European Burn Journal doi: 10.3390/ebj7020035

Authors: Gianpiero Tebano Caterina Convertino Luigi Raumer Rossella Sgarzani Davide Melandri Francesco Cristini

Background: Hospital-acquired infections (HAIs) represent the most significant complications in patients hospitalized for severe burn injuries, after the immediate post-burn resuscitation phase, and are associated with substantial morbidity and mortality. Methods: This is a narrative review. Evidence was extracted mainly with an in-depth search of MEDLINE, focusing on guidelines, randomized controlled trials, and relevant observational studies published in the last 25 years. The reference lists of the most relevant publications were screened to retrieve additional relevant information. Results: Wound infections, bloodstream infections, pneumonia, and urinary tract infections account for the majority of infectious complications. Their diagnosis can be challenging, particularly in the context of wound infections and sepsis. Burn severity and the resulting disruption of tissue and organ homeostasis can alter the pharmacokinetic and pharmacodynamic (PK/PD) properties of antibiotics, rendering standard dosing and administration strategies inadequate. Higher doses, prolonged or continuous infusions, and therapeutic drug monitoring may be required to optimize antibiotic exposure. The emergence of multidrug-resistant (MDR) pathogens (particularly MDR Gram-negative bacilli) has been widely reported across diverse epidemiological settings and occurs frequently in patients with prolonged hospitalization, further complicating treatment. As a result, the use of broad-spectrum antibiotics is substantial, both for empirical therapy and for targeted treatment. Although antimicrobial stewardship programs can promote more appropriate antibiotic use, evidence on how to effectively implement these strategies in Burn Intensive Care Units remains limited. Conclusions: HAIs in burn patients represent a highly complex clinical scenario. Clinical severity is often significant, diagnosis can be challenging, and MDR pathogens are very prevalent, with high consumption of broad-spectrum antibiotics. Moreover, PK/PD properties of antibiotics can be altered. Antimicrobial stewardship can promote appropriate antimicrobial use, but implementation in this setting has not been adequately studied. Close multidisciplinary collaboration between burn specialists and infectious diseases physicians is essential to ensure effective patient management.

European Burn Journal doi: 10.3390/ebj7020034

Authors: Hongyu Tang Shenjing Yu Rui Zhang Zheng Zhu Li Gui

Background: Early management of adult burn injuries in resource-constrained environments—such as battlefields and primary care facilities—remains hindered by the absence of standardized, evidence-based protocols. This study aimed to systematically synthesize existing evidence and develop an integrated framework of actionable recommendations to optimize prehospital and early emergency care. Methods: A comprehensive evidence synthesis was conducted across 14 international and domestic bibliographic databases and authoritative repositories. Eligible sources included clinical practice guidelines, expert consensus statements, evidence summaries, and systematic reviews. Literature quality was appraised using validated instruments, and best-practice recommendations were extracted and thematically synthesized across the continuum of early burn care. Results: Fifty-nine high-quality studies yielded 77 recommendations across 13 domains, spanning from scene safety and burn process cessation through airway, breathing, and circulatory management to wound care, infection control, and transfer preparation. An integrated, context-adaptive framework was established to guide resource-calibrated interventions rather than rigid protocol adherence. Conclusions: These findings provide tiered guidance for frontline healthcare providers and inform the development of emergency care standards in resource-limited settings. Future research should prioritize field validation and contextual implementation to address barriers to evidence translation and enhance real-world applicability.

European Burn Journal doi: 10.3390/ebj7020033

Authors: Yamile Montecinos-Rodríguez Francisco J. Torres-Santana Noureddine Lakouari Lorena Díaz-González

Background: Burn severity assessment is clinically relevant and often requires timely decision-making. Visual classification of second- and third-degree burns remains subjective and prone to observer variability. Methods: This study aimed to develop and evaluate a deep learning model for the automatic classification of second- and third-degree burn images. A dataset of clinical burn images from a private wound care clinic was used to train a convolutional neural network. Hyperparameter optimization and color channel sensitivity analysis were performed to identify the optimal model configuration. Model performance was evaluated using standard classification metrics on training, validation, and independent test datasets, and results were compared with transfer learning approaches. Results: The best performance was achieved using a compact model trained exclusively with the green color channel, obtaining an accuracy of 0.94, precision of 0.96, recall of 0.92, and an F1-score of 0.94 on the independent test set. This model outperformed more complex transfer learning approaches while reducing computational complexity. Conclusions: These findings indicate that using only the green color channel enables efficient and accurate burn classification. The proposed model was also integrated into a graphical user interface, supporting its potential application in clinical and educational environments.

European Burn Journal doi: 10.3390/ebj7020032

Authors: Quentin Isaacs Chrysis Sofianos Adelin Muganza Brian Brummer

Background: Timely admission to a specialised burn unit is considered crucial for optimising outcomes in burn patients. However, the impact of delayed admission on hospital length of stay and clinical outcomes remains unclear, particularly in resource-constrained settings such as South Africa. This retrospective study aimed to determine whether admission to a burn unit more than 24 h after injury was associated with increased length of stay, sepsis, or mortality. Methods: A retrospective case-audit study was conducted at the Chris Hani Baragwanath Academic Hospital Adult Burn Unit, Johannesburg, from January 2018 to December 2022. Patients were categorised into early (≤24 h) and delayed (>24 h) admission groups. The primary outcome was length of stay; secondary outcomes included sepsis incidence and in-hospital mortality. Results: A total of 123 files were analysed; 71 (58%) were admitted within 24 h. The median length of stay was 14 days, with no statistical difference between the two groups (p = 0.7). The overall mortality rate was 13%, with 68% occurring in the early admission group. Sepsis occurred in 27% of patients. Multivariate analysis revealed that early admission was independently associated with longer length of stay. Conclusions: In this single-centre retrospective case note audit with a limited sample size and significant risk of selection bias, delayed admission to a burn unit was not associated with increased length of stay, mortality, or sepsis. However, these findings should be considered preliminary and require confirmation in larger, prospective studies. The higher rate of surgical intervention in the delayed admission group warrants further investigation.

European Burn Journal doi: 10.3390/ebj7020031

Authors: Joshua P. Kronenfeld Louis R. Pizano Ray I. Gonzalez Joyce I. Kaufman Shevonne Satahoo Carl I. Schulman

Objective: Surgical simulation has been shown to improve efficiency, performance, and time to mastery for complicated procedures, but simulation training is not always considered when introducing new devices or products. As part of a performance improvement project, we sought to design and evaluate simulation training for the skin cell suspension autograft (SCSA) with surgery residents during their Burn rotation. Methods: Residents were asked to read instructional materials and watch training videos before coming into the simulation lab for the training session supervised by a Burn surgeon. A qualitative survey was designed and administered after completion of the rotation. Results: Twelve residents have completed the training thus far. Their feedback from the training session was rated on a five-point Likert scale and indicated that the simulation activity was an appropriate length (4.6/5.0), was thorough (4.8/5.0), and led to more confidence (4.4/5.0) and less apprehension (4.4/5.0) when performing the procedure on live patients. This was followed by their use of the product in the operating room with complete success. Conclusions: The novel SCSA training shows great promise for improving the confidence and performance of surgical residents. This could allow for a shorter time for residents to become independent in its use, thereby allowing for increased operative efficiency with the opportunity to significantly improve trainee expertise.

European Burn Journal doi: 10.3390/ebj7020030

Authors: Nadia Depetris Alette E. E. de Jong Clemens Schiestl Fredrik Huss Gregoire Bondu Jill Meirte Jyrki Vuola Luís Cabral Moustafa Elmasry Raluca Tatar Bulea Robert Zajíček Stian Almeland Yvonne Wilson

Abstracts of the plenary sessions, workshops, and poster presentations of the 4th EBA Educational Course in Bucharest, Romania, 15–16 May 2026.

European Burn Journal doi: 10.3390/ebj7020029

Authors: Hajime Matsumura Takahiro Ueda Rei Ogawa Yasuhiko Kaita Hiroyuki Sakurai Kazutaka Soejima Junichi Sasaki

Background: NexoBrid® (NXB), an enzymatic debridement agent approved in Japan in 2022, provides a less invasive alternative to surgical excision for burn treatment. However, its optimal therapeutic benefit depends on appropriate patient selection and proper application technique. Existing international consensus documents are not fully applicable to clinical practice in Japan because of differences in available devices and drugs. Therefore, a Japan-specific consensus document was developed by a panel of seven Japanese burn experts, including four plastic surgeons and three emergency physicians. Methods: A questionnaire-based survey was conducted using the Delphi method to achieve expert consensus. Consensus was defined as agreement by at least 80% of committee members for each statement. A total of 27 statements were evaluated over two rounds. Results: Consensus was achieved for 20 of 27 statements (74.1%) in the first round and for 21 of 27 statements (77.8%) in the second round. The finalised statements were organised into seven categories according to their attributes: indications, pain management, application timing, application technique, post-application wound care, skin grafting, and scarring/aesthetic outcomes. Conclusions: This consensus document integrates the opinions of plastic surgeons and emergency physicians in Japan, while also incorporating relevant international perspectives, to provide practical guidance on the use of NXB for burn treatment. It is intended to improve the quality of burn care by clarifying efficacy, safety, and precautions associated with NXB use. These recommendations should be updated as further clinical experience accumulates.

European Burn Journal doi: 10.3390/ebj7020028

Authors: Rahel Kassa Bayou Meheret Befekadu Demmissie Bethelhem Kassa Bayou Laura Pompermaier Hanna Yemane Berhane Bacha Mirkena Dhabi

Background: Burn injuries are a major cause of morbidity and mortality in low- and middle-income countries, yet remain underreported due to limited data systems. This study describes the epidemiology of burn patients admitted to two major burn centers in Addis Ababa, Ethiopia, and identifies predictors of in-hospital mortality. Methods: A cross-sectional study was conducted among patients with new burn injuries admitted between 1 September 2021, and 1 November 2023, at the Addis Ababa Burn, Emergency, and Trauma Center (AaBET) and Yekatit 12 Medical College (Y12MC) hospitals. Data were extracted from medical records. Descriptive statistics summarized patient characteristics, and binary logistic regression with multivariable analysis identified factors associated with in-hospital mortality using adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Results: Chart completeness was 96.2%. Among 800 patients, 57% were female, with a median age of 18 years (range: 0–89); approximately 80% were under 30 years. Scalds were the leading cause (49.1%). In-hospital mortality was 8.5% (95% CI: 6.5–10.4). Significant predictors included inhalation injury (AOR 6.53), TBSA ≥ 15% (AOR 3.33), deep burns (AOR 1.96), and ICU admission (AOR 14.42). Conclusions: In-hospital mortality was moderate, disproportionately affecting children and young adults, underscoring the need to strengthen critical care and management of severe burns.

European Burn Journal doi: 10.3390/ebj7020027

Authors: Nicole Lee Ascanio Tridente Niall Martin Odhran Shelley on behalf of the UK Working Group for Enzymatic Debridement on behalf of the UK Working Group for Enzymatic Debridement

Background: Over the past ten years, enzymatic debridement has been used more often to treat burn injuries in the UK and Europe. Even though it is increasingly adopted, there are still major differences in how it is practiced. These differences are mainly due to varying levels of professional experience, differences in the interpretation of available evidence, and concerns about safety and effectiveness. Methods: To help resolve these issues and create more consistent care, the UK National Consensus Working Group was formed. This group brought together burn care experts from different backgrounds to review current methods, published research, and consensus guidelines. They used a structured approach that included educational webinars, a thorough review of the literature, and a national survey using the Delphi method to gather expert opinions and real-world experiences. Results: As a result of this process, the UK Consensus Statement for the Use of Enzymatic Debridement in Burn Care was created and officially approved after extensive consultation at national meetings. The main recommendations focus on safely and effectively including enzymatic debridement in burn care, the need for clear procedures, and identifying areas where further research is needed, such as patient outcomes and dressing methods. Conclusions: The goal of this consensus statement is to unify practices, guide future research, and support ongoing improvements in burn care throughout the UK.

European Burn Journal doi: 10.3390/ebj7020026

Authors: Jill Meirte Stefania Anna Simone Sabrina Belemkasser Jonathan Bayuo

Background: Burn injuries profoundly impact the survivors’ physical, psychological and social well-being, with sexuality, intimacy and body image remaining among the most disrupted yet least addressed areas of rehabilitation. Limited professional training, social discomfort, and a lack of clinical guidance contribute to these unmet needs. Recognizing sexuality as an essential part of health, this interdisciplinary project developed evidence-informed recommendations and communication tools to support both burn survivors and healthcare professionals in discussing intimacy, sexuality, and body image after burn injury. Methods: An interdisciplinary expert group conducted a narrative literature review, supplemented with grey literature and lived experience resources. These insights informed two practical tools: a poster for healthcare professionals and burn centers, and a patient-focused brochure. Both underwent iterative refinement through multicultural feedback from patients and professionals across Europe, Asia and Africa, followed by final validation during an interdisciplinary workshop at the 2025 European Burns Association (EBA) Conference. Results: The literature indicated that burn injuries affect sexuality and body image through interacting physiological, psychological, sensory, relational, and sociocultural factors. Common challenges included reduced desire, anxiety, fear of rejection, altered self-perception, and discomfort initiating conversations about intimacy. Professionals reported limited training, insufficient privacy and cultural barriers. Conclusions: The developed tools and these recommendations aim to normalize dialog, support proactive screening, and promote culturally sensitive patient-centered burn rehabilitation. Embedding sexuality and intimacy within burn care requires ongoing professional training and the identification of dedicated resource persons within each team.

