Segmentation and quantitative analysis of optical coherence tomography (OCT) images of laser burned skin based on deep learning.

Evaluation of skin recovery is an important step in the treatment of burns. However, conventional methods only observe the surface of the skin and cannot quantify the injury volume. Optical coherence tomography (OCT) is a non-invasive, non-contact, real-time technique. Swept source OCT uses near infrared light and analyzes the intensity of light echo at different depths to generate images from optical interference signals. To quantify the dynamic recovery of skin burns over time, laser induced skin burns in mice were evaluated using deep learning of Swept source OCT images. A laser-induced mouse skin thermal injury model was established in thirty Kunming mice, and OCT images of normal and burned areas of mouse skin were acquired at day 0, day 1, day 3, day 7, and day 14 after laser irradiation. This resulted in 7000 normal and 1400 burn B-scan images which were divided into training, validation, and test sets at 8:1.5:0.5 ratio for the normal data and 8:1:1 for the burn data. Normal images were manually annotated, and the deep learning U-Net model (verified with PSPNe and HRNet models) was used to segment the skin into three layers: the dermal epidermal layer, subcutaneous fat layer, and muscle layer. For the burn images, the models were trained to segment just the damaged area. Three-dimensional reconstruction technology was then used to reconstruct the damaged tissue and calculate the damaged tissue volume. The average IoU value and f-score of the normal tissue layer U-Net segmentation model were 0.876 and 0.934 respectively. The IoU value of the burn area segmentation model reached 0.907 and f-score value reached 0.951. Compared with manual labeling, the U-Net model was faster with higher accuracy for skin stratification. OCT and U-Net segmentation can provide rapid and accurate analysis of tissue changes and clinical guidance in the treatment of burns.

Burn-Induced Cicatricial Eyelid Retraction: A Challenging Case and Review of Management Principles.

Thermal and chemical burns can result in cicatricial eyelid retraction, characterized by an abnormal resting position of the eyelid margin and increased palpebral fissure height. Eyelid retraction often leads to exposure keratopathy, which can cause complications ranging from mild dry eye to globe-threatening ulceration and perforation. Prompt intervention includes aggressive lubrication, moisture chambers, eyelid tarsorrhaphy, and retraction repair surgery. Discussed here is a burn patient that developed severe cicatricial eyelid retraction and ectropion, leading to severe exposure keratopathy and infectious corneal ulceration with perforation. The patient required aggressive medical intervention, as well as 2 surgeries to restore the normal eyelid anatomy to protect the globe.

Conductive Hyaluronic Acid/Deep Eutectic Solvent Composite Hydrogel as a Wound Dressing for Promoting Skin Burn Healing Under Electrical Stimulation.

Burns can cause severe damage to the skin due to bacterial infection and severe inflammation. Although conductive hydrogels as electroactive burn-wound dressings achieve remarkable effects on accelerating wound healing, issues such as imbalance between their high conductivity and mechanical properties, easy dehydration, and low transparency must be addressed. Herein, a double-network conductive eutectogel is fabricated by integrating polymerizable deep eutectic solvents (PDESs)including acrylamide/choline chloride/glycerol (acrylamide-polymerization crosslink) and thiolated hyaluronic acid (disulfide-bonding crosslink). The introduction of PDESs provides the eutectogel with a conductivity (up to 0.25 S·m-1) and mechanical strength (tensile strain of 59-77%) simulating those of natural human skin, as well as satisfactory tissue adhesiveness, self-healing ability, and antibacterial properties. When combined with exogenous electrical stimulation, the conductive eutectogel exhibits the ability to reduce inflammation, stimulate cell proliferation and migration, promote collagen deposition and angiogenesis, and facilitate skin tissue remodeling. This conductive eutectogel shows great potential as a dressing for healing major burn wounds.

Application of Aleppo pine extract for skin burn treatment.

