European Burn Journal

Research

15 pages, 1034 KB

Open AccessArticle

Objective Longitudinal Monitoring of Burn Wound Area Using 3D Surface Scanning: A Pilot Study

by Bibiána Ondrejová, Katarína Dudová, Monika Michalíková, Lucia Bednarčíková, Jozef Živčák, Tomáš Demčák and Peter Lengyel

Eur. Burn J. 2026, 7(1), 15; https://doi.org/10.3390/ebj7010015 - 6 Mar 2026

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Abstract

Background: Burn assessment traditionally relies on visual inspection and 2D estimation, which introduces substantial variability in determining wound size and healing progression. Three-dimensional (3D) surface scanning offers a more objective alternative, yet the clinical utility of area-based metrics obtained from 3D surface data [...] Read more.

Background: Burn assessment traditionally relies on visual inspection and 2D estimation, which introduces substantial variability in determining wound size and healing progression. Three-dimensional (3D) surface scanning offers a more objective alternative, yet the clinical utility of area-based metrics obtained from 3D surface data remains insufficiently defined. This pilot study aimed to evaluate structured-light 3D scanning for objective longitudinal quantification of the burn wound surface area and a description of area-based healing dynamics derived from repeated measurements. Methods: Eighteen patients with 43 acute thermal burns underwent serial structured-light scanning, followed by manual segmentation of wound regions and the calculation of absolute and percentage area reduction as well as TBSA-normalized metrics. Longitudinal monitoring was performed by comparing sequential 3D surface models acquired at defined clinical follow-ups, enabling the calculation of absolute area change (ΔA), percentage reduction, daily healing rate, and ΔTBSA%. Results: Baseline wound areas ranged from 7.27 to 2137.98 cm². Percentage area reduction ranged from 5.25% to 92.30%. The overall reduction in burn burden (ΔTBSA) ranged from 0.07% to 12.94%. Large wounds tended to show rapid absolute area reduction (>100–300 cm²/day) during early follow-up, while small superficial burns frequently achieved >80% reduction within 10–15 days. Conclusions: These findings suggest that 3D surface scanning may support the objective longitudinal assessment of burn wound healing. This pilot provides a basis for future studies evaluating additional topographic parameters and broader clinical applications. Full article

(This article belongs to the Special Issue Innovative Applications and Challenges of Emerging Materials and Technologies in Burn Treatment)

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9 pages, 583 KB

Open AccessArticle

Nexobrid Use in the Elderly

by Alexander Lugilde Guerbek, Jordi Serracanta Domenech, Antonio Bulla, José Antonio López Martínez, Danilo Rivas Nicolls, Alex Arteaga, Alejandro Grabosky Elbaile, Sara Orois and J. P. Barret

Eur. Burn J. 2025, 6(4), 58; https://doi.org/10.3390/ebj6040058 - 7 Nov 2025

Cited by 2 | Viewed by 761

Abstract

Background: Enzymatic debridement with Nexobrid (NXB) is established for burn care, but specific outcomes in the elderly remain poorly characterized. This study evaluates the safety, efficacy, and clinical outcomes of NXB in patients aged ≥65 years. Methods: A retrospective case-series of 43 consecutive [...] Read more.

Background: Enzymatic debridement with Nexobrid (NXB) is established for burn care, but specific outcomes in the elderly remain poorly characterized. This study evaluates the safety, efficacy, and clinical outcomes of NXB in patients aged ≥65 years. Methods: A retrospective case-series of 43 consecutive elderly patients (mean age 74.5 years) with deep partial- to full-thickness burns treated with NXB at a single burn center. Data on demographics, burn characteristics, treatment chronology, and complications were analyzed. Results: The median total burn surface area (TBSA) was 11%. NXB was applied selectively, with a mean debrided area of 7.41% TBSA, primarily on limbs and hands. While 76.7% of patients ultimately required surgical autografting, no patient required an escharotomy in NXB-treated areas. The mortality rate was 25.6%, which was lower than expected for a median revised Baux score of 90, which is expected to be more than 50%. Hypertrophic scarring occurred in 28.1% of survivors, associated with a prolonged median healing time of 63 days. Conclusions: In elderly burn patients, NXB facilitates precise eschar removal and reliably prevents compartment syndrome, demonstrating a strong safety profile even in high-risk individuals. Its primary benefit shifts from reducing surgical incidence to optimizing the wound bed for grafting. These findings support the use of NXB in the elderly, with the understanding that subsequent grafting is often still required due to age-related delayed healing. Full article

(This article belongs to the Special Issue Innovative Applications and Challenges of Emerging Materials and Technologies in Burn Treatment)

