Treatment Of Second-degree Burn Wounds Research Articles

Expert consensus on the treatment of second-degree burn wounds (2024 edition)

Second-degree burn is the most common type of burns in clinical practice and hard to manage. The choice of its treatment requires not only consideration of the different outcomes that may arise from dressing changes or surgical treatments themselves, but also evaluation of factors such as burn site, ages of patients, and burn area. Meanwhile, there is no unified standard and specification for the diagnosis, classification, surgical procedure, and infection judgment and grading of second-degree burn wounds, which significantly affects the formulation of clinical treatment plans and the consistency of clinical studies. Moreover, there is relatively few guidelines or expert consensus for the management of second-degree burn wounds, and no comprehensive and systematic guideline or expert consensus for the treatment of second-degree burn wounds. The consensus writing group developed the Expert consensus on the treatment of second-degree burn wounds (2024 edition) based on evidence-based medicine evidence and expert opinion. This expert consensus put forward 58 specific recommendations from four aspects: pre-hospital first aid, non-surgical treatment, surgical treatment, and infection prevention and treatment of second-degree burns wounds, aiming to form a standardized clinical treatment plan for second-degree burns.

Expert consensus on the treatment of second-degree burn wounds (2024 edition)Ⅰ: pre-hospital first aid and non-surgical treatment

Second-degree burn is the most common type of burns in clinical practice and hard to manage. At present, there is no unified standard or specification for the first aid, diagnosis, classification, manner of conservative dressing change, and choice of external dressings or medications for second-degree burn wounds, which significantly affects the formulation of clinical treatment plans and the consistency of clinical studies. The consensus writing group developed the Expert consensus on the treatment of second-degree burn wounds (2024 edition)Ⅰ: pre-hospital first aid and non-surgical treatment based on evidence-based medicine evidence and expert opinion. This expert consensus put forward 29 specific recommendations from 2 aspects: pre-hospital first aid and non-surgical treatment for second-degree burn wounds, aiming to form a standardized clinical treatment plan for second-degree burn wounds.

Consensus on the treatment of second-degree burn wounds (2024 edition).

Second-degree burns are the most common type of burn in clinical practice and hard to manage. Their treatment requires not only a consideration of the different outcomes that may arise from the dressing changes or surgical therapies themselves but also an evaluation of factors such as the burn site, patient age and burn area. Meanwhile, special attention should be given to the fact that there is no unified standard or specification for the diagnosis, classification, surgical procedure, and infection diagnosis and grading of second-degree burn wounds. This not only poses great challenges to the formulation of clinical treatment plans but also significantly affects the consistency of clinical studies. Moreover, currently, there are relatively few guidelines or expert consensus for the management of second-degree burn wounds, and no comprehensive and systematic guidelines or specifications for the treatment of second-degree burns have been formed. Therefore, we developed the Consensus on the Treatment of Second-Degree Burn Wounds (2024 edition), based on evidence-based medicine and expert opinion. This consensus provides specific recommendations on prehospital first aid, nonsurgical treatment, surgical treatment and infection treatment for second-degree burns. The current consensus generated a total of 58 recommendations, aiming to form a standardized clinical treatment plan.

3D-printed hydrogels dressings with bioactive borate glass for continuous hydration and treatment of second-degree burns.

