bluuebunny/crossref_metadata_2025_split huggingface dataset:
137 Maximal Harvest Density of Full-Thickness Skin Columns in Skin Replacement Therapy
Authors: Cooper Laura E , Chapa Javier A , Christy Sean E , Chan Rodney K , Carlsson Anders H 
Published: April 2021

Abstract

Introduction
Split-thickness skin grafts (STSGs) are the mainstay of skin replacement therapy but fail to adequately reproduce basic skin functions and subject patients to new, open wounds that can cause significant pain and scarring. Full-thickness skin grafts (FTSGs) have improved cosmetic outcomes and better recapitulate skin functions, but few sites can serve as donors and requirement for “take” is greater. Prior research has shown that full-thickness skin column (FTSC) harvest results in improved healing of the injured site and decreased morbidity of the donor site at 10% harvest density. This study aims to determine the maximal harvest density of FTSC donor sites.

Methods
Ten donor sites were created on the dorsum of anesthetized swine (Sus scrofa domestica). STSG donor sites were harvested with a dermatome (12/1000 inch) and compared to FTSC donor sites with the highest possible harvest ratio of sixteen 1.5mm-diameter skin columns/1cm2 (28% harvest density). Donor site morbidity was assessed via re-epithelialization, contraction, pigmentation, number of hair follicles, and scar thickness on post-burn day (PBD) 7, 14, 21, 28, 60, and 90.

Results
There were no significant differences in re-epithelialization or contraction between FTSC and STSG donor sites. STSG donor site pigmentation was significantly decreased as compared to control on all assessment days (p=0.0161, 0.0003, 0.0031, 0.0095, 0.0244, respectively), and remained significantly hypopigmented as compared to FTSC starting at PBD 14 (p&lt; 0.0001). Pigmentation was decreased for FTSC donor sites at PBD 14 (p=0.0204) but significance was lost by PBD 21. Both FTSC and STSG donor sites showed significantly fewer hair follicles as compared to control at PBD 7 (p=0.0011, 0.0003, respectively). On PBD 21, STSG had significantly less hair follicles as compared to FTSC donor sites (p=0.0010). This resolved by PBD 28. FTSC scars were significantly thicker than both control and STSG at PBD 28 (p=0.0348, 0.0038, respectively) and PBD 60 (p=0.0174, 0.0329, respectively). This significance was lost by PBD 90.

Conclusions
No statistically significant differences were seen in re-epithelialization and contraction between FTSC and STSG donor sites. STSG were hypopigmented as compared to FTSC donor sites and had significantly less hair follicles at day 21. FTSC donor site scars were significantly thicker than STSG. Although decreased donor site morbidity has been observed at lower harvest densities (10%), these results were not seen at 28%, which likely exceeds the optimal harvest density.
142 Transcriptome Analysis Captures Radiation Exposure in a Dose-sensitive Manner and Predicts Short-term Survival in a Mouse Model
Authors: Alkhalil Abdulnaser , Clifford John L , Miller Stacy-Ann , Guatam Aarti , Jett Marti , Hammamieh Rasha , Moffatt Lauren T , Shupp Jeffrey W 
Published: April 2021

Abstract

Introduction
A mass exposure to irradiation would be a challenge to health care systems. A simple tool or test that indicates the intensity of the absorbed radiation or the chances of survivability would be invaluable in this scenario. To identify biomarkers that potentially could provide novel biodosimetry tools, we have conducted a radiation dose-response and time-course experiment in mice that includes an assessment of the transcriptome of the skin.

Methods
Groups of mice (n=5) received whole-body X-ray exposures (0, 1, 3, 6, or 20Gy) and skin biopsies were obtained from each animal at times post-irradiation (h2, Days 4, 7, 21, 28). Biopsies were collected from the 20Gy cohort for only days 0, 4, and 7. Total RNA was isolated and microarrays were performed and analyzed using custom R scripts to obtain lists of probe sets differentially expressed. Changes in gene expression at Benjamini-Hochberg FDR adjusted P &lt; 0.05 and FC &gt;2 were deemed significant. Analyses were performed comparing the different doses of X-ray exposure over all time points.