European Burn Journal doi: 10.3390/ebj7020025

Authors: Elad Zvi Melissa Neely Louise Higgins Maja Garcia Melinda Pacquola Eldho Paul Alex Padiglione Heather Cleland Cheng Hean Lo

Background: Burn patients are highly susceptible to hospital-acquired infections (HAIs), and contaminated near-patient surfaces can act as reservoirs for multidrug-resistant organisms (MROs). Ultraviolet-C (UV-C) room disinfection is increasingly used as an adjunct to manual cleaning, but real-world data in adult burns settings remain limited. Methods: We evaluated adjunctive UV-C disinfection in a tertiary adult trauma and burns surgical ward using a two-part observational design. Part A compares MRO-related HAI incidence before UV-C implementation (12 May 2015–11 May 2020; retrospective) with its incidence after implementation (14 July 2020–13 July 2021; prospective). Part B is a matched pre/post environmental sampling study (December 2022–December 2024) of 44 vacant rooms. Paired swabs from a single randomised high-touch surface per room were collected immediately before and after UV-C disinfection and processed by an independent laboratory. Results: Part A included 7589 admissions (6415 before-UV-C; 1174 after-UV-C) with 2728 UV-C cycles delivered after implementation. MRO-related HAI incidence decreased from 18.3 to 10.2 per 1000 bed-days (p < 0.01). In Part B, the proportion of swabs with <10 CFU increased after UV-C disinfection (66% vs. 50%, p = 0.02). Among swabs with non-negligible baseline contamination and excluding increases, the median CFU reduction was 97% (SD 12%; p < 0.001), with no significant differences in reduction across sampled surface types. Conclusion: In an adult burns surgical ward, adjunctive UV-C disinfection was associated with reduced MRO-related HAI incidence and a substantial reduction in environmental bioburden on high-touch surfaces. These real-world findings support UV-C as a feasible adjunct to standard cleaning in high-risk burn services and inform future controlled evaluations.

European Burn Journal doi: 10.3390/ebj7020024

Authors: Carlotta Paola Maria Canonica Irene Paraboschi Eleonora Durante Francesca Izzo Anna Mandelli Sara Costanzo Elvira Conti Gloria Pelizzo Anne Le Touze

Background: Deep burns in pediatric population often require split-thickness skin grafts (STSGs) and the identification of an optimal donor site is crucial to minimize morbidity, accelerate healing and reduce short- and long-term complications. The scalp appears to be increasingly used in clinical practice, but evidence remains limited, despite the promise of novel bioengineering and regenerative approaches. Methods: A systematic review about the use of scalp for STSG in pediatrics was conducted across PubMed, Scopus, and Cochrane (2005–2025). Clinical outcomes considered were donor-site healing time, early and late complications, perioperative practices, and quality of scars. Results: Four studies met the inclusion criteria (n = 417, mean age 2.9–7.3 years) with follow-up periods up to 27 years. Epithelialization occurred between 7 and 25 days. Early complications included folliculitis (up to 44% in certain hair types) and delayed healing (n = 13; 52%). A rigorous harvesting technique is needed to avoid preventable complications. Late sequelae included alopecia (1.6% to 33%—the latter largely unperceived by patients) and hypertrophic scarring (1.6–4%). Scar quality was rated good in >80% of cases. Conclusions: Evidence supports the scalp as a safe, efficient, and cosmetically favorable donor site for pediatric STSG. Based on evidence and clinical experience, we propose the first structured scalp-donor management algorithm to optimize safety, reduce complications, and standardize perioperative care in the management of pediatric burns.

European Burn Journal doi: 10.3390/ebj7020023

Authors: Lachlan James Madge Lisa J. Martin Emma Catherine Mill Fiona M. Wood Tiffany L. Grisbrook

Background: Hand burns are a key criterion for immediate referral to tertiary burn centres in Australia, New Zealand, and internationally, yet few studies have examined how paediatric burn epidemiology, surgical management, and length of stay (LOS) differ according to the extent of hand involvement. The objective of this study was to describe and compare the demographic profiles, burn injury characteristics, and clinical management between three groups: children with (1) burns involving only the hands, (2) burns involving the hands and other sites, and (3) burns not involving the hands who were admitted to the paediatric Burns Service of Western Australia (BSWA) over a 10-year period. Methods: This cross-sectional study included all burn admissions to the state paediatric burn unit between July 2012 and June 2022. Descriptive statistics and univariate regression used to compare groups. A multivariate log-linear regression model was used to assess the independent association between hand involvement and length of hospital stay, adjusting for identified confounders. T Results: Children with burns isolated to the hands were younger, had a smaller percentage of total body surface area (%TBSA), were more likely to have sustained contact or friction burns, and were more likely to undergo skin grafting procedures compared to those with burns involving the hands and other sites, and those with burns not involving the hands. Despite these differences, hand involvement was not identified as an independent predictor of initial LOS. Conclusion: Paediatric patients with hand burns did not have longer initial hospital admissions than those without hand involvement. Future research needs to assess longer term impacts of hand burns.

European Burn Journal doi: 10.3390/ebj7020022

Authors: Thai Ngoc Minh Nguyen Nhu Lam Nguyen Dinh Hung Tran

Inhalation injury (II) exacerbates burn mortality via obstructive fibrin casts. We evaluated a protocol combining scheduled flexible bronchoscopy (FOB) with nebulized heparin and N-acetylcysteine (NAC). This single-center, randomized controlled trial enrolled 76 mechanically ventilated adult burn patients with bronchoscopically confirmed II. The intervention (n = 38) comprised a 7-day protocol of scheduled FOB with alternating nebulized heparin (5000 IU) and 20% NAC every 4 h. Controls (n = 38) received standard care with on-demand FOB. Primary outcomes were 28-day mortality and day-7 Lung Injury Score (LIS). Unadjusted 28-day mortality was lower in the intervention group (57.9% vs. 81.6%; p = 0.025), alongside a decreased median day-7 LIS (1.0 vs. 1.38; p = 0.021). Respiratory mechanics improved significantly, demonstrating reduced driving pressure and increased static compliance (p < 0.001). However, in multivariable Cox regression, baseline injury severity independently predicted mortality, while the intervention indicated a non-significant hazard reduction trend (aHR = 0.66, 95% CI: 0.36–1.23). No systemic anticoagulation occurred. In conclusion, scheduled FOB with nebulized heparin and NAC improves respiratory mechanics and attenuates lung injury in II. Although unadjusted mortality decreased, baseline severity remains the primary mortality driver, suggesting this protocol is a physiologically beneficial adjunct requiring further multicenter validation. Trial registration: Thai Clinical Trials Registry, TCTR20260408001 (retrospectively registered).

European Burn Journal doi: 10.3390/ebj7020021

Authors: Sergio Arlati Paolo Aseni

Background: Evaporative water loss from burn wounds is a major but often neglected component of early fluid requirements. Despite its physiological importance, no dedicated review has quantified acute post-burn evaporative water loss (TEWL) and its interaction with modern resuscitation strategies in over 40 years. Recent mass-casualty burn events in specialized centers have re-emphasized the clinical importance of accurate early fluid balance, which is particularly challenging. Methods: A scoping review (PRISMA-ScR) of historical quantitative studies and 23 contemporary (2015–2025) adult major-burn resuscitation cohorts was conducted. Expected TEWL was derived from Lamke benchmarks; interstitial edema was estimated from the only available regression of simultaneous fluid input and 24 h weight change. A novel TEWL/edema ratio was tested against resuscitation volume (mL/kg/%TBSA) and the established input/output (I/O) ratio. Results: In the acute phase, the median TEWL normalized to total body surface area was 71 mL/m2/h [52–79 mL/m2/h], allowing for calculation of the TEWL/edema ratio. The TEWL/edema ratio was inversely correlated with the resuscitation fluid dose (R2 = 0.811) and the I/O ratio as well (R2 = 0.86), crossing unity at 2.85 mL/kg/%TBSA. A ratio > 1 signals high evaporative drive and/or possible under-resuscitation; a ratio < 1 alerts to fluid creep before significant weight gain. Conclusions: The TEWL/edema ratio is the first physiology-grounded, easily calculable resuscitation endpoint that complements urine output by providing insight into whether administered fluid is lost as obligatory evaporation or sequestered as edema. Routine estimation of expected TEWL and early monitoring of the TEWL/edema ratio may help guide goal-directed burn resuscitation, especially when early excision is delayed or impossible. Given the substantial inter-individual variability, the ratio derived from aggregate data should not be interpreted as a patient-specific predictor.

European Burn Journal doi: 10.3390/ebj7020020

Authors: Einar Logi Snorrason Fredrik Huss Ali Modarressi Morten Kildal

While the global surgeon deficit continues to demand urgent action, traditional “over-the-shoulder” teaching is increasingly constrained by infection-control demands and crowded operating rooms. Over the past four years, we integrated head-mounted smart cameras into reconstructive-surgery workshops across East Africa. Utilizing voice-controlled, stabilized video technology, we provided trainees with a high-definition, wearer’s-perspective view that enhanced visualization without compromising the sterile field. Following remarkably high acceptance in Africa, we have initiated a pilot study at the National Burn Centre in Sweden to apply these lessons to a high-income setting. Our findings suggest that this technology improves surgical education while supporting infection-control stewardship through reduced overcrowding. This experience illustrates a reverse innovation, where tools refined under the logistical constraints of African operating theatres offer scalable solutions for universal challenges in surgical training and patient safety.

European Burn Journal doi: 10.3390/ebj7010019

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

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).

European Burn Journal doi: 10.3390/ebj7010018

Authors: Susanne Rein Jule Schmiechen Jochen Gille Thomas Kremer

Introduction: Various scoring systems are applied to burn patients to assess the perioperative and mortality risks as well as comorbidities. Objective: The purpose of this study was to compare the predictive accuracies for mortality of different scoring systems: the Abbreviated Burn Severity Index (ABSI), Bogenhausen ABSI (BABSI), American Society of Anesthesiologists (ASA) classification, Charlson Comorbidity Index (CCI) and modified Frailty Index-5 (mFI-5). Materials and Methods: We retrospectively analyzed 644 burn patients treated at one burn center between September 2018 and May 2022. Results: Median scores were 5 (range: 1–16), 5 (range: 2–17.5), 2 (range: 1–5), 0 (range: 0–14) and 0 (range: 0–5) for the ABSI, BABSI, ASA, CCI and mFI-5, respectively. Significantly different median score results were observed between survivors and non-survivors: ABSI: 5 vs. 10; BABSI: 5 vs. 10.5; ASA: 2 vs. 4; CCI: 0 vs. 5; and mFI-5: 0 vs. 2 (p < 0.001 for all scores). Predictive accuracies were excellent for the BABSI (AUC = 0.963), ABSI (AUC = 0.952), and ASA (AUC = 0.916), whereas fair predictive accuracies were found for the CCI (AUC = 0.851) and mFI-5 (AUC = 0.760). Good calibration was observed for the BABSI, ABSI, CCI, and mFI-5, whereas calibration was poor for the ASA. Conclusion: All five scores significantly differentiate between survivors and non-survivors. However, the strongest discriminatory power and best calibration for mortality prediction were observed for the BABSI and ABSI scores. Therefore, the application of both scores is recommended in daily routine.

European Burn Journal doi: 10.3390/ebj7010017

Authors: Ingrid Parry Cameron Ward Jeffrey Fine David G. Greenhalgh Michelle A. James Katharine M. Hinchcliff

Background: Hand burns are common in children and can result in long-term functional impairment. The Hand Burn Severity (HABS) score is an anatomy-specific measure of hand burn severity, but its relationship to functional outcomes in pediatric patients has not been well defined. The purpose of this study was to determine whether HABS, measured at the time of injury, is associated with longitudinal upper extremity functional outcomes in children. Methods: We conducted a 24-month prospective longitudinal study of children aged 2–18 years with hand burns. Burn severity was determined using HABS at enrollment, and outcomes were measured using the Burn Outcomes Questionnaire (BOQ) and the eight-item Patient-Reported Outcomes Measurement Information System-Upper Extremity (PROMIS-UE8). Repeated-measures linear regression models evaluated associations between HABS and outcomes over time, adjusting for age, dominant- and bilateral-hand involvement, and surgery. Results: A total of 119 children with 165 hand burns were enrolled. Higher HABS scores, indicating more severe injury, were significantly associated with lower BOQ upper extremity function domain scores, indicating poorer health, at 2- and 6-months post burn, but not at later time points. Higher HABS scores were independently associated with lower patient-reported PROMIS-UE8 scores, indicating poorer health, across the 2-year follow-up period. Conclusions: These findings indicate that higher HABS scores at the time of injury are associated with poorer upper extremity outcomes, particularly in the early post-burn period, suggesting that HABS may help identify children who could benefit from closer monitoring or early rehabilitation planning.

European Burn Journal doi: 10.3390/ebj7010016

Authors: Julien-Moritz Thielmann Wolfram Heitzmann Michael Ried Jan-Philipp Stromps Maria von Kohout Paul Christian Fuchs Till Markowiak

Background: Major cervical burns often require tracheostomy (TT); however, it remains unclear whether TT timing relative to cervical wound coverage (WC) and the choice of coverage modality affect peristomal wound healing. Methods: In this retrospective single-center cohort study, we included 48 adults with thermally induced cervical burns who underwent TT between 2015 and 2024 in a specialized burn ICU. Eleven patients died before decannulation and were excluded from the primary endpoint analysis. Cervical wound-healing disturbance (CWHD) as a primary endpoint was assessed in the remaining 37 patients, including 13 treated with advanced cervical dressings and 24 treated with split-thickness skin grafts (STSG). Results: CWHD occurred in 2/13 (15.4%) with advanced dressings and 11/24 (45.8%) after STSG. Within the grafted subgroup, complication rates did not differ significantly according to TT sequencing relative to WC, TT–WC interval, grafting technique (mesh vs. Meek), or tracheostoma closure method (all p > 0.05). In multivariable logistic regression, only cervical burn depth independently predicted CWHD. Conclusion: In patients with cervical burns requiring TT, burn depth/severity, rather than TT timing, grafting strategy, or closure technique, appears to drive peristomal wound complications, supporting individualized planning instead of rigid algorithms.

European Burn Journal doi: 10.3390/ebj7010015

Authors: Bibiána Ondrejová Katarína Dudová Monika Michalíková Lucia Bednarčíková Jozef Živčák Tomáš Demčák Peter Lengyel

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.

