Partial Thickness Burns In Children Research Articles

A Pilot Randomised Controlled Trial Evaluating a Regenerative Epithelial Suspension for Medium-Size Partial-Thickness Burns in Children: The BRACS Trial

Background: There is little evidence regarding the efficacy of Regenerative Epidermal Suspension (RES™) management for paediatric partial-thickness burns. The Biobrane® RECELL® Autologous skin Cell suspension and Silver dressings (BRACS) Trial evaluated three dressings for the re-epithelialisation of partial-thickness burns in children. Methods: Eligible children (age ≤ 16 years; ≥5% TBSA; ≤48 h of injury) were randomised to silver dressings, RES™/Biobrane® or Biobrane®. The measured outcomes were the time to re-epithelialisation (primary outcome), pain, itch, intervention fidelity, treatment satisfaction, health-related quality of life, health resource utilisation and adverse effects. Results: The median time to re-epithelialisation in days was no different for RES™/Biobrane® at 12 (IQR: 5.6–18.4; n = 7) and slower by two days for Biobrane® at 14 (IQR: 6.3–21.7; n = 7) when compared to silver dressings 12 (IQR: 3.7–20.3; n = 8). Reduced pain, fewer infections, no sepsis, no skin graft, and the lowest impact on health-related quality of life were reported in the RES™/Biobrane® group compared to other groups. Due to the COVID-19 pandemic, recruitment suspension resulted in a smaller cohort than expected and an underpowered study. Conclusions: The pilot trial findings should be interpreted cautiously; however, they indicate that a fully powered randomised controlled trial is warranted to substantiate the role of RES™ for medium to large paediatric partial-thickness burn management.

Suprathel® or Mepilex® Ag for treatment of partial thickness burns in children: A case control study

AimThe study aim was to investigate if Suprathel® can be an adequate alternative to Mepilex® Ag for the treatment of partial-thickness scalds in children. MethodsA retrospective study including 58 children admitted to The Burn Centre in Linköping, Sweden between year 2015 and 2022. Of the 58 children, 30 were dressed with Suprathel ® and 28 with Mepilex ® Ag. Outcomes investigated were healing time, burn wound infection (BWI), need for operations and number of dressing changes. ResultsWe found no significant differences in any of the outcomes. In the Suprathel ® group 17 children and in the Mepilex ® Ag group 15 children were healed within 14 days. Ten children from each group received antibiotics for suspected BWI and two from each group underwent an operation with skin grafting. Each group had on median four dressing changes. ConclusionsTwo different treatments were compared for children with partial-thickness scalds, and the data indicates that similar results are received with both dressings.

Usability and effectiveness of Suprathel\xae in partial thickness burns in children

PurposeEvaluation of usability and effectiveness of Suprathel® in the treatment of partial thickness burns in children.MethodsA prospective, observational study to evaluate adherence of Suprathel® to the wound bed, reepithelialization time, grafting, wound colonization and infection, pain, dressing changes, length of hospital stay (LOS) and scar formation.ResultsTwenty-one children (median age 2.4 years, range 5 months–14 years) with a median total body surface area (TBSA) of 4 % (range 1–18) were included. Median LOS was 10 days (range 3–20). Median outer layer dressing changes was 3 (range 1–14). Suprathel® was only adherent in wounds debrided with Versajet®. Median reepithelialization time was 13 days (range 7–29). Three patients needed a split skin graft. There were 7 (33 %) patients with wound colonization before application of Suprathel®. This increased to 12 (57 %) patients during treatment. One patient developed a wound infection. Median visual analog scale (VAS) scores for background and procedural pain in patients >7 years were 3.2 (range 2–5) and 3.5 (range 2–5), respectively. In younger patients, median background and procedural COMFORT-B scores were 13.8 (range 10–23) and 14.8 (range 13–23, p = 0.03), respectively. Patient and Observer Scar Assessment Scale (POSAS) scores were favorable after 3 and 6 months post burn.ConclusionsSuprathel® provides potential advantages regarding pain and scar formation, but extensive wound debridement is needed to achieve adequate adherence.

