Search Results (642)

Skin meshing facilitates the greater expansion of donor skin through patterned slits and is widely used for treating extensive burn injuries. However, the actual expansion often falls below manufacturers’ claims. Previous computational analyses using the isotropic Yeoh model have shown that Langer’s line orientation and slit direction significantly affect induced stress and meshing ratios, yet the use of nonlinear anisotropic models that represent collagen fiber alignment corresponding to Langer’s lines remains unexplored. This study employs a nonlinear anisotropic Gasser–Ogden–Holzapfel (GOH) model with slit orientations of 0°, 45°, and 90°, consistent with geometries reported in the literature, to quantify induced stress in skin meshing by incorporating collagen fibers within the dermis layer. The GOH parameters were calibrated to human back skin data uniaxially stretched parallel and perpendicular to Langer’s lines using Levenberg–Marquardt optimization in the GIBBON toolbox (MATLAB R2023a) coupled with FEBio v4.0, achieving a standard deviation of 3% relative to experimental data. The GOH model predicted the highest induced stress at 100% strain for the 45° slit parallel to Langer’s lines and the lowest for the 90° slit perpendicular, exceeding 40 MPa due to absence of damage and rupture modeling but accurately representing anisotropic mesh behavior. Full article

Introduction: Chronic wounds are a growing healthcare challenge, with infections being major complications that delay healing. Biofilms are structured microbial communities encased in extracellular polymeric substances. Biofilms confer antimicrobial resistance, promote inflammation, and protect pathogens from host defenses. These mechanisms make eradication difficult with standard therapies. Methods: A focused literature review was conducted using PubMed (2010–2025) to examine the role of biofilms in chronic wounds, diabetic foot ulcers (DFUs), and burn injuries, as well as conventional and emerging treatment strategies. Studies are included if they addressed microbial composition, host–microbe interactions, or therapeutic outcomes in clinical or translational models. Discussion: Biofilms are implicated in up to 60% of chronic wounds and more than half of burn wounds. In DFUs, both bacterial and fungal biofilms contribute to chronicity and impaired healing. Conventional treatments such as debridement and antiseptics reduce surface biofilm burden but rarely achieve full eradication. Emerging approaches include quorum sensing inhibitors, bacteriophage therapy, matrix-degrading enzymes, electroceutical dressings, antifungal strategies, and nanotechnology. They show promise when integrated with standard wound care. Conclusions: Biofilms are central to the pathogenesis of chronic wounds, DFUs, and burns. Integrating mechanism-based antibiofilm therapies with standard care represents a key research priority to improve healing outcomes. Full article

The development of advanced wound dressings that integrate favorable physico-mechanical properties with the ability to support physiological healing processes remains a critical challenge in biomaterials science. An ideal dressing should modulate the wound microenvironment, prevent infection, maintain hydration, and possess adequate strength and elasticity. This study aimed to fabricate and characterize electrospun chitosan (CS)-based 3D scaffolds dual-reinforced with halloysite nanotubes (HNTs) and cerium oxide nanoparticles (CeONPs) to enhance material properties and biological performance. HNTs were incorporated to improve electrospinnability and provide mechanical reinforcement, while CeONPs were added for their redox-modulating and anti-inflammatory activities. Composite mats were fabricated via non-capillary electrospinning. The individual and synergistic effects of HNTs and CeONPs were systematically evaluated using physico-chemical methods (SEM, EDX, WAXS, TGA, mechanical testing) and biological assays (in vitro cytocompatibility with mesenchymal stem cells, in vivo biocompatibility, and wound healing efficacy in a rat model). Scaffolds containing only HNTs exhibited defect-free nanofibers with an average diameter of 151 nm, whereas the dual-filler (CS-PEO-HNT-CeONP) composites showed less uniform fibers with a rough surface and a larger average diameter of 233 nm. The dual-filler system demonstrated significantly enhanced mechanical properties, with a Young’s modulus nearly double that of pure CS mats (881 MPa vs. 455 MPa), attributed to strong interfacial interactions. In vivo, the CS-PEO-HNT-CeONP scaffolds degraded more slowly, promoted earlier formation of a connective tissue capsule, and elicited a reduced inflammatory response compared to single-filler systems. Although epithelialization was temporarily delayed, the dual-filler composite ultimately facilitated superior tissue regeneration, characterized by a more organized, native-like collagen architecture. The synergistic combination of HNTs and CeONPs within a CS matrix yields a highly promising scaffold for wound management, offering a unique blend of tailored biodegradability, enhanced mechanical strength, and the ability to guide healing towards a regenerative rather than a fibrotic outcome, particularly for burns and traumatic injuries. Full article

