**Author details**

*11.3.3. For deep second-degree, third-degree, and fourth-degree burns*

10 Hot Topics in Burn Injuries

tion and maintains moisture before surgery [1, 2, 11].

safety of tissue engineering methods in burn wound treatment [1, 2, 24].

tissue transfers [1].

The removal of the necrotic tissue, prevention of infection, and the maintenance of a moist

Eschar is the tough, leathery necrotic tissue seen in full-thickness burns. Circumferential eschar tissue may compromise circulation on extremities or restrict breathing over the chest. Escharotomy may be indicated in these patients. In the case of compartment syndrome, fasciotomy should be performed [3, 12]. Eschar tissue does not break down spontaneously, except in the case of infection [12]. Although the necrotic tissue of small deep burns may be treated by topical necrolytic agents, surgical debridement is needed in extensive burns [11]. As spontaneous healing is not expected and the scar formation is the final outcome of deep seconddegree and third-degree burns, early excision of the eschar and grafting are the preferred treatments for these wounds. After the excision of eschar, temporary wound covering for the first days by topical antimicrobials (silver sulfadiazine) or wound dressings prevents infec-

As the formation of scar can be prevented by the early and appropriate management of burn wound, excision should be done as soon as the patient is stabilized [3, 12]. Although the splitthickness autografts are the gold standard method in deep burns, they have many disadvantages. Allografts and xenografts may serve a good option for larger burns until the allografts are incorporated; however, they have also many limitations [1, 2]. Tissue engineering has provided a new era in the wound care field. Skin tissue regeneration by tissue-engineered products showed promising results in wound healing. Tissue scaffolds, healing-promoting factors (growth factors), stem cells, and gene therapy are the current solutions provided by bioengineering. Tissue scaffolds consist of epidermal, dermal, or composite substitutes which can provide a three-dimensional tissue for the optimal proliferation of cells and tissue regrowth. Several growth factors may be used as healing-promoting factors. Although the experimental studies with either embryonic or adult stem cells demonstrate the potential use of stem cells in the treatment of chronic wounds, further research is required to investigate their long-term effects on wound healing process. Gene therapy is a promising approach for the future treatment of burn wounds. It involves the transfer of genes into cells that encode growth factors required for enhancing wound repair. However, its use in burn wounds is limited by technical challenges. In conclusion, further trials are required to explore the long-term effects and

Fourth-degree burns are associated with significant functional impairments which require complicated and repeated surgeries. They often lead to amputations. Whereas local flaps may be used for the reconstruction of mild to moderate cases, burns with extensive damage need

The common goal of all therapeutic tools abovementioned is to optimize wound healing, prevent scar formation, and minimize the functional disability. There are more other treatments that have been used for these purposes with varying success. Hyperbaric oxygen therapy has been suggested as a safe and effective treatment for burn wounds and can be used in conjunction with other modalities for burn patients [2, 25]. Silicone gels have been suggested to be useful in burns which carry high risk of hypertrophic scarring. They are recommended to be used before

environment are the primary goals to facilitate the wound healing in deep burns [11].

Selda Pelin Kartal<sup>1</sup> \*, Cemile Tuğba Altunel<sup>2</sup> and Dilek Bayramgurler<sup>3</sup>

\*Address all correspondence to: pelin@dr.com

1 Dermatology Department, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey

