113 Successful Treatment of Sulfur Mustard Burns with Silver-Nylon Dressings

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S75-S76
Author(s):  
David J Barillo ◽  
Claire R Croutch ◽  
Anthony R Barillo ◽  
Frances M Reid
Keyword(s):  
Sulfur Mustard ◽  
Standard Of Care ◽  
Silver Ion ◽  
Systemic Absorption ◽  
Chemical Weapon ◽  
Regional Conflicts ◽  
Partial Thickness ◽  
Significant Difference ◽  
Good Laboratory ◽  
Partial Thickness Burns

Abstract Introduction Sulfur mustard (SM) is a chemical weapon first used in 1917 and in 11 subsequent regional conflicts including use by ISIS in Syria in 2016. SM skin exposure results in burns that are indolent, recurrent and hard to treat. Despite 100 years of experience, there is no standard of care for SM burns. We tested silver-nylon dressings in a porcine model of partial thickness SM injury. Methods The study was performed in an AAALAC-approved facility under Good Laboratory Practices (GLP) standards. A total of 1320 superficial or deep partial thickness burns were produced in 165 Gottingen minipigs by vapor cap exposure. The wounds were then debrided with 7 days of saline wet/wet dressings. Silver-nylon dressings were applied and changed daily, every 4 days or every 7 days. Control dressings were silver sulfadiazine changed daily. Dressings were left intact for 30 days followed by 7 days of no treatment. Animals were euthanized and wounds assessed by histopathology (primary endpoint). The non-inferiority margin for histopathology score was 1.5 (10% of maximum possible score). Results There was no mortality or wound infection seen. Silver-nylon when applied once every 7 days to superficial or deep wounds was not inferior to the comparator treatment, SSD on gauze, as evaluated by histopathology (Δ =0.38 95% CI = 0.15, p = 0.0001). There was no statistical difference when comparing silver nylon applied daily, every 4 days or every 7 days in either superficial or deep wounds Chart # 1). Blood silver levels were drawn pre-study, mid study and at autopsy. Blood silver levels were negative in all cases (n= 480). At study end, silver ion was detected in virtually all wounds. Mean skin silver ion levels in wounds treated with daily SSD on gauze or BCD bandage every 1, 4, or 7-days were 3.74, 3.61, 5.43, and 4.40 μg/g, respectively for deep dermal wounds and 2.41, 1.91, 3.75, and 2.73 μg/g,respectively for superficial dermal wounds.There was no statistically significant difference between any of the bandage treatments with regard to silver ion levels in skin punch biopsies collected on Study Day 46. Conclusions Silver nylon dressings provide effective treatment for sulfur mustard burns. As in prior studies, silver-nylon provides high wound silver levels without systemic absorption. The data from this study was submitted to the US Food and Drug Administration, resulting in the first-ever FDA clearance for a product indicated to treat sulfur-mustard skin burns. Applicability of Research to Practice Silver-nylon dressings can be successfully used to treat cutaneous partial-thickness sulfur mustard skin burns.

scholarly journals The Introduction of a Protocol for the Use of Biobrane for Facial Burns in Children

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
A. D. Rogers ◽  
S. Adams ◽  
H. Rode
Keyword(s):  
Standard Of Care ◽  
Healing Time ◽  
Partial Thickness ◽  
Facial Burns ◽  
Aesthetic Results ◽  
Cadaver Skin ◽  
The Face ◽  
One Year ◽  
Partial Thickness Burns ◽  
Historical Controls

Biobrane has become an indispensible dressing with three established indications in acute burns care at our institution: (1) as the definitive dressing of superficial partial thickness facial burns, (2) after tangential excision of deep burns when autograft or cadaver skin is unavailable, and (3) for graft reduction. This paper details our initial experience of Biobrane for the management of superficial partial thickness facial burns in children and the protocol that was compiled for its optimal use. A retrospective analysis of theatre records, case notes and photographs was performed to evaluate our experience with Biobrane over a one-year period. Endpoints included length of stay, analgesic requirements, time to application of Biobrane, healing times, and aesthetic results. Historical controls were used to compare the results with our previous standard of care. 87 patients with superficial partial thickness burns of the face had Biobrane applied during this period. By adhering to the protocol we were able to demonstrate significant reductions in hospital stay, healing time, analgesic requirements, nursing care, with excellent cosmetic results. The protocol is widely accepted by all involved in the optimal management of these patients, including parents, anaesthetists, and nursing staff.

