A History of Burn Care (Closed)

A topical collection in Medicina (ISSN 1648-9144). This collection belongs to the section "Epidemiology & Public Health".

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Editors


E-Mail Website
Co-Guest Editor
Burn Center and Plastic Surgery, Unfallkrankenhaus Berlin, Warenerstr. 7, 12683 Berlin, Germany
Interests: burn injury care; plastic-surgical reconstruction; skin spray transplantation

Topical Collection Information

Dear Colleagues,

Controlling fire was an important step in the emergence of human cultures and civilizations. However, since the discovery of fire, its potential danger for humans has also been seen. Therefore, people started treating burns very early on. The first information detailing the treatment of burns was found on papyrus dating to the 15th century BC.

A lot has happened since then, especially in recent years and decades, in the area of the treatment of burn injuries. New dressings and skin replacement materials have been developed, as well as new concepts in the field of intensive care. Early surgical treatment has also been established. Nevertheless, it seems very important to not forget the old techniques, but to build on the experiences and results of our predecessors and to continue to develop treatments. Research is an important cornerstone for further development. The aim of this Special Issue is to provide a journey through time from the past to the future of burn injury treatment.

Prof. Dr. Lars P. Kamolz
Dr. Bernd Hartmann
Guest Editors

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Keywords

  • burn care
  • dressing
  • skin substitutes
  • intensive care
  • history
  • research
  • drugs
  • debridement

Published Papers (10 papers)