OBJECTIVE: To investigate the Pinus halepensis extracts and determine its healing and antibacterial effects, and to evaluate the treatment of skin burns. METHODS: Aqueous and ethanolic extracts and topical based on Aleppo pine plant extracts were prepared. Thirty male and female Wistar rats were used to study the cutaneous toxicity of extracts from the bark of P. halepensis. The extracts' healing potential for burn wounds were also assessed by evaluating the clinical and macroscopic aspects of the wounds. The antibacterial activity of crude extracts of P. halepensis as well as its wound healing abilities was verified in this investigation. RESULTS: In animals with acute dermal toxicity, there were no signs of treatment-related toxicity or death. The extracts of these plants could be transformed into phytomedicines for the treatment of infected wounds. The results demonstrated that formulated ointments are successful in treating second-degree burns in rats and may be suitable for the short-term therapeutic treatment of second-degree burns. CONCLUSION: This study successfully answered our problem, regarding the efficacy of our extract for treating second-degree burns in rats. Further studies are needed to confirm these results by identifying the molecules responsible for these activities and examining their mechanism of action.

Laparoscopic light source skin burn.

Skin burn injury from light cables is a rare complication of laparoscopic surgery, but it can be severe and distressing for both the patient and the surgeon. A case report of skin burns due to laparoscopic light source is presented in this article, followed by an experimental trial to confirm the findings, and review of literature. The light source is usually connected to the camera to give adequate light inside the abdominal cavity for visualization of the internal organs, and hence, safe surgery. The light source should deliver cool light to prevent any burn from heat to skin or internal organs, but in fact, it is not usually cool and can reach high temperatures. Precautions and recommendations to avoid skin burns due to the light source are included. Surgeons should be aware of burns from light sources in laparoscopic surgery and take precautions to prevent them.

A Comparative Analysis of the Outcomes of Various Graft Types in Burn Reconstruction Over the Past 24 Years: A Systematic Review.

Burn injuries, a major global health concern, result in an estimated 180,000 fatalities annually. Despite tremendous progress in treatment methods over the years, the morbidity and mortality associated with burns remain significant. Autologous skin grafting, particularly split-thickness skin grafting (STSG), has been a cornerstone in burn reconstruction, and it has facilitated survival and functional recovery for total body surface area (TBSA) significantly. However, the requirement for primary closure at the donor site due to the constraints of full-thickness donor harvesting continues to pose challenges. The introduction of dermal regenerative templates (DRT) in the late 1970s marked a substantial step forward in tissue engineering, addressing the inadequacy of dermal replacement with STSGs. This systematic review aimed to compare the outcomes of different graft types - bioengineered, autografts, allografts, and xenografts - in burn reconstruction over the last 24 years. The review focused on the pros and cons of each graft type, offering clinical insights grounded in experience and evidence. The approach involved a systematic review of studies published in English from January 2000 to January 2024, covering randomized controlled trials (RCTs), cohort studies, case-control studies, and case series. The participants comprised individuals of all ages who underwent burn reconstruction with skin grafts, specifically split-thickness grafts, full-thickness grafts, composite grafts, and epidermal grafts (autografts, allografts, and xenografts) and bioengineered grafts. The primary outcomes were functional and cosmetic results, patient satisfaction, graft survival, and complications. The risk of bias was evaluated using the Cochrane risk-of-bias tool for randomized trials version 2 (RoB 2), the Newcastle-Ottawa Scale (NOS) for non-randomized studies, and the Canada Institute for Health Economics (IHE) quality appraisal tool for case series. Our initial search yielded a total of 1,995 articles, out of which 10 studies were selected for final analysis. Among the four clinical trials assessed, 75% showed a high risk of bias. The studies reviewed involved various graft types, with six studies (60%) concentrating on allografts, three (30%) on autografts, and one (10%) on bioengineered skin grafts. The outcomes were varied, underlining the intricate nature of burn wound management. Our evaluation revealed promising results for autologous-engineered skin substitutes and allografts but also highlighted methodological disparities among the studies included. The dominance of observational studies and the diversity of outcome measures present obstacles to direct comparisons. Future research should address these limitations, employing well-structured RCTs, standardized outcome measures, and exploring long-term outcomes and patient-specific factors. The rapidly evolving field of regenerative medicine offers great potential for novel grafting methods. This systematic review provides valuable insights into the diverse outcomes of burn reconstruction using different graft types. Autologous-engineered skin substitutes and allografts seem to hold significant promise, suggesting a possible shift in grafting techniques. However, methodological inconsistencies and the lack of high-quality evidence underscore the necessity for further research to fine-tune burn care approaches.

