Second-degree Burns Research Articles

Burn injury characteristics and outcomes among pediatric and adult patients admitted to Ministry of National Guard Health Affairs (MNGHA) hospitals in Saudi Arabia

ObjectiveThis study aims to describe the characteristics and outcomes of burn injuries in pediatric and adult patients admitted to Ministry of National Guard Health Affairs (MNGHA) hospitals in Saudi Arabia. MethodsA multicenter retrospective cohort study was conducted between 2015 and 2021 in five hospitals run by the MNGHA inSaudi Arabia. The study included 555 patients who were admitted to the hospital with burns, and data were collected from an institutional trauma registry on various aspects such as sociodemographic variables, burn clinical characteristics and burn outcomes. The differences in epidemiological data, general characteristics, and outcomes of burn patients with ≤18 and >18 years of age among Saudi hospitalized patients. The associations between patient characteristics and burn outcomes were assessed using multivariable logistic regression. ResultsMost of the participants representing 66.1% males and females 33.9%. Flame and contact were the most common causes of burn injuries, accounting for 43.6% and 43.2% of cases, respectively; followed by chemical (6.7%), then electrical (5.4%), and friction (1.1%). The study revealed that pediatric were the most frequently admitted age group for burn injuries with most cases occurring at home (57%). Pediatric patients had a higher percentage of hot fluid injuries, accounting for 77.5 % of cases (P = 0.00). Flame injuries were more prevalent in adults, accounting for 65.3% of cases (P < 0.05). The study reported that there were significant associations between age, gender, % TBSA, body region affected, and inhalation injury with admission to the ICU in patients with burn injuries. Relative to patients with third degree burns, first and second-degree burns were associated with a lower likelihood of mortality (OR 0.13, 95% CI: 0.03,0.51, p = 0.00). ConclusionThe study’s findings can be utilized to aid in the implementation of different prevention programs and allocate appropriate resources for treatment to reduce the incidence and morbidity of burn injuries. It is essential to continue educating the public on fire safety in the home environment. This can help raise awareness, promote household safety precautions, and encourage early medical care seeking.

Evaluation of Burns Patient in a Tertiary Care Hospital

This article describes the evaluation and management of a child with severe burns in a tertiary care center with a dedicated tertiary-level burns unit. An 8-year-old child with 25% Second-degree scald burns was evaluated and treated with ATLS, WHO Guidelines, and assessed with Abbreviated Burn Severity Index (ABSI) score. We have used routine blood investigations, and microbiological investigations. The child was treated with intravenous fluids and antibiotics. In addition, regenerative treatment modalities were used to improve wound healing.

Review of the Healing Potential of Burn Wounds with Aloe Vera Extract Cream: The Influence of Formula and Virgin Coconut Oil Application

This paper discusses the potential of using Aloe vera extract cream with various formulas, including the incorporation of Virgin Coconut Oil (VCO) as a cream base, for burn wound healing. The study aims to investigate the healing effects of second-degree burn wounds in mice using Aloe vera extract cream with different formulas. Phytochemical analysis identified the presence of phenols, tannins, and saponins in the Aloe vera extract. The results of the wound healing tests indicate that Aloe vera extract creams with different formulas have the potential to accelerate healing, with a healing time range of 8 to 14 days. Formulas containing VCO as a cream base showed faster healing, likely due to the medium-chain saturated fatty acid content in VCO that supports tissue regeneration. Aloe vera extract also possesses cleansing and antiseptic properties that can prevent infections in wounds. Although healing times varied among the different formulas, the main conclusion is that Aloe vera extract creams have the potential to support the healing of second-degree burn wounds.

Treatment of superficial and deep partial width second degree burn's wound with allogeneic cord blood platelet gel.

