Burn Wound Healing: Clinical Complications, Medical Care, Treatment, and Dressing Types: The Current State of Knowledge for Clinical Practice

Green synthesis of magnesium oxide nanoparticles using the extract of Falcaria vulgaris to enhance the healing of burn wounds

Treating burn lesions has always been challenging because any product should be cheap, accessible, and have anti-bacterial commodities and tissue regeneration properties. The green synthesis of magnesium oxide nanoparticles (GS-MgONPs) can create an optimal prospect that is safe with low toxicity in biological tissue and better safety for application while including the antibacterial effect. This recent study aimed to evaluate the effectiveness of burn wound treatment using GS-MgONPs in rats. GS-MgONPs were synthesised for the first time using a Falcaria vulgaris extract (FVE) and characterised. Thirty male Wistar rats were divided into five groups: An untreated group, conventional product treated group, GS-MgONPs (1 wt%), GS-MgONPs (3 wt%) and 5. FVE (1 wt%). Treatments commenced immediately following burn induction and were administered daily for a duration of 21 d. GS-MgONPs showed a spherical morphology with a diameter of less than 100 nm. The NPs (1% and 3 wt%) and FVE demonstrated significant growth inhibition against Staphylococcus aureus while showing no cytotoxic effects on human fibroblast cells. The proposed subjects treated with 1 wt% and 3 wt% GS-MgONPs were able to significantly increase the rate of wound closure (p < 0.05). Histological observations revealed that collagen formation and epithelial regeneration were more pronounced in the groups receiving 1 wt% and 3 wt% MgONPs. These results indicate that GS-MgONPs effectively enhance the regeneration process.

BSP promotes skin wound healing by regulating the expression level of SCEL

Burn injuries are complex, life-threatening events involving intricate cellular and molecular processes, including angiogenesis, which is vital for effective wound healing. Bletilla striata polysaccharide (BSP), a bioactive compound from Bletilla striata, exhibits anti-inflammatory and wound-healing properties. However, its impact on angiogenesis modulation, particularly through the synaptopodin-2-like (SCEL) gene, remains poorly understood. The effects of BSP on HMEC-1 cells exposed to lipopolysaccharide (LPS) were assessed using cell viability, migration, apoptosis, and angiogenesis assays. SCEL's role was explored through lentiviral transfection to manipulate SCEL expression. Animal models were employed to evaluate BSP's therapeutic potential in burn wound healing, with histological analysis, immunohistochemistry (IHC), and molecular assays to assess tissue repair and angiogenesis. BSP significantly alleviated LPS-induced damage in HMEC-1 cells by promoting cell survival, reducing apoptosis, and enhancing migration and angiogenesis. BSP treatment downregulated SCEL expression, reversing LPS-induced cellular damage. In SCEL-overexpressing cells and mice, BSP's beneficial effects on wound healing were attenuated, indicating SCEL's regulatory role in angiogenesis. In vivo, BSP accelerated burn wound closure, improved tissue organization, and enhanced angiogenesis, as evidenced by increased CD31 expression. SCEL overexpression impaired these effects, highlighting the essential role of SCEL downregulation in BSP-mediated healing. BSP promotes burn wound healing by modulating angiogenesis via SCEL downregulation, facilitating cell survival, migration, and vascularization. These findings position BSP as a promising therapeutic agent for burn wound treatment, with further investigation into SCEL's molecular mechanisms offering potential for novel wound care strategies.

Advancing Therapeutic Solutions for Burn Wounds: Potential Use of Noninvasive Ultrasound-Driven Splenic Stimulation

Significance: Burn wound injuries are a global health challenge, affecting millions annually and resulting in significant morbidity, mortality, and economic burden. The urgent need for accessible and cost-effective therapeutic alternatives, especially for underserved populations, has driven interest in novel approaches such as noninvasive splenic stimulation using pulsed-focused ultrasound (pFUS). This technique targets systemic inflammation, a key factor in delayed wound healing, offering a potential shift in burn care management. Recent Advances: Preclinical studies have shown that pFUS applied to the spleen can accelerate wound healing by activating the cholinergic anti-inflammatory pathway, promoting pro-angiogenic and anti-inflammatory responses. While current treatments-including biologics, antioxidants, and growth factors-have limitations, pFUS presents a noninvasive alternative. One interventional study and ongoing clinical trials are now investigating its application in burn wound care, marking an important step toward clinical translation. Critical Issues: Despite encouraging results, research on splenic stimulation for wound healing remains limited. The small number of studies highlights the need for further investigation into the underlying mechanisms, optimal treatment parameters, and potential risks. Additionally, the scalability and cost-effectiveness of pFUS in diverse clinical settings require thorough evaluation. Future Directions: Ongoing clinical trials will provide critical data on the efficacy and safety of splenic pFUS in burn patients. Future research should focus on expanding clinical studies, refining stimulation protocols, and exploring its broader application in tissue repair. If validated, this approach could offer a cost-effective, noninvasive treatment, particularly valuable in socioeconomically challenged regions.

Association between Intestinal Flora Metabolites and Coronary Artery Vulnerable Plaque Characteristics in Coronary Heart Disease

Aims/Background The incidence of coronary heart disease (CHD) has been increasing annually. Patients with severe conditions may die from myocardial infarction, heart failure or malignant arrhythmia. Intestinal flora plays an important role in various metabolic processes, such as atherosclerosis, tumour formation, and inflammation. However, its direct role in promoting plaque vulnerability must be further explored and validated. Therefore, this study aims to explore the relationship between changes in intestinal flora, its metabolites in CHD patients and the vulnerability characteristics of coronary plaques. Methods This study recruited 180 subjects, among these, 90 CHD patients diagnosed between January 2023 and January 2024 were selected as the CHD group and 90 healthy volunteers were selected as the control group following a principle of 1:1 ratio. The differences in intestinal flora composition, metabolite levels, and blood biochemical indexes were compared between the two study groups. Based on the coronary angiography (CAG) and intravascular ultrasound (IVUS) results, the CHD group was divided into two sub-groups for stratified comparative analysis: the stable plaque group (n = 49) and the vulnerable plaque group (n = 41). Results The CHD group had reduced intestinal Bifidobacteria and lactic acid bacteria counts and higher intestinal Escherichia coli and Enterococcus levels than the control group (p < 0.05). Moreover, trimethylamine-N-oxide (TMAO) and phenylacetylglutamine (PAGln) levels were significantly higher in the CHD group compared to the control group (p < 0.05). Similarly, the CHD group exhibited substantially elevated serum triglyceride (TG), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) levels compared to the control group. However, compared to the control group, the high-density lipoprotein cholesterol (HDL-C) levels were significantly lower in the CHD group (p < 0.05). Furthermore, the serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum urea nitrogen (BUN), and serum creatinine (Scr) were comparable in the two experimental groups (p > 0.05). Similarly, intestinal Bifidobacteria, lactic acid bacteria, Escherichia coli, and Enterococcus compositions were comparable in CHD patients with vulnerable plaque and those with stable plaque (p > 0.05). Moreover, CHD patients with vulnerable plaque had elevated TMAO and PAGln levels than those with stable plaque (p < 0.05). However, TG, TC, HDL-C, LDL-C, ALT, AST, BUN, and Scr levels were comparable between CHD patients with a vulnerable plaque and those with stable plaque (p > 0.05). Multivariate regression analysis showed that diabetes, elevated TMAO levels, and elevated PAGln levels were potential risk factors for coronary plaque vulnerability (p < 0.05). Conclusion In summary, CHD patients exhibit significant intestinal flora imbalance, with elevated TMAO and PAGln metabolite levels, which are related to the characteristics of plaque instability.

Comparison of Efficacy and Safety between Two Silver-Containing Dressings in the Treatment of Deep Partial-Thickness Thermal Burns: A Multicenter, Double-Blind, Non-Inferiority, Randomized Clinical Trial

Aims/Background Silver-containing dressings are commonly utilized in burns treatment by virtue of their excellent antibacterial properties. Further research is needed to determine the type of silver-containing dressing that is more effective and safer for burns treatment. Pyperbranched polyamide-Ag dressing (HBPs-Ag dressing) is a modified polyamide dressing with a uniform coating of the Amino-terminated hyperbranched polymer (HBP-NH2)/Ag+ compound on its surface. This study aimed to evaluate the efficacy and safety of a silver ion-containing dressing (HBPs-Ag) for wound contact layer in the treatment of deep partial-thickness burns versus a silver-impregnated tulle dressing (Atrauman Ag). Methods This study was conducted between October 2019 to January 2021 at six sites in China. A total of 132 patients with deep partial-thickness burns (aged 18-65 years, injury occurring within 72 hours, burns <30% total burn surface area) were randomized 1:1 to HBPs-Ag group (study group) or Atrauman Ag group (control group). Data were obtained and analyzed, including total efficacy, wound healing rate, wound healing time, rate of negative bacterial culture from wound secretions, systemic response, skin or tissue irritation, local skin color changes, wound swelling, wound pain and adverse events. Results For partial thickness burns, the HBPs-Ag dressing was not inferior to Atrauman Ag dressing because the total efficiency of HBPs-Ag group (98.3%) was comparable to that of Atrauman Ag group (94.7%) (p > 0.05). There were no significant differences in efficacy, wound healing rate, wound healing time, and rate of negative bacterial culture from wound secretions between the two groups (p > 0.05). There were no statistical differences in all safety indicators tested between the two groups (p > 0.05). Silver was detected in the blood or urine of only 5 patients (3.79%). Conclusion The HBPs-Ag dressing was not inferior to Atrauman Ag dressing in deep partial-thickness burns treatment, with both of them showcasing comparable efficacy and safety. Clinical Trial Registration Chinese Clinical Trial Registry (ChiCTR2100049814).

