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Ji S, Xiao S, Xia Z. Consensus on the treatment of second-degree burn wounds (2024 edition). BURNS & TRAUMA 2024; 12:tkad061. [PMID: 38343901 PMCID: PMC10858447 DOI: 10.1093/burnst/tkad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/29/2023] [Accepted: 12/08/2023] [Indexed: 02/21/2024]
Abstract
Second-degree burns are the most common type of burn in clinical practice and hard to manage. Their treatment requires not only a consideration of the different outcomes that may arise from the dressing changes or surgical therapies themselves but also an evaluation of factors such as the burn site, patient age and burn area. Meanwhile, special attention should be given to the fact that there is no unified standard or specification for the diagnosis, classification, surgical procedure, and infection diagnosis and grading of second-degree burn wounds. This not only poses great challenges to the formulation of clinical treatment plans but also significantly affects the consistency of clinical studies. Moreover, currently, there are relatively few guidelines or expert consensus for the management of second-degree burn wounds, and no comprehensive and systematic guidelines or specifications for the treatment of second-degree burns have been formed. Therefore, we developed the Consensus on the Treatment of Second-Degree Burn Wounds (2024 edition), based on evidence-based medicine and expert opinion. This consensus provides specific recommendations on prehospital first aid, nonsurgical treatment, surgical treatment and infection treatment for second-degree burns. The current consensus generated a total of 58 recommendations, aiming to form a standardized clinical treatment plan.
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Affiliation(s)
- Shizhao Ji
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
| | - Shichu Xiao
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
| | - Zhaofan Xia
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
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Preliminary Assessment of Burn Depth by Paper-Based ELISA for the Detection of Angiogenin in Burn Blister Fluid-A Proof of Concept. Diagnostics (Basel) 2020; 10:diagnostics10030127. [PMID: 32120826 PMCID: PMC7151184 DOI: 10.3390/diagnostics10030127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 11/28/2022] Open
Abstract
Rapid assessment of burn depth is important for burn wound management. Superficial partial-thickness burn (SPTB) wounds heal without scars, but deep partial-thickness burn (DPTB) wounds require a longer healing time and have a higher risk of scar formation. We previously found that DPTB blister fluid displayed a higher angiogenin level than SPTB blister fluid by conventional ELISA. In this study, we developed a paper-based ELISA (P-ELISA) technique for rapid assessment of angiogenin concentration in burn blister fluid. We collected six samples of SPTB blister fluid, six samples of DPTB blister fluid, and seven normal healthy serum samples for analysis. We again chose ELISA to measure and compare angiogenin levels across all of our samples, but we developed a P-ELISA tool and compared sample results from that tool to the results from conventional ELISA. As with conventional ELISA, DPTB blister fluid displayed higher angiogenin levels than SPTB in P-ELISA. Furthermore, our P-ELISA results showed a moderate correlation with conventional ELISA results. This new diagnostic technique facilitates rapid and convenient assessment of burn depth by evaluating a key molecule in burn blister fluid. It presents a novel and easy-to-learn approach that may be suitable for clinically determining burn depth with diagnostic precision.