Therapeutic effect of mitochondrial transplantation on burn injury.

As mitochondrial damage or dysfunction is commonly observed following burn injuries, we investigated whether mitochondrial transplantation (MT) can result in therapeutic benefits in the treatment of burns. Human immortalized epidermal cells (HaCaT) and Kunming mice were used to establish a heat-injured cell model and a deep partial-thickness skin burn animal model, respectively. The cell model was established by exposing HaCaT cells to 45 or 50 °C for 10 min, after which cell proliferation was assayed using fluorescent double-staining and colony formation assays, cell migration was assessed using colloidal gold migration and scratch assays, and cell cycle progression and apoptosis were measured by flow cytometry. Histopathological staining, immunohistochemistry, nick-end labeling analysis, and enzyme-linked immunosorbent assays were used to evaluate the effects of MT on inflammation, tissue recovery, apoptosis, and scar growth in a mouse model. The therapeutic effects were observed in the heat-injured HaCaT cell model. MT promoted cell viability, colony formation, proliferation, and migration; decreased G1 phase; promoted cell division; and decreased apoptosis. Wound-healing promotion, anti-inflammation (decreased mast cell aggregation, down-regulated of TNF-α, IL-1ß, IL-6, and up-regulated IL-10), acceleration of proliferation recovery (up-regulated CD34 and VEGF), apoptosis reduction, and scar formation reduction (decreased collagen I/III ratio and TGF-ß1) were observed in the MT mouse model. The MT mode of action was, however, not investigated in this study. In conclusion, our data indicate that MT exerts a therapeutic effect on burn injuries both in vitro and in vivo.

Nonsurgical Treatment of Postburn Hypopigmentation: A Literature Review.

The treatment of postburn hypopigmentation was primarily surgical before the advent of new technologies. Medical devices and therapies are emerging to manage scar sequelae that can be disfiguring and associated with severe psychosocial impact. These innovations have been poorly investigated for hypopigmentation, but they represent a real hope. We reviewed all articles published on Pubmed up to June 2022. Included studies had to specifically focus on treating postburn hypopigmented scars. All articles evaluating transient solutions such as make-up, and articles describing inflammation-linked hypopigmentation with no etiological details or no burn injury history were excluded. Through this review, we have highlighted 6 different types of nonsurgical treatments reported in postburn leukoderma potentially allowing definitive results. Electrophoto-biomodulation or E light (combining intensive pulsed light, radiofrequency, and cooling), topical daylight psoralen UVA therapy, and lasers (fractional lasers using pulse energies or CO2FL devices, lasers-assisted drug delivery as local bimatoprost and tretinoin or pimecrolimus) have been explored with encouraging results in hypopigmented burns. Finally, other promising medical strategies include using FK506, a nonsteroidal anti-inflammatory drug, to induce melanogenesis or using melanocyte-stimulating hormones with fractional laser-assisted drug deliveries, which are expected to emerge soon.

A rare complication after radiofrequency catheter ablation in an adolescent case: skin burn.

Radiofrequency catheter ablation is a preferred treatment method for cardiac arrhythmias in children due to its high success rate and low complication risk. We present an adolescent patient who underwent radiofrequency catheter ablation for Wolff-Parkinson-White syndrome and developed a skin burn at the site of the electrode patch. Skin burns can catastrophic consequences, especially in patients with life-threatening arrhythmias; therefore, clinicians should be aware of this complication.

Sustainable Approach of Functional Biomaterials-Tissue Engineering for Skin Burn Treatment: A Comprehensive Review.

