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Current Drug Safety

Editor-in-Chief

ISSN (Print): 1574-8863
ISSN (Online): 2212-3911

Mini-Review Article

Concise Review on Scientific Approaches to Burns and Scars

Author(s): Hitesh Malhotra, Prerna Sharma*, Mohammad Amjad Kamal, Peeyush Kaushik and Nidhi Rani*

Volume 19, Issue 2, 2024

Published on: 12 June, 2023

Page: [191 - 199] Pages: 9

DOI: 10.2174/1574886318666230509143017

Price: $65

Abstract

Burns are large open surgical lesions bathed in virulent pus that result in rupturing of the cutaneous membrane, which has serious consequences such as an extensive loss of proteins, and body fluids, increased chances of infections, and sometimes death. These can be classified based on their penetration levels, i.e., first-degree burns penetrating the epidermis, second-degree burns including both epidermis and dermis, third-degree burns to both layers including the hair follicular cells, sweat glands and various core tissues, fourth-degree burns to adipose tissue, fifth stage burns to muscles, and sixth stage burns to bones. Wound healing/wound repair is a very perplexing process in which the tissues of the affected/burnt area repairs themselves to attain their original form and functionality but develop a scar at the wound site. This article mainly focuses on the algorithms to differentiate various degrees of burns, general first aid approaches to burns and scars, the rationale of treatment of burns, basic mechanisms highlighting the healing processes in humans in terms of free from scar formation as well as with scar formation at their elementary levels including cellular as well as biochemical levels, utility, and progression of pre-clinical data to humans and finally approaches for the improvement of scar formation in man.

Keywords: Burns, clinical, infections, pre-clinical, scar, wound, healing processes.

