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Thorfinn, Johan
Publications (10 of 26) Show all publications
Karlsson, M., Elmasry, M., Steinvall, I., Sjöberg, F., Olofsson, P. & Thorfinn, J. (2020). Scarring at Donor Sites after Split-Thickness Skin Graft: A Prospective, Longitudinal, Randomized Trial. Advances in Skin & Wound Care, 33(12)
Open this publication in new window or tab >>Scarring at Donor Sites after Split-Thickness Skin Graft: A Prospective, Longitudinal, Randomized Trial
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2020 (English)In: Advances in Skin & Wound Care, ISSN 1527-7941, E-ISSN 1538-8654, Vol. 33, no 12Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate if previous findings on the association between dressing treatments and subjective opinion on final donor site scar outcome using the Patient and Observer Scar Assessment Scale (POSAS) can be confirmed objectively. The previous study showed that patients dressed with hydrofiber covered with film were more satisfied with their donor site scars than patients receiving porcine xenograft or polyurethane foam dressings. METHODS: Scar outcome measurements were assessed by a blinded observer using POSAS and the Cutometer dual MPA 580 device to measure the viscoelasticity of skin. RESULTS: A total of 17 participants were included in this study, five of whom were treated with hydrofiber, six with polyurethane foam, and another six with porcine xenograft. There were no significant differences among groups in any of the POSAS items or in the viscoelasticity measurements made with the Cutometer. CONCLUSIONS: The investigators could not confirm previous associations between dressing treatment and long-term donor site scars. No associations between donor sites healing times and final scarring were found. Hypopigmentation was reported in 15 of 17 donor sites evaluated.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2020
Keywords
Cutometer; donor site; dressing; graft; scar; split-thickness skin graft
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-171957 (URN)10.1097/01.ASW.0000720256.45983.28 (DOI)000591735900001 ()33208665 (PubMedID)
Available from: 2020-12-17 Created: 2020-12-17 Last updated: 2023-01-11
Karlsson, M., Steinvall, I., Olofsson, P., Thorfinn, J., Sjöberg, F., Åstrand, L., . . . Elmasry, M. (2020). Sprayed cultured autologous keratinocytes in the treatment of severe burns: a retrospective matched cohort study.. Annals of burns and fire disasters, 33(2), 134-142
Open this publication in new window or tab >>Sprayed cultured autologous keratinocytes in the treatment of severe burns: a retrospective matched cohort study.
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2020 (English)In: Annals of burns and fire disasters, ISSN 1592-9558, Vol. 33, no 2, p. 134-142Article in journal (Refereed) Published
Abstract [en]

The standard treatment of burns is early excision followed by autologous skin grafting. The closure of extensive deep burns poses a considerable challenge. Cultured autologous keratinocytes have been used since 1981 in an effort to improve healing. However, the time required to culture the cells and the lack of a dermal component limit the expectations of outcome. Our aim was to compare the duration of hospital stay between patients who were treated with autologous skin grafts and cultured autologous keratinocytes and those who were treated with autologous skin grafting without cultured autologous keratinocytes. In this retrospective study all patients treated with cultured autologous keratinocytes between 2012 and 2015 were matched by size and depth of burn with patients not treated with cultured autologous keratinocytes. Multivariable regression was used to analyse associations between duration of hospital stay and treatment adjusted for age, mortality, size and depth of the burn. Then, we investigated the possibility of differentiation of human bone marrow stem cell line to keratinocyte- like cells as a future direction. The regression analysis showed a coefficient of 17.36 (95% CI -17.69 to 52.40), p= 0.32, for hospital stay in the treatment group, compared with the matched group. Our results showed no difference in the duration of hospital stay between the two treatments. Autologous stem cells should be considered as a future modality of burn management, although further studies are needed.

