Journal of Burn Care & Research最新文献

Hand burns pose complex clinical challenges due to the intricate anatomy of the hand and its indispensable role in daily activities. In this retrospective cohort study, we evaluated 88 adult patients admitted to a specialized burn center with burns involving one or both hands. We collected demographics, burn characteristics, and clinical variables from medical records, and assessed functional outcomes 1 year after injury using the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Nonparametric tests compared patient subgroups, a 6-factor multivariable regression (age, %TBSA, depth, digital involvement, bilateral involvement, and amniotic-membrane use) identified predictors of more severe functional impairment. Although larger burns required longer hospital stays, neither burn size nor depth emerged as independent predictors of hand function in the multivariable model. In contrast, anatomical burn site, particularly digital and bilateral hand involvement, was strongly associated with higher DASH scores, highlighting the importance of the precise location of the burn in long-term recovery. Age also played a critical role, with older patients showing worse outcomes regardless of other clinical factors. Surgical management varied across the cohort, with the use of amniotic membrane grafts standing out as a potentially favorable approach. Patients receiving these grafts showed lower DASH scores, suggesting better preservation of hand function compared to other methods. While these findings reinforce the need to focus on specific anatomical areas and patient age in treatment planning, they also point to innovative biologic materials as a promising avenue for functional recovery. Multicenter studies may help refine these observations and guide burn care in the future.

Steam inhalation therapy is common practice for coryzal symptoms, especially in children. However, it can cause major scald injuries due to accidental contact with the hot water. The authors used an electronic database to retrospectively identify all children admitted with burn injuries secondary to steam inhalation therapy during a 5-year period from September 2019 to August 2024 at Trousseau Hospital pediatric burn unit. Data collected included patient demographics, mechanism of burn, burn areas and extent, need of surgical treatment, type of hospitalization, length of stay, infections, and other complications. The authors also conducted a brief literature review. A total of 33 children were identified during a 5-year period at our center, with median age of 6 years old, and male predominance (60.6%). A total of 81.8% of children were burned to perineum and/or thigh areas, with 63.6% over perinea more precisely. In total, 51.5% were admitted in intensive care unit, before being transferred to surgical ward, for a mean hospital stay of 18 days. Surgery was needed for 51.5% of children. Moreover, the literature review found only rare controversial benefits to this practice, and many warnings about its dangers. Burn injuries secondary to steam inhalation therapy in children are common cause of severe morbidity with long-term sequelae. They also contribute to a significant number of surgeries and extended hospital stays, therefore increasing costs for national health systems. Authors highlighted a worrying outbreak of cases linked to extensive media coverage of this practice. Better public awareness through simple public advice and prevention policies could help to reduce these injuries.

Genital burn injuries raise concerns about potential abuse. Understanding the demographics of this patient population is critical for planning patient care. This study determines the demographic predictors of suspected abuse in genital burn injuries using a national database. A retrospective review was conducted using the Burn Care Quality Platform data from 2013 to 2022. Genital burn patients suspected of abuse were identified, and demographics, burn characteristics, and clinical data were analyzed. Multiple logistic regression was used to evaluate factors associated with suspected abuse. Of the 3833 genital burn patients with available data on suspected abuse, 258 (6.7%) were identified as suspected abuse victims. Younger age (OR = 0.927 per year, 95% CI, 0.894-0.961, P < .001) was protective, and Black patients had higher odds of suspected abuse compared to White patients (OR = 2.10, 95% CI, 1.35-3.27, P = .001). Living in skilled nursing facilities (OR = 285.91, 95% CI, 11.36-7198.82, P = .001), homelessness (OR = 62.48, 95% CI, 15.11-258.43, P < .001), and adult group homes (OR = 51.29, 95% CI, 6.25-421.07, P < .001) were strongly associated with abuse. Mental/personality disorders (OR = 11.03, 95% CI, 2.97-40.94, P < .001) and dementia (OR = 7.18, 95% CI, 1.19-43.18, P = .031) increased odds. Contact burns had higher odds compared to scalds (OR = 3.27, 95% CI, 1.04-10.26, P = .042), but the impact of TBSA varied by burn type, with larger flame burns less likely associated with abuse than scalds (OR = 0.963, 95% CI, 0.939-0.989, P = .005). This study provides valuable insight into demographic characteristics associated with suspected abuse in genital burns. The identification of these patients early on will allow proper treatment and discharge planning.

