Journal of Burn Care & Research最新文献

Cell suspension autograft (CSA) is a non-cultured, autologous cellular suspension used in partial-thickness burns or as an adjunct to widely meshed split-thickness skin grafts (STSG). While CSA has been shown to improve patient outcomes in burn care, literature is limited in highlighting its impact on mortality when used in combination with STSG. This retrospective, matched, case-control study investigates the clinical efficacy of CSA in adult burn patients admitted to a regional burn center from 2015 to 2023. Patients treated with CSA and STSG (n = 63, "CSA-treated") were compared against patients treated with STSG alone (n = 126, "non-CSA-treated"). Non-CSA-treated patients were matched in a 2:1 fashion to CSA-treated patients based on third-degree total body surface area burned (TBSA) and age. Outcomes included mortality, length of stay (LOS), intensive care unit LOS (ICU LOS), and number of procedures. Multivariate analyses revealed that CSA-treated patients had a significant reduction in mortality (p=.0445) and a 78.9% reduction in odds of death (OR: 0.211) compared to non-CSA-treated patients. CSA-treated patients displayed non-significant increases in LOS (p=.0670), ICU LOS (p=.0851), and number of procedures (p=.9084). Selection and chronology bias may partially account for the improved mortality in the CSA-treated group. The non-significant increases in LOS, ICU LOS, and number of procedures may be reflective of increased survivorship. These findings demonstrate that CSA enhances survival in burn patients when used with STSG, warranting further research to confirm these results.

Pyogenic granuloma (PG) is a benign vascular proliferation that commonly arises following trauma. Its occurrence in healing burn wounds, particularly in infants, is rare and poses diagnostic challenges. We present the case of an 11-month-old male who developed multiple rapidly growing, angiomatous nodules on the right cheek and scalp two weeks after sustaining a second-degree scald burn from boiling milk. The lesions exhibited typical bleeding and friability, prompting surgical excision and coverage with split-thickness skin grafts. Histopathological examination confirmed the diagnosis of PG. Postoperative recovery was uneventful, and follow-up at 2.5 years showed complete resolution without recurrence and minimal scarring. This case illustrates a rare but distinct manifestation of post-burn PG (PGB), emphasizing the importance of recognizing this reactive vascular phenomenon. A comprehensive review of the 38 cases reported in the literature so far underscores the variable clinical presentations and management strategies, reinforcing surgical excision as a reliable and curative intervention.

Timely closure of acute, full-thickness wounds is critical in minimizing complications such as infection, fluid loss, and impaired healing, all of which can adversely affect long-term patient outcomes. Although meshed autografting is the current standard of care, its effectiveness is limited by the need for donor skin and the re-epithelialization of expanded interstices. Prior research has shown that combining meshed autografts with skin cell suspension autograft (SCSA) enhances epidermal regeneration. In this study, we further investigate the mechanisms by which SCSA promotes re-epithelialization when applied with a widely expanded (3:1) meshed autograft in a full-thickness porcine wound model. Histological analyses demonstrate complete closure of graft interstices as early as three days post-surgery. A dual mechanism of re-epithelialization was observed, with keratinocytes migrating both from the edge of healthy skin from the interstice and within the center of interstices to form a continuous epithelial monolayer. The presence of a high number of proliferating cells in the wound bed further supports the regenerative activity of SCSA. These findings offer valuable mechanistic insight into the role of SCSA in accelerating wound closure and provide additional evidence for its use in improving outcomes for patients with acute full-thickness wounds.

