title: Cooling of burns: Mechanisms and models.
abstract: The role of cooling in the acute management of burns is widely accepted in clinical practice, and is a cornerstone of basic first aid in burns. This has been underlined in a number of animal models. The mechanism by which it delivers its benefit is poorly understood, but there is a reduction in burns progression over the first 48 h, reduced healing time, and some subjective improvements in scarring when cooling is administered after burning. Intradermal temperature normalises within a matter of seconds to a few minutes, yet the benefits of even delayed cooling persist, implying it is not simply the removal of thermal energy from the damaged tissues. Animal models have used oedema formation, preservation of dermal perfusion, healing time and hair retention as indicators of burns severity, and have shown cooling to improve these indices, but pharmacological or immunological blockade of humoural and cellular mediators of inflammation did not reproduce the benefit of cooling. More recently, some studies of tissue from human and animal burns have shown consistent, reproducible, temporal changes in gene expression in burned tissues. Here, we review the experimental evidence of the role and mechanism of cooling in burns management, and suggest future research directions that may eventually lead to improved treatment outcomes.
authors.affiliation: Department of Plastic Surgery, Stoke Mandeville Hospital, and the Department of Oncology, University of Oxford, Green Templeton College, 43 Woodstock Road, Oxford OX2 6HG, United Kingdom. Electronic address: edmund.wright@oncology.ox.ac.uk.
authors.forename: E H
authors.initials: EH
authors.lastname: Wright
authors.affiliation: Medical Oncology, Department of Oncology, University of Oxford, Green Templeton College, 43 Woodstock Road, Oxford OX2 6HG, United Kingdom.
authors.forename: A L
authors.initials: AL
authors.lastname: Harris
authors.affiliation: Department of Plastic Surgery, Oxford University Hospitals, and the Botnar Research Centre, University of Oxford, Green Templeton College, 43 Woodstock Road, Oxford OX2 6HG, United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: Furniss
mesh_terms: D000818:Animals; D002056:Burns / Q000628:therapy*; D017679:Cryotherapy / Q000379:methods*; D004195:Disease Models, Animal; D004487:Edema; D005392:First Aid / Q000379:methods*; D006801:Humans; D012867:Skin / Q000098:blood supply* / Q000276:immunology / Q000473:pathology; D013997:Time Factors; D014945:Wound Healing
keywords: Animal; Burn; Cooling; Human; Mechanism; Model