INTRODUCTION
Nearly 500,000 individuals seek care for burns yearly in the United States, with 40,000 requiring inpatient care and over 3,000 dying from burn injuries yearly.1 An average of 308 burn injuries per year occur in US service members during deployment – almost one burn injury daily.2 The majority of these injuries are sustained from improvised explosive devices (IED) resulting in burn scars. Military personnel who served our country and suffered from disfiguring trauma scars have difficulty assimilating into the civilian workplace, and need complex medical care.
Pathophysiology of Scarring and Contractures From Burns
Superficial burn injuries, first-degree epidermal injuries, or superficial dermal injuries, leaving dermal accessory structures intact, will heal by re-epithelialization. Re-epithelialization results in minor scarring, although it frequently causes dyspigmentation.
Deep dermal or full-thickness burns destroy epidermal structures so that the wounds cannot re-epithelialize; with wounds that remain open for 2 or 3 weeks. Fibroblasts and myofibroblasts migrate into the wound starting the first few days after injury, helping the wound to contract and close. This results in contractures and hypertrophic scars.
Hypertrophic scarring from burns results in a disequilibrium between collagen production and degradation, with increased contraction resulting from the activation of the tissue growth factor-beta (TGF-β) pathway causing remodeling and scar formation.3 This disequilibrium leads to decreased elasticity and increased dermal thickness that produces disfigurement, dysfunction of the skin, dysesthesia, and pruritus.4 Severe burns can result in contractures that limit the range of motion and adversely affect the ability to perform daily activities.
Traumatic Burns and Considerations in the Military Population
Complex limb trauma, including amputation with prosthetic-limb interface complications, salvaged limb scarring, web contracture of hand digits, and hypertrophic scarring, dramatically limits the ability to function in daily life.
Pathophysiology of Scarring and Contractures From Burns
Superficial burn injuries, first-degree epidermal injuries, or superficial dermal injuries, leaving dermal accessory structures intact, will heal by re-epithelialization. Re-epithelialization results in minor scarring, although it frequently causes dyspigmentation.
Deep dermal or full-thickness burns destroy epidermal structures so that the wounds cannot re-epithelialize; with wounds that remain open for 2 or 3 weeks. Fibroblasts and myofibroblasts migrate into the wound starting the first few days after injury, helping the wound to contract and close. This results in contractures and hypertrophic scars.
Hypertrophic scarring from burns results in a disequilibrium between collagen production and degradation, with increased contraction resulting from the activation of the tissue growth factor-beta (TGF-β) pathway causing remodeling and scar formation.3 This disequilibrium leads to decreased elasticity and increased dermal thickness that produces disfigurement, dysfunction of the skin, dysesthesia, and pruritus.4 Severe burns can result in contractures that limit the range of motion and adversely affect the ability to perform daily activities.
Traumatic Burns and Considerations in the Military Population
Complex limb trauma, including amputation with prosthetic-limb interface complications, salvaged limb scarring, web contracture of hand digits, and hypertrophic scarring, dramatically limits the ability to function in daily life.
