Management Of Burn Injuries Research Articles

On-site burn severity assessment using smartphone-captured color burn wound images

Accurate assessment of burn severity is crucial for the management of burn injuries. Currently, clinicians mainly rely on visual inspection to assess burns, characterized by notable inter-observer discrepancies. In this study, we introduce an innovative analysis platform using color burn wound images for automatic burn severity assessment. To do this, we propose a novel joint-task deep learning model, which is capable of simultaneously segmenting both burn regions and body parts, the two crucial components in calculating the percentage of total body surface area (%TBSA). Asymmetric attention mechanism is introduced, allowing attention guidance from the body part segmentation task to the burn region segmentation task. A user-friendly mobile application is developed to facilitate a fast assessment of burn severity at clinical settings. The proposed framework was evaluated on a dataset comprising 1340 color burn wound images captured on-site at clinical settings. The average Dice coefficients for burn depth segmentation and body part segmentation are 85.12 % and 85.36 %, respectively. The R2 for %TBSA assessment is 0.9136. The source codes for the joint-task framework and the application are released on Github (https://github.com/xjtu-mia/BurnAnalysis). The proposed platform holds the potential to be widely used at clinical settings to facilitate a fast and precise burn assessment.

A Paintable Small-Molecule Hydrogel with Antimicrobial and ROS Scavenging Activities for Burn Wound Healing.

Delayed wound healing induced by bacterial infection and a persistent inflammatory response remains a great clinical challenge. Herein, we reported a paintable, anti-bacterial, and anti-inflammatory Nap-F3K-CA (Nap-Phe-Phe-Phe-Lys-Caffeic Acid) hydrogel for burn wound management based on caffeic acid (CA)-functionalized short peptides (Nap-Phe-Phe-Phe-Lys). Hydrogels are assembled by non-covalent interactions between gelators, and the incorporation of CA promotes the self-assembly of the hydrogel. After being applied to burn wounds, the hydrogel effectively adapted to irregular wound beds and maintained a moist protective environment at the wound. The Nap-F3K-CA hydrogel can scavenge ROS to relieve oxidative damage and downregulate proinflammatory levels. The Nap-F3K-CA hydrogel also displayed potent antibacterial activity against Gram-positive and Gram-negative bacteria, which reduced the incidence of wound infections. Moreover, the hydrogel exhibited good biocompatibility and hemostatic function. In vivo experiments demonstrated that the Nap-F3K-CA hydrogel significantly accelerated the repair of the skin structure including promoting collagen deposition, vascular regeneration, and hair follicle formation. These findings proved the clinical application potential of the Nap-F3K-CA hydrogel as a promising burn wound dressing.

Fighting A New Front On An Old Battlefield: Examining the Development of Topical Antimicrobial Care to Control Burn Wound Sepsis.

Recognition of invasive burn wound sepsis as a major cause of morbidity and mortality in burn injured patients has profoundly changed the management of burn wounds and its associated complications. The development of effective topical antimicrobial therapy is one of the last major developments of modern burn care and has been driven by major world events and scientific breakthroughs. Topical antimicrobial burn care has evolved from the use of anecdotal remedies to scientific breakthroughs such as Moyer's successful dilution of silver nitrate solution, Fox's described benefit of silver sulfadiazine use in animal models, and Pruitt's dramatic improvement in post-burn mortality using topical mafenide acetate in burn wounds. The objective of this manuscript is to review the definition of burn wound sepsis and highlight the major developments and breakthroughs in topical burn wound care throughout history. This includes historical events like major wars or domestic fires that have influenced or impacted the understanding and treatment of burn wounds. Newer advances in topical antimicrobial care such as nanosilvers and dressing technologies that improve the morbidity and mortality associated with burn wound sepsis and novel approaches to management will also be discussed. To improve burn care, it is prudent to look to the past and learn from the experiences of those who contributed to the control of burn wound sepsis.

A carboxymethyl cellulose/chitosan-based hydrogel harvests robust adhesive, on-demand detachment and self-healing performances for deep burn healing

The irregularities resulting from burns and the discomfort associated with changing dressings during treatment remain challenging to provide effective wound therapy. Hydrogels typically lack the capacity to adhere to tissue and are unable to remain at the wound site for an adequate duration, or fail to detach from tissue when required. In this study, a carboxymethyl cellulose/chitosan-based hydrogel with robust tissue adhesion, self-healing and on-demand detachment was designed via a Schiff-base reaction for deep burn healing. The network structure is self-repairing and does not require external stimulation. The injectable hydrogel fragments undergo self-healing, forming a piece of hydrogel that adapts to the shape of the wound and completely fills the scald wound. The Schiff-base reaction in the hydrogel is formed by the aldehyde group of dialdehyde-modified carboxymethyl cellulose (DCMC) and the amino group of dopamine modified carboxymethyl chitosan (CS-DA), which acts as a dynamic crosslink and endows the hydrogel with self-healing capability and on-demand detachment from tissues by using a benign amino acid solution. Additionally, the incorporation of dopamine has been demonstrated to augment the adhesive properties of the hydrogel. Cytotoxicity assays revealed that the hydrogels exhibit favourable biocompatibility. This research offers a promising approach for the management of burn injuries and represents a significant advancement in the development of cellulose/chitosan hydrogels for biomedical applications.

The effect of acellular scaffold loaded with Wharton's jelly-derived stem cells and mineral pitch on healing of burn model in rat.

Severe burns often result in an exacerbated inflammatory response, which can contribute to further injury. This inflammatory response may lead to an increased risk of infection, multiple organ failure, and death. This study aimed to investigate the potential of reducing inflammation to enhance burn wound healing in rats using ovine's small intestinal submucosa as a carrier for Wharton's jelly mesenchymal stem cells (WJ-MSCs) and Mineral Pitch (MP). A rat burn model was developed, and the animals were divided into four groups: control group: burn, placebo group: scaffold-treated burn, cell experimental group: WJ-MSCs seeded scaffold-treated burn, and cell and MP experimental group: scaffolds loaded with WJ-MSCs and MP-treated burn. After treating the wounds in the relevant groups and sampling them on days 5, 14 and 21, histological and pathological parameters, and the expression of genes involved in angiogenesis and epithelialization were evaluated. The study results revealed several findings in the burn wounds. These included changes in mast cell populations, a decrease in inflammatory neutrophils and lymphocytes, an increase in fibroblasts and blood vessels, and upregulation of angiogenesis and epithelialization genes. These changes collectively contributed to enhanced wound healing in cell and MP experimental group compared to the other groups. The findings suggest that scaffolds loaded with Wharton's jelly-derived stem cells and MP can serve as engineered tools to modulate inflammatory conditions during the burn wound healing process. These interventions can improve burn wound management and promote better outcomes.

A dopamine-assisted antioxidative in situ-forming hydrogel with photothermal therapy for enhancing scarless burn wound healing

Burn wounds are characterized by complex physiological and pathophysiological response and the management of burn wounds is challenging. In situ-forming hydrogels and photothermal therapy (PTT) are promising treatments for wound healing. However, current research on biomaterials for burn treatment mainly focuses on either promoting healing or inhibiting scar formation, few studies have combined the two functions of one material. In this study, we prepared a multifunctional, in-situ cross-linked hydrogel termed CPOD hydrogel, which integrates carboxymethyl chitosan (CMCS), polyvinyl alcohol (PVA), oxidized hyaluronic acid (OHA), and dopamine (DA), coupled with photothermal therapy (PTT). In vitro experiments showed that the CPOD hydrogel had outstanding biocompatibility, suitable tissue adhesion and mechanical properties, excellent antimicrobial and antioxidant properties. This hydrogel showed PTT properties, which could produce mild heat in the early stage and higher temperatures in the later stage under NIR radiation. In the treatment of burn wounds of mice, application of CPOD hydrogel with PTT significantly promoted wound healing in the early stage and inhibited scar formation in the later stage, showing great potential for future innovation and application.

