European burn journal最新文献

Burn injuries remain a complex clinical challenge, particularly in reconstructive settings where donor sites are limited. Integra^® Dermal Regeneration Template (IDRT), a bilayer dermal substitute, facilitates neodermis formation and supports functional and aesthetic recovery following burn trauma. This narrative review and expert opinion synthesizes current literature and clinical experience on the application of IDRT in post-burn reconstruction. It discusses the biological mechanism of dermal regeneration, surgical protocols including wound bed preparation and grafting, and considerations for anatomical regions such as the face, torso, and limbs. The review emphasizes key factors influencing successful outcomes, including patient selection, timing, and multidisciplinary coordination. Potential complications, such as infection, hematoma, and poor graft adherence, are addressed along with prevention and management strategies. Special considerations for pediatric and elderly populations are also highlighted. Through evidence-based insights and illustrative case examples, this review aims to inform surgical decision-making and promote best practices in reconstructive burn care using IDRT.

Full-thickness skin grafts are a cornerstone in reconstructive surgery for extensive skin defects, particularly in pediatric patients, where rapid vascularization is essential for successful engraftment. Traditional defatting methods using scalpels and scissors are labor-intensive and increase the risk of graft or operator injury. To improve efficiency and safety, a mechanical defatting device called LOMA (named after the inventors Loff and Maja) was developed at Klinikum Stuttgart. This study evaluates the first 28 transplants performed with it, assessing graft outcomes using the POSAS and comparing physical properties of the grafts with those of healthy contralateral skin, ankle skin, and palmar skin using DermaLab Combo's ultrasound and elasticity probes. Results showed that grafts prepared with LOMA exhibited similar physical characteristics to contralateral healthy skin. Differences in elasticity were observed when compared to ankle skin, and significant disparities were found when compared to palmar skin. POSAS scores averaged 3.3 from patients and 2.2 from physicians, indicating satisfaction with functional and aesthetic outcomes. The findings support the effectiveness of full-thickness skin grafts, particularly when prepared using the LOMA system. Further multicenter studies are recommended to compare LOMA-prepared grafts with those using conventional techniques to quantify the added value of this mechanical defatting approach.

Background: Severe burn injuries often lead to lasting physical and psychological consequences. Post-traumatic stress disorder (PTSD) is common among burn survivors and may be influenced by persistent somatic complaints. This study examined whether PTSD is associated with a higher burden of physical symptoms during and after inpatient rehabilitation.

Methods: We conducted a subgroup analysis of a multicenter prospective cohort study involving 103 adult burn patients in inpatient rehabilitation. Based on Impact of Event Scale-Revised (IES-R) scores and clinical evaluation, patients were grouped as PTSD (n = 43) or No PTSD (n = 60). Physical symptoms assessed included skin dryness (xerosis), temperature sensitivity (cold/heat), numbness, skin tightness, and increased sweating.

Results: Patients with PTSD reported significantly more physical symptoms at follow-up than those without PTSD: xerosis (74% vs. 50%, p = 0.03), cold sensitivity (61% vs. 35%, p = 0.02), heat sensitivity (63% vs. 39%, p = 0.03), numbness (63% vs. 33%, p = 0.006), skin tightness (82% vs. 52%, p = 0.004), and sweating (45% vs. 19%, p = 0.01). PTSD patients also had more severe burns, reflected in higher full-thickness TBSA (2% vs. 0%, p = 0.03) and elevated ABSI scores (median 6 vs. 5, p = 0.04).

Conclusion: PTSD is associated with a higher and more persistent burden of physical skin symptoms after severe burns. These findings underscore the importance of early PTSD screening and integrated psychological-somatic rehabilitation to improve long-term recovery and quality of life.

Fluid resuscitation after thermal injury is paramount to avoid burn shock and restore organ perfusion. Both over- and under-resuscitation can lead to unintended consequences affecting patient outcomes. While many studies have examined systemic effects, limited data exist on how fluid resuscitation impacts burn wound progression in the acute period. Furthermore, the mechanisms underlying burn wound progression remain not fully understood. This study used a swine model to investigate how varying resuscitation levels affect peri-burn wound dynamics. Twenty-seven female Yorkshire pigs were anesthetized, subjected to 40% total body surface area burn and 15% hemorrhage, then randomized (n = 9) to receive decision-support-driven (adequate, 2-4 mL/kg/%TBSA), fluid-withholding (under, <1 mL/kg/%TBSA), or high-constant-rate (over, >>4 mL/kg/%TBSA) resuscitation. Pigs were monitored for 24 h in an intensive care setting prior to necropsy. Laser Doppler Imaging (LDI) was conducted pre-burn and at 2, 6, 12, and 24 h post burn to assess perfusion. Biopsies were taken from burn, peri-burn (within 2 cm), and normal skin. RNA was isolated at 24 h for the qRT-PCR analysis of IL-6, CXCL8, and IFN-γ. At hour 2, LDI revealed increased peri-burn perfusion in over-resuscitated animals vs. under-resuscitated animals (p = 0.0499). At hour 24, IL-6 (p = 0.0220) and IFN-γ (p = 0.0253) were elevated in over-resuscitated peri-burn skin. CXCL8 showed no significant change. TUNEL staining revealed increased apoptosis in over- and under-resuscitated peri-burn skin. Differences in perfusion and cytokine expression based on resuscitation strategy suggest that fluid levels may influence burn wound progression.

Introduction: Superficial partial thickness burns generally do not require surgical intervention and are managed with specialized wound dressings. Mepilex Ag^® is commonly used and often represents the standard of care. This study evaluated the clinical performance of pure silk compared to Mepilex Ag^®.

