Burn Injury Ebook

Regrow New Skin

This brand new method teaches you how to heal and regrow skin that was damaged in acute burn injuries, and grow the skin back better than it ever was before. This eBook was written as an alternative method to heal skin, as opposed to the traditional methods that have been used by doctors for years. This all new method uses recent discoveries and studies to show the best ways to get new skin in order to make brand new, smooth skin. Many customers have been really satisfied with the results that they got. Some people were able to get rid of scars, some people banished bedsores, some people were able to get rid of itches! No matter what sort of topical pain you are facing, from burns to acne to sores, you will be able to get rid of the pain and live comfortably and happily as a result!

Regrow New Skin Summary


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Contents: Ebook
Author: Ed Polaris
Price: $37.00

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Highly Recommended

I usually find books written on this category hard to understand and full of jargon. But the author was capable of presenting advanced techniques in an extremely easy to understand language.

My opinion on this e-book is, if you do not have this e-book in your collection, your collection is incomplete. I have no regrets for purchasing this.

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Future directions in clinical nutritional support in relation to wound healing

With regard to the specific nutrient requirement in burn injury, one amino acid of special interest is proline. Posttranslational modification of proline on collagen molecule is important to collagen formation and wound healing. The interstitial proline content has been found to be related to wound healing.46 Metabolically, proline is a nutritionally dispensable amino acid. Its formation and disposal are closely related to the metabolism of ornithine and glutamate (Figure 4.2). Ornithine is one of the components of the urea cycle, and glutamate availability is closely related to the metabolism of a-glutarate, an intermediate of the tricarboxylic acid (TCA) cycle (Figure 4.3). In patients with thermal injuries, hypermetabolism and increased nitrogen loss indicate an accelerated TCA cycle and accelerated urea cycle activities, which drains both ornithine and glutamate. Because proline occupies one corner of the metabolic triangle interrelating these three amino acids, the de novo...

Metabolism in the healing wound

The accelerated muscle glutamine release that occurs after surgical stress can be profound. Muhlbacher et al. demonstrated that following treatment with the glucocorticoid dexamethasone, glutamine efflux was increased fourfold from the hindquarter muscles in a canine model 60 . Over a period of 9 d, the steroid-treated dogs developed muscle glutamine depletion and a negative nitrogen balance. Similar results were described in animals during sepsis, starvation, acidosis, and burn injury

Chapter References

LaLonde, C., Nayak, U., Hennigan, J., and Demling, R. (1996). Antioxidants prevent the cellular deficit produced in response to burn injury. Journal of Burn Care and Rehabilitation, 17, 379-83. Preiser, J.C., et al. (1996). Nitric oxide production is increased in patients after burn injury. Journal of Trauma, 40, 368-71.

Fluid and electrolyte management

Major thermal injury causes massive fluid shift from the vascular space to the interstitial and intracellular compartments, resulting in soft tissue edema and, if not replaced, hypovolemic shock. The management principles for burn shock are no different than those for any form of hypovolemic shock. However, since it is relatively simple to quantitate the severity of a burn injury and difficult to assess the intravascular volume loss visually, a number of formulas have been developed to predict the volume required to restore or maintain intravascular volume. These equations call for 2 to 4 ml3 of isotonic crystalloid per kilogram of body weight for each per cent of the body surface area burned in the first 24 h half is given within the first 8 h following injury. The formulas provide a reasonable guide to initial resuscitation but should not be followed rigorously. Subsequent fluid replacement should be based on patient response. Patients who require significantly more than the...

Pharmacokinetics in burned patients

A supranormal cardiac output, with increased blood flow to the splanchnic and renal beds, elevated temperature, hypoproteinemia, and major fluid shifts are common during the hypermetabolic phase of burn injury. Renal blood flow is significantly increased, but renal tubular function is depressed. Drugs cleared primarily by filtration may show accelerated elimination, while those secreted by the tubules may accumulate. Hepatic drug metabolism is more complex, but some generalizations are possible. Drug elimination by oxidation or reduction, hydroxylation, etc. will often be impaired, while conjugation reactions are preserved. Plasma protein levels are significantly altered during this period. Even when nutrition is well maintained, albumin synthesis is depressed as a component of the acute phase response, while synthesis of aracid glycoprotein is increased. Drugs with significant albumin binding usually show an increase in the free drug, but the free fraction of drugs binding to aracid...

