Advancements in Regenerative Strategies Through the Continuum of Burn Care

Abstract

Burns are caused by several mechanisms including flame, scald, chemical, electrical, and ionizing and non-ionizing radiation. Approximately half a million burn cases are registered annually, of which 40 thousand patients are hospitalized and receive definitive treatment. Burn care is very resource intensive as the treatment regimens and length of hospitalization are substantial. Burn wounds are classified based on depth as superficial (first degree), partial-thickness (second degree), or full-thickness (third degree), which determines the treatment necessary for successful healing. The goal of burn wound care is to fully restore the barrier function of the tissue as quickly as possible while minimizing infection, scarring, and contracture. The aim of this review is to highlight how tissue engineering and regenerative medicine strategies are being used to address the unique challenges of burn wound healing and define the current gaps in care for both partial- and full-thickness burn injuries. This review will present the current standard of care (SOC) and provide information on various treatment options that have been tested pre-clinically or are currently in clinical trials. Due to the complexity of burn wound healing compared to other skin injuries, burn specific treatment regimens must be developed. Recently, tissue engineering and regenerative medicine strategies have been developed to improve skin regeneration that can restore normal skin physiology and limit adverse outcomes, such as infection, delayed re-epithelialization, and scarring. Our emphasis will be centered on how current clinical and pre-clinical research of pharmacological agents, biomaterials, and cellular-based therapies can be applied throughout the continuum of burn care by targeting the stages of wound healing: hemostasis, inflammation, cell proliferation, and matrix remodeling.

Antibiotic Delivery Strategies to Treat Skin Infections When Innate Antimicrobial Defense Fails

“…There are four interrelated variables that contribute to therapeutic efficacy when treating an infected, chronic wound: (1) local tissue concentrations of antimicrobials at the infection site; (2) microbial flora of the site; (3) presence of ischemia or necrotic tissue that impairs drug distribution; and (4) antimicrobial resistance [32]. Early treatment of infected skin wounds includes debridement of necrotic tissue, antibiotic application, and covering the wound [33]. Historically, antimicrobials have been administered both topically and systemically (oral or intravenous route) for treating chronic wound infections [32].…”

A study on new experimental induction of wound using metal surface contact in a rat model

“…The third degree involves epidermis, dermis, and hypodermis. Burns have slight pain or no pain, and can be brown, white, or burned and feel irm and rubbery to palpation devoid of blanching (Stone et al, 2018). During the burn, injury tissue organization is lost with cell injury, in lammation, necrosis, and loss of collagen ibers.…”

Influence of fibrin matrices and their released factors on epidermal substitute phenotype and engraftment

“…In those cases, skin allograft cannot be an option for permanent epidermal restoration, as allogenic epidermis is ultimately rejected (Burd & Chiu, ). Meshed STSG, meek grafting, micrografting, and epidermal blister grafting are neither satisfactory because they result in poor cosmetic and functional outcomes (Stone Ii et al, ; Ter Horst, Chouhan, Moiemen, & Grover, ). Epidermal substitutes of cultured keratinocytes, such as cultured epithelial autograft (CEA) have been used as an alternative treatment since the 1980's (O'Connor, Mulliken, Banks‐Schlegel, Kehinde, & Green, ).…”

“…In those cases, skin allograft cannot be an option for permanent epidermal restoration, as allogenic epidermis is ultimately rejected (Burd & Chiu, 2005). Meshed STSG, meek grafting, micrografting, and epidermal blister grafting are neither satisfactory because they result in poor cosmetic and functional outcomes (Stone Ii et al, 2018;Ter Horst, Chouhan, Moiemen, & Grover, 2018).…”