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EBJ

Journal Description

European Burn Journal

European Burn Journal (formerlyEuropean Journal of Burn Care) is an international, peer-reviewed, open access journal on burn care and burn prevention, and is published quarterly online. It is the official journal of theEuropean Burns Association (EBA).
  • Open Access— free for readers, witharticle processing charges (APC) paid by authors or their institutions.
  • High Visibility: indexed within ESCI (Web of Science)PMCPubMedScopus and other databases.
  • Journal Rank: CiteScore - Q2 (Health Professions (miscellaneous))
  • Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 29.7 days after submission; acceptance to publication is undertaken in 5.7 days (median values for papers published in this journal in the first half of 2025).
  • Recognition of Reviewers: APC discount vouchers, optional signed peer review, and reviewer names published annually in the journal.
  • Companion journal:Healthcare.
Impact Factor: 1.2 (2024); 5-Year Impact Factor: 1.3 (2024)

Latest Articles

15 pages, 525 KB  
Systematic Review
Exergames in the Rehabilitation of Burn Patients: A Systematic Review of Randomized Controlled Trials
byInês Santos,Marta Ferreira andCarla Sílvia Fernandes
Eur. Burn J.2025,6(4), 60;https://doi.org/10.3390/ebj6040060 - 27 Nov 2025
Abstract
The rehabilitation of burn patients is essential and is intrinsically linked to conventional rehabilitation; the motivational challenges faced by burn patients in maintaining engagement with these rehabilitation programs are well known. It is understood that the use of other resources, particularly technological ones, [...] Read more.
The rehabilitation of burn patients is essential and is intrinsically linked to conventional rehabilitation; the motivational challenges faced by burn patients in maintaining engagement with these rehabilitation programs are well known. It is understood that the use of other resources, particularly technological ones, associated with conventional rehabilitation could overcome these constraints and thereby optimize the rehabilitation program and health outcomes. The objective of this study is to synthesize the available evidence on the use of exergames in rehabilitation programs for burn patients. This systematic review was developed following the guidelines of the Joanna Briggs Institute (JBI). The search was conducted in the following databases: Medline®, CINAHL®, Sports Discus®, Cochrane®, and Scopus® during May 2025. The PRISMA Checklist Model was used to organize the information from the selected studies. Seven RCTs were included, involving a total of 236 participants. Outcomes related to the use of exergames in the rehabilitation of burn patients were identified, including increased range of motion, functionality, strength, speed of movement, improved balance, reduced fear and pain, and satisfaction with the technological resource used. It is believed that the results of this review, which confirmed the advantage of using exergames, such as Nintendo Wii, PlayStation, Xbox Kinect, or Wii Fit, to optimize the functionality of burn patients, can support clinical decision-making and encourage the integration of exergames to improve rehabilitation programs for burn patients.Full article
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16 pages, 396 KB  
Review
Evidence-Based Management of Burns: A Narrative Review of Evolving Practices
byAnna Jolly Neriamparambil,Raja Sawhney andWei Lun Wong
Eur. Burn J.2025,6(4), 59;https://doi.org/10.3390/ebj6040059 - 10 Nov 2025
Abstract
Background: The last decade has seen transformative changes in burn care, driven by advances in pharmacology, regenerative medicine, surgical techniques, and digital technologies. As management strategies evolve beyond survival to encompass functional and esthetic recovery, this review consolidates current evidence to inform best [...] Read more.
Background: The last decade has seen transformative changes in burn care, driven by advances in pharmacology, regenerative medicine, surgical techniques, and digital technologies. As management strategies evolve beyond survival to encompass functional and esthetic recovery, this review consolidates current evidence to inform best practice.Methods: A comprehensive narrative review was conducted using PubMed to identify peer-reviewed English-language articles from the past 10 years relevant to acute and long-term burn management. Selection focused on high-level evidence, including randomized controlled trials, systematic reviews, and meta-analyses, emphasizing novel and evolving clinical interventions.Results: Key advances include the integration of propranolol and oxandrolone for metabolic modulation; enzymatic debridement agents such as NexoBrid®; regenerative approaches like epidermal cell sprays (e.g., RECELL®) and dermal substitutes (e.g., Integra®, MatriDerm®, NovoSorb® BTM); and innovations in scar modulation, notably fractional CO2 laser therapy. The emergence of 3D bioprinting, and artificial intelligence further supports a shift toward precision burn medicine.Conclusions: Burn management is evolving from protocol-driven to patient-centred care, underpinned by high-quality evidence and technological innovation. The integration of systemic, local, and rehabilitative strategies is improving outcomes in survival, function, and quality of life. Ongoing challenges include cost, access, and translation of novel therapies into widespread clinical practice.Full article
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9 pages, 583 KB  
Article
Nexobrid Use in the Elderly
byAlexander Lugilde Guerbek,Jordi Serracanta Domenech,Antonio Bulla,José Antonio López Martínez,Danilo Rivas Nicolls,Alex Arteaga,Alejandro Grabosky Elbaile,Sara Orois andJ. P. Barret
Eur. Burn J.2025,6(4), 58;https://doi.org/10.3390/ebj6040058 - 7 Nov 2025
Abstract
Background: Enzymatic debridement with Nexobrid (NXB) is established for burn care, but specific outcomes in the elderly remain poorly characterized. This study evaluates the safety, efficacy, and clinical outcomes of NXB in patients aged ≥65 years. Methods: A retrospective case-series of 43 consecutive [...] Read more.
