Cell suspension autograft (CSA) is a non-cultured, autologous cellular suspension used in partial-thickness burns or as an adjunct to widely meshed split-thickness skin grafts (STSGs). While CSA has been shown to improve patient outcomes in burn care, literature is limited in highlighting its impact on mortality when used in combination with STSG. This retrospective, matched, case–control study investigates the clinical efficacy of CSA in adult patients with burn injuries admitted to a regional burn center from 2015 to 2023. Patients treated with CSA and STSG (n = 63, “CSA-treated”) were compared against patients treated with STSG alone (n = 126, “non-CSA-treated”). Non-CSA-treated patients were matched in a 2:1 fashion to CSA-treated patients based on third-degree burned TBSA and age. Outcomes included mortality, length of stay (LOS), intensive care unit LOS (ICU LOS), and number of procedures. Multivariate analyses revealed that CSA-treated patients had a significant reduction in mortality (P = .0445) and a 78.9% reduction in odds of death (OR: 0.211) compared to non-CSA-treated patients. Cell suspension autograft-treated patients displayed nonsignificant increases in LOS (P = .0670), ICU LOS (P = .0851), and number of procedures (P = .9084). Selection and chronology bias may partially account for the improved mortality in the CSA-treated group. The nonsignificant increases in LOS, ICU LOS, and number of procedures may be reflective of increased survivorship. These findings demonstrate that CSA enhances survival in patients with burn injuries when used with STSG, warranting further research to confirm these results.
Background: Considerable variability exists in the described clinical and radiographic indications for use, surgical techniques, postoperative management, and risk profile after trochleoplasty for the management of patellofemoral instability (PFI). In areas of clinical uncertainty, a cohesive summary of expert opinion and identification of areas of variation in current practice can be useful in guiding current practice and future research efforts. Purpose: To assess the current indications for use, surgical techniques, postoperative rehabilitation practices, and observed complication profile for trochleoplasty in the management of PFI among surgeons who perform this procedure. Study Design: Cross-sectional study. Methods: A 21-item cross-sectional survey was developed to evaluate trochleoplasty in its current practice among surgeons around the world. The survey was distributed between December 2021 and April 2022 to the orthopaedic surgeon membership of multiple national and international knee, arthroscopy, and sports medicine societies to identify any surgeon with experience performing the trochleoplasty procedure in practice for the management of PFI. Descriptive statistics of survey responses were performed to address study aims, and univariate analyses were performed to compare differences between high- and low-volume trochleoplasty surgeons. Results: Survey distribution identified 32 orthopaedic surgeons with experience performing the trochleoplasty procedure. Procedural indications were most commonly felt to be met with Dejour classification of B or D on magnetic resonance imaging. Trochleoplasty was felt by most to be appropriate as a primary surgical intervention for PFI. A majority of surgeons utilized a Bereiter (thin-flap) trochleoplasty technique with suture-based fixation and performed concurrent medial patellofemoral ligament reconstruction, but other concomitant procedures varied. Range-of-motion precautions and bracing practices varied among respondents, and arthrofibrosis was the most frequently cited observed complication. High- and low-volume trochleoplasty surgeons differed in their radiographic and age-based indications for the procedure. Conclusion: Study findings indicated that variation exists in the surgical indicators, technique, and postoperative rehabilitation practices of trochleoplasty surgeons, with specific differences noted between high- and low-volume trochleoplasty surgeons. The results of this survey identified areas of equipoise and treatment variation that should direct future research efforts in the study of the trochleoplasty procedure.
Infiltration and activation of peripheral immune cells are critical in the progression of multiple sclerosis and its experimental animal model, experimental autoimmune encephalomyelitis (EAE). This study investigates the role of high mobility group box 1 (HMGB1) in oligodendrocyte precursor cells (OPCs) in modulating pathogenic T cells infiltrating the central nervous system through the blood-brain barrier (BBB) by using OPC-specific HMGB1 knockout (KO) mice. We found that HMGB1 released from OPCs promotes BBB disruption, subsequently allowing increased immune cell infiltration. The migration of CD4+ T cells isolated from EAE-induced mice was enhanced when co-cultured with OPCs compared to oligodendrocytes (OLs). OPC-specific HMGB1 KO mice exhibited lower BBB permeability and reduced immune cell infiltration into the CNS, leading to less damage to the myelin sheath and mitigated EAE progression. CD4+ T cell migration was also reduced when co-cultured with HMGB1 knock-out OPCs. Our findings reveal that HMGB1 secretion from OPCs is crucial for regulating immune cell infiltration and provides insights into the immunomodulatory function of OPCs in autoimmune diseases.