European Burn Journal doi: 10.3390/ebj7010014

Authors: Sara Enblom Fredrik Huss

Background: A burn injury is a complex trauma often followed by complications, one of which is fatigue. The objective of this study was to validate the Fatigue Severity Scale (FSS) in an adult Swedish burn cohort. Methods: A prospective cohort study was performed at the Burn Center at Uppsala University Hospital in Uppsala, Sweden. All patients who were registered for follow-up 6 months after their burn injury were asked to participate. Included patients completed questionnaires at 6 and 12 months postburn. Psychometric properties were investigated, including internal consistency (Cronbach’s alpha) and concurrent validity, comparing FSS with the Brief Fatigue Inventory (BFI), which was considered to be the “gold standard.” Convergent validity was investigated among the fatigue assessments and quality of life, depression/anxiety, and daily activities. Results: In total, 70 included patients attended both visits. FSS demonstrated high internal consistency (Cronbach’s alpha: 0.96 at both timepoints). There was high concurrent validity between FSS and BFI on both occasions (Spearman’s rho: 0.816 and 0.863, respectively), and the convergent validity was strong. Conclusions: The result indicates that the two fatigue scales correspond well to each other and that the FSS, therefore, is a valid and reliable assessment of fatigue in adult Swedish burn patients.

European Burn Journal doi: 10.3390/ebj7010013

Authors: Maurice Mimoun Marc Chaouat Nathaniel Malca Oren Marco David Boccara Kevin Serror

Background: Early excision and autologous split-thickness skin grafting are the cornerstone of surgical management in severe burn injuries. In patients with extremely extensive deep burns, the lack of available donor sites represents a major life-threatening limitation. In the exceptional situation of monozygotic twins, skin isografting offers a unique solution by providing immunologically compatible skin without the risk of rejection. Case report: We report the case of a 33-year-old man who sustained flame burns involving 95% of his total body surface area, resulting in an extremely poor initial prognosis (ABSI 14, UBS 245). After early resuscitation and staged surgical excisions, the absence of sufficient autologous donor sites precluded definitive coverage using conventional techniques. On day 3, the existence of a monozygotic twin brother was identified. HLA genotyping confirmed complete identity, and skin donation was authorized by an independent ethics committee. Methods: Definitive wound coverage was achieved using staged split-thickness skin isografts harvested from the donor twin. Ultra-thin grafts (<0.2 mm) were obtained in three procedures (days 7, 11, and 45), primarily from the scalp, thighs, and back, and applied following sequential excisions. Results: All grafts survived without immunological rejection. Donor-site morbidity was minimal, with rapid healing and only mild residual hypopigmentation. The patient was discharged to rehabilitation on day 145. At 5-year follow-up, wounds were fully healed, functional outcome was satisfactory, and quality of life was good, with return to work and full independence. Conclusions: Skin isografting from a monozygotic twin is a rare but effective salvage strategy for patients with massive deep burns when autologous donor sites are insufficient, provided that ethical, legal, and donor safety considerations are rigorously addressed.

European Burn Journal doi: 10.3390/ebj7010012

Authors: Julia Kleinhapl Rudy Ji Lucineia Gainski Danielski George Golovko Alen Palackic Philong Nguyen Ludwik K. Branski Steven E. Wolf Celeste C. Finnerty Oscar E. Suman

Background: Weight extremes are linked to morbidity, yet their impact on burn outcomes remains underinvestigated. Prior studies suggest an ‘obesity paradox’, showing survival benefits and better functional outcomes in obese patients. Methods: This study used the global real-world database TriNetX to assess the association between body mass index (BMI) and clinical outcomes in adult burn patients, categorized using WHO definitions. After 1:1 propensity score matching for demographics, burn severity, and smoke inhalation injury, clinical outcomes were analyzed over a six-month period following burn injury. Outcomes included mortality, sepsis, pneumonia, acute kidney injury (AKI), cardiovascular events, graft complications, skin infections, and psychological impairment. Results: After matching, 9736 patients were included in the underweight versus normal weight comparison, 72,274 in overweight versus normal weight, 71,195 in obesity versus normal weight, and 9732 in underweight versus obesity. Underweight patients were associated with higher mortality and increased risks of sepsis, pneumonia, cardiovascular events, and psychological impairment. Overweight and obese patients showed higher survival rates and overall better clinical outcome associations. Conclusions: These findings are consistent with the previously described ‘obesity paradox’ in burn care and identify underweight burn patients as a distinct high-risk subgroup.

European Burn Journal doi: 10.3390/ebj7010011

Authors: Tyler Jerome Osborne Grant Rowe Dale W. Edgar Mark Fear Fiona M. Wood Timothy Fairchild Brook Galna Pippa Kenworthy Brad Wall

Background: Burn injury induces a prolonged inflammatory response that may contribute to long-term metabolic dysfunction. Exercise is known to reduce inflammation in various clinical populations; however, its effect on chronic post-burn inflammation remains unclear. This crossover trial investigated the impact of a 6-week exercise intervention on tumour necrosis factor-alpha (TNF-α) in adults with non-severe burns sustained more than one year prior. Methods: Twenty-one participants were randomised to complete either a 6-week exercise program or a control period first, separated by a 4-week washout. The exercise program comprised three supervised sessions per week of combined resistance and cardiovascular training. Primary (TNF-α) and secondary (muscle strength, cardiovascular fitness) outcomes were assessed pre- and post-intervention. Results: Fifteen participants completed the protocol with high adherence (90.4%). Exercise significantly improved quadriceps strength and cardiovascular fitness, confirming the intervention’s safety and efficacy in this cohort. However, TNF-α concentrations were not elevated at baseline and did not significantly change following exercise compared with control (mean difference: +0.5 pg·mL−1, p = 0.249). Exercise is safe and beneficial for non-severely burned patients who sustained their injury > 1 year ago. However, inflammation was not elevated in this cohort, precluding our ability to test the effects of exercise on chronic inflammation.

European Burn Journal doi: 10.3390/ebj7010010

Authors: Theodora Ligomenou Eirini Nikolaidou Argiro Pipinia Georgios Trellopoulos Stavros Galanis Myrto Tzimou Georgia Vasileiadou Sophia Papadopoulou

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.

European Burn Journal doi: 10.3390/ebj7010009

Authors: Koen Maertens Nancy Van Loey Peter Moortgat Jill Meirte

Background: Pathological scarring (PS) following surgical procedures, burns, or trauma poses significant clinical, psychological, and socio-economic challenges. Despite the high prevalence of PS, reliable information resources are limited, often leading individuals to depend on unvalidated online sources. To address this gap, we developed MyScarSpecialist.com, an evidence-based website providing comprehensive information on scar types, characteristics, and treatment options. This study aimed to optimize the website through co-creation with patients and clinicians. Methods: Semi-structured focus group meetings were conducted with patients and carers; sessions were recorded, transcribed, and analyzed using thematic analysis. Results: From the 3 focus group meetings with 15 patients with scars and 3 carers, four key themes emerged: (1) Information Sources: The Role of Professionals, Peers, and Digital Media in information sharing; (2) Desired information: From scar typing to treatment outcomes to psychosocial impact; (3) Website design: Audience preferences on content layering, information load, and image positioning; (4) Readability: Optimizing content for comprehension. Participants highlighted the need for enhanced peer support and resources addressing the psychological impact of scarring. Conclusions: These findings provide comprehensive insights for optimizing medical educational websites, ensuring inclusivity, accessibility, and empowerment for patients through co-designed strategies.

European Burn Journal doi: 10.3390/ebj7010008

Authors: Silvia Borghetti Ugo Maria Pierucci Chiara Palladino Stefania Vimercati Francesca Selmin Andrea Marcellusi Giulia Tosi Alessia Musitelli Elena Zoia Irene Paraboschi Gloria Pelizzo

Background: Pediatric burns cause considerable morbidity and hospital resource use. Advanced dressings on moderate-degree pediatric burns that accelerate healing may offset acquisition costs by shortening length of stay (LOS). Objective: The aim of this study was to assess the budget impact of introducing an oxygen-enriched olive-oil dressing for pediatric burns (grade I–IIG; total body surface area < 20%) at a tertiary children’s hospital. Methods: A hospital-perspective budget impact analysis was conducted according to ISPOR guidance over a 4-year horizon (2022–2025). The study population included 32 inpatients (<18 years) with non-extensive, moderate-degree burns treated between 2022 and 2023. Two scenarios were modeled: (i) standard of care (SoC) and (ii) SoC plus the oxygen-enriched olive-oil dressing (OEoD), with annual caseload projections to 2025. Costs combined treatment (dressings, drugs, and devices) and hospitalization data provided by the hospital’s Control & Management Unit. The average daily hospitalization cost was €1438.99. Results: Compared with SoC, the OEoD scenario increased per-patient dressing costs (mean €271.4 vs. €121.9) but reduced LOS (mean 7.3 vs. 16.6 days), leading to lower overall hospitalization expenditure. Total annual costs decreased by 7%, 13%, 16%, and 18% across 2022–2025, respectively (for example, 2025: €612,516 vs. €751,445; Δ −€138,929). Cumulative 4-year savings reached €337,399. Deterministic sensitivity analysis confirmed the robustness of these findings, with savings persisting under variable assumptions. Conclusions: Despite higher acquisition costs, oxygen-enriched olive-oil dressings were associated with shorter LOS and meaningful budget savings in pediatric burn care. These results support their integration into multidisciplinary burn management pathways and call for further prospective multicenter validation.

European Burn Journal doi: 10.3390/ebj7010007

Authors: Katarína Dudová Bibiána Ondrejová Tomáš Demčák Monika Michalíková Lucia Bednarčíková Jozef Živčák Peter Lengyel Erik Eliáš

Accurate documentation of burn wounds is essential for evaluating treatment outcomes and monitoring healing progression. Traditional two-dimensional (2D) photography remains the clinical standard but lacks depth and volumetric accuracy. Three-dimensional (3D) scanning offers enhanced visualization of wound morphology and tissue vitality, potentially improving objectivity in burn assessment. This study compares two handheld 3D scanning systems—Artec Eva and Revopoint Miraco—in documenting acute and healing burn wounds, using standard clinical photography as the reference. Fifteen patients with second-degree and third-degree burns were prospectively examined at the Burn Unit of AGEL Hospital Košice-Šaca, with five representative cases selected for detailed analysis. For each patient, clinical photographs and paired 3D scans were obtained under standardized conditions and evaluated for color fidelity, wound margin clarity, representation of epithelialisation islands, necrotic tissue, and correlation with clinical findings. Across all cases, Artec Eva demonstrated superior color accuracy, clearer wound delineation, and more realistic visualization of tissue vitality and re-epithelialisation. Revopoint Miraco reliably captured wound shape but produced darker tones and exaggerated surface relief, occasionally distorting depth perception. Overall, both systems successfully identified key healing features; however, Artec Eva provided more clinically accurate and visually consistent results. Three-dimensional scanning represents a valuable adjunct to conventional burn documentation.

European Burn Journal doi: 10.3390/ebj7010006

Authors: Yazeed Temraz Theeb Al Salem Shaimaa Khan Raghad Alshehri Lina Alosaimi Mariam Hantoul Rahaf Alrajhi Rayya Alabdali Amal Bahumayim Ibtihal Al Jafin Fai Al Qazlan Abdulmajeed Al Ehaideb

Objective: To identify key predictors of clinical outcomes in burn survivors and clarify the role of mixed-depth burns and confounding by indication in observational rehabilitation research. Design: Retrospective cohort study using data from a burn rehabilitation registry (January 2024 to July 2025). Setting: Burn rehabilitation center. Participants: 120 adult patients (age ≥ 18 years) with burns affecting ≥1% total body surface area (TBSA) and complete baseline data. Interventions: Not applicable. Main Outcome Measures: Primary outcome was functional improvement (ΔFIM). Secondary outcomes included pain reduction (ΔPain), scar severity (Vancouver Scar Scale; VSS), Activities of Daily Living (ADL) improvement, and Range of Motion (ROM) recovery. Multivariable linear and logistic regression models were used to identify predictors. Results: Patients achieved significant improvements in function (mean ΔFIM = 11.3 ± 8.9 points) and pain (mean ΔPain = 1.28 ± 0.81). Having a mixed-depth burn was the strongest predictor of worse scar outcomes (β = 2.52, 95% CI: 0.93 to 4.12, p = 0.002) and failure to achieve full ROM (OR = 0.089, 95% CI: 0.008 to 0.930, p = 0.043). An apparent association between inpatient ward care and better scar outcomes (β = −1.30, p = 0.020) was determined to be an artifact of confounding by indication, as the outpatient group had a higher proportion of high-risk mixed-depth burns (6.2% vs. 3.5%). Longer therapy duration was the only significant predictor of achieving ADL goals (OR = 1.014, 95% CI: 1.002 to 1.026, p = 0.025). Conclusions: Injury characteristics, particularly the presence of a mixed-depth burn, emerged as the dominant predictors of long-term scar and functional outcomes. This study identifies mixed-depth burns as a potentially high-risk clinical phenotype requiring targeted therapeutic strategies and demonstrates the critical importance of accounting for confounding by indication when evaluating rehabilitation outcomes in observational burn research.

European Burn Journal doi: 10.3390/ebj7010005

Authors: Amira Allahham Dinithi Atapattu Victoria Shoesmith Fiona M. Wood Lisa J. Martin

Background: A childhood burn presents new and unfamiliar challenges to patients and their parents during recovery. These injuries can negatively impact activities such as independence in self-care, participation in physical activity, and social interaction. As such, pediatric burn patients are at risk of poorer quality of life (QoL) outcomes after their burn. In this longitudinal, observational cohort study, we examined the social, demographic, and clinical factors that were associated with a poor QoL at 12 months postburn for pediatric patients aged > 2 years with non-severe burns in Western Australia. Methods: Inpatients were recruited from the pediatric burn unit at Perth Children’s Hospital in Western Australia between February 2021 and September 2022. Demographic and family information (age, sex, postcode, parental education, languages spoken at home) and clinical data (burn cause, TBSA%, location, surgical interventions, length of stay) were collected at baseline. At 6 and 12 months, caregivers completed the Brisbane Burn Scar Impact Profile (BBSIP). Results: A total of 37 caregivers completed the Brisbane Burn Scar Impact Profile (BBSIP). For the child’s QoL, 57% of caregivers reported that some impact remained for overall QoL, 32% for sensory intensity, 46% for sensitivity, 22% for daily living (22%), and 19% for emotional reactions. Parent worry was impacted in 46% of caregivers. Being female was associated with greater long-term impacts, particularly in overall functioning and parental worry. The burn location also influenced outcomes, with injuries to the upper limbs linked to higher sensory intensity and emotional impact. Children from culturally and linguistically diverse (CaLD) backgrounds, indicated by those speaking a language other than English at home (LOTE), demonstrated significantly greater effects across several domains, including overall impact, daily living, appearance, and parent worry. Conclusions: A substantial proportion of children continued to experience impacts from non-severe burns across multiple domains, indicating that even small-area burns can have lasting effects. The factors associated with worse scores were the child being female, the families being linguistically diverse, and upper body burns.