Recent advances in additive manufacturing have led to the development of innovative solutions for tissue regeneration. Hydrogel materials have gained significant attention for burn wound treatment in clinical practice among various advanced dressings due to their soothing and moisturizing activity. However, prolonged healing, pain, and traumatic removal due to the lack of long-term wound hydration are some of the challenges in the treatment of second-degree burn wounds. In this study, 3D-printed dressings were fabricated using gelatin, alginate, and bioactive borate glass (BBG) using an extrusion-based bioprinter. After ionic crosslinking, the 3D-printed dressings were characterized for mechanical properties, degradation rate, hydration activity, and in vitro cell viability using human fibroblasts. The results demonstrated that in 3D-printed dressings with 20 wt% BBG, Young's modulus increased by 105%, and 10-day degradation rate decreased by 62%. Addition of BBG prevented the burst release of water from hydrogel dressings and enabled the continuous water release for up to 10 days, which is crucial in treating second-degree burn wounds. 3D-printed hydrogel dressings with BBG showed long-term cell viability that can be a result of the accumulative release of therapeutic ions from BBG particulate. The in vivo wound healing functionality of the dressings was investigated using a rat model with a second-degree burn wound. Our animal study showed that the 3D-printed dressings with BBG exhibited faster wound closure, non-adhesive contact, non-invasive debridement, and non-traumatic dressing removal. Histological analysis suggested that 3D-printed dressings contributed to more uniform re-epithelialization and tissue remodeling compared to the non-printed hydrogels of the same compositions. Critically, 3D-printed dressings with BBG led to significant regeneration of hair follicles compared to the 3D-printed hydrogel, non-printed hydrogel, and the control groups. The superior outcome of the 3D-printed hydrogel-BBG20 dressings can be attributed to the bioactive formulation, which promotes moist wound healing for longer time periods, and the non-adhesive porous texture of the 3D-printed dressings with increased wound-dressing interactions. Our findings provided proof of concept for the synergistic effect of bioactive formulation and the porous texture of the 3D-printed hydrogel dressings incorporated with BBG on continuous water release and, consequently, on second-degree burn wound healing.

Therapeutic Efficacy of Great Plantain (Plantago major L.) in the Treatment of Second-Degree Burn Wounds: A Case-Control Study.

Background Great plantain (Plantago major L. or P.major) is a medicinal plant that is available all around the world. The whole plant has several bioactive compounds including terpenoids, flavonoids, phenolic compounds, alkaloids, fatty acids, iridoid glycosides, polysaccharides, and vitamins. Scientific studies have recognized several medical benefits like wound healing, anti-inflammatory, antimicrobial, antiulcerative, and antioxidative agents. The wound-healing capacity of this plant has been investigated under in vivo and ex vivo conditions. In the current study, we aim to compare the therapeutic effect of the P.major extract with 1% sulfadiazine on the healing of second-degree burn wounds. Method Second-degree burn victims were included in our study. The investigation and control group, respectively, received P. major ointment 10% and silver sulfadiazine ointment 1%. The bacterial culture from the wound site was taken on days 3, 7, 10, 13, and last day of hospitalization. Patients' subjective complaints were obtained through the visual analog scale (VAS). All patients were treated and evaluated in the hospital. Result Among the 15 patients, 11 were male, and the mean age was 33.3 years. The average complete healing duration was 11.73 vs. 13 days in the P. major and control group, respectively (P=0.166). On the third day, infection control was similar between the two groups, and on the seventh day, all bacterial cultures were negative. Although there was a significant reduction in pain scores during the recovery time, no significant differences in pain reduction were noted between the two groups (P=0.849). Conclusion We showed that P.major ointment is a safe and suitable herbal compound in the treatment of second-degree burn wounds that not only has wound-healing properties but also is an analgesic and antimicrobial compound.

Evaluation of Bacterial Cellulose Dressing versus Vaseline Gauze in Partial Thickness Burn Wounds and Skin Graft Donor Sites: A Two-Center Randomized Controlled Clinical Study.

