Burn Healing Time Research Articles

The Effect of Giving Mangrove Leaf Extract (Rhizophora apiculata) on the Healing of Burn Wounds in Male White Rats (Rattus novergicus) of the Sprague Dawley Strain

A burn wound is damage or loss of tissues caused by contact with a heat source and can be classified into four degrees: I, IIA, IIB, and III. Anti-inflammatory and antioxidant agents such as mangrove leaves can be applied to aid the healing process of burns. One alternative method is to use mangrove leaf extract. This study aims to understand the acceleration of burn healing by applying mangrove leaf extract (Rhizophora apiculata). This study was a true experimental study with a post-test-only control group design, divided into five groups: Knormal (without treatment), K+ (bioplacenton), P1 (20% extract), P2 (30% extract), and P3 (40% extract). Burn wounds were observed for 21 days and assessed with average wound shortening, healing time, and the Bates-Jensen wound assessment tool. Based on the results of statistical tests, it was found that the application of Rhizophora apiculata leaf extract affected the healing of burns in white rats, resulting in a reduction in the burn area (P Value: 0.001). The application of mangrove leaf extract had an effect on the healing time of burns in white rats (P Value: 0.001). An effective dose of mangrove leaf extract was a concentration of 40% for healing burns, a higher effectiveness in healing burns compared to the standard drug, bioplacenton. The administration of mangrove leaf extract positively affects the healing of burns in male white rats (Rattus novergicus) of the Sprague Dawley strain, especially with an extract concentration of 40%.

The Use of Laser Doppler Imaging in Nitric Acid Burns: A Case Report and Literature Review.

Laser Doppler Imaging (LDI) technology has been validated to assess thermal burn depth by predicting wound healing potential. However, there is no clear evidence for its use in chemical burns. We present a case of an 8% total burn surface area (TBSA) nitric-acid burn following an industrial accident, in an otherwise healthy 36-year-old man. LDI assessment was suggestive of poor healing potential of >21 days, warranting surgical management. However, conservative management was opted for based on clinical assessment as the wound eschar appeared thin and more consistent with epithelial staining. Patient follow-up confirmed a total burn healing time of two months, suggesting that the LDI assessment was accurate. A comprehensive literature review was performed using the MEDLINE (PubMed) database to identify animal or clinical studies evaluating the efficacy of LDI in chemical burns. A qualitative synthesis of our findings is presented. We identified two experimental studies in porcine models with sulphur mustard burns, each confirming the accuracy of LDI assessment when compared to the histopathology findings. Limited experimental animal studies on the use of LDI suggest similar validity in chemical burns, and this correlates with the clinical outcome in this case. However, this alone is insufficient to prove its validity and define its role in the assessment of chemical burns. Clinical trials are required to further assess and define the parameters of LDI use and efficacy in this context.

The Use of Infrared Thermography (IRT) in Burns Depth Assessment: A Diagnostic Accuracy Meta-Analysis

Background: The timely diagnosis of burns depth is crucial to avoid unnecessary surgery and delays in adequate management of patients with burn injuries. Whilst it is mostly a clinical diagnosis, indocyanine green, laser Doppler imaging and infrared thermography have been used alongside clinical findings to support the diagnosis. Infrared thermography is a noninvasive technique which uses temperature differences to diagnose tissue burn depth. Our study aims to assess its use in differentiating between superficial and deep burns. Methods: We conducted a systematic literature review and meta-analysis using electronic databases. We used a mixed-effects logistic regression bivariate model to estimate summary sensitivity and specificity and developed hierarchical summary receiver operating characteristic (HSROC) curves. Results: We identified 6 studies reporting a total of 197 burns, of which 92 were proven to be deep burns. The reference standard was clinical assessment at the time of injury and burn healing time. The pooled estimates for sensitivity and specificity were 0.84 (95% CI 0.71–0.92) and 0.76 (95% CI 0.56–0.89), respectively. Conclusions: IRT is a promising burns assessment modality which may allow surgeons to correctly classify burn injuries at the time of presentation. This will allow a more efficient management of burns and timely surgical intervention.