Burns are caused by a variety of mechanisms, including flames, hot liquids, metallurgy, chemicals, electric current, and ionizing and non-ionizing radiation. The most significant burn wound management involves complete repair and regeneration as soon as possible while minimizing infection, contraction, and scarring in the damaged tissue area. Some factors such as delivery of nutrients, growth factors, and oxygen are essential to promote and stimulate the wound healing progress in the burns area. When these factors are not provided, the burn wound undergoes a physiological crisis. The use of growth factors is a promising approach to overcoming this limitation. Umbilical cord blood platelet concentrates are a rich natural source of growth factors. This clinical trial used growth factors released from the lysis of umbilical cord blood platelet concentrates that have a key role in promoting re-epithelization and regeneration of damaged tissues by forming a fibrin network. This study evaluated the effectiveness of allogeneic cord blood platelet gel topical dressing in a group of patients diagnosed with superficial and deep partial thickness (second-degree) burn wounds. Clinical outcomes were compared between the intervention group and a control group of patients with superficial second-degree burn wounds who received the standard routine treatment including paraffin gauze wound dressing and silver sulfadiazine ointment. The study's results showed that the increased rate of recovery and tissue granulation completely promoted to wound healing and burn wound closure, decreased the recovery time, and reduced inflammation and scars caused by burn injuries. However, the use of cord blood platelet gel topical dressing is not currently a routine treatment method in patients suffering from burn wounds. However, the study's results showed that allogenic cord blood platelet gel could be used to treat superficial and deep second-degree burns as a routine treatment. It was also shown that allogenic cord blood platelet gel topical dressing could be a candidate for autograft or after autograft skin transplantation surgery (in donor and recipient sites) instead of skin surgery in some patients. Allogeneic topical wound dressing provides an effective treatment that offers a faster rate of epithelialization and healing of wounds and also decreases patients' scar and inflammation level as well as the length of recovery time. This, finally, leads to better burn wound management and the improved quality of burn wound treatment.

Impact of Psych-Educational Awareness Program on Emotional Status among Mothers Having Children with Second-Degree Burn

Impact of Psych-Educational Awareness Program on Emotional Status among Mothers Having Children with Second-Degree Burn

Copper-based dressing: Efficacy in a wound infection of ex vivo human skin

This study aimed to evaluate the wound healing and antibacterial effects of two experimental copper dressings compared to a commercial silver dressing. Burn wounds were created in the ex vivo human skin biopsies, then were infected by Staphylococcus aureus. Tissues were treated with copper dressings, silver dressing, or a dressing without any antibacterial component. An infected wound tissue without treatment was considered as the control group. Three days after treatments, tissues were analyzed by bacterial count and histology staining, while their media was used to assess the expression of cytokines and chemokines. Histology staining confirmed the presence of second-degree burn wounds and colonization of bacteria in the surface and superficial layer of tissues. The results demonstrated a higher antibacterial effect, improved epithelium formation, and decreased wound area in one of the copper dressings compared to other dressings. Markers associated with infection control increased in both the copper and silver-treated groups. The cytokine profiling analysis revealed increased expression of markers related to angiogenesis and anti-inflammatory responses and decreased pro-inflammatory cytokine responses in the infected wound treated with one of the copper dressings. Our results confirmed the efficacy of the experimental copper dressing in reducing bacteria and promoting wound healing.

PEGylated curcumin-loaded poly(vinyl alcohol)/Zwitterionic poly(sulfobetaine vinylimidazole)-grafted chitosan nanofiber as a second-degree burn wound dressing

Burn injuries damage skin function and increased the risk of infection. Using natural-inspired antibiotic-free nanofibrous in wound healing has attracted increasing attention. Here, mPEG-Curcumin (mPEG-CUR) was synthesized through a novel, cheap, and high-efficiency method, and incorporated onto poly(vinyl alcohol) (PVA)/zwitterionic poly(sulfobetaine vinylimidazole)-grafted chitosan (CS-g-PNVIS) nanofiber. Due to the lack of electrospinning capability of CS-g-PNVIS and its brittleness, to obtain nanofibers with uniform and bead-free morphology, PVA was used as an electrospinning aid polymer, so that the prepared nanofibers have suitable mechanical properties with an average diameter between 115 ± 18–157 ± 39 nm. The heat-treated nanofibers have adequate swelling and dimensional stability. Time-killing assay proved the antibacterial activity of the mPEG-CUR-loaded nanofibers towards Gram-positive and Gram-negative bacterium. The MTT investigation illustrated the non-cytotoxicity and biocompatibility of the nanofibers. In vivo studies exhibited significant improvement in the mean wound area closure by applying mPEG-CUR nanofibers. The mPEG-CUR-loaded nanofibers showed the highest antioxidant (86 %) power after 40 min. Moreover, nanofibers possess a desirable WVT rate (3.4 ± 0.24–5.5 ± 0.3 kg/m2.d) and good breathability and had the potential to supply a suitable moist environment in the wounded area. This approach can be the beginning of a new path in designing a new generation of nanofiber mats for wound healing applications.