Background: Enzymatic debridement with Nexobrid (NXB) is established for burn care, but specific outcomes in the elderly remain poorly characterized. This study evaluates the safety, efficacy, and clinical outcomes of NXB in patients aged ≥65 years. Methods: A retrospective case-series of 43 consecutive elderly patients (mean age 74.5 years) with deep partial- to full-thickness burns treated with NXB at a single burn center. Data on demographics, burn characteristics, treatment chronology, and complications were analyzed. Results: The median total burn surface area (TBSA) was 11%. NXB was applied selectively, with a mean debrided area of 7.41% TBSA, primarily on limbs and hands. While 76.7% of patients ultimately required surgical autografting, no patient required an escharotomy in NXB-treated areas. The mortality rate was 25.6%, which was lower than expected for a median revised Baux score of 90, which is expected to be more than 50%. Hypertrophic scarring occurred in 28.1% of survivors, associated with a prolonged median healing time of 63 days. Conclusions: In elderly burn patients, NXB facilitates precise eschar removal and reliably prevents compartment syndrome, demonstrating a strong safety profile even in high-risk individuals. Its primary benefit shifts from reducing surgical incidence to optimizing the wound bed for grafting. These findings support the use of NXB in the elderly, with the understanding that subsequent grafting is often still required due to age-related delayed healing.Full article
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15 pages, 258 KB  
Review
Comparative Analysis of Recent Burn Guidelines Regarding Specific Aspects of Anesthesia and Intensive Care
byRolf K. Gigengack,Joeri Slob,J. Seppe H. A. Koopman,Cornelis H. Van der Vlies andStephan A. Loer
Eur. Burn J.2025,6(4), 57;https://doi.org/10.3390/ebj6040057 - 29 Oct 2025
Abstract
Background: Critical care for patients with severe burn injuries is challenging, particularly in the first 24–48 h. Multiple guidelines exist but their recommendations vary in content and in the level of detail. Methods: This narrative review analyzed recent (last 10 years) adult burn [...] Read more.
Background: Critical care for patients with severe burn injuries is challenging, particularly in the first 24–48 h. Multiple guidelines exist but their recommendations vary in content and in the level of detail. Methods: This narrative review analyzed recent (last 10 years) adult burn guidelines in English, Dutch and German, sourced from PubMed, Medline and official burn society publications. The review focused on airway management, mechanical ventilation, fluid resuscitation, pain management and procedural sedation. Results: All guidelines emphasize early airway assessment and timely intubation in patients at risk for loss of airway patency; however, a strategy for analyzing patients at risk is lacking. Lung-protective ventilation strategy is generally recommended. Fluid resuscitation is the cornerstone during the first phase, though recommendations for thresholds, volume and adjuncts differ. (Chronic) pain management should be multimodal, combining pharmacologic and non-pharmacologic approaches, but specifics on choice of modality are limited, also, there is no uniform strategy for procedural sedation management. Conclusion: Current guidelines offer broadly consistent recommendations for initial burn care but differ in specifics, reflecting evidence gaps. Future guidelines should address advances in airway management, fluid resuscitation endpoints, volume and adjuncts, and give a more detailed (chronic) pain strategy to improve standardization and outcomes.Full article
8 pages, 828 KB  
Case Report
Expanding the Limits of Burn Care: Survival After a 92% Total Body Surface Area Burn
byRafael Rocha,Odete Martinho,Filipe Marques da Costa,Gaizka Ribeiro,Fátima Xambre andMiguel Ribeiro de Andrade
Eur. Burn J.2025,6(4), 56;https://doi.org/10.3390/ebj6040056 - 20 Oct 2025
Abstract
Introduction: Massive burns, particularly those exceeding 90% total body surface area (TBSA), represent one of the most demanding challenges in critical care and reconstructive surgery. Advances in resuscitation, early excision, and wound coverage techniques have improved survival rates, but despite these advances, [...] Read more.
