Association of Dutch Burn Centres

IntroductionInfected chronic wounds present a dual therapeutic challenge, requiring both the eradication of pathogens and the restoration of tissue homeostasis. Often the current treatments are ineffective against multidrug-resistant (MDR) pathogens and fail to promote wound healing. Antimicrobial peptides, such as bovine lactoferricin (LfcinB), offer a promising alternative owing to their broad-spectrum activity and immunomodulatory properties. The branched tetrameric LfcinB-derived peptide (LBT; (RRWQWR)4K2Ahx2-C2) is particularly attractive, as its multivalent architecture enhances antimicrobial potency and provides a tunable branching core for structural modifications.MethodsIn this study, three novel tetrameric variants were designed by substituting the L-lysine branching residues in LBT with non-natural lysine derivatives to alter motif orientation and linker flexibility. Among the novel peptides, the diaminopropionic acid (DAP)-modified variant, (LBT-1; (RRWQWR)4DAP2Ahx2-C2) was selected as best-performing candidate based on antimicrobial and hemolytic activity assessment.ResultsCompared to LBT, the novel LBT-1 demonstrated superior activity against methicillin-resistant Staphylococcus aureus (MRSA) and MDR Acinetobacter baumannii, achieving rapid bactericidal action within 5 minutes. LBT-1 also exhibited potent activity across the ESKAPE(E) panel and against the emerging MDR fungal pathogen Candidozyma auris. Beyond direct antimicrobial effects, LBT-1 enhanced macrophage-mediated bacterial clearance, neutralized endotoxins, and accelerated wound closure in vitro. Importantly, LBT-1 showed superior pro-angiogenic activity in vitro and achieved significantly higher bactericidal activity against MRSA in an ex vivo human skin wound infection model. This study identifies LBT-1 as a multifunctional therapeutic that addresses key pathological features of chronic wounds.ConclusionTogether, these findings validate our peptide design strategy, revealing previously unknown characteristics of the LBT peptide and the enhanced multifunctionality achieved with LBT-1, supporting its continued development for chronic wound management.

ABSTRACTThis study aimed to determine if skin types can be accurately assessed via melanin scores measured with a colormeter, and whether scar characteristics of people with different skin types are different at various stages of healing. Melanin scores of a Cortex DSM Colormeter were validated against the Fitzpatrick skin type questionnaire in healthy volunteers and unaffected skin of burn and scar patients (N = 137) to determine melanin index cut‐offs per skin type. Scar quality in children and adults at 3, 6, and 12 months post‐burn using DSM Colormeter and the Patient and Observer Scar Assessment Scale (POSAS) was analysed in a cohort of > 1000 patients. Data from 137 individuals showed good correlation between melanin index and Fitzpatrick skin types (Spearman's rho: 0.72 Dermaspectrometer, 0.69 DSM II; p < 0.0001). Scar characteristics varied by skin type for erythema, pigmentation, vascularization, and overall POSAS scores. Children had significantly thicker scars than adults, regardless of skin type, varying from 0.3 to 1.4 points difference on the observer scale at 12 months post burn. We conclude that skin type can be objectively classified using the melanin index, showing a strong correlation with the Fitzpatrick questionnaire. Skin type influences scar outcomes, especially pigmentation and vascularization. Children, particularly those with lighter skin, tend to develop thicker scars than adults. Recognising these differences can improve scar management and patient education.

Amplitude-mode (A-mode) ultrasonography is a promising technique to monitor loss and recovery of skeletal muscle in patients with burns. However, its clinimetric properties are unknown. Therefore, we determined its feasibility, interrater, and intrarater reliability, and clinical utility. Skeletal muscle thickness of upper arms and legs was assessed longitudinally in hospitalized adult patients with ≥ 5 % total body surface area (TBSA) burns, by pairs of two out of five raters. Feasibility was evaluated by % successful assessments, reliability by intra-class correlation coefficients (ICCs), and clinical utility by smallest detectable change (SDC). Thirty-four patients participated (77 % male; mean age 48 ± 17 y, median TBSA burned 12 % [IQR 7-19]). Images were acquired on 69 % of planned occasions, and 89 % of images could be analyzed. Overall interrater ICCs were ≥ 0.84 (for pairs: 0.63-0.99) and intrarater ICCs were ≥ 0.95 (for pairs: 0.45-0.99). The overall interrater SDC was ≤ 33 % of the measured mean (for pairs: 3-52 %), while intrarater SDC was ≤ 20 % (for pairs: 3-48 %). All five raters could measure legs with moderate to excellent reliability, whereas for arms some demonstrated poor reliability. A-mode ultrasonography assessment of skeletal muscle in patients with burns is feasible. However, reliability and clinical utility are rater-dependent; therefore we recommend assessments by the same rater.

The Quality Cost Indicator (QCI) model supports value-based health care at the institutional level, by calculating disease-specific health outcomes per unit cost over time. The aim of this study was to adapt the QCI model for specialized burn care (the BC-QCI model) and explore its utilization using real-world data. Burn care outcome indicators were selected through an iterative process with multiple stakeholders. Threshold values were established per outcome indicator and average total healthcare costs were calculated. A cohort of adult burn patients (n = 1449) admitted for at least one day and/or had undergone surgery in Dutch burn centers between 2020 and 2023 was used, with a follow-up period of 12 months. The proportion of patients who achieved textbook outcome (i.e., having achieved all the outcome indicators), the average total costs per patient, and QCI values were calculated. Of all patients, 54% achieved all five outcome indicators (i.e., length of stay, wound infections, other complications, discharge destination, and predicted mortality). The most successful outcome indicator was ‘predicted mortality’ (passed by 99% of the population), the least successful outcome indicator was ‘length of stay’ (62%). The patients who failed to achieve one or more outcome indicators (46%) had significantly higher average total costs compared to the patients who achieved textbook outcome (54%) (€50,134 [€47,810-€52,850] vs. €11,721 [€11,096-€12,429]). The BC-QCI model is a solid foundation to provide insights into the outcomes and costs for specialized burn care at the institutional level.

s of the plenary and special interest sessions, workshops, and oral and poster presentations of the 21st EBA Congress in Berlin, Germany, from 3 to 6 September 2025.

