Background Burn wound infection (BWI) is a leading cause of morbidity in paediatric burns. Distinguishing infection from post-burn systemic inflammatory response syndrome (SIRS) is challenging in minor burns where biomarker patterns are poorly characterised. C-reactive protein (CRP) is widely used clinically, yet its temporal behaviour in this setting remains unclear. Aim This study aimed to characterise CRP trajectories over seven days post-burn in children with minor scalds, comparing patterns between those treated with systemic antibiotics for clinically suspected BWI and those not treated. A secondary aim was to explore whether CRP elevations associate more strongly with suspected infection than burn size alone. Methods This retrospective single-centre study included 344 children treated for scald injuries between 2015 and 2020. Serial CRP values from day 0–7 were extracted from medical records. Trajectories were compared using mixed-effects modelling, epidemiological differences with non-parametric tests, and antibiotic prescription factors with logistic regression. Results Antibiotics were prescribed in 26% of children. CRP trajectories diverged significantly from day 2 to day 6 post-burn (all p < 0.05), with antibiotic-treated children showing a mean difference of 13 mg/L in the first week (p = 0.008). Burn size contributed modestly to CRP variation (2 mg/L per 1% TBSA). Children treated for infection had larger burns and longer hospital stays. Conclusion CRP trajectories differed substantially between children treated and not treated with antibiotics for suspected infection, while burn size explained only a small proportion of variation. CRP kinetics may serve as a clinical adjunct when infection is suspected, though cautious interpretation is warranted given the interaction between biomarker levels and treatment decisions.

BACKGROUND:Postburn facial scars represent a major reconstructive challenge due to the functional and aesthetic importance of the face. The preexpanded occipitocervicopectoral (OCP) flap provides thin, color-matched tissue suitable for facial resurfacing. This study aimed to evaluate the versatility and outcomes of unilateral and bilateral preexpanded OCP flaps in postburn facial reconstruction. METHODS:A prospective study was conducted between May 2021 and May 2023, including 26 patients with postburn facial scars who underwent resurfacing using unilateral or bilateral preexpanded OCP flaps. Tissue expanders were placed beneath the planned flap and progressively inflated before the flap was transferred. A novel flap design, termed the "COVID" or "bat" flap, was developed and derived from bilateral expanded OCP flaps, enabling simultaneous bilateral facial reconstruction after division along the midline. Demographic, clinical, and surgical data were collected, and patient-reported outcomes were assessed using the FACE-Q questionnaire before and after surgery. RESULTS:Twenty-nine preexpanded OCP flaps were transferred in 26 patients (17 males, 9 females; mean age, 14 years). The mean expander volume was 393 mL, and the mean flap dimensions were 12 × 8 cm. No total flap loss occurred. Distal necrosis developed in 5 flaps (17%), all located at or above the zygomatic arch, and was managed successfully with conservative measures or skin grafting. FACE-Q analysis demonstrated significant postoperative improvement across all domains ( P  < 0.001), except for "appraisal of neck." Subgroup analysis revealed no significant difference in FACE-Q improvement between patients with and without distal flap necrosis. CONCLUSIONS:The preexpanded OCP flap provides a reliable and aesthetically favorable option for postburn facial resurfacing, offering color-matched, thin tissue coverage with minimal donor-site morbidity. The bilaterally preexpanded "COVID" modification further enhances its versatility for simultaneous reconstruction of both cheeks and the upper neck.

Cardiac arrest following severe burn injury is rare but devastating, reflecting profound systemic compromise from hypovolemia, hypoxia, toxic exposure, or metabolic derangement. Despite recognition of these mechanisms, data on incidence, causes, and outcomes remain limited, and no burn-specific resuscitation guidance exists. A scoping review was performed using the Joanna Briggs Institute framework and PRISMA-ScR guidelines. MEDLINE and EMBASE were searched to August 2025 for studies describing cardiac arrest in adult burn patients. Data were thematically synthesized by mechanism and setting. A modified Delphi process with a multidisciplinary expert panel established consensus recommendations for management (agreement ≥ 85

