Narrow Results

The objective of this report is to present a case of hand burn linear contracture release performed under local anesthesia. It also introduces the one-per-mil tumescent solution consisted of 0.2% lidocaine and 1:1.000.000 epinephrine as a local anesthesia formula, which has the potential of providing adequate anesthesia as well as hemostatic effect during surgery of the hand without tourniquet. The surgery was performed on a 19 year-old male patient with multiple thumb and fingers flexion linear contracture for 105 minutes without any obstacle. The patient did not complain any pain and discomfort during the procedure; while bloodless operative field was successfully achieved. At four-month follow up, the patient could fully extend his thumb, middle and ring finger, while the index was limited by 10° at the DIP joint. Overall, the patient was satisfied with the outcome.

Burn Management.

Tissue engineered skin was the first out of the stable of tissues that could be made in the laboratory from biopsies of patients skin expanded and then delivered back to them. As patients have been benefiting from cultured skin cells since 1981,¹ at 25 years old this is far from being a new area. In this article the question of to what extent tissue engineered skin has finally come of age will be reviewed.

There are currently three clinical areas where it can benefit man — for the treatment of patients with extensive skin loss due to burns injuries, to accelerate or initiate healing in patients with chronic non-healing ulcers and for reconstructive surgery purposes (an area which is still in its infancy but can encompass the treatment of pigmentation defects and diseases such as vitiligo and scarring and hopefully blistering diseases). There are also many in vitro applications where having a physiologically relevant model of skin can teach us more about normal and pathological skin biology than working with monolayers of skin cells.

This chapter looks at why tissue engineered skin was initially developed for burns injuries and how it is now also used for chronic wounds and beginning to be used for reconstructive surgery. The challenges that remain are then considered followed by a summary of some of the in vitro applications for tissue engineered skin.