Management Of Partial Thickness Burns Research Articles

The optimal timing of outpatient Biobrane™ application for superficial and mid dermal partial thickness burns: Evidence for the ‘12-hour rule’

BackgroundBiobrane™ is a skin substitute used for the definitive management of partial thickness burns. No studies have examined the optimal timing of Biobrane™ application in this setting. The purpose of this study was to determine whether there was a clinically significant difference in applying Biobrane to a superficial and mid dermal partial thickness burn within 12h after burn. MethodsFrom August 2016–February 2017, 29 consecutive superficial and mid dermal partial thickness burn injuries were prospectively treated with Biobrane™ within 12h of the injury. This ‘early Biobrane™’ cohort was compared to a historical cohort of 148 patients who were treated with Biobrane™ for superficial and mid dermal burns after 12h after injury during 2015 to 2016. Multivariate regression analysis was used to determine the difference in time to re-epithelialisation and number of outpatient visits between the two cohorts. ResultsIn the ‘early Biobrane™’ group, the mean TBSA was 3.5±2.7%. and the mean time to Biobrane™ application was 7.1±2.7h after burn injury. The mean time to re-epithelialisation in this group was 9.1±3.0 days, and no patients underwent skin grafting. In the ‘delayed Biobrane™’ group, the mean TBSA was 2.6±2.8% and the mean time to Biobrane™ application was 35.1±21.4h. The mean time to re-epithelialisation was 14.8±8.7 days, with 3 patients undergoing skin grafting. Regression analysis demonstrated a statistically significant 63% reduction in time to re-epithelialisation (95% CI=0.23–0.60; P<0.0001) with early Biobrane™ application. ConclusionPatients treated with application of Biobrane™ within 12h of superficial and mid dermal partial thickness burns have a statistically significant reduction in healing time when compared to patients treated with standard Biobrane™ practice.

Biobrane Dressing for Second Degree Burns in Children

Objectives: Biobrane is a flexible biosynthetic wound dressing that is known for its success in the definitive management of partial thickness burns in many centers. The aim of the study was to conduct our experience with Biobrane dressing for second degree burns in children and to compare it with traditional dressings. Methods: A prospective study included children with second degree burns in whom Biobrane was used for dressing. Those were compared to children having the same burn degree where traditional dressing with silver sulfadiazine or nitrofurazone were used. Data analyzed using SPSS version 17. Results: Sixty eight patients with age ranged from 2 to 12 years were included. Patients in the Biobrane group had statistically significant less dressing changes, less admission days and less time for re-epithelialization.15.6% of patients in control group developed burn wound infection compared to 2.8% in the treatment group(P value = 0.062). Conclusion: When used in children with second degree burns, Biobrane could result in less healing times, less frequent dressing changes and decreased hospital stay compared to traditional dressings. Further research to clarify other outcomes is needed.

Nanocrystalline silver gel versus conventional silver sulfadiazine cream as topical dressing for second-degree burn wound: A clinicopathological comparison

Background: The use of topical chemotherapy is fundamental to prevent infections thereby reducing local inflammation, pain and early healing in superficial, and deep dermal burns. Among the whole gamut, choice of topical agents became an important decisive factor. Silver sulfadiazine (SSD) cream has been an important part of burns management for many years. The major complications attributed to silver compounds are due to the complex or anion sulfadiazine, not the silver itself. With better understanding of the physical and chemical properties, nanocrystalline silver particles have emerged as the most studied material for burn wound dressing recently. Having in mind the difficulties experienced, the aim of the present study is to compare SSD with nanosilver (nano-Ag) gel dressing to treat second-degree burn wounds. Materials and Methods: Over a period of 24 months, a total of 90 cases were studied. 45 patients randomly included in each group, further divided into two subgroups depending on depth (superficial and deep) and involvement of total body surface area (10%–20% and >20%–30%) to minimize bias. Clinical, microbiological, and histological parameters were analyzed. Results: In NS group, significantly less pain observed throughout the study period in both superficial and deep dermal burn patient. Pseudomonas was the predominant flora. Nano-Ag gel was effective in controlling most of the microorganisms except Klebsiella and Proteus sp. Healthy granulation tissue appeared faster (P = 0.0009) in deep dermal burns in nano-Ag group and confirmed histologically. Overall wound healing was more satisfactory in nano-Ag group for both superficial and deep dermal wounds, clinically as well as by histological examination. Conclusions: Clinical and histological studies showed that nano-Ag gel has a positive impact on overall healing process of the patients and proved more beneficial for the management of partial thickness burn as compared to SSD.