European Burn Journal doi: 10.3390/ebj7010004

Authors: Sebastian Holm Fredrik Huss Bahaman Nayyer Johann Zdolsek

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.

European Burn Journal doi: 10.3390/ebj7010003

Authors: Dorothy Bbaale Priyansh Nathani Shlok Patel Anshul Mahajan Bhavna Chavla Christoph Mohr Julia Elrod Shobha Chamania Judith Lindert

Background: Burns result in approximately 180,000 deaths annually, with the majority occurring in rural regions of Africa and Southeast Asia. This study aimed to assess the available resources, key challenges, and potential solutions in burn care from the perspective of healthcare providers in India. Methods: An online survey was conducted among burn care professionals across India. The survey was disseminated via social media platforms, burn care networks, and hospital representatives. Results: A total of 105 respondents, primarily from tertiary care centers, participated in the survey. Of these, 64.2% were affiliated with government hospitals, and 40.1% served catchment areas extending beyond 300 km. Dedicated burn units were present in 88.0% of government hospitals, compared to 66.9% in non-government facilities. Treatment costs were significantly lower in government hospitals, with 88.8% offering care either free of charge or at minimal cost (p ≤ 0.00001). Conclusions: The findings reveal significant gaps in staff training, intensive care monitoring, and infection prevention. Many patients initially seek help from traditional healers, often delaying appropriate treatment and worsening outcomes. Enhancing education, implementing standard monitoring practices, and ensuring adherence to clinical protocols are critical steps toward improving burn care outcomes in India.

European Burn Journal doi: 10.3390/ebj7010002

Authors: Tarryn Kay Prinsloo Wayne George Kleintjes Kareemah Najaar

(1) Background: Inhalation injury significantly worsens burn outcomes but lacks a standardized definition and diagnostic consensus, complicating prognosis. Existing diagnostic tools often show limited sensitivity and specificity, reducing clinical utility. This study aimed to identify potential clinical markers, recorded at or shortly after admission, for inhalation injury prognostication. (2) Methods: A retrospective cohort study of 59 burn patients admitted to Tygerberg Hospital’s Burn Centre (South Africa) between 23 April 2016 and 15 August 2017 was conducted. Descriptive statistics were reported based on data type and distribution. Fisher’s exact test, Spearman’s rank correlation (rho), and partial least squares regression (VIP scores) assessed associations, correlations, and predictive value. p < 0.05 (two-tailed) denoted significance. (3) Results: Severe inhalation injury accounted for 61% of admissions (mean 11.2; CI = 9.5–12.9), with a 38.9% mortality rate. Significant associations (p ≤ 0.008) and positive correlations (p ≤ 0.06) were noted for total body surface area (rho = 0.357), complications (rho = 0.690), and burns intensive care unit length of stay (BICU LOS, rho = 0.908). Complications and BICU LOS showed the strongest predictive contributions (VIP = 1.229 and 1.372). Lactate (rho = 0.331, p < 0.011) and hoarseness (rho = −0.314, p < 0.015) correlated significantly but lacked association. (4) Conclusions: Findings suggest elevated lactate may serve as a prognostic marker, while BICU LOS and complications may reflect disease progression. A multi-marker approach is recommended.

European Burn Journal doi: 10.3390/ebj7010001

Authors: Mary Grace Murray Ryan M. Johnson Abigail B. Plum Natalia Carbajal Garcia Kevin E. Galicia Alexandra Brady Madison Kipp Irene B. Helenowski Madison M. Tschann Connor Guzior Richard P. Gonzalez Mashkoor A. Choudhry John C. Kubasiak

Background: Pneumonia contributes to post-burn morbidity and mortality. Understanding the mechanisms that predispose burn patients to pneumonia is crucial to both stratifying patients at increased risk and developing targeted interventions. Methods: A prospective observational study was conducted with 47 human patients who sustained large burn injuries with serum collected on days 2 and 3 post-burn and assessed for Angiopoietin-1 (Ang-1) and -2 (Ang-2). C57BL/6 mice were subjected to either sham injury or a 12.5% total body surface area (TBSA) scald burn injury, and plasma and lungs were assessed. Results: Patients who developed pneumonia within 30 days of injury had higher serum Ang-2 and Ang-2/1 ratio on post-injury days 2 and 3. Similar to patient findings, we observed an increase in Ang-2 in burn mice compared to sham. Within the lungs of burn mice, we found significant increases in Tyrosine kinase with immunoglobulin and epidermal growth factor homology domains 2 (TIE2) receptor transcript Tek, downstream mediators TNFAIP3 Interacting Protein 2 (Tnip2) and phosphoinositide-3-kinase regulatory subunit 1 (Pik3r1), in addition to endothelial adhesion molecules intracellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1), along with neutrophil infiltration and markers compared to sham. Conclusions: These findings suggest that burn injury increases Angiopoetin-2 and downstream signaling in the lungs, which may contribute to post-burn pulmonary dysfunction. Further studies are necessary to understand if modulating the Ang–TIE2 axis can protect against pneumonia post-burn.

European Burn Journal doi: 10.3390/ebj6040061

Authors: Elizabeth Blears Jagger Godarzi Sharon Shania Krish Kondisetti Julie Caffrey Andrew J. Murton

Background: Burn patients can suffer prolonged hospital stays, infections, and wound breakdown. Given the complexity of burns, it is often difficult to determine which underlying factors contribute to complications. The Burn Care Quality Platform (BCQP) is the largest database of burn patients globally available, and it accounts for underlying or coinciding disease conditions present in burn patients. Muscle wasting conditions, such as sarcopenia, cachexia, and protein malnutrition, are suspected of causing worse outcomes. Prior analysis of BCQP data (2000–2017) demonstrated that patients with muscle wasting had prolonged hospitalization and adverse outcomes. Methods: Building on our previous work, we extended logistic regression analysis to BCPQ data through 2022 to assess whether reporting and outcomes had changed. Results: Updated BCQP data demonstrated a statistically significant increase in mortality in cachexia vs. non-muscle wasting patients (Odds Ratio [OR]: 2.2 [95% Confidence Interval (CI): 1.3–3.7], p = 0.004), but no increase in mortality was seen with protein malnutrition (OR: 1.1 [95% CI: 0.93–1.35], p = 0.239). However, the diagnosis rate of muscle wasting conditions decreased by 53% since the previous analysis, suggesting a potential under-reporting of these diagnoses in BCQP patients. Conclusions: Burn care could be augmented by better diagnosis of underlying conditions that predispose to muscle wasting.

European Burn Journal doi: 10.3390/ebj6040060

Authors: Inês Santos Marta Ferreira Carla Sílvia Fernandes

The rehabilitation of burn patients is essential and is intrinsically linked to conventional rehabilitation; the motivational challenges faced by burn patients in maintaining engagement with these rehabilitation programs are well known. It is understood that the use of other resources, particularly technological ones, associated with conventional rehabilitation could overcome these constraints and thereby optimize the rehabilitation program and health outcomes. The objective of this study is to synthesize the available evidence on the use of exergames in rehabilitation programs for burn patients. This systematic review was developed following the guidelines of the Joanna Briggs Institute (JBI). The search was conducted in the following databases: Medline®, CINAHL®, Sports Discus®, Cochrane®, and Scopus® during May 2025. The PRISMA Checklist Model was used to organize the information from the selected studies. Seven RCTs were included, involving a total of 236 participants. Outcomes related to the use of exergames in the rehabilitation of burn patients were identified, including increased range of motion, functionality, strength, speed of movement, improved balance, reduced fear and pain, and satisfaction with the technological resource used. It is believed that the results of this review, which confirmed the advantage of using exergames, such as Nintendo Wii, PlayStation, Xbox Kinect, or Wii Fit, to optimize the functionality of burn patients, can support clinical decision-making and encourage the integration of exergames to improve rehabilitation programs for burn patients.

European Burn Journal doi: 10.3390/ebj6040059

Authors: Anna Jolly Neriamparambil Raja Sawhney Wei Lun Wong

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.

European Burn Journal doi: 10.3390/ebj6040058

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

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.

European Burn Journal doi: 10.3390/ebj6040057

Authors: Rolf K. Gigengack Joeri Slob J. Seppe H. A. Koopman Cornelis H. Van der Vlies Stephan A. Loer

Background: Critical care for patients with severe burn injuries is challenging, particularly in the first 24–48 h. Multiple guidelines exist but their recommendations vary in content and in the level of detail. Methods: This narrative review analyzed recent (last 10 years) adult burn guidelines in English, Dutch and German, sourced from PubMed, Medline and official burn society publications. The review focused on airway management, mechanical ventilation, fluid resuscitation, pain management and procedural sedation. Results: All guidelines emphasize early airway assessment and timely intubation in patients at risk for loss of airway patency; however, a strategy for analyzing patients at risk is lacking. Lung-protective ventilation strategy is generally recommended. Fluid resuscitation is the cornerstone during the first phase, though recommendations for thresholds, volume and adjuncts differ. (Chronic) pain management should be multimodal, combining pharmacologic and non-pharmacologic approaches, but specifics on choice of modality are limited, also, there is no uniform strategy for procedural sedation management. Conclusion: Current guidelines offer broadly consistent recommendations for initial burn care but differ in specifics, reflecting evidence gaps. Future guidelines should address advances in airway management, fluid resuscitation endpoints, volume and adjuncts, and give a more detailed (chronic) pain strategy to improve standardization and outcomes.

European Burn Journal doi: 10.3390/ebj6040056

Authors: Rafael Rocha Odete Martinho Filipe Marques da Costa Gaizka Ribeiro Fátima Xambre Miguel Ribeiro de Andrade

Introduction: Massive burns, particularly those exceeding 90% total body surface area (TBSA), represent one of the most demanding challenges in critical care and reconstructive surgery. Advances in resuscitation, early excision, and wound coverage techniques have improved survival rates, but despite these advances, mortality remains high, and standardized treatment protocols are lacking. Case Report: We report a case which demonstrates survival and meaningful recovery in an extreme case of massive burns. A 57-year-old woman sustained 92% TBSA burns following a gas explosion at her home. She developed burn shock requiring aggressive fluid resuscitation and vasopressor support. Due to extensive burns and limited donor sites, staged debridement with temporary allograft coverage was performed, followed by Meek micrografting for definitive wound closure. After 197 days in the Burn Unit and an additional three months of rehabilitation, she regained functional independence. Conclusions: While historically considered non-survivable, burns exceeding 90% TBSA are increasingly being successfully treated with multimodal strategies. This case highlights the importance of multidisciplinary care in redefining survival expectations for massive burn patients. As burn care continues to evolve, further research is needed to refine treatment strategies, enhance long-term functional outcomes and standardize protocols for these complex cases.

European Burn Journal doi: 10.3390/ebj6040055

Authors: Nikki Leigh Allorto Reitze Rodseth David Gray Bishop

Background: Routine early surgery for all deep burns in low-resource settings is not currently achievable. We designed and implemented a simple triage strategy that selected patients to be prioritised for early surgery based on a more urgent need and greater potential benefit. The primary outcome was the ability to perform surgery in the priority group within three days of the decision. Methods: This was a prospective, descriptive study undertaken at a tertiary hospital in Pietermaritzburg, South Africa. All patients referred to the Grey’s Hospital Burn Service were triaged into either priority or non-priority groups. Priority designation was based on total burn surface area (TBSA) > 15%, the presence of sepsis, or limb-threatening injury. Data related to demographic information, injury, and outcomes were collected and managed using REDCap electronic data capture tools. Results: There were 191 admissions with 42 (22%) meeting priority criteria. The priority group had larger burns (TBSA 25 [Interquartile range 15–30] vs. 8 [3–15]%) and included all septic injuries. We provided early surgery within a median of 1.4 (interquartile range 0.5–3.3) days of the decision for surgery being made. A total of 75% of patients were operated within 72 h of the decision, and 43% within 10 days of injury. The system identified a sicker cohort, as evidenced by high mortality, ICU admission, and acute kidney injury rates. In the non-priority group, reported outcomes were more positive, but with a high injury-to-discharge days per percentage TBSA. Conclusions: This simple triage strategy represents a novel approach for prioritising access to burn surgery in a setting where global surgery standards are desirable but not always possible. We were able to identify the high-risk groups and provide surgery within acceptable time frames. Future research should be aimed at refining this triage system and improving outcomes in the priority group.

European Burn Journal doi: 10.3390/ebj6040054

Authors: Beke Sophie Larsen Tina Straube Kathrin Kelly Robert Huber Madita Göb Julia Siebert Lutz Wünsch Judith Lindert

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.

European Burn Journal doi: 10.3390/ebj6040053

Authors: Abdullah F. Alharthi Khalid Al Sulaiman Sultan Alotaibi Rahaf Alqahtani Nader Damfu Aisha Alharbi Sufyan Alomair Haifa A. Alhaidal Ohoud Aljuhani

Burn injuries are a major cause of morbidity and mortality, largely due to complications such as infection. Impairment of the immune system following burns increases susceptibility to both internal and external infections, underscoring the need for effective infection control strategies in burn care. In addition, burn patients frequently exhibit profound alterations in drug pharmacokinetics and pharmacodynamics (PK/PD), particularly during the resuscitation and hypermetabolic phases. In the resuscitation phase, increased capillary permeability and reduced cardiac output can prolong drug distribution, delay therapeutic response, lower peak plasma concentrations, and slow elimination. In contrast, the hypermetabolic phase is characterized by elevated catecholamine levels and enhanced tissue perfusion, which accelerate drug distribution and clearance. These physiological changes often necessitate antimicrobial dose adjustments to maintain therapeutic efficacy. This review emphasizes the critical importance of infection prevention and management in burn patients, with a focus on optimizing antimicrobial dosing and therapeutic monitoring in the context of PK/PD alterations.