Effects Of Resveratrol On The Cell Cycle Machinery

Resveratrol has been reported to induce growth arrest of more than a dozen diverse cancer cell lines, with arrest primarily in the G 0-12 or S phase of the cell cycle.1314 Growth arrest may involve direct inhibitory effects of resveratrol against ribonucleotide reductase (IC50 100 pM),15 which is vital to DNA synthesis owing to its catalysis of the reduction of ribonucleotides to deoxyribonucleotides, and resveratrol suppression of ornithine decarboxylase (ODC) induction, evidently through attenuation of myc expression.16 Resveratrol has profound effects on the cell cycle machinery. Resveratrol induction of the cyclin kinase inhibitor (CKI) WAF1 p21 accompanied the G1 arrest response to the polyphenol in cultured cells10-12 and was also associated with resveratrol amelioration of ultraviolet B-induced damage to mouse skin.17 Studies with p53-null cells indicate that, in at least some cases, resveratrol induces G1 arrest and WAF1 p21 expression in a p53-independent manner,12 while...

Proinflammatory cytokine

Supplies of these amino acids may assist the response (2). Indeed whey protein, which is rich in sulfur amino acids, has been shown to be beneficial in the treatment of children suffering from burn injury (5). Children receiving whey protein, rather than a standard high protein enteral formulation, had higher plasma C3 complement and IgG concentrations and less bacteremic days and better survival.

Selected Bibliography of Journal Articles

Gelfand JA, Donelan M et al. (1983) Preferential activation and depletion of the alternative complement pathway by burn injury. Ann Surg 198(1) 58-62 3. Gelfand JA, Donelan M (1982) Alternative complement pathway increases mortality in a model of burn injury in mice. J Clin Invest 70(6) 1170-1176 12. Ward RS, Hayes-Lundy C et al. (1994) Evaluation of topical therapeutic ultrasound to improve response to physical therapy and lessen scar contracture after burn injury. J Burn Care Rehabil 15(1) 74-79

Airway Obstruction Plays Role in ALI

There are several reasons that the airway cast formation should be avoided. First of all, airway obstruction causes ventilation-perfusion mismatching. As a consequence of airway obstruction, some parts of the lung are ventilated but some are not. The blood flow to the nonventilated part will be a shunt flow. Second, if the patients are under mechanical ventilation, the tidal volume of air goes only into the ventilated part of lung. When the ventilator is volume controlled, it causes a significant increase in airway pressure. From our experience, histological investigation showed less than 10 percent obstruction in noninjured sheep bronchi or bronchioles, but after smoke inhalation with burn injury or smoke inhalation with pneumonia, the obstructed area significantly increased to 30 to 40 percent of the area 6 . The sheep with elevation in airway pressure showed marked increases in mRNA for the chemokine IL-8 in the pulmonary microcirculatory area, along with evidence of neu-trophil...

Patterning the Facial Skeleton by the Pharyngeal Endoderm

The 'boundary cap cells' of the dorsal root entry zone and motor exit points in the embryonic spinal cord were identified recendy as a source ofNC stem cells during neurogenesis.136'137 These cells, which are derived from late-emigrating trunk NCCs, produce Schwann cells but also differentiate into subsets of sensory neurones and satellite glial cells in the mouse DRG, as shown by Cre-recombinase fate mapping using the Krox20 locus.136 Moreover, mouse' boundary cap cells in clonal cultures comprise self-renewing progenitors for glia, sensory neurones and myofibroblasts.137 In the mammalian skin, progenitors isolated either from the dermal papillae138'139 or the epidermal bulge area140'141 of hair follicles, behave in vitro as pluripotent stem cells endowed with both neural and mesenchymal lineage potentials. Genetic tracing using Wntl-Cre transgenic mice revealed that these progenitors are of NC origin. In the head region, the NCCs invade the presumptive skin early in mouse...