Introduction: Massive burns, particularly those exceeding 90% total body surface area (TBSA), represent one of the most demanding challenges in critical care and reconstructive surgery. Advances in resuscitation, early excision, and wound coverage techniques have improved survival rates, but despite these advances, mortality remains high, and standardized treatment protocols are lacking.Case Report: We report a case which demonstrates survival and meaningful recovery in an extreme case of massive burns. A 57-year-old woman sustained 92% TBSA burns following a gas explosion at her home. She developed burn shock requiring aggressive fluid resuscitation and vasopressor support. Due to extensive burns and limited donor sites, staged debridement with temporary allograft coverage was performed, followed by Meek micrografting for definitive wound closure. After 197 days in the Burn Unit and an additional three months of rehabilitation, she regained functional independence.Conclusions: While historically considered non-survivable, burns exceeding 90% TBSA are increasingly being successfully treated with multimodal strategies. This case highlights the importance of multidisciplinary care in redefining survival expectations for massive burn patients. As burn care continues to evolve, further research is needed to refine treatment strategies, enhance long-term functional outcomes and standardize protocols for these complex cases.Full article
(This article belongs to the Special IssueControversial Issues in Intensive Care-Related Burn Injuries)
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12 pages, 296 KB  
Article
A Prospective Observational Study to Determine the Efficacy of a Theatre Prioritisation Tool in Optimal Utilisation of Limited Theatre Time for Deep Burn Injury in a Resource-Restricted Setting
byNikki Leigh Allorto,Reitze Rodseth andDavid Gray Bishop
Eur. Burn J.2025,6(4), 55;https://doi.org/10.3390/ebj6040055 - 17 Oct 2025
Abstract
Background: Routine early surgery for all deep burns in low-resource settings is not currently achievable. We designed and implemented a simple triage strategy that selected patients to be prioritised for early surgery based on a more urgent need and greater potential benefit. The [...] Read more.
Background: Routine early surgery for all deep burns in low-resource settings is not currently achievable. We designed and implemented a simple triage strategy that selected patients to be prioritised for early surgery based on a more urgent need and greater potential benefit. The primary outcome was the ability to perform surgery in the priority group within three days of the decision.Methods: This was a prospective, descriptive study undertaken at a tertiary hospital in Pietermaritzburg, South Africa. All patients referred to the Grey’s Hospital Burn Service were triaged into either priority or non-priority groups. Priority designation was based on total burn surface area (TBSA) > 15%, the presence of sepsis, or limb-threatening injury. Data related to demographic information, injury, and outcomes were collected and managed using REDCap electronic data capture tools.Results: There were 191 admissions with 42 (22%) meeting priority criteria. The priority group had larger burns (TBSA 25 [Interquartile range 15–30] vs. 8 [3–15]%) and included all septic injuries. We provided early surgery within a median of 1.4 (interquartile range 0.5–3.3) days of the decision for surgery being made. A total of 75% of patients were operated within 72 h of the decision, and 43% within 10 days of injury. The system identified a sicker cohort, as evidenced by high mortality, ICU admission, and acute kidney injury rates. In the non-priority group, reported outcomes were more positive, but with a high injury-to-discharge days per percentage TBSA.Conclusions: This simple triage strategy represents a novel approach for prioritising access to burn surgery in a setting where global surgery standards are desirable but not always possible. We were able to identify the high-risk groups and provide surgery within acceptable time frames. Future research should be aimed at refining this triage system and improving outcomes in the priority group.Full article
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16 pages, 3170 KB  
Article
Assessment of Attenuation Coefficient and Blood Flow at Depth in Pediatric Thermal Hand Injuries Using Optical Coherence Tomography: A Clinical Study
byBeke Sophie Larsen,Tina Straube,Kathrin Kelly,Robert Huber,Madita Göb,Julia Siebert,Lutz Wünsch andJudith Lindert
Eur. Burn J.2025,6(4), 54;https://doi.org/10.3390/ebj6040054 - 1 Oct 2025
Abstract
Background: Optical Coherence Tomography (OCT) is a high-resolution imaging technique capable of quantifying Blood Flow at Depth (BD) and the Attenuation Coefficient (AC). However, the clinical relevance of these parameters in burn assessment remains unclear. This study investigated whether OCT-derived metrics can differentiate [...] Read more.
Background: Optical Coherence Tomography (OCT) is a high-resolution imaging technique capable of quantifying Blood Flow at Depth (BD) and the Attenuation Coefficient (AC). However, the clinical relevance of these parameters in burn assessment remains unclear. This study investigated whether OCT-derived metrics can differentiate between superficial and deep pediatric hand burns. Method: This prospective, single-center study analyzed 73 OCT scans from 37 children with thermal hand injuries. A structured algorithm was used to evaluate AC and BD. Results: The mean AC was 1.61 mm−1 (SD ± 0.48), with significantly higher values in deep burns (2.11 mm−1 ± 0.53) compared to superficial burns (1.49 mm−1 ± 0.38;p < 0.001), reflecting increased optical density in more severe burns. BD did not differ significantly between burn depths, although superficial burns more often showed visible capillary networks. Conclusions: This is the first study to assess both AC and BD using OCT in pediatric hand burns. AC demonstrated potential as a diagnostic marker for burn depth, whereas BD had limited utility. Image quality limitations highlight the need for technical improvements to enhance OCT’s clinical application.Full article
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19 pages, 604 KB  
Review
Managing Infections in Burn Patients: Strategies and Considerations for Antimicrobial Dosing
byAbdullah F. Alharthi,Khalid Al Sulaiman,Sultan Alotaibi,Rahaf Alqahtani,Nader Damfu,Aisha Alharbi,Sufyan Alomair,Haifa A. Alhaidal andOhoud Aljuhani
Eur. Burn J.2025,6(4), 53;https://doi.org/10.3390/ebj6040053 - 1 Oct 2025
Abstract
Burn injuries are a major cause of morbidity and mortality, largely due to complications such as infection. Impairment of the immune system following burns increases susceptibility to both internal and external infections, underscoring the need for effective infection control strategies in burn care. [...] Read more.