2022

Jump to: 2021

17 pages, 367 KiB  
Review
A Narrative Review of the History of Burn-Related Depression and Stress Reactions
by Shivan N. Chokshi, Carter M. Powell, Yulia Gavrilova, Steven E. Wolf and Deepak K. Ozhathil
Medicina 2022, 58(10), 1395; https://doi.org/10.3390/medicina58101395 - 05 Oct 2022
Cited by 9 | Viewed by 2343
Abstract
While the roots of burn care date back several millennia, recognition and treatment of psychiatric trauma has had a more contemporary journey. Our understanding of burn care has evolved largely separately from our understanding of psychiatry; however, proper care of the burn patient [...] Read more.
While the roots of burn care date back several millennia, recognition and treatment of psychiatric trauma has had a more contemporary journey. Our understanding of burn care has evolved largely separately from our understanding of psychiatry; however, proper care of the burn patient relies on the comprehension of both disciplines. Historically, high burn mortality rates have caused clinicians to focus on the physiological causes of burn mortality. As burn care improved in the 20th century, providers began to focus on the long-term health outcomes of burn patients, including mitigating mental health consequences of trauma. This shift coincided with advances in our understanding of psychological sequelae of trauma. Subsequently, an association between burn trauma and mental illness began to emerge. The current standard of care is the result of thousands of years of evolving practices and theories, yet our understanding of the pathophysiology of depression among survivors of severe burn injury is far from complete. By taking measure of the past, we aim to provide context and evidence for our current standards and emphasize areas for future lines of research. Full article
19 pages, 2542 KiB  
Article
Infections in Burn Patients: A Retrospective View over Seven Years
by Savas Tsolakidis, David Lysander Freytag, Elisabeth Dovern, Ziyad Alharbi, Bong-Sung Kim, Khosrow Siamak Houschyar, Georg Reumuth, Benedikt Schäfer, Hans-Oliver Rennekampff, Norbert Pallua and Gerrit Grieb
Medicina 2022, 58(8), 1066; https://doi.org/10.3390/medicina58081066 - 08 Aug 2022
Cited by 5 | Viewed by 4111
Abstract
Backgroundand objectives: Burn patients represent a challenging cohort because the injuries entail a vulnerability to colonisation by microorganisms. The ensuing infections can lead to serious complications and, in many cases, to the death of the burn patient. Surgical intervention and wound [...] Read more.
Backgroundand objectives: Burn patients represent a challenging cohort because the injuries entail a vulnerability to colonisation by microorganisms. The ensuing infections can lead to serious complications and, in many cases, to the death of the burn patient. Surgical intervention and wound dressings, as well as antibiotic treatment, are crucial for optimising the treatment of the patient. Materialand Methods: In this retrospective analysis, we analysed the treatment course, antibiotic therapy, and general complications of 252 burn patients with second- or third-degree burns over a time span of 7 years. Results: Patients who developed infections tended to have, on average, a higher total body surface area (TBSA), higher abbreviated burn severity index (ABSI) scores, and longer hospital stays. Patients who were admitted to the burn unit after 2006 had significantly shorter stays in the burn unit. TBSA and ABSI scores were lower in the patient cohort admitted after 2006. Patients exhibiting a TBSA greater than 30% had significantly longer hospital stays and antibiotic treatment periods. TBSA and ABSI scores were significantly higher in patients who died. The results of binary logistic regression indicate that a higher ABSI score increases the odds ratio of developing an infection. Bacteria number had no significant effect on the odds of patient death but positively influenced the odds ratio of developing an infection. TBSA was negatively associated with the risk of developing an infection and was an insignificant predictor of mortality. Conclusions: To gauge the optimal treatment for a burn patient, it is crucial for practitioners to correctly select, dose, and time antibiotics for the patient. Monitoring bacterial colonisation is vital to nip rising infection in the bud and ensure the correct antibiotic selection. This will help prevent the development of multi-resistant bacteria. Full article
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14 pages, 744 KiB  
Review
Therapeutic Strategies to Reduce Burn Wound Conversion
by Alen Palackic, Jayson W. Jay, Robert P. Duggan, Ludwik K. Branski, Steven E. Wolf, Naseem Ansari and Amina El Ayadi
Medicina 2022, 58(7), 922; https://doi.org/10.3390/medicina58070922 - 11 Jul 2022
Cited by 6 | Viewed by 4580
Abstract
Burn wound conversion refers to the phenomenon whereby superficial burns that appear to retain the ability to spontaneously heal, convert later into deeper wounds in need of excision. While no current treatment can definitively stop burn wound conversion, attempts to slow tissue damage [...] Read more.