Hypermetabolism and nutritional support

The hypermetabolic response to burn injury surpasses, in both magnitude and duration, that associated with any other disease process. It can be thought of as consisting of two distinct components. First is the increased heat loss from the destruction of the skin's barrier function. Homeostasis in the face of such heat loss demands increased heat production and hence hypermetabolism. This component of demand can be reduced by decreasing the heat loss with occlusive dressings or by raising the ambient temperature. The second component appears to be mediated by humoral factors such as catecholamines, prostanoids, and cytokines from the burn wound, the gut, or elsewhere. Efforts to reduce this component of the demand have focused on agents such as propranolol and ibuprofen ( Con .etaA 1.994).

Selection of free flaps

Reconstruction Finger With Own Tissue

Electrical burn injury with soft tissue loss of the volar distal forearm skin and exposed flexor tendons. Fig. 9. Electrical burn injury with soft tissue loss of the volar distal forearm skin and exposed flexor tendons. Fig. 11. Debridement of an electrical burn injury always results in a much larger wound than the initial defect. Forearm and wrist volar skin loss resurfaced with an an-terolateral thigh flap. Fig. 11. Debridement of an electrical burn injury always results in a much larger wound than the initial defect. Forearm and wrist volar skin loss resurfaced with an an-terolateral thigh flap.

Protein and Amino Acid Needs in Disease

Most of the discussion to this point has centered around amino acid and protein metabolism in normal individuals. Although the effect of disease on amino acid and protein requirements is beyond the limits of this introductory chapter, a few important general points need to be made. The first is that energy and protein needs are tied together, as illustrated in Eigure2J.6. When metabolic rate rises, body protein is mobilized for use as a fuel (amino acid oxidation) and for supply of carbon for gluconeogenesis. Several disease states increase metabolic rate. The first is infection, in which the onset of fever is a hallmark of increased metabolic rate. The second is injury, be it trauma, burn injury, or surgery per se. Along with onset of a hypermetabolic state comes a characteristic increase in the loss of protein measured by increased urea production. Sir David Cuthbertson observed over 60 years ago that a simple bone fracture causes significant loss of N in the urine ( 181). Since...

Protein and amino acid metabolism

During stress and burn injury, synthesis of glutamine is inadequate to meet metabolic demands 108 , and it becomes conditionally essential. Parry-Billings 109 found in patients with major burn injury that plasma glutamine concentration was 58 lower than normal controls, and it remained low for at least 21 d postinjury. Although plasma concentrations of all amino acids were decreased after burn injury, glutamine levels did not return to normal, whereas concentrations of alanine and branched-chain amino acids did 109 . The authors postulated that the decrease in glutamine concentration may be a contributing factor to the immunosuppression that occurs after major burn injury. Because glutamine is needed for lymphocyte proliferation, and because it is the main energy source for enterocytes, it may be important in the maintenance of gut barrier function 110 . The effect of glutamine deficiency is also seen when in vitro glutamine supplementation of neutrophils isolated from burn patients...

Clinical Trials With Retinoids

Oral retinol (25,000 nmol day) reduces by 32 the development of squamous cell carcinomas of the skin in high-risk patients, with no apparent toxicity, as shown in a study that involved 5 years of treatment and nearly 4 years of follow-up.37 In contrast, oral retinol had no effect on basal cell carcinoma, and neither retinol nor isotretinoin (13-ds-RA) affected the incidence of nonmelanoma skin cancers. An extension of this work demonstrated the safety and enhanced efficacy of using 50,000 and 75,000 nmol day of vitamin A for 1 year in patients with sun-damaged skin.38

Essential fatty acids and other specific fatty acids

In the context of wound healing, the obvious role for essential fatty acids is on modulation of inflammation and the immune response.112-114 An examination of the literature in this area will uncover some conflicting data as to the benefits of essential rn-3 and rn-6 fatty acids in wound healing. One study in essential fatty acid deficient (EFAD) rats found that the healing rate of partial-thickness cutaneous burns was significantly decreased compared to controls.115 However, this study also found that healed single dorsal skin incisions were stronger in control animals, but there was no difference between the groups when ventral skin incisions with underlying fascial incisions were measured. These results would suggest that the type of wound or wound location and regional environment (adipose tissue ) may influence healing. Another study on cutaneous wound healing in EFAD rats concluded that essential fatty acids were not necessary for cutaneous wound repair.116 In this study, there...

