811 Comparison of an Enzymatic Debrider with Antibiotic Ointment in the Outpatient Care of Minor Partial Thickness Burns

Abstract Introduction In the U.S. about 450,000 people per year receive medical burn care through hospital emergency departments, hospital outpatient clinics, free-standing urgent care centers and private physician offices. Burns are generally classified in terms of depth and severity. Outpatient management of partial thickness burns normally involves the application of an ointment, which may contain an antibiotic and is widely used in burn care. This clinical study has been designed to prospectively evaluate potential benefits of an enzymatic debrider in partial thickness burn wounds compared to antibiotic only treatment. The primary purpose of this study is to compare an enzymatic debrider with a topical antibiotic ointment in the proportion healed at 3 weeks after initiation of treatment, and time to healing (in weeks). Methods A convenience sample of 20 subjects, aged 19–56, with an acute thermal burn injury less than 72 hours old, and less than 10% TBSA were randomly assigned to outpatient treatment with an enzymatic debrider or a topical antibiotic. The proportion of subjects healed after 3 weeks of treatment was analyzed using ANOVA. In addition, a t-test comparison between the enzymatic debrider and the topical antibiotic was performed. Results For partial thickness burns, the mean time to heal using an enzymatic debrider was 18 days compared to 28 days for the topical antibiotic. However, there was no statistical significance in burn wound closure between subjects receiving an enzymatic debrider compared to a topical antibiotic, t (13) = .677; p = .510. An analysis of variance comparing an enzymatic debrider and a topical antibiotic also showed no statistical significance in time to heal (F=.849, p=374). Conclusions Due to the small sample size, the results from this study do not support the use of an enzymatic debrider versus a topical antibiotic in treating partial thickness burn injuries to advance wound closure or shorten time to heal. The results of this study show clinical significance, with burn wounds healed in 18 days when an enzymatic debrider was used compared to 28 days when a topical antibiotic was used. The lack of statistical significance was due to an under-powered study. Furthermore, partial thickness burns should spontaneously heal within 7–14 days, regardless of the topical treatment, excluding concomitant co-morbidities. Applicability of Research to Practice Continued research is necessary, employing larger sample sizes to adequately compare the use of an enzymatic debrider compared to topical antibiotics in deep partial thickness burn wounds. In addition, outpatient management of deep thickness and full-thickness burn injuries, utilizing sharp debridement in conjunction with enzymatic debridement, in patients who decline surgical treatment of burn wounds should be explored, analyzing time to heal, scar evaluation, and cost analysis,

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In Vivo Assessment of Burn Depth and Wound Healing Using a Handheld Terahertz Hyperspectral Scanner

10.21203/rs.3.rs-138599/v1 ◽

2021 ◽

Author(s):

Omar Osman ◽

Zachery Harris ◽

Juin Zhou ◽

Mahmoud Khani ◽

Adam Singer ◽

...

Keyword(s):

Electromagnetic Scattering ◽

Healing Process ◽

Burn Injuries ◽

Spectral Amplitude ◽

Burn Care ◽

Partial Thickness ◽

Partial Thickness Burn ◽

Signal Contrast ◽

Partial Thickness Burns

Abstract The accuracy of clinical assessment in partial-thickness burn injuries has remained as low as 50-75%. Depending on the depth and environmental factors in the wound, such as reactive oxygen species, inflammation, and autophagy, partial-thickness burns can heal spontaneously or require surgical intervention. In this study, we demonstrate that Terahertz Time-Domain Spectral Imaging (THz-TDSI) is a promising tool for in vivo quantitative assessment of burn injuries. We used a novel handheld THz-TDSI scanner to characterize burn injuries in a porcine scald model with histopathological control. Prior work used THz reflectivity (representation of tissue hydration) as the only source of signal contrast. However, we used the spectral amplitude and the spectral slope of the terahertz electric field to distinguish the different severities of burns, suggesting that the energy loss due to electromagnetic scattering from skin constituents serves an additional metric to quantitatively assess burn injuries. Statistical analysis (n = 40) indicates that THz-TDSI can accurately differentiate between partial-thickness and full-thickness burn injuries (1-way ANOVA, p < 0.05) and monitor the healing process of partial thickness burns. THz-TDSI has the potential to improve burn care outcomes by helping surgeons to make objective decisions for early excision.