Results
Mice in the 20Gy group were euthanized by d7 and the dose was considered lethal. Animals in 1, 3, and 6Gy groups completed the full experiment to d28. Sammon plot analysis of transcriptomes showed clear separation of samples based on the irradiation levels and time after exposure. The clearest separation was between samples of lethal and sublethal doses. Samples from animals exposed to sublethal doses separated more based on timepoints rather than the IR dose suggesting a level of similarity in the progression of the response to sublethal doses. Downregulation was the dominant modulation in the significantly differentially transcribed genes (SDTGs) in the 20Gy group. Temporal changes in ratios of upregulated/downregulated SDTGs (P &lt; 0.05 and FC &gt; 2) revealed further the difference between of transcriptome responses after exposure to lethal and sublethal doses and indicated a delayed peaks response with increasing IR doses within the sublethal range. About 59% of the SDTGs in 20gy were common to all timepoints while no more than 11% were common at the same duration in the other groups. Ratios of the number of SDTGs at h2 to those common to all TPs decreased in a dose-dependent manner with potential radiation dosimetric applications.

Conclusions
These results demonstrate a solid ability in detecting IR exposure, differentiating lethal and sublethal exposures, and differentiating among the exposure to sublethal doses.
506 Creating Strategic Structure, Curriculum, and Training to Provide an Effective Virtual Burn Camp During a Pandemic.
Authors: Mayer Nichole F , Mikolaj Kerry , Schuetz Tim , Boulter Trudy 
Published: April 2021

Abstract

Introduction
When forming our virtual burn camp, burn camp leadership generated themes for each day to formulate a strategic camp curriculum, providing building blocks over the week to create camp community and connection. Each of the themes were well defined with defining concepts. The goal of the program was to provide consistency and guidance for our staff who were located all over the country and beyond to structure our virtual programming for our campers.

Methods
Burn camp leadership created a theme for each of the 5 days of virtual burn camp to create fluidity across the camp. Supporting these daily themes, we defined 5 core words to further outline the overall theme for the day. Our opening day theme was Creating Community. Accompanying our theme of Creating Community, we provided counselors with the following driving concepts: acceptance, belonging, inclusion, bonded, and connection.
Our theme for the second day was Growth. We provided the following driving concepts to support Growth: develop, flourish, thrive, stretch, and progressing. The third day’s theme was Inspire with the following driving concepts: encourage, motivate, energize, enthuse, and lead. Dream was the theme for the fourth day with the following driving concepts: aspire, consider, visualize, imagine, and ambition. Our last day of camp our theme was Hope to inspire kids to look into the future beyond virtual burn camp. The driving concepts included: optimism, plan, promise, confidence, and wish.
These themes and driving concepts with definitions were provided to our cabin counselors prior to camp and were sent out each morning. Counselors were required to complete a Google Survey at the end of each day to assess effectiveness and ability to execute the theme for the day.

Results
The themes and driving concepts allowed for intentionality for each day that provided fluidity for our virtual burn camp. Each daily theme built on the previous theme(s) to provide a connected community and intentional camp experience. Results of our Google Surveys showed the counselors were able to create community, facilitate growth, inspire campers, encourage campers to dream and instill hope.

Conclusions
Despite a challenging circumstance and an unprecedented situation facing our burn camp, our burn camp leadership team was able to create a structured and strategic framework with which to guide our virtual burn camp. This structure allowed our counselors to feel empowered to facilitate programming each day to connect our campers and move them forward despite difficult times.
513 Continuous Heparin Infusion in Burn Patients on Continuous Renal Replacement Therapy
Authors: Sullivan Louisa , Quan Asia N , Richey Karen J , Foster Kevin N 
Published: April 2021

Abstract

Introduction
Hyper-coagulopathy has been widely described in patients following burn injury. In burn patients with renal dysfunction requiring continuous renal replacement therapy (CRRT), citrate is commonly used to anticoagulate the circuit. However, if venous thromboembolism develops, or if the patient requires treatment-dose anticoagulation for acute coronary syndrome or atrial fibrillation, an unfractionated heparin (UFH) infusion can be used for anticoagulation. This study reviewed the use of heparin infusion in burned patients on concomitant continuous renal replacement therapy.

