing at a systemic level are currently ongoing.However,further research and consideration in surgery will be needed to provide definitive confirmation of the efficacy of growth factor therapies for intractable wounds. | Sho Yamakawa Kenji Hayashida | 2019 | Burns & Trauma2019，7，1： | 11 |
| 11 | Severe burn injury alters intestinal microbiota composition and impairs intestinal barrier in mice显示文摘Background:The intestinal barrier integrity is crucial for maintaining intestinal homeostasis,and the mechanisms of intestinal barrier disruption induced by burn injury remain obscure.This study was aimed to investigate the changes of intestinal microbiota and barrier function in burned mice to further comprehend the mechanisms of burn-induced intestinal barrier dysfunction.Methods:Samples were from mice inflicted with 30%total body surface area(TBSA)full-thickness burns.The intestinal permeability,tight junction proteins expressions,zonula occludens-1(ZO-1)localization,inflammatory cytokines expressions,and short-chain fatty acids(SCFAs)contents were determined.The microbial community was assessed via 16S rDNA Illumina sequencing.Results:The intestinal permeability was increased after severe burn injury,peaking at 6 h post-burn,with approximately 20-folds of the control(p<0.001).The expression of tight junction proteins(ZO-1,occludin,claudin-1,and claudin-2)was significantly altered(p<0.05).The ZO-1 morphology was dramatically changed following burn injury.The fecal SCFAs’contents(acetate,propionate,butyrate,isobutyrate,and isovalerate)were noticeably declined after burn injury(p<0.05).The expressions of pro-inflammatory cytokines(interleukin(IL)-1βand IL-6)in ileal mucosa were increased,whereas the expressions of anti-inflammatory cytokines(IL-4 and IL-13)were decreased following burn injury(p<0.05).In addition,burned mice showed an alteration of intestinal microbial community,such as decreased diversity,reduced Bacteroidetes abundance,and increased Firmicutes abundance.Conclusions:The severe burn-induced intestinal barrier dysfunction is along with the alterations of microbial community. | Yanhai Feng Yalan Huang Yu Wang Pei Wang Fengjun Wang | 2019 | Burns & Trauma2019，7，1： | 11 |
| 12 | Joint contractures in severe burn patients with early rehabilitation intervention in one of the largest burn intensive care unit in China:a descriptive analysis显示文摘Background:Joint contracture is the major clinical complication in burn patients,especially,the severe burn patients.This study aimed to investigate the number and severity of joint contractures in patients with burns affecting greater than or equal to 50%of the total body surface area(TBSA)undergoing early rehabilitation in a burn intensive care unit(BICU).Methods:We analyzed burn patients with burns affecting greater than or equal to 50%of the TBSA admitted to a BICU who received early rehabilitation within 7 days post-injury from January 2011 to December 2015.Demographic and medical information was collected.The range of motion(ROM)of different joints was measured 1 month post-admission.Spearman’s correlation coefficient and logistic regression analysis was used to determine predictors of the presence and severity of contractures.Result:The average affected TBSA of the included burn patients was 67.4%,and the average length of stay in the BICU was 46.2±28.8 days.One hundred and one of 108 burn patients(93.5%)developed at least one joint contracture.The ROM in 67.9%of the affected joints was mildly limited.The majority of contractures in severe burn patients were mild(37.7%)or moderate(33.2%).The wrist was the most commonly affected joint(18.2%),followed by the shoulder,ankle,hip,knee,and elbow.A predictor of the presence of contractures was the length of hospital stay(p=0.049).The severe contracture was related to the area of full-thickness burns,the strict bed rest time,and the duration of rehabilitation in BICU.The length of rehabilitation stay(days)in patients with moderate contracture is 54.5%longer than that in severe contracture(p=0.024)Conclusion:During the long stay in BICU,the length of rehabilitation stay in a BICU could decrease the severity of contractures from severe to moderate in the patients with equal to 50%of the TBSA.Hence,this research reveals the important role of early rehabilitation interventions in severe burn patients. | Jianglin Tan Jian Chen Junyi Zhou Huapei Song Huan Deng Ming Ao Gaoxing Luo Jun Wu | 2019 | Burns & Trauma2019，7，1： | 9 |