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Davidović S, Babić N, Jovanović S, Barišić S, Grković D, Miljković A. Serum erythropoietin concentration and its correlation with stage of diabetic retinopathy. BMC Ophthalmol 2019; 19:227. [PMID: 31727007 PMCID: PMC6857223 DOI: 10.1186/s12886-019-1240-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 11/06/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Erythropoietin (EPO) is one of the systemic angiogenic factors, and its role in ocular angiogenesis and in diabetic retinopathy (DR) is not yet fully understood. The latest research data reveal a possible correlation of higher erythropoietin concentrations in the blood and in the eye with the development of more advanced stages of DR. The main aim of this work was to examine the possible influence of serum concentrations of erythropoietin on the development of diabetic retinopathy in patients with diabetes mellitus type 2. METHODS The research involved 90 patients examined at the University Eye Clinic of the Clinical Center of Vojvodina, Novi Sad, Serbia. The first group comprised 60 patients with diabetes mellitus lasting for 10 years or more, with diabetic retinopathy. The second, control group consisted of 30 healthy individuals. In the first group of 60 patients with diabetes, 30 of them had non-proliferative diabetic retinopathy (NPDR), and 30 had proliferative diabetic retinopathy (PDR). Laboratory EPO serum levels were determined, and they were correlated to the stage of DR. Concentration of EPO was assessed by ELISA method. RESULTS The highest average concentration of EPO in serum (9.95 mIU/ml) was determined in the group of people with diabetes with PDR. The lowest average concentration of EPO in the serum (6.90 mIU/ml) was found in the control group. The average concentration of EPO in serum in the group of patients with diabetes with NPDR was 7.00 mIU/ml. The EPO concentration in serum was elevated in the group of PDR, and it was directly proportional to the level of the clinical stadium of PDR, being significantly higher in the moderate and severe subgroup of PDR comparing to the control healthy subjects, NPDR and mild PDR (p = 0.007). CONCLUSIONS Significantly elevated serum concentration of EPO in the advanced stages of DR, and positive correlation between EPO serum concentration and clinical stages of PDR, suggest that erythropoietin represents an important growth factor from blood, which plays a significant role in retinal ischemia and angiogenesis in diabetic retinopathy, especially in the proliferative stage of this disease.
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Affiliation(s)
- Sofija Davidović
- Faculty of Medicine, Department of Ophthalmology, University of Novi Sad, Novi Sad, 21000, Serbia.
- Eye Clinic, Clinical Center of Vojvodina, Hajduk Veljkova 1-9, Novi Sad, 21000, Serbia.
| | - Nikola Babić
- Faculty of Medicine, Department of Ophthalmology, University of Novi Sad, Novi Sad, 21000, Serbia
- Eye Clinic, Clinical Center of Vojvodina, Hajduk Veljkova 1-9, Novi Sad, 21000, Serbia
| | - Sandra Jovanović
- Faculty of Medicine, Department of Ophthalmology, University of Novi Sad, Novi Sad, 21000, Serbia
- Eye Clinic, Clinical Center of Vojvodina, Hajduk Veljkova 1-9, Novi Sad, 21000, Serbia
| | - Sava Barišić
- Eye Clinic, Clinical Center of Vojvodina, Hajduk Veljkova 1-9, Novi Sad, 21000, Serbia
| | - Desanka Grković
- Faculty of Medicine, Department of Ophthalmology, University of Novi Sad, Novi Sad, 21000, Serbia
- Eye Clinic, Clinical Center of Vojvodina, Hajduk Veljkova 1-9, Novi Sad, 21000, Serbia
| | - Aleksandar Miljković
- Faculty of Medicine, Department of Ophthalmology, University of Novi Sad, Novi Sad, 21000, Serbia
- Eye Clinic, Clinical Center of Vojvodina, Hajduk Veljkova 1-9, Novi Sad, 21000, Serbia
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Redox Profiling Reveals Clear Differences between Molecular Patterns of Wound Fluids from Acute and Chronic Wounds. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:5286785. [PMID: 30581533 PMCID: PMC6276414 DOI: 10.1155/2018/5286785] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/23/2018] [Indexed: 12/31/2022]
Abstract
Wound healing is a complex multiphase process which can be hampered by many factors including impaired local circulation, hypoxia, infection, malnutrition, immunosuppression, and metabolic dysregulation in diabetes. Redox dysregulation is a common feature of many skin diseases demonstrated by virtually all cell types in the skin with overproduction of reactive oxygen and nitrogen species. The objective of this study was to characterize the redox environment in wound fluids and sera from patients suffering from chronic leg ulcers (n = 19) and acute wounds (bulla fluids from second degree burns; n = 11) with serum data also compared to those from healthy volunteers (n = 7). Significantly higher concentrations of TNF-α, interleukine-8, vascular endothelial growth factor, and lactate dehydrogenase (measure of cell damage) were found in fluids from chronic wounds compared to acute ones. The extent of protein carbonylation (measure of protein oxidation), lipid peroxidation, and tyrosine nitration (indicator of peroxynitrite production) was similar in acute and chronic wound fluids, while radical scavenging activity and glutathione (GSH) levels were elevated in chronic wound fluids compared to acute wounds. Sera were also assessed for the same set of parameters with no significant differences detected. Nitrotyrosine (the footprint of the potent oxidant peroxynitrite) and poly(ADP-ribose) (the product of the DNA damage sensor enzyme PARP-1) could be detected in wound biopsies. Our data identify multiple signs of redox stress in chronic wounds with notable differences. In chronic wounds, elevations in antioxidant levels/activities may indicate compensatory mechanisms against inflammation. The presence of nitrotyrosine and poly(ADP-ribose) in tissues from venous leg ulcers indicate peroxynitrite production and PARP activation in chronic wounds.