Burn injuries are a major cause of morbidity and mortality, largely due to complications such as infection. Impairment of the immune system following burns increases susceptibility to both internal and external infections, underscoring the need for effective infection control strategies in burn care. In addition, burn patients frequently exhibit profound alterations in drug pharmacokinetics and pharmacodynamics (PK/PD), particularly during the resuscitation and hypermetabolic phases. In the resuscitation phase, increased capillary permeability and reduced cardiac output can prolong drug distribution, delay therapeutic response, lower peak plasma concentrations, and slow elimination. In contrast, the hypermetabolic phase is characterized by elevated catecholamine levels and enhanced tissue perfusion, which accelerate drug distribution and clearance. These physiological changes often necessitate antimicrobial dose adjustments to maintain therapeutic efficacy. This review emphasizes the critical importance of infection prevention and management in burn patients, with a focus on optimizing antimicrobial dosing and therapeutic monitoring in the context of PK/PD alterations.Full article
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16 pages, 385 KB  
Systematic Review
Effectiveness and Safety of Topically Applied Tranexamic Acid with Epinephrine in Surgical Procedures: A Systematic Review
byHedieh Keshavarz,Weber Wei Chiang Lin,Shawn Dodd,Janice Y. Kung andJoshua N. Wong
Eur. Burn J.2025,6(3), 52;https://doi.org/10.3390/ebj6030052 - 22 Sep 2025
Abstract
Background: Topical tranexamic acid (TXA), often combined with epinephrine, is used to reduce perioperative bleeding. This systematic review evaluates the safety and effectiveness of this combination across surgical procedures. Methods: A comprehensive search of eight databases was conducted from inception to 26 June [...] Read more.
Background: Topical tranexamic acid (TXA), often combined with epinephrine, is used to reduce perioperative bleeding. This systematic review evaluates the safety and effectiveness of this combination across surgical procedures. Methods: A comprehensive search of eight databases was conducted from inception to 26 June 2025. Studies were eligible if they compared topically or locally applied TXA with epinephrine to epinephrine alone in surgical patients. Animal studies, case reports, non-English publications, and studies without comparators were excluded. Screening, data extraction, and risk of bias assessments followed PRISMA guidelines. Results: Ten studies met inclusion criteria (four randomized and six non-randomized), covering burn surgery, rhytidectomy, liposuction, septoplasty, endoscopic sinus surgery, dacryocystorhinostomy, and joint arthroplasty. TXA was applied topically or via tumescent infiltration. Most studies reported reduced intraoperative blood loss, improved surgical field visibility, lower drain output, shorter hemostasis time, and reduced transfusion rates. No increase in thromboembolic or major complications was observed. Conclusion: The combination of TXA and epinephrine appears safe and maybe effective for perioperative bleeding control. However, heterogeneity in dosing and outcomes limits generalizability. Further research is needed to standardize protocols and confirm long-term safety.Full article
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17 pages, 903 KB  
Article
Scientific Production on Chemical Burns: A Bibliometric Analysis (1946–2024)
byJosé-Enrique Cueva-Ramírez,Gregorio Gonzalez-Alcaide,Isabel Belinchón-Romero andJose-Manuel Ramos-Rincon
Eur. Burn J.2025,6(3), 51;https://doi.org/10.3390/ebj6030051 - 9 Sep 2025
Abstract
Background: Chemical burns represent a persistent global health challenge due to their high prevalence, causing lifelong disabilities and socioeconomic burdens. Although research on chemical burns has expanded over the past century, no comprehensive study has mapped the intellectual structure, global collaboration patterns, and [...] Read more.