Place, publisher, year, edition, pages
Palermo, Italy: Mediterranean Council for Burns and Fire Disasters, 2020
Keywords
burn, duration of hospital stay, outcome, sprayed cultured autologous keratinocytes, stem cells
National Category
Medical Biotechnology (with a focus on Cell Biology (including Stem Cell Biology), Molecular Biology, Microbiology, Biochemistry or Biopharmacy)
Identifiers
urn:nbn:se:liu:diva-170222 (URN)32913435 (PubMedID)
Available from: 2020-10-02 Created: 2020-10-02 Last updated: 2023-01-11Bibliographically approved
Frew, Q., Rennekampff, H.-O., Dziewulski, P., Moiem, N., Zahn, T., Hartmann, B. & Siemers, F. (2019). Betulin wound gel accelerated healing of superficial partial thickness burns: Results of a randomized, intra-individually controlled, phase III trial with 12-months follow-up. Burns, 45(4), 876-890
Open this publication in new window or tab >>Betulin wound gel accelerated healing of superficial partial thickness burns: Results of a randomized, intra-individually controlled, phase III trial with 12-months follow-up
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2019 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 45, no 4, p. 876-890Article in journal (Refereed) Published
Abstract [en]

Objective: Acceleration of wound healing promises advantages for patients and caregivers in reducing the burden of disease, avoiding complications such as wound infections, and improving the long-term outcome. However, medicines that can accelerate wound healing are lacking. The objective of this open, blindly evaluated, randomized, multicenter phase III study was to compare intra-individually the efficacy and tolerability of Oleogel-S10 with fatty gauze dressing versus Octenilin (R) wound gel with fatty gauze dressing in accelerating the healing of superficial partial thickness burn wounds. Methods: Acute superficial partial thickness burn wounds in adults caused by fire, heat burn or scalding were divided into 2 halves and randomly assigned to treatment with Oleogel-S10 or Octenilin (R) wound gel. Photos for observer-blinded analysis of wound healing were taken at each wound dressing change. Percentages of reepithelialization were assessed at defined intervals. Efficacy and tolerability were evaluated based on a 5-point Likert scale. Results: Of 61 patients that were enrolled, 57 received the allocated intervention and 48 completed treatment. The percentage of patients with earlier wound healing was significantly higher for Oleogel-S10 (85.7%, n=30) compared to Octenilin (R) wound gel (14.3%, n= 5, p amp;lt;0.0001). The mean intra-individual difference in time to wound closure was -1.0 day in favour of Oleogel-S10 (-1.4, -0.6; 95% CI, p amp;lt;0.0001). Most investigators (87.0%) and patients (84.8%) evaluated the efficacy of Oleogel-S10 to be better or much better than that of Octenilin (R) wound gel. Long-term outcome 3 months and 12 months post injury was improved in some patients. Conclusions: Oleogel-S10 (Episalvan) significantly accelerated the healing of superficial partial thickness burn wounds. It was safe and well tolerated. (C) 2018 Elsevier Ltd and ISBI. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2019
Keywords
Partial thickness wounds; Grade 2a burns; Superficial partial thickness burns; Betulin; Birch bark extract; Randomized clinical trial
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-158321 (URN)10.1016/j.burns.2018.10.019 (DOI)000467914900015 ()30559054 (PubMedID)
Note

Funding Agencies|Amryt AG, Niefern-Oeschelbronn, Germany

Available from: 2019-07-02 Created: 2019-07-02 Last updated: 2020-05-01
Pompermaier, L., Steinvall, I., Elmasry, M., Thorfinn, J. & Sjöberg, F. (2018). Burned patients who die from causes other than the burn affect the model used to predict mortality: a national exploratory study. Burns, 44(2), 280-287
Open this publication in new window or tab >>Burned patients who die from causes other than the burn affect the model used to predict mortality: a national exploratory study
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2018 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 44, no 2, p. 280-287Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: The Baux score - the sum of age and total body surface area burned (TBSA %) - is a good predictor of mortality has a high specificity but low sensitivity. Our aim was to examine the causes of death in patients who die with Baux scores of <100, which may explain the lower sensitivity and possibly affect the prediction of mortality.

METHODS: All patients admitted to our centre for burn care from 1993 to 2015 (n=1946) were included in this retrospective, descriptive, exploratory study. The study group comprised those patients who died with Baux scores of <100 (n=23), and their medical charts were examined for the cause of death and for coexisting diseases.