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Predominance of CD14+ Cells in Burn Blister Fluids. Ann Plast Surg 2018; 80:S70-S74. [PMID: 29369908 DOI: 10.1097/sap.0000000000001305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Burn blister fluid contains several angiogenic factors to promote wound neovascularization. In our previous study, we found that deep partial-thickness burn (DPTB) wounds showed higher expression levels of angiogenin to enhance vascularization compared with superficial partial-thickness burn wounds. Neovascularization is a complex process that involves an interaction between circulating angiogenic cells and mediators. We hypothesized that in addition to angiogenic factors burn blisters may contain specific cell types. The aim of the present study was to characterize the specific cells present in burn blisters. METHODS Twenty-four burn blister fluid samples were obtained with informed consent from patients with superficial partial-thickness burn (n = 16) or DPTB (n = 8) wounds. Blister cells were isolated from individual intact blisters and characterized with flow cytometry analysis using CD14, CD34, vascular endothelial growth factor receptor 2, and CD133 markers. CD14 and CD34 blister cells were also isolated using a magnetic-activated cell sorting system to examine their potential for endothelial differentiation. Angiogenin levels in the burn blister fluids were evaluated with enzyme-linked immunosorbent assay. RESULTS CD14 cells were the most highly represented cell type in the burn fluids of both groups, although a significantly greater percentage of CD14 cells were observed in DPTB fluids. CD14 blister cells had a higher potency to differentiate into functional endothelial cells as compared with CD34 cells. The proportion of CD14 cells gradually increased after burn injury. In contrast to CD14 cells, angiogenin showed the highest expression levels at day 1 postburn. With regard to burn wound neovascularization, angiogenin expression was partially correlated with CD14 blister cells in the burn fluids. CONCLUSIONS We provide the first report on the characterization of blister cells in burn fluids. Our data suggest that CD14 blister cells may play a role in burn wound neovascularization. Measurement of CD14 blister cells serves as a possible tool for assessing burn wound status.
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Burn Eschar Stimulates Fibroblast and Adipose Mesenchymal Stromal Cell Proliferation and Migration but Inhibits Endothelial Cell Sprouting. Int J Mol Sci 2017; 18:ijms18081790. [PMID: 28820426 PMCID: PMC5578178 DOI: 10.3390/ijms18081790] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 07/31/2017] [Accepted: 08/12/2017] [Indexed: 12/03/2022] Open
Abstract
The majority of full-thickness burn wounds heal with hypertrophic scar formation. Burn eschar most probably influences early burn wound healing, since granulation tissue only forms after escharotomy. In order to investigate the effect of burn eschar on delayed granulation tissue formation, burn wound extract (BWE) was isolated from the interface between non-viable eschar and viable tissue. The influence of BWE on the activity of endothelial cells derived from dermis and adipose tissue, dermal fibroblasts and adipose tissue-derived mesenchymal stromal cells (ASC) was determined. It was found that BWE stimulated endothelial cell inflammatory cytokine (CXCL8, IL-6 and CCL2) secretion and migration. However, BWE had no effect on endothelial cell proliferation or angiogenic sprouting. Indeed, BWE inhibited basic Fibroblast Growth Factor (bFGF) induced endothelial cell proliferation and sprouting. In contrast, BWE stimulated fibroblast and ASC proliferation and migration. No difference was observed between cells isolated from dermis or adipose tissue. The inhibitory effect of BWE on bFGF-induced endothelial proliferation and sprouting would explain why excessive granulation tissue formation is prevented in full-thickness burn wounds as long as the eschar is still present. Identifying the eschar factors responsible for this might give indications for therapeutic targets aimed at reducing hypertrophic scar formation which is initiated by excessive granulation tissue formation once eschar is removed.