Background: Despite the advancements of pharmacological treatments and gauze dressings in the field of skin wound healing, these methods present numerous limitations. Therefore, developing a multifunctional material capable of efficiently promoting skin wound healing is particularly crucial.

Methods: Citric acid (CA)-modified chitosan (CS) loaded with shikonin (SK) (CA-CS-SK) hydrogel was prepared via the freeze-thaw method. The physical properties of the hydrogel were profiled through Fourier transform infrared spectroscopy, SEM, rotational rheometry, swelling experiment, degradation rate analysis, and drug release experiments. Furthermore, the biocompatibility of the hydrogel was comprehensively evaluated through hemolysis assay, CCK-8 cytotoxicity detection, and live/dead cell staining. Antimicrobial activity against Escherichia coli and Staphylococcus aureus of the hydrogel was gauged in vitro, and its therapeutic performance was ultimately validated in a mouse full-thickness wound model through hematoxylin and eosin staining and enzyme-linked immunosorbent assay.

Results: The CA-CS-SK hydrogel exhibited appropriate rheological properties, swelling ratio, degradation rate, and drug release rate. It effectively suppressed the proliferation of E coli and S aureus, with superior inhibitory effects compared to CA-CS hydrogel and SK alone. In addition, the hydrogel showed no significant toxicity to human dermal fibroblasts and did not cause erythrocyte rupture. Animal model experiments demonstrated that, compared to cotton gauze, CA-CS hydrogel, and SK, the CA-CS-SK hydrogel reduced levels of tumor necrosis factor-α and interleukin-6 at the wound site, alleviated the inflammatory response, and promoted wound healing.

Conclusion: The CA-CS-SK hydrogel possesses high antibacterial activity, excellent biocompatibility, and efficient wound healing promotion capabilities, making it a highly promising material for skin wound treatment.

Background: Burn injuries trigger complex immune responses and gene expression changes, impacting wound healing and systemic inflammation. Understanding these changes is crucial for identifying biomarkers and therapeutic targets.

Methods: We analyzed two gene expression omnibus datasets (wound tissue [GSE8056] and blood [GSE37069]) to identify differentially expressed genes (DEGs) in burn injury samples versus controls. Immune cell proportions were assessed using CIBERSORT. Functional enrichment analyses (Gene Ontology and Kyoto Encyclopedia of Genes and Genomes) and protein-protein interaction networks were constructed to identify key genes and pathways.

Results: We identified 1170 upregulated and 1227 downregulated DEGs. Gene Ontology analysis revealed enrichment in neutrophil activation, inflammatory response, and extracellular matrix organization. Kyoto Encyclopedia of Genes and Genomes analysis highlighted cytokine-cytokine receptor interaction, TNF, and IL-17 signaling pathways. Immune infiltration analysis showed significant changes in neutrophils, macrophages (M1/M2), and T-cell subsets. Protein-protein interaction network analysis identified five hub genes: JUN, STAT1, Bcl2, MMP9, and TLR2.

Conclusions: This study provides a comprehensive bioinformatic analysis of gene expression and immune responses in burn injuries. The identified DEGs, hub genes, and pathways offer insights into the immune response mechanisms and suggest potential targets for diagnostic and therapeutic interventions in burn injury management.

Sickle cell disease (SCD) is an autosomal recessive disorder characterized by abnormal hemoglobin (Hb), vaso-occlusive crises, and hemolytic anemia. Hydroxyurea has been proven effective in managing SCD but is associated with nonhealing skin ulcers. Additionally, its effects on wound healing in burn patients remain unclear. This study investigates the role of hydroxyurea in mortality, wound infection, wound disruption, and sepsis among SCD patients with burn injuries. Using the TriNetX database, cohorts were identified based on ICD-10 codes for adult patients aged 18 years or older diagnosed with SCD, previous burn injury, and hydroxyurea use. Propensity score matching was performed for demographics (age, sex, race, ethnicity), comorbidities that affect wound healing, and clinical variables (burn severity and SCD severity). Mortality, wound infection, wound disruption, and sepsis were assessed at 30 days, 3 months, and 6 months postburn injury. Statistical methods such as chi-square analysis and risk ratio were used, with a statistical significance at P < .05. Hydroxyurea cohort had significantly higher risk for wound healing outcomes such as wound disruption, wound infection, and recurrent sepsis at each time outcome. However, hydroxyurea cohort had a significantly lower risk of mortality compared to the control group at each time outcome. This study highlights the need to consider hydroxyurea's impact on wound healing when developing treatments for SCD patients with burn injury. Further research is needed to investigate its mechanism in wound healing processes and develop safer treatment alternatives.

