Lyophilised tilapia skin as a xenograft for superficial partial thickness burns: a novel preparation and storage technique

2020 ◽  
Vol 29 (10) ◽  
pp. 598-602
Author(s):  
Edmar Maciel Lima Júnior ◽  
Manoel Odorico de Moraes Filho ◽  
Bruno Almeida Costa ◽  
Ana Paula Negreiros Nunes Alves ◽  
Maria Elisabete Amaral de Moraes ◽  
...  
Keyword(s):  
Total Body Surface Area ◽  
Outpatient Basis ◽  
Good Adherence ◽  
Burn Treatment ◽  
Partial Thickness ◽  
Total Body ◽  
Partial Thickness Burns ◽  
Upper Abdomen ◽  
And Storage ◽  
Storage Technique

Despite a considerable decrease in its incidence worldwide, burns remain the fourth most common type of trauma. The majority of burns are small, with 75% of injuries treated on an outpatient basis. Tilapia skin, as a biological material, has been suggested as an option for the management of burn wounds. After good results were obtained with the use of a glycerolised version of tilapia skin in burned children and adults, it was hypothesised that similar outcomes could be achieved with the use of a lyophilised version of tilapia skin. We report the case of a 33-year-old female patient with scalds to the upper abdomen, and both breasts, arms and forearms. Involvement of 10% of total body surface area with superficial partial thickness burns was calculated. The good adherence of tilapia skin to the wound bed, a 10-day period for complete re-epithelialisation of the wounds and the absence of side effects suggested that the lyophilised version of tilapia skin is effective for burn treatment. Compared with glycerolisation, lyophilisation is thought to permit extended storage of sterile tissue and decreased costs related to distribution and transport, but further studies are needed to confirm this.

Use of a biosynthetic wound dressing to treat burns: a systematic review

2020 ◽  
Vol 29 (Sup12) ◽  
pp. S16-S22
Author(s):  
Farimah Rahimi ◽  
Reza Rezayatmand
Keyword(s):  
Systematic Review ◽  
Wound Dressing ◽  
Large Scale ◽  
Scientific Evidence ◽  
Ease Of Use ◽  
Wound Dressings ◽  
Split Thickness Skin Graft ◽  
Burn Treatment ◽  
Partial Thickness ◽  
Partial Thickness Burns

Objective: Accelerating the process of wound healing, reducing infection risks, and decreasing pain and discomfort in the burn area are important goals of burn treatment. To achieve these goals, the use of biosynthetic wound dressings has increased in recent years. Suprathel (PolyMedics Innovations, Germany) is a biosynthetic wound dressing used to treat both partial-thickness burns and split-thickness skin graft (STSG) donor sites, full-thickness wounds, large-scale abrasions, and scar revisions. Method: This study is a systematic review of empirical evidence reported on the application of the biosynthetic wound dressing in burns up to 2017. Keywords such as ‘Suprathel’, ‘effectiveness’, ‘safety’, and ‘cost’ were searched in PubMed, Cochrane, Scopus and Embase databases. Results: A total of 14 publications were identified, based on the inclusion and exclusion criteria. The findings reported in the literature reviewed were classified in terms of safety, effectiveness and cost-effectiveness of use of the biosynthetic wound dressing. Regarding safety and effectiveness, the dressing was found to yield desirable results, particularly for partial thickness burns and STSG donor sites. As of 2017 no health economics assessments have been carried out. Conclusion: Despite the desirable advantages of the biosynthetic wound dressing with respect to its effectiveness, safety and ease of use, its major limitation was found to be its cost. However, in the absence of comprehensive studies on the quantification of all factors, there is scant scientific evidence for making reliable conclusions from this systematic review.

