Abstract
According to the American Burn Association, approximately 486,000 annual burns occur in the United States and approximately 40,000 of these require inpatient hospitalization (Burn Incidence Fact Sheet 2016. American Burn Association. http://ameriburn.org/who-we-are/media/burn-incidence-fact-sheet/. Accessed 29 Aug 2017). With the introduction of early excision and grafting and better critical care management, decreased mortality rates have introduced an opportunity for burn providers to address functional recovery after burn injury including management of late wound complications. Years after patients’ burns have “healed,” they continue to present to clinic with various problems including pruritus, contractures, and cosmesis (Thomspon et al., J Burn Care Res 34:477–482, 2013). In spite of this, clinicians have limited understanding of scar pathophysiology and continue to struggle with management.
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References
Dupuytren G, Doane AS. Clinical lectures on surgery: delivered at Hotel Dieu. Boston: Carter, Hendee; 1832.
Center for Disease Control. Release of ICD-10-CM https://www.cdc.gov/nchs/icd/icd10cm.htm#FY%202018%20release%20of%20ICD-10-CM (2018).
Jackson D. The diagnosis of depth of burning. J Br Surg. 1953;40:588–96.
Jackson D. Second thoughts on the burn wound. J Trauma. 1969;9:839–62.
Rowan MP, Cancio LC, Elster EA, et al. Burn wound healing and treatment: review and advancements. Crit Care. 2015;19:243–55.
Tiwari VK. Burn wound: how it differs from other wounds? Indian J Plast Surg. 2012;45:364–73.
Santoro MM, Gaudino G. Cellular and molecular facets of keratinocyte reepithelization during wound healing. Exp Cell Res. 2005;304:274–86.
Zhu Z, Ding J, Shankowsky HA, et al. The molecular mechanism of hypertrophic scar. J Cell Commun Signal. 2013;7:239–52.
Gurtner GC, Werner S, Barrandon Y, et al. Wound repair and regeneration. Nature. 2008;453:314–21.
Santoro MM, Gaudino G. Cellular and molecular facets of keratinocyte reepithelization during wound healing. Exp Cell Res. 2005;30:274–86.
Leibovich SJ, Ross R. The role of the macrophage in wound repair. Am J Pathol. 1975;78:71–95.
Ladak A, Tredget EE. Pathophysiology and management of the burn scar. Clin Plast Surg. 2009;36:661–74.
Mills CD, Ley K. M1 and M2 macrophages: the chicken and the egg of immunity. J Innate Immun. 2014;6:716–26.
Tacchio C, Cassatella MA. Neutrophil-derived cytokines involved in physiological and pathological angiogenesis. Chem Immunol Allergy. 2014;99:123–37.
Levy V, Lindon C, Zheng Y, et al. Epidermal stem clels arise from the hair follicle after wounding. FASEB J. 2007;21:1358–66.
Martin P. Wound healing: aiming for perfect skin regeneration. Science. 1997;276:75–81.
Koster MI. Making an epidermis. Ann N Y Acad Sci. 2009;1170:7–10.
Garner WL. Epidermal regulation of dermal fibroblast activity. Plast Reconstr Surg. 1996;102:135–9.
Chetty BV, Boissey RE, Warden GD, et al. Basement membrane and fibroblast aberration in blisters at the donor, graft, and spontaneously healed sites in patients with burns. Arch Dermatol. 1992;125:181–6.
Sarrazy V, Billet F, Micallef L, et al. Mechanisms of pathological scarring: role of myofibroblasts and current developments. Wound Repair Regen. 2011;19(Suppl):s10–5.
Tonnesen MG, Feng X, Clark RA. Angiogenesis in wound healing. J Investig Dermatol Symp Proc. 2000;5:40–6.
Hollander DA, Erli HJ, Theisen A, Falk S, Kreck T, Muller S. Standardized qualitative evaluation of scar tissue properties in an animal wound healing model. Wound Repair Regen. 2003;4:150–7.
Kischer CW. The microvessels in hypertrophic scars, keloids and related lesions: a review. J Submicrosc Cytol Pathol. 1992;24:281–96.