Management of partial thickness burn of the dorsum skin in a 3-year-old male German shepherd

A 3-year-old, 25 kg male German shepherd dog was presented to the Veterinary Teaching Hospital of Federal University of Agriculture, Abeokuta with the chief complaint of anorexia. History revealed that the dog had been off feed for about three days. Furthermore, there was a fire incidence in the residence of the dog in the absence of the owner five days prior to presentation. The fire burnt the skin of the dorsum. At presentation, general clinical examination revealed normal vital parameters, and normal mucous membrane. Physical examination revealed flame burns from the cervical region (the C-spine) to the caudal region (the sacral bone). This lesion was painful to touch. Anaesthesia was achieved using 6mg/kg Propofol® (Dongkook pharmaceutical, Korea) administered intravenously and 30ml of lignocaine HCL® (AzraZeneca,UK) infiltrated around the wound edge from the c-spine to the sacral bone. The hair around the burns area was clipped, the wound was debrided and cleansed using 10% solution of Chlorhexidine gluconate® (Saro LifeCare Ltd, Nigeria). Dermazin® cream was applied topically on the wound and the dog was given 4.5ml Enrofloxacine, intramuscularly (I.M), 4ml Multivitamin I.M and 4ml Vitamin B complex as supportives. On the second day of presentation, Dermazin® cream was replaced with pure honey® (FUNAAB Consult) for wound dressing. 5ml Vitamin C I.M. was included in the treatment regime on Day 4. All medications were given for 6 days except for wound dressing with pure honey® which continued until complete healing was achieved 88 days post presentation. Daily wound dressing with honey in this case re-vitalized the tissue, prevented re-infection and aided the lesion to proceed to the remodeling phase.Keywords: German shepherd dog, Partial thickness burn, Pure honey, Rehabilitation, Wound debridement

Comparative effectiveness of different wound dressings for patients with partial-thickness burns: study protocol of a systematic review and a Bayesian framework network meta-analysis

IntroductionSelecting a suitable wound dressing for patients with partial-thickness burns (PTBs) is important in wound care. However, the comparative effectiveness of different dressings has not been studied. We report the...

Collagen dressings in the management of partial thickness pediatric burns: Our experience

Background: Burns in the pediatric patients are usually caused due to accidental spillage and scalding by hot liquids. These are usually partial thickness burns. Collagen dressings have a better outcome in the management of partial thickness burns. Methodology: One hundred patients <12 years of age were included in a retrospective study from January 2013 to 2016. Patients were analyzed in terms of age and sex of the patient, type of burns, duration of presentation, degree and percentage of burns, and complications. Results: The mean age of presentation was 4 years. Ninety-eight percent of children had burns secondary to scalding. Collagen was applied for all patients. Ninety-two patients had no complication. Eight patients had minor complications. Conclusion: Collagen sheet is very useful in first- and second-degree burns in children. It is well tolerated, provides multiple benefits, and it has fewer complications.

The Effectiveness of Using Banana Leaf Dressing in Management of Partial Thickness Burns’ Wound

Background & Aim : An important factor in the healing of partial thickness burn is early and effective coverage with a dressing that is non-adherent; protects the wound from trauma and decrease pain during dressing change and ensures feeling of comfort and ease of handling. Wound care needs to be undertaken in the context of the local environment and access to costly wound products is not an option in many settings. In these situations, creativity and innovation have led to many excellent alternatives being developed. So this study amid to investigate the effectiveness of Banana Leaf Dressing (BLD) over partial thickness burns in terms of pain reduction, increasing comfort, easy removability of dressing, and early wound healing among burns patients who admitted with burns up to 50% of TBSA in selected hospital. Methods & Materials: A convenient sample of 38 patients with partial thickness burn wound over comparable areas, e.g. either upper extremities or lower extremities or both, comparable body areas were used as study and control areas in the same patient. Data were collected on three points of time during patient hospitalization using discomfort score, dressing removal pain score, and the easiness of dressing removal score. Results: BLD has significant out come on wound healing process. Patient suffered less discomfort and less pain during dressing removal with BLD than with ordinary dressing. Also with BLD removal of dressing was easier than ordinarydressing. In addition, time to complete healing was significantly less with BLD than others. Conclusion: It was clear that BLD is a completely non-adherent, nearly painless, and cheaper dressing.

