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In the management of partial thickness burns, it is difficult to balance between conservative management and surgical intervention. Our hypothesis was that a triangular relationship exists between protease/anti-protease profile at the burn wound surface, angiogenesis and re-epithelialisation. By manipulation of the biochemical profile at the wound level, we determined to affect the nature and extent of angiogenesis and resulting re-epithelialisation. We performed a randomised longitudinal observational study on partial thickness burns in adult patients presenting to two regional burns units. Our results demonstrated that a high-protease wound environment is associated with lower levels of the angiogenic factor VEGF, a lower more uniform change in wound bloodflow and a uniform well healed wound with an architecturally normal epidermis. In addition, we found that a low protease wound environment is associated with higher levels of the angiogenic factor VEGF, a higher wound bloodflow throughout the wound healing period and a more chaotic, hypercellular, overkeratinised, and chaotic thickened epidermis.

Original publication




Journal article



Publication Date





474 - 486


Adolescent, Adult, Aged, Bandages, Hydrocolloid, Burns, Cell Count, Epithelial Cells, Humans, Immunohistochemistry, Laser-Doppler Flowmetry, Middle Aged, Negative-Pressure Wound Therapy, Neovascularization, Physiologic, Peptide Hydrolases, Skin, Wound Healing, Young Adult