Infection
Colonization with micro-organisms, Staphylococcus aureus in particular, is a common feature of larger area burn wounds despite high standards of care. Current topical treatments such as Flammazine require improvement because re-epithelialization can also be impaired. Although antibiotics are available, the general antimicrobial treatment policy is to limit the use of antibiotics in relation to development of bacterial multidrug resistance, which continues to increase steadily worldwide.
Interaction between virulence factors and defense mechanisms in bacterial infections of burn wounds: improved models for personalized treatment design (grant 22.105)
We have been using burn wound models to test the effect of various antimicrobials. However, survival and colonization of S. aureus in burn wound models was variable and differed greatly between bacterial strains and skin donors, which makes the interpretation of the data more difficult. We need additional information on this host-pathogen interaction to be able to develop meaningful models that facilitate the development of new antimicrobial treatment strategies in (burn) patients.
Burns Research Lab Beverwijk, Tianne Spreij
Partner: Erasmus MC, Streeklab Haarlem
Wound healing & treatment innovations
By gaining insight into the processes that lead to wound healing and scar formation, new treatment methods are developed that reduce or possibly be prevented.
Development and implementation of a tissue-engineered, autologous skin construct (grant 22.110)
Deep (burns) wounds result in scars, which can have a major impact on the quality of life of patients. The current treatment, transplantation of autologous skin graft, still has many disadvantages such as donor-site morbidity and shortage of donor site. The aim of this research is to develop an autologous skin construct that can be produced in a short time and is able to cover a large wound area. This will result in less scar formation and fewer operations, which will improve the quality of life of the patient.
Burn Research Lab Beverwijk, Prof. Dr. E. Middelkoop
Understanding dysregulation in the immune response after burn injury: the road to therapeutic intervention (grant 22.106)
Burns are often followed by a derailed immune response that can cause damage to surrounding tissues and increases the risk of infection. In tur slowing down the recovery of patients. To improve treatment of burn injury, safe and effective ways to restore immune homeostasis are needed. With sophisticated in vitro cell- and skin models, defined aspects of the post-burn immune response can be simulated. These models will function as a platform to study burn-induced immune reactions and test interventions that modulate immune reactions to improve wound healing without the need for animal experimentation.
Burns Research Lab Beverwijk, Patrick Mulder
Partner: Stichting Proefdiervrij
Application of hair follicles/hair follicle stem cells for skin constructs (HARESCON, grant PPS 21.01)
Skin appendages, including hair follicles (HF) are necessary for proper skin function. Deep (burn) wounds result in loss of these appendages and they cannot be restored with the current treatments. Stem cells resident in HF are involved in hair regeneration and wound healing and previous studies have shown that implementation of these cells in in vivo animal models induce hair growth. We aim to translate this strategy to humans by generating 3D skin constructs with the ability to regenerate hair.
Burn Research Lab Beverwijk, Prof. Dr. E. Middelkoop
Partner: HASCI, Amsterdam, C. Gho, MD PhD
NETosis in burn-induced microvascular thrombosis in the skin and wound deepening: a causative factor, biomarker and therapeutic target (grant NETOSIS)
In burned patients, the conversion of partial thickness burn wounds to deeper or full thickness burn wounds is a common occurrence. This wound deepening leads to increased tissue loss, delayed healing, hypertrophic scarring, contractures, increased need for surgical excisions, an increased chance of burn wound infections and death. In this project we aim to unravel the mechanisms underlying burn-induced NETosis and resultant microvascular thrombosis and damage and to determine how these relate to wound deepening and suboptimal healing. We also aim to study whether therapeutic inhibition of NETosis can counteract this conversion.
Amsterdam UMC, Burn Research Lab Beverwijk, Red Cross Hospital, Britt v/d Leeden
SkinTERM, Horizon2020 (H2020-MSCA-ITN-20, project number 955722)
SkinTERM stands for Skin Tissue Engineering and Regenerative Medicine and aims to convert the normal mode of skin repair into skin regeneration by delivering excellently and multidisciplinary trained scientists able to take this research area to the next level. https://cordis.europa.eu/project/id/955722
Amsterdam UMC, Burn Research Lab Beverwijk, Dr. Bouke Boekema
Unravelling the inflammatory response and the influence of Alkaline Phosphatase in severe burn patients by mathematical modelling, MAP4B-study (grant 18.01)
The project will advance scientific fundamental knowledge on inflammatory aspects of severe burns and the influence of Alkaline Phosphatase on this reaction. This will allow the development of new treatment strategies to improve health care and quality of life for severe burn wound patients and possibly other fibrotic pathologies, and optimal recovery of severe burn patients will reduce health care costs due to shorter hospital stay and reduced time out of work.
Red Cross Hospital Beverwijk, Burn Research Lab Beverwijk, Dr. A. Pijpe.
PAST4Future
A platform in which materials and technologies will be developed to stimulate research with so-called organotypic skin, small pieces of cultured skin. The goal of this project is to widely implement these skin models for better skin research and facilitate the development of novel therapeutics for skin diseases.
Projectnumber: 62003784 https://past4future.org/
The effect of cerium nitrate treatment on the inflammatory response in patients with burns
In this study we will address the working mechanism of Flammacerium at the cellular level in adult humans with (full thickness) burn wounds. The results of the study will provide more knowledge about the precise working mechanism of Flammacerium, and might be a game changer in burn care worldwide, whereby overall mortality and scar formation can be further reduced.
Burn Centre Groningen, Burn Research Lab Beverwijk, SMHJ Scholten-Jaegers
The potential use of Rotational Thromboelastometry (ROTEM) in burn care (grant 19.102)
Burn injuries are a common global trauma with systemic effects, including abnormal clotting function. Viscoelastic clotting tests offer real-time insights into clotting compared to traditional tests. A case study at the Burn Center Rotterdam highlighted the importance of monitoring clotting function, as abnormal results were associated with the development of a venous thromboembolism.
Maasstad Hospital Rotterdam, Joeri Slob
Human extracellular matrix based hydrogel for clinical applications and organotypic skin models
This study seeks to create a new hydrogel based on human extracellular matrix (hECM) to replace rat tail collagen in reconstructed human skin models. The goal is to develop a fully human-based hydrogel suitable for clinical applications as a dermal matrix.
Amsterdam UMC, Ibrahim Korkmaz
Scar treatment & reconstructions
When burn patients are discharged from the hospital, a big challenge begins: coping with scars. Sometimes these scars are very thick, red and rough (hypertrophic), which can be debilitating. Much research on burns is therefore aimed at improving or preventing scars.
POSAS-kids
The Patient and Observer Scar Assessment Scale (POSAS) is a widely used tool for measuring scar quality, but not developed for children. The project aims to address this gap by developing a version of the POSAS tailored to children with burn scars.
Red Cross Hospital Beverwijk, Frederique Kemme
Rehabilitation & function
The ultimate challenge of burn care is how best to enable people who have sustained a burn injury to return to their pre-injury functional status, while maximizing their emotional and cosmetic outcomes. Achieving adequate, if not pre-injury, levels of functioning is of course important on the short term. There is also a growing understanding however, of the importance of maintaining certain levels of fitness and activity throughout life to prevent morbidity and disability later on in life. Ensuring that patients timely achieve their maximal levels of functioning is thus also important to prevent them from getting into the negative spiral of deconditioning, inactivity, and disability on the long term. Studies are aimed at enabling patients to function as well as possible again.
Lifelong Fitness Testing (LIFT): Development of a Steep Ramp Test Toolkit for monitoring cardiorespiratory fitness in adults and elderly (grant 20.01)
One of the potential consequences of burns is a reduction in cardiorespiratory fitness (CRF). As CRF is predictive for (long-term) health and functioning, recovery of CRF after hospital discharge is important. In this project, the feasibility of the steep ramp test, (SRT), a short maximal exercise test on a cycle ergometer, will be explored.
Martini Hospital Groningen, prof. MK Nieuwenhuis
Patients’ perspectives on adapting to life after TEN: identifying long-term health problems (grant 20.102)
Toxic Epidermal Necrolysis (TEN) is a rare, but very serious disease. The Dutch burn centres are expertise centres for TEN disease. Despite some overlap with burn care, nurses are faced with specific care problems in TEN patients and patients may face typical physical and psychosocial problems related to TEN. The objective of this study is to identify patient-perceived affected physical, psychological and social domains after TEN using a qualitative approach.
Maasstad Hospital Rotterdam, Margriet van Baar
National Specialised Burn Care, Education & Research
The mission of our consortium, consisting of all three Dutch Burn Centres, is to achieve the best possible quality of life, autonomy and reintegration into daily life for every burn patient. We aim to reach this by optimal person-centred care matching a patient’s preferences and goals through providing the right care, at the right time, in the right place for the right price for every patient.
Part 1 – Early skin grafting versus conservative treatment for intermediate depth wounds
Many burn patients have intermediate burn wounds. The optimal acute care for these wounds is a major topic of debate worldwide and there is no gold standard or consensus on the best treatment strategy. It is therefore of utmost importance that a strategy is applied that aligns with a specific patient’s preferences and goals. The aim of this Subproject is therefore to optimize person-centred acute burn care by ensuring that patients’ preferences and goals are met in the decision to undergo early skin grafting (<7 days) or conservative treatment.
