Steven E Wolf

Steven E Wolf
University of Texas Southwestern Medical Center | UT Southwestern · Department of Surgery

MD

About

587
Publications
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20,476
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Publications

Publications (587)
Article
Geospatial proximity to American Burn Association (ABA)-verified burn centers or self-designated burn care facilities varies across the country. This study evaluates the impact of distance to treatment center on long-term, patient-reported outcomes. Data from the Burn Model System (BMS) National Longitudinal Database were analyzed. Demographic and...
Article
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Burn wound conversion refers to the phenomenon whereby superficial burns that appear to retain the ability to spontaneously heal, convert later into deeper wounds in need of excision. While no current treatment can definitively stop burn wound conversion, attempts to slow tissue damage remain unsatisfactory, justifying the need for new therapeutic...
Article
Objective: To compare the six-minute walk test and the Modified Bruce treadmill test in paediatric patients with severe burns. Subjects: A total of 67 children, aged 7-17 years, with severe burns. Methods: Participants were assigned to randomly perform the six-minute walk test and the Modified Bruce treadmill test on discharge from acute burn...
Article
Dermal fibroblasts in pathological scars secrete constitutively elevated levels of TGF-β, signaling the transcription of fibrotic genes via activin-like kinase 5 (ALK5). In the present study, we examine the antifibrotic effects of galunisertib, a small-molecule inhibitor of ALK5, on fibroproliferative dermal fibroblasts in an in vitro model of woun...
Article
Disparities in socioeconomic status and minority status impacts the risk of burn injury and the severity of that injury, thus impacting the subsequent cost of care. We aimed to characterize the demographic details surrounding receipt of financial assistance due to burn injury and its relationship with health-related quality of life scores. Particip...
Article
Background C-reactive protein (CRP) is an acute-phase protein in response to inflammation after traumatic injury. We posit that C-reactive protein (CRP) is reliable in predicting morbidity and mortality following severe burn. In this study, we explored the relationship between serum CRP values and clinical outcomes in the severely burned. Methods...
Article
Objective To determine the effects of short bouts of ergometric exercises on the number of days in the burn intensive care unit (ICU), body mass, and functional ambulation. Design Multi-center, randomized controlled trial. Setting Burn intensive care unit. Participants Children ages 7–17 with severe burns covering over 30% total body surface are...
Article
Burns disrupt the protective skin barrier with consequent loss of cutaneous temperature regulation, infection prevention, evaporative losses, and other vital functions. Chronically, burns lead to scarring, contractures, pain, and impaired psychosocial well-being. Several skin substitutes are available and replace the skin and partially restore func...
Article
Introduction Previous analyses of tracheostomy in paediatric burns was hindered by a lack of multi-institution or nationwide analysis. This study aims to explore the effects of tracheostomy in paediatric burn patients in such an analysis. De-identified data was obtained from the TriNetX Research Network database. Methods Two cohorts were identifie...
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Introduction Bacterial infections are a leading cause of complications in burn patients. However, ambiguity remains around the most common infectious etiologies and their resulting complications. Our study identifies which bacterial infections will lead to specific complications and tracks infection rates of these bacteria over time. Methods Burn...
Article
Introduction Severe burn disrupts cardiovascular function which can lead to critical shock. To counteract cardiovascular collapse, there is a systemic increase of catecholamines released in response to severe burn. Previous studies showed that β1- adrenergic receptor (AR)_ protein expression was significantly increased in the cardiac right ventricl...
Article
Introduction An area of rehabilitation research in burns is the impact of co-morbidities. Obesity is one of these, is an increasing public health concern, and its role remains controversial regarding burn injury and physical recovery. Our aim was to evaluate associations between body mass index (BMI) as a measure of obesity, at discharge and self-r...
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Introduction Hypertension (HTN) is a prevalent condition in the United States and leads to an increased risk of developing other comorbidities. However, the impact of hypertension following severe burns on patient outcomes is not known. We hypothesize that post-burn hypertension is associated with an increased risk of other comorbidities and mortal...
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Introduction In lieu of outdated and limited patient studies on excision for severe burns, a more comprehensive analysis is indicated to determine the effects of early skin excision following burn. This study aims to address the outcomes of early excision. Methods Data collection and analysis was performed using TriNetX, a national research databa...