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Yoo K, Suh KY, Choi GH, Kwak IS, Seo DK, Kym D, Yoon H, Cho YS, Kim HO. Serial Changes of Heat Shock Protein 70 and Interleukin-8 in Burn Blister Fluid. Ann Dermatol 2017; 29:194-199. [PMID: 28392647 PMCID: PMC5383745 DOI: 10.5021/ad.2017.29.2.194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 07/22/2016] [Accepted: 07/27/2016] [Indexed: 12/22/2022] Open
Abstract
Background It has been reported that heat shock protein 70 (HSP70) and interleukin-8 (IL-8) play an important role in cells during the wound healing process. However, there has been no report on the effect of HSP70 and IL-8 on the blisters of burn patients. Objective This study aimed to evaluate the serial quantitative changes of HSP70 and IL-8 in burn blisters. Methods Twenty-five burn patients were included, for a total of 36 cases: twenty cases on the first day, six cases on the second, five cases on the third, three cases on the fourth, and two cases on the fifth. A correlation analysis was performed to determine the relationship between the concentration of HSP70 and IL-8 and the length of the treatment period. Results The HSP70 concentration was the highest on the first day, after which it decreased down to near zero. Most HSP70 was generated during the first 12 hours after the burn accident. There was no correlation between the concentration of HSP70 on the first day and the length of the treatment period. No measurable concentration of IL-8 was detected before 5 hours, but the concentration started to increase after 11 hours. The peak value was measured on the fourth day. Conclusion While HSP70 increased in the first few hours and decreased afterwards, IL-8 was produced after 11 hours and increased afterward in burn blister fluid. These findings provide new evidence on serial changes of inflammatory mediators in burn blister fluid.
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Affiliation(s)
- Kicheol Yoo
- Department of Emergency Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Kang Yeol Suh
- Department of Emergency Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Gi Hun Choi
- Department of Emergency Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - In-Suk Kwak
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Dong Kook Seo
- Department of Plasticsurgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Dohern Kym
- Department of Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyeon Yoon
- Burn Institute, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yong Se Cho
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hye One Kim
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Topical Negative Pressure on Burns: An Innovative Method for Wound Exudate Collection. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1117. [PMID: 27975022 PMCID: PMC5142488 DOI: 10.1097/gox.0000000000001117] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 09/13/2016] [Indexed: 12/16/2022]
Abstract
Supplemental Digital Content is available in the text. Burn wound exudate is an important source of information on the wound-healing process and systemic improvement of burn patients. Identification of biomarkers for the prediagnosis of local or systemic complications in patients will have a great impact on adapting personalized procedures in burn treatment. No efficient exudate collection method exists that offers a direct and continuous collection over time. We developed an innovative system based on the negative pressure wound therapy technique to directly collect exudate from burn wounds over several days after burn. This method did not cause any complication or pain for patients, and positive influence on wound healing was seen. Exudate samples were further used in different projects for studying biochemical profile, trace element content, kinetics of bacterial growth, and cell cytotoxicity.
