Reflections on tissue engineering and trauma therapy

Although all of Trauma Care has remarkably improved during the latter half of the last century the treatment of burn injury has substantially out paced other areas and serves as an excellent example illustrating the improvements taking place in the treatment of injured patients. Although Trauma treatment lagged behind the rest of medicine in mid-century today it rests solidly on the cutting edge of advancing therapeutic knowledge and practice in areas of metabolism, immunology, infection control, critical care, tissue engineering and the delivery of clinical care. It is important to understand what has happened to allow the treatment of injury to be so effective. The bench mark therapeutic moves that have had major effects allowing the present highly effective treatment are: immediate tailored fluid resuscitation, preventive (prophylactic) and topical antibiotics, metabolically designed nutritional therapy and most important early definitive repair of the injury. All must be delivered early after trauma if they are to be optimally effective in preventing the complications of injury that are devastating if encountered. Unfortunately, all problems are not solved by todays treatment of injury, improved as it is. These problems are largely related to an inexact understanding: of the physiologic changes of aging, of the exact pathophysiologic events in inhalation injury and multisystem organ failure and of the technology required to replace those body parts damaged by the injury itself that lead to death or to healing with loss of function. There will be major improvements in the understanding and ability to effectively deal with the problems of aging and inhalation injury through basic and clinical research but perhaps the major improvement in injury treatment will come through the ability to replace worn out, defective or damaged body parts through technologies that resemble regeneration. Here the concepts of Tissue Engineering have much to contribute and it is worth exploring the donation of Tissue Engineering to dermal replacement following burn injury to serve as an example of what types of additions to treatment Tissue Engineering can make.