European Burn Journal doi: 10.3390/ebj6030052

Authors: Hedieh Keshavarz Weber Wei Chiang Lin Shawn Dodd Janice Y. Kung Joshua N. Wong

Background: Topical tranexamic acid (TXA), often combined with epinephrine, is used to reduce perioperative bleeding. This systematic review evaluates the safety and effectiveness of this combination across surgical procedures. Methods: A comprehensive search of eight databases was conducted from inception to 26 June 2025. Studies were eligible if they compared topically or locally applied TXA with epinephrine to epinephrine alone in surgical patients. Animal studies, case reports, non-English publications, and studies without comparators were excluded. Screening, data extraction, and risk of bias assessments followed PRISMA guidelines. Results: Ten studies met inclusion criteria (four randomized and six non-randomized), covering burn surgery, rhytidectomy, liposuction, septoplasty, endoscopic sinus surgery, dacryocystorhinostomy, and joint arthroplasty. TXA was applied topically or via tumescent infiltration. Most studies reported reduced intraoperative blood loss, improved surgical field visibility, lower drain output, shorter hemostasis time, and reduced transfusion rates. No increase in thromboembolic or major complications was observed. Conclusion: The combination of TXA and epinephrine appears safe and maybe effective for perioperative bleeding control. However, heterogeneity in dosing and outcomes limits generalizability. Further research is needed to standardize protocols and confirm long-term safety.

European Burn Journal doi: 10.3390/ebj6030051

Authors: José-Enrique Cueva-Ramírez Gregorio Gonzalez-Alcaide Isabel Belinchón-Romero Jose-Manuel Ramos-Rincon

Background: Chemical burns represent a persistent global health challenge due to their high prevalence, causing lifelong disabilities and socioeconomic burdens. Although research on chemical burns has expanded over the past century, no comprehensive study has mapped the intellectual structure, global collaboration patterns, and thematic evolution of scientific production on chemical burns to determine how research in the area has evolved and the existence of gaps or imbalances that need to be addressed. Objective: The aim was to analyze the scientific production on chemical burns using bibliometric methods, identifying key contributors, evolving themes, and research gaps. Methods: Eligible documents contained the MeSH descriptor and were listed both in PubMed (1946 to 2024) and in the Web of Science Core Collection. The documents were analyzed with Bibliometrix version 5.0 and VOSviewer version 1.6.20. The metrics included were annual productivity, citation networks, co-authorship patterns, and keyword co-occurrence. Results: The analysis included 3943 articles from 757 journals. The annual average was 25.8 articles, with a growth rate of 0.65% from 1946 to 2024. The USA produced the most articles (n = 1547), followed by China (n = 890). The USA also led in international collaboration, working with 26 countries. Harvard University was the leading institution (n = 325) and Burns the leading journal (n = 306), followed by Cornea (n = 132). The most common subject category of the research was surgery (n = 1185 docs) and ophthalmology (n = 984). Reim M. was the most prolific author (n = 35), while Basu S. had the most citations (n = 1159). The main clinical MeSH descriptors were “Eye burns” (n = 1158), “Esophageal stenosis” (n = 683), and “Caustics” (n = 659). Conclusions: The results show slight growth in scientific production on chemical burns. The USA and China are leading research in this field, and the main reported finding was eye burns.

European Burn Journal doi: 10.3390/ebj6030050

Authors: Jocelyn Ivana I Gusti Putu Hendra Sanjaya

The use of fish skin grafts as xenografts is a promising alternative for wound healing. Several studies have shown fish skin grafts to be a safer and more effective option compared to other alternatives, due to the large amount of fatty acids, including omega-3, which have been proven to promote wound healing. The purpose of this study was to evaluate the efficacy of fish skin grafts as wound dressing. A literature search up to March 2024 was conducted using the electronic databases of PubMed, Cochrane, and ScienceDirect. A total of 158 patients from six studies were included in this systematic review. All studies showed early wound healing using fish skin grafts; one study showed that wound healing was halved compared to paraffin gauze. Complete wound healing using fish skin grafts was noted as early as 30 days. Out of 114 patients treated with fish skin grafts, 1 patient showed signs of infection, and no patients showed allergic reactions. One study also found that fish skin grafts provide satisfactory wound scar quality. This study concludes that fish skin grafts are a great alternative and should be considered in wound treatment. The high omega-3 component that is preserved in fish skin grafts promotes faster wound healing and contains antibacterial agents that prevent infection. However, randomized control trials with a larger sample size are recommended to further assess the efficacy of fish skin grafts.

European Burn Journal doi: 10.3390/ebj6030049

Authors: Nadia Depetris Alette E. E. de Jong Jill Meirte Thomas Leclerc Jose Ramon Martinez Mendez Clemens Schiestl Frank Siemers Andy Williams Paul P. M. van Zuijlen Jyrki Vuola Stian Almeland Luís Cabral Bernd Hartmann

Abstracts of the plenary and special interest sessions, workshops, and oral and poster presentations of the 21st EBA Congress in Berlin, Germany, from 3 to 6 September 2025.

European Burn Journal doi: 10.3390/ebj6030048

Authors: Uashar Badakhshan Reza Zamani Tanimola Martins

Background: Burn injuries are among the most distressing injuries, affecting approximately 250,000 people annually in the UK. While extensive research has explored how gender, health, and socioeconomic factors influence burn injury rates, ethnic disparities in burns have received less attention. Methods: The review followed the PRISMA framework for database searches. Search terms included concepts of ethnicity and burn injuries in the UK. Results: From the initial 3339 search results, 11 studies were selected following the eligibility screening. White ethnic groups made up 52.4% of admissions, whereas Asians and Black groups made up 24.9% and 5.9%, respectively. Trends showed a decline in admissions among White patients and a rise in admissions among Black patients. Children aged 1 to 5 years were most affected, particularly in the Asian and Black groups. Males constituted 58.0% of admissions, while females accounted for 42.0%. Most burns occurred at home, with scalds, particularly among children. Ethnic minorities were more likely to apply unsuitable topical treatments and had higher rates of psychological referrals. Conclusions: The review underscores important ethnic disparities in burn injuries and outcomes. Targeting policies to address them could result in a more equitable healthcare system and improved outcomes for burn patients in the UK.

European Burn Journal doi: 10.3390/ebj6030047

Authors: Frederik Schlottmann Sarah Strauß Peter Maria Vogt Vesna Bucan

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.

European Burn Journal doi: 10.3390/ebj6030046

Authors: Andrea Mc Kittrick Lola Hammond Jason Brown

Rationale: Burn injuries to the face can have devastating consequences functionally and cosmetically for individuals and can result in increased depressive symptoms and low self-esteem. Burn injuries have the potential to cause contracture of the skin, especially on the face due to multiple concave surfaces, possibly causing facial deformity. These functional and cosmetic implications can interrupt activities of daily living. Although there is consensus in the literature that early interventions contribute to improved outcomes for eyelid ectropion, there is currently limited consensus regarding the techniques used in the management of eyelid ectropion post burn injuries. Objectives: The aim of this scoping review was to explore the evidence in the literature to identify surgical and non-surgical techniques to manage and prevent eyelid ectropion post burn. Method: Five databases (PubMed, CINAHL, Embase, Cochrane, and Scopus) were searched for articles published between January 2014 and August 2024. Two reviewers completed the search. Each article was screened independently by each reviewer against the inclusion and exclusion criteria. Where disagreement arose, a third reviewer was consulted for resolution. Results: n = 56 articles were sources in the initial search. Post screening, n = 20 met the criteria for full review; n = 14 were included in the final review. All studies reported on surgical techniques used to manage eyelid ectropion post burn, and only one study reported on non-surgical techniques. All studies were observational in design. Conclusions: There is a paucity of research addressing the surgical and non-surgical techniques for the management and prevention of eyelid ectropion following burns in the adult population. The existing literature primarily consists of case studies and case series, which limits the robustness of the evidence base for the effective management of this condition post burn.

European Burn Journal doi: 10.3390/ebj6030045

Authors: Clemens Maria Schiestl Naiem Moiemen Patrick Duhamel Isabel Jones Marcello Zamparelli Juan Carlos López-Gutiérrez Simon Kuepper

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.

European Burn Journal doi: 10.3390/ebj6030044

Authors: Philipp Christoph Köhler Helen Glosse Steffan Loff Raphael Staubach

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.

European Burn Journal doi: 10.3390/ebj6030043

Authors: Felix J. Klimitz Martin Aman Hubert Neubauer Annette Stolle Hans Ziegenthaler Tobias Niederegger Adriana C. Panayi Gabriel Hundeshagen Ulrich Kneser Leila Harhaus

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.

European Burn Journal doi: 10.3390/ebj6030042

Authors: Tamer R. Hage Edward J. Kelly Eriks Ziedins Babita Parajuli Cameron S. D’Orio David M. Burmeister Lauren Moffatt Jeffrey W. Shupp Bonnie C. Carney

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.

European Burn Journal doi: 10.3390/ebj6030041

Authors: Jan Akkan Mahsa Bagheri Sophia Mezger Paul Christian Fuchs Maria von Kohout Wolfram Heitzmann Rolf Lefering Jennifer Lynn Schiefer

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.

European Burn Journal doi: 10.3390/ebj6030040

Authors: Ascanio Tridente Joanne Lloyd Pete Saggers Nicole Lee Brendan Sloan Kathryn Puxty Kayvan Shokrollahi Nina C. Dempsey

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.

European Burn Journal doi: 10.3390/ebj6030039

Authors: Danielle Rijpma Karel Claes Anouk Pijpe Henk Hoeksema Ignace De Decker Jozef Verbelen Matthea Stoop Kimberly De Mey Febe Hoste Paul van Zuijlen Stan Monstrey Annebeth Meij-de Vries

In the original publication [...]

European Burn Journal doi: 10.3390/ebj6030038

Authors: Henry Krasner Emma Chevalier Samantha Chang David Slattery Syed Saquib

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.

European Burn Journal doi: 10.3390/ebj6030037

Authors: Eirini Nikolaidou Andriana Lazaridou Christina Iasonidou Alexandra Tsaroucha Sophia Papadopoulou Eleni Kaldoudi Apostolos Sovatzidis Despoina Kakagia

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.

European Burn Journal doi: 10.3390/ebj6020036

Authors: Kelly Aranka Ayli Kwa Annika Catherina Reuvers Jorien Borst-van Breugel Anouk Pijpe Paul P. M. van Zuijlen Roelf S. Breederveld Annebeth Meij-de Vries

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.

European Burn Journal doi: 10.3390/ebj6020035

Authors: Marianne Kruse Ida Katinka Lenz David Josuttis Philip Plettig Klaus Hahnenkamp Denis Gümbel Claas Güthoff Bernd Hartmann Martin Aman Marc Dominik Schmittner Volker Gebhardt

Background: Finding the optimal amount of fluid is a major challenge in burn shock. Although there is evidence that a restrictive fluid regime is beneficial, current practice shows fluid resuscitation still well above recommendations. The extent of trauma, pre-hospital care and the patient’s pre-existing conditions influence requirements. Methods: We analysed outcomes and influencing factors of fluid regimes in a retrospective cohort study including 90 severely burnt patients resuscitated with the same protocol. Results: The mean amount of fluids in the first 24 h was 6.5 mL/kg bodyweight (BW)/% total burn surface area (TBSA). A total of 14% received restrictive (<4), 34% received liberal (4–6) and 51% received excessive (>6) mL/kgBW/%TBSA fluids. There was no difference regarding mortality, age, complications, organ failure, inhalation injury or full-thickness burns in the groups. Patients with excessive fluid therapy had a significantly lower ABSI score (9 vs. 11, p = 0.05) and TBSA (35 vs. 51%, p < 0.001), while patients with a restrictive fluid therapy needed fewer incidences of surgery to cover burn wounds (3.5 vs. 9.0 vs. 7.0, p = 0.008). History of liver disease or alcohol abuse tended to indicate excessive fluid administration. Patients with pre-existing heart failure received restrictive fluid therapy (23 vs. 3 vs. 4%, p = 0.03). Conclusions: Individualised, timely therapy monitoring is as essential as identifying patients with a higher or lower fluid requirement. Excessive fluid resuscitation had fewer deleterious consequences in complications than expected but seems to influence wound healing. Awareness of circumstances that prompt deviations from recommended fluid rates remains elementary.

European Burn Journal doi: 10.3390/ebj6020034

Authors: Eva Verdaguer Antonio Bulla Jordi Serracanta Danilo Rivas Juan P. Barret

Introduction: The indication for a free flap in acute burn reconstruction is very specific. It should avoid several complications that are more common in the burned patient population. We propose an anterolateral thigh (ALT) flap as a first option for primary burn reconstruction in microvascular free flap reconstruction in burned patients. Patients and Methods: A retrospective review of all acutely burned patients treated with microvascular ALT free flap reconstruction between the years 2005 and 2022 in the Vall d’Hebron Barcelona Hospital Campus Burn Centre was conducted. Results: We performed 30 ALT flaps for primary burn reconstruction. The majority of patients were male (87.5%), with a mean age of 36.7 years, and 37% of patients were smokers. High-voltage electrical burns were the most common etiology. The mean time between burn injury and microsurgery was 22 days. The main recipient site was the lower limb. The flap survival rate was 96.6%. One patient required a meshed skin graft to cover a defect in the proximal third due to peripheral flap necrosis. One flap experienced mild congestion, which resolved spontaneously. Another flap had a local infection, which resolved with antibiotic therapy and surgical debridement. Conclusions: An ALT flap offers several advantages to a burned patient, provided that the surgical technique and postoperative management described in this study are followed. We propose it as the first option for primary burn reconstruction using free flaps in a burned patient.