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The Efficacy of Five Different Wound Dressings on Some Histological Parameters in Children With Partial-Thickness Burns

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa063 ◽

2020 ◽

Vol 41 (6) ◽

pp. 1179-1187 ◽

Cited By ~ 1

Author(s):

Birsen Harma ◽

Mehmet Gül ◽

Mehmet Demircan

Keyword(s):

Stratum Corneum ◽

Gold Standard ◽

Statistical Significance ◽

Healing Process ◽

Total Body Surface Area ◽

Wound Dressings ◽

Control Group ◽

Burn Wounds ◽

Partial Thickness ◽

Partial Thickness Burns

Abstract An ideal dressing should ensure that the wound remains moist with exudates but not macerated. Currently, there is no dressing available to suit all wounds, at all stages of the healing process. Although silver-containing dressings are the gold standard for burn wound care, few high-level trials have been completed comparing the clinical utilities of these dressings. In our study, five different types of wound dressings: carboxymethyl cellulose hydrofiber dressing with ionized silver (CMCH-Ag), polyethylene-polyethylene terephthalate aqua fiber dressing with elementary silver (PPAF-Ag), calcium alginate (CA), calcium + zinc alginate (CZA), and 0.2% nitrofurazone-embedded (NF) gauze dressings were compared in regard to histopathological parameters. Children aged between 0 and 18 years with small or middle-sized partial-thickness burns that affected less than 30% of the total body surface area were included in this study. The study groups (CMCH-Ag, PPAF-Ag, CA, and CZA) and the control group (NF) were randomly attained. Wound healing was evaluated by punch biopsies on the 21st day. The thickness of the stratum corneum and the epithelium, the number of papillae, and the papillary length were calculated and compared. The histological parameters of healing, except the stratum corneum thickness, did not show any statistical significance among the groups (P > .05). The dressings that included silver, calcium, or zinc showed useful and similar effects in noninfective burn wounds when compared with nitrofurazone-only dressings. Thus, it may be concluded that silver-containing wound dressings should not be considered as the gold standard in noninfective partial-thickness burn wounds in children.

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The use of a non-medicated dressing for superficial-partial thickness burns in children: a case series and review

Scars Burns & Healing ◽

10.1177/2059513119896954 ◽

2019 ◽

Vol 5 ◽

pp. 205951311989695

Author(s):

Ter-Er Kusu-Orkar ◽

Umar Islam ◽

Benjamin Hall ◽

Evan Araia ◽

Nikki Allorto

Keyword(s):