Techniques to Assess Cutaneous Microvascular Function in Vivo

Skin in a raster pattern and build up a two-dimensional image of red blood cell flux up to a depth of approximately 0.6 to 1 mm. It is able to provide a real-time output of temporal and spatial changes in skin blood flux, particularly during dermal provocation. As the scanning head may be mounted 30 cm or more above the skin surface, it also allows space for manipulation within the scanned area. Thus, scanning laser Doppler imaging has been used by many groups to study the dermal microvasculature in a wide range of disease states including hypertension, diabetes, and peripheral vascular disease, in inflamed and damaged skin following burn injury, and in nonhealing wounds.

Carbohydrate requirementsenergy metabolism

Hyperglycemia is a complication of excessive carbohydrate (glucose) provision and must be addressed in reference to the higher percentages of carbohydrate need suggested. Clearly, there is a hyperglycemic effect in the flow phase of burn injury as well as in critically ill patients who may also have a wound. Although short-term hyperglycemia accompanies the stress response to injury, persistent hyperglycemia is a problem that has commonly been associated with poor wound healing and immunity (7). Pediatric burn patients with poor glucose control experienced reduced skin graft take and subsequent mortality. Total caloric intake should be evaluated, as hypercaloric feeding may be associated with hyperglycemia. Further, because carbohydrate is a key substrate in burn wound healing, internal insulin production may be enhanced. Insulin, an anabolic hormone, has positive effects on nitrogen utilization. The use of exogenous insulin has been shown to lead to a decrease in peripheral muscle...

Metabolic Effects of Cytokines in Burns Trauma and Sepsis

Ebb And Flow After Trauma

Alterations of hepatic protein synthesis, such as reduction in albumin, transferrin, and pre-albumin production and dramatic rises in the acute phase proteins, a-1 antitrypsin, a-2 macroglobulin, procalcitonin, C-reactive protein (CRP), and fibrinogen were originally considered effects of IL-1 and TNF 27,28 . However, IL-6 has also been demonstrated to be a mediator of the hepatic acute phase response to trauma and infection 29-31 . Unlike TNF and IL-1, sustained elevations of IL-6 plasma levels have been found following major burn injury 32,33 , sepsis 17,34-36 , and trauma 37 . Other acute phase response proteins include lactoferrin leading to depressed serum iron concentration, which is inhibitory for growth of microorganisms 38 , and ceruloplasmin and metallothionien with reduced serum zinc and copper in trauma and sepsis 38-42 . Serial measurement of prealbumin and CRP can be used to monitor nutritional status. For example, if prealbumin is not increasing and CRP is not...

Topical antimicrobial agents

Burn injury not only produces thermal necrosis of skin, but also causes microvascular thrombosis, leaving the burn avascular and inaccessible to systemic antimicrobials. Topical antimicrobials are designed for direct application to the wound, with the goal of slowing colonization by bacteria and delaying invasive infection. No topical agent is capable of sterilizing the wound. The ideal topical agent should have activity against organisms likely to be encountered on the wound, should not interfere with wound healing, should not be painful or expensive, should have little or no systemic toxicity, and should be easy to apply and remove. Although topical agents may delay the onset of invasive sepsis, they cannot prevent it indefinitely. Surgical wound closure must be obtained as soon as possible.

Initial assessment

The size of a burn injury is usually expressed in terms of the percentage of the body surface area involved. This measurement is utilized to predict resuscitation fluid volumes and to assess prognosis. Unfortunately, this number is not readily apparent on inspection of the patient. The simplest and most widely used guide for The area of the body involved in burn injury has little effect on resuscitation requirements or survival, but has a major impact on functional and cosmetic outcome. Traditional high-risk areas include the face, hands, feet, and perineum. Facial burns from flame should suggest the possibility of smoke inhalation. The eyes should be examined both directly and with the use of fluorescein and ultraviolet light to detect corneal or conjunctival injury. If burns involve the periorbital area, the patient should be warned to anticipate swelling which may prohibit opening the eyes and often lasts for 48 h. Advance warning will often avoid needless anxiety. Hand burns...


