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Objetivo: Avaliar a probabilidade de adequação do consumo alimentar de cobre e zinco de pacientes queimados hospitalizados na cidade de Fortaleza, Ceará. Método: Trata-se de um estudo prospectivo, descritivo, quantitativo, realizado entre abril e maio de 2017. Foi aplicado recordatório alimentar de 24 horas em três dias não consecutivos. O consumo declarado foi convertido em valores de nutrientes e avaliado quanto í probabilidade de adequação. Certificado de Apresentação de Apreciação Ética nº 60526116.9.0000.5047. Resultado: Participaram 21 pacientes hospitalizados em um centro de tratamento de queimados, sendo 61,9% do sexo masculino e 38,1% do sexo feminino, com faixa etária de 19 a 48 anos. Identificou-se maior distribuição da amostra na faixa superior a 85% de probabilidade de adequação do consumo observado, estando nesse ní­vel ou acima 85,71% da população total no consumo adequado de cobre e 90,47% da população total para o consumo adequado de zinco. Conclusão: Foi possí­vel identificar alta prevalência de probabilidade de adequação do consumo de cobre e zinco.

Introduction Nexobrid®, a bromelain-based type of enzymatic debridement, has become more prevalent in recent years. We present the recommendations on enzymatic debridement (Nexobrid®)’s role based on the practice knowledge of expert Italian users. Methods The Italian recommendations, endorsed by SIUST (Italian Society of Burn Surgery), on using enzymatic debridement to remove eschars for burn treatment were defined. The definition followed a process to evaluate the level of agreement (a measure of consensus) among selected experts, representing Italian burn centers, concerning defined clinical aspects of enzymatic debridement. The consensus involved a multi-phase process based on the Delphi method. Results The consensus panel included experts from Italy with a combined experience of 1068 burn patients treated with enzymatic debridement. At the end of round 3 of the Delphi method, the panel reached 100% consensus on 26 out of 27 statements. The panel achieved full, strong consensus (all respondents strongly agreed on the statement) on 24 out of 27 statements. Discussion The statements provided by the Italian consensus panel represent a “ready to use” set of recommendations for enzymatic debridement in burn surgery that both draw from and complete the existing scientific literature on the topic. These recommendations are specific to the Italian experience and are neither static nor definitive. As such, they will be updated periodically as further quality evidence becomes available.

On December 9, 2019, Whakaari/White Island volcano in New Zealand erupted with 47 people on the island. Thirty-one people survived long enough to enter the New Zealand National Burn network—13 were repatriated to Australia within 72 hours and 14 of the remaining 18 were treated at the National Burn Center at Middlemore Hospital in Auckland. Our department has previously published a model to calculate the total operative requirements for any given burn surface area for the first 4 weeks of burn treatment. From this model, we calculated the predicted surgical time and operative visit requirements for each patient and compared this to their actual requirements. Actual requirements were also recorded beyond 4 weeks until discharge. Results show that the average variance for operative minutes was significantly above predicted with both the full-thickness burn model (average variance 3.24) and the electrical burn model (average variance 2.65). There was a wide range in both cases (0.54–6.17 and 0.44–5.06, respectively). There was less variance from predicted values of operative visits required than operative minutes (mean: 1.58; range 0.9–3.02). Overall, the values for patients with smaller burns showed the greatest variability from predictions with regard to the total number of operative visits during the first 4 weeks of care. Additionally, patients with burn size greater than 50% TBSA required significant theater access beyond 4 weeks. Analysis of these findings will assist with future planning in both disaster and non-disaster settings in the provision of burn care.

The initial care of burn wounds and choice of dressing are pivotal to optimally support the healing process. To ensure fast re‐epithelialisation within 10–14 days and prevent complications, an optimal healing environment is essential. An innovative dressing based on nanocellulose was used for the treatment of burns in children. Children (0–16 years) with clean, partial‐thickness burn wounds, 1 to 10% of the total body surface area were included. Complete re‐epithelialisation was achieved within 7–17 days, with 13 patients showing re‐epithelialised >95% by day 10. Satisfying results concerning time to re‐epithelialisation and material handling were obtained. The possibility to leave the dressing on the wounds for 7 days showed a positive effect in the treatment of children, for whom every hospital visit may cause massive stress reactions. The nanocellulose‐based dressing is a promising tool in conservative treatment of burns. Reducing the frequency of dressing changes supports a fast and undisturbed recovery; moreover, the dressing provides an optimal moist healing environment. The time to re‐epithelialisation is comparable to frequently used materials, and cost reduction effect can be achieved without loss of quality. Possible pain and distress levels are kept to a minimum; therefore, flexibility and compliance of the patients and their parents are enhanced.

In the burn treatment landscape, a variety of skin substitutes, human tissue-sourced products, and other products are being developed based on tissue engineering (ie, the combination of scaffolds, cells, and biologically active molecules into functional tissue with the goal of restoring, maintaining, or improving damaged tissue or whole organs) to provide dermal replacement, prevent infection, or prevent or mitigate scarring. Skin substitutes can have a variety of compositions (cellular vs acellular), origins (human, animal, or synthetically derived), and complexities (dermal or epidermal only vs composite). The regulation of tissue-engineered products in the United States occurs by one of several pathways established by the U.S. Food and Drug Administration, including a Biologics License Application (BLA), a 510(k) (Class I and Class II devices), Premarket Approval (Class III devices), or a human cells, tissues, and cellular and tissue-based products designation. Key differentiators among these regulatory classifications include the amount and type of data required to support a filing. For example, a BLA requires a clinical trial(s) and evaluation of safety and efficacy by the Center for Biologics Evaluation and Research. Applicable approved biological products must also comply with submission of advertising and promotional materials per regulations. This review provides a description of, and associated requirements for, the various regulatory pathways for the approval or clearance of tissue-engineered products. Some of the regulatory challenges for commercialization of such products for the treatment of burns will be explored.