Graphical Abstract
[1]
Robert R, Meyer W, Bishop S, Rosenberg L, Murphy L, Blakeney P. Disfiguring burn scars and adolescent self-esteem. Burns 1999; 25(7): 581-5.
[http://dx.doi.org/10.1016/S0305-4179(99)00065-0] [PMID: 10563682]
[2]
Newell R. Psychological difficulties amongst plastic surgery ex-patients following surgery tothe face: A survey. Br J Plast Surg 2000; 53(5): 386-92.
[http://dx.doi.org/10.1054/bjps.1999.3273] [PMID: 10876274]
[3]
Layton AM. Optimal management of acne to prevent scarring and psychological sequelae. Am J Clin Dermatol 2001; 2(3): 135-41.
[http://dx.doi.org/10.2165/00128071-200102030-00002] [PMID: 11705090]
[4]
Rumsey N, Clarke A, White P. Exploring the psychosocial concerns of outpatients with disfiguring conditions. J Wound Care 2003; 12(7): 247-52.
[http://dx.doi.org/10.12968/jowc.2003.12.7.26515] [PMID: 12894695]
[5]
Lawrence JW, Fauerbach JA, Heinberg L, Doctor M. Visible vs hidden scars and their relation to body esteem. J Burn Care Rehabil 2004; 25(1): 25-32.
[http://dx.doi.org/10.1097/01.BCR.0000105090.99736.48] [PMID: 14726736]
[6]
McGrouther DA. Facial disfigurement. BMJ 1997; 314(7086): 991.
[http://dx.doi.org/10.1136/bmj.314.7086.991] [PMID: 9112836]
[7]
Valente SM. Visual disfigurement and depression. Plast Surg Nurs 2004; 24(4): 140-6.
[http://dx.doi.org/10.1097/00006527-200410000-00003] [PMID: 15632721]
[8]
Bayat A, McGrouther DA. Clinical management of skin scarring. Skinmed 2005; 4(3): 165-73.
[http://dx.doi.org/10.1111/j.1540-9740.2005.02507.x] [PMID: 15891253]
[9]
May H. Treatment of burns. Am J Surg 1944; 63(1): 34-46.
[http://dx.doi.org/10.1016/S0002-9610(44)90452-6]
[10]
Wilson WC, Macgregor AR, Stewart CP. The clinical course and pathology of burns and scalds under modern methods of treatment. Br J Surg 2005; 25(100): 826-65.
[http://dx.doi.org/10.1002/bjs.18002510012]
[11]
Pinnegar MD, Pinnegar FC III. History of burn care. Burns 1986; 12(7): 508-17.
[http://dx.doi.org/10.1016/0305-4179(86)90079-3] [PMID: 3536030]
[12]
Hettiaratchy S, Dziewulski P. Path physiology and types of burns. BMJ 2004; 328(7453): 1427-9.
[13]
Andronicus M, Oates RK, Peat J, Spalding S, Martin H. Non-accidental burns in children. Burns 1998; 24(6): 552-8.
[http://dx.doi.org/10.1016/S0305-4179(98)00062-X] [PMID: 9776094]
[14]
Church D, Elsayed S, Reid O, Winston B, Lindsay R. Burn wound infections. Clin Microbiol Rev 2006; 19(2): 403-34.
[http://dx.doi.org/10.1128/CMR.19.2.403-434.2006] [PMID: 16614255]
[15]
Sharma BR. Infection in patients with severe burns: Causes and prevention thereof. Infect Dis Clin North Am 2007; 21(3): 745-59.
[http://dx.doi.org/10.1016/j.idc.2007.06.003] [PMID: 17826621]
[16]
Ahuja RB, Bhattacharya S. Burns in the developing world and burn disasters. BMJ 2004; 329(7463): 447-9.
[http://dx.doi.org/10.1136/bmj.329.7463.447] [PMID: 15321905]
[17]
Weinstein RA, Mayhall CG. The epidemiology of burn wound infections: Then and now. Clin Infect Dis 2003; 37(4): 543-50.
[http://dx.doi.org/10.1086/376993] [PMID: 12905139]
[18]
Arturson G. Pathophysiological aspects of the burn syndrome with special reference to liver injury and alterations of capillary permeability. Acta Chir Scand Suppl 1961; 274 (Suppl. 274): 1-135.
[PMID: 13684586]
[19]
Leape LL. Initial changes in burns: Tissue changes in burned and unburned skin of rhesus monkeys. J Trauma 1970; 10(6): 488-92.
[http://dx.doi.org/10.1097/00005373-197006000-00007] [PMID: 4986535]
[20]
Herndon D. Total Burn Care. (2nd ed.), WB Saunders: London 2002.
[21]
Forjuoh SN. Burns in low- and middle-income countries: A review of available literature on descriptive epidemiology, risk factors, treatment, and prevention. Burns 2006; 32(5): 529-37.