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16 pages, 3170 KB

Open AccessArticle

Assessment of Attenuation Coefficient and Blood Flow at Depth in Pediatric Thermal Hand Injuries Using Optical Coherence Tomography: A Clinical Study

by Beke Sophie Larsen, Tina Straube, Kathrin Kelly, Robert Huber, Madita Göb, Julia Siebert, Lutz Wünsch and Judith Lindert

Eur. Burn J. 2025, 6(4), 54; https://doi.org/10.3390/ebj6040054 - 1 Oct 2025

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Abstract

Background: Optical Coherence Tomography (OCT) is a high-resolution imaging technique capable of quantifying Blood Flow at Depth (BD) and the Attenuation Coefficient (AC). However, the clinical relevance of these parameters in burn assessment remains unclear. This study investigated whether OCT-derived metrics can differentiate [...] Read more.

Background: Optical Coherence Tomography (OCT) is a high-resolution imaging technique capable of quantifying Blood Flow at Depth (BD) and the Attenuation Coefficient (AC). However, the clinical relevance of these parameters in burn assessment remains unclear. This study investigated whether OCT-derived metrics can differentiate between superficial and deep pediatric hand burns. Method: This prospective, single-center study analyzed 73 OCT scans from 37 children with thermal hand injuries. A structured algorithm was used to evaluate AC and BD. Results: The mean AC was 1.61 mm⁻¹ (SD ± 0.48), with significantly higher values in deep burns (2.11 mm⁻¹ ± 0.53) compared to superficial burns (1.49 mm⁻¹ ± 0.38; p < 0.001), reflecting increased optical density in more severe burns. BD did not differ significantly between burn depths, although superficial burns more often showed visible capillary networks. Conclusions: This is the first study to assess both AC and BD using OCT in pediatric hand burns. AC demonstrated potential as a diagnostic marker for burn depth, whereas BD had limited utility. Image quality limitations highlight the need for technical improvements to enhance OCT’s clinical application. Full article

(This article belongs to the Special Issue Innovative Applications and Challenges of Emerging Materials and Technologies in Burn Treatment)

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15 pages, 1248 KB

Open AccessArticle

In Vitro Silencing of MHC-I in Keratinocytes by Herpesvirus US11 Protein to Model Alloreactive Suppression

by Frederik Schlottmann, Sarah Strauß, Peter Maria Vogt and Vesna Bucan

Eur. Burn J. 2025, 6(3), 47; https://doi.org/10.3390/ebj6030047 - 21 Aug 2025

Viewed by 1227

Abstract

Background: Secondary rejection remains a major obstacle in skin allografting. Some viruses, such as human herpesvirus and cytomegalovirus, evade immune detection through proteins like the unique short glycoprotein 11 (US11), which down-regulates major histocompatibility complex (MHC) class I expression. This study explores the [...] Read more.

Background: Secondary rejection remains a major obstacle in skin allografting. Some viruses, such as human herpesvirus and cytomegalovirus, evade immune detection through proteins like the unique short glycoprotein 11 (US11), which down-regulates major histocompatibility complex (MHC) class I expression. This study explores the use of recombinant US11 protein as a biopharmaceutical approach to reduce MHC-I expression and thus decrease alloreactivity in human primary keratinocytes. Methods: Human keratinocytes were treated with recombinant US11 protein, and MHC-I expression was assessed via Western blot and flow cytometry. To evaluate immunomodulatory effects, US11-stimulated keratinocytes were co-cultured with peripheral blood mononuclear cells (PBMCs), and interferon-gamma (IFN-γ) levels were measured by ELISA. Additionally, ex vivo human skin tissue was stimulated with US11 to assess long-term MHC-I modulation. Results: US11 treatment significantly reduced MHC-I surface expression in keratinocytes. Co-cultures showed decreased IFN-γ secretion, indicating lower T cell activation. Human skin tissue stimulated with US11 exhibited reduced MHC-I expression after 7 days. Conclusions: This proof-of-concept study suggests that recombinant US11 protein may serve as an effective biopharmaceutical to reduce keratinocyte immunogenicity. Further in vitro and in vivo studies are warranted to validate its potential for clinical application in skin transplantation. Full article

(This article belongs to the Special Issue Innovative Applications and Challenges of Emerging Materials and Technologies in Burn Treatment)

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17 pages, 2297 KB

Open AccessArticle

Development of a Device for Defatting Full Skin Grafts Through Mechanical Defatting in Children and Adolescents

by Philipp Christoph Köhler, Helen Glosse, Steffan Loff and Raphael Staubach

Eur. Burn J. 2025, 6(3), 44; https://doi.org/10.3390/ebj6030044 - 14 Aug 2025

Viewed by 705

Abstract

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. [...] Read more.

