Journal of Burn Care & Research最新文献

Microstomia, or small oral aperture, often results from facial burns. This condition appears as scars form within the oral tissue and at the oral commissures, narrowing the oral opening, and leading to mobility, speech, respiratory difficulties, emotional distress, and social interaction challenges. This study examines the presence of reported burn microstomia and its related clinical factors. Pediatric and adult data from a multicenter longitudinal database from 2003-2005 were analyzed to determine the frequency of microstomia at discharge. Summary statistics were used to describe clinical characteristics, demographics, and burn location in pediatric and adult burn survivors. Clinical and burn characteristics were then tested to determine if there was an association with the development of microstomia. Data revealed 4.7% (n = 10) of adult burn survivors (n=214) and 11% (n =10) of pediatric burn survivors (n=91) presented with microstomia at hospital discharge. Those with microstomia had significantly larger TBSA burns, higher rate of inhalation injury, more days on ventilation, and higher rate of adjacent contractures. No differences were found when considering age, sex, race, ethnicity, etiology of burn, or discharge location. Burn size and length of time requiring ventilation were predictive of microstomia. Knowledge of these risk factors suggests therapists should focus on early microstomia prevention, even during times of ventilation, especially in those with larger burn injuries. The high incidence of adjacent contractures demonstrates the impact of cutaneokinematic skin recruitment and suggests areas beyond the perioral should be considered when developing a treatment and prevention program for microstomia following a burn injury.

Hyperbaric oxygen therapy (HBOT) involves inhaling 100% oxygen at pressures exceeding one atmosphere within a chamber. It is used across several specialties and has been proposed as an adjunct in burn management to enhance healing and improve outcomes. Despite increasing interest, evidence supporting its efficacy in burn care remains inconsistent, with no clear consensus in practice. A literature search was conducted in September 2025 across PubMed, Cochrane Library, and Embase without date restrictions to identify studies evaluating HBOT for burn treatment. Inclusion criteria were human studies, English-language articles, and full-text availability. Study selection followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers screened titles and abstracts, and a third resolved discrepancies. Eligible studies described HBOT as a burn treatment and reported clinical outcomes. Thirteen studies met inclusion criteria: 5 randomized controlled trials, 7 cohort studies, and 1 case-control study, evaluating 566 burn patients. Burn severity, HBOT protocols, and outcomes varied substantially. Several studies reported reduced need for surgery and shorter hospital stays with HBOT. Trends toward improved healing and lower infection risk were noted, while mortality benefits were inconsistent. Heterogeneity in design and treatment regimens limited synthesis via meta-analysis. HBOT shows promise as an adjunct in burn care, improving healing and reducing complications. However, variability and inconsistent outcomes limit definitive conclusions. Well-designed randomized trials are needed to establish standardized protocols and clarify its clinical role in burn management. Until then, burn centers may consider HBOT for acute injuries and threatened grafts.

Burn patients exhibit one of the most intense hypermetabolic responses among critically ill populations, making them highly susceptible to malnutrition-linked to prolonged hospital stays and delayed wound healing. While cannabis is recognized for its appetite-stimulating properties in acute settings, its association with the nutritional demands of burn injuries remains underexplored. A single-institution retrospective study was conducted on adult burn patients with <20% total body surface area (TBSA) who tested positive for cannabis on admission urine toxicology between 2015 and 2024. These patients were matched 1:1 with controls who tested negative for cannabis. The primary predictor variable was cannabis use, while outcomes included burn characteristics, prealbumin and albumin levels, overall outcomes, and complications. Significance was set at p<.05. We analyzed 76 cannabis positive burn patients and 76 controls. No significant differences were found in demographics or outcomes. When controlling for BMI, cannabis intoxication was not significantly associated with changes in admission prealbumin (18.8 vs 19.2, p=.804) or admission albumin (3.9 vs 4.0, p=.375) levels. There was also no significant variation in the number of days post-admission required to achieve peak prealbumin (3.8 vs 3.9, p=.876) and albumin level (0.3 vs 1.0, p=.088). Increased age was associated with a reduction in admission albumin (p<.001), and Caucasian patients had increased albumin compared to other races (p=.048). Cannabis intoxication had no significant association with pre-burn injury nutritional status. Further research with larger sample sizes is necessary to fully understand the complex relationship.

Patients with severe burns endure intense pain, which is amplified by serial operations, daily dressing changes, and regular physical therapy. While peripheral nerve blocks have become increasingly popular in the management of isolated burns to the extremities, there have been few reports on the use of neuraxial anesthesia to treat burn pain. Here, we describe the inclusion of epidural anesthesia in our algorithm for management of burns to the lower trunk, bilateral lower extremities, buttocks, and perineum. We hypothesized that epidural anesthesia would be associated with reduced opioid use and improved pain scores. We performed a retrospective review of all patients admitted to a verified burn center who underwent epidural catheter placement between 2018 and 2024. Visual analog scale (VAS) pain scores and opioid consumption (standardized in morphine milligram equivalents [MME]) were extracted for the several days before and after placement of each patient's first epidural catheter. During the study period, 11 patients underwent epidural catheterization in our burn unit. An average of 1.8 (SD 1.3) catheters were placed per patient, for a total of 20 catheters. All patients experienced significant reductions in daily opioid consumption (92.5 MME/day pre-epidural to 58.1 MME/day post-epidural, p = 0.008) and average pain scores (6.25 pre-epidural to 2.45 post-epidural; p = 0.008). Minor complications including nausea/vomiting and pruritis occurred in 4 patients. There were no major complications or infections. We conclude that epidural anesthesia is safe and effective for relieving pain and decreasing opioid consumption in burn patients.

