Wound Colonization Research Articles

Bacterial Colonization of Burn Wounds

The objective behind this work was to find out the bacteriological profile of post burn infections in wound. The study was carried out from December 2010 to February 2011 at the Burns Unit of Al –Kindy Hospital and Al-Yarmook Hospital in Baghdad. Sixty burn patients have been investigated for bacterial profile of burn wound infections. Specimens were collected in the form of wound swabs. The organisms were isolated and identified by standard microbiological methods. Antimicrobial susceptibility test has been done by ATB-PSE5 kit(BioMereiux). Pseudomonas aeruginosa 35(58.3 %) was found to be the most common isolate followed by Klebsiella pneumonae 10(16.6%), Staphylococcus aureus 7(10%). ,E.coli 3(5%), Proteus merabilis 1(1.6 %), others 2(3.3 %).and sterile cultures 2(3.3 %). Antibiotic susceptibility pattren for Pseudomonas aeruginosa isolates have shown high susptibility for Amikacin 30(85.0%), Pipracillin-Tazobactam 27(77.2%) Piperacillin 25(71.4%), Ciprofloxaqcin 25(71.4%) and Colistin 24(68.5%) and low susceptibility for Tobramycin 20(57.2%) Gentamycin 18(51.0%). Psudomonas was found to be resistant to most of the therapeutic agent.

Bacterial Colonization of Burn Wounds

The objective behind this work was to find out the bacteriological profile of post burn infections in wound. The study was carried out from December 2010 to February 2011 at the Burns Unit of Al –Kindy Hospital and Al-Yarmook Hospital in Baghdad. Sixty burn patients have been investigated for bacterial profile of burn wound infections. Specimens were collected in the form of wound swabs. The organisms were isolated and identified by standard microbiological methods. Antimicrobial susceptibility test has been done by ATB-PSE5 kit(BioMereiux). Pseudomonas aeruginosa 35(58.3 %) was found to be the most common isolate followed by Klebsiella pneumonae 10(16.6%), Staphylococcus aureus 7(10%). ,E.coli 3(5%), Proteus merabilis 1(1.6 %), others 2(3.3 %).and sterile cultures 2(3.3 %). Antibiotic susceptibility pattren for Pseudomonas aeruginosa isolates have shown high susptibility for Amikacin 30(85.0%), Pipracillin-Tazobactam 27(77.2%) Piperacillin 25(71.4%), Ciprofloxaqcin 25(71.4%) and Colistin 24(68.5%) and low susceptibility for Tobramycin 20(57.2%) Gentamycin 18(51.0%). Psudomonas was found to be resistant to most of the therapeutic agent.

Wound dressings based on silver sulfadiazine solid lipid nanoparticles for tissue repairing

The management of difficult to heal wounds can considerably reduce the time required for tissue repairing and promote the healing process, minimizing the risk of infection. Silver compounds, especially silver sulfadiazine (AgSD), are often used to prevent or to treat wound colonization, also in presence of antibiotic-resistant bacteria. However, AgSD has been shown to be cytotoxic in vitro toward fibroblasts and keratinocytes and consequently to retard wound healing in vivo. Recently, platelet lysate (PL) has been proposed in clinical practice for the healing of persistent lesions. The aim of the present work was the development of wound dressings based on AgSD loaded in solid lipid nanoparticles (SLNs), to be used in association with PL for the treatment for skin lesions. SLN were based on chondroitin sulfate and sodium hyaluronate, bioactive polymers characterized by well-known tissue repairing properties. The encapsulation of AgSD in SLN aimed at preventing the cytotoxic effect of the drug on normal human dermal fibroblasts (NHDFs) and at enabling the association of the drug with PL. SLN were loaded in wound dressings based on hydroxypropylmethyl cellulose (HPMC) or chitosan glutamate (CS glu). These polymers were chosen to obtain a sponge matrix with suitable elasticity and softness and, moreover, with good bioadhesive behavior on skin lesions. Dressings based on chitosan glutamate showed antimicrobial activity with and without PL. Even though further in vivo evaluation could be envisaged, chitosan based dressings demonstrated to be a suitable prototype for the treatment for skin lesions.