Laser doppler imaging – the role of poor burn perfusion in predicting healing time and guiding operative management

AimTo identify if the proportion of poor blood flow (blue) within an LDI (Laser doppler Imaging) image of a burn independently correlates with healing time. MethodsPatient age, gender, burn type, and burn surface area were collected from the IBID (International Burn Injury Database). All LDI images were copied from the MoorLDI2-BI- Laser Doppler (MLDI) Scanner, onto Adobe Photoshop® version 2020 for pixel counting analysis and calculation of % TBSA (Total Body Surface Area) blue. Multiple linear regression analysis determined whether a proportional relationship was present for each parameter (age, gender, % TBSA Blue and comorbidities) with healing time. Results110 patients with 197 burns were scanned with MLDI. Median age was 5 years (IQR 1–6). Median burn surface area was 1.5% (IQR 1–2.4). 56.4% of patients were male and patients were scanned an average of 2.68 days (SD±1.37) following burn injury. Number of physical comorbidities and age were found to have a statistically significant relationship with healing time (p = 0.03, p = 0.002). Gender and %TBSA blue did not have a statistically significant relationship with healing time (p = 0.07 and p = 0.058 respectively). We found a statistically significant difference in the mean healing time between burns with and without blue (3.43 weeks vs. 2.80 weeks, p = 0.0001). % TBSA Blue was more than four times higher in the operated group (0.48% vs. 0.11%) and was shown to have a statistically significant relationship with decision to operate (p = 0.027). Positive predictive value for the presence of blue on operative rate was 71.6%. Age, gender and number of comorbidities did not have a statistically significant influence on operative rate (p = 0.07, p = 0.50 and p = 0.49). Conclusion% TBSA blue was not found to be a reliable independent indicator of burn healing time, but the presence of blue within an LDI image, advanced patient age and increased number of comorbidities did have a statistically significant relationship with healing time. This suggests their standardised inclusion into management decisions regarding intermediate depth burns is warranted.

The Comparative Study of Efficiency of Hyaluronic Acid Based Dressings and Atraumatic Dressings in Local Treatment of Partial-Thickness Burns

Partial-thickness burns (II degree according to ICD 10) remain a significant problem in combustiology. New approaches to the treatment of burn patients are associated with a group of modern dressings or skin substitutes based on natural biopolymers. Hyaluronic acid (HA) based polymers which is a natural component of the extracellular matrix, are promising.Aims of study. А comparative study of the effectiveness of an atraumatic wound dressing based on a polyamide mesh and hyaluronic acid based wound dressings in the treatment of partial-thickness burns.Material and methods. The work is based on the observation of 215 patients who were hospitalized in the Burn Department of the Far Eastern Medical Center in 2014–2018. All patients underwent surgical treatment of burn wounds - dermabrasion on days 2–3. To close of the postoperative wound, two types of dressings were used: based on hyaluronic acid (HA), n=61 and atraumatic dressings (AD), n=154. The effectiveness of treatment was assessed in terms of the healing time of burns, the severity of the general and local inflammatory response, and the quality of the restored skin.Results. In the treatment with HA based dressings, burns healed five days faster; the wound healing time up to 21 days was noted in 90.2% of cases, with the use of AD — only in 57.1% of cases. HA dressings required replacement half as often as AD. With the use of HA dressings, the local and general inflammatory response to the burn wound developed less frequently and was managed faster. Resistant microorganisms and colonies with abundant growth, were found in the main group one and a half times less often than in the comparison group. When using HA dressings, the restored skin is much less likely to suffer from hypertrophy and scarring.Conclusions. Treatment with HA-based wound dressings in patients with partial-thickness burns are more effective than treatment with traditional atraumatic dressing. Biopolymer skin substitutes is optimal for the treatment of partial-thickness burns in the postoperative period, since the frequency of dressings and the likelihood of secondary microbial contamination of wounds decreases, the degree of contamination of wounds with microflora decreases, and favorable conditions are created for the wound process.

Beta-Adrenergic Blockade in Critical Illness.

Catecholamine upregulation is a core pathophysiological feature in critical illness. Sustained catecholamine β-adrenergic induction produces adverse effects relevant to critical illness management. β-blockers (βB) have proposed roles in various critically ill disease states, including sepsis, trauma, burns, and cardiac arrest. Mounting evidence suggests βB improve hemodynamic and metabolic parameters culminating in decreased burn healing time, reduced mortality in traumatic brain injury, and improved neurologic outcomes following cardiac arrest. In sepsis, βB appear hemodynamically benign after acute resuscitation and may augment cardiac function. The emergence of ultra-rapid βB provides new territory for βB, and early data suggest significant improvements in mitigating atrial fibrillation in persistently tachycardic septic patients. This review summarizes the evidence regarding the pharmacotherapeutic role of βB on relevant pathophysiology and clinical outcomes in various types of critical illness.