Solid Metal Chemical and Thermal Injury Management.

Solid metals may create a variety of injuries. White phosphorous (WP) is a metal that causes both caustic and thermal injuries. Because of its broad use in munitions and smoke screens during conflicts and wars, all military clinicians should be competent at WP injury identification and acute therapy, as well as long-term consequence recognition. English-language manuscripts addressing WP injuries were curated from PubMed and Medline from inception to January 31, 2024. Data regarding WP injury identification, management, and sequelae were abstracted to construct a Scale for the Assessment of Narrative Review Articles guideline-consistent narrative review. White phosphorous appears to be ubiquitous in military conflicts. White phosphorous creates a characteristic wound appearance accompanied by smoke, a garlic aroma, and spontaneous combustion on contact with air. Decontamination and burning prevention or cessation are key and may rely on aqueous irrigation and submersion or immersion in substances that prevent air contact. Topical cooling is a key aspect of preventing spontaneous ignition as well. Disposal of all contaminated clothing and gear is essential to prevent additional injury, especially to rescuers. Long-term sequelae relate to phosphorous absorption and may lead to death. Chronic or repeated exposure may induce jaw osteonecrosis. Tactical Combat Casualty Care recommendations do not currently address WP injury management. Education and management regarding WP acute injury and late sequelae is essential for acute battlefield and definitive facility care. Resource-replete and resource-limited settings may use related approaches for acute management and ignition prevention. Current burn wound management recommendations should incorporate specific WP management principles and actions for military clinicians at every level of skill and environment.

THE USE OF POLOXAMER 188 IN BURN INJURY TREATMENT: A SYSTEMATIC LITERATURE REVIEW.

Although there have been numerous advancements in burn wound management, burn injuries are still a major cause of morbidity and mortality in the United States, and novel therapeutics are still needed to improve outcomes. Poloxamer 188 (P188) is a synthetic copolymer with Food and Drug Administration (FDA) approval that has many biological applications. This study aimed to review the literature on P188 in burn injuries and its effects based on burn mechanisms. We employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to complete this systematic literature review. We searched the databases of Google Scholar, PubMed, and SCOPUS using the keywords burn, p188, poloxamer 188, and pluronic F68 in combination. Two reviewers independently screened the articles for inclusion. Articles that were not in English, were book chapters or conference proceedings, or did not evaluate P188 in the setting of burn injuries were excluded. We included a total of 33 full-text articles with both in vivo and in vitro preclinical studies. P188 was found to be beneficial in animal and cell studies evaluating electrical and thermal burn injuries. P188 was also found to be useful in burn wound management. Although its utility may be limited in radiation injuries, P188 may be helpful in delaying the initial damage caused by radiation burns. P188 therefore has the potential to be used as a therapy in both burn wound management and in the treatment of systemic injuries sustained through burns. Future studies should aim to assess the efficacy of P188 in clinical models of burn injury.

Healing mechanism of cotton bandages loaded with PNIPAM/GO-Ag hydrogel on deep second-degree burn wounds in a rat model

Dressings play a crucial role in the management of burn wounds. In this study, cotton bandages were modified with poly (N-isopropylacrylamide)/graphite oxide/nano silver (PNIPAM/GO-Ag) hydrogel to obtain a novel dressing (PNIPAM/GO-Ag/COT). The healing effect of the PNIPAM/GO-Ag/COT dressing on deep second-degree burn wounds in rats and the changes of related inflammatory factors were explored and analyzed systematically. The deep second-degree burn model was established by the steam scald method in Sprague–Dawley (SD) rats. The granulation tissue, collagen deposition, the expression of tumor necrosis factor-α (TNF-α), and basic fibroblast growth factor (bFGF) in the wound were evaluated by means of HE staining, Masson staining, ELISA, and immunohistochemistry methods. The results showed that, compared with the blank group (rats without the dressing treatment), the PNIPAM/GO-Ag/COT dressing reduced the expression of TNF-α by approximately 18 % and promoted the bFGF expression in wound tissue. Compared to the control group (rats with the gauze treatment), the wound healing rate in the PNIPAM/GO-Ag/COT dressing group was 58 % on the 14th day, with an increase of 30 %. These results demonstrated that the PNIPAM/GO-Ag/COT dressing primarily promoted burn wound healing by reducing inflammatory reactions, promoting collagen deposition, and enhancing the expression of bFGF.

