Biotechnological Management of Skin Burn Injuries: Challenges and Perspectives in Wound Healing and Sensory Recovery

Abstract

Many wound management protocols have been developed to improve wound healing after burn with the primordial aim to restore the barrier function of the skin and also provide a better esthetic outcome. Autologous skin grafts remain the gold standard in the treatment of skin burn, but this treatment has its limitation especially for patients presenting limited donor sites due to extensive burn areas. Deep burn injuries also alter the integrity of skin-sensitive innervation and have an impact on patient's quality of life by compromising perceptions of touch, temperature, and pain. Thus, patients can suffer from long-term disabilities ranging from cutaneous sensibility loss to chronic pain. The cellular mechanisms involved in skin reinnervation following injury are not elucidated yet. Depending on the depth of the burn, nerve sprouting can occur from the wound bed or the surrounding healthy tissue, but somehow this process fails to provide correct reinnervation of the wound during scarring. In addition, several clinical observations indicate that damage to the peripheral nervous system influences wound healing, resulting in delayed wound healing or chronic wounds, underlining the role of innervation and neuromediators for normal cutaneous tissue repair development. Promising tissue engineering strategies, including the use of biomaterials, skin substitutes, and stem cells, could provide novel alternative treatments in wound healing and help in improving patient's sensory recovery.

New insights into the roles of myofibroblasts and innervation during skin healing and innovative therapies to improve scar innervation

“…Nerve regeneration also occurs during the wound healing process . Interestingly, symptoms of itch and pain, and abnormal thermo‐sensory thresholds, are present in excessive scarring in the skin, suggesting that these pathological situations are closely associated with small nerve fibres.…”

“…Another therapeutic strategy to improve reinnervation during the wound healing process is the use of biomaterials (for review, see ). These biomaterials must be biocompatible, flexible and porous.…”

“…Currently, a number of skin substitutes are available to accelerate wound closure and enhance wound healing . Unfortunately, none of them are designed to promote wound reinnervation and it has also been suggested that promoting fast wound closure may be deleterious on nerve regrowth.…”

Using Artificial Skin Devices as Skin Replacements: Insights into Superficial Treatment

“…Nevertheless, this can prove to be challenging due to the complexity of the human body. This can be seen by the occurrence of chronic side effects in the case of skin grafting despite the established nature of this surgical procedure . This indicates the need for a clearer understanding of wound diagnosis, and also how the treatment method will possibly interact with the body.…”

Chitosan–poly(caprolactone) nanofibers for skin repair

“…Because of the large surface area of skin, cutaneous wound healing, associated with acute or pathological conditions, represents a significant clinical challenge and socioeconomic burden [1–3] . Chronic wounds, such as non-healing ulcers, and wounds due to trauma, such as large burns, often cannot heal via normal mechanisms due to underlying pathology and/or severity and require the application of skin substitutes to promote repair.…”