scholarly journals Comparison of the effectiveness of Aloe Vera Gel with 2% Nitrofurazone ointment on the healing of superficial second-degree burns. Randomised clinical trial

2020 ◽  
Author(s):  
Shokoh Varaei ◽  
hadi ranjbar ◽  
parichehr sabaghzadeh ◽  
sanaz bostani ◽  
Soodabhe amirsalari
Keyword(s):  
Clinical Trial ◽  
Assessment Tool ◽  
Aloe Vera ◽  
Control Area ◽  
The Body ◽  
Partial Thickness ◽  
Aloe Vera Gel ◽  
Significant Difference ◽  
The Mean ◽  
Partial Thickness Burns

Abstract Background: Burn injuries are one of the most common sources of trauma globally that comprise a significant drain on long-term personal and healthcare cost Large surface area burn wounds are difficult to manage and may result in significant physiologic and psychological sequelae. The aim of this study was to compare the effectiveness of Aloe Vera gel with 2%Nitrofurazone ointment in the healing of superficial partial thickness burns wounds. Methods: The present study was a split body controlled, randomized clinical trial. The sample was recruited from patients with superficial partial thickness burns wound who were prescribed to treat with 2% Nitrofurazone ointment. Thirty patients with at least two burn, each burn on an alternate side of the body, entered the study — samples allocated to two area which received Aloe Vera gel or 2% Nitrofurazone ointment on their burns. Bates-Jensen Wound. assessment tool (BWAT) was used to evaluate the healing of burns. the epithelialization parameter and sum score Bates-Jensen tools evaluated before, one, two and three weeks after the beginning of treatment. Results: The mean ± SD of epithelialization parameter in Aloe Vera area were 5.0±00.00, 4.0±46.57, 3.0±50.57, 2.0±56.62. The mean ± SD of epithelialization parameter in 2% Nitrofurazone ointment area were 5.0±00.00, 4.0±66.54, 3.0±76.50, 3.0±03.61.and The mean ± SD of BWAT scores in Aloe Vera area were 30.32 ± 3.28, 27.33 ± 3.38, 21.33 ± 3.13, 16.12 ± 2.16 respectively (F(2, 65.07) =440.00, p=0.001). The mean ± SD of BWAT scores in 2% Nitrofurazone ointment area were 30.51 ± 3.79, 28.45 ± 3.49, 23.36 ± 2.89, 19.23 ± 2.11 ( F(1, 52.00) =228.00, p=0.001).Conclusions: There is a significant difference in epithelialization parameter and (BWAT) scores between intervention and control area. Based on this study it looks like that aloe vera gel could promoted epithelialization and wound closure more effectively than 2% Nitrofurazone ointment

664 “Minimally Invasive” Skin Grafting with Enzymatic Debridement and Autologous Skin Cell Spray

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S187-S188
Author(s):  
Steven Kahn ◽  
Ashley Hink ◽  
Jordan Karsch ◽  
Elizabeth Halicki ◽  
William L Hickerson ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Skin Graft ◽  
Donor Site ◽  
Standard Of Care ◽  
Full Thickness ◽  
Skin Cell ◽  
Partial Thickness ◽  
Small Pore ◽  
Partial Thickness Burns ◽  
Enzymatic Debridement