E Pulmonary dysfunction after thermal injury may be secondary to inhalational injury, aspiration, shock, sepsis, congestive heart failure, or trauma. The presence of inhalational injury increases mortality by 20 , whereas pneumonia increases the risk of mortality by 40 in burn patients. In the resuscitation phase of burn injury, lung injury results from hypoxia and subsequent reoxygenation, CO and cyanide toxic-ity, airway edema, chest wall, and pulmonary compliance problems. Hypoproteinemia may contribute to edema formation in the postresuscitative phase. (Rogers MC, et al. Textbook of Pediatric Intensive Care, 3rd Edition p. 1522.)

Acute mucosal ulceration

A special form of acute ulceration is the Curling ulcer seen in major burn injury. Burn patients often have single ulcers which may penetrate quite deep into the gastric or upper duodenal wall and, in contrast with stress ulcers, may even cause perforation. Cushing ulcers, which are seen in patients with neurological injury, fall between the two other acute ulcer forms. For completeness, a fourth type of acute mucosal ulceration caused by drugs, mainly non-steroidal anti-inflammatory drugs (NSAIDs), should be noted. There are often multiple erosions combined with deeper ulcers. Characteristically, these acute ulcerations are most often found in the gastric mucosa while peptic ulcers are most often seen in the duodenum. The pathogenesis of NSAID-induced ulcers is complex but is probably related to inhibition of prostaglandin synthesis by a non-selective inhibition of the enzyme cyclo-oxygenase.

Inhalation injury and respiratory burns

Increase in extravascular lung water. The severity and duration, usually from 24 h to 5 days, depends on the nature of the inhalation injury and the presence or absence of an associated cutaneous burn injury. An inflammatory exudate, containing high concentrations of thromboxane A 2 and glucuronidase, rapidly forms in the tracheobronchial tree. The end result of this cascade is progressive airway obstruction. Neutrophils present in the lung at the time of injury are trapped additional neutrophils are recruited to the lung by release of chemotactic factors produced by stimulated pulmonary macrophages. Release of the oxygen free radicals and proteolytic enzymes results in fibronectin degradation and interstitial matrix disruption.

Children with psychiatric disorder

Frequent in traumatized children, including those who have suffered burn injury, (28) abuse 29) or road traffic accidents 30 Treatment of the sleep disturbance has appeared to improve their emotional state,(31 but further research is needed to assess the therapeutic contribution of specific treatment for the sleep disorder as part of the overall care of traumatized children.

Thiamine and wound healing

Thiamine's impact on wound repair has also been studied using rat models. Alvarez and Gilbreath10 showed that inadequate thiamine intake also leads to a decrease in the tensile strength of wounds in thiamine-deficient animals. The focus of this study was on the breaking strength of excised wounds, the isometric shrink tension of skin, and the lysyl oxidase activity of both normal and repairing skin. Lysyl oxidase was analyzed, because it controls one of the initial steps in the cross-linking of elastin and collagen. Three groups of rats were fed either a thiamine-deficient diet or a thiamine-deficient diet that was supplemented with either 1 or 3 mg of thiamine HCl. Deficiency was established via measurement of urinary thiamine concentrations, and at this time, the animals were wounded. Ten days later, significant differences were noted in both isometric shrink tension and breaking strength of all three groups. Lysyl oxidase activity was significantly different between control animals...


The author is a Fellow of the American College of Surgeons and is a member of the American Society of Parenteral and Enteral Nutrition, the American Burn Association, the International Society of Burn Injury, the Wound Healing Society, the American Association of Plastic Surgeons, and the American Society of Plastic Surgery.


Airway and parenchymal injury are often not the only factors limiting ventilation following smoke inhalation injury the burn eschar can also limit gas exchange. Burn injury to the trunk that is full thickness and circumferential may restrict chest wall expansion and result in the need for higher airway pressures to attain the same level of ventilation. Chest wall escharotomies, which release this constricting band, can be lifesaving. Escharotomies, which can be performed at the bedside because of the insensate nature of third-degree burns, are carried through the eschar and the superficial fascia only to that depth that will permit the cut edges of the eschar to separate. The incisions are made in the anterior axillary lines and, if the eschar extends onto the anterior abdominal wall and restricts motion of the costal margin, are connected transversely across the chest by a subcostal escharotomy incision.