Obstructed vein delivery of ceftriaxone via poly(vinyl-pyrrolidone)-iodine-chitosan nanofibers for the management of diabetic foot infections and burn wounds

Superficial skin injuries especially burn injuries and unhealed diabetic foot open wounds remain troubling for public health. The healing process is often interrupted by the invasion of resistant pathogens that results in the failure of conventional procedures outside the clinical settings. Herein, we designed nanofibers dressing with intrinsic antibacterial potential of poly(vinyl-pyrrolidone)-iodine/ poly (vinyl)-alcohol by electrospinning with chitosan encapsulating ceftriaxone (CPC/NFs). The optimized electrospun CPC/NFs exhibited smooth surface morphology with average diameter of 165 ± 7.1 nm, drug entrapment and loading efficiencies of 76.97 ± 4.7 % and 8.32 ± 1.73 %, respectively. The results displayed smooth and uniformed fibers with adequate thermal stability and ensured chemical doping. The enhanced in vitro antibacterial efficacy of CPC/NFs against resistant E. coli isolates and biosafety studies encourage the use of designed nanofibers dressing for burn injuries and diabetic foot injuries. In vivo studies proved the healing power of dressing for burn wounds model and diabetic infected wounds model. Immunofluorescence investigation of the wound tissue also suggested promising healing ability of CPC/NFs. The designed approach would be helpful to treat these infected skin open wounds in the hospitals and outside the clinical settings.

Assessing Pediatric Burn Wound Infection Using a Point-of-Care Fluorescence Imaging Device.

Wound infection is the most common complication among pediatric burn patients. When not treated promptly, burn wound infection may lead to delayed healing, failure of skin grafts, or death. Standard burn wound assessment includes inspection for visual signs and symptoms of infection (VSSI) and microbial sampling. To aid in the assessment of burn wound infection, the MolecuLight, a point-of-care autofluorescence imaging device, was introduced at our pediatric burn program in 2020. The MolecuLight uses violet light to illuminate the wound bed, causing clinically relevant quantities of 29 different species of bacteria (>104 CFU/g) to fluoresce in real time. The objectives of this study were to evaluate the role of the MolecuLight in the management of pediatric burn wounds and determine if the findings from the MolecuLight corresponded to VSSI and/or microbial sampling. A retrospective review of patients 0-18 years who had burn wounds assessed with the MolecuLight between November 1, 2020 and June 8, 2023 was conducted. Data were extracted from the medical records of 178 eligible patients with 218 wounds imaged with the device. Fluorescence corresponded with VSSI in 81% of wounds and microbial findings in 82% of wounds. MolecuLight fluorescence, in combination with VSSI, improved sensitivity for detecting wound infections by 39% and decreased specificity by 19% compared to visual signs and symptoms in isolation. Incorporation of the MolecuLight in standard burn wound assessments can improve the detection of infections, which may promote improved wound healing outcomes and antimicrobial stewardship.