Burns are a widespread global public health traumatic injury affecting many people worldwide. Non-fatal burn injuries are a leading cause of morbidity, resulting in prolonged hospitalization, disfigurement, and disability, often with resulting stigma and rejection. The treatment of burns is aimed at controlling pain, removing dead tissue, preventing infection, reducing scarring risk, and tissue regeneration. Traditional burn wound treatment methods include the use of synthetic materials such as petroleum-based ointments and plastic films. However, these materials can be associated with negative environmental impacts and may not be biocompatible with the human body. Tissue engineering has emerged as a promising approach to treating burns, and sustainable biomaterials have been developed as an alternative treatment option. Green biomaterials such as collagen, cellulose, chitosan, and others are biocompatible, biodegradable, environment-friendly, and cost-effective, which reduces the environmental impact of their production and disposal. They are effective in promoting wound healing and reducing the risk of infection and have other benefits such as reducing inflammation and promoting angiogenesis. This comprehensive review focuses on the use of multifunctional green biomaterials that have the potential to revolutionize the way we treat skin burns, promoting faster and more efficient healing while minimizing scarring and tissue damage.

Electrochemical therapy (EChT) of cancer tumor with an external anode, a way to achieve pathological complete response.

There is a critical need for re-evaluation of electrochemical therapy (EChT) approaches of solid tumors to address the challenges of the currently used method: incomplete pathological response. The coexistence of anode and cathode in the tumor region resulted in acid-alkaline mixation (buffered pH) when the electrodes are so near each other (d < 1 cm), and in the non-affected lesions when the electrodes are far from each other (d > 1 cm), both have resulted in intact tumoral lesions in EChT field. Here, we presented a designation model study of EChT with an external anode out of the tumor and filled the tumor with dense distribution of cathode electrodes to completely destroy the tumoral lesions without any remaining vital tumoral residues. Anode was located in a biological ionic gel chamber (located on top of the skin) which mediates the ionic interface between the external anode and intratumoral cathode. Our newly reported method can solve the lack of a comprehensive therapeutic guideline for any solid tumors. A remarkable increase in the efficiency of EChT without any over-treating was achieved by alkaline therapy of the tumor (without any limitation in locating cathodic needles all over the tumor) and an external acidic region on top of the skin in a cylindrical gel chamber. We found that the destructive volumes and treating ability of mice tumors by this newly represented method were more significant than the conventional EChT method in fewer therapy sessions and no damage to the skin (both anode and cathode electrodes inside the tumor) (P < 0.05). Results of this study applied to mouse model tumors shed new light on returning attraction to EChT as a valuable complementary method for treating different types of solid breast tumors.

An Extended Model for Analyzing the Heat Transfer in the Skin-Microenvironment-Fabric System during Firefighting.

This study proposed an extended multi-layer heat transfer model to simulate skin burns of firefighters during firefighting. The proposed model takes into account the effect of fabric movement frequencies, fabric movement amplitudes and human body movement speeds on the heat transfer between the skin and the heat source under low-level radiative exposure. The simulation performance was validated against the simulations in the published literature in terms of the heat transfer in the multi-layer fabric system, skin temperature and skin burns. The results indicated that the fabric periodic movement caused by human body movement decreased the time to skin burns and the skin temperature increased with increasing fabric movement amplitude. During firefighting, the time to 2nd degree burn was 33.3-35.2% shorter at medium human body movement speed than at low and high movement speeds. Furthermore, at low movement speeds, the time to 2nd degree burn was negatively associated with fabric movement amplitude, whereas it was delayed by 12.9-29.8% at the fabric movement amplitude of 2.5 mm at medium and high human body movement speeds. This research provides foundational knowledge for the development of a new generation of firefighters' protective clothing (FPC) and the assessment of skin burns in firefighters.

MiR-711 and miR-183-3p as potential markers for vital reaction of burned skin.

