Speaker 1: This episode features descriptions that some listeners might find upsetting.
Speaker 1: Please listen with discretion.
Speaker 2: Hi, I'm Emma. In May of twenty twenty, I was
Speaker 2: working at my job as a bookbinder when a machine
Speaker 2: error caused my dominant hand to be crushed and burned
Speaker 2: inside a machine used for stamping foil designs onto book covers.
Speaker 2: That day, I went to the er for treatment, where
Speaker 2: I also got to have my first covia test. About
Speaker 2: a week later, I had my first surgery. The first
Speaker 2: procedure was extensive wound abreadment that couldn't have been achieved
Speaker 2: while I was awake, and the application of homographed, which
Speaker 2: is essentially a very fancy band aid that's cadaver skin.
Speaker 2: A couple of days later, after allowing the wound site
Speaker 2: to calm down a little bit, the homograft was removed
Speaker 2: and something called BTM, or biodegradable temporizing matrix was placed
Speaker 2: on the burn site. BTM is an incredible innovation. It's
Speaker 2: basically a sort of foam that acts as a structure
Speaker 2: for the body to rebuild tissue into over time. Over
Speaker 2: a period of several months, the BTM then dissolves, leaving
Speaker 2: just the newly grown tissues. After the BTM was placed,
Speaker 2: I went home for about a month to allow the
Speaker 2: sites to mature. During this time, I had to rinse
Speaker 2: the wound and the BTM every four hours with dake
Speaker 2: In solution, which is a diluted bleach concoction that's been
Speaker 2: in use since the Civil War for wound care. After
Speaker 2: a month, I went in for my third and final surgery.
Speaker 2: My surgeon took a skin graft from the right guy
Speaker 2: and applied it to the matured BTM. Watching the graft's
Speaker 2: heel and adhere to the healthy tissue around the wound
Speaker 2: site was really incredible and honestly felt miraculous. I eventually
Speaker 2: was made custom compression gloves and got to attend hand therapy,
Speaker 2: and about three months after my injury, I was able
Speaker 2: to return to work. But never fear. I don't work
Speaker 2: on that machine anymore. We keep a distance from each other.
Speaker 2: I'm very happy to say that I've had a really
Speaker 2: good outcome. I'm very fortunate to have an incredible risk
Speaker 2: of motion and good strength in my hand, to the
Speaker 2: point that I don't have to think about my injury
Speaker 2: most days. Dealing with the immediate aftermath of a burn
Speaker 2: is really difficult.
Speaker 3: I dealt with nausea, fatigue, lack of appetite, pain, discomfort, fear,
Speaker 3: and a lot of isolation, especially during my long hospital
Speaker 3: stays during COVID, I had a lot of support and
Speaker 3: care from my family, especially my parents who allowed me
Speaker 3: to stay with them and.
Speaker 2: Took care of a lot of really extensive wound care,
Speaker 2: my coworkers who visited and checked in on me frequently,
Speaker 2: and a really fantastic medical team that went above and
Speaker 2: beyond in caring for me. It took at least a
Speaker 2: year after my final surgery to begin to feel like
Speaker 2: I was returning to normalcy. But I also had a
Speaker 2: very small burned area, about one percent TBSA or total
Speaker 2: body surface area. I have so much respect and empathy
Speaker 2: for those that are recovering from large and the strength
Speaker 2: it takes to endure that every day. I also want
Speaker 2: to take a moment to recognize and emphasize the importance
Speaker 2: of workers compensation. Without workers' compensation, the cost for burn
Speaker 2: treatment and wound care supplies would have been astronomical. It's
Speaker 2: so important that workers have access to medical care and
Speaker 2: financial support to help them recover from injury. Sustained at
Speaker 2: work and receive long term care for any lingering complications.
Speaker 1: Emma, thank you, thank you so much for sharing your
Speaker 1: story with us. It is so meaningful, like and you
Speaker 1: hit on such a number a number of incredibly important points. Yeah,
Speaker 1: and we just really appreciate you being willing to relive
Speaker 1: that and I know, and.
Speaker 4: Go through it all and share it with us and
Speaker 4: share it with all of our listeners.
Speaker 1: Thank you, Yeah, thank you.
Speaker 3: Hi.
Speaker 1: I'm erin Welsh.
Speaker 4: And I'm erin Allman Updike.
Speaker 1: And this is this podcast will kill you. Welcome back
Speaker 1: to Burns. Welcome Back Burns Part two. We're here, We're here.
Speaker 1: This is the episode where if you didn't listen to
Speaker 1: the first episode, go check it out, because it really
Speaker 1: does lay some important groundwork for what burn are, how
Speaker 1: we measure the severity, what's going on, and I mean
Speaker 1: really the treatment of burns throughout most of human history,
Speaker 1: which is yeah, kind of which is grim, grim, it
Speaker 1: really is. But this episode is where things turned around.
Speaker 4: So yeah, today we're talking how we have figured out
Speaker 4: how to treat burns in modern times and how we
Speaker 4: treat them today.
Speaker 1: And how we treat them today. Yeah, it's pretty it
Speaker 1: just it It's one of those topics that makes me go,
Speaker 1: can you believe how far like medicine is so cool?
Speaker 1: Science is so cool.
Speaker 4: I feel like it's one of the topics. Wow, this
Speaker 4: is gonna get too niche. I just thought of this,
Speaker 4: but it's one of the topics that makes that would
Speaker 4: make doctor who be like humans? You know how Doctor
Speaker 4: Who Humans?
Speaker 1: That's adorable.
Speaker 4: Yes, yes, yes, anyways, anyways, before we can do any
Speaker 4: of that, it's quarantiney time.
Speaker 1: It is. We're drinking the same thing that we drank
Speaker 1: last week, which is a non alcoholic Beasneys that we're
Speaker 1: calling by degrees and listen. We're not equipped to create
Speaker 1: a new cocktail recipe every week. We're in the hundreds
Speaker 1: of episodes now listen, and so we drink it. We're
Speaker 1: making we're borrowing from established knowledge, which is Besney's.
Speaker 4: So you can find the full recipe on our website,
Speaker 4: this Podcastwekilia dot com, and on all of our social
Speaker 4: media channels.
Speaker 1: You can. We didn't mention this, but it is honey
Speaker 1: and lemon and non alcoholic gin and it's great. And
Speaker 1: on our website, which is also great, you can find
Speaker 1: lots of things like transcripts, you can find links to
Speaker 1: merch links to our bookshop dot Org affiliate page, our
Speaker 1: Goodreads list, music by Bloodmobile, first hand account form, contact
Speaker 1: us form, and about us page that hasn't seen an
Speaker 1: update in a number of years and doesn't have that
Speaker 1: much information anyway, so to see what information is provided,
Speaker 1: check it out. You really sold that about us page? There?
Speaker 1: Do we even have like the start date of the podcast,
Speaker 1: which still blows my mind that we are in our
Speaker 1: ninth year of doing.
Speaker 4: This, I know, No, we don't have that on there.
Speaker 4: It might say that we're still in grad school, which
Speaker 4: is quite out of date.