Silver Sulfadiazine or Biobrane Dressings

Background In the treatment of partial thickness burns in pediatrics, silver sulfadiazine (SSD) has been widely used. Biobrane, a biosynthetic dressing, has gained popularity for treatment as well for its promotion of epithelial growth. Nonetheless, there is limited information on the comparison of SSD and Biobrane for the treatment of partial-thickness burns in children. This literature review aimed to provide objective data on increased epithelial growth and decreased infection risk of SSD and Biobrane. Purpose The aim of this study was to conduct a literature review to examine the use of Biobrane dressings in comparison with SSD for the treatment of partial-thickness burns in children to improve epithelial growth and decrease risk of infection as compared with SSD. Results Seven systemic reviews were included in the literature review. Evidence showed that there was limited high-quality evidence to confirm the effectiveness of Biobrane compared with SSD in the pediatric population with partial thickness burns in regard to fewer dressing changes, improved healing time, and reduced wound infections. Some evidence exists showing Biobrane's ease in use and improved healing time when compared with SSD. Recommendations for Practice Future research is necessary to investigate Biobrane and SSD within large pediatric burn populations to establish its effectiveness and provide high-quality evidence for the treatment of pediatric partial-thickness burns.

Randomized controlled trial of three burns dressings for partial thickness burns in children

BackgroundThis study compared the effects of three silver dressing combinations on small to medium size acute partial thickness burns in children, focusing on re-epithelialization time, pain and distress during dressing changes. MethodChildren (0–15 years) with clean, ≤10% total body surface area (TBSA) partial thickness burns who met the inclusion criteria were included in the study. Children received either (1) Acticoat™; (2) Acticoat™ with Mepitel™; or (3) Mepilex Ag™ dressings. Measures of burn re-epithelialization, pain, and distress were recorded at dressing changes every 3–5 days until full re-epithelialization occurred. ResultsOne hundred and three children were recruited with 96 children included for analysis. No infections were detected for the course of the study. When adjusted for burn depth, Acticoat™ significantly increased the expected days to full re-epithelialization by 40% (IRR=1.40; 95% CI: 1.14–1.73, p<0.01) and Acticoat™ with Mepitel™ significantly increased the expected days to full re-epithelialization by 33% (IRR=1.33; 95% CI: 1.08–1.63, p≤0.01) when compared to Mepilex Ag™. Expected FLACC scores in the Mepilex Ag™ group were 32% lower at dressing removal (p=0.01) and 37% lower at new dressing application (p=0.04); and scores in the Acticoat™ with Mepitel™ group were 23% lower at dressing removal (p=0.04) and 40% lower at new dressing application (p<0.01), in comparison to the Acticoat™ group. Expected Visual Analog Scale-Pain (VAS-P) scores were 25% lower in the Mepilex Ag™ group at dressing removal (p=0.04) and 34% lower in the Acticoat™ with Mepitel™ group (p=0.02) at new dressing application in comparison to the Acticoat™ group. There was no significant difference between the Mepilex Ag™ and the Acticoat™ with Mepitel™ groups at all timepoints and with any pain measure. ConclusionMepilex Ag™ is an effective silver dressing, in terms of accelerated wound re-epithelialization time (compared to Acticoat™ and Acticoat™ with Mepitel™) and decreased pain during dressing changes (compared to Acticoat™), for clean, <10% TBSA partial thickness burns in children.

English

SUMMARY: BACKGROUND: Burn injuries present a major public health problem for children. In India this constitutes about one-fourth of total burn injuries. This article deals with situations that need to be addressed in the care of partial thickness wounds in children to provide optimal conditions for wound protection and repair while minimizing the morbidity and complications. AIM: To compare outcomes for pediatric age group patients who were applied beta- glucan collagen or anti-microbial dressing as primary wound covering in respect to pain, infection rate and healing time. DESIGN OF STUDY: Randomized controlled trial. SETTINGS AND DESIGN: Tertiary care hospital of central India from 2008-2010. METHODS: Patients admitted at tertiary care centre with partial thickness burns at first presentation were recruited to randomized controlled trial. Patients in trial were randomly allocated for beta-glucan collagen or anti-microbial dressings. RESULTS: Seventy-two patients were recruited over 28 months. Two were excluded from final analysis due to premature demise. Out of seventy subjects thirty-five were in BGC group while remaining thirty-five were in SSD group. Subjects were in 1-11 age range with majority being in 1-5 age groups. Out of total seventy patients thirty-three were male and thirty-three were females. Flame burns and scald burns were equally distributed in both groups and difference was not significant. Most of the patients presented within 6 hrs of initial injury (54.7%). TBSA% in BGC group was 16.4 while it was 18.2 in control group. Most of the patients in both the groups had burn injury over upper limb followed by anterior trunk. Partial thickness burns in children can be cost effectively treated with BGC with decreased pain, mean healing time and hospital stay with good cosmetic results.

