The treatment of burns: An exercise in emergency surgery

Jackson, Deborah

doi:10.1097/00006534-195406000-00037

Cited by 6 publications

(8 citation statements)

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“…Burns are dynamic injuries that are characterized by a central zone of irreversible cell necrosis surrounded by a potentially reversible zone of ischemia 1,2 . Much research has focused on developing therapies aimed at preventing the conversion of the zone of ischemia to full necrosis 3 .…”

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confidence: 99%

Apoptosis and Necrosis in the Ischemic Zone Adjacent to Third Degree Burns

Singer

McClain

Taira

et al. 2008

Academic Emergency Medicine

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Objectives: Burns are characterized by a central zone of necrosis surrounded by a zone of potentially reversible ischemia. The authors explored the contribution of necrosis and apoptosis to cell death in the zone of ischemia.Methods: A previously established rat contact thermal injury model that utilizes a brass comb to produce four distinctive burns sites separated by three ''interspaces'' of unburned skin was used. The interspaces represent the zone of stasis or ischemia while the burn sites represent the zone of coagulation. With this model, most unburned interspaces progress to necrosis over 2 to 3 days. Full-thickness 3-mm biopsies were obtained from the interspaces, burns, and normal skin controls at 30 minutes, 24 hours, and 48 hours after injury. Slides were stained with hematoxylin and eosin as well as activated cleaved caspase-3 (CC3a) for evidence of apoptosis and high-mobility group box 1 (HMGB1) for evidence of necrosis.Results: Necrosis was not seen at 30 minutes, but was found in a large number of cells within the epidermis, sebaceous glands, and follicles at 24 and 48 hours. Faint nuclear CC3a staining indicative of apoptosis was present in a minority of cells within the epidermis, dermal fibroblasts, dermal follicles, and dermal sebaceous glands at 30 minutes and to a lesser degree at 24 and 48 hours.Conclusions: Both early apoptosis and delayed necrosis are present in the zone of ischemia, contributing to injury progression. Necrosis appears to play a larger role than apoptosis in injury progression in the comb burn model. ACADEMIC EMERGENCY MEDICINE 2008; 15:549-554 ª

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confidence: 99%

Apoptosis and Necrosis in the Ischemic Zone Adjacent to Third Degree Burns

Singer

McClain

Taira

et al. 2008

Academic Emergency Medicine

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“…Factors involved in ensuring minimal time to epithelialization are preventing wound conversion by avoiding over-resuscitation, preventing secondary wound infection, avoiding chemical toxicity from topical wound agents, and accurate surgical decision-making for deep wounds only [27][28][29] . The major challenge in burn depth assessment is in partial-thickness wounds where clinical evaluation by experienced clinicians is often inaccurate, in part because of the evolving inflammation that progresses in deep dermal wounds in the zone of stasis [30,31] . Thus, new instruments to aid as adjuncts to evaluate burn depth are becoming useful tools.…”

Section: Prevention Of Scarring After Thermal Injurymentioning

confidence: 99%

Prevention and management of scarring after thermal injury

Wong¹,

Lin²,

Ding³

et al. 2021

PAR

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Survival from burn injury has improved considerably over the past two decades such that the quality of life of the victim of thermal injuries has become a major concern. Severe proliferative scarring or hypertrophic scarring (HTS) is an all too frequent complication of burn wound healing that severely compromises quality of life for surviving burn victims. Prevention of such scarring in burn patients involves better understanding of the pathophysiology of scar formation, development of newer methods for determining depth of burn injury and earlier and advanced surgical interventions. Many established and evolving novel treatments for HTS in patients after thermal injury exist and include antifibrotic pharmaceuticals and cellular-based therapies as reviewed herein.

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“…Burn wound progression or burn conversion has been studied over half a century since Jackson described three zones of typical burn wounds (a central zone [zone of coagulation], the intermediate zone [zone of stasis], and the outer zone [zone of hyperemia]). The zone of necrosis does not initially undergo necrosis but experiences complete cessation of blood flow within the first 24 hours 3 . Since then, it has been recognized burn wounds undergo a dynamic progression during the first few days after injury.…”

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confidence: 99%

Thermal injury induces early blood vessel occlusion in a porcine model of brass comb burn

Wang

Salsbury

et al. 2021

Sci Rep

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Burn wound progression is an important determinant of patient morbidity and mortality after injury. In this study, we used the brass comb contact burn to determine burn wound vertical injury progression with a focus on blood vessel occlusion and endothelial cell death. Class A 3-month-old Yorkshire pigs received a brass comb contact burn. Burn wounds were sampled at 0, 30 min, 1, 2, 4, and 24 h. Hematoxylin Phloxin Saffron staining and vimentin immunostaining were performed to determine the depth of blood vessel occlusion and endothelial cell death, respectively. The depth of blood vessel occlusion increased by 30 min (p < 0.005) and peaked by 1 to 4 h (p > 0.05). The depth of endothelial cell death risen to a plateau at 30 min (p < 0.005) to 2 h and then peaked at 24 h (p < 0.03). We observed a progression of blood vessel occlusion and vascular endothelial cell death from the middle of the dermis to the hypodermis within 2 h to 4 h after the initial injury, namely a progression from a second-degree (partial thickness) to third-degree (full thickness) burn. These data suggest that therapeutic interventions during this time window may provide a better outcome by reducing or preventing vertical progression of blood vascular occlusion or endothelial cell death.

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The treatment of burns: An exercise in emergency surgery

Cited by 6 publications

References 0 publications

Apoptosis and Necrosis in the Ischemic Zone Adjacent to Third Degree Burns

Apoptosis and Necrosis in the Ischemic Zone Adjacent to Third Degree Burns

Prevention and management of scarring after thermal injury

Thermal injury induces early blood vessel occlusion in a porcine model of brass comb burn

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