Superficial Partial-thickness Wounds Research Articles

Current challenges in the treatment of paediatric burn patients: a retrospective experience at a Viennese burn unit

Burn trauma in paediatric patients continues to be highly relevant socio-economically since the number of inpatients treated per year has not declined over the past few decades. The treatment of paediatric burn victims places high demands on medical staff and the use of wound dressings and surgical techniques. This study aimed to give a current overview of the inpatient management and treatment methods for paediatric burn patients at a specialised burn centre in Vienna. All children and adolescents who were treated at the children's ward of the Division of Plastic and Reconstructive Surgery at the Medical University of Vienna between 2012 and 2016 due to a recent burn trauma were retrospectively analysed. 115patients were treated due to a recent burn trauma. Median age was 2 years (0-18). Scalds accounted for 74 % of traumas. Median affected body surface area was 5 % (1-40 %). Conservative treatment of superficial partial-thickness wounds (62 %) was performed with MepilexAg in 98 % of cases and required a median healing time of 11 days (4-34). 38 % (n = 44) of patients had deep partial-thickness or full-thickness burns . The use of Suprathel after tangential excision of the burn eschar in more superficial deep partial-thickness burns led to satisfying healing times. The use of modern dressings in the conservative treatment of superficial partial-thickness burns allows for atraumatic dressing changes and fast recoveries. The use of Suprathel in more superficial deep partial-thickness burns is a reliable and safe alternative to autologous skin grafting. Scar prophylaxis and regular follow-up examinations are crucial to prevent secondary morbidity due to scar contractures. It is important to raise awareness among parents in order to decrease the number of paediatric burn patients in the future.

The Feasibility of a Handheld Electrospinning Device for the Application of Nanofibrous Wound Dressings.

Objectives: The aim of this study was to determine the feasibility of a portable electrospinning device for the application of wound dressings. Approach: Four polymer nanofibers dressings were applied on superficial partial thickness wounds to a porcine model and compared with a traditional paraffin tulle gras dressing. The polymer nanofibrous dressings were applied using a handheld portable electrospinning device activated at a short distance from the wound. The partial thickness donor sites were evaluated on day 2, 7, and 14 when dressings were removed and tissue samples were taken for histological examination. Results: No significant difference was detected between the different electrospun nanofibrous dressings and traditional paraffin tulle gras. Desirable characteristics of the electrospun nanofiber dressing group included nontouch technique, ease of application, adherence and reduction in wound edema and inflammation. There was no delayed wound healing or signs of infection reported in both the electrospun nanofiber and traditional tulle gras dressings. Innovation: Used on partial thickness wounds, polymer electrospun nanofiber dressings provide excellent surface topography and are a nontouch, feasible, and safe method to promote wound healing with the potential to reduce wound infections. Such custom-made nanofibrous dressings have implications for the reduction of pain and trauma, number of dressing changes, scarring, and an added cost benefit. Conclusion: We have demonstrated that this portable handheld electrospinning device can be utilized for different formulations and materials and customized according to the characteristics of the target wound at the various stages of wound healing.

Noncultured Keratinocyte/Melanocyte Cosuspension: Effect on Reepithelialization and Repigmentation—A Randomized, Placebo-Controlled Study

Randomized controlled trials in the literature investigating the efficacy of noncultured keratinocyte/melanocyte suspensions are scarce; however, the advocates of such techniques press the value of their application based largely on case studies and anecdote. Caucasian patients with burn hypopigmentation seldom request cosmetic revision making worthwhile clinical trials difficult so that informal case treatments with new therapies generate anecdotal results. A randomized, placebo-controlled trial was carried out to evaluate whether cosuspensions of noncultured skin cells are capable of (1) decreasing the time to reepithelialization and (2) reestablishing pigmentation in vitiligo leukoderma following epidermal/superficial dermal ablation (in the knowledge that a positive result would make the technique likely to be successful in burn hypopigmentation). Vitiligo is common and is socially more debilitating such that suitable trial subjects for new therapies from this pool are more forthcoming. This study demonstrated that suspensions of noncultured keratinocytes and melanocytes do not decrease the time to epithelialization of superficial partial thickness wounds compared with controls. It also suggested that the achievement, quality, and duration of any pigmentation were unpredictable and largely disappointing. Some pigmentation was recorded in placebo-treated areas indicating an effect of the method of epidermal ablation in these patients. These findings have mandated a complete review of the use of these techniques in burn care at the Royal Adelaide Hospital; they have been omitted from surgical protocols where the aim of use was to speed reepithelialization. Their infrequent use in burns hypopigmentation will continue contingent on the successful repigmentation of a test patch.

Behandlung der Verbrennungswunde in der Praxis – Welche Kriterien dienen der Einschätzung der Wunde?

Burn injuries are a common trauma. Burn injuries to the skin are divided according their depth into erythema, superficial partial thickness, deep partial thickness and full thickness wounds. Superficial partial thickness wounds are characterized by intense pain and a positive blanching test. Superficial partial thickness wounds of up to 10 % total body surface area can be treated as out-patients. Large burns and those at critical areas like hand, face and genitalia should be treated in surgical departments or may require treatment at specialized burn centers. Superficial partial thickness burns are treated topically with antimicrobial ointments or wound dressings. It is of major importance to avoid desiccation of the wound bed. Reepithelialization should be completed by day 14. Infection of the wound or a non-healing wound makes surgical intervention necessary. In the case of postburn scarring silicon dressings and compression garments are necessary.

Behandlung der Verbrennungswunde in der Praxis – Welche Kriterien dienen der Einschätzung der Wunde?

Die kutane Verbrennung stellt eine häufige Verletzung dar. Verbrennungen werden bezüglich der Verbrennungstiefe in 1-, 2a-, 2b-, 3- und 4-gradige Verbrennungen eingeteilt. 2a-gradige Verbrennungen, die nur bis in die oberflächlichen Anteile der Dermis reichen und durch erhebliche Schmerzen und positive Rekapilarisierung erkennbar sind, werden konservativ behandelt. Großflächige Verbrennungen (> 15 %-2a-gradig bei Erwachsenen) und Verbrennungen an speziellen Lokalisationen (Gesicht, Hände, Genitale) sind jedoch stationär zu behandeln. Die konservative Behandlung wird mit topischen Salben und Wundauflagen durchgeführt. Ein Austrocknen des Wundgrundes ist zu vermeiden. Die Reepithelisierung sollte nach 14 Tagen abgeschlossen sein. Infizierte Wunden oder eine ausbleibende Heilung machen eine operative Intervention notwendig. Eine Nachbehandlung mit Narbenpflege und Kompression kann auch bei konservativ behandelten zweitgradigen Verbrennungswunden notwendig sein.