Early Experience with Biobrane™ in Singapore in the Management of Partial Thickness Burns

In this study, we present a preliminary pictorial report on the use of Biobrane™ in the management of patients admitted with &gt;10% Total Body Surface Area (TBSA) partial thickness burns, using a standardised application protocol. In highlighting a successful case series with Biobrane™ application to all key areas of the body, we demonstrate promising early results; all patients showed excellent wound healing following early application of Biobrane™. This ensures pain relief, allows early mobilisation and results in a shorter length of stay (7–28 days) in the hospital.

Growth factor therapy in patients with partial-thickness burns: a systematic review and meta-analysis.

Growth factor (GF) therapy has shown promise in treating a variety of refractory wounds. However, evidence supporting its routine use in burn injury remains uncertain. We performed this systematic review and meta-analysis assessing randomised controlled trials (RCTs) to investigate efficacy and safety of GFs in the management of partial-thickness burns. Electronic searches were conducted in PubMed and the Cochrane databases. Endpoint results analysed included wound healing and scar formation. Thirteen studies comprising a total of 1924 participants with 2130 wounds (1131 GF receiving patients versus 999 controls) were identified and included, evaluating the effect of fibroblast growth factor (FGF), epidermal growth factor (EGF) and granulocyte macrophage-colony stimulating factor (GM-CSF) on partial-thickness burns. Topical application of these agents significantly reduced healing time by 5·02 (95% confidence interval, 2·62 to 7·42), 3·12 (95% CI, 1·11 to 5·13) and 5·1 (95% CI, 4·02 to 6·18) days, respectively, compared with standard wound care alone. In addition, scar improvement following therapy with FGF and EGF was evident in terms of pigmentation, pliability, height and vascularity. No significant increase in adverse events was observed in patients receiving GFs. These results suggested that GF therapy could be an effective and safe add-on to standard wound care for partial-thickness burns. High-quality, adequately powered trials are needed to further confirm the conclusion.

Clinical application and viability of cryopreserved cadaveric skin allografts in severe burn: A retrospective analysis

IntroductionCadaveric cutaneous allografts are used in burns surgery both as a temporary bio-dressing and occasionally as definitive management of partial thickness burns. Nonetheless, limitations in the understanding of the biology of these grafts have meant that their role in burns surgery continues to be controversial. MethodsA review of all patients suffering 20% or greater total body surface area (TBSA) burns over an eight year period that received cadaveric allografts were identified. To investigate whether tissue viability plays a role in engraftment success, five samples of cryopreserved cadaveric cutaneous allograft processed at the Donor Tissue Bank of Victoria (DTBV) were submitted to our laboratory for viability analysis using two methods of Trypan Blue Exclusion and tetrazolium salt (MTT) assays. ResultsDuring the study period, 36 patients received cadaveric allograft at our institution. The average total burn surface area (TBSA) for this group of patients was 40% and all patients received cadaveric skin as a temporizing measure prior to definitive grafting. Cadaveric allograft was used in complicated cases such as wound contamination, where synthetic dressings had failed. Viability tests showed fewer than 30% viability in processed allografts when compared to fresh skin following the thawing process. However, the skin structure in the frozen allografts was histologically well preserved. ConclusionCryopreserved cutaneous cadaveric allograft has a positive and definite role as an adjunct to conventional dressing and grafting where available, particularly in patients with large TBSA burns. The low viability of cryopreserved specimens processed at DTBV suggests that cell viability in cadaveric allograft may not be essential for its clinical function as a wound dressing or even as permanent dermal substitute.