Objective: Accelerating the process of wound healing, reducing infection risks, and decreasing pain and discomfort in the burn area are important goals of burn treatment. To achieve these goals, the use of biosynthetic wound dressings has increased in recent years. Suprathel (PolyMedics Innovations, Germany) is a biosynthetic wound dressing used to treat both partial-thickness burns and split-thickness skin graft (STSG) donor sites, full-thickness wounds, large-scale abrasions, and scar revisions. Method: This study is a systematic review of empirical evidence reported on the application of the biosynthetic wound dressing in burns up to 2017. Keywords such as ‘Suprathel’, ‘effectiveness’, ‘safety’, and ‘cost’ were searched in PubMed, Cochrane, Scopus and Embase databases. Results: A total of 14 publications were identified, based on the inclusion and exclusion criteria. The findings reported in the literature reviewed were classified in terms of safety, effectiveness and cost-effectiveness of use of the biosynthetic wound dressing. Regarding safety and effectiveness, the dressing was found to yield desirable results, particularly for partial thickness burns and STSG donor sites. As of 2017 no health economics assessments have been carried out. Conclusion: Despite the desirable advantages of the biosynthetic wound dressing with respect to its effectiveness, safety and ease of use, its major limitation was found to be its cost. However, in the absence of comprehensive studies on the quantification of all factors, there is scant scientific evidence for making reliable conclusions from this systematic review.

Negative pressure wound therapy (NPWT), which has been applied in various medical specialties to accelerate wound healing, has been the object of a few investigations. We explored the effectiveness of NPWT and the possibility of its inclusion in burn management guidelines. Randomised controlled trials comparing NPWT with non‐NPWT treatments for burn wounds were extracted from PubMed. For the risk of bias analysis, all included studies were evaluated according to the Cochrane risk of bias tool and the approaches outlined in the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) Handbook. Outcomes such as graft take rate in the first week, infection rate, and overall complication rate were analysed. Six studies that included a total of 701 patients met our inclusion criteria. Qualitative analysis revealed that the NPWT group had a significantly better overall graft rate in the first week (P = 0.001) and a significantly lower infection rate (P = 0.04). No significant difference in the overall complication rate was found. Our results indicate that NPWT is a safe method for stimulating healing and lowering the infection rate of burn wounds. NPWT can be part of general burn management, and its incorporation into burn treatment guidelines is recommended.

IntroductionThere is an absence of evidence regarding predictors of moderate to severe pain in children undergoing acute burn treatment. This investigation aimed to determine if relationships existed between patient and clinical characteristics, and pain at first dressing change for children with acute burn injuries.MethodsA retrospective cohort investigation was conducted using clinical data from pediatric burn patients treated at the Queensland Children’s Hospital, Brisbane, Australia. Data extracted included patient and burn characteristics, first aid, and follow-up care. Observational pain scores were categorized into three groups (mild, moderate, and severe pain), and bivariate and multivariable relationships were examined using proportional odds ordinal logistic regression. Data from 2013 pediatric burns patients were extracted from the database.ResultsFactors associated with increased odds of procedural pain included: hand burns (OR 1.7, 95% CI 1.3 to 2.1, pDiscussionIt is recommended that patients presenting with one or more of the aforementioned factors are identified before their first dressing change, so additional pain control methods can be implemented.

Despite a considerable decrease in its incidence worldwide, burns remain the fourth most common type of trauma. The majority of burns are small, with 75% of injuries treated on an outpatient basis. Tilapia skin, as a biological material, has been suggested as an option for the management of burn wounds. After good results were obtained with the use of a glycerolised version of tilapia skin in burned children and adults, it was hypothesised that similar outcomes could be achieved with the use of a lyophilised version of tilapia skin. We report the case of a 33-year-old female patient with scalds to the upper abdomen, and both breasts, arms and forearms. Involvement of 10% of total body surface area with superficial partial thickness burns was calculated. The good adherence of tilapia skin to the wound bed, a 10-day period for complete re-epithelialisation of the wounds and the absence of side effects suggested that the lyophilised version of tilapia skin is effective for burn treatment. Compared with glycerolisation, lyophilisation is thought to permit extended storage of sterile tissue and decreased costs related to distribution and transport, but further studies are needed to confirm this.

Although new therapeutic approaches for burn treatment have made progress, there is still need for efficient coverage of donor fields. Promising dressing for skin graft donor site should be biocompatible, attach easily to the wound bed, remain in place until donor site has renewed, and decrease morbidity at the site. Porcine skin may be applied as a dressing for severe burns. Therefore pig skin xenografts can be used also as donor field coverage. In the Burn Treatment Centre, we used gauze soaked in Vaseline to secure donor fields. The aim of the study was to check if transgenic porcine skin is better than standard in donor site coverage used in our center. We showed that dressing reduces pain experienced by patients. The dressing leads to a reduction of hospitalization time by an average of 8 days. The dressing is as safe as the gold standard. Securing the donor field reduces the risk of colonization of the wound in the second smear after application by 60%. The disadvantage of the dressing is the inability to absorb blood; the use of hemostatic ointments in combination with the skin of transgenic pigs should be considered in the future.

Burns is a form of acute skin injury caused by trauma to heat, cold, electricity, chemicals, friction, or radiation with a high incidence rate. However, burns that are not properly treated will have an impact on further problems in the future, such as the appearance of hypertrophy scar, keloid, and contractures caused issues that have an impact on decreasing the quality of life. One of the newest methods of healing burns is using the secretome from mesenchymal stem cells. One case was reported, a 47-year-old woman with second-degree burns who was given intervention in the form of secretome from Placenta Warton Jelly Mesenchymalchymal Stem Cell (SC-PWJSC). During the 20 days of the intervention, there was excellent wound healing without hypertrophy scar or keloid with significant no local or systemic side effects were found.