| 13 | Optimized clinical practice for superaged patients with hip fracture:significance of damage control and enhanced recovery program显示文摘With the advent of global aging,the incidence,mortality,and medical costs of hip fracture among aged patients are increasing annually.The number of controlled clinical studies and health economics analyses that conform to evidence-based medicine principles is growing day by day.However,unfortunately,no specific recommendations regarding the procedures for the treatment of hip fracture are available.Meanwhile,the existence of both traditional treatment systems and new treatment theories means that most doctors confront difficult choices in their daily practice.These factors make the therapeutic approach for aged patients,especially among superaged patients with hip fracture,extremely challenging.This study focuses on superaged patients(>80 years as defined by the World Health Organization)with hip fracture and includes their preoperative pathological condition;therapeutic decision-making in terms of the benefit and risk ratio,damage control theory,and enhanced recovery after surgery were also investigated.These patients were discussed specifically by combining the current treatment strategies from several experts and the results of a meta-analysis published recently.The study presents some new ideas and approaches currently recognized in the field,such as preoperative assessment,surgical planning,safety consideration,complication intervention,and enhanced recovery implementation,and further presents some clear interpretations regarding misunderstandings in clinical practice.Finally,optimized treatment according to damage control principles and enhanced recovery after surgery during the perioperative period among superaged hip fracture patients is defined. | Zaiyang Liu Jun Zhang Kaiqi He Yumei Zhang Yuan Zhang | 2019 | Burns & Trauma2019，7，1： | 9 |
| 14 | The 1470 nm diode laser with an intralesional fiber device:a proposed solution for the treatment of inflamed and infected keloids显示文摘Background:Keloids are the result of abnormal wound healing and often are subject to infections and recurrent inflammation.We present a study conducted with a 1470 nm diode laser using an intralesional optical fiber device for the treatment of inflamed keloid scars.We evaluate its efficacy as a novel alternative method to decrease keloid infection and inflammation.Methods:The patients who underwent 1470 nm laser treatment from February 2016 to February 2018 at the plastic and reconstructive surgery department of the Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University with keloid accompanying serious local infection and fester were included.Patients took curative effect evaluation before and 1 year after the treatment.The test items included infection frequency in each year;pain,by visual analogue scale(VAS);itch,using VAS;quality of life(QOL),using QOL scale;and blood supply,using PeriCam PSI.Results:A total of 19 patients(mean age 35.21 years,range 11–66)with history of inflamed keloids with episodes of infection or abscess were enrolled.Patients underwent to a 1470 nm laser therapy for average of 1.16 times.After treatment,infection frequency and blood supply in keloids were reduced(p<0.001).Pain,itching,and QOL were improved(p<0.001).Conclusion:The present study shows that 1470 nm fiber laser treatment could improve inflamed keloids fairly well by decreasing inflammation,and a relative stabilization of collagen composition.Therefore,it is an effective minimally invasive scar therapy,but further studies are essential to confirm the present results. | Ke Li Fabio Nicoli Wen Jing Xi Zheng Zhang Chunxiao Cui Ahmed Al-Mousawi Alberto Balzani Yun Tong Yixin Zhang | 2019 | Burns & Trauma2019，7，1： | 8 |
| 15 | Platelet-rich plasma accelerates skin wound healing by promoting re-epithelialization显示文摘Background:Autologous platelet-rich plasma(PRP)has been suggested to be effective for wound healing.However,evidence for its use in patients with acute and chronic wounds remains insufficient.The aims of this study were to comprehensively examine the effectiveness,synergy and possible mechanism of PRP-mediated improvement of acute skin wound repair.Methods:Full-thickness wounds were made on the back of C57/BL6 mice.PRP or saline solution as a control was administered to the wound area.Wound healing rate,local inflammation,angiogenesis,re-epithelialization and collagen deposition were measured at days 3,5,7 and 14 after skin injury.The biological character of epidermal stem cells(ESCs),which reflect the potential for re-epithelialization,was further evaluated in vitro and in vivo.Results:PRP strongly improved skin wound healing,which was associated with regulation of local inflammation,enhancement of angiogenesis and re-epithelialization.PRP treatment significantly reduced the production of inflammatory cytokines interleukin-17A and interleukin-1β.An increase in the local vessel intensity and enhancement of re-epithelialization were also observed in animals with PRP administration and were associated with enhanced secretion of growth factors such as vascular endothelial growth factor and insulin-like growth factor-1.Moreover,PRP treatment ameliorated the survival and activated the migration and proliferation of primary cultured ESCs,and these effects were accompanied by the differentiation of ESCs into adult cells following the changes of CD49f and keratin 10 and keratin 14.Conclusion:PRP improved skin wound healing by modulating inflammation and increasing angiogenesis and re-epithelialization.However,the underlying regulatory mechanism needs to be investigated in the future.Our data provide a preliminary theoretical foundation for the clinical administration of PRP in wound healing and skin regeneration. | Pengcheng Xu Yaguang Wu Lina Zhou Zengjun Yang Xiaorong Zhang Xiaohong Hu Jiacai Yang Mingying Wang Binjie Wang Gaoxing Luo Weifeng He Biao Cheng | 2020 | Burns & Trauma2020，8，1： | 8 |