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Introduction Racial minorities have been recognized to experience worse health outcomes for many medical conditions. However, it is not clear if these outcomes are associated with pre-existing conditions or the quality of care those patients receive. In burns, little information on the relationship between race and burn comorbidities is available....
Article
Introduction Management of the upper airway is crucial to burn care, especially in the setting of inhalation injury or burns to the face or neck. Endotracheal intubation is often performed to secure the airway; however, tracheostomy may be necessary in patients requiring prolonged ventilatory support. This study compares long-term outcomes of burn...
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Introduction Despite advancements in burn care, the optimal treatment to prevent or treat hypertrophic scars is still elusive. Therefore, the objective of this study is to compare the efficacy of five glucocorticoid medications commonly used in the treatment of hypertrophic scarring in burned patients using a large patient database. Methods Patien...
Article
Introduction Access to healthcare and insurance coverage are associated with quality of life, morbidity, and mortality outcomes. However, most studies have only focused on same-admission and short-term outcomes due to the lack of national longitudinal data and there is limited data on this topic in the burn literature. Our aim was to determine the...
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Introduction The pathophysiological response to major trauma has gender dimorphism in outcomes associated with sex hormones levels. However, little is known of the effects of female hormones on outcomes in burn patients. Previous studies demonstrated exogenous estrogen alleviates hyper-inflammation after burn. We thus posit that female patients hav...
Article
Introduction Geospatial access to American Burn Association (ABA)-verified burn centers or self-designated burn care facilities varies across the country. It is often necessary to transport patients hundreds of miles to provide definitive burn care and rehabilitation services. This study evaluates the impact of distance to treatment center on long-...
Article
Introduction Pregnancy naturally strains a woman’s body, and is exacerbated by additional stressors, such as severe burn. This study seeks to establish a national incidence rate of burns during pregnancy, as well as categorize the patients epidemiologically and by percent total body surface area (%TBSA) burned. We posit that pregnancies complicated...
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Introduction The risk of coagulopathy is increased in severe burns. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed in burn patients to relieve pain and reduce inflammation. This study investigates the impact of NSAIDs on burn induced coagulopathy in severely burned patients. Methods Severe burn patients (total body surface a...
Article
Introduction Use of prescription pain medication after burn injury is commonly required. However, little is known about long-term pain medication use and its association with outcomes. Therefore, the purpose of this study is to assess patterns of prescription pain medication use after discharge and the association between these medications and qual...
Article
Introduction Financial toxicity negatively impacts recovery after injury. Financial assistance (FA; e.g., disability income, food stamps, low-income housing voucher) may mitigate the impacts of financial toxicity. We aimed to describe FA after burn injury and its association with health-related quality of life (HRQL) and return to work. Methods Da...
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Introduction The COVID-19 pandemic was a devastating occurrence that left millions in critical condition in emergency rooms (ER) across the country. While hospitalizations due to COVID-19 increased exponentially in the last year, several reports have indicated declines in ER use due to common non-COVID related problems. There is currently a dearth...
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Introduction The use of opioids in the medical field has contributed to the growing opioid epidemic. Nonetheless, opioids remain imperative in the treatment for pain management in burns. While some studies have addressed the use of opioids in surgery, a comprehensive analysis of the pattern of opioids use in burns has not been investigated. This st...
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Introduction Prior studies explored neuropsychological disorders in the context of burn severity; however, the relationship between occurrence after burn and sleep has not been investigated. This study aims to determine if patients that developed a first-time sleep disorder after burn injury are more likely to develop a psychological or nervous sys...
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Introduction Burn injuries place patients in a compromised state, especially those with pre-existing comorbidities. The presence of cancer complicates care and worsens outcomes for patients suffering from illnesses unrelated to burns, such as sepsis. Therefore, we posit the incidence of burn injury on patients with preexisting cancer diagnoses resu...
Article
Introduction There is little published research on the long-term outcomes of military service members with burn injuries. Military service members are often exposed to extraordinary challenges and adverse experiences that might influence their recovery from a burn injury. Therefore, to better understand the outcomes of service members with burn inj...
