Histological assessment of tangentially excised burn eschars

Indeterminate-Depth Burn Injury—Exploring the Uncertainty

“…The depth of a burn wound dictates the healing course, need for surgery, and morbidity associated with the injury. 1,2 Thus, depth is one of the most important determinants of burn wound management. Indeterminate-depth burns (IDB) represent a perplexing diagnostic and management challenge for clinicians.…”

Improving the histologic characterization of burn depth

“…Dermatopathologists are rarely called upon to interpret thermal injury and may be unfamiliar with the unique appearance of thermally injured tissue. Numerous studies have detailed the characteristics of hematoxylin and eosin (H&E) stained sections of mammalian burn wound tissue, and the use of H&E staining as a method to determine the depth of injury . One study used vessel patency as a measure of tissue viability in human burn tissue and posited that the final level of vascular patency demonstrated increased sensitivity as compared with structural changes to collagen during thermal denaturation due to different thresholds for thermal injury .…”

“…Some authors insist that collagen can be evaluated with H&E alone; however, characteristics of collagen in H&E‐stained tissue that correlate with denaturation have been variously described as glass‐like or as a separation of collagen . In other cases, authors do not provide detailed descriptions of collagen changes, other than identifying the entire section as necrotic, despite the presence of epithelial lined appendages with a normal appearance . Furthermore, studies that advocate more complex staining methods such as Masson's Trichrome or polarization light evaluation of Picrosirius red‐stained tissue may mislead interpretation of collagen health, as these techniques mainly identify changes in collagen fiber alignment and can be dependent on the timing of the burn injury …”

Burn Wound Healing and Tissue Engineering

“…Furthermore, the extent of excision is based on visual presence of bleeding of the viable wound bed, which may not always be accurate. A histological study of excised burn eschar suggests that not uncommonly, normal viable tissue is sacrificed while non-viable eschar may remain 32 . Thus, additional methods that enhance surgical assessment of the endpoint of excision beyond visualization of bleeding may further improve the selectivity and specificity of this time honoured procedure.…”