| 16 | Assessing keloid recurrence following surgical excision and radiation显示文摘Keloids are a fibroproliferative disorder that can result from a cutaneous injury to the reticular dermis.Recurrence rates as high as 100%have been reported following surgical excision alone.Consequently,a variety of post-surgical techniques have been employed to prevent keloid recurrence,including the use of radiation.Although numerous studies have shown post-excisional X-rays,electron beam,lasers and brachytherapy can reduce the rate of keloid recurrence,numerous inconsistencies,including a wide range of definitions for keloid recurrence,make it difficult to compare study outcomes.The review aims to examine the various means for defining keloid recurrence in clinical trials involving the use of radiation therapy.Searches of the Cochrane Library and PubMed were performed to identify the available information for post-surgical keloid recurrence following radiation therapy.Each identified study was reviewed for patient followup and criteria used to define keloid recurrence.The search results included clinical studies with external beam radiation,brachytherapy and superficial radiation therapy.Many studies did not include a definition of keloid recurrence,or defined recurrence only as the return of scar tissue.Other studies defined keloid recurrence based on patient self-assessment questionnaires,symptoms and scar elevation and changes in Kyoto Scar Scale,Japan Scar Workshop Scale and Vancouver Scar Scale scores.The results of this review indicate keloidectomy followed by radiation therapy provide satisfactory recurrence rates;however,clinical studies evaluating these treatments do not describe treatment outcomes or use different definitions of keloid recurrence.Consequently,recurrence rates vary widely,making comparisons across studies difficult.Keloid recurrence should be clearly defined using both objective and subjective measures. | Michael H.Gold Mark S.Nestor Brian Berman David Goldberg | 2020 | Burns & Trauma2020，8，1： | 8 |
| 17 | Skin bioprinting:the future of burn wound reconstruction?显示文摘Burns are a significant cause of trauma,and over the years,the focus of patient care has shifted from just survival to facilitation of improved functional outcomes.Typically,burn treatment,especially in the case of extensive burn injuries,involves surgical excision of injured skin and reconstruction of the burn injury with the aid of skin substitutes.Conventional skin substitutes do not contain all skin cell types and do not facilitate recapitulation of native skin physiology.Three-dimensional(3D)bioprinting for reconstruction of burn injuries involves layer-by-layer deposition of cells along with scaffolding materials over the injured areas.Skin bioprinting can be done either in situ or in vitro.Both these approaches are similar except for the site of printing and tissue maturation.There are technological and regulatory challenges that need to be overcome for clinical translation of bioprinted skin for burn reconstruction.However,the use of bioprinting for skin reconstruction following burns is promising;bioprinting will enable accurate placement of cell types and precise and reproducible fabrication of constructs to replace the injured or damaged sites.Overall,3D bioprinting is a very transformative technology,and its use for wound reconstruction will lead to a paradigm shift in patient outcomes.In this review,we aim to introduce bioprinting,the different stages involved,in vitro and in vivo skin bioprinting,and the various clinical and regulatory challenges in adoption of this technology. | Mathew Varkey Dafydd O.Visscher Paul P.Mvan Zuijlen Anthony Atala James J.Yoo | 2019 | Burns & Trauma2019，7，1： | 8 |
| 18 | Minimizing treatment complexity of combat-related soft tissue injuries using a dedicated tension relief system and negative pressure therapy augmented by high-dose in situ antibiotic therapy and oxygen delivery: a retrospective study显示文摘Background:Following combat-related,extensive soft tissue injury from gunshot wounds or blasts,prolonged duration from injury to full wound closure is associated with infection,increased morbidity and mortality,failure to mobilize,poor functional outcome and increased cost.The purpose of this study was to evaluate a novel treatment enabling early primary closure of combat wounds.Methods:This was a retrospective study of 10 soldiers and civilians with extensive combat-related soft tissue limb injuries(5 gunshot wounds,5 blasts)treated using the TopClosure^(■)Tension Relief System(TRS)with simultaneous administration of regulated oxygen-enriched and irrigation negative pressure-assisted wound therapy(ROINPT)via the Vcareα^(■)device.Results:Nine patients were treated during the acute phase of injury and one was treated following removal of a flap due to deep infection 20 years after injury