Article
Objective Increased body weight has been associated with reduced muscle wasting in the early catabolic phase after a severe burn. Yet, overweight and obese non-burn children often exhibit impaired musculoskeletal function, which may lead to poor physical function (PF). We aimed to determine the association between body mass index (BMI) at discharge...
Article
Introduction: Infections related to the skin are the principal drivers of morbidity and mortality following severe burn, therefore a diverse armamentarium of topical antimicrobial agents were developed over the history of burn care. The last 30 years witnessed dramatic changes in the application of surgical intervention and utilization of topical...
Article
Background: As the cost of healthcare rises, it is imperative to assess value delivered to patients and impact on the economic viability of institutions. We aimed to characterize plastic surgery operative time management and identified areas for efficiency improvement. Methods: Procedures from a US academic plastic surgery division from Septembe...
Article
Background: People living with burn injury often face long-term physical and psychological sequelae associated with their injuries. Few studies have examined the impacts of burn injuries on long-term health and function, life satisfaction, and community integration beyond five years post-injury. The purpose of this study was to examine these outco...
Article
Background: Rhabdomyolysis is a severe condition responsible for up to 10% of acute kidney injury (AKI) cases. Severely burned patients are susceptible to developing both rhabdomyolysis and acute kidney injury, but whether burned patients with rhabdomyolysis are at greater risk of acute kidney injury compared to non-burned patients with rhabdomyol...
Article
Introduction The costs required to provide acute care for patients with serious burn injuries are significant. In the US, these costs are often shared by patients. However, the impacts of pre-injury finances on health-related quality of life (HRQL) have been poorly characterized. We hypothesized that lower income and public payers would be associat...
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Severe burns result in cardiovascular dysfunction, but responses in the peripheral vasculature are unclear. We hypothesize that severe burns disturb arterial contractility through acute changes in adrenergic and cholinergic receptor function. To address this, we investigated the changes in carotid artery contractility and relaxation following a sev...
Article
Cell-based therapy imparts its therapeutic effects via soluble growth factors and vesicular bodies like exosomes. A systematic review with a meta-analysis of pre-clinical studies was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the modified Stroke Therapy Academic Industry Roundtable (STAIR...
Article
Introduction Burn survivors experience barriers to returning to work. For those who do return to work, little is known regarding whether they achieve pre-injury productivity (i.e., equivalent or gain in income compared to pre-injury income). Identifying patients at risk of not achieving pre-injury productivity is important for targeting services th...
Article
Background: Patient-reported outcomes are important for understanding recovery after burn injury, benchmarking service delivery and measuring the impact of interventions. PROMIS-29 domains have been validated for use among diverse populations though not among burn survivors. The purpose of this study was to examine validity and reliability of PROM...
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Purpose To examine agreement between pediatric burn survivor self- and caregiver proxy-report on multiple PROMIS domains and examine factors associated with differences between self- and proxy-reports. Methods Children 8–17 years of age and their caregivers completed PROMIS measures (physical function, depression, peer relationships, pain interfer...
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Muscle wasting is common and persistent in severely burned patients, worsened by immobilization during treatment. In this review, we posit two major phenotypes of muscle wasting after severe burn, cachexia and sarcopenia, each with distinguishing characteristics to result in muscle atrophy; these characteristics are also likely present in other cri...
Article
A contemporary, age-specific model for the distribution of burn mortality in children has not been developed for over a decade. Using data from TriNetX, a global federated health research network, and the American Burn Association’s Nation Burn Repository (NBR), we investigated non-survival distributions for paediatric burns in the United States. P...
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Abstract: Background and Objectives: Porcine xenografts have been used successfully in partial thickness burn treatment for many years. Their disappearance from the market led to the search for effective and efficient alternatives. In this article, we examine the synthetic epidermal skin substitute Suprathel® as a substitute in the treatment of par...
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Thermal injuries have been a phenomenon intertwined with the human condition since the dawn of our species. Autologous skin translocation, also known as skin grafting, has played an important role in burn wound management and has a rich history of its own. In fact, some of the oldest known medical texts describe ancient methods of skin translocatio...