The Incidence of Methicillin-Resistant Staphylococcus aureus in Pressure Ulcers

Colonization of chronic wounds with methicillin-resistant Staphylococcus aureus continues to be an important healthcare concern. Aside from the morbidity associated with infections, colonization alone can contribute to outbreaks at long-term-care facilities and within hospitals. Despite the prevalence of pressure ulcers, the incidence of S aureus in these chronic wounds is unknown.

Persistence of bacteria like Pseudomonas aeruginosa in non-healing venous ulcers

There is evidence that chronic inflammation due to bacterial wound colonization delays wound healing. In this study, in a Leipzig (Germany) cohort of chronic wound patients, the microbiological spectrum in 2005 and in 2010 was evaluated, as were patients with continuous ulceration sequentially over a decade from 2001-2011. We retrospectively analysed the microbial swabs of 126 patients with chronic leg ulcers caused by chronic venous insufficiency. In the cross-sectional analysis in both 2005 and 2010, as well as in the longitudinal analysis, Staphylococcus aureus, Pseudomonas aeruginosa, Proteus mirabilis and Enterococcus faecalis were respectively the most common pathogens colonizing chronic leg ulcers. In the longitudinal analysis from 2001-2011, the same bacterial species could be identified ≥ 3 years consecutively in 20/35 patients. Normally only one or two species could persistently be demonstrated over the years. The subgroup of patients with ≥ 3 x confirmation of P. aeruginosa in their swabs showed a longer wound duration compared to all patients in the longitudinal group. We registered the persistence of bacteria like P. aeruginosa or S. aureus in consecutive bacterial swabs over the years in individual patients with non-healing venous ulcerations.

Inflammatory Cytokine and Chemokine Expression is Associated With Heterotopic Ossification in High-Energy Penetrating War Injuries

Heterotopic ossification (HO) develops frequently after modern high-energy penetrating war injuries. The purpose of this prospective study was to identify and characterize the unique cytokine and chemokine profile associated with the development of HO as it pertained to the systemic inflammatory response after penetrating combat-related trauma. Patients with high-energy penetrating extremity wounds were prospectively enrolled. Surgical debridement along with the use of a pulse lavage and vacuum-assisted-closure device was performed every 48-72 hours until definitive wound closure. Wound bed tissue biopsy, wound effluent, and serum were collected before each debridement. Effluent and serum were analyzed for 22 relevant cytokines and chemokines. Tissue was analyzed quantitatively for bacterial colonization. Correlations between specific wound and patient characteristics were also analyzed. The primary clinical outcome measure was the formation of HO as confirmed by radiographs at a minimum of 2 months of follow-up. Thirty-six penetrating extremity war wounds in 24 patients were investigated. The observed rate of HO in the study population was 38%. Of the 36 wounds, 13 (36%) demonstrated HO at a minimum follow-up of 2 months. An elevated injury severity score was associated with the development of HO (P = 0.006). Wound characteristics that correlated with the development of HO included impaired healing (P = 0.005) and bacterial colonization (P < 0.001). Both serum (interleukin-6, interleukin-10, and MCP-1) and wound effluent (IP-10 and MIP-1α) cytokine and chemokine bioprofiles were individually associated and suggestive of the development of HO (P < 0.05). A severe systemic and wound-specific inflammatory state as evident by elevated levels of inflammatory cytokines, elevated injury severity score, and bacterial wound colonization is associated with the development of HO. These findings suggest that the development of HO in traumatic combat-related wounds is associated with a hyper-inflammatory systemic response to injury. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Characterization of silver sulfadiazine-loaded solid lipid nanoparticles by thermal analysis

The aim of this study is the solid-state characterization of solid lipid nanoparticles (SLN) based on Compritol® 888 (C888) and Lutrol® F68 (F68), loaded with silver sulfadiazine (AgSD), used to develop sponge-like dressings to treat chronic skin ulcers such as decubitis and leg ulcers. Silver compounds like AgSD, in fact, are used to prevent and/or to treat wound colonization that could impair healing, also in the case of antibiotic-resistant bacteria. Thermal analysis, with support from powder X-ray diffractometry and Fourier transform infrared spectroscopy, is used to characterize lipid and drug bulk, unloaded and drug-loaded SLN. In particular, differential scanning calorimetry is used to investigate the degree of crystallinity and the solid-state modification of lipid, two parameters correlated to drug incorporation and drug release rates. The solid-state characterization demonstrates AgSD entrapment in C888 as a core enclosed into F68 shell. AgSD SLN are also stored at different temperatures 25 and 37 °C, respectively, to study the effect of storage conditions, that induce an increase of the lipid crystallinity index correlated to drug release from the lipid matrix.

