Characterization of growth hormone enhanced donor site healing in patients with large cutaneous burns.

BACKGROUND: Human growth hormone is an anabolic agent that attenuates injury-induced catabolism and stimulates protein synthesis. Recombinant human growth hormone (rhGH) administered therapeutically to patients with massive burns has been shown to increase the rate of skin graft donor site healing. It has been postulated that growth hormone affects wound healing and tissue repair by stimulating the production of insulin-like growth factor-1 (IGF-1) by the liver to increase circulating IGF-1 concentrations. The mechanism by which it improves wound healing, however, remains in question. The authors hypothesize that rhGH up-regulates IGF-1 receptors and IGF-1 levels both systemically and locally in the wound site to stimulate cell mitosis and increase synthesis of laminin, collagen types IV and VII, and cytokeratin. This hypothesis was tested in nine patients with burns covering > 40% of total body surface area. OBJECTIVE: The authors assessed the efficacy of rhGH in promoting several major building materials in the donor site of patients with massive burns. METHODS: Ten massively burned patients with full-thickness burns covering more than 40% of total body surface area were participants in a placebo-controlled prospective study to determine the efficacy of 0.2 mg/kg/day rhGH on donor site wound healing and to identify some of the major components involved in wound healing and its integrity. RESULTS: Donor sites in burn patients receiving rhGH showed an increased coverage by the basal lamina of 26% for placebo to 68% coverage of the dermal-epidermal junction. Insulin-like growth factor-1 receptors and laminin, types IV and VII collagen, and cytokeratin-14 all increased significantly. Healing times of the donor sites were significantly decreased compared with patients receiving placebo. CONCLUSION: Results indicate that growth hormone or its secondary mediators may directly stimulate the cells of the epidermis and dermis during wound healing to produce the structural proteins and other components needed to rebuild the junctional structures.     

Effects of recombinant human growth hormone on donor-site healing in severely burned children.

The beneficial effects of growth hormone on wound healing in severely burned children were studied. Forty patients who were 2 to 18 years old, with 40% or more total body surface area (TBSA) and 20% or more TBSA full-thickness flame or scald burns, were randomized in a double-blind study to receive placebo or 0.1 mg/kg/day recombinant human growth hormone (rHGH) until the first donor site healed or to receive 0.2 mg/kg/day rHGH or placebo from admission throughout hospitalization. Patients receiving 0.2 mg/kg/day rHGH demonstrated significantly higher serum IGF-1 levels at 4.8 +/- 1.7 U/mL compared to placebos at 1.6 +/- 0.4 U/mL (p less than 0.05) and a significant decrease in donor-site healing times compared to placebo (p less than 0.05). Length of hospital stay (LOS/%TBSA) was decreased from 0.80 +/- 0.10 days/%TBSA burned in the placebo group to 0.54 +/- 0.04 days/%TBSA burned in the 0.2 mg/kg/day treatment group (p less than 0.05). This translates, for the average 60% TBSA burned patient, to a decrease in LOS from 46 to 32 days.     

重组人生长激素在严重烧伤病人中的应用研究

目的 探讨生长激素对大面积烧伤病人蛋白质代谢、创面愈合能力、免疫功能及预后的作用。方法 选择４２例大面积烧伤病人,随机分为重组人生长激素治疗组和对照组,并分析比较两组一般状况、蛋白质代谢、创面愈合时间、免疫功能,结果 ｒｈＧＨ组一般情况良好,体重增加,血浆蛋白质水平,供皮区愈合时间及体液和细胞免疫功能均比对照组好。结论ｒｈＧＨ能有效促进蛋白质合成,缩短创面愈合时间,增强机体免疫能力,从而提高大面积     