Günümüzde doku mühendisliği çalışmaları her geçen gün artmaktadır. Doku mühendisliği alanında yeni bir etki yaratan bu çalışmanın amacı, cilt mekanizmasının işlevini mekanik ve biyolojik olarak taklit edebilen üç boyutlu yara örtüleri üretmektir. İşlem sırasında matris polimeri olarak poli (vinil alkol) (PVA) kullanılmış ve aljinik asit sodyum tuzu (SA), Jelatin-Metakriloil (GelMA) ve farklı miktarlarda Gentamisin Sülfat (GS) matriks oluşturmak için yapılara ayrı ayrı entegre edilmiştir. Termal, mekanik, morfolojik, kimyasal özellikler ve biyouyumluluk davranışları detaylı olarak değerlendirildi. Mekanik test sonuçları, 15 mg GS ile PVA (%13 hacim/ağırlık)-SA (% 2 hacim/ağırlık)- GelMA %0.25 hacim/ağırlık) yara örtüsünün yaklaşık 12.5 MPa ile en yüksek gerilme mukavemetini gösterdiğini göstermiştir. Termal karakterizasyon sonuçlarına göre, tüm yara örtüleri 220°C civarında benzer erime sıcaklığına sahipti. Yara örtüsünün biyouyumluluk özellikleri mitokondriyal dehidrojenaz aktivitesi ile test edildi ve in vitro çalışmalar, 20 mg GS ile PVA (%13 hacim/ağırlık) -SA (%2 hacim/ağırlık)- GelMA %0.25 hacim/ağırlık) kompozit yapının, fibroblast hücre hattı ile kültürlendikten sonra, diğer yapılara göre daha fazla hücre canlılığına sahip olduğunu gösterdi. Nowadays, tissue engineering studies are increasing day by day. The aim of this study, which has a new impact on field of tissue engineering, is to produce three-dimensional wound dressings that can mimic the function of the skin mechanism mechanically and biologically. During the process, poly (vinyl alcohol) (PVA) was used as a matrix polymer and alginic acid sodium salt (SA), Gelatin-Methacryloyl (GelMA) and different amounts of Gentamicin Sulphate (GS) were integrated separately with the matrix to build the constructs respectively. Thermal, mechanic, morphological, chemical features and biocompatibility behaviors were evaluated in detail. Mechanical test results demonstrated that wound dressing of PVA (13% w/v) -SA (2% w/v)- GelMA 0.25% w/v) with 15 mg GS displayed the highest strain strength of around 12.5 MPa. According to thermal characterization results, all wound dressing had similar melting temperature around 220°C. Biocompatibility properties of the wound dressing were tested by mitochondrial dehydrogenase activity, and in vitro studies showed that the of PVA (13% w/v) -SA(2% w/v)- GelMA 0.25% w/v) with 20 mg GS composite construct had more cell viability than the other constructs by making use of the fibroblast cell line.

Amaç: Bu çalışmanın amacı 2011 yılının Ocak ayından 2020 yılının Aralık ayı bitimine kadar, yanık merkezimizde tedavi edilen yanık hastalarına ait kayıtların epidemiyolojik olarak incelenmesidir. Yöntemler: Bu tanımlayıcı ve kesitsel türdeki çalışma Dicle Üniversitesi Tıp Fakültesi Hastanesi Yanık Merkezinde, retrospektif olarak gerçekleştirildi. 2011-2020 yılları arasında yanık vakaları elektronik hasta kayıtlarından elde edildi ve incelendi. İstatistiksel analizler Statistical Package for Social Sciences for IBM 25 paket programı ile yapıldı. Veri değerlendirmesinde tanımlayıcı istatistik yöntemleri (sayı, yüzde ve aritmetik ortalama vb) ve ki kare testi kullanıldı. Bulgular: Çalışmamızın örneklemini oluşturan 3227 yanık hastasının %55,3’ü 1-5 yaş aralığında ve %52,5’inin erkek olduğu belirlendi. Vakaların %42,7’si 2011-2013 yılları arasında gerçekleşmiştir. Yanıkların %64,1’inin sıcak sıvı yanığı, %50,4’ünün ikinci derece yanık olduğu saptandı. En fazla yanık vakası 2011-2013’te görülmüş ve vakalar 2020’ye doğru azalma göstermiştir. Yanık yaralanmasından en çok etkilenen yaş aralığının 1-5 arası ve en yüksek oranda yanık nedeninin sıcak sıvılar olduğu belirlendi (χ2 =5,560, p

The use of household cleaners during non‐commercial cleaning applications is a very common task, and the chemical makeup of the cleaning solutions vary as much as their applications do. Although most users of these products follow the written safety directions and are generally careful with their use, it is not uncommon for users to suffer toxicologic effects of these cleaners without proper protective equipment. In this case report, we describe an unusual chemical burn pattern to the hand of a young female patient after prolonged exposure to a xylene‐containing product without proper chemical‐resistant gloves. Fortunately, with prompt recognition, and urgent referral for burn treatment, the patient underwent a successful debridement of the burn and suffered minimal functional impairment.

Background: Currently silk fibroin is used more and more in the biomedical researches, including a potential research direction in creating wound dressing. Turmeric powder is a natural drug with many properties suitable for treatment of burns such as anti-inflammatory, anti-bacterial, anti-fungal, especially reducing formation of scars. Methods: In this study, sericin is removed from the silk to obtain fibroin fiber. Fibroin fiber and turmeric powder are dissolved by formic acid adding calcium chloride (CaCl2). Created fibroin films (FF) are then evaluated in some characteristics such as surface structure, chemical structure, tensile strength, absorbency, dehydration rate, biodegradation ability, pH determination, preventing bacteria ability and cytotoxicity test. Results: All results indicated that created FF is fulfilled with all the required properties of wound dressings. Conclusions: This study is the first step to creating foundation and orientation for the development of commercial wound dressings.

