Objective To investigate the outcome of repairing the peripheral nerve defects with the tissue engineered nerve constructed by Schwann cells and fibrin glue. Methods Wallerian degenerated sciatic nerve were harvested from the 4-week-old New Zealand rabbits for culture of Schwann cells. The Schwann cells were then separated, amplified and purified, and then were identified by the S-100 protein immunochemical staining. The cultured Schwann cells (1×106/ml) were mixed with fibrin glue to form the Schwann cell-fibrin glue compound, which was observed by the inverted phase contrastmicroscope. The compound filled some silicone tubes (Group A) and biomembrane (Group B) to fabricate the tissue engineered nerves with a purpose of repairing the 10-mm defects in the New Zealand rabbit tibia nerves. The autologous nerve grafting was performed in Group C. The electrophysiological examination and the histomorphological analysis were performed at 10 weeks after the transplantation. Results All the rabbits survived through the experiment. In Group A, all the rabbits developed an ulcer in the soles of their left feet at 3-4weeks after the transplantation, while less ulceration developed in Groups B and C. At 10 weeks after the transplantation, the electrophysiological examination was performed, the elective stimulation failed to pass through the nerve grafts, and no composed muscular action potential was found in all the rabbits in Group A; the elective stimulation could pass through all the nerve grafts in Groups B and C, and could evoke the composed muscular action potential; the composed muscular action potential and the nerve conduct velocity in the two groups were 4.21±0.82 mV and 3.40±5.40 m/s vs. 4.80±1.15 mV and 36.55±6.43 m/s(Pgt;0.05). In Group A, no regrown axon was found in the nerve grafts, but neuromawas found to have formed in the both ends of the silicon tube. In Groups B and C, there was no obvious neuroma formation but regrown axons could be found to have regenerated. The histomorphological analysis on the regrown axons showed thatthere was no statistically significant difference between Groups B and C. Conclusion The tissue engineered nerve fabricated with Schwann cells, fibrin glue, and biomembrane can promote the nerve regeneration, and its reparative effect is similar to that of the autologous nerves; therefore, the future of its clinical practice is brilliant.
Objective To investigate the effectiveness of autogenous platelet-rich plasma (PRP) gel with acellular xenogeneic dermal matrix in the treatment of deep II degree burns. Methods From January 2007 to December 2009, 30 cases of deep II degree burns were treated. There were 19 males and 11 females with an average age of 42.5 years (range, 32-57 years).The burn area was 10% to 48% of total body surface area. The time from burn to hospitalization was 30 minutes to 8 hours. All patients were treated with tangential excision surgery, one side of the wounds were covered with autogenous PRP gel and acellular xenogeneic dermal matrix (PRP group), the other side of the wounds were covered with acellular xenogeneic dermal matrix only (control group). The heal ing rate, heal ing time, infection condition, and scar formation were observed. Results At 7 days after operation, the infection rate in PRP group (6.7%, 2/30) was significantly lower than that in control group (16.7%, 5/30, P lt; 0.05). The healing times were (18 ± 4) days and (22 ± 4) days respectively in PRP group and control group, showing significant difference (P lt; 0.05). The healing rates at 14 days and 21 days were 75% ± 7% and 88% ± 5% in PRP group, were 62% ± 15% and 73% ± 7% in control group, showing significant difference (P lt; 0.05). RPR group was superior to control group in elasticity, color, appearance, softness, scar formation, and heal ing qual ity. Conclusion Autogenous PRP gel with acellular xenogeneic dermal matrix can accelerate the wound healing of deep II degree burns as well as alleviate the scar proliferation.
Objective To explore the appl ication of damage control surgery (DCS) strategy in the treatment of severe burn-trauma combined injury. Methods From January 2004 to December 2009, 28 patients with severe burn-trauma combined injury received salvage treatment according to DCS, including 12 cases of burn combining injury at 2 sites, 6 cases ofburn combining injury at 3 sites, and 10 cases of burn combining injury at 4 sites or above. There were 18 males and 10 females with a median age of 39.5 years (range, 8-56 years). The burn area was 15% to 56% of total body surface area. The injury severity score a (ISS) was 25 to 56, and the traumatic index was 17 to 24. Lethal triad syndrome occurred in all patients. Of them, 16 cases were on admission immediatly after first-aid, and 12 cases were thansferred from other hospitals. The time from injury to hospital ization was 20 minutes to 36 hours. All patients were treated by immediate fluid resuscitation and emergent operation to control hemorrhage and contaminations. Biological dressings were used to seal the wounds provisionally. The systemic therapy was carried out as soon as the vital signs of the patients became stable. Results In 26 survivors, 23 achieved wound heal ing by first intention, 3 had a l ittle residual wound at discharge. The hospital ization days were 31 to 398 days (62 days on average). However, 1 patient died of multiple organ failure, another 1 patient died of severe cerebral trauma with refractory shock. Conclusion The DCS strategy is effective in reducing mortal ity of patients with severe burn-trauma combined injury.