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Stem cell application in acute burn care and reconstruction

02 July 2019
Volume 3 · Issue 3

Abstract

Burn injuries have a consistently high rate of mortality and morbidity, principally due to sepsis and systemic inflammation. Furthermore, wound closure is often troubled by a limited supply of autologous skin graft availability. Researchers are now looking at augmenting alternative sources for tissues engineering, including stem cells in the bone marrow, fat and hair follicles. Many studies suggest that the ability of stem cells to augment the clinical care of thermally-injured patients shows great potential. However, while our understanding of stem-cell biology has expanded dramatically over the last two decades, significant insight is still required so the full potential of these cells can be safely harnessed and transferred to patient care. This article provides a commentary on the evidence supporting a role for stem-cell therapy in acute burn care and tissue reconstruction, with particular reference to those in the bone marrow, adipose tissue and hair follicle.

Burns are common injuries, with an estimated 250,000 sustained each year in the UK, of which 175,000 attend the emergency department (ED) and 13,000 require hospitalisation.1 Thermal injury results in the loss of the protective epidermal and dermal layers, allowing evaporation and extra-vasation of fluids, substantial protein losses, systemic inflammation and entry of pathogens. Additionally, burn injury presents a significant insult to the skin, resulting in depletion of local stem cell (SC) populations and an impaired wound healing response.2

The surgical management of these complex injuries has advanced significantly over the last 50 years, following the introduction of tangential excision,3 cultured keratinocyte autografts,4 and epidermal and dermal substitutes. The overarching principle of these techniques involves early excision of the burn eschar and restoration of epidermal integrity, both of which are required to limit local and systemic infection.5,6

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