Highlights • NPWT significantly reduced length of hospitalization. • Also had minimal complication. • This procedure can be an alternative treatment for burn patients., Introduction Burn injuries continue to be a global burden. Burn wound treatment often requires a long treatment time and often results in high morbidity and mortality. Until now, there is still no ideal burn wound treatment for all patients. Presentation of cases Here we report 3 cases of burn patients. Every patient underwent wound debridement and followed by installation of Negative Pressure Wound Therapy (NPWT) on the site of burn injuries. All of patients was discharged in a good condition. Discussion NPWT is an application of sub-atmospheric pressure that is placed on the wound. Today, the use of negative pressure therapy is a new strategy in managing burn injuries. NPWT can reduce the length of stay of burn patients that can be associated with faster wound healing, and reduce bacterial levels in burns. Conclusion The combination of debridement and NPWT in burn patients can be an alternative procedure because it can promote faster wound healing and reduce the length of hospitalization. Furthermore, this is the first report of NPWT usage for the treatment of burn patients in Indonesia.

Hyperbaric oxygen therapy (HBOT) uses higher atmospheric pressure air or pure oxygen on the human body to facilitate wound healing. Usually, planimetry and oximetry are used in the quantitative evaluation of hyperbaric oxygen therapy effects. However, a noninvasive, quick and easy-to-perform method of evaluation is still required. Thus, the main aim of our study was to assess the usefulness of thermal imaging in evaluating the effects of hyperbaric oxygen therapy on hard-to-heal wounds and to compare these results with that of parameters obtained from planimetry. The studies were performed at the Burn Treatment Center in Siemianowice Slaskie. The study included 60 patients (28 women and 32 men) aged between 48 and 82 who had hard-to-heal wounds localized on their lower extremities. Thermal images were carried out during three stages (I: 0–10 sessions, II: 10–20 sessions and III: more than 20 sessions of HBOT) of the treatment cycle, before entering and after leaving the hyperbaric chamber, respectively. The results showed that the temperature of the regions of interest decreased with the number of completed treatments. Moreover, obtained isotherm area of crura as well as temperature differences between the regions of interest surrounding the wound decreased with the duration of treatment, which suggests an improvement in microcirculation through neovascularization. Our research may lead to planning of a new diagnostic device that uses and correlates several imaging techniques. It seems that the combination of thermal imaging with planimetry can give the physician an additional diagnosis information, as well as information about the effects of therapy at the structural and metabolic level. In addition, both methods are noninvasive, painless, fast and safe, which is very important in the treatment of hard-to-heal wounds.

The burn treatment room at our tertiary-care centre is run by a multidisciplinary team, providing care to primarily burn patients who require moderate to deep sedation to undergo dressing changes in a monitored setting outside the operating room. There is little literature on the safety, efficacy, and logistics of treating outpatient pediatric burn patients in this manner. This study reviews the safety of deep sedation in the burn treatment room.A retrospective chart review of patients with burns treated in the burn treatment room from 2013 to 2015 was conducted. Patient demographics, diagnosis, procedure details, sedation, and adverse events were recorded. Data were analyzed descriptively.Sevety-four patients with burns had a total of 308 visits in the burn treatment room for burn bath and/or dressing changes. Scald burns were the most common mechanism of injury (n = 56). Most burns were superficial and mid-dermal (54%), initially estimated at 5% to 10% TBSA (50%). Of the 308 visits, 304 required sedation. Adverse events were recorded in 11 (3.6%) of 304 sedated procedures. None of these events were critical: 7 patients required intravenous conversion due to inadequate oral sedation, 2 experienced brief apnea episodes but recovered spontaneously, and 2 had delayed discharge of more than 2 hours due to residual sedation.The burn treatment room is a safe and effective setting for treating pediatric burn patients, bypassing what might historically require operating suite inpatient management.La salle de traitement des brûlures du centre de soins tertiaires des chercheurs est dirigée par une équipe multidisciplinaire qui soigne surtout des patients brûlés ayant besoin d’une sédation modérée à profonde pour faire changer leurs pansements dans un milieu surveillé hors du bloc opératoire. Peu de publications portent sur l’innocuité, l’efficacité et la logistique de ce type de traitement ambulatoire pour les patients brûlés d’âge pédiatrique. La présente étude analyse l’innocuité de la sédation profonde à la salle de traitement des brûlures.Les chercheurs ont procédé à une analyse rétrospective des dossiers de patients brûlés traités à la salle de traitement des brûlures entre 2013 et 2015. Ils ont noté les caractéristiques démographiques, le diagnostic, le détail des interventions, la sédation et les événements indésirables des patients et fait une analyse descriptive des données.Soixante-quatorze patients brûlés sont allés un total de 308 fois à la salle de traitement des brûlures pour faire laver leurs brûlures ou changer leurs pansements. Les brûlures par liquide chaud étaient les plus courantes (n = 56). La plupart étaient superficielles et touchaient le derme moyen (54 %), pour une estimation initiale de 5 % à 10 % de la surface corporelle (50 %). Des 308 visites, 304 ont fait l’objet d’une sédation. Onze événements indésirables (3,6 %), dont aucun n’était critique, ont découlé des 304 interventions sous sédation. En effet, neuf patients ont dû passer à une sédation intraveineuse parce que la sédation orale était inadéquate, deux ont présenté de brefs épisodes d’apnée, mais se sont rétablis spontanément, et le congé de deux cas a dû être retardé de plus de deux heures à ause d’une sédation résiduelle.La salle de traitement des brûlures est un lieu sécuritaire et efficace pour traiter les patients brûlés d’âge pédiatrique et permet d’éviter ce qui nécessitait auparavant un passage au bloc opératoire et une hospitalisation.