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

2020 ◽  
Vol 41 (6) ◽  
pp. 1179-1187 ◽  
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.

scholarly journals Hyaluronic acid covers in burn treatment: a systematic review

2016 ◽  
Vol 50 (3) ◽  
pp. 522-528 ◽  
Author(s):  
Michel Marcos Dalmedico ◽  
Marineli Joaquim Meier ◽  
Jorge Vinícius Cestari Felix ◽  
Franciele Soares Pott ◽  
Francislene de Fátima Cordeiro Petz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hyaluronic Acid ◽  
Randomized Controlled Trials ◽  
Complete Healing ◽  
Silver Sulfadiazine ◽  
Controlled Trials ◽  
Burn Treatment ◽  
Randomized Controlled ◽  
Partial Thickness ◽  
Partial Thickness Burns

Abstract OBJECTIVE To evaluate the effectiveness of hyaluronic acid in the healing of partial thickness burns. METHOD Systematic review of randomized controlled trials on the use of hyaluronic acid for the topical treatment of skin burns, based on recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS Two randomized controlled trials that analyzed 143 patients with partial thickness burns and/or deep partial thickness burns were selected. They compared the application of hyaluronic acid 0.2% associated to silver sulfadiazine 1% 5g/cm2 versus silver sulfadiazine 1% 5g/cm2 alone for the outcome of complete healing. CONCLUSION This review emphasizes the need for new well-designed randomized controlled trials to establish the therapeutic relevance of hyaluronic acid with respect to the healing of burns of partial thickness or deep partial thickness.

Randomized Controlled Trial of Polyhexanide/Betaine Gel Versus Silver Sulfadiazine for Partial-Thickness Burn Treatment

2017 ◽  
Vol 16 (1) ◽  
pp. 45-50 ◽  
Author(s):  
Saruta Wattanaploy ◽  
Kusuma Chinaroonchai ◽  
Nantaporn Namviriyachote ◽  
Pornprom Muangman
Keyword(s):  
Wound Healing ◽  
Bacterial Colonization ◽  
Controlled Trial ◽  
Total Body Surface Area ◽  
Silver Sulfadiazine ◽  
P Value ◽  
Full Potential ◽  
Burn Treatment ◽  
Partial Thickness ◽  
Partial Thickness Burn

Silver sulfadiazine is commonly used in the treatment of partial-thickness burns, but it sometimes forms pseudo-eschar and delays wound healing. Polyhexanide/betaine gel, a new wound cleansing and moisturizing product, has some advantages in removing biofilm and promotes wound healing. This study was designed to compare clinical efficacy of polyhexanide/betaine gel with silver sulfadiazine in partial-thickness burn treatment. From September 2013 to May 2015, 46 adult patients with partial-thickness burn ≥10% total body surface area that were admitted to the Burn Unit of Siriraj Hospital within 48 hours after injury were randomly allocated into 2 groups. One group was treated with polyhexanide/betaine gel, and the other group was treated with silver sulfadiazine. Both groups received daily dressing changes and the same standard care given to patients with burns in this center. Healing times in the polyhexanide/betaine gel group and silver sulfadiazine group were 17.8 ± 2.2 days and 18.8 ± 2.1 days, respectively ( P value .13). There were no significant differences in healing times, infection rates, bacterial colonization rates, and treatment cost in both groups. The pain score of the polyhexanide/betaine gel group was significantly less than the silver sulfadiazine group at 4 to 9 days after treatment ( P < .001). The satisfactory assessment result of the polyhexanide/betaine gel group was better than that in the silver sulfadiazine group. These data indicate the need for adequately designed studies to elicit the full potential of polyhexanide gel as a wound dressing for partial-thickness burn wounds.

scholarly journals Dressing for Partial Thickness Burn Using Microbial Cellulose and Transparent Film Dressing : A Comparative Study

1970 ◽  
Vol 2 (2) ◽  
Author(s):  
Shelly M Djaprie ◽  
Aditya Wardhana
Keyword(s):  
Bacterial Contamination ◽  
Transparent Film ◽  
Microbial Cellulose ◽  
Accelerate Wound Healing ◽  
Partial Thickness ◽  
Partial Thickness Burn ◽  
Strong Adhesion ◽  
Moist Environment ◽  
Total Body ◽  
Partial Thickness Burns

