Characteristic of Repairing Pathological and Physiological Changes

A revolutionary concept(Characteristic of Morphological Chages of Burn Injury Pathology) for the thorough repair of the aforementioned pathomorphological changes is put forward by the author after years of study of skin regeneration. 

The data derived from previous studies worldwide is marginally useful as it involved tissues treated by the standard treatment model of conventional burns surgery and burns care. 

Of note is that this treatment itself prevented people from understanding the natural repair mechanisms of burns wounds healing.

A case in point is Dr. Jeckson who stated that he had never had a chance to observe how burns wounds heal in spite of his several decades of experience in the research and treatment of burns.

What he had observed, admittedly, was either the burns wound covered by crust/eschar and thick dressing, reactive granulation tissue, or the absence of burn tissue due to surgical excision.

His admission suggests that conventional burns therapy worldwide is limited to surgical excision and skin grafting therapy. 

Confirmation of that unfortunate fact is offered by the famous burn surgeon and chairman of the American Burn Association Dr. Deitch who stated in 1988: ‘Burn surgeons only know how to excise and graft skin instead of how to regenerate skin.’ 

These remarks pinpoint the importance of evaluating innovations in burns regenerative medicine and therapy.

Following the separation, rejection or discharge of necrotic tissues, the residual viable skin tissue or information tissue (isogenous tissues and cells residing in subcutaneous tissue related to dermis and epidermis) remains in the injured area. 

The pathological change of natural burns repairing begins as follows:

1.  Superficial second-degree burns involve only the epidermis, so the repairing takes place in the epidermis tissue.

The wound itself heals spontaneously without leaving a trace of scar whatever therapy is used since epidermis is formed by the layer-by-layer changes of basal cell layers.

2   Deep second-degree burns involve part or most of the necrotic dermis.

The pathology of repairing varies when different therapeutic techniques are applied. When treatment of dry and crust formation is applied, necrotic tissues are promoted to form a crust that is rejected from the underlying viable tissues along with the zone of leukocyte infiltration. 

If no infection and suppurative pathological change occur in the sub-crust, then the epithelial cells in residual dermis may grow along the zone of sub-crustal leukocyte infiltration. This then covers the wound under which dermis collagenous fibers and blood vessels proliferate in a disorderly manner.

The wound closes pathologically via this epithelization and scar formation follows the shedding of crust. If subcrustal infection and suppurative pathological changes occur, the wound may be further injured and deep second-degree burns may progress into third-degree trauma followed by a full-thickness necrosis resulting in granulation of the wound. 

The wound resolves with permanent pathological healing even if it had a chance to close by skin grafting. However, suppose the necrotic tissues were to be discharged from the wound without causing any injury to the wound. Suppose also that the residual viable tissues were retained to the degree that a physiological environment is established sufficient to promote spontaneous residual tissue repair. 

In this case, we would witness wound healing without scar formation. By managing environment and local substances to optimize endogenous repair and regeneration, we facilitate healing of deep second-degree burns resulting in scar-free healing and recovery to normal tissue anatomy and physiology. 

3. Third-degree burns are equivalent to full-thickness burns and involve tissue beneath the dermis. 

They are defined according to the concept of skin burns. 

In terms of anatomy or histology or cytology, the skin consists of two layers: the epidermis derived from ectoderm, and dermis (corium) derived from meso-blast. 

Full-thickness refers to the combination of epidermis and dermis. As the conjunction area between the underlayer of dermis and subcutaneous tissue is an area like a rugged highland instead of a plane, full-thickness projects deep into the surface layer of subcutaneous tissue. In other words, full-thickness or third-degree burns involve tissue as deep as the surface layer of the subcutaneous tissue.

Burn injuries involving most of the subcutaneous tissue and muscle layer extend beyond and should be excluded from the conception of skin burns. Diagnosis should be made in accordance with the injured tissue. 

For example, burns involving partial or major subcutaneous tissue should be termed subcutaneous tissue burns, burns involving full subcutaneous tissue and muscle layer should be termed muscle burns, burns involving full muscle layer and bone should be termed bone burns. 

It is same with the diagnosis of electric injury: burns caused by electricity are the ordinary skin burns while burns caused by electric current involve skin, subcutaneous, muscle, bone as well as other tissues which electric current penetrates.

For a better and simpler understanding, Dr. Xu has tried to classify third-degree burns into third superficial and third deep burns, of which the latter refers to non-skin burns involving the tissue under the subcutaneous layer. 

Thus, we might differentiate between skin and non-skin burns.

The pathological repairing of third-degree burns is characterized by the repairing of granulation tissue. 

There is no epithelial cell in subcutaneous tissue for closing the wound due to the full-thickness necrosis. 

It is conventionally recognized that a wound with a diameter of around 2 cm may close by migration of epithelial cells from the wound margin and heal spontaneously, while the larger wound should only be closed and healed by surgical skin grafting. 

Remarkably, despite this conventional wisdom, the author’s studies proved that third-degree burns wounds therapy is possible through direct pathological or physiological healing without surgical intervention. 

The results of these studies indicated that: 

(1) Subsequent to burns, the adult tissue cells in residual viable subcutaneous and/or fat layer may be converted into adult skin stem cells.

(2) Adult stem cells have the potential to regenerate and duplicate the organ of full-thickness skin. 

 

(3) The aforementioned regeneration and duplication was accomplished by the collaborative efforts of endogenous human regenerative potentials and control of localized tissue environmental conditions.