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Interstitial‐matrix edema in burns: Mechanistic insights from subatmospheric pressure treatment in vivo

Thermal injury disrupts fluid homeostasis and hydration, affecting hemodynamics and local interstitial fluid‐driving forces, leading rapidly to edema. This study explores local mechanisms in vivo, after deep partial‐thickness burns in the dermal matrix. Heat‐damaged skin was obtained from pig corpses, byproducts of unrelated burn treatment protocols approved by the Institutional Animal‐Care‐and‐Use Committee. Hydration potential and flow rates were measured by osmotic stress techniques at 4 and 37 °C, and collagen folding/unfolding was examined by differential scanning calorimetry and diffusion tensor magnetic resonance imaging. Kinetic and equilibrium hydration parameters differed in heat‐damaged and undamaged skin; the mean hydration potential and initial flow rates of damaged skin were negative at 37 but positive at 4 °C, in contrast to the positive mean at either temperature of explants taken from undamaged skin sites on the same animals. After subatmospheric pressure treatment (125 mmHg), parameters in damaged reversed to values similar to those of undamaged, whereas the proportion of folded collagen and unidirectional resistance to water diffusion increased. Together, results support interfacial rather than colloidosmotic fluid transfer mechanisms in burns and confirm in vivo the relevance of collagen folding/unfolding, further suggesting collagen structural transitions as potential therapeutic targets and models for engineered biomimetic materials.