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Introduction Third-degree burns are known to affect the epidermis, dermis, hypodermis and adjacent structures, causing damage to the dermal matrix. To date, the gold standard treatment is autologous skin grafting. However, its effectiveness is limited owing to its availability and cost. Depending on the severity of the wound, the maturation of the graft can take several weeks. The cosmetic results are often unsatisfactory. Given the need to develop new therapies to improve the management and quality of life of patients, cell therapy has become a promising alternative. Objective To describe the evolution of non-grafted third-degree burns after subcutaneous application of autologous bone marrow (BM) total nucleated cells (TNCs). Case report We present the case of a 52-year-old male patient with a third-degree scald on the external surface of the left foot. Nine days after the burn, 2 ml of autologous BM TNCs were applied subcutaneously around the wound. An autologous skin graft was not performed; therefore, healing was performed with second intention. The patient had good clinical evolution without any keloid scars or complications. Conclusion Although current treatments for third-degree burns still have limitations, recent studies have shown the effectiveness of stem cells in these types of burns by allowing accelerated healing. However, further studies are required to demonstrate their efficacy and safety.

The goal of this study was to determine what effect obese body weight and a burn injury can have on the metabolism of glucose and lipids in rats. We used a 3 * 3 factorial model design to provide basic glucose and lipid metabolic data characterizing the interaction between different weight and burn injury groups. Two hundred Sprague Dawley rats were categorized into three weight groups (normal, overweight, obese) and then further divided into control, second-degree, and third-degree burn groups. Our model compared interactions between weight and burn injury factors according to the above groups. Blood glucose and lipid metabolism indicators were monitored on the 1st, 3rd, 7th, and 14th days after burn injury occurred, and burned skin and blood samples were collected for testing. Compared with the normal weight group, the overweight group’s fast blood glucose, fast insulin, and homeostasis model assessment of insulin resistance were higher (P < .05), and FBG in the obese group was higher than the normal weight group (P < .05). Burn injuries combined with obese body weight had an interactive effect on fast blood glucose, fast insulin, and homeostasis model assessment of insulin resistance after burn injury (P < .05). Burn injury combined with obese body weight had an interaction on low-density lipoprotein cholesterol on the 3rd day after burn injury (P < .05). Burn injury combined with obese weight had no interaction on triglyceride, total cholesterol, and high-density lipoprotein cholesterol (P > .05). Rats in the overweight and obese weight groups were observed to develop an adaptation and tolerance to a higher metabolic rate after burn injuries occurred.

Background: Burn are trauma that can cause local and systemic damage including hypermetabolism, inflammation, and hyperglicemia. Stress Induced Hyperglycemia (SIH) occurs by increasing gluconeogenesis and insulin resistance. Both of these are mediated through an increase in regulated stress hormones and proinflammatory cytokines. Melatonin has been proposed as a burn supportive therapy that may prevent oxidative damage and inhibit excessive inflammatory responses. Aim: Proving the effects of melatonin supplementation on blood glucose level in male Wistar rats with burn injury. Methods: This research was an experimental with randomized control group pre-post test design. Twelve healthy male Wistar rats were included and divided into two groups, control and experimental group. Each rat was induced 30% burn injury under anesthesia. Rats in control group were given placebo, while rats in experimental group were treated with melatonin i.p at 0, 8 and 16 hours after burn injury. Blood samples were collected from the retroorbital sinuses at 0, 3, and 24 hours. Data were analyzed statistically by Paired t-Test and Independent t-Test. Results: In male Wistar rats with third degree burns given placebo, blood sugar levels significantly increase in 0-3 hours (p=0.006) and 0-24 hours (p=0.037). Meanwhile, in male Wistar rats with third degree burns given melatonin, blood sugar levels did not change significantly in 0-3 hours (p=0.470), 0-24 hours (p=0.286), dan 3-24 hours (p=0.833). Conclusions: Melatonin administration can not significantly reduce blood sugar levels. Keywords: Burn, burn injury, blood glucose level, melatonin.

Auto-skin grafting is the current treatment of choice for extensive burns. Nevertheless, the lack of donor sites for skin grafting remains one of the greatest limiting factors for the treatment of extensively burned patients. We present the case of a 53-year-old male patient with deep and full thickness burns on 91% of the total body surface area. We used the Meek technique for split-thickness skin graft expansion to treat this patient. In order to obtain sufficient skin for grafting, we repeatedly harvested the same anatomical areas. Acceleration of burn wounds, recipient, and donor site healing was achieved by systemic treatment with recombinant human growth hormone and topical recombinant human epidermal growth factors. This combined, complex treatment modality contributed to the successful skin repair in this patient.