Burn wound conversion refers to the phenomenon whereby superficial burns that appear to retain the ability to spontaneously heal, convert later into deeper wounds in need of excision. While no current treatment can definitively stop burn wound conversion, attempts to slow tissue damage remain unsatisfactory, justifying the need for new therapeutic interventions. To attenuate burn wound conversion, various studies have targeted at least one of the molecular mechanisms underlying burn wound conversion, including ischemia, inflammation, apoptosis, autophagy, generation of reactive oxygen species, hypothermia, and wound rehydration. However, therapeutic strategies that can target various mechanisms involved in burn wound conversion are still lacking. This review highlights the pathophysiology of burn wound conversion and focuses on recent studies that have turned to the novel use of biologics such as mesenchymal stem cells, biomaterials, and immune regulators to mitigate wound conversion. Future research should investigate mechanistic pathways, side effects, safety, and efficacy of these different treatments before translation into clinical studies. Full article
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10 pages, 553 KiB  
Systematic Review
In Vivo Models for Hypertrophic Scars—A Systematic Review
by Stefan Rössler, Sebastian Philipp Nischwitz, Hanna Luze, Judith C. J. Holzer-Geissler, Robert Zrim and Lars-Peter Kamolz
Medicina 2022, 58(6), 736; https://doi.org/10.3390/medicina58060736 - 30 May 2022
Cited by 5 | Viewed by 2687
Abstract
Backgroundand Objectives: Hypertrophic scars following surgeries or burns present a serious concern for many patients because these scars not only lead to an aesthetical but also to a functional and psychological burden. Treatment of hypertrophic scars is challenging because despite various treatment [...] Read more.
Backgroundand Objectives: Hypertrophic scars following surgeries or burns present a serious concern for many patients because these scars not only lead to an aesthetical but also to a functional and psychological burden. Treatment of hypertrophic scars is challenging because despite various treatment options, a low level of evidence hinders preference of any specific treatment plan. To properly identify new therapeutic approaches, the use of in vivo models remains indispensable. A gold standard for hypertrophic scars has not been established to date. This review aims at giving a comprehensive overview of the available in vivo models. Materials and Methods: PubMed and CINAHL were queried for currently existing models. Results: Models with mice, rats, rabbits, pigs, guinea pigs and dogs are used in hypertrophic scar research. Rodent models provide the advantage of ready availability and low costs, but the number of scars per animal is limited due to their relatively small body surface, leading to a high number of test animals which should be avoided according to the 3Rs. Multiple scars per animal can be created in the guinea pig and rabbit ear model; but like other rodent models, these models exhibit low transferability to human conditions. Pig models show a good transferability, but are cost-intensive and require adequate housing facilities. Further, it is not clear if a currently available pig model can deliver clinical and histological features of human hypertrophic scars concurrently. Conclusions: None of the analyzed animal models can be clearly recommended as a standard model in hypertrophic scar research because the particular research question must be considered to elect a suitable model. Full article
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15 pages, 839 KiB  
Article
Life after Burn, Part I: Health-Related Quality of Life, Employment and Life Satisfaction
by Maria Fernanda Hutter, Christian Smolle and Lars-Peter Kamolz
Medicina 2022, 58(5), 599; https://doi.org/10.3390/medicina58050599 - 27 Apr 2022
Cited by 4 | Viewed by 2054
Abstract
Background and Objectives: As advances in medicine are proceeding, so are treatment goals shifting from sheer mortality rates to improving HRQoL and social reintegration after burn injury. Following this trend, we aimed to assess HRQoL, employment and life satisfaction after burn injury [...] Read more.
Background and Objectives: As advances in medicine are proceeding, so are treatment goals shifting from sheer mortality rates to improving HRQoL and social reintegration after burn injury. Following this trend, we aimed to assess HRQoL, employment and life satisfaction after burn injury to gain insight on confounding factors. Materials and Methods: This single-center follow-up study was conducted using the SF-36 V1.0 in German and further questions evaluating employment and life satisfaction. It reached 128 adult in-patients (recall 33.0%) with former burn injuries, treated between 2012 and 2019 at the Division of Plastic, Aesthetic and Reconstructive Surgery at the University Hospital of Graz. The questionnaire outcomes were set into relation with clinical data obtained from the medical records. Statistical analysis was performed with SPSS 27.0 for Windows. Results: Of the 128 participants, 72.7% were male and 27.3% female. The