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. Full article

(This article belongs to the Special Issue Innovative Applications and Challenges of Emerging Materials and Technologies in Burn Treatment)

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11 pages, 1055 KB

Open AccessArticle

Can Pure Silk Compete with the Established Mepilex Ag^® in the Treatment of Superficial Partial Thickness Burn Wounds? A Prospective Intraindividual Study

by Jan Akkan, Mahsa Bagheri, Sophia Mezger, Paul Christian Fuchs, Maria von Kohout, Wolfram Heitzmann, Rolf Lefering and Jennifer Lynn Schiefer

Eur. Burn J. 2025, 6(3), 41; https://doi.org/10.3390/ebj6030041 - 11 Jul 2025

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Abstract

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Innovative Applications and Challenges of Emerging Materials and Technologies in Burn Treatment)

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18 pages, 3636 KB

Open AccessArticle

The Reconstruction of Various Complex Full-Thickness Skin Defects with a Biodegradable Temporising Matrix: A Case Series

by Julie van Durme, Thibaut Dhont, Ignace De Decker, Michiel Van Waeyenberghe, Kimberly De Mey, Henk Hoeksema, Jozef Verbelen, Petra De Coninck, Nathalie A. Roche, Phillip Blondeel, Stan Monstrey and Karel E. Y. Claes

Eur. Burn J. 2025, 6(2), 24; https://doi.org/10.3390/ebj6020024 - 14 May 2025

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Abstract

Background and Objectives: Traditionally, full-thickness skin defects (FTSDs) are covered with split-thickness skin grafts (STSGs). This usually provides an epidermal coverage but entails a high risk of hypertrophic scarring mainly due to the absence of the dermal layer. The Novosorb^® Biodegradable Temporising [...] Read more.

Background and Objectives: Traditionally, full-thickness skin defects (FTSDs) are covered with split-thickness skin grafts (STSGs). This usually provides an epidermal coverage but entails a high risk of hypertrophic scarring mainly due to the absence of the dermal layer. The Novosorb^® Biodegradable Temporising Matrix (BTM) is a novel synthetic dermal substitute that has been used for the reconstruction of various complex and/or large defects in our center. The aim of this article is to evaluate the clinical performance of the BTM as a synthetic dermal substitute for complex FTSD reconstruction in a European context. Materials and methods: This case series focused on the treatment of complex FTSDs with the BTM. After wound debridement, the BTM was applied according to a defined protocol. Once adequate vascularization was observed, the sealing membrane was removed and the neo-dermis was covered with STSGs. Patient demographics, comorbidities, wound defect localization and etiology, wound bed preparations, time of BTM application and removal, time to complete wound healing after STSG, complications, and HTS formation were recorded. Results: The BTM was used to treat FTSDs in six patients with complex wounds from degloving (3), burns (1), ulcerations (1), and necrotizing fasciitis (1). Successful integration occurred in five cases (83%), with one partial integration. The BTM remained in situ for an average of 20.7 days before delamination and STSG coverage. No major complications occurred, though one case had hypergranulation with secondary STSG infection. Two patients were lost to follow-up, while the remaining four had excellent aesthetic and functional outcomes with good-quality scars. Conclusions: Within the limits of this small and heterogeneous case series, the BTM appears to be a promising option for the reconstruction of complex FTSDs of varying etiologies. Its successful integration in most cases and limited complication rate support its clinical potential. However, given this study’s retrospective design and limited sample size, further prospective studies are required to validate these findings and assess long-term outcomes. Full article

(This article belongs to the Special Issue Innovative Applications and Challenges of Emerging Materials and Technologies in Burn Treatment)

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13 pages, 3392 KB

Open AccessArticle

Bioabsorbable Poly(vinyl alcohol)–Citric Acid Dressings: Wound Healing Studies in an Experimental In Vivo Model

by Jonalba Mendes Pereira, Emilia Angela Lo Schiavo Arisawa, Antônio Luiz Martins Maia Filho, José Figueredo-Silva, Nicoly Alves, Carolina Hahn da Silveira and Lucia Vieira

Eur. Burn J. 2025, 6(2), 18; https://doi.org/10.3390/ebj6020018 - 8 Apr 2025

Cited by 2 | Viewed by 1343

Abstract

Background: The wound healing process presents notable challenges for nursing teams, requiring extensive knowledge of wound care materials. A nanoparticle-free, bioabsorbable pol-yvinyl alcohol (PVA) with citric acid (CA) dressing produced by simple electrospin-ning was evaluated to treat acute wound healing in rats. This [...] Read more.