Objective Bacterial cellulose (BC) dressing, which can maintain a moist environment and prevent the invasion of pathogens, has become a competitive dressing material for burn wound treatment. This study was conducted to evaluate the treatment efficacy of a novel China-made BC dressing for the treatment of second-degree burn wounds and skin graft donor sites. Methods 212 patients with second-degree burn wounds or skin graft donor sites were enrolled from two research centers. They were randomly assigned to the BC dressing group (study group) or the Vaseline gauze (VG) dressing group (control group). Wound conditions were assessed before and after treatment. Dressings were changed according to the condition of the wound bed. Healing rate and healing time were recorded as primary endpoints to evaluate the efficacy of BC dressing against VG dressing. Erythema, swelling, exudation, bleeding, subeschar purulence, and pain were assessed as secondary endpoints. Results 207 participants completed the trial and their wounds all healed within 28 days. The average healing times for superficial and deep secondary burn wounds and skin graft donor sites in the BC group were 8.12, 15.77, and 10.55 days, respectively. In the VG group, the average healing times for superficial and deep secondary burn wounds and skin graft donor sites were 9.30, 15.27, and 11.19 days, respectively. The healing time of superficial burn wounds in the BC group was statistically shorter than that in the VG group. There was no difference in the frequency of dressing changing between two groups. The BC dressing showed equal efficacy with the VG dressing at all secondary endpoints. Conclusion The novel BC dressing could be used for the management of second-degree burn wounds and skin graft donor sites. With a shorter healing time in superficial secondary burn wound than that of the VG dressing, the BC dressing showed noninferiority in the treatment of superficial and deep secondary burn wounds and skin graft donor sites versus the VG dressing. This study is registered with the Chinese Clinical Trial Registry (registry number: ChiCTR1800014377 (http://www.chictr.org.cn)).

Amniotic membrane dressing versus nitrofurazone-impregnated dressing in the treatment of second-degree burn wounds: a randomized clinical trial.

Both the amniotic membrane biologic dressing and nitrofurazone-impregnated dressing are treatment options for burn wounds. To compare the efficacy of these treatments in healing second-degree burns, a randomized clinical trial was conducted among patients with second-degree burns who had no comorbidities or history of addiction and were referred to a burn center in Urmia, Iran, between December 2017 and September 2019. Patients were randomly assigned to one of 2 study groups. Wounds were dressed in either amniotic membrane covered with moistened gauze/petrolatum or nitrofurazone-impregnated gauze. Comparative groups were matched according to percentage of burn (total body surface area). The dressing application occurred once daily in the nitrofurazone group and once weekly in the amniotic membrane group. The study was conducted until all wounds healed. The study outcomes included the infection rate of the wound, pain severity related to dressing changes, dressing change frequency, epithelialization rate, hospitalization length of stay, morphine use, and scarring. Data were collected in real time by the researcher via observation, interview, examination of the patient, and, eventually, completion of a checklist. Analyzed quantitative and qualitative variables were reported as mean ± standard deviation and percentage (frequency). Each group included 35 participants (24 men, 11 women; age, 20.05 ± 3.60 years in the amniotic dressing group; and 20 men, 15 women; age, 21.60 ± 2.02 years in the nitrofurazone-impregnated gauze group). Assessment was performed on days 1, 7, 14, and 30 from the initial treatment and at discharge. No significant difference was noted in the rate of infection between the 2 groups. Epithelialization was complete (100%) by day 7 in the amniotic membrane group, versus 77% in the nitrofurazone group. Pain following dressing application, length of hospitalization, morphine use, and scarring at day 14 were significantly lower (P < .05) in the amniotic membrane group. This study indicated that the use of amniotic membrane dressing improved factors key to healing in second-degree burn wounds compared with nitrofurazone-impregnated dressing. Further research with a larger sample is warranted.

Fabrication and evaluation of gelatin/hyaluronic acid/chondroitin sulfate/asiatic acid based biopolymeric scaffold for the treatment of second-degree burn wounds – Wistar rat model study