Enhancing burn wound care with pre-crosslinked 3D-printed patches: Bromelain delivery and aloe vera bioactives integration for improved healing outcomes

Burn wounds remain a major clinical challenge due to the limitations of traditional dressings, which often fail to address the diverse needs of patients and varying wound types. This study aimed to advance burn care by developing a 3D-printed patch incorporating natural bioactive compounds from bromelain and aloe vera. The patch was formulated using pre-crosslinked chitosan and alginate hydrogels to ensure suitability for 3D printing and subsequent use. Rheological analysis revealed weak gel behaviour and shear-thinning properties, ensuring excellent printability. The patches exhibited outstanding swelling behaviour and controlled degradation (30 %), alongside notable antioxidant and anti-inflammatory potential, with a polyphenolic content of 1.43 ± 0.07 mg CAE/g and effective scavenging of DPPH, ABTS, and NO radicals, with IC50 values of 29.51 ± 0.30, 10.31 ± 0.28, and 5.94 ± 0.42 mg/mL, respectively. Bioactive compounds from bromelain were consistently released across various pH levels, supporting their therapeutic efficacy. Cell viability studies confirmed strong support for cell growth, while in vitro scratch tests demonstrated biocompatibility and promotion of wound closure. Histological analysis of ex vivo burn models revealed cellular necrosis and protein denaturation characteristic of burn wounds. Application of the patches significantly improved epidermal morphology and enhanced proliferation markers such as Ki67 and α-SMA, indicative of accelerated wound healing. While further clinical validation is needed, these findings underscore the potential of the 3D-printed patches as an innovative solution for burn wound care, offering improved bioactive delivery and enhanced healing outcomes compared to conventional dressings.

Management of Acute Hand Burns: A Survey of American Burn Association-Verified Burn Centers

Hand burns have a significant impact on the long-term function of burn patients. Recently, new protocols and technologies, such as dermal substitutes, have been introduced for the treatment of hand burns. This cross-sectional study investigates the preferred current management of acute hand burns and the role of dermal substitutes in treatment. A 10-question survey related to acute hand burns management was sent to 64 directors of American Burn Association (ABA)-verified burn centers. A total of 51.6% (n = 33) directors of ABA-verified burn centers responded to the survey. For the treatment of superficial partial-thickness hand burns, 90.9% preferred a nonoperative approach. Conversely, most respondents chose a single-stage excision and skin graft for deep partial-thickness hand burns (75.8%) and full-thickness hand burns (51.5%). However, for full-thickness hand burns, some surgeons prefer a 2-stage reconstruction involving excision and placement of a skin substitute (27.3%) or allograft (9.1%), followed by a skin graft. Only 6.1% would utilize a 3-stage reconstruction involving excision and allograft, excision and skin substitute, followed by skin grafting. Among surgeons who used skin substitutes (n = 26), Integra (42.3%) and Novosorb-Biodegradable Temporizing Matrix (23.1%) were preferred. The top reasons for choosing 1 specific dermal substitute were surgeon's preference (n = 20; 76.9%) and cost (n = 9; 34.6%). While a conservative nonoperative approach is preferred for superficial partial-thickness hand burns, excision and skin grafting as a 1-stage procedure remains the most common strategy for deep partial-thickness and full-thickness hand burns.

The Individual-Level and Community-Level Social Determinants of Burn Injuries: A Single-Institution Study From the Southwestern United States

Burn injuries are a significant public health concern, causing life-threatening complications and substantial hospitalization costs for patients. It has been shown that burn injuries may affect individuals differently based on demographic factors and socioeconomic status, among other variables. In the Southwestern United States with high ambient temperatures, specific burn etiologies, such as pavement burns, may pose a disproportionately high risk for disadvantaged communities and homeless individuals. This study uniquely explores burn injuries in relation to patients' socioeconomic status in Las Vegas, Nevada by using the Distressed Community Index to quantify socioeconomic status utilizing individual-level and community-level indicators. This single-institution and retrospective study collected data from all patients admitted to a burn center located in Las Vegas. Data were analyzed through Chi-square, one-way ANOVA, and post-hoc analysis with Tukey's test. Patients residing in distressed communities contributed to the greatest number of burn injuries; however, there was a lack of significant association between socioeconomic status and burn injury (P = 202). Additionally, specific burn etiologies and demographic characteristics were associated with variations in burn patient hospital course, complications, resources utilized and outcomes. Distressed patients were significantly associated with public insurance (P < 0.001), and public insurance users were associated with pavement burns-one of the most severe burn injuries (P < 0.001). This study emphasizes the importance of developing comprehensive burn prevention resources tailored to vulnerable populations, especially in regions with increased incidence of severe burn injuries, in order to reduce burn burden and mortality.

A Review of the Development of Biopolymer Hydrogel-Based Scaffold Materials for Drug Delivery and Tissue Engineering Applications

Biopolymer hydrogel-based scaffold materials have received a lot of interest in tissue engineering and regenerative medicine because of their unique characteristics, which include biocompatibility, biodegradability, and the ability to replicate the natural extracellular matrix (ECM). These hydrogels are three-dimensional biopolymer networks that are highly hydrated and provide a supportive, wet environment conducive to cell growth, migration, and differentiation. They are especially useful in applications involving wound healing, cartilage, bone, and soft tissue regeneration. Natural biopolymers such as collagen, chitosan, hyaluronic acid, and alginate are frequently employed as the foundation for hydrogel fabrication, providing benefits such as low toxicity and improved cell adherence. Despite their potential, biopolymer hydrogel scaffolds have various difficulties that prevent broad clinical implementation. Key difficulties include the challenge of balancing mechanical strength and flexibility to meet the needs of various tissues, managing degradation rates to line up with tissue regeneration, and assuring large-scale manufacturing while retaining scaffold uniformity and quality. Furthermore, fostering appropriate vascularization and cell infiltration in larger tissues remains a significant challenge for optimal tissue integration and function. Future developments in biopolymer hydrogel-based scaffolds are likely to concentrate on addressing these obstacles. Strategies such as the creation of hybrid hydrogels that combine natural and synthetic materials, smart hydrogels with stimulus-responsive features, and 3D bioprinting technologies for accurate scaffold production show significant potential. Furthermore, integrating bioactive compounds and growth factors into hydrogel matrices to promote tissue regeneration is critical for enhancing therapeutic results.

Effects of black mulberry, chokeberry, and elderberry extracts on the healing of burn wounds

BACKGROUND

In the burn affected area of the skin, the progression or deepening of wounds is related to oxidative stress. Especially in the highly susceptible stasis zone, tissues survive to the extent that they can cope with oxidative stress.

OBJECTIVE

This study investigated the potential of extracts (E) derived from the fruits (F) and leaves (L) of elderberry (E), chokeberry (C), and black mulberry (M), which are rich in antioxidant properties, to enhance the recovery of the stasis zone in burn wounds.

METHODS

The study employed a sample size of 56 healthy rats. The comb burn model was used. The rats were administered the extracts via gastric gavage for a period of 21 days. Histological examination and biochemical analyses were conducted on biopsies taken from the stasis zone on the 3rd, 7th, and 21st days of the study. Photography was performed for macroscopic evaluations. The histological assays included the evaluation of inflammatory cell infiltration, reepithelialization, and collagenization, as well as immunohistochemical analysis of vascular endothelial growth factor (VEGF). Bioassays pertaining to the enzymatic activities of catalase, superoxide dismutase, glutathione peroxidase, and malondialdehyde (MDA) levels were performed.

RESULTS

In macroscopic evaluation, a significant difference was found between the groups in terms of stasis area (F=3.58, p2< 0.001). Post-hoc analyses showed that there was a significant difference between CFE-ELE, EFE-Burn, ELE-Burn and MLE-Burn groups in terms of stasis zones (p < 0.05). However, the difference between the groups according to time was not significant (F=1.36, p = 0.16). At the end of the 21-day experiment, inflammatory cell infiltration was higher in the burn group compared to the other groups, but similar to the CFE group. Re-epithelialization was similar in the burn group compared to the fruit extract groups and significantly lower compared to the leaf extract groups. Furthermore, a significant increase in collagenization and VEGF immunoreactivity was observed in all treatment groups compared to the burn group (p < 0.05). However, no significant difference was detected between the treatment groups. The treatment groups presented a notable reduction in MDA levels in comparison to the burn group (p < 0.001).

