Heparin mimetic peptide nanofiber gel promotes regeneration of full thickness burn injury

Abstract Objective Burn wound progression is an inflammation driven process where an initial partial-thickness thermal burn wound can evolve over time to a full-thickness injury. We have developed an oil-in-water nanoemulsion formulation (NB-201) containing benzalkonium chloride for use in burn wounds that is antimicrobial and potentially inhibits burn wound progression. We used a porcine burn injury model to evaluate the effect of topical nanoemulsion treatment on burn wound conversion and healing. Methods Anesthetized swine received thermal burn wounds using a 25cm 2 surface area copper bar heated to 80 oC. Three different concentrations of NB-201 (10%, 20%, or 40% nanoemulsion), silver sulfadiazine cream or saline were applied to burned skin immediately after injury and on days 1, 2, 4, 7, 10, 14, and 18 post-injury. Digital images and skin biopsies were taken at each dressing change. Skin biopsy samples were stained for histological evaluation and graded. Skin tissue samples were also assayed for mediators of inflammation. Results Dermal treatment with NB-201 diminished thermal burn wound conversion to a full-thickness injury as determined by both histological and visual evaluation. Comparison of epithelial restoration on day 21 showed that 77.8% of the nanoemulsion treated wounds had an epidermal injury score of 0 compared to 16.7% of the silver sulfadiazine treated burns (p=0.01). Silver sulfadiazine cream and saline treated wounds (controls) converted to full-thickness burns by day 4. Histological evaluation revealed reduced inflammation and evidence of skin injury in NB-201 treated sites compared to control wounds. The nanoemulsion treated wounds often healed with complete regrowth of epithelium and no loss of hair follicles (NB-201: 4.8±2.1, saline: 0±0, silver sulfadiazine: 0±0 hair follicles per 4mm biopsy section, p<0.05). Production of inflammatory mediators and sequestration of neutrophils were also inhibited by NB-201. Conclusions Topically applied NB-201 prevented the progression of a partial-thickness burn wound to full-thickness injury and was associated with a concurrent decrease in dermal inflammation.

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536 Road Rash: Understanding a Challenging Form of Burn Injury

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.165 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S106-S107

Author(s):

Zachary J Collier ◽

Katherine J Choi ◽

Christopher H Pham ◽

Haig A Yenikomshian ◽

Justin Gillenwater

Keyword(s):

High Risk ◽

Burn Injury ◽

Tissue Injury ◽

Wound Infections ◽

Full Thickness ◽

Optimal Care ◽

Deep Tissue Injury ◽

Traumatic Tattoo ◽

High Degree ◽

Level 1 Trauma Center

Abstract Introduction Road rash is a unique burn injury due to imbedded foreign debris and deeply seeded bacteria. Literature on this injury fails to address its unique mechanism and ways to reduce scarring and infection. Given the paucity of data, a retrospective review was performed at a single level 1 trauma center to study friction burn characteristics and outcomes from these injuries Methods We performed a systematic literature search with PubMed, Scopus, and OvidSP Medline databases using the following keywords: friction burn, traumatic tattoo, and road rash. Subsequently, we analyzed all patients treated by our ABA verified burn center for friction related injuries from January 1, 2015 to September 15, 2019 and evaluated demographics, interventions, and outcomes. Results Twenty-four pertinent articles were identified. Seven articles were included after full-text analysis. Analysis of 225 patients from these studies identified an average age of 23±7 years with 66% male. Most occurred from motor accidents (74%) with industrial (11%) and blast (10%) mechanisms accounting for the majority of the remaining cases. None of the studies recorded TBSA, but 49% were full thickness and 36% had associated injuries. Most patients (58%) required surgery. At our institution, 44 patients met inclusion criteria and the majority were young (25±18 years), men (75%), involved in motor accidents (75%), and low TBSA burns (6.3±5.6%). Over half (57%) had full thickness burns and 72% required surgery. Length of stay was 12±11 days. Of the 27% of patients with traumatic tattooing on admission, 92% successfully had all foreign debris removed by discharge. Eight (18%) patients had wound infections. Importantly, 75% of patients with wound infections had delayed evaluation by a burn practitioner; elucidating a strong and significant correlation (p< 10–5, Cramer’s V 0.84). Conclusions While road rash injuries are often small TBSA, the majority tend to be full thickness, often involve underlying critical structures and frequently require operative intervention. Significantly, patients who developed wound infections were often not evaluated by a burn provider. Applicability of Research to Practice The unique trauma of road rash causes a high degree of superficial and deep tissue injury with high risk for contamination, infection, and scarring such that rapid debridement is critical for optimal care. Burn surgeons should be consulted early as these patients have a high risk of wound infection when not consulted by wound experts.

