Cooling the burn wound: evaluation of different modalites

doi:10.1016/S0305-4179(99)00133-3

Burns

Volume 26, Issue 3, 1 May 2000, Pages 265-270

https://doi.org/10.1016/S0305-4179(99)00133-3 Get rights and content

Abstract

A study was undertaken to investigate the cooling and healing effect of different modalities: Melaleuca Alternifolia Hydrogel (Levtrade International (Pty) Ltd.) was compared with tap water as a coolant following application onto a fresh deep partial thickness hot water burn in a porcine model. Four identical circular scalds were created on the backs of 10 pigs. One wound was not treated and served as a control. The other 3 wounds were either cooled with tap water (15°C) or had Melaleuca Hydrogel dressing applied immediately, or after a 30 min delay. Intradermal temperatures were monitored in all wounds: preburn, during the burn and at regular intervals for 1 h. The wounds were biopsied for histological assessment. These samples were repeated at 24 h and 3 weeks. The mean decrease in final temperature at 1 h was in comparison to the preburn temperature; control +0.44°C (i.e. a temperature increase); water −7.82°C; Melaleuca Hydrogel −3.87°C; Melaleuca Hydrogel after 30 min delay −2.67°C. Clinical and histological assessment at 21 days indicated more rapid healing in both the Melaleuca Hydrogel and water-cooled burns compared with the untreated controls.

Effective cooling of the burn wound and an increased rate of wound healing was achieved by both repeated tap water compresses and by immediate or delayed application of Melaleuca Hydrogel. Cooling is an effective means to reduce tissue damage and increase wound healing.

Introduction

Cooling the burn wound has been used empirically for centuries in an attempt to reduce pain and decrease mortality [1]. Ordinary tap water is recommended by the British Burn Association as the treatment of choice for the first aid management of burns and scalds [2]. However, the best method and the ideal temperature required to achieve cooling are unknown, as the published data regarding cooling is both confusing and sometimes even contradictory.

This is largely because different animals or models have been used in experimentation, different depths of burn wounds have been created and different criteria have been used to assess outcome [3], [4], [5], [6], [7].

Melaleuca Alternifolia Hydrogel is a new commercial dressing designed for the acute treatment of burns [8], [9]. By composition it contains 96% water, melaleuca alternifolia oil and emulsifiers at a pH 5.5–7. The hydro-gel is impregnated within a thin layer of foam and presented sterile in different size sheets within sealed aluminium packets. It has a turpentine-like odour.

This study was undertaken to investigate the cooling effect of different modalities on the burn wound and to assess their effect on wound healing. The melaleuca oil was compared with tap water at 15°C in a controlled deep partial thickness burn created on the back of a porcine model [3].

Section snippets

Materials and methods

Four identical burns measuring 90 mm in diameter were created para-sagittal on the backs of 10 consecutive anaesthetised Landrace large white pigs ( $mean weight =28.1 kg$ ). The relatively large size of the animal allowed for each of the four wounds to be treated differently and thus each animal could serve as an independent experimental model.

General anaesthesia was administered using sodium thiopentone and halothane gas. The pigs were intubated and the internal jugular vein cannulated to provide

Results

Eight pigs were available for assessment. Two pigs died in the immediate postoperative period from respiratory depression.

Discussion

Cooling the burn wound as an emergency measure has been shown to be beneficial both clinically and experimentally [10], [11], [12], [13], [14], [15], [16]. Cryotherapy improves the tissue response to thermal injury. This is achieved by a reduction in post burn hyperthermia, reduced inflammatory and microvascular changes, and less tissue necrosis and fibrosis. In addition there is less release of histamine, prostaglandins, thromboxanes, as well as reduced aerobic metabolism, less lactate

Acknowledgements

The authors wish to thank Levtrade International (Pty) Ltd for the financial support received for this project.

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View full text

Cooling the burn wound: evaluation of different modalites

Abstract

Introduction

Section snippets

Materials and methods

Results

Discussion

Acknowledgements

Burns

Burns

Burns

Burns

Burns

J. Surg. Res.

Br. J. Plast. Surg.

Burns

Ultrastructural aspects of cooled thermal injury

J. Trauma

Observations on the cold water treatment of cutaneous burns

J. Path.

Australian tea-tree oil

Aust. J. Pharm.

Australian tea-tree oil of melaleuca terpinen 4-01 type

Chem. Austr.