Biomedical subjects
Publications and source records attributed to E Dantzer.
BACKGROUND: Injuries by airbags are seen more frequently as more vehicles are equipped. CASE REPORTS: 7 cases of burns by airbags are reported. Most of burns are second degree lesions located on upper extremity and trunk. DISCUSSION: Lots of components are implicated in airbag deployment. So, three types of burn are described: thermal, chemical and friction. The treatment is simple. But, omission could be potentially dangerous, especially alkali chemical keratitis.
Early excision and prompt coverage in severely burned patients are the best way to lessen morbidity and improve survival. Repair of full-thickness burns requires replacement of both dermal and epidermal components of skin and treatment with split thickness autografts replaces both of them. But healthy skin is not sufficient in extensive burns. Alternative to split thickness skin grafts have been studied by several groups including epidermis, dermis or a complete replacement comprising epidermis and dermis. Because of the difficulties in homografts supplying, a new way was use to replace the dermis. In 1981, Yannas and Burke were the first to develop such a matrix. Intégra is available in France since 1997 and was used in our service for the treatment of both acute and reconstructive surgery for burned patients. Twenty patients were treated for acute surgery. Nineteen patients were treated for reconstructive surgery of burn scar contractures. Fifty-one grafts of Intégra were performed. Long-term final results seem to show that Intégra improve cosmetical and functional results and is a new surgical alternative for the treatment of burns in the acute phase as well as in late surgery of deformities.
Integra was initially developed for the primary coverage of acute burns. It acts as a network for dermal reconstruction. An epidermal graft overlay is necessary after 3 weeks to achieve the in vivo reconstruction of a full-thickness skin equivalent. The quality of the functional and aesthetic results achieved led us to evaluate the potential of Integra in the treatment of burn scars and for general reconstructive surgery. We present a series of 31 patients who underwent Integra grafting for reconstructive surgery at a total of 39 operational sites. The average area grafted per procedure was 267 cm(2). Complications (silicone detachment, failure of the graft, haematoma) were observed in nine cases. The length of follow-up ranged from 0.5 year to 4 years. Two patients (two sites) were lost to follow-up; the final results in the remaining patients were considered to be good in 28 cases, average in six cases and poor in three cases. The disadvantages of using Integra in reconstructive surgery are the necessity of two operations, the risks of infection under the silicone layer, of the silicone becoming detached and of recurrence of contraction. On the other hand, Integra has many advantages including its immediate availability, the availability of large quantities, the simplicity and reliability of the technique, and the pliability and the cosmetic appearance of the resulting cover. In the light of these preliminary results, Integra appears as a new alternative to full-thickness skin grafting, skin expansion and even skin flaps for reconstructive surgery.
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The nose is in the medial portion of the face and is frequently injured in trauma of this area. Due to its situation its structure and shape, and its essential function, this organ is particularly exposed in the case of facial burns. These injuries, are usually associated with larger injuries, and frequently with systemic problems, such as respiratory problems. The authors describe nasal burns in the larger context of facial burns, and summarize recent data on this topic. They then recall the fascinating story of rhinopoiesis through the ages. The third part is devoted to their personal approach to reconstruction of the nose in severe panfacial burns, using a forehead flap with one or several tissue expanders.
The face is one of the areas of the body most frequently affected by burns. Pressure therapy maintains facial scars until maturation is achieved to present hypertrophic scars or contractures. Elastic pressure garments are usually used, but they do not provide adequate pressure on areas such as naso-labial folds or labio-chin folds. Silicone splints are therefore added under this elastic face mask. A rigid transparent face mask or silicone face mask allows better management of facial scars. A positive plastic mold is obtained from a negative alginate mold of the patient's face. A high temperature plastic is heated and stretched on to the positive mold. The mask is worn continuously excepted when bathing eating and rehabilitation. Follow up is necessary to prevent complications and to revise the mask as the scars change. Nostril and oral commissures are treated with inserts which maintain adequate size or corrected contractures. Satisfactory results can be obtained with cooperative patients.
General anaesthesia is often required for burns dressing. Ketamine was the most common agent for carrying out removal of adherent dressings. Disadvantages are delirium on emergence from anaesthesia and prolonged recovery. We have studied an intravenous combination of propofol and ketamine in 29 burned patients for 39 dressings. After induction with 1 mg.kg-1 of propofol and 0.75 mg.kg-1 of ketamine, the maintenance rate was 2.5 mg.kg-1.h-1 of each agent. Satisfactory intraoperative conditions were obtained in all cases. Mean time of recovery was less than 15 min. Unpleasant dreaming occurred in 3 patients only, without agitation. The technique proved to be simple, effective and should revive interest for ketamine in the management of burned patients.
In large cutaneous defects due to severe burns, dermal mesenchyme healing has to be controlled in order to avoid granulation tissue that rapidly leads to important contractures and hypertrophic scars. We report a study about the use of an artificial dermis made of human collagen (I and III) and several glycosaminoglycans. This artificial dermis was grafted on Sprague-Dawley rats after a 9 cm2 skin excision on the back. An identical control area was made just under it, on the same animal. The animals were killed on day 2, 7, 14, 21, 30 and different parameters were studied: clinical study, bacteriological study, histopathological appearance, scanning and transmission electron microscopy, immunological study, physical parameters, UV absorption. Direct and indirect cytotoxicity tests, performed on cell cultures showed no change in the morphology and of the growth of the keratinocytes or of the fibroblasts. A biocompatibility study showed on the early days (day 2, 7, 14) that adherence of artificial dermis to the underlying tissue was good. There was virtually no bacterial colonization. Ultrastructural study showed an important cellular colonization, with an inflammatory appearance at the beginning. After a while, fibroblasts appeared, with synthesis of neocollagen fibers as early as the second week. Histological study showed neovessels in the artificial dermis. Later (day 21, 30) the inflammation was less severe and the amount of endogenous collagen increased.(ABSTRACT TRUNCATED AT 250 WORDS)