mean age at the time of injury was 40.0 ± 15.7 years and mean %TBSA among the study population was 9.2 ± 11.0%. The male patients had sustained more extensive injuries (p = 0.005). However, the female patients scored significantly (p < 0.05) and consistently lower in all the domains of the SF-36, except for “bodily pain” (p = 0.061). Moreover, the female patients scored lower in all the domains of life satisfaction, although significant differences were only found in the domains of fulfillment (p = 0.050) and mental wellbeing (p = 0.015). Furthermore, employment status differed significantly between the male and female patients before as well as after the burn injury. Proportionally less women were employed at both time points. Overall, unemployment had declined. Conclusions: Life satisfaction after burn injury in this study cohort seems to be good. Return to work has shown a promising trend. Strikingly, HRQoL and life satisfaction were lower in women after burn injury. Further research on the reasons for this gender discrepancy might improve HRQoL and life satisfaction after burns. Full article
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10 pages, 587 KiB  
Article
Life after Burn, Part II: Substance Abuse, Relationship and Living Situation of Burn Survivors
by Christian Smolle, Maria-Fernanda Hutter and Lars-Peter Kamolz
Medicina 2022, 58(5), 563; https://doi.org/10.3390/medicina58050563 - 19 Apr 2022
Cited by 4 | Viewed by 1820
Abstract
Background and Objectives: After burns, social reintegration is a primary long-term objective. At the same time, substance-abuse disorders are more common in burn patients. The aim of this study was to assess prevalence of substance abuse pre- and postburn as well as [...] Read more.
Background and Objectives: After burns, social reintegration is a primary long-term objective. At the same time, substance-abuse disorders are more common in burn patients. The aim of this study was to assess prevalence of substance abuse pre- and postburn as well as living situation and relationship status relative to patient-reported health-related quality of life (HRQoL). Patients and Methods: Burn survivors treated as inpatients between 1 January 2012 and 31 December 2019 were retrospectively identified. Collected clinical data included: age, gender, time since injury, burn extent (%TBSA), and substance abuse. Patient-reported living situation, relationship status, smoking habits, alcohol and drug consumption pre- and postburn as well as the SF-36 study were ascertained via telephone survey. Inductive statistical analysis comprised uni- and multivariate testing. A p < 0.05 was considered as statistically significant. Results: A total of 128 patients, 93 (72.7%) men, with a mean age of 40.0 ± 15.7 years were included. Mean TBSA was 9.2 ± 11.0% and significantly lower in women (p = 0.005). General health SF-36 scores were significantly lower in women (67.6 ± 29.8) than men (86.0 ± 20.8, p = 0.002). Smoking decreased from 38.8% pre- to 31.1% postburn. A significant reduction in alcohol consumption was noted over time (p = 0.019). The rate of never-drinkers was 18.0% pre- and 27.3% postburn. Drug abuse was rare both pre- (7.8%) and postburn (5.3%). Living situation remained stable. None of the participants depended on assisted living or lived in a care facility postburn. In total, 75.8% and 67.2% were in a relationship pre- and postburn. Patients with higher alcohol consumption postburn were significantly more often male (p = 0.013) and had higher SF-36 general health scores (p < 0.001). Conclusions: HRQoL is better in men than in women after burn injury. A slight decrease in substance abuse postburn was noted. The connection between HRQoL and substance abuse after burn injuries needs to be investigated further in the future. Full article
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12 pages, 923 KiB  
Review
Review of History of Basic Principles of Burn Wound Management
by Hyunjin Kim, Seongmee Shin and Donghoon Han
Medicina 2022, 58(3), 400; https://doi.org/10.3390/medicina58030400 - 07 Mar 2022
Cited by 1 | Viewed by 6940
Abstract
Thermal energy is an essential and useful resource to humans in modern society. However, a consequence of using heat carelessly is burns. Burn injuries have various causes, such as exposure to flame, radiation, electrical, and chemical sources. In this study, we reviewed the [...] Read more.
Thermal energy is an essential and useful resource to humans in modern society. However, a consequence of using heat carelessly is burns. Burn injuries have various causes, such as exposure to flame, radiation, electrical, and chemical sources. In this study, we reviewed the history of burn wound care while focusing on the basic principles of burn management. Through this review, we highlight the need for careful monitoring and customization when treating burn victims at each step of wound care, as their individual needs may differ. We also propose that future research should focus on nanotechnology-based skin grafts, as this is a promising area for further improvement in wound care. Full article
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2021