Purpose: A cytological assessment of the effectiveness of eye burns complex treatment using low-intensity infrared laser radiation (LILR) was performed. Material and methods. 42 patients (64 eyes) with eye burns of different etiology and severity were examined. For the patients of the main group (21 patients, 30 eyes) low-intensity infrared laser radiation was added to the traditional treatment methods. Results. Decrease in the number of basophils and the amount of exudation during the inflammatory process indicated the suppression of the initial forms of inflammatory mediators – histamine and serotonin; the disappearance of leukocytes and restoration of the cytoplasm structure and epithelial nuclei was the result of the prostaglandins and leukotrienes suppression by LILR. An increase in the nuclear cytoplasmic ratio (NCR) was the result of the metabolic processes activation and the increase of their regenerative ability. Conclusion. Therefore, the use of LIRL is considered to be an effective method of the eye burn treatment since it triggers and prolongs the effect of the primary therapy.

A skin cell-spray grafting technique that enables the on-site application of freshly isolated autologous single cell suspensions was already applied in many cases on caucasian patients with low skin coloration. Our project hypothesis is that these suspensions contain keratinocytes and vital melanocytes, that are of particular interest for the treatment of patients of darker skin color. To test this, we applied an in vitro model, wherein the feasibility of i) isolating and ii) spraying of freshly isolated autologous melanocyte-keratinocyte cell suspensions was investigated. Primary human epidermal keratinocytes (HEKs) and melanocytes (MCs) were isolated from skin biopsies (n=8). Biochemical parameter, cell counts, cell morphology, growth behavior and immunofluorescence results were compared in two groups using MC cultures and co-cultures of MCs with HEKs. Case information on using the method clinically with one patient is included. The sprayed mixed cell suspensions proliferated in all groups without measurable loss of viability, and MCs exhibited a regular cell morphology in monoculture up to passage 4°. The sprayed MCs and HEKs demonstrated in vitro glucose and lactate metabolism that was comparable to the pipetted controls. In co-culture, well distributed CK14+ HEKs and NKI/beteb+ MCs could be demonstrated, which interacted in the in vitro model. The ratio of HEKs : MCs in our primary cultures were microscopically counted (n=8 each) as mean +/- SD 1,211,000 (+/- 574,343) HEK : 99,625 (+/- 59,025) MC; i.e., a ratio of approx. 12 : 1. Using the isolation method clinically for a patient with dark skin coloration after suffering severe second-degree burns shows a satisfying re-pigmentation of the resulting wound post healing. Freshly isolated spray-on melanocyte/keratinocyte suspensions provide for a considerable amount of viable HEKs and MCs. Using MCs in spray-grafting suspensions could represent a promising approach for treating severe partial-thickness burns and innovative therapy developments that also aim to address cosmetic aspects.

Aksu, Buket/0000-0001-7555-0603; Okur, Neslihan Ustundag/0000-0002-3210-3747; okur, mehmet evren/0000-0001-7706-6452 WOS:000477709600013 The purpose of this research was to prepare and evaluate the potential use of in situ gel formulations for dermal delivery of fusidic acid for burn wound treatment. Temperature sensitive in situ gels were successfully developed by the cold technique using poloxamer 188, poloxamer 407, poloxamer 338. Finally, the concentration of fusidic acid in formulations was 2% (w/w). The developed formulations were optimized using quality by design (QbD) approach. The prepared formulations were evaluated for clarity, sol-gel transition temperature, gelling capacity, pH, viscosity and drug content. The gelation temperatures of all the fusidic acid loaded formulations were within the range of 30-34 degrees C. Furthermore, sterility, antibacterial activity, stability, in vitro fusidic acid release, ex vivo permeation, and penetration study of these formulations were also examined. The wound healing feature was appraised by determining the wound contraction and by a histopathological survey. Based on the observed antimicrobial and wound healing effects, the formulations containing fusidic acid could be employed as an alternative to commercial cream. This novel formulation can be employed for making burn wound healing process more efficient.

INTRODUCTION In burn care, as in other medical fields, there is a tendency to increase the required number of patients for center certifications. Does the increase in patient load automatically improve the quality of burn care? What are the benchmark parameters that have been shown to improve burn care? METHODS To answer these questions, Medline, Cochrane Library, and Livivo were searched from inception through January 2018 for all studies evaluating the influence of treatment parameters on outcomes in different burn care settings. RESULTS Fifteen studies were included in this systematic review. In adults, not a single study showed a decreased mortality due to a higher patient load. However, in children, 2 studies demonstrated a further decrease of the already low mortality due to an increase in patient load. In contrast to patient load, benchmark parameters that had a significant influence on the outcome of burn care for adults and children were: single bed isolation, residency programs, American Burn Association certifications of burn centers, speed of wound closure, and standard operating procedures for burn care. CONCLUSIONS This systematic review demonstrates that a clear correlation between patient load and mortality reduction in adult burn treatment is not supported by the existing literature, requiring future studies. In contrast, all efforts aiming to improve the quality of burn care, such as isolation of burn patients, speed of wound closure, American Burn Association verification and especially standard operating procedures for burn care improve survival and quality of burn care.

Ambient/room temperature settings in burn treatment areas vary greatly due to a lack of evidence-based guidelines to direct care. While it is generally understood that ambient/room temperature impacts patient body temperature and metabolism, the ideal settings for optimizing patient outcomes are unclear. The literature assessing this topic is scarce, with many of the articles having significant limitations. We aim to summarize the current evidence for ambient/room temperature control, to address gaps in current reviews addressing this topic, and to elucidate topics requiring further research. PubMed and Google Scholar databases were queried for studies which evaluated the effect of the ambient/room temperature on burn patient core body temperature, patient metabolism, and outcomes among those treated in trauma bays, burn ICUs, and operating rooms. Although existing literature lacks sufficient patient outcome data regarding specific ambient/room temperatures, we highlight physiological processes that are impacted by changes in room temperatures in an effort to describe strategies that can allow for improved patient core body temperature control and outcomes in burn care settings.

