16 Chapter 1 proliferation of keratinocytes and production of collagen, which are required for tissue restoration [55]. After substantial burn injury, it is thought that processes in the immune response are derailed, leading to persistent inflammation. Ongoing inflammation and an aberrant wound healing process can lead to long-term sequalae such as excessive scar formation, hypertrophic scars and contractures [6,38,56]. Such functional and cosmetic impairments will also impact patients’ mental well-being [14,57]. The processes in wound healing are connected to one another and inflammation proposedly plays a central role (Figure 3). Some of these processes are better elucidated than others. For instance, it is still poorly understood which immune reactions are distorted during burn injury or how bone marrow stress response leads to reduced lymphocyte activity and immune deficiency. Also, a great portion of the available evidence comes exclusively from animal studies [58]. It is therefore necessary to shine more light on the reactions in the burn-induced immune response and to bridge the gap between animal data and the human situation [59]. To limit complications and improve wound healing in patients, it is of utmost importance that the involved immune cells and inflammatory mediators are studied in more detail. More information on specific subsets and interplay between cells will help to design more effective ways to improve wound healing after major burn injuries. Figure 3. Scheme of reactions and consequences to burn injury. It highlights a central role of the immune response. SYNTHESIS OF AVAILABLE LITERATURE Researchers have previously investigated burn injury and have sought for ways to improve treatment. Most investigational or interventional studies in the field of burn injury have been performed on experimental animals [58,60,61]. Most of these studies focused on only a few aspects of wound healing and inflammation. Since it is difficult to keep up with all the information and because existing evidence is scattered, there is a strong need for an overview of the available literature [62]. Systematic reviewing
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