Pathophysiology of Burn Wounds

In this chapter, the fundamentals of burn wound pathophysiology are discussed. Burns can be caused by flame, scald, contact with hot (or cold) substances, chemicals, or electricity. The resulting wound is assessed according to depth and size. Locally, three different zones in a wound are distinguished: the coagulation, stasis, and hyperemia zone that show different physiologic changes. In general, the wound healing in burn wounds happens in the same phases as regular wound healing. Yet, there are some peculiarities that are to be considered. Especially the wound size and the resulting edema lead to an increment in inflammatory processes and a surplus in cells like mast cells, macrophages, or neutrophils. These cells and circulating cytokines further uphold and endorse the inflammation process. Ultimately, this leads to a prolonged healing, which in turn makes burn wounds more prone to infections than other wounds. With prolonged healing and proneness to infection, two highly associated risk factors for pathological scarring are evident in burns. This might at least partially explain the significantly higher prevalence of pathologic scars after burns. These findings rationalize several current scar treatment strategies targeting the inflammatory processes with mixed success. Further insights in detailed scar pathophysiology are necessary to ultimately develop the optimal treatment for pathologic scarring.