Speaker 1: No, we graduate updated twenty eighteen. Yeah, yeah, listen. Anyways, anyways,
Speaker 1: let's get to the episode itself. Let us right after
Speaker 1: this break. Last week I took us through the history
Speaker 1: of burns from before humans were humans until the late
Speaker 1: eighteen hundreds early nineteen hundreds, which is quite a lot
Speaker 1: of time to cover just a few millennia, I think.
Speaker 1: I I think the earliest thing I mentioned was like
Speaker 1: four hundred million years ago fire was possible on this planet.
Speaker 1: So but for that entire time that we covered, burns
Speaker 1: remained pretty much beyond the reach of medicine in nineteen hundred,
Speaker 1: those who were under sixty one years of age who
Speaker 1: had burns covering more than twenty five percent of the
Speaker 1: body surface. Of those, one hundred percent died. Wow. One
Speaker 1: percent in nineteen hundred, twenty five percent total body surface area. Wow,
Speaker 1: in adults under fifty under sixty one.
Speaker 4: But it's actually interesting that it's not also an adults
Speaker 4: over age sixty one. But I wonder if they're just
Speaker 4: weren't that many of them?
Speaker 1: I mean, I'm sure that there were. I don't know why.
Speaker 1: I think because mortality even increases further at that point,
Speaker 1: but it doesn't. Okay, how can it increase beyond one
Speaker 1: hundred percent. I'm not sure why that.
Speaker 4: It might be a lower body surface area even or
Speaker 4: something like that. I think because age is a big
Speaker 4: part of it. Oh my god, though that's horrific. Yep, yep,
Speaker 4: that's very different than today. Just so everyone's aware.
Speaker 1: Well, and that's sort of what I wanted to kind
Speaker 1: of establish where where things stood in nineteen hundred. Yeah,
Speaker 1: fifty years later, nineteen fifty, nearly seventy percent survived. Wow.
Speaker 1: So the mortality had gone down to thirty percent, from
Speaker 1: one hundred percent to thirty percent. That's huge, that's huge,
Speaker 1: It's unfathomable. Yeah, yeah, wow. In those fifty years, burn
Speaker 1: care had undergone a profound revolution, and we've continued to
Speaker 1: make tremendous strides up through the present day. And I'm
Speaker 1: going to leave those present day strides to you, Aarin,
Speaker 1: And what I want to focus on instead is those
Speaker 1: fifty or so years what changed in medicine to drive
Speaker 1: such a transformation. There was no oh, single moment or breakthrough,
Speaker 1: but there were many. There was skin grafting, antiseptic technique,
Speaker 1: fluid balance and nutritional support, antibiotics, and airway management. Really
Speaker 1: it was through integrating all of these medical advancements, through
Speaker 1: the formation of burn care as a specialized approach, that
Speaker 1: the scales finally tipped. The survival rates that this integrated
Speaker 1: management could now achieve were beyond the imagination of any
Speaker 1: physician in past centuries. Like I imagine someone trying to treat
Speaker 1: someone with a burn in like fifteen hundred and then
Speaker 1: coming today to a burn center and just just like
Speaker 1: chills that. It's amazing to think about how much.
Speaker 4: The opposite of Outlander.
Speaker 1: Yes, yeah, here's some moldy bread, we'll try that out. Yeah, yeah. Yeah,
Speaker 1: But so what I want to do today is take
Speaker 1: us through how that happened piece by piece skin grafts
Speaker 1: and burn excision. Okay, So these approaches date back to
Speaker 1: ancient times. For instance, in the fifth century CE, Sushruda,
Speaker 1: the famous surgeon from ancient India, described how he treated
Speaker 1: amputated noses by taking a flap of skin from the
Speaker 1: forehead and then later the butt and then grafting it
Speaker 1: over the nose wound. Fascinating. Yeah, So skin grafting in
Speaker 1: that way has very very deep roots. Wow. And from
Speaker 1: this point until the eighteen hundreds, a few physicians had
Speaker 1: tried their hand at grafting over the centuries, with varying
Speaker 1: rates of success. Allegedly, the first rhinoplasty I think was
Speaker 1: performed in the sixteen hundreds or sixteenth century, I can't remember, Okay,
Speaker 1: like a while ago, Yeah, a while ago. Yeah. But
Speaker 1: still it was very much touch and go, not very
Speaker 1: It was definitely more of an art that a science,
Speaker 1: and things turned around in the eighteen hundreds. The early
Speaker 1: part of the century saw a few surgeons experimenting with
Speaker 1: skin grafting in animals, which showed some promise, but more
Speaker 1: importantly those experiments helped to clarify some crucial concepts about
Speaker 1: tissue death, circulation, and immune rejection. What's actually going on
Speaker 1: in the wound healing process, and what's necessary for the
Speaker 1: skin graft to actually take right.
Speaker 4: What is it that determines whether or not this one
Speaker 4: is going to work versus that one?
Speaker 1: Yep, yeah, okay. In eighteen sixty nine, inspired by these
Speaker 1: animal experiments, Swiss surgeon Jacques Louis Reverden, who was still
Speaker 1: a medical intern at the time, transplanted a tiny slice
Speaker 1: of skin into the middle of a wound, free skin grafting,
Speaker 1: no skin flaps required, so finding success with this, he
Speaker 1: varied his approach to see what was possible your own skin,
Speaker 1: skin from another human related to you, skin from a
Speaker 1: human not related to you, skin from another species. Just
Speaker 1: let's run the full gamut here. This free skin grafting
Speaker 1: technique was first applied to burns in eighteen seventy when
Speaker 1: a surgeon named G. D. Pollock treated his eight year
Speaker 1: old patients thigh burn by transplanting skin from her abdomen
Speaker 1: to the wound, and after six weeks the grafts looked
Speaker 1: pretty excellent, which is kind of incredible. Yeah, skin grafting
Speaker 1: became really popular and other surgeons refined various techniques like
Speaker 1: the split thickness skin graft where you take bits of
Speaker 1: the dermis along with the epidermis, and this technique promoted
Speaker 1: faster healing and less scar formation, which reduced scar contractures,
Speaker 1: which also you'll talk about.
Speaker 4: I know.
Speaker 1: And skin grafting proved to be a major advancement in
Speaker 1: burn care, and physicians also noticed that wounds healed much
Speaker 1: more quickly and completely when that burned tissue was removed beforehand.
Speaker 1: So that was where sort of the excision comes in,
Speaker 1: which people had experimented with in the past, but it
Speaker 1: kind of became more of like this seedms to be
Speaker 1: a routine part of things, right, age is actually helping,
Speaker 1: this is helpace. Was it was debated, yeah, okay, oh.
Speaker 1: By the early nineteen hundreds, grafting and burn decision with
Speaker 1: a wound decision was they were pretty well established techniques.
Speaker 1: But no matter how skillfully you grafted or debrided, if
Speaker 1: your instruments weren't clean, if the wound wasn't clean, infection
Speaker 1: often led to death. Aniseptic technique. This is like a
Speaker 1: mini history of many different medicine.
Speaker 4: Yeah, like the thing is that revolutionized all of medicine
Speaker 4: also revolutionized burd mars the.
Speaker 1: Surprise, surprise, Yeah, okay, so antiseptic technique. For centuries, surgery
Speaker 1: of any kind remained a last resort, an act of desperation.