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Introduction Severe burns result in decreased skeletal muscle mass and function. Recent evidence suggests that massive burns disrupt the motor-neural system including motor neurons to partially explain skeletal muscle dysfunction in response to burns. However, impact of demyelination on burn induced skeletal muscle dysfunction has not been investig...
Article
Introduction Inhibition of TGF-β has shown promising in vitro and in vivo results for reduction of hypertrophic scarring after burn injury. However, TGF-β regulates diverse cellular pathways apart from fibrosis, including physiologic wound healing, cell cycle control, and homeostasis. Galunisertib, a novel small molecular tyrosine kinase inhibitor...
Article
Introduction For decades, controversy has raged regarding the placement of tracheostomy in severe paediatric burns. Numerous variables including extent of smoke inhalation injury, % TBSA burned, age of the patient, and co-morbidities among others complicate reaching consensus. Furthermore, paediatric patients are particularly susceptible to complic...
Article
Introduction Burn patients are prone to infections, which often warrants broad-spectrum antibiotic coverage. Vancomycin is a common antibiotic used at burn centers and is administered alone, or in combination with other agents such as piperacillin-tazobactam (Pip/Tazo). A recent study showed that this combination therapy was associated with increas...
Article
Introduction Long-term chronic cardiovascular dysfunction is a well-reported outcome in patients who have suffered severe burns associated with diminished muscle mass and hypermetabolism. Devastating burn injuries sometimes warrant extremity amputation to preserve life over limb. A lower extremity amputation can exacerbate the risk of burn-related...
Article
Introduction Burn injuries can be life-altering events that involve intensive healthcare, changes in body image, psychological stress and financial toxicity. Burn survivors frequently experience numerous and varied barriers to returning to work. For those who return to work, little is known regarding whether they achieve pre-injury productivity (i....
Article
Introduction Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis syndrome (TENS) share immune-mediated etiology for epidermal detachment and pharmacologic triggers. Both conditions are on a spectrum of diseases of varying severity, with TENS representing the graver end of the continuum. The demographics and comorbidities of this populatio...
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Introduction Over the past three decades, it has been repeatedly demonstrated that early surgical intervention is associated with improved outcomes in burns, however, large-scale studies regarding the incidence of operative treatment in burn patients are lacking. We conducted a retrospective study using the TriNetX database, a global, real-time ele...
Article
Introduction Patient-reported outcomes are important for burn injury research and clinical practice. The PROMIS-29 profile has been validated for use in diverse populations and numerous conditions, though not among people living with burn injuries. The purpose of this study was to examine validity and reliability of PROMIS-29 scores in adults with...
Article
Introduction The National Burn Repository (NBR) is the recognized standard for data collection models within the academic burn community. Despite its robust capabilities, the NBR poses challenges to access and exploration that can be intimidating to some researchers. As a result, user-friendly alternative databases have grown in popularity. We comp...
Article
Introduction The critical care, surgery, and rehabilitation required to recover patients with serious burn injuries are associated with high financial costs. In the US, these costs are often borne by patients. However, the relationship between pre-injury finances (personal income and payer) and health-related quality of life (HRQL) of burn survivor...
Article
Introduction Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis Syndrome (TENS) are part of a spectrum of autoimmune conditions, which cause epidermal detachment and keratinocyte necrosis. Due to the rare incidence, a dramatic heterogeneity in treatment algorithms and prolonged discussion of controversial therapies has ensued. We queried...
Article
Introduction A contemporary, age-specific model for the distribution of burn mortality in children has not been developed for over a decade. Using data from both TriNetX, a global federated health research network, and the American Burn Association’s Nation Burn Repository (NBR), we investigated non-survival distributions for paediatric burns in th...
Article
Introduction Burn survivors often face many long-term physical and psychological symptoms associated with their injury. To date, however, few studies have examined the impact of burn injuries on quality of life beyond 2 years post-injury. The purpose of this study is to examine the physical and mental well-being of burn survivors up to 20 years aft...
Article
Introduction Rhabdomyolysis, a rapid breakdown of damaged skeletal muscle, is a serious complication known to occur in approximately 1% of burn patients. Muscle breakdown products can accumulate in the renal tubules leading to acute kidney injury (AKI) and increased deaths. Burn-associated factors such as under-resuscitation, infection, and nephrot...
