Skip to main content

Long-Term Pathophysiology and Consequences of a Burn Including Scarring, HTS, Keloids and Scar Treatment, Rehabilitation, Exercise

  • Chapter
  • First Online:
Burn Care and Treatment

Abstract

The most common etiologies of burn represent flame and scald burns [1]. Scald burns are most common in victims up to 5 years of age [1]. There is a significant percentage of burns in children that are due to child abuse [2]. A number of risk factors have been linked to burn injury including age, location, demographics, and low economic status [3]. People of increased risk for severe burn injury represent young children and elderly as well as patients of impaired judgment and mobility [1]. The available resources in a given community greatly influence morbidity and mortality since lack of adequate resources significantly affects education, rehabilitation, and survival rates for burn victims. To date, the overall survival rate for burns is 94.6 %, but for at risk populations, survival may be nearly impossible [1]. As demonstrated in a recent milestone study by our group, a burn size of roughly 60 % TBSA represents the crucial threshold for postburn morbidity and mortality in a modern pediatric burn care setting [4].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 99.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Pham TN, Kramer CB, Wang J, Rivara FP, Heimbach DM, Gibran NS, Klein MB (2009) Epidemiology and outcomes of older adults with burn injury: an analysis of the national burn repository. J Burn Care Res 30(1):30–36

    Google Scholar 

  2. Andronicus M, Oates RK, Peat J, Spalding S, Martin H (1998) Non-accidental burns in children. Burns 24(6):552–558

    Article  PubMed  CAS  Google Scholar 

  3. Fire deaths and injuries: fact sheet. http://www.cdc.gov/HomeandRecreationalSafety/Fire-Prevention/fires-factsheet.html

  4. Kraft R, Herndon DN, Al-Mousawi AM, Williams FN, Finnerty CC, Jeschke MG (2012) Burn size and survival probability in paediatric patients in modern burn care: a prospective observational cohort study. Lancet 379(9820):1013–1021

    Article  PubMed  Google Scholar 

  5. Herndon DN, Hart DW, Wolf SE, Chinkes DL, Wolfe RR (2001) Reversal of catabolism by beta-blockade after severe burns. N Engl J Med 345(17):1223–1229

    Article  PubMed  CAS  Google Scholar 

  6. Jeschke MG, Chinkes DL, Finnerty CC, Kulp G, Suman OE, Norbury WB, Branski LK, Gauglitz GG, Mlcak RP, Herndon DN (2008) Pathophysiologic response to severe burn injury. Ann Surg 248(3):387–401

    PubMed  Google Scholar 

  7. van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R (2001) Intensive insulin therapy in critically ill patients. N Engl J Med 345(19):1359–1367

    Article  PubMed  Google Scholar 

  8. Jeschke MG, Mlcak RP, Finnerty CC, Norbury WB, Gauglitz GG, Kulp GA, Herndon DN (2007) Burn size determines the inflammatory and hypermetabolic response. Crit Care 11(4):R90

    Article  PubMed  Google Scholar 

  9. Norbury WB, Herndon DN (2007) Modulation of the hypermetabolic response after burn injury. In: Herndon DN (ed) Total burn care, 3rd edn. Saunders/Elsevier, New York, pp 420–433

    Chapter  Google Scholar 

  10. Mlcak RP, Jeschke MG, Barrow RE, Herndon DN (2006) The influence of age and gender on resting energy expenditure in severely burned children. Ann Surg 244(1):121–130

    Article  PubMed  Google Scholar 

  11. Hart DW, Wolf SE, Mlcak R, Chinkes DL, Ramzy PI, Obeng MK, Ferrando AA, Wolfe RR, Herndon DN (2000) Persistence of muscle catabolism after severe burn. Surgery 128(2):312–319

    Article  PubMed  CAS  Google Scholar 

  12. Jeschke MG, Gauglitz GG, Kulp GA, Finnerty CC, Williams FN, Kraft R, Suman OE, Mlcak RP, Herndon DN (2011) Long-term persistence of the pathophysiologic response to severe burn injury. PLoS One 6(7):e21245

    Article  PubMed  CAS  Google Scholar 

  13. Gauglitz GG, Herndon DN, Kulp GA, Meyer WJ 3rd, Jeschke MG (2009) Abnormal insulin sensitivity persists up to three years in pediatric patients post-burn. J Clin Endocrinol Metabol 94(5):1656–1664

