scholarly journals Evaluation of EpiProtect® microbial cellulose burns dressings in young children

2020 ◽  
Vol 6 ◽  
pp. 205951312094050
Author(s):  
Lindsay A Shanks ◽  
Andrea Cronshaw ◽  
K Skaria Alexander ◽  
Jonathan A Davies ◽  
Ciaran P O’Boyle
Keyword(s):  
Young Children ◽  
Total Body Surface Area ◽  
Case Series ◽  
Skin Grafting ◽  
Healing Time ◽  
Full Thickness ◽  
Burn Wound ◽  
Partial Thickness ◽  
Split Skin Grafting ◽  
Effective Analgesia

Introduction: EpiProtect® is a biosynthetic cellulose dressing indicated for the treatment of superficial burns and the dressing of deep burns. Prior to this study the youngest reported patient treated with EpiProtect® was aged 13 years. Method: Data were collected prospectively for patients aged < 5 years, presenting to the Children’s Burns Unit with ⩾ 2% total body surface area (TBSA) burns sustained by any mechanism. Results: Thirty children were treated (median age = 17 months, age range = 1–61 months). Thirty-six burn depths were documented: superficial partial thickness (SPT) in 53% (n=19); mid-partial thickness (MPT) in 33% (n=12); deep partial thickness (DPT) in 11% (n=4); and full thickness (FT) in 3% (n=1). Median burn size was 4.5% TBSA (range = 2%–12%). EpiProtect® was applied under general anaesthesia in all cases. The median length of stay (LOS) was two days (range = 0–6 days). EpiProtect® was tolerated well and provided effective analgesia for subsequent dressing changes. Median healing time was 13 days (SPT burns), 14 days (MPT) and 24 days (DPT burns). Three patients required split skin grafting. Hypertrophic scarring arose in one patient. Discussion: This case series represents the youngest published patient group to have been treated with EpiProtect®. Authors conclude that EpiProtect® provides a safe, reliable and well-tolerated dressing option for all burn depths in young children. Importantly, EpiProtect® is culturally neutral and may be used in situations which, for cultural reasons, may preclude the use of animal-derived products. Further studies are warranted to evaluate pain scores, burn depth, size and LOS correlation, and comparative analysis between dressing types. Lay Summary Burn injuries in the paediatric population are common and often require multiple dressing changes. Dressing changes can be painful and distressing to both children and their care givers. This article describes the experience of using a synthetically derived burns dressing, called EpiProtect®, in children aged ⩽ 5 years. Thirty patients were recruited with varying depths of scald burns and all underwent application of EpiProtect® dressing. The results suggested that EpiProtect® was a user-friendly dressing that can be used to treat partial-thickness burns and to dress full-thickness (FT) burns. It was well-tolerated and provided effective analgesia at the time of dressing changes. There was no incidence of increased burn wound infection rates and all wounds healed. In addition, as EpiProtect® is a synthetic product, it has the benefit of being culturally neutral, which is advantageous in a culturally diverse population. Further studies are warranted to evaluate the effectiveness of this dressing and to compare it to similar dressings that are available.

scholarly journals Management of facial burns

2020 ◽  
Vol 8 ◽  
Author(s):  
David G Greenhalgh
Keyword(s):  
Skin Grafting ◽  
Healing Time ◽  
The Body ◽  
Full Thickness ◽  
Partial Thickness ◽  
Facial Burns ◽  
The Face ◽  
Partial Thickness Burns

Abstract Burns to the face affect a part of the body that cannot be hidden and thus exposes potentially major changes in appearance to society. Therefore, it is incumbent upon the caregiver to optimize healing and minimize scarring. The goal for partial-thickness burns is to have them heal within 2–3 weeks to minimize healing time. For full-thickness burns there needs to be strategies to optimize the outcomes for skin grafting and minimize scarring. The goal of this review is to discuss the best way to improve the outcomes of these devastating injuries.