Methods
This study was a retrospective review of patients in a single burn center over six years. Patients were included if they were 18 years or older and receiving UFH as a continuous infusion for VTE, acute coronary syndrome (ACS), or new onset atrial fibrillation while on concomitant CRRT.

Results
Eight patients were included. Seven of eight patients reached a therapeutic aPTT level. The maximum rate of heparin infusion which was required to produce a therapeutic aPTT was 34 units/kg/hr while the minimum was 9 units/kg/hr. The patient requiring the highest heparin infusion rate met criteria for heparin resistance. Four of eight patients developed clinically significant bleeding while on heparin infusion. All four patients had some duration of concomitant citrate infusion during heparin infusion and all four were receiving heparin for VTE. Each of these patients required a heparin infusion rate of 24 units/kg/hr or greater to obtain therapeutic aPTT levels. Patients who did not have clinically significant bleeding had a maximum therapeutic heparin infusion rate of 22 units/kg/hr or less.

Conclusions
Heparin infusion can be used successfully in burn patients who are receiving concomitant CRRT, with the majority (7 of 8) of the patients in this study able to achieve a therapeutic aPTT level. Clinically significant bleeding occurred in 50% of patients and was associated with higher rates of heparin infusion (&gt; 24 units/kg/hr) and the use of concomitant citrate infusion to anticoagulate the CRRT circuit. Heparin resistance appeared to be present in at least one patient in the study, with high doses of heparin required to achieve a therapeutic aPTT level.
520 Weight-based vs. BSA-based Fluid Resuscitation Predictions in Pediatric Burn Patients
Authors: Stevens Jan V , Prieto Nina , Ridelman Elika , Klein Justin D , Shanti Christina M 
Published: April 2021

Abstract

Introduction
Current practice for major pediatric burns includes fluid resuscitation using formulas that estimate fluid requirements based on weight and/or body surface area (BSA) along with percent total burn surface area (TBSA). Adult studies have shown that these formulas can cause fluid overload in obese patients and increase risk of complications. These findings have not been validated in pediatric patients. This study aims to evaluate whether a weight-based resuscitation formula increases the risk of complications in obese children following burn injuries and compares fluid estimates to those that incorporate BSA.

Methods
A retrospective review was conducted on 110 children (≤ 18 years old) admitted to an ABA-verified urban pediatric burn center from October 2008 to May 2020. Patients had ≥15% TBSA, were resuscitated with the weight-based Parkland formula, and had fluids titrated to urine output every two hours (1 ml/kg/hr if ≤ 30kg; 0.5 ml/kg/hr if &gt; 30kg). Demographics, burn type, and TBSA were collected on admission. BSA-based Galveston and BSA-incorporated Cincinnati formula resuscitation predictions were also calculated. Output and input volumes were collected at 8h and 24h post-injury. Complications were collected throughout the hospital stay. Patients were classified into CDC-defined weight groups based on percentile ranges. Statistical analysis was conducted using SPSS Statistics version 10.0.

Results
This study included 11 underweight, 60 normal weight, 18 overweight, and 21 obese children. Our patients had a mean age-based weight CDC percentile of 62.2%, and mean TBSA of 25.4%. Predicted resuscitation volumes increased as CDC percentile increased for all three formulas (p=0.033, 0.092, 0.038), however there were no significant differences between overweight and obese children. Total fluid administered was higher as CDC percentile increased (p=0.023). However, overweight children received more total fluid than obese children. The difference between total fluids given and Galveston predicted resuscitation volumes were significant across all groups (p=0.042); however, the difference using the Parkland and Cincinnati formulas were not statistically significant. There were more children in the normal weight group who developed complications compared to other groups, but these findings were not significant.