Background: The wound healing process presents notable challenges for nursing teams, requiring extensive knowledge of wound care materials. A nanoparticle-free, bioabsorbable pol-yvinyl alcohol (PVA) with citric acid (CA) dressing produced by simple electrospin-ning was evaluated to treat acute wound healing in rats. This PVA-CA combination promotes crosslinking, increases the dressing capacity of absorption and confers heal-ing properties due to the citric acid antioxidant action. Methods: The dressing was tested in a quantitative experiment on 1.9 cm acute dermatological lesions in rats (n = 12), com-paring the PVA-CA-treated group with the untreated control group (CG). Samples were collected at 3, 7 and 14 days after lesion induction to evaluate the inflammatory process and tissue healing. Results: The macroscopic and histological data on the third day showed similar characteristics in both groups; however, after fourteen days, the PVA-CA group exhibited complete healing, accompanied by recomposition of the skin layers, whereas the wounds in the CG did not close completely. Conclusions: The results highlight that electrospun PVA-AC dressings improve healing outcomes and constitute a prom-ising and affordable solution, providing a suitable environment for tissue repair, re-ducing inflammatory cell infiltration, blood vessel formation, and restoration of epi-thelial tissue, reducing the time of the healing process of acute wounds. Full article

(This article belongs to the Special Issue Innovative Applications and Challenges of Emerging Materials and Technologies in Burn Treatment)

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15 pages, 6197 KB

Open AccessArticle

Preliminary Study on the Development of a Real-Time Pressure-Monitoring Facial Mask for Burn Rehabilitation

by Hyunjun Shin, Gyung-Jin Jeon, Seok-Jin Hwang, Hyeonseok Cho, Young-Min Cho, Hyoung-Soon Youn, Jisu Seo, Sehoon Park, Yoon-Soo Cho and Gyu-Seok Kim

Eur. Burn J. 2025, 6(1), 12; https://doi.org/10.3390/ebj6010012 - 3 Mar 2025

Viewed by 1694

Abstract

The most common aftereffect of severe burns in patients is hypertrophic scarring. Hypertrophic scars typically form following severe burns; it refers to excessive collagen production in the dermal layer during the healing process, resulting in an abnormal raised scar. Currently, practical treatments for [...] Read more.

The most common aftereffect of severe burns in patients is hypertrophic scarring. Hypertrophic scars typically form following severe burns; it refers to excessive collagen production in the dermal layer during the healing process, resulting in an abnormal raised scar. Currently, practical treatments for suppressing hypertrophic scars include laser therapy, pressure therapy, and the application of silicone sheets for moisture retention. The most extensively used treatment involves compression therapy using specially designed garments for the affected areas. However, this method has limitations when applied to curved surfaces like the face. To address this issue, three-dimensional (3D) scanning and 3D printing techniques have been actively developed for face masks and have shown promising clinical results. Unfortunately, current facial masks under development lack a sensor system to measure pressure, making it difficult to ensure consistent and appropriate pressures during clinical trials. In this study, we have developed a burn pressure mask capable of real-time pressure monitoring. The facial mask developed in this study utilizes an FSR-type sensor to measure the pressure applied to the skin. We have also embedded electrical wires within the mask to enhance its comfort and wearability. For this study, two patients wore the facial mask with real-time pressure measurement capabilities for 4 weeks in 12 h per day on average. We evaluated whether the mask maintained the appropriate pressure range (15–25 mmHg) throughout the clinical trial and whether it effectively inhibited scar formation. Through the analysis of recorded pressure signal data, we confirmed that the patients consistently maintained the appropriate pressure while wearing the mask during the clinical trial. Additionally, we observed significant differences in skin moisture levels, transepidermal water loss, and scar thickness before and after the experiment. These findings suggest that the facial mask, featuring real-time monitoring capabilities, effectively prevents the formation of hypertrophic scars. Full article

(This article belongs to the Special Issue Innovative Applications and Challenges of Emerging Materials and Technologies in Burn Treatment)

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14 pages, 3045 KB

Open AccessArticle

Burn Wound Dynamics Measured with Hyperspectral Imaging

by Thomas Wild, Jörg Marotz, Ahmed Aljowder and Frank Siemers

Eur. Burn J. 2025, 6(1), 7; https://doi.org/10.3390/ebj6010007 - 13 Feb 2025

Cited by 1 | Viewed by 1225

Abstract

Introduction: Hyperspectral Imaging (HSI) combined with an augmented model-based data processing enables the measurement of the depth-resolved perfusion of burn wounds. With these methods, the fundamental problem of the wound dynamics (wound conversion or progression) in the first 4 days should be parametrically [...] Read more.