Total body surface area (TBSA) is a well-known risk factor for short-term outcomes after burn injury, such as mortality or sepsis. It is less effective for predicting longer-term outcomes like burn scar contractures. Early and reliable identification of patients at risk of contractures and other scar-related problems could help guide preventative efforts and improve outcomes for burn survivors. Cutaneous Functional Units (CFUs) offer a potential metric for predicting scar outcomes because they quantify burn severity and extent within more localized and functionally relevant areas of the body. This study compared predictive models using CFUs, TBSA, and both CFU+TBSA to determine the value of incorporating CFU data into models that predict loss of range of motion (ROM) after a burn injury. The following predictive models were compared: 1) TBSA - included patient-level extent (%) of burn; 2) CFU - included % of burn within each defined CFU area; and 3) CFU+TBSA - included % burn at both body-level and CFU-level. All models included core variables of sex, age, race, and individual joint motion. The outcome variable was ROM, measured at hospital discharge at the joint level using degrees converted to a proportion of typical ROM. Model discrimination was assessed using the Area Under the Receiver operating characteristic curve (Harrell’s C statistic). The models were developed using fractional regression and logit function with one dataset and validated on an independent dataset to ensure unbiased assessment. Models were developed using data from a prospective, longitudinal, multi-site cohort study including 7463 joint motions from 307 adult burn survivors. The combined CFU+TBSA model had the highest C statistic, followed by the CFU model, then the TBSA model (Table 1). The improvements in the C-statistic of the CFU model (p=0.03) and TBSA+CFU model (p=0.00) were statistically significant compared to the TBSA model but were not different from each other (p=0.48), suggesting that models including CFU are better. The CFU +TBSA model was applied to an independent dataset of 66 patients and 1467 joint motion observations from a prospective cross-sectional study of adults with burn scar contractures. The C statistic was.639 (95%CI: 0.571, 0.707; p=0.00), demonstrating significant but lower discrimination in this external dataset. Predictive models that include CFUs alone or CFU+TBSA can better distinguish joint motions at risk for loss of ROM than TBSA alone. The CFU+TBSA model also demonstrated moderate discriminatory power in an independent dataset. This study established the statistical value and utility of using CFUs to predict motion loss and sets the stage for further investigation, including clinical relevance and validation with other patient samples. Prediction of scar problems after burn injury. N/A
A next-generation transparent biosynthetic wound matrix was developed for the treatment of partial-thickness burn injuries. It is composed of an outer slitted 2D silicone epidermal analogue, with customizable pores, which facilitates diffusion of gas and exudate from the wound bed. The silicone sheet is bonded to a nylon knitted fabric coated with porcine gelatin and aloe to induce adherence to the wound until healed. The purpose of this study was to compare the next-generation transparent biosynthetic wound matrix to a commonly used silver-containing foam dressing for the treatment of partial-thickness burns. The study was multicenter, randomized, and open-label. Patients with superficial to deep partial-thickness burns < 30% TBSA were included and treated within 72 hours post-injury. Primary outcomes included 100% re-epithelialization (closure) at 2 weeks and time to conversion to alternative therapy. Secondary outcomes included healing at 1 and 3 weeks, adverse events, pain, and number of dressing changes. A total of 67 patients (42 pediatric & 25 adult) were treated, 32 with the silver foam dressing and 35 with the transparent biosynthetic wound matrix. After 1 week, half the silver foam-treated wounds were closed (p=0.25) (Figure). More patients achieved closure with the transparent biosynthetic wound matrix at weeks 2 and 3 but did not reach statistical significance (p = 0.36 and p = 0.25, respectively) (Figure). Additionally, the transparent biosynthetic wound matrix was associated with significantly lower overall odds of a dressing change (OR 0.15, p=0.67), likely attributable to the adherent nature of the matrix. No differences in conversion to alternate therapies were noted. Overall pain scores and adverse events, including infection, were similar between groups. The biosynthetic wound matrix is a safe and effective treatment for partial-thickness burns. The biosynthetic wound matrix offers the advantages of being transparent to continuously monitor the wound, being adherent to reduce the need for dressing changes and allowing for bathing after 72 hours. The biosynthetic wound matrix is a safe and effective option for the treatment of partial-thickness burns in pediatric and adult patients, and may offer clinical advantages to the patient and caregivers over a silver impregnated foam dressing. Study funded by manufacturer