Background: Wound dressing aims are to create moist and warm condition to accelerate wound healing, decrease level of pain, collects of exudate, decrease the need of dressing changes, cost effectiveness and protection from bacterial contamination. Microbial cellulose creates a moist environment and strong adhesion to the wound to prevent bacterial contamination and protects from temperature changes. Meanwhile transparent film dressing has advantages such as easy to evaluate, rapid rate of epithelialization and provides high comfort for patients. This study aims to evaluate the efficacy of microbial cellulose dressing compare to transparent film dressing as control, in the treatment of partial thickness burn. Method: We perform a single blind randomized clinical trial study. All patients with partial thickness burn with total body surface less than 20% area burns at any age presenting to our burn unit will be included in the study. They were dressed using microbial cellulose and transparent film as control. Result: The epithelialization rate of patients treated by microbial cellulose was significantly faster and less pain, especially in day 3 and 10 (p=0,000) than those treated with transparent dressing. This study showed patient using microbial cellulose no need to change dressing, meanwhile in transparent dressing it need 2 to 3 times dressing changes and costs more money. Conclusion: The use of microbial cellulose dressing is a versatile and effective dressing for partial thickness burns. This innovative material will be an alternative dressing in partial-thickness burn wounds. 

Use of Tilapia Skin as a Xenograft for Pediatric Burn Treatment: A Case Report

2019 ◽  
Vol 40 (5) ◽  
pp. 714-717 ◽  
Author(s):  
Bruno Almeida Costa ◽  
Edmar Maciel Lima Júnior ◽  
Manoel Odorico de Moraes Filho ◽  
Francisco Vagnaldo Fechine ◽  
Maria Elisabete Amaral de Moraes ◽  
...  
Keyword(s):  
Low Cost ◽  
Total Body Surface Area ◽  
Morphological Structure ◽  
Treatment Center ◽  
Burn Treatment ◽  
Partial Thickness ◽  
Institutional Review ◽  
Partial Thickness Burn ◽  
The Face ◽  
Pediatric Burns

Abstract Burns represent the fifth most common cause of nonfatal childhood injuries in the world. The Nile tilapia skin (Oreochromis niloticus) is widely available in Brazil and demonstrated, in previous studies, noninfectious microbiota, morphological structure similar to that of human skin, and good outcomes when used as a xenograft for treatment of experimental burns in rats. A 3-year-old boy was admitted to a burn treatment center in Fortaleza, Brazil, with scalds in the left side of the face, neck, anterior thorax, abdomen, and left arm. Involvement of 18% of total body surface area with superficial partial thickness burns was calculated. After local Institutional Review Board approval and written permission from the patient’s legal caregiver were obtained, application of tilapia skin as an occlusive dressing was performed. Good adherence of tilapia skin to the wound bed was detected. The patient was discharged from the hospital with a total of 10 days required for the complete re-epithelialization of his superficial partial thickness burn. No adverse effects were noted. We believe that further studies conducted by our researchers will allow this innovative, low-cost, widely available and easy to apply biomaterial to firm itself as a relevant option in the therapeutic arsenal of pediatric burns, producing significant social and financial impact for the health system.

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 Porcine Xenograft and Epidermal Fully Synthetic Skin Substitutes in the Treatment of Partial-Thickness Burns: A Literature Review

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 432
Author(s):  
Herbert L. Haller ◽  
Sigrid E. Blome-Eberwein ◽  
Ludwik K. Branski ◽  
Joshua S. Carson ◽  
Roselle E. Crombie ◽  
...  
Keyword(s):  
Healing Time ◽  
Subsequent Treatment ◽  
Skin Substitute ◽  
Skin Substitutes ◽  
Burn Treatment ◽  
Advantages And Disadvantages ◽  
Partial Thickness ◽  
Partial Thickness Burn ◽  
Partial Thickness Burns ◽  
Porcine Xenograft