CONCLUSION

This study demonstrated the efficacy of fruit and leaf extracts in burn healing. Histological examination revealed that leaf extracts exhibited superior healing effects compared to fruit extracts. These results suggest that bioactive components in fruits and leaves may have different biological effects.

Unfolded protein responses: Dynamic machinery in wound healing

Skin wound healing is a dynamic process consisting of multiple cellular and molecular events that must be tightly coordinated to repair the injured tissue efficiently. The healing pace is decided by the type of injuries, the depth and size of the wounds, and whether wound infections occur. However, aging, comorbidities, genetic factors, hormones, and nutrition also impact healing outcomes. During wound healing, cells undergo robust processes of synthesizing new proteins and degrading multifunctional proteins. This imposes an increasing burden on the endoplasmic reticulum (ER), causing ER stress. Unfolded protein response (UPR) represents a collection of highly conserved stress signaling pathways originated from the ER to maintain protein homeostasis and modulate cell physiology. UPR is known to be beneficial for tissue healing. However, when excessive ER stress exceeds ER's folding potential, UPR pathways trigger cell apoptosis, interrupting tissue regeneration. Understanding how UPR pathways modulate the skin's response to injuries is critical for new interventions toward the control of acute and chronic wounds. Herein, in this review, we focus on the participation of the canonical and noncanonical UPR pathways during different stages of wound healing, summarize the available evidence demonstrating UPR's unique position in balancing homeostasis and pathophysiology of healing tissues, and highlight the understudied areas where therapeutic opportunities may arise.

Differentiation of antimicrobial toxicity and sepsis-induced disseminated intravascular coagulation in an orthopedic burn patient in India: a case report

Drug-induced thrombocytopenia, hemolytic anemia, and leukopenia are serious, and sometimes fatal, complications of common medications. These conditions are challenging to diagnose in patients with polytrauma injuries due to the presence of multiple potential etiologies. In such clinical scenarios, sepsis-induced disseminated intravascular coagulation is a more frequent diagnosis. The clinical manifestations of these conditions can be indistinguishable. We present the case of a 32-year-old man who sustained a left open grade 2 leg fracture and 18% to 20% second-degree superficial electrical flash burns on his right leg. Following primary management, skin testing for antibiotic sensitivity was performed, and prophylactic therapy with ceftriaxone, gentamycin, and metronidazole was initiated for the grossly contaminated wounds. On the second day of emergency admission, the patient developed hepatorenal dysfunction accompanied by severe thrombocytopenia (<30×103/mm3). The suspected antimicrobial agents were discontinued by the third day. Within 48 hours, the patient's hepatorenal function markedly improved; however, the blood dyscrasia progressed to severe pancytopenia over the next few days. Despite worsening parameters, the patient's vitals were maintained, and he exhibited no overt bleeding. On the fourth day, the patient developed opportunistic fungal bronchopneumonia, indicated by bilateral lower lobe infiltrates on chest x-ray and an elevated serum galactomannan level. He received supportive care, broad-spectrum antibiotics, and antifungal treatment, with a full recovery within 2 weeks. Antibiotic toxicity must be distinguished from other medical conditions to ensure appropriate management and a favorable prognosis.

Postacute Overview of Burn Injuries: Pathophysiology, Management, and Future Directions

This article provides a comprehensive overview of the pathophysiology, treatment methods, outpatient rehabilitation, and future directions related to burn injuries. It details the classification of burns, treatment strategies, wound care management, and rehabilitation processes. Modern approaches, such as AI-supported models and telemedicine, are highlighted in burn treatment. The article aims to present evidence-based best practices in burn care to healthcare professionals, offering insights into future research areas. Emphasis is placed on how recent innovations and technological advancements in burn management can improve patient outcomes.

Physicochemically Cross-linked Injectable Hydrogel: an Adhesive Skin Substitute for Burned Wound Therapy

Burns carry a large surface area, varying in shapes and depths, and an elevated risk of infection. Regardless of the underlying etiology, burns pose significant medical challenges and a high mortality rate. Given the limitations of current therapies, tissue-engineering-based treatments for burns are inevitable. Herein, we developed a natural physicochemically cross-linked adhesive injectable skin substitute (SS) comprising chitosan (Ch) and silk fibroin (SF), cross-linked with tannic acid (TA) through hydrogen bonding, and incorporated with fresh platelet-rich fibrin (FPRF). SF was also chimerically cross-linked with riboflavin (RF) under visible light to ensure desirable biodegradability rate and nontoxicity. Double cross-linked SS exhibited a semibilayer (SBSS) structure with smaller pores in the upper layer. In the CaCl2-treated FPRF, the activated platelets augmented vascular endothelial growth factor (VEGF) and platelet-derived GF (PDGF) release. The resultant SBSS possessed optimal adhesion, hemocompatibility, and significant antibacterial and antioxidant activities (P ≤ 0.05). The rat liver injury model confirmed the rapid hemostatic effect of SBSS. Furthermore, the bottom layer of SBSS promoted L929 fibroblast growth, proliferation, and migration. SBSS-treated wounds showed lower inflammatory cells, earlier epithelialization, significant angiogenesis, and faster healing. The proposed SBSS could be an ideal remedy for burn wound therapy.

A carboxymethyl chitosan and dextran hydrogel with slow and rapid photothermal conversion for sequential promoting burn wound healing and inhibiting scar proliferation

Facilitating swift burn wound healing while effectively preventing scar formation continues to be a considerable challenge in medical practice. In this study, an injectable carboxymethyl chitosan/oxidized dextran/polyvinylpyrrolidone/dopamine (COPD) hydrogel was designed for the effective sequentially promotion of burn wound healing and inhibition of scar formation. The COPD hydrogel precursor solution was injected into the burn wound via a double-barreled syringe and transformed into an adherent hydrogel within 25 s. The inclusion of dopamine imparted good free radical scavenging properties to the hydrogel. In particular, the gradual oxidation of dopamine to polydopamine enabled a unique heat production pattern-initially slow (photothermal conversion efficiency: 30.3 %) and then rapidly temperature increasing (photothermal conversion efficiency: 42.8 %) -under single laser irradiation. The effect of promoting healing at the initial stage of the wound was evaluated by constructing a male C57BL/6 mice model with deep second-degree burns, observation of the wound area, PCR analysis, and immunohistochemical staining. Furthermore, the scar inhibition was confirmed by observing reduced expression levels of α-SMA and COLI, along with a decreased collagen I/III ratio. With tunable mechanical properties (maximum compressive strength of 966.4 ± 51.7 kPa), the COPD hydrogel holds significant promise as an adjunctive photothermal platform for intelligent burn wound management.

Exosome laden sprayable thermo-sensitive polysaccharide-based hydrogel for enhanced burn wound healing

Severe burns pose significant threats to patient well-being, characterized by pain, inflammation, bacterial infection, and extended recovery periods. While exosome-loaded hydrogels have demonstrated considerable promise in wound healing, current formulations often fall short of achieving optimal therapeutic efficacy for burn wounds due to challenges related to their adaptability to wound shape and limited anti-bacterial capabilities. In this study a novel exosome laden sprayable thermosensitive polysaccharide-based hydrogel (ADA-aPF127@LL18/Exo) comprising alginate dialdehyde (ADA) and aminated Pluronic F127 (aPF127) was fabricated via Schiff base reaction. ADA-aPF127@LL18/Exo exhibited sustained release of exosome and enhanced antibacterial efficacy. Furthermore, the biological assessments displayed excellent biocompatibility and enhanced in vitro cell proliferation and migration. In a deep partial thickness burn model, ADA-aPF127@LL18/Exo significantly augmented wound healing processes by accelerating epithelialization, promoting granulation tissue formation and collagen deposition, inducing hair follicle regeneration, effectively mitigating inflammatory responses, and facilitating enhanced neovascularization. In conclusion, ADA-aPF127@LL18/Exo represents a highly promising therapeutic dressing for the treatment of deep burns, exhibiting multifaceted properties conducive to efficient wound management.

Clinical prediction of wound re-epithelisation outcomes in non-severe burn injury using the plasma lipidome

Whilst wound repair in severe burns has received substantial research attention, non-severe burns (<20 % total body surface area) remain relatively understudied, despite causing considerable physiological impact and constituting most of the hospital admissions for burns. Early prediction of healing outcomes would decrease financial and patient burden, and aid in preventing long-term complications from poor wound healing. Lipids have been implicated in inflammation and tissue repair and may play essential roles in burn wound healing. In this study, plasma samples were collected from 20 non-severe burn patients over six weeks from admission, including surgery, and analysed by liquid chromatography-tandem mass spectrometry and nuclear magnetic resonance spectroscopy to identify 850 lipids and 112 lipoproteins. Orthogonal projections to latent structures-discriminant analysis was performed to identify changes associated with re-epithelialisation and delayed re-epithelisation. We demonstrated that the lipid and lipoprotein profiles at admission could predict re-epithelisation outcomes at two weeks post-surgery, and that these discriminatory profiles were maintained up to six weeks post-surgery. Inflammatory markers GlycB and C-reactive protein indicated divergent systemic responses to the burn injury at admission. Triacylglycerols, diacylglycerols and low-density lipoprotein subfractions were associated with re-epithelisation (p-value <0.02, Cliff's delta >0.7), whilst high-density lipoprotein subfractions, phosphatidylinositols, phosphatidylcholines, and phosphatidylserines were associated with delayed wound closure at two weeks post-surgery (p-value <0.01, Cliff's delta <-0.7). Further model validation will potentially lead to personalised intervention strategies to reduce the risk of chronic complications post-burn injury.