Clinical utility of fungal screening assays in adults with severe burns

BackgroundFungal wound infection is a leading cause of burn wound infections, and diagnosis is often delayed as it conventionally requires culture and histopathology. Fungal screening assays have sped diagnosis of invasive fungal infections in other populations. Few studies have evaluated the performance of fungal screening assays outside of the hematologic malignancy and hematopoietic stem cell transplant populations. MethodsWe performed a three year retrospective analysis of all fungal screening assays in burn patients in the ICU between 2008 and 2011. The primary goal was to evaluate the correlation between the two available fungal screening assays, (1→3)-β-d-glucan (BG) and galactomannan (GM) assay, and fungal wound colonization (FWC) and infection (FWI). We also evaluated previously hypothesized causes of false positives and their associations with false positives in the burn population. ResultsWe identified 53 patients [median 29% total body surface area burned (TBSA), IQR 17–51] with BG or GM serological tests available, of which 15 had a FWI or FWC. FWC/FWI was associated with higher TBSA (p=0.02). BG and GM correlated with TBSA (BG 0.57, p<0.01; GM 0.35, p=0.02), but neither assay was associated with FWI/FWC or species of fungus involved when FWI/FWC was diagnosed. ConclusionsPositive BG and GM fungal screening assays are not associated with FWI/FWC, or with species of fungus when FWC/FWI is present. BG false positives are common and associated with higher TBSA burns.

Suction assisted pulse lavage: randomised controlled studies comparing its efficacy with conventional dressings in healing of chronic wounds

Chronic, open, non-healing wounds pose a continual challenge in medicine as the treatment is variable and there are no documented consistent responses. Although wound aetiologies vary and there are a number of factors that affect chronic wound pathogenesis, wound ischaemia and bacterial colonisation of wounds are the chief concerns among them. Conventionally, pulse lavage has been used primarily as a wound debriding device. To address both the critical factors of wound ischaemia and bacterial burden, a couple of technical points were proposed and applied in this study. The objective of our study was to evaluate pulse lavage therapy's ability to improve the healing rate of chronic wounds compared to that of the traditional saline-wet-to-moist dressings. The study period was from 1 August 2010 to 31 January 2012 and was conducted in our institution. Thirty patients with 31 chronic, non-healing wounds were enrolled in the study after obtaining proper consent. Subjects were randomised (15 patients each) to the pulse lavage group and the control group. Patients in the test group were subjected to irrigation of their wounds with pulsed lavage at 10 to 15 psi pressure. In the control group, wound was closed by applying moist betadine saline gauze dressings after cleaning with saline. Wounds treated with pulse lavage system significantly reduced in size, had better control of bacterial contamination and had overall faster healing rates. Efficacy of pulse lavage can be increased by correct method of administration of the irrigant.

Effect of fresh human amniotic membrane dressing on graft take in patients with chronic burn wounds compared with conventional methods

BackgroundBurns are among the most devastating forms of injury. Nowadays the standard treatment for deep partial thickness and full-thickness burn is early excision and grafting, but this technique is not always feasible; and this leads to chronicity and microbial colonization of burn wounds. Interesting properties of human amniotic membrane made us use it in management of chronic infected burn wounds. MethodsFrom January 2008 to September 2010, in a prospective clinical trail, 38 patients (76 limbs) with symmetric chronic burn wounds in both upper or lower limbs included in this study. Tissue cultures were taken from all the wounds. For the right, after debridement of granulation tissue and meshed split thickness skin grafting, the graft surfaces were covered with amniotic membrane dressing and in left limb wounds, after debridement, skin grafting was done in conventional method. 21days later, the success rate of graft take was compared between two groups. ResultsThe study group was composed of 76 limbs in 38 patients with mean age of 27.18±6.38 and burn in 29.18±7.23 TBSA%. The most common causes of the burn wounds chronicity in the selected patients was delayed admission due to poor compliance of the patients (44.8%). Staphylococcus was the most frequent isolate in wounds in our patients (62.85%). Mean graft take was observed in 90.13% of right upper limbs, and 67.36% of left upper limbs; which was significantly different (P<0.001). ConclusionsOur study showed that human amniotic membrane dressing significantly increases the success rate of graft take in chronic wounds, and it can be recommended as an important dressing in chronic burn wounds management, due to interesting anti-microbial, and better graft take effects.