Background and Objectives: Porcine xenografts have been used successfully in partial thickness burn treatment for many years. Their disappearance from the market led to the search for effective and efficient alternatives. In this article, we examine the synthetic epidermal skin substitute Suprathel® as a substitute in the treatment of partial thickness burns. Materials and Methods: A systematic review following the PRISMA guidelines has been performed. Sixteen Suprathel® and 12 porcine xenograft studies could be included. Advantages and disadvantages between the treatments and the studies’ primary endpoints have been investigated qualitatively and quantitatively. Results: Although Suprathel had a nearly six times larger TBSA in their studies (p < 0.001), it showed a significantly lower necessity for skin grafts (p < 0.001), and we found a significantly lower infection rate (p < 0.001) than in Porcine Xenografts. Nonetheless, no significant differences in the healing time (p = 0.67) and the number of dressing changes until complete wound healing (p = 0.139) could be found. Both products reduced pain to various degrees with the impression of a better performance of Suprathel® on a qualitative level. Porcine xenograft was not recommended for donor sites or coverage of sheet-transplanted keratinocytes, while Suprathel® was used successfully in both indications. Conclusion: The investigated parameters indicate that Suprathel® to be an effective replacement for porcine xenografts with even lower subsequent treatment rates. Suprathel® appears to be usable in an extended range of indications compared to porcine xenograft. Data heterogeneity limited conclusions from the results.

Delayed Healing Associated with Silver Sulfadiazine Use for Partial Thickness Scald Burns in Children

2018 ◽  
Vol 84 (6) ◽  
pp. 836-840
Author(s):  
Steven L. Raymond ◽  
Antonia Zecevic ◽  
Shawn D. Larson ◽  
Ana Ruzic ◽  
Saleem Islam
Keyword(s):  
Primary Outcome ◽  
Total Body Surface Area ◽  
Silver Sulfadiazine ◽  
Compression Garments ◽  
Area Burned ◽  
Partial Thickness ◽  
Single Center Study ◽  
Total Body ◽  
Topical Antimicrobial ◽  
Scar Therapy

Burns are a leading cause of injury in children. Management principles vary widely, with no consensus about the best treatment. The purpose of this study was to compare outcomes of three different dressings for pediatric partial-thickness scald burns. A retrospective, single-center study was conducted for patients 0–16 years old with a diagnosis of acute partial-thickness scald burn between July 2007 and December 2012. Data regarding prehospital, inpatient, and outpatient course were collected. Cohort was stratified into topical antimicrobial (TA) ointment, silver sulfadiazine (SS), and biosynthetic dressing (BD) groups for analysis. The primary outcome of interest was time to full healing. One hundred and seventy-seven patients met all study criteria. Overall, mean total body surface area burned was 8.3 per cent. TAwas used in 24 per cent cases, SS in 32 per cent, and BD in 44 per cent. The groups were comparable in terms of presenting burn characteristics and hospital course with the exception of the BD group being associated with greater extent of injury. Patients treated with SS had a significantly longer time to full healing and increased requirement of compression garments for scar therapy. Based on these data, the authors have amended their practice and presently use BD or TA dressings to improve healing.

Pathophysiology and assessment of burns

2016 ◽  
Author(s):  
John A. M. Paro ◽  
Geoffrey C. Gurtner
Keyword(s):  
Burn Injury ◽  
Subcutaneous Fat ◽  
Total Body Surface Area ◽  
Coagulative Necrosis ◽  
Partial Thickness ◽  
Degree Burn ◽  
Sizing System ◽  
Total Body ◽  
Burn Depth ◽  
Second Degree

Burn injury represents a complex clinical entity with significant associated morbidity and remains the second leading cause of trauma-related death. An understanding of the local and systemic pathophysiology of burns has led to significant improvements in mortality. Thermal insult results in coagulative necrosis of the skin and the depth or degree of injury is classified according to the skin layers involved. First-degree burns involve only epidermis and heal quickly with no scar. Second-degree burns are further classified into superficial partial thickness or deep partial thickness depending on the level of dermal involvement. Damage in a third-degree burn extends to subcutaneous fat. There is a substantial hypermetabolic response to severe burn, resulting in significant catabolism and untoward effects on the immune, gastrointestinal, and renal systems. Accurate assessment of the extent of burn injury is critical for prognosis and initiation of resuscitation. Burn size, measured in total body surface area, can be quickly estimated using the rule of nines or palmar method. A more detailed sizing system is recommended once the patient has been triaged. Appropriate diagnosis of burn depth will be important for later management. First-degree burns are erythematous and painful, like a sunburn; third-degree burns are leathery and insensate. Differentiating between second-degree burn types remains difficult. There are a number of formalized criteria during assessment that should prompt transfer to a burn centre.

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