Speaker 1: Before science and medicine had connected the dots between dirty
Speaker 1: instruments and deadly infections, anyone bold enough to go into
Speaker 1: surgery believed that the best surgeons wore the bloodiest, filthiest coats.
Speaker 1: So gross to think of it. It was like, Wow, you've
Speaker 1: got some experience. How many people have you operated on today?
Speaker 1: Fifteen and you haven't rinsed your hands once? That's what
Speaker 1: I want in a surgeon.
Speaker 5: No, no, thank you, please.
Speaker 1: No, no thankfully. Joseph Lister see our Sepsis Episode revolutionized
Speaker 1: surgery in the eighteen fifties with his recognition that if
Speaker 1: you operated with cleaning surgical tools and you cleaned the wound,
Speaker 1: your patients were less likely to die his solution of choice.
Speaker 1: His antiseptic solution of choice was carbolic acid, often mixed
Speaker 1: with vaziline for use in burn patients to reduce the
Speaker 1: pain of having acid rubbed into your wound. Yeah, okay.
Speaker 1: Later during World War One, other antiseptic solutions were developed,
Speaker 1: like boric acid, acetic acid, and a twenty five percent
Speaker 1: solution of sodium hypochlorite also called Dakin solution. Still use
Speaker 1: that today, Still use that today. Antiseptic technique was a
Speaker 1: major step forward in reducing infections and deaths following surgery,
Speaker 1: such as removing burnt tissue or performing skin graphs, and
Speaker 1: the same principles were used for wound management in burn
Speaker 1: patients even if they didn't have surgery. Because your skin,
Speaker 1: as you've talked about, is a barrier to infection. When
Speaker 1: that barrier is disrupted, it leaves it super vulnerable to infection.
Speaker 1: And so if you can find a way to decrease
Speaker 1: that vulnerability through aniseptic ointments, antimicrobial ointments, bandages that are
Speaker 1: infused with antiseptic components, stuff stuff. These things are integral
Speaker 1: in improving outcomes for those who have burns, both minor
Speaker 1: and major. By reducing infection through aniseptic technique and these
Speaker 1: specialized ointments, physicians could chip away at one major major
Speaker 1: source of mortality for burns, but other threats remained. Fluid
Speaker 1: balance and nutritional support. Yeah, yeah, this is a big one,
Speaker 1: more than I realized. I think, despite having rewatched all
Speaker 1: of ER, I don't think it really hit home to
Speaker 1: me how important this part of it was. As though
Speaker 1: ER is a super super accurate It's like I'm saying,
Speaker 1: despite med school to bite er same same. Over the centuries,
Speaker 1: a handful of physicians had noticed that providing a burn
Speaker 1: patient with lots of replenishing fluids and food seemed to help.
Speaker 1: But this was very much against the beliefs of the day.
Speaker 1: Things like blood letting and purging were still the standard
Speaker 1: for centuries, and it wasn't really until the late eighteen hundreds,
Speaker 1: the late eighteen hundreds that doctors began to crack the
Speaker 1: code on fluid balance and nutritional support.
Speaker 2: Wow.
Speaker 1: And it started when a few doctors observed that the
Speaker 1: renal failure in burn patients looked very similar to that
Speaker 1: that they observed in cholera patients. Oh yeah, or their
Speaker 1: bodies were extremely dehydrated and they just their fluid balance
Speaker 1: was not it was in super imbalance. I guess right.
Speaker 4: They're losing tons of fluid and they're losing tons of
Speaker 4: electrolytes because they're pooping pure water's at a time in cholera,
Speaker 4: and that totally makes sense because the same thing is happening.
Speaker 4: It's just going out through this surface area that you
Speaker 4: have lost from your skin.
Speaker 1: Yep. Fascinating. Yeah, that was sort of like the first
Speaker 1: little light bulb of moment. And then one doctor went
Speaker 1: further and discovered in eighteen ninety three that blisters and
Speaker 1: burned tissues were filled with plasma, meaning that fluid, that
Speaker 1: fluid was not where it should be. And so it
Speaker 1: was like, oh, this is the same thing. It's just
Speaker 1: longs in our blood lung somewhere else, not we're in
Speaker 1: the blister. Yeah. And some people then tinkered around with
Speaker 1: fluid replacement with saline administered orally, rectly or intravenously, But
Speaker 1: it wasn't really until World War One that the technique
Speaker 1: was refined, and not until nineteen twenty one that it
Speaker 1: was applied systematically to burn patients. Okay, so that year
Speaker 1: a fire broke out at the rialto Theater in New Haven, Connecticut,
Speaker 1: and a professor at Yale, Frank Underhill, saw that the
Speaker 1: composition of fluid and blisters was the same as plasma,
Speaker 1: and loss of those compounds, he suspected is what led
Speaker 1: to shock in burn patients, and so he was like,
Speaker 1: I think that this is actually causing that fluid loss
Speaker 1: is causing mortality in burn patients. It's not toxins. So
Speaker 1: previously it was believed that toxins were the thing that
Speaker 1: killed people, which it can still be if you think
Speaker 1: of toxins as like bacterial infection or fung infact, that.
Speaker 4: Would be more usually later rather than like immediately following.
Speaker 1: Yeah, So he's like, this is an emergency, Like, this
Speaker 1: is what's happening right now, fluid loss. We can we
Speaker 1: treat fluid loss. I mean this was a huge step
Speaker 1: forward because fluid loss could be reversed by providing saline
Speaker 1: solution with protein intravenously, and later work in this area
Speaker 1: led to formulas to quantify how much fluid was needed
Speaker 1: depending on the age and the size of the person
Speaker 1: and the surface area and the depth of their burn.
Speaker 1: About a decade after the rialto Theater fire, which happened
Speaker 1: in nineteen twenty one, physicians began to notice that burn
Speaker 1: patients also needed an increased caloric intake, and that extreme
Speaker 1: loss of lean body mass put them at high risk
Speaker 1: for poor outcomes. So death decreased wound healing, impaired immunity,
Speaker 1: and so on. So the nitty gritty of how to
Speaker 1: best provide adequate nutrition and calories that took decades to
Speaker 1: figure out or again consensus on, but the recognition of
Speaker 1: this issue was absolutely critical. Next up is antibiotics. Antisepsis
Speaker 1: and antimicrobial dressings were a huge step forward, but they
Speaker 1: didn't always entirely prevent infection. The development of penicillin in
Speaker 1: the early nineteen forties, I mean, it was discovered in
Speaker 1: nineteen twenty eight, but it wasn't widely available until the
Speaker 1: war ended in nineteen forty five, and then later broad
Speaker 1: spectrum antibiotics. This really helped to control infection when it
Speaker 1: did arise in burn patients. One of the very first
Speaker 1: uses of penicillin in the general public was, in fact,
Speaker 1: after the Coconut Grove nightclub fire in Boston on November
Speaker 1: twenty eighth, nineteen forty two. Huh, Yeah, I didn't know that. Yeah,
Speaker 1: I think I feel like I remember talking about it
Speaker 1: in our Antibiotics episode, and you.
Speaker 5: Probably what that was season three years so I remember it. No, no,
Speaker 5: But Coconut Grove sounds vaguely familiar, though, isn't it.