Polymeric multilayers that localize the release of chlorhexidine from biologic wound dressings

Biologic wound dressings contain animal-derived components and are susceptible to high infection rates. To address this issue, we report an approach that permits incorporation of non-toxic levels of the small molecule antiseptic ‘chlorhexidine’ into biologic dressings. The approach relies on the fabrication of polyelectrolyte multilayer (PEMs) films containing poly(allylaminehydrochloride) (PAH), poly(acrylicacid) (PAA), and chlorhexidine acetate (CX) on elastomeric poly(dimethylsiloxane) (PDMS) sheets. The PEMs (20–100 nm thick) are subsequently stamped onto the wound-contact surface of a synthetic biologic dressing, Biobrane, which contains collagen peptides. Chlorhexidine loading in the PEMs was tailored by tuning the number of (CX/PAA) bilayers deposited, providing burst release of up to 0.98 ± 0.06 μg/cm2 of CX over 24 h, followed by zero-order release of 0.35 ± 0.04 μg/cm2/day for another week. Although the CX concentrations released were below the reported in vitro cytotoxicity limit (5 μg/mL over 24 h) for human dermal fibroblasts, they killed 4 log10 counts of pathogenic bacteria Staphylococcus aureus in solution. The CX/PEMs could be stamped onto Biobrane with high efficiency to provide CX release kinetics and in vitro antibacterial activity similar to that on PDMS stamps. In a full-thickness ‘splinted’ dermal wound-model in normal wild-type mice, the CX-functionalized Biobrane showed no decrease in either its adherence to the wound-bed or wound closure rate over 14 days. The murine wounds topically inoculated with ∼105 CFU/cm2 of S. aureus and treated with CX-functionalized Biobrane demonstrated a 3 log10 decrease in the wound’s bacterial burden within 3 days, compared to persistent bacterial colonization found in wounds treated with unmodified Biobrane (n = 10 mice, p < 0.005). Overall, this study presents a promising approach to prevent bacterial colonization in wounds under biologic dressings.

In vitro characterization of multivalent adhesion molecule 7-based inhibition of multidrug-resistant bacteria isolated from wounded military personnel

Treatment of wounded military personnel at military medical centers is often complicated by colonization and infection of wounds with pathogenic bacteria. These include nosocomially transmitted, often multidrug-resistant pathogens such as Acinetobacter baumannii-calcoaceticus complex, Pseudomonas aeruginosa and extended spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae. We analyzed the efficacy of multivalent adhesion molecule (MAM) 7-based anti-adhesion treatment of host cells against aforementioned pathogens in a tissue culture infection model. Herein, we observed that a correlation between two important hallmarks of virulence, attachment and cytotoxicity, could serve as a useful predictor for the success of MAM7-based inhibition against bacterial infections. Initially, we characterized 20 patient isolates (five from each pathogen mentioned above) in terms of genotypic diversity, antimicrobial susceptibility and important hallmarks of pathogenicity (biofilm formation, attachment to and cytotoxicity toward cultured host cells). All isolates displayed a high degree of genotypic diversity, which was also reflected by large strain-to-strain variability in terms of biofilm formation, attachment and cytotoxicity within each group of pathogen. Using non-pathogenic bacteria expressing MAM7 or latex beads coated with recombinant MAM7 for anti-adhesion treatment, we showed a decrease in cytotoxicity, indicating that MAM7 has potential as a prophylactic agent to attenuate infection by multidrug-resistant bacterial pathogens.

Novel models for bacterial colonization and infection of full‐thickness wounds in rats

An animal model is needed to study the pathophysiology of wound infections; however, an animal model that is reproducible and clinically relevant has not previously been available. In addition, an animal model of wound colonization generated in a manner similar to the wound infection model would be useful. Here, we describe new animal models of the wound infection continuum for the characterization of essential host-pathogen relationships. We determined the conditions needed to establish rat models of stable wound colonization and infection, without the use of disturbing factors (e.g., foreign bodies or induction of diabetes mellitus). We found that the age of the rats, bacterial inoculum size, and wound location were important elements in generating reproducible, obvious, spreading wound infections. We inoculated approximately 6-month-old rats with 2.06 × 10(9) or 4.12 × 10(9) colony-forming units of Pseudomonas aeruginosa to generate the wound colonization and wound infection models, respectively. Wounds were made 2 cm cranial to the greater trochanter. These clinically relevant and highly reproducible animal models can be used to investigate the mechanisms of wound infection and monitor the effect of therapeutic agents in vivo.

