Rational manipulation of specific biological targets may hold promise for more effective and successful outcomes toward post-burn scar mitigation. Recent advances in our understanding of the cellular events and molecular signaling pathways underlying fibrotic scar development have led us to pursue investigational approaches to specifically targeted therapies. Other topical antibiotic agents and therapeutic occlusive or exposure dressings are all commonly used to facilitate healing and to prevent scar formation, although these non-molecularly targeted therapies have resulted in variable clinical outcomes ( Leon-Villapalos et al., 2008 Block et al., 2015).Īlthough exuberant fibro-proliferation in the burn area starts as part of the normal wound healing, variations in cellular responses can lead to excessive scar-producing processes ( Gurtner et al., 2008 Penn et al., 2012). Over the past decade, a variety of advanced burn dressings have been introduced, many of them containing silver compounds for their long-standing antimicrobial effects. Silicone sheets, tapes, and gel formulations physically cover the healing area and are widely used as a general approach to scar mitigation ( Meier and Nanney, 2006 Bleasdale et al., 2015). Preventive therapies to reduce the formation of widespread HTS is fundamental to burn care and can significantly alter the outcome depending on the efficacy of treatment, timing of treatment, and duration of treatment. Even with precise operative technique, proper excision and grafting can still result in undesirable HTS that may not be cosmetically acceptable ( Berman et al., 2008 Ashab Yamin et al., 2015 Chua et al., 2016 Zhu et al., 2016). (2006) in a study of pediatric scald burns. This is due to the increasing risk of HTS that doubles from 20 to 40% between 2 and 3 weeks, as demonstrated by Cubison et al. It is generally accepted that any burn that is not expected to heal on its own within 3 weeks should undergo excision and grafting as early as is feasible. Deep partial-thickness burns and full thickness (third-degree) burns usually require excision with reconstruction (often skin grafting) and are more prone to developing HTS. Superficial partial thickness (second-degree) burns typically heal spontaneously within days to weeks and may result in scarring. Superficial (first-degree) burns heal without the need for surgery and typically do not lead to adverse scar formation or hyperpigmentation as the entire dermis is preserved. The approach to treating a burn wound begins with accurately diagnosing the depth and size of the burn, which is of critical importance for deciding the timing and approach to management. These patients may require long hospitalizations and multiple reconstructive procedures to prevent abnormal scar formation, including HTS and/or contracture ( Ashab Yamin et al., 2015 Aba, 2016 Chua et al., 2016).ĭespite modern advances in surgical techniques and biomedical technologies, management of facial burns remains challenging and post-burn scar formation may be inevitable. Reconstruction of burned skin, soft tissues, and other structures may require a combination of skin grafts, flaps, and tissue expansion techniques used to restore the functional and esthetic units of the craniofacial region. Facial burns are particularly devastating to the affected patient who experiences psychological stress during acute treatment and subsequent lower quality of life when scars manifests. Over 50% of burn injuries involve the head and neck region and deep second and third-degree burns in this region often result in hypertrophic scar (HTS) formation leading to an assortment of debilitating effects both functionally and cosmetically ( Sethi et al., 2014 Aba, 2016). In the United States alone, burn incidents that demand medical treatment exceed more than 400,000 cases each year, ∼40,000 of which require hospitalization and intensive post-burn care ( Berman et al., 2008 Murray et al., 2012 Sethi et al., 2014 Aba, 2016 Zhu et al., 2016). Burn injuries represent one of the leading causes of accidental death worldwide.
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