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There are many types of burn wounds caused by thermal, radiation, chemical, or electrical contact.

• Thermal burns. These burns are due to heat sources which raise the temperature of the skin and tissues and cause tissue cell death or charring. Hot metals, scalding liquids, steam, and flames, when coming into contact with the skin, can cause thermal burns.

• Radiation burns. These burns are due to prolonged exposure to ultraviolet rays of the sun, or to other sources of radiation such as X-ray.

• Chemical burns. These burns are due to strong acids, alkalies, detergents, or solvents coming into contact with the skin or eyes.

• Electrical burns. These burns are from electrical current, either alternating current (AC) or direct current (DC).

What are the classifications of burns?

Burns are classified as first-, second-, or third-degree, depending on how deep and severely they penetrate the skin’s surface.

• First-degree (superficial) burns
  First-degree burns affect only the epidermis, or outer layer of skin. The burn site is red, painful, dry, and with no blisters. Mild sunburn is an example. Long-term tissue damage is rare and usually involves an increase or decrease in the skin color.

• Second-degree (partial thickness) burns
  Second-degree burns involve the epidermis and part of the dermis layer of skin. The burn site appears red, blistered, and may be swollen and painful.

• Third-degree (full thickness) burns
  Third-degree burns destroy the epidermis and dermis. Third-degree burns may also damage the underlying bones, muscles, and tendons. When bones, muscles, or tendons are also burned, this may be referred to as a fourth-degree burn. The burn site appears white or charred. There is no feeling in the area since the nerve endings are destroyed.

wound vacuum therapy in burn wound

Third degree burns, after adequate debridement, may benefit from NPT, which may be applied as an adjuvant in bed preparation for subsequent skin grafting, or as a method of optimizing the integration of skin grafts. Patients with electrical trauma, which generally cause deep burn wounds with extensive tissue destruction and progressive tissue damage, are also NPT candidates. The increase in blood perfusion secondary to NPT use is beneficial to burn injury. Kamolz et al. observed this in 2003, in a prospective study comparing the blood perfusion of burned hands that underwent conservative therapy and NPT. In the conservatively treated group, the authors observed reduced limb blood perfusion, which did not occur in the NPT-treated group.

Pressure ulcers (PU) are caused by the pressure maintained between a bone prominence and the patient’s bed, leading to ischemia and necrosis of the involved tissues. They are common in patients with some mobility restriction, such as spinal cord injuries (paraplegic and quadriplegic) and patients under prolonged sedation. The most frequent sites of their development are the sacral, sciatic, trochanteric, calcaneal and occipital regions, among others.

The application of wound vacuum therapy in these wounds has the main objective of improving the local conditions for a later repairing surgery to obtain definitive cutaneous cover. This sequence is valid mainly in the cases of Pressure ulcers stages III and IV of the National Pressure Ulcer Advisory Panel (NPUAP), represented by deeper wounds, with muscular or bone exposure. Clinical reports such as that performed by Batra and Asseja¹⁹, however, show that even more complex wounds, when acute, could be treated only with NPT.

In 2002, Ford et al conducted a randomized, controlled study with 41 patients with deep Pressure ulcers, comparing NPT with topical healing promoter gels. The mean percentage reduction in ulcer volume was higher in the NPT group (51.8% vs. 42.1%, p=0.46). The mean number of capillaries per wound bed field was also higher in the NPT group (p=0.75). The authors stated that NPT promotes healing and neovascularization when compared to topical gel treatment²⁰.

Ashby et al., in 2012, conducted a randomized controlled trial in patients with pressure ulcers grades III and IV, showing superior benefits of NTP in comparison with moist dressing.

source: https://www.scielo.br/j/rcbc/a/W6qy4BFN9DkdTRsGy6jrfkk/?lang=en&format=html#

Chronic wounds are deep and difficult to repair. Often, the top of the injury heals before the bottom, so the wound collapses in on itself. Over time, this can result in scar tissue and reduced skin function. Skin equivalent is a new way for healing wounds.