Porcine xenografts vs. (cryopreserved) allografts in the management of partial thickness burns: Is there a clinical difference?

Porcine xenografts and cryopreserved allografts are used for the management of partial thickness burns and both biological materials have strong advocates with regard to clinical performance, the possibility of disease transfer from donor to recipient and other clinical aspects. A literature analysis was performed in an attempt to investigate whether true (statistically significant) differences exist on clinical performance and on other determinants for use.Comparing the results of this study with a similar, previously published study performed on possible differences amongst different types of allograft in the management of partial thickness burns, both allografts and porcine xenograft seem to perform equally well clinically with regard to healing related outcomes. In addition, the risk of disease transfer, in real life, was shown to be minimal. Consequently, clinical aspects being equal, other aspects such as price and availability should be used to decide which material to use for the management of partial thickness burns.

Preservation methods of allografts and their (lack of) influence on clinical results in partial thickness burns

Allografts, cadaver skin and amnion membrane are considered the golden standard in the management of partial thickness burns. However, debate on whether the tissue needs to be viable is on-going, since many believe that viable grafts result in better healing. The objective of this literature survey was to analyse the evidence on the method of preservation of allografts (cadaver skin or amnion membrane, glycerol, cryopreservation, lyophilisation) having a clinical impact on the healing of partial thickness burns. The survey focussed on preservation techniques and clinical outcomes (reepithelialisation) in partial thickness burns, as well as on differences in viability, immunogenicity and antimicrobial properties of the preservation methods. Most studies on allograft treatment of partial thickness burns are observational, with only one study of a (historical) comparative nature. A true meta-analysis was not performed and the results of this survey are observational in nature as well: they indicate that there is no evidence that viability of the graft influences healing outcomes. Thus, instead of viability, other aspects, such as intrinsic antimicrobial safety of the preservation method and cost should be the primary criteria for the choice of preservation method to be used for allografts.

Dried irradiated human amniotic membrane as a biological dressing for facial burns—A 7-year case series

Background Facial burns are common and have a significant impact on patient function and psychosocial well being. Human amnion has been used for many years as a temporary biological wound dressing in the management of partial thickness burns. The observed advantages of human amnion treatment include pain relief, ease of use, prevention of infection and acceleration of wound healing. Objective This study evaluated our 7 years of working with dried irradiated human amnion in the treatment of facial burns. Method A review of patients, treated with dried human amnion for facial burns between 2001 and 2008. Demographic details collected included age, gender, total facial surface area burned, type of burn and cause of injury. The effectiveness of the treatment was determined by wound infection rate, frequency of dressing reapplication, healing time and resulting scarring. Results Thirty-three patients with superficial partial thickness burn were identified (25 males, 8 females). The average age of the patients was 16.5 years (range: 8 months to 64 years). The causes included scalding ( n = 15), contact burning ( n = 13) and flash burning ( n = 5). The mean percent total facial surface area burned was 2.7% (range: 0.5–8.5%). None of the patients developed facial wound infections. Eighty-five percent ( n = 28) of the patients needed a single application of the dried amnion. The average healing time was 5.4 days (range: 2–14 days). Thirteen patients (39%) had burns confined to the facial area, of which three were discharged and treated as outpatients. Long-term follow up showed two hypopigmented scars, one hyperpigmented scar and one hypertrophic scar. Conclusion Superficial partial thickness facial burns can be effectively treated with dried irradiated human amnion membrane.

Moist exposed burn ointment: Role of alternative therapy in the management of partial-thickness burns

Moist exposed burn ointment: Role of alternative therapy in the management of partial-thickness burns

The efficacy of Helix aspersa Müller extract in the healing of partial thickness burns: A novel treatment for open burn management protocols

Snail extracts have been increasingly used in numerous dermatologic conditions and recent literature attributes healing, soothing and anti-aging properties to them. This study evaluates the efficacy of Helix aspersa extract in an open wound management protocol for deep partial thickness (PT) facial burns and compares it to moist exposure burn ointment (MEBO). A total of 27 adult patients with deep partial thickness facial burns (group A) were treated by application of a snail extract cream twice daily for a maximum period of 14 days or until full epithelialization. Times until debridement and epithelialization of the burn surface were compared with those of 16 patients (group B, control) treated by MEBO. Pain scores were recorded using a visual analogue scale (VAS) on the fourth post-burn day before and 30 min after application. Mean times for eschar detachment were 9±2 days (group A) and 11±2 days (group B) (p=0.003) and for burn surface epithelialization were 11±2 days and 15±3 days respectively (p≤0.001). VAS pain scores after application in group A were significantly lower compared to group B (p≤0.001). Helix aspersa extract is a natural, safe and effective alternative treatment in open wound management of partial thickness burns in adults.

