Original contributionOutpatient management of partial-thickness burns: Biobrane® versus 1% silver sulfadiazine
A randomized, prospective study comparing the use of Biobrane® (group 1) with the use of 1% silver sulfadiazine (group 2) in treating 56 partial-thickness burn wounds was carried out in 52 outpatients with burns that comprised less than 10% of their total body surface area. The two groups were similar in age, gender, race, and extent of burn. Wounds of patients in group 1 (30) were compared with those of group 2 (26) for healing time, pain, compliance with scheduled visits, and costs. Infected and skin-grafted wounds were excluded from healing time analysis. Infection rates of the two groups were similar (three of 30 vs two of 26). One patient in each group underwent skin grafting. Healing times of group 1 wounds were significantly less than those of group 2 (10.6 ± 0.8 vs 15.0 ± 1.2 days, P < .01). Using a pain scale of 1 to 5, Biobrane®-treated patients averaged lower pain scores at 24 hours after the burn (1.6 ± 0.8 vs 3.6 ± 1.3, P < .001) and used less pain medication. Compliance with scheduled outpatient visits was also improved in the Biobrane®-treated group (88.6% vs 63.2% attendance, P < .001). Idealized total treatment costs averaged $434 for patients in group 1 compared with $504 for patients in group 2. We conclude that when used on properly selected wounds. Biobrane® therapy can significantly decrease pain and total healing time without increasing the cost of outpatient burn care. Improved patient compliance may be an added benefit.
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Cited by (96)
The Linkoping burn centre in Sweden has, even though being a high income country, reported high burn wound infections (BWI) frequencies in scalded children compared to similar populations in other parts of the world.
The aim was to investigate possible explanations for differences in frequency of BWI among children with partial thickness burns treated at the Linköping burn centre in Sweden, and that reported in other studies.
In order to investigate what BWI criteria that were used in similar studies a literature search on PubMed Central was done along with a retrospective analysis of children previously diagnosed as infected to confirm or reject the high infection frequency reported earlier.
Of the 34 selected publications reporting on BWI frequency 16 (47%) did not define a criteria for the BWI diagnosis and almost a third did not report on wound culturing. Of those who did report the use a third do not mention any bacterial growth found is these cultures. The retrospective analysis on children at the centre did not show any decrease in infection frequency even with some disagreement on onset for the BWI.
The reporting of criteria and diagnosis of burn wound infection is highly variable making it difficult to interpret results and come to conclusions. The high frequency of BWI at the centre might be a result of close monitoring due to study participation, use of clean instead of sterile routine at dressing changes or low thresholds for the diagnosis in respect to changes in infection markers.
Biobrane™ is a skin substitute used for the definitive management of partial thickness burns. No studies have examined the optimal timing of Biobrane™ application in this setting. The purpose of this study was to determine whether there was a clinically significant difference in applying Biobrane to a superficial and mid dermal partial thickness burn within 12 h after burn.
From August 2016–February 2017, 29 consecutive superficial and mid dermal partial thickness burn injuries were prospectively treated with Biobrane™ within 12 h of the injury. This ‘early Biobrane™’ cohort was compared to a historical cohort of 148 patients who were treated with Biobrane™ for superficial and mid dermal burns after 12 h after injury during 2015 to 2016. Multivariate regression analysis was used to determine the difference in time to re-epithelialisation and number of outpatient visits between the two cohorts.
In the ‘early Biobrane™’ group, the mean TBSA was 3.5 ± 2.7%. and the mean time to Biobrane™ application was 7.1 ± 2.7 h after burn injury. The mean time to re-epithelialisation in this group was 9.1 ± 3.0 days, and no patients underwent skin grafting. In the ‘delayed Biobrane™’ group, the mean TBSA was 2.6 ± 2.8% and the mean time to Biobrane™ application was 35.1 ± 21.4 h. The mean time to re-epithelialisation was 14.8 ± 8.7 days, with 3 patients undergoing skin grafting. Regression analysis demonstrated a statistically significant 63% reduction in time to re-epithelialisation (95% CI = 0.23–0.60; P < 0.0001) with early Biobrane™ application.
Patients treated with application of Biobrane™ within 12 h of superficial and mid dermal partial thickness burns have a statistically significant reduction in healing time when compared to patients treated with standard Biobrane™ practice.
To describe how nursing care is delivered to patients with epidermal necrolysis in burn units/specialized units in Spain and a selection of countries.