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Banyard DA, Adnani BO, Melkumyan S, Araniego CA, Widgerow AD. Endothelial progenitor cells and burn injury - exploring the relationship. BURNS & TRAUMA 2016; 4:4. [PMID: 27574674 PMCID: PMC4964096 DOI: 10.1186/s41038-016-0028-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 01/13/2016] [Indexed: 12/25/2022]
Abstract
Burn wounds result in varying degrees of soft tissue damage that are typically graded clinically. Recently a key participant in neovascularization, the endothelial progenitor cell, has been the subject of intense cardiovascular research to explore whether it can serve as a biomarker for vascular injury. In this review, we examine the identity of the endothelial progenitor cell as well as the evidence that support its role as a key responder after burn insult. While there is conflicting evidence with regards to the delta of endothelial progenitor cell mobilization and burn severity, it is clear that they play an important role in wound healing. Systematic and controlled studies are needed to clarify this relationship, and whether this population can serve as a biomarker for burn severity.
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Affiliation(s)
- Derek A Banyard
- Department of Plastic Surgery, Center for Tissue Engineering, University of California, Irvine, 200S Manchester Ave, Ste 650, Orange, CA 92868 USA
| | - Blake O Adnani
- Department of Plastic Surgery, Center for Tissue Engineering, University of California, Irvine, 200S Manchester Ave, Ste 650, Orange, CA 92868 USA
| | - Satenik Melkumyan
- Department of Plastic Surgery, Center for Tissue Engineering, University of California, Irvine, 200S Manchester Ave, Ste 650, Orange, CA 92868 USA
| | - Cheryl Ann Araniego
- Department of Plastic Surgery, Center for Tissue Engineering, University of California, Irvine, 200S Manchester Ave, Ste 650, Orange, CA 92868 USA
| | - Alan D Widgerow
- Department of Plastic Surgery, Center for Tissue Engineering, University of California, Irvine, 200S Manchester Ave, Ste 650, Orange, CA 92868 USA
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Mirdell R, Iredahl F, Sjöberg F, Farnebo S, Tesselaar E. Microvascular blood flow in scalds in children and its relation to duration of wound healing: A study using laser speckle contrast imaging. Burns 2016; 42:648-54. [PMID: 26810445 DOI: 10.1016/j.burns.2015.12.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 11/09/2015] [Accepted: 12/05/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Microvascular perfusion changes in scalds in children during the first weeks after injury is related to the outcome of healing, and measurements of perfusion, based on laser Doppler imaging, have been used successfully to predict the need for excision and grafting. However, the day-to-day changes in perfusion during the first weeks after injury have not to our knowledge been studied in detail. The aim of this study, based on a conservative treatment model where excision and grafting decisions were delayed to day 14 after injury, was to measure changes in perfusion in scalds using laser speckle contrast imaging (LSCI) during the first three weeks after injury. METHODS We measured perfusion with LSCI in 34 patients at regular intervals between 6h after injury until complete reepithelialization or surgery. Duration of healing was defined as the time to complete reepithelialization. RESULTS Less perfusion, between 6 and 96h after injury, was associated with longer duration of healing with the strongest association occurring between 72 and 96h. Burns that healed within 14 days had relatively high initial perfusion, followed by a peak and subsequent slow decrease. Both the maximum perfusion and the time-to-peak were dependent on the severity of the burn. Burns that needed excision and grafting had less initial perfusion and a gradual reduction over time. CONCLUSION The perfusion in scalds in children shows characteristic patterns during the first weeks after injury depending on the duration of wound healing, the greatest difference between wounds of different severity being on the 4th day. Perfusion should therefore preferably be measured on the fourth day if it is to be used in the assessment of burn depth.
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Affiliation(s)
- Robin Mirdell
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Fredrik Iredahl
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Folke Sjöberg
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Hand and Plastic Surgery and Burns, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Simon Farnebo
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Hand and Plastic Surgery and Burns, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Erik Tesselaar
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Radiation Physics and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
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Human Amniotic Membrane as a Biological Source for Regenerative Medicine. PERINATAL TISSUE-DERIVED STEM CELLS 2016. [DOI: 10.1007/978-3-319-46410-7_5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Zang T, Broszczak DA, Broadbent JA, Cuttle L, Lu H, Parker TJ. The biochemistry of blister fluid from pediatric burn injuries: proteomics and metabolomics aspects. Expert Rev Proteomics 2015; 13:35-53. [PMID: 26581649 DOI: 10.1586/14789450.2016.1122528] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Burn injury is a prevalent and traumatic event for pediatric patients. At present, the diagnosis of burn injury severity is subjective and lacks a clinically relevant quantitative measure. This is due in part to a lack of knowledge surrounding the biochemistry of burn injuries and that of blister fluid. A more complete understanding of the blister fluid biochemistry may open new avenues for diagnostic and prognostic development. Burn insult induces a highly complex network of signaling processes and numerous changes within various biochemical systems, which can ultimately be examined using proteome and metabolome measurements. This review reports on the current understanding of burn wound biochemistry and outlines a technical approach for 'omics' profiling of blister fluid from burn wounds of differing severity.
