Supplementation of glutamine and probiotics should be emphasised in scar prevention in conservatively managed children post burn injury

Abstract

Burns destroy the skin barrier and can lead to fluid exudation, insufficient blood volume, infection and even death.¹ The slower the skin wound healed, the greater the more likely the occurrence of scar hyperplasia.² How to quickly promote the healing of skin wounds in burn patients and reduce the incidence of scar hyperplasia has always been a hot topic for burn plastic surgeons. Recently, we read the published study by Stephanie Ball et al.³ that scar outcomes for conservatively managed children post burn injury: a retrospective study. In this article, the authors mentioned an increasing prevalence of HTS with an increasing number of days to heal. Notably, 7.5%–20% prevalence in children heal conservatively between 14 and 21 days, 45%–56% in children heal conservatively between 21 and 30 days and 81%–94% in children heal conservatively in more than 30 days. Therefore, they believed that promoting skin wound healing and giving appropriate scar intervention measures were effective ways to prevent scar hyperplasia. However, the authors only mentioned interventions to prevent scar hyperplasia in the article, such as pressure, silicone, hydration, ROM/splint, wound dressings, corticosteroid cream and sensory desensitisation exercises, did not mention the intervention to promote rapid skin wound healing.

According to our clinical experience, nutritional support for burn patients is the key to promoting rapid healing of skin wounds.⁴ In nutritional support therapy, glutamine supplementation is a common treatment for burn plastic surgeons. Glutamine is a non-essential amino acid and is the only amino acid that can pass directly through the cerebrovascular barrier.⁵ Glutamine can protect gastric mucosa, promote protein synthesis and strengthen muscle. Therefore, glutamine can effectively promote the rapid healing of skin wounds in burn patients. It has been shown that glutamine can provide carbon and nitrogen to promote biosynthesis.⁶ Glutamine derived from macrophages can enhance satellite cells and muscle regeneration. All of these mechanisms can promote the healing of skin wounds. The first 6 months after the burn is the most active scar period, and scarring is most pronounced during this period. Therefore, we recommend that glutamine supplementation be given to burn patients during the first six months of treatment to prevent scar hyperplasia.

In addition, in subsequent studies, we recommend probiotics and glutamine enteral support therapy for paediatric burn patients. Probiotics can regulate the intestinal microecological balance, improve the body immunity of burn patients and increase the absorption and utilisation of glutamine.⁷ The treatment with these two drugs can effectively shorten the wound healing time of paediatric burn patients, so as to prevent scar hyperplasia.

This study by the authors makes us realise the importance of promoting burn wound healing to prevent scar hyperplasia. At the same time, it also makes us understand a variety of effective interventions to prevent scar hyperplasia. However, for burn patients, especially paediatric burn patients, nutritional support treatment is also an important treatment measure to promote wound healing. The nutritional support treatment of burn patients should be paid more attention by burn plastic surgeons.

This research was supported by the Guilin Technology Application and Promotion Plan (No. 2020011204-2), Guangxi Natural Science Foundation under Grant (No. 2024GXNSFAA010170) and Industry-University-Research Innovation Fund of Science and Technology Development Center of the Ministry of Education (No. 2021JH017).

The authors declare no conflicts of interest.