Background The number of patients in need of a liver transplant far exceeds the supply of available organs. This imbalance could be dramatically reduced should the donor organ pool be expanded by rendering marginal cases transplantable rather than discarded. The polyu2010pharmacological drug cocktail CEPT (Chromanu20101, Emricasan, Polyamine, and Transu2010ISRIB [integrated stress inhibitor]) has been found to improve the inu2010vitro viability of human pluripotent stem cells (hPSCs) following cryopreservation. It is worth exploring CEPT's ability to inhibit various apoptotic pathways and preserve cellular function for potentially mitigating warm ischemic stress of the anhepatic phase of graft implantation and promoting more rapid graft recovery following reperfusion with continuous treatment. Methods Rat livers without warm ischemia and CEPT supplementation are the healthy control: fresh group (n = 3). Roomu2010temperature warm ischemia was used to replicate the anhepatic phase of graft implantation in the control group (n = 6) and the experimental CEPT group (n = 6) without and with CEPT supplementation, respectively. Transplantation was modeled by ex vivo reperfusion at 37u2103 for 6 h with William's Eu2010based hepatocyte culture media and with CEPT supplementation in the CEPT group. Results Livers treated with CEPT during warm ischemia and subsequent reperfusion have improved hepatocellular function as indicated by increased oxygen utilization, stable pH, and improved cholangiocyte function, indicated by the increased hourly rate of bile production. Furthermore, resistance, an endothelial injury marker, and caspase 3/7, an apoptotic marker, were lower. Conclusion To improve the utilization of available donor livers, different stages of the organ transplantation process can be optimized. The anhepatic phase, which includes the period from the removal of the native liver from the recipient to the reperfusion of the donor's graft liver through the portal vein during graft implantation, can be targeted using CEPT for mitigating warm ischemiau2010induced injury that occurs during vascular anastomosis.
Neck tissue expansion is a versatile tool for aesthetic and functional post-burn reconstruction when addressing burn scars in the neck or lower two-thirds of the face. Tissue expansion offers advantages over other reconstructive modalities such as the opportunity to resurface scars with excellent color and texture match of expanded skin while limiting donor site morbidity. The aim of this study was to evaluate our 20-year institutional experience with neck tissue expansion for postburn reconstruction. A retrospective review was conducted on consecutive patients aged 0–21 years old admitted to a specialized pediatric burn hospital from January 2004 to January 2024 for postburn reconstruction with neck tissue expansion. Complications were categorized as major or minor, with major complications defined as those which required premature removal of the tissue expander. A total of 31 neck tissue expanders were placed in 19 patients. The mean age at reconstruction was 15 years (range 4 to 21 years), 53% were female, and 47% were international referrals. The average total body surface area (TBSA) was 30% (range 7% - 66%). Sixty three percent of patients had sustained a flame burn mechanism of injury. The time period from burn injury to reconstruction averaged 6 years and the large majority (81%) had undergone prior reconstructive efforts. The average area to be reconstructed was 114 cm2 and patients went through expansion processes for an average of 102 days. The major complications rate was 0%. The minor complication rate was 26%, which included four cases of delayed wound healing, two seromas, one implant exposure, and one infection. These all resolved with operative intervention and resulted in successful reconstruction. Patients were followed postoperatively for an average of 4 years. Burn scar contracture in the neck can lead to significant functional and aesthetic deformities. Our results demonstrate how tissue expansion of the neck can be a successful and versatile treatment modality for postburn reconstruction. Reconstruction of neck burn scar contracture using tissue expansion is a safe modality that provides similar tissue while limiting donor site morbidity. N/A
Stigma is defined as when someone is treated negatively or devalued due to a particular characteristic or attribute. People with physical appearances that differ from the expected, such as individuals with burn injury, are at risk for stigmatization. This may influence quality of life and can lead to social isolation. Therefore, this study aims to examine stigma and its predictors in the burn population. Adult burn survivors from a multicenter longitudinal database from 2015-24 were examined. The primary outcome variable was the self-reported Neuro-QoL stigma scale assessed at 6, 12, 24, and 60 months after injury. Overall scale and individual item scores were calculated at all time points. Linear mixed-effects models with random effects assessed demographic and clinical variables associated with stigma levels over time (overall scale and individual items with separate models). A total of 787 adult burn survivors were included in the study. Most aspects of stigma, including overall stigma, improved over time. In contrast, item level data demonstrated more frequent reports of people avoiding looking at them over time (1.44 at 6 months to 1.55 at 60 months, SD=0.9 and 1.0, respectively). At 6 months post-injury, burn survivors’ mean stigma score was 49.3 (SD=8.7), which is near the general population norm of 50 and demonstrates that slightly over 50% of burn survivors are below population-based norms. Younger age, non-White race, larger burn size and substance use were all associated with higher levels of stigma (p< 0.05). Individual item data shows that amputation is associated with less unhappiness with appearance (p=0.008). Negative predictors of various individual items of the stigma scale included self-inflicted cause of injury, counseling services received, and anxiety medication use (p< 0.05). This study demonstrates that stigma is common and largely improves over time after burn injury. In addition, age, race, burn size, and substance use are predictors of overall stigma. Various demographic and clinical factors may also predict individual aspects of stigma, demonstrating the complexity of stigma and its application to the burn population. Understanding the prevalence and predictors of stigma can help target early interventions for those at high risk for its adverse effects in the burn population. NIDILRR #90DPBU0008; #90DPGE0004. Partial Support was obtained from Shriners Hospitals for Children (Grant #79136-BOS-23 and 79138-BOS-23).