Jump to: 2022

12 pages, 343 KiB  
Review
Sepsis in Burns—Lessons Learnt from Developments in the Management of Septic Shock
by Dorothee Boehm and Henrik Menke
Medicina 2022, 58(1), 26; https://doi.org/10.3390/medicina58010026 - 24 Dec 2021
Cited by 6 | Viewed by 4041
Abstract
After surviving the acute phase of resuscitation, septic shock is the cause of death in the majority of burn patients. Therefore, the management of septic shock is a cornerstone in modern burn care. Whereas sepsis therapy in general has undergone remarkable developments in [...] Read more.
After surviving the acute phase of resuscitation, septic shock is the cause of death in the majority of burn patients. Therefore, the management of septic shock is a cornerstone in modern burn care. Whereas sepsis therapy in general has undergone remarkable developments in the past decade, the management of septic shock in burn patients still has a long way to go. Instead, the differences of burn patients with septic shock versus general patients have been emphasized and thus, burn patients were excluded in every sepsis study which are the basis for modern sepsis therapy. However, due to the lack of evidence in burn patients, the standards of procedure for general sepsis therapy have been adopted in burn care. This review identifies the differences of burn patients with sepsis versus other septic patients and summarizes the scientific basis for modern sepsis therapy in general ICU patients and burn patients. Consequently, the results in general sepsis research should be transferred to burn care, which means the implementation of effective screening, early resuscitation, and efficient antimicrobial treatment. Therefore, on the basis of past developments and in the light of the current update of the Surviving Sepsis Campaign guidelines, this review introduces the “Burn SOFA score” and the “3 H’s of burn sepsis” as a screening tool for early sepsis recognition in burn patients. Full article
21 pages, 432 KiB  
Review
Oxygen, pH, Lactate, and Metabolism—How Old Knowledge and New Insights Might Be Combined for New Wound Treatment
by Herbert Leopold Haller, Frank Sander, Daniel Popp, Matthias Rapp, Bernd Hartmann, Mehmet Demircan, Sebastian Philipp Nischwitz and Lars Peter Kamolz
Medicina 2021, 57(11), 1190; https://doi.org/10.3390/medicina57111190 - 01 Nov 2021
Cited by 19 | Viewed by 3489
Abstract
Over time, we have come to recognize a very complex network of physiological changes enabling wound healing. An immunological process enables the body to distinguish damaged cells and begin a cleaning mechanism by separating damaged proteins and cells with matrix metalloproteinases, a complement [...] Read more.
Over time, we have come to recognize a very complex network of physiological changes enabling wound healing. An immunological process enables the body to distinguish damaged cells and begin a cleaning mechanism by separating damaged proteins and cells with matrix metalloproteinases, a complement reaction, and free radicals. A wide variety of cell functions help to rebuild new tissue, dependent on energy provision and oxygen supply. Like in an optimized “bio-reactor,” disturbance can lead to prolonged healing. One of the earliest investigated local factors is the pH of wounds, studied in close relation to the local perfusion, oxygen tension, and lactate concentration. Granulation tissue with the wrong pH can hinder fibroblast and keratinocyte division and proliferation, as well as skin graft takes. Methods for influencing the pH have been tested, such as occlusion and acidification by the topical application of acidic media. In most trials, this has not changed the wound’s pH to an acidic one, but it has reduced the strong alkalinity of deeper or chronic wounds. Energy provision is essential for all repair processes. New insights into the metabolism of cells have changed the definition of lactate from a waste product to an indispensable energy provider in normoxic and hypoxic conditions. Neovascularization depends on oxygen provision and lactate, signaling hypoxic conditions even under normoxic conditions. An appropriate pH is necessary for successful skin grafting; hypoxia can change the pH of wounds. This review describes the close interconnections between the local lactate levels, metabolism, healing mechanisms, and pH. Furthermore, it analyzes and evaluates the different possible ways to support metabolism, such as lactate enhancement and pH adjustment. The aim of wound treatment must be the optimization of all these components. Therefore, the role of lactate and its influence on wound healing in acute and chronic wounds will be assessed. Full article
11 pages, 6440 KiB  
Review
Implementation and Validation of Free Flaps in Acute and Reconstructive Burn Care
by Benjamin Ziegler, Gabriel Hundeshagen, Jan Warszawski, Emre Gazyakan, Ulrich Kneser and Christoph Hirche
Medicina 2021, 57(7), 718; https://doi.org/10.3390/medicina57070718 - 16 Jul 2021
Cited by 3 | Viewed by 3309
Abstract
Microsurgical free flap reconstruction in acute burn care offers the option of reconstructing even challenging defects in a single stage procedure. Due to altered rheological and hemodynamic conditions in severely burned patients, it bears the risk of a higher complication rate compared to [...] Read more.
Microsurgical free flap reconstruction in acute burn care offers the option of reconstructing even challenging defects in a single stage procedure. Due to altered rheological and hemodynamic conditions in severely burned patients, it bears the risk of a higher complication rate compared to microsurgical reconstruction in other patients. To avoid failure, appropriate indications for free flap reconstruction should be reviewed thoroughly. Several aspects concerning timing of the procedure, individual flap choice, selection and preparation of the recipient vessels, and perioperative measures must be considered. Respecting these specific conditions, a low complication rate, comparable to those seen in microsurgical reconstruction of other traumatic limb defects, can be observed. Hence, the free flap procedure in acute burn care is a relatively safe and reliable tool in the armamentarium of acute burn surgery. In reconstructive burn care, microsurgical tissue transfer is routinely used to treat scar contractures. Due to the more robust perioperative condition of patients, even lower rates of complication are seen in microsurgical reconstruction. Full article
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