Burns are sores on the skin caused by chemicals, hot water, or fire. Most people take the wrong approach to burn treatment, such as applying toothpaste or oil. Honey is one of the natural ingredients that is often used for the treatment of burns which ensures different pharmacological properties. In this study, the ability of honey to heal partial burns was tested using 27 male wistar rats (Rattus norvegicus) as experimental subjects. In the experiment, a post-test only control group design was chosen. The experimental rats were divided into three groups: honey, silver sulfadiazine, and control. The rats burns were intentionally created using a 1.2 x 1.2 cm steel plate heated with solder. Features under observation were contraction and burn photography. The median (range) or mean SD was used to present all data. In the observation period, on the fifth, seventh, and ninth days, there was a significant difference in wound contraction between the honey and silver sulfadiazine groups (P value 0.173, 0.012, 0.146). However, in the last two days, wound contraction increased in the honey and silver sulfadiazine groups (P value 0.598). Finally, after five days of treatment, it can be stated that honey has significant wound healing effectiveness.

Major burn trauma initiates a cascade of physiological events that cause profound stress on the body, resulting in significant complications which often lead to death. An understanding of these events may afford earlier and more precise interventions which, in turn, may reduce these complications, thus, improving patient outcomes. Burn trauma is associated with numerous inflammatory events that result in the release of free radicals, which promote oxidative stress and subsequent tissue damage. These mass-inflammatory events affect the body systemically, leading to several detrimental responses including complement activation, excessive histamine release, decrease in blood pressure, release of reactive oxygen species, and ultimately multiple organ dysfunction syndrome (MODS). However, recent studies conducted on the use of antioxidants as a part of a burn treatment protocol have shown promising results. In this review, we will discuss the current research and advancements in the treatment of burn trauma with the use of antioxidants, and how the early administration of antioxidant can possibly reduce the risk of developing MODS.

Considerable reorganization of the regional network for pediatric burn treatment during the pandemic was required to cope with severe burn injuries in small children. In support of the emergency network for burns during the COVID-19 pandemic, we referred to regional indications for centralization in our hospital for all children aged less than 5 years who presented with severe burns, &gt, 15% of total body surface area (TBSA), or who necessitated admittance to the pediatric intensive care unit (PICU). A new service with a dedicated management protocol was set up to treat pediatric burns in our SARS-CoV-2 pediatric hospital during the lockdown period. A multidisciplinary burn treatment team was set up to offer compassionate and comprehensive burn care. Patient’s clinical data, burn features, treatment and follow up were recorded. A higher number of admissions was recorded from February to December 2020 compared with the same period in 2019 (52 vs. 32 admissions). Eighteen patients were admitted to the COVID-19 Service (10 M/8 F, 3.10 ± 2.6 yrs), ten children (55.5%) were hospitalized in the ward and eight in the ICU (44.5%). Fifty percent of the cases presented with lesions extending over &gt, 15% TBSA, in one case, TBSA was 35%. All patients suffered 2nd-degree burns, while five patients also had 3rd degree lesions covering more than 15% TBSA. All of the injuries occurred at home. No major secondary infections were recorded. Successful treatment was achieved in 94.4% of cases. The average length of stay was 15.2 ± 12.6 days. A proactive, carefully planned service, involving a multidisciplinary team, was created to ensure appropriate care in a pediatric hospital during the COVID-19 period, despite the effective pandemic associated challenges. Better health promotion in pediatric burn cases should also include dedicated TBSA assessment and a database of children’s burn characteristics.

Abstract: Burn wounds are complex and intricate injuries that have become a common cause of trauma leading to significant mortality and morbidity every year. Dressings are applied to burn wounds with the aim of promoting wound healing, preventing burn infection and restoring skin function. The dressing protects the injury and contributes to recovery of dermal and epidermal tissues. Polymer-based nanotherapeutics are increasingly being exploited as burn wound dressings. Natural polymers such as cellulose, chitin, alginate, collagen, gelatin and synthetic polymers like poly (lactic-co-glycolic acid), polycaprolactone, polyethylene glycol, and polyvinyl alcohol are being obtained as nanofibers by nanotechnological approaches like electrospinning and have shown wound healing and re-epithelialization properties. Their biocompatibility, biodegradability, sound mechanical properties and unique structures provide optimal microenvironment for cell proliferation, differentiation, and migration contributing to burn wound healing. The polymeric nanofibers mimic collagen fibers present in extracellular matrix and their high porosity and surface area to volume ratio enable increased interaction and sustained release of therapeutics at the site of thermal injury. This review is an attempt to compile all recent advances in the use of polymer-based nanotherapeutics for burn wounds. The various natural and synthetic polymers used have been discussed comprehensively and approaches being employed have been reported. With immense research effort that is currently being invested in this field and development of proper characterization and regulatory framework, future progress in burn treatment is expected to occur. Moreover, appropriate preclinical and clinical research will provide evidence for the great potential that polymer-based nanotherapeutics hold in the management of burn wounds.