[http://dx.doi.org/10.1016/j.burns.2006.04.002] [PMID: 16777340]
[22]
Nguyen TT, Gilpin DA, Meyer NA, Herndon DN. Current treatment of severely burned patients. Ann Surg 1996; 223(1): 14-25.
[http://dx.doi.org/10.1097/00000658-199601000-00004] [PMID: 8554414]
[23]
Wolf SE. Critical care in the severely burned: Organ support and management of complications. In: Total Burn Care 3rd ed Elsevier: Amsterdam, natherlands,2007.
[http://dx.doi.org/10.1016/B978-1-4160-3274-8.50037-4]
[24]
Settle JAD. Fluid therapy in burns. J R Soc Med 1982; 75 (Suppl. 1): 6-11.
[PMID: 20894452]
[25]
Demling RH. Fluid replacement in burned patients. Surg Clin North Am 1987; 67(1): 15-30.
[http://dx.doi.org/10.1016/S0039-6109(16)44130-7] [PMID: 3544265]
[26]
Baxter CR. Fluid volume and electrolyte changes of the early postburn period. Clin Plast Surg 1974; 1(4): 693-709.
[http://dx.doi.org/10.1016/S0094-1298(20)30126-7] [PMID: 4609676]
[27]
Aulick LH, Wilmore DW, Mason AD Jr, Pruitt BA Jr. Influence of the burn wound on peripheral circulation in thermally injured patients. Am J Physiol 1977; 233(4): H520-6.
[PMID: 910969]
[28]
Yilkok ST, Isamade ES, Oba AF. Outcome of burn patients managed in a general intensive care unit. Niger J Surg 2005; 11: 1-4.
[29]
Douglas HE, Dunne JA, Rawlins JM. Management of burns. Surgery 2017; 36(9): 511-8.
[30]
Demling RH, Will JA, Belzer FO. Effect of major thermal injury on the pulmonary microcirculation. Surgery 1978; 83(6): 746-51.
[PMID: 644466]
[31]
Baxter CR, Cook WA, Shires GT. Serum myocardial depressant factor of burn shock. Surg Forum 1966; 17: 1-2.
[PMID: 5920908]
[32]
Hilton JG, Marullo DS. Effects of thermal trauma on cardiac force of contraction. Burns 1986; 12(3): 167-71.
[http://dx.doi.org/10.1016/0305-4179(86)90154-3] [PMID: 3708412]
[33]
Leape LL. Kinetics of burn edema formation in primates. Ann Surg 1972; 176(2): 223-6.
[http://dx.doi.org/10.1097/00000658-197208000-00018] [PMID: 4627767]
[34]
Demling RH, Mazess RB, Witt RM, Wolberg WH. The study of burn wound edema using dichromatic absorptiometry. J Trauma 1978; 18(2): 124-8.
[http://dx.doi.org/10.1097/00005373-197802000-00009] [PMID: 633420]
[35]
Arturson G, Jakobsson OP. Oedema measurements in a standard burn model. Burns 1985; 12(1): 1-7.
[http://dx.doi.org/10.1016/0305-4179(85)90176-7] [PMID: 4063865]
[36]
Herndon DN, Abston S, Stein MD. Increased thromboxane B2 levels in the plasma of burned and septic burned patients. Surg Gynecol Obstet 1984; 159(3): 210-3.
[PMID: 6433494]
[37]
Evans JA, Darlington DN, Gann DS. A circulating factor(s) mediates cell depolarization in hemorrhagic shock. Ann Surg 1991; 213(6): 549-57.
[http://dx.doi.org/10.1097/00000658-199106000-00004] [PMID: 2039285]
[38]
Lund T, Reed RK. Acute hemodynamic effects of thermal skin injury in the rat. Circ Shock 1986; 20(2): 105-14.
[PMID: 3779904]
[39]
Shires G, Cunningham JN, Baker CRF, et al. Alterations in cellular membrane function during hemorrhagic shock in primates. Ann Surg 1972; 176(3): 288-95.
[http://dx.doi.org/10.1097/00000658-197209000-00004] [PMID: 4627396]
[40]
Cuttle L, Pearn J, McMillan JR, Kimble RM. A review of first aid treatments for burn injuries. Burns 2009; 35(6): 768-75.
[http://dx.doi.org/10.1016/j.burns.2008.10.011] [PMID: 19269746]
[41]
Paddle-Ledinek JE, Masterton JP, Sutherland R. The effect of immediate cooling on burns. Bull Clin Rev Burn Inj 1984; 1(2): 27.
[42]
Shulman AG. Ice water as primary treatment of burns. Simple method of emergency treatment of burns to alleviate pain, reduce sequelae, and hasten healing. JAMA 1960; 173(17): 1916-9.
[http://dx.doi.org/10.1001/jama.1960.03020350034007] [PMID: 14446305]
[43]
Earle J. An essay on the means of lessening the effects of fire on the human body. C. Clarke: London 1799.
