The Use of Dermal Substitute in Deep Burns of Functional/Mobile Anatomic Areas at Acute Phase After Early Excision and Subsequent Skin Autografting: Dermal Substitute Prevents Functional Limitations

Current Approaches to Wound Repair in Burns: How far Have we Come From Cover to Close? A Narrative Review

Burn injuries are a significant global health concern, with more than 11 million people requiring medical intervention each year and approximately 180,000 deaths annually. Despite progress in health and social care, burn injuries continue to result in socioeconomic burdens for victims and their families. The management of severe burn injuries involves preventing and treating burn shock and promoting skin repair through a two-step procedure of covering and closing the wound. Currently, split-thickness/full-thickness skin autografts are the gold standard for permanent skin substitution. However, deep burns treated with split-thickness skin autografts may contract, leading to functional and appearance issues. Conversely, defects treated with full-thickness skin autografts often result in more satisfactory function and appearance. The development of tissue-engineered dermal templates has further expanded the scope of wound repair, providing scar reductive and regenerative properties that have extended their use to reconstructive surgical interventions. Although their interactions with the wound microenvironment are not fully understood, these templates have shown potential in local infection control. This narrative review discusses the current state of wound repair in burn injuries, focusing on the progress made from wound cover to wound closure and local infection control. Advancements in technology and therapies hold promise for improving the outcomes for burn injury patients. Understanding the underlying mechanisms of wound repair and tissue regeneration may provide new insights for developing more effective treatments in the future.

Prevention and Treatment of Burn Scar Contracture: A Practical Review

Burn contracture affects close to one-third of all burn patients, leading to significant functional impairment and costs. Effective prevention and treatment strategies are necessary to decrease morbidity and unnecessary costs. This scoping review aimed to summarize prevention and treatment strategies used for management of burn scar contractures published in the literature since 2000. A comprehensive PubMed review was performed in October 2022 to identify methods of burn contracture prevention and treatments. Non-English, duplicate, and unavailable articles were excluded. Data were extracted including publication year, techniques, and outcomes. A total of 327 publications met criteria for inclusion. Most articles were published in 2011 (n = 22). Treatment strategies were discussed in 82.9% of studies, prevention in 16.5%, and both in 0.6%. The most common areas discussed included the upper extremity (n = 127) and neck (n = 102). Flaps were the most frequently used method (n = 208), followed by autografts (n = 89). Most preventative therapies were still in early stages of development. Burn contracture management requires a highly individualized approach with many available reconstructive techniques available. Further research is needed to improve prevention techniques and decrease morbidity and cost to patients.

Accelerated Wound Closure of Deep Partial Thickness Burns with Acellular Fish Skin Graft

Thermal injuries are caused by exposure to a variety of sources, and split thickness skin grafts are the gold standard treatment for severe burns; however, they may be impossible when there is no donor skin available. Large total body surface area burns leave patients with limited donor site availability and create a need for treatments capable of achieving early and complete coverage that can also retain normal skin function. In this preclinical trial, two cellular and tissue based products (CTPs) are evaluated on twenty-four 5 × 5 deep partial thickness (DPT) burn wounds. Using appropriate pain control methods, DPT burn wounds were created on six anesthetized Yorkshire pigs. Wounds were excised one day post-burn and the bleeding wound beds were subsequently treated with omega-3-rich acellular fish skin graft (FSG) or fetal bovine dermis (FBD). FSG was reapplied after 7 days and wounds healed via secondary intentions. Digital images, non-invasive measurements, and punch biopsies were acquired during rechecks performed on days 7, 14, 21, 28, 45, and 60. Multiple qualitative measurements were also employed, including re-epithelialization, contraction rates, hydration, laser speckle, and trans-epidermal water loss (TEWL). Each treatment produced granulated tissue (GT) that would be receptive to skin grafts, if desired; however, the FSG induced GT 7 days earlier. FSG treatment resulted in faster re-epithelialization and reduced wound size at day 14 compared to FBD (50.2% vs. 23.5% and 93.1% vs. 106.7%, p < 0.005, respectively). No differences in TEWL measurements were observed. The FSG integrated into the wound bed quicker as evidenced by lower hydration values at day 21 (309.7 vs. 2500.4 µS, p < 0.05) and higher blood flow at day 14 (4.9 vs. 3.1 fold change increase over normal skin, p < 0.005). Here we show that FSG integrated faster without increased contraction, resulting in quicker wound closure without skin graft application which suggests FSG improved burn wound healing over FBD.

The Descriptive Epidemiology and Outcomes of Hospitalized Burn Patients in Southern Turkey: Age-Specific Mortality Patterns

The current descriptive analysis was designed to document the common epidemiologic characteristics and outcomes of burn injuries, and age-specific mortality patterns covering all age groups admitted for treatment to the Burn Center of Adana City Training and Research Hospital. Medical records were retrospectively analyzed. The patients were stratified into two age groups as pediatric and adults, and then into 10 sub-age groups. Among the 946 patients of the study population, there were 24 mortalities with a mortality rate of 2.5%. Patients within the age range of 70 to 79 years had the highest mortality rate of 33.3%; followed by 60 to 69, 80+, 18 to 29, 10 to 17, and <5 sub-age groups, whose mortality rates were 13.0%, 7.8%, 7.2%, 2.4%, and 0.5%, respectively. In terms of multivariate regression analysis of factors predicting mortality among burn patients in all age groups, fire-flame related burns, age ≥18 years, TBSA burned ≥20% (TBSA ≥20%), the existence of inhalation injury, deep partially/full-thickness burns were found to be significant prognostic factors of mortality. The strongest association was seen in TBSA ≥60% segment (P < .0001), which had 25.9 times more death risk. As expected, a similar trend was detected when the age groups stratified into age groups, and the strongest association was in the 60+ sub-age group (P < .0001), whose had 5.84 times more likely death; followed by 29 to 59 and 18 to 29 sub-age groups, with the odds ratios of 2.12 (95% confidence interval = 1.25-3.61) and 2.08 (95% confidence interval = 1.90-4.05), respectively. Oppose to these findings; the 0 to 17 sub-age group was not found to have a statistically significant effect in predicting mortality.