Conclusions
The Parkland formula tended to underpredict fluid needs in the underweight, normal weight, and overweight children, and it overpredicted fluid needs for the obese. Further research is needed to determine the value of weight-based vs BSA-based or incorporated formulas in terms of their risk of complications.
537 Autologous Skin Cell Suspension for the Treatment of Small (≤10% TBSA) Mixed-Depth Burns
Authors: Carter Jeffrey E , Holmes James H , Foster Kevin N , Smith David J , Shupp Jeffrey W 
Published: April 2021

Abstract

Introduction
Split-thickness skin grafts (STSGs) have been the standard of care for many decades. Despite their widespread use, STSGs frequently fail. Autologous skin cell suspension (ASCS) is an FDA approved point of care regenerative medicine technology that reduces donor skin requirements without compromising clinical outcomes. ASCS allows for early treatment and less donor skin harvested that may be useful for hard-to-treat anatomical locations, in compromised patients that have risks for impaired wound healing, or elderly patients with thinner skin. We examined ASCS treatment as an adjunct to meshed autografts in adults with small mixed-depth/full-thickness burns.

Methods
We obtained IRB-approval for a prospective, multi-center, uncontrolled observational study that allowed continued access to ASCS before FDA approval (ClinicalTrials.gov Identifiers: NCT03333941). Subjects with mixed-depth/full-thickness injuries that required skin grafting with a minimum treatment area of 320 cm2 and burns ranging from 5–50% TBSA were eligible for study enrollment. Our analyses included only patients &gt;18 years of age and ≤10% TBSA mixed-depth/full-thickness injuries that had completed the trial. All subjects had ≥1 burn wounds treated with meshed autografts (2:1–4:1) in combination with ASCS. Healing outcomes were accessed following ASCS treatment by direct visualization of each individual wound and included healing, scar outcomes, and safety data.

Results
Analyses included 20 subjects older than 18 years of age with ≤10% TBSA mixed-depth/full-thickness injuries. Of these, compromised wound healing was seen in 50.0% of subjects. Burn wounds with ≥90% re-epithelialization increased over time, with 62%, 80%, and 100% of wounds achieving closure at Weeks 1, 2, and 8, respectively. Similar results were seen in subjects with comorbidities known to affect wound healing and in elderly subjects despite their risks for impaired healing. Total POSAS patient (37.8 and 35.4) and observer scores were comparable (23.3 and 18.4) at Weeks 12 and 24. Safety events were typical for this patient population, and no serious adverse events occurred for any of the wounds.

Conclusions
This analysis provides additional information supporting the use of ASCS for the treatment of small, mixed-depth/full-thickness acute thermal burn injuries in adults, notably those with risk factors for impaired wound healing.
540 Treatment of Severe Burns with Autologous Skin Cell Suspension and Meshed Autograft with Allograft Overlay
Authors: Houng Abraham , O’Sullivan Geoffrey , Lodescar Rachelle 
Published: April 2021

Abstract

Introduction
Autologous skin cell suspension (ASCS) is gaining in popularity in the treatment of severe burns. Prior to the approval of ASCS, widely meshed autograft with allograft overlay is the standard of care in the treatment of severe burns. We are reporting a novel technique of using ASCS and widely meshed autograft with allograft overlay on a series of patients with full thickness flame and scald burns.

Methods
The study is a retrospective chart review of patients from May 2019 to February of 2020. Inclusion criteria: full thickness injury, had multiple staged excisions, with or without allografting, grafted widely meshed 4:1 autograft and ASCS with allograft overlay. Demographic data, grafting information, and time to re-epithelization with photographic evidence were collected.

Results
Six patients were studied from the inclusion criteria: age 24–70, TBSA% 16–77. All surgeries were performed by a single surgeon. All patients had excision/wound bed preparation via tangential excision, autografted with 4:1 mesh. ASCS was applied, and 2:1 allograft was secured onto the wound. Size of the grafts range from 235 cm2 to 3880 cm2. Average time to ≥95% re-epithelialization was 23 days (range 15 days to 35 days).