Investigation of the Effect of Camellia Sinensis Essence Cream on Skin Burns

Background/Objective: Burn injuries are among the most common causes of trauma globally, affecting millions annually. Current treatments often rely on topical agents, but alternatives to synthetic formulations are increasingly sought due to safety and efficacy concerns. This study aimed to evaluate the therapeutic effects of a cream containing Camellia sinensis (white tea) extract on third-degree burn-induced skin lesions in a rat model. Methods: Thirty-two male Sprague-Dawley rats were randomized into four groups: control, Burn only, Burn + Camellia sinensis extract, and Burn + Camellia sinensis cream. Skin biopsies were evaluated using histopathological, immunohistochemical, and biochemical methods. Malondialdehyde (MDA) and glutathione (GSH) levels were measured to assess oxidative stress, while histological damage and immunoreactivity for collagen I, collagen III, NF-kβ/p65, TNF-alfa, 8-OhDG, and caspase-3 were analyzed. Results: The Camellia sinensis cream significantly reduced MDA levels and increased GSH levels compared to the burn-only group (p < 0.001). Histological analysis revealed enhanced epidermal regeneration and reduced dermal damage. The immunohistochemical findings demonstrated reduced NF-kβ/p65, TNF-alfa, 8-OhDG, caspase-3, collagen I, and collagen III immunopositivity in the cream-treated group (p < 0.001). Conclusions: Camellia sinensis cream demonstrated significant protective and reparative effects on burn-induced skin damage, suggesting its potential as a natural, effective, and safe alternative for burn management.

Comparing Artificial Intelligence Guided Image Assessment to Current Methods of Burn Assessment

Appropriate identification of burn depth and size is paramount. Despite the development of burn depth assessment aids [eg, laser Doppler imaging (LDI)], clinical assessment, which assesses partial-thickness burn depth with 67% accuracy, currently remains the most consistent standard of practice. We sought to develop an image-based artificial intelligence system that predicts burn severity and wound margins for use as a triaging tool in thermal injury management. Modified EfficientNet architecture trained by 1684 mobile-device-captured images of different burn depths was previously used to create a convoluted neural network (CNN). The CNN was modified to a novel boundary attention mapping (BAM) algorithm using elements of saliency mapping, which was used to recognize the boundaries of burns. For validation, 144 patient charts that included clinical assessment, burn location, total body surface area, and LDI assessment were retrieved for a retrospective study. The clinical images underwent CNN-BAM assessment and were directly compared with the LDI assessment. CNN using a 4-level burn severity classification achieved an accuracy of 85% (micro/macro-averaged receiver operating characteristic scores). The CNN-BAM system can successfully highlight burns from surrounding tissue with high confidence. CNN-BAM burn area segmentations attained a 91.6% accuracy, 78.2% sensitivity, and 93.4% specificity, when compared to LDI methodology. Results comparing the CNN-BAM outputs to clinical and LDI assessments have shown a high degree of correlation between the CNN-BAM burn severity predictions to those extrapolated from LDI healing potential (66% agreement). CNN-BAM algorithm gives equivalent burn-depth detection accuracy as LDI with a more economical and accessible application when embedded in a mobile device.

Multi-functional dressings for recovery and screenable treatment of wounds: A review

Considerable research has focused on advanced wound dressing technology over the past decade. The increasing emphasis on health and medical treatment is crucial to the modern healthcare system. Consequently, high-quality wound dressings with advanced standards are essential for superior medical care. Next-generation multifunctional wound dressings feature antibacterial properties, pain relief, biocompatibility, drug delivery, flexibility, and exudate absorption. Today, biomimetic models, tissue engineering, and synthetic skin are integrated with emerging wound healing technologies, offering a new perspective on wound management. Based on the classification model of multifunctional and advanced wound dressings, various AI-assisted wound management technologies are also highly efficient. The primary goals of advanced wound dressing technologies include faster wound healing, prevention of microbial contamination, preservation of skin aesthetics, reduction of treatment costs, and increased patient comfort. The latest technologies in this field not only promote faster healing and the treatment of deep wounds but also emphasize continuous control and monitoring of the healing process. These screenable wound dressings can be smart sensors to detect wound status based on parameters such as pH, moisture, temperature, and oxygen levels. This enables wound status monitoring and appropriate treatment responses. These technologies facilitate wound observation and monitoring, as well as the evaluation and control of the healing process through various models and strategies, such as the fabrication of functional nanomaterials, computer algorithms, and artificial intelligence. This review presents an overview of the most prominent new technologies in wound dressings, along with their innovative approaches.

Exploring the gaps: A scoping review of burn injury research in skin of colour

Burn injury management and outcomes reveal observed disparities in individuals with darker skin tones, likely influenced by limited representation in medical literature and clinical research. These gaps may contribute to variations in care quality and outcomes for these populations. A comprehensive literature search was conducted across PubMed, Scopus, and Embase databases, initially yielding 74 articles. Due to limited relevant studies directly addressing the research question, the approach shifted from a systematic review to a scoping review to allow for a broader exploration of potential disparities in burn injury outcomes. Following these criteria, 31 relevant articles were identified and analysed. The analysis suggests an underrepresentation of diverse skin tones in medical textbooks and clinical research, limitations in current burn assessment tools for darker skin, and a lack of tailored treatment protocols. Studies indicate that patients with darker skin tones may face higher risks of complications and varied outcomes, potentially influenced by systemic healthcare challenges and limited guidelines addressing diverse skin types. This scoping review highlights the importance of more inclusive research and clinical practices that consider the specific needs of individuals with darker skin tones. Addressing these observed gaps can support improvements in burn injury management, ultimately contributing to more equitable healthcare for all skin types.

Promotion of chronic wound healing by plant-derived active ingredients and research progress and potential of plant polysaccharide hydrogels

Wound healing is a complex biochemical process. The use of herbal medicine in wound healing not only carries forward the wisdom of traditional medicine, with its anti-inflammatory and immune-regulating effects, but also reflects the direction of modern biopharmaceutical technology, such as its potential in developing new biomaterials like hydrogels. This article first outlines the inherent structural properties of healthy skin, along with the physiological characteristics related to chronic wounds in patients with diabetes and burns. Subsequently, the article delves into the latest advancements in clinical and experimental research on the impact of active constituents in herbal medicine on wound tissue regeneration, summarizing existing studies on the mechanisms of various herbal medicines in the healing of diabetic and burn wounds. Finally, the paper thoroughly examines the application and mechanisms of plant polysaccharide hydrogels containing active herbal compounds in chronic wound healing. The primary objective is to provide valuable resources for the clinical application and development of herbal medicine, thereby maximizing its therapeutic potential. It also represents the continuation of traditional medical wisdom, offering new possibilities for advancements in regenerative medicine and wound care.

Dexmedetomidine on the interplay of IL-6 and STAT3 pathways in adrenal gland damage-induced scalding burns in rats

Scalding burns are a common form of thermal injury that often leads to systemic complications. Pro-inflammatory cytokines like interleukin-6 (IL-6) and the activation of signal transducer and activator of transcription 3 (STAT3) pathways have been linked to the pathophysiology of organ damage caused by burns. This study aimed to investigate the potential therapeutic effects of dexmedetomidine, an α2-adrenergic receptor agonist with anti-inflammatory properties, on the interplay of IL-6 and STAT3 pathways in adrenal gland damage following scalding burns in rats. Twenty-eight rats were divided randomly into four groups. Rats in group 1 (n=7, control) were given only 0.9% intraperitoneal (i.p.) NaCl. Rats in group 2 (n=7, DEX) were exposed to 25°C water for 17 s on day 1 and received 100 mcg/kg/day dexmedetomidine i.p. for 3 days; for rats in group 3 (n=7, Burn), boiling water of 94°C was applied inside for 17 s. Rats in group 4 (n=7, Burn+DEX) were exposed to 94°C water for 17 s and received 100 mcg/kg/day dexmedetomidine i.p. for 3 days. Adrenal gland tissues were histopathological examined, and STAT3, IL-6, and TUNEL staining were performed using immunohistochemically. Our results revealed that scalding burns increased IL-6 and STAT3 expression in the adrenal glands of rats. Histological analysis demonstrated that dexmedetomidine administration ameliorated adrenal gland damage and reduced inflammatory cell infiltration. Our findings suggest that dexmedetomidine protects the adrenal glands in scalding burns. This protection appears to be mediated, at least in part, by its modulation of IL-6 and STAT3 pathways.