European Burn Journal doi: 10.3390/ebj6020033

Authors: Anna Jolly Neriamparambil Richard Wong She Paul Andrew Baker Lindsay Damkat-Thomas Joyce Antony

Substantial research interest has been shown over the past ten years in the management of burn injuries. This bibliometric analysis aims to identify and evaluate the most cited articles that have significantly advanced the field of burn injury management. The 100 most cited articles published from January 2014 to September 2024 were collated using the Web of Science database. The full text of each article was meticulously analyzed for descriptive parameters including subject matter, journal of publication, authorship, institutional affiliation, country of origin, and year of publication. The 100 most cited articles had an average of 203 citations, with the most cited article reaching 754 citations and the least cited article cited 105 times. The subjects ranged from enhancing wound care outcomes to metabolic support, fluid management, and infection prevention and management. These articles were distributed across 59 source journals, with 44% of articles having been published in just ten prominent journals. While bibliometric analyses do not accurately gauge scientific merit, this study illuminates the significant contributions to burn management over the past decade and provides valuable insights into research trends in the field.

European Burn Journal doi: 10.3390/ebj6020032

Authors: Christina Nikolaou Maximos Frountzas Emmanouil I. Kapetanakis Dimitrios Stefanoudakis Nikolaos A. Papadopulos Stylianos Kykalos Dimitrios Schizas Dimitrios Iliopoulos

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.

European Burn Journal doi: 10.3390/ebj6020031

Authors: Maria Fueth Simon Bausen Sonja Verena Schmidt Felix Reinkemeier Marius Drysch Yonca Steubing Jannik Hinzmann Marcus Lehnhardt Elisabete Macedo Santos Christoph Wallner

Firework-related injuries remain a serious public health issue in Germany, especially during New Year’s Eve. While many injuries are minor, the misuse of illegal or homemade fireworks can cause severe trauma resembling military combat injuries and can heavily burden emergency services. Notably, injury rates declined during the COVID-19 firework bans, underscoring the impact of preventive measures. We report two cases of young males with severe injuries from illicit fireworks. The first is a case of a 16-year-old that detonated an illegal Polish firework ball bomb, sustaining 9% total body surface area (TBSA) burns (second- to third-degree), hand fractures, compartment syndrome of the hand, and soft-tissue trauma. He underwent multiple surgeries, including fasciotomy, osteosynthesis, and skin grafting. The other case presented is a 19-year-old man who was injured by a homemade device made of bundled firecrackers, suffering deep facial and bilateral hand burns. He required prolonged ventilation, surgical debridement, and treatment with Kerecis® fish skin and Epicite® dressings. Both required intensive ICU care, interdisciplinary management, and lengthy rehabilitation. Total hospital costs amounted to €58,459.52 and €94,230.23, respectively, as calculated according to the standardized German DRG. These cases illustrate the devastating impact of illegal fireworks. The devastating consequences of explosive trauma are often difficult to treat and may lead to long-term functional and psychological impairments. Prevention through public education, stricter regulations, and preparedness is essential. Pandemic-era injury reductions support sustained policy efforts.

European Burn Journal doi: 10.3390/ebj6020030

Authors: Celine Auxenfans Rocio G. Valencia Philippe Abdel-Sayed Miguel Alaminos Jean-François Brunet Fernando Campos Jesus Chato-Astrain Gloria Carmona Anthony de Buys Roessingh Stephanie Droz-Georget Melinda Farkas Ana Fernandez Gonzalez Enikö Gönczi Fredrik Huss Bernd Hartmann Barbara Heusi Alexandra Karström Naiem Moiemen Giulia Sartoris Antje Spranger Marina Trouillas Claudia Rosas Jyrki Vuola Vivienne Woodtli Clemens Schiestl Sophie Böttcher

Autologous skin substitutes represent a promising advancement in the treatment of burn injuries, offering personalized solutions for patients with extensive skin loss. This white paper synthesizes the current knowledge on laboratory-generated autologous skin substitutes in Europe, incorporating expert opinions and legal considerations. The white paper examines the scientific principles underlying autologous skin substitute development, including cell sourcing, bioengineering techniques, and clinical applications. The regulatory framework governing the production and use of these advanced therapies in Europe is also examined, highlighting challenges in standardization, safety, and approval pathways. The text features expert insights that offer a real-world perspective on the clinical viability and translational hurdles of autologous skin substitutes. The findings highlight the potential of autologous skin substitutes to improve burn treatment outcomes while emphasizing the need for harmonized regulations to facilitate clinical implementation. Despite technological advancements, significant challenges persist, including production costs, scalability, and long-term efficacy. Another focus of this white paper are the legal changes, which have significantly impacted the production and availability of these technologies. The review concludes that while autologous skin substitutes hold great promise, further research, regulatory refinement, and interdisciplinary collaboration are essential to optimize their integration into clinical practice.

European Burn Journal doi: 10.3390/ebj6020029

Authors: Wayne George Kleintjes Tarryn Kay Prinsloo

Cultured epidermal autografts (CEAs) serve as an alternative permanent skin replacement, though high costs often limit their use in resource-constrained settings and to life-saving cases. This case report presents the first documented cosmetic application of a modified CEA technique in a bodybuilder, demonstrating favorable aesthetic outcomes. A 28-year-old Black male with a 20% total body surface area burn sustained in a domestic fire exhibited superficial and deep partial-thickness burns to the face, arms, torso, and feet. Refusing grafts from visible donor sites, treatment using a low-cost modified CEA approach was employed to minimize donor site morbidity. Keratinocytes harvested from a groin biopsy were cultured on Cutimed Sorbact® (Essity AB, BSN Medical (Pty) Ltd., Pinetown, RSA) dressings with autogenous plasma and hydrogel supplementation and incubated at 37 °C for two weeks. Xenografts provided temporary coverage before CEA transplantation. Graft take was 85%, with minor (15%) loss at 21 days, requiring small autograft coverage. At two months, the Vancouver Scar Scale score was 4, indicating optimal pigmentation, smoother texture, and minimal scarring. These findings align with limited studies on CEAs for cosmetic applications, suggesting this cost-effective technique may broaden the scope of CEAs beyond life-saving interventions to include aesthetic reconstruction, reducing both donor site morbidity and scarring.

European Burn Journal doi: 10.3390/ebj6020028

Authors: Ariana Genovese Srinivasagam Prabha Sahar Borna Cesar A. Gomez-Cabello Syed Ali Haider Maissa Trabilsy Cui Tao Antonio Jorge Forte

(1) Burn injuries demand multidisciplinary, evidence-based care, yet the extensive literature complicates timely decision making. Retrieval-augmented generation (RAG) synthesizes research while addressing inaccuracies in pretrained models. However, citation bias in sourcing for RAG often prioritizes highly cited studies, overlooking less-cited but valuable research. This study examines RAG’s performance in burn management, comparing citation levels to enhance evidence synthesis, reduce selection bias, and guide decisions. (2) Two burn management datasets were assembled: 30 highly cited (mean: 303) and 30 less-cited (mean: 21). The Gemini-1.0-Pro-002 RAG model addressed 30 questions, ranging from foundational principles to advanced surgical approaches. Responses were evaluated for accuracy (5-point scale), readability (Flesch–Kincaid metrics), and response time with Wilcoxon rank sum tests (p < 0.05). (3) RAG achieved comparable accuracy (4.6 vs. 4.2, p = 0.49), readability (Flesch Reading Ease: 42.8 vs. 46.5, p = 0.26; Grade Level: 9.9 vs. 9.5, p = 0.29), and response time (2.8 vs. 2.5 s, p = 0.39) for the highly and less-cited datasets. (4) Less-cited research performed similarly to highly cited sources. This equivalence broadens clinicians’ access to novel, diverse insights without sacrificing quality. As plastic surgery evolves, RAG’s inclusive approach fosters innovation, improves patient care, and reduces cognitive burden by integrating underutilized studies. Embracing RAG could propel the field toward dynamic, forward-thinking care.

European Burn Journal doi: 10.3390/ebj6020027

Authors: Rares-Adrian Giurgiu Eliza-Maria Bordeanu-Diaconescu Andreea Grosu-Bularda Adrian Frunza Sabina Grama Raducu-Andrei Costache Carina-Ioana Cristescu Tiberiu-Paul Neagu Ioan Lascar Cristian-Sorin Hariga

Face and neck burns present significant clinical challenges due to their proximity to the airway, predisposing patients to inhalation injuries and subsequent respiratory complications. In our cohort of 206 patients, facial and neck burns were associated with a markedly higher incidence of inhalation injury (34.8% vs. 2.8%), necessitating more frequent endotracheal intubation (51.9% vs. 14.1%). Furthermore, respiratory infections were significantly more common in patients with facial and neck burns (26.7% vs. 7%, p < 0.001), with respiratory secretion cultures revealing a predominance of Pseudomonas aeruginosa (39.58%), Acinetobacter baumanii (18.75%), and Klebsiella pneumoniae (6.25%). In contrast, patients without facial and neck burns primarily exhibited Pseudomonas aeruginosa (50%) in their cultures. These complications translated into a significantly increased mortality rate in patients with facial and neck burns (31.1% vs. 12.7%), with a reduced mean survival period (66.7 days vs. 84.3 days) and a 2.8-fold increase in the hazard of mortality. Additionally, older age emerged as a significant determinant for the development of respiratory infections. Multivariable model regression analysis revealed that only TBSA remained a consistent and independent predictor for adverse respiratory outcomes and increased mortality, while face and neck burns are more causally associated with TBSA.

European Burn Journal doi: 10.3390/ebj6020026

Authors: Danielle Rijpma Karel Claes Anouk Pijpe Henk Hoeksema Ignace De Decker Jozef Verbelen Matthea Stoop Kimberly De Mey Febe Hoste Paul van Zuijlen Stan Monstrey Annebeth Meij-de Vries

Mesh grafting and Meek micrografting are split-thickness skin graft expansion techniques. This study aimed to compare the effectiveness of Meek and Mesh expansion ratios 1:2 and 1:3 in smaller wounds. An intra-patient randomized controlled trial was conducted at two burn centers (the Netherlands and Belgium). Wound outcomes, e.g., take rate, re-epithelialization rate, and donor site size, were measured. At 3 months post-surgery, patient preference and scar quality were evaluated with the Patient and Observer Scar Assessment Scale (POSAS), cutometer and dermaspectrometer. Seventy patients with a TBSA of 10 ± 10% (mean ± SD) were included. The take rate was 79 ± 25% vs. 87 ± 19% (p = 0.003), Meek vs. Mesh, respectively. At follow-up, a majority of observer and patient POSAS items were statistically significantly lower, corresponding with better scar quality for Mesh grafting compared to Meek micrografting. The scar elasticity was 0.37 ± 0.20 vs. 0.42 ± 0.21 (p = 0.013) and mean melanin 13.3 ± 8.3 vs. 12.1 ± 7.7 (p = 0.019) for Meek vs. Mesh, respectively, and the patient preference was 32%, 49%, and 19% for Meek, Mesh, and no preference. Other outcomes showed no statistically significant difference. In patients with smaller wounds, Mesh showed superiority on most wound and short-term scar results. Nevertheless, patient preference within the 1:3 expansion ratio group and donor site size were in favor of Meek.

European Burn Journal doi: 10.3390/ebj6020025

Authors: Luca Simione

Burn injuries lead to significant physical and psychological consequences, including chronic pain, post-traumatic stress, depression, and social isolation. Mindfulness-based interventions (MBIs) have been proposed as a holistic approach to address these challenges in burn rehabilitation. This systematic review evaluates the efficacy of dispositional mindfulness and MBIs, including mindfulness meditation, yoga, and self-compassion training, in managing pain, emotional distress, and psychosocial adaptation in burn survivors. A comprehensive literature search was conducted through MEDLINE and Web of Science, covering studies up to February 2025, with additional papers retrieved from Google Scholar and Semantic Scholar. Studies were included if they reported quantitative data on the effects of MBIs in burn patients and/or their families, excluding opinion pieces, editorials, reviews, and qualitative studies. After screening 91 studies retrieved from the databases and adding a compelling paper retrieved from the other sources explored, 12 studies were included in the final pool, categorized into cross-sectional studies (n = 6), and intervention studies (n = 6). The extracted data included publication year, research design, sample characteristics, intervention details, main findings, and data for quality assessment. The synthesis of the results suggests that mindfulness is associated with reduced psychological symptoms, improved emotional regulation, and enhanced self-compassion, leading to better coping strategies and social reintegration. However, the long-term efficacy of MBIs remains inconclusive, and further research is needed to differentiate mindfulness-specific effects from those of general physical exercise. Evidence also suggests that mindfulness interventions may reduce anxiety and secondary trauma in children with burns and their caregivers. This review highlights the potential of MBIs as adjuncts to conventional burn rehabilitation programs, but further high-quality trials are needed to establish their sustained efficacy and to understand the specific benefits of mindfulness.

European Burn Journal doi: 10.3390/ebj6020024

Authors: 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 Karel E. Y. Claes

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.

European Burn Journal doi: 10.3390/ebj6020023

Authors: Colleen M. Ryan Jeffrey C. Schneider Pengsheng Ni Mary D. Slavin Amy Acton Ananya Vasudevan Allan Sosa-Ebert Lewis E. Kazis

The Life Impact Burn Recovery Evaluation (LIBRE) Profile was developed to assess long-term social participation outcomes for adult burn survivors. Traditional clinical burn recovery outcomes focus on early physical complications and psychosocial issues, but there is a growing need for quantitative measures of long-term recovery that assess experiences deemed relevant to burn survivors. The LIBRE Profile, co-produced with input from burn survivors and clinicians and grounded in the World Health Organization’s International Classification of Functioning, Disability and Health (WHO-ICF) conceptual framework, addresses the measurement gap by focusing on six domains of social participation: social interactions, social activities, family and friends, work and employment, romantic relationships, and sexual relationships. The LIBRE Profile uses Item Response Theory (IRT) and computer adaptive tests (CAT) to minimize respondent burden while maintaining accuracy. Psychometric evaluations have validated the LIBRE Profile as a reliable and clinically useful tool that can help clinicians and burn survivors monitor recovery and inform personalized care. Future work includes LIBRE Profile development for pediatric populations, further international language translations, and the development of an APP for broader personal and clinical use. This paper provides a comprehensive overview of the LIBRE Profile’s development, psychometric foundations, and future directions, advocating for its adoption in clinical practice and burn survivor communities.

