Control of skin blood flow and sweating in grafted skin

移植皮肤中皮肤血流量和出汗的控制

• 批准号: 7907091
• 负责人: CRAIG G CRANDALL
• 金额: $ 20.8万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7907091
• 关键词: Acclimatization; Address; Area; Blood Vessels; Blood flow; Body Surface Area; Burn injury; Cardiovascular system; Climate; Cutaneous; Data; Environment; Ergometry; Exercise; Exertion; Generations; Heating; Human; Humidity; Individual; Injury; Leg; Measures; Medical; Military Personnel; Modification; Patients; Peripheral; Persons; Physicians; Principal Investigator; Protocols documentation; Regulation; Rehabilitation therapy; Relative (related person); Risk; Safety; Series; Severities; Skin; Skin Transplantation; Skin graft; Surgeon; Sweat; Sweating; Techniques; Temperature; Testing; Tissues; Treatment Protocols; United States; Vasodilation; Vasodilator Agents; Work; Workload; improved; injured; internal control; novel; public health relevance; response

DESCRIPTION (provided by applicant): Each year 40,000 to 70,000 individuals are hospitalized for burn related injuries, and of this number between 6,400 and 11,200 have severe burns covering at least 20% of the person's total body surface area (BSA). Twenty years ago burns covering half of a person's BSA were fatal. However, due to medical advances, patients with 90% BSA burned are now surviving these injuries Serious burns damage the skin, requiring, in many cases, excising the damaged tissue and subsequent skin grafting. Increases in skin blood flow and sweating are critical responses for humans to appropriately regulate internal temperature during physical exertion and/or hyperthermic exposure. However, findings from the principal investigator and others show that vasodilatory and sweating responses in grafted skin are impaired or absent regardless of the maturity of the graft. Thus, patients with large areas of grafted skin may have reduced thermal tolerance. This important question has not been adequately addressed as it remains unknown to what extent skin grafting impairs the regulation of internal temperature, or whether heightened vasodilator and sweating responses from non-injured skin can compensate for reduced heat dissipating capacity of grafted skin. Thus, the first objective of this project is to test the hypothesis that subjects with 20-35% of BSA grafted skin will have normal thermoregulatory responses, subjects with 40-55% BSA grafted skin will have moderately impaired thermoregulatory responses, and subjects with >60% BSA grafted skin will have severely impaired thermoregulatory responses when compared to non-grafted subjects. It is unknown whether individuals with substantial BSA of grafted skin can adapt to elevated temperature climates and thereby reduce their risk of a heat-related injury. Heat acclimation is a widely accepted approach to improve temperature regulation in individuals required to work (i.e., firefighters or military personnel), or who choose to exercise, in hot environmental conditions. It may be that heat acclimation is effective in improving temperature regulation of individuals with skin grafts over large portions of their body. To this end, the second objective of this project is to test the hypothesis that heat acclimation improves temperature regulation of individuals with varying BSA of grafted skin. Answers to the proposed questions, as well as related mechanisms, will be pursued using novel techniques to assess both central and peripheral control of thermoregulatory efferent variables. The academic environment in which this work will be conducted is unique in that surgeons and rehabilitation physicians, who treat skin graft patients, will collaborate with investigative physiologists to address these important questions. The information gained from the proposed studies will be valuable to clinicians, patients, and the military towards an understanding of the effects of serious burn injuries and subsequent skin grafting on human temperature regulation, and whether heat acclimation will allow these individuals to better tolerate a hyperthermic challenge and thus improve thermal safety and comfort. PUBLIC HEALTH RELEVANCE: Grafted skin has impaired capability to increase skin blood flow and sweating and thus individuals with a large portion of their body having grafted skin may have compromised temperature regulatory capacity; although this has not been confirmed. The overall objectives of the proposal are to identify the extent by which skin grafting impairs temperature regulation and to investigate whether heat acclimation improves temperature regulation. The information gained from the proposed studies will be valuable to clinicians, patients, and the military towards an understanding of the effects of serious burn injuries and subsequent grafting on human temperature regulation, and whether heat acclimation will allow these individuals to better tolerate a hyperthermic challenge and thus improve thermal safety and comfort.

描述（由申请人提供）：每年有40,000至70,000个人因烧伤相关伤害而住院，在6,400至11,200之间，严重的烧伤占该人总体表面积的至少20％（BSA）。二十年前，覆盖一个人的BSA一半的燃烧是致命的。但是，由于医疗的进步，现已烧毁了90％BSA的患者现在正在幸存这些伤害，严重烧伤会损害皮肤，在许多情况下，需要减轻受损的组织并随后的皮肤移植。皮肤血流和出汗的增加是对人类在身体劳累和/或过度热暴露期间适当调节内部温度的关键反应。然而，主要研究人员和其他人的发现表明，与移植物的成熟度如何，嫁接皮肤中的血管舒张和出汗反应受到损害或没有。因此，具有大面积移植皮肤的患者可能会降低热耐受性。这个重要的问题尚未得到充分解决，因为它仍然未知皮肤移植在多大程度上会损害内部温度的调节，或者血管舒张剂的增强和无损害皮肤的出汗反应能否补偿嫁接皮肤的降温能力降低。因此，该项目的第一个目标是测试假设，即20-35％的BSA接枝皮肤的受试者将具有正常的热调节反应，患有40-55％BSA移植皮肤的受试者具有适度的热管反应受损的受试者，受试者的受试者> 60％BSA移植的皮肤受到严重症状的影响，当受试者受到对受试者的影响效果。尚不清楚具有大量嫁接皮肤BSA的个体是否可以适应升高的温度气候，从而降低与热相关损伤的风险。热适应是一种广泛接受的方法，可以改善工作所需的个人（即消防员或军事人员）或选择在炎热的环境条件下运动的人。热适应可能有效地改善了大部分身体上皮肤移植物的温度调节。为此，该项目的第二个目标是检验以下假设：热适应改善了嫁接皮肤BSA不同的个体的温度调节。将使用新型技术来评估拟议问题的答案以及相关的机制，以评估体温调节传出变量的中央和外围控制。进行这项工作的学术环境是独一无二的，因为治疗皮肤移植患者的外科医生和康复医生将与调查生理学家合作解决这些重要问题。从拟议的研究中获得的信息将对临床医生，患者和军队有价值，以理解严重烧伤伤害的影响以及随后的皮肤对人类温度调节的影响，以及热适应能力是否会使这些人能够更好地耐受性耐受性挑战，从而改善热安全性和舒适性和舒适性。公共卫生相关性：嫁接的皮肤损害了增加皮肤血液流动和出汗的能力，因此患有大部分身体的患者嫁接皮肤可能会损害温度调节能力；尽管尚未得到证实。该提案的总体目标是确定皮肤嫁接损害温度调节的程度，并研究热适应是否可以改善温度调节。从拟议的研究中获得的信息将对临床医生，患者和军队有价值，以理解严重烧伤伤害的影响以及随后对人类温度调节的影响，以及热适应是否会使这些人能够更好地容忍高热的挑战，从而改善热安全和舒适性和舒适性。