Artificial Intelligence in Global Health -A Framework and Strategy for Adoption and Sustainability.

Artificial Intelligence (AI) applications in medicine have grown considerably in recent years. AI in the forms of Machine Learning, Natural Language Processing, Expert Systems, Planning and Logistics methods, and Image Processing networks provide great analytical aptitude. While AI methods were first conceptualized for radiology, investigations today are established across all medical specialties. The necessity for proper infrastructure, skilled labor, and access to large, well-organized data sets has kept the majority of medical AI applications in higher-income countries. However, critical technological improvements, such as cloud computing and the near-ubiquity of smartphones, have paved the way for use of medical AI applications in resource-poor areas. Global health initiatives (GHI) have already begun to explore ways to leverage medical AI technologies to detect and mitigate public health inequities. For example, AI tools can help optimize vaccine delivery and community healthcare worker routes, thus enabling limited resources to have a maximal impact. Other promising AI tools have demonstrated an ability to: predict burn healing time from smartphone photos; track regions of socioeconomic disparity combined with environmental trends to predict communicable disease outbreaks; and accurately predict pregnancy complications such as birth asphyxia in low resource settings with limited patient clinical data. In this commentary, we discuss the current state of AI-driven GHI and explore relevant lessons from past technology-centered GHI. Additionally, we propose a conceptual framework to guide the development of sustainable strategies for AI-driven GHI, and we outline areas for future research.

PENYEMBUHAN LUKA BAKAR PADA TIKUS PUTIH DENGAN MENGGUNAKAN EKSTRAK DAUN PEGAGAN (CENTELLA ASIATICA) 25% DAN EKSTRAK DAUN PETAI CINA (LEUCAENA LEUCOCEPHALA) 30%

Burns are one of the injuries that require the best care to achieve optimal cure. Several previous studies have suggested that leaf extract of Centella asiatica and chinese petai leaf potential as burning healing agent for mild and moderate degree besides medical treatment. The purpose of this study was to explain the difference of effectiveness of leaf extract of pegagan leaves 25% by giving 30% petai chinese extract to heal burns. The samples were white rats (Rattus norvegicus) with total of 28 tails selected according to inclusion criteria then divided into 4 groups randomly is group of leaf extract of pegagan leaf 25% (K1), 30% petai petroleum extract (K2) Gel base (K3) and control (K4). The design of this study used the randomized posttest only control group design and analyzed using Anova and post Hoc Duncan test. The measured variable is the duration of wound healing. Anova test results and Post Hoc Duncan test duration of burn wound healing show that 30% Chinese petai extract group has significant difference with other group with p-value <0,05. Treatment of burns by using chinese petroleum extract 30% more effective than 25% of pegagan leaf extract in healing burns in white rats (Rattus norvegicus) as evidenced by the fastest healing time of burns.

Increased burn healing time is associated with higher Vancouver Scar Scale score.

Increased burn wound healing time has been shown to influence abnormal scarring. This study hypothesised that scar severity increases commensurate to the increase in time to healing (TTH) of the wound.Wound healing and scar data from burn patients treated by the Burn Service of Western Australia at Royal Perth Hospital were examined. The relationship between TTH and scar severity, as assessed by the modified Vancouver Scar Scale (mVSS), was modelled using regression analysis. Interaction terms evaluated the effect of surgery and total body surface area – burn (TBSA) on the main relationship. Maximum likelihood estimation was used to account for potential bias from missing independent variable data.The sample had a median age of 34 years, TTH of 24 days, TBSA of 3% and length of stay of five days, 70% were men and 71% had burn surgery. For each additional day of TTH, the mVSS score increased by 0.11 points (P ≤ 0.001) per day in the first 21 days and 0.02 points per day thereafter (P = 0.004). The relationship remained stable in spite of TBSA or surgical intervention. Investigation of the effect of missing data revealed the primary model underestimated the strength of the association.An increase in TTH within 21 days of injury is associated with an increase in mVSS or reduced scar quality. The results confirm that efforts should be directed toward healing burn wounds as early as possible.