    Article  CAS  Google Scholar 

  14. Deitch EA, Wheelahan TM, Rose MP, Clothier J, Cotter J (1983) Hypertrophic burn scars: analysis of variables. J Trauma 23(10):895–898

    Article  PubMed  CAS  Google Scholar 

  15. Lewis WH, Sun KK (1990) Hypertrophic scar: a genetic hypothesis. Burns 16(3):176–178

    Article  PubMed  CAS  Google Scholar 

  16. Brown JJ, Bayat A (2009) Genetic susceptibility to raised dermal scarring. Br J Dermatol 161(1):8–18

    Article  PubMed  CAS  Google Scholar 

  17. Van Loey NE, Van Son MJ (2003) Psychopathology and psychological problems in patients with burn scars: epidemiology and management. Am J Clin Dermatol 4(4):245–272

    Article  PubMed  Google Scholar 

  18. Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG (2011) Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med 17(1–2):113–125

    PubMed  CAS  Google Scholar 

  19. Baur PS, Larson DL, Stacey TR, Barratt GF, Dobrkovsky M (1976) Ultrastructural analysis of pressure-treated human hypertrophic scars. J Trauma 16(12):958–967

    Article  PubMed  CAS  Google Scholar 

  20. Macintyre L, Baird M (2006) Pressure garments for use in the treatment of hypertrophic scars–a review of the problems associated with their use. Burns 32(1):10–15

    Article  PubMed  Google Scholar 

  21. Kelly AP (2004) Medical and surgical therapies for keloids. Dermatol Ther 17(2):212–218

    Article  PubMed  Google Scholar 

  22. Reno F, Sabbatini M, Lombardi F, Stella M, Pezzuto C, Magliacani G, Cannas M (2003) In vitro mechanical compression induces apoptosis and regulates cytokines release in hypertrophic scars. Wound Repair Regen 11(5):331–336

    Article  PubMed  Google Scholar 

  23. Van den Kerckhove E, Stappaerts K, Fieuws S, Laperre J, Massage P, Flour M, Boeckx W (2005) The assessment of erythema and thickness on burn related scars during pressure garment therapy as a preventive measure for hypertrophic scarring. Burns 31(6):696–702

    Article  PubMed  Google Scholar 

  24. Sawada Y, Sone K (1992) Hydration and occlusion treatment for hypertrophic scars and ­keloids. Br J Plast Surg 45(8):599–603

    Article  PubMed  CAS  Google Scholar 

  25. Fulton JE Jr (1995) Silicone gel sheeting for the prevention and management of evolving hypertrophic and keloid scars. Dermatol Surg 21(11):947–951

    Article  PubMed  Google Scholar 

  26. Reish RG, Eriksson E (2008) Scar treatments: preclinical and clinical studies. J Am Coll Surg 206(4):719–730

    Article  PubMed  Google Scholar 

  27. Slemp AE, Kirschner RE (2006) Keloids and scars: a review of keloids and scars, their pathogenesis, risk factors, and management. Curr Opin Pediatr 18(4):396–402

    Article  PubMed  Google Scholar 

  28. Jalali M, Bayat A (2007) Current use of steroids in management of abnormal raised skin scars. Surgeon 5(3):175–180

    Article  PubMed  CAS  Google Scholar 

  29. Cruz NI, Korchin L (1994) Inhibition of human keloid fibroblast growth by isotretinoin and triamcinolone acetonide in vitro. Ann Plast Surg 33(4):401–405

    Article  PubMed  CAS  Google Scholar 

  30. Boyadjiev C, Popchristova E, Mazgalova J (1995) Histomorphologic changes in keloids treated with Kenacort. J Trauma 38(2):299–302

    Article  PubMed  CAS  Google Scholar 

  31. Robles DT, Berg D (2007) Abnormal wound healing: keloids. Clin Dermatol 25(1):26–32

    Article  PubMed  Google Scholar 

  32. Murray JC (1994) Keloids and hypertrophic scars. Clin Dermatol 12(1):27–37

    Article  PubMed  CAS  Google Scholar 

  33. Lawrence WT (1991) In search of the optimal treatment of keloids: report of a series and a review of the literature. Ann Plast Surg 27(2):164–178

    Article  PubMed  CAS  Google Scholar 

  34. Boutli-Kasapidou F, Tsakiri A, Anagnostou E, Mourellou O (2005) Hypertrophic and keloidal scars: an approach to polytherapy. Int J Dermatol 44(4):324–327