Evaluation of decellularized caprine small intestine submucosa encapsulated with nano-formulations of cerium oxide and curcumin in the management of burn wound

The management of burn injuries presents a significant challenge in clinical settings, yet an optimal solution remains elusive. Therefore, this study aimed to develop a topical therapeutic formulation to address the complex issues hindering burn wound healing. Emphasizing the sustained presence of bioactive principles, we synthesized a bioactive gel derived from decellularized caprine small intestine submucosa (D-CIS) and encapsulated it with nano-formulations of cerium oxide and curcumin to create a burn wound dressing material with enhanced properties. The choice of encapsulated components was guided by their antimicrobial, antioxidant, and immune-modulating characteristics, along with their inherent ability to gradually release bioactive substances. The encapsulated (cerium oxide and curcumin) D-CIS bioactive gel demonstrated a range of properties, including antimicrobial, antioxidant, and anti-inflammatory effects, along with sustained release kinetics of bioactive molecules. These combined effects facilitated accelerated burn wound healing by mitigating oxidative stress, reducing inflammation, and promoting cell recruitment for epithelial and vascular regeneration. This study contributes to the development of a novel bioactive gel incorporating cerium oxide and curcumin, offering a promising approach to enhance burn wound healing.

REGENERATIVE MEDICINE IN BURN INJURY: A BIBLIOMETRIC ANALYSIS AND LITERATURE REVIEW

Highlights: This research analyzes regenerative medicine trends for burn injuries, providing valuable insights into focal points and article characteristics, enhancing understanding of this critical healthcare issue. This research analyzes trends in regenerative medicine for burn injuries, highlighting emerging areas like 3D printing, nanotechnology, and photothermal therapy as promising future research directions. Abstract: Introduction: Burn injuries represent a significant global health concern, demanding effective management strategies to mitigate their impact. Regenerative medicine offers promising approaches to address burn injury management, utilizing innovative techniques to improve wound healing and tissue regeneration. This paper presents a comprehensive bibliometric analysis and literature review, highlighting trends, hotspots, and article profiles in the application of regenerative medicine for burn injury management, offering valuable insights for future research to enhance burn care. Methods: A Scopus database search spanning from 2004 to 2024 was conducted using keywords related to regenerative medicine, burn injuries, and wound healing, yielding 602 relevant documents for analysis. Subsequent bibliometric analysis using VOSviewer and Biblioshiny identified key trends and contributors in the field. Results: The results indicate an increase in research studies over the years, peaking in 2022, followed by a slight decline. Zhang Y emerged as the top researcher, with the United States leading in research output. Researchers primarily focused on four main areas: materials and techniques, injury management, cell-based therapies, and wound healing strategies. Emerging areas such as 3D printing, nanotechnology, and photothermal therapy are gaining interest for future research. Conclusion: This study provides valuable insights into the evolving landscape of regenerative medicine for burn injury management. Zhang Y's significant contributions and the United States' leading role underscore the global effort in advancing research in this area. The exploration of new technologies like 3D printing and nanotechnology, alongside traditional approaches, signifies the dynamic nature of biomedical research in addressing burn injuries.

An on-demand antibacterial hydrogel for precise and rapid elimination of bacterial infection in a murine partial thickness scald burn wound

Burn wounds trigger prolonged inflammation, impair healing, and result in a high mortality rate. The effective management of burn patients requires a targeted approach to regulate the wound microenvironment, maintaining sterility while fostering conditions conducive to healing and functionality. Here, we developed a targeted antibacterial pH/temperature-responsive silver nanoparticle (AgNP) hydrogel triggering the release of silver ions based on changes in the burn wound microenvironment. The delivery system not only exerts a strong antibacterial effect owing to the localization and interfacial interaction of ultrasmall AgNPs against the bacterial surface and deeply embedded cells within the biofilm but also downregulates the bacterial pore-forming genes, thereby overwhelmingly deactivating bacterial responses through a multifaceted mechanism of action. We demonstrate that the application of AgNP hydrogel results in pH-dependent bacterial killing and elimination of over 95 % of pathogens while being non-toxic to mammalian cell viability and migration. Furthermore, the in vivo preclinical burn infection murine model demonstrates the eradication of S. aureus infection leading to a progressive burn repair supported by increased collagen deposition, anti-inflammatory properties, and increased burn angiogenesis. Overall, this strategy provides a targeted approach to addressing drug-resistant chronic burn infections, thereby contributing to improved management of burn injuries.