The nose is one of the most challenging facial parts to reconstruct. Its asymmetries, defects, or disharmonies are easily noticeable. The complex contours, highlights, shadows, and special shape of its subunits make nasal reconstruction more difficult in panfacial burn than that of nonburned ones. This retrospective study was conducted at Zare Hospital. Twenty-five panfacial burn cases with nasal defects were studied from 2010 to 2019. Profile photos were manipulated by Adobe Photoshop. Based on the difference between the burn-related shortened nasal length and the expected photoshopped one, the severity of the short nose was detected, and the strategy of the surgery was determined. Of the 25 cases, 10 cases with normal nasal length and projection, or mild short nose with minimal alar rim, tip and/or columellar defect underwent nasal reconstruction with skin and/or composite graft. Nine patients with normal nasal length or mild to moderate short nose but moderate to severe alar defect underwent reconstruction with turndown flap plus skin and/or composite graft. Pre-expanded forehead flap (n = 1) and delayed scarred or skin grafted forehead flap (n = 5) were used for six patients with severe short nose defect. There are several procedural alternatives for the reconstruction of burn-related mild to moderate nasal deformity. For severe and deep panfacial burn, delayed forehead flap seems safe with acceptable color and texture harmony. Our designed algorithm could potentially improve the selection of proper nasal reconstruction techniques and assist novice surgeons.

Thermal injuries may cause significant damage to large areas of the skin. Extensive and deep burn wounds require specialized therapy. The optimal method in the strategy of treating extensive, full thickness burns (III°) is the use of autologous split thickness skin grafts STSG (Busuioc et al. Rom J Morphol Embryol 4:1061-1067, 2012; Kitala D, Kawecki M, Klama-Baryla A, Łabuś W, Kraut M, Glik J, Ryszkiel I, Kawecki MP, Nowak M. Allogeneic vs. Autologous Skin Grafts in the Therapy of Patients with Burn Injuries: A Restrospective, Open-label Clinical Study with Pair Matching. Adv Clin Exp Med. 2016 Sep-Oct;25(5):923-929.; Glik J, Kawecki M, Kitala D, Klama-Baryla A, Łabuś W, Grabowski M, Durdzinska A, Nowak M, Misiuga M, Kasperczyk A. A new option for definitive burn wound closure - pair matching type of retrospective case-control study of hand burns in the hospitalized patients group in the Dr Stanislaw Sakiel Center for Burn Treatment between 2009 and 2015. Int Wound J. 2017 Feb 21. https://doi.org/10.1111/iwj.12720 . [Epub ahead of print]; Prim et al. May 24Wound Repair Regen., 2017; Grossova et al. Mar 31Ann Burns Fire Disasters 30:5-8, 2017). The main limitation of that method is the inadequate amount of healthy, undamaged skin (donor sites), which could be harvested and used as a graft. Moreover, donor sites are an additional wounds that require analgesic therapy, leave scars during the healing process and they are highly susceptible to infection (1-6). It must be emphasized that in terms of the treatment of severe, deep and extensive burns, and there should be no doubt that the search for a biocompatible skin substitute that would be able to replace autologous STSG is an absolute priority. The above-mentioned necessitates the search for new treatment methods of severe burn wounds. Such methods could consider the preparation and application of bioengineered, natural skin substitutes. At present, as the clinical standard considered by the physicians may be use of available biological skin substitutes, e.g., human allogeneic skin, in vitro cultured skin cells, acellular dermal matrix ADM and revitalized ADMs, etc. (Busuioc et al. Rom J Morphol Embryol 4:1061-1067, 2012; Kitala D, Kawecki M, Klama-Baryla A, Łabuś W, Kraut M, Glik J, Ryszkiel I, Kawecki MP, Nowak M. Allogeneic vs. Autologous Skin Grafts in the Therapy of Patients with Burn Injuries: A Restrospective, Open-label Clinical Study with Pair Matching. Adv Clin Exp Med. 2016 Sep-Oct;25(5):923-929.; Glik J, Kawecki M, Kitala D, Klama-Baryla A, Łabuś W, Grabowski M, Durdzinska A, Nowak M, Misiuga M, Kasperczyk A. A new option for definitive burn wound closure - pair matching type of retrospective case-control study of hand burns in the hospitalised patients group in the Dr Stanislaw Sakiel Center for Burn Treatment between 2009 and 2015. Int Wound J. 2017 Feb 21. https://doi.org/10.1111/iwj.12720 . [Epub ahead of print]; Prim et al. May 24Wound Repair Regen., 2017; Grossova et al. Mar 31Ann Burns Fire Disasters 30:5-8, 2017; Łabuś et al. FebJ Biomed Mater Res B Appl Biomater 106:726-733, 2018).

Burn wounds can create significant damage to human skin, compromising one of the key barriers to infection. The leading cause of death among burn wound patients is infection. Even in the patients that survive, infections can be notoriously difficult to treat and can cause lasting damage, with delayed healing and prolonged hospital stays. Biofilm formation in the burn wound site is a major contributing factor to the failure of burn treatment regimens and mortality as a result of burn wound infection. Bacteria forming a biofilm or a bacterial community encased in a polysaccharide matrix are more resistant to disinfection, the rigors of the host immune system, and critically, more tolerant to antibiotics. Burn wound-associated biofilms are also thought to act as a launchpad for bacteria to establish deeper, systemic infection and ultimately bacteremia and sepsis. In this review, we discuss some of the leading burn wound pathogens and outline how they regulate biofilm formation in the burn wound microenvironment. We also discuss the new and emerging models that are available to study burn wound biofilm formation in vivo. Funding Agencies|British Society for Antimicrobial Chemotherapy [BSAC-2018-0095]; Innovate UK Smart Grant [37800]; FRAME, Young European Research University Network Mobility Award, NC3Rs PhD Studentship [NC/V001582/1]; BBSRC New Investigator AwardUK Research & Innovation (UKRI)Biotechnology and Biological Sciences Research Council (BBSRC) [BB/V007823/1]; Academy of Medical Sciences/the Wellcome Trust/ the Government Department of Business, Energy and Industrial Strategy/the British Heart Foundation/Diabetes UK Springboard Award [SBF006\1040]

Three-dimensional (3D) bioprinting is a rapidly growing technology that has been widely used in tissue engineering, disease studies, and drug screening. It provides the unprecedented capacity of depositing various types of biomaterials, cells, and biomolecules in a layer-by-layer fashion, with precisely controlled spatial distribution. This technology is expected to address the organ-shortage issue in the future. In this paper, discussion about 3D printers, three categories of 3D bioprinting strategies: inkjet-based printing (IBP), extrusion-based printing (EBP), and light-based printing (LBP), case studies of 3D bioprinted skin and kidney are discussed. Study of burn skin surgery, current development in 3D Bioprinted skin for burn treatment is reviewed as well. Finally, the main challenges in current studies and startup in Bioprinting are discussed.