Efficacy and Safety of Autologous Nanofat Injection in the Treatment of Postburn Scars Using Optical Skin Imaging Analysis

BACKGROUND

Burn scars are considered one of the challenging issues that can affect the quality of life by causing aesthetic and functional problems. Injecting nanofat particles, which are considered a source of stem cells, into the dermis and/or subcutis of the burned area is considered a promising procedure for the treatment of scars and the correction of volume shortage and skin renewal.

OBJECTIVE

To assess the safety and effectiveness of using autologous nanofat injections to treat burn scars.

METHODS

Thirty patients with postburn scars participated in the trial. Each patient received one session of liposuction, which was then converted into nanofat and injected back into the scar tissue. Four months after the session, the evaluation was conducted both objectively using the Antera camera 3D imaging and subjectively using the Vancouver scar scale (VSS).

RESULTS

Because there were statistically significant improvements in the treated scars' height, color, vascularity, and pliability, the total VSS scores differed significantly before and after treatment. Furthermore, the Antera 3D imaging revealed a statistically significant variation in the treated scars' indentations, erythema, and pigmentation scores.

CONCLUSION

The study findings demonstrated that nanofat is a successful postburn scar treatment option that improves patients' quality of life.

Trends in protein derived materials for wound care applications

Natural resource based polymers, especially those derived from proteins, have attracted significant attention for their potential utilization in advanced wound care applications. Protein based wound care materials provide superior biocompatibility, biodegradability, and other functionalities compared to conventional dressings. The effectiveness of various fabrication techniques, such as electrospinning, phase separation, self-assembly, and ball milling, is examined in the context of developing protein-based materials for wound healing. These methods produce a wide range of forms, including hydrogels, scaffolds, sponges, films, and bioinspired nanomaterials, each designed for specific types of wounds and different stages of healing. This review presents a comprehensive analysis of recent research that investigates the transformation of proteins into materials for wound healing applications. Our focus is on essential proteins, such as keratin, collagen, gelatin, silk, zein, and albumin, and we emphasize their distinct traits and roles in wound care management. Protein-based wound care materials show promising potential in biomedical engineering, offering improved healing capabilities and reduced risks of infection. It is crucial to explore the potential use of these materials in clinical settings while also addressing the challenges that may arise from their commercialization in the future.

Efficacy of neutral electrolyzed water vs. common topical antiseptics in the healing of full‑thickness burn: Preclinical trial in a mouse model

Burn injuries impose challenges such as infection risk, pain management, fluid loss, electrolyte imbalance and psychological and emotional impact, on healthcare professionals, requiring effective treatments to enhance wound healing. The present study evaluated the efficacy superoxidized electrolyzed solution (SES), with low (SES-low) or high (SES-high) concentrations of active species, alone or in combination with a formulation in gel (G), in comparison with commonly prescribed treatments for burn injury, including nitrofurazone (NF) and silver sulfadiazine (S); normal saline was used as placebo (PI). A scald burn model was established in BALB/c mice. Measurements of the burned area and histological parameters such as inflammatory infiltration state, epithelial regeneration and collagen fibers were evaluated on days 3, 6, 9, 18 and 32 to assess healing score and status. All treatments achieved wound closure at day 32; histopathological parameters indicated that SES-low and SES-low + G performed better than the Pl and S groups (P<0.05). All treatments showed a lower count of inflammatory cells compared with S (P<0.05); for collagen deposition and orientation, SES-low + G showed a more uniform horizontal orientation compared with Pl, SES-high + G, NF and S groups (P<0.05). SES-Low was the most effective substance to induce favorable and organized healing, while S was the worst, inducing disorganized closure of the wound due to a pro-inflammatory effect.

An injectable epoxidized soybean oil/gelatin-based photothermal biogel with remarkable rapid hemostasis capability for wound repair

The development of wound dressings with rapid hemostasis, antibacterial activity without the addition of antibiotics and on-demand removability that effectively avoid secondary damage to the wound during replacement still faces significant challenges. Herein, injectable epoxidized soybean oil/gelatin-based photothermal biogel with outstanding tissue adhesion, on-demand removability, shape-adaptability, and antibacterial performance is prepared as a removable wound dressing for wound repair. The biogel is composed of two types of hydrophilic/hydrophobic three-dimensional network structures, which interweave together through dynamic imine bonds, coordination bonds and numerous hydrogen bonds to synergistically improve injectability, self-healing, tissue adhesion, and compressive performance of the biogel. Moreover, the prepared EG-02 biogel not only has excellent thermal stability, biodegradability, hemocompatibility, and RBCs and platelet adhesion properties, but also displays outstanding cytocompatibility and the ability to promote cell migration. Furthermore, the EG-02 biogel treated with a near-infrared (NIR) laser (808 nm, 0.2 W·cm-2) exhibits prominent photothermal cycling stability and antibacterial performance. Notably, the EG-02 biogel presents remarkable rapid hemostasis capability, with the hemostatic time greatly shortened to 40 s and the blood loss significantly reduced to 89.2 mg. Therefore, the injectable photothermal biogel, as a fascinating candidate for on-demand removable wound dressing, has shown promising application prospects in wound repair.

Research progress and application of chitosan dressings in hemostasis: A review

Hemorrhage affects human health, and severe bleeding remains a leading contributor to trauma-related mortality. The speed and effectiveness of the application of hemostatic materials are critical. Conventional hemostatic dressings such as bandages and gauze are gradually being replaced by new types of hemostatic dressings due to their poor hemostatic and antibacterial properties. Chitosan, a biopolymer, is biodegradable and nontoxic and possesses hemostatic and antibacterial properties. Chitosan induces hemostasis through direct contact with red corpuscles and platelets, independent of the coagulation pathways of the host, rendering it an optimal hemostatic dressing. It is widely used in wound care, particularly to stop bleeding, promote wound healing, and provide antimicrobial properties. This article reviews the recent research and development of chitosan-based hemostatic dressings, focusing on trauma hemostasis, burn hemostasis, diabetic skin ulcer hemostasis and other aspects. It also emphasizes the significance of chitosan dressings in wound hemostasis and healing, identifies their research opportunities in hemostasis and wound healing, and explores new research directions.

The national burden of mortality and its associated factors among burn patients in Ethiopia. A systematic review and meta-analysis

BACKGROUND

Despite all advances in burn prevention, treatment, acute care, and rehabilitation, burn injuries continue to cause significant mortality and disability in Ethiopia. Thus, this review and meta-analysis aimed to assess the pooled prevalence and the determinants of mortality in Ethiopia.

METHODS

This systematic review was conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A structured search of databases (Medline/PubMed, Google Scholar, CINAHL, EMBASE, HINARI, and Web of Science) was undertaken. Selection, screening, reviewing, and data extraction were done by independent reviewers using a Microsoft Excel spreadsheet. The quality of the included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool. A random-effects meta-analysis model with a 95 % confidence interval was computed to estimate the pooled effect size (i.e., prevalence and odds ratio). Publication bias was checked using the funnel plot, Egger's, and Begg's tests. The heterogeneity of studies was assessed using I2 statistics. Subgroup analysis based on the region and age group was done.

RESULTS

This systematic review and meta-analysis included a total of ten studies. The pooled prevalence of mortality among patients with burn injuries in Ethiopia was found to be 6.01 % (95 % CI: 2.75, 9.26). Subgroup analysis based on the region showed that the pooled prevalence of mortality was highest in the Oromia region (12.02 %), followed by the Amhara region (8.5 %). Additionally, subgroup analysis based on patients' ages revealed that the pooled estimates of mortality among all age groups and children were 5.18 % and 7.91 %, respectively. The meta-analysis demonstrated that the extent of burn > 10 % TBSA (OR = 5.04, 95 % CI: 2.72, 9.35), presence of comorbidity (OR = 4.01, 95 % CI: 1.44, 11.18), and presence of a 3rd degree burn (OR = 10.64, 95 % CI: 2.82, 40.16) were significantly associated with mortality among burn patients.

CONCLUSION AND RECOMMENDATIONS

The national prevalence of mortality among burn patients in Ethiopia was high. The extent of burn, presence of comorbidity, and 3rd degree burns were significant predictors of mortality. We strongly recommend that health care workers give special attention to burn patients with greater extent and depth of burn, and for those who have comorbid diseases.

3D Printing-Based Hydrogel Dressings for Wound Healing

Skin wounds have become an important issue that affects human health and burdens global medical care. Hydrogel materials similar to the natural extracellular matrix (ECM) are one of the best candidates for ideal wound dressings and the most feasible choices for printing inks. Distinct from hydrogels made by traditional technologies, which lack bionic and mechanical properties, 3D printing can promptly and accurately create hydrogels with complex bioactive structures and the potential to promote tissue regeneration and wound healing. Herein, a comprehensive review of multi-functional 3D printing-based hydrogel dressings for wound healing is presented. The review first summarizes the 3D printing techniques for wound hydrogel dressings, including photo-curing, extrusion, inkjet, and laser-assisted 3D printing. Then, the properties and design approaches of a series of bioinks composed of natural, synthetic, and composite polymers for 3D printing wound hydrogel dressings are described. Thereafter, the application of multi-functional 3D printing-based hydrogel dressings in a variety of wound environments is discussed in depth, including hemostasis, anti-inflammation, antibacterial, skin appendage regeneration, intelligent monitoring, and machine learning-assisted therapy. Finally, the challenges and prospects of 3D printing-based hydrogel dressings for wound healing are presented.

