Treatment Of Partial Thickness Burns Research Articles

The use of Urgotul™ in the treatment of partial thickness burns and split‐thickness skin graft donor sites: a prospective control study

The use of paraffin-impregnated gauze for burns and skin graft donor sites is commonly associated with wound adherence with consequent pain and trauma upon removal. This prospective clinical study was performed to evaluate a new class of lipido-colloid dressings (Urgotul) in promoting healing and in reducing tissue adherence. In a 6-month period, 25 consecutive patients were recruited. Two separate burn or donor sites on each patient were dressed with tulle-gras (TG) or Urgotul and covered with standard secondary dressings. Objective assessment of wounds by two reviewers, and patients' subjective assessments were recorded. Twenty-three (92%) patients were followed up for a mean of 3 months. Mean time to complete epithelialisation was 9.6 and 11.9 days for the Urgotul and TG sites respectively (P < 0.05). Bleeding was seen in 52% of Urgotul sites compared with 100% of the TG sites at first dressing change (P < 0.05). Patients reported 'moderate pain' during dressing change in 22% and 57% in the Urgotul and TG groups respectively (P < 0.05), with 35% of TG sites being 'very painful' requiring extra analgesia. We found that compared with TG, Urgotul was associated with faster epithelialisation, less pain and trauma (bleeding) during dressing changes.

Preliminary results with the use of spray keratinocytes in the treatment of partial thickness burns

Preliminary results with the use of spray keratinocytes in the treatment of partial thickness burns

Effect of imiquimod on partial-thickness burns

Background Burns can result in substantial morbidity through fibroblast proliferation and contracture. Imiquimod (IMQ), an immune response modifier and upregulator of endogenous cytokine expression, has been shown to suppress fibroblast proliferation. It is widely used in the treatment of viral, neoplastic and non-neoplastic skin conditions and has recently been tested in the reduction of hypertrophic scarring and keloids. To our knowledge, no other study has so far evaluated the effect of IMQ on cutaneous burns. Methods Partial-thickness burns were produced on the dorsum of 32 Wistar rats. Right-sided wounds received saline and left-sided wounds received 5% IMQ cream three times/week following injury. Photographs taken on post-burn days (PBD) 4, 7, 14 and 21 were evaluated for wound appearance using a clinical assessment scale and a visual analog scale. Scars were measured by digital planimetry. Samples stained with hematoxylin–eosin were submitted to conventional histological analysis. Samples stained with Sirius Red were analyzed under polarized light for collagen morphometry. Results Visual scores were higher in the saline group on PBD 21 ( p < 0.05). Wound edge migration rates were lower ( p < 0.05) and conventional histology showed accentuated inflammation and delayed reepithelialization in the IMQ group. Type-I and type-III collagen deposition increased in the saline group and decreased in the IMQ group. Conversely, the proportion between type-I and type-III collagen differed significantly between treatments on PBD 4 and 21 ( p < 0.05 in both cases). Conclusions Short-term topical imiquimod treatment of partial-thickness burns in rats did not improve clinical appearance and scarring but rather decreased fibrosis. Significant differences in collagen deposition were observed between the treatments.

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.

Randomized Clinical Study of SilvaSorb® Gel in Comparison to Silvadene® Silver Sulfadiazine Cream in the Management of Partial-Thickness Burns

This prospective, randomized study assessed the clinical, microbiological, and patient comfort characteristics of two silver-based topical agents in the management of partial-thickness burn wounds. Pediatric patients were randomly assigned to treatment with either SilvaSorb Gel (Medline Industries, Munedelein, IL) or Silvadene silver sulfadiazine cream (King Pharmaceuticals, Bristol, TN) for up to 21 days or to the point of full reepithelialization of the wound. Inclusion criteria were patients ranging in age from 2 months to 18 years with TBSA ranging from 1 up to 40%. A total of 24 patients were enrolled and completed the study. Findings demonstrated that the use of SilvaSorb Gel was associated with less pain and greater patient satisfaction when compared with Silvadene. No statistically significant differences were found when assessing the rate of infection, time to reepithelialization, or the number of dressings changes required during treatment. The reduction of pain and improved overall patient satisfaction with the use of SilvaSorb Gel compared with Silvadene indicates an important role for SilvaSorb Gel in treatment of partial-thickness burns in a pediatric population.

The efficacy of Aloe vera, tea tree oil and saliva as first aid treatment for partial thickness burn injuries

Many alternative therapies are used as first aid treatment for burns, despite limited evidence supporting their use. In this study, Aloe vera, saliva and a tea tree oil impregnated dressing (Burnaid ®) were applied as first aid to a porcine deep dermal contact burn, compared to a control of nothing. After burn creation, the treatments were applied for 20 min and the wounds observed at weekly dressing changes for 6 weeks. Results showed that the alternative treatments did significantly decrease subdermal temperature within the skin during the treatment period. However, they did not decrease the microflora or improve re-epithelialisation, scar strength, scar depth or cosmetic appearance of the scar and cannot be recommended for the first aid treatment of partial thickness burns.

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.

Klinische Erfahrungen mit dem Versajet-System® in der Verbrennungsbehandlung - Indikationen und Anwendungen

Early debridement and early skin grafting are the "Gold standard" in the surgical treatment of burns. There are different debridement methods available. Concerning the treatment of burns, surgical-sharp debridement, laser ablation and hydrosurgery system are used. While in full thickness burns the sharp debridement is advisable, the Versajet shows its benefits in the treatment of partial thickness burns. Especially for debridement of difficult to treat areas - face, neck, lips, fingers, interdigital spaces, convex and concave areas the Versajet System shows its benefits. With the Versajet System, tissue excision is precise; moreover it helps to avoid the damage of viable tissue and its vascular supply.

P270: Amniotic membrane as wound coverage: The effects of irradiation and different processing methods on growth factor content

Introduction: Amnion is used worldwide as a biological dressing for the treatment of partial-thickness burns and chronic wounds. Special processing and sterilization is required to ensure consistent quality and to minimize the risk of infection before amnion can be placed on wounds. However, any processing step potentially destroys valuable growth factors present in the biological tissue that may benefit wound healing. The purpose of this study was to evaluate how different processing modalities affect the growth factor content of human amniotic membrane. Materials and Methods: Amnion was retrieved from 40 female donors after cesarean section and processed in the following way: Group1: Removal of chorion and wash with saline (n=10); Group 2: Like group 1 and additional wash with 0.5% hypochlorite solution (n=10); Group 3: Like group 2 plus additional storage in antimicrobial storage solution for 3 days (n=10); Group 4: Like group 3 plus additional removal of the epithelium with trypsin and detergents (n=10). After processing, the membranes were stored in glycerol at -80°C; for sterilization, half of each group was irradiated with a total dose of 920 kRad (9.2 kGy) using a Cobalt60 gamma source, the other half received no irradiation. Using ELISA, we then examined the membranes for EGF, VEGF, FGF-1, FGF-2, PDGF-BB and TGF-α. The membranes were also examined for bacterial contamination. Results: The concentration of EGF, VEGF, FGF-1, FGF-2, and PDGF-BB in the fully processed membrane (Group 4) was significantly lower than in fresh amnion (Group 1, p<0.001). The content of TGF-α remains unchanged in all groups. Irradiation with 920 kRad only influenced the content of FGF-1 and FGF-2 in group 2 (p<0.05 vs. non-irradiated group); in all other groups, growth factor concentrations remain similar after irradiation. All groups showed no bacterial growth. Discussion: Sterilization with gamma-rays only marginally affects growth factor content in human amniotic membrane, while chemical processing and removal of epithelium eliminates nearly all important growth factors. The use of fresh human amniotic membrane, sterilized with gamma rays, is a safe and feasible way for coverage of burn and chronic wounds.

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...

The treatment of partial-thickness burns: Amnion versus topical antimicrobial crème

Wound coverage for second degree burns remains a clinical challenge. In the present study we investigated whether the use of Amnion is safe and may represent a new therapeutic option for children with partial-thickness facial burns compared to standard topical treatment. Methods: Children with partial-thickness burns of the upper body and the face admitted between 2002 and 2004 were included in this study. Children were divided into two groups to receive either Amnion (n=48) or topical antimicrobials (2% Polymyxin B/ Bacitracin ointment) (n=53). Demographics (age, sex, race, TBSA, burn areas), length of hospital stay (LOS), rate of infections (RI), and need for systemic antibiotic treatment were compared between the two groups. The long term outcome was assessed in 14 patients in the Amnion and 17 patients in the topical group who returned for 3 to 6 month follow-ups. Results: There was no difference in age, gender, TBSA, burn area, LOS and RI between the two groups. The amnion group required significantly less systemic antibiotics compared to the standard treatment, p<0.05. One patient showed a mild facial swelling after Amnion application. Three patients in the topical group had a local reaction to the therapy. In each group, two patients showed hypertrophic scar development at the follow-up visits. Conclusion: This study indicates that Amnion is safe and may have advantages as a wound coverage for second degree facial burns compared to the standard topical ointments. However, a large prospective study should be performed in order to introduce Amnion as a treatment option.

