Biological dressing is a paradigm shift in children’s scald burn: our experience

Background: Burn injury has multiple causes but scald burn is the most common type of burn in children. Prototype of scald burn is hot water burn. Change of burn dressing in children is challenging. Biological collagen dressing has totally changed the management of scald burn or it is a paradigm shift in the management of scald burn in children. Aim of this study was to achieve early wound healing with less complication and to prevent change of frequent dressings in children.Methods: A prospective study was done in 30 patients of scald burn under 12 years of age between November 2020 to July 2021. Meticulous debridement and deroofing of all blisters and removal of dead skin were performed. Bovine meshed wet collagen dressing was thoroughly rinsed with normal saline three times to remove the preservative isopropyl alcohol. After that collagen dressing applied over the raw area. Paraffin with chlorhexidine impregnated gauze dressing applied over the collagen. First dressing was changed at post operative day five.Results: All burn wounds healed well between 10-14 days without any complications. In follow up no hypertrophy of skin and almost same skin color had noted.Conclusions: We conclude that collagen dressing is a paradigm shift in the management of scald burn. It is cost effective, pain less, requires less frequent change of dressing with good match of skin color.

Comparison of the outcome of amnion versus conventional (Vaseline-impregnated gauze) dressing in superficial partial thickness burn patients in terms of healing time and mean pain.

Objectives: To compare the healing time and mean pain score of Amnion versus Conventional (Vaseline-impregnated gauze) dressing in superficial partial thickness burn patients. Study Design: Randomized controlled study. Settings: Plastic & Reconstructive Surgery Department, Jinnah Hospital & Burn Center, Lahore. Period: January 2018 to January 2019. Material & Methods: A total of 60 patients with superficial second degree burns full filling the inclusion criteria were recruited for the study. Subjects were divided into two groups randomly. All patients were followed up regularly and dressing was changed on alternate days in Group B (Vaseline-impregnated gauze) and only secondary dressing was changed in Group A (amnion) until the auto sloughage (self-removal) of amnion. Outcome variables i.e. pain during first dressing change and healing time were noted. Statistical analysis of data was done using SPSS version 22. Quantitative variables i.e. age, duration of burn, total body surface area, pain during dressing and healing time were presented as mean and standard deviation. Frequency and percentage was calculated for qualitative variables like gender. The pain during dressing change and healing time of both groups were compared for difference. Student’t’ test was applied to compare the outcome and p-value ≤0.05 was considered as significant. Results: Out of sixty cases, 18 (30.0%) were females and 42 (70.0%) were males, with female to male ratio of 1:2.3. Mean age of patients in group A was 33.0 ± 10.19 years and in group B was 33.73 ± 9.55 years. The mean pain score in group A (amnion group) was 1.93 ± 0.91 and in group B (Vaseline-impregnated gauze) was 3.33 ± 1.56 with p-value of 0.0001. The mean healing time in group A (amnion group) was 15.73 ± 2.79 days and in group B (Vaseline-impregnated gauze) was 22.80 ± 4.44 days with p-value of 0.0001. Conclusion: Amnion dressing in superficial partial thickness burn patients is more effective in terms of mean pain score and healing time as compared to conventional (Vaseline-impregnated gauze) dressing.

Procoagulant and Antimicrobial Effects of Chitosan in Wound Healing

Chitosan, a polysaccharide derived from chitin, has excellent wound healing properties, including intrinsic antimicrobial and hemostatic activities. This study investigated the effectiveness of chitosan dressing and compared it with that of regular gauze dressing in controlling clinically surgical bleeding wounds and profiled the community structure of the microbiota affected by these treatments. The dressings were evaluated based on biocompatibility, blood coagulation factors in rat, as well as antimicrobial and procoagulant activities, and the microbial phylogenetic profile in patients with abdominal surgical wounds. The chitosan dressing exhibited a uniformly fibrous morphology with a large surface area and good biocompatibility. Compared to regular gauze dressing, the chitosan dressing accelerated platelet aggregation, indicated by the lower ratio of prothrombin time and activated partial thromboplastin time, and had outstanding blood absorption ability. Adenosine triphosphate assay results revealed that the chitosan dressing inhibited bacterial growth up to 8 d post-surgery. Moreover, 16S rRNA-based sequencing revealed that the chitosan dressing effectively protected the wound from microbial infection and promoted the growth of probiotic microbes, thereby improving skin immunity and promoting wound healing. Our findings suggest that chitosan dressing is an effective antimicrobial and procoagulant and promotes wound repair by providing a suitable environment for beneficial microbiota.