Background: Chemical burns represent a persistent global health challenge due to their high prevalence, causing lifelong disabilities and socioeconomic burdens. Although research on chemical burns has expanded over the past century, no comprehensive study has mapped the intellectual structure, global collaboration patterns, and thematic evolution of scientific production on chemical burns to determine how research in the area has evolved and the existence of gaps or imbalances that need to be addressed. Objective: The aim was to analyze the scientific production on chemical burns using bibliometric methods, identifying key contributors, evolving themes, and research gaps. Methods: Eligible documents contained the MeSH descriptor and were listed both in PubMed (1946 to 2024) and in the Web of Science Core Collection. The documents were analyzed with Bibliometrix version 5.0 and VOSviewer version 1.6.20. The metrics included were annual productivity, citation networks, co-authorship patterns, and keyword co-occurrence. Results: The analysis included 3943 articles from 757 journals. The annual average was 25.8 articles, with a growth rate of 0.65% from 1946 to 2024. The USA produced the most articles (n = 1547), followed by China (n = 890). The USA also led in international collaboration, working with 26 countries. Harvard University was the leading institution (n = 325) andBurns the leading journal (n = 306), followed by Cornea (n = 132). The most common subject category of the research was surgery (n = 1185 docs) and ophthalmology (n = 984). Reim M. was the most prolific author (n = 35), while Basu S. had the most citations (n = 1159). The main clinical MeSH descriptors were “Eye burns” (n = 1158), “Esophageal stenosis” (n = 683), and “Caustics” (n = 659). Conclusions: The results show slight growth in scientific production on chemical burns. The USA and China are leading research in this field, and the main reported finding was eye burns.Full article
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9 pages, 529 KB  
Systematic Review
Evaluation of the Efficacy of Fish Skin Grafts as Wound Dressings: A Systematic Review
byJocelyn Ivana andI Gusti Putu Hendra Sanjaya
Eur. Burn J.2025,6(3), 50;https://doi.org/10.3390/ebj6030050 - 8 Sep 2025
Abstract
The use of fish skin grafts as xenografts is a promising alternative for wound healing. Several studies have shown fish skin grafts to be a safer and more effective option compared to other alternatives, due to the large amount of fatty acids, including [...] Read more.
The use of fish skin grafts as xenografts is a promising alternative for wound healing. Several studies have shown fish skin grafts to be a safer and more effective option compared to other alternatives, due to the large amount of fatty acids, including omega-3, which have been proven to promote wound healing. The purpose of this study was to evaluate the efficacy of fish skin grafts as wound dressing. A literature search up to March 2024 was conducted using the electronic databases of PubMed, Cochrane, and ScienceDirect. A total of 158 patients from six studies were included in this systematic review. All studies showed early wound healing using fish skin grafts; one study showed that wound healing was halved compared to paraffin gauze. Complete wound healing using fish skin grafts was noted as early as 30 days. Out of 114 patients treated with fish skin grafts, 1 patient showed signs of infection, and no patients showed allergic reactions. One study also found that fish skin grafts provide satisfactory wound scar quality. This study concludes that fish skin grafts are a great alternative and should be considered in wound treatment. The high omega-3 component that is preserved in fish skin grafts promotes faster wound healing and contains antibacterial agents that prevent infection. However, randomized control trials with a larger sample size are recommended to further assess the efficacy of fish skin grafts.Full article
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247 pages, 1169 KB  
Conference Report
21st Congress of the European Burns Association (EBA)
byNadia Depetris,Alette E. E. de Jong,Jill Meirte,Thomas Leclerc,Jose Ramon Martinez Mendez,Clemens Schiestl,Frank Siemers,Andy Williams,Paul P. M. van Zuijlen,Jyrki Vuola,Stian Almeland,Luís Cabral andBernd Hartmann
Eur. Burn J.2025,6(3), 49;https://doi.org/10.3390/ebj6030049 - 3 Sep 2025
Cited by 1
Abstract
Abstracts of the plenary and special interest sessions, workshops, and oral and poster presentations of the 21st EBA Congress in Berlin, Germany, from 3 to 6 September 2025.Full article
19 pages, 2063 KB  
Systematic Review
Exploring Ethnic Disparities in Burn Injury Outcomes in the UK: A Systematic Review
byUashar Badakhshan,Reza Zamani andTanimola Martins
Eur. Burn J.2025,6(3), 48;https://doi.org/10.3390/ebj6030048 - 22 Aug 2025
Abstract
Background: Burn injuries are among the most distressing injuries, affecting approximately 250,000 people annually in the UK. While extensive research has explored how gender, health, and socioeconomic factors influence burn injury rates, ethnic disparities in burns have received less attention. Methods: The review [...] Read more.
Background: Burn injuries are among the most distressing injuries, affecting approximately 250,000 people annually in the UK. While extensive research has explored how gender, health, and socioeconomic factors influence burn injury rates, ethnic disparities in burns have received less attention. Methods: The review followed the PRISMA framework for database searches. Search terms included concepts of ethnicity and burn injuries in the UK. Results: From the initial 3339 search results, 11 studies were selected following the eligibility screening. White ethnic groups made up 52.4% of admissions, whereas Asians and Black groups made up 24.9% and 5.9%, respectively. Trends showed a decline in admissions among White patients and a rise in admissions among Black patients. Children aged 1 to 5 years were most affected, particularly in the Asian and Black groups. Males constituted 58.0% of admissions, while females accounted for 42.0%. Most burns occurred at home, with scalds, particularly among children. Ethnic minorities were more likely to apply unsuitable topical treatments and had higher rates of psychological referrals. Conclusions: The review underscores important ethnic disparities in burn injuries and outcomes. Targeting policies to address them could result in a more equitable healthcare system and improved outcomes for burn patients in the UK.Full article
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15 pages, 1248 KB  
Article
In Vitro Silencing of MHC-I in Keratinocytes by Herpesvirus US11 Protein to Model Alloreactive Suppression
byFrederik Schlottmann,Sarah Strauß,Peter Maria Vogt andVesna Bucan
Eur. Burn J.2025,6(3), 47;https://doi.org/10.3390/ebj6030047 - 21 Aug 2025
Abstract
Background: Secondary rejection remains a major obstacle in skin allografting. Some viruses, such as human herpesvirus and cytomegalovirus, evade immune detection through proteins like the unique short glycoprotein 11 (US11), which down-regulates major histocompatibility complex (MHC) class I expression. This study explores the [...] Read more.