Antimicrobial Properties ◽

Case Series ◽

Length Of Hospital Stay ◽

Hot Water ◽

Secondary Outcome ◽

Wound Complications ◽

Burn Wounds ◽

Partial Thickness ◽

Partial Thickness Burn ◽

Partial Thickness Burns

Background: Cutimed® Sorbact® is a dressing marketed as having antimicrobial properties and easy application without the threat of antibiotic resistance and difficult accessibility. There is little evidence on the clinical outcomes of the use of Cutimed® Sorbact® in adults and currently no evidence of use of Cutimed® Sorbact® on superficial-partial thickness burn injuries in children. Objective: To summarise the clinical outcome of burn wounds in children with superficial-partial thickness burns in which Cutimed® Sorbact® was used. Method: An observational case series was conducted in Edendale Hospital, Pietermaritzburg, South Africa over the course of four weeks. Patients where included if they were aged < 10 years and had a ⩽ 15% superficial-partial burn. The primary outcome measure was time to 95% re-epithelialisation. Secondary outcome measures included wound complications, adverse healing and number of dressing changes. Results: Ten patients (five girls, five boys; age range = 11 months–8 years) were included in this case series. All participants had a type VI Fitzpatrick skin type and 80% of burns were hot water burns. Of all patients treated with Cutimed® Sorbact®, 50% healed within seven days, 70% within 14 days and 100% within 21 days. There was only one wound complication noted in this study and there was no adverse healing in any burn wounds. The mean number of dressing changes was 1.4 (range = 1–2) and length of hospital stay was in the range of 0–11 days (mean = 5.1 days). Conclusion: Cutimed® Sorbact® is a safe, useful and cost-effective dressing that should be used as an alternative for superficial-partial burns in children.

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Coming to Consensus: What Defines Deep Partial Thickness Burn Injuries in Porcine Models?

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa132 ◽

2020 ◽

Cited By ~ 1

Author(s):

Angela L F Gibson ◽

Bonnie C Carney ◽

Leila Cuttle ◽

Christine J Andrews ◽

Christine J Kowalczewski ◽

...

Keyword(s):

Animal Models ◽

Burn Injury ◽

Burn Injuries ◽

Partial Thickness ◽

Partial Thickness Burn ◽

Consensus Statements ◽

Partial Thickness Burns ◽

Burn Depth ◽

Histological Staining ◽

Educational Component

Abstract Deep partial thickness burns are clinically prevalent and difficult to diagnose. In order to develop methods to assess burn depth and therapies to treat deep partial thickness burns, reliable, accurate animal models are needed. The variety of animal models in the literature and the lack of precise details reported for the experimental procedures make comparison of research between investigators challenging and ultimately affect translation to patients. They sought to compare deep partial thickness porcine burn models from five well-established laboratories. In doing so, they uncovered a lack of consistency in approaches to the evaluation of burn injury depth that was present within and among various models. They then used an iterative process to develop a scoring rubric with an educational component to facilitate burn injury depth evaluation that improved reliability of the scoring. Using the developed rubric to re-score the five burn models, they found that all models created a deep partial thickness injury and that agreement about specific characteristics identified on histological staining was improved. Finally, they present consensus statements on the evaluation and interpretation of the microanatomy of deep partial thickness burns in pigs.

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658 Early Interventions with Autologous Skin Cell Suspension Leads to Positive Outcomes

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.323 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S194-S194

Author(s):

Nicole M Kopari

Keyword(s):

Cell Suspension ◽

Early Treatment ◽

Wound Closure ◽

Delayed Presentation ◽

Average Hospital ◽

Burn Care ◽

Skin Cell ◽

Partial Thickness ◽

Small Pore ◽

Partial Thickness Burns

Abstract Introduction Following initial stabilization, the primary goal of burn care is rapid wound closure to restore the barrier function and mechanical integrity of the skin. Time to wound closure is an important consideration when establishing the treatment plan, with a goal of re-epithelialization by 21 days to reduce the risks of hypertrophic scars (HTS), however, new research suggests that HTS can occur when healing is achieved as early as day 8. Early treatment of deep partial-thickness burns with autologous skin cell suspension (ASCS) was implemented at our burn center to achieve early wound closure and decrease hospital length of stay (LOS). Methods An IRB-approved, retrospective chart review of patients admitted between January 2020 to July 2020 was completed to evaluate the effectiveness of ASCS when applied as an early treatment defined as within 3 days of injury. Burn patients were excluded with delayed presentation >7 days, patients who only received ASCS to donor sites, and patients who died from unrelated comorbidities. Patients were excised to viable tissue. Patients with intact dermis were treated with ASCS. Patients without intact dermis were treated with ASCS and widely meshed autograft. Non-absorbent, small pore dressings were applied to the wound then covered with bismuth-petrolatum dressing, dry gauze, and compression bandage. Patients appropriate for discharge were followed-up in clinic for the first dressing change. Results Twenty-three patients were treated with ASCS utilizing this early intervention approach with 16 patients meeting inclusion criteria. Patients ranged from 15 months to 73 years of age and included 6 females and 10 males. The median total body surface area (TBSA) was 7.3% (range 2-23). Patients were taken for ASCS application between post burn day 0-3 (average 1.5). Average hospital LOS was 2.4 days. Operative dressings were removed between day 7-12 and >90% re-epithelization was noted between day 7-18 (mean 11). The mean LOS/%TBSA was 0.3. No patients required re-operation for closure of their wounds or reconstructive interventions for scarring. Conclusions Early excision of deep partial-thickness burns with application of ASCS allowed for healing to be achieved in a timely fashion. Implementation of an early operative approach to burn care allowed for a decrease in LOS and a decreased overall number of dressing changes.