Abstract Introduction Minimally invasive surgery is increasingly becoming standard of care across numerous subspecialties. However, burn surgery has lagged behind; as the mainstay of reconstruction still involves wound excision with a knife, a commensurately sized skin graft, and a painful donor site. In recent years, several new technologies have the potential to be used synergistically to perform “minimally invasive” skin grafts. Enzymatic debridement with bromelain and autologous skin cell spray (ASCS) have independently been shown to reduce the need for split-thickness skin graft (STSG) and decrease the donor site size when grafting is performed. Bromelain is more likely to preserve healthy dermis and ASCS allows an 80:1 expansion. Due to constraints regarding the temporal course of these products only being available via studies before one was FDA approved, these two therapies have not been utilized together in the US until recently. A paucity of literature regarding their use in combination currently exists. Methods This study is a single site review of patients treated the continued access study protocol for bromelain-based enzymatic debridement and with ASCS per the FDA-approved instructions for use. Enzymatic debridement was performed over a 4-hour period with appropriate analgesia. Deep partial-thickness burns with residual dermis were treated with ASCS after enzymatic debridement and superficial dermabrasion. Wounds were dressed with a small pore non-adherent film and layered gauze. Full-thickness burn injuries were treated with conventional STSG. Results Two patients were treated over a 2 week period. One was a 51 yr old male with 17% TBSA superficial and deep partial thickness flame burns, of which 11% were deemed deep enough to warrant treatment with enzymatic debridement. 15% TBSA was treated with ASCS including the arms, back, and posterior neck with a 24 sq cm donor site. Wound closure was noted post-operative day 7 with complete re-epithelialization. The second patient was a 21-year-old male with several comorbidities impairing wound healing (diabetes [HgbA1c of 9.9], scurvy, and zinc deficiency. He had deep-partial and full-thickness burns to bilateral feet. The dorsum of the right foot was reconstructed with ASCS only and a 6 sq cm donor site, and the left foot was treated with a 3:1 meshed STSG and ASCS overspray with 100% take. Conclusions Enzymatic debridement and ASCS can be utilized to treat deep partial-thickness burns with a “minimally invasive” reconstruction. The donor sites in both patients were much smaller than had they been treated with a conventional meshed STSG. Further study is needed to determine which subsets of patients and burn wound characteristics are optimal for this combination of technologies. More data regarding outcomes such as length of stay, costs, and scar formation compared to standard of care is also warranted.

scholarly journals Hydrosurgical debridement versus conventional surgical debridement for acute partial-thickness burns

2020 ◽  
Author(s):  
Justin CR Wormald ◽  
Ryckie G Wade ◽  
Jonathan A Dunne ◽  
Declan P Collins ◽  
Abhilash Jain
Keyword(s):  
Surgical Debridement ◽  
Partial Thickness ◽  
Partial Thickness Burns

scholarly journals Testing telediagnostic thyroid ultrasound in Peru: a new horizon in expanding access to imaging in rural and underserved areas

2021 ◽  
Author(s):  
T. J. Marini ◽  
S. L. Weiss ◽  
A. Gupta ◽  
Y. T. Zhao ◽  
T. M. Baran ◽  
...  
Keyword(s):  
Thyroid Nodule ◽  
Standard Of Care ◽  
The United States ◽  
Epidemiological Studies ◽  
Thyroid Ultrasound ◽  
Target Region ◽  
Experienced Radiologist ◽  
Significant Difference ◽  
Size Evaluation