Introduction: Hyperspectral Imaging (HSI) combined with an augmented model-based data processing enables the measurement of the depth-resolved perfusion of burn wounds. With these methods, the fundamental problem of the wound dynamics (wound conversion or progression) in the first 4 days should be parametrically analyzed and evaluated. Material and Methods: From a cohort of 59 patients with burn injuries requiring medical intervention, 281 homogenous wound segments were selected and subjected to clinical classification based on the duration of healing. The classification was retrospectively assigned to each segment during the period from day 0 to day 2 post-burn. The perfusion parameters were presented in two parameter spaces describing the upper and deeper perfusion. Results: The investigation of value distributions within the parameter spaces pertaining to four distinct categories of damage from superficial dermal to full-thickness burns during the initial four days reveals the inherent variability and distinct patterns associated with wound progression, depending on the severity of damage. The analysis highlights the challenges associated with estimating the burn degrees during this early stage and elucidates the significance of deeper tissue perfusion in the classification process, which cannot be discerned through visual inspections. Conclusions: The feasibility of early classification on day 0 or 1 was assessed, and the findings indicate a restricted level of reliability, particularly on day 0, primarily due to the substantial variability observed in wound characteristics and inherent dynamics. Full article

(This article belongs to the Special Issue Innovative Applications and Challenges of Emerging Materials and Technologies in Burn Treatment)

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Review

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16 pages, 1262 KB

Open AccessReview

Use of Artificial Intelligence in Burn Assessment: A Scoping Review with a Large Language Model-Generated Decision Tree

by Sebastian Holm, Fredrik Huss, Bahaman Nayyer and Johann Zdolsek

Eur. Burn J. 2026, 7(1), 4; https://doi.org/10.3390/ebj7010004 - 4 Jan 2026

Viewed by 642

Abstract

Background: Burns cause about 180,000 deaths annually and lead to substantial morbidity, especially in low- and middle-income countries. Clinical assessment of burn depth and TBSA relies on visual and bedside examination and remains subjective. Convolutional neural networks (CNNs) have been proposed to improve [...] Read more.

Background: Burns cause about 180,000 deaths annually and lead to substantial morbidity, especially in low- and middle-income countries. Clinical assessment of burn depth and TBSA relies on visual and bedside examination and remains subjective. Convolutional neural networks (CNNs) have been proposed to improve objectivity in image-based burn assessment, but clinical generalizability and acceptance remain uncertain. Aims: To map current evidence on CNN performance for burn TBSA, burn depth and treatment-related tasks and to explore whether a large language model (LLM) can organize extracted findings into a transparent, literature-derived orientation decision tree. Methods: We performed a scoping review following PRISMA-ScR. PubMed, Web of Science and Cochrane were searched on 5 April 2025. Eligible studies reported CNN analysis of 2D burn images and quantitative performance metrics. We summarized reported values descriptively. We then provided a structured summary of extracted findings to ChatGPT to draft a one-page orientation decision tree. Two consultant burn surgeons reviewed the figure for clarity and plausibility. Results: Of 659 records, 24 studies were included. Across studies, reported performance for TBSA and depth assessment was often high, but study designs, datasets, labels, imaging modalities and validation strategies varied substantially. High reported performance does not necessarily imply clinical robustness or real-world accuracy. A single study reported high test-set accuracy for graft versus non-graft using heavily expanded data. This value should not be generalized. Conclusions: CNNs show promise for image-based burn TBSA and depth assessment, but heterogeneity, dataset limitations and limited external validation restrict interpretation and clinical transfer. The LLM-derived decision tree is a literature-synthesis orientation figure, not a clinical decision-support tool. Full article

(This article belongs to the Special Issue Innovative Applications and Challenges of Emerging Materials and Technologies in Burn Treatment)

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16 pages, 396 KB

Open AccessReview

Evidence-Based Management of Burns: A Narrative Review of Evolving Practices

by Anna Jolly Neriamparambil, Raja Sawhney and Wei Lun Wong

Eur. Burn J. 2025, 6(4), 59; https://doi.org/10.3390/ebj6040059 - 10 Nov 2025

Cited by 1 | Viewed by 1779

Abstract

Background: The last decade has seen transformative changes in burn care, driven by advances in pharmacology, regenerative medicine, surgical techniques, and digital technologies. As management strategies evolve beyond survival to encompass functional and esthetic recovery, this review consolidates current evidence to inform best [...] Read more.

