Editorial

1 pages, 178 KiB

Open AccessEditorial

A History of Burn Care

by Lars-Peter Kamolz and Bernd Hartmann

Medicina 2021, 57(6), 541; https://doi.org/10.3390/medicina57060541 - 28 May 2021

Cited by 1 | Viewed by 1792

Burn injuries are still one of the most common and devastating injuries in humans and the treatment of major burns remains a major challenge for physicians worldwide [...] Full article

(This article belongs to the Special Issue A History of Burn Care)

Research

Jump to: Editorial, Review

8 pages, 292 KiB

Open AccessArticle

Historical Perspectives on the Development of Current Standards of Care for Enzymatic Debridement

by Wolfram Heitzmann, Paul Christian Fuchs and Jennifer Lynn Schiefer

Medicina 2020, 56(12), 706; https://doi.org/10.3390/medicina56120706 - 17 Dec 2020

Cited by 8 | Viewed by 2487

Abstract

Background and Objective: The use of plant-based products for burn treatment dates back to 1600 BC. Enzymatic debridement, which can be achieved as non-surgical or conservative debridement, has recently gained increasing attention. Several reviews have been published thus far. However, there has been [...] Read more.

Background and Objective: The use of plant-based products for burn treatment dates back to 1600 BC. Enzymatic debridement, which can be achieved as non-surgical or conservative debridement, has recently gained increasing attention. Several reviews have been published thus far. However, there has been no historical article including the achievements of the last 20 years, and this is the first review to present the achievements made in the field of enzymatic debridement in the last 20 years. This study aimed to present a historical overview of the development of enzymatic debridement until the present day. Methods: Enzymes from bacteria and plants were initially used for full-thickness burn treatment; however, they did not gain attention. Papain-derived products were the first plant-based products used for enzymatic debridement. Sutilains gained broad use in the 70s and 80s but came off market in the 1990s. Bromelain has been used for burn treatment owing to its strong debriding properties. NexoBrid^™ is used as a minimally invasive approach for enzymatic debridement of deep dermal burns. However, its use has been limited due to commercially available bromelain and the presence of four distinct cysteine proteinases. NexoBrid^™ involves faster eschar removal together with reduced blood loss, leading to improved long-term outcomes. However, research on nonoperative enzymatic debridement of burns has taken decades and is still ongoing. Results: Overall, the results of our study indicate that necrectomy, which has been used for a long time, remains the standard of care for burns. However, enzymatic debridement has several advantages, such as faster eschar removal, reduced blood loss, and reduced need for skin grafting, especially in cases of facial and hand burns. Enzymatic debridement cannot replace surgical intervention, as the enzyme only works on the surface of the eschar. Enzymatic debridement is not recommended in the early phase of scald burns. Conclusions: Enzymatic debridement has become an integral part of burn therapy and the standard of care in specific burn centers. Full article

(This article belongs to the Special Issue A History of Burn Care)

Review

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24 pages, 1796 KiB

Open AccessReview

Porcine Xenograft and Epidermal Fully Synthetic Skin Substitutes in the Treatment of Partial-Thickness Burns: A Literature Review

by Herbert L. Haller, Sigrid E. Blome-Eberwein, Ludwik K. Branski, Joshua S. Carson, Roselle E. Crombie, William L. Hickerson, Lars Peter Kamolz, Booker T. King, Sebastian P. Nischwitz, Daniel Popp, Jeffrey W. Shupp and Steven E. Wolf

Medicina 2021, 57(5), 432; https://doi.org/10.3390/medicina57050432 - 30 Apr 2021

Cited by 19 | Viewed by 5102

Abstract

Background and Objectives: Porcine xenografts have been used successfully in partial thickness burn treatment for many years. Their disappearance from the market led to the search for effective and efficient alternatives. In this article, we examine the synthetic epidermal skin substitute Suprathel [...] Read more.

