Abstract Critical illness-related corticosteroid insufficiency (CIRCI) presents as refractory hemodynamic shock in critically ill patients. Research on CIRCI and its treatment in burn patients is limited. We sought to review the use of corticosteroids in a burn population during their first week of hospitalization. The burn registry and the electronic medical records were queried for burn patients admitted between January 2015 and December 2025. The following variables were abstracted: demographics, burn history, hospital course, and treatments. Outcome variables included length of stay (LOS), infections, graft loss, pharmacological treatment, and mortality. The two groups were compared with Student’s T-test and Chi Square where appropriate. A multivariant analysis was performed to determine independent predictors of CIRCI, infection and mortality. Significance was determined at p<0.05 level. The study group consisted of 87 patients in hemodynamic shock receiving vasopressors, with 47 also receiving corticosteroids. The corticosteroid group had larger burns (37.6 v 25.1%), more resuscitation (15.9 v 8.1 L), more vasopressor days (6.23 v 3.7 d), more ventilator days (19.72 v 7.83 d), more infections (66% v 34%) and longer LOS (51.53 v 26.05 d), all p<0.05. On multivariant analysis, variables independently related to the diagnosis of CIRCI were age and resuscitation fluids; to infection were corticosteroid use; and to mortality were age. Overall, over 50% of patients in hypotensive shock during their first week of treatment were diagnosed and treated with corticosteroids for suspected CIRCI. More study is needed to determine the appropriate role of corticosteroid use in early burn treatment.
Abstract This randomized controlled trial compared autologous skin grafting (ASG) and cultured epithelial autografts (CEA) in patients with severe burns. A total of 120 patients with burns involving more than 30% of the total body surface area were randomly assigned to ASG (n = 60) or CEA (n = 60). Primary outcomes included wound healing time, 2-week graft survival, and Vancouver Scar Scale (VSS) scores at 3 and 6 months. Secondary outcomes included postoperative pain, complications, and serum biomarkers. Baseline characteristics were comparable between groups. Compared with ASG, CEA was associated with a longer wound healing time and lower 2-week graft survival. However, VSS scores at both follow-up time points were significantly lower in the CEA group. Postoperative pain at 72 hours and complication rates were also lower in patients treated with CEA. In addition, epidermal growth factor and transforming growth factor-β1 levels were higher, while C-reactive protein levels were lower in the CEA group at 3 days postoperatively. In conclusion, although CEA results in delayed wound healing, it offers improved scar quality, reduced pain, and fewer complications, and may serve as an effective alternative for severe burn patients with limited donor skin.
Hypertrophic burn scars are associated with significant functional impairment and psychosocial morbidity. While fractional CO2 laser therapy has demonstrated efficacy in improving scar quality and symptoms, limited data exist on how baseline scar characteristics and patient factors influence treatment response. This study evaluated whether baseline scar severity, total body surface area (TBSA), and duration of initial hospital stay predict responsiveness to fractional CO2 laser therapy, and whether laser treatment is associated with a reduced need for scar contracture release procedures. A retrospective cohort study was conducted including patients with burn injuries who underwent fractional CO2 laser therapy. Scar severity was assessed using the Vancouver Scar Scale (VSS) before and after treatment. Additional variables included TBSA, length of initial hospitalization, and incidence of subsequent scar contracture release procedures. A control cohort of patients with burn injuries who did not receive laser therapy was included for comparison. Statistical analyses were performed to identify predictors of scar improvement and associations with procedural outcomes. Baseline VSS score was the strongest predictor of treatment response, with higher initial severity associated with greater improvement following laser therapy. Total body surface area and hospital length of stay were not significantly associated with treatment response. Laser therapy was associated with fewer scar contracture release procedures; however, this did not reach statistical significance, likely due to limited sample size. These findings suggest initial scar severity is a key determinant of laser responsiveness and support further study in larger cohorts.