and flap reconstruction.Two patients had upper limb injury and the rest lower limb injury.With the aid of the TRS and/or ROINPT,immediate primary closure during reconstruction was achieved in 6 patients and delayed primary closure in three.Only one patient required a skin graft to close a small area of the wound after most of the wound had been closed by delayed primary closure.Wound closure was achieved within 0–37 days(median:12.5 days,interquartile range:2.75–19.75)from injury.Conclusions:The TRS is a novel device for effective,early skin stretching and secure wound closure through the application of stress relaxation and mechanical creep,achieving primary closure of large defects using a simplified surgical technique and reducing the need for closure using skin grafts and flaps and the use of tissue expanders.Delivering supplemental oxygen to the wound by ROINPT reverses the reduced oxygen levels inherent in conventional negative pressure-assisted wound therapy,mitigating anaerobic contamination and reducing infection.Irrigation may accelerate the evacuation of infectious material from the wound and provide a novel method for antibiotic administration.The combination of TRS and ROINPT devices allow for early primary closure with improved functionality of combat-related limb injuries. | Moris Topaz Itamar Ashkenazi Oren Barzel Seema Biswas Dan Atar Nurit Shadmi Itzhak Siev-Ner | 2021 | Burns & Trauma2021，9，1： | 7 |
| 19 | Application of stem cells in peripheral nerve regeneration显示文摘Traumatic peripheral nerve injury is a worldwide clinical issue with high morbidity.The severity of peripheral nerve injury can be classified as neurapraxia,axonotmesis or neurotmesis,according to Seddon’s classification,or five different degrees according to Sunderland’s classification.Patients with neurotmesis suffer from a complete transection of peripheral nerve stumps and are often in need of surgical repair of nerve defects.The applications of autologous nerve grafts as the golden standard for peripheral nerve transplantation meet some difficulties,including donor nerve sacrifice and nerve mismatch.Attempts have been made to construct tissue-engineered nerve grafts as supplements or even substitutes for autologous nerve grafts to bridge peripheral nerve defects.The incorporation of stem cells as seed cells into the biomaterial-based scaffolds increases the effectiveness of tissue-engineered nerve grafts and largely boosts the regenerative process.Numerous stem cells,including embryonic stem cells,neural stem cells,bone marrow mesenchymal stem cells,adipose stem cells,skin-derived precursor stem cells and induced pluripotent stem cells,have been used in neural tissue engineering.In the current review,recent trials of stem cell-based tissue-engineered nerve grafts have been summarized;potential concerns and perspectives of stem cell therapeutics have also been contemplated. | Sheng Yi Yu Zhang Xiaokun Gu Li Huang Kairong Zhang Tianmei Qian Xiaosong Gu | 2020 | Burns & Trauma2020，8，1： | 7 |
| 20 | One-step approach for full-thickness skin defect reconstruction in rats using minced split-thickness skin grafts with Pelnac overlay显示文摘Background:Split-thickness skin grafting is the current gold standard for the treatment of traumatic skin loss.However,for patients with extensive burns,split-thickness skin grafting is limited by donor skin availability.Grafting split-thickness skin minced into micrografts increases the expansion ratio but may reduce wound repair quality.Dermal substitutes such as Pelnac can enhance the healing of full-thickness skin wounds,but their application currently requires two surgeries.The present study investigated whether it is possible to repair full-thickness skin defects and improve wound healing quality in a single surgery using Pelnac as an overlay of minced split-thickness skin grafts in a rat model.Methods:A full-thickness skin defect model was established using male Sprague-Dawley rats of 10 weeks old.The animals were randomly divided into control and experimental groups in which Vaseline gauze and Pelnac,respectively,were overlaid on minced split-thickness skin grafts to repair the defects.Wound healing rate and quality were compared between the two groups.For better illustration of the quality of wound healing,some results were compared with those obtained for normal skin of rats.Results:We found that using Pelnac as an overlay for minced split-thickness skin grafts accelerated wound closure and stimulated cell proliferation and tissue angiogenesis.In addition,this approach enhanced collagen synthesis and increased the formation of basement membrane and dermis as well as the expression of growth factors related to wound healing while reducing scar formation.Conclusions:Using minced split-thickness skin grafts overlaid with Pelnac enables the reconstruction of fullthickness skin defects in a single step and can increase the healing rate while improving the quality of wound healing. | Tong Liu Chao Qiu Chi Ben Haihang Li Shihui Zhu | 2019 | Burns & Trauma2019，7，1： | 7 |
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