European Burn Journal doi: 10.3390/ebj6020022

Authors: Catrin Griffiths Timothy Pickles Ella Guest Diana Harcourt

A PROM is a measure of patient needs and therapeutic progress. This paper outlines the validation of the CARe Burn Scale: Parent/Caregiver Form, a PROM that measures quality of life in parents/caregivers supporting a child with a burn injury. A literature review and interviews with sixteen parents and six burns health professionals informed the development of the PROM conceptual framework/draft form. Cognitive debriefing interviews with five parents and seven burns-specialist health professionals provided feedback to ascertain content validity, and two-hundred and four parents/caregivers took part in the field testing. Rasch measurement theory (RMT) analyses and internal consistency tests were conducted to create a shortened version and for psychometric validation. The final conceptual framework included eight domains/individual scales: Physical Well-being, Confidence with Managing Burn Wound/Scar Treatments, Social Situations, Partner Relationship, Self-worth, Negative Mood, Parent Concerns about the Appearance of their Child’s Burn Wounds/Scars, and Positive Growth. Seven scales had solutions from RMT analyses and passed internal consistency criteria. Confidence with Managing Burn Wound/Scar Treatments did not fit the Rasch model but was retained as a checklist based on theoretical insight. The CARe Burn Scale: Parent/Caregiver Form is the first and only burn-specific PROM that assesses parents’ own health needs when caring for a child with a burn.

European Burn Journal doi: 10.3390/ebj6020021

Authors: Dale O. Edwick Kerry L. Burns Lara N. Buonvecchi Xiaolu Wang Audrey M. Lim Dale W. Edgar

Prolonged healing time of acute burn wounds is associated with increased pain, infection, risk of scarring, poorer mobility and higher financial and emotional burden. Electrical stimulation (ES) reduces healing time in chronic wounds; however, its reported use on acute burn wounds is limited. This systematic review (SR) aimed to evaluate the relative benefit of ES compared to routine wound care on the healing time of acute burn wounds in adults. The online databases queried included Cochrane Database of SR’s, MEDLINE, EMBASE, PUBMED and CINAHL. The search criteria included RCTs involving the application of ES of varying voltage, duration and modality in acute burn patients aged ≥18 years. The primary outcome investigated was days to burn wound closure, while the secondary outcomes included edema and infection. Four RCTs were discovered, involving a total of 143 participants with a mean age 35.5 years. Two RCTs demonstrated (a) 36% (2.6 days) reduction in time to wound closure with ES (p < 0.001); and (b) significant reduction in wound area with ES (11.2 ± 3.2 cm2, p < 0.001) compared to controls at 21 days. Two RCTs found ES promoted better wound-healing environments, reducing edema, bacterial infection, and biofilm. This review highlighted low-risk wound-healing benefits with ES as a feasible adjunct to routine burn care.

European Burn Journal doi: 10.3390/ebj6020020

Authors: Pablo Rodríguez-Ferreyra Régulo López-Callejas Teresa Narváez-Robles Benjamín Gonzalo Rodríguez-Méndez Omar Israel Gayosso-Cerón Antonio Mercado-Cabrera Irene Lule-Reyna Othoniel Mondragón-Dagio Raúl Valencia-Alvarado Jesús Duarte-Mote

The effective treatment of severe burns in pediatric patients is essential for minimizing complications and promoting optimal recovery. This study investigates the use of non-thermal atmospheric pressure plasma (NTAPP) as an adjuvant therapy in combination with Epifast® for the experimental group, compared to standard care involving early excisions and Epifast® for the control group. A randomized controlled trial was conducted with 40 pediatric patients suffering from superficial partial-thickness and deep dermal burns. The experimental group that received NTAPP daily demonstrated a significant reduction in the need for skin grafts, requiring only 10% compared to 40% in the control group (p = 0.02). Although there were no statistically significant differences in the length of hospital stay, the experimental group showed a trend toward shorter stays (9.85 days vs. 11.65 days; p = 0.38) and lower analgesic consumption (13.01 doses vs. 21.15 doses; p = 0.09). Additionally, the infection rate in the NTAPP-treated group was significantly lower at 25%, compared to 37.95% in the control group (p < 0.05). These findings suggest that NTAPP enhances wound healing while reducing surgical morbidity and the risk of infections. In conclusion, this study highlights the transformative potential of NTAPP as an innovative strategy in pediatric burn management. It combines clinical efficacy with a less invasive approach, representing a significant advance in regenerative medicine and opening new avenues for research into advanced therapies.

European Burn Journal doi: 10.3390/ebj6020019

Authors: Bogdan Oprita Georgeta Burlacu Vlad Mircea Ispas Ioana Adriana Serban Ruxandra Oprita

Background: Burns represent one of the most severe injuries encountered in the pre-hospital and ED environment, with essential features and an often negatively powerful impact on patients’ quality of life. Preventive measures can significantly reduce the number of cases presenting to medical facilities; knowledge and the correct application of first aid measures in the pre-hospital stage have a significant role in reducing the risk of complications and in obtaining optimal outcomes. Methods: This retrospective one-year single-center study analyzed 399 adult burn patients treated at the Clinical Emergency Hospital of Bucharest (CEHB) in 2023. Information concerning the main characteristics of the patients (age, sex, and residence), etiology and severity of burns, and pre-hospital management of patients was analyzed. Results: Most patients (63.41%) resided in urban areas, with a higher prevalence of males (55.89%). Thermal burns accounted for 77.69% of cases, primarily caused by water, food, oil, or flames. Burns covered ≤10% TBSA in 77.19% of cases, while 6.52% extended beyond 50% TBSA. First aid was provided to 52.63% of patients at the accident site, often by non-specialized individuals. The mean time to presentation was 34.90 h, with significant correlations between time, age, burned body surface area, and burn depth. Conclusions: There is a real need for improvements in first-aid training and health initiatives to enhance pre-hospital burn care. Better documentation of the care provided to patients before being admitted to specialized centers, as well as further studies in this field, are absolutely necessary for improving prevention programs and burn management in the acute stage.

European Burn Journal doi: 10.3390/ebj6020018

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

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.

European Burn Journal doi: 10.3390/ebj6020017

Authors: Gloria Pelizzo Valeria Calcaterra Michela Marinaro Paola Baldassarre Carlotta Paola Maria Canonica Gianvincenzo Zuccotti

Background: Burn injuries constitute a significant global health challenge, especially in pediatric populations, where they are a leading cause of morbidity and mortality. Pediatric burns require particular attention due to their unique pathophysiology, long-term consequences on growth and development, and psychological impacts. Methods: We propose a comprehensive review of recent advancements in understanding the key aspects of hormonal and metabolic changes in burned children, aiming to guide therapeutic interventions, improve outcomes, and reduce the global burden of these injuries. Results: Effective management of the physiological stress response in pediatric burn patients necessitates a multidisciplinary approach integrating medical, nutritional, and rehabilitative strategies. Timely nutritional support and individualized plans preserve muscle mass, promote wound healing, and reduce complications and organ dysfunction risk. Advances in pharmacological interventions, such as beta-blockers, anabolic agents, and hormonal treatment, offer promising pathways to improve recovery and mitigate long-term complications. Early mobilization and physiotherapy are essential for preventing complications of prolonged immobility, including muscle wasting, joint contractures, and functional decline; their effectiveness is closely tied to advancements in minimally invasive procedures, regenerative medicine, and reconstructive techniques, particularly for pediatric patients. Conclusions: While current strategies have significantly improved survival and outcomes for pediatric burn patients, ongoing research is critical to refine these new care strategies.

European Burn Journal doi: 10.3390/ebj6010016

Authors: Dale W. Edgar Colleen M. Ryan Marianne K. Nieuwenhuis Ulrike Van Daele Jill M. Cancio

The Editors thank the investigators for displaying tenacity, evidenced by the significant revisions that were necessary to complete this project [...]

European Burn Journal doi: 10.3390/ebj6010015

Authors: Jonathan Bayuo Joyce Pwavra Jephtah Davids Anita Eseenam Agbeko Paa Ekow Hoyte-Williams Frank Bediako Agyei Pius Agbenorku

Burn injuries can trigger a series of metabolic and catabolic responses that exert significant impacts on an individual’s nutritional status, necessitating continuous nutritional support and education to aid recovery. However, burn units in developing countries often face resource limitations that can negatively affect these needs. This study aimed to explore the challenges related to post-burn nutrition and nutrition education in our burn unit and identify ways to improve the situation. An interpretive description approach was used, and convenience sampling recruited fifty-three participants, including 18 adult burn survivors and their primary caregivers (each as a single dyad), 10 informal caregivers of paediatric burn survivors, and 25 burn care staff. The data were analysed through thematic analysis, revealing three main themes and seven subthemes. The findings highlight an unstructured approach to nutrition and education, along with financial constraints affecting adherence. To address these issues, strategies such as using educational materials like videos and booklets/leaflets in the local language are suggested to develop relevant interventions. In conclusion, while there are concerns about nutrition and education, there are also opportunities to improve the situation.

European Burn Journal doi: 10.3390/ebj6010014

Authors: Sebastian Holm Reza Tabrisi Johann Zdolsek

Nitrous oxide has a wide range of medical applications, such as being used as an analgesic in general anesthesia, dental procedures, childbirth and sedation. Lately, it has also been employed as an inhalant recreational drug to induce brief euphoria. Recent studies indicate a worldwide rise in the incidence of skin frostbites associated with nitrous oxide use. A scoping review was conducted to synthesize and summarize the existing literature published in English regarding frostbite injuries associated with the recreational use of nitrous oxide. The literature search was carried out in July 2024 using databases such as Embase, Web of Science and PubMed®. From an initial pool of 83 publications, 8 studies were ultimately selected for full-text review as they met our inclusion criteria for analysis. Additionally, we provide a representative clinical case involving a 21-year-old male who experienced frostbite following skin exposure to nitrous oxide. Most publications on nitrous oxide induced frostbites are from recent years, primarily between 2022 and 2024, with the first case documented in 1996. These injuries are mostly observed in young adults, with a female dominance, and are typically localized to the inner thighs. According to the existing literature, the predominant treatment approach is conservative management, with excision and split-thickness skin grafting (STSG) in the second place. This study represents the first literature review summarizing frostbite injuries to the skin from nitrous oxide misuse. There is a need for enhanced preventive measures to raise public awareness and reduce the incidence of frostbite injuries associated with the recreational use of nitrous oxide.

European Burn Journal doi: 10.3390/ebj6010013

Authors: Courtney Kelly Rodney K. Chan Anders H. Carlsson

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.

European Burn Journal doi: 10.3390/ebj6010012

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

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.

European Burn Journal doi: 10.3390/ebj6010011

Authors: Niamh Keohane Jennifer Driver Randeep Mullhi Elizabeth Chipp Barbara Torlinska Tomasz Torlinski

The association between hypothermia and poor outcomes in severe burn injury is well established. However, the significance of the core-peripheral temperature gradient has not previously been investigated. Institutional guidance at our burns centre advocates avoiding hypothermia and targeting a body temperature between 37.5 and 39.5 °C. The core-peripheral temperature gap should be ≤2 °C, based on expert opinion. Data from 61 patients admitted to the Intensive Care Unit (ICU) with severe burns between 2016 and 2022 were analysed. A higher core temperature at 48 h, avoidance of hypothermia and a core-peripheral temperature gap > 2 °C were associated with reduced odds of mortality. The mean core body temperature and core-peripheral temperature gap increased over the first 48 h (r = 0.5, p < 0.001). All non-survivors had a core-peripheral gap < 2 °C at 48 h. Survivors had a higher mean 48 h gap (1.6 [95%CI:1.3–1.9]) than non-survivors (0.8 [95%CI:0.2–1.4; p = 0.04]). Our findings support previous studies suggesting that avoiding hypothermia and achieving a higher target temperature are associated with reduced mortality. However, it challenges the previous expert consensus that a lower core-peripheral gap indicates better outcomes. Further research with a larger cohort of patients is required to identify whether a higher core-peripheral temperature gap predicts outcomes in critically ill patients with severe burns.

European Burn Journal doi: 10.3390/ebj6010010

Authors: Sarthak Sinha Altay Baykan Karen Hulin Doug Baron Vincent Gabriel Frankie O. G. Fraulin

Background: Assessing hypertrophic scar (HTS) interventions is challenging because scars continue to undergo dynamic changes. A split-scar design can distinguish treatment effects from natural HTS evolution. Despite promising reports of ablative fractional CO2 lasers (AFCO2Ls) for HTS, split-scar evidence, particularly in pediatric scars, remains limited. Objective: To explore the feasibility of a split-scar design in assessing AFCO2L’s impact on pediatric HTS and to identify potential trends in treatment outcomes. Methods: Initially designed as a prospective single-center split-scar randomized controlled trial, our study transitioned to a feasibility trial due to recruitment challenges. Pediatric patients aged 1–17 years with HTS suitable for split-scar evaluation received three AFCO2L treatments at 6–8-week intervals, with outcomes assessed using the Vancouver Scar Scale (VSS), SCAR-Q, and Cutometer. Results: Recruitment was limited by COVID-19 restrictions, concerns about general anesthesia for split-scar treatment, and low interest in divided-scar interventions, resulting in only 6 participants with 9 scars enrolled, far below the target sample size of 44. This small heterogeneous sample precluded meaningful clinical outcome analysis. Conclusions: Our feasibility trial highlights challenges in conducting rigorous pediatric HTS studies and the need for careful interpretation of evidence due to potential publication bias. Future trials should focus on tailored recruitment and comprehensive reporting to improve feasibility and reliability.