Biobrane versus duoderm for the treatment of intermediate thickness burns in children: A prospective, randomized trial

In this study, we directly compared the efficacy of Biobrane ® and Duoderm ® for the treatment of small intermediate thickness burns in children in a prospective, randomized fashion to determine their relative impact on wound healing, pain scores, and cost. Patients under 18 years of age with intermediate thickness burns on a surface area less than 10% were enrolled and treated with one of the two dressing systems. Data collected included mechanism of injury, time to complete healing, pain scores, and institutional cost of materials until healing was complete. No significant difference in time to healing or pain scores was detected between the two groups. The cost of each treatment was statistically more expensive in the Biobrane ® group. The results of this study demonstrate that Duoderm ® and Biobrane ® provide equally effective treatment of partial thickness burns among in the pediatric population. However, Duoderm ® is statistically less expensive than Biobrane ® and can be considered a first-line treatment option for intermediate thickness burn wounds in children.

A Prospective, Randomized Trial of Acticoat Versus Silver Sulfadiazine in the Treatment of Partial-Thickness Burns: Which Method Is Less Painful?

Despite recent improvements in analgesia, pain control during dressing changes continues to be a major challenge in patients with burns. We investigated two different dressing modalities to compare how much pain the patient experienced during and after the dressing change. Patients with partial-thickness burns that required only topical wound care were assigned randomly to treatment with Acticoat (Smith and Nephew USA, Largo, FL) or silver sulfadiazine (AgSD). The outcome variable was pain during wound care, which was measured using visual analog pain scores. The mean visual analog pain scores for the wounds treated with Acticoat or AgSD wounds were 3.2 and 7.9, respectively (P < .0001; paired Student's t-test). In 41 of the 47 paired pain score observations, the pain in the wound treated with AgSD was perceived as greater than in the wound treated with Acticoat. Burn wound care with Acticoat is less painful than burn wound care with AgSD in patients with selected partial-thickness burns.

Treatment of partial-thickness burns: a prospective, randomized trial using transcyte: Kumar RJ, Kimble RM, Boots R, et al. Aust N Z J Surg 2004 (August);74:622-626

Treatment of partial-thickness burns: a prospective, randomized trial using transcyte: Kumar RJ, Kimble RM, Boots R, et al. Aust N Z J Surg 2004 (August);74:622-626

The use of homograft compared to topical antimicrobial therapy in the treatment of second-degree burns of more than 40% total body surface area

The traditional approach for the treatment of partial-thickness burns has been the application of topical antimicrobial therapy to control bacterial colonization, avoid progression to invasive infection, and allow healing of the underlying burn wound. Infection is associated with apparent conversion of a second-degree burn to full-thickness injury that requires autografting, to say nothing of a source of sepsis, which has been associated with multiorgan failure and death. We postulated that early debridement and coverage of large partial-thickness burns (>40% total body surface area) with homograft would preserve underlying tissue, improves healing, and decreases morbidity. We present data obtained in 16 patients treated with the application of homograft compared to 13 patients treated with the traditional approach consisting of twice daily applications of silver sulfadiazine. The treatment of massive second-degree burns with homograft reduced hospital length of stay ( P<0.01). We thus conclude that in patients with >40% total body surface area burns, early debridement and wound coverage with homograft is an alternative method to the conservative non-operative approach with topical antimicrobial therapy.

A historical appraisal of the use of cryopreserved and glycerol-preserved allograft skin in the treatment of partial thickness burns

Two studies into the use of allograft skin in the treatment of partial thickness burn injuries in this burn centre have provided the opportunity to discuss changes and similarities over a 20 year period. The first study described results obtained with cryopreserved allografts in partial thickness burns in the period 1979–1981. The second study concerned patients with partial thickness injuries treated with glycerol-preserved allografts in the period 1998–2000. A reduction was noted concerning the need for secondary autografting in the group treated with glycerolized allografts. The probability that this difference has occurred by chance is small ( P=0.089). Various other factors that might account for the differences in outcome, include general improvements in health and social welfare, differences in treatment protocols, and differences in allograft properties. A prospective comparative trial is indicated to study direct differences between the two types of allograft.