Background: Uses of gentian violet as a marker to determine burn depth, to facilitate early tangential excision.Patient and Method: A prospective study conducted on eighteen burned patients, they were admitted to Burns and Plastic Surgery Hospital in Sulaimani, with deep second and third degree burn, and they underwent early tangential excision with the guidance of gentian violet and grafting. Incisional biopsy was taken from two patients and sent for histopathology, they resulted in staining of dead tissues and preservation of normal tissues.Results: The mean age of the patients was (23.25) years. (77.7%) were with flame burn and (22.3%) were with scald burn. With the use of our method (55.5%) of patients needed one session and (44.5%) of patients needed more than one session of excision and grafting. The mean of excised and grafted area was (9.97%) TBSA. (77.7%) of patients with good graft take (90-100%), (16.6%) of patients with moderate graft take (50-89%), (5.5%) of patients with poor graft take (

The treatment of full-thickness skin burn using nanomaterials is promising as a medical application reducing the risk of infection and severe dermal scarring. Therefore, this study aims to evaluate the effectiveness of nanomaterials, particularly 3% silver nanoparticles containing ointment (3% SNO), on the full-thickness skin burn of laboratory mice. A total number of 36 male mice were used, equally divided into three groups: negative control (not burned and not treated); positive control (+ve) (burned and treated with castor oil and white petroleum jelly); and SNO-treated group (burned and treated with 3% SNO). The skin of the animals’ back was shaved. A 2x0.5 cm metal plate was heated on a burner to burn the skin of the animals of positive control and SNO-treated groups. Pseudomonas aeruginosa bacterial suspension was applied to the burnt area. The application of SNO, as well as the mixture of white petroleum jelly and castor oil, was started after 6 hours of inducing burns and continued for 14 days (three times daily) in the respected groups. The SNO-treated group showed accelerated healing within 14 days demonstrated by re-epithelialization of the epidermal layer and proliferation of the fibroblasts in the dermal layer. Less healing evidence was observed in the +ve control group in the same period. In conclusion, to our knowledge, this is the first study that uses a 3% SNO formula and has found that it has a promising impact on the treatment of infected skin burns.

Burns are complex injuries that lead to hyperglycemia as a stress response. Diabetes Mellitus (DM) is a hormonal and metabolic disorder categorized by impaired insulin secretion and yielding to elevate plasma glucose levels and therefore complicates the therapy of burns, it is also developed via uncontrolled stress reaction to the burn. Also, DM will impact on nutrition and lifestyle of burn patients. This review provides pathophysiology, difficulties and managements of burns related to the patients with DM to offer evidence-based care to seriously ill people. Performing a treatment for diabetic burn patient is difficult for healthcare professionals. Traumatic burn in non-diabetic people may develop stress-induced hyperglycemia which ends up with DM due to endocrine complications from their injury. The higher risk for burn injuries is found in pre-existing DM. Special medical plan should be employed to control burns. Additionally, treatments for present burn must be reformed to avoid diabetes mellitus, management of glucose level, and help healing process in diabetic foot ulcer.

Burns are caused by various external factors, such as radiation, chemicals, electricity, hot surfaces or liquids, which can seriously damage the integrity of the skin. Due to the lack of blood vessel formation, immunosuppression, and sensitivity to various infections, third-degree burns can damage the entire skin layer and delay the healing process. Therefore, this study was planned to evaluate the therapeutic effects of nano ZnO, nano CUR alone and in the composite form in third-degree burns. Topical 1% w/w skin ointments of nano ZnO, Curcuma longa (C. longa) nanoparticles (nano-CUR) and a composite of ZnO and C. longa nanoparticles (nano ZnO/CUR composite) were formulated for the treatment of burn wounds after characterization. A total of 25 rabbits from the animal house were grouped in 4 treatment (nano ZnO, nano CUR, nano ZnO/CUR and positive control) groups with 5 rabbits in each, while 5th group as a negative control group. These rabbits of four treatment groups were branded with the red-hot iron bar having a diameter of 10 mm for 15 seconds to create two burn wounds on each rabbit after induction of anesthesia. Healing time and wound contraction rate were conducted at 7th, 14th, 21st and 28th day after wound infliction while histopathological examination was conducted at 28th day after woud infliction. The statistical evaluation showed that nano ZnO/CUR composite group took less time to heal wound (avg, 24.25D ± 0.5) as compared to other groups of nano ZnO (26.25D ± 0.5), nano CUR (28D ± 0.82) and positive control (36.25D ± 0.5) with a similar pattern as observed for contraction rate of the wound. Histopathological analysis showed higher collagen deposition, vascularization, angiogenesis and fibrosis by nano ZnO/CUR composite treated group as compared to other groups. The study concluded that the application of nano ZnO/CUR composite ointment will heal third-degree burn wounds rapidly as compared to solus alone application.

We report a case of third-degree burn involving 5% of the total body surface area caused by off-label use of Hanautherm®, an infrared radiant heat lamp for bed-warming, in a patient with severe accidental hypothermia. This iatrogenic burn required repeated surgical interventions and long-term hospitalization and caused subsequent cosmetic disfigurement and functional disability. To our knowledge, this is the first reported adult case of iatrogenic burn occurring during treatment for hypothermia. Radiant heat lamps should never be used for rewarming of patients with hypothermia without careful observation.

