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Advances in Care for Burn and Hypertrophic Scar: Innovations in Prevention and Dermal Regeneration.

Benjamin L. Savitz,Vignesh Chennupati,Oliver C. Alexander,Erin N Abbott,Ronald M. Cornely,Elizabeth L Dale Slater

Published 2025 in Annals of Plastic Surgery

ABSTRACT

ABSTRACT Hypertrophic scarring (HTS) remains a critical challenge in burn care, often resulting in debilitating contractures, chronic pain, and significant psychosocial burden. While current treatment emphasizes structural repair, recent advances underscore the importance of addressing the biological drivers of fibrosis. This review synthesizes evolving strategies in burn scar prevention, highlighting tissue-engineered matrices, autologous cell therapies, and predictive molecular tools that shift care from reactive to regenerative. Innovations such as biologic and synthetic dermal matrices (eg, Integra, BTM, Restrata) and autologous skin cell suspensions (eg, ReCell) have demonstrated improved dermal architecture restoration and reduced donor site morbidity. Concurrently, emerging genetic and proteomic biomarkers including transforming growth factor β1, interleukin-6, and vitamin D receptor polymorphisms offer the potential to stratify patients by HTS risk, enabling personalized therapeutic interventions. Biologic agents like rhPDGF and mesenchymal stem cells represent additional avenues for modulating fibroblast activity and enhancing regenerative outcomes. Looking forward, integration of machine learning with real-time biomarker profiling may enable dynamic, patient-specific care pathways. Because burn management continues to evolve, the convergence of predictive diagnostics, biologic modulation, and engineered skin replacements holds the promise of not only minimizing fibrosis but also restoring functional, native-like skin-marking a paradigm shift toward precision burn reconstruction.

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