Use of Suprathel® for partial thickness burns in children

We evaluated the use of Suprathel®, a synthetic skin substitute, for partial thickness burns in children. Thirty-three children (20 females, 13 males; mean age 29months, range 5months to 11years) with burns were treated with Suprathel®. The burns were superficial partial thickness (n=24) or mid-dermal (n=19); the median %TBSA was 4% (range 1–13%).Suprathel® was applied after debridement, followed by Vaseline gauze, dry gauze and crepe bandage. The outer dressings were changed every 5–10days unless clinical problems dictated otherwise.Median healing time was 16days (range 9–38days). Ten patients took longer than 21days to heal, of whom four developed hypertrophic scarring, which was strongly associated with wound infection (p<0.05). Healing time of superficial partial thickness and mid-dermal burns was not significantly different (p=0.494).Suprathel® is an effective skin substitute for the treatment of partial thickness burns in children. The majority of burns in children are mixed depth, and Suprathel® has the advantage that it may also be used to treat mid-dermal burns. It behaves like a biological dressing but is not animal derived, so is acceptable to all religious and ethnic groups. Further studies to evaluate the efficacy and cost effectiveness of Suprathel® compared to other dressings in children are warranted.

Topical silver sulfadiazine vs collagenase ointment for the treatment of partial thickness burns in children: a prospective randomized trial

BackgroundThe 2 most commonly used topical agents for partial thickness burns are silver sulfadiazine (SSD) and collagenase ointment (CO). Silver sulfadiazine holds antibacterial properties, and eschar separation occurs naturally. Collagenase ointment is an enzyme that cleaves denatured collagen facilitating separation but has no antibacterial properties. Currently, there are no prospective comparative data in children for these 2 agents. Therefore, we conducted a prospective randomized trial. MethodsAfter institutional review board approval, patients were randomized to daily debridement with SSD or CO. Primary outcome was the need for skin grafting. Patients were treated for 2 days with SSD with subsequent randomization. Polymyxin was mixed with CO for antibacterial coverage. Debridements were performed daily for 10 days or until the burn healed. Grafting was performed after 10 days if not healed. ResultsFrom January 2008 to January 2011, 100 patients were enrolled, with no differences in patient characteristics. There were no differences in clinical course, outcome, or need for skin grafting. Wound infections occurred in 7 patients treated with CO and 1 patient treated with SSD (P = .06). Collagenase ointment was more expensive than SSD (P < .001). However, total hospital charges did not differ. ConclusionThere are no differences in outcomes between topical SSD or CO in the management of childhood burns results.

Effectiveness of Biobrane for treatment of partial-thickness burns in children

Purpose Wound care for partial-thickness burns should alleviate pain, decrease hospital length of stay, and be readily applied to a variety of wounds. The effectiveness of Biobrane (UDL Laboratories, Rockford, IL) is compared with that of Beta Glucan Collagen (BGC; Brennan Medical, St. Paul, MN) in a retrospective cohort study. Methods A retrospective chart review of all children treated at a tertiary care pediatric hospital between 2003 and 2009 identified patients with partial-thickness burns treated with Biobrane. These patients were compared with historical controls treated with BGC. Results A total of 235 children between the ages of 4 weeks and 18 years with an average of 6.0% body surface area partial-thickness burns were treated with Biobrane. In a multivariate statistical analysis, patients treated with Biobrane healed significantly faster than those treated with BGC (Biobrane vs BGC: median, 9 vs 13 days; P = .019; hazard ratio, 1.68). In addition, patients who required inpatient treatment trended toward having shorter length of hospital stay in the Biobrane group (2.6 vs 4.1 days, P = .079). Conclusion Partial-thickness burn care consists of early debridement and application of a burn wound dressing. Biobrane dressings result in faster healing compared with BGC and may decrease hospital length of stay for patients requiring inpatient admission.

