Burn wound healing: present concepts, treatment strategies and future directions

Abstract

Burns are the most extensive forms of soft tissue injuries occasionally resulting in extensive and deep wounds and death. Burns can lead to severe mental and emotional distress, because of excessive scarring and skin contractures. Treatment of burns has always been a difficult medical problem and many different methods have been used to treat such injuries, locally. Biofilms are a collection of microorganisms that delay wound healing. One of the new methods of prevention and treatment of burn wound infections is application of antimicrobials, which act on biofilms and prevent the wound infection. Biofilm initiates a persistent, low-grade, inflammatory response, impairing both the epithelialisation and granulation tissue formation. Skin grafts have been shown to dramatically reduce deaths from infection. However, grafting has considerable limitations. Such injuries are long-lasting and many patients suffer from chronic pain for a long time. Tissue engineering is a new approach in reducing the limitations of conventional treatments and producing a supply of immunologically tolerant artificial tissue, leading to a permanent solution for damaged tissues; such criteria make it a cost-effective and reliable treatment modality. To overcome the present limitations of burn wound healing, knowledge about the latest findings regarding healing mechanisms is important. Here the authors discuss the most important events regarding burn wound healing and review the latest treatment strategies that have been used for burn wounds from in vitro to clinical levels. Finally, we discuss the role of tissue engineering and regenerative medicine in the future of burn wound healing, modelling and remodelling.

3,3′-Diindolylmethane stimulates exosomal Wnt11 autocrine signaling in human umbilical cord mesenchymal stem cells to enhance wound healing

“…Skin grafts can reduce deaths from infection. However, such injuries are long-lasting and many patients suffer from chronic pain for a long time 39, 40. Cell-based therapies and tissue regeneration are new approach to overcome the present limitations of burn wound healing.…”

Studying the healing and long-term outcomes of two partial thickness wound models using different wound dressings

“…5). Oedema is marked, and sensation is altered in areas of a deep partial-thickness burn [31][32][33]. In this thesis the term deep dermal burns (DDB) will be used for burns of this depth.…”

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“…They are strong and have controllable degradation rates, are less expensive, having more reliable sources of raw material and can provide a wide range of physical properties using various fabrication techniques. 52 Despite acceptable results in epithelialization of keratinocytes with synthetic polymers, no successful epidermal graft has been achieved, due to their limited cellular recognition and tissue compatibility. Synthetic polymers in combination with natural polymers can be used for temporary dressing, epidermal/dermal cell carriers, or full-thickness skin equivalent, 53 PLGA/collagen, 54 PLA/ chitosan, 55 PCL/chitosan, 56 PCL/collagen 57 currently used for skin graft development.…”