Background: Secondary rejection remains a major obstacle in skin allografting. Some viruses, such as human herpesvirus and cytomegalovirus, evade immune detection through proteins like the unique short glycoprotein 11 (US11), which down-regulates major histocompatibility complex (MHC) class I expression. This study explores the use of recombinant US11 protein as a biopharmaceutical approach to reduce MHC-I expression and thus decrease alloreactivity in human primary keratinocytes. Methods: Human keratinocytes were treated with recombinant US11 protein, and MHC-I expression was assessed via Western blot and flow cytometry. To evaluate immunomodulatory effects, US11-stimulated keratinocytes were co-cultured with peripheral blood mononuclear cells (PBMCs), and interferon-gamma (IFN-γ) levels were measured by ELISA. Additionally, ex vivo human skin tissue was stimulated with US11 to assess long-term MHC-I modulation. Results: US11 treatment significantly reduced MHC-I surface expression in keratinocytes. Co-cultures showed decreased IFN-γ secretion, indicating lower T cell activation. Human skin tissue stimulated with US11 exhibited reduced MHC-I expression after 7 days. Conclusions: This proof-of-concept study suggests that recombinant US11 protein may serve as an effective biopharmaceutical to reduce keratinocyte immunogenicity. Further in vitro and in vivo studies are warranted to validate its potential for clinical application in skin transplantation.Full article
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18 pages, 346 KB  
Review
Interventions for Functional and Cosmetic Outcomes Post Burn for Eyelid Ectropion—A Scoping Review
byAndrea Mc Kittrick,Lola Hammond andJason Brown
Eur. Burn J.2025,6(3), 46;https://doi.org/10.3390/ebj6030046 - 19 Aug 2025
Abstract
Rationale: Burn injuries to the face can have devastating consequences functionally and cosmetically for individuals and can result in increased depressive symptoms and low self-esteem. Burn injuries have the potential to cause contracture of the skin, especially on the face due to [...] Read more.
Rationale: Burn injuries to the face can have devastating consequences functionally and cosmetically for individuals and can result in increased depressive symptoms and low self-esteem. Burn injuries have the potential to cause contracture of the skin, especially on the face due to multiple concave surfaces, possibly causing facial deformity. These functional and cosmetic implications can interrupt activities of daily living. Although there is consensus in the literature that early interventions contribute to improved outcomes for eyelid ectropion, there is currently limited consensus regarding the techniques used in the management of eyelid ectropion post burn injuries.Objectives: The aim of this scoping review was to explore the evidence in the literature to identify surgical and non-surgical techniques to manage and prevent eyelid ectropion post burn.Method: Five databases (PubMed, CINAHL, Embase, Cochrane, and Scopus) were searched for articles published between January 2014 and August 2024. Two reviewers completed the search. Each article was screened independently by each reviewer against the inclusion and exclusion criteria. Where disagreement arose, a third reviewer was consulted for resolution.Results:n = 56 articles were sources in the initial search. Post screening,n = 20 met the criteria for full review;n = 14 were included in the final review. All studies reported on surgical techniques used to manage eyelid ectropion post burn, and only one study reported on non-surgical techniques. All studies were observational in design.Conclusions: There is a paucity of research addressing the surgical and non-surgical techniques for the management and prevention of eyelid ectropion following burns in the adult population. The existing literature primarily consists of case studies and case series, which limits the robustness of the evidence base for the effective management of this condition post burn.Full article
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15 pages, 2582 KB  
Review
Use of Integra® Dermal Regeneration Template Bilayer in Burn Reconstruction: Narrative Review, Expert Opinion, Tips and Tricks
byClemens Maria Schiestl,Naiem Moiemen,Patrick Duhamel,Isabel Jones,Marcello Zamparelli,Juan Carlos López-Gutiérrez andSimon Kuepper
Eur. Burn J.2025,6(3), 45;https://doi.org/10.3390/ebj6030045 - 18 Aug 2025
Abstract
Burn injuries remain a complex clinical challenge, particularly in reconstructive settings where donor sites are limited. Integra® Dermal Regeneration Template (IDRT), a bilayer dermal substitute, facilitates neodermis formation and supports functional and aesthetic recovery following burn trauma. This narrative review and expert [...] Read more.
