The role of silver sulphadiazine in the conservative treatment of partial thickness burn wounds: A systematic review

Cannabinoids in Integumentary Wound Care: A Systematic Review of Emerging Preclinical and Clinical Evidence

This systematic review critically evaluates preclinical and clinical data on the antibacterial and wound healing properties of cannabinoids in integument wounds. Comprehensive searches were conducted across multiple databases, including CINAHL, Cochrane library, Medline, Embase, PubMed, Web of Science, and LILACS, encompassing records up to May 22, 2024. Eighteen studies met the inclusion criteria. Eleven were animal studies, predominantly utilizing murine models (n = 10) and one equine model, involving 437 animals. The seven human studies ranged from case reports to randomized controlled trials, encompassing 92 participants aged six months to ninety years, with sample sizes varying from 1 to 69 patients. The studies examined the effects of various cannabinoid formulations, including combinations with other plant extracts, crude extracts, and purified and synthetic cannabis-based medications administered topically, intraperitoneally, orally, or sublingually. Four animal and three human studies reported complete wound closure. Hemp fruit oil extract, cannabidiol (CBD), and GP1a resulted in complete wound closure in twenty-three (range: 5-84) days with a healing rate of 66-86% within ten days in animal studies. One human study documented a wound healing rate of 3.3 cm2 over 30 days, while three studies on chronic, non-healing wounds reported an average healing time of 54 (21-150) days for 17 patients by oral oils with tetrahydrocannabinol (THC) and CBD and topical gels with THC, CBD, and terpenes. CBD and tetrahydrocannabidiol demonstrated significant potential in reducing bacterial loads in murine models. However, further high-quality research is imperative to fully elucidate the therapeutic potential of cannabinoids in the treatment of bacterial skin infections and wounds. Additionally, it is crucial to delineate the impact of medicinal cannabis on the various phases of wound healing. This study was registered in PROSPERO (CRD42021255413).

A novel antibiotic: the antimicrobial effects of CFBSA and its application on electronspun wound dressing

N-chloro-N-fluorobenzenesulfonylamide (CFBSA), was a novel chlorinating reagent, which exhibits potential antibacterial activities. In this study, CFBSA was confirmed as a wide-broad antimicrobial and bactericidal drug against different gram-negative bacteria, gram-positive bacteria and fungi, while it was found to have low cytotoxicity for eukaryotic cells. In addition, microorganism morphology assay and oxidative stress test was used to determine the antimicrobial mechanisms of CFBSA. According to the results, CFBSA probably had a target on cell membrane and killed microorganism by disrupting its cell membrane. Then, CFBSA was first combined with poly(L-lactide-co-caprolactone) (PLCL)/SF via electrospinning and applied in wound dressings. The characterization of different PLCL/SF of CFBSA-loaded nanofibrous mats was investigated by SEM, water contact angle, Fourier transform infrared spectroscopy, cell compatibility and antimicrobial test. CFBSA-loaded PLCL/SF nanofibrous mats showed excellent antimicrobial activities. In order to balance of the biocompatibility and antibacterial efficiency, SP-2.5 was selected as the ideal loading concentration for further application of CFBSA-loaded PLCL/SF. In conclusion, the electrospun CFBSA-loaded PLCL/SF nanofibrous mat with its broad-spectrum antimicrobial and bactericidal activity and good biocompatibility showed enormous potential for wound dressing.

Management of Pediatric Superficial Partial-Thickness Burns with Polyhexamethylene Biguanide: Outcomes and Influencing Factors

Background: In burn care, achieving swift healing with minimal complications remains paramount. This investigation assesses the role of polyhexamethylene biguanide (PHMB) in managing pediatric superficial partial-thickness burns, focusing on the effects of various patient-specific factors on recovery. Methods: Through a retrospective analysis of 27 pediatric cases treated with PHMB, we evaluated the impact of age, burn size, dressing frequency, treatment delay, cold therapy application, and analgesic usage on the time until reepithelialization (TTRE). Results: The