Current concepts on burn wound conversion—A review of recent advances in understanding the secondary progressions of burns

Abstract

Burn wound conversion describes the process by which superficial partial thickness burns convert into deeper burns necessitating surgical intervention. Fully understanding and thus controlling this phenomenon continues to defy burn surgeons. However, potentially guiding burn wound progression so as to obviate the need for surgery while still bringing about healing with limited scarring is the major unmet challenge. Comprehending the pathophysiologic background contributing to deeper progression of these burns is an essential prerequisite to planning any intervention. In this study, a review of articles examining burn wound progression over the last five years was conducted to analyze trends in recent burn progression research, determine changes in understanding of the pathogenesis of burn conversion, and subsequently examine the direction for future research in developing therapies. The majority of recent research focuses on applying therapies from other disease processes to common underlying pathogenic mechanisms in burn conversion. While ischemia, inflammation, and free oxygen radicals continue to demonstrate a critical role in secondary necrosis, novel mechanisms such as autophagy have also been shown to contribute affect significantly burn progression significantly. Further research will have to determine whether multiple mechanisms should be targeted when developing clinical therapies.

Indeterminate-Depth Burn Injury—Exploring the Uncertainty

“…41 In addition to the systemic response to injury, local responses such as inflammatory cell infiltration, microthromboses leading to ischemia, and oxidative stress from reperfusion play a major role in burn wound progression. 42 In a murine model of burns, a study compared the inflammatory response in very early (24 h after burn) and later (8 d after burn) injuries. 41 Delayed excision resulted in a more severe cytokine and chemokine regulatory cell response compared with early excision.…”

Toll-Like Receptor Signaling in Burn Wound Healing and Scarring

“…Reviewed elsewhere are strategies for reducing burn wound progression, 55 dampening cutaneous wound inflammation for improving healing, 56 and treating diseases (metabolic) driven by DAMPs 57 ; in this study, we review therapeutic strategies that can potentially ameliorate burn wound progression, systemic inflammation, and hypertrophic scarring through targeting of TLR pathways. Targets of TLR signaling pathways span from the DAMPs and PAMPs that trigger TLRs and extend to downstream kinases that activate the transcription factors driving the expression of inflammatory mediators (Fig.…”

In vitro and in vivo investigation of a novel amniotic‐based chitosan dressing for wound healing

“…Hemostasis, inflammation, cell proliferation, and cellular migration are the main phases of skin remodeling during the skin heal. In context of burn wound, it has been accepted that the acceleration of wound repair is the best treatment . Since 100 years ago, AM has been applied to repair epithelial defects and chronic wounds .…”

“…In context of burn wound, it has been accepted that the acceleration of wound repair is the best treatment. 34,35 Since 100 years ago, AM has been applied to repair epithelial defects and chronic wounds. 36 Although, its use is cost effective, safe and effective, its application was limited based on the size and depth of the injury and its firm adhesive properties.…”