The efficacy of low-level laser therapy for the healing of second-degree burn wounds on lower limbs of glucocorticoid-dependent patients.

This study was designed to investigate the effect of 630 ~ 650-nm red light on treating second-degree burns on lower limbs of glucocorticoid-dependent patients. Sixty-two glucocorticoid-dependent patients with the second-degree burns on lower limbs were divided into the control group (n = 25) and the observation group (n = 37) according to the treatment sequence and the patients' willingness. The patients in both groups were conventionally treated with 1% sulfadiazine silver cream dressing, with the only difference that the observation group received an additional 630-650-nm red light irradiation for 20min before dressing. Each group was observed for 21days, and observation ended if the wound healing was terminated. The wound healing rates, wound secretions, marginal response, and pain/itching levels were monitored and assessed. Compared with the control group, the observation group showed higher wound healing rate, fewer wound secretions, and more relief in marginal response. Clinical observation showed that 630-650-nm red light could effectively reduce wound purulent drainage/discharge, relieve the marginal response as well as pain, and promote wound healing.

Radiosterilized Pig Skin, Silver Nanoparticles and Skin Cells as an Integral Dressing Treatment for Burns: Development, Pre-Clinical and Clinical Pilot Study.

Radiosterilized pig skin (RPS) has been used as a dressing for burns since the 1980s. Its similarity to human skin in terms of the extracellular matrix (ECM) allows the attachment of mesenchymal stem cells, making it ideal as a scaffold to create cellularized constructs. The use of silver nanoparticles (AgNPs) has been proven to be an appropriate alternative to the use of antibiotics and a potential solution against multidrug-resistant bacteria. RPS can be impregnated with AgNPs to develop nanomaterials capable of preventing wound infections. The main goal of this study was to assess the use of RPS as a scaffold for autologous fibroblasts (Fb), keratinocytes (Kc), and mesenchymal stem cells (MSC) in the treatment of second-degree burns (SDB). Additionally, independent RPS samples were impregnated with AgNPs to enhance their properties and further develop an antibacterial dressing that was initially tested using a burn mouse model. This protocol was approved by the Research and Ethics Committee of the INRLGII (INR 20/19 AC). Transmission electron microscopy (TEM) and dynamic light scattering (DLS) analysis of the synthesized AgNPs showed an average size of 10 nm and rounded morphology. Minimum inhibitory concentrations (MIC) and Kirby-Bauer assays indicated that AgNPs (in solution at a concentration of 125 ppm) exhibit antimicrobial activity against the planktonic form of S. aureus isolated from burned patients; moreover, a log reduction of 1.74 ± 0.24 was achieved against biofilm formation. The nanomaterial developed with RPS impregnated with AgNPs solution at 125 ppm (RPS-AgNPs125) facilitated wound healing in a burn mouse model and enhanced extracellular matrix (ECM) deposition, as analyzed by Masson's staining in histological samples. No silver was detected by energy-dispersive X-ray spectroscopy (EDS) in the skin, and neither by Inductively Coupled Plasma Mass Spectrometry (ICP-MS) in different organs of the mouse burn model. Calcein/ethidium homodimer (EthD-1), 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT), and scanning electron microscopy (SEM) analysis demonstrated that Fb, Kc, and MSC could attach to RPS with over 95% cell viability. Kc were capable of releasing FGF at 0.5 pg above control levels, as analyzed by ELISA assays. An autologous RPS-Fb-Kc construct was implanted in a patient with SDB and compared to an autologous skin graft. The patient recovery was assessed seven days post-implantation, and the patient was followed up at one, two, and three months after the implantation, exhibiting favorable recovery compared to the gold standard, as measured by the cutometer. In conclusion, RPS effectively can be used as a scaffold for the culture of Fb, Kc, and MSC, facilitating the development of a cellularized construct that enhances wound healing in burn patients.