Cultured allogenic keratinocytes, produced as Kaloderm® (Tego Science, Seoul, Korea), are an effective dressing material for burn wounds. Generally, deep second-degree contact, steam, and flame burns tend to progress to third-degree burns. This study reviews the efficacy of cultured allogenic keratinocytes in deep second-degree burn patients. This is a retrospective study of 64 patients treated between November 2013 and April 2019. A half of deep second-degree contact, steam, and flame burn patients were treated with cultured allogenic keratinocytes. The other half were treated with chlorhexidine gauze and antibiotic ointment. The primary outcome was time to wound closure. A secondary outcome was the number of Kaloderm sheets used. Groups were compared based on the type of burn and treatment. In the experimental group, the median times to reepithelization were 10.0 days for the contact burn group, 13.5 days for the flame burn group, and 11.0 days for the steam burn group. Progression to a third-degree burn occurred in only one patient in the experimental group and four patients in the control group. Patients treated with cultured allogenic keratinocytes required a mean time of 11.7 ± 2.4 days for complete closure, whereas the mean time to complete closure in the control group was 16.4 ± 5.3 days. Patients with deep second-degree burns from flame, steam, and contact treated with cultured allogenic keratinocytes reepithelialized faster than those treated with chlorhexidine dressings.

BACKGRUND: The coagulation status of burn patients is generally impaired and is a major factor of the deteriorating burn patients’ overall situation. In trauma and other patient groups, the differential diagnosis of coagulation impairment has been largely improved by the use of rotational thromboelastometry (ROTEM®). The aim of this prospective observational study was the differentiated observation of coagulopathy in severely burned patients using standard parameters and ROTEM® thrombelastometry during the relevant stages of burn disease. PATIENTS AND METHODS: Twelve patients that sustained at least 20% third degree burns of total body surface area (TBSA) were included in the study. Standard and ROTEM® coagulation analyses were performed on admission and then twice daily during the first 14 days following burn trauma. RESULTS: Although the initial assessment of DIC was similar for both standard labs and ROTEM® measurements, more patients were detected to be in a state of worsening coagulation status for a longer time in ROTEM® than in standard measurements. In addition, one patient was rated in to be in decompensated DIC for 3 days according to ROTEM® measurements, while no patient was rated to be in a decompensated DIC based on standard parameters. CONCLUSION: This study points towards a more complex picture and higher occurrence of DIC in burn patients when thrombelastometric measurements like ROTEM® are taken into account in addition to standard coagulation parameters.

Scalds in the elderly are frequently associated with the use of a bathtub and a disturbed consciousness. Therefore, the total burn surface area is often high. The initial clinical presentation displays a stark erythema of the skin, which frequently does not represent the true depth. The aim of this study was to characterize and assess medical features and outcome of scalds sustained in the bathtub. We conducted a retrospective study at a burn intensive care unit (BICU) between 2011 and 2018. Medical features as well as the treatment in these patients were statistically analyzed. We identified 16 patients and divided them into two groups regarding survival and lethality. The mean total burn surface area was 37.50 ± 19.47%. In 81.25% of the patients, we found a previous history of neurological or psychiatric disorders. Dementia and alcohol abuse were the most common triggers for the trauma. The statistical analysis showed a significant difference for the ABSI-score and the presence of multi organ failure (P-value .0462, respectively, .0004). Erythematous skin areas tended to progress into full thickness burns. We, therefore, coined the term “lobster redness” for these regions. Scalds sustained in the bathtub are devastating injuries. Initial assessment can be misleading and might delay early necrectomy. The wounds request even more attention, if the injuries occurred due to unconsciousness because of the longer exposure to heat. Early necrectomy should be considered. A biopsy with histological workup can be useful. Furthermore, we recommend special safety precautions for neurologically and psychiatrically affected patients.

Reconstruction of breast burns are challenging, as it includes both functional and aesthetic components. Transverse myocutaneous gracilis (TMG) flap has been used for postmastectomy breast reconstruction in the absence of abdominal donor site availability. Use of this flap for the breast burns is limited. A 32-year-old female sustained 54% second and third degree burns resulting with bilateral total breast loss. Anterior and posterior thorax, upper and mid abdomen, neck, shoulders, and bilateral upper extremities were also involved. Inner medial thighs had an ample amount of tissue and had never been used as donor sites. The left TMG (28 × 12 cm, 1,413 g) was used for right, and the right TMG (30 × 14 cm, 1,635 g) was used for the left breast, 3 months apart. The contracture on the chest wall was completely excised. Venous anastomosis to the venae commitantes was performed using a 2.5 mm coupler, followed by an end-to-end arterial anastomosis to the internal mammary artery. Flaps were inset in a fashion so that the inferior part became the inframammary fold, and the anterior and posterior wings were joined in the upper pole, creating a conical shape. Minimal wound dehiscence in the postoperative course healed with dressing changes and both flaps survived completely. Nipple reconstruction and areolar tattooing was performed. The patient was very happy with the outcome at seventh year follow-up. TMG may be a valuable option even in bilateral cases of microsurgical autologous free tissue transfer for total aesthetic reconstruction of postburn breast loss.

Due to the complexity involved in the healing process of full thickness burns, the literature looks for alternatives to optimize tissue reconstruction. The objective of this study was to explore the action of photobiomodulation therapy associated with MSCs in the healing process of third degree burns. A total of 96 male Wistar rats were used, distributed in four groups with 24 animals each: Control Group, Laser Group, Cell Therapy Group, and Laser Group and Cell Therapy. The burn was performed with aluminum plate (150 °C). We performed analysis of wound contraction, histology, immunohistochemistry, birefringence analysis, and immunoenzymatic assay to evaluate tissue quality. Our results demonstrate that the association of the techniques is able to accelerate the repair process, modulating the inflammatory process, presenting a cutaneous tissue with better quality. Thus, we conclude that the use of photobiomodulation therapy associated with cell therapy is a promising treatment in the repair of total thickness burns.