Silver-Coated Nylon Dressing Plus Active DC Microcurrent for Healing of Autogenous Skin Donor Sites

Burn wounds are a significant cause of morbidity and mortality, and improved outcomes are demonstrated with early closure of both primary burn wounds and skin donor sites. Thus, technology that decreases the healing time of burns and donor sites would be potentially lifesaving. We present the results of a single-center, prospective, double-blinded, randomized controlled trial to evaluate the efficacy of silver-coated dressing with active microcurrent in comparison to silver-coated dressing with sham microcurrent on wound-closure time for autogenous skin donor sites. Four hundred five patients were screened for treatment of their donor sites using a silver-coated nylon dressing with either sham or active microcurrent stimulation. Thirty patients were enrolled in the study and then randomized. Of these, 5 patients were removed from analysis due to protocol deviations. Differences in time-to-closure were analyzed using Kaplan-Meier analysis and the proportional hazard regression model. Subjective verbal pain rating scores (0-10; 0, no pain; 10, worst pain) were also recorded. All devices were blinded and programmed at an outside facility, so that every patient had either an active or sham device. The study was unblinded only after the final patient's donor site had healed. All patients achieved donor-site healing before postoperative day 20. The 14 patients in the active microcurrent group [mean, 10.8 (2.9) days; range, 7-15 days] experienced no difference in time to wound healing as compared to the remaining patients in the sham microcurrent group [mean, 11.1 (2.0) days; range, 8-14 days; P = 0.75]. There were no differences in pain from one group compared to the other. None of the donor sites exhibited clinical signs of infection. In a sample size of 25 burn patients, the addition of direct microcurrent to silver-nylon dressings did not decrease time to wound closure of skin donor sites, and it did not show a difference in reported pain levels.

Do illness perceptions and mood predict healing time for burn wounds? A prospective, preliminary study

Some burn wounds take longer to heal than others, but this cannot be fully explained by physical factors such as burn size and depth. Research interest has therefore focussed on the potential contribution of psychological factors, such as perception of the burn and distress, to the wound healing process. ObjectivesUsing the framework of Leventhal's Common-Sense Model, we investigated whether patients’ perceptions of their burn wounds and distress contributed to healing time, and whether this was via the mediating role of adherence to treatment recommendations. MethodSeventy-two adult burn-injured outpatients completed questionnaire measures of burn perceptions (Brief Illness Perception Questionnaire), distress (Hospital Anxiety and Depression Scale), trauma symptoms (Impact of Event Scale-Revised) and appearance concerns (Derriford Appearance Scale-24). Burn characteristics, healing time and adherence data were taken from clinic notes. ResultsDistress, trauma symptoms and appearance concerns were positively correlated with negative burn perceptions. In regression analysis, burn perceptions added significantly to the prediction of burn healing time after age, medical factors and burn characteristics had been controlled for. Adherence measures were not significantly correlated with burns perceptions. ConclusionsOur findings suggest that patients’ perceptions of their burns contribute to healing time. Further research on the mechanisms of this association is warranted.

Burn wound healing time assessed by laser Doppler imaging. Part 2: Validation of a dedicated colour code for image interpretation

Introduction Laser Doppler imaging (LDI) has been investigated and used since 1993 for the assessment of burn wounds. Here we describe tests that validate use of the dedicated colour palette, derived in Part 1, for a standardised interpretation of LDI images for prediction of healing time (<14 days, 14–21 days or >21 days). We also describe clinical and technical factors to be taken into account during LDI imaging and during image interpretation. Methods (1) A cohort of images, selected at random, were assessed, according to strict rules of interpretation, by 6 clinicians against photographs of healing, for accuracy of healing time prediction and clinical usefulness using five-point scales. (2) All images were assessed technically in a similar way for accuracy and the accuracy was further studied by analysing the data by ordinal logistic regression to predict the dependence of burn healing time on demographic variables (age, sex, race, %TBSA, burn cause and site). (3) Where average LDI blood flow could be determined, regression analysis was used to assess the potential accuracy of the technique. Results (1) Clinical accuracy was found to be 93% and usefulness was 89%; (2) technical accuracy was found to be 96%; (3) regression analysis found that a potential accuracy of 90.9% could be achieved using LDI results alone, increasing to 92% if gender was also considered; no other parameters had an influence on healing time prediction. Conclusion LDI can be used in a standardised way as a valid tool for improving on clinical assessment of burn wounds. This can enable earlier appropriate management.