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. Full article

Burn injuries represent a significant global burden, with children under the age of five among the most vulnerable groups. This narrative review will explore the main causes of burns in early childhood (under 6 years of age), the associated risks, current treatment approaches, and the long-term implications of these injuries. It will also highlight areas where further research is needed to improve prevention and management strategies for burns in this vulnerable population. Results showed that burns in children under six years old represent a significant clinical and preventive challenge, with physical, psychological, and social implications. Research has identified common causes, particularly scalds from hot liquids, while advancing innovative treatments such as bioengineered skin substitutes, virtual reality, and telemedicine. Preventive interventions at the household and community levels have also proven effective. However, major limitations remain: studies often lack age-specific focus, rely on retrospective data, underrepresent low-resource settings, and lack standardized protocols. To improve outcomes, future research must adopt a more targeted, multidisciplinary approach and address long-term physical and psychological effects to ensure comprehensive, age-appropriate care. Full article

Introduction: Charred bodies represents a significant challenge for forensic pathologists due to the destructive effects of fire on human remains. Although most fire-related deaths are accidental, cases of suicide and homicide are not uncommon. Case Report: We report a peculiar case of a severely burned body discovered inside a torched vehicle. Under judicial investigation, a full autopsy was performed, including macroscopic and microscopic examination of key anatomical structures: the inspection of oral cavity revealed no soot deposits; a foreign object (a chestnut) was found anterior to the epiglottis, though not lodged within the glottis; no thermal injuries or soot were observed in the upper or lower airways. Histological analysis excluded thermal damage at the alveolar–capillary interface. Alveolar spaces appeared both hyperinflated and ectatic, likely due to septal rupture, suggestive of acute pulmonary emphysema and multiorgan congestion. Carboxyhemoglobin levels were below 5%, indicating a low level which did not support intravital inhalation of combustion gases. Based on the comprehensive medico-legal findings, the cause of death was attributed to an asphyxial mechanism. It was further demonstrated that the burning of the body occurred post-mortem. DNA extraction from two dental specimens enabled positive identification of the victim. Subsequent investigations confirmed the case to be a femicide. The perpetrator, following a domestic altercation over jealousy, suffocated his young wife and attempted to simulate accidental choking by placing a chestnut in her mouth. He then staged a vehicular fire to mimic a fatal accident. Conclusions: The case underlines that a multidisciplinary forensic approach is essential, and must integrate different methodologies and the analysis of both circumstantial evidence and scene investigation. Full article

Background/Objectives: Unintentional home injuries (UHIs) are a major yet preventable cause of morbidity and mortality among children. This study aimed to analyze the epidemiological characteristics, injury mechanisms, and clinical outcomes of pediatric UHIs over a nine-year period in Türkiye. Methods: This retrospective study included all children under 18 years who were diagnosed with UHIs in the Pediatric Emergency Department (PED) of a tertiary university hospital between January 2016 and November 2024. Demographic data, injury mechanisms, imaging findings, surgical interventions, hospitalizations, and Pediatric Intensive Care Unit (PICU) admissions were statistically analyzed. Results: Among 852,090 PED visits, 12,327 (1.4%) were diagnosed with UHIs. Most patients were younger than five years (72.1%) and male (56.8%). The leading causes were falls/collisions (60.6%), burns (12.1%), and foreign body aspirations (10.4%). Hospitalization and PICU admission rates were 11.7% and 1.2%, respectively, mainly involving children aged 2–4 years. Younger age and corrosive ingestion were independent predictors of hospitalization, while burns, falls/collisions, corrosive ingestion, poisoning, and foreign body aspiration significantly increased PICU admission risk. A marked rise in both hospital and PICU admissions was observed during the COVID-19 pandemic. Two fatalities occurred following falls. Conclusions: Falls, burns, and foreign body aspirations were the most common causes of pediatric UHIs, predominantly affecting children aged 2–4 years. Strengthening caregiver supervision, promoting safer home environments, and implementing targeted prevention programs are essential to reduce their impact on children and healthcare systems. Full article