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Affiliation(s)
- Tuo Zang
- a Tissue Repair and Regeneration Program , Institute of Health and Biomedical Innovation , Kelvin Grove , Australia.,b School of Biomedical Sciences , Queensland University of Technology , Brisbane , Australia.,c Wound Management Innovation Co-operative Research Centre , West End , Australia
| | - Daniel A Broszczak
- a Tissue Repair and Regeneration Program , Institute of Health and Biomedical Innovation , Kelvin Grove , Australia.,b School of Biomedical Sciences , Queensland University of Technology , Brisbane , Australia.,c Wound Management Innovation Co-operative Research Centre , West End , Australia
| | - James A Broadbent
- a Tissue Repair and Regeneration Program , Institute of Health and Biomedical Innovation , Kelvin Grove , Australia.,b School of Biomedical Sciences , Queensland University of Technology , Brisbane , Australia.,c Wound Management Innovation Co-operative Research Centre , West End , Australia
| | - Leila Cuttle
- a Tissue Repair and Regeneration Program , Institute of Health and Biomedical Innovation , Kelvin Grove , Australia.,b School of Biomedical Sciences , Queensland University of Technology , Brisbane , Australia.,d Centre for Children's Burns and Trauma Research , Queensland University of Technology, Institute of Health and Biomedical Innovation at the Centre for Children's Health Research , South Brisbane , Australia
| | - Haitao Lu
- a Tissue Repair and Regeneration Program , Institute of Health and Biomedical Innovation , Kelvin Grove , Australia.,b School of Biomedical Sciences , Queensland University of Technology , Brisbane , Australia
| | - Tony J Parker
- a Tissue Repair and Regeneration Program , Institute of Health and Biomedical Innovation , Kelvin Grove , Australia.,b School of Biomedical Sciences , Queensland University of Technology , Brisbane , Australia
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Pan BS, Vu AT, Yakuboff KP. Management of the Acutely Burned Hand. J Hand Surg Am 2015; 40:1477-84; quiz 1485. [PMID: 26043803 DOI: 10.1016/j.jhsa.2015.02.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 02/14/2015] [Accepted: 02/21/2015] [Indexed: 02/02/2023]
Abstract
Despite contributing a small percentage to the total body surface area, hands are the most commonly burned body part and are involved in over 90% of severe burns. Although the mortality of isolated hand burns is negligible, morbidity can be substantial given our need for functioning hands when performing activities of daily living. The greatest challenges of treating hand burns are 2-fold. First, determining the depth of injury can be difficult even for the most experienced surgeon, but despite many diagnostic options, clinical examination remains the gold standard. Second, appropriate postoperative hand therapy is crucial and requires a multidisciplinary approach with an experienced burn surgeon, hand surgeon, and hand therapist. Ultimately, the goals of treatment should include preservation of function and aesthetics. In this review, we present an approach to the management of the acutely burned hand with discussion of both conservative and surgical options. Regardless of the initial treatment decision, subsequent care for this subset of patients should be aimed at preventing debilitating postburn scar contractures that can severely limit hand function and ultimately require reconstructive surgery.