Background: Detailed assessments, documentation, and evaluation of the wound characteristics in hard-to-heal wounds are essential for optimizing and individualizing wound care. However, the remaining challenge in clinical care includes the lack of high accuracy and precision tools for automated wound size (surface area and depth assessment) and a wound bed evaluation, i.e., a qualitative and quantification assessment of slough and necrosis. Objective/Methods: This study evaluates the accuracy and precision of the AI-powered technique, SeeWound© 2, compared to digital planimetry for a wound surface area and a wound bed characterization (slough and necrosis) in “in vitro” models and in patients, and a probe for depth, including diabetic foot ulcers, venous ulcers, pressure ulcers, and ischemic ulcers. Results: The data show that accuracy and precision (SeeWound© 2) for the wound surface area, the depth, and the wound bed characterization (slough and necrosis) were accuracy 96.28% and 90.00%, (CV 5.56%), respectively (wound size); 90.75% and 89.55%, (CV 3.07%), respectively (wound depth); 80.30% (slough) and 84.73% (necrosis) and 93.51% (slough) (CV 4.15%) and 82.35% (CV 8.34%) (necrosis). The precision for the digital planimetry was 88.61% (CV 7.00%) (slough) 85.74% (CV 7.54%) (necrosis). Conclusions: The overall accuracy and precision of the AI model in identifying wound size and depth were close to 90%, except for the accuracy and precision for slough and necrosis, where levels around 80% were achieved when compared to digital planimetry. The findings for the wound surface area and depth assessments, together with quantification of slough and necrosis, suggest that the SeeWound© 2 model can offer significant clinical benefits by improving documentation and supporting decision-making in wound management.

Background:. The supraclavicular artery island flap (SCAIF) has been used extensively to reconstruct postburn scars in the head and neck region. Its landmark and vascular supply from the supraclavicular artery have been demonstrated before. The aim was to assess its versatility following an increase in pedicle length to be supplied by the transverse cervical artery, along with tunneling the pedicle under the sternocleidomastoid muscle to reach distant sites that the classic SCAIF could not reach. Methods:. A retrospective analysis was conducted of 25 consecutive patients in whom SCAIFs were performed to reconstruct remote head and neck postburn scars. Pedicle length, flap diameter, and complications were recorded with demographic and burn-related data. Results:. The study included 18 (72%) men and 7 (18%) women. The mean age was 15.7 years, and the mean injury time was 15 months before flap transfer. Isolated neck injury was the most affected site (44%). The mean length and width of the SCAIF were 16.6 and 6.5 cm, respectively. The mean length of its extended vascular pedicle based on transverse cervical artery was 7.2 cm. The donor site was closed primarily in all cases. All flaps survived completely, except 2 (8%) that exhibited partial necrosis. Conclusions:. The SCAIF is reliable for reconstructing postburn deformities in the head and neck region. Our results indicate that the increased pedicle length and the submuscular tunnel allow reliable distant flap transfer without the risk of excessive traction or vessel kinking.

Scarring and its long-term sequelae, contribute significantly to morbidity following burn injuries. Factors associated with less favourable scar outcomes include the depth of burn, younger age, pigmented skin types and prolonged healing times. The aim of primary burn surgery is to debride non-viable tissue, to enable healing. However, international consensus regarding the optimal timing for debridement and grafting in pediatric patients with burns is lacking. Delayed wound healing is thought to increase the risk of poor scar quality, however, the evidence for this is weak with few studies investigating long-term outcomes in pediatric patients. The aim of this study, therefore, was to investigate the effect of patient and treatment factors on scar quality, one year after skin grafting in pediatric patients with burns. Patient factors included age, skin type, and site of burn, while treatment factors included timing of surgery, type of surgery, and healing times. Pediatric patients (age < 18 years) presenting to a National Burn Unit from 2011 until 2020, inclusive were considered for inclusion in the study. Burn injuries between 1% and 14.9% total body surface area (TBSA) and who required skin grafting for the primary treatment of their burn, were included. Patients who failed to attend their 12-month follow-up visit were excluded. Standardised clinical photographs were assessed using a modified version of the Patient and Observer Scar Assessment Scale, version 2.0 (POSAS). Thirty children (median age 3.9 years) were included. Factors with an independent effect on higher (worse) POSAS scores were younger age at the time of injury ( p < 0.001), body site of the trunk ( p < 0.002), or the lower extremity ( p < 0.001) and a longer duration of healing time after skin grafting ( p = 0.003). The duration of time between injury and surgery was not an independent factor for POSAS scores ( p = 0.56). We had insufficient numbers to discriminate differences in scar quality for different graft types; meshed versus non-meshed. In this study, we found that long-term scar outcomes in pediatric burn patients after skin grafting were worse for those injured at a younger age, with burns on the trunk or lower extremity, or with prolonged healing time after grafting. The robustness of this conclusion is limited by the small sample size of the study cohort and by our use of photographic scar assessment .