Speaker 1: Yeah, Okay, but yeah, so that was the first time
Speaker 1: that penicillin was used to see if it improved. And
Speaker 1: I don't think I think that the data were not
Speaker 1: strong enough to see did this actually help anything. Yeah,
Speaker 1: there was a lot of still a lot of other
Speaker 1: things that needed to be figured out. But but this
Speaker 1: tragedy also led to the refinement of fluid replacement calculations
Speaker 1: and the recognition of airway injuries after a fire. Yeah,
Speaker 1: and so but since since then, since this nightclub fire,
Speaker 1: antibiotics have often been employed in treating systemic infections that
Speaker 1: arise after a burn, or used prophylactically to prevent infection
Speaker 1: in the first place. But their use in burn patients
Speaker 1: can be tricky. So, first, antibiotic resistance is a major problem,
Speaker 1: especially for certain types of bacteria found after burns, like pseudomonous. Yeah,
Speaker 1: and antibiotic use can also lead to other opportunistic pathogens
Speaker 1: taking over, so for example, certain fungal species such as
Speaker 1: Canada albacans. So it's it's not, it's not it's a
Speaker 1: little bit of a mixed bag, or it's like, it's not,
Speaker 1: it's not the way that antiseptic technique or fluid replacement
Speaker 1: is the role that it plays in the history, especially because.
Speaker 4: You're talking about like systemic antibiotics, right, like ivy antibiotics
Speaker 4: or oral antibiotics, like the kind that you would use
Speaker 4: to treat an infection, And yes, that and that makes
Speaker 4: sense because we don't really use them that much in
Speaker 4: burns today.
Speaker 1: Yeah, unless we need to.
Speaker 4: Unless exactly, so having it needed exactly exactly yea.
Speaker 1: But yeah, like you said, I mean the systemic part
Speaker 1: of it, and so having this knowledge of anti microwheal
Speaker 1: properties to then infuse bandages. I kind of lumped that
Speaker 1: in with the aniseptic technique, but like that was a
Speaker 1: huge part of it. Yes, just like how do we
Speaker 1: topically treat this and prevent infection?
Speaker 2: Yeah?
Speaker 1: Right, And then last on the list is airway management.
Speaker 1: So this includes both the recognition of airway injury as
Speaker 1: well as ways to treat it. Now, if we're still
Speaker 1: considering just that fifty year window between nineteen hundred and
Speaker 1: nineteen fifty, airway management was mostly restricted to recognizing the
Speaker 1: damage that smoke inhalation could do to lungs that could
Speaker 1: lead to poor outcomes. The doctors treating victims of the
Speaker 1: coconut Grove nightclub fire in Boston in nineteen forty two
Speaker 1: made note of this quote. It was obvious almost at
Speaker 1: once that we were dealing with something more than the
Speaker 1: problem of burned skin. A severe impairment of respiration also existed.
Speaker 1: End quote.
Speaker 4: And this was due to Yeah information, that's so interesting
Speaker 4: that that's so late.
Speaker 1: I think that people recognized it, but it like what
Speaker 1: can men do about it? Right? I mean, I think
Speaker 1: that I don't know. I don't know, I don't know.
Speaker 4: I know it's a lot there's a lot of components there.
Speaker 1: There's a lot of components. This is like the one
Speaker 1: where I was like, I don't even know where to
Speaker 1: begin covering the history of this, because respiratory issues following burns.
Speaker 1: It could be due to direct burns. Carbon monoxide poisoning
Speaker 1: can happen inhalation of the toxic substances that are being
Speaker 1: burned burned. Later on, it could be bacterial pneumonia due
Speaker 1: to impaired immune response.
Speaker 4: Or ventilation assistance like we see today if someone is
Speaker 4: intobated because of swelling yep.
Speaker 1: Yep, yep. Right, So there's a lot of there's a
Speaker 1: lot of factors to.
Speaker 2: This, and.
Speaker 1: Doctors though I think that the recognition that those who
Speaker 1: had smoke inhalation injury and pneumonia tended to experience worse outcomes,
Speaker 1: and that led to increased focus on how to better
Speaker 1: manage lung injury alongside wound management, raloid balance, nutritional support,
Speaker 1: and so on. And then later, of course, supplemental oxygen
Speaker 1: and the invention of mechanical ventilators led to some relief.
Speaker 1: But really, like what you can kind of see is
Speaker 1: the pieces of all of this, like, Okay, well, we're
Speaker 1: relieving the threat due to fluid imbalance, We're relieving the
Speaker 1: threat due to infection in the wound directly, we're relieving
Speaker 1: the threat of all of these different things and kind
Speaker 1: of saying, okay, what's left that we can improve upon?
Speaker 1: And that's how the history of burn treatment kind of goes.
Speaker 1: And it's a lot, right, Like it's a lot, even
Speaker 1: though I haven't been talking for all that long compared
Speaker 1: to somehow sometimes how I go on and on, there's
Speaker 1: I'm sure that you've already forgotten the details of how
Speaker 1: fluid replacement was discovered or the earliest skin graft performed,
Speaker 1: And if you have forgotten, don't sweat it, like that's
Speaker 1: you don't need to remember the details. The important thing
Speaker 1: that I want everyone to take away from all of
Speaker 1: this is kind of what I already said at the top.
Speaker 1: It's not one thing that changed the landscape of burn care.
Speaker 1: It's many things, not working in isolation, but coordinated care.
Speaker 1: At the end of the nineteen forties, researchers had made
Speaker 1: all of these incredible advancements that made survival after a
Speaker 1: severe burn more possible. But one last step remained before
Speaker 1: possible turned into probable, and that was the formation of
Speaker 1: burn units or burn centers, coordinated round the clockcare that
Speaker 1: integrates expertise across many different disciplines, working as a team.
Speaker 1: The first burn units in the United States were founded
Speaker 1: in the mid twentieth century, and they have transformed burn
Speaker 1: care and offered tremendous hope. They also act as a
Speaker 1: research unit, constantly striving to improve not only survival, but
Speaker 1: quality of life, pain management, psychological trauma, stigma, physical therapy.
Speaker 1: At these centers, people with burns are treated not in
Speaker 1: pieces but as a whole. And as we've gotten better
Speaker 1: at managing the immediate injury, at managing the physiological impact
Speaker 1: of burns, it has also left us more able to
Speaker 1: address and improve the injury to the parts that you
Speaker 1: can't see, like the huge trauma that happens, the stigma,
Speaker 1: all of these different aspects, and I just like, especially
Speaker 1: after doing these episodes, really want to acknowledge the incredible
Speaker 1: work of the healthcare professional at these centers because it
Speaker 1: is crucial what they do.
Speaker 4: I think too airin it shows how much, like all
Speaker 4: of the changes that you had mentioned, just kind of
Speaker 4: show how much people have started to recognize or pay
Speaker 4: attention to the fact that a burn is not just
Speaker 4: skin damage. It's not the same thing as a cut
Speaker 4: or a scrape. It is a system wide is a
Speaker 4: whole body, system wide event that we have to treat
Speaker 4: as such.