Fish skin dressing for wound regeneration: A bioactive component review of omega-3 PUFAs, collagen and ECM

Wound healing is a complex biological process that involves several stages, including hemostasis, inflammation, proliferation, and remodeling. Traditional wound dressings, to a certain extent, can provide wound protection but are limited in promoting wound healing, reducing scar formation, and preventing bacterial infections. In recent years, with the advancement of research in biomedical materials, fish skin dressings have become a research hotspot in the field of tissue regeneration due to their remarkable biocompatibility and precious bioactive components. However, current research on fish skin dressings remains focused on clinical treatment. To further deepen and promote the development of fish skin dressings, we put emphasis on discussing main bioactive components in fish skin. This article has reviewed the advantages of fish skin dressings in wound regeneration, especially the promotive effects of its main bioactive components-Omega-3 polyunsaturated fatty acids, collagen derived from fish skin, and the extracellular matrix of fish skin-on the wound healing process. Besides, by critically summarizing the research issues of each bioactive component, this review assists researchers in better defining the next direction of research, thereby designing the optimal dressing for different types of wounds.

Advancing burn wound treatment: exploring hydrogel as a transdermal drug delivery system

Burn injuries are prevalent and life-threatening forms that contribute significantly to mortality rates due to associated wound infections. The management of burn wounds presents substantial challenges. Hydrogel exhibits tremendous potential as an ideal alternative to traditional wound dressings such as gauze. This is primarily attributed to its three-dimensional (3D) crosslinked polymer network, which possesses a high water content, fostering a moist environment that supports effective burn wound healing. Additionally, hydrogel facilitates the penetration of loaded therapeutic agents throughout the wound surface, combating burn wound pathogens through the hydration effect and thereby enhancing the healing process. However, the presence of eschar formation on burn wounds obstructs the passive diffusion of therapeutics, impairing the efficacy of hydrogel as a wound dressing, particularly in cases of severe burns involving deeper tissue damage. This review focuses on exploring the potential of hydrogel as a carrier for transdermal drug delivery in burn wound treatment. Furthermore, strategies aimed at enhancing the transdermal delivery of therapeutic agents from hydrogel to optimize burn wound healing are also discussed.

Development and performance evaluation of a clinical prediction model for sepsis risk in burn patients

Sepsis is a common and severe complication in burn patients and remains one of the leading causes of mortality. This retrospective study aimed to develop a predictive model for the risk of in-hospital sepsis among burn patients treated at Guangzhou Red Cross Hospital between January 2022 and January 2024, with the goal of improving clinical outcomes through early prevention based on risk stratification. A total of 302 eligible patients were randomly divided into training and validation cohorts in a 7:3 ratio for model development and validation, respectively. Predictive factors were initially selected using LASSO regression, followed by logistic regression analysis to establish the prediction model and construct a nomogram. The final model incorporated 4 independent predictors: burn area (odds ratio [OR] = 1.043, 95% confidence interval [CI]: 1.026-1.062/1%), hemoglobin (OR = 0.968, 95% CI: 0.954-0.980/1 g/L), diabetes (OR = 10.91, 95% CI: 2.563-56.62), and potassium (OR = 3.091, 95% CI: 1.635-6.064/1 mmol/L). The areas under the receiver operating characteristic curve were 0.875 and 0.861 for the training and validation cohorts, with Youden indexes of 0.634 and 0.600, respectively. The calibration curve and decision curve analysis demonstrated good predictive accuracy and clinical utility of the model. These findings suggest that our developed model exhibits robust predictive performance for the risk of in-hospital sepsis in burn patients, and early prevention strategies based on risk stratification may potentially improve clinical outcomes.

Synergetic Effects of Sericin and Turmeric on Burn Wound Healing in Mice

Burn wounds are one of the most hazardous issues, globally. Silkworm produces a protein called sericin. Sericin assists in wound healing by facilitating the proliferation of keratinocytes and fibroblasts, while turmeric is potentially helpful in wound healing because of its antioxidant, anti-inflammatory, and anti-infectious activities. The current study aimed to investigate the synergetic and individual effects of turmeric, sericin, and their nanoparticles on burn wounds in mice. The female mice having age of 2 months (each weighing 29-30 g) were arbitrarily distributed in 7 groups. Five mice were added to each group. Burn wounds were induced in mice by using a hot metal rod. Burn wounds were evaluated histologically and morphologically. Turmeric nanoparticles substantially improved the wound contraction area as compared to the negative control group and other treatment groups. The serum level of glutathione (4.9 ± 0.1 µmol/L), catalase (6.0 ± 0.2 mmol/mL), glutathione peroxidase (183.4 ± 5.1 U/L), and superoxide dismutase (194.6 ± 5.1 U/mL) was significantly increased in the turmeric nanoparticles (TNPs) group as compared to the negative control (2.8 ± 0.1 µmol/L, 3.5 ± 0.1 mmol/mL, 87.8 ± 3.0 U/L, and 92.0 ± 4.8 U/mL respectively). The minimum levels of malondialdehyde (3.8 ± 0.2 mmol/L) were noticed in the TNPs group contrary to the negative control (7.4 ± 0.2 mmol/L). The restoration of the epidermis was also observed to be faster in the TNPs group as compared to all other treatment groups. The histopathological analysis also demonstrated the effectiveness of turmeric, sericin, and their nanoparticles. In conclusion, turmeric, sericin, and their nanoparticles are effective in improving the healing process of burn wounds, but TNPs showed the most effective results as compared to all other treatment groups.

Burn Wound Healing Abilities of a Uronic Acid Containing Exopolysaccharide Produced by the Marine Bacterium Halomonas malpeensis YU-PRIM-29 T

Bacterial exopolysaccharides (EPS) are an emerging class of biopolymers with extensive applications in different fields due to their versatile physico-chemical and biological properties. The role of EPS in healing of different wound types is gaining interest in the tissue engineering sector. Burn is one of the devitalizing injuries that causes greater physical harm and can be fatal. Appropriate treatment modalities have to be followed for faster healing outcomes and to minimize the risk. In this study, a bacterial EPS (EPS-H29) from the marine bacterium Halomonas malpeensis YU-PRIM-29 T was used to treat the burn wound in vivo. The biochemical and structural characterizations of EPS-H29 were carried out using standard methods. In addition, FE-SEM, conformational, rheological, and HP-GPC analyses were carried out. In vitro biocompatibility of EPS-H29 was studied in human dermal fibroblasts (HDFs) and keratinocytes (HaCaT). Scratch assay was used to study the wound healing in vitro. For in vivo evaluation, burn wound (second-degree) was created on Wistar albino rats and treated with EPS-H29 along with appropriate control groups. The total sugar and protein contents of EPS-H29 were 72.0 ± 1.4% and 4.0 ± 0.5%, respectively, with a molecular weight of 5.2 × 105 Da. The lyophilized samples exhibited porous surface features, and in solution, it showed triple helical conformation and shear thickening behavior. In vitro cell-based assays showed biocompatibility of EPS-H29 up to 200 μg/mL concentration. At a concentration up to 50 μg/mL, EPS-H29 promoted cell proliferation. Significant increase in the HDF cell migration was evident with EPS-H29 (15 μg/mL) treatment in vitro and induced significantly higher (p ≤ 0.0001) closure of the scratch area (90.3 ± 1.1%), compared to the control (84.3 ± 1.3%) at 24 h. Enhanced expression of Ki-67 was associated with the cell proliferative activities of EPS-H29. The animals treated with EPS-H29 showed improved healing of burn wounds with significantly higher wound contraction rate (80.6 ± 9.4%) compared to the positive control (54.6 ± 8.0%) and untreated group (49.2 ± 3.7%) with histopathological evidence of epidermal tissue formation at 15 days of treatment. These results demonstrate the biocompatibility and burn wound healing capability of EPS-H29 and its potential as an effective topical agent for the burn wound care.

Enhanced healing of burn wounds by multifunctional alginate-chitosan hydrogel enclosing silymarin and zinc ‎oxide ‎nanoparticles

Multifunctional wound dressings have been applied for burn injuries to avoid complications and promote tissue regeneration. In the present study, we fabricated a natural alginate-chitosan hydrogel comprising silymarin and green-synthesized zinc ‎oxide ‎nanoparticles (ZnO NPs). Then, the physicochemical attributes of ZnO NPs and loaded hydrogels were analyzed. Afterward, wound healing efficacy was evaluated in a rat model of full-thickness dermal burn wounds. The findings indicated that ZnO NPs were synthesized via reduction with phytochemicals from Elettaria cardamomum seeds extract. The microscopic images exhibited fairly spherical ZnO NPs (35-45 nm), and elemental analysis verified the relevant composition. The hydrogel, containing silymarin and biosynthesized ZnO NPs, displayed a uniform appearance, smooth surfaces, and a porous structure. Moreover, infrared spectroscopy ‎identified functional groups, confirming the successful loading without adverse interactions. The obtained hydrogel exhibited great water absorption, high porosity, sustainable degradation for several days, and enhanced antioxidant capability of the combined loaded component. In vivo studies revealed faster and superior wound healing, achieving nearly complete closure by day 21. Histopathology confirmed improved cell growth, tissue regeneration, collagen deposition, and neovascularization. It is believed that this multifunctional hydrogel-based wound dressing can be applied for effective burn wound treatment.