RESULTS: Crude mortality was 5% (93/1946) for the overall cohort, and a quarter of the patients who died (23/93) had Baux scores of less than 100 (range 64-99). In this latter group, flame burns were the most common (18/23), the median (10th-90th centile) age was 70 (46-86) years and for TBSA 21 (5.0-40.5) %, of which 7 (0-27.0) % of the area was full thickness. The main causes of death in 17 of the 23 were classified as "other than burn", being cerebral disease (n=9), cardiovascular disease (n=6), and respiratory failure (n=2). Among the remaining six (burn-related) deaths, multiple organ failure (predominantly renal failure) was responsible. When we excluded the cases in which the cause of death was not related to the burn, the Baux mortality prediction value improved (receiver operating characteristics area under the curve, AUC) from 0.9733 (95% CI 0.9633-0.9834) to 0.9888 (95% CI 0.9839-0.9936) and the sensitivity estimate increased from 45.2% to 53.9%.

CONCLUSION: Patients with burns who died with a Baux score <100 were a quarter of all the patients who died. An important finding is that most of these deaths were caused by reasons other than the burn, usually cerebrovascular disease. This may be the explanation why the sensitivity of the Baux score is low, as factors other than age and TBSA % explain the fatal outcome.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Baux score, Burns, Cause of death, Mortality
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-142898 (URN)10.1016/j.burns.2017.07.014 (DOI)000427535000006 ()28830698 (PubMedID)2-s2.0-85027674409 (Scopus ID)
Note

Funding agencies: Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Region Ostergotland; Linkoping University, Linkoping, Sweden

Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2021-12-28Bibliographically approved
Karlsson, M., Elmasry, M., Steinvall, I., Sjöberg, F., Olofsson, P. & Thorfinn, J. (2018). Scarring At Donor Sites After Split-Thickness Skin Graft: A Prospective, Longitudinal, Randomized Trial. Advances in Skin & Wound Care, 3(4), 183-188
Open this publication in new window or tab >>Scarring At Donor Sites After Split-Thickness Skin Graft: A Prospective, Longitudinal, Randomized Trial
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2018 (English)In: Advances in Skin & Wound Care, ISSN 1527-7941, E-ISSN 1538-8654, Vol. 3, no 4, p. 183-188Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this study was to evaluate scarring at split-thickness skin graft donor sites 8 years after surgery.

METHODS: At surgery, 67 patients were randomized to hydrofiber, polyurethane foam, or porcine xenograft treatment. Scars were evaluated with the Patient and Observer Scar Assessment Scale.

RESULTS: Results showed significant differences in observed scar outcomes at donor sites, leaving the polyurethane foam–treated and the porcine xenograft–treated patients with the least satisfying scars. Multivariable regression analysis showed that the group treated with the xenografts had worse scores for overall opinion of the scar than did the other groups (P = .03), the most important factor being pigmentation. There was no correlation between duration of healing time and quality of the scar.

CONCLUSIONS: There were significant differences among the groups, with the hydrofiber group being the most satisfied with the appearance of their scar.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
National Category
Surgery Otorhinolaryngology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-146085 (URN)10.1097/01.ASW.0000530684.31491.5f (DOI)000435188200008 ()29561343 (PubMedID)
Available from: 2018-03-27 Created: 2018-03-27 Last updated: 2023-01-11Bibliographically approved
Elmasry, M., Steinvall, I., Thorfinn, J., Abdelrahman, I., Olofsson, P. & Sjöberg, F. (2017). Staged excisions of moderate-sized burns compared with total excision with immediate autograft: an evaluation of two strategies.. International journal of burns and trauma, 7(1), 6-11
Open this publication in new window or tab >>Staged excisions of moderate-sized burns compared with total excision with immediate autograft: an evaluation of two strategies.
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2017 (English)In: International journal of burns and trauma, ISSN 2160-2026, Vol. 7, no 1, p. 6-11Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Different surgical techniques have evolved since excision and autografting became the treatment of choice for deep burns in the 1970s. The treatment plan at the Burn Center, Linköping University Hospital, Sweden, has shifted from single-stage excision and immediate autografting to staged excisions and temporary cover with xenografts before autografting. The aim of this study was to find out if the change in policy resulted in extended duration of hospital stay/total body surface area burned (LOS/TBSA%).

METHODS: Retrospective clinical cohort including surgically-managed patients with burns of 15%-60% TBSA% within each treatment group. The first had early full excisions of deep dermal and full thickness burns and immediate autografts (1997-98), excision and immediate autograft group) and the second had staged excisions before final autografts using xenografts for temporary cover (2010-11, staged excision group).

