“Out of Touch”—Recovering Sensibility after Burn Injury: A Review of the Literature

Abstract

Background: Full-thickness burn injuries (FTBI) not only lead to a significant burden in multiple ways, including social life and self-esteem, but have also a tremendous impact on environmental interaction by reducing sensibility in manifold ways. On these grounds, possible ways and solutions to recover sensibility in burn wounds are essentials and should not be overlooked. Methods: A review of experimental, clinical studies and the related literature was performed with the aim to highlight post-burn nerve regeneration and discover ways for sensory re-integration to complement the therapeutic concept. Results: In human burn injuries, it has been hypothesized that grafted cells, partly multipotent stem cells, could be additionally responsible for nerve regeneration in burn wound areas. In addition, burn eschar excision, performed within a short post-burn time frame, can reduce or even avoid long-term nerve damage by reducing post-burn toxic mediator release. Various animal studies could demonstrate sensory reinnervation of different qualities in burn wounds. Post-burn scar tissue prevents, or at least decelerates, nerve reinnervation, but could be reduced by targeted mediators. Conclusion: Sensory loss is present in skin grafted areas following full-thickness burn-wound excision, thereby leading to a reduction in quality of life. In addition, various mediators might reduce or avoid nerve damage and should be considered at an early stage as part of a holistic burn-patient therapeutic approach. In addition, supportive multifaceted physical therapy strategies are essential.

Damage-induced basal epithelial cell migration modulates the spatial organization of redox signaling and sensory neuron regeneration

“…Burn wounded patients have poor prognosis and frequently suffer from chronic pain and altered sensory perception [23][24][25][26]67,68 , indicating a defect in the regenerative capacity of the peripheral sensory nervous system after burn. A roadblock to developing better treatments to improve sensory outcomes or burn wound healing in general is our lack of understanding of underlying wound pathophysiology 69 .…”

“…Thermal injury results in chronic pain and lack of sensation, suggesting that an abnormal sensory neuron response contributes to burn wound pathophysiology [22][23][24][25][26] . Despite this, we lack an understanding of why sensory neuron function is impaired after burns.…”

“…While epithelial tissue is well adapted to repair from mechanical damage, burn wounds heal poorly. Thermal injury results in chronic pain and lack of sensation in the affected tissue, suggesting that an abnormal sensory neuron response contributes to burn wound pathophysiology (Blais et al, 2013; Choinière et al, 1991; Pavoni et al, 2010; Tirado-Esteban et al, 2020; Tsolakidis et al, 2022). Despite this, we lack an understanding of why sensory neuron function is impaired after burn.…”

Role of burn severity and posttraumatic stress symptoms in the co-occurrence of itch and neuropathic pain after burns: A longitudinal study

“…First, although the literature is positive about using self-report questionnaires to assess spontaneous pain-related sensations ( 31 ), allodynia, and loss of sensory function were not measured because clinical examination is required ( 49 ). Loss of sensory function or numbness has been documented in burn scars, indicating its relevance ( 50 ). Clinical assessments that document stimulus-evoked sensory sensations and temporal summation may inform underlying nerve damage and consequently, therapy ( 49 ).…”