Bromelain-based enzymatic debridement of e-cigarette burns: a single unit experience

2019 ◽  
Vol 28 (11) ◽  
pp. 758-761
Author(s):  
Weiguang Ho ◽  
Christopher D. Jones ◽  
Daniel Widdowson ◽  
Hilal Bahia
Keyword(s):  
Total Body Surface Area ◽  
Case Series ◽  
Skin Grafting ◽  
Burn Injuries ◽  
Chemical Burns ◽  
Burn Wound ◽  
Total Body ◽  
Partial Thickness Burns ◽  
Enzymatic Debridement

Objective: It is widely accepted that the early debridement of burns improves outcome. There is increasing evidence that enzymatic debridement is an effective technique for removal of full-thickness and deep-dermal burns, reducing blood loss and often the need for autologous skin grafting by avoiding over excision of the burn. We aim to highlight the potential use of this form of debridement as an alternative to surgical management in patients with electronic cigarette (e-cigarette)-associated flame burn injuries. Methods: This case series presents the use of Nexobrid (MediWound Ltd, Israel), a non-surgical, bromelain-based enzymatic debridement technique, in patients with deep partial-thickness burns (range: 1–3% total body surface area), avoiding the need for autologous skin grafting. Results: Burn wounds in two patients healed within 14 days without complications or the need for further surgical intervention. Another patient required further dressings after discharge but failed to attend follow-up appointments. These results are comparable with those reported by others using conservative management of e-cigarette burns. Conclusion: The authors wish to raise awareness of the potential for a combination of thermal and chemical burns related to e-cigarette explosions. Chemical burns should be excluded by pH testing of the burn wound. From our experience, small e-cigarette-associated flame burns can be considered for management with enzymatic debridement.

scholarly journals The scalp as a donor site for skin grafting in burns: retrospective study on complications

2016 ◽  
Vol 4 ◽  
pp. 1-6 ◽  
Author(s):  
Dorota Teresa Roodbergen ◽  
Adrianus Fredericus Petrus Maria Vloemans ◽  
Zjir Mezjda Rashaan ◽  
Jacob Cornelis Broertjes ◽  
Roelf Simon Breederveld
Keyword(s):  
Retrospective Study ◽  
Surface Area ◽  
Complication Rate ◽  
Donor Site ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
Healing Time ◽  
Late Complications ◽  
Split Skin Grafting ◽  
Total Body

Abstract Background Split skin grafting (SSG) is the cornerstone in the treatment of deep burns and large skin defects. Frequently used donor sites are the thigh, abdomen and buttocks. The scalp is less common while considered as a reliable donor site. Advantages are a large surface area, rapid wound healing, cosmetically favourable results and multiple harvests from the same donor site. Complications include scab formation, chronic folliculitis and alopecia but have been recorded sporadically in previous studies. This article evaluates the complication rate of the scalp donor site in the treatment of deep burns in the Beverwijk Burn Centre. Methods A retrospective study was performed of all patients who received a skin graft from the scalp at the Beverwijk Burn Centre between January 2004 and December 2012. Data were collected from medical files of included patients, including gender, age, type of burn (scald, flame, other) and total body surface area (TBSA) burned at the time of first surgery. Postoperative variables were healing time of the donor site and incidence of complications. During follow-up, the incidence of late complications was reviewed. Results A total number of 105 grafts were analysed in 93 patients: 58 males (62 %) and 35 females (38 %), with a median age of 2 years and 3 months old. Of the patients, 30 (32 %) had flame burns and 57 (61 %) had scald burns. Eighty-seven percent of patients had a TBSA burned of 5 % or less. All donor sites healed within 14 days. No alopecia or scar hypertrophy developed at the donor sites. Two patients (2.2 %) developed folliculitis; one patient (1.1 %) showed scab formation. Conclusions The scalp as a donor site in our Burn Centre shows a comparable short-term complication rate to the previous literature, with quick healing and no long-term complications. Therefore, we propose the consideration of the scalp as a primary donor site, especially in young children, where the scalp offers a larger donor site area than the buttocks or thighs.