重组人生长激素在严重烧伤病人中的应用研究

目的探讨生长激素对大面积烧伤病人蛋白质代谢、创面愈合能力、免疫功能及预后的作用。方法选择４２例大面积烧伤病人,随机分为重组人生长激素（ｒｈＧＨ）治疗组和对照组,并分析比较两组一般状况、蛋白质代谢、创面愈合时间、免疫功能。结果ｒｈＧＨ组一般情况良好,体重增加,血浆蛋白质水平、供皮区愈合时间及体液和细胞免疫功能均比对照组好。结论ｒｈＧＨ能有效促进蛋白质合成,缩短创面愈合时间,增强机体免疫能力,从而提高大面积烧伤病人生存率。     

联合应用谷氨酰胺和重组人生长激素对严重烧伤患者蛋白代谢的影响

目的　探讨联合应用谷氨酰胺 (Gln)和重组人生长激素 (rhGH)对严重烧伤患者蛋白代谢的影响。　方法　将 6 0例严重烧伤患者随机分为对照组、Gln组及Gln rhGH组 ,每组 2 0例。对照组患者于伤后 1～ 14d口服甘氨酸作为安慰剂 ,并行常规治疗 ;Gln组于伤后 1～ 14d口服Gln 0 5g·kg-1·d-1;Gln rhGH组患者口服Gln(剂量、时间同Gln组 ) ,且伤后 7～ 14d皮下注射rhGH 0.2U·kg-1·d-1。3组患者于伤后 1、7、14d检测其血浆Gln浓度 ,伤后 14、2 1d检测血浆白蛋白水平 ,记录伤后 30d创面愈合率和总住院日。　结果　Gln rhGH组伤后 7d血浆Gln浓度为 ( 4 5 2 .2 8± 2 1.72 )μmol/L,高于对照组 ( 32 5 .12± 2 5 .34) μmol/L(P <0.0 5)。伤后 2 1dGln rhGH组血浆白蛋白水平为( 31.37± 4 .31) g/L,高于对照组 ( 2 6 .16± 3.12 ) g/L及Gln组 ( 2 8.2 6± 3.2 9)g/L( P <0 0 5 )。伤后 30dGln rhGH组创面愈合率高于对照组及Gln组 ,而总住院日少于对照组及Gln组 (P <0.0 5或 0 .0 1)。　结论　联合应用Gln和rhGH能显著提高严重烧伤患者血浆Gln水平 ,促进机体蛋白的合成 ,提高创面愈合率。     

联合应用重组人生长激素和胰岛素样生长因子-1对烫伤大鼠创面愈合及蛋白质代谢影响的实验研究

目的　了解联合应用重组人生长激素(rhGH)和胰岛素样生长因子-1(IGF-1)对烫伤大鼠创面愈合及蛋白质代谢的影响。方法　Wistar大鼠40只,深Ⅱ度烫伤,随机分成四组,分别接受rhGH(每天0.1 U/kg 称A组)、rhGH加IGF-1(每天rhGH 0.1U/kg 加IGF-1 2.0 m g/kg称C组)、IGF-1(每天2.0 m g/kg 称B组)和林格氏液(每天2 m l/kg 称D组)治疗2 周后,分析比较各组大鼠一般状况、创面愈合时间和蛋白质代谢情况。结果　治疗2 周后C、A 组体重开始增加,4 周后C组体重是A组的1.65 倍,而D组在4～5 周后才开始增加;C组创面愈合天数为(17.1±4.4)天,A组为(20.5±4.8)天,D组为(29.7±6.3)天,C组创面愈合时间明显短于D组,而B组则差异不明显;C组蛋白质升高比A 组和B组明显,有统计学意义(P< 0.01)。结论　联合应用rhGH和IGF-1 比单纯应用rhGH 或IGF-1 对缩短创面愈合时间、促进蛋白质合成均有明显的效果     

An alternative dressing material for the split-thickness skin graft donor site: oxidized regenerated cellulose