Maasstad Hospital Rotterdam, Roos Salemans, SalemansR@maasstadziekenhuis.nl
Part 2 – Tissue Engineered skin constructs; applying shared decision making to meet patients’ goals and preferences
Tissue engineered (TE) skin constructs have been introduced in burn care to improve quality of wound healing however despite promising results, tissue-engineered products still do not have firm footing in treatment protocols. Tissue-engineered products are not a ‘one size fits all’. Our aim is to improve patient-centred burn care and to create effective personalized treatment strategies of Tissue-engineered (TE) skin constructs for patients with full thickness wounds.
Red Cross Hospital Beverwijk, Anna van den Bosch, avandenbosch@rkz.nl
Part 3 – A blended person-centred aftercare program, directed at patients’ self-management
The aim of the overarching project is to improve person-centered burn care by developing and embedding a systematic and sustainable value-based healthcare (VBHC) framework using existing data registries. In this Subproject on aftercare we will develop, implement, and study the effectiveness of a blended person-centered aftercare program, directed at patients’ self-management.
Martini Hospital Groningen, Sharon Blok
Part 4 – Value based burn-care
In recent years, value-based care has become increasingly significant in healthcare. Value-based care prioritizes providing the best care for the patient while also adding value to the patient’s experience. This study aims to create and utilize methods to assess the cost-effectiveness of value-based burn care. It involves examining health outcomes that are significant to patients relative to the costs associated with burn care.
Martini Hospital Groningen, Raaba Thambithurai
Psychology
Although the majority of people with burns are able to achieve a satisfactory quality of life after a burn injury, there is a group of patients who do not reach this level. This may mean that some health-related issues are overlooked.
A nurse-led program for nurses to support adolescents towards adulthood
The aim of this project is to develop, implement, and evaluate a nurse-led program that enables nurses and nurse specialists to support the transition to adulthood for adolescents after burn injuries and guide their parents through their changing roles. The project endeavours to enhance healthcare quality by emphasizing empowerment, self-management, and person-centered care, particularly concerning the transition to adulthood.
Martini Hospital Groningen, Ina van Ingen Schenau-Veldman
Exploration of Contextual Factors in Pain Experience: A Qualitative Study
Pain is a well-known issue in burn care, particularly pain stemming from frequent and extensive wound care procedures. Pain has negative implications for quality of life and well-being in both the short and long term. The objective of this study is to enhance personalized pain management by examining experiences of pain and the positive and negative influence of contextual factors on pain perception from the perspectives of patients, family members, and nurses among adults with burn injuries.
Red Cross Hospital Beverwijk, Chloe Balland
Computational Modelling
The Missing Link in Burn Wound Care; from bench to bedside and back (grant 22.112)
This project aims, through an interdisciplinary research approach, to model the clinical outcomes of scarring with underlying cellular and molecular processes. We aim to identify patterns between scar outcome parameters measured in the clinic and laboratory outcomes on cellular and tissue level using computational modeling to simulate scar formation. Deeper insights in (early stage) processes in scar formation, enable improvements in (timing of) interventions in burn care and quality of life of burn patients on long-term
Burn Research Lab Beverwijk, Adinda Mieras
Computational modelling of burn injuries (grant COMBI)
By forming an interdisciplinary network between various disciplines, processes involved in burn wound healing will be investigated using computational modelling. Preclinical data generated in existing and ongoing projects using 3D in vitro skin models (e.g. 1st, 2nd and 3rd degree burn wound models, hypertrophic scar model) will now be correlated to existing clinical data, including visual data, and integrated into the model. In this way, the dynamic processes and tissue organization occurring after burn wound infliction can be investigated.
Amsterdam UMC, Dr. H. I. Korkmaz
Use of machine learning to improve computational stimulations
Understanding the underlying biological mechanisms behind the formation of hypertrophic scars and contractures is essential for improving burn wound care. This is achieved through mathematical models expressed in terms of systems of coupled nonlinear partial differential equations. In our current study, we extend the principles of our model to multidimensional frameworks where we can vary the geometry of the wound, incorporate the epidermis, and simulate both contraction and hypertrophy. Subsequently, we train neural networks with these simulations and supplement them with available clinical datasets.
Hasselt University, Ginger Egberts
Necrotizing Soft Tissue Infections (NSTI)
The Necrotizing Soft Tissue Infections Knowledge project, Phase 2. SnapShot study (grant 22.111)
The aim of our study project is to gain insight in the epidemiology of NSTI in the Netherlands and further to improve early recognition and treatment to increase the survival, and the QoL of patients with/survivors of NSTI.
Red Cross Hospital Beverwijk, dr. A de Vries
Prevention
The etiology of severe burn accidents in children under 5 years old; implications for burn prevention (PrEvA2 study)
This research aims to identify factors influencing the behavior of individuals involved in severe burn accidents in children under 5 years old, as well as the environmental factors contributing to these accidents. This information will be used to develop effective prevention programs using the PRECEDE-PROCEED model.
Dutch Burns Foundation Beverwijk, Evan van Zoonen
