Nonsilver treatment vs. silver sulfadiazine in treatment of partial-thickness burn wounds in children: A systematic review and meta-analysis

Abstract Objective Burn wound progression is an inflammation driven process where an initial partial-thickness thermal burn wound can evolve over time to a full-thickness injury. We have developed an oil-in-water nanoemulsion formulation (NB-201) containing benzalkonium chloride for use in burn wounds that is antimicrobial and potentially inhibits burn wound progression. We used a porcine burn injury model to evaluate the effect of topical nanoemulsion treatment on burn wound conversion and healing. Methods Anesthetized swine received thermal burn wounds using a 25cm 2 surface area copper bar heated to 80 oC. Three different concentrations of NB-201 (10%, 20%, or 40% nanoemulsion), silver sulfadiazine cream or saline were applied to burned skin immediately after injury and on days 1, 2, 4, 7, 10, 14, and 18 post-injury. Digital images and skin biopsies were taken at each dressing change. Skin biopsy samples were stained for histological evaluation and graded. Skin tissue samples were also assayed for mediators of inflammation. Results Dermal treatment with NB-201 diminished thermal burn wound conversion to a full-thickness injury as determined by both histological and visual evaluation. Comparison of epithelial restoration on day 21 showed that 77.8% of the nanoemulsion treated wounds had an epidermal injury score of 0 compared to 16.7% of the silver sulfadiazine treated burns (p=0.01). Silver sulfadiazine cream and saline treated wounds (controls) converted to full-thickness burns by day 4. Histological evaluation revealed reduced inflammation and evidence of skin injury in NB-201 treated sites compared to control wounds. The nanoemulsion treated wounds often healed with complete regrowth of epithelium and no loss of hair follicles (NB-201: 4.8±2.1, saline: 0±0, silver sulfadiazine: 0±0 hair follicles per 4mm biopsy section, p<0.05). Production of inflammatory mediators and sequestration of neutrophils were also inhibited by NB-201. Conclusions Topically applied NB-201 prevented the progression of a partial-thickness burn wound to full-thickness injury and was associated with a concurrent decrease in dermal inflammation.

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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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