The split-thickness skin graft (STSG) donor sites have been treated with various and plenty of dressing techniques and materials. An ideal STSG donor site dressing should have antibacterial, hemostatic, and promoting epidermal healing properties. We have performed a prospective study to evaluate the effect of the oxidized regenerated cellulose on STSG donor site healing. Between January 2002 and January 2005, 40 patients who were operated in any kind of reconstructive operations with STSG donor sites were included in the study. One half of the wound was covered with oxidized regenerated cellulose and the other half of the same wound of the same patient was covered with fine mesh gauze treated with Furacin (nitrofurazone). The patients were grouped into 2 depending on the dressing technique: group I, semiclosed and group II, closed. The wounds were evaluated for healing time, infection, pain perception of the patient, and final esthetic results. The oxidized regenerated cellulose side of the group I was healed in a mean of 6.5 +/- 0.51 days; in group II, 5.4 +/- 0.50 days (range, 5-6 days). The fine mesh gauze treated with Furacin in group I was healed in a mean of 9.9 +/- 0.97 days (range, 8-11 days); in group II, 8.4 +/- 0.99 days (range, 7-10 days). There was a statistical significance between the oxidized regenerated cellulose side and the fine mesh gauze side (P < 0.001) in group I and group II separately. The difference between group I and group II was statistically significant in the oxidized regenerated cellulose side (P < 0.001), and the difference between group I and group II was statistically significant in the fine mesh gauze side (P < 0.005). The antibacterial, hemostatic, and absorbable property of the oxidized regenerated cellulose could ensure the utilization as an alternative STSG donor site dressing, especially because the positive influence over the wound healing was proven.     

Whitehead''s varnish and Jelonet--a better dressing for skin graft donor sites than Jelonet alone.

Two methods of skin autograft donor site management were evaluated in 40 patients in a prospective randomised double-blind clinical trial. Donor sites were dressed using either a standard dressing of Jelonet, gauze, wool and a crêpe bandage or Jelonet, Whitehead's varnish (compound iodoform paint BPC), gauze, wool and a crêpe bandage. Donor site pain was assessed daily using a linear analogue scale, and the healing time of the donor area was recorded. Whitehead's varnish significantly reduced donor site pain compared to the standard dressing (P = 0.0006). Although overall healing time was not statistically different in the two groups, larger donor sites treated with Jelonet and Whitehead's varnish healed more quickly than those treated with the standard dressing alone.     

The use of silver coated dressings on donor site wounds: a prospective, controlled matched pair study

Acticoat, a new silver-coated dressing, produces a moist healing environment along with the sustained release of ionic silver for improved microbial control. These properties suggest that Acticoat might be a useful donor site dressing. However, there are no human studies which assess Acticoat for this use. The purpose of this study was to compare the healing of human skin graft donor sites dressed with Acticoat, to the healing of those dressed with Allevyn, an occlusive moist-healing environment material, which is our standard donor site dressing. In burn patients who had undergone burn excision and grafting, identical side-by-side split thickness donor site wound pairs were dressed with Allevyn and Acticoat. Re-epithelialization was directly assessed daily by a single observer from post-operative day 6 onward, and by four independent observers who rated the extent of re-epithelialization by viewing standardized digital images of the wounds that had been obtained on post-operative days 6, 8, 10,and 12. Donor sites were swabbed for bacterial culture on days 3, 6, and 9. Subsequently, each study donor site scar was rated by a blinded observer using the Vancouver Scar Scale at 1, 2, and 3 months. Sixteen paired sites in 15 patients (3 female, 12 male) were studied. Donor sites dressed with Allevyn were >90% re-epithelialized at a mean of 9.1+/-1.6 days while donor sites dressed with Acticoat required a mean of 14.5+/-6.7 days to achieve >90% re-epithelialization (P=0.004). The Allevyn sites had significantly greater estimated re-epithelialization at days 6, 8, 10 and 12 than the Acticoat sites based on the observations of the digital images. There were no significant differences in the incidence of positive bacterial cultures with either dressing at days 3, 6, and 9. Donor sites dressed with Acticoat had significantly worse scars at 1 and 2 months but this difference resolved by 3 months. Our findings do not support the use of Acticoat as a skin graft donor site dressing.     

Effects of basic fibroblast growth factor on the healing of partial-thickness donor sites. A prospective, randomized, double-blind trial.

