Der Unfallchirurg
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There is a world-wide growing interest in cultured epithelium. It is commonly accepted that cultured epithelial auto- or allografts can stimulate wound healing and shorten re-epithelialization time. Sheets of cultured autologous epidermal cells have been used for more than 15 years as grafts to achieve permanent coverage of full-thickness burn wounds. ⋯ Especially burn wounds of the face have been treated successfully, avoiding over-grafting and achieving highly acceptable, aesthetic and functional results. Many laboratories are developing dermal equivalents, combining synthetic and biological materials in order to form a multilayer neodermis. Although it seems possible to cultivate adnexae of the skin, a neodermis with cultivated adnexae is not yet in sight.
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High-voltage injuries cause localised entrance and exit burns, extensive arc, flame and flash burns and, even more dangerous, necrosis of the underlying muscles on the pathway of the current through the body. Therefore it should be recognized that the ensuing disease is more like a crush injury than a thermal burn. The extent of injury cannot be judged by the percentage and depth of the skin burn. ⋯ Ten patients (23.3%) sustained fractures and other injuries from falls, seven (16.3%) of them severe polytrauma. Initial cardiac arrhythmics were diagnosed in 16.6% of the primarily treated patients. Thirty per cent of our patients had neurological complications such as peripheral paresis, tetraplegia and paraplegia, 20.7% of these caused solely by the electric current.