A human model of burn injury that quantifies the benefit of cooling as a first aid measure

Background Burn injuries are a major cause of morbidity and mortality worldwide. Cooling of burns is widely practiced as a first aid measure, but the efficacy of cooling burns in human skin has not been demonstrated. A safe, consistent, ethically acceptable model of burning and cooling in live human skin in vivo was developed, and used to quantify the effects of cooling. Methods Novel apparatus was manufactured to create and cool burns in female patients who were anaesthetised for breast reconstruction surgery using a deep inferior epigastric artery perforator flap. Burns were excised between one and three hours after creation and analysed using histopathological assessment. Differences between groups were tested for statistical significance using ANOVA or paired t-tests as appropriate. Results All 25 patients approached agreed to take part in the study. There were no adverse events. Increased contact duration lead to increased burn depth, with a contact time of 7.5 seconds at 70˚C leading to a mid-dermal burn. Burn depth progressed over time following injury, but importantly this was modified by cooling the burn at 16˚C for 20 minutes. On average, cooling salvaged 25% of dermal thickness. Conclusions This is the first study to demonstrate favourable effects of cooling on human burns. Public heath messaging should further emphasise cooling in the first aid management of burns. This model system will allow dissection of the molecular effects of cooling burns, and provide a platform for testing novel therapies aimed at reducing the impact of burn injury.