The use of glycerol-preserved allografts in the Beverwijk Burn Centre: a retrospective study

This report describes 156 consecutive patients treated with glycerol-preserved allograft skin (GPA) in the Beverwijk Burn Centre between January 1996 and July 2001. Patients with burn and non-burn lesions are included. Age varied from 7 months to 90.7 years. Four different procedures have been identified: (1) sandwich grafting technique; (2) treatment of partial-thickness burns with GPA as a membranous dressing; (3) improvement of wound condition; (4) scar release: a temporary coverage of release incisions with allograft skin to improve the wound bed and to benefit further relaxation of the wound primary to autografting. The main points of interest in this inventory are the results of treatment, the aetiology and the extent of the wounds treated with GPA, the day post injury the GPA treatment was started, the duration of the treatment, the number of allograft applications, the occurrence of wound infection and wound treatment before GPA application. Concerning the scar release an inventory was made of the anatomic sites that were involved. Sandwich grafting, which is the treatment of choice at this centre for extensive, full-thickness injuries, was performed on 129 wounds. The average burn size in all 70 patients treated was 35.6% TBSA with 26.9% full thickness. In all cases meshed GPA was used. Partial or complete healing was achieved in 57.6% of wounds. In the treatment of partial-thickness burns, non-meshed GPA was used in all 57 cases. Complete healing without further treatment was achieved in 45.6% of the cases. Excision and autologous skin grafting was needed in 26.3% of the cases. Meshed GPA was used to improve the condition of 88 non-healing wounds. Spontaneous healing was promoted in 13.6% of the wounds, and the wound bed was successfully prepared for autografting in 39.8% of the cases. In all 52 scar releases a viable wound bed was obtained prior to autografting. Autologous graft take was 100% and no autologous re-grafting was necessary. Allografts in the popliteal space were changed most frequently.

A newly developed hydrofibre dressing, in the treatment of partial-thickness burns

A newly developed, carboxymethylcellulose based hydrofibre dressing, Aquacel®, was tested for the treatment of partial thickness burns. In this study 84 patients with mainly partial thickness burns were included, 76 patients received 1 or 2 days pre-treatment with a topical antimicrobial agent. Clinical behaviour showed a strong resemblance with cadaver skin treatment with respect to adherence to the wound. Adverse reactions, incidence of clinical wound infection, healing time and the need for wound excision and grafting were analysed, as was the final outcome using the ‘Vancouver Scar Scale’. The mean size of the wounds treated with the hydrofibre dressing was 6.0% body surface area (min: 1%, max: 18%). Two patients clinically showed signs of a wound infection during treatment, but in general wound cultures were low or negative. In 42 patients (50%) the wounds healed completely within 10 days, in six patients (7%) small defects remained that healed by further treatment with a topical antimicrobial cream. In 36 patients (43%) excision and grafting of the remaining deeper parts of the wounds was performed as this is the standard therapy in the centre for all burned areas that have not healed within 2–3 weeks post-injury. The extent of the surgical procedures was limited since 66.1% of the wound area had healed already at the end of the hydrofibre treatment. In 54 patients the outcome of the treatment after 2–3 months was analysed by means of the Vancouver Scar Scale, which showed favourable results in general, and especially for patients who did not require surgery. Compared to earlier experience with allograft skin it was concluded that hydrofibre dressing is a safe, suitable and easy to use material for treatment of partial thickness burns.

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.

Treatment of partial thickness burns of the hand with the preshaped, semipermeable Procel Burn Cover: results of a multicentre study in the burn centres of Berlin, Duisburg and Munich

The results of a prospective clinical study conducted in three German burn centres are reported. The subject of the evaluation was to show the effectiveness of a new, preshaped, semipermeable burn dressing that is resistant to fluids and bacteria but highly permeable to vapour. The dressing was used in conjunction with 1 per cent silver sulphadiazine cream in treating partial thickness burns of the hand. In 49 patients, 72 partial thickness burned hands were treated. The application proved to be very easy. The time for a dressing change was short (5–10 min). The duration of treatment was 13 days on average. Complications due to infections did not occur. Because of the semipermeable properties of the dressing material, skin macerations occurred in only a few instances (13 per cent) as a result of inappropriate cream application or extremely high exudation rates, and these did not adversely affect the healing process. Patients achieved the ability to perform activities of daily living early with positive results for the patients, the physician and the nursing team.