It is estimated that each year in the United States, 1.25 million burn injuries occur, and it is known that between 60,000 and 80,000 people require in-hospital care for their burns, and that 1.4 people per 100,000 of the population will die as a result of a burn (1). Morbidity from a burn also may be considerable and includes disfigurement as well as the possibility of permanent impairment of functional abilities. The cost of hospital care for a patient with flame burns and/or smoke inhalation injury ranges from $29,560 to $117,506 (USD) per patient, whereas the cost of a single fire-related death, including loss of future earning potential, is estimated at between $250,000 and $1 million (1). It should be readily apparent then, that burn injuries are a major source of morbidity, mortality, and financial loss.

The endothelium, which at the outset might seem to be a relatively minor player in the complex overall picture of a burn injury, in fact has a major role in the pathophysiology that follows a burn. The thesis of this chapter is that the burn wound should be conceptualized as a dynamic “organ,” and that the endothelium within this organ, in concert with the coagulation, fibrinolytic, and inflammatory pathways, is responsible for many of the local as well as systemic derangements that follow a burn.

Thermal injury to the skin and soft tissues acutely produces local damage at the site of the injury and systemic derangements distant from the injury. Although heat itself is the initial insult at the injury site, the host response to the heat-induced injury is responsible for both ongoing local tissue damage, as well as numerous remote pathophysiological alterations.