Postoperative care after lymphaticovenous anastomosis

In this report, we discuss the postoperative protocol for patients undergoing lymphaticovenous anastomosis (LVA) in our unit. Immediately after LVA, the incision site is closed over a small Penrose drain and a simple gauze dressing is applied without compression. In the first 5 days, ambulation is allowed, but limb elevation is actively encouraged to promote lymphatic flow across the newly formed anastomosis. Prophylactic antibiotics are routinely given to prevent infection because this patient group is susceptible to infections, which could trigger thrombosis in the anastomosis.

PEDIATRIC WOUND CARE: A TREATMENT DILEMMA

Treating a pediatric-wound requires epitome of expertise especially in neonates. The treating-surgeons usually need to emphasize on multiple-factors. It is very difcult for both surgeon and parents to choose between operative-procedure and non-operative procedure like high quality dressing e.g. nanocrystalline-silver-dressing. The aim of this study is to report nanocrystallinesilver-dressing (Acticoat) as one of good treatment-options for skin-defect-wound especially in neonates and share our experiences gained during the management. Material & Methods: 20-pediatric patients were treated with acticoat dressing and followed up after 48 hours. If acticoat was dry, we poured distilled water to wet. Gauze-dressing was done over the acticoat. If dressing is soaked and pus was seen trickling, acticoat was reapplied after thorough wash and cleaning. We ensured that there was no foreign body in the wound. Results: 20-pediatric-patients were treated at this centre with Nanocrystalline-silver-dressing (Acticoat). Out-of-these, 17-patients were infants. 08-were neonates among infants. Burn, trauma, infections and iatrogenic injury are major-etiology. Mean-sessions-of-acticoatdressing mean-days-of-treatment 3.1 17.6 days respectively and are and . 9-out-of-20-cases were burn-cases with mean-sessions of dressing and mean-days of treatment were and . Mean-satisfactory-Score of parents was (out of 10) We found no 02 12.11-days 9.15 . t a single-case of treatment-failure and not single-case local as well as systemic toxic-effect. Conclusion: Acticoat is one of the best treatment-options for tissue-defect-wound especially in pediatric-cases and those who are unt for surgery. Satisfactory-level of parents is very high with acticoat as it can be managed as outpatient. Acticoat-dressing was very effective, relatively pain-free and did not require frequent-change of dressing.

Comparing Banana Leaf Dressing and Vaseline Gauze Dressing for Split-Thickness Skin Graft Donor Sites in a Ugandan Hospital

Introduction: This study compared the effectiveness of banana leaf dressing (BLD) with the commonly used Vaseline gauze dressing (VGD) on split-thickness skin graft (SSG) donor sites. VGD is not completely nonadherent and is associated with pain on removal. BLD is smooth, non-adherent, pain-free and available. Methods: In this prospective study, consecutive patients were dressed with either BLD or VGD. Ease of applying and removing the dressings was scored. Pain scores were taken on postoperative days 3, 5, 7, 9 and 10. On day 10, the dressing was changed, epithelialization recorded and a swab taken for microbial culture. Average cost of each dressing was calculated. Results: There was no significant difference between postoperative pain scores with either dressing (p=0.992). BLD patients had less pain on dressing change (p=0.006). Both dressings were easy to apply; BLD was easier to remove (p=0.000). Wounds with BLD re-epithelialized faster (p=0.0158). 40% of wounds grew no organism on microbial culture, 25% grew Staphylococcus aureus and 35% grew unusual organisms (p=0.482). VGD was 4 times more expensive than BLD (p=0.000). Conclusion: Banana leaf dressing is effective and highly recommended for dressing SSG donor sites.Keywords: Split-thickness skin graft, Donor sites, Banana leaf dressing, Vaseline gauze dressing