Traumatic tattoos, resulting from the accidental impregnation of foreign particles are common consequences of road traffic accidents and explosions. Unlike conventional tattoos, these occur when high-impact events embed foreign materials into the skin, causing persistent discoloration and cosmetic disfigurement. Preventing the permanent inclusion of these particles through immediate removal is widely considered as the best strategy. Nowadays, the preventing procedures by the means of scrubbing remain insufficient and the need for delayed additional methods is of the main causes of concern. Consequently, we aim to propose a new therapeutic protocol with enzymatic debridement to prevent and treat traumatic tattoos. In this prospective study, we included patients diagnosed with traumatic tattoos referred to our National Burn Center during 9 months (from June 2024 to March 2025). All were treated with enzymatic debridement (Nexobrid®) to remove necrotic tissues after initial cleaning of the wound. Pigmented surface was evaluated before and after enzymatic debridement. 15 consecutive patients were successfully treated with enzymatic debridement (Nexobrid®) under sedation within the 24 first hours after the initial incident. 92.5% of the surface of pigmented dermis was cleared from pigments after treatment, thus preventing the occurrence of traumatic tattoos. No adverse events were reported during the treatment. Enzymatic debridement presents a comprehensive approach to wound care in cases of traumatic tattoos, offering precision, tissue preservation, and user-friendly application, to optimize functional and cosmetic outcomes. These advantages position it as an effective alternative to more traditional methods, particularly in settings that require minimal invasiveness and maximal tissue conservation.

Burn pain is among the most distressing and complex aspects of burn injuries, significantly impeding the treatment process and overall patient care. Despite advancements in pain management, many burn patients continue to experience inadequate relief. Investigating the experiences of both patients and healthcare providers offers valuable insights into the challenges of pain management. This qualitative study was conducted in Iran between 2024 and 2025. Eighteen hospitalized burn patients and twenty-one healthcare providers-including physicians, nurses, psychologists, and physiotherapists-were selected through purposive sampling. Data were gathered via semi-structured individual interviews until saturation and analyzed using Graneheim and Lundman's content analysis method, supported by MAXQDA 2020 software. Four main categories and thirteen subcategories emerged: "Endless suffering accompanied by a sense of collapse," "The cycle of suffering and restlessness," "Barriers to pain relief," and "A holistic approach to pain management." Findings showed that patients endured severe physical pain along with psychological distress such as anxiety, despair, and sleep disturbances, while healthcare providers emphasized systemic barriers, resource limitations, and the restricted effectiveness of current approaches. These results highlight the multifaceted and enduring nature of burn pain and underscore the importance of addressing both patient experiences and provider challenges. In conclusion (shortened), burn pain represents one of the most intense and debilitating forms of suffering, with consequences extending beyond the physical dimension. Targeted strategies informed by these insights may improve the quality of care and patient outcomes.

Burns are associated with significant morbidity and mortality. Palliative care (PC) has been shown to improve patients' comfort, clinical decision-making, and overall satisfaction in the burn unit. The purpose of this paper is to describe the frequency of PC utilization after burn injury and to understand the patient characteristics that affect whether they are seen by PC. We conducted a retrospective study by querying the HCUP National Inpatient Sample, identifying patients admitted with a primary burn diagnosis from 2016-2021. Patient characteristic differences were assessed between patients who did and did not receive PC using chi-square analyses and multi-variable regression, weighted to represent the national population. Revised Baux (rBaux) scores were calculated. Of 146,455 patients admitted with a primary burn diagnosis, 3,535 (2.4%) received PC consultation. Of 5,205 patients who died prior to discharge (3.6% of total), 2,370 (45.5% of deaths) had a PC encounter. Older patients, patients with larger burns, and patients with higher rBaux scores were most likely to receive PC. White patients were more likely to receive PC than Black and Hispanic patients. Patients in teaching hospitals were more likely to receive PC than those in rural, nonteaching hospitals. Patients in northern regions received PC more often than those in other regions. More than half of patients with burn injuries who died prior to discharge did not receive PC. Older patients and those with higher rBaux scores received PC most often. Further research is necessary to identify burn patients most likely to benefit from and receive PC.