Methods: A prospective, single-center intraindividual study was conducted on adult patients with superficial partial thickness burns. Each burn wound was divided, treating one half with pure silk and the other with Mepilex Ag^®. Clinical parameters including wound closure time, pain levels, and scar quality at 3-month follow-up were analyzed.

Results: Twenty-four patients were included (mean TBSA: 5.8%). Mepilex Ag^® showed a trend towards a shorter wound closure time (10.5 vs. 11.5 days; p = 0.223). Pain scores remained below 4/10 for both dressings throughout treatment. However, Mepilex Ag^® demonstrated significantly lower pain on day one (3.5 vs. 2.77; p = 0.039) and day two (2.91 vs. 2.27; p = 0.041). Scar quality after 3 months was similar.

Conclusion: Both dressings proved to be effective treatment options. Pure silk required fewer resources, showed high clinical practicality, and demonstrated a similar performance to Mepilex Ag^® in key clinical parameters, making it an interesting option for other clinics and our standard of care.

Fluid management is a critical component in the treatment of patients suffering with major burns. Clinicians must carefully balance judicious resuscitation with the risks of over- or under-resuscitation. We aimed to identify factors associated with survival in burns patients and determine the importance of resuscitation practices. Patients requiring admission to Burns Services in the United Kingdom between 1 April 2022 and 31 March 2023 were included in the National Burns Audit project on fluid resuscitation practices, to evaluate factors associated with survival and Critical Care Length of Stay (CCLoS). A total of 198 patients were included in the analyses, with median age of 51 years (interquartile range, (IQR) 35-62 years), median Total Burn Surface Area (TBSA%) of 27.5% (IQR 20-40%), and median Baux score 82.5 (IQR 66-105). The following were found to be significant for survival: younger age, smaller TBSA%, lower Baux score and independence from renal replacement therapy. Neither the mechanism of burns nor the fluid resuscitation volumes appeared to influence survival. Although interventions such as tracheostomy or the number of surgical procedures did not appear to affect survival, fluid replacement of more than 6 mL/kg/%TBSA independently predicted longer CCLoS. Volume of fluid resuscitation, within the limits examined in this cohort, did not impact likelihood of survival.

In the original publication [...].

In some regions, extreme heat can result in pavement temperatures that are high enough to cause severe burn injuries within seconds of skin contact. This risk is elevated for unhoused individuals who may lack adequate clothing and shelter and have susceptibility to other risk factors, including substance use and in turn loss of consciousness. While prior studies have shown worse outcomes for unhoused individuals due to delays in care and higher susceptibility, there is a lack of data on the impact of pavement burns specifically within this population. This single-institution retrospective cohort study aims to explore burn severity and hospital outcomes in housed vs. unhoused patients with pavement burns. The data were analyzed using independent samples t-tests and logistic regression when appropriate, with p < 0.05 considered statistically significant. A total of 305 individuals met the inclusion/exclusion criteria and comprised the final study cohort, 17.7% of which were unhoused. There was no significant difference in TBSA, survival to discharge, or hospital length of stay between housed and unhoused patients. While unhoused individuals may still be at heightened risk for pavement burns due to exposure to extreme heat and a lack of protective measures, these results may additionally suggest consistent emergency care for patients regardless of housing status. Furthermore, these results highlight the importance of developing targeted outreach and prevention programs and equitable emergency care protocols for vulnerable populations.

Background: Coagulopathy in severe burn injury is associated with complications and mortality.

Methods: We compared 3 tests (EXTEM, INTEM, FIBTEM) of rotational thromboelastometry (ROTEM), a viscoelastic coagulation assay (VCA), with conventional coagulation assays (CCAs), fibrinogen, d-dimers and coagulation factors during the five post-burn days in survivors and non-survivors with severe burn injury, in order to correlate the results with burn coagulopathy and prognosis.

Results: Seventeen survivors and ten non-survivors, with mean total burn surface area of 33.78% were included. CCAs measurements were abnormal, but unable to detect coagulopathy. At day 2, D-dimers and fibrinogen levels were statistically augmented for non-survivors. Regarding VCAs, FIBTEM MCF increased for non-survivors at day 2 and remained increased for the whole post-burn period. Furthermore, FIBTEM A10 and A20 at day 2 and EXTEM A10, EXTEM A20, EXTEM MCF, and EXTEM CFT at day 5 took abnormal values for the same group (p < 0.05). These changes were underlined through abnormal measurements of coagulation factors.

Conclusions: CCAs are poor indicators of coagulation status in burn injury, whereas VCAs are more sensitive markers, demonstrating coagulopathy and patients at greater risk of mortality.

Short- and long-term hand function was evaluated in adult patients with deep dermal and full-thickness hand burns after treatment with enzymatic debridement (NexoBrid^® MediWound Ltd., Yavne, Israel), assessing the results at discharge and 3, 6, and 12 months post-burn. This prospective cohort study was performed in the Burn Center in Beverwijk between March 2017 and December 2019. Hand function was assessed using Modified Kapandji Index scores, the Jebsen-Taylor Hand Function Test, and range of motion; scar quality using the Patient and Observer Scar Assessment Scale version 2.0; and quality of life using the Quick Disability Arm Shoulder Hand Questionnaire and the Canadian Occupational Performance Measure. Ten patients (14 hand burns) were included. The need for a skin graft after NexoBrid^® was 86%, and 50% needed additional surgical excision before skin grafting. Digits 3 and 4 achieved near-to-normal total active motion, and at least 50% of the hands achieved a normal range within the Jebsen-Taylor Hand Function Test in four items at 12 months post-burn. Scar quality and quality of life improved significantly over time. The present study can be considered as a proof-of-concept study for future clinical trials on enzymatic debridement for hand burns.