The burn wound exudate—An under-utilized resource

Abstract

Introduction The burn wound exudate represents the burn tissue microenvironment. Extracting information from the exudate relating to cellular components, signaling mediators and protein content can provide much needed data relating to the local tissue damage, depth of the wound and probable systemic complications. This review examines the scientific data extracted from burn wound exudates over the years and proposes new investigations that will provide useful information from this underutilized resource. Method A literature review was conducted using the electronic database PubMed to search for literature pertaining to burn wound or blister fluid analysis. Key words included burn exudate, blister fluid, wound exudate, cytokine burn fluid, subeschar fluid, cytokine burns, serum cytokines. 32 relevant article were examined and 29 selected as relevant to the review. 3 papers were discarded due to questionable methodology or conclusions. The reports were assessed for their affect on management decisions and diagnostics. Furthermore, traditional blood level analysis of these mediators was made to compare the accuracy of blood versus exudate in burn wound management. Extrapolations are made for new possibilities of burn wound exudate analysis. Results Studies pertaining to burn wound exudate, subeschar fluid and blister fluid analyses may have contributed to burn wound management decisions particularly related to escharectomies and early burn wound excision. In addition, information from these studies have the potential to impact on areas such as healing, scarring, burn wound conversion and burn wound depth analysis. Conclusion Burn wound exudate analysis has proven useful in burn wound management decisions. It appears to offer a far more accurate reflection of the burn wound pathophysiology than the traditional blood/serum investigations undertaken in the past. New approaches to diagnostics and treatment efficacy assessment are possible utilizing data from this fluid. Burn wound exudate is a useful, currently under-utilized resource that is likely to take a more prominent role in burn wound management.

Evaluation of haemoglobin in blister fluid as an indicator of paediatric burn wound depth

“…As blister fluid is a plasma filtrate [19] proximal to the burn injury, there is potential for alterations in protein abundance which are detectable in blood to also be detectable in blister fluid. Blister fluid has previously been evaluated for its potential in biomarker discovery and measurement [20] and its utility in investigating the burn wound microenvironment [21], although it remains unclear whether changes in the local wound environment are detectable in this sample type or whether they would be masked by larger, systemic alterations. The ability to detect wound site-specific alterations in protein abundance may affect the ability of blister fluid to perform as a sample type for diagnostic or prognostic tests.…”

Thermal Injuries in Veterinary Forensic Pathology

“…Furthermore, various cytokines have been detected in blisters of burning wounds. 88 However, lack of cellular infiltration does not indicate that the burning lesion inevitably developed after death. Blister-like epidermal lesions caused by bruising, blistering, or bullous skin diseases and putrefaction have to be considered as differential diagnoses.…”

Microvascular blood flow in scalds in children and its relation to duration of wound healing: A study using laser speckle contrast imaging

“…The perfusion in those regions generally varied like that in less severe wounds, but instead of a gradual decrease in perfusion to the degree measured in uninjured skin, these wounds maintained high perfusion even when the adjacent more severely burned areas were healing. This could be caused by cytokines and growth factors in the exudate that originated from the central wound, which caused a spillover signaling effect [12,13]. Raised concentrations of heparinbinding EGF-like growth factor in the advancing epithelial margin could also cause an increase in perfusion [14].…”