LncRNA AGAP2-AS1 stabilizes ATG9A to promote autophagy in endothelial cells - Implications for burn wound healing

Deep second- or mixed-degree burn lesions are difficult to heal due to the impaired dermis supporting of epidermis renewal and nutrition delivery. Early dermis debridement and preservation speed healing and enhance results, emphasizing the need of knowing processes that promote burn-denatured dermis recovery, notably endothelial cell angiogenesis and autophagy. Integrative bioinformatics investigations identified AGAP2-AS1 as a highly elevated lncRNA in burn tissues. Pearson's correlation study connected AGAP2-AS1 to 112 differently co-expressed protein-coding genes involved in burn healing processes such cell cycle and TGF-beta receptor signaling. Experimental validation showed that heat damage elevated AGAP2-AS1 in HUVECs and HDMECs. Functionally, AGAP2-AS1 overexpression in heat-denatured HUVECs and HDMECs increased cell survival, migration, invasion, and angiogenesis. In addition, AGAP2-AS1 overexpression increased endothelial cell autophagy. Additional investigation showed AGAP2-AS1's association with ATG9A, stabilizing it. Post-heat damage, ATG9A knockdown drastically reduced HUVEC and HDMEC survival, migration, invasion, angiogenesis, and autophagy. More notably, ATG9A knockdown drastically reduced the benefits of AGAP2-AS1 overexpression on endothelial cell functions and autophagy. The positive association between AGAP2-AS1 and ATG9A expression in burn tissue samples highlights their crucial roles in endothelial cell response to heat injury, indicating that targeting this axis may aid burn wound healing. The research found that lncRNA AGAP2-AS1 stabilizes ATG9A and promotes autophagy in endothelial cells. These results imply that targeting the AGAP2-AS1/ATG9A axis may improve angiogenesis and tissue regeneration in burn injuries, revealing burn wound healing molecular pathways.

Advances in Smart-Response Hydrogels for Skin Wound Repair

Hydrogels have emerged as promising candidates for biomedical applications, especially in the treatment of skin wounds, as a result of their unique structural properties, highly tunable physicochemical properties, and excellent biocompatibility. The integration of smart-response features into hydrogels allows for dynamic responses to different external or internal stimuli. Therefore, this paper reviews the design of different smart-responsive hydrogels for different microenvironments in the field of skin wound therapy. First, the unique microenvironments of three typical chronic difficult-to-heal wounds and the key mechanisms affecting wound healing therapeutic measures are outlined. Strategies for the construction of internal stimulus-responsive hydrogels (e.g., pH, ROS, enzymes, and glucose) and external stimulus-responsive hydrogels (e.g., temperature, light, electricity, and magnetic fields) are highlighted from the perspective of the wound microenvironment and the in vitro environment, and the constitutive relationships between material design, intelligent response, and wound healing are revealed. Finally, this paper discusses the severe challenges faced by smart-responsive hydrogels during skin wound repair and provides an outlook on the combination of smart-responsive hydrogels and artificial intelligence to give scientific direction for creating and using hydrogel dressings that respond to stimuli in the clinic.

Phage therapy: A novel approach against multidrug-resistant pathogens

The rapid rise of multidrug-resistant (MDR) organisms has created a critical need for alternative treatment options. Phage therapy is gaining attention as an effective way to fight bacterial infections by using lytic bacteriophages to specifically target and kill harmful bacteria. This review discusses several phage therapeutic options and emphasizes new developments in phage biology. Phage treatment has proven to be successful against MDR bacteria, as evidenced by multiple human clinical trials that indicate favorable results in treating a range of diseases caused by these pathogens. Despite these promising results, challenges such as phage resistance, regulatory hurdles, and the need for standardized treatment protocols remain. To effectively combat MDR bacterial infections, future research must focus on enhancing phage effectiveness, guaranteeing safety for human usage and incorporating phage therapy into clinical practice.

Evaluation of a Cosmetic Formulation Containing Arginine Glutamate in Patients with Burn Scars: A Pilot Study

Background: Patients with burn scars require effective treatments able to alleviate dry skin and persistent itching. Ion pairing has been employed in cosmetic formulations to enhance solubility in solvents and improve skin permeability. To evaluate the efficacy and safety of the cosmetic formula "RE:pair (arginine-glutamate ion pair)", we analyzed scar size, itching and pain, skin barrier function, scar scale evaluation, and satisfaction in our study participants. Methods: A total of 10 patients were recruited, and the formula was used twice a day for up to 4 weeks. Results: Itching was significantly alleviated after 4 weeks of treatment (95% CI = -0.11-1.71) compared to before application (95% CI = 2.11-4.68). Transepidermal water loss (TEWL) showed an 11% improvement after 4 weeks (95% CI = 3.43-8.83) compared to before application (95% CI = 3.93-9.88), and skin coreneum hydration (SCH) showed a significant 41% improvement after 4 weeks (95% CI = 43.01-62.38) compared to before application (95% CI = 20.94-40.65). Conclusions: Based on the confirmation that RE:pair improves skin barrier function and relieves itching, it is likely to be used as a topical treatment for burn scars pending evaluation in follow-up studies (IRB no. HG2023-016).

A comprehensive evaluation of dermal fibroblast therapy in clinical trials for treating skin disorders and cosmetic applications: a scoping review

BACKGROUND

Fibroblast cells have the ability to improve skin conditions through regenerative medicine and cell-based therapies. The purpose of this scoping review is to assess the contribution of fibroblast cells to skin homeostasis and extracellular matrix deposition in clinical trials involving skin disorders and cosmetic applications.

METHODS

Using targeted search terms, published publications from January 2000 to August 2023 that addressed fibroblast uses in clinical trials of skin conditions were obtained from bibliographic databases like PubMed, Scopus, and Web of Science (WoS). Precise inclusion and exclusion criteria were used during the screening process. The potential benefits of induction treatment with fibroblasts lead to the choosing of clinical trials for this kind of treatment.

RESULTS

Out of the 820 published ppapers initially identified, only 35 studies fulfilled our meticulous eligibility criteria after careful screening. To ensure clarity, we methodically eliminated any duplicate or irrelevant published papers, thereby offering a transparent account of our selection process.

CONCLUSION

This study highlights the advantages of fibroblast therapy in treating skin conditions such as diabetic foot, venous leg ulcers, and cosmetic reasons. Fibroblasts possess remarkable regenerating capabilities, making dermal fibroblast therapy crucial in cell-based and skin regenerative treatments. Nevertheless, additional research is required for more disorders and cosmetic applications.

Healing Potential of the Marine Polysaccharides Carrageenan and Ulvan on Second-Degree Burns

The treatment of second-degree burn wounds presents a significant clinical challenge, often characterized by prolonged healing times and risk of complications. In this study, the wound healing potential of bioactive marine sulfated polysaccharides ulvan and carrageenan formulated in gels at concentrations of 1.5%, 5.0%, and 10% w/w was evaluated. Hairless female SKH-hr2 mice (n = 7 per treatment) with burn-inflamed skin were treated with the polysaccharide-based gels, and the therapeutic efficacy was assessed using a comprehensive array of evaluation methods, including a histopathological analysis, clinical observation, photo-documentation, an image analysis, an evaluation of biophysical skin parameters, and FT-IR spectroscopy. Our findings indicate that the 10% w/w carrageenan gel exhibited significant enhancement in wound healing, particularly in the early stages of the healing process. This was evidenced by the restoration of the α-helix structure of collagen and the configuration of glycosaminoglycans, as demonstrated by FT-IR absorption bands of the skin both in vivo and ex vivo. Furthermore, the 5% w/w ulvan gel also demonstrated notable efficacy in promoting wound healing, particularly in the later stages of the healing process. These results suggest that carrageenan and ulvan gels hold promise for improving the efficiency of wound healing in second-degree burn wounds. Our study contributes to the understanding of the therapeutic potential of marine polysaccharides and provides insights into their mechanism of action in promoting wound healing.

Advancements in cell-based therapies for thermal burn wounds: a comprehensive systematic review of clinical trials outcomes

BACKGROUND

Burn trauma is one of the major causes of morbidity and mortality worldwide. The standard management of burn wounds consists of early debridement, dressing changes, surgical management, and split-thickness skin autografts (STSGs). However, there are limitations for the standard management that inclines us to find alternative treatment approaches, such as innovative cell-based therapies. We aimed to systematically review the different aspects of cell-based treatment approaches for burn wounds in clinical trials.