Speaker 1: Yeah, yeah, it is such a to me. It is
Speaker 1: such an interesting way of approaching medicine because it's you
Speaker 1: have to have expertise in all of these different areas
Speaker 1: all at once and apply them differently, and each case
Speaker 1: is different and at the same time, as amazing as
Speaker 1: incredible as these centers are, they can only help someone
Speaker 1: if someone has access to them, which is a pervasive
Speaker 1: issue across the globe that I know you'll talk about,
Speaker 1: and as transformative as burn treatment has been over the
Speaker 1: past century. Continued improvement can only be achieved through funding
Speaker 1: for research. And I know everyone who's listening has heard
Speaker 1: this all before, but I just it bears repeating, like
Speaker 1: it bears repeating until we all internalized tel something changes,
Speaker 1: what changes. But with that, Aaron, I'll turn it over
Speaker 1: to you now to fill us in on some of
Speaker 1: the incredible treatments out there for burn injuries that happened
Speaker 1: after those fifty years.
Speaker 4: Were Oh, I can't wait to do that. Erin the
Speaker 4: basic principles of burn care today. Erin kind of fall
Speaker 4: along a lot of the same lines that you just
Speaker 4: walked us through and how we figured out to do
Speaker 4: a better job at treating burns. So what I want
Speaker 4: to walk through is less of the acute phase of
Speaker 4: fluid resuscitation and nutrition management and airway control, which is
Speaker 4: integral and so important in those first especially those first
Speaker 4: like twenty four, forty eight, seventy two hours. All of
Speaker 4: that is imperative. So I'm not, you know, knocking the
Speaker 4: importance of that. But what I want to really focus
Speaker 4: on is the long term on how we treat these
Speaker 4: burn wounds to heal them over time. Because the technology
Speaker 4: that we have now to improve upon these outcomes is
Speaker 4: really truly phenomenal, and it builds on everything that you
Speaker 4: talked about already erin. So the first part is the surgery,
Speaker 4: and this idea of surgical excision is a mainstay of
Speaker 4: burn care. For anything that is a deep partial thickness,
Speaker 4: so a to be a second degree like a deep
Speaker 4: second degree burn, or worse, a third degree or down
Speaker 4: into the muscle or bone tissue, surgical excision early is
Speaker 4: a mainstay. Exactly when and exactly how early depends on
Speaker 4: the burn center depends on the situation, but usually within
Speaker 4: the first day or two or three to remove all
Speaker 4: of the dead or necrotic tissue. What this does is
Speaker 4: it helps to ensure that the surrounding tissue has less
Speaker 4: damage because remember we talked in last episode about how
Speaker 4: there's kind of a zone around the worst part of
Speaker 4: the burn that is really at risk of further damage.
Speaker 4: So by removing the necrotic tissue, we can help to
Speaker 4: kind of keep that tissue viable. And this can go
Speaker 4: in a lot of different ways. So sometimes it means
Speaker 4: like actual surgery with like sharp instruments where things are
Speaker 4: kind of scraped away down to healthy bleeding viable tissue.
Speaker 4: Sometimes it might mean newer technology like water, like high
Speaker 4: pressured water we now have, which is fascinating, and that's
Speaker 4: to basically like go through the planes of tissue, but
Speaker 4: in a way that causes hopefully less damage to healthy tissue,
Speaker 4: because it can sometimes be really hard to tell apart
Speaker 4: healthy tissue from dead tissue.
Speaker 1: How does it help sorry, no, yeah, yeah, I mean
Speaker 1: I have yeah, how does it help preserve healthy tissue?
Speaker 4: Like?
Speaker 1: How's yeah?
Speaker 4: Essentially because it's not going to cause as much damage,
Speaker 4: So it's not something that's sharp where you're going to
Speaker 4: accidentally cut where you didn't mean to. But it's just
Speaker 4: really high pressured water that can kind of go through
Speaker 4: the layers and it will like take off the dead
Speaker 4: tissue because that is dead, so it kind of just
Speaker 4: falls away.
Speaker 1: Okay, So it does a better dress pressure with distinguishing
Speaker 1: healthy and not healthy.
Speaker 4: Tissue, potentially in some scenarios.
Speaker 1: Okay.
Speaker 4: Sometimes we might also use enzymatic debreatment, which you mentioned aarin.
Speaker 4: Some of the solutions that they used way back when
Speaker 4: might still be solutions that we use today to kind
Speaker 4: of in a much more gentle manner debreed away all
Speaker 4: of that dead tissue. In some cases, we might even
Speaker 4: use maggot larval therapy.
Speaker 1: I was wondering about that.
Speaker 4: Okay, yes, and so that might not be you know,
Speaker 4: not in those first twenty four to forty eight hours,
Speaker 4: but especially if areas become necrotic later or places that
Speaker 4: you didn't get to in surgery. There's a lot of
Speaker 4: reasons why you might end up using those kinds of
Speaker 4: therapies later. But removing the dead tissue is the first,
Speaker 4: incredibly important step. Next is preventing infection, and this is
Speaker 4: both next and at the same time. So that means
Speaker 4: washing wounds right to remove any remove any debris, and
Speaker 4: then covering wounds whether they needed surgical excision or not,
Speaker 4: with antibiotic infused dressings or ointments or.
Speaker 1: What have you.
Speaker 4: And we've had huge improvements, like there are way too
Speaker 4: many to count in terms of the types of dressings
Speaker 4: and anti my chrobial dressings. A lot of the ones
Speaker 4: that we use in burns tend to be silver infused dressings,
Speaker 4: and that's because silver is a good antimicrobial that is
Speaker 4: really only topical, so it's not penetrating deep, it's not
Speaker 4: going systemic, et cetera. But honey based dressings, alovera based dressings.
Speaker 4: With all of these the goal is to inhibit the
Speaker 4: growth of bacteria to reduce the chance of infection. IV antibiotics,
Speaker 4: like I mentioned, we don't tend to use unless there
Speaker 4: is an infection that leads to something like sepsis, because
Speaker 4: not only is it overboard to use ivy antibiotics that
Speaker 4: might increase the risk of antibiotic resistance and other things,
Speaker 4: but also these wounds don't really have any blood flow,
Speaker 4: so IVY antibiotics don't really work.
Speaker 1: That was sort of the conclusion of the coconut growth
Speaker 1: that were like, we don't know if this did anything or.
Speaker 4: Not exactly, Yeah, and it might not.
Speaker 1: Might not have maybe for some people that death.
Speaker 4: Yeah, But for any burn that needed a surgical excision,
Speaker 4: any burn that extended into the deep part of the dermis,
Speaker 4: into that subcutaneous tissue is not going to be able
Speaker 4: to heal completely on its own, and it is going
Speaker 4: to need some kind of help from something like a
Speaker 4: skin graft or a skin substitute. So the gold standard
Speaker 4: for treatment of any burn that had to have a
Speaker 4: surgical excision is still a skin graft, even though they're
Speaker 4: apparently as old as dirt, so old, I had no idea.