Travis TE, Mino MJ, Moffatt LT, et al. Biphasic presence of fibrocytes in a porcine hypertrophic scar model. J Burn Care Res. 2015;36:e125–35.
Ehrlich HP. Wound closure: evidence of cooperation between fibroblasts and collagen matrix. Eye. 1988;2:149–57.
Gabbiani G. The myofibroblast in wound healing and fibrocontractive diseases. J Pathol. 2003;200:500–3.
Baum J, Duffy HS. Fibroblasts and myofibroblasts: what are we talking about? J Cardiovasc Pharmacol. 2011;57:37–379.
Levenson SM, Geever EF, Crowley LV, et al. Healing of rat skin wounds. Ann Surg. 1965;161:293–308.
Hocking AM, Gibran NS. Mesenchymal stem cells: paracrine signaling and differentiation during cutaneous wound repair. Exp Cell Res. 2010;316:2213–9.
Nambu M, Kishimoto S, Nakamura S, et al. Accelerated wound healing in healing-impaired db/db mice by autologous adipose tissue-derived stromal cells combined with atelocollagen matrix. Ann Plast Surg. 2009;62:317–21.
Wu Y, Chen L, Scott PG, et al. Mesenchymal stem cells enhance wound healing through differentiation and angiogenesis. Stem Cells. 2007;25:2648–59.
Lee SH, Jin SY, Song JS, et al. Paracrine effects of adipose derived stem cells on keratinocytes and dermal fibroblasts. Ann Dermatol. 2012;24:136–43.
Mustoe TA, Cooter RD, Gold MH, et al. International clinical recommendations on scar management. Plast Reconstr Surg. 2002;110:560–71.
Ogawa R. The most current algorithms for the treatment and prevention of hyperrophic scars and keloids. Plast Reconstr Surg. 2010;125:557–68.
Tyack Z, Simons M, Spinks A, et al. A systematic review of the quality of burn scar rating scales for clinical and research use. Burns. 2012;38:6–18.
Tyack Z, Wasiak J, Spinks A, et al. A guide to choosing a burn scar rating scale for clinical or research use. Burns. 2013;39:1341–50.
Thompson CM, Sood RF, Honari S, et al. What score on the Vancouver scar scale constitutes a hypertrophic scar? Results from a survey of North American burn care providers. Burns. 2015;41:1442–8.
Lumenta DB, Siepmann E, Kamolz LP, et al. Internet-based survey on current practice for evaluation, prevention, and treatment of scars, hypertrophic scars, and keloids. Wound Repair Regen. 2014;22:483–91.
Rinkevich R, Walmsley GG, Hu MS, et al. Science. 2015;348:aaa2151.
Kwan PO, Tredget EE. Biological principles of scar and contracture. Hand Clin. 2017;33:277–92.
Kischer CW, Pindur J, Krasovith P, et al. Characteristics of granulation tissue which promote hypertrophic scarring. Scanning Microsc. 1990;4:877–87.
Ogawa R. Keloid and hypertrophic scars are the results of chronic inflammation in the reticular dermis. Int J Mol Sci. 2017;18:606–16.
Honardoust D, Varkey M, Marcoux Y, et al. Reduced decorin, fibromodulin, and transforming growth factor: B3 in deep dermis leads to hypertrophic scarring. J Burn Care Res. 2012;33:218–27.
Tredget EE, Wang R, Shen Q, et al. Transforming growth factor-beta mRNA and protein in hypertrophic scar tissues and fibroblasts: antagonism by IFN-alpha and IFN-gamma in vitro and in vivo. J Interferon Cytokine Res. 2000;20:143–52.
Scott PG, Dodd CM, Tredget EE, et al. Immunohistochemical localization of the proteoglycan decorin, biglycan, and versican and transforming growth factor-beta in human post-burn hypertrophic and mature scars. Histopathology. 1995;26:423–31.
Scott JR, Muangman PR, Tamura RN, et al. Substance P levels and neutral endopeptidase activity in acute burn wounds and hypertrophic scar. Plast Reconstr Surg. 2005;115:1095–102.