Biobrane: A Versatile Tool in the Armamentarium of the Reconstructive and Burns Surgeon

Sir: Biobrane is becoming increasingly popular in the management of superficial and moderate-depth partial-thickness burns. When used appropriately, it has been shown to reduce pain levels, healing time, inpatient stay, and nursing requirements when compared with traditional dressings. We would like to draw the attention of the reconstructive community to the versatility of Biobrane above and beyond these well-known indications. Biobrane is a biosynthetic wound dressing first developed by Woodruff in 1979. It has many of the “ideal” properties highlighted by Pruitt and Levine in 1984.1 There is a great deal of literature available outlining the successful use of Biobrane in the management of partial-thickness burns in pediatric patients. There is also evidence for its use in the treatment of partial- and full-thickness burns in the adult, particularly in large burns and those involving joints and the hand. Various application modifications have been published to overcome coverage of difficult areas (e.g., use of the Biobrane glove to dress the foot and the Biobrane “jacket” to dress the torso). In addition to covering the burn wound, it is also used in the management of split-thickness skin graft donor sites, in both burned and nonburned patients. Its use in stenting split-thickness skin grafts has also been advocated. The use of Biobrane has been reported to cover the axillary defect following surgical excision for hidradenitis suppurativa.2 This single-stage procedure, with no donor-site morbidity, exhibited the ability to use Biobrane in colonized tissues. The limitations included a longer healing time and increased cost of dressing. Biobrane has also been used successfully after laser resurfacing of the face.3 It was well tolerated, minimized pain and drainage, decreased erythema, reduced healing time, and simplified nursing care. Similarly, Biobrane has been used as a dressing after mechanical dermabrasion. This study showed that Biobrane reduced erythema and healing time by up to 50 percent when compared with air-exposed wounds. The use of Biobrane has been reported in the successful treatment of serious skin conditions, such as toxic epidermal necrolysis4 and paraneoplastic pemphigus. Biobrane was applied to the extensive areas of erosion to assist in pain management and to provide a temporary barrier function. The treatment of serious skin conditions such as toxic epidermal necrolysis and pemphigus with Biobrane is an area that warrants further evaluation, as it may contribute to the overall treatment and comfort of these patients. Chronic wounds such as large venous ulcers have also been managed successfully using Biobrane. There are several case reports concerning the use of Biobrane in the contemporary literature. The skin substitute was used in the treatment of a life-threatening esophageal fistula by covering an expandable metallic stent and in the management of subcutaneous colostomy perforation. Biobrane has also been used in the successful management of sternotomy wounds that were not closed immediately due to massive intraoperative edema formation. Adverse affects following the use of Biobrane are uncommon, but surgeons should be aware of the possibility of contact dermatitis, hypersensitivity, and hypertrophic scarring.5 We believe that Biobrane is a highly versatile tool that should be in the armamentarium of all reconstructive and burns surgeons. Further randomized controlled trials assessing its use in a variety of conditions are warranted. Iain S. Whitaker, M.R.C.S. The Welsh Plastic Surgery and Burns Unit The Morriston Hospital Swansea, United Kingdom Paul Mallinson, M.B.Ch.B. Pinderfield's Hospital Wakefield, United Kingdom Peter J. Drew, F.R.C.S.(Edin.), F.R.C.S.(Eng.), F.R.C.S.Plast. Department of Burns and Plastic Surgery The Welsh National Plastic Surgery and Burns Unit The Morriston Hospital Swansea, United Kingdom DISCLOSURE None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this communication.