Clinical Evaluation Comparing the Efficacy of Aquacel® Ag Hydrofiber® Dressing Versus Petrolatum Gauze With Antibiotic Ointment in Partial-Thickness Burns in a Pediatric Burn Center

We conducted this Institutional Review Board-approved retrospective study to compare Aquacel Ag Hydrofiber dressing (Aquacel Ag) to a standard dressing for the treatment of partial thickness burns in children. We used the St. Christopher's Hospital burn center registry to identify 20 pediatric patients who had sustained partial thickness burns over a 10-month period. Ten of these patients had been treated with Aquacel Ag Hydrofiber dressing and 10 were treated with conventional Xeroflo gauze with Bacitracin Zinc ointment, the institutional standard of care for nonoperative partial-thickness burn wounds. Inclusion criteria included anyone with partial-thickness burns below the age of 18 years and in excellent baseline health. Exclusion criteria included inhalation injury, presence of full-thickness burns necessitating surgical debridement, cellulitic, or infected wounds, and percentage total body surface area involvement greater than 40%. Outcomes measured for the Aquacel Ag versus the Xeroflo gauze with Bacitracin Zinc ointment group included hospital length of stay (2.4 vs. 9.6 days), total number of in-house dressing changes (2.7 vs. 17.1), pain on a 10-point scale associated with dressing changes (6.4 vs. 8.2), total number of intravenous narcotic administrations (2.3 vs. 14.4), nursing time adjusted for percentage total body surface area (1.9 vs. 3.5 min), time to wound reepithelialization (10.3 vs. 16.3 days), and patient primary caregiver satisfaction score using a 4-point scale--with four delineating maximum satisfaction (3.8 vs. 1.8). Aquacel Ag proved to be a safe and effective means of treating partial thickness burns with a significant reduction in nursing time and patient pain involved with dressing changes.

A Critical Evaluation of the Use of Biobrane as a Biologic Skin Substitute

Biobrane and Biobrane-L are becoming increasingly popular in the management of superficial and moderate-depth partial-thickness burns, particularly in pediatric patients. When used appropriately, they have been shown to reduce pain levels, healing time, inpatient stay, and nursing requirements when compared with traditional dressings. In this manuscript, we provide a critical evaluation of the evidence base for the varied uses of Biobrane within the field of plastic and reconstructive surgery.We present a comprehensive review of MEDLINE-cited articles, the proceedings of national meetings, relevant books, and information from the suppliers to provide the reconstructive surgeon with an evidence base for the use of Biobrane. We also take this opportunity to discuss religious and ethical issues and the complications of Biobrane application.Biobrane is a versatile biosynthetic wound dressing. There is good evidence (Grade A) to support the use of Biobrane in the management of burns, particularly in partial-thickness burns in children. Biobrane also has many potential uses as a dressing outside the burns unit of which we feel reconstructive surgeons should be aware. Conditions resulting in disruption of the epidermis such as toxic epidermal necrolysis (TEN) and paraneoplastic pemphigus have been managed successfully using Biobrane (Grade B). Biobrane has also been successfully used following dermabrasion, skin-graft harvesting, and laser resurfacing (Grades B to C). Temporary coverage with Biobrane has been successfully used in individuals with chronic wounds such as open sternotomy sites and venous ulcers (Grades B to C). Biobrane has a wealth of potential uses outside its traditional remit; however, further prospective clinical trials are warranted if these new applications are to become more widely accepted.

Ocena wyników zachowawczego i operacyjnego leczenia oparzeń głębokich pośredniej grubości u dzieci

Ocena wyników zachowawczego i operacyjnego leczenia oparzeń głębokich pośredniej grubości u dzieci

Biobrane ® in bairns with burns and bugs?