Scott JR, Muangman P, Gibran NS. Making sense of hypertrophic scar: a role for nerves. Wound Repair Regen. 2007;15:S27–31.
Malenfont A, Forget R, Papillon J, et al. Prevalence and characteristics of chronic sensory problems in burn patients. Pain. 1996;67:493–500.
Carrougher GJ, Martinez EM, McMullen KS, et al. Pruritus in adult burn survivors: postburn prevalence and risk factors associated with increased intensity. J Burn Care Res. 2013;34(1):94–101.
Ahuja RB, Gupta R, Gupta G, et al. A comparative analysis of cetirizine, gabapentin and their combination in the relief of post-burn pruritus. Burns. 2011;37:203–7.
Brooks JP, Malic CC, Judkins KC. Scratching the surface—managing the itch associated with burns: a review of current knowledge. Burns. 2008;34:751–60.
Shimizu S, Tanaka H, Sakaki S, et al. Burn depth affects dermal interstitial fluid pressure, free radical production, and serum histamine levels in rats. J Trauma. 2003;54:683–7.
Schneider JC, Harris NL, El Shami A, et al. A descriptive review of neuropathic-like pain after Burn injury. J Burn Care Res. 2006;27:524–8.
Yagmur C, Guneren E, Kefeli M, et al. The effect of surgical denervation on prevention of excessive dermal scarring: a study on rabbit ear hypertrophic scar model. J Plast Reconstr Aesthet Surg. 2011;64:1359–65.
Ogawa R. Mechanobiology of scarring. Wound Repair Regen. 2011;19(Suppl 1):s2–9.
Ogawa R, Okai K, Tokumura F, et al. The relationship between skin stretching/contraction and pathologic scarring: the important role of mechanical forces in keloid generation. Wound Repair Regen. 2012;20:149–57.
Kim JY, Willard JJ, Supp DM, et al. Burn scar biomechanics following pressure garment therapy. Plast Reconstr Surg. 2015;136:572–81.
Friedrich EE, Niknam-Bienia S, Xie P, et al. Thermal injury model in the rabbit ear with quantifiable burn progression and hypertrophic scar. Wound Repair Regen. 2017;25:327–37.
Silverstein, et al. Hypertrophic scarring etiology and control of disabling complications in burned soldiers. Ann Res Progr Rep (US Army Institute of Surgical Research). 1972;37:1–5.
Zhu KQ, Carrougher GJ, Gibran NS, et al. Review of the female Duroc/Yorkshire pig model of human fibroproliferative scarring. Wound Repair Regen. 2007;15(Suppl 1):S32–9.
Sood RF, Muffley LA, Seaton ME, et al. Dermal fibroblasts from the red Duroc pig have an inherently fibrogenic phenotype: an in vitro model of fibroproliferative scarring. Plast Reconstr Surg. 2015;136:990–1000.
Seaton M, Hocking A, Gibran NS. Porcine models of cutaneous wound healing. ILAR J. 2015;56:127–38.
Hollander DA, Erli HJ, Theisen A, et al. Standardized qualitative evaluation of scar tissue properties in an animal wound healing model. Wound Repair Regen. 2003;11:150–7.
Engrav LE, Garner WL, Tredget EE. Hypertrophic scar, wound contraction, and hyper-hypopigmentaiton. J Burn Care Res. 2007;28:593–7.
Thompson CM, Hocking AM, Honari S, et al. Genetic risk factors for hypertrophic scar development. J Burn Care Res. 2013;34:477–82.
Santucci M, Borgogni L, Reali UM, et al. Keloids and Hypertrophic scars of caucasians show distinctive morphologic and immunophenotypic profiles. Virchows Arch. 2001;438:457–63.
Sood RF, Hocking AM, Muffley LA, et al. Genome-wide association study of postburn scarring indentifies a novel protective variant. Ann Surg. 2015;262:563–39.
Goverman J, Mathews K, Goldstein R, et al. Adult contractures in burn injury: a burn model system national database study. J Burn Care Res. 2017;38:e328–36.
