Clinical evidence based nano crystalline silver dressing rationality, efficacy and strategy in extensive burn patients survival

Sudhir Singh

doi:10.18231/j.ijced.2020.054

Abstract

Extensive burns of more than 50% have high mortality and those over 90% have almost nil survival rate. All resuscitative measures fail as patient gets infected leading to burn wound sepsis causing septicemia and leading to mortality as the end clinical result. So we need clinically evidenced and rationally based burn dressing strategy to increase extensive burn patient survival. This is random retrospective selection of five patients in each two groups from second degree burn patients of more than 50 percent treated by collagen in one group and other by Nanocrystalline Silver dressings and observed for clinical evidence of patients survival keeping all resuscitative and treatment modalities as standard treatment protocol in all cases. The nano crystalline silver dressing is cost effective, rational and evidence based strategy. It is easy to use, has powerful anti bacterial effect, decreased frequency of dressing changes, shortened time of wound cleaning and painless dressing. It helps make the wound sterile for further treatment within a week. It is a great weapon in the hand of Burn Surgeon for rapid and better recovery of patients. This nano crystalline sustained release silver dressings are best suited to take care of burn wounds of more than 50%. Bacteriophages treatment is reserved for multiple drug resistant bacteria and had good recovery.

Highlights

There are many old burn wound dressings like honey, potato peel, banana leaves, alo-vera juice, collagen applications, soframycin ointment and even the traditional silver sulfadiazine cream
For patients treated with nanocrystalline silver, we used Acticoat in which dressings were changed after 72 hours and sometimes Acticoat Flexi 7 in which dressings changed in seven days
The nanocrytalline sustained release silver dressings are best suited to take care of burn wound of more than 50%. [Nanocrystalline silver Patients Figure 1 A,B,C,D; Figure 2 A,B; Figure 3 A,B.] This is followed by collagen dressing which is less effective in killing bacteria but helps in regeneration of damaged skin barrier. [Collagen patients Figure 4 A,B,C; Figure 5 ; Figure 6 A,B; Figure 7] Both if used judiciously give better survival even in 90% TBSA burn patients

Summary

Introduction

There are many old burn wound dressings like honey, potato peel, banana leaves, alo-vera juice, collagen applications, soframycin ointment and even the traditional silver sulfadiazine cream. The clinical evidence we get is that they are not helping in survival of extensive burn patients of more than fifty percent surface area even in second degree burns. Extensive burns of more than 50% have high mortality and those over 90% have almost nil survival rate. All resuscitative measures fail as patient gets infected leading to burn wound sepsis causing septicemia and leading to mortality as the end clinical result. We need clinically evidenced and rationally based burn dressing strategy to increase extensive burn patient survival

Methods

Findings

Discussion

Conclusion