Abstract:Research in burn care for the calendar year 2009 was robust and diverse with >1400 research articles published on a wide range of topics. In this review, the authors highlight some innovative and potentially impactful research related to the overall care of burn- injured patients. The authors grouped articles according to the following categories: critical care, infection, inhalation injury, epidemiology, psychology, wound characterization and treatment, nutrition and metabolism, pain and itch management, burn… Show more
“…B urn injuries constitute a major worldwide public health problem (1) and cause more severe physiological stress than other traumas (2,3). Superficial burns usually heal with minimal scarring, but treatments for second-and third-degree burn injuries remain far from optimal (1,4).…”
Neovascularization is a critical determinant of wound-healing outcomes for deep burn injuries. We hypothesize that dextran-based hydrogels can serve as instructive scaffolds to promote neovascularization and skin regeneration in third-degree burn wounds. Dextran hydrogels are soft and pliable, offering opportunities to improve the management of burn wound treatment. We first developed a procedure to treat burn wounds on mice with dextran hydrogels. In this procedure, we followed clinical practice of wound excision to remove full-thickness burned skin, and then covered the wound with the dextran hydrogel and a dressing layer. Our procedure allows the hydrogel to remain intact and securely in place during the entire healing period, thus offering opportunities to simplify the management of burn wound treatment. A 3-week comparative study indicated that dextran hydrogel promoted dermal regeneration with complete skin appendages. The hydrogel scaffold facilitated early inflammatory cell infiltration that led to its rapid degradation, promoting the infiltration of angiogenic cells into the healing wounds. Endothelial cells homed into the hydrogel scaffolds to enable neovascularization by day 7, resulting in an increased blood flow significantly greater than treated and untreated controls. By day 21, burn wounds treated with hydrogel developed a mature epithelial structure with hair follicles and sebaceous glands. After 5 weeks of treatment, the hydrogel scaffolds promoted new hair growth and epidermal morphology and thickness similar to normal mouse skin. Collectively, our evidence shows that customized dextran-based hydrogel alone, with no additional growth factors, cytokines, or cells, promoted remarkable neovascularization and skin regeneration and may lead to novel treatments for dermal wounds.
“…B urn injuries constitute a major worldwide public health problem (1) and cause more severe physiological stress than other traumas (2,3). Superficial burns usually heal with minimal scarring, but treatments for second-and third-degree burn injuries remain far from optimal (1,4).…”
Neovascularization is a critical determinant of wound-healing outcomes for deep burn injuries. We hypothesize that dextran-based hydrogels can serve as instructive scaffolds to promote neovascularization and skin regeneration in third-degree burn wounds. Dextran hydrogels are soft and pliable, offering opportunities to improve the management of burn wound treatment. We first developed a procedure to treat burn wounds on mice with dextran hydrogels. In this procedure, we followed clinical practice of wound excision to remove full-thickness burned skin, and then covered the wound with the dextran hydrogel and a dressing layer. Our procedure allows the hydrogel to remain intact and securely in place during the entire healing period, thus offering opportunities to simplify the management of burn wound treatment. A 3-week comparative study indicated that dextran hydrogel promoted dermal regeneration with complete skin appendages. The hydrogel scaffold facilitated early inflammatory cell infiltration that led to its rapid degradation, promoting the infiltration of angiogenic cells into the healing wounds. Endothelial cells homed into the hydrogel scaffolds to enable neovascularization by day 7, resulting in an increased blood flow significantly greater than treated and untreated controls. By day 21, burn wounds treated with hydrogel developed a mature epithelial structure with hair follicles and sebaceous glands. After 5 weeks of treatment, the hydrogel scaffolds promoted new hair growth and epidermal morphology and thickness similar to normal mouse skin. Collectively, our evidence shows that customized dextran-based hydrogel alone, with no additional growth factors, cytokines, or cells, promoted remarkable neovascularization and skin regeneration and may lead to novel treatments for dermal wounds.
“…Burns are among the most devastating of all injuries, producing overwhelming physiologic and psychologic impairments. [1][2][3] Most of burns involve thermal damage such as scalding and fires, while the minority occurs when exposed to ultraviolet radiation, radioactivity, chemicals or electricity. [4][5] Globally in 2004, 11 million people with burn injuries were brought to medical attention, accounting for over 300,000 deaths.…”
Traditional wound dressings, including cotton gauze, absorbent pads and bandages, can cause trauma and pain to wounds during dressing changes, leading to a variety of physical and psychosocial sequelae. The aim of this study was to adapt an in vitro model of adherence to evaluate the effects of various methods to theoretically reduce the adherence of wound dressings. Gelatin in liquid form was cast onto poly(ethylene terephthalate) (PET) fabric and allowed to solidify and progressively dry to simulate wound desiccation in the clinical setting. A 180° peel test of PET from the gelatin slab yielded adherence data of peeling energy. The peeling energy of PET increased with the drying time. It was possible to reduce the force by drying at 75% relative humidity (RH). After drying for 24h, either 500μL of water or surfactant solution was added onto the PET surface (16×60mm(2)). The peeling energy decreased dramatically with wetting and there was no significant difference between water and surfactant. As a long-term strategy for decreasing adherence, a thin layer of polyacrylamide (PAM) hydrogel was deposited onto PET fabric via UV irradiation. This resulted in a much lower peeling energy without severely compromising fabric flexibility. This hydrogel layer could also serve as a reservoir for bioactive and antimicrobial agents which could be sustainably released to create a microbe-free microenvironment for optimized wound healing.
“…[2][3][4][5] The wound healing process is a complex procedure involving responses of many different cell types and growth factors. [2][3][4][5] The wound healing process is a complex procedure involving responses of many different cell types and growth factors.…”
We report an injectable aldehyded 1-amino-3,3-diethoxy-propane (ADEP)-hyaluronic acid (AHA)-chitosan (CS) hydrogel. This hydrogel can enhance wound healing by promoting cell migration, proliferation, granulation and angiogensis. During sol-gel transition, no chemical crosslinking agent was introduced and the structure of polysaccharide HA was grafted with a functional molecule, 1-amino-3,3-diethoxy-propane, but without using oxidation to break the HA structure as previously reported. Rheological tests showed the injectability and stability of this AHA-CS hydrogel. Full thickness skin defects (1 cm  1 cm) were made on mice and the adipose derived stem cell loaded gel was tested in the healing-impaired wound. The AHA-CA hydrogel significantly accelerated wound closure, increased cell proliferation (Ki67 marker) and promoted keratinocyte migration (p63 marker). Histological examination demonstrated that the gel significantly advanced granulation tissue and capillary formation in the gel-treated wounds. mRNA expressions of angiogenesis (VEGF-A), chemotactic factors (SDF-1) and ECM-remodeling MMPs (MMP1 and MMP9) were also up-regulated in the hydrogel-treated wounds.
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