A phase I/II clinical study was performed to evaluate the safety and potential efficacy of topical recombinant human basic fibroblast growth factor on the healing of partial-thickness skin graft donor sites in burned children. Each child served as his or her own control. In a blinded and random fashion, one donor site was sprayed with basic fibroblast growth factor (5 microg/cm(2)) on days 0 to 4 after harvest, whereas the other site was treated with vehicle. Twelve patients were entered in the study but one patient died of sepsis that was unrelated to growth factor treatment. Of the remaining 11 patients, no adverse events related to basic fibroblast growth factor occurred. Serum basic fibroblast growth factor levels were never detected and antibody levels remained unchanged. No differences in the rate of epithelialization or days until complete closure were noted (basic fibroblast growth factor = 12.9 +/- 3.9 days, placebo = 12.2 +/- 5.5 days; mean +/- standard error of the mean). No differences in pain, itching, wound fragility, erythema, scarring, or pigmentation were noted. All of the scars matured within 1 year with good to excellent results. Investigators, patients, or families could not distinguish between the two wounds. Although basic fibroblast growth factor proved safe, no enhancement of donor site healing was seen in this small study. Because the time for donor site healing limits subsequent autograft use in patients with sizeable burns, studies should focus on accelerating healing in patients with larger burns where donor site healing is delayed and reharvest is required.     

Effect of recombinant human growth hormone on catabolic hormones and free fatty acids following thermal injury.

Severe burn injury elicits the release of catabolic hormones that contribute to negative nitrogen balance, protein wasting, and impaired wound healing. Previous studies have shown that burn patients receiving recombinant human growth hormone (rhGH) therapy have an increase in the rate of skin donor site healing and a shorter hospital stay. The mechanism by which rhGH exerts its effects, however, is not clearly understood. This study examines the effects of rhGH on circulating levels of catabolic hormones and nonesterified fatty acids in pediatric burn patients. Patients with greater than 40% total body surface area burn were randomly assigned to receive placebo (n = 8) or 0.2 mg/kg/day rhGH (n = 6) throughout their hospitalization. All patients had early morning blood samples assessed for catecholamines (CAT), cortisol, insulin, glucagon, and free fatty acid (FFA) levels during a period of hypermetabolism. No differences could be demonstrated in age, burn size, postburn day of evaluation, resting energy expenditure per kilogram, respiratory rate, heart rate, respiratory quotient, serum cortisol, and serum glucose between placebo- and rhGH-treated patients. The rhGH-treated group did show a significant elevation (p less than 0.05) in insulin-like growth factor-1 (55.9 +/- 14.5 vs. 168 +/- 23.7 mU/mL), total catecholamines (1,817 +/- 177 vs. 1,117 +/- 137 pg/mL), norepinephrine (1,257 +/- 121 vs. 867 +/- 113 pg/mL), epinephrine (385 +/- 175 vs. 147 +/- 36 pg/mL), insulin (32.8 +/- 3.3 vs. 25.0 +/- 3.0 mU/mL), glucagon (215 +/- 18 vs. 158 +/- 22 pg/mL), and free fatty acids (0.74 +/- 0.01 vs. 0.59 +/- 0.04 mEq/L) compared with the placebo group (data expressed as mean +/- SE).(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of Human Recombinant Growth Hormone on Donor-site Healing in Burned Adults

