Cuenca-Pardo JA, Álvarez-Díaz CJ, Luján-Olivar F, Escalona-Mancilla A, Trujillo-González J

Idioma: Español
Referencias bibliográficas: 61
Paginas: 62-71
Archivo PDF: 246.75 Kb.

RESUMEN

El objetivo de este estudio fue determinar las diferencias en la evolución clínica en niños con quemaduras extensas producidas por inmersión en líquidos calientes, tratados con escisión tangencial total de las quemaduras y cubiertos con aloinjertos de epidermis humana cultivada (Grupo I o de estudio), comparados con aquéllos tratados en forma tradicional con escisión precoz y cubiertos con crema antimicrobiana (Grupo II o control). La estancia hospitalaria para el Grupo I fue de 14.4 días y para el Grupo II de 24 días (p ‹ 0.01). La epitelización para el Grupo I fue de 83.8% y para el Grupo II de 63.8% (p ‹ 0.03). El número de cirugías para el Grupo I fue de 2.2 por paciente y para el Grupo II de 4.9 (p ‹ 0.006). Las complicaciones se presentaron en 20% del Grupo I y en 46.6% del Grupo II (p ‹ 0.001). Encontramos muchas ventajas cuando los niños con quemaduras por líquidos se tratan con escisión precoz de la totalidad de las lesiones y aplicación de aloinjertos de epidermis humana cultivada. Esta estrategia ayuda a la regeneración de la epidermis y también reduce complicaciones, número de cirugías y estancia hospitalaria.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Salisbury RE. Thermal Burns. In: McCarthy JP. Plastic Surgery. Philadelphia: WB Saunders Co 1990: 787-984.

2. Bendlin A. Tratamiento inicial de quemaduras graves. En: Bendlin A, Linares HA, Benaim F. Tratado de Quemaduras. México: Interamericana 1993: 149-160.

3. Cuenca-Pardo J, Alvarez-Díaz CJ, Comprés-Pichardo TA. Related factors in burn children. Epidemiological study of the burn unit at the “Magdalena de las Salinas” Traumatology Hospital. J Burn Care Res 2008; 29: 468-474.

4. Jeffrey RS, Byron DP. Recent outcomes in the treatment of burn injury in the United States: A Report from the American Burn Association Patient Registry. J Burn Care Rehabil 1995; 16: 219-32.

5. Betancourt SMJ. Mortalidad infantil por quemaduras y síndrome de respuesta inflamatoria sistémica. Rev Med IMSS 2004; 42(2): 103-108.

6. Horton JW, Sanders B, White DJ, Maass DL. The effects of early excision and grafting on myocardial inflammation and function after burn injury. Journal of Trauma-Injury, Infection & Critical Care 2006; 61: 1069-1077.

7. Benmeir P, Sagi A. An analysis of mortality in patients with burns covering 40 per cent BSA or more: a retrospective review covering 24 years (1964-88). Burns 1991; 17: 402-5.

8. Germann G, Barthold U. The impact of risk factors and pre-existing conditions on the mortality of burn patients and the precision of predictive admission-scoring systems. Burns 1997; 23: 195-203.

9. Still J, Law E. Primary excision of the burn wound. Clin Plast Surg 2000; 27: 23-47.

10. Barret JP, Herndon DN. Effects of burn wound excision on bacterial colonization and invasion. Plast Reconstr Surg 2003; 111: 744-750.

11. Arturson G. Cambios fisiopatológicos. En: Bendlin A, Linares HA, Benaim F. Tratado de Quemaduras. México: Interamericana 1993: 127-144.

12. Nguyen TT, Gilpin DA, Meyer NA, Herndon DN. Current treatment burned severely patients. Ann Surg 1996; 225: 14-25.

13. Cuenca-Pardo J, Álvarez-Díaz CJ. Costo-beneficio de la cirugía precoz del paciente quemado comparado con cirugía tardía. Cir Plast 2000; 10: 5-7.

14. Yi Biao Wang. Survival and wound contraction of full-thickness skin grafts are associated with the degree of tissue edema of the graft bed in immediate excision and early wound excision and grafting in a rabbit model. J Burn Care Res 2007; 28: 182-186.

15. Cole JK, Engrav LH. Early excision and grafting of face and neck burns in patients over 20 years. Plast Reconstr Surg 2002; 109: 1266-1273.

16. Ong YS, Samuel M, Song C. Meta-analysis of early excision of burns. Burns 2006; 32: 145-150.

17. Hunt JL, Sato R. Early tangential excision and immediate mesh autografting of deep dermal hand burns. Ann Surg 1979; 189: 147-151.