RESULTS: The study included 57 patients with deep dermal and full-thickness burns, 28 of whom had excision and immediate autografting, and 29 of whom had staged excisions with xenografting before final autografting. Adjusted (LOS/TBSA%) was close to 1, and did not differ between groups. Mean operating time for the staged excision group was shorter and the excised area/operation was smaller. The total operating time/TBSA% did not differ between groups.

CONCLUSION: Staged excisions with temporary cover did not affect adjusted LOS/TBSA% or total operating time. Staged excisions may be thought to be more expensive because of the cost of covering the wound between stages, but this needs to be further investigated as do the factors that predict long term outcome.

Place, publisher, year, edition, pages
E-Century Publishing Corporation, 2017
Keywords
Burn surgery, moderate sized burns, xenografts
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-135745 (URN)28123862 (PubMedID)
Available from: 2017-03-20 Created: 2017-03-20 Last updated: 2024-01-10Bibliographically approved
Elmasry, M., Steinvall, I., Thorfinn, J., Abbas, A., Adly, O., Abdelrahman, I., . . . Sjöberg, F. (2016). Scald management protocols - outcome differences in two different time periods using different treatment strategies.. Annals of burns and fire disasters, 29(2), 139-143
Open this publication in new window or tab >>Scald management protocols - outcome differences in two different time periods using different treatment strategies.
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2016 (English)In: Annals of burns and fire disasters, ISSN 1592-9558, Vol. 29, no 2, p. 139-143Article in journal (Refereed) Published
Abstract [en]

Over the years the treatment of scalds in our centre has changed, moving more towards the use of biological dressings (xenografts). Management of scalds with mid dermal or deep dermal injuries differs among centers using different types of dressings, and recently biological membrane dressings were recommended for this type of injury. Here we describe differences in treatment outcome in different periods of time. All patients with scalds who presented to the Linkoping Burn Centre during two periods, early (1997-98) and later (2010-12) were included. Data were collected in the unit database and analyzed retrospectively. A lower proportion of autograft operations was found in the later period, falling from 32% to 19%. Hospital stay was shorter in the later period (3.5 days shorter, p=0.01) and adjusted duration of hospital stay/TBSA% was shorter (1.2 to 0.7, p=0.07). The two study groups were similar in most of the studied variables: we could not report any significant differences regarding outcome except for unadjusted duration of hospital stay. Further studies are required to investigate functional and aesthetic outcome differences between the treatment modalities.

Place, publisher, year, edition, pages
Mediterranean Council for Burns and Fire Disasters, 2016
Keywords
burns, duration of stay, outcome, scalds
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-135746 (URN)28149237 (PubMedID)
Available from: 2017-03-20 Created: 2017-03-20 Last updated: 2024-01-10Bibliographically approved
Elmasry, M., Steinvall, I., Thorfinn, J., Olofsson, P., Abbas, A., Abdelrahman, I., . . . Sjöberg, F. (2016). Temporary coverage of burns with a xenograft and sequential excision, compared with total early excision and autograft. Annals of burns and fire disasters, 29(3), 196-201
Open this publication in new window or tab >>Temporary coverage of burns with a xenograft and sequential excision, compared with total early excision and autograft
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2016 (English)In: Annals of burns and fire disasters, ISSN 1592-9558, Vol. 29, no 3, p. 196-201Article in journal (Refereed) Published
Abstract [en]

During the 80s and 90s, early and total excision of full thickness burns followed by immediate autograft was the most common treatment, with repeated excision and grafting, mostly for failed grafts. It was hypothesized, therefore, that delayed coverage with an autograft preceded by a temporary xenograft after early and sequential smaller excisions would lead to a better wound bed with fewer failed grafts, a smaller donor site, and possibly also a shorter duration of stay in hospital. We carried out a case control study with retrospective analysis from our National Burn Centre registry for the period 1997-2011. Patients who had been managed with early total excision and autograft were compared with those who had had sequential smaller excisions covered with temporary xenografts until the burn was ready for the final autograft. The sequential excision and xenograft group (n=42) required one-third fewer autografts than patients in the total excision and autograft group (n=45), who needed more than one operation (p<0.001). We could not detect any differences in duration of stay in hospital / total body surface area burned% (duration of stay/TBSA%) (2.0 and 1.8) (p=0.83). The two groups showed no major differences in terms of adjusted duration of stay, but our findings suggest that doing early, smaller, sequential excisions using a xenograft for temporary cover can result in shorter operating times, saving us the trouble of making big excisions. However, costs tended to be higher when the burns were > 25% TBSA.