An extracellular matrix (ECM) mimicking architecture was introduced with gelatin glycosaminoglycans like hyaluronic acid and chondroitin sulfate and a triterpenoid using asiatic acid, possessing biodegradable and biocompatible properties that mark the functionality for the treatment of second-degree burn wounds. In the present work, a foam-based scaffold was fabricated and sterilized with gamma radiation at a 2.5 Mrad dose. The scaffolds were further characterized for morphology, swelling, degradation behaviour, release of bioactive components, ATR-FTIR, mechanical, thermal properties and compared with control. In vitro cytocompatibility of the developed scaffold was studied with L929 mouse fibroblast cells and human mesenchymal stem cells based on deoxyribonucleic acid and lactate dehydrogenase assay. Additionally, the developed scaffold was evaluated for its biocompatibility on the Wistar rat to assess any toxicity induced to the animal based on blood biochemistry and histopathology analysis. Finally, we assessed the efficacy of developed foam scaffolds on the second-degree burn wound-induced Wistar rat with a scaffold alone and a scaffold seeded with human bone-marrow-derived mesenchymal stem cells in a wound healing study for 28 d. The wound contraction assay, histopathology, immunohistochemistry analysis and pro-healing marker quantification using hexosamine, hydroxyproline, and pro-inflammatory markers like TNF-α and MMP-2 were carried out and compared with the commercially available wound dressing. The results revealed that foam-based ECM mimic was cytocompatible, biocompatible and biodegradable in 18 ± 3 d in in vivo conditions and the scaffold fostered the process of healing of second-degree burns within 28 d of treatment. The obtained result proved that the scaffold has a potential for clinical settings in second-degree burn wound treatment.

The Effect of Myrtus, Honey, Aloe vera and Pseudomonas Phage Treatment on Infected Second Degree Burns: in vivo Study

Many researches have been exerted to find an application dressing for wound healing and also attain a considerable microbial reduction in burn wounds. In this study, the healing effect of a mixed herbal ointment (containing Myrtus, honey, Aloe vera, and pseudomonas phage) on the healing process of second degree burn wounds infected with Pseudomonas aeruginosa in comparison was evaluated. For this purpose, a hot metal square piece (4×2 cm, 50 g) was applied using a standard burning technique, and the applied pressure on the skin kept the same for all animals, then infected with Pseudomonas aeruginosa. Rats were randomly divided into 2 groups. Group 1 was treated with mixed herbal ointment, and group 2 received no treatment (control group). The treatment was daily, and sampling was weekly for three consecutive weeks (7, 14, and 21-day). Formalin 10% was used for tissue fixation. Wound healing in test and control groups was investigated by macroscopic and microscopic methods using Hematoxylin-Eosin staining. It wound contraction evaluation (Image J software). Macroscopic findings showed that wound contraction of the mixed herbal ointment group was significantly higher than the control group for 21 days. Hematoxylin-Eosin staining revealed that the epithelialization was considerably more completed in the mixed herbal ointment group in comparison with the control group. Also, neovascularization was significantly higher in the mixed herbal ointment group. The comparative results demonstrated that the mixed herbal ointment group had a significant difference (P&lt;0.05) with a non-treated group (control). Therefore, the mixed herbal ointment is suggested as a suitable candidate for the treatment of second-degree burn wounds infected to pseudomonas aeruginosa.

Comparative study of silver-sulfadiazine-impregnated collagen dressing versus conventional burn dressings in second-degree burns.

Background:The advantages of biological skin dressings like collagen are well-known. It makes wound impermeable to bacteria and creates the most physiological interface between the wound surface and the environment. Silver-sulfadiazine-impregnated collagen (SIC) is a type 1 collagen impregnated with silver sulfadiazine (SSD)-loaded alginate microspheres to deliver SSD in a controlled fashion to manage infected burn wounds for an extended period of time with lesser dressing changes.Materials and Methods:In this study, we used SIC for the treatment of second-degree burn wounds in 25 patients and compared with similar burn wounds in 25 patients treated with conventional dressings.Results:For SIC-treated group, we observed improved wound healing in all the patients after 7 days except two patients who required skin grafting, and none of them had any serious complications. For conventionally treated group, improved wound healing was seen in 14 patients, whereas the rest of the patients required prolong dressing or skin grafting. All the patients who were treated with SIC were satisfied with healing of wound and pain relief.Conclusion:Second-degree burn wounds are well-treated with SIC in the form of good healing, control of infection, and reducing pain without any serious complications when compared with conventional dressing.