[44]
Blocker TG Jr, Lewis SR, Grant DA, Blocker V, Bennett JE. Experiences in the management of the burn wound. Plast Reconstr Surg 1960; 26(6): 579-89.
[http://dx.doi.org/10.1097/00006534-196012000-00002]
[45]
Rose HW. Initial cold water treatment for burns. Northwest Med 1936; 35(7): 267-70.
[46]
Brown CR, Price PB, Reynolds LE. Effects of local chilling in the treatment of burns. Surg Forum 1956; 6: 85-7.
[PMID: 13391423]
[47]
King TC, Zimmerman JM, Price PB. Effect of immediate short-term cooling on extensive burns. Surg Forum 1962; 13: 487-8.
[PMID: 14032872]
[48]
King TC, Price PB. Surface cooling following extensive burns. JAMA 1963; 183(8): 677-8.
[http://dx.doi.org/10.1001/jama.1963.63700080022017g] [PMID: 14032871]
[49]
Poy NG, Williams HB, Woolhouse FM, Williams HB. The alteration of mortality rates in burned rats using early excision, homo-grafting and hypothermia, alone and in combination. Plast Reconstr Surg 1965; 35(2): 198-206.
[http://dx.doi.org/10.1097/00006534-196502000-00010] [PMID: 14264471]
[50]
Maenthaisong R, Chaiyakunapruk N, Niruntraporn S, Kongkaew C. The efficacy of aloe vera used for burn wound healing: A systematic review. Burns 2007; 33(6): 713-8.
[http://dx.doi.org/10.1016/j.burns.2006.10.384] [PMID: 17499928]
[51]
Ghelardini C, Galeotti N, Salvatore G, Mazzanti G. Local anaesthetic activity of the essential oil of Lavandula angustifolia. Planta Med 1999; 65(8): 700-3.
[http://dx.doi.org/10.1055/s-1999-14045] [PMID: 10630108]
[52]
Dursun N, Liman N, Özyazgan İ, Güneş I, Saraymen R. Role of thymus oil in burn wound healing. J Burn Care Rehabil 2003; 24(6): 395-9.
[http://dx.doi.org/10.1097/01.BCR.0000095513.67541.0F] [PMID: 14610426]
[53]
Karaman S, Digrak M, Ravid U, Ilcim A. Antibacterial and antifungal activity of the essential oils of Thymus revolutus Celak from Turkey. J Ethnopharmacol 2001; 76(2): 183-6.
[http://dx.doi.org/10.1016/S0378-8741(01)00238-0] [PMID: 11390134]
[54]
Meier K, Nanney LB. Emerging new drugs for scar reduction. Expert Opin Emerg Drugs 2006; 11(1): 39-47.
[http://dx.doi.org/10.1517/14728214.11.1.39] [PMID: 16503825]
[55]
Reish RG, Eriksson E. Scars: A review of emerging and currently available therapies. Plast Reconstr Surg 2008; 122(4): 1068-78.
[http://dx.doi.org/10.1097/PRS.0b013e318185d38f] [PMID: 18827639]
[56]
Reish RG, Eriksson E. Scar treatments: Preclinical and clinical studies. J Am Coll Surg 2008; 206(4): 719-30.
[http://dx.doi.org/10.1016/j.jamcollsurg.2007.11.022] [PMID: 18387479]
[57]
Ferguson MWJ, O’Kane S. Scar–free healing: From embryonic mechanisms to adult therapeutic intervention. Philos Trans R Soc Lond B Biol Sci 2004; 359(1445): 839-50.
[http://dx.doi.org/10.1098/rstb.2004.1475] [PMID: 15293811]
[58]
Whitby DJ, Ferguson MWJ. Immunohistochemical localization of growth factors in fetal wound healing. Dev Biol 1991; 147(1): 207-15.
[http://dx.doi.org/10.1016/S0012-1606(05)80018-1] [PMID: 1879607]
[59]
O’Kane S, Ferguson MWJ. Transforming growth factor βs and wound healing. Int J Biochem Cell Biol 1997; 29(1): 63-78.
[http://dx.doi.org/10.1016/S1357-2725(96)00120-3] [PMID: 9076942]
[60]
Shah M, Rorison P, Ferguson MWJ. The role of transforming growth factorsbeta in cutaneous scarring. In: Garg HG, Longaker MT, Eds. Scar less wound Healing. Marcel Dekker Inc : New York 2000; pp. 213-26.
[http://dx.doi.org/10.1201/b14004-11]
[61]
Cowin AJ, Holmes TM, Brosnan P, Ferguson MWJ. Expression of TGF-β and its receptors in murine fetal and adult dermal wounds. Eur J Dermatol 2001; 11(5): 424-31.
[PMID: 11525949]
[62]
Gawronska-Kozak B. Regeneration in the ears of immunodeficient mice: Identification and lineage analysis of mesenchymal stem cells. Tissue Eng 2004; 10(7-8): 1251-65.