Burn injuries remain a complex clinical challenge, particularly in reconstructive settings where donor sites are limited. Integra® Dermal Regeneration Template (IDRT), a bilayer dermal substitute, facilitates neodermis formation and supports functional and aesthetic recovery following burn trauma. This narrative review and expert opinion synthesizes current literature and clinical experience on the application of IDRT in post-burn reconstruction. It discusses the biological mechanism of dermal regeneration, surgical protocols including wound bed preparation and grafting, and considerations for anatomical regions such as the face, torso, and limbs. The review emphasizes key factors influencing successful outcomes, including patient selection, timing, and multidisciplinary coordination. Potential complications, such as infection, hematoma, and poor graft adherence, are addressed along with prevention and management strategies. Special considerations for pediatric and elderly populations are also highlighted. Through evidence-based insights and illustrative case examples, this review aims to inform surgical decision-making and promote best practices in reconstructive burn care using IDRT.Full article
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17 pages, 2297 KB  
Article
Development of a Device for Defatting Full Skin Grafts Through Mechanical Defatting in Children and Adolescents
byPhilipp Christoph Köhler,Helen Glosse,Steffan Loff andRaphael Staubach
Eur. Burn J.2025,6(3), 44;https://doi.org/10.3390/ebj6030044 - 14 Aug 2025
Abstract
Full-thickness skin grafts are a cornerstone in reconstructive surgery for extensive skin defects, particularly in pediatric patients, where rapid vascularization is essential for successful engraftment. Traditional defatting methods using scalpels and scissors are labor-intensive and increase the risk of graft or operator injury. [...] Read more.
Full-thickness skin grafts are a cornerstone in reconstructive surgery for extensive skin defects, particularly in pediatric patients, where rapid vascularization is essential for successful engraftment. Traditional defatting methods using scalpels and scissors are labor-intensive and increase the risk of graft or operator injury. To improve efficiency and safety, a mechanical defatting device called LOMA (named after the inventors Loff and Maja) was developed at Klinikum Stuttgart. This study evaluates the first 28 transplants performed with it, assessing graft outcomes using the POSAS and comparing physical properties of the grafts with those of healthy contralateral skin, ankle skin, and palmar skin using DermaLab Combo’s ultrasound and elasticity probes. Results showed that grafts prepared with LOMA exhibited similar physical characteristics to contralateral healthy skin. Differences in elasticity were observed when compared to ankle skin, and significant disparities were found when compared to palmar skin. POSAS scores averaged 3.3 from patients and 2.2 from physicians, indicating satisfaction with functional and aesthetic outcomes. The findings support the effectiveness of full-thickness skin grafts, particularly when prepared using the LOMA system. Further multicenter studies are recommended to compare LOMA-prepared grafts with those using conventional techniques to quantify the added value of this mechanical defatting approach.Full article
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12 pages, 612 KB  
Article
Post-Traumatic Stress Disorder (PTSD) Is Associated with Increased Physical Skin Symptom Burden Following Severe Burn Injuries: Subgroup Analysis of a Multicenter Prospective Cohort
byFelix J. Klimitz,Martin Aman,Hubert Neubauer,Annette Stolle,Hans Ziegenthaler,Tobias Niederegger,Adriana C. Panayi,Gabriel Hundeshagen,Ulrich Kneser andLeila Harhaus
Eur. Burn J.2025,6(3), 43;https://doi.org/10.3390/ebj6030043 - 8 Aug 2025
Cited by 2
Abstract
Background: Severe burn injuries often lead to lasting physical and psychological consequences. Post-traumatic stress disorder (PTSD) is common among burn survivors and may be influenced by persistent somatic complaints. This study examined whether PTSD is associated with a higher burden of physical symptoms [...] Read more.