555 Early Application of a Water-soluble Surfactant Dressing for Partial-thickness Burn Wounds to Reduce Wound Conversion

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S126-S126
Author(s):  
David M Hill ◽  
Ammar O Mahmood ◽  
Matthew B Mitchell ◽  
Jakob H Allen ◽  
William L Hickerson ◽  
...  
Keyword(s):  
Case Series ◽  
Water Soluble ◽  
Wound Dressings ◽  
Protective Mechanism ◽  
Full Thickness ◽  
Burn Wound ◽  
Early Application ◽  
Burn Wounds ◽  
Partial Thickness ◽  
Soluble Surfactant

Abstract Introduction Surfactant-based wound dressings have been utilized in chronic, non-healing wounds and small burn wounds to soften and aid removal of wound debris. In vitro data suggest enhanced healing properties are due to the ability to stabilize and potentially reseal plasma membranes, thereby, retaining cellular integrity and enhance wound healing. Further, surfactant-based wound dressings are non-ionic and may facilitate removal, sensitize, or prevent bacterial biofilms. Biofilms are an evolved, protective mechanism bacteria utilize to reduce antimicrobial efficacy. Removal or penetration of biofilms is essential for bacterial eradication. This case series presents outcomes from use of a water-soluble surfactant dressing (WSD) is used at hospital admission for treating partial thickness (PT) burn wounds. Methods This retrospective, single-center, electronic health record review, included patients, if they were admitted between August 1, 2019 - January 31, 2020, at least 18 years old, and sustained a PT burn wound treated with WSD on admission. Pregnant or incarcerated patients were excluded. The WSD was applied following initial wound debridement, and then twice daily until either discharge or it was deemed burn wound excision would be required. PT tissue salvage was calculated from body mass index (BMI), PT total body surface area (TBSA) burned, and cm2 requiring autografting. SigmaPlot 11.0 was utilized for statistical analysis. Results Thirty-two patients were included. All but one patient had a TBSA burned less than 20% with median (IQR) of 6% (3.5,9). Fifteen also had some full thickness injuries. Seventy-eight percent had flame injuries; 19% contact. Two had inhalation injuries. All but four had a significant past medical and/or social history. Fifty-nine percent had a history of substance abuse and 22% had diabetes. Nine patients had a delayed admission. The median BMI was 26 (24.3,34.2). There were no deaths. Seven patients were discharged within 48 hours to complete outpatient treatment. Median length of stay was 7 days (4.8,12.8). There was lack of any full thickness conversion to the applied areas in 69% of patients; 91% demonstrated either complete or some tissue salvage. Median % PT tissue salvage was 100 (75.3,100). The WSD was well tolerated and no patients developed a wound infection to the applied area. Conclusions Understanding inherent design limitations, this case series demonstrates feasibility of early application, and potential efficacy preventing wound conversion in a complex population with comorbidities and polysubstance abuse.

Dermal Nanoemulsion Treatment Reduces Burn Wound Conversion and Improves Skin Healing in a Porcine Model of Thermal Burn Injury

2021 ◽  
Author(s):  
Vladislav A Dolgachev ◽  
Susan Ciotti ◽  
Emma Liechty ◽  
Benjamin Levi ◽  
Stewart C Wang ◽  
...  
Keyword(s):  
Burn Injury ◽  
Hair Follicles ◽  
Silver Sulfadiazine ◽  
Histological Evaluation ◽  
Full Thickness ◽  
Burn Wound ◽  
Thermal Burn ◽  
Burn Wounds ◽  
Partial Thickness ◽  
Mediators Of Inflammation

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&lt;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.