Background and Objectives: Porcine xenografts have been used successfully in partial thickness burn treatment for many years. Their disappearance from the market led to the search for effective and efficient alternatives. In this article, we examine the synthetic epidermal skin substitute Suprathel^® as a substitute in the treatment of partial thickness burns. Materials and Methods: A systematic review following the PRISMA guidelines has been performed. Sixteen Suprathel^® and 12 porcine xenograft studies could be included. Advantages and disadvantages between the treatments and the studies’ primary endpoints have been investigated qualitatively and quantitatively. Results: Although Suprathel had a nearly six times larger TBSA in their studies (p < 0.001), it showed a significantly lower necessity for skin grafts (p < 0.001), and we found a significantly lower infection rate (p < 0.001) than in Porcine Xenografts. Nonetheless, no significant differences in the healing time (p = 0.67) and the number of dressing changes until complete wound healing (p = 0.139) could be found. Both products reduced pain to various degrees with the impression of a better performance of Suprathel^® on a qualitative level. Porcine xenograft was not recommended for donor sites or coverage of sheet-transplanted keratinocytes, while Suprathel^® was used successfully in both indications. Conclusion: The investigated parameters indicate that Suprathel^® to be an effective replacement for porcine xenografts with even lower subsequent treatment rates. Suprathel^® appears to be usable in an extended range of indications compared to porcine xenograft. Data heterogeneity limited conclusions from the results. Full article

(This article belongs to the Special Issue A History of Burn Care)

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7 pages, 489 KiB

Open AccessReview

The History of Carbon Monoxide Intoxication

by Ioannis-Fivos Megas, Justus P. Beier and Gerrit Grieb

Medicina 2021, 57(5), 400; https://doi.org/10.3390/medicina57050400 - 21 Apr 2021

Cited by 7 | Viewed by 2993

Abstract

Intoxication with carbon monoxide in organisms needing oxygen has probably existed on Earth as long as fire and its smoke. What was observed in antiquity and the Middle Ages, and usually ended fatally, was first successfully treated in the last century. Since then, [...] Read more.

Intoxication with carbon monoxide in organisms needing oxygen has probably existed on Earth as long as fire and its smoke. What was observed in antiquity and the Middle Ages, and usually ended fatally, was first successfully treated in the last century. Since then, diagnostics and treatments have undergone exciting developments, in particular specific treatments such as hyperbaric oxygen therapy. In this review, different historic aspects of the etiology, diagnosis and treatment of carbon monoxide intoxication are described and discussed. Full article

(This article belongs to the Special Issue A History of Burn Care)

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17 pages, 426 KiB

Open AccessReview

Contemporary Aspects of Burn Care

by Arij El Khatib and Marc G. Jeschke

Medicina 2021, 57(4), 386; https://doi.org/10.3390/medicina57040386 - 16 Apr 2021

Cited by 6 | Viewed by 2960

Abstract

The past one hundred years have seen tremendous improvements in burn care, allowing for decreased morbidity and mortality of this pathology. The more prominent advancements occurred in the period spanning 1930–1980; notably burn resuscitation, early tangential excision, and use of topical antibiotic dressings; [...] Read more.

The past one hundred years have seen tremendous improvements in burn care, allowing for decreased morbidity and mortality of this pathology. The more prominent advancements occurred in the period spanning 1930–1980; notably burn resuscitation, early tangential excision, and use of topical antibiotic dressings; and are well documented in burn literature. This article explores the advancements of the past 40 years and the areas of burn management that are presently topics of active discussion and research. Full article

(This article belongs to the Special Issue A History of Burn Care)

28 pages, 9726 KiB

Open AccessReview

A Narrative Review of the History of Skin Grafting in Burn Care

by Deepak K. Ozhathil, Michael W. Tay, Steven E. Wolf and Ludwik K. Branski

Medicina 2021, 57(4), 380; https://doi.org/10.3390/medicina57040380 - 15 Apr 2021

Cited by 25 | Viewed by 8698

Abstract

Thermal injuries have been a phenomenon intertwined with the human condition since the dawn of our species. Autologous skin translocation, also known as skin grafting, has played an important role in burn wound management and has a rich history of its own. In [...] Read more.

Thermal injuries have been a phenomenon intertwined with the human condition since the dawn of our species. Autologous skin translocation, also known as skin grafting, has played an important role in burn wound management and has a rich history of its own. In fact, some of the oldest known medical texts describe ancient methods of skin translocation. In this article, we examine how skin grafting has evolved from its origins of necessity in the ancient world to the well-calibrated tool utilized in modern medicine. The popularity of skin grafting has ebbed and flowed multiple times throughout history, often suppressed for cultural, religious, pseudo-scientific, or anecdotal reasons. It was not until the 1800s, that skin grafting was widely accepted as a safe and effective treatment for wound management, and shortly thereafter for burn injuries. In the nineteenth and twentieth centuries skin grafting advanced considerably, accelerated by exponential medical progress and the occurrence of man-made disasters and global warfare. The introduction of surgical instruments specifically designed for skin grafting gave surgeons more control over the depth and consistency of harvested tissues, vastly improving outcomes. The invention of powered surgical instruments, such as the electric dermatome, reduced technical barriers for many surgeons, allowing the practice of skin grafting to be extended ubiquitously from a small group of technically gifted reconstructive surgeons to nearly all interested sub-specialists. The subsequent development of biologic and synthetic skin substitutes have been spurred onward by the clinical challenges unique to burn care: recurrent graft failure, microbial wound colonization, and limited donor site availability. These improvements have laid the framework for more advanced forms of tissue engineering including micrografts, cultured skin grafts, aerosolized skin cell application, and stem-cell impregnated dermal matrices. In this article, we will explore the convoluted journey that modern skin grafting has taken and potential future directions the procedure may yet go. Full article