Patients suffering severe burns have an accelerated catabolism with a highly negative nitrogen balance that may worsen their prognosis. Somatropin treatment has been shown to improve this balance in different hypercatabolic situations. Moreover, in children with extensive burns it also reduces the healing time of the skin graft donor site and shortens the hospital stay. In the existing literature there are no controlled prospective clinical trials in adult patients that confirm these data. Our aim was to demonstrate the efficacy of recombinant growth hormone (somatropin) in reducing the healing time of the skin graft donor sites and the length of stay in the burn unit in adult patients with severe burns. A randomized, double-blind, placebo-controlled clinical trial was carried out in 24 adult patients with severe burns (more than 40% of the total body surface burned or more than 15% full-thickness burns). Patients received placebo (n = 11) or somatropin (n = 13) at a dosage of 0.15 mg/kg/day divided into two equal doses (every 12 hours) via intramuscular injection. Treatment was initiated the day the first autograft was performed and terminated the day the patient was discharged from the burn unit. The mean number (+/- SD) of skin grafts per patient was similar between the two groups (4.2 +/- 1.8 vs 3.4 +/- 1.8 in the placebo and somatropin groups, respectively). No reduction in the healing time of the skin graft donor site was observed in the somatropin group compared to the placebo group. Likewise, the time admitted to the burn unit was not significantly different, either in the absolute number of days (36.2 +/- 19.7 vs 30.1 +/- 16.8 days in the placebo and somatropin groups, respectively) or in relation to the percentage of the total body surface burned or the body surface with full-thickness burns. Growth hormone and insulin-like growth factor I (IGF-I) levels were three and five times higher, respectively, in the somatropin group than in the placebo group. Ten of the patients treated with somatropin experienced hyperglycemia, and seven of them required insulin treatment. No other adverse side effect was observed. One patient in the placebo group died as a result of sepsis and multiple organ failure. Somatropin, with the treatment regimen and dosage used in these studies, did not reduce the healing time of the skin graft donor sites or the length of hospitalization in the burn unit in adult patients with severe burns.     

组织工程化表皮膜片构建及其在供皮区的应用研究

目的构建组织工程化表皮细胞膜片并应用于供皮区创面治疗。方法利用患者少量自体或同种异体正常皮肤分离、培养、扩增的表皮细胞,接种于壳聚糖明胶膜构建成表皮细胞膜片;将膜片移植于治疗组供皮区创面、适度加压,同时设立对照组:空白材料对照以及传统油纱布对照覆盖创面。于术后5～10d、30d、90d行大体观察、组织学检查、广谱角蛋白、外皮蛋白、层粘连蛋白、免疫组织化学检测以及Ⅰ、Ⅲ型胶原比值测定(偏光显微镜、RTPCR)。结果利用自体及异体表皮细胞和壳聚糖明胶膜能够构建出人表皮细胞膜片,应用于临床供皮区创面治疗15例,经过3个月随访,疗效肯定。移植膜片创面愈合时间(8.1±1.3)d,空白材料对照区为(16.2±3.8)d,空白油纱布对照区为(23.0±5.8)d。移植膜片存活良好,结构较完整、术后30d及90d观察:12例无明显增生,3例有轻度增生(20.0%),而空白油纱布对照区11例遗留增生性瘢痕(74.4%,χ2=8.127,P<0.01)。结论表皮细胞-壳聚糖明胶膜片能促进供皮区创面早期愈合并减少后期瘢痕增生,具有良好治疗效果。     

PVP-iodine in hydrosomes and hydrogel--a novel concept in wound therapy leads to enhanced epithelialization and reduced loss of skin grafts

BACKGROUND: Moist wound treatment improves healing at a possibly increased risk of bacterial infection and many local antiseptics impair healing. A moist treatment modality with efficient antimicrobial activity would be desirable. METHODS: In this monocentric, randomized, observer blinded, phase III study, a new hydrosome polyvinyl-pyrrolidone (PVP)-iodine preparation in hydrogel containing iodine in a 3% concentration (Repithel) was investigated for its effect on epithelialization in patients receiving meshed skin grafts. Grafts of 167 patients (donor site defects, burn wounds, or chronic defects) were dressed either with Repithel (n=83) covered with a gauze (Jelonet), or Jelonet-gauze only (n=84) until healing. RESULTS: Grafts receiving Repithel healed significantly earlier (9.4 days versus 12.4 days; p<0.0001) and faster than controls as measured by neo-epithelialization of mesh holes between days 7 and 11 (91.2+/-22.8% versus 82.3%+/-28.6, p<0.0001). A subgroup analysis showed that the effects on grafted burn wounds (p=0.0042) and chronic defects (p<0.0001) was more significant than on donor sites. Also a higher take rate of grafts (p=0.0053) and a reduced loss of grafts was observed with Repithel treatment (8 grafts versus 20 grafts) (p=0.0063, respectively). Smokers had improved graft take (p=0.0069) and higher rate of epithelialization (p=0.0040) compared to smokers of the control group. CONCLUSIONS: The results demonstrate significant clinical advantages of Repithel. This new local wound healing drug combines antisepsis and wound moisture efficiently resulting in significantly enhanced epithelialization, decreased transplant losses, and significantly improved healing especially in smokers.     