Post-traumatic lymphedema (PTL) is a chronic and often under-recognized sequela of soft tissue trauma, leading to persistent swelling, functional impairment, and increased risk of infection. While lymphedema is traditionally associated with oncologic interventions, growing evidence highlights the significant burden of PTL in trauma patients. This review provides a comprehensive analysis of the current understanding of PTL, including epidemiology, risk factors, pathophysiology, diagnostic modalities, and treatment strategies. PTL often occurs after high-impact musculoskeletal injuries (such as open fractures with significant soft tissue loss) or burns (especially if deep or circumferential). This risk is increased if injury occurs at critical areas of increased lymphatic density (such as anteromedial leg, medial knee, medial thigh, medial elbow, or medial arm). Advances in imaging techniques, including indocyanine green lymphography and magnetic resonance lymphangiography, have improved early detection and classification of PTL. Management approaches range from conservative therapies, such as complete decongestive therapy (CDT), to surgical interventions, including lymphaticovenous anastomosis (LVA), vascularized lymph node transfer (VLNT), and vascularized lymph vessel transfer (VLVT)/lymph-interpositional-flap transfer (LIFT). We report on our experience with two patients. At our center, we diagnose and stage PTL with ICG lymphography and trial CDT for 6 months. If there is no significant improvement, we recommend LVA. If there is insufficient improvement after 12 months, we recommend LIFT/repeat LVA/VLNT. We also treat open fractures with significant soft tissue defects with LIFT, as prophylaxis against PTL. PTL remains an underdiagnosed condition, necessitating increased awareness and intervention to prevent long-term disability. Full article

Burn injury triggers a complex inflammatory cascade in which the interplay between pro- and anti-inflammatory mediators determines recovery or progression to sepsis, ventilator-associated pneumonia (VAP) or multi-organ dysfunction, and mortality. We systematically searched PubMed, Embase, Cochrane Library, Web of Science, and Scopus for studies published between 2006 and 2024, identifying 1883 records. We conducted a comprehensive systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After screening and eligibility assessment, 24 studies covering both pediatric and adult populations met the inclusion criteria. Data on cytokines, acute-phase proteins, complement fragments, and systemic inflammatory indices were synthesized narratively. The evidence indicates that the inflammatory response to burn injury is not a linear sequence of events but a dynamic and unstable equilibrium, where outcomes are determined less by the initial magnitude of cytokine release and more by the persistence of dysregulated inflammation or failure of compensatory mechanisms. Full article

Second-degree burns are common dermal injuries requiring effective interventions to promote timely and complete skin regeneration. This study evaluated the wound-healing efficacy of topical hydrogels containing powdered licorice root (Glycyrrhiza glabra L.) extract at concentrations of 5%, 10%, and 20% w/w in a standardized murine model. Female SKH-hrHR2 hairless mice (n = 8 per group) were subjected to second-degree thermal burns, and treatment hydrogel formulations were applied once daily under occlusive dressings. Wound healing was assessed by planimetric area measurements, transepidermal water loss (TEWL), and histopathology. By Day 19, complete wound closure was achieved in 87.5% of animals in the 5% group, compared with 50.0% in the 10% group, 37.5% in the 20% group, and 25.0% in the sodium alginate control (Fisher’s exact test, p = 0.008). TEWL remained unchanged in the 5% group (baseline vs. Day 19: 8.4 ± 1.2 vs. 8.6 ± 1.3 g/m²/h; p > 0.05) but increased significantly in all other groups (e.g., sodium alginate: 8.2 ± 1.1 to 13.5 ± 2.0 g/m²/h; p = 0.0001). Histologically, the 5% formulation showed near-normal epidermal architecture and minimal inflammation (mean total score 2.0) compared with higher concentrations (6.0 for 10% and 7.3 for 20%) and sodium alginate (8.3). These findings demonstrate that a 5% Glycyrrhiza glabra hydrogel provides, among the concentrations studied here, the most favorable balance of wound closure, barrier restoration, and histological recovery, supporting its further development as a topical therapy for second-degree burns. Full article