Outcomes of the glove-gauze regimen for managing burn injuries of the hand

2020 ◽  
Vol 45 (7) ◽  
pp. 737-741
Author(s):  
Oleksandra Vyrva ◽  
Elliott Smock ◽  
Joel Pessa ◽  
Sunil M. Thirkannad
Keyword(s):  
Physical Therapy ◽  
Range Of Motion ◽  
Full Range ◽  
Effective Means ◽  
Healing Time ◽  
Full Thickness ◽  
Level Of Evidence ◽  
Partial Thickness ◽  
And Function ◽  
Hand Burns

We studied the efficacy of the glove-gauze regimen in treating superficial, partial-thickness and small full-thickness hand burns. Outcome measures included healing time, need for surgical intervention, need for formal physical therapy, restoration of range of motion, return to function and incidence of infection. All patients ( n = 123) successfully completed the regimen with an average healing time of 3.7 weeks. None required surgical debridement and seven (6%) required formal physical therapy. One hundred and eighteen patients (96%) regained full range of motion and 122 (99%) returned to their previous level of work. We believe that the glove-gauze regimen provides a simplified and effective means of managing hand burns. We conclude from our patients that the glove-gauze regimen is an effective treatment that can ensure uneventful healing of superficial, partial-thickness and small full-thickness burns. A majority of our patients healed with full range of motion and function without formal physical therapy. Level of evidence: IV

726 The Use of Xeroform Dressings for Partial Thickness Scald Burn Injuries in a Verified Pediatric Burn Center

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S194-S195
Author(s):  
Lisa C Vitale ◽  
Jennifer Livingston ◽  
Erica Curtis ◽  
Katherine Oag ◽  
Christina M Shanti ◽  
...  
Keyword(s):  
Burn Injury ◽  
Wound Care ◽  
Total Body Surface Area ◽  
Burn Injuries ◽  
Wound Complications ◽  
Burn Wound ◽  
Burn Center ◽  
Partial Thickness ◽  
Partial Thickness Burn ◽  
At Home

Abstract Introduction For children who have suffered a burn injury one of the greatest challenges is managing pain with an adequate yet practical burn wound dressing that will ultimately be managed at home. Medical product companies have created a variety of wound care products available on the market. These products are advertised to be more superior over one another in categories such as decrease in wound infections, minimization of pain, ease of dressing application, increased dressing wear time, and better wound healing. With all the options for burn wound care there are many factors to consider when choosing a burn dressing such as cost, ease of dressing for families at home, comfort, and efficacy. At our ten year verified pediatric burn center we have tried many different burn wound care products, however we have found Xeroform and bacitracin to be the most practical and easy to use for our patient population. Methods A retrospective chart review was performed from 2016–2018 of all cascading scald injuries to children 0–5 years of age treated at our verified pediatric burn center. 179 patients were included in this review. Of those patients a total of 52 patients were excluded, 28 patients had no follow up, 21 patients received alternate dressings, and 3 patients had full thickness injuries requiring a split thickness skin graft (STSG). Charts were reviewed for total body surface area (TBSA), length of stay (LOS), discharge dressing type, complications, and time to healing. All patients included routinely received consistent application of the Xeroform and bacitracin. Results 127 patients discharged with Xeroform dressings were included in this study with an average age of 1.4 years old (range 0–5 years) and average TBSA of 2.5% (range 0.25–13%). The average LOS was 1.6 days (range 1–10 days). In this sample 32 (25%) patients were healed within 7 days. 77 (61%) patients were healed within 7–14 days. 11 (9%) patients were healed within 14–21 days. 7 (5%) patients were healed in greater than 21 days. There were no wound complications identified within this study group. Conclusions Using Xeroform as our standard of practice has streamlined the care provided to our patients. We have demonstrated consistent effective re-epithelization, protection from infection, and ease of dressings for families and burn providers. In our experience Xeroform has provided a versatile way to care for partial thickness burn injuries. Applicability of Research to Practice We suggest Xeroform and bacitracin dressings be used for partial thickness burn injuries in patients under 5 years of age. This dressing may be superior to other products because it allows for bathing while providing good wound epithelization and is easy to use.

scholarly journals Increased burn healing time is associated with higher Vancouver Scar Scale score