Background: The last decade has seen transformative changes in burn care, driven by advances in pharmacology, regenerative medicine, surgical techniques, and digital technologies. As management strategies evolve beyond survival to encompass functional and esthetic recovery, this review consolidates current evidence to inform best practice. Methods: A comprehensive narrative review was conducted using PubMed to identify peer-reviewed English-language articles from the past 10 years relevant to acute and long-term burn management. Selection focused on high-level evidence, including randomized controlled trials, systematic reviews, and meta-analyses, emphasizing novel and evolving clinical interventions. Results: Key advances include the integration of propranolol and oxandrolone for metabolic modulation; enzymatic debridement agents such as NexoBrid^®; regenerative approaches like epidermal cell sprays (e.g., RECELL^®) and dermal substitutes (e.g., Integra^®, MatriDerm^®, NovoSorb^® BTM); and innovations in scar modulation, notably fractional CO₂ laser therapy. The emergence of 3D bioprinting, and artificial intelligence further supports a shift toward precision burn medicine. Conclusions: Burn management is evolving from protocol-driven to patient-centred care, underpinned by high-quality evidence and technological innovation. The integration of systemic, local, and rehabilitative strategies is improving outcomes in survival, function, and quality of life. Ongoing challenges include cost, access, and translation of novel therapies into widespread clinical practice. Full article

(This article belongs to the Special Issue Innovative Applications and Challenges of Emerging Materials and Technologies in Burn Treatment)

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12 pages, 821 KB

Open AccessReview

The Potential Use of Fibrin Sealants in Burn Wound Management: A Comprehensive Review of Experimental and Clinical Studies

by Christina Nikolaou, Maximos Frountzas, Emmanouil I. Kapetanakis, Dimitrios Stefanoudakis, Nikolaos A. Papadopulos, Stylianos Kykalos, Dimitrios Schizas and Dimitrios Iliopoulos

Eur. Burn J. 2025, 6(2), 32; https://doi.org/10.3390/ebj6020032 - 5 Jun 2025

Cited by 1 | Viewed by 1885

Abstract

Fibrin sealants have been implemented in the management of burn wounds. They can be used either in combination with skin grafts for full-thickness burns or alone for treating superficial and deep dermal burns. The aim of this review was to provide critical insights [...] Read more.

Fibrin sealants have been implemented in the management of burn wounds. They can be used either in combination with skin grafts for full-thickness burns or alone for treating superficial and deep dermal burns. The aim of this review was to provide critical insights regarding the efficacy of fibrin sealants in enhancing wound healing, improving graft adherence, and reducing complications. Therefore, evidence from experimental models and clinical trials was synthesized, underscoring the transformative role of fibrin sealants in modern burn care. This comprehensive review includes recent evidence on the potential benefits of fibrin sealants in the management of superficial and deep dermal or full-thickness burn injuries. Clinical and experimental evidence underscores some benefits in utilizing fibrin sealants in the management of superficial and deep dermal burn injuries, or in combination with skin grafts in full-thickness burns. Furthermore, fibrin sealants diminish postoperative pain and facilitate quick recovery for daily activities; however, controversy regarding their cost still remains. This review concludes that fibrin sealants could serve as a safe and effective therapeutic option for burn wound management. The safety and efficacy of their utilization, along with their wide availability and easiness to use, could make them an alternative treatment choice when a specialized plastic surgery service is not available, or in the emergency setting across different healthcare systems. Full article

(This article belongs to the Special Issue Innovative Applications and Challenges of Emerging Materials and Technologies in Burn Treatment)

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11 pages, 1633 KB

Open AccessReview

Novel Techniques in Fractional Skin Replacement

by Courtney Kelly, Rodney K. Chan and Anders H. Carlsson

Eur. Burn J. 2025, 6(1), 13; https://doi.org/10.3390/ebj6010013 - 6 Mar 2025

Viewed by 1500

Abstract

The gold standards for coverage of wounds that cannot be primarily closed are full thickness skin grafts (FTSGs) and split thickness skins graft (STSGs). FTSGs harvest sites generally require primary closure, which limits availability, especially when treating larger wounds. STSGs have many shortcomings, [...] Read more.