Local effects

The initiation of burn injury begins with damage to or loss of the victim's skin, which acts as an interface with the physical environment. The skin, which is the largest organ in the body, is not just a passive envelope, but a physiologically and immunologically active organ. In the immediate zone of injury, microcirculatory thrombosis and protein coagulation result in tissue death. A zone of ischemia exists between dead and living tissue in the early postburn period ( iDemJln g ,1.990). Impaired blood flow can persist in this zone of ischemia even after restoration of systemic hemodynamic parameters. The hallmark of tissue reaction in this zone is edema formation.

Timing of surgery

Patient stability and the extent and depth of burn injury should determine the timing of burn surgery among the priorities of patient care. Small burns (< 10 per cent TBSA) are rarely life threatening and risk of infection is usually low therefore surgery should be delayed until it is clearly indicated and can be performed with minimal risk. The surgeon may elect to follow small burns of indeterminate depth for 10 to 14 days to permit separation of superficial eschar, which will either confirm or obviate the need for surgery. Such observation is justified provided that the patient is stable and ambulatory, wound care and pain control are adequate, and there is no evidence of infection. In most cases, wounds that have not separated after 14 days will benefit from excision and skin grafting. ( CD Fig,u,re,,,,4)


Both the rate and extent of gastrointestinal absorption of individual aminoglycosides are generally quite low. For example, more than 95 of an oral dose of neomycin is excreted unchanged in the feces. The systemic bioavailability of the aminoglycosides is low across other membranes as well. For example, gentam-icin is poorly absorbed from a topical ophthalmic preparation, and there is little systemic absorption of either inhaled tobramycin or aminoglycosides instilled into the urinary bladder. Neomycin bioavailability across intact skin is also low, although absorption across damaged skin can be significant nephrotoxicity can occur in burn patients treated with topical neomycin.

Table 1424

Wolfe, R., Relation of metabolic studies to clinical nutrition the example of burn injury, Am. J. Clin. Nutr., 64, 800-808, 1996. Demling, R. and Orgill, D., The anticatabolic and wound healing effects of the testosterone analog, oxandrolone, after severe burn injury, J. Crit. Care Med, 15, 12-18. Saito, H., Anabolic agents in trauma and sepsis reflecting body mass and function, Nutrition, 17, 554-556, 1998. Demling, R.H. and Orgill, D.P., The anticatabolic and wound healing effects of the testosterone analog oxandrolone after severe burn injury, J. Crit. Care, 15, 12-17, 2000. 119. Demling, R.H., Comparison of the anabolic effects and complications of human growth hormone and the testosterone analog, oxandrolone, after severe burn injury, Burns, 25 , 215-221, 1999.

Microcheck 223

Extensive skin damage can result from a toxin absorbed into the circulation from a localized infection. An immunological reaction to circulating microbial products can damage the kidneys. Changes in the skin in an infectious disease commonly reflect similar changes in other body tissues. Zoonoses involving ticks and small mammals pose a widespread danger to humans. Complex ecological factors can govern the incidence of infectious diseases.

Types of surgery

A cornerstone of modern burn treatment is early excision, in which eschar is removed surgically before it can separate. Early excision and skin grafting of burn wounds reduces time in hospital and costs, improves functional and cosmetic outcomes, promotes early rehabilitation, relieves suffering, and almost certainly improves survival. Excision removes the eschar which causes much of the inflammatory response to burn injury and serves as a source of burn wound infection. The incidence of burn wound sepsis has declined dramatically since the widespread adoption of early excision.

Routes of Exposure

Routes Exposure

Dermal penetration Nanoparticles of titanium dioxide and zinc oxide are currently used in advanced sunscreens to enhance the UV absorption efficiency and because they become transparent. The evidence of potential penetration into the epidermis, however, is mixed and so they continue to be used. In the workplace, the main potential cause by which the skin can be exposed to nanoparticles is by handling nanopowders during their manufacture or use. It is still unclear whether nanoparticles will penetrate the skin and cause any toxicological problems. However, most of the limited work that has been reported has been carried out on intact skin. The effect of flexing the skin has yet to be fully explored as has the penetration through damaged skin.12