Relationship between healing time and mean perfusion units of laser Doppler imaging (LDI) in pediatric burns

Background Laser Doppler imaging (LDI) is a noninvasive technique used to assess burn depth. However, there have been no studies regarding the use of LDI in predicting burn healing time. Objectives The aims of this study are to evaluate the relationship between healing time and the amount of perfusion seen on LDI and to determine a cut-off value for LDI that predicts if a burn will heal within 14 days. Study design Consecutive patients younger than 15 years old with partial-thickness burns were recruited from May to November 2006 for this prospective observational study. The mean number of perfusion units (PU) as determined by LDI (Periscan PIM 3 system) was obtained within 2–3 days following injury. Healing time was estimated clinically by two physicians and marked by the observation of reepithelization. The mean PU was compared between the early (healed with 14 days) and late healing groups (healed later than 14 days). The usefulness of the mean PU in predicting healing time within 14 days was estimated by receiver operating characteristic curve analysis. Results A total of 103 patients with 181 partial-thickness burn wounds were enrolled in this study. The mean PU from LDI was higher in the early healing group compared to the late healing group (380.2 ± 157.8 vs. 185.8 ± 115.8, p < 0.001). When using 250 PUs as a cut-off value to predict early healing, the sensitivity and specificity were 80.6% and 76.9%, respectively. The area under the ROC curve was 0.844 ( p < 0.001, 95% CI = 0.780–0.908). Conclusions This study suggests the mean PU as determined by LDI can be used as a valuable tool in predicting the healing time of burn wounds.

Using ordinal logistic regression to evaluate the performance of laser-Doppler predictions of burn-healing time

BackgroundLaser-Doppler imaging (LDI) of cutaneous blood flow is beginning to be used by burn surgeons to predict the healing time of burn wounds; predicted healing time is used to determine wound treatment as either dressings or surgery. In this paper, we do a statistical analysis of the performance of the technique.MethodsWe used data from a study carried out by five burn centers: LDI was done once between days 2 to 5 post burn, and healing was assessed at both 14 days and 21 days post burn. Random-effects ordinal logistic regression and other models such as the continuation ratio model were used to model healing-time as a function of the LDI data, and of demographic and wound history variables. Statistical methods were also used to study the false-color palette, which enables the laser-Doppler imager to be used by clinicians as a decision-support tool.ResultsOverall performance is that diagnoses are over 90% correct. Related questions addressed were what was the best blood flow summary statistic and whether, given the blood flow measurements, demographic and observational variables had any additional predictive power (age, sex, race, % total body surface area burned (%TBSA), site and cause of burn, day of LDI scan, burn center). It was found that mean laser-Doppler flux over a wound area was the best statistic, and that, given the same mean flux, women recover slightly more slowly than men. Further, the likely degradation in predictive performance on moving to a patient group with larger %TBSA than those in the data sample was studied, and shown to be small.ConclusionModeling healing time is a complex statistical problem, with random effects due to multiple burn areas per individual, and censoring caused by patients missing hospital visits and undergoing surgery. This analysis applies state-of-the art statistical methods such as the bootstrap and permutation tests to a medical problem of topical interest. New medical findings are that age and %TBSA are not important predictors of healing time when the LDI results are known, whereas gender does influence recovery time, even when blood flow is controlled for.The conclusion regarding the palette is that an optimum three-color palette can be chosen 'automatically', but the optimum choice of a 5-color palette cannot be made solely by optimizing the percentage of correct diagnoses.

Prediction of burn healing time using artificial neural networks and reflectance spectrometer

Background: Burn depth assessment is important as early excision and grafting is the treatment of choice for deep dermal burn. Inaccurate assessment causes prolonged hospital stay, increased medical expenses and morbidity. Based on reflected burn spectra, we have developed an artificial neural network to predict the burn healing time. Purpose: Our study is to develop a non-invasive objective method to predict burn-healing time. Methods and materials: Burns less than 20% TBSA was included. Burn spectra taken on the third postburn day using reflectance spectrometer were analyzed by an artificial neural network system. Results: Forty-one spectra were collected. With the newly developed method, the predictive accuracy of burns healed in less than 14 days was 96%, and that in more than 14 days was 75%. Conclusions: Using reflectance spectrometer, we have developed an artificial neural network to determine the burn healing time with 86% overall predictive accuracy.