Surgical Management of Burn Patients

Leon-Villapalos, Jorge

doi:10.1007/978-3-030-18940-2_34

Cited by 3 publications

(4 citation statements)

References 77 publications

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“…Skin grafting is a mainstay for the treatment of severe burns and traumatic injuries and has revolutionized the survival of burn patients (8). Unfortunately, skin grafts are not a perfect replacement for injured skin and may result in debilitating fibrotic HTS formation and severe contractures that may require multiple rounds of revision surgeries (8)(9)(10)(11)(12). In addition, there are currently no FDAapproved pharmacologic therapies to prevent these complications and improve outcomes after grafting (7,13,14).…”

Section: Discussionmentioning

confidence: 99%

“…Although skin grafts serve an important function in rapidly restoring the barrier function of the skin to prevent infection and reduce mortality, secondary contraction during graft healing results in HTS formation (8). Healed skin grafts are also characterized by increased fragility, abnormal pigmentation, and poor texture, compared to unwounded skin (9). Revision rates after skin grafting have been reported to be as high as 20 to 30% (10), with younger patients sometimes requiring multiple rounds of skin grafting as they grow, presenting additional challenges in donor site availability (11,12).…”

Section: Introductionmentioning

confidence: 99%

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Disrupting mechanotransduction decreases fibrosis and contracture in split-thickness skin grafting

et al. 2022

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Burns and other traumatic injuries represent a substantial biomedical burden. The current standard of care for deep injuries is autologous split-thickness skin grafting (STSG), which frequently results in contractures, abnormal pigmentation, and loss of biomechanical function. Currently, there are no effective therapies that can prevent fibrosis and contracture after STSG. Here, we have developed a clinically relevant porcine model of STSG and comprehensively characterized porcine cell populations involved in healing with single-cell resolution. We identified an up-regulation of proinflammatory and mechanotransduction signaling pathways in standard STSGs. Blocking mechanotransduction with a small-molecule focal adhesion kinase (FAK) inhibitor promoted healing, reduced contracture, mitigated scar formation, restored collagen architecture, and ultimately improved graft biomechanical properties. Acute mechanotransduction blockade up-regulated myeloid CXCL10-mediated anti-inflammation with decreased CXCL14-mediated myeloid and fibroblast recruitment. At later time points, mechanical signaling shifted fibroblasts toward profibrotic differentiation fates, and disruption of mechanotransduction modulated mesenchymal fibroblast differentiation states to block those responses, instead driving fibroblasts toward proregenerative, adipogenic states similar to unwounded skin. We then confirmed these two diverging fibroblast transcriptional trajectories in human skin, human scar, and a three-dimensional organotypic model of human skin. Together, pharmacological blockade of mechanotransduction markedly improved large animal healing after STSG by promoting both early, anti-inflammatory and late, regenerative transcriptional programs, resulting in healed tissue similar to unwounded skin. FAK inhibition could therefore supplement the current standard of care for traumatic and burn injuries.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Disrupting mechanotransduction decreases fibrosis and contracture in split-thickness skin grafting

et al. 2022

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“…The third one, though, requires hospital therapy and surgical intervention for the removal of charred skin associated or not with grafts or with the use of regeneration systems. 34,35 Even though the healing process of burnt skin presents cellular and tissue events similar to other cases of wound healing regarding the skin, the chemical or thermal burn leads to the creation of a necrotic tissue that needs to be removed naturally or surgically for healing to occur. This necrotic tissue also facilitates colonization processes by microorganisms on the surface of the wounds, since the cells of the immune system do not reach the region of dead tissue, which generates greater local inflammatory conditions.…”

Section: Skin Healing Process After Burnmentioning

confidence: 99%

“…The first two types can be reversed with the use of drugs and regeneration systems. The third one, though, requires hospital therapy and surgical intervention for the removal of charred skin associated or not with grafts or with the use of regeneration systems 34,35 …”

Section: Skinmentioning

confidence: 99%

Dressing systems based on chitosan as active transport platforms in the treatment of burnt skin: Mini‐review

Muniz

Menezes

2022

Polymers for Advanced Techs

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Burns are one of the most common injuries worldwide, affecting thousands of people every year. These wounds, when more severe, can pose a risk to the individual's systemic health and lead to many hospital visits. Among the possible complications arising from cases of deep or generalized burns, sepsis, scar tissue contraction after inadequate healing, and burn shock caused by hypovolemia stand out. Burnt skin is extremely susceptible to bacteria and other pathogens, due to the loss of the protection provided by intact layers of skin, which can severely hinder its proper healing. Several strategies can be used to treat these injuries, among which, the use of hydrogel‐based dressings stands out because of the wet wound healing process. Thus, many studies have focused on the therapeutic effects of chitosan‐based hydrogels for better wound healing due to the good characteristics of this matrix, which include the high biocompatibility, antimicrobial activity, and ability to act as a carrier for the local delivery of actives. In this perspective, studies that explore hydrogel formulations containing chitosan showed the high versatility of these systems that have already been used as transport platforms for natural actives, biomolecules, synthetic antimicrobials, and even antimicrobial nanoparticles. The results of these studies indicate that the use of dressings based on hydrogels containing chitosan can accelerate the healing of wounds caused by burns in the animal model and achieve synergistic antimicrobial effects with some actives, indicating that chitosan hydrogels hold great promise in developing healing systems to regenerate burnt skin

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Topical amlodipine-loaded solid lipid nanoparticles for enhanced burn wound healing: A repurposed approach

M. Salah,

Elbedaiwy,

Helmy

et al. 2024

International Journal of Pharmaceutics

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Surgical Management of Burn Patients

Cited by 3 publications

References 77 publications

Disrupting mechanotransduction decreases fibrosis and contracture in split-thickness skin grafting

Disrupting mechanotransduction decreases fibrosis and contracture in split-thickness skin grafting

Dressing systems based on chitosan as active transport platforms in the treatment of burnt skin: Mini‐review

Topical amlodipine-loaded solid lipid nanoparticles for enhanced burn wound healing: A repurposed approach

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