Speaker 4: The way that we do skin grafting today is mostly
Speaker 4: by what's called a split thickness skin graft, so that
Speaker 4: means a skin graft that has both epidermis and a
Speaker 4: small amount the very top of the dermis. For more
Speaker 4: sensitive areas or more cosmetically important areas like say the
Speaker 4: face or maybe even the hands, you might use a
Speaker 4: full thickness skin graft, so that would be epidermis and
Speaker 4: the whole entirety of the dermis. And skin grafts are
Speaker 4: really fascinating. You could probably talk in way more detail
Speaker 4: about them, but I will just give us all the
Speaker 4: basics of how these work. Essentially, you take a healthy,
Speaker 4: non burned piece of skin and use that to cover
Speaker 4: the burned wound. You adhere it with staples or sutures
Speaker 4: or something. Ideally the skin comes from you, yeah, because
Speaker 4: then your body recognizes it and there's much less risk
Speaker 4: of rejection or anything like that. There's two ways that
Speaker 4: we can do this, depending on how important the cosmetic
Speaker 4: outcome is and how large the burn wound is. In
Speaker 4: some areas, you might take a piece of skin and
Speaker 4: just use it as is to cover sort of just
Speaker 4: like a flap graft essentially. Okay, in other cases, you
Speaker 4: might do what's called meshing, which means you take the
Speaker 4: skin that you're going to use as the graft and
Speaker 4: you run it through a machine that basically turns it
Speaker 4: into a mesh so that you can stretch it over
Speaker 4: a much larger area. Your face doesn't look like it
Speaker 4: appreciates that.
Speaker 1: I appreciate the technology. Not it is. It is so fascinating.
Speaker 4: My dad had one of these skin grafts, not for
Speaker 4: a burn, he had a fasciotomy for compartment syndrome, but
Speaker 4: he so he has two scars.
Speaker 1: One that's barely.
Speaker 4: Visible, it's just like a little bit of discoloration on
Speaker 4: his upper thigh that's a perfect rectangle from where they
Speaker 4: took a section of his skin. And then on his
Speaker 4: lower leg he has a wound that is it's a
Speaker 4: little bit deformed because his wound was all the way
Speaker 4: down to the muscle basically, but it also is a
Speaker 4: bit stippled looking like it's you can tell that it
Speaker 4: wasn't like completely covered, and that's because that was meshed,
Speaker 4: and so he had this mesh covering of his own
Speaker 4: skin that covered that wound while it was healing.
Speaker 1: Okay, so this is the meshing. I mean, it's very cool.
Speaker 1: It's just it's not it's not my favorite thing to
Speaker 1: think about the actual process of that, fair enough, but
Speaker 1: this meshing, So this is for larger areas to then
Speaker 1: reduce sort of how much skin you're taking from other
Speaker 1: parts of your.
Speaker 4: Body exactly exactly, Okay, yeah, yeah, yeah. Because if a
Speaker 4: person is stable, their burn wound is clean, and they
Speaker 4: have enough donatable other skin, then this is a way
Speaker 4: that ideally skin grafting would be done. But in many
Speaker 4: cases someone might not have enough skin, maybe their burn
Speaker 4: area was really really high, or maybe they're just not
Speaker 4: very stable, they're super sick at the time, and so
Speaker 4: we don't want to risk a prolonged surgery where we
Speaker 4: also have to take skin from other areas to try
Speaker 4: and make it into a graft to cover, and so
Speaker 4: in those cases we might use what's called an alo graft,
Speaker 4: which means skin from someone else. Usually it's a cadaveric
Speaker 4: skin graft, or sometimes even zenografting, which is with another
Speaker 4: animal's skin, so something like poresine skin or something. These
Speaker 4: are usually temporary because usually our body is going to
Speaker 4: reject them in one way or another, and so they
Speaker 4: act as a covering, but often have to be removed
Speaker 4: after a couple of weeks or so, or if there's
Speaker 4: any signs of infection.
Speaker 1: So they act as a covering and they are a
Speaker 1: better covering than surgical dressings, ointments, et cetera. Well, that's
Speaker 1: a great question, Aaron.
Speaker 4: It all is going to depend and this is really
Speaker 4: where we can get into some of the life changing
Speaker 4: technologies that exist in the world of burn healing, because
Speaker 4: there are now a huge variety of things that are
Speaker 4: there to act as essentially skin substitutes. Okay, whether a
Speaker 4: skin graft isn't possible, or whether you know, maybe something
Speaker 4: wasn't quite enough to warrant a skin graft, but you're
Speaker 4: worried that the healing process is still going to take
Speaker 4: a really long time, and dressing changes are incredibly painful
Speaker 4: and can be really distressing, and so a lot of
Speaker 4: these other skin substitutes, even if they're not taking the
Speaker 4: place of a graft, maybe they're used while we're waiting
Speaker 4: for a graft. Maybe they're used in a place to
Speaker 4: reduce the need for frequent dressing changes. Even if we
Speaker 4: don't need a skin graft later on. There's some really
Speaker 4: incredible things. Some of them are still in the realm,
Speaker 4: not of science fiction, but of more research, and some
Speaker 4: of them are already accessed, like commercially available, and if
Speaker 4: you have access to a great burn center that actually
Speaker 4: can get them, then you can get them. So let's
Speaker 4: talk about what some of these might look like. Some
Speaker 4: of these dressings might be made from natural polymers like kitan,
Speaker 4: which is fascinating, like from an insect exoskeleton and things
Speaker 4: like that, right, Okay. Some of them might be made
Speaker 4: from cellulose from plants, or even like fibrine or hyaluronic acid, collagen, gelatin,
Speaker 4: any kind of polymer that you can think of that
Speaker 4: might come from nature. And others are from synthetic polymers,
Speaker 4: something like silica or maybe synthetic carbon based compounds. And
Speaker 4: these dressings can come in a really wide variety of textures.
Speaker 4: Some of them are what are called hydrogels, which still
Speaker 4: take me. I still can only barely understand them because
Speaker 4: they basically are these things that help to soak up
Speaker 4: fluid in the wound, so they reduce how wet that
Speaker 4: wound is going to be, and then they by hydrating themselves.
Speaker 4: They also like their properties become more available to your
Speaker 4: skin or to your healing wound.
Speaker 1: They are they weird blot and moisturize, Yes, yes, yes, moisturize.
Speaker 4: There's also films, patches, sponges, nanofibers. There's a lot of
Speaker 4: interest in like nanomedicines for these dressings. But the goal
Speaker 4: of all of these things is to promote wound healing
Speaker 4: and reduce the amount of time that it takes for
Speaker 4: our body to actually grow new skin in and of itself.
Speaker 4: They also serve to reduce the risk of infection, and
Speaker 4: the goal is to maintain a kind of optimal wound
Speaker 4: healing environment, and wounds heal best when they are moist
Speaker 4: but not too wet, because too much fluid can actually
Speaker 4: impair wound healing. You need to be able to have
Speaker 4: oxygen flow in and out, so you need something that's
Speaker 4: semi permeable like our skin is and prevents infection. Right,
Speaker 4: So something that's going to block other either have antibiotics
Speaker 4: in it or can just block other microbes from getting in.
Speaker 4: And ideally these dressings can also help to reduce pain
Speaker 4: either because they have something in them that's analgesic or
Speaker 4: just because they're reducing the number of dressing changes and
Speaker 4: the friction or anything that you might have from other dressings. So,
Speaker 4: like I said, there's two, there's literally too many of
Speaker 4: these kinds that can go into these. One that I
Speaker 4: think is quite interesting is an acellular fish skin.
Speaker 1: Excuse me, right, so you know how I said.