2017 ◽  
Vol 3 ◽  
pp. 205951311769632 ◽  
Author(s):  
Vidya Finlay ◽  
Sally Burrows ◽  
Maddison Burmaz ◽  
Hussna Yawary ◽  
Johanna Lee ◽  
...  
Keyword(s):  
Wound Healing ◽  
Total Body Surface Area ◽  
Likelihood Estimation ◽  
Healing Time ◽  
Burn Wound ◽  
Interaction Terms ◽  
Burn Wound Healing ◽  
Primary Model ◽  
Burn Surgery ◽  
The Relationship

[Formula: see text] Increased burn wound healing time has been shown to influence abnormal scarring. This study hypothesised that scar severity increases commensurate to the increase in time to healing (TTH) of the wound. Wound healing and scar data from burn patients treated by the Burn Service of Western Australia at Royal Perth Hospital were examined. The relationship between TTH and scar severity, as assessed by the modified Vancouver Scar Scale (mVSS), was modelled using regression analysis. Interaction terms evaluated the effect of surgery and total body surface area – burn (TBSA) on the main relationship. Maximum likelihood estimation was used to account for potential bias from missing independent variable data. The sample had a median age of 34 years, TTH of 24 days, TBSA of 3% and length of stay of five days, 70% were men and 71% had burn surgery. For each additional day of TTH, the mVSS score increased by 0.11 points ( P ≤ 0.001) per day in the first 21 days and 0.02 points per day thereafter ( P = 0.004). The relationship remained stable in spite of TBSA or surgical intervention. Investigation of the effect of missing data revealed the primary model underestimated the strength of the association. An increase in TTH within 21 days of injury is associated with an increase in mVSS or reduced scar quality. The results confirm that efforts should be directed toward healing burn wounds as early as possible.

scholarly journals Hyperpigmentation after surgery for a deep dermal burn of the dorsum of the hand: partial-thickness debridement followed by medium split-thickness skin grafting vs full-thickness debridement followed by thick split-thickness skin grafting

2016 ◽  
Vol 4 ◽  
pp. 1-11 ◽  
Author(s):  
Yoshitaka Kubota ◽  
Nobuyuki Mitsukawa ◽  
Kumiko Chuma ◽  
Shinsuke Akita ◽  
Yoshitaro Sasahara ◽  
...  
Keyword(s):  
Skin Graft ◽  
Skin Grafting ◽  
Japanese Patients ◽  
Interquartile Range ◽  
Split Thickness Skin Graft ◽  
Full Thickness ◽  
Color Spaces ◽  
Partial Thickness ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting

Abstract Background Early excision and skin grafting are commonly used to treat deep dermal burns (DDBs) of the dorsum of the hand. Partial-thickness debridement (PTD) is one of the most commonly used procedures for the excision of burned tissue of the dorsum of the hand. In contrast, full-thickness debridement (FTD) has also been reported. However, it is unclear whether PTD or FTD is better. Methods In this hospital-based retrospective study, we compared the outcomes of PTD followed by a medium split-thickness skin graft (STSG) with FTD followed by a thick STSG to treat a DDB of the dorsum of the hand in Japanese patients. To evaluate postoperative pigmentation of the skin graft, quantitative analyses were performed using the red, green, and blue (RGB) and the hue, saturation, and brightness (HSB) color spaces. We have organized the manuscript in a manner compliant with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Results Data from 11 patients were analyzed. Six hands (five patients) received grafts in the PTD group and eight hands (six patients) received grafts in the FTD group. Graft take was significantly better in the FTD group (median 98 %, interquartile range 95–99) than in the PTD group (median 90 %, interquartile range 85–90) (P &lt; 0.01). Quantitative skin color analyses in both the RGB and HSB color spaces showed that postoperative grafted skin was significantly darker than the adjacent control area in the PTD group, but not in the FTD group. Conclusions There is a possibility that FTD followed by a thick STSG is an option that can reduce the risk of hyperpigmentation after surgery for DDB of the dorsum of the hand in Japanese patients. Further investigation is needed to clarify whether the FTD or the thick STSG or both are the factor for the control of hyperpigmentation.

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