In forensic practice, the identification of antemortem burns and postmortem burns is of the utmost importance. Reports from previous studies have shown that miRNAs, with lengths stretching over 18-25 nucleotides, are highly stable and resistant to degradation. However, there has been little research into the application of miRNAs in identifying antemortem and postmortem burns. This study compared the expression of miR-711 and miR-183-3p levels in mouse and postmortem human burned skins using RT-qPCR assay. RT-qPCR examination of burned mouse skins showed that increased miR-711 and miR-183-3p expression in comparison to intact skin tissues. The increased expressions of these two miRNAs were observed until 120 h after death in burned mouse skins, whereas no significant changes were found in postmortem burned skins. In human burned skins, the increased levels of these two miRNAs at 48 h following autopsy occurred in 19 of 26 subjects, which appeared to be related to the severity of the burn. These findings suggest that miR-711 and miR-183-3p may act as biomarkers for vital reaction of skin burn.Key pointsThis study investigated miR-711 and miR-183-3p levels in mouse and postmortem human burned skins using RT-qPCR.Increased miR-711 and miR-183-3p levels were observed in burned mouse skins.The increased expressions of these two miRNAs were observed until 120 h after death in burned mouse skin.The increased levels of these two miRNAs were observed until 48 h after autopsy in 19 of 26 forensic cases, which appeared to be related to the severity of the burn.

[Morphological features of skin injuries caused by conducted energy weapons (CEWs)]. / Morfologicheskie osobennosti povrezhdenii kozhi, prichinennykh vystrelami iz distantsionnykh elektroshokovykh ustroistv.

The objective of the study is to identify, compare and analyze morphological features of skin injuries resulting from the experimental firing of various models of conducted energy weapons (CEWs) In the experimental study, the design features of the provided CEWs models and characteristics of skin injuries were studied using a simulator, a pig carcass, shot without a barrier point-blank, and at the distance of 0.5 cm, 5 cm, 50 cm, and 4.5 m. The results of expert and experimental studies showed differences in morphological features of skin lesions from two different CEW models with different designs. To make an objective expert conclusion on the kind of CEW used to damage the skin, distance, and angle to the target, it is necessary to perform appropriate experiments with at least two different models of these devices.

Terapia celular en quemadura de segundo grado profundo: reporte de caso clínico / Cell therapy in deep second-degree burn wound: clinical case report

Se reporta el caso de un paciente pediátrico con quemaduras de segundo grado profundo en muslo derecho, con superficie corporal quemada del 8% por agua caliente, que recibió terapia celular como estrategia terapeútica alternativa. Tras procedimiento terapeútico con injertos de piel, se evidenció remanente una úlcera secundaria a quemadura (7 x 4 cm); por lo que, se procedió a valoración para terapia con células madres mesenquimales autólogas procedentes de médula ósea. Se realizó 8 sesiones de sembrado de células madre. La respuesta y evolución fueron favorables, la regeneración de tejidos se dio desde la profundidad hacia la superficie y desde el lateral a medial de la úlcera. Se evidenció revascularización y posterior epitelización de la zona afectada, sin secuelas de cicatrización.

Case report of a pediatric patient with deep second degree burn wounds on the right thigh, body surface area burnt 8% due to boiling water, who received cell therapy as an alternative therapeutic strategy. After a therapeutic procedure with skin grafts, a remaining burn wound (7 x 4 cm) was evidenced; consequently, an assessment for therapy using autologous mesenchymal stem cells derived from bone marrow was made. It was performed 8 sessions of somatic stem cells seeding. Results were favorable, tissue regeneration occurred from the depth to the surface, and from the lateral to medial side of the burn wound. Revascularization and subsequent epithelialization in the affected area were evidenced, without scarring repercussion.

Treatment of hyperpigmentation after burn: A literature review.

OBJECTIFY: Skin pigmentation disorders are one of the most frequent sequelae after burn injury. While these conditions often improve over time, some are permanent and cause severe psychological disorders (especially on the face). Given the frequency of these disorders and their benign nature, the scientific community has great difficulty postponing these patient follow-ups. Publications on their management are rare, and there is no consensus on the gold standard treatment for skin dyschromia. Herein, we performed a literature review including the various treatments currently proposed to manage these hyperpigmentations. METHODS: All reported articles up to February 2021 were reviewed on Pubmed. Studies on the treatment of hyperpigmented scars were included if they were secondary to burn injuries. Excluded articles evaluated transient treatments, such as makeup, and articles on inflammatory hyperpigmentation without etiological details or not secondary to burns. RESULTS: 201 articles were identified, and 13 studies were included. Topical creams used in inflammatory hyperpigmented lesions such as hydroquinone and first-line retinoids are controversial due to their inconstant efficacy. Various types of laser and pulsed light treatments have shown their effectiveness but can also aggravate pigmentation. CONCLUSION: Dyschromia after burn remains a therapeutic challenge. Hyperpigmentations after burn should be treated on a case-by-case basis, using data from the literature, clinical experience and measuring the risk/benefit ratio.