18. Reig AC, Tejerina PB. Massive burns: a study of epidemiology and mortality. Burns 1994; 20: 51-54.

19. Janzekovic Z. A new concept in an early excision and immediate grafting of burns. J Trauma 1970; 10: 1103-1108.

20. Quinby CW, Hoover GH. Clinical trials of amniotic membranes in burn wound care. Plast Reconstr Surg 1982; 70: 711-7.

21. Sawhney CP. Amniotic membrane as a biological dressing in the management of burns. Burns 1989; 15: 339-42.

22. Wong L. The many uses of allograft skin. Ostomy Wound Manage 1995; 41(4): 36-8, 40-2.

23. Franchelli S, Muggianu M, Dalla Costa R, Rainero ML, Campora E, Santi PL. In vitro antimicrobial effects of fresh split skin, homologous-cultured epithelium and porcine split skin grafts for wound coverage. Burns 1992; 18: 237-40.

24. Chua AW, Ma DR, Song IC, Phan TT, Lee ST, Song C. In vitro evaluation of fibrin mat and Tegaderm wound dressing for the delivery of keratinocytes-implications of their use to treat burns. Burns 2008; 34: 175-80.

25. Ehrlich HP. Understanding experimental biology of skin equivalent: from laboratory to clinical use in patients with burns and chronic wounds. Am J Surg 2004; 187(5A): 29S-33S.

26. Wisser D, Steffes J. Skin replacement with a collagen based dermal substitute, autologous keratinocytes and fibroblasts in burn trauma. Burns 2003; 29(4): 375-80.

27. Ong YS, Samuel M, Song C. Meta-analysis of early excision of burns. Burns 2006; 32(2): 145-50.

28. Herndon DN, Spies M. Modern burn care. Semin Pediatr Surg 2001; 10(1): 28-31.

29. Mosier MJ, Gibran NS. Surgical excision of the burn wound. Clin Plast Surg 2009; 36(4): 617-25.

30. Dorai AA, Lim CK, Fareha AC, Halim AS. Cultured epidermal autografts in combination with MEEK Micrografting technique in the treatment of major burn injuries. Med J Malaysia 2008; 63 Suppl A: 44.

31. Lumenta DB, Kamolz LP, Frey M. Adult burn patients with more than 60% TBSA involved-Meek and other techniques to overcome restricted skin harvest availability-the Viennese concept. J Burn Care Res 2009; 30: 231-42.

32. Boyce ST, Kagan RJ, Yakuboff KP, Meyer NA, Rieman MT, Greenhalgh DG, Warden GD. Cultured skin substitutes reduce donor skin harvesting for closure of excised, full-thickness. Burns Ann Surg 2002; 235: 269-279.

33. Benmeir P, Sagi A. An analysis of mortality in patients with burns covering 40 per cent BSA or more: a retrospective review covering 24 years (1964-88). Burns 1991; 17: 402-5.

34. Germann G, Barthold U. The impact of risk factors and pre-existing conditions on the mortality of burn patients and the precision of predictive admission-scoring systems. Burns 1997; 23: 195-203.

35. Jeffrey RS, Byron DP. Recent outcomes in the treatment of burn injury in the United States: A report from the American burn association patient registry. J Burn Care Rehabil 1995; 16: 219-32.

36. Reig AC, Tejerina PB. Massive burns: a study of epidemiology and mortality. Burns 1994; 20: 51-54.

37. Quinby CW, Hoover GH. Clinical trials of amniotic membranes in burn wound care. Plast Reconstr Surg 1982; 70: 711-7.

38. Sawhney CP. Amniotic membrane as a biological dressing in the management of burns. Burns 1989; 15: 339-42.

39. De Luca M, Albanese E, Bondanza S. Multicenter experiences in the treatment of burns whit autologous and allogeneic cultured epithelium fresh or preserved in a frozen state. Burns 1989; 15: 303.

40. Nuñez-Gutiérrez H, Castro-Muñoz LF, Kuri-Harcuch W. Combined use of allograft and autograft epidermal cultures in therapy of burns. Plast Reconstr Surg 1996; 98: 929-939.

41. Wood FM, Kolybaba ML, Allen P. The use of cultured epithelial autograft in the treatment of major burn injuries: a critical review of the literature. Burns 2006; 32: 395-401.

42. Munster AM. Cultured skin for massive burns. A prospective controlled trial. Ann Surg 1996; 224:372-377.

43. Sood R, Balledux J, Koumanis DJ, Mir HS, Chaudhari S, Roggy D, Zieger M, Cohen A, Coleman JJ. Coverage of large pediatric wounds with cultured epithelial autografts in congenital nevi and burns: results and technique. J Burn Care Res 2009; 30: 576-86.

