Burn injury is a complex traumatic event with various local and systemic effects, affecting several organ systems beyond the skin. The pathophysiology of the burn patient shows the full spectrum of the complexity of inflammatory response reactions. In the acute phase, inflammation mechanism may have negative effects because of capillary leak, the propagation of inhalation injury and the development of multiple organ failure. Attempts to mediate these processes remain a central subject of burn care research. Conversely, inflammation is a necessary prologue and component in the later-stage processes of wound healing. In this review, we are attempting to present the current science of burn wound pathophysiology and wound healing. We also describe the evolution of innovative strategies for burn management.

Tubulization as an alternative to autologous nerve grafting successfully bridges relatively short nerve gaps. Digital nerve lesions are ideal for clinical outcome studies, but only a few data have been published so far. We are presenting our clinical experiences based on a review of the outcome and techniques in the current literature. Fifteen digital nerve lesions in 14 patients have been overcome by interpositional grafting of a hollow collagen I conduit. A follow-up of 12 months could be guaranteed in 12 cases. The mean nerve gap was 12.5 AE 3.7 mm. Four out of 12 patients, assessed 12 months postoperatively, showed excellent sensibility (S4). Five patients achieved good sensibility, one poor, and two no sensibility. Our results confirm tubulization as one possible technique in nerve reconstruction. However, the indication has to be set carefully, and the operation still requires solid microsurgical skills, especially for proper handling and debridement of the severed nerve endings.

Nerve injuries are common in trauma surgery and appear more frequently if the upper extremity is affected. The aim of this study is to estimate possible predictors of the outcome after nerve injury of the upper extremity and to demonstrate feasible tools to follow up postoperative nerve regeneration for the daily clinical practice. During January 2000 until December 2004, a total of 372 nerve lesions of the upper extremity have been treated in our clinic. Patient's age, site of nerve lesion, concomitant injuries, and the timing of surgical repair could be outlined to be significant predictors for clinical outcome. Digital nerve lesions showed the best regenerative capacity. Most predictors of clinical outcome such as patient's age, concomitant injuries, and site of lesion cannot be influenced. But knowing the predictors helps specify the prognosis of nerve regeneration. For the daily clinical practice, static two-point discrimination, location of Tinel's sign, and grip strength measurement seem to be fast and reproducible tools to follow up nerve regeneration at the upper extremity.