Medicinal Herbs from Phytoinformatics: An Aid for Skin Burn Management.

Skin burn injury is the most common cause of trauma that is still considered a dreadful condition in healthcare emergencies around the globe. Due to the availability of a variety of regimes, their management remains a dynamical challenge for the entire medical and paramedical community. Indeed, skin burn injuries are accompanied by a series of several devastating events that lead to sepsis and multiple organ dysfunction syndromes. Hence, the challenge lies in the development of a better understanding as well as clear diagnostic criteria and predictive biomarkers, which are important in their management. Though there are several regimes available in the market, there are still numerous limitations and challenges in the management. In this review article, we have discussed the various biomarkers that could be targeted for managing skin burn injuries. Instead of focusing on allopathic medication that has its adverse events per se, we have discussed the history, ethnopharmacology properties, and prospects of identified phytomedicines from a well-established herbal informatics model. This review article not only discusses the benefits of scrutinized phytocompounds but also the development of novel druggable phyto-compounds to target skin burn injury at a lower cost with no adverse effects.

Therapeutic potential of second degree's skin burns by topical dressing of Teucrium ramosissimum that promotes re-epithelialization.

The aim of the report is to assess the protective effect of powder aerial part of Teucrium ramosissimum (TS) on the in vivo wound-healing of second-degree burn injuries. Teucrium phytocompounds were characterized by FTIR, HPLC, and GC/MS spectra. Burn wound models were employed to evaluate the in vivo wound-healing activity. Thirty six wistar rats with burn wounds were divided into six groups and treated daily with TS, the mixture of Teucrium and honey (TS-HY), thymol and Dermosalic® (0.05%) (DS) creams. Skin epithelialization was monitored on the 4th, 13th, and 21st days. Proteins and the level of malondialdehyde in the burned skin were assessed. Microscopic and macroscopic investigations of skin wound tissues showed significant wound closure rate via complete epidermal reepithelization and regeneration, higher protein content, collagen synthesis and deposition, hair follicles growth post wounding that were promoted in TS-, thymol-, TS-HY- and DS-treated wound tissues compared to the untreated burned wound tissues that was characterized by the absence of the epithelialization, vascularization and the formation of the epidermis layer. Additionally, the skin healing potential of TS and TS-HY was validated by markedly decreased of lipid peroxidation. Overall, TS was found to possess complete wound closure and improves the healing process.

Spindle-Like Zinc Silicate Nanoparticles Accelerating Innervated and Vascularized Skin Burn Wound Healing.

The treatment of severe burn injuries is a crucial challenge in skin tissue engineering. Severe burns are always accompanied with large-area neurovascular networks damage, leading to the lack of excitation functions and difficulty in self-healing. Therefore, it is of great importance to develop biomaterials which can not only promote wound healing but also simultaneously reconstruct cutaneous neurovascular networks. In this study, Zn2 SiO4 (ZS) nanoparticles-incorporated bioactive nanofibrous scaffolds are designed for innervated and vascularized skin burn wound healing. ZS nanoparticles with spindle-like morphology are synthesized via a facile hydrothermal method. The incorporation of ZS nanoparticles endows the scaffolds with excellent angiogenic and neurogenic activities in vitro. Additionally, in vivo results show that the ZS nanoparticles-incorporated scaffolds have favorable re-epithelialization, innervation, and vascularization abilities through local release of bioactive Zn and Si ions from ZS nanoparticles, leading to rapid wound healing featuring with newly formed blood vessels and nerve fibers. Taken together, this study suggests that the spindle-like ZS nanoparticles are useful bioactive agents for stimulating vascularization and innervation of functional skin repair. The bioactive inorganic nanoparticles may be used for multifunctional tissue regeneration.