The gold standards for coverage of wounds that cannot be primarily closed are full thickness skin grafts (FTSGs) and split thickness skins graft (STSGs). FTSGs harvest sites generally require primary closure, which limits availability, especially when treating larger wounds. STSGs have many shortcomings, including donor site morbidity. Fractional autologous skin replacement can be utilized in conjunction with or in lieu of STSGs to both improve graft outcomes of large wounds and to decrease donor site morbidity. Skin can be mechanically or chemically fractionated. Fractionated skin can be advantageous, as adnexal structures provide additional functionality without donor site morbidity. In this review, we will discuss current and emerging techniques in fractional skin replacement. Full article

(This article belongs to the Special Issue Innovative Applications and Challenges of Emerging Materials and Technologies in Burn Treatment)

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20 pages, 1425 KB

Open AccessReview

Efficacy of Dialkylcarbamoylchloride (DACC)-Impregnated Dressings in Surgical Wound Management: A Review

by Madhan Jeyaraman, Naveen Jeyaraman, Swaminathan Ramasubramanian, Arulkumar Nallakumarasamy, Shrideavi Murugan, Tarun Jayakumar and Sathish Muthu

Eur. Burn J. 2025, 6(1), 1; https://doi.org/10.3390/ebj6010001 - 21 Jan 2025

Viewed by 3261

Abstract

Surgical site infections (SSIs) are a significant challenge in postoperative care, leading to increased morbidity, extended hospital stays, and elevated healthcare costs. Traditional antimicrobial dressings, such as those containing silver or iodine, have limitations, including cytotoxicity and the potential for antimicrobial resistance. Dialkylcarbamoyl [...] Read more.

Surgical site infections (SSIs) are a significant challenge in postoperative care, leading to increased morbidity, extended hospital stays, and elevated healthcare costs. Traditional antimicrobial dressings, such as those containing silver or iodine, have limitations, including cytotoxicity and the potential for antimicrobial resistance. Dialkylcarbamoyl chloride (DACC)-impregnated dressings offer a novel approach, employing a physical mechanism to bind and remove bacteria without the use of chemical agents, thereby reducing the risk of resistance. This review summarizes current evidence on the efficacy of DACC dressings in preventing SSIs and promoting wound healing. Findings from multiple studies indicate that DACC dressings reduce bacterial burden and SSI rates across various surgical procedures, including cesarean sections and vascular surgeries. Additionally, DACC dressings demonstrate potential in managing hard-to-heal wounds, such as diabetic foot ulcers, by reducing bacterial load and biofilm formation. Furthermore, they present advantages in antimicrobial stewardship and cost-effectiveness by minimizing the need for antibiotics and decreasing overall healthcare expenses. However, the current literature is limited by small sample sizes, methodological weaknesses, heterogeneity in study designs, and a lack of long-term data. Future research should focus on high-quality randomized controlled trials across diverse surgical populations, comprehensive cost-effectiveness analyses, and long-term outcomes to establish the full clinical impact of DACC dressings. With further validation, DACC-impregnated dressings could become a critical tool in sustainable postoperative wound care. Full article

(This article belongs to the Special Issue Innovative Applications and Challenges of Emerging Materials and Technologies in Burn Treatment)

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16 pages, 2217 KB

Open AccessReview

Bromelain in Burn Care: Advancements in Enzymatic Debridement and Patient Outcomes

by Eliza-Maria Bordeanu-Diaconescu, Sabina Grama, Andreea Grosu-Bularda, Adrian Frunza, Mihaela-Cristina Andrei, Tiberiu-Paul Neagu and Ioan Lascar

Eur. Burn J. 2024, 5(4), 438-453; https://doi.org/10.3390/ebj5040039 - 12 Dec 2024

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Abstract

The management of severe burns is a complex process that requires a multidimensional approach to ensure optimal healing of burn wounds, minimize complications, and improve the prognosis of patients. Surgical debridement is considered the gold standard for removing necrotic tissue; however, this approach [...] Read more.

The management of severe burns is a complex process that requires a multidimensional approach to ensure optimal healing of burn wounds, minimize complications, and improve the prognosis of patients. Surgical debridement is considered the gold standard for removing necrotic tissue; however, this approach involves risks such as bleeding, the potential removal of viable tissue during excision, and technical challenges in complex anatomical areas. Recent advancements highlight the role of enzymatic debridement using NexoBrid^®, which offers a less invasive alternative to surgical excision while having the ability to selectively debride necrotic tissue and preserve viable tissue. NexoBrid^® has shown efficacy in reducing debridement time, minimizing the need for additional surgeries, and improving overall wound healing outcomes. This review discusses the clinical indications, advantages, and considerations for choosing between surgical and enzymatic debridement. Emerging studies suggest the potential for enzymatic debridement to be safe and effective even for larger burn areas, making it a promising option in modern burn care. However, ongoing evaluation and integration into clinical protocols will be essential to fully realize its benefits in specialized burn treatment and to establish protocols. Full article

(This article belongs to the Special Issue Innovative Applications and Challenges of Emerging Materials and Technologies in Burn Treatment)

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13 pages, 1466 KB

Open AccessSystematic Review

The Diagnostic Value of Indocyanine Green in the Assessment of Depth of Burn Injuries: A Systematic Review

by Marie K. Hilgarth, Samuel Knoedler, Gabriel Hundeshagen, Adriana C. Panayi, Bong-Sung Kim, Jochen-Frederick Hernekamp and Valentin F. M. Haug

Eur. Burn J. 2026, 7(1), 19; https://doi.org/10.3390/ebj7010019 - 19 Mar 2026

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Abstract

Background: Accurate assessment of burn depth remains a clinical challenge and requires specific training. To improve diagnostic accuracy, various technical methods have been developed. This review summarizes current evidence on indocyanine green (ICG) fluorescence imaging for burn depth assessment and compares its performance [...] Read more.