The Posttraumatic Growth Inventory (PTGI) was developed to measure positive psychological changes individuals can experience after trauma. While the 10-item form (PTGI-10) is relatively brief, an even shorter version would be valuable in situations where participant response burden is of particular concern. The PTGI-10 was administered to 1076 adults recovering from moderate to severe burn injury between 6 months and 20 years after injury as part of an ongoing longitudinal study. Analyses completed to inform item selection included classical test theory analyses of reliability (ie, Cronbach's alpha) and item performance, item response theory analyses, and qualitative item review. A focus group selected items for a new short form while considering results of the analyses as well as item content and acceptability. Score agreement between the PTGI-10 and the newly created short form was examined. A confirmatory factor analysis supported unidimensionality; however, reliability (α = 0.94) and results of local dependency indicated items were highly redundant. A new 3-item short form (PTGI-3) was created and includes 1 item from each of the 3 categories of perceived benefits identified in posttraumatic growth theory. Reliability of the new short form is moderate (>0.8) for scores ±1 SD around the mean. Scores on the PTGI-3 correlate highly (r = 0.94) with scores on the PTGI-10. The PTGI-3 has sufficient reliability for group comparisons, balances item content, and includes items that are acceptable to people with burn injury.

Burn injuries among migrants crossing the Mediterranean increasingly represent a serious health issue, particularly in southern Europe. We retrospectively reviewed 91 migrant patients admitted to the Burn Center of ARNAS Civico Hospital in Palermo between 2015 and 2025: 65 (71.4%) had chemical burns from seawater-fuel mixtures, 25 (27.5%) had flame burns due to vessel explosions or torture, and 1 (1.1%) had a burn injury of other etiology. Mean age was 25 ± 9.84 years, and mean TBSA was 16.09% ± 11.06%. Chemical burns healed faster than flame burns (P = .0043). Split-thickness grafting was required in 40.0% of flame burns versus 3.07% of chemical burns (P = .000026). Inhalation pneumonia occurred in 20% of flame burns versus 3.07% of chemical burns (P = .0164), and sepsis developed in 28.0% of flame burns versus 0% of chemical burns (P = .000064). Among the 7 septic patients, mean burn surface area was 32.14% ± 16.54% TBSA, and 2 patients (28.57%) died. Predominant isolates included Acinetobacter baumannii and Klebsiella pneumoniae. These findings highlight the elevated risk of surgical, pulmonary, and infectious complications following flame burns in resource-limited maritime settings. Optimized burn care protocols, rapid microbiological diagnostics, and improved postrescue coordination are critical to reducing morbidity and mortality in this high-risk group.

Pediatric burn injuries remain a leading cause of global morbidity, with complications such as delayed healing, infection, and hypertrophic scarring contributing to long-term functional and psychosocial burden. Polylactic acid skin substitutes have gained traction as a synthetic dressing option in pediatric burn care, yet outcome variability across studies necessitates a formal synthesis. Our objective was to evaluate the efficacy of polylactic acid skin substitutes in pediatric burn management by assessing healing time, infection rates, hypertrophic scarring, and pain scores through a systematic review and meta-analysis. A systematic search of PubMed, Scopus, and Embase identified studies reporting outcomes of pediatric burn patients treated with polylactic acid membranes. Nine studies (n = 811 pediatric patients) met inclusion criteria. Meta-analyses were conducted for healing time, infection rate, and hypertrophic scarring. Four additional studies were analyzed qualitatively due to heterogeneity in outcome reporting or study design. The pooled weighted mean healing time across 3 studies was 14.0 days (95% CI, 9.7-18.4), with moderate heterogeneity (I2 = 48.9%). The pooled infection rate across 4 studies was 5% (95% CI, 0%-66%), and the pooled hypertrophic scarring rate from 2 studies was 12% (95% CI, 1%-73%). Narrative synthesis revealed additional benefits, including systemic antioxidant effects, though challenges such as premature detachment were noted. In conclusion, polylactic acid skin substitutes demonstrate favorable performance in pediatric burn management, promoting timely reepithelialization, reducing infection, and mitigating scarring risk. While overall findings support its utility, variability in outcome definitions and moderate heterogeneity highlight the need for standardized protocols.