1. Summary The physiological and immunological impact of burns in children is well described. Biobrane 1 is a commonly used product in the treatment of superficial burns in children and has many attractive properties, warranting its use. Unfortunately, bacterial super-infections and serious sepsis due to Staphylococcus aureus and group A beta haemolytic are ever increasing complications in the patients under the age of five who have been exposed to Varicella Zoster Viruses. Biobrane 1 , despite its healing properties, is a foreign substance and we ask the question whether recent or current chickenpox is a relative contraindication to its use. Burns, due to their very nature, pose a challenging problem with regard to bacterial super-infection, especially in very young children. In recent years, the acute management of scalds and superficial burns in young patients (bairns: Scottish term for children) has changed. Current practice involves thorough cleansing of the wound, usually under general anaesthesia, and application of Biobrane 1 (Bertek Pharmaceuticals Inc., Morgantown, West Virginia, USA). It is marketed on the premise that the highly purified peptides from porcine dermal collagen, bonded to a nylon and silicone semipermeable membrane, minimises bacterial proliferation by minimising dead space. Previously, partial thickness burns in children involved painful daily bathing, washing and cleansing of the burn wound followed by topical application of antimicrobial creams [1]. Biobrane 1 diminishes the need for daily wound dressing which increases exposure of the wound, has an analgesic effect and, therefore, minimises the use of painkillers while providing a suitable environment for re-epithelialisation. One randomised trial showed that there were also fewer infections when compared with 1% silver sulphadiazine [1]. Since changing our protocol for the management of paediatric burns, two cases have come to light which we feel warrant further investigation concerning its use in children with burns who also have a current or recent Varicella Zoster Virus infection or who may have been exposed to it. Bacterial super-infections are one of the most common complications following Varicella Zoster Virus infection. Although other complications such as Reyes syndrome, encephalitis, pneumonia, hepatitis, glomerulonephritis, cerebellar ataxia, arthritis and purpura fulminans are also recognised, skin and soft tissue infection are still the most frequent manifestations of the virus within healthy children [2,3]. These complicated infections are more common in children below the age of five and are largely due to S. aureus (SA) and group A beta haemolytic streptococcus

Treatment of partial‐thickness burns: a prospective, randomized trial using TranscyteTM

The purpose of the present study was to compare the effectiveness of three burns dressings (TransCyte, a bio-engineered skin substitute; Biobrane; and Silvazine cream (silver sulphadiazine and 0.2% chlorhexidine)), in treating children with partial-thickness burns. The primary objective was to determine the days until > or =90% re-epithelialization. The secondary objectives were to evaluate the number of wounds requiring autografting and the number of dressing changes/local wound care required. Study wounds were identified on each patient and the patients were randomized to receive TransCyte or Biobrane or Silvazine. Assessment of study wound closure began at 2 days after treatment and continued at least every other day thereafter until the wounds re-epithelialized or were autografted. A laser Doppler imaging system was used as an adjunct to assessing the depth of the burn. Thirty-three patients with 58 wound sites enrolled in the study (TransCyte, n = 20, Biobrane, n = 17; Silvazine, n = 21). Mean time to re-epithelialization was 7.5 days for TransCyte, 9.5 days for Biobrane, and 11.2 days for Silvazine. The number of wounds requiring autografting were 5/21 (24%) for Silvazine, 3/17 (17%) for Biobrane, and 1/20 (5%) for TransCyte. When used in partial-thickness burns in children, TransCyte promotes fastest re-epithelialization and required less overall dressings then Biobrane or Silvazine. Patients who received Silvazine or Biobrane require more autografting than those treated with TransCyte.

Effectiveness of beta-glucan collagen for treatment of partial-thickness burns in children

Beta glucan collagen matrix (BGC), which combines the carbohydrate beta-glucan with collagen, has been used as a temporary coverage for adult partial thickness burns with reported good results. Observed advantages of BGC coverage include reduction of pain, improved healing, and better scar appearance. Potentially even more important in children is the elimination of painful daily dressing changes to the burned epithelial surface, as well as decreased fluid loss. This report details the authors' 2-year experience with BGC in a pediatric burn center. Retrospective chart review of 225 consecutive pediatric patients treated at our institution between 1997 and 1999 identified 43 patients (19%) with suspected partial thickness burns treated with BGC as the primary wound dressing. BGC was applied to a debrided burn wound and secured with steri-strips, kerlix, and an ace wrap. After 24 hours, adherence of the BGC was confirmed and then left open to air. The most common cause of burn injury was scald (61%), followed by flame (37%), and contact (2%). The average age of patients was 5.5 years (range, 6 weeks to 16 years) and mean percent total body surface area burned was 9.3% (1% to 35%). Thirty-four patients (79%) had the BGC remain intact while the wound healed underneath, with excellent cosmetic results, minimal analgesic requirements, and no need for repetitive dressing changes. Nine patients (21%) had the BGC removed before wound healing: 6 patients lost the BGC because of progression of the burn to full thickness, 2 had BGC nonadherence over a joint, and 1 had an unexplained nonadherence. Partial-thickness burns in children can be effectively treated with BGC with good results, even in infants and toddlers. BGC markedly simplifies wound care for the patient and family and seems to significantly decrease postinjury pain.