Journal of Burn Care & Research最新文献

Burn injuries trigger complex inflammatory and metabolic cascades that impair wound healing and increase morbidity. Fibroblast Growth Factor 2 (FGF2), a potent mediator of cellular proliferation, angiogenesis, and extracellular matrix remodeling, has emerged as a promising therapeutic agent in burn care. This systematic review evaluated the biological mechanisms, delivery strategies, and clinical outcomes associated with FGF2 in burn wound healing to clarify its therapeutic value and translational potential. Following PRISMA 2020 standards, a structured literature search was conducted across PubMed, EMBASE, Web of Science, Cochrane, and Google Scholar to identify studies investigating FGF2 in thermal injury. Eligible records included clinical trials, in vivo models, and in vitro experiments. Methodological quality and risk of bias were assessed using the Newcastle-Ottawa Scale, SYRCLE tool, and Oxford Levels of Evidence. Thirty-three studies (1992-2025) met inclusion criteria, encompassing randomized controlled trials, animal models, and mechanistic analyses. FGF2 accelerated repair by stimulating fibroblast proliferation, keratinocyte migration, angiogenesis, and matrix organization. Topical FGF2 formulations shortened healing time and improved scar quality in partial-thickness burns. Innovative carriers, including hydrogels, liposomes, and gene-activated matrices, enhanced bioavailability and sustained local effects. In diabetic and complex burn models, FGF2 mitigated inflammation, preserved barrier integrity, and promoted re-epithelialization. Efficacy depended on dosage and wound characteristics. Studies reported favorable safety profiles with few and mild adverse events. FGF2 demonstrates regenerative and immunomodulatory potential in burn management. Broader adoption requires harmonized regulatory evaluation, optimized delivery systems, and multicenter validation to define its role in precision-guided burn care.

Voice and swallowing dysfunction are common after smoke inhalation injury, however, burn survivors often do not seek follow up for ongoing dysphonia, dysphagia or exercise intolerance, which may be a result of undiagnosed airway scarring or stenosis. The aim of this study is to evaluate trends in dysphonia, dysphagia, and upper airway injury after smoke inhalation injury. A retrospective case series with chart review was performed of all patients admitted with smoke inhalation injury from 2018 to 2022. Patient demographics, injury patterns, voice, airway, and swallowing symptoms, laryngoscopic findings, swallowing evaluations, and hospital course were collected. Fifty patients met inclusion criteria, of whom 36 (72%) were males and 14 (28%) were female. Ages ranged from 20 to 79 (mean 48.2) years. Forty patients (80%) underwent flexible laryngoscopy during admission, of which 80% had abnormalities. Patient-reported dysphonia had a positive predictive value of 76% for abnormal laryngoscopic findings. Patient reported dysphagia had a positive predictive value of 100% for abnormalities on clinical or instrumental swallowing evaluation but a <30% negative predictive value. Eight patients were seen in follow-up by Otolaryngology, of whom 75% had abnormal laryngoscopic findings and 50% required surgery for airway stenosis. Although patient symptoms were highly predictive of abnormal findings on laryngoscopy and swallowing evaluation, objective evidence of dysphagia was also very common in asymptomatic patients. Universal Speech Language Pathology assessment would allow for early detection of swallowing dysfunction in this patient population and long term follow up is warranted to avoid missed injuries or delays in care.

Frailty is a clinical state characterized by increased vulnerability to stressors, leading to an increased risk of adverse health outcomes. The modified Frailty Index (mFI-5), based on five comorbidities-diabetes mellitus, heart failure, pulmonary disease, hypertension, and totally or partially dependent functional health status -has shown predictive value for treatment outcomes and mortality. The primary objective of this study was to evaluate differences in clinical outcomes between burn patients with mFI-5 scores of 0, 1, and ≥2. The secondary objective was to determine whether the mFI-5 score independently predicts adverse outcomes. A retrospective analysis of 644 burn patients treated between September 2018 and May 2022 was conducted. Data on comorbidities, complications, ventilation status, surgical procedures, length of stay, and discharge destination were analyzed. Statistical analyses included Pearson's chi-square test, Kruskal-Wallis test, and adjusted multivariate regression analysis. Higher mFI-5 scores were associated with worse overall outcomes, including longer hospital stay, higher rates of complications, more frequent need for mechanical ventilation, a greater number of skin grafts and necrectomies, and more frequent discharge to non-home settings. Multivariate analyses showed that a higher mFI-5 score compared to mFI-5=0 was independently associated with higher rates of urinary tract infections (mFI-5≥2: OR 2,41, 95% CI: 1.19-4.86, p=0.014) and non-home discharge (mFI-5=1: OR 2.34, 95% CI: 1.00-5.45, p=0.049). The mFI-5 is a strong predictor of complications and adverse outcomes in burn patients. Its quick, simple application makes it a valuable risk stratification tool in specialized burn centers.