European Burn Journal doi: 10.3390/ebj6010009

Authors: Dinithi Atapattu Victoria M. Shoesmith Eva Kierath Mark W. Fear Fiona M. Wood Lisa J. Martin

Burns significantly impact children’s physical and psychosocial recovery, even in cases of non-severe injuries, leading to long-term health and mental health risks. This study explores the psychosocial benefits of a community-based exercise program for children recovering from burn injuries, addressing concerns such as anxiety, reduced physical activity, and social challenges. A pre-test–post-test design assessed the effects of an 8-week community-based trampoline exercise intervention on psychosocial outcomes in children and their caregivers. No significant or clinically meaningful physical improvements were observed across measures such as MET score, grip strength, BMI percentile, or heart-rate recovery despite a significant improvement in trampolining performance (p < 0.0001). Psychosocial outcomes showed improved child emotional function (PedsQL, p = 0.024) as reported by parents, though children’s self-reported emotional function and Child PTSD Symptom Scale (CPSS) scores remained unchanged. Parent-reported strengths and difficulty scores for the child remained stable over time but were higher than population norms for hyperactivity and emotional difficulty. Parental post-traumatic stress symptoms decreased significantly over time (p = 0.050), with reductions in avoidance (p = 0.009), hypervigilance (p = 0.007), and intrusion scores (p = 0.026). Children significantly improved their trampolining performance, while parents reported enhanced emotional function for their child. However, children’s self-reports did not reflect these emotional improvements.

European Burn Journal doi: 10.3390/ebj6010008

Authors: Sara Guila Fidel-Kinori Vicente García-Sánchez Maria Sonsoles Cepeda-Diez Carmina Castellano-Tejedor Josep Antoni Ramos-Quiroga Joan Pere Barret-Nerín

Background: In 1994, the first Spanish study on patients with self-inflicted burns (SIB) was published, showing a prototypical profile of a patient with SIB: adult male, unmarried and, in 75% of the cases, with a psychiatric background. In addition, SIB accounted for 1.98% of the total admissions in a Burns Unit between 1983 and 1991, a lower percentage than other European studies. The present study aims to replicate this work, updating this profile and comparing it with the current profile. Methods: We compared the clinical and socio-demographic characteristics of 67 patients admitted during 1983–1991 (Study I) with those of 36 patients admitted during 2010–2015 (Study II). Results: It was observed that the percentage of patients with SIB admitted to the Burns Unit was lower in Study II than in Study I (1.45% vs. 1.98%). Significant age differences were identified (t(101) = −2.074, p = 0.041, 95% CI [−11.739, −0.261]). Similarly, there were statistically significant differences in several clinical characteristics, such as psychiatric history (X2 = 11.591, p = 0.001), the occurrence of previous autolytic attempts (X2 = 7.714, p = 0.007), the place where the incident occurred (X2 = 11.647, p = 0.020), the etiology of the burn (X2 = 13.142, p = 0.004), and triggers (X2 = 6.420, p = 0.036). Conclusions: Several differences have arisen between the two studies, mainly related to the specific characteristics of SIB (e.g., etiology, triggering cause, and place of the incident), possibly attributable to the social changes that have occurred in the last 20 years. These results will add to our knowledge and will stress various precipitating factors that may lead to SIB, with the final goal of designing preventive strategies.

European Burn Journal doi: 10.3390/ebj6010007

Authors: Thomas Wild Jörg Marotz Ahmed Aljowder Frank Siemers

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.

European Burn Journal doi: 10.3390/ebj6010006

Authors: Patrick M. Honoré Sydney Blackman Emily Perriens Jean-Charles de Schoutheete Serge Jennes

The early detection, diagnosis, anticipation, and therapy of infections to prevent sepsis and septic shock remain significant challenges in cases of grave burns. This narrative review explores various tools for early infection detection, including emerging biomarkers, the American Burn Association’s clinical criteria, and traditional blood parameters. A comparative study of the American Burn Association, Mann-Salinas, and Sepsis-3 criteria highlights the superior early detection capabilities of the Sepsis-3 criteria. However, the authors recommend that sepsis should be prospectively evaluated, identified, and classified by the intensive care group, rather than by relying solely on retrospective items, though the latter may still be necessary in certain cases. Advances in biomarker identification, including polymerase chain reaction (PCR) and gene expression (mRNA) profiling, offer diagnostic advantages over current methods, enabling early detection within 4 to 6 h of intensive care unit admission. Mass spectrometry also shows promise for the rapid determination of bacteria, yeast, and fungi based on bacteria protein profiles. Source control remains crucial, and the use of antibacterial topical agents has significantly improved the survival rates of severely burned patients. However, antibiotic selection must be made judiciously to avoid resistance. Despite these advancements, significant progress is still needed to improve the rapid identification, actual presence, prevention, and therapy of infections to reduce the incidence of sepsis and septic shock in this patient subgroup.

European Burn Journal doi: 10.3390/ebj6010005

Authors: Marina C. Heijblom J. Nicolaas Dijkshoorn Marianne K. Nieuwenhuis Anouk Pijpe Cornelis H. van der Vlies Margriet E. van Baar Inge Spronk

Surviving a burn can dramatically alter a child’s life, yet few studies examined long-term health-related quality of life (HRQL). This study assessed HRQL 5–7 years post-burn in children with mild/intermediate and severe burns and identified associated factors. Parents of children (5− < 18 years) who were hospitalized or had burn surgery between 08/2011 and 09/2012 completed the Burn Outcomes Questionnaire (BOQ). Outcomes were compared between two subgroups: children with mild/intermediate burns (<10% total body surface area (TBSA) burned) versus severe burns ((1) aged <10 years old at the time of injury with >10% (TBSA) burned; (2) aged ≥10 years with >20% TBSA burned; or (3) >5% full-thickness burns). A total of 102 children were included (mean age at survey: 8.4 (3.0) years; mean former TBSA: 7.1%). At a mean of 5.7 years post-burn, many parents rated their child’s health as excellent (46.1%) or very good (35.3%), with few reporting issues with ‘pain’ (2.3%), ‘physical function and sports’ (1.6%), and ‘upper extremity function’ (0.9%). Parents of children with severe burns indicated significantly more problems with ‘appearance’ (89.2% versus 71.5%; p = 0.014) and ‘parental concern’ (94.1% versus 84.8%; p = 0.021). Upper limb burns, facial burns, burn size, length of hospital stay, full-thickness burns, and the number of surgeries predicted poorer outcomes. In general, these findings indicate positive long-term HRQL, though especially children with full-thickness burns and/or surgical interventions face a higher risk of reduced HRQL. The results can be used to inform children and their families about the long-term implications. Furthermore, healthcare professionals can use these insights to identify children at higher risk of poorer long-term HRQL.

European Burn Journal doi: 10.3390/ebj6010004

Authors: Joanne S. Page Dale W. Edgar Tiffany L. Grisbrook Angela Jacques Paul M. Gittings Fiona M. Wood Carly J. Brade

Measuring exercise intensity for safety and to inform prescription in acute burn survivors, is challenging. This study aimed to assess the validity of adult patient end-of-workout rating of session perceived exertion (sRPE); and calculated training load (TL) (sRPE × session duration) as measures of exercise intensity. Secondly, the study aimed to compare clinician and patient perception of exercise effort during physiotherapist-led sessions. Repeated RPE data were collected every 5-min during two resistance exercise sessions completed by 25 burns patients. Physiological (heart rate [HR], blood lactate [BLa]) and perceptual measures (sRPE, ratings of pain, fatigue, delayed onset muscle soreness, sleep quality and stress) were also captured. Adjusted, multivariable linear regression models were used to determine the associations between sRPE and TL and significant predictor variables. Paired t-tests were performed to compare clinician and participant sRPE. Results: Average RPE calculated from 5-min repeats, after adjustment for age and %TBSA, was significantly associated with sRPE, F(1, 45) = 100.82, (p < 0.001, adjusted R2 = 0.64) and TL, F(1, 45) = 33.66, (p < 0.001, adjusted R2 = 0.39). No significant differences between patient and clinician sRPE were apparent (p = 0.948). Thus, one-off reporting of sRPE and calculated TL may be appropriate markers to monitor exercise intensity and aid prescription in individuals with burn injuries, regardless of patient and burn characteristics or time since burn. There was also no difference between patient and clinician’s perceptions of exercise effort.

European Burn Journal doi: 10.3390/ebj6010003

Authors: Nathanael Q. E. Yap Dilip K. Vankayalapati Sum-Yu C. Lee Hafsa O. Sulaiman Alma Sato M Zaid Shami Valeria Antoniou James W. F. Burns Hayato Nakanishi Christian A. Than Graeme Southwick

Silver foam dressings have been extensively used in the management of burn injuries; however, its application in children requires elucidation. A literature search was conducted from database inception to October 2023. Eligible studies reported paediatrics patients under 21 years of age receiving silver dressings for burns or scalds. This review was registered prospectively with PROSPERO (CRD42023470239). 18 studies met the inclusion criteria with a total of 701 patients. The pooled mean time to re-epithelisation (TTRE) was 12.9 days (95% CI: 11.2, 14.6, I2 = 94%). The pooled mean duration of hospitalisation was 9.8 days (95% CI: 3.9, 15.7; I2 = 100%). Mean number of total dressing changes per patient was 3.6 (95% CI: 2.2, 4.9; I2 = 99%). There were a total of 98 complications, including 30 (30.6%) infections, 29 (29.6%) surgical requirements, 14 (14.3%) hypertrophic scarring, 17 (17.3%) escalations of care, 5 (5.1%) burn depth progression, and 3 (3.1%) others. Silver foam dressings appear as a safe and effective approach in terms of healing rate and dressing change frequency for selected paediatric patients with burn injuries. Despite the promising results, further comparative studies are required to evaluate the selection criteria and long-term effect of silver foam dressing.

European Burn Journal doi: 10.3390/ebj6010002

Authors: Mayer Tenenhaus Hans-Oliver Rennekampff

Patients who have been injured by burns often suffer from persistent and debilitating post burn pruritus. Despite a myriad of therapeutic interventions and medications, this complex condition remains particularly difficult to ameliorate. Recently, a new generation of antipruritic medications has demonstrated clinical success in managing pruritus in a number of dermatologic, nephritic and hepatic disease states, targeting unique aspects of the pruritic pathways. While specific trials demonstrating efficacy and safety are currently lacking, the purported mechanisms of action and similarities to the targeted inflammatory markers, pruritogens and neural pathways of these new medications, in concert with clinical evidence, hold promise for burn patients.

European Burn Journal doi: 10.3390/ebj6010001

Authors: Madhan Jeyaraman Naveen Jeyaraman Swaminathan Ramasubramanian Arulkumar Nallakumarasamy Shrideavi Murugan Tarun Jayakumar Sathish Muthu

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.

European Burn Journal doi: 10.3390/ebj5040041

Authors: Jacob M. Dougherty Hannan A. Maqsood Christopher J. Rittle Eva S. Blake Zhaohui Fan Bryant W. Oliphant Mark R. Hemmila Naveen F. Sangji

Background: Burn injuries can require hospitalization, operations, and long-term reconstruction. Burn-injured patients can experience short- or long-term disability. We investigated lost workdays (LWDs), short-term disability (STD), and long-term disability (LTD) in the 12-month period following a burn injury. Methods: An observational cohort study was conducted using a commercial claims database, IBM® MarketScan®. Patients aged ≤65 years with an ICD-10 burn diagnosis from 2018 to 2019 were included. The International Classification of Diseases, 10th Revision (ICD-10), procedure and Current Procedural Terminology (CPT) codes were used to identify patients undergoing burn-related operations. Patients were mapped to data tables for LWDs, STD, and LTD for the 12 months pre- and post-injury. Paired t-tests were employed to compare the pre- and post-injury outcomes. Results: We identified 1745 patients with burn diagnoses. Of those, 263, 1449, and 1448 patients had data available for LWDs, STD, and LTD, respectively. STD and LTD were reported by 8.1% and 0.0% of patients in the 12-month period pre-injury, respectively, and 20.3% and 1.0% of patients in the 12-month period post-injury, respectively. Average days of STD increased from 3.70 to 9.34 days following injury. Conclusions: Burn injuries are associated with increased STD and LTD utilization. Quantifying the impact of burn injuries on patients’ work will help us understand the economic implications of burns, which is a key area in burn research.

European Burn Journal doi: 10.3390/ebj5040040

Authors: Gurpreet Singh Pramod Yadav Arnab Chanda

The development of artificial skin that accurately mimics the mechanical properties of human skin is crucial for a wide range of applications, including surgical training for burn injuries, biomechanical testing, and research in sports injuries and ballistics. While traditional materials like gelatin, polydimethylsiloxane (PDMS), and animal skins (such as porcine and bovine skins) have been used for these purposes, they have inherent limitations in replicating the intricate properties of human skin. In this work, we conducted uniaxial tensile tests on freshly obtained cadaveric skin to analyze its mechanical properties under various loading conditions. The stress–strain data obtained from these tests were then replicated using advanced skin simulants. These skin simulants were specifically formulated using a cost-effective and moldable multi-part silicone-based polymer. This material was chosen for its ability to accurately replicate the mechanical behavior of human skin while also addressing ethical considerations and biosafety concerns. In addition, the non-linear mechanical behavior of the developed skin simulants was characterized using three different hyperelastic curve-fit models (i.e., Neo-Hookean, Mooney–Rivlin, and Yeoh models). Moreover, these innovative simulants offer an ethical and practical alternative to cadaveric skin for use in laboratory and clinical settings.

European Burn Journal doi: 10.3390/ebj5040039

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

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.

European Burn Journal doi: 10.3390/ebj5040038

Authors: Kaarle Antila Jyrki Vuola Andrew Lindford

Autologous skin grafts are the gold standard for definitive wound coverage in burn care, but allograft skin grafts are essential for providing temporary coverage in cases of extensive burns. The Helsinki Skin Bank, established in 1995 at the Helsinki Burn Centre, is Finland’s only licensed skin bank, serving a population of 5.5 million. It procures human skin allografts from multi-organ donors in the Greater Helsinki area and preserves them using glycerol, a method pioneered by the Euro Skin Bank. Between 2009 and 2020, the Helsinki Skin Bank procured skin from 263 donors and provided allografts to 248 patients, primarily burn victims. Over time, procurement methods have improved significantly, resulting in an increase in the amount of skin harvested per donor. Despite rising costs due to more stringent European Union regulations and the need for round-the-clock operations, the bank has remained cost-effective. The glycerol preservation method ensures microbiological safety and effective storage, with minimal contamination issues. The future may see advances in skin substitutes and stem cell treatments, but for now, allogenic skin remains crucial in burn care due to its availability, ease of use, and cost-efficiency. Running a small, professional skin bank for a single burn center has proven successful and sustainable.