Background: Social determinants of health (SDOH) have been shown to contribute to disparities in burn outcomes. This study leverages patient data from a regional burn center serving Texas and New Mexico to evaluate whether national indices of social vulnerability accurately predict in-hospital mortality among burn patients from underserved areas.

Methods: We conducted a retrospective cohort study of 1,841 patients treated for burn injuries over a five year period (2019-2024). 16 ZIP code-level SDOH metrics including Social Vulnerability Index (SVI) and Socioeconomic Status (SES) were quantified. Univariate and multivariable logistic regression analyses were performed to assess the impact of SDOH on mortality. Patients were stratified into quartiles to explore dose-response relationships.

Results: In univariate analysis, higher SES scores (indicating greater deprivation) was the strongest SDOH metric associated with mortality (OR = 6.28, p = 0.0018). In multivariable analysis, patients in the most deprived SES quartile (Q4) had more than double the odds of mortality compared to the least deprived (Q1) (OR = 2.20, p = 0.0199). Significant clinical predictors included age, second- and third-degree TBSA, alcohol use disorder, COPD, and obesity. SVI was not independently associated with mortality after adjustment.

Conclusion: SES was an independent predictor of in-hospital burn mortality in this regional cohort after adjusting for clinical factors. Other aggregate scores poorly predicted mortality after controlling clinical variables. This is potentially due to the influence of urban demographics of these indices. Further research should investigate metrics to better capture rural SDOH to improve rural burn care.

Hand burns pose significant rehabilitation challenges. While compression therapy is well-established for chronic scar management, evidence for its application during the acute phase remains limited. This study evaluated the effectiveness of early compression therapy on edema, passive range of motion, and grip strength in acute hand burns. A randomized controlled trial was conducted at a tertiary burn centre between November 2023 and March 2025. Thirty-two adult patients (40 hands) with superficial and/or deep partial-thickness hand burns were randomly assigned to control (standard care; 16 patients, 20 hands) or intervention groups (standard care plus compression therapy at 8 mmHg; 16 patients, 20 hands). Outcomes measured at baseline and end of acute phase included hand edema, metacarpophalangeal joint passive range of motion (PROM), and grip strength. Statistical analyses included paired and independent t-tests, ANCOVA, and effect size calculations. Groups were homogeneous at baseline. The intervention group demonstrated significantly greater improvements: PROM increased 23.6±12.8° versus 8.6±16.7° (p=0.003, Cohen's d=1.00), grip strength improved 4.2±5.9 kg versus declined 0.8±5.0 kg (p=0.006, d=0.92), and edema reduced 4.2±2.9 cm versus 2.3±2.1 cm (p=0.025, d=-0.74). ANCOVA confirmed significant effects after adjusting for baseline values (all p<0.01). No adverse events occurred. Early compression therapy during acute hand burns significantly improves outcomes with large effect sizes. These findings support considering earlier initiation of compression therapy (48-72 hours post-injury) as part of acute hand burn management protocols.

Background: Skin substitutes are vital in burn care. While physician-industry partnerships drive innovation and access, they also raise concerns regarding bias and conflicts in product promotion. This study analyzes current trends in physician-company financial relationships within the skin substitute market related to burn treatment.

Methods: The Physician Payments Sunshine Act mandates transparency in reporting industry payments to physicians. Companies with the largest market share of skin substitutes and burn wound coverage products were evaluated. Physician payment records from 2017 to 2023 were extracted and analyzed by category, including consulting fees, speaker compensation for non-accredited education, food and beverage, and travel.

Results: Eight companies representing 28 products distributed nearly $45 million in direct payments to physicians over six years; company totals varied by up to $13.5 million. Annual per-physician payments ranged from $0.35 to $1,088,405.68 (median $47.17, IQR $21.44 to $130.57). The highest expenditure categories were non-accredited speaker compensation ($2,741,643.65/year), which declined during COVID-19, and consulting fees ($1,046,408.71/year), which remained stable. Excluding pandemic years (2020-2021), total annual payments ranged from $3,233.73 to $4,379,242.77 (median: $115,052.45). Only two companies, Kerecis and Avita, demonstrated consistent increases in payments over the past three years.

Conclusion: Physician payments in the skin substitute market vary widely. The wide variability-from negligible sums to over a million dollars-questions the adequacy of blanket disclosure statements as a meaningful representation of physician involvement in research and product promotion. These findings suggest opportunity for greater transparency in disclosure statements.

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.