In recent decades, wildfires have increased in frequency and geographic scale across the globe. The human health implications and ecological succession after wildfires are well documented and studied, but there is a lack of empirical research about the direct effects of wildfires on wildlife. Recent wildfires have demonstrated the need to better understand animal burn injuries and innovations in veterinary burn treatment. An online survey was distributed to wildlife rehabilitation facilities internationally to collect baseline information about the number and type of burned wildlife cases admitted, treatments used, and survivorship of wildlife affected by wildfires. Approximately 80% (n = 49) of all respondents (n = 61) reported admitting cases of burned wildlife from 2015 to 2018. Respondents included facilities from six different countries and roughly 43% of facilities reported having a veterinarian on staff. Electrical burns were most commonly reported with 89% of respondents stating that they had seen electrical burns while 38% of respondents reported seeing wildfire-source thermal burns in wildlife patients. Respondents were asked about their frequency of use of different treatment methods. Bandages, colloid fluids, and opioids were used at significantly higher rates at facilities with veterinarians compared with facilities that did not report having a veterinarian; however, survival of burned wildlife patients did not significantly differ based on the factor of having a veterinarian on staff. Long-term and short-term complications were commonly reported for wildlife burn patients; 88% of facilities reported scarring, 81% reported alopecia, and 61% reported sepsis. Burned animals admitted to facilities were reported to have equal odds of dying and surviving. Burn care recommendations have changed considerably in recent decades. This study provided a unique opportunity to compare contemporary recommendations in human medicine with current methods used in wildlife rehabilitation facilities to identify potential areas of further investigation and improvement for wildlife medicine.

Background and Objective: The use of plant-based products for burn treatment dates back to 1600 BC. Enzymatic debridement, which can be achieved as non-surgical or conservative debridement, has recently gained increasing attention. Several reviews have been published thus far. However, there has been no historical article including the achievements of the last 20 years, and this is the first review to present the achievements made in the field of enzymatic debridement in the last 20 years. This study aimed to present a historical overview of the development of enzymatic debridement until the present day. Methods: Enzymes from bacteria and plants were initially used for full-thickness burn treatment, however, they did not gain attention. Papain-derived products were the first plant-based products used for enzymatic debridement. Sutilains gained broad use in the 70s and 80s but came off market in the 1990s. Bromelain has been used for burn treatment owing to its strong debriding properties. NexoBrid&trade, is used as a minimally invasive approach for enzymatic debridement of deep dermal burns. However, its use has been limited due to commercially available bromelain and the presence of four distinct cysteine proteinases. NexoBrid&trade, involves faster eschar removal together with reduced blood loss, leading to improved long-term outcomes. However, research on nonoperative enzymatic debridement of burns has taken decades and is still ongoing. Results: Overall, the results of our study indicate that necrectomy, which has been used for a long time, remains the standard of care for burns. However, enzymatic debridement has several advantages, such as faster eschar removal, reduced blood loss, and reduced need for skin grafting, especially in cases of facial and hand burns. Enzymatic debridement cannot replace surgical intervention, as the enzyme only works on the surface of the eschar. Enzymatic debridement is not recommended in the early phase of scald burns. Conclusions: Enzymatic debridement has become an integral part of burn therapy and the standard of care in specific burn centers.

Introduction Burn injuries remain common in the world, with an average of more than thousands of cases requiring medical attention each year. Singapore sees an average of 220 burns admissions annually. Given the high number of burn cases in Singapore, the authors identified that there is a need for more public awareness on first aid burn treatment. Acute management of burns can improve eventual patient outcome. The authors devised a simple mnemonic that can be used in burns education for first aid treatment, intended to be taught to trained personnel, who will have the first contact with these burn patients. The aim of the study was to assess the viability of implementing this mnemonic, B.U.R.N.S, to facilitate first aid education for burns. Material and methods In a pilot study, we first presented this mnemonic as a poster to 30 full-time burn care medical professionals. Feedback was then obtained from this group of medical professionals and used it to revise the mnemonic. The mnemonic was subsequently taught to 400 medical professionals, who are predominantly involved in the pre-hospital management of burns. They are then asked to reiterate the mnemonic to test the ease of remembering the mnemonic. Objective feedback was obtained with a 5-point scoring system. Results The results indicated a significant improvement in burn first aid knowledge after the implementation of the mnemonic, from a score of 3.67 to 4.77. The content was deemed as appropriate and easy to understand and recall, and participants were able to reiterate the content, and will recommend this mnemonic to be used for burns teaching for first aid. Conclusion The study results suggest that this B.U.R.N.S. mnemonic and visual aid is simple and easy to apply, especially for uniformed personnel, as these individuals may have the first contact with the burns victims, and it is important for them to render the appropriate burns first aid treatment. Overall, burns first aid awareness and education can be improved with the implementation of this mnemonic and poster. Moving forward, we aim to integrate the B.U.R.N.S. into educational programmes in professional institutions involved in responding to burns (medical and nursing schools of Singapore), as well as in schools and public institutions, for educational purpose to raise public awareness. We wish to also be able to do so on an international level when courses are conducted.