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Affiliation(s)
- Brian S Pan
- Division of Pediatric Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Anthony T Vu
- Division of Plastic, Reconstructive, Hand and Burn Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kevin P Yakuboff
- Division of Pediatric Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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Tanzer C, Sampson DL, Broadbent JA, Cuttle L, Kempf M, Kimble RM, Upton Z, Parker TJ. Evaluation of haemoglobin in blister fluid as an indicator of paediatric burn wound depth. Burns 2015; 41:1114-21. [PMID: 25637955 DOI: 10.1016/j.burns.2014.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 12/21/2014] [Accepted: 12/25/2014] [Indexed: 01/13/2023]
Abstract
The early and accurate assessment of burns is essential to inform patient treatment regimens; however, this first critical step in clinical practice remains a challenge for specialist burns clinicians worldwide. In this regard, protein biomarkers are a potential adjunct diagnostic tool to assist experienced clinical judgement. Free circulating haemoglobin has previously shown some promise as an indicator of burn depth in a murine animal model. Using blister fluid collected from paediatric burn patients, haemoglobin abundance was measured using semi-quantitative Western blot and immunoassays. Although a trend was observed in which haemoglobin abundance increased with burn wound severity, several patient samples deviated significantly from this trend. Further, it was found that haemoglobin concentration decreased significantly when whole cells, cell debris and fibrinous matrix was removed from the blister fluid by centrifugation; although the relationship to depth was still present. Statistical analyses showed that haemoglobin abundance in the fluid was more strongly related to the time between injury and sample collection and the time taken for spontaneous re-epithelialisation. We hypothesise that prolonged exposure to the blister fluid microenvironment may result in an increased haemoglobin abundance due to erythrocyte lysis, and delayed wound healing.
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Affiliation(s)
- Catherine Tanzer
- Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia; School of Biomedical Science, Faculty of Health, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia; Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, Royal Children's Hospital, Herston, Brisbane, QLD, Australia; Wound Management Innovation Co-operative Research Centre, Kelvin Grove, Brisbane, QLD, Australia.
| | - Dayle L Sampson
- Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia; School of Biomedical Science, Faculty of Health, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia; Wound Management Innovation Co-operative Research Centre, Kelvin Grove, Brisbane, QLD, Australia.
| | - James A Broadbent
- Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia; School of Biomedical Science, Faculty of Health, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia; Wound Management Innovation Co-operative Research Centre, Kelvin Grove, Brisbane, QLD, Australia.
| | - Leila Cuttle
- Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia; School of Biomedical Science, Faculty of Health, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia; Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, Royal Children's Hospital, Herston, Brisbane, QLD, Australia.
| | - Margit Kempf
- Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, Royal Children's Hospital, Herston, Brisbane, QLD, Australia.
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, Royal Children's Hospital, Herston, Brisbane, QLD, Australia.
| | - Zee Upton
- Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia; School of Biomedical Science, Faculty of Health, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia.
| | - Tony J Parker
- Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia; School of Biomedical Science, Faculty of Health, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia.
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15
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Wang X, Zhang Y, Han C. Angiogenin, an angiogenic factor with potential for tissue engineering applications. Wound Repair Regen 2014; 22:288-9. [PMID: 24635180 DOI: 10.1111/wrr.12150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Xingang Wang
- Department of Burns & Wound Care Centre, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
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16
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Widgerow AD, King K, Tocco-Tussardi I, Banyard DA, Chiang R, Awad A, Afzel H, Bhatnager S, Melkumyan S, Wirth G, Evans GRD. The burn wound exudate-an under-utilized resource. Burns 2014; 41:11-7. [PMID: 24986597 DOI: 10.1016/j.burns.2014.06.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 04/11/2014] [Accepted: 06/04/2014] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The burn wound exudate represents the burn tissue microenvironment. Extracting information from the exudate relating to cellular components, signaling mediators and protein content can provide much needed data relating to the local tissue damage, depth of the wound and probable systemic complications. This review examines the scientific data extracted from burn wound exudates over the years and proposes new investigations that will provide useful information from this underutilized resource. METHOD A literature review was conducted using the electronic database PubMed to search for literature pertaining to burn wound or blister fluid analysis. Key words included burn exudate, blister fluid, wound exudate, cytokine burn fluid, subeschar fluid, cytokine burns, serum cytokines. 32 relevant articles were examined and 29 selected as relevant to the review. 3 papers were discarded due to questionable methodology or conclusions. The reports were assessed for their affect on management decisions and diagnostics. Furthermore, traditional blood level analysis of these mediators was made to compare the accuracy of blood versus exudate in burn wound management. Extrapolations are made for new possibilities of burn wound exudate analysis. RESULTS Studies pertaining to burn wound exudate, subeschar fluid and blister fluid analyses may have contributed to burn wound management decisions particularly related to escharectomies and early burn wound excision. In addition, information from these studies has the potential to impact on areas such as healing, scarring, burn wound conversion and burn wound depth analysis. CONCLUSION Burn wound exudate analysis has proven useful in burn wound management decisions. It appears to offer a far more accurate reflection of the burn wound pathophysiology than the traditional blood/serum investigations undertaken in the past. New approaches to diagnostics and treatment efficacy assessment are possible utilizing data from this fluid. Burn wound exudate is a useful, currently under-utilized resource that is likely to take a more prominent role in burn wound management.