Exploiting potency of negative pressure in wound dressing using limited access dressing and suction-assisted dressing

Role of negative pressure dressing and moist wound healing are well established in the treatment of both acute and chronic wounds with certain advantages and disadvantages in both the techniques. Both these techniques prevents wound colonization, but the negative pressure dressing method has proved to have a greater potency to remove secretions, prevent wound invasion and eradication established infection. In both these techniques there is no accessibility to wound environment. Limited access dressing (LAD) is a moist wound dressing with negative pressure. It provides limited access to the wound through two small ports for both dressers and pathogens. The LAD design has notable advantages like wound isolation that reduces chance of wound colonization and safe disposal of infected materials (important factor to reduce hospital-acquired infections), while avoiding some major disadvantages such as opacity of dressing materials, inaccessible offensive smelling wound environment, and relatively high treatment costs. In LAD a definite intermittent negative pressure regimen is followed. The intermittent negative pressure (cycle of 30 minutes suction and 3½ hours rest) is effective. Overall, the LAD is a safe and effective alternative to conventional dressing methods. LAD is an excellent research tool for wound healing as frequent/continuous record of wound healing is possible without disturbing the wound healing process. LAD is an effective dressing for limb salvage in cases of acute and chronic complex wounds. Leech effect prevents wound related systematic response syndrome and sepsis. Suction-assisted dressing (SAD) is a combination of semiocclusive dressing with negative pressure. It works by removal of fluids by intermittent (like LAD) negative pressure and preventing bacterial invasion. SAD is especially advantageous where soakage is less, there is no dead tissue covering the wound (e.g., following skin grafting), superficial skin wounds (e.g., donor area) and also where LAD is technically difficult to apply over circumferential trunk and neck dressings under anesthesia.

Opportunistic Pathogens in Diabetic Foot Lesions

Accurate identification of infection in diabetic foot lesions is essential as the alternative can result in complicated medical and/or surgical interventions. The aim should be the differentiation between colonization and infection to avoid premature initiation of antimicrobial therapy. Diabetic foot ulcers provide a suitable environment for a diversity of microorganisms to first contaminate then subsequently colonize the wound. Infection can occur when a pathogenic factor produced by one or more microorganisms exceeds the capacity of the host immune system causing tissue damage and triggering both local and systemic inflammatory responses. The progression from wound colonization to infection is influenced by various factors including type and depth of the wound, blood supply, immune status of the patient. The quantity of microbial flora and pathogenicity expressed by the microorganisms involved will also have an effect.

Comparison of the Antiseptic Efficacy of Tissue-Tolerable Plasma and an Octenidine Hydrochloride-Based Wound Antiseptic on Human Skin

Colonization and infection of wounds represent a major reason for the impairment of tissue repair. Recently, it has been reported that tissue-tolerable plasma (TTP) is highly efficient in the reduction of the bacterial load of the skin. In the present study, the antiseptic efficacy of TTP was compared to that of octenidine hydrochloride with 2-phenoxyethanol. Both antiseptic methods proved to be highly efficient. Cutaneous treatment of the skin with octenidine hydrochloride and 2-phenoxyethanol leads to a 99% elimination of the bacteria, and 74% elimination is achieved by TTP treatment. Technical challenges with an early prototype TTP device could be held responsible for the slightly reduced antiseptic properties of TTP, compared to a standard antiseptic solution, since the manual treatment of the skin surface with a small beam of the TTP device might have led to an incomplete coverage of the treated area.

