Journal of Burn Care & Research最新文献

Post-burn pruritus (PBP) significantly affects patients, causing discomfort and hindering recovery. Antihistamines, which block H1 receptors, are commonly prescribed for PBP, yet large-scale studies on their usage patterns are limited. This study evaluates antihistamine prescription trends and provider practices for PBP across varying burn severities from moderate to severe burns (≥20% TBSA). A treatment pathways analysis was performed using TriNetX, a global, federated, deidentified database. Patients with burns ≥20% TBSA from the past 20 years (2004-2024) who developed pruritus were identified and stratified into four cohorts: 20-40%, 40-60%, 60-80%, and ≥80% TBSA. The analysis evaluated trends in antihistamine prescriptions, including the number of patients treated with antihistamines, types prescribed, and median times to treatment initiation, duration, and therapy switching. The total sample included 2,754 patients (20-40% TBSA, n=1,712; 40-60%, n=613; 60-80%, n=253; ≥80%, n=176). Over 70% received antihistamines, with hydroxyzine as the most common first-line therapy, followed by diphenhydramine. Across all cohorts, the average of the median times for initiation, therapy duration, and time before switching was 16.75 days, 90.25 days, and 27.75 days, respectively. Significant variations in the timing of therapy initiation suggest a gap in consistent symptom management during critical recovery periods, potentially affecting patient comfort and overall outcomes. These findings underscore the importance of vigilant post-burn assessment, stepwise escalation based on response, and complementary strategies to optimize PBP management. Frequent switching and prolonged durations suggest a need for more effective and tailored therapeutic approaches to improve recovery outcomes for burn patients.

Burn injuries represent a worldwide public health concern. Nigella sativa (NS), a herbal medicinal plant, widely used in Ayurveda, Unani, and Siddha holds potential to address this issue. This review evaluated the potential of NS extract and its key component, Thymoquinone (TQ), in accelerating burn wound healing, focusing on their mechanisms, safety, and efficacy. Studies were retrieved from PubMed, Google Scholar, and ScienceDirect using keywords "Nigella sativa," "Thymoquinone," "burns," and "wound healing." Reports were screened for suitability, and the scientific name was verified on www.worldfloraonline.org. NS extract and TQ accelerate burn wound healing in vitro and in vivo through various mechanisms involving anti-inflammatory, anti-oxidative, anti-microbial, and tissue regenerative effects. TQ achieved 91.35% wound closure in NIH/3T3 cells (mouse fibroblasts) and wound closure rate of 2.35 ± 0.05% in 3T3-CCL92 cells (fibroblasts from mouse embryos). It also reduced oxidative stress and inflammation in murine burn models. Nanoformulations of TQ showed higher safety (LD₅₀: 300-2000 mg/kg) than pure TQ (LD₅₀: 50-300 mg/kg). A Phase I trial confirmed the safety of black cumin oil (5% TQ) at 200 mg/day for 90 days in healthy adults. Therefore, formulations based on NS extract and TQ can manage burn injuries and be extrapolated into clinical settings.

Burns are a leading cause of childhood injury. Analysis of pediatric burn epidemiology is essential for targeting educational and public health strategies but there is limited available UK data, particularly traversing the COVID-19 pandemic. We hypothesize that the last 20 years have seen significant changes in injury patterns and service provision, with a marked effect from national lockdown measures. This study aims to describe the epidemiology of pediatric burns referrals and admissions within a pediatric burns unit in the UK over 20 years (2005-2024). A retrospective analysis was performed for pediatric patients referred to our center between 2005 and 2024. The International Burn Injury Database (iBID) was used to extract demographic and injury information. Data before, during and after COVID-19 lockdown periods was compared. 6919 patients met the inclusion criteria. 1872 (27.1%) of patients required admission. There was a significant reduction in admission rate following covid despite an increase in average TBSA (p<0.01). Most cases were scalds (n=3100, 44.8%) or contact burns (n=2650, 38.3%). The majority of patients were aged under 5 years (n=4529, 65.5%), with a rise in referrals for older children across the study period. There was a noticeable rise in aerosol-related flash burns, cold burns and treadmill- related friction burns during and after the pandemic. This study provides epidemiological data for the development of public health initiatives and adaptation of pediatric burns services. Emerging mechanistic trends and service re-design following the COVID pandemic requires further multi-center evaluation to inform future care.