Skin is an ectodermal derivative that maintains internal homeostasis of the body. Any damage to the skin like burn injury internal homeostasis is lost, resulting in delayed healing. The aim is to study the histoarchitecture comparative effect of silver nitrate gel, and BMSCs (DDP) on third-degree burns in Wistar rats. A burn wound of size 2.5 cm (length) x 2.5 cm (breadth) x 6 mm (depth) was created using a preheated metal plate on flanks of Wistar rat. Every burn wound was treated with silver nitrate gel (commercially available as silverex), bone marrow differentiated dermal precursors, and monitored for 1, 7, 14, 21 days until wound healing. Wound surface area was measured and compared among groups with histological and gross observations. The healing time was faster in bone marrow differentiated dermal precursors (DDP) group compared to control. Prolonged silver nitrate gel usage heals burn wound with no infection, but silver toxicity was noted. Wound contraction is slower but steady using bone marrow differentiated dermal precursors (DDP) cell when compared to the group treated with silver nitrate gel. The data from this study help use to use bone marrow differentiated dermal precursors (DDP) cells as an alternate and effective way to treat burn wounds.

BACKGROUND Covering burn wounds, especially high surface area burns has been always a challenge for surgeons. The Meek technique has been introduced to increase the covering area. There is paucity of clinical trials comparing the Meek technique and mesh in the same individuals to assess it efficacy. METHODS In a case-control study, 20 patients with grade III burns who underwent the Meek technique and mesh in different areas/limbs were enrolled. Expansion rate, re-epithelization, operation time, wound infection, graft failure, etc. were compared between the two groups. RESULTS Among patients, 18 were males and 2 were females. The mean of total body surface area (TBSA) was 36.9±16.6%. Mean time of re-epithelialization in the Meek group was 2.8±2.5 months and in the mesh group was 5.0±2.1 months (p=0.01). Operation time was shorter in modified Meek technique (p=0.04). Expansion ratio was higher in modified Meek technique (p=0.04). Local wound infection rates were slightly different without a statistically significant difference. CONCLUSION Meek technique provided higher surface area coverage in comparison to mesh; in addition to faster re-epithelization. Therefore, it is recommended to consider the Meek technique as a routine procedure, especially those with high surface area burns.

Pseudoepitheliomatous hyperplasia (PEH) is a reactive epithelial proliferation secondary to a wide range of stimuli, including traumatic injury, inflammation, infection, and tumors of the skin. PEH secondary to burn injury is rarely reported. We report three cases of PEH patients after burn injury. All three cases were confirmed with the existence of bacterial infection, and all these cases were second- or third-degree burns. All three patients were treated with negative pressure wound therapy after wound debridement or tangential excision. All the wounds healed without split-thickness skin grafting and recurrence.

Fibroblast growth factor 2 (FGF-2) is a multifunctional protein that has major roles in wound healing, tissue repair, and regeneration. This therapeutic protein is widely used for burn treatment because it can stimulate cell proliferation and differentiation, angiogenesis, and extracellular matrix remodeling. In this study, we developed a simple method using a controlled heated brass rod to create a homogenous third-degree burn murine model and evaluated the treatment using recombinant human FGF-2 (rhFGF-2). The results indicated that the wound area was 0.83 ± 0.05 cm2 and wound depth was 573.42 ± 147.82 μm. Mice treated with rhFGF-2 showed higher rates of wound closure, granulation tissue formation, angiogenesis, and re-epithelialization than that of phosphate-buffered saline (PBS)-treated group. In conclusion, our lab-made rhFGF-2 could be a potentially therapeutic protein for burn treatment as well as a bioequivalent drug for other commercial applications using FGF-2.

Fungal kerion is a hypersensitivity reaction to a scalp dermatophyte which gains access to the hair shaft following physical trauma. However, precipitating injuries are rarely reported. We report the case of a 4-year-old girl who presented with non-healing scalp lesions following a deep dermal forehead scald caused by hot water. The third degree burn was epithelialized with two autologous split skin grafts from a donor thigh site. The grafts were complicated by early bacterial infection treated with intravenous antibiotics. The child returned to her remote community and was lost to follow up. Three months later, fungal kerion at the same site as the burn was clinically diagnosed and confirmed with culture of Trichophyton tonsurans from plucked hair samples. Her condition improved after treatment with oral terbinafine and co-trimoxazole (for suspected bacterial co-infection). Clinical recognition of fungal kerion following a deep burn injury as a trauma mechanism is presented to facilitate early recognition in other children with similar risk factors.