(This article belongs to the Special Issue A History of Burn Care)

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14 pages, 719 KiB

Open AccessReview

Historical Evolution of Skin Grafting—A Journey through Time

by Michael Kohlhauser, Hanna Luze, Sebastian Philipp Nischwitz and Lars Peter Kamolz

Medicina 2021, 57(4), 348; https://doi.org/10.3390/medicina57040348 - 05 Apr 2021

Cited by 29 | Viewed by 8715

Abstract

Autologous skin grafting was developed more than 3500 years ago. Several approaches and techniques have been discovered and established in burn care since then. Great achievements were made during the 19th and 20th century. Many of these techniques are still part of the [...] Read more.

Autologous skin grafting was developed more than 3500 years ago. Several approaches and techniques have been discovered and established in burn care since then. Great achievements were made during the 19th and 20th century. Many of these techniques are still part of the surgical burn care. Today, autologous skin grafting is still considered to be the gold standard for burn wound coverage. The present paper gives an overview about the evolution of skin grafting and its usage in burn care nowadays. Full article

(This article belongs to the Special Issue A History of Burn Care)

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16 pages, 1380 KiB

Open AccessReview

Technical and Medical Aspects of Burn Size Assessment and Documentation

by Michael Giretzlehner, Isabell Ganitzer and Herbert Haller

Medicina 2021, 57(3), 242; https://doi.org/10.3390/medicina57030242 - 05 Mar 2021

Cited by 13 | Viewed by 4477

Abstract

In burn medicine, the percentage of the burned body surface area (TBSA-B) to the total body surface area (TBSA) is a crucial parameter to ensure adequate treatment and therapy. Inaccurate estimations of the burn extent can lead to wrong medical decisions resulting in [...] Read more.

In burn medicine, the percentage of the burned body surface area (TBSA-B) to the total body surface area (TBSA) is a crucial parameter to ensure adequate treatment and therapy. Inaccurate estimations of the burn extent can lead to wrong medical decisions resulting in considerable consequences for patients. These include, for instance, over-resuscitation, complications due to fluid aggregation from burn edema, or non-optimal distribution of patients. Due to the frequent inaccurate TBSA-B estimation in practice, objective methods allowing for precise assessments are required. Over time, various methods have been established whose development has been influenced by contemporary technical standards. This article provides an overview of the history of burn size estimation and describes existing methods with a critical view of their benefits and limitations. Traditional methods that are still of great practical relevance were developed from the middle of the 20th century. These include the “Lund Browder Chart”, the “Rule of Nines”, and the “Rule of Palms”. These methods have in common that they assume specific values for different body parts’ surface as a proportion of the TBSA. Due to the missing consideration of differences regarding sex, age, weight, height, and body shape, these methods have practical limitations. Due to intensive medical research, it has been possible to develop three-dimensional computer-based systems that consider patients’ body characteristics and allow a very realistic burn size assessment. To ensure high-quality burn treatment, comprehensive documentation of the treatment process, and wound healing is essential. Although traditional paper-based documentation is still used in practice, it no longer meets modern requirements. Instead, adequate documentation is ensured by electronic documentation systems. An illustrative software already being used worldwide is “BurnCase 3D”. It allows for an accurate burn size assessment and a complete medical documentation. Full article

(This article belongs to the Special Issue A History of Burn Care)

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15 pages, 379 KiB

Open AccessReview

A Short History of Skin Grafting in Burns: From the Gold Standard of Autologous Skin Grafting to the Possibilities of Allogeneic Skin Grafting with Immunomodulatory Approaches

by Frederik Schlottmann, Vesna Bucan, Peter M. Vogt and Nicco Krezdorn

Medicina 2021, 57(3), 225; https://doi.org/10.3390/medicina57030225 - 02 Mar 2021

Cited by 25 | Viewed by 4915

Abstract

Due to groundbreaking and pioneering developments in the last century, significant improvements in the care of burn patients have been achieved. In addition to the still valid therapeutic standard of autologous split-thickness skin grafting, various commercially available skin substitutes are currently available. Significant [...] Read more.