Burn wounds pose significant challenges due to their susceptibility to microbial invasion and limited effective dressing options. This study aimed to evaluate the wound healing potential of a sericin-based self-healing and stretchable hydrogel loaded with Psidium guajava L. extract against full-thickness burn wounds in mice. The hydrogel was characterized by physicochemical analyses including SEM, FTIR, XRD, viscosity, pH, swelling degree, weight loss, and mechanical strength. In vivo experiments used a Swiss albino mice burn model, where 6 mm full-thickness wounds were induced with a hot metal rod. Hydrogels were applied topically at regular intervals, and wound healing was assessed through wound contraction measurements, healing time, and histological analysis. Hematological parameters and serum biomarkers i.e. pro- and anti-inflammatory cytokines, matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinases (TIMPs), antioxidants (GSH, GPx, CAT, SOD), angiogenic factors (VEGF), and oxidative stress markers (MDA) were also evaluated. Results demonstrated that the hydrogels exhibited high swelling capacity and notable weight loss, suggesting effective absorption of wound exudates and reduced infection risk. Notably, Hydrogel 4 (3% sericin + 3% P. guajava L.) achieved significantly improved wound healing (89.66%) compared to controls (37.16%) by day 15. Histological examination confirmed collagen deposition and hair follicle regeneration, indicative of complete healing. Hematological findings showed increased red blood cell counts and reduced white blood cells, reflecting resolution of inflammation. Serum analyses revealed elevated anti-inflammatory markers (IL-10), TIMPs, and antioxidants (GSH, GPx, CAT, SOD), alongside decreased pro-inflammatory cytokines (IL-6, IL-8, IL-1β, TNF-α), MMPs, angiogenic factor VEGF, and oxidative stress marker MDA. Hydrogel 4 showed a 3.47-fold increase in SOD and a 68% reduction in MDA, underscoring its efficacy in mitigating oxidative stress. In conclusion, the sericin-based hydrogel infused with P. guajava L. exhibited excellent physicochemical and biological properties, promoting effective burn wound healing. Hydrogel 4 demonstrated the most pronounced therapeutic benefits, making it a promising candidate for advanced wound dressing applications.

Severe burns unleash a hyper-catabolic and immunosuppressive state that erodes lean tissue and delays repair. Alpha-ketoglutarate (α-KG), usually delivered enterally as the dipeptide ornithine α-ketoglutarate, feeds the tricarboxylic-acid cycle, donates nitrogen for amino-acid synthesis, and modulates collagen formation and immunity. We systematically appraised the biological mechanisms, delivery strategies, and clinical outcomes associated with α-KG/OKG in burn care to clarify its therapeutic value and translational readiness. A PRISMA-2020-compliant search of PubMed, EMBASE, Web of Science, Cochrane, and Google Scholar up to May 2025 identified clinical, in-vivo, and relevant in-vitro studies linking α-KG or OKG with thermal injury. Study quality was assessed using the Newcastle-Ottawa Scale, SYRCLE Risk-of-Bias tool, and Oxford Levels of Evidence. Fifteen studies published between 1984 and 2024 met inclusion criteria, including clinical, animal, and mechanistic work, most conducted in France. Across studies, OKG supplementation replenished glutamine and arginine pools, improved nitrogen balance, preserved muscle mass, and promoted wound healing through enhanced collagen synthesis and immune modulation. Clinical data confirmed improved nitrogen retention, reduced muscle breakdown, and faster wound closure. Preclinical studies further showed that α-KG preconditioning enhances stem cell-driven regeneration and vascularization. Additional effects, such as improved glucose tolerance and hepatic enzyme preservation, suggest some benefits occur independently of glutamine pathways. This review highlights α-KG and OKG as promising adjuncts to enhance metabolic recovery, wound repair, and immune competence after burns. Evidence supports improved nitrogen balance and healing, but findings remain limited by heterogeneity and small cohorts, warranting renewed and well-powered studies.

Methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen in burn-injured patients. Many studies have evaluated the overall utility of MRSA nares polymerase chain reaction (PCR) swabs for antimicrobial stewardship; however, there is a paucity of data in burns. This study evaluated the clinical utility of MRSA PCR in burn-injured patients at an academic medical center. This retrospective, single-center chart review included admitted adult burn-injured patients from July 2020 to June 2024. The primary objective was to determine the overall negative predictive value (NPV) of MRSA PCR in patients with burn injuries for suspected MRSA infections. Secondary objectives included determining the sensitivity, specificity, NPV, and positive predictive value (PPV) of MRSA PCR for specific culture types. There were 89 patients, and 289 cultures were included. The overall prevalence of MRSA positive cultures was 13.4% for the study period. For the primary outcome, the NPV of MRSA PCR was 98.3% (95% confidence interval, 95.5%-99.5%). For the whole cohort the PPV was 22.5%, sensitivity was 73.4%, and specificity was 86.1%. The total cost of vancomycin therapy (doses and levels) was US $37 935.75, which was estimated using average wholesale price. A cost avoidance of US $378.15 per patient was estimated for patients not meeting criteria for vancomycin therapy. Overall, this study found a high NPV for MRSA PCR in burn-injured patients with suspected infections. In addition, MRSA PCR may be used along with other clinical markers to decrease the use of antimicrobials targeting MRSA, which may help decrease the cost of therapy.

Burns to the perianal region pose specific challenges in management due to the complex structure of the surrounding tissue, bacterial contamination, and repetitive stress. Fecal diversion via diverting ostomy may be elected in these injuries because of its potential to enhance wound healing and skin graft adherence; however, its use introduces alternative risks such as prolonged ileus, fistula, leakage, and failure of reversal. This study aimed to determine the perspectives of burn surgeons regarding the use of diverting ostomy for perianal burn injuries. We conducted a survey of 12 physicians who are burn center directors in the Northeast Region of the American Burn Association regarding their practices for patients with full-thickness perianal burn injuries requiring a skin graft. Response rate was 11/12 (92%). Six individuals (54.5%) reported "Never (0%)" to performing a diverting ostomy in this context; the remaining 5 individuals responded "Rarely (<10%)." Reasons stated for performing a diverting ostomy in the "Rarely" group included cases where the patient suffered an intra-anal or anorectal injury. These results were summarized with a relevant review of the literature and experience in our clinical practice. Our findings indicate that diverting ostomy is a relatively uncommon practice for burn surgeons treating full-thickness buttocks injuries. With appropriate wound care and critical care management, good outcomes can be obtained without the need for diverting ostomy. Non-surgical alternatives to fecal diversion are commonly used by burn specialists and should be considered in perianal burn injuries.

High-voltage electrocution injuries can result in extensive, multisystem tissue damage, including vascular injuries. The decision between revascularization and early amputation remains challenging, especially given the risks of hemorrhage, infection, and repair failure. A comprehensive literature review was performed using PubMed, Scopus, and Cochrane databases with predefined MeSH terms and keywords related to electrocution and arterial injury. Nineteen relevant human studies were selected after screening. In addition, we present a case of high-voltage upper limb injury in which an arterial interposition graft using the deep inferior epigastric artery (DIEA) was performed in an attempt to maintain hand perfusion. Most published reports describe venous grafts-the most commonly used option-or flow-through flaps as reconstructive options. To date, no previous cases have reported the use of arterial grafts in this context. Arterial injuries may present acutely or subacutely, and a variety of repair techniques have been described, without clear evidence favoring one approach over another. In our case, despite technically successful placement of a DIEA arterial graft following radial artery rupture, early thrombosis and distal ischemia occurred, ultimately resulting in limb loss. Vascular injury from electrocution is often more extensive than macroscopically evident. Reconstructive attempts should be considered only in stable patients, especially when preserving the dominant limb in young individuals. Although arterial grafts offer structural advantages, they may not overcome the systemic and local damage induced by electrocution. Further research is needed to define clearer guidelines for vascular repair versus amputation in these complex scenarios.