Conclusions
By using this novel technique, average time to fully epithelized was 23 days. This compares favorably to the previously presented outcome of ≥95% re-epithelialization in 96% of ASCS-treated wounds after 8 weeks. More studies are needed to validate this finding.
548 Heterotopic Ossification or Dystrophic Calcinosis Cutis in Burn Scars - A Case Series
Authors: Blome-Eberwein Sigrid A , Pinataro Cassandra 
Published: April 2021

Abstract

Introduction
Heterotopic ossification of large joints is a commonly seen and described entity in Burn survivors. We have observed a rather uncommon phenomenon in a series of 4 Burn survivors who presented to our Burn center for scar treatment and open wounds many years after their injuries. A chronic, small, splinter-like subcutaneous irritation led to open wounds and infections in their burn scars. A similar condition is known as dystrophic calcinosis cutis in the dermatologic literature, but caused by calcium metabolism changes in otherwise healthy skin.

Methods
The demographics and history of illness was documented in all 4 patients. A literature review was performed. The calcified bone-like irritant was removed surgically in all patients, sometimes in more than one location. Pathologic evaluation was performed on the removed specimen. Strategies leading to healing of the wounds were evaluated.

Results
Four publications were found addressing this phenomenon in Burn scars, all case reports. All of our patients had undergone curettage of the lesions by a dermatologist in the past without resolution. All lesions were excised surgically and proved to extend subcutaneously far more extensively than the visible skin lesion. X rays proved not helpful in preoperative assessment of the extent. All wounds healed after the irritant was removed.

Conclusions
All lesions appeared to have formed along tendon or fascia remnants underneath the burn scars, exerting pressure on the overlying epithelium which eventually led to breakdown and necrosis. This finding prompted the term “heterotopic cutaneous ossification”. Chronic tension and inflammation were assumed in the etiology, rather than calcium metabolism abnormalities or systemic connective tissue disease, which were not present in these patients. Research is needed to establish the prevalence, cause, and prevention of this condition in Burn survivors.
552 Limb Salvage: Amputations Prevented with Dehydrated Human Amnion/Chorion Membrane Allografts (dHACM) Used in Combination with Decellularized Human Collagen Matrix (dHCM)
Authors: Matthews Marc R , Helmick Emily , Mellon Christopher , Thornburg Danielle , Kowal-Vern Areta , Tettelbach William H , Foster Kevin N 
Published: April 2021

Abstract

Introduction
Burn and traumatic limb injuries with exposed bone/tendon typically require surgical flaps or amputations for healing. Some burn patients are not candidates for these invasive techniques. Placental amniotic membrane has been used as a wound dressing for more than 100 years and may offer an alternative to flaps and/or amputations. Processed dehydrated human amnion/chorion membrane (dHACM), from human placental tissue, contains type 1 human collagen as well as non-viable cells and 285 identified regulatory proteins including growth factors, chemokines, cytokines, metalloproteinases, and other tissue growth and inflammatory mediators. dHACM has been successfully used as a dressing for wound ulcers, burns, donor sites, & surgical debridement. This study reports the use of dHCAM as a limb salvage tool in four patients with severe injuries.

Methods
This is a retrospective case series of patients suffering severe lower extremity injury with bone/tendon exposure that had applied dHACM/dHCM over or packed (depending on wound depth), then covered with 3% bismuth tribromophenate petrolatum dressing & glycerol/ hydroxyethylcellulose lubricant. Negative pressure wound therapy (NPWT) was initiated; wound re-evaluation occurred in seven days. dHACM/dHCM was reapplied if required (bone still exposed).

Results
There were 3 males and 1 female with three burns and one NSTI. The mean±sd (median) age was 58±23 (61) years; % total burn surface area 3±3 (2); length of hospital stay 48±30 (40) days; number of tangential excisions & debridements 6.5±1 (6.5); days from admission to product application 49±47 (34) and discharge 24±19 (19) days; negative pressure wound therapy (NPWT) 53±6 (56) days. All four patients continued treatment upon discharge with clinic visits and home NPWT. All recovered with good results and no complications. Treatment may be continued with NPWT therapy at home or in a skilled nursing facility. Patients healed after two to three dHACM/dHCM applications and did not require leg or foot amputations.

Conclusions
In select limb salvage cases, dHACM/HCM may be a promising alternative to extremity amputations, tissue transfer flaps or other techniques for secondary intention healing of wounds with bone/tendon exposure.