Place, publisher, year, edition, pages
Mediterranean Council for Burns and Fire Disasters, 2016
Keywords
autograft, burn surgery, sequential excision, total early excision, xenograft
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-137912 (URN)28149249 (PubMedID)
Available from: 2017-06-01 Created: 2017-06-01 Last updated: 2024-01-10
Nilsson, H., Jonson, C.-O., Vikström, T., Bengtsson, E., Thorfinn, J., Huss, F., . . . Sjöberg, F. (2013). Simulation-assisted burn disaster planning. Burns, 39(6), 1122-1130
Open this publication in new window or tab >>Simulation-assisted burn disaster planning
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2013 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 39, no 6, p. 1122-1130Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to evaluate the Swedish medical systems response to a mass casualty burn incident in a rural area with a focus on national coordination of burn care. Data were collected from two simulations of a mass casualty incident with burns in a rural area in the mid portion of Sweden close to the Norwegian border, based on a large inventory of emergency resources available in this area as well as regional hospitals, university hospitals and burn centres in Sweden and abroad. The simulation system Emergo Train System (R) (ETS) was used and risk for preventable death and complications were used as outcome measures: simulation I, 18.5% (n = 13) preventable deaths and 15.5% (n = 11) preventable complications; simulation II, 11.4% (n = 8) preventable deaths and 11.4% (n = 8) preventable complications. The last T1 patient was evacuated after 7 h in simulation I, compared with 5 h in simulation II. Better national coordination of burn care and more timely distribution based on the experience from the first simulation, and possibly a learning effect, led to a better patient outcome in simulation II. The experience using a system that combines both process and outcome indicators can create important results that may support disaster planning.

Place, publisher, year, edition, pages
Elsevier, 2013
Keywords
Burns; Rural areas; Surge capacity; Mass casualty incidents; Preparedness
National Category
Medical and Health Sciences
Research subject
Disaster Medicine
Identifiers
urn:nbn:se:liu:diva-86596 (URN)10.1016/j.burns.2013.01.018 (DOI)000324349700014 ()
Available from: 2012-12-19 Created: 2012-12-19 Last updated: 2020-02-04Bibliographically approved
Thorfinn, J., Angelidis, I. K., Gigliello, L., Pham, H. M., Lindsey, D. & Chang, J. (2012). Bioreactor optimization of tissue engineered rabbit flexor tendons in vivo. JOURNAL OF HAND SURGERY-EUROPEAN VOLUME, 37E(2), 109-114
Open this publication in new window or tab >>Bioreactor optimization of tissue engineered rabbit flexor tendons in vivo
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2012 (English)In: JOURNAL OF HAND SURGERY-EUROPEAN VOLUME, ISSN 1753-1934, Vol. 37E, no 2, p. 109-114Article in journal (Refereed) Published
Abstract [en]

Tissue-engineered rabbit flexor tendons reseeded with cells are stronger in vitro after culture in a bioreactor. It is not known whether this effect persists in vivo. Tenocytes from New Zealand white rabbits were seeded onto rabbit rear paw flexor tendons that were deprived of cells and exposed to cyclic strain in a bioreactor. Reseeded constructs that were kept unloaded in a medium for 5 days were used as controls. The tendons were implanted to bridge a zone II defect in the rabbit. After explantation 4 weeks later, the ultimate tensile strength (UTS) and elastic modulus (EM) were determined. Tendon constructs that were exposed to cyclic strain had significantly improved UTS and EM. Histology showed that cellularity was increased in the bioreactor tendons.

Place, publisher, year, edition, pages
SAGE Publications (UK and US), 2012
Keywords
Hand flexor tendon, tissue engineering, tenocytes, bioreactor optimization, cell culture
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-75278 (URN)10.1177/1753193411419439 (DOI)000299481700003 ()
Note
Funding Agencies|Veterans Affairs Medical Merit Review Grant||Veterans Affairs Rehabilitation Research & Development Merit Review Grant||Swedish Fulbright Commission||County Council of Ostergotland (Sweden)||Borje Gabrielssons Memorial Fund||Swedish Society of Medicine||Johan & Jakob Soderberg Foundation||Linkoping Society of Medicine||Available from: 2012-02-27 Created: 2012-02-24 Last updated: 2012-02-27
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