Due to groundbreaking and pioneering developments in the last century, significant improvements in the care of burn patients have been achieved. In addition to the still valid therapeutic standard of autologous split-thickness skin grafting, various commercially available skin substitutes are currently available. Significant progress in the field of tissue engineering has led to the development of promising therapeutic approaches. However, scientific advances in the field of allografting and transplant immunology are of great importance. The achievement of various milestones over the past decades has provided thought-provoking impulses in the field of skin allotransplantation. Thus, biologically viable skin allotransplantation is still not a part of the clinical routine. The purpose of this article is to review the achievements in burn surgery with regards to skin allotransplantation in recent years. Full article

(This article belongs to the Special Issue A History of Burn Care)

10 pages, 298 KiB

Open AccessReview

A History of Fluid Management—From “One Size Fits All” to an Individualized Fluid Therapy in Burn Resuscitation

by Dorothee Boehm and Henrik Menke

Medicina 2021, 57(2), 187; https://doi.org/10.3390/medicina57020187 - 23 Feb 2021

Cited by 11 | Viewed by 4026

Abstract

Fluid management is a cornerstone in the treatment of burns and, thus, many different formulas were tested for their ability to match the fluid requirements for an adequate resuscitation. Thereof, the Parkland-Baxter formula, first introduced in 1968, is still widely used since then. [...] Read more.

Fluid management is a cornerstone in the treatment of burns and, thus, many different formulas were tested for their ability to match the fluid requirements for an adequate resuscitation. Thereof, the Parkland-Baxter formula, first introduced in 1968, is still widely used since then. Though using nearly the same formula to start off, the definition of normovolemia and how to determine the volume status of burn patients has changed dramatically over years. In first instance, the invention of the transpulmonary thermodilution (TTD) enabled an early goal directed fluid therapy with acceptable invasiveness. Furthermore, the introduction of point of care ultrasound (POCUS) has triggered more individualized schemes of fluid therapy. This article explores the historical developments in the field of burn resuscitation, presenting different options to determine the fluid requirements without missing the red flags for hyper- or hypovolemia. Furthermore, the increasing rate of co-morbidities in burn patients calls for a more sophisticated fluid management adjusting the fluid therapy to the actual necessities very closely. Therefore, formulas might be used as a starting point, but further fluid therapy should be adjusted to the actual need of every single patient. Taking the developments in the field of individualized therapies in intensive care in general into account, fluid management in burn resuscitation will also be individualized in the near future. Full article

(This article belongs to the Special Issue A History of Burn Care)

16 pages, 1087 KiB

Open AccessReview

Made in Germany: A Quality Indicator Not Only in the Automobile Industry But Also When It Comes to Skin Replacement: How an Automobile Textile Research Institute Developed a New Skin Substitute

by Herbert Leopold Haller, Matthias Rapp, Daniel Popp, Sebastian Philipp Nischwitz and Lars Peter Kamolz

Medicina 2021, 57(2), 143; https://doi.org/10.3390/medicina57020143 - 05 Feb 2021

Cited by 3 | Viewed by 3032

Abstract

Successful research and development cooperation between a textile research institute, the German Federal Ministry of Education and Research via the Center for Biomaterials and Organ Substitutes, the University of Tübingen, and the Burn Center of Marienhospital, Stuttgart, Germany, led to the development of [...] Read more.

Successful research and development cooperation between a textile research institute, the German Federal Ministry of Education and Research via the Center for Biomaterials and Organ Substitutes, the University of Tübingen, and the Burn Center of Marienhospital, Stuttgart, Germany, led to the development of a fully synthetic resorbable temporary epidermal skin substitute for the treatment of burns, burn-like syndromes, donor areas, and chronic wounds. This article describes the demands of the product and the steps that were taken to meet these requirements. The material choice was based on the degradation and full resorption of polylactides to lactic acid and its salts. The structure and morphology of the physical, biological, and degradation properties were selected to increase the angiogenetic abilities, fibroblasts, and extracellular matrix generation. Water vapor permeability and plasticity were adapted for clinical use. The available scientific literature was screened for the use of this product. A clinical application demonstrated pain relief paired with a reduced workload, fast wound healing with a low infection rate, and good cosmetic results. A better understanding of the product’s degradation process explained the reduction in systemic oxidative stress shown in clinical investigations compared to other dressings, positively affecting wound healing time and reducing the total area requiring skin grafts. Today, the product is in clinical use in 37 countries. This article describes its development, the indications for product growth over time, and the scientific foundation of treatments. Full article