Descriptive cross-sectional study. Data were collected through a structured questionnaire which was sent to nurse managers in all burn units in Spain and a selection of countries. Descriptive statistics was used to summarize the results.
All BU/SUs in Spain (n = 12) and seven BU/SUs from a selection of countries completed the questionnaire. A lack of specific nursing protocols on Epidermal Necrolysis was observed in most burn units in Spain. Skin cleansing techniques such as showering were only reported by participants from Spain. Use of antiseptics was less frequent in other countries. Conservative skin management was the most extended practice reported by all participants. The use of vaginal molds to prevent synechiae and coverage of the ocular surface with amniotic membrane to minimize sequelae were rarely reported. Pain assessment was not always documented in sedated patients and few participants reported the use of specific scales for this purpose. All nurses agreed in the need for consensus nursing care guidelines on the disease.
Nursing care in patients with epidermal necrolysis varied between burn units in Spain. Differences and similarities were observed when compared with burn units in other countries. Genital and ocular care were outdated in all BU/SUs. Pain assessment documentation was suboptimal. Evidence-based nursing care guidelines were generally demanded by all participants to help reduce mortality and morbidity of this rare and often devastating disease.
Care of outpatient burns
2018, Total Burn Care: Fifth EditionSmaller burns may be treated in the outpatient setting, though proper care should be taken in the assessment of the patient to ensure appropriateness of outpatient management. This chapter discusses the recommended criteria for referral to a designated burn center, in addition to identifying those who would be better suited to inpatient care. The initial care of smaller burns, as well as commonly used dressings used for burn wound management are discussed in this chapter as well as some more advanced treatments such as biologic and synthetic grafting materials that can be utilized in the out-patient setting. Out-patient management of non-thermal burn injuries is also elucidated. The importance of recognizing abuse in the burn victim is discussed. The important issue of pain management in the out-patient setting is discussed. Finally, factors that should be addressed at the initial and follow-up visits are discussed, including wound closure, pruritis, and rehabilitation.
Excisional surgical debridement (SD) is still the gold standard in the treatment of deeply burned hands, though the intricate anatomy is easily damaged. Previous studies demonstrated that enzymatic debridement with the bromelain debriding agent NexoBrid® (EDNX) is more selective and thus can preserve viable tissue with excellent outcome results. So far no method paper has been published presenting different treatment algorithms in this new field. Therefore our aim was to close this gap by presenting our detailed learning curve in EDNX of deeply burned hands.
We conducted a single-center prospective observational clinical trial treating 20 patients with deeply burned hands with EDNX. Different anaesthetic procedures, debridement and wound treatment algorithms were compared and main pitfalls described.
EDNX was efficient in 90% of the treatments though correct wound bed evaluation was challenging and found unusual compared to SD. Post EDNX surprisingly the majority of the burn surface area was found overestimated (18 wounds). Finally we simplified our process and reduced treatment costs by following a modified treatment algorithm and treating under plexus anaesthesia bedside through a single nurse and one burn surgeon solely. Suprathel® could be shown to be an appropriate dressing for wound treatment after EDNX. Complete healing (less 5% rest defect) was achieved at an average of day 28.
EDNX in deep burned hands is promising regarding handling and duration of the treatment, efficiency and selectivity of debridement, healing potential and early rehabilitation. Following our treatment algorithm EDNX can be performed easily and even without special knowledge in burn wound depth evaluation.
Care of Outpatient Burns
2017, Total Burn Care, Fifth EditionSmaller burns may be treated in the outpatient setting, though proper care should be taken in the assessment of the patient to ensure appropriateness of outpatient management. This chapter discusses the recommended criteria for referral to a designated burn center, in addition to identifying those who would be better suited to inpatient care. The initial care of smaller burns, as well as commonly used dressings used for burn wound management are discussed in this chapter as well as some more advanced treatments such as biologic and synthetic grafting materials that can be utilized in the out-patient setting. Out-patient management of non-thermal burn injuries is also elucidated. The importance of recognizing abuse in the burn victim is discussed. The important issue of pain management in the out-patient setting is discussed. Finally, factors that should be addressed at the initial and follow-up visits are discussed, including wound closure, pruritis, and rehabilitation.
Presented at the University Association for Emergency Medicine Annual Meeting in Philadelphia, Pennsylvania, May 1987. Also presented at the Geneva Congress on Burns in Geneva, Switzerland, June 1987. Sponsored by the International Society Burn Injuries and the World Health Organization.