Effects including photobiomodulation of galactomannan gel from Cassia grandis seeds in the healing process of second-degree burns

The epithelium recovery of skin-burned wounds has been currently achieved by several therapies, for example, hydrogel-based dressings and photobiomodulation therapy (PBMT). Thus, this work aimed to evaluate the healing activity of Cassia grandis seeds' galactomannan gel, associated or not with PBMT, in second-degree burns. Sixty male Wistar rats were assigned to four groups: Control (CG), Gel (GG), Laser/PBMT (LG), and Laser+Gel (GLG). Burns were made with an aluminum bar (90 °C), and submitted to clinical observations diary and area measurements at specific days. Microscopic analysis was based on histological criteria. The results showed that GG, LG, and GLG had a higher contraction rate (p < 0.05) than CG on the 14th experimental day, not differing from each other (∼95 %). At 21 days, all groups showed complete contraction (p > 0.05). Considering the histological results, LG and GLG showed excellent pro-wound healing properties after 14 days; at 21 days, all groups showed wound recovery compared to previous days. In view of the macroscopic and microscopic observations, the isolated treatments (Gel or Laser) effectively accelerated healing; however, the association (Laser+Gel) promoted re-epithelialization and stromal remodeling with better evolution of epithelium recovery due to the positive synergistic effect, thus emerging as a promising therapeutic alternative in the repair of burns.

Surgical management of burn injury patients : Comments on the guidelines on treatment of thermal injuries in adults

The treatment of burn injury patients is aunique challenge for clinicians. The extent of thermal injuries ranges from very small burns to life-threatening burn injuries. Insufficient treatment can result in a substantial impairment in the quality of life. In order to avoid such sequelae a targeted treatment must be carried out. A precise diagnosis determines the necessary treatment. Superficial second-degree burns (2a) not involving the face, hand or joints with atotal body surface area smaller than 10% can usually be treated with modern wound dressings in an outpatient setting. Deep second-degree burns (2b) are an indication for debridement. In addition to the classical surgical procedures with tangential excision, enzymatic debridement can also be employed. Similarly, indeterminate burns (2a/2b) are also considered to be an indication for enzymatic debridement. Third-degree burns are treated with early debridement and skin grafting. These patients can also benefit from special dermal replacement procedures for an improvement of the functional and esthetic results. Due to the long-term visible sequelae of burns, aftercare of these patients is indicated.

A frog peptide provides new strategies for the intervention against skin wound healing

BackgroundAmphibian derived pro-healing peptides as molecular probes might provide a promising strategy for development of drug candidates and elucidation of cellular and molecular mechanisms of skin wound healing. A novel skin amphibian peptide, OA-RD17, was tested for modulation of cellular and molecular mechanisms associated with skin wound healing.MethodsCell scratch, cell proliferation, trans-well, and colony formation assays were used to explore the pro-healing ability of peptide OA-RD17 and microRNA-632 (miR-632). Then, the therapeutic effects of OA-RD17 and miR-632 were assessed in mice, diabetic patient ex vivo skin wounds and SD rats. Moreover, hematoxylin and eosin (H&E), enzyme-linked immunosorbent assay (ELISA), immunohistochemistry, and immunofluorescence staining were performed to detect skin wound tissue regeneration, inflammatory factors expression, and macrophage polarization. Finally, RNA sequencing, molecular docking, co-localization, dual luciferase reporter, real-time quantitative reverse transcription PCR (RT-qPCR), and Western blotting were used to explore the mechanism of OA-RD17 and miR-632 on facilitating skin wound healing.ResultsThe non-toxic peptide (OA-RD17) promoted macrophage proliferation and migration by activating MAPK and suppressed inflammation by inhibiting NF-κB. In keratinocytes, OA-RD17 inhibited excessive inflammation, and activated MAPK via the Toll-like receptor 4 (TLR4) to promote proliferation and migration, as well as up-regulate the expression of miR-632, which targeted GSK3β to activate Wnt/β-catenin to boost proliferation and migration in a positive feedback manner. Notably, OA-RD17 promoted transition from the inflammatory to proliferative stage, accelerated epidermal and granulation regeneration, and exhibited therapeutic effects on mouse and diabetic patient ex vivo skin wounds. MiR-632 activated Wnt/β-catenin to promote full-thickness skin wound healing in rats.ConclusionsOA-RD17 exhibited promising therapeutic effects on mice (full-thickness, deep second-degree burns), and ex vivo skin wounds in diabetic patients by regulating macrophages proliferation, migration, and polarization (MAPK, NF-κB), and keratinocytes proliferation and migration (TLR4/MAPK/miR-632/Wnt/β-catenin molecular axis). Moreover, miR-632 also activated Wnt/β-catenin to promote full-thickness skin wound healing in rats. Notably, our results indicate that OA-RD17 and miR-632 are promising pro-healing drug candidates.Graphical