Background: Severe burn injuries often lead to lasting physical and psychological consequences. Post-traumatic stress disorder (PTSD) is common among burn survivors and may be influenced by persistent somatic complaints. This study examined whether PTSD is associated with a higher burden of physical symptoms during and after inpatient rehabilitation. Methods: We conducted a subgroup analysis of a multicenter prospective cohort study involving 103 adult burn patients in inpatient rehabilitation. Based on Impact of Event Scale—Revised (IES-R) scores and clinical evaluation, patients were grouped as PTSD (n = 43) or No PTSD (n = 60). Physical symptoms assessed included skin dryness (xerosis), temperature sensitivity (cold/heat), numbness, skin tightness, and increased sweating. Results: Patients with PTSD reported significantly more physical symptoms at follow-up than those without PTSD: xerosis (74% vs. 50%,p = 0.03), cold sensitivity (61% vs. 35%,p = 0.02), heat sensitivity (63% vs. 39%,p = 0.03), numbness (63% vs. 33%,p = 0.006), skin tightness (82% vs. 52%,p = 0.004), and sweating (45% vs. 19%,p = 0.01). PTSD patients also had more severe burns, reflected in higher full-thickness TBSA (2% vs. 0%,p = 0.03) and elevated ABSI scores (median 6 vs. 5,p = 0.04). Conclusion: PTSD is associated with a higher and more persistent burden of physical skin symptoms after severe burns. These findings underscore the importance of early PTSD screening and integrated psychological-somatic rehabilitation to improve long-term recovery and quality of life.Full article
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14 pages, 2806 KB  
Article
Pilot Study on Resuscitation Volume’s Effect on Perfusion and Inflammatory Cytokine Expression in Peri-Burn Skin: Implications for Burn Conversion
byTamer R. Hage,Edward J. Kelly,Eriks Ziedins,Babita Parajuli,Cameron S. D’Orio,David M. Burmeister,Lauren Moffatt,Jeffrey W. Shupp andBonnie C. Carney
Eur. Burn J.2025,6(3), 42;https://doi.org/10.3390/ebj6030042 - 28 Jul 2025
Abstract
Fluid resuscitation after thermal injury is paramount to avoid burn shock and restore organ perfusion. Both over- and under-resuscitation can lead to unintended consequences affecting patient outcomes. While many studies have examined systemic effects, limited data exist on how fluid resuscitation impacts burn [...] Read more.
Fluid resuscitation after thermal injury is paramount to avoid burn shock and restore organ perfusion. Both over- and under-resuscitation can lead to unintended consequences affecting patient outcomes. While many studies have examined systemic effects, limited data exist on how fluid resuscitation impacts burn wound progression in the acute period. Furthermore, the mechanisms underlying burn wound progression remain not fully understood. This study used a swine model to investigate how varying resuscitation levels affect peri-burn wound dynamics. Twenty-seven female Yorkshire pigs were anesthetized, subjected to 40% total body surface area burn and 15% hemorrhage, then randomized (n = 9) to receive decision-support-driven (adequate, 2–4 mL/kg/%TBSA), fluid-withholding (under, <1 mL/kg/%TBSA), or high-constant-rate (over, >>4 mL/kg/%TBSA) resuscitation. Pigs were monitored for 24 h in an intensive care setting prior to necropsy. Laser Doppler Imaging (LDI) was conducted pre-burn and at 2, 6, 12, and 24 h post burn to assess perfusion. Biopsies were taken from burn, peri-burn (within 2 cm), and normal skin. RNA was isolated at 24 h for the qRT-PCR analysis of IL-6, CXCL8, and IFN-γ. At hour 2, LDI revealed increased peri-burn perfusion in over-resuscitated animals vs. under-resuscitated animals (p = 0.0499). At hour 24, IL-6 (p = 0.0220) and IFN-γ (p = 0.0253) were elevated in over-resuscitated peri-burn skin. CXCL8 showed no significant change. TUNEL staining revealed increased apoptosis in over- and under-resuscitated peri-burn skin. Differences in perfusion and cytokine expression based on resuscitation strategy suggest that fluid levels may influence burn wound progression.Full article
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11 pages, 1055 KB  
Article
Can Pure Silk Compete with the Established Mepilex Ag® in the Treatment of Superficial Partial Thickness Burn Wounds? A Prospective Intraindividual Study
byJan Akkan,Mahsa Bagheri,Sophia Mezger,Paul Christian Fuchs,Maria von Kohout,Wolfram Heitzmann,Rolf Lefering andJennifer Lynn Schiefer
Eur. Burn J.2025,6(3), 41;https://doi.org/10.3390/ebj6030041 - 11 Jul 2025
Abstract
Introduction: Superficial partial thickness burns generally do not require surgical intervention and are managed with specialized wound dressings. Mepilex Ag® is commonly used and often represents the standard of care. This study evaluated the clinical performance of pure silk compared to Mepilex [...] Read more.
Introduction: Superficial partial thickness burns generally do not require surgical intervention and are managed with specialized wound dressings. Mepilex Ag® is commonly used and often represents the standard of care. This study evaluated the clinical performance of pure silk compared to Mepilex Ag®. Methods: A prospective, single-center intraindividual study was conducted on adult patients with superficial partial thickness burns. Each burn wound was divided, treating one half with pure silk and the other with Mepilex Ag®. Clinical parameters including wound closure time, pain levels, and scar quality at 3-month follow-up were analyzed. Results: Twenty-four patients were included (mean TBSA: 5.8%). Mepilex Ag® showed a trend towards a shorter wound closure time (10.5 vs. 11.5 days;p = 0.223). Pain scores remained below 4/10 for both dressings throughout treatment. However, Mepilex Ag® demonstrated significantly lower pain on day one (3.5 vs. 2.77;p = 0.039) and day two (2.91 vs. 2.27;p = 0.041). Scar quality after 3 months was similar. Conclusion: Both dressings proved to be effective treatment options. Pure silk required fewer resources, showed high clinical practicality, and demonstrated a similar performance to Mepilex Ag® in key clinical parameters, making it an interesting option for other clinics and our standard of care.Full article
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