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556 The Use of a Concentrated Surfactant Based Gel to Promote Burn Wound Healing

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.206 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S126-S127

Author(s):

Rebecca Coffey ◽

Rachel Penny

Keyword(s):

Wound Healing ◽

New Product ◽

Ease Of Use ◽

Burn Injuries ◽

Full Thickness ◽

Burn Wound ◽

Burn Wounds ◽

Burn Care ◽

Product Trial ◽

Burn Wound Healing

Abstract Introduction Strategies to remove necrotic tissue from burn wounds include excisional and non-excisional debridement. Alternative treatments could promote burn wound healing while minimizing patient discomfort and the need for surgery. We evaluated the usage of a concentrated surfactant gel (CSG) to promote burn wound healing in those with indeterminate depth and full thickness burn injuries. Methods An IRB approved retrospective study was conducted during a 10-patient new product trial period with enrollment between September and October 2019. Patients included in this study had indeterminate or full thickness burn wounds and were treated with a concentrated surfactant-based gel. Patients with non-burn diagnoses were excluded. Data collected included demographic information, injury descriptors, and additional burn wound characteristics. Results A total of 10 patients were included in this study as part of a new product trial. The subjects were 80% male with an average TBSA of 7.5%. 40% had indeterminate and 60% had full thickness burn wounds. Prior to initiation of the CSG, the burn wounds had been open for an average of 41 days. There were no infections or complications with usage of the CSG. 90% of patients reported less pain than the standard of care topical agents for burns. Average duration of treatment with the CSG until healing was 28 days. After usage of the CSG, no patients required surgery. Conclusions Our findings support the usage of a concentrated surfactant-based gel in patients with burn wounds. Patients reported decreased pain during dressing changes and ease of use compared to the standard topical agent in burn care. It also prevented surgical debridement in those with indeterminate and full thickness burn injuries.

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miRNAs as Regulators of the Early Local Response to Burn Injuries

International Journal of Molecular Sciences ◽

10.3390/ijms22179209 ◽

2021 ◽

Vol 22 (17) ◽

pp. 9209

Author(s):

Ines Foessl ◽

Christoph Walter Haudum ◽

Ivan Vidakovic ◽

Ruth Prassl ◽

Joakim Franz ◽

...

Keyword(s):