Design and performance evaluation of a firefighting protective suit with an incorporated liquid-cooled system

A liquid-cooled garment with active cooling function can make up for deficiency of the human thermoregulatory system and passive thermal insulation of the firefighting protective suit. Fabrics treated at different inlet temperatures and pipeline intervals were applied in multilayered liquid-cooled fabric assemblies (LCFAs). The heat absorbed by the skin and the second-degree burn time were evaluated by the stored energy test under low heat radiation. Results indicated that the thermal protective performance of the LCFAs was significantly improved, with the second-degree burn time increasing more than 50% on average. There was a strong negative correlation between the thermal protective performance and cooling effect under different pipeline intervals, while the negative correlation was weak for different inlet temperatures. The results gained from this study may provide valuable insight for design of the inlet temperature and pipeline interval of a liquid-cooled system in the firefighting protective suit.

Transplantation of human induced pluripotent stem cell derived keratinocytes accelerates deep second-degree burn wound healing.

Current evidence shows that human induced pluripotent stem cells (hiPSCs) can effectively differentiate into keratinocytes (KCs), but its effect on skin burn healing has not been reported. To observe the effects of hiPSCs-derived KCs transplantation on skin burn healing in mice and to preliminarily reveal the underlying mechanisms. An analysis of differentially expressed genes in burn wounds based on GEO datasets GSE140926, and GSE27186 was established. A differentiation medium containing retinoic acid and bone morphogenetic protein 4 was applied to induce hiPSCs to differentiate into KCs. The expression of KCs marker proteins was detected using immunofluorescence staining. A model of a C57BL/6 mouse with deep cutaneous second-degree burn was created, and then phosphate buffered saline (PBS), hiPSCs-KCs, or hiPSCs-KCs with knockdown of COL7A1 were injected around the wound surface. The wound healing, re-epithelialization, engraftment of hiPSCs-KCs into wounds, proinflammatory factor level, and the NF-κB pathway proteins were assessed by hematoxylin-eosin staining, carboxifluorescein diacetate succinimidyl ester (CFSE) fluorescence staining, enzyme linked immunosorbent assay, and Western blotting on days 3, 7, and 14 after the injection, respectively. Moreover, the effects of COL7A1 knockdown on the proliferation and migration of hiPSCs-KCs were confirmed by immunohistochemistry, EdU, Transwell, and damage repair assays. HiPSCs-KCs could express the hallmark proteins of KCs. COL7A1 was down-regulated in burn wound tissues and highly expressed in hiPSCs-KCs. Transplantation of hiPSCs-KCs into mice with burn wounds resulted in a significant decrease in wound area, an increase in wound re-epithelialization, a decrease in proinflammatory factors content, and an inhibition of NF-κB pathway activation compared to the PBS group. The in vitro assay showed that COL7A1 knockdown could rescue the inhibition of hiPSCs-KCs proliferation and migration, providing further evidence that COL7A1 speeds up burn wound healing by limiting cell proliferation and migration. In deep, second-degree burn wounds, COL7A1 can promote KC proliferation and migration while also suppressing the inflammatory response.

3D-printed hydrogels dressings with bioactive borate glass for continuous hydration and treatment of second-degree burns.

