- Email: [email protected]
Biological skin substitutes in burn treatment-Where shall we go?
Burns 3 3 S ( 2 0 0 7 ) S1–S172
S107
burns. They generally wait for help to arrive or run for help. They do not help themselves because they are ignorant about the dos and don’ts in the panic times. We are trying to reach out to the urban population using all mass media, popular commonly used everyday product having information in the local language and through the school education program. To reach out to the rural population, cooperation is sought from various NGOs working in those regions. Our aim is to reach every home, explaining to them about the first aid namely: how to extinguish fire and cool the burned area and escape safely from a smoke filled room. All these activities are being conducted by the Burn Care Foundation which is sponsored by Association of American Physicians from India (AAPI). doi:10.1016/j.burns.2006.10.247 Modulation of matrix metalloproteinase activity by silver-containing dressings Walker M. a , Cochrane C. b , Bowler P. a a
Department of Veterinary Clinical Science, University of Liverpool, UK ConvaTec Wound TherapueticsTM, Global Development Centre, UK E-mail address: [email protected] (M. Walker).
b
During wound repair and remodelling, proteolytic enzyme activity occurs within the extracellular matrix. One of the major proteolytic enzyme groups involved is the matrix metalloproteinases (MMP), which include both gelatinase and collagenase enzymes. In these studies several wound dressing categories (e.g. Hydrofiber® , Alginate and oxidized regenerated cellulose) were used, which included both a silver-containing dressing and a non-silver-containing dressing. Both the physical and chemical properties of these dressings were investigated. Specifically MMP-2 and MMP-9 were tested and the results showed that while all the dressings contributed to a reduction in both MMP-2 and MMP-9 activity, the silver-containing dressings performed much better, showing that silver provides an additional ability to modulate MMP activity. The results also differentiated the silver non-containing dressings, suggesting that differences in the physical properties of the dressings also play a role in helping to reduce important and potentially ‘corrosive’ proteolytic enzyme (e.g. MMP) activity in the localized wound environment. Hydrofiber® is a registered trademark of E.R. Squibb and Sons L.L.C. doi:10.1016/j.burns.2006.10.248 Biological skin substitutes in burn treatment-Where shall we go? Koller J. University Hospital Bratislava, Slovakia E-mail address: [email protected]. One of the major challenges of extensive deep burns treatment by surgical methods of early excision and wound closure is skin substitution. Skin substitutes are wound coverings which can temporarily replace (substitute) some of the skin functions, particularly the barrier function, protective function and selective permeability. The first written report pertaining the use of skin xenografts goes back to the 15th Century B.C. and was mentioned in the Papyrus of Ebers. The first report which described the clinical use of human skin allografts was the manuscript of Branca of Sicily from the year 1503. Even in the present time in most of the renowned burn centers the so called “classical skin substitutes”, such as human skin allografts, or xenografts, or amnion, are in current use. The progress in biotechnology and tissue engineering in the last decades contributed to the construction and fabrication of advanced types of skin substitutes either of purely biological origin, such as acellular human, or xenogenic dermis, or cultured autologous, or allogeneic human cells. Another such types of substitutes are represented by three-dimensional constructs of naturally occurring components like collagen and hyaluronic acid combined with some synthetic products like silicone or other synthetic material. Many new materials are in the phase of research, and just very few of them are already manufactured for clinical use. A typical example of such a product is an artificial dermis template combined with a silicone-based epidermal substitute, which is marketed under the name of Integra (Johnsson&Johnsson). Successful use of skin substitutes depend very much on the surgical techniques, skill and experience of the surgeons together with appropriate indications for use of the particular types of substitutes in particular clinical situations. Adequate surgical techniques together with the comprehensive “total burn care” managed by burn surgeons and the burn team are the key issues for successful treatment of the victims of extensive and deep burn injuries. doi:10.1016/j.burns.2006.10.249
S107
burns. They generally wait for help to arrive or run for help. They do not help themselves because they are ignorant about the dos and don’ts in the panic times. We are trying to reach out to the urban population using all mass media, popular commonly used everyday product having information in the local language and through the school education program. To reach out to the rural population, cooperation is sought from various NGOs working in those regions. Our aim is to reach every home, explaining to them about the first aid namely: how to extinguish fire and cool the burned area and escape safely from a smoke filled room. All these activities are being conducted by the Burn Care Foundation which is sponsored by Association of American Physicians from India (AAPI). doi:10.1016/j.burns.2006.10.247 Modulation of matrix metalloproteinase activity by silver-containing dressings Walker M. a , Cochrane C. b , Bowler P. a a
Department of Veterinary Clinical Science, University of Liverpool, UK ConvaTec Wound TherapueticsTM, Global Development Centre, UK E-mail address: [email protected] (M. Walker).
b
During wound repair and remodelling, proteolytic enzyme activity occurs within the extracellular matrix. One of the major proteolytic enzyme groups involved is the matrix metalloproteinases (MMP), which include both gelatinase and collagenase enzymes. In these studies several wound dressing categories (e.g. Hydrofiber® , Alginate and oxidized regenerated cellulose) were used, which included both a silver-containing dressing and a non-silver-containing dressing. Both the physical and chemical properties of these dressings were investigated. Specifically MMP-2 and MMP-9 were tested and the results showed that while all the dressings contributed to a reduction in both MMP-2 and MMP-9 activity, the silver-containing dressings performed much better, showing that silver provides an additional ability to modulate MMP activity. The results also differentiated the silver non-containing dressings, suggesting that differences in the physical properties of the dressings also play a role in helping to reduce important and potentially ‘corrosive’ proteolytic enzyme (e.g. MMP) activity in the localized wound environment. Hydrofiber® is a registered trademark of E.R. Squibb and Sons L.L.C. doi:10.1016/j.burns.2006.10.248 Biological skin substitutes in burn treatment-Where shall we go? Koller J. University Hospital Bratislava, Slovakia E-mail address: [email protected]. One of the major challenges of extensive deep burns treatment by surgical methods of early excision and wound closure is skin substitution. Skin substitutes are wound coverings which can temporarily replace (substitute) some of the skin functions, particularly the barrier function, protective function and selective permeability. The first written report pertaining the use of skin xenografts goes back to the 15th Century B.C. and was mentioned in the Papyrus of Ebers. The first report which described the clinical use of human skin allografts was the manuscript of Branca of Sicily from the year 1503. Even in the present time in most of the renowned burn centers the so called “classical skin substitutes”, such as human skin allografts, or xenografts, or amnion, are in current use. The progress in biotechnology and tissue engineering in the last decades contributed to the construction and fabrication of advanced types of skin substitutes either of purely biological origin, such as acellular human, or xenogenic dermis, or cultured autologous, or allogeneic human cells. Another such types of substitutes are represented by three-dimensional constructs of naturally occurring components like collagen and hyaluronic acid combined with some synthetic products like silicone or other synthetic material. Many new materials are in the phase of research, and just very few of them are already manufactured for clinical use. A typical example of such a product is an artificial dermis template combined with a silicone-based epidermal substitute, which is marketed under the name of Integra (Johnsson&Johnsson). Successful use of skin substitutes depend very much on the surgical techniques, skill and experience of the surgeons together with appropriate indications for use of the particular types of substitutes in particular clinical situations. Adequate surgical techniques together with the comprehensive “total burn care” managed by burn surgeons and the burn team are the key issues for successful treatment of the victims of extensive and deep burn injuries. doi:10.1016/j.burns.2006.10.249