Progressive burn injury documented with vimentin immunostaining.

Abstract

Precise determination of burn depth during the immediate postburn period remains an unresolved clinical problem. In an attempt to provide a new clinical option to aid in diagnosis of burn depth, an immunohistochemical marker (antivimentin) was used to examine excisional tissues or serial punch biopsies, or both, in partial-thickness human burn injuries. To test the hypothesis that burn injury continues to progress beyond the first 24 hours, burn depth was assessed by quantitative morphometric analysis in both a partial-thickness porcine burn model and in sequential samples from human patients. Vimentin immunostaining of ubiquitous mesenchymal populations resulted in a precise demarcation between burn eschar and the viable underlying dermis at 1 to 5 days after burn trauma. Porcine wounds showed continuous and significant progression in burn depth during days 1 through 3, but wounds were no deeper on the fourth postburn day. Similarly, 13 of 14 patients showed significant progression in burn depth between 1 to 5 days after burn injury. In conclusion, immunohistochemical staining with an antisera targeted toward a widely dispersed cell population in the dermis can be utilized as an effective tool to confirm the depth of tissue injury during the acute postburn period. Data from our randomly selected patients with partial-thickness burn suggest that burn wounds continue to demarcate for several days.