Necrosis in Burns

Necrosis in burns has a major impact on dermal regeneration and functional and esthetic results. Thus, the patient’s satisfaction and quality of life are determined by the timely regeneration process of all dermal layers. Pathophysiological changes after burn trauma lead to different perfusion patterns (“zones”). Inflammation has been described having a key role in maintaining reduced subdermal perfusion with increased risk of burn necrosis. In addition, various key regulators of inflammation have been identified to play a critical role in activating burn necrosis. This chapter analyzes the impact of necrosis in acute burns and gives an overview of the currently available literature of pathophysiology, apoptosis, and inflammation in burns resulting in primary, secondary, or tertiary burn necrosis. Local therapeutic options are discussed, but it is not intended to be exhaustive with regard to systemic reactions and systemic therapy in case of burn necrosis. In summary, there is increasing evidence of pathophysiology of necrosis in burns in animal models, but there is still a lack of transfer to clinical application.