Skin fibrosis, especially hypertrophic scars (HTS), remains understudied with few effective treatments. Studying HTS is challenging due to its natural tendency to improve over time, making it hard to separate intervention effects. This study evaluated fractional ablative laser treatment for symptomatic HTSs, focusing on variability in patient response. It was hypothesized that pain and itch would decrease post-treatment, and that demographic or injury characteristics might predict responders. A retrospective chart review analyzed pre-treatment and six post-laser sessions using the Patient Scar Assessment Scale (POSAS) for pain and itch (1 = low, 10 = high). Patients showing a ≥ 3 point improvement were classified as "responders" (n = 48 for pain, n = 62 for itch); those with ≤2 point improvement or worsening were "non-responders" (n = 62 for pain, n = 76 for itch). In total, 110 patients were analyzed for pain and 138 for itch. Most patients were non-responders for both pain (56.4%) and itch (55.1%). Responders experienced significant reductions in pain and itch after the first session, with stable scores thereafter (p<.0001). Non-responders showed no significant improvement in pain and, for itch, even a significant worsening after the first session. No significant differences were found between groups based on sex, skin type, race, scar age, scar size, or patient age. Responders had higher baseline pain and itch scores than non-responders. The greatest symptom relief occurred after the first treatment. Demographic and injury characteristics did not predict treatment response.

Frostbite injuries account for 2000-4000 hospital admissions annually in the U.S., with 30% of severe cases requiring amputation and up to 70% result in long-term sequelae or disability. Traditional practice following frostbite injury is to delay surgical intervention 4-6 weeks to preserve limb length, tissue coverage, and reduce complications. This study examines amputation timing among frostbite patients in the U.S. and identifies factors influencing early versus delayed amputation. This retrospective study used the Nationwide Readmission Database from 2016-2020 to identify frostbite admissions. Logistic regression models identified predictors of early amputation. Among 4786 patients with frostbite injury, 1422 (29.7%) underwent amputation. Of these, 977 (68.7%) had early amputations. Drug and alcohol use and housing insecurity were more prevalent among amputated patients, but was not associated with early amputation. Female sex, drug or alcohol use, comorbidities, infection or cellulitis, and mental health diagnoses were associated with a lower likelihood of early amputation. In adjusted models, infection/cellulitis was associated with lower odds of early amputation in the full cohort and not associated with timing in the non-elective subset. Across U.S. admissions captured in the NRD, amputations commonly occurred within 30 days of presentation, diverging from historical "watchful waiting" practices. Social drivers of health influence need for and timing of amputations. Infection and cellulitis, which may necessitate urgent intervention, was not associated with increased likelihood of early amputation timing. Future research should explore factors driving early amputation and assess the impact of amputation timing on functional outcomes.

The development of an autologous, full-thickness skin replacement remains the holy grail for the treatment of full thickness skin loss from burns, wounds, and trauma. With massive burn injury and limited donor-site, cultured epidermal autografts (CEAs) can be lifesaving, however they have significant limitations. Furthermore, reconstruction in such patients is challenging. We describe the compassionate use of an autologous, engineered, hydrogel skin graft with keratinocytes and fibroblasts (EHSG-KF), in the treatment of a pediatric patient with massive burn injury. A compassionate use exemption was obtained from the U.S. Food and Drug Administration allowing for up to 3 separate treatments using an EHSG-KF for a 3-year-old patient with a 90% TBSA burn. Grafts were based on plastically compressed collagen type I hydrogels with incorporated keratinocytes and fibroblasts. We retrospectively review our experience with two separate applications and early outcomes. A 2x2cm split thickness skin graft was harvested and shipped internationally for processing. At the same time, contracture releases were performed, and dermal matrices were applied. EHSG-KF were then applied approximately 4 weeks after contracture release. In some areas, EHSG-KF was applied without a dermal matrix, immediately post debridement. Grafts were secured for 7 days with staples and covered with silver foam and tie over bolsters or circumferential gauze wrapping. Graft take was >95%. This novel EHSG-KF was relatively easy to handle, apply, and care for, similar to a traditional autologous FTSG. Engraftment rate was >95% and the resulting healed skin appears to be durable. Our impression has been extremely positive, particularly when compared to traditional CEAs. Additional trials in Europe using this particular EHSG-KF are ongoing.

Skin graft complications may include pain, contractures, hypertrophic scars (HSc), hypersensitivity, and recurrent wounds. Complications involving grafts to the genitalia, perineum, and/or buttocks can be particularly challenging, directly affecting walking, sitting, voiding, bowel elimination, sexual function, and intimacy, ultimately diminishing quality of life. Perineal and pelvic floor rehabilitation (PPFR) is commonly used to treat various pelvic floor disorders; however, its application following burn injury or necrotizing fasciitis has not been previously described. This manuscript presents the evaluation and treatment outcomes of patients with necrotizing fasciitis or Fournier's gangrene. Initial evaluation was conducted approximately four months post-admission by a certified pelvic floor physiotherapist and occupational therapist. Treatment included pelvic floor rehabilitation, patient education, sensory re-education, bladder and bowel training, use of adapted pressure garments, gel application, cutaneous and myofascial stretching, and manual therapy. This report details the outcomes of two male patients (37 and 69 years old) who underwent skin grafting and reconstructive surgery following necrotizing fasciitis and Fournier's gangrene. Both presented with complex wounds that closed approximately four months post-admission, accompanied by contractures, HSc, altered sensory perception, incontinence, and sexual intimacy dysfunction. Following PPFR treatment, improvements were observed in pruritus, urinary and fecal retention capacity, sexuality-related fear avoidance, penile deviation, lower extremity range of motion, satisfaction with sexual function, and sensory perception. This is the first description of a standardized PPFR protocol in this context, demonstrating that specialized interdisciplinary rehabilitation can enhance sexual function, body image satisfaction, and overall quality of life in patients with genital, perineal, and/or buttock grafts.