Speaker 4: Sometimes we can use like xenographs from like poresine skin,
Speaker 4: so pigs or something like that. There is a acellular
Speaker 4: fish skin that can be used now for wound healing,
Speaker 4: including burns, but it can kind of act again as
Speaker 4: like a temporary skin, so you put it on, leave
Speaker 4: it on until your skin starts to re epithelialize itself.
Speaker 4: It's my mind is blown by that. I know fish,
Speaker 4: it's really fish skin. That that was what I think
Speaker 4: one of the newest ones for me. But then there's
Speaker 4: also a lot of interest in things that are even
Speaker 4: more They honestly sound like science fiction y. So there
Speaker 4: are things that are available actually that are kind of
Speaker 4: like scaffolds that we actually can take some of our
Speaker 4: own cells, send them off to these companies who engineer
Speaker 4: them and then spray them or or otherwise infuse them
Speaker 4: into these like films, these scaffolds that we then can
Speaker 4: use as addressing.
Speaker 1: I feel like I read about this in Replaceable You
Speaker 1: by Mary Roach It's possible. It is that that totally
Speaker 1: blew my mind, like basically kind of three D printing
Speaker 1: your own cells.
Speaker 4: Well yeah, so, and that's even I would say, a
Speaker 4: separate thing because three D printed cells is a huge
Speaker 4: area of research, and it's been done on animal models.
Speaker 4: I think there is actually some like clinical inhuman data
Speaker 4: from it, but it's all in the realm of research
Speaker 4: as far as I can tell right now. But that's
Speaker 4: even like a step beyond what already does exist, which
Speaker 4: are these like these dressings that you can impregnate even
Speaker 4: with your own cells.
Speaker 1: So cool. I'm sorry, it's just like what I mean,
Speaker 1: it's like and it's to me, it's it's a really
Speaker 1: interesting trajectory of burn care because for for millennia, it
Speaker 1: was the focus was on the wound itself, very topical,
Speaker 1: very isolated, the local treatments, and then once more awareness
Speaker 1: was gained about the systemic effects that burns can have,
Speaker 1: then it was like, well, we need to provide supportive
Speaker 1: care for fluids, for food, for antiseptic technique, all of
Speaker 1: these different things airway management, and then now we have
Speaker 1: a lot of those things more under control, right, can
Speaker 1: go back to the burn and say, I mean, I
Speaker 1: know it's all been done simultaneously, but like we're now
Speaker 1: kind of some of the most exciting researches in this
Speaker 1: area of how do we promote healing again fixing exact
Speaker 1: on that burn itself on the toxic local area, right.
Speaker 4: And I think what's so interesting too is it's kind
Speaker 4: of like like what you were saying, it's for a
Speaker 4: long time it was just how can.
Speaker 1: People survive this y? Right?
Speaker 4: Like early on it was probably just treating the people
Speaker 4: who did survive, So that's why it was just treating
Speaker 4: the burns of people who did survive, And then it
Speaker 4: was can we help people to survive even if they
Speaker 4: had a big burn, And now we absolutely can. How
Speaker 4: can we make sure that they thrive going forward?
Speaker 1: Yes? Quality of life? Yeah, quality of life.
Speaker 4: And so for that reason, a lot of the research
Speaker 4: that is going on right now in burns and wound
Speaker 4: healing is into improving these especially bioengineered types of skin grafts,
Speaker 4: and this idea of three D printing and using our
Speaker 4: own cells or other cells, like just things that will
Speaker 4: help to promote healing. And the reason why this is
Speaker 4: so important is to reduce the risk of scarring because,
Speaker 4: especially in cases when we cannot do an auto collag
Speaker 4: is skin grafts. So if you cannot take skin from
Speaker 4: yourself to be able to do a skin graft, then
Speaker 4: one of the most common complications of burn wounds is
Speaker 4: what's called hypertrophic scarring. And hypertrophic scarring is as high
Speaker 4: as seventy percent in people with burn injuries. And basically
Speaker 4: what happens is that as the scar forms, it is
Speaker 4: laying down collagen in this like linear way that ends
Speaker 4: up lacking the flexibility of uninjured skin.
Speaker 1: And is that because it's like just trying to get
Speaker 1: this done as quickly as possible.
Speaker 4: Kind of that's kind of the way that I think
Speaker 4: of it. I don't know if that's like a perfect
Speaker 4: but that's kind of the way that I think of it.
Speaker 4: When you have a large area your body's just like
Speaker 4: get it down, get something down, we need to cover
Speaker 4: this up right, And when that happens, there ends up
Speaker 4: being too much of this collagen deposited and like not
Speaker 4: the right types of collagen basically, and it results in
Speaker 4: a very thick, inflexible scar and it's really painful and
Speaker 4: really itchy. This is different, by the way, than a
Speaker 4: keyloid scar, which can also be a complication of burn injury.
Speaker 4: But keyloid scars grow beyond the edge of the initial wound,
Speaker 4: and that's because of them being stuck in that proliferative
Speaker 4: phase of wound healing and not moving on to this
Speaker 4: remodeling phase of typical scar formation. So certain types of
Speaker 4: skin might be more prone to keloids than others, but
Speaker 4: overall all, burned skin is very prone to hypertrophic scarring.
Speaker 4: And both keyloid scars and hypertrophic scars can be painful,
Speaker 4: they can be hugely impactful on quality of life, and
Speaker 4: they're really hard to treat after the fact. Additionally, what
Speaker 4: happens as this like dysregulated collagen is being laid down,
Speaker 4: is that you also have what are called myofibroblasts that
Speaker 4: are being laid down. And these are cells that our
Speaker 4: body uses specifically to close up the wound bed itself. So,
Speaker 4: like you said, are they just trying to get it done? Yes,
Speaker 4: And so our body uses these cells that try and
Speaker 4: decrease the area of the wound by contracting it, and
Speaker 4: that can result in what are called contractors. And you've
Speaker 4: mentioned these a few times erin, but these are basically
Speaker 4: scars that can form that are very tight and painful,
Speaker 4: and especially in an area where you need to have movement,
Speaker 4: like your hand or your face, I mean almost anywhere
Speaker 4: on your body your skin needs to be able to move.
Speaker 4: That can really impact quality of life and like the
Speaker 4: ability to do the things that you need to be
Speaker 4: able to do. In general, the deeper the wound, So
Speaker 4: the deeper the burn, the worse likelihood there is for
Speaker 4: scar formation or like the more likely you are to
Speaker 4: have bad scars.
Speaker 1: Okay, that's a weird way to say that, apologies.
Speaker 4: But what we know, and what I think is really interesting,
Speaker 4: is that this is more related to the time that
Speaker 4: it takes to heal. So any dressings or any treatments
Speaker 4: that we have can reduce healing time to less than
Speaker 4: twenty one days or so significantly reduces the risk of
Speaker 4: especially hypertrophic scarring.
Speaker 1: Maybe this is like a question for another episode, Maybe
Speaker 1: we should do an episode on like just wound healing
Speaker 1: scars in general. Yeah, but I feel like, what is
Speaker 1: the skin is different, whether it's whether there's at whether
Speaker 1: there's not a graph like hair, does the hair grow
Speaker 1: does it not grow? But what is different in what
Speaker 1: makes it different? And if that's beyond the scope, then
Speaker 1: we can just say we'll get to that another time.