Recent advances in additive manufacturing have led to the development of innovative solutions for tissue regeneration. Hydrogel materials have gained significant attention for burn wound treatment in clinical practice among various advanced dressings due to their soothing and moisturizing activity. However, prolonged healing, pain, and traumatic removal due to the lack of long-term wound hydration are some of the challenges in the treatment of second-degree burn wounds. In this study, 3D-printed dressings were fabricated using gelatin, alginate, and bioactive borate glass (BBG) using an extrusion-based bioprinter. After ionic crosslinking, the 3D-printed dressings were characterized for mechanical properties, degradation rate, hydration activity, and in vitro cell viability using human fibroblasts. The results demonstrated that in 3D-printed dressings with 20 wt% BBG, Young's modulus increased by 105%, and 10-day degradation rate decreased by 62%. Addition of BBG prevented the burst release of water from hydrogel dressings and enabled the continuous water release for up to 10 days, which is crucial in treating second-degree burn wounds. 3D-printed hydrogel dressings with BBG showed long-term cell viability that can be a result of the accumulative release of therapeutic ions from BBG particulate. The in vivo wound healing functionality of the dressings was investigated using a rat model with a second-degree burn wound. Our animal study showed that the 3D-printed dressings with BBG exhibited faster wound closure, non-adhesive contact, non-invasive debridement, and non-traumatic dressing removal. Histological analysis suggested that 3D-printed dressings contributed to more uniform re-epithelialization and tissue remodeling compared to the non-printed hydrogels of the same compositions. Critically, 3D-printed dressings with BBG led to significant regeneration of hair follicles compared to the 3D-printed hydrogel, non-printed hydrogel, and the control groups. The superior outcome of the 3D-printed hydrogel-BBG20 dressings can be attributed to the bioactive formulation, which promotes moist wound healing for longer time periods, and the non-adhesive porous texture of the 3D-printed dressings with increased wound-dressing interactions. Our findings provided proof of concept for the synergistic effect of bioactive formulation and the porous texture of the 3D-printed hydrogel dressings incorporated with BBG on continuous water release and, consequently, on second-degree burn wound healing.

Reconstruction of extreme post-burn scar contracture of the ankle using a thoracodorsal artery perforator flap: a case report

Post-burn scar contracture associated with deep second-degree or higher burns in the joint area can lead to joint immobility and may cause chronic ulcers, substantially impacting patients’ quality of life. Surgical intervention is necessary, with local flaps or skin grafts being the first option. In extreme cases, free flap transfer may be required to address large defects that occur after contracture release. This study presents a successful case of reconstruction using free flap transfer in a patient with severe post-burn scar contracture, which resulted in a club-like deformed ankle with a nonfunctional joint. Despite the extreme deformity and nonfunctioning joint, we utilized a thoracodorsal artery perforator flap to stably cover the newly fused joint in a neutral position. After reconstruction, the patient was able to wear shoes and ambulate. This case highlights the potential of free flap transfer even in the most challenging situations where joint function is severely compromised.

Effects of irradiated biological dressings on second-degree burn wounds.

To explore the effect of irradiated biological dressing (IBD) on second degree burn wounds. Eighty patients with second-degree burns who were treated in our department were selected and randomly divided into IBD group and traditional dressing (TD) group by random number table method. The dressing change, wound healing, comfort and adverse reactions of patients in the two groups were compared and analysed. The number of dressing changes in the IBD group was significantly less than that in the TD group, and the pain degree of dressing changes was significantly lower than that in the TD group (P<0.05). The dressing comfort of the IBD group was higher than that of the TD group, the secondary trauma score was lower than that of the TD group, the wound scar hyperplasia score was lower than that of the TD group, and the healing time was shorter than that of the TD group (P<0.05). There was no statistically significant difference in adverse reactions between the two groups (P>0.05). IBD can promote the healing of second-degree burn wounds, improve patient comfort, reduce secondary trauma and wound scarring, and improve patients' quality of life.

Ulvan/Silver nanoparticle hydrogel films for burn wound dressing

Ulvan is a polysaccharide from green algae that shows good hydrogel film dressing characteristics. Silver nanoparticles (AgNP) can be incorporated into the hydrogel film to improve antibacterial properties and provide a potential burn treatment. In this study, we developed a novel hydrogel film wound dressing composed of ulvan and silver nanoparticles. Two concentrations (0.5 mM and 1 mM) of silver nitrate were used to produce ulvan-silver nanoparticles hydrogel film (UHF–AgNP0.5 and UHF–AgNP1), respectively. The physicochemical characteristics of the hydrogel films were evaluated, including particle size, zeta potential, Fourier transform infrared (FTIR), X-ray diffractometry (XRD), scanning electron microscope and energy-dispersive X-ray (SEM-EDX). Furthermore, the in vitro antimicrobial activity, and second-degree burn wound healing test were evaluated. The UHF–AgNP0.5 showed the highest antimicrobial activity compared to UHF–AgNP1 and UHF film. Meanwhile, an in vivo study using Wistar rats induced second-degree burns showed that UHF–AgNP0.5 significantly accelerated the healing process by regulating the inflammatory process, increasing re-epithelialization, and improving the vascularization process. Ulvan-silver nanoparticle hydrogel films have the ability to accelerate the healing of second-degree burns and are potential candidates for wound dressings.