    Article  PubMed  Google Scholar 

  35. Jaros E, Priborsky J, Klein L (1999) Treatment of keloids and hypertrophic scars with cryotherapy. Acta Medica (Hradec Kralove) Suppl 42(2):61–63

    CAS  Google Scholar 

  36. Yosipovitch G, Widijanti Sugeng M, Goon A, Chan YH, Goh CL (2001) A comparison of the combined effect of cryotherapy and corticosteroid injections versus corticosteroids and cryotherapy alone on keloids: a controlled study. J Dermatolog Treat 12(2):87–90

    Article  PubMed  CAS  Google Scholar 

  37. Guix B, Henriquez I, Andres A, Finestres F, Tello JI, Martinez A (2001) Treatment of keloids by high-dose-rate brachytherapy: a seven-year study. Int J Radiat Oncol Biol Phys 50(1):167–172

    Article  PubMed  CAS  Google Scholar 

  38. Ogawa R, Mitsuhashi K, Hyakusoku H, Miyashita T (2003) Postoperative electron-beam irradiation therapy for keloids and hypertrophic scars: retrospective study of 147 cases followed for more than 18 months. Plast Reconstr Surg 111(2):547–555

    Article  PubMed  Google Scholar 

  39. Atiyeh BS (2007) Nonsurgical management of hypertrophic scars: evidence-based therapies, standard practices, and emerging methods. Aesthetic Plast Surg 31(5):468–494

    Article  PubMed  Google Scholar 

  40. Leventhal D, Furr M, Reiter D (2006) Treatment of keloids and hypertrophic scars: a meta-analysis and review of the literature. Arch Facial Plast Surg 8(6):362–368

    Article  PubMed  Google Scholar 

  41. Fitzpatrick RE (1999) Treatment of inflamed hypertrophic scars using intralesional 5-FU. Dermatol Surg 25(3):224–232

    Article  PubMed  CAS  Google Scholar 

  42. Davison SP, Dayan JH, Clemens MW, Sonni S, Wang A, Crane A (2009) Efficacy of intralesional 5-fluorouracil and triamcinolone in the treatment of keloids. Aesthet Surg 29(1):40–46

    Article  Google Scholar 

  43. Sadeghinia A, Sadeghinia S (2012) Comparison of the efficacy of intralesional triamcinolone acetonide and 5-fluorouracil tattooing for the treatment of keloids. Dermatol Surg 38(1):104–109

    Article  PubMed  CAS  Google Scholar 

  44. Darougheh A, Asilian A, Shariati F (2009) Intralesional triamcinolone alone or in combination with 5-fluorouracil for the treatment of keloid and hypertrophic scars. Clin Exp Dermatol 34(2):219–223

    Article  PubMed  CAS  Google Scholar 

  45. Branski LK, Herndon DN, Pereira C, Mlcak RP, Celis MM, Lee JO, Sanford AP, Norbury WB, Zhang XJ, Jeschke MG (2007) Longitudinal assessment of Integra in primary burn management: a randomized pediatric clinical trial. Crit Care Med 35(11):2615–2623

    Article  PubMed  Google Scholar 

  46. Clayman MA, Clayman SM, Mozingo DW (2006) The use of collagen-glycosaminoglycan copolymer (Integra) for the repair of hypertrophic scars and keloids. J Burn Care Res 27(3):404–409

    Article  PubMed  Google Scholar 

  47. Petrie NC, Vranckx JJ, Hoeller D, Yao F, Eriksson E (2005) Gene delivery of PDGF for wound healing therapy. J Tissue Viability 15(4):16–21

    PubMed  Google Scholar 

  48. Rogers B, Lineaweaver WC (2002) Skin wound healing and cell-mediated DNA transport. J Long Term Eff Med Implants 12(2):125–130

    PubMed  CAS  Google Scholar 

  49. Gauglitz GG, Jeschke MG (2011) Combined gene and stem cell therapy for cutaneous wound healing. Mol Pharm 8(5):1471–1479

    Article  PubMed  CAS  Google Scholar 

  50. Engrav LH, Covey MH, Dutcher KD, Heimbach DM, Walkinshaw MD, Marvin JA (1987) Impairment, time out of school, and time off from work after burns. Plast Reconstr Surg 79(6):927–934

