title: The burn wound exudate-an under-utilized resource.
abstract: BACKGROUND
  The burn wound exudate represents the burn tissue microenvironment. Extracting information from the exudate relating to cellular components, signaling mediators and protein content can provide much needed data relating to the local tissue damage, depth of the wound and probable systemic complications. This review examines the scientific data extracted from burn wound exudates over the years and proposes new investigations that will provide useful information from this underutilized resource.
  
  
  METHODS
  A literature review was conducted using the electronic database PubMed to search for literature pertaining to burn wound or blister fluid analysis. Key words included burn exudate, blister fluid, wound exudate, cytokine burn fluid, subeschar fluid, cytokine burns, serum cytokines. 32 relevant articles were examined and 29 selected as relevant to the review. 3 papers were discarded due to questionable methodology or conclusions. The reports were assessed for their affect on management decisions and diagnostics. Furthermore, traditional blood level analysis of these mediators was made to compare the accuracy of blood versus exudate in burn wound management. Extrapolations are made for new possibilities of burn wound exudate analysis.
  
  
  RESULTS
  Studies pertaining to burn wound exudate, subeschar fluid and blister fluid analyses may have contributed to burn wound management decisions particularly related to escharectomies and early burn wound excision. In addition, information from these studies has the potential to impact on areas such as healing, scarring, burn wound conversion and burn wound depth analysis.
  
  
  CONCLUSIONS
  Burn wound exudate analysis has proven useful in burn wound management decisions. It appears to offer a far more accurate reflection of the burn wound pathophysiology than the traditional blood/serum investigations undertaken in the past. New approaches to diagnostics and treatment efficacy assessment are possible utilizing data from this fluid. Burn wound exudate is a useful, currently under-utilized resource that is likely to take a more prominent role in burn wound management.
authors.affiliation: Director Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States. Electronic address: awidgero@uci.edu.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Widgerow
authors.affiliation: Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States.
authors.forename: Kassandra
authors.initials: K
authors.lastname: King
authors.affiliation: Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Tocco-Tussardi
authors.affiliation: Research Fellow Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States.
authors.forename: Derek A
authors.initials: DA
authors.lastname: Banyard
authors.affiliation: Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States.
authors.forename: Ryan
authors.initials: R
authors.lastname: Chiang
authors.affiliation: Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States.
authors.forename: Antony
authors.initials: A
authors.lastname: Awad
authors.affiliation: Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States.
authors.forename: Hassan
authors.initials: H
authors.lastname: Afzel
authors.affiliation: Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States.
authors.forename: Shweta
authors.initials: S
authors.lastname: Bhatnager
authors.affiliation: Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States.
authors.forename: Satenik
authors.initials: S
authors.lastname: Melkumyan
authors.affiliation: Plastic Surgery Dept, University of California, Irvine, United States.
authors.forename: Garrett
authors.initials: G
authors.lastname: Wirth
authors.affiliation: Plastic Surgery Dept, University of California, Irvine, United States.
authors.forename: Gregory R D
authors.initials: GR
authors.lastname: Evans
mesh_terms: D001458:Bandages; D002056:Burns / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D002921:Cicatrix / Q000276:immunology; D016207:Cytokines / Q000276:immunology*; D005122:Exudates and Transudates / Q000166:cytology / Q000276:immunology*; D006801:Humans; D014945:Wound Healing / Q000276:immunology*
chemical_list: D016207:Cytokines
keywords: Blister; Burn fluid; Cytokines; Diagnostics; Exudate; Subeschar fluid