(This article belongs to the Special Issue A History of Burn Care)

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24 pages, 737 KiB

Open AccessReview

The History and Development of Hyperbaric Oxygenation (HBO) in Thermal Burn Injury

by Christian Smolle, Joerg Lindenmann, Lars Kamolz and Freyja-Maria Smolle-Juettner

Medicina 2021, 57(1), 49; https://doi.org/10.3390/medicina57010049 - 08 Jan 2021

Cited by 12 | Viewed by 2991

Abstract

Background and Objectives: Hyperbaric oxygenation (HBO) denotes breathing of 100% oxygen under elevated ambient pressure. Since the initiation of HBO for burns in 1965, abundant experimental and clinical work has been done. Despite many undisputedly positive and only a few controversial results on [...] Read more.

Background and Objectives: Hyperbaric oxygenation (HBO) denotes breathing of 100% oxygen under elevated ambient pressure. Since the initiation of HBO for burns in 1965, abundant experimental and clinical work has been done. Despite many undisputedly positive and only a few controversial results on the efficacy of adjunctive HBO for burn injury, the method has not yet been established in clinical routine. Materials and Methods: We did a retrospective analysis of the literature according to PRISMA—guidelines, from the very beginning of HBO for burns up to present, trying to elucidate the question why HBO is still sidelined in the treatment of burn injury. Results: Forty-seven publications (32 animal experiments, four trials in human volunteers and 11 clinical studies) fulfilled the inclusion criteria. Except four investigators who found little or no beneficial action, all were able to demonstrate positive effects of HBO, most of them describing less edema, improved healing, less infection or bacterial growth and most recently, reduction of post-burn pain. Secondary enlargement of burn was prevented, as microvascular perfusion could be preserved, and cells were kept viable. The application of HBO, however, concerning pressure, duration, frequency and number of treatment sessions, varied considerably. Authors of large clinical studies underscored the intricate measures required when administering HBO in severe burns. Conclusions: HBO unquestionably has a positive impact on the pathophysiological mechanisms, and hence on the healing and course of burns. The few negative results are most likely due to peculiarities in the administration of HBO and possibly also to interactions when delivering the treatment to severely ill patients. Well-designed studies are needed to definitively assess its clinical value as an adjunctive treatment focusing on relevant outcome criteria such as wound healing time, complications, length of hospital stay, mortality and scar quality, while also defining optimal HBO dosage and timing. Full article

(This article belongs to the Special Issue A History of Burn Care)

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9 pages, 797 KiB

Open AccessReview

Burn Care in the Greek and Roman Antiquity

by Christoph Wallner, Eric Moormann, Patricia Lulof, Marius Drysch, Marcus Lehnhardt and Björn Behr

Medicina 2020, 56(12), 657; https://doi.org/10.3390/medicina56120657 - 28 Nov 2020

Cited by 6 | Viewed by 2699

Abstract

The last century brought about more rapid new developments in the treatment of burns, which significantly lowered the mortality of burn injuries. However, burns were already treated in antiquity, where the threshold from spirituality to scientific medicine originated. The existing literature on burn [...] Read more.

The last century brought about more rapid new developments in the treatment of burns, which significantly lowered the mortality of burn injuries. However, burns were already treated in antiquity, where the threshold from spirituality to scientific medicine originated. The existing literature on burn treatment is very limited and there are many cross-references, some of them incorrect. The aim of this work by an interdisciplinary team of historians and physicians is to offer a more precise reproduction of the burn treatment of Greek and Roman antiquity using original texts in context and with a modern scientific background. There are many sources from ancient doctors on the subject of burn treatment, as well as the treatment of burned-out wounds and frostbite, which have not yet been mentioned. The literature research also showed an understanding of scientific contexts in ancient medicine, such as antiseptics or rheology. Interestingly, there was a change in burn medicine from everyday Greek medicine to Roman military medicine with other burn patterns. The care of patients using analgetics and the therapy of burn shock arose from the literature. The ancient world is considered to be the foundation of medicine, but it is believed to have been based mainly on shamanism rather than science. However, already more than two millennia ago, burns were correctly assessed and treated according to today’s scientific standards and scientific relationships were recognized. Full article

(This article belongs to the Special Issue A History of Burn Care)

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