Growth hormone treatment in pediatric burns: a safe therapeutic approach.

OBJECTIVE: To determine the safety and efficacy of recombinant human growth hormone (rhGH) in the treatment of children who are severely burned. SUMMARY BACKGROUND DATA: During the last decade, we have used recombinant human growth hormone (rhGH; 0.2 mg/kg/day s.q.) to successfully treat 130 children with more than 40% total body surface area (TBSA) burns to enhance wound healing and decrease protein loss. A significant increase in the mortality of adult patients in the intensive care unit who were given rhGH has recently been reported in two large European trials which questions the therapeutic safety of rhGH. METHODS: The records of 263 children who were burned were reviewed. Patients receiving either rhGH at 0.2 mg/kg/day subcutaneously as part of a randomized clinical trial (n = 48) or therapeutically (n = 82) were compared with randomized placebo-administered controls (n = 54), contiguous matched controls (n = 48), and matched patients admitted after August 1997, after which no patients were treated with rhGH (n = 31). Morbidity and mortality, which might be altered by rhGH therapy, were considered with specific attention to organ function or failure, infection, hemodynamics, and calcium, phosphorous, and albumin balance. RESULTS: A 2% mortality was observed in both rhGH and saline placebo groups in the controlled studies, with no differences in septic complications, organ dysfunction, or heart rate pressure product identified. In addition, no difference in mortality could be shown for those given rhGH therapeutically versus their controls. No patient deaths were attributed to rhGH in autopsies reviewed by observers blinded to treatment. Hyperglycemic episodes and exogenous insulin requirements were higher among rhGH recipients, whereas exogenous albumin requirements and the development of hypocalcemia was reduced. CONCLUSIONS: Data indicate that rhGH used in the treatment of children who were severely burned is safe and efficacious.     

人组织工程全层皮肤在烧伤创面中厚供皮区的应用

目的观察人组织工程全层皮肤(ActivSkin)在中厚供皮区临床应用效果.方法 9例患者,年龄17～43岁.其中5例1%～6%总体表面积烧伤,深Ⅱ度～Ⅲ度;4例烧伤后瘢痕.每例患者2个部位创面,均使用自体中厚皮片修复.切取皮片后供区遗留创面随机分为试验组和对照组,行自体对照观察.试验组创面采用ActivSkin修复,对照组创面采用凡士林油纱覆盖.术后观察创面疼痛、愈合时间及治愈率;术后7～30 d每日观察创面愈合情况,1、3、6个月定期随访.结果试验组创面术后疼痛明显减轻,愈合时间为9.67±2.92 d,比对照组16.56±2.96 d提前,差异有统计学意义(P＜0.05);治愈率均为100%.术后随访试验组创面供皮区愈合后未见水疱、残余创面发生,瘢痕形成减轻;对照组创面4例于术后3个月内有水泡形成,残余创面发生. 结论ActivSkin可减轻中厚供皮区创面疼痛,加速愈合,并能预防供皮区愈合后水疱、残余创面发生,降低瘢痕形成.     

Comparison of two dressings in the management of partial-thickness donor sites

This study evaluated and compared the performance of an adhesive hydro-cellular dressing with that of a paraffin gauze dressing in the treatment of partial-thickness skin-graft donor site wounds. Fifty patients were included in the study, each acting as his/her own control. Donor site area ranged from 20 cm2 to 71 cm2; half the area of each patient's donor site was treated with the trial dressing, the other half with paraffin gauze. Outcome measures assessed were: time to complete epithelialisation; ease of dressing removal; pain on removal; and appearance of the wound bed. The trial dressing demonstrated a significantly faster healing time (p < 10(-6)) and enhanced patient comfort.     