Speaker 4: I do think it would be interesting to do a
Speaker 4: whole episode on that airing, because there is a lot
Speaker 4: to it. It's all going to depend on the depth
Speaker 4: of the wound of if there was a skin graft,
Speaker 4: where did that skin come from, whether melanocytes were completely lost.
Speaker 4: Those are our pigment producing cells, and so that's why
Speaker 4: a lot of times we see changes in pigment and
Speaker 4: then yes, like our body is healing by scar formation,
Speaker 4: especially if you have lost them the skin stem cells
Speaker 4: to where you're not fully regenerating the skin that was
Speaker 4: there before, but you are instead filling it with scar
Speaker 4: It's like it is a different tissue than the skin
Speaker 4: was initially.
Speaker 1: If that makes sense, Yeah, why, Yeah.
Speaker 4: We could do a whole episode on it someday.
Speaker 3: YEA.
Speaker 4: But what I think is really, I mean, there is
Speaker 4: so much work that has been done and it's such
Speaker 4: important work, but the biggest issue, there's a lot of
Speaker 4: biggest issues, but one of them is how are these
Speaker 4: new technologies going to be made available because right now
Speaker 4: most of the people who really could benefit from access
Speaker 4: to these new technologies do not have access to them.
Speaker 4: So the World Health Organization reports that globally there's at
Speaker 4: least eleven million people who have burns bad enough that
Speaker 4: they are being reported, which likely means that they are severe,
Speaker 4: so more than ten or twenty percent of your body
Speaker 4: surface area.
Speaker 1: That we don't have great numbers on that.
Speaker 4: Because we do not have like global repositories of burn data.
Speaker 4: No one's reporting all of this on a country by
Speaker 4: country scale. And this results in at least one hundred
Speaker 4: and eighty thousand deaths from burns worldwide every single year.
Speaker 4: And it's estimated that ninety percent of burns, and I
Speaker 4: think ninety five percent of deaths from burns occur in
Speaker 4: low and middle income areas of the world. And this
Speaker 4: is severe burns, not just burn burns. Mortality rates from
Speaker 4: burns have dropped substantially in high income countries, but that's
Speaker 4: to a much greater degree than the decreases in mortality
Speaker 4: in low and middle income countries. We also see a
Speaker 4: bimodal age distribution in who is most likely to have burns.
Speaker 4: Young children under age five and working age adults are
Speaker 4: the two highest groups that suffer from burns, and like
Speaker 4: I said in last week's episode, flame burns and scald
Speaker 4: burns are the most common types of burns, with chemical
Speaker 4: and electrical burns being relatively rare, and kids under age
Speaker 4: five are more likely to get scald burns than flame burns,
Speaker 4: so from hot water and things like that. In the US,
Speaker 4: where we have a little bit more like hard data,
Speaker 4: it's estimated that more than half a million people seek
Speaker 4: medical treatment for their burns each year.
Speaker 1: Wow.
Speaker 4: And that results in anywhere from twenty five to forty
Speaker 4: thousand hospitalizations depending on the year that you've looked at,
Speaker 4: and at least four thousand deaths in the US from
Speaker 4: burns every single year. Despite all of our advancements in treatment,
Speaker 4: and like we've mentioned, burn injuries can result in really
Speaker 4: severe scarring, which is painful and can be disfiguring, which
Speaker 4: can result in social stigma, isolation, and has a really
Speaker 4: profound effect on people's mental health health. And I don't
Speaker 4: want to discount the effect on the health of caregivers,
Speaker 4: the care of people who have had burn trauma is
Speaker 4: very prolonged, it can be very intensive, and that can
Speaker 4: be really hard on caregivers, especially if you don't have
Speaker 4: access to something like a specialized burn center, which even
Speaker 4: in high income countries, over twenty percent of the population
Speaker 4: in this country does not live within two hours by
Speaker 4: ground or air of a burn center, which means that
Speaker 4: they don't have access, and that's in a high income country.
Speaker 4: In low and middle income countries, they have even less access.
Speaker 4: So there's been a lot of research too on people
Speaker 4: who have suffered burns, people who have been caregivers of
Speaker 4: people with burns, and people who care, medical professionals and
Speaker 4: things on what do we need to do, what are
Speaker 4: the priorities in burn management? And the biggest ones that
Speaker 4: have been identified so far are improving the actual wound management,
Speaker 4: and so that's where I think most of the research
Speaker 4: that I have seen has really been in, which is
Speaker 4: like wound dressings and skin substitutes and all of these things.
Speaker 4: But the second most common response was improving psychosocial outcomes, yes,
Speaker 4: which I think that we have done maybe less of
Speaker 4: a great job of focusing on so. And then other
Speaker 4: things like rehab and helping to treat scarring after the
Speaker 4: fact were other things that were identified as kind of
Speaker 4: high priorities, And I think it shows that when we
Speaker 4: have access to dedicated facilities, to teams who are really
Speaker 4: experts in burn care, and to these incredible technological developments
Speaker 4: and advancements that we've seen, there is the potential for
Speaker 4: the treatment of burns to be phenomenal.
Speaker 1: Like, yeah, really really incredible, right, we have so many
Speaker 1: things in our toolkit. Yes, but yeah again who has
Speaker 1: access to the toolkit? Yeah?
Speaker 4: Yeah, and that Aaron is burns today.
Speaker 1: Yeah, I don't have no words. Yeah, So instead of a lot,
Speaker 1: I'll say sources, how about tell you where you can
Speaker 1: learn more? There we go, There we go again. I
Speaker 1: have a bunch of papers for this. I am a
Speaker 1: shout out. Just a few. There's by More nineteen ninety nine.
Speaker 1: Then and now treatment volume, wound coverage, lung injury, and antibiotics.
Speaker 1: It sort of like personal reflections on how treatment of
Speaker 1: burns has changed. And then by Jackson nineteen ninety one
Speaker 1: the evolution of burn treatment in the last fifty years.
Speaker 1: So from that's interesting paper. Then by Barrow and Herndon.
Speaker 1: I think it's a book chapter called history of Treatments
Speaker 1: of burns.
Speaker 4: Love it. I actually just I will still shout out
Speaker 4: again the paper I shouted out last week, which was
Speaker 4: from Nature Reviews Disease Primers. It has a lot in
Speaker 4: there about how we treat burns today, and it was
Speaker 4: from twenty twenty, so relatively recent. But I have some
Speaker 4: other ones as well. There was one from twenty twenty
Speaker 4: three from the International jour of Molecular Sciences that was
Speaker 4: called an Overview of Recent developments and the Management of
Speaker 4: burn Injuries. I found that one helpful. There was a
Speaker 4: couple from the Lancet. One that was from the Lancet
Speaker 4: Global Health that I mentioned that was called the top
Speaker 4: ten research priorities in Global burns Care. So that one
Speaker 4: was kind of how we need to focus on burn
Speaker 4: care going forward. Another one just specifically on hypertrophic scarring
Speaker 4: and how much we need to focus on that. A
Speaker 4: whole other paper on nanotechnologies. Oh my gosh, there's so
Speaker 4: much more. You can find them all on our website,
Speaker 4: this podcast will Kill You dot com under the episodes tab.
Speaker 1: You can thank you again so much to Emma for
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Speaker 4: Thank you to Leanna and Tom and Pete and Mark
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