Early Phase ◽

Target Genes ◽

Burn Injury ◽

Ex Vivo ◽

Expression Patterns ◽

Treatment Success ◽

Burn Injuries ◽

Specific Gene ◽

Partial Thickness ◽

Partial Thickness Burn

In burn injuries, risk factors and limitations to treatment success are difficult to assess clinically. However, local cellular responses are characterized by specific gene-expression patterns. MicroRNAs (miRNAs) are single-stranded, non-coding RNAs that regulate mRNA expression on a posttranscriptional level. Secreted through exosome-like vesicles (ELV), miRNAs are intracellular signalers and epigenetic regulators. To date, their role in the regulation of the early burn response remains unclear. Here, we identified 43 miRNAs as potential regulators of the early burn response through the bioinformatics analysis of an existing dataset. We used an established human ex vivo skin model of a deep partial-thickness burn to characterize ELVs and miRNAs in dermal interstitial fluid (dISF). Moreover, we identified miR-497-5p as stably downregulated in tissue and dISF in the early phase after a burn injury. MiR-218-5p and miR-212-3p were downregulated in dISF, but not in tissue. Target genes of the miRNAs were mainly upregulated in tissue post-burn. The altered levels of miRNAs in dISF of thermally injured skin mark them as new biomarker candidates for burn injuries. To our knowledge, this is the first study to report miRNAs altered in the dISF in the early phase of deep partial-thickness burns.

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420 Complete Wound Closure in Partial Thickness Burns with the Use of Collagen Extracellular Matrix Dressings and an Antimicrobial Foam: A Prospective Cohort, Single Site, Pilot Study

Journal of Burn Care & Research ◽

10.1093/jbcr/iry006.342 ◽

2018 ◽

Vol 39 (suppl_1) ◽

pp. S182-S182

Author(s):

M Diss ◽

G Lindberg ◽

C Asamah ◽

Y Patel

Keyword(s):

Extracellular Matrix ◽

Pilot Study ◽

Prospective Cohort ◽

Wound Closure ◽

Single Site ◽

Partial Thickness ◽

Partial Thickness Burns

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Fabrication, characterization and evaluation of the efficacy of gelatin/hyaluronic acid microporous scaffolds suffused with aloe-vera in a rat burn model

Journal of Biomaterials Applications ◽

10.1177/08853282211061821 ◽

2021 ◽

pp. 088532822110618

Author(s):

Lalita Mehra ◽

Smritee Mehra ◽

Nidhi Tiwari ◽

Thakuri Singh ◽

Harish Rawat ◽

...

Keyword(s):

Hyaluronic Acid ◽

Growth Factor ◽

Aloe Vera ◽

Gamma Scintigraphy ◽

Gravimetric Analysis ◽

Burn Wounds ◽

Partial Thickness ◽

Partial Thickness Burn

Burn induced injuries are commonly encountered in civilian and military settings, leading to severe morbidity and mortality. Objective of this study was to construct microporous bioactive scaffolds of gelatin-hyaluronic acid suffused with aloe-vera gel (Gela/HA/AvG), and to evaluate their efficacy in healing partial-thickness burn wounds. Scaffolds were characterized using Fourier transform-infrared spectroscopy, Scanning electron microscopy, and Thermo-gravimetric analysis to understand intermolecular interactions and morphological characteristics. In-vitro fluid uptake ability and hemolytic index of test scaffolds were also determined. In-vitro collagenase digestion was done to assess biodegradability of scaffolds. Wound retraction studies were carried out in Sprague Dawley rats inflicted with partial-thickness burn wounds to assess and compare efficacy of optimized scaffolds with respect to negative and positive control groups. In-vivo gamma scintigraphy using Technetium-99m labeled Immunoglobulin-G ( 99m Tc-IgG) as imaging agent was also performed to validate efficacy results. Histological and immunohistochemical comparison between groups was also made. Scaffolds exhibited mircoporous structure, with pore size getting reduced from 41.3 ± 4.3 µm to 30.49 ± 5.7 µm when gelatin conc. was varied from 1% to 5%. Optimized test scaffolds showed sustained in-vitro swelling behavior, were biodegradable and showed hemolytic index in range of 2.4–4.3%. Wound retraction study along with in-vivo gamma scintigraphy indicated that Gela/HA/AvG scaffolds were not only able to reduce local inflammation faster but also accelerated dermis regeneration. Immunohistochemical analysis, in terms of expression levels of epidermal growth factor and fibroblast growth factor-2 also corroborated in-vivo efficacy findings. Gela/HA/AvG scaffolds, therefore, can potentially be developed into an effective dermal regeneration template for partial-thickness burn wounds.

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