Researchers from The University of Western Australia (UWA; Perth, Australia) have partnered with industry to conduct a world-first study to investigate a new product—a topical scareless wound healing cream containing the drug PXS-6302 (Pharmaxis)—that has the potential to prevent or reduce scars forming after trauma and particularly following burn injury.

This research have started in Australia.

Kylie Sandy-Hodgetts, Mark Fear, and Fiona Wood, all from UWA Medical School and the Skin Integrity Research Institute UWA, are working with industry partner pharmaceutical company Pharmaxis, clinical trials facility Linear Clinical, the Burn Injury Research Unit, and Burns Service at Fiona Stanley Hospital.

Sandy-Hodgetts says skin scars placed a substantial physical and psychological burden on patients. “Current treatments aim to rectify the scar in the acute phase, such as during wound healing and scar maturation, through options such as compression therapy, silicone gel sheeting, or when the scar is established by cryotherapy, scar revision, or laser with limited outcomes at times,” she adds. “This new compound may potentially avoid the need for invasive procedures such as further surgery or laser procedures.”

The world-first human trial, led by Wood and Sandy-Hodgetts, aims to determine the safety and tolerability of the product in healthy volunteers, which will lead to further trials in burns and surgical patients.

“Scar formation following surgery has a huge impact on patient wellbeing and how they feel about themselves,” Sandy-Hodgetts comments.

“What we are hoping is that this new scarless wound healing cream may have the potential to improve scar outcomes in patients following surgery.”

Wood notes that it was exciting for the research team to explore a novel path to reduce scarring and to be moving closer to that goal: “Scar-less healing is the vision that has motivated our work over many decades”.

Pharmaxis CEO Gary Phillips says that the company is also very excited to see its expertise in fibrosis being applied to help patients with scarring.

“We have had a long and productive collaboration with researchers at UWA and this world-first trial of our drug PXS-6302 will establish whether the remarkable results seen in the pre-clinical models can be replicated in patients,” he states.

“Scarring can have a devastating and life-long impact on people who have suffered traumatic injuries. A topical cream to reduce scarring would have a significant role in treatment”.

Specialised oral nutritional supplement can be a therapeutic option for hard-to-heal wounds, conclude Adriano A Mehl (Universidade Tecnológica Federal do Paraná, Curitiba, Brazil) and colleagues in the Journal of Wound Care.

“Hard-to-heal wounds [defined as those that fail to proceed through the healing phases of haemostasis, inflammation, proliferation, and tissue remodelling in three to four weeks] represent a silent epidemic,” Mehl et al write. “They affect a large fraction of the world’s population and pose a growing threat to public health, with a substantial negative economic impact.”

Based on the logic that nutritional intake plays an essential role in repairing damaged tissue, as has previously been established in the literature, the investigators conducted a prospective, randomised controlled assessment of the effects of nutritional supplements specialised in the repair of hard-to-heal wounds. The supplements used contained the amino acids proline and arginine, as well as high levels of vitamins A, C, and E, in addition to zinc and selenium. Mehl was the principal investigator.

Mehl, the principal investigator for the study, explained the choice underpinning this choice of nutritional make-up: “Although wound healing is a complex process, collagen synthesis is required for it to take place. This synthesis depends on proline and lysine hydroxylation, the presence of cofactors such as vitamins A, E and C, iron, zinc and selenium, and the oxygenation of cells. For this process to occur ideally, special attention must be given to factors such as adequate protein energy supply. In spite of this, little is known about the exact mechanism of some nutrients in the healing process, as well as their direct action on the healing process, supplementation dosage, and optimal period of use.”

Mehl and colleagues comment: “Awareness among health professionals of the important role that nutrition plays in overall wellness and disease treatment is very low, and should be encouraged. An early and timely nutritional intervention will help reverse the negative consequences of malnutrition. The use of a specialised oral nutritional supplement aimed at healing should be considered from the initial assessment as a tool of early intervention in wound treatment.

“An adequate nutritional status can be measured not only through wound evolution and resolution but also through absence of infections and other complications during the healing process. The specialised oral nutritional supplement tested achieved the nutritional goals and provided this study with results that corroborate the findings in the literature.”

Despite saying that the findings of this study are “promising”, the authors also say a larger study is needed to corroborate their results.