[http://dx.doi.org/10.1089/ten.2004.10.1251] [PMID: 15363180]
[63]
Gawronska-Kozak B, Bogacki M, Rim JS, Monroe WT, Manuel JA. Scarless skin repair in immunodeficient mice. Wound Repair Regen 2006; 14(3): 265-76.
[http://dx.doi.org/10.1111/j.1743-6109.2006.00121.x] [PMID: 16808805]
[64]
Beare AHM, Metcalfe AD, Ferguson MWJ. Location of injury influences the mechanisms of both regeneration and repair within the MRL/MpJ mouse. J Anat 2006; 209(4): 547-59.
[http://dx.doi.org/10.1111/j.1469-7580.2006.00641.x] [PMID: 17005026]
[65]
Clark RAF, McCall RL, Ferguson MWJ, Eds. Foetal wound healing and the development of anti-scarring therapies for adult wound healing The molecular and cellular biology of wound repair. Plenum Press: New York 1996; pp. 561-600.
[66]
Cowin AJ, Brosnan MP, Holmes TM, Ferguson MW. Endogenous inflammatory response to dermal wound healing in the foetal and adult mouse. Dev Dyn 1998; 212(3): 385-93.
[67]
Colwell AS, Krummel TM, Longaker MT, Lorenz HP. An in vivo mouse excisional wound model of scarless healing. Plast Reconstr Surg 2006; 117(7): 2292-6.
[http://dx.doi.org/10.1097/01.prs.0000219340.47232.eb] [PMID: 16772931]
[68]
Schrementi ME, Ferreira AM, Zender C, DiPietro LA. Site-specific production of TGF-β in oral mucosal and cutaneous wounds. Wound Repair Regen 2008; 16(1): 80-6.
[http://dx.doi.org/10.1111/j.1524-475X.2007.00320.x] [PMID: 18086295]
[69]
Metcalfe AD, Willis H, Beare A, Ferguson MWJ. Characterizing regeneration in the vertebrate ear. J Anat 2006; 209(4): 439-46.
[http://dx.doi.org/10.1111/j.1469-7580.2006.00632.x] [PMID: 17005017]
[70]
Mustoe TA, Cooter RD, Gold MH, et al. International clinical recommendations on scar management. Plast Reconstr Surg 2002; 110(2): 560-71.
[http://dx.doi.org/10.1097/00006534-200208000-00031] [PMID: 12142678]
[71]
Bayat A, McGrouther DA, Ferguson MW. Skin scarring. BMJ 2003; 326(7380): 88-92.
[http://dx.doi.org/10.1136/bmj.326.7380.88] [PMID: 12521975]
[72]
Occleston NL, O’Kane S, Goldspink N, Ferguson MWJ. New therapeutics for the prevention and reduction of scarring. Drug Discov Today 2008; 13(21-22): 973-81.
[http://dx.doi.org/10.1016/j.drudis.2008.08.009] [PMID: 18824245]
[73]
Durani P, Occleston N, O’Kane S, Ferguson MWJ. Avotermin: A novel antiscarring agent. Int J Low Extrem Wounds 2008; 7(3): 160-8.
[http://dx.doi.org/10.1177/1534734608322983] [PMID: 18757391]
[74]
Bush J, Duncan JAL, Bond JS, et al. Scar-improving efficacy of avotermin administered into the wound margins of skin incisions as evaluated by a randomized, double-blind, placebo-controlled, phase II clinical trial. Plast Reconstr Surg 2010; 126(5): 1604-15.
[http://dx.doi.org/10.1097/PRS.0b013e3181ef8e66] [PMID: 21042116]
[75]
Dallon JC, Ehrlich HP. A review of fibroblast-populated collagen lattices. Wound Repair Regen 2008; 16(4): 472-9.
[http://dx.doi.org/10.1111/j.1524-475X.2008.00392.x] [PMID: 18638264]
[76]
Harunari N, Zhu KQ, Armendariz RT, et al. Histology of the thick scar on the female, red Duroc pig: Final similarities to human hypertrophic scar. Burns 2006; 32(6): 669-77.
[http://dx.doi.org/10.1016/j.burns.2006.03.015] [PMID: 16905264]
[77]
Xie Y, Zhu KQ, Deubner H, et al. The microvasculature in cutaneous wound healing in the female red Duroc pig is similar to that in human hypertrophic scars and different from that in the female Yorkshire pig. J Burn Care Res 2007; 28(3): 500-6.
[http://dx.doi.org/10.1097/BCR.0B013E318053DAFE] [PMID: 17438498]
[78]
Bond JS, Duncan JAL, Sattar A, et al. Maturation of the human scar: An observational study. Plast Reconstr Surg 2008; 121(5): 1650-8.
[http://dx.doi.org/10.1097/PRS.0b013e31816a9f6f] [PMID: 18453989]

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