Background: Accurate assessment of burn depth remains a clinical challenge and requires specific training. To improve diagnostic accuracy, various technical methods have been developed. This review summarizes current evidence on indocyanine green (ICG) fluorescence imaging for burn depth assessment and compares its performance with clinical, histological, and alternative modalities such as Laser Doppler imaging (LDI). Methods: A systematic literature search was conducted in PubMed/MEDLINE, Cochrane and Google Scholar to identify studies evaluating burn depth using ICG fluorescence imaging. Studies from 1995 to 2024 were included if they compared ICG to at least one reference method (clinical assessment, biopsy, or other technical modalities). Data extraction was performed independently by two reviewers. Risk of bias was assessed using the Newcastle–Ottawa Scale. The study selection workflow is shown in the PRISMA 2020 flow diagram for systematic reviews. Results: Nine studies with a total of 151 patients, published between 1995 and 2024, met the inclusion criteria. Results were synthesized descriptively due to substantial methodological heterogeneity. Two studies reported high accuracy of ICG fluorescence imaging for identifying nonviable tissue and supporting surgical planning, although differentiation between superficial and deep partial-thickness burns (SPTBs/DPTBs) was inconsistent. In one study, ICGA-guided assessment reduced or avoided excision in 10 of 20 burn sites (50%). Yet heterogeneity in measurement protocols, cut-off values, and reference standards limited comparability across studies. Conclusions: Due to its limited accuracy in differentiating SPTBs and DPTBs, ICG imaging has restricted utility for burn depth assessment, though it may still offer intraoperative benefit during necrosectomy. Registration: PROSPERO International prospective register of SRs by the National Institute of Health Research (CRD420251161190). Full article

(This article belongs to the Special Issue Innovative Applications and Challenges of Emerging Materials and Technologies in Burn Treatment)

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Open AccessCase Report

Intravascular Rewarming in Major Burns: A Rare but Serious Catheter-Related Complication

by Theodora Ligomenou, Eirini Nikolaidou, Argiro Pipinia, Georgios Trellopoulos, Stavros Galanis, Myrto Tzimou, Georgia Vasileiadou and Sophia Papadopoulou

Eur. Burn J. 2026, 7(1), 10; https://doi.org/10.3390/ebj7010010 - 9 Feb 2026

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Abstract

Introduction: Patients with major burn injuries are highly susceptible to hypothermia due to extensive skin loss, aggressive fluid resuscitation, repeated surgical procedures, and exposure during wound care. Hypothermia is associated with coagulation disorders, increased blood loss, impaired immune response, prolonged hospitalization, and [...] Read more.

Introduction: Patients with major burn injuries are highly susceptible to hypothermia due to extensive skin loss, aggressive fluid resuscitation, repeated surgical procedures, and exposure during wound care. Hypothermia is associated with coagulation disorders, increased blood loss, impaired immune response, prolonged hospitalization, and increased mortality. When conventional warming strategies fail, intravascular temperature management systems may be employed, although they carry risks inherent to central venous catheters. Case Report: We report the case of a 26-year-old male with 66% total body surface area flame burns and inhalational injury, admitted to the Burns Intensive Care Unit with persistent hypothermia despite standard warming measures. An intravascular temperature management catheter was inserted via the femoral vein and successfully restored normothermia. Due to clinical instability, the catheter remained in situ beyond the recommended duration. During attempted catheter removal, significant resistance was encountered, raising concern for mechanical malfunction. Imaging confirmed catheter entrapment without fracture. Multidisciplinary management involving vascular surgery and interventional radiology enabled successful removal using endovascular snare techniques. A detached balloon fragment was identified and secured with venous stenting. Conclusions: This report describes the first documented case of complicated removal of an intravascular warming catheter due to balloon detachment in burn patients. Physicians using these devices should be aware of this possible complication and be prepared for its management. Full article

(This article belongs to the Special Issue Innovative Applications and Challenges of Emerging Materials and Technologies in Burn Treatment)

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