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Affiliation(s)
- Alan D Widgerow
- Director Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States.
| | - Kassandra King
- Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States
| | - Ilaria Tocco-Tussardi
- Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States
| | - Derek A Banyard
- Research Fellow Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States
| | - Ryan Chiang
- Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States
| | - Antony Awad
- Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States
| | - Hassan Afzel
- Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States
| | - Shweta Bhatnager
- Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States
| | - Satenik Melkumyan
- Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States
| | - Garrett Wirth
- Plastic Surgery Dept, University of California, Irvine, United States
| | - Gregory R D Evans
- Plastic Surgery Dept, University of California, Irvine, United States
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17
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Pan SC. Burn blister fluids in the neovascularization stage of burn wound healing: A comparison between superficial and deep partial-thickness burn wounds. BURNS & TRAUMA 2013; 1:27-31. [PMID: 27574619 PMCID: PMC4994503 DOI: 10.4103/2321-3868.113332] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Burn wound healing is a complex and dynamic process that involves the interaction between different cell types and mediators. Neovascularization is an imperative stage of wound healing and consists of not only angiogenesis but also adult vasculogenesis. A superficial partial-thickness burn (SPTB) heals within 2 weeks without scarring. A deep partial-thickness burn (DPTB), conversely, requires 2 weeks or longer to heal and requires an aggressive treatment to prevent hypertrophic scarring. Burn blisters on the skin are a hallmark of not only SPTB but also DPTB; however, the effect of burn blister fluids on the neovascularization in these types of burns has not been fully explored. To verify this effect, the role of different burn fluids and the angiogenic factors that modulate this process are currently under investigation.
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Affiliation(s)
- Shin-Chen Pan
- Department of Surgery, Section of Plastic and Reconstructive Surgery, National Cheng Kung University Medical College and Hospital, 138 Sheng Li RD, Tainan
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18
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Pan SC, Wu LW, Chen CL, Shieh SJ, Chiu HY. Angiogenin expression in burn blister fluid: Implications for its role in burn wound neovascularization. Wound Repair Regen 2012; 20:731-9. [DOI: 10.1111/j.1524-475x.2012.00819.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 04/29/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | - Li-Wha Wu
- Institute of Molecular Medicine and Cardiovascular Research Center; National Cheng Kung University Medical College and Hospital; Tainan; Taiwan
| | - Chung-Lin Chen
- Department of Surgery, Section of Plastic and Reconstructive Surgery; National Cheng Kung University Medical College and Hospital; Tainan; Taiwan
| | - Shyh-Jou Shieh
- Department of Surgery, Section of Plastic and Reconstructive Surgery; National Cheng Kung University Medical College and Hospital; Tainan; Taiwan
| | - Haw-Yen Chiu
- Department of Surgery, Section of Plastic and Reconstructive Surgery; National Cheng Kung University Medical College and Hospital; Tainan; Taiwan
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