Despite advances in burn care, mortality in adult patients with extensive burn injuries remains a concern, particularly in those who develop concurrent acute respiratory distress syndrome (ARDS). In cases of ARDS refractory to conventional treatments, venovenous extracorporeal membrane oxygenation (ECMO) may represent a viable salvage therapy, even in the major burn population. We present the case of a 38-year-old man with full thickness burns to over 80% of his body, who developed severe ARDS 4 days postburn. After failing to respond to deep sedation, paralysis, and proning, ECMO therapy was initiated to maintain oxygenation and ventilation. Over the next 14 days, while the patient was treated with ECMO, he successfully underwent three major operations to debride and allograft approximately 65% of his body surface area, including one in the prone position. ECMO therapy was discontinued on postburn day 18, and the patient had his wounds reconstructed and survived his injuries. To the best of our knowledge, this is the first report of a burn patient with such severe burns requiring surgical intervention that has been treated with ECMO and survived, and the first case of a burn patient on ECMO having surgery in the prone position. They conclude this case serves as a “proof of concept” that ECMO is a potential treatment for appropriately selected major burn patients with ARDS who fail to respond to other therapies.

Introduction: Electrical burns are potentially devastating injuries and most often occur at the workplace. Scalp defects following electrical burns are a rare occurrence and usually present as a reconstructive challenge. Case Presentation: Male, 31 years old, suffered a high voltage electrical burn at work that resulted in a scalp defect with exposed bone and a third degree burn in the left leg and foot complicated by a compartment syndrome, which needed an emergent fasciotomy and later an amputation below the knee. The scalp defect was covered by a local transposition flap and a skin graft. At 3 months post-operatively flap survived completely with no necrosis or other complications. A satisfactory cosmesis and preservation of scalp contour were achieved. Conclusion: Reconstructive ladder must be respected in reconstruction of these rare and complex defects. Local transposition flaps, if available, are often an ideal choice for scalp reconstruction in that the adjacent tissue is of similar quality to the original defect tissue with a long-term durability, contour preservation, minimal donor site morbidity and an acceptable cosmesis.

Introduction: Burns are one the most common skin damages which require medical intervention to be fully-recovered. In this light, tissue engineering field presents a vide verity of strategies including both scaffold-based and cell-based approaches to recover the damaged site. Materials and Methods: In this study, the effects of granulocyte-colony stimulating factor (G-CSF) administration on mobilization of the bone marrow mesenchymal stem cells (MSCs) into defect area and treatment of the skin burn wound was examined in vivo. The G-CSF was injected intravenously into rats subjected to third degree burn wound. At days 3, 5, 7, 15 and 30 post-injections, the defect site was removed and investigated by H&E and Malory’s trichrome staining. The number of MSCs in blood samples was also determined by flow cytometry assay. Results: According to the results, intravenously administration of G-CSF significantly increased collagenesis and number of fibroblast cells infiltrated into the burned site, while decreased the severity of acute inflammatory response and amount of inflammatory cells comparing to control. The number of MSCs in bloodstream, representing the rate of MSCs migration, showed a 4-fold increase in the experimental group compared to control. Conclusions: The current study suggests the potential of intravenously administration of G-CSF as an effective strategy for treatment of severe burn injuries.

A high incidence of honey oil and methamphetamine production has led to an increase in burn victims presenting to this regional burn center in California. This study aims to compare patient outcomes resulting from burn injuries associated with honey oil and methamphetamine production. This is a retrospective cohort study using the regional burn registry to identify patients with burn injuries related to honey oil production or methamphetamine purification explosions from January 1, 2008 to December 31, 2017. Patient demographics and clinical outcomes data were abstracted from the burn registry and medical records. A total of 91 patients were included in the final analysis and 59.3% (n = 54) were related to honey oil injury. There was no statistically significant difference between honey oil and methamphetamine burn injuries in regard to clinical outcomes, including mortality (1.9% vs 8.1%, P = .1588), third-degree burn (47.2% vs 59.5%, P = .2508), mechanical ventilator usage (50% vs 69.4%, P = .0714), median hospital length of stay (LOS; 10 vs 11 days, P = .5308), ICU LOS (10 vs 11 days, P = .1903), total burn surface area (26.5% vs 28.3%, P = .8313), and hospital charge (median of US$85,561 vs US$139,028, P = .7215). Honey oil burn injuries are associated with similar hospital LOS, similar ICU LOS, similar total burn surface area, and present a costly public health concern. With the recent legalization of marijuana in California, commercial production of honey oil in addition to increasing education about the risks of illicit honey oil production may alleviate associated risks.

This study aimed to investigate the preventive and therapeutic effects of ulinastatin on the recovery of vascular permeability and hemodynamics in shock-affected organs during early burn injury.Twelve beagle dogs with 35% TBSA full-thickness burn were randomized to control group (CG, n = 6) and ulinastatin group (UG, n = 6).Hemodynamic parameters were determined by PICCO before burn and at 0.5 h, 1 h, 2 h, 4 h, 6 h, 8 h post-burn. Plasma volume (PV) were deduced through indocyanine green (ICG) method. Blood samples were drawn to determine hematocrit (HCT) at each time. Intestinal mucosal blood flow (IMBF) was determined by laser Doppler flowmetry. Evans blue (EB) method was taken to measure the vasopermeability of heart, liver, spleen, kidney and small intestine. Pathological tests were also performed.Compared with CG,UG had better hemodynamic parameters (improved mean arterial pressure and cardiac output) (P 0.05). HCT rose in both groups, while in UG the rising extent was less than that in CG (P 0.05). PV and IMBF in both groups declined, but in UG the extent were less (P 0.05). Both EB content of liver, spleen, kidney and small intestine in UG were much lower than that in CG at 8 h post-burn (P 0.05). Pathological changes showed that severe injury was significantly ameliorated in UG.Ulinastatin helped to moderate the quick loss of circulatory volume and improved hemodynamic indices in beagle dogs who had suffered 35% third degree burn injuries. It may serve as a therapeutic agent for reducing vascular permeability, thereby preventing fluid loss following major burn injury.