Clinical evaluation of the efficiency and safety of the Tromboguard® hemostatic dressing for donor sites of split-thickness skin graft: A multicenter study

Worldwide, burns are the fourth most frequent type of injury. The treatment of burn wounds requires a lot of experience and an interdisciplinary approach including both surgical treatment and pharmacological wound care. The most common management of burn wounds is debridement and wound closure through the use of skin grafts. The purpose of the study was to evaluate the hemostatic and antibacterial effects of the commercially available Tromboguard® foam dressing with an active layer containing alginates and chitosan. The site of application of the product was the donor fields for skin grafts. Findings proved that a polyurethane foam dressing with an active chitosan-alginate layer is a useful option for achieving rapid hemostasis, antimicrobial protection and effective healing at split-thickness skin graft donor sites. Substances present in the active layer promote clot formation and the wound healing process.

Graphene-silymarin-loaded chitosan/gelatin/hyaluronic acid hybrid constructs for advanced full-thickness burn wound management

Burn wounds (BWs) with extensive blood loss, along with bacterial infections and poor healing, may become detrimental and pose significant rehabilitation obstacles in medical facilities. Therefore, the freeze-drying method synthesized novel hemocompatible chitosan, gelatin, and hyaluronic acid infused with graphene oxide-silymarin (CGH-SGO) hybrid constructs for application as a BW patch. Most significantly, synthesized hybrid constructs exhibited an interconnected-porous framework with precise pore sizes (≈118.52 µm) conducive to biological functions. Furthermore, the FTIR and XRD analyses document the constructs' physiochemical interactions. Similarly, enhanced swelling ratios, adequate WVTR (736 ± 78 g m−2 hr−1), and bio-degradation rates were seen during the physiological examination of constructs. Following the in vitro investigations, SMN-GO added to constructs improved their anti-bacterial (against E.coli and S. aureus), anti-oxidant, hemocompatible, and bio-compatible characteristics in conjunction with prolonged drug release. Furthermore, in vivo, implanting constructs on wounds exhibited significant acceleration in full-thickness burn wound (FT-BW) healing on the 14th day (CGH-SGO: 95 ± 2.1 %) in contrast with the control (Gauze: 71 ± 4.2 %). Additionally, contrary to gauze, the in vivo rat tail excision model administered with constructs assured immediate blood clotting. Therefore, CGH-SGO constructs with an improved porous framework, anti-bacterial activity, hemocompatibility, and biocompatibility could represent an attractive option for healing FT-BWs.

A Meta-Analysis of the Mortality and the Prevalence of Burn Complications in Western Populations.

Management of burn injuries is complex, with highly variable outcomes occurring among different populations. This meta-analysis aims to assess the outcomes of burn therapy in North American and European adults, specifically mortality and complications, to guide further therapeutic advances. A systematic review of PubMed, Web of Science, and Cochrane was performed. Random-effect meta-analysis of proportions was conducted to assess the overall prevalence of the defined outcomes. In total, 54 studies were included, pooling 60 269 adult patients. A total of 53 896 patients were in North America (NA, 89.4%), and 6373 were in Europe (10.6%). Both populations experienced similar outcomes. The overall pooled prevalence of mortality was 13% (95% CI, 8%-19%) for moderate burns, 20% (95% CI, 12%-29%) for severe burns in the NA region, and 22% (95% CI, 16%-28%) for severe burns in Europe. Infectious complications were the most common across both regions. European studies showed an infection rate for patients with moderate and severe burns at 8% and 76%, respectively, while NA studies had rates of 35% and 54%. Acute kidney injury (39% vs 37%) and shock (29% vs 35%) were the next most common complications in European and NA studies, respectively. The length of stay was 27.52 days for patients with severe burns in Europe and 31.02 days for patients with severe burns in NA. Burn outcomes are similar between Western populations. While outcomes are reasonably good overall, infectious complications remain high. These findings encourage the development of further therapeutic strategies disclosing respective costs to enable cost/efficiency evaluations in burn management.