The relationship between protease/anti-protease profile, angiogenesis and re-epithelialisation in acute burn wounds

In the management of partial thickness burns, it is difficult to balance between conservative management and surgical intervention. Our hypothesis was that a triangular relationship exists between protease/anti-protease profile at the burn wound surface, angiogenesis and re-epithelialisation. By manipulation of the biochemical profile at the wound level, we determined to affect the nature and extent of angiogenesis and resulting re-epithelialisation. We performed a randomised longitudinal observational study on partial thickness burns in adult patients presenting to two regional burns units. Our results demonstrated that a high-protease wound environment is associated with lower levels of the angiogenic factor VEGF, a lower more uniform change in wound bloodflow and a uniform well healed wound with an architecturally normal epidermis. In addition, we found that a low protease wound environment is associated with higher levels of the angiogenic factor VEGF, a higher wound bloodflow throughout the wound healing period and a more chaotic, hypercellular, overkeratinised, and chaotic thickened epidermis.

Results of an Internet Survey on the Treatment of Partial Thickness Burns, Full Thickness Burns, and Donor Sites

The objective of this study was to analyze which materials and methods are used for the management of partial and full thickness burns, as well as donor sites. An Internet survey was used to poll directors of burn centers around the world on their preferences for local treatment of different types of burns and donor sites. Results were tabulated and expressed as a percentage of the total number of answers for a given indication. Although many new wound care materials have been launched in the last decade, few of these actually are used widely. The most commonly used materials for partial thickness burns and donor sites are still silver sulphadiazine 1% cream, other antimicrobial ointments and creams and impregnated gauze type dressings. Of the newly available treatment modalities, only two silver dressings were chosen frequently as a primary option for the management of partial thickness burns and donor sites. For full thickness burns, the primary choice is excision and grafting. The diversity of dressings and techniques indicated as preferred in this survey, including many that are known to have side effects, indicates that there is no consensus on topical treatment of partial thickness burns and donor sites. Many respondents prefer "tried and true" materials over newer dressings, particularly if the latter have not been tested in a clinical trial.

A Phase III, Randomized, Comparative Evaluation of a Hydrofiber® Dressing with Ionic Silver And Silver Sulfadiazine in The Management of Partial-Thickness Burns

Silver sulfadiazine 1% cream (SSD) has been the gold standard for treatment of partial thickness and mid-dermal burns. However, SSD has several disadvantages including at least daily dressing changes and significant pain with removal of the SSD prior to re-application. Previously in a Phase II trial, a Hydrofiber® moisture-retention dressing combined with 1.2% ionic silver (AQUACEL® Ag - AQAg) was studied in the treatment of partial thickness burns. AQAg had satisfactory rates of reepithelialization, reduction in pain during dressing changes, and sustained antimicrobial activity. A Phase III, prospective, randomized, multi-center study, involving 8 United States burn centers, compared AQAg versus SSD, for up to 21 days, as wound dressing in the treatment of partial thickness and mid-dermal burns. Patients were at least 2 months of age, sustained mainly a flash, flame, or scald burn which involved between 5–40% total body surface area (TBSA), and had not been treated with antibiotics...

Microbicidal properties of a silver-containing hydrofiber dressing against a variety of burn wound pathogens.

Partial-thickness burns are often characterized by microbial contamination and copious exudate produced during the early postburn period. Consequently, topical wound management often relies on the use of antimicrobial agents and absorbent dressings, and an AQUACEL Hydrofiber Dressing containing ionic silver has been designed to meet such needs. To assess the antimicrobial properties of the AQUACEL Hydrofiber dressing, samples were challenged with a wide variety of recognized burn wound pathogens in a simulated wound fluid model. Dressing samples were inoculated with the challenge organisms at time zero and then reinoculated on days 4 and 9 to mimic the worst-case clinical scenario. The dressing was shown to be microbicidal against aerobic and anaerobic bacteria (including antibiotic-resistant strains), yeasts, and filamentous fungi during a 14-day test period. Based on our results, the silver-containing dressing is likely to provide a barrier to infection, in addition to providing proven fluid-handling benefits of the AQUACEL Hydrofiber dressing, in the management of partial-thickness burns.