Review of Current Strategies for Reducing Burn Wound Conversion

A recent review of relevant studies revealed that no current therapies conclusively stop burn wound conversion, and strategies to slow damage to tissue continue to fall short, highlighting the need for future studies and innovative therapeutic interventions. 

Burn wound conversion, the phenomenon of a burn wound that appears superficial and seemingly able to heal spontaneously but later develops into a deeper wound requiring excision, poses a challenge to clinicians. Past studies have targeted many molecular mechanisms that underlie burn wound conversion, but effective therapies to target these mechanisms remain lacking. “Future research should investigate mechanistic pathways, side effects, safety, and efficacy of these different treatments before translation into clinical studies,” according to the review’s authors.

The World Health Organization (WHO) estimates that 180,000 deaths worldwide are attributed to burns each year, particularly in lower-income countries. Initial management of burn injuries can be lifesaving and reduce long-term complications in patients; however, whereas full-thickness and deep partial-thickness burns are generally treated with excision and grafting, more superficial wounds are often treated only with dressings and allowed to heal spontaneously. In some of these burn wounds, however, various mechanisms lead to burn wound conversion, wherein the wound will become a deep partial-thickness or full-thickness wound and eventually require excision. New therapeutic treatments are needed to slow and stop these mechanisms, and the multitude of mechanisms that may be involved led the study’s authors to specifically highlight “the need for pleiotropic agents that can target various mechanisms involved in burn wound conversion at the same time.”

Researchers reviewed studies on burn wound conversion published between January 2012 and March 2022, aiming to provide an overview of the pathophysiological pathways involved in burn wound conversion, as well as recent therapeutical approaches. The study’s goal was to help physicians maximize areas of tissue viability and ultimately improve long-term outcomes for burn wound patients. Focusing on burn wounds that required acute medical care, the author noted a scarcity of primary literature covering the effects of burn wound first aid on wound conversions and pointed out a general lack of consensus across governments, hospitals, and councils regarding first aid protocol for burns.

In this review, the researchers considered studies identifying a variety of mechanisms that may underlie burn wound conversion, which included inflammation, ischemia, T cells and macrophages, autophagy, and reactive oxygen species. Current treatments focused on each of these mechanisms were examined, as were a range of other treatments, such as hyperbaric oxygen therapy, mesenchymal stem cells, bromelain-based Gel dressing (Debrase), and negative pressure wound therapy, revealing promising results from each of these treatments but an overall dearth of evidence, particularly in human trials.

Taking all the mechanisms involved in burn wound conversion into account, the study’s authors conclude that multimodal therapeutic approaches are needed to provide maximum attenuation of wound conversion and reduce long-term complications, saying, “Future research should investigate pathways, side effects, and efficacy of different treatments to translate these findings to patients. Furthermore, there is an increased need for different imaging modalities that may better characterize and predict burn wound depth and assist in clinical decision-making.”

-Kirra Fedyszyn, Associate Digital Editor

Palackic A, Jay JW, Duggan RP, Branski LK, Wolf SE, Ansari N, El Ayadi A. Therapeutic Strategies to Reduce Burn Wound Conversion. Medicina. 2022; 58(7):922. https://doi.org/10.3390/medicina58070922