Specific protease activity indicates the degree of Pseudomonas aeruginosa infection in chronic infected wounds

Chronic non-healing wounds are a major health problem with resident bacteria strongly implicated in their impaired healing. A rapid-screen to provide detailed knowledge of wound bacterial populations would therefore be of value and help prevent unnecessary and indiscriminate use of antibiotics-a process associated with promoting antibiotic resistance. We analysed chronic wound fluid samples, which had been assessed for microbial content, using 20 different fluorescent labelled peptide substrates to determine whether protease activity correlated with the bacterial load. Eight of the peptide substrates showed significant release of fluorescence after reaction with some of the wound samples. Comparison of wound fluid protease activities with the microbiological data indicated that there was no correlation between bacterial counts and enzyme activity for most of the substrates tested. However, two of the peptide substrates produced a signal corresponding with the microbial data revealing a strong positive correlation with Pseudomonas aeruginosa numbers. This demonstrated that short fluorescent labelled peptides can be used to detect protease activity in chronic wound fluid samples. The finding that two peptides were specific indicators for the presence of P. aeruginosa may be the basis for a diagnostic test to determine wound colonisation by this organism.

Control of blue and green mold decay of citrus fruit by Pichia membranefaciens and induction of defense responses

Penicillium italicum and Penicillium digitatum are critical pathogens for citrus fruit. In this study, the ability of yeast Pichia membranefaciens to control P. italicum and P. digitatum during storage was examined, and the possible biocontrol mechanisms were discussed. Disease incidence after treatments with autoclaved cell culture or culture filtrate of P. membranefaciens was not effective in preventing the decay and even aggravated the disease degree. Disease incidence and lesion diameter were lower in fruit treated with living yeast cell suspension and washed cell suspension when compared to the respective control. Furthermore, disease control was more efficient when P. membranefaciens was applied. Rapid wound colonization by P. membranefaciens was observed both at 4 and at 20°C. Correspondingly, yeast population on the inoculated wounds increased by more than 4 and 11 folds after 48h inoculation. In addition, citrus fruit dipped in 1×108CFUmL−1P. membranefaciens had lower disease incidence, and the fruit dipped or inoculated with P. membranefaciens had increased in phenolic and flavonoid compounds content, peroxidase (POD), polyphenoloxidase (PPO), phenylalanine ammonia-lyase (PAL), chitinase (CHI) and β-1,3-glucanase activities in citrus fruit peel, all of which were correlated with the onset of induced resistance. This result suggested that competition for nutrients and space on wounds, and induced host defenses appear to contribute to the control mechanism of P. membranefaciens.

Burn unit: colonization of burn wounds and local environment

We present the results of a comparative prospective study of the resistance profile of strains isolated from pathological material of patients hospitalized in the burn unit of the military hospital in Rabat and from their environment over a period of one and a half years (July 2009-February 2011). The study concerned 125 pathological products from patients (40 men, 20 women; mean age 38±14.8 years; range 2 to 80 years) hospitalized with burns. This allowed the isolation of 86 non-redundant bacterial strains during the first period and 50 during the second. The dominant species were Acinetobacter baumannii (15.6%), followed by Pseudomonas aeruginosa (13.8%) and Staphylococcus aureus (11%). During the second period, we noted the abundance of A. baumannii (15.5%), followed by P. aeruginosa (11.3%) and Klebsiella pneumoniae (8.5%). Of the 104 environmental samples of burn patients, 139 microorganisms were isolated. Coagulase-negative staphylococcus was the most abundant strain in the two study periods (69.2% and 64.6%). All species showed an almost identical sensitivity to the various antibiotics tested.

Comparison of topical zinc oxide and silver sulfadiazine in burn wounds: an experimental study

We aimed to compare the effects of topical zinc oxide and topical silver sulfadiazine in the treatment of partial-thickness burn wounds. The study was conducted with 20 New Zealand rabbits, and burn wounds were created by a brass probe. The animals were randomly divided into two groups. The burns were treated with zinc oxide (Group O) or silver sulfadiazine (Group S) with daily application. The wound healing process was followed both clinically and histopathologically. We determined the days at which 50% and 80% re-epithelization was observed. The mean time for 50% and 80% re-epithelization was 21.4 and 25.4 days in Group O and 25.8 and 30.2 days in Group S, respectively (p<0.001). The mean score for wound colonization was lower in Group O. The difference was statistically significant at weeks 2, 3, 4, and 6 (p<0.001). In the histopathological examination, the thicknesses of the epidermis, dermis and scar tissue were 0.12 mm, 3.80 mm and 244 mm in Group O, and 0.16 mm, 4.76 mm and 3.16 mm in Group S, respectively (p<0.001). In this experimental burn study, zinc oxide was more effective than silver sulfadiazine in terms of epithelization, dermis maturation and scar formation.