IntroductionHuman keratinocytes require relatively long propagation time which impedes their availability as autologous cell transplantation within a clinically reasonable timeframe. There is an unmet need for efficient xeno-free cell expansion approaches to propagate human keratinocytes as regenerative therapy.MethodsPrimary human keratinocytes and HaCaT cells were cultured on glass, plastic, and animal-derived collagen I matrix for 10 days. Proliferation, migration, DNA methylation, as well as gene and protein expression were assessed to characterize the effect of the tested culture substrates on keratinocytes at the molecular and functional levels.ResultsKeratinocytes cultured on glass exhibited faster proliferation, global DNA demethylation and upregulation of epidermal differentiation markers. Scratch wound assay revealed that keratinocytes cultured on glass demonstrated enhanced cell migration compared to those on plastic or collagen I. Multiplex immunoassays identified temporal and substrate-dependent variations in a panel of keratinocyte-specific secreted factors, encompassing immunomodulatory cytokines, growth factors, and angiogenic factors.DiscussionGlass, as a culture substrate, promotes epidermal differentiation and enhances keratinocyte migration. The latter is a critical factor in re-epithelialization and wound healing. Functional properties suggest that glass may optimize the inflammatory response and promote efficient wound repair, making it a promising candidate for the short-term expansion of keratinocytes for transplantation purposes. Further in-vivo validation is required to definitively establish the efficacy of keratinocytes cultured on glass for clinical applications.

Difficult-to-heal wounds management accounts for about 4% of healthcare costs, highlighting the need for innovative solutions. Extracellular signals drive cell proliferation during tissue regeneration, while epigenetic mechanisms regulate stem cell homeostasis, differentiation, and skin repair. Exploring epigenetic regulation in adipose-derived stem cells (ADSCs) holds promise for improving skin injury treatments. We investigated the effects of histone deacetylase inhibitor (SAHA) on ADSCs to better understand its cellular and molecular impacts. ADSCs were treated with SAHA for 72 h, showing no change in cell viability at the studied concentrations. However, the expression of histone deacetylase decreased at 1000 nM, while the cell proliferation marker Ki-67 increased after SAHA treatment, as confirmed by immunofluorescence. CCND1 gene expression increased, whereas protein expression of the proliferating cell nuclear antigen (PCNA) decreased. Cell cycle analysis showed an increase in G2 phase in SAHA-treated cells. Microarray analysis revealed 74 upregulated and 40 downregulated differentially expressed genes, including upregulation of P53 targets, CDKN1A and MDM2. Proteomic analysis identified 631 upregulated and 823 downregulated proteins compared to the vehicle. Pathway enrichment analysis showed cell cycle, ATP-dependent chromatin remodeling and DNA processes were among the affected pathways. This study suggests SAHA modulates ADSCs’ biological processes, highlighting its potential for skin regeneration.

Sepsis continues to be a leading cause of adverse outcomes in burn patients[1-6].Despite advances in resuscitation,surgery,and critical care,septic complications contribute substantially to long-term morbidity and mortality.

Globally, road traffic accidents (RTAs) remain a major cause of death, particularly among individuals aged 15-30 years. While Sweden has been at the forefront of traffic safety through the Vision Zero initiative, in-hospital management remains crucial in determining RTA outcomes. Drawing on North American evidence suggesting improved survival at trauma centres, the Swedish healthcare system has increasingly emphasised trauma centralisation. However, comprehensive national data from Sweden are scarce. Given the country's unique demographic and geographic characteristics, including vast sparsely populated areas, direct comparisons with other Western systems are challenging. We analysed the epidemiology and risk factors for 30-day mortality among 95,954 RTA-related hospital admissions in Sweden between 2008 and 2021. Predictors included the ICD-based Injury Severity Score (ICISS), age, sex, Charlson Comorbidity Index (CCI), year of event, and hospital level. Mortality risk was modelled using explainable artificial intelligence (XAI) via Extreme Gradient Boosting (XGBoost) with SHapley Additive exPlanations (SHAP), alongside conventional multivariable logistic regression for comparison. The most influential predictors of 30-day mortality, in descending order, were ICISS, age, CCI, event year, hospital level, and sex. A clear trend toward centralisation was observed, with Level 1 hospitals admitting the most severely injured patients. However, after risk adjustment, the hospital level was not independently associated with 30-day mortality. The XAI model outperformed logistic regression in both discrimination and calibration, confirming these findings. This study represents a comprehensive national analysis of in-hospital outcomes following RTAs in Europe. ICISS, age, sex, and comorbidity influenced mortality risk, while overall survival improved over time. The assumption that trauma centralisation confers a universal survival advantage does not appear to hold in the Swedish context. These findings underscore the need to re-evaluate trauma system design under Scandinavian conditions-ensuring that timely access to hospital care is not compromised by centralisation.