Enrichment of creatine-gelatin cryogel with Zataria multiflora essential oil and titanium dioxide nanoparticles as a potential wound dressing

The prevalence of microbial infections in wounds, particularly burn wounds, presents a significant medical concern due to the inherent vulnerability of compromised skin to pathogen colonization and invasion. This study focused on the synthesis and evaluation of a creatine-gelatin cryogel, enriched with Zataria multiflora essential oil and titanium dioxide nanoparticles for potential wound dressing applications. The chemical and physical characteristics of the formulation were characterized by Fourier transform infrared spectroscopy, scanning electron microscopy, atomic force microscopy, and mechanical tests. Further studies such as wound fluid absorptivity, water vapor transmission rate, solubility, moisture content, porosity, and release properties were investigated. The release test demonstrated an encapsulation efficiency of 98.8 % and a loading capacity of 16.45 %, signifying a suitable cryogel matrix. The disk diffusion assay demonstrated that the synthesized cryogel had excellent antimicrobial efficacy against Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Candida species. Additionally, the cryogel exhibited great cytocompatibility and hemocompatibility (∼100 %). Our findings suggest that the creatine-gelatin cryogel blend enriched with Zataria multiflora essential oil and titanium dioxide nanoparticles possesses structural integrity, a cell-friendly nature, moisture-retaining capabilities, and biocompatible characteristics. These properties collectively render it an exceptionally suitable material for advanced wound dressings. Moreover, the demonstrated functional properties of the cryogel, including its ability to prevent infection, exhibit antioxidant activity, and retain moisture, underscore its potential for effective burn wound management.

Burn Wounds and Enzymatic Debridement (ED)-Past, Present, and Future.

Excision of necrotic and devitalized tissues of deep burns is key for optimal care of burn injuries. However, the modality of early tangential excision followed by skin grafting proposed by Zora Janzekovic 5 decades ago was not received initially with great enthusiasm. At present, it developed to become the standard of care (SOC) despite the special expertise it necessitates and the general anesthesia it requires in addition to several drawbacks including excessive blood loss, risk of hypothermia, and most importantly potential excision of normal non-burned tissues. Conservative non-surgical selective enzymatic debridement (ED) at present is becoming more popular as an adjunct or even an alternative approach. A systematic review of the PubMed electronic database was conducted to identify all experimental and clinical studies about ED of burn wounds. Additional separate searches were also conducted to identify any reports missed by the initial systematic review. Full texts of 59 reports (42 clinical and 17 experimental studies) were retrieved for analysis. A total of 46 studies (11 experimental and 35 clinical) were about the pineapple extract debriding agent. In total, 23 clinical studies describing promising favorable results with pineapple bromelain-based debridement (BBD) concentrate were published in the last 3 years (2020-2023). Though available evidence is not entirely in favor of replacing the current surgical SOC with BBD, it certainly presents ED as a highly advantageous modality for the management of burn wounds. Newly described keratinase and SN514 also are promising new products. They both still await further investigation before being clinically adopted.

Initial Pediatric Burn Management: A Practical Guide.

Children have an imperative to explore their environment to grow and develop, which puts them at risk for sustaining burn injury. Burn injury remains the third leading cause of injury-related death worldwide. Plastic surgeons, as experts in the evaluation and management of cutaneous injuries, are frequently called upon to evaluate and treat children with burn injuries. This article focuses on the unique physiologic aspects of children and how they impact initial evaluation and management of burn injury. Children are not "little adults," and they have different airway, circulatory, and cutaneous systems. Understanding the signs of potential child abuse is important to avoid further child harm. Finally, recognition of the criteria for referral to a pediatric burn center is important to optimize both short- and long-term outcomes for patients and families.