The Association Between the Timing of Initiation of Pharmacologic Venous Thromboembolism Prophylaxis with Outcomes in Burns Patients.

Hospitalized burn patients are at increased risk for venous thromboembolism (VTE). Guidelines regarding thromboprophylaxis in burn patients are unclear. This study aims to compare the outcomes of early versus late thromboprophylaxis initiation in burn patients. In this 3-year analysis of 2017-2019 ACS-TQIP, adult(18-64years) burn patients were identified after applying inclusion/exclusion criteria and stratified based on timing of initiation of VTE prophylaxis: Early(<24 hours of admission); Late(>24 hours). Outcomes were deep venous thrombosis(DVT), pulmonary embolism(PE), unplanned return to operating room (OR), unplanned intensive care unit (ICU) admission, post-prophylaxis packed red blood cells (PRBC) transfusion, and mortality. Nine thousand two hundred and seventy-two patients were identified. Overall, median age was 41years, 71.5% were male, and median[IQR] injury severity score was 3[1-8]. 53% had second-degree burns, and 80% had less than 40% of total body surface area affected. Median time to thromboprophylaxis initiation was 11[6-20.6]hours. Overall VTE rate was 0.9% (DVT-0.7%, PE-0.2%). On univariable analysis, early prophylaxis group had lower rates of DVT(0.6% vs 1.1%, P = .025), and PE(0.1% vs 0.6%, P < .001). On multivariable regression, late prophylaxis was associated with 1.8 times higher odds of DVT (aOR = 1.8, 95% CI = 1.04-3.11, P = .03), 4.8 times higher odds of PE(aOR = 4.8, 95% CI = 1.9-11.9, P < .001), and 2 times higher odds of unplanned ICU admission(aOR = 2.1, 95% CI = 1.4-3.1, P < .001). Furthermore, early thromboprophylaxis was not associated with increased odds of post-prophylaxis PRBC transfusion(aOR = 1.1, 95% CI = 0.8-1.4, P = .4), and mortality(aOR = 0.68, 95% CI = 0.4-1.1, P = .13). Early VTE prophylaxis in burn patients is associated with decreased rates of DVT and PE, without increasing the risk of bleeding and mortality. VTE prophylaxis may be initiated within 24 hours of admission to reduce VTE in this high-risk patient population.

Preparation and evaluation of a polycaprolactone/chitosan/propolis fibrous nanocomposite scaffold as a tissue engineering skin substitute.

Recently, the application of nanofibrous mats for dressing skin wounds has received great attention. In this study, we aimed to fabricate and characterize an electrospun nanofibrous mat containing polycaprolactone (PCL), chitosan (CTS), and propolis for use as a tissue-engineered skin substitute. Raw propolis was extracted, and its phenolic and flavonoid contents were measured. The physiochemical and biological properties of the fabricated mats, including PCL, PCL/CTS, and PCL/CTS/Propolis were evaluated by scanning electron microscopy (SEM), atomic force microscopy (AFM), mechanical analysis, swelling and degradation behaviors, contact angle measurement, cell attachment, DAPI staining, and MTT assay. On the other hand, the drug release pattern of propolis from the PCL/CTS/Propolis scaffold was determined. A deep second-degree burn wound model was induced in rats to investigate wound healing using macroscopical and histopathological evaluations. The results revealed that the propolis extract contained high amounts of phenolic and flavonoid compounds. The fabricated scaffold had suitable physicochemical and mechanical properties. Uniform, bead-free, and well-branched fibers were observed in SEM images of mats. AFM analysis indicated that the addition of CTS and propolis to PCL elevated the surface roughness. MTT results revealed that the electrospun PCL/CTS/Propolis mat was biocompatible. The presence of fibroblast cells on the PCL/CTS/Propolis mats was confirmed by DAPI staining and SEM images. Also, propolis was sustainably released from the PCL/CTS/Propolis mat. The animal study revealed that addition of propolis significantly improved wound healing. The nanofibrous PCL/CTS/Propolis mat can be applied as a tissue-engineered skin substitute for healing cutaneous wounds, such as burn wounds.