Burn injuries significantly impact morbidity and mortality, with early surgical intervention crucial for improving outcomes. However, concomitant traumatic brain injury frequently complicates burn management, potentially delaying timely surgical treatment due to neurological concerns. Optimal timing of burn surgery in patients with concurrent traumatic brain injury remains uncertain, necessitating clearer insights into their clinical outcomes. This retrospective study reviewed burned adults admitted to a Swiss Burn Center between 2014 and 2023. Patients were grouped as burns with traumatic brain injury, burns alone, burns with other trauma, or electrical burns. Demographics, injury characteristics, timing of surgery, complications, and outcomes were analyzed. Generalized linear models and logistic regression were applied. Among 602 patients, 27 (4.5 %) had a traumatic brain injury. Mortality was highest in this group (22.2 %) compared to isolated burns (3.7 %), burns with other trauma (7.4 %), and electrical burns (4.8 %). Surgical delays (>72 h) occurred only in burn patients with traumatic brain injury (22.2 %), mainly due to hemodynamic instability, intracranial pressure monitoring, or additional trauma. Delayed surgery correlated with more surgical interventions (p=.018) and longer operative times (p=.048). Complications were more frequent: wound infections (48.1 %) and graft loss (22.2 %) were significantly higher in the traumatic brain injury group. In conclusion, burns with concomitant traumatic brain injury define a distinct, high-risk subgroup with increased surgical delays, complications, and mortality. Management requires an interdisciplinary approach, balancing early surgical intervention with neuroprotective strategies to optimize patient outcomes.

Healthcare professionals who care for burn survivors are frequently exposed to patient pain, trauma, and distress, placing them at high risk for burnout, compassion fatigue, and secondary traumatic stress. These occupational stressors threaten both the health and career longevity of providers and the quality of patient care. Perceived support-an individual's belief that organizational and social supports are present and reliable-may mitigate these risks and promote professional well-being. This secondary analysis examined the relationship between perceived support and professional quality of life outcomes in burn therapists. Data (n=140) were drawn from a 2023 survey utilizing the Professional Quality of Life Scale; additional items assessed perceptions of workplace and peer support. Findings from Spearman rank-sum analyses demonstrated significant positive associations between compassion satisfaction and perceived support. Specifically, feeling connected to others and having trusted colleagues to discuss struggles were strongly protective, while feeling "bogged down by the system" was linked to higher stress and lower satisfaction. Both feelings of connection and support correlated with lower levels of workplace burnout. Results highlight the critical role of interpersonal and organizational supports in sustaining resilience and compassion among burn therapists. Interventions that foster team connectedness, reduce systemic barriers, and enhance perceptions of organizational concern may reduce occupational stress, strengthen professional fulfillment, and decrease turnover. Promoting perceived support is an actionable strategy to protect the well-being of burn rehabilitation providers and, ultimately, improve patient outcomes.

There is growing awareness of the indirect trauma exposure experienced by health care providers and the resulting development of secondary traumatic stress (STS). However, STS in burn care clinicians has not been examined thoroughly. The current study aimed to examine feasibility of study procedures in this population, estimate the prevalence of STS, and examine the relationship between STS and additional factors. Cross-sectional data were collected from 103 burn clinicians from 15 different occupations working in a large civilian burn center in the U.S. Participants completed measures of STS, burnout, demographics, and occupation-related information. Study procedures were feasible. Over forty percent (42.16%) of participants met criteria for moderate to severe STS. STS was significantly correlated with younger age and burnout subscales. Binomial logistic regression analyses showed that the overall model containing burnout subscales was statistically significant and able to distinguish between respondents who endorsed symptoms consistent with PTSD due to STS and those that did not. Results on STS and time spent with burn patients varied. Non-significant results were found regarding STS and the remaining demographic and occupational variables. Results support the feasibility of studying STS in this population, and the prevalence of STS among burn care clinicians warrants attention. Important information was added to the extant literature on related risk and protective factors. Increased knowledge about STS in this population will help to inform prevention efforts and interventions at both the individual and organizational level to prioritize staff well-being and improve patient care.