[libribook.com] Traumatic Scar Tissue Management 1st Edition

Sequelae and Complications
A critical burn injury is a unique trauma that often is accompanied by significant
metabolic disturbances as well as a change in the normal state of innate and
adaptive immunity (Shankar et al. 2007). Human skin acts as a blockade against
environmental insults and against colonization of pathogenic microbes, and is
also an immune organ with significant surveillance and thermoregulatory
functions. This knowledge helps us to understand that the loss of large portions
of skin as the result of burns results in impaired immunity, metabolic
compromises, fluid shifts, and heat loss (Shankar et al. 2007).
Burn injuries can cause severe muscle loss, muscle weakness, contractures, and
traumatic scars, leading to lifelong physical impairments (Diego et al. 2013).
Severe burns may require the removal of the dermal layer and subsequent skin
graft procedure(s) (Ganio et al. 2013).
Burn injury sequelae can occur as a result of scarring associated with the burn
trauma or graft proceedures.
Traumatic Scars
Hypertrophic scarring is the most common type of scar tissue formed after a
burn injury. Hypertrophic scars are formed in 30–72% of burn survivors after
injury. In addition to the above noted risk factors, hypertrophic scar development
associated with burn injuries is mainly influenced by wound healing time
(delayed 3 weeks or more), the depth (degree of injury), extent (size/surface area
affected) and if multiple surgical or graft procedures are performed (Deitch et al.
1983, Cubison et al. 2006, Thompson et al. 2013, Cho et al. 2014).
Unfortunately, most of the published information on post-burn scarring does not
accurately define these factors and the body’s whirlpool of physiological
responses to burn injury continue to be studied and researched (Spurr &
Shakespeare 1990, Bombaro et al. 2003, Cho et al. 2014).
What do we know? Fibroblasts play a key role in wound healing and scar
formation as they:
• Actively release cytokines