This study examined the characteristics, experiences, motivations, and preferences of healthy volunteers participating in Phase I clinical trials in Sweden. A descriptive, cross-sectional survey was conducted among 135 healthy volunteers who had participated in at least one Phase I clinical trial from 2021 to 2024. Volunteers considered trial personnel, financial compensation, and regulatory review and approval as highly important factors in their decision to participate. Willingness to participate varied depending on trial characteristics, with greater reluctance for trials involving discomfort or perceived higher risks. Experiences, motivations, and preferences were comparable irrespective of age, gender, occupation, or income. Participants had disproportionately low incomes but reported financial satisfaction comparable to the general population. Unlike findings in other regions, there was no overrepresentation of migrants or the unemployed. Insights from this study can help guide trial design considerations to facilitate equitable recruitment and reduce the burden of participation.

Introduction: The epidemiology, care, and outcomes of perineal and genital burns (PG ) in high -income countries have been previously described, but an analysis of this topic in LMICs has yet to be performed. We use the World Health Organization 's Global Burn Registry to fill this gap. Methods: The GBR was searched from inception to November 2023 to identify all burn patients, excluding cases from high -income countries. Demographics and mechanism of injury were re - trieved. Primary outcomes were length of hospital stay (LOHS ), surgical intervention, discharge with physical impairment, and mortality. A multivariate regression analysis was performed controlling for burnt total body surface area (TBSA ), age, sex, inhalation injury, mechanism of burn and care center characteristics.

Background: Those with self-inflicted burns are a small but consistent group among burn patients, with large injuries and conflicting findings regarding their in-hospital mortality. Overall, burn survivors have a shorter life expectancy, as compared with national controls, but long-term mortality after self-inflicted burns is understudied. The aim of this retrospective study was to investigate possible differences in long-term mortality among survivors after self-inflicted and accidental burns.Methods: All adult patients with burns admitted at the Linkoping Burn Centre and discharged alive between 2000 and 2017 were included, and end of follow up was April 26, 2021. Those with unknown survival status at that time were excluded. A Cox proportional hazards regression model, adjusted for age and sex, was used to analyse long term mortality.Results: Among the 930 patients included in this study, 37 had self-inflicted burns. Overall, median follow up period was 8.8 years and crude mortality was 24.7%. After adjustment for age and sex, self-inflicted burns were independently associated with long-term mortality, Hazard Ratio= 2.08 (95% CI 1.13-3.83). Post hoc analysis showed that the effect was most pronounced during the first years after discharge although it was noticeable over the whole study period.Conclusion: Long-term risk of mortality after discharge from a burn centre was higher in patients with self-inflicted burns than in patients with accidental burns. The effect was noticeable over the whole study period although it was most pronounced during the first years after discharge.

Introduction: The role of Adipose-derived mesenchymal stem cells (AD-MSCs) in skin wound healing remains to be fully characterized. This study aims to evaluate the regenerative potential of autologous AD-MSCs in a non-healing porcine wound model, in addition to elucidate key miRNA-mediated epigenetic regulations that underlie the regenerative potential of AD-MSCs in wounds.Methods: The regenerative potential of autologous AD-MSCs was evaluated in porcine model using histopathology and spatial frequency domain imaging. Then, the correlations between miRNAs and proteins of AD-MSCs were evaluated using an integration analysis in primary human AD-MSCs in comparison to primary human keratinocytes. Transfection study of AD-MSCs was conducted to validate the bioinformatics data.Results: Autologous porcine AD-MSCs improved wound epithelialization and skin properties in comparison to control wounds. We identified 26 proteins upregulated in human AD-MSCs, including growth and angiogenic factors, chemokines and inflammatory cytokines. Pathway enrichment analysis highlighted cell signalling-associated pathways and immunomodulatory pathways. miRNA-target modelling revealed regulations related to genes encoding for 16 upregulated proteins. miR-155-5p was predicted to regulate Fibroblast growth factor 2 and 7, C-C motif chemokine ligand 2 and Vascular cell adhesion molecule 1. Transfecting human AD-MSCs cell line with anti-miR-155 showed transient gene silencing of the four proteins at 24 h post-transfection.Discussion: This study proposes a positive miR-155-mediated gene regulation of key factors involved in wound healing. The study represents a promising approach for miRNA-based and cell-free regenerative treatment for difficult-to-heal wounds. The therapeutic potential of miR-155 and its identified targets should be further explored in-vivo.