Effects of topical treatment of second-degree burn wounds with Lactobacillus acidophilus on the wound healing process in male rats

Effects of topical treatment of second-degree burn wounds with Lactobacillus acidophilus on the wound healing process in male rats

The effects of Arnebia euchroma ointment on second-degree burn wounds: a randomized clinical trial

Ethnobotanical relevanceBurn injuries can cause detrimental long-term consequences and call for immediate management. Avicenna's Canon of Medicine, describing the use of Abu-Khalsa (Arnebia euchroma) (AE) as being effective for burn healing. The purpose of this study was to evaluate the healing effects of AE ointment (AEO) on patients with a second-degree burn wound and compare its results with silver sulfadiazine cream (SSD). Materials and methodsIn this prospective, single-blind clinical trial, 45 patients with similar types of second-degree burns at two different sites of the body were randomly assigned to the two treatment groups. One burn wound site of the patient was treated with SSD and another similar burn wound site with AEO once a day until complete healing was achieved. Wound size and percentage of wound healing were evaluated at 15 days. Satisfaction, clinical adverse events such as pain, burning, warming, erythema, edema, infection, inflammation, and general wound area were assessed on a visual analogue scales, and 6-point scales. ResultsThe healing time was significantly shorter in the site treated with AEO than SSD (13.9±5.3 vs. 17.5±6.9 days, respectively). The severity of pain and burning were reduced in the AEO site compared with SSD site at the time of dressing change, while the warming score was significantly higher in the AEO wound area. Side-effects were lower in the site treated with AEO. ConclusionIn this clinical study, we demonstrated that AEO has benefits over SSD in the treatment of second-degree burn wounds and wound healing and is a viable medication for the management of second-degree burns.

The effects of topical vitamin C solution on the necrotic tissue volume of burn wounds

Background and Purpose: Vitamin C is administered orally or intravenously for the treatment of burn wounds. However, effects of the topical application of vitamin C remain unclear. This study aimed to evaluate the effects of topical vitamin C solution on the necrotic tissue volume of second-degree burn wounds. Methods: This clinical trial was conducted on 30 patients with second-degree burns admitted to the burn unit of Vasee Hospital of Sabzevar, Iran. Burn wound areas were divided into two parts, receiving routine treatment with sulfadiazine ointment and vitamin C in addition to sulfadiazine. After cleaning the wounds, dressings were replaced daily. Depth of burn wounds in each area was observed to be similar. Burn wounds were examined on days one, three, seven and 14 after the burn incidents using Bates-Jensen Wound Assessment Tool. Data analysis was performed in SPSS version 20 using repeated measures ANOVA. Results: In patients of the experimental area, mean volume of necrotic tissue was1.033±0.182 at baseline, while it reached 1.233±0.430 on day 14 after the incident. In the control group, mean volume of necrotic tissue was 1.000±0.000 at baseline, while it increased to 1.700±0.794 on day 14 after the incident. On day 14, a significant difference was observed between the experimental and control groups in this regard (P=0.018; f=5.982). Conclusion: According to the results of this study, topical administration of vitamin C could be largely effective in the treatment of second-degree burn wounds.