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Too Hot to Handle? Full-Thickness Burn Injury in a Child Caused by Cyanoacrylate Glue and Cotton—A Case Report and Experimental Study

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa174 ◽

2020 ◽

Author(s):

Madeleine Jacques ◽

Sonia Tran ◽

Monique Bertinetti ◽

Andrew J A Holland

Keyword(s):

Case Report ◽

Burn Injury ◽

Exothermic Reaction ◽

Skin Grafting ◽

Radiant Heat ◽

Maximum Temperature ◽

Full Thickness ◽

Cyanoacrylate Glue ◽

Potential Harm ◽

Education And Awareness

Abstract Domestic superglue (cyanoacrylate) in the hands of children can have devastating consequences, especially when cotton clothing is involved. When cotton comes into contact with cyanoacrylate, an intense exothermic reaction occurs, creating temperatures high enough to cause significant thermal injury. A literature review found 16 such cases of burns documented (2 adult and 14 pediatric). This article presents a case report of a 4-year-old child sustaining a full-thickness burn injury to her leg requiring skin grafting when superglue was spilt onto cotton pants. She was sitting near a fan heater at the time. An experiment was conducted to replicate the exothermic reaction between superglue and cotton and to determine if the addition of radiant heat would have any significant effect. The maximum temperature reached with one 3-g tube of superglue onto cotton pyjamas was 91°C (196°F) and occurred approximately 90 seconds postapplication. It took more than 3 minutes for the temperature to cool below 40°C (104°F). The addition of radiant heat from a fan heater placed 60 cm from the clothing found that the temperature peak was similarly reached and cooled, but the temperature did not reduce below 52°C (126°F) for over 20 minutes, proving that potential harm may be amplified if first aid is not appropriately sought. Product labeling and the knowledge of potential harm from such mechanism of injury remain inadequate. It is hoped that the reporting of this case contributes to an increase in public education and awareness of such dangers and may contribute to preventing avoidable future incidences.

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An In Vivo Comparison of Commonly Used Topical Antimicrobials on Skin Graft Healing After Full-Thickness Burn Injury

Journal of Burn Care & Research ◽

10.1097/bcr.0000000000000072 ◽

2015 ◽

Vol 36 (2) ◽

pp. e47-e54 ◽

Cited By ~ 1

Author(s):

Ozan L. Abbas ◽

Huseyin Borman ◽

Taner Bahar ◽

Nilgün M. Ertaş ◽

Mehmet Haberal

Keyword(s):

Skin Graft ◽

Burn Injury ◽

Full Thickness ◽

Graft Healing ◽

Topical Antimicrobials

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Restoration of skin pigmentation after deep partial or full-thickness burn injury

Advanced Drug Delivery Reviews ◽

10.1016/j.addr.2017.10.010 ◽

2018 ◽

Vol 123 ◽

pp. 155-164 ◽

Cited By ~ 10

Author(s):

Niann-Tzyy Dai ◽

Hsin-I Chang ◽

Yi-Wen Wang ◽

Keng-Yen Fu ◽

Tai-Chun Huang ◽

...

Keyword(s):

Burn Injury ◽

Skin Pigmentation ◽

Full Thickness

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Loss of Type A neuronal cells in the dorsal root ganglion after a non-severe full-thickness burn injury in a rodent model

Burns ◽

10.1016/j.burns.2018.04.008 ◽

2018 ◽

Vol 44 (7) ◽

pp. 1792-1800 ◽

Cited By ~ 2

Author(s):

Vetrichevvel Palanivelu ◽

Siaavash Maghami ◽

Hilary J. Wallace ◽

Dulharie Wijeratne ◽

Fiona M. Wood ◽

...

Keyword(s):

Dorsal Root Ganglion ◽

Dorsal Root ◽

Burn Injury ◽

Neuronal Cells ◽

Type A ◽

Rodent Model ◽

Full Thickness

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854 Modified Millard Forked-flap for Complete Nasal Stenosis After Smoking While on Home Oxygen

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.422 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S265-S265

Author(s):

Sagar Mulay ◽

Roger L Simpson ◽

Ahmed Nasser ◽

Basil Nwaoz

Keyword(s):