44. Wisser D, Steffes J. Skin replacement with a collagen based dermal substitute, autologous keratinocytes and fibroblasts in burn trauma. Burns 2003; 29: 375-80.

45. Chalumeau M, Saulnier JP, Ainaud P, Lebever H, Stephanazzi J, Lecoadou A, Carsin H. Initial general management and surgery of six extensively burned children treated with cultured epidermal autografts. J Ped Surg 1999; 34: 602-5.

46. Loss M, Wedler V, Künzi W, Meuli-Simmen C, Meyer VE. Artificial skin, split-thickness autograft and cultured autologous keratinocytes combined to treat a severe burn injury of 93% of TBSA. Burns 2000; 26: 644-52.

47. Boyce ST, Goretsky MJ, Greenhalgh DG, Kagan RJ, Rieman MT, Warden GD. Comparative assessment of Cultured Skin Substitutes and native skin autograft for treatment of full-thickness burns. Ann Surg 1995; 222: 743-752.

48. De Luca M, Albanese E, Bondanza S. Multicenter experiences in the treatment of burns whit autologous and allogeneic cultured epithelium fresh or preserved in a frozen state. Burns 1989; 15: 303.

49. Leon-Villapalos J, Eldardiri M, Dziewulski P. The use of human deceased donor skin allograft in burn care. Cell Tissue Bank 2010; 11: 99-104.

50. Madden MR, LaBruna AA, Hajjar DP, Staiano-Coico L. Transplantation of cryopreserved cultured epidermal allografts. J Trauma 1996; 40: 743-50.

51. Fabre JW. Epidermal allografts. Immunol Lett 1991; 29: 161-5.

52. Duinslaeger L, Verbeken G, Reper P, Delaey B, Vanhalle S, Vanderkelen A. Lyophilized keratinocyte cell lysates contain multiple mitogenic activities and stimulate closure of meshed skin autograft-covered burn wounds with efficiency similar to that of fresh allogeneic keratinocyte cultures. Plast Reconstr Surg 1996; 98: 110-7.

53. Gilen V, Faure M, Mauduit G, Thivolet J. Progressive replacement of human cultured epithelial allograft by recipient cell as evidence by HLA Class and antigen expression. Dermatological 1987; 175: 166-170.

54. Oliver AM, Kaawach W, Mithoff EW, Watt A, Abramovich DR, Rayner CR. The differentiation and proliferation of newly formed epidermis on wounds treated with cultured epithelial allografts. Br J Dermatol 1991; 125: 147-54.

55. Sosa-Serrano AF, Álvarez-Díaz CJ. Cuenca-Pardo J. Tratamiento de quemaduras de espesor total mediante autoinjertos mallados cubiertos con aloinjertos criopreservados de epidermis humana cultivada in vitro. Reporte de un caso. Cir Plast 1999; 9: 126-29.

56. Cuenca-Pardo J. Álvarez-Díaz CJ. Tratamiento de quemaduras masivas con autoinjertos mallados y aloinjertos de epidermis cultivada in vitro. Reporte de un caso. Cir Plast 1999; 9: 78-82.

57. Yanaga H, UdohY, Yamauchi T, Yamamoto M, Kiyokawa K, Inoue Y, Tai Y. Cryopreserved cultured epidermal allografts achieved early closure of wounds and reduced scar formation en deep partial-thickness burn wounds and split-thickness skin donor sites of pediatric patients. Burns 2001; 27: 689-698.

58. Rivas-Torres M, Amato D, Arambula-Alvarez H, Kuri-Harcuch W. Controlled clinical study of skin donor sites and deep partial-thickness burns treated whit cultured epidermal allograft. Plast Reconstr Surg 1996; 98: 279-287.

59. Alvarez-Diaz C, Cuenca-Pardo J. Controlled clinical study of deep partial-thickness burns treated with frozen cultured human allogenic epidermal sheets. J Burn Care Rehabil 2000; 21: 291-299.

60. Cuenca-Pardo J, Álvarez-Diaz C. Estudio clínico controlado de quemaduras de espesor total tratadas con autoinjertos en malla cubiertos con aloinjertos de epidermis humana cultivada. Cir Plast 1999; 9: 126-129.

61. Braye F, Pascal P, Bertin-Maghit M, Colpart JJ, Tissot E, Damour O. Advantages of using a bank of allogenic keratinocytes for the rapid coverage of extensive and deep second-degree burns. Med Biol Eng Comput 2000; 38: 248-52.