    Article  PubMed  CAS  Google Scholar 

  51. Kildal M, Andersson G, Fugl-Meyer AR, Lannerstam K, Gerdin B (2001) Development of a brief version of the Burn Specific Health Scale (BSHS-B). J Trauma 51(4):740–746

    Article  PubMed  CAS  Google Scholar 

  52. Jeschke MG, Williams FN, Gauglitz GG, Herndon DN (2012) Burns. In: Townsend M, Beauchamp RD, Evers MB, Kenneth ML (eds) Sabiston textbook of surgery, vol 19. Elsevier, Philadelphia, p 521

    Chapter  Google Scholar 

  53. Schneider JC, Bassi S, Ryan CM (2011) Employment outcomes after burn injury: a comparison of those burned at work and those burned outside of work. J Burn Care Res 32(2):294–301

    Article  PubMed  Google Scholar 

  54. Brych SB, Engrav LH, Rivara FP, Ptacek JT, Lezotte DC, Esselman PC, Kowalske KJ, Gibran NS (2001) Time off work and return to work rates after burns: systematic review of the literature and a large two-center series. J Burn Care Rehabil 22(6):401–405

    Article  PubMed  CAS  Google Scholar 

  55. Bowden ML, Thomson PD, Prasad JK (1989) Factors influencing return to employment after a burn injury. Arch Phys Med Rehabil 70(10):772–774

    PubMed  CAS  Google Scholar 

  56. Dyster-Aas J, Kildal M, Willebrand M (2007) Return to work and health-related quality of life after burn injury. J Rehabil Med 39(1):49–55

    Article  PubMed  Google Scholar 

  57. Moi AL, Wentzel-Larsen T, Salemark L, Hanestad BR (2007) Long-term risk factors for impaired burn-specific health and unemployment in patients with thermal injury. Burns 33(1):37–45

    Article  PubMed  Google Scholar 

  58. Schneider JC, Bassi S, Ryan CM (2009) Barriers impacting employment after burn injury. J Burn Care Res 30(2):294–300

    Article  PubMed  Google Scholar 

  59. Hart DW, Wolf SE, Chinkes DL, Beauford RB, Mlcak RP, Heggers JP, Wolfe RR, Herndon DN (2003) Effects of early excision and aggressive enteral feeding on hypermetabolism, catabolism, and sepsis after severe burn. J Trauma 54(4):755–761; discussion 761–764

    Article  PubMed  CAS  Google Scholar 

  60. Hart DW, Wolf SE, Ramzy PI, Chinkes DL, Beauford RB, Ferrando AA, Wolfe RR, Herndon DN (2001) Anabolic effects of oxandrolone after severe burn. Ann Surg 233(4):556–564

    Article  PubMed  CAS  Google Scholar 

  61. Herndon DN, Tompkins RG (2004) Support of the metabolic response to burn injury. Lancet 363(9424):1895–1902

    Article  PubMed  CAS  Google Scholar 

  62. Przkora R, Herndon DN, Suman OE, Jeschke MG, Meyer WJ, Chinkes DL, Mlcak RP, Huang T, Barrow RE (2006) Beneficial effects of extended growth hormone treatment after hospital discharge in pediatric burn patients. Ann Surg 243(6):796–801; discussion 801–803

    Article  PubMed  Google Scholar 

  63. Al-Mousawi AM, Williams FN, Mlcak RP, Jeschke MG, Herndon DN, Suman OE (2010) Effects of exercise training on resting energy expenditure and lean mass during pediatric burn rehabilitation. J Burn Care Res 31(3):400–408

    Article  PubMed  Google Scholar 

  64. Cucuzzo NA, Ferrando A, Herndon DN (2001) The effects of exercise programming vs traditional outpatient therapy in the rehabilitation of severely burned children. J Burn Care Rehabil 22(3):214–220

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gerd G. Gauglitz MMS, MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Wien

About this chapter

Cite this chapter

Gauglitz, G.G. (2013). Long-Term Pathophysiology and Consequences of a Burn Including Scarring, HTS, Keloids and Scar Treatment, Rehabilitation, Exercise. In: Jeschke, M., Kamolz, LP., Shahrokhi, S. (eds) Burn Care and Treatment. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1133-8_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-7091-1133-8_10

  • Published:

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-1132-1

  • Online ISBN: 978-3-7091-1133-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics