Novel methods to monitor and support the cutaneous microcirculation in burn wounds: A review

Abstract

Background. The cutaneous microcirculation refers to the dermal ultrastructure and the microvascular physiology of the skin, in both healthy and injured states. In the specialty of burn surgery, this concept is particularly relevant owing to its strong association with wound healing. In the clinical context, our ability to assess the cutaneous microcirculation is an area of increasing research. The ability to support and optimise the cutaneous microcirculation in burn wounds is an area in which we lack experience, both clinically and academically.

Objective. To collate information on methods of monitoring and supporting the cutaneous microcirculation in burn wounds.

Methods. We conducted a systematic review to find new techniques used around the world to (i) assess the cutaneous microcirculation; and (ii) optimise the cutaneous microcirculation in burn wounds to improve patient outcomes. We used online and paper-based scientific databases for our search. The goal of the review was to find the techniques that showed the greatest potential in their clinical applicability to burn surgery.

Results. A range of new techniques is being widely used to assess the cutaneous microcirculation. Most prominently, the use of laser Doppler flowmetry and in vivo reflectance confocal microscopy show the most promising results and the largest pool of data about their use. Both these methods are non-invasive and provide real-time in vivo information. However, the clinical applicability of these methods remains limited, and requires further research. A number of pilot studies have also been conducted using novel methods to optimise the cutaneous microcirculation in animals. These include the use of agents such as prostaglandins, doxycycline and extracorporeal shockwaves to stimulate or inhibit pathways involved in the cutaneous microcirculation.

Conclusion. Although there is a growing body of research into the assessment and optimisation of the cutaneous microcirculation in burn wounds, its clinical applicability still requires further investigation. The future is promising if further in vivo studies on animals and humans are conducted