Silk sericin ameliorates wound healing and its clinical efficacy in burn wounds

The aim of this study was to evaluate the effect of silk sericin, a protein from silkworm cocoon, on scratch wound healing in vitro. For applicable result in clinical use, we also study the efficacy of sericin added to a standard antimicrobial cream, silver zinc sulfadiazine, for open wound care in the treatment of second-degree burn wounds. In vitro scratch assays show that sericin at concentration 100μg/mL can promote the migration of fibroblast L929 cells similar to epidermal growth factor (positive control) at 100μg/mL. After 1 day of treatment, the length of scratch in wounds treated with sericin was significantly shorter than the length of negative control wounds (culture medium without sericin). For clinical study, a total of 29 patients with 65 burn wounds which covered no less than 15% of total body surface area were randomly assigned to either control (wounds treated with silver zinc sulfadiazine cream) or treatment (wounds treated with silver zinc sulfadiazine with added sericin cream) group in this randomized, double-blind, standard-controlled study. The results showed that the average time to reach 70% re-epithelialization of the burned surface and complete healing in the treatment group was significantly shorter, approximately 5-7days, than in the control group. Regarding time for complete healing, control wounds took approximately 29.28±9.27days, while wounds treated with silver zinc sulfadiazine with added sericin cream took approximately 22.42±6.33days, (p=0.001). No infection or severe reaction was found in any wounds. This is the first clinical study to show that silk sericin is safe and beneficial for burn wound treatment when it is added to silver sulfadiazine cream.

The effect of dressing with fresh kiwifruit on burn wound healing

This study was designed to evaluate the wound healing effects of kiwifruit in the treatment of second-degree burn wounds in rats. Sixty rats were each randomly assigned to 1 of 3 groups. A deep second-degree burn was created on the lateral flank of each rat with a standard burning procedure in the form of applying a heated plaque. In the control group (group C; n = 20) burns were dressed with Vaseline sterile gauze after normal saline irrigation. In group S (n = 20), the lesions were treated with silver sulfadiazine cream after normal saline irrigation. In the third group (group K; n = 20), the burn wounds were dressed with kiwifruit. The dressings were changed twice a day in all groups. The response to treatments was assessed histologically at day 21 postburn and microbiologically on days 7 and 21. Macroscopic evaluation was performed every day to determine wound closure rate, measure burn wound area, and investigate macroscopic edema, hyperemia, and epithelialization. Histopathologic evaluation included monitoring of epithelialization, vascularization, granulation tissue formation, and inflammatory cell response. On day 21, the wounds in the group K healed completely in comparison to other groups (P < .0001). There was significant reduction in wound area size in the group K in all evaluation days as compared with groups S and C (P < .0001). Microscopic evaluation revealed a high grade of neovascularization in group K lesions in contrast with groups S and C (P < .0001). Wound infection was dramatically less common in the group K compared with the other 2 groups (P < .05). We suggest that the dramatic antibacterial, debridement, wound contracture, and angiogenic effect of kiwifruit induced a significant wound healing in burn ulcers and might be useful in treating chronic ulcers, such as bedsores.

Feasibility and Clinical Applicability of Polihexanide for Treatment of Second-Degree Burn Wounds

Objectives: Due to a partial rejection of mesh split-thickness skin grafts (mesh grafts) after application of povidone-iodine and silver nitrate and due to its better in vitro tolerance, polihexanide was investigated as an alternative and its applicability in the treatment of second-degree burn wounds. Methods: In 4 patients with poorly healing decubitus ulcers the mesh grafts were each divided into three areas which were pre-treated with either undiluted povidone-iodine solution, 1% silver nitrate solution or 0.04% polihexanide solution. After 7 days of application the wound areas were compared clinically and histologically. Thereafter 14 patients (average extent of burns 28% TBSA) were treated in the same way. Results: Clinically and histologically the mesh grafts treated with polihexanide showed by far the best re-epithelialization compared with the deep tissue necrosis and marked fibrin discharge observed for application of povidone-iodine and silver nitrate. The second-degree burn wounds treated with polihexanide epithelialized without any further débridement after an average of 10 days with remarkable freedom from pain. Compared with silver nitrate treatment, no fibrin film was observed on the wound. Conclusion: Polihexanide proved clinically and histologically superior to povidone-iodine and silver nitrate. For the treatment of second-degree burns, which cannot primarily be covered by plastic surgery, polihexanide is suitable because in addition to its antiseptic efficacy it does not inhibit the re-epithelialization process.