Abstract Purpose Thyroid ultrasound is a key tool in the evaluation of the thyroid, but billions of people around the world lack access to ultrasound imaging. In this study, we tested an asynchronous telediagnostic ultrasound system operated by individuals without prior ultrasound training which may be used to effectively evaluate the thyroid and improve access to imaging worldwide. Methods The telediagnostic system in this study utilizes volume sweep imaging (VSI), an imaging technique in which the operator scans the target region with simple sweeps of the ultrasound probe based on external body landmarks. Sweeps are recorded and saved as video clips for later interpretation by an expert. Two operators without prior ultrasound experience underwent 8 h of training on the thyroid VSI protocol and the operation of the telemedicine platform. After training, the operators scanned patients at a health center in Lima. Telediagnostic examinations were sent to the United States for remote interpretation. Standard of care thyroid ultrasound was performed by an experienced radiologist at the time of VSI examination to serve as a reference standard. Results Novice operators scanned 121 subjects with the thyroid VSI protocol. Of these exams, 88% were rated of excellent image quality showing complete or near complete thyroid visualization. There was 98.3% agreement on thyroid nodule presence between VSI teleultrasound and standard of care ultrasound (Cohen’s kappa 0.91, P < 0.0001). VSI measured the thyroid size, on average, within 5 mm compared to standard of care. Readers of VSI were also able to effectively characterize thyroid nodules, and there was no significant difference in measurement of thyroid nodule size (P = 0.74) between VSI and standard of care. Conclusion Thyroid VSI telediagnostic ultrasound demonstrated both excellent visualization of the thyroid gland and agreement with standard of care thyroid ultrasound for nodules and thyroid size evaluation. This system could be deployed for evaluation of palpable thyroid abnormalities, nodule follow-up, and epidemiological studies to promote global health and improve the availability of diagnostic imaging in underserved communities.

scholarly journals Can ultrasound suffice for triaging patients requiring surgical correction of rotator cuff tears—a comparative evaluation of ultrasound and magnetic resonance imaging

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Aniket Agarwal ◽  
Kavita Vani ◽  
Anurag Batta ◽  
Kavita Verma ◽  
Shishir Chumber
Keyword(s):  
Rotator Cuff ◽  
Biceps Tendon ◽  
Surgical Correction ◽  
Statistical Testing ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Partial Thickness ◽  
Linear Probe ◽  
Significant Difference ◽  
Sensitivity Specificity

Abstract Background Objectives: To comparatively evaluate the role of ultrasound and MRI in rotator cuff and biceps tendon pathologies and to establish ultrasound as a consistently reproducible, quick and accurate primary investigation modality sufficient to triage patients requiring surgical correction of full thickness rotator cuff tears. Methods: Fifty patients, clinically suspected to have rotator cuff and/or biceps tendon pathologies, with no contraindications to MRI, were evaluated by US and MRI, in a prospective cross-sectional observational study. US was done with high-frequency linear probe, and MRI was done on a 1.5-T scanner using T1 oblique sagittal, proton density (PD)/T2 fat-suppressed (FS) oblique sagittal, T1 axial, PD/T2 FS axial, T1 oblique coronal, T2 oblique coronal and PD FS oblique coronal sequences. Statistical testing was conducted with the statistical package for the social science system version SPSS 17.0. The sensitivity, specificity, PPV, NPV and accuracy were also calculated to analyze the diagnostic accuracy of US findings correlating with MRI findings. A p value less than 0.05 was taken to indicate a significant difference. Results Mean age was 45 years; 74% patients were males; 77% females and 60% males had tears. Majority of patients with rotator cuff tears were in the sixth decade of life. The frequency of tears was higher among older patients. Fourteen percent of patients had full thickness tears while 64% had partial thickness tears. US was comparable to MRI for detection of full thickness tears with overall sensitivity, specificity, PPV and accuracy of 93.8%, 100%, 100% and 98.2%, respectively (p value < 0.001). For partial thickness tears, US had overall sensitivity, specificity, PPV and accuracy of 75.6%, 82.6%, 89.5% and 78%, respectively (p value < 0.001), as compared to MRI. Subacromial-subdeltoid bursal effusion and long head of biceps tendon sheath effusion were common associated, though, non-specific findings. Conclusion Ultrasound findings in our study were found to be in significant correlation with findings on MRI in detection of rotator cuff tears. US was equivalent to MRI in detection of full thickness tears and fairly accurate for partial thickness tears. Therefore, US should be considered as the first line of investigation for rotator cuff pathologies.

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

2011 ◽  
Vol 46 (9) ◽  
pp. 1759-1763 ◽  
Author(s):  
Aaron P. Lesher ◽  
Ryan H. Curry ◽  
Jill Evans ◽  
Valerie A. Smith ◽  
Michael T. Fitzgerald ◽  
...  
Keyword(s):  
Partial Thickness ◽  
Partial Thickness Burns
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