Transportation access, a social determinant of health, influences health outcomes and community participation. However, transportation is an underexplored factor in burn outcomes. Therefore, this study aims to examine the associations between transportation access, service utilization, and community reintegration after burn injury. A multicenter burn longitudinal dataset was analyzed from 2018 to 2024. Self-reported mode of transportation was examined for adults at discharge and 6, 12, 24, and 60 months after injury. The population was categorized into two groups: driving their own vehicle versus other modes of transportation (riding with someone else, public transit, and not applicable). Self-reported utilization of outpatient care services included physical/occupational therapy, peer support, psychological services, and burn-related surgeries. Demographic and clinical variables were compared between groups. Logistic and linear regression analyses, respectively, examined the association between transportation modality and service utilization and community integration (Community Integration Questionnaire – Social Interaction domain) at 6 months. Of the 563 participants with self-reported transportation data at 6 months, 373 (66.3%) reported driving their own vehicle, 151 (26.8%) riding with someone else, and 31 (5.5%) using public transit. The proportion of those who reported driving their own vehicle increased at each post-injury time point (74.7-83.8%). The driving own-vehicle group was more likely to be White (p=0.002), non-Hispanic/Latino (p=0.001), higher educated, earning a higher income, employed, and married or living with a partner; they also exhibited shorter acute and rehabilitation hospital stays and were less likely to have a range of motion deficit and receive disability income (p< 0.001 for all other comparisons). Regression analyses revealed no significant associations between driving one’s own vehicle and utilization of the four health care services examined at 6 months. In contrast, regression analysis indicated that driving one’s own vehicle was associated with higher community integration scores (β = 1.23, p< 0.001). This study found that driving one’s own vehicle was positively associated with community integration but not with utilization of services 6 months after injury. Results suggest that transportation access may play an important role early in community reintegration. Addressing transportation barriers may contribute to improved community integration outcomes after burn injury. NIDILRR #90DPBU0008 and #90DPGE0004
There has been an emergence of using the antifibrinolytic agent tranexamic acid (TXA) in plastic surgery as an innovative measure to reduce intraoperative bleeding. However, limited data exists regarding topical application of TXA in patients undergoing postburn reconstruction. This study aims to evaluate the effect of topical TXA on blood loss, postoperative complication, and wound healing in postburn reconstructive skin grafting. A single-center retrospective cohort study was conducted on all consecutive patients aged 0–21 years old admitted to a pediatric burn center from July 2018 to July 2023 for postburn reconstructive skin grafting by the senior author (D.N.D). The patients in the intervention group received 2.5% TXA applied topically. The primary outcome analyzed was blood loss per cm2 burn area excised. Secondary outcomes included adverse events and postoperative complications such as hematoma, seroma, infection, 2-week delayed wound healing, and 4-week delayed wound healing. A total of 111 patients were included in this study. For the treatment group, 47 patients received topical TXA during 68 operations on 120 skin graft recipient sites. The control group included 64 patients undergoing 118 operations with 204 skin graft recipient sites. The mean age at reconstruction was 11.7 ± 5.1 years, 53.2% of patients were male, and 44.1% were international referrals. The primary cause of initial injury was flame burn mechanism (73.6%) and the average total body surface area was 43.4 ± 25.0%. Of the 324 skin graft sites, the most common donor site was the thigh, and 63.7% were split-thickness harvested at an average of 14 microns. Patient demographics and reconstructive burn characteristics were similar among both groups (p>0.05). Skin graft recipient sites that received topical TXA had significantly lower blood loss per cm2 burn area excised (0.27 ± 0.53 ml/cm2 vs 0.66 ± 2.1 ml/cm2, p=0.028). Skin graft recipient sites that received TXA did not exhibit significantly different rates of delayed wound healing at 2-week follow-up (2.5% vs 4.9%, p=0.291) or 4-week follow-up (2.5% vs 2.4%, p=0.982). Rate of hematoma among skin graft recipient sites that received TXA was not significantly different than those that did not (0% vs 0.5%, p=0.442). There were no cases of infection or seroma in either group. No adverse events were observed. Both cohorts had long-term follow-up with an average of 2.5 ± 1.7 years in the control group and 1.1 ± 0.8 years in the TXA group. Topical TXA may reduce intraoperative bleeding in postburn reconstructive skin grafting with low risk of systemic complications. Of the 120 skin graft recipient sites that received topical TXA, there were no cases of hematoma formation and there was not an increased risk of delayed wound healing. This is the first study that evaluates topical application of TXA as a promising adjunct in postburn reconstructive skin grafting in children. N/A