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. Full article

Background: Extensive skin injuries from severe burns or chronic non-healing ulcers overwhelm the body’s natural repair mechanisms, while current therapeutic approaches relying on autologous skin grafting are limited by donor site availability. Three-dimensional epithelial spheroid cultures enhance stem cell regenerative potential, but standardized comparative methodologies are lacking. Methods: We established a comprehensive framework comparing scaffold-free and scaffold-based epithelial spheroid systems using HaCaT keratinocytes. High-throughput approaches utilized BioFloat and ELPLASIA 96-well platforms, while low-throughput 6-well ULA plates generated heterogeneous populations (holospheres, merospheres, paraspheres). Scaffold-based studies embedded spheroids in Matrigel to evaluate outgrowth capacity. ROCK1 inhibitor treatment was assessed for stemness enhancement. Results: High-throughput systems generated uniform spheroids with high reproducibility and consistent circularity. Low-throughput cultures produced heterogeneous populations with distinct size distributions (holospheres: 408.7 μm², merospheres: 99 μm², paraspheres: 14.1 μm²). In Matrigel scaffolds, merospheres and paraspheres migrated outward, forming epithelial sheets, while holospheres remained intact as BMI-1+ stem cell reservoirs. ROCK1 inhibition enhanced holosphere formation, preserved stemness markers, and reduced premature differentiation. Conclusions: This standardized toolbox demonstrates scaffold-free systems optimize scalability for screening while scaffold-based approaches enable physiologically relevant regenerative studies. Integration of both methodologies provides flexibility matching experimental design to scientific objectives, accelerating translation to clinical applications. Full article

Burn injury represents a complex trauma involving numerous local and systemic pathological alterations, which are frequently exacerbated by the phenomenon of burn wound conversion or secondary deepening. Conventional clinical management relies heavily on the application of skin grafts, which primarily serve to provide temporary wound coverage and environmental isolation. However, such grafting procedures often prove insufficiently effective and fail to prevent the progression of the burn wound. While contemporary tissue engineering strategies aim to correct specific pathological processes, they fall short of achieving complete and functional restoration of the skin. Consequently, there is a pressing need for the development of novel therapeutic interventions capable of exerting a multifactorial influence on the regeneration process. A promising avenue of research involves microRNA-based therapeutics. These RNA molecules function as master regulators of gene expression, capable of simultaneously modulating entire clusters of genes implicated in wound regeneration and the prevention of burn wound conversion. Therapeutic strategies focused on the targeted delivery of microRNAs to the wound bed hold the potential for creating effective treatment modalities that surpass existing options and effectively prevent burn deepening. This review consolidates current knowledge on the pathogenesis of burn wounds, elucidates the complex interplay between genes and microRNAs during tissue regeneration and describes both existing and experimental microRNA-based delivery approaches aimed at minimizing burn-related complications and enhancing the quality of tissue repair. Full article

Today, hydrogen is already widely regarded as up-and-coming source of energy. It is essential to meet energy needs while reducing environmental pollution, since it has a high energy capacity and does not emit carbon oxide when burned. However, for the widespread application of hydrogen energy, it is necessary to search new technical solutions for both its production and storage. A promising effective and cost-efficient method of hydrogen generation and storage can be the use of solid materials, including nanomaterials in which chemical or physical adsorption of hydrogen occurs. Focusing on the recommendations of the DOE, the search is underway for materials with high gravimetric capacity more than 6.5% wt% and in which sorption and release of hydrogen occurs at temperatures from −20 to +100 °C and normal pressure. This review aims to summarize research on hydrogen generation and storage using silicon nanostructures and silicon composites. Hydrogen generation has been observed in Si nanoparticles, porous Si, and Si nanowires. Regardless of their size and surface chemistry, the silicon nanocrystals interact with water/alcohol solutions, resulting in their complete oxidation, the hydrolysis of water, and the generation of hydrogen. In addition, porous Si nanostructures exhibit a large internal specific surface area covered by SiH_x bonds. A key advantage of porous Si nanostructures is their ability to release molecular hydrogen through the thermal decomposition of SiHx groups or in interaction with water/alkali. The review also covers simulations and theoretical modeling of H₂ generation and storage in silicon nanostructures. Using hydrogen with fuel cells could replace Li-ion batteries in drones and mobile gadgets as more efficient. Finally, some recent applications, including the potential use of Si-based agents as hydrogen sources to address issues associated with new approaches for antioxidative therapy. Hydrogen acts as a powerful antioxidant, specifically targeting harmful ROS such as hydroxyl radicals. Antioxidant therapy using hydrogen (often termed hydrogen medicine) has shown promise in alleviating the pathology of various diseases, including brain ischemia–reperfusion injury, Parkinson’s disease, and hepatitis. Full article

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