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Surgical site infection risk continues to increase due to lack of efficacy in current standard of care drugs. New methods to treat or prevent antibiotic-resistant bacterial infections are needed. Multivalent Adhesion Molecules (MAM) are bacterial adhesins required for virulence. We developed a bacterial adhesion inhibitor using recombinant MAM frag...
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Introduction Inhalation injuries carry significant acute care burden including prolonged ventilator days and length of stay. However, few studies have examined post-acute outcomes of inhalation injury survivors. This study compares the long-term outcomes of burn survivors with and without inhalation injury. Methods Data collected by the Burn Model...
Article
Purpose of review: ICU survivors frequently suffer significant, prolonged physical disability. 'ICU Survivorship', or addressing quality-of-life impairments post-ICU care, is a defining challenge, and existing standards of care fail to successfully address these disabilities. We suggest addressing persistent catabolism by treatment with testostero...
Preprint
Full-text available
Background: Skeletal muscle injury leads to loss of muscle function that lasts well into recovery and can be permanent. Application of the novel bio-scaffold termed porcine-derived urinary bladder matrix (UBM) has a potential benefit to mitigate injury through tissue regeneration. To date, findings of potential benefit in animal models were limited...
Article
Introduction Our Burn Center provides care to persons living in southeast area of our State. Patients residing in this area sometimes have low socioeconomic status (SES), and are often unable to return to burn clinic for continued care due to transportation barriers. Typically driving distance is over 80 miles involving ferry access, taking two or...
Article
Introduction Severe burn causes a dramatic metabolic response associated with multi-organ damage. Mononeuropathy is also associated to muscle wasting after injury. Schwann cells are the glial cells that support neurons in the nervous system. S100 calcium-binding protein B (S100B) and Myelin basic protein (MBP) are biomarkers of Schwann cells. We hy...
Book
The second edition of this volume provides updated information on acute burn treatment. It also discusses genomic responses to burns and novel techniques in this area. Divided into four topical parts, this book provides insights into the history, epidemiology, prevention of burns, as well as initial and pre-hospital management of burns, acute burn...
Chapter
Severe burn caused hypermetabolism-sustained muscle wasting and other comorbidities. The goal of nutrition support and other care management is to maintain energy homeostasis in burn patients. Due to dramatic changes and other factors that influence over the time course after burn, the plan of nutrition support has to be adjusted continuously with...
Article
Severe burn leads to substantial skeletal muscle wasting that is associated with adverse outcomes and protracted recovery. The purpose of our study was to investigate muscle tissue homeostasis in response to severe burn. Muscle biopsies from the right m. lateralis were obtained from 10 adult burn patients at the time of their first operation. Patie...
Article
Introduction This study investigated changes in plasma fibrinogen metabolism and changes in coagulation in severely burned adults. Methods Ten patients (27±3 years; 91± 6kg) with 51±3% TBSA were consented and enrolled into an institutional review board approved prospective study. On the study day, stable isotope infusion of 1-13C-phenylalanine and...
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Abstract Prior work established that exercise alleviates muscle function loss in a clinically relevant rodent model mimicking the clinical sequelae of severely burned patients. On the basis of these data, we posit that pharmacologic treatment with insulin combined with exercise further mitigates loss of muscle function following severe burn with im...
Article
Muscle wasting induced by severe burn worsens clinical outcomes is associated with hyperglycemia. A novel muscle-specific secretory factor, musclin, was reported to regulate glucose metabolism with a homologous sequence of natriuretic peptides. The purpose of the study was to investigate musclin expression in response to burn injury in both human a...
Article
Background Our group previously demonstrated high patient satisfaction for the treatment of hypertrophic burn scar (HBS) with the erbium: yttrium aluminum garnet (Er:YAG) laser, but this and other literature supporting the practice suffer from a common weakness of a reliance on subjective assessments by patients or providers. Herein, we sought to p...
Article
Background: Ambulatory surgery centers (ASCs) are frequently utilized; however some ambulatory procedures may be performed in hospital outpatient departments (HOPs). Our aim was to compare operating room efficiency between our ASC and HOP. Methods: We reviewed outpatient general surgery procedures performed at our ASC and HOP. Total case time wa...