Persistent wound infection delays epidermal maturation and increases scarring in thermal burns

Authors

  • Adam J. Singer MD,

    1. From the Departments of Emergency Medicine and Dermatology, State University of New York at Stony Brook, Stony Brook, and
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  • Steve A. McClain MD

    1. From the Departments of Emergency Medicine and Dermatology, State University of New York at Stony Brook, Stony Brook, and
    2. Department of Pathology, Montefiore Medical Center, Bronx, New York.
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  • Presented in part at the Annual Meeting of The Society for Academic Emergency Medicine, May 2001, Atlanta, GA.

Reprint requests: Adam J. Singer, MD, Department of Emergency Medicine, Stony Brook University, UH-L4-515, Stony Brook, NY 11794-7400. Fax (631) 444-6233; Email: adam.singer@sunysb.edu.

Abstract

We developed a reliable scale measuring epidermal maturation during wound healing and determined the effects of persistent infection on epidermal maturation and dermal scarring after cutaneous burns. A secondary analysis of data from 80 contaminated burns collected during a randomized experiment comparing four topical burn therapies in a contaminated porcine burn model was performed. Persistent infection was defined histologically as the presence of intradermal neutrophils containing bacteria at 14 days. Epidermal maturation at 14 days was classified into one of five categories from least (0) to most (4) mature using strictly defined criteria. Dermal scarring was classified as none, superficial, or deep. The epidermal classification system was highly reliable (ρ = 0.97). At 14 days, 18% of burns were infected. Most infected wounds (79%) had an immature epidermis (types 0–2) while most noninfected wounds (75%) had a mature epidermis (types 3 or 4); χ2 and χ2 for linearity both p < 0.001. Deep scars were more common in infected (93%) than noninfected wounds (29%), p < 0.001. We conclude that our scale is reliable and that persistence of infection 14 days after thermal injury is associated with delayed epidermal maturation and deep scarring. (WOUND REP REG 2002;10:372–377)

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