Bacterial cellulose is well known for its excellent contributions in biomedical applications due to its superior properties. However the lack of antimicrobial property restricts its use in wound healing. To address the complications in third degree burns, thymol enriched bacterial cellulose hydrogel (BCT) was developed in this study. The incorporation of thymol into bacterial cellulose along with its chemical and thermal changes were investigated by FTIR, TGA and DSC respectively. Antimicrobial studies revealed that BCT possess excellent biocidal activity against burn specific pathogens. The in vitro biocompatibility studies were carried out in mouse 3T3 fibroblast cells. The BCT hydrogel facilitated the growth of fibroblast cells, exhibiting low toxicity, and increased cell viability. The burn wound healing efficiency of the BCT hydrogel was examined in vivo using female albino Wistar rats. Histopathological studies reveal that the wound treated with BCT hydrogel showed faster wound closure than BC and control groups. All these findings, suggest that BCT hydrogel can be used as resourceful and natural burn wound dressing material.

Highlights • Therapy for high grade burns: immediate debridement, coverage with suitable dressings. • Post-burn scar contracture-surgery: at least one year after the burn injury. • Mobilization of Mesenchymal Stem Cells in infants is a autologous stem cell therapy., Introduction Burn injuries in newborns are particularly complex cases. Since these patients are rare, there is little experience and no existing standardized treatment. Presentation of case This report examines a case of accidental second to third-degree burning of the heel and toes on the left foot in a new-born girl. The burns covered an estimated 1% of the total body surface area (TBSA). After an initial debridement and 32 days of non-surgical wound therapy with Adaptic® fat gauze dressings, we were able to achieve an aesthetically and functionally satisfactory result including the complete preservation of all toes. In order to eliminate a scar contracture, we carried out a Z-plasty one year later. Discussion Modern wound treatment following the principle of less frequent dressing changes allows the burn wound to have better re-epithelialization. New findings in stem cell research indicate that the high proportion of mesenchymal stem cells (MSC) in postnatal blood is also involved in the regeneration and healing of burns. To our knowledge, this is the first case report dealing with initial non-surgical combustion therapy in a newborn. Conclusion There is evidence that newborns have a much higher potential for wound healing than adults. Proper position in long-term immobilization of toes is important to prevent scar contracture and deformity.

Burns on the face pose unique management challenges because they are in a place that is constantly visible, so scars are hard to hide. The goal of this study was to review our experience of adult patients who had face burns. We performed a retrospective review of adult patients (≥18 years old) who were admitted to a regional burn center from July 2015 to June 2019 with face burns. Sex, age, ethnicity, burn etiology, burn size, and discharge status were collected from electronic medical records of the patients who met study criteria. Descriptive statistics, Student’s t-tests, and chi-square tests were performed in Stata/SE 16.1. Significance was defined as a P-value < .05. In 4 years, 595/1705 patients (~35% of admissions) were admitted with face burns. The mean age was 44.9 ± 17.0 (mean ± SD) years, with the majority being men (475, 80%). The mean burn size was 19.8 ± 20.9% TBSA with 10.1 ± 19.8% TBSA being third degree. The mean head burn size for any face burn was 2.8 ± 1.8% TBSA. The majority of burns were due to flames (478, 80%) and of those 122 (21%) were from accelerant use and 43 (7%) resulted from propane or butane use. Scalds caused 53 (9%), electric 25 (4%), hot tar 5 (1%), and chemical 5 (1%). Overall, 208 (35%) patients had grafting of some portion of their body, but only 31 patients (5.2%) had face grafting. The mean age of those with face grafting compared with patients who did not need grafting was 45.9 ± 13.8 and 44.9 ± 17.2 years, respectively. Patients who needed grafting had a mean third-degree burn size of 31.7 ± 25.4% TBSA and a mean head (including face) burn size of 4.7 ± 2.0% TBSA, whereas patients who did not need grafting had a mean third-degree burn size of 8.9 ± 18.7% TBSA and a mean head burn size of 2.7 ± 1.8% head TBSA. Patients requiring face grafts had longer lengths of stay, intensive unit stays, ventilator days, and mortality than those whose face burns healed spontaneously. Overall, head burns in adults were common within the 4-year time span we studied, but only a small fraction (5%) had face grafts. The patients who needed grafting for their head burns had significantly larger total body and face burns and had a 2.4-fold higher mortality rate compared to patients who did not need grafting. Most face burns were caused by flame, especially the use of accelerants or flammable gases. Prevention efforts should focus on avoiding the use of accelerants and being careful with flammable gases.