Goverman J, Mathews K, Goldstein R, et al. Pediatric contractures in burn injury: a burn model system national database study. J Burn Care Res. 2017;38:e192–9.
Levi B, Jayakumar P, Giladi A, et al. Risk factors for the development of heterotopic ossification in seriously burned adults: a national institute on disability, independent living and rehabilitation research burn model system database analysis. J Trauma Acute Care Surg. 2015;79:870–6.
Orchard GR, Paratz JD, Blot S, et al. Risk factors in hospitalized patients with burn injuries for developing heterotopic ossification—a retrospective analysis. J Burn Care Res. 2015;36:465–70.
Schneider JC, Simko LC, Goldstein R, et al. Predicting heterotopic ossficaition early after burn injuries. A risk scoring system. Ann Surg. 2017;266:179–84.
Peterson JR, Eboda ON, Brownley RC, et al. Effects of aging on osteogenic response and heterotopic ossification following burn injury in mice. Stem Cells Dev. 2015;24:205–13.
Ranganathan K, Peterson J, Agarwal S, et al. Role of gender in burn-induced heterotopic ossification and mesenchymal cell osteogenic differentiation. Plast Reconstr Surg. 2015;135:1631–41.
Holavanahali RK, Helm PA, Kowalske KG. Long-term outcomes in patients surviving large burns: the skin. J Burn Care Res. 2010;31:631–9.
Chadwick SL, Yip C, Ferguson MW, et al. Repigmentation of cutaneous scars depends on original wound type. J Anat. 2013;223(1):74–82.
Park HY, Kosmadaki M, Yaar M, et al. Cellular mechanisms regulating human melanogenesis. Cell Mol Life Sci. 2009;66:1493–506.
Sirimahachaiyakul P, Sood RF, Muffley LA, et al. Race does not predict melanocyte heterogenous responses to dermal fibroblast-derived mediators. PLoS One. 2015;10:e0139135.
Greenhalgh DG. A primer on pigmentation. J Burn Care Res. 2015;36:247–57.
Shen R, Zhang J, Zhang F, et al. Clinical characteristics and therapeutic analysis of 51 patients with Marjolin’s ulcers. Exp Ther Med. 2015;10:1364–74.
Bozkurt M, Kapi E, Kuvat SV, et al. Current concepts in the management of Marjolin’s ulcers: outcomes from a standardized treatment protocol in 16 cases. J Burn Care Res. 2010;31:776–80.
Fleming MD, Hunt JL, Purdue GF, et al. Marjolin’s ulcer: a review and reevaluation of a difficult problem. J Burn Care Rehabil. 1990;11:460–9.
Yanofsky VR, Mercer SE, Phelps RG. Histopathological variants of cutaneous squamous cell carcinoma: a review. J Skin Cancer. 2011;2011:210813.
Lawrence JW, Rosenberg LE, Fauerbach JA. Comparing the body esteem of pediatric survivors of burn injury with the body esteem of an age-matched comparison group without burns. Rehabil Psychol. 2007;52:370–9.
Pope SJ, Solomons WR, Done DJ, et al. Body image, mood and quality of life in young burn survivors. Burns. 2007;33:747–55.
Lawrence JW, Rosenberg L, Mason S, et al. Comparing parent and child perceptions of stigmatizing behavior experience by children with burn scars. Body Image. 2011;8:70–3.
Hunter TA, Medved MI, Hiebert-Murphy D, et al. Put on your face to face the world: women’s narratives of burn injury. Burns. 2013;39:1588–98.
Lawrence JW, Mason ST, Schomer K, et al. Epidemiology and impact of scarring after burn injury: a systematic review of the literature. J Burn Care Res. 2012;33:136–46.
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Yenikomshian, H.A., Gibran, N.S. (2020). Burn Wound Healing and Scarring Pathophysiology. In: Ogawa, R. (eds) Total Scar Management. Springer, Singapore. https://doi.org/10.1007/978-981-32-9791-3_2
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DOI: https://doi.org/10.1007/978-981-32-9791-3_2
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