Sudden disruptions to the social environment of older adults living alone, such as the COVID-19 pandemic, can challenge their ability to maintain well-being. This study employed an interpretative phenomenological analysis to explore how Dutch older adults (≥65years) living alone maintained their well-being during the COVID-19 pandemic. Between June and October 2021, we conducted 20 semi-structured interviews with older adults living alone in the Netherlands. Participants were recruited through online newsletters and home care and social work institutions. We identified three key themes. The theme "Filling the void of being alone" captures participants' ongoing search for a sense of connection, and the challenges they faced related to social exclusion. The theme "Navigating challenging situations to maintain well-being" illustrates participants' struggle with disrupted daily routines and how they tried to regain a sense of control to stay well. Lastly, the theme "Reverberating echoes of the past" conveys how participants' life histories shaped their responses to the pandemic and the role of acceptance in this process. Overall, our results highlight great individual variability in how older adults living alone maintained their well-being during the COVID-19 pandemic. This underscores the need for interventions and support strategies that accommodate the unique needs of older adults living alone when opportunities for social engagement are limited.

Collagen is critical to the structure and function of skin tissues, with the collagen I/III ratios influencing fibrillogenesis, fiber organization, and skin mechanics. Abnormal collagen organization, such as in fibrosis or scar tissue, compromises both skin functionality and aesthetics. In this study, we employed label-free polarization resolved second harmonic generation (PSHG) microscopy to investigate collagen structure in artificial collagen matrices with various Col I/III ratios at the fibril scale (∼1 to 3μm) and in ex vivo human healthy and scarred skin at the fiber scale (∼10 to 20μm). Complementary third harmonic generation (THG) microscopy provided additional structural information. Our results indicate that an increasing Col I/III ratio is associated with longer fibril length, higher PSHG intensity, and a reduced effective α-helix pitch angle of fibrils. In pure Col I, the effective α-helix pitch angle is determined to be 47.72∘. These observations indicate alterations in fibril assembly. Furthermore, although the α-helix pitch angle of fibers in both healthy and scarred skin was approximately 46.7∘, healthy skin exhibited 24% greater variability in fiber orientation, suggesting a more randomized organization compared to scar tissue. THG imaging further revealed a higher cellular density in scar tissue, consistent with the inflammatory activity associated with wound healing. Immunohistochemical (IHC) staining using dermatansulphate and Col III-specific antibodies confirmed that the Col I/III ratio is higher in healthy skin (2.2) than in scarred skin (1.6). These findings underscore the potential of PSHG microscopy for label-free, quantitative assessment of collagen structure across multiple scales, with THG offering complementary cellular insights. This integrated approach represents a promising strategy for real-time, in vivo monitoring and automated quantification of collagen organization in clinical applications, including dermatology, burn treatment, and fibrosis monitoring.

Perceived fatigue significantly impacts quality of life after burns, yet how often it occurs is unknown. Therefor this study assessed the prevalence of perceived fatigue of burn survivors. In February 2023, a systematic literature search was performed in CINAHL, Embase, PsycInfo, PubMed and Web of Science. Studies reporting the prevalence of post-burn perceived fatigue were included. In ten cross-sectional studies of moderate-high quality with measurements between 5.3 days and 42 years post burn, the prevalence of perceived fatigue varied between 5 % and 78 % with no apparent time trends. Broad study populations hindered explaining this varying prevalence by age or %TBSA. In four high-quality longitudinal studies with 3-5 measurements between 1 and 24 months post burn, the prevalence decreased over time, dropping from approximately 70 to 50 % in adults and 65 to 28 % in children. Studies used various measurement instruments and cut-off points for operationalizing perceived fatigue, severely limiting the interpretation and comparison of prevalence rates across studies. The high prevalence and persistent nature of perceived fatigue among burn survivors emphasize its crucial role in burn rehabilitation. Future studies should prioritize identifying individuals with adverse trajectories of perceived fatigue and unravelling underlying mechanisms to develop effective treatments for reducing post-burn perceived fatigue.

In adults, scars are formed after deep skin wound injuries like burns. However, the fetal microenvironment allows for scarless skin regeneration. One component that is abundantly present in the fetal extracellular matrix is hyaluronan (HA). To study whether biomaterials with HA improve wound healing, type I collagen scaffolds with and without HA were prepared and characterized. Their immune effect was tested using macrophages and their phenotypes were analyzed through cell surface markers and cytokine expression after 48 h. Since fibroblasts are the main cellular component in the dermis, adult, fetal and eschar-derived cells were cultured on scaffolds for 14 days and evaluated using histology, gene and protein expression analyses. Biochemical assays demonstrated that HA was successfully incorporated and evenly distributed throughout the scaffolds. Macrophages (M0) cultured on Col I+HA scaffolds exhibited a profile resembling the M2c-like phenotype (CD206high, CD163high and IL10high). HA did not significantly affect gene expression in adult and fetal fibroblasts, but significantly reduced scarring-related genes, such as transforming growth factor beta 1 (TGFB1) and type X collagen alpha 1 chain (COL10A1), in myofibroblast-like eschar cells. These findings highlight the potential of incorporating HA into collagen-based skin substitutes to improve the wound healing response.