Burn depth is a critical factor in determining the healing potential of a burn as the extent of injury ultimately guides overall treatment. Visible-Light Hyperspectral Imaging is an FDA-approved, noninvasive, and noncontrast imaging technology that uses light waves within the visible spectrum to evaluate skin and superficial soft tissue perfusion. In this case report, visible-light hyperspectral imaging was used to evaluate a 37-year-old male who presented to the Emergency Department with a thermal burn of the trunk, back, and right upper extremity. Images were taken at initial evaluation, 6 hours postinjury, and again during daily dressing changes until hospital day 5 when the patient underwent surgical debridement. In this patient, operative treatment was postponed until 89.7 hours postinjury, at which point the clinical examination showed clear visual demarcation in regions of irreversible damage. Comparatively, visible-light hyperspectral imaging analysis of the permanently injured tissue demonstrated acute but varying changes in both oxygenated hemoglobin and deoxygenated hemoglobin at the time of initial evaluation. The most dramatic change in tissue oxygenation occurred between 6.5 and 39.3 hours, demonstrating visible-light hyperspectral imaging’s ability to detect significant differences in oxygenation values between areas of second-degree superficial burns and areas of second-degree deep and third-degree burns in the acute period. The data suggest that the utilization of visible-light hyperspectral imaging in this 6.5- to 39.3-hour window may help predict final burn depth before clinical assessment, potentially allowing for surgical intervention within the first 48 hours following injury.

Background: The treatment of 3rd degree burns represents a major medical challenge. Pinus vegetable cellulose is a biomaterial with characteristic similar to bacterial cellulose. Aim: To evaluate the safety of cellulose membrane (Pinus sp) in the treatment of 3rd burns in rats and to compare its effectiveness with the bacterial membrane already on the market. Method: Thirty-three Wistar rats were beaten with a 3rd degree burn on back skin by applying water at 98º C for 30 s. Then, they were divided into three groups (n=11): group 1 - simple dressing with gauze; group 2 - dressing with bacterial cellulose membrane; and group 3 - dressing with vegetable cellulose membrane. The animals were maintained for 15 days to check the general clinical status, macroscopic aspect, contraction of the wounds and microscopic analysis for the degree of healing and collagenization. Results: They were clinically well during the experiment. During the removal of the dressing, there was bleeding in the wound of the control group, unlike the groups treated with cellulose membranes, which protected the bed from injury. The macroscopic evaluation showed a greater contraction of the wounds treated with the membranes in relation to the control. A microscopic analysis revealed that most of the wounds were in advanced healing degree with predominance of mature collagen in all groups. Conclusion: Pinus sp cellulose membrane showed efficacy similar to that of the bacterial membrane in the treatment of 3rd degree burns. RESUMO Racional: O tratamento das queimaduras de 3˚ grau representa grande desafio na área médica. A celulose vegetal de pinus é biomaterial com características semelhantes às da celulose bacteriana. Objetivo: Avaliar a segurança da membrana de celulose vegetal (Pinus sp) no tratamento de queimaduras de terceiro grau em ratos e comparar sua eficácia com a da membrana bacteriana já comercializada. Método: Trinta e três ratos Wistar foram submetidos à queimadura de 3º grau na pele do dorso mediante aplicação de água a 98º C durante 30 s. Em seguida, foram distribuídos em três grupos (n=11): grupo 1 - curativo simples com gaze; grupo 2 - curativo com membrana de celulose bacteriana; e grupo 3 - curativo com membrana de celulose vegetal . Os animais foram avaliados durante 15 dias para verificar o estado clínico geral, aspecto macroscópico, contração das feridas e análise microscópica pelo grau de cicatrização e colagenizacao. Resultados: Permaneceram clinicamente bem durante o experimento. Durante a retirada do curativo houve sangramento na ferida do grupo controle, diferentemente dos grupos tratados com as membranas de celulose, que protegeram o leito da lesão. A análise microscópica mostrou que a maioria das feridas apresentava-se em grau avançado de cicatrização, com predomínio de colágeno maduro em todos os grupos. Houve maior contração das feridas tratadas com as membranas em relação ao grupo controle. Conclus ão: A membrana de celulose de Pinus sp apresentou eficácia semelhante à da membrana bacteriana no tratamento de queimaduras de 3˚ grau.

Refereed/Peer-reviewed Topical drug therapy is one of the most effective approaches in third-degree burn wound treatments. To optimize and enhance drug permeation through burn eschar, we need to characterize this barrier, most importantly, its affinity to drugs; the subject of this investigation. Hansen Solubility Parameters (HSP), as polarity and affinity scale, were measured here for human third-degree burn eschar through uptake studies using 19 solvents at 25 °C and 32 °C and two hydration levels by gravimetric method combined with thermal analysis and Karl Fischer titration. HSP parameters of dispersion (δD), bipolar (δP), and hydrogen bonding (δH) were calculated by HSPiP software. Results showed δD, δP, and δH of 17.0, 12.5, 14.6 and 16.8, 12.4, 14.4 at 25 and 32 °C respectively for normally-hydrated samples. Full hydration increased HSP values to 17.2, 12.9, 15.3 (25 °C) and 17.1, 12.8, 15.1 (32 °C). Good correlations between solvents uptakes and HSP values were observed for all parameters; higher for δP. Increased temperature decreased them with more changes in δH. Relative Energy Differences (RED) were calculated and shown to be a good parameter for predicting drug-eschar affinity. The obtained information is useful for drug selection and carrier design in drug delivery through burn eschar.