Effects of a silicone-coated polyamide net dressing and calcium alginate on the healing of split skin graft donor sites: a prospective randomised trial

An open randomised prospectively controlled trial was performed to assess the healing efficacy, slippage rate and degree of discomfort on removal of calcium alginate and a silicone-coated polyamide net dressing on split skin graft donor sites. Sixteen patients were randomised to the calcium alginate group and 14 to the silicone-coated group. The donor sites were assessed at days 7, 10, 14 and up to day 21. The mean time to healing in the calcium alginate group was 8.75 +/- 0.78 days (range 7 to 14 days) compared to 12 +/- 0.62 days (range 7 to 16 days) for the silicone-coated group (p < 0.01). Although more silicone-coated dressings slipped (5 versus 1), the difference was not statistically significant. Pain during the first dressing change was assessed using a visual analogue pain scale. Although no significant differences were found between the groups, it was necessary to change the dressing protocol in the silicone-coated arm of the trial after entering the first two patients. Overlaid absorbent gauze adhered to the donor site through the fenestrations in the dressing necessitating the placement of paraffin gauze between the experimental dressing and the overlying cotton gauze. There was one infection in the study, occurring in the alginate group. Based on these results we recommend calcium alginate as the dressing of choice for split skin graft donor sites.     

Randomized placebo‐controlled human pilot study of cold atmospheric argon plasma on skin graft donor sites

Cold atmospheric plasma has already been shown to decrease the bacterial load in chronic wounds. However, until now it is not yet known if plasma treatment can also improve wound healing. We aimed to assess the impact of cold atmospheric argon plasma on the process of donor site healing. Forty patients with skin graft donor sites on the upper leg were enrolled in our study. The wound sites were divided into two equally sized areas that were randomly assigned to receive either plasma treatment or placebo (argon gas) for 2 minutes. Donor site healing was evaluated independently by two blinded dermatologists, who compared the wound areas with regard to reepithelialization, blood crusts, fibrin layers, and wound surroundings. From the second treatment day onwards, donor site wound areas treated with plasma (n = 34) showed significantly improved healing compared with placebo‐treated areas (day 1, p = 0.25; day 2, p = 0.011; day 3, p < 0.001; day 4, p < 0.001; day 5, p = 0.004; day 6, p = 0.008; day 7, p = 0.031). Positive effects were observed in terms of improved reepithelialization and fewer fibrin layers and blood crusts, whereas wound surroundings were always normal, independent of the type of treatment. Wound infection did not occur in any of the patients, and no relevant side effects were observed. Both types of treatment were well tolerated. The mechanisms contributing to these clinically observed effects should be further investigated.     

Porcine dermal collagen as a wound dressing for skin donor sites and deep partial skin thickness burns

Collagen was extracted by pepsin digestion from porcine skin, and collagen membrane was prepared by salt precipitation. The porcine collagen membrane was evaluated as a burn wound dressing in deep partial skin thickness burn wounds in rats. Burn wounds, 4 × 4 cm, were inflicted by exposure of skin to 75°C for 15 s followed by de-epithelialization. Wound healing was assessed by planimetry of epithelialization on day 10 after injury. Open wounds exhibited 24 per cent of wound area re-epithelialized. Collagen membrane dressing significantly improved the healing to 69 per cent of wound area (P < 0.0001). In a completely separate experiment, the porcine collagen membrane was applied as a wound dressing to the donor sites of burn patients, and its effect on wound healing was compared with that of a petroleum jelly gauze dressing. The donor sites covered with petroleum jelly gauze had re-epithelialized by an average of 14.5 days (ranging from 13 to 16 days) after wounding. The wounds dressed with collagen membrane demonstrated a significant increase in the healing rate. Complete re-epithelialization was observed by 10.3 days (ranging from 10 to 12 days) after wounding (P < 0.0001).