METHODS

A systematic search through PubMed, Medline, Embase, and Cochrane Library databases was carried out using a combination of keywords, including "Cell transplantation", "Fibroblast", "Keratinocyte", "Melanocyte", or "Stem Cell" with "Burn", "Burn wound", or "Burn injury". Firstly, titles and abstracts of the studies existing in these databases until "February 2024" were screened. Then, the selected studies were read thoroughly, and considering the inclusion and exclusion criteria, final articles were included in this systematic review. Moreover, a manual search was performed through the reference lists of the included studies to minimize the risk of missing reports.

RESULTS

Overall, 30 clinical trials with 970 patients were included in our study. Considering the type of cells, six studies used keratinocytes, nine used fibroblasts, eight used combined keratinocytes and fibroblasts, one study used combined keratinocytes and melanocytes, five used combined keratinocytes and fibroblasts and melanocytes, and one study used mesenchymal stem cells (MSCs). Evaluation of the preparation type in these studies showed that cultured method was used in 25 trials, and non-cultured method in 5 trials. Also, the graft type of 17 trials was allogeneic, and of 13 other trials was autologous.

CONCLUSIONS

Our study showed that employing cell-based therapies for the treatment of burn wounds have significant results in clinical studies and are promising approaches that can be considered as alternative treatments in many cases. However, choosing appropriate cell-based treatment for each burn wound is essential and depends on the situation of each patient.

Chitosan-based Mupirocin and Alkanna tinctoria extract nanoparticles for the management of burn wound: In vitro and in vivo characterization

Serious consequences including septicemia and amputations can result from complex wounds, which is a serious healthcare concern. In addition, there are currently only a few choices for management, which justifies the search for novel, highly effective wound-healing medications. This research work was aimed at fabricating chitosan-based Alkanna tinctoria and Mupirocin nanoparticles by ionic gelation technique for burn wound management. Preliminary studies were conducted, and the prepared nanoparticles were characterized by various techniques that involve, high-performance liquid chromatography for the detection of components in A. tinctoria root extract, ATR-FTIR, particle size, zeta potential, percent drug content (DC%), percent entrapment efficiency (EE%), scanning electron microscopy, and transmission electron microscopy (TEM) for surface morphology. The optimized formulation CS-AT-MU-NPs3 shows a particle size of 340.8 ± 34.46 nm and positive zeta potential 27.3 ± 3.10 mV. In vitro drug release study was also performed, which demonstrated improved and controlled release of the drug from the nanoparticles. The CS-AT-MU-NPs3 exhibited a maximum release up to 92.61% (AT) and 88.35% (MU). Antibacterial and antifungal activities of the formulation were also accessed by utilizing the agar well diffusion technique. The combination of AT and MU in chitosan-based nanoparticles was significantly effective against bacterial and fungal strains like Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans as compared to other formulations. The skin irritation study was also conducted, which shows that the prepared formulation did not cause any observable changes to the skin in terms of inflammation, erythema, edema, or any other symptoms associated with skin irritation. All the chitosan-based nanoparticles showed almost 75% reduction in wound contraction, while the optimized formulation CS-AT-MU-NPs3 showed complete wound healing on the 15th day. Based on the results, it can be assumed that chitosan-based nanoparticles containing A. tinctoria and Mupirocin demonstrated good wound healing and could be used to effectively manage burn wounds of any description.

Characterization of an Escherichia coli phage Tequatrovirus YZ2 and its application in bacterial wound infection

The increasing prevalence of drug-resistant Escherichia coli (E. coli) resulting from the excessive utilization of antibiotics necessitates the immediate exploration of alternative approaches to counteract pathogenic E. coli. Phages, with their unique antibacterial mechanisms, are considered promising candidates for treating bacterial infections. Herein, we isolated a lytic Escherichia phage Tequatrovirus YZ2 (phage YZ2), which belongs to the genus Tequatrovirus. The genome of phage YZ2 consists of 168,356 base pairs with a G + C content of 35.34% and 269 putative open reading frames (ORFs). Of these, 146 ORFs have been annotated as functional proteins associated with nucleotide metabolism, structure, transcription, DNA replication, translation, and lysis. In the mouse model of a skin wound infected by E. coli, phage YZ2 therapy significantly promoted the wound healing. Furthermore, histopathological analysis revealed reductions in IL-1β and TNF-α and increased VEGF levels, indicating the potential of phages as effective antimicrobial agents against E. coli infection.

3D Printing of Naturally Derived Adhesive Hemostatic Sponge

Hydrogel hemostatic sponges have been recognized for its effectiveness in wound treatment due to its excellent biocompatibility, degradability, as well as multi-facet functionalities. Current research focuses on optimizing the composition and structure of the sponge to enhance its therapeutic effectiveness. Here, we propose an adhesive hydrogel made from purely natural substances extracted from okra and Panax notoginseng. We utilize 3-dimensional (3D) printing technology to fabricate the hemostatic hydrogel scaffold, incorporating gelatin into the hydrogel and refining the mixing ratio. The interaction between gelatin and okra polyphenols contributes to successful injectability as well as stability of the printed scaffold. The okra in the scaffold exhibits favorable adhesion and hemostatic effects, and the total saponins of Panax notoginseng facilitate angiogenesis. Through in vitro experiments, we have substantiated the scaffold's excellent stability, adhesion, biocompatibility, and angiogenesis-promoting ability. Furthermore, in vivo experiments have demonstrated its dual functionality in rapid hemostasis and wound repair. These features suggest that the 3D-printed, natural substance-derived hydrogel scaffolds have valuable potential in wound healing and related applications.

Advances of antimicrobial dressings loaded with antimicrobial agents in infected wounds

Wound healing is a complex process that is critical for maintaining the barrier function of the skin. However, when a large quantity of microorganisms invade damaged skin for an extended period, they can cause local and systemic inflammatory responses. If left untreated, this condition may lead to chronic infected wounds. Infected wounds significantly escalate wound management costs worldwide and impose a substantial burden on patients and healthcare systems. Recent clinical trial results suggest that the utilization of effective antimicrobial wound dressing could represent the simplest and most cost-effective strategy for treating infected wounds, but there has hitherto been no comprehensive evaluation reported on the efficacy of antimicrobial wound dressings in promoting wound healing. Therefore, this review aims to systematically summarize the various types of antimicrobial wound dressings and the current research on antimicrobial agents, thereby providing new insights for the innovative treatment of infected wounds.

Stem Cell-Derived Nanovesicles Embedded in Dual-Layered Hydrogel for Programmed ROS Regulation and Comprehensive Tissue Regeneration in Burn Wound Healing

Burn wounds often bring high risks of delayed healing process and even death. Reactive oxygen species (ROS) play a crucial role in burn wound repair. However, the dynamic process in wound healing requires both the generation of ROS to inhibit bacteria and the subsequent reduction of ROS levels to initiate and promote tissue regeneration, which calls for a more intelligent ROS regulation dressing system. Hence, a dual-layered hydrogel (Dual-Gel) tailored to the process of burn wound repair is designed: the inner layer hydrogel (Gel 2) first responds to bacterial hyaluronidase (Hyal) to deliver aggregation-induced emission photosensitizer functionalized adipose-derived stem cell nanovesicles, which generate ROS upon light irradiation to eliminate bacteria; then the outer layer hydrogel (Gel 1) continuously starts a long-lasting consumption of excess ROS at the wound site to accelerate tissue regeneration. Simultaneously, the stem cell nanovesicles trapped in the burns wound also provide nutrients and mobilize neighboring tissues to thoroughly assist in inflammation regulation, cell proliferation, migration, and angiogenesis. In summary, this study develops an intelligent treatment approach on burn wounds by programmatically regulating ROS and facilitating comprehensive wound tissue repair.

Multidisciplinary Management and Autologous Skin Grafting in a Patient with Severe Burns: A Case Study

Background: Heat burns are a prevalent type of trauma. Rapid and effective treatment is crucial for deep burns to minimize complications. Autologous skin grafting is a highly effective treatment for full-thickness burns. A multidisciplinary team plays a vital role in managing burn patients undergoing skin grafting, from initial contact to outpatient follow-up. Case Summary: This case study involves a 56-year-old patient who suffered burns on 60% of his body following an alcohol explosion on an open flame. The patient underwent autologous skin grafting at a Major Burn Center. Initial symptoms included severe pain and immobility, but the patient remained alert and breathed spontaneously. The diagnosis was a loss of epidermis and dermis with burns covering 60-69% of the total body surface area (TBSA) and third-degree burns covering 10% TBSA. Post-discharge, the patient showed significant improvement, with complete healing of the grafts and partial resolution of other lesions. Six months after the intervention, the patient significantly improved his autonomy and mobility. Conclusions: This case highlights the importance of burn prevention and the critical role of multidisciplinary teams in the entire care pathway of burn patients. Appropriate diagnosis, complete treatment, and continuous multidisciplinary support are essential to prevent complications and ensure recovery.