Background: Burns death both intentional and non-intentional considered among the most disastrousoutcome of burn injuries.Objectives: To measure the case fatality rate in hospitalized burn patients and to investigate in-hospitalmortality among burn injury cases who were admitted to Al–Sadiq Teaching Hospitalburn center from thefirst of January to the end of June, 2020.Methodology: This is an observational descriptive case series study conducted on all cases who died fromburn injury among patients who were admitted to the biggest teaching hospital in Babylon Province – Iraq.Data were collected from patients themselves or their companions and from patients’ hospital records, usinga pretested questionnaire designed for collection the requested information.Results: The mean age ± SD (Standard Deviation) of burn death victims were 24.5±17.66 years. Youngage group (15-24 years) represents the highest proportion (50%). Male to female ratio was 1:2.25. The casefatality rate was 26.6%(32/120). The majority of cases were from rural areas, 67% of suicidal burn deathshad more than 50% of burnt total body surface area. Intentional burn deaths victims had significantly severeburns (third degree burn and high-burnt surface area) as compared to accidental burn deaths. There was astatistically significant difference as regards the mode of burns between the intentional and accidental burndeaths, all intentional deaths were burnt with flame.Conclusions: The case fatality rate of burn injuries was high, females outnumbered males, and suicidal burndeaths were significantly associated with severe burn as compared to the accidental ones.

This is the first study to evaluate the topical application of Lobelia alsinoides Lam (LT) ethanolic extract on burns in rats. A deep third-degree burn wound was inflicted in adult male Wistar rats and the burns were dressed daily with a topical ointment formulation (Patent filed) comprising of Lobelia alsinoides Lam (5% and 10% w/w). The wound had noteworthy contraction and quicker eschar removal in 10% w/w LT-treated groups followed by 5% w/w treated groups on comparing with the commonly prescribed ointment (SilverexTM containing 1% w/w Silver sulfadiazine). Histopathological analysis showed that ointment containing 10% w/w LT ethanolic extract significantly increased fibroblast growth, which plays a major role in anatomic integrity, collagen synthesis, and accelerated the rate of the healing process. This study shows that the ethanolic extract of Lobelia alsinoides Lam, a previously pharmacologically unreported traditional medicinal plant, possesses wound contraction and eschar removal properties on burn wounds.

BackgroundChronic pain, unrelated to the burn itself, can manifest as a long-term complication in patients sustaining burn injuries. The purpose of this study was to determine the prevalence of chronic neuropathic pain (CNP) and compare burn characteristics between patients who developed CNP and patients without CNP who were treated at a burn center.MethodsA single-center, retrospective analysis of 1880 patients admitted to the adult burn center was performed from 1 January 2014 to 1 January 2019. Patients included were over the age of 15 years, sustained a burn injury and were admitted to the burn center. CNP was diagnosed clinically following burn injury. Patients were excluded from the definition of CNP if their pain was due to an underlying illness or medication. Comparisons between patients admitted to the burn center with no pain and patients admitted to the burn center who developed CNP were performed.ResultsOne hundred and thirteen of the 1880 burn patients developed CNP as a direct result of burn injury over 5 years with a prevalence of 6.01%. Patients who developed CNP were a significantly older median age (54 years vs. 46 years, p = 0.002), abused alcohol (29% vs. 8%, p abused substances (31% vs. 9%, p ConclusionsThe prevalence of CNP over 5 years was 6.01% in the burn center. Older ages, alcohol abuse, substance abuse, current daily smoking, greater percent of total body surface area (%TBSA) burns, third degree burns, being intubated on mechanical ventilation, having more surgeries and longer hospital LOS were associated with developing CNP following burn injury, compared to patients who did not develop CNP following burn injury.

More than 23,000 smoke inhalation injuries are reported in the United States each year. While the pathophysiology of smoke inhalation-induced lung injury is well studied, little is known about the acute effects of smoke inhalation on the central nervous system (CNS). Tragic events, such as those of the nightclub fire in Brazil in 2013, suggest that neurological complications occur following smoke inhalation injury, with the most commonly reported symptoms being a persistent headache, memory loss, and paresthesia. Additionally, one case report described that smoke inhalation alone was associated with progressive cognitive and psychiatric impairments, lasting for years after the initial injury, with neurological dysfunctions starting within one-month post-injury and persisting for over 14 years. These reports lead to the conclusion that acute smoke inhalation injury results in a long-term global decrease in metabolic activity and deterioration of several areas of the brain. In this study, using a well-characterized ovine model, we aimed to characterize acute pathophysiological changes in the brain induced by smoke inhalation, with and without third-degree skin burn injury. Our data show that smoke inhalation, regardless of the presence of third-degree skin burn, leads to diffuse histopathological changes in the brain and loss of blood-brain barrier integrity resulting in dilated and congested blood vessels and micro-hemorrhaging. These findings provide important information that can be used to develop effective and novel treatment options for patients with smoke and burn injuries aimed at alleviating CNS dysfunction.