Cleft Lip ◽

Burn Injury ◽

Full Thickness ◽

Upper Lip ◽

Nasal Vestibule ◽

Full Thickness Skin ◽

Thickness Skin ◽

Initial Symptoms ◽

Cleft Lip Repair ◽

The Aesthetic

Abstract Introduction Nasal stenosis is an uncommon burn scar deformity which can result in breathing obstruction. The reconstruction of nasal stenosis secondary to burns can be challenging due to the limitation of localized tissue, rate of recurrence, and burn injury to the surrounding areas. A vascularized composite flap of local composite tissue (forked flap) from the lip can reliably reconstruct the nasal vestibule and nasal sill diminishing the risk of recurrent nasal stenosis. We describe our use of a modified Millard forked flap, a cleft lip repair technique. Methods A 52-year-old female presented with complete stenosis of the right nares secondary to burn contracture of the nostril, vestibule, and upper lip. She had suffered a flash burn to her face while smoking on home oxygen requiring prolonged ventilatory support and only received topical dressings. Three months after her burn injury she was referred for the reconstruction of her contractures. A lateral rhinotomy was performed to define the nasal floor defect. Scar release of the remaining vestibule and ala and the aesthetic units of the lip were defined. A supple unburned area of the upper lip was harvested as a vascularized composite forked flap and rotated into the vestibule defining the vestibule floor. The ala was rotated outward and full-thickness skin grafts was used to resurface the vestibular portion. The lateral aesthetic subunit of the lip was then resurfaced as a complete unit with a full-thickness skin graft. She later required fabricated nasal splint for nighttime stenting and serial daytime nostril dilatation with Hegar dilators. Results At nine months post-reconstruction, the patient maintains a patent nasal airway with limited vertical lip contraction, resolution of her initial symptoms of sinus congestion, and no further difficulty breathing. Conclusions In 1955, Ralph Millard presented the rotation-advancement technique for cleft lip repair. The Procedure was designed to create a softer, more natural-looking reconstructed lip. In the cleft lip repair, he suggested preserving the prolabial tissue lateral to the central segment as forked flaps that were rotated and banked on the nasal vestibule floor. Had that principle not been appreciated, that tissue might have been discarded in order to respect the aesthetic unit of the lip. The surgeon must utilize reliable principles to restore and retain form and function. The use of this modified forked flap incorporated composite vascularized tissue for the nostril floor reconstruction while respecting the subunit reconstruction of the lip. Applicability of Research to Practice Reconstruction of the injury needs to restore both functional and aesthetic deformities. Utilization of a local vascularized composite graft, taken from an area to be discarded within the upper lip subunit, provided quality tissue that significantly reduces the risk of secondary nasal contracture.

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Intradermal methylene blue administration on the progression of burn injuries

Journal of Wound Care ◽

10.12968/jowc.2021.30.sup9a.viii ◽

2021 ◽

Vol 30 (Sup9a) ◽

pp. VIIIi-VIIIx

Author(s):

Vinícius FM Beldi ◽

Marina J Rosique ◽

Luis Fernando Tirapelli ◽

Eny KU Moriguti ◽

Altacílio A Nunes ◽

...

Keyword(s):

Methylene Blue ◽

Visual Analysis ◽

Burn Injury ◽

Intradermal Injection ◽

Good Evidence ◽

Burn Injuries ◽

Control Group ◽

Adjacent Area ◽

Full Thickness ◽

Inflammatory Infiltration

Objective: A burn injury has two defined areas: central necrosis and an adjacent area of ischaemia, which may or may not progress to necrosis. The concentration of nitric oxide (NO) increases after burn injury and may originate from potent oxidising agents. Methylene blue (MB) may act as an antioxidant and is supposed to reduce burn progression. This investigation was carried out to evaluate the effects of intradermal MB on necrosis progression in burns. Methods: Full-thickness burn injuries were performed by applying a heated metal comb on the shaved back of male Wistar rats. The animals were divided into three groups: Control (C, n=7); MB (2mg/kg) one hour after burn injury (MB1h, n=11); and MB (2mg/kg) six hours after burn injury (MB6h, n=8). After seven days the lesions were photographed for visual assessment of burn necrosis; full-thickness cuts of lesions were dyed with Masson and Giemsa for microscopic histopathology; and tissue fragments of unburned interspaces were processed for chemiluminescence with nitrite/nitrate (NOX) and malondialdehyde (MDA) as oxidative stress markers. Results: No statistically significant differences between groups were observed during visual analysis and NOX dosage. However, in microscopic analysis, the MB1h and MB6h groups showed smaller areas of necrosis, less inflammatory infiltration, and a more significant extension of interspaces. Furthermore, the dosage of MDA revealed that the MB1h group showed lower values when compared with the control group (p=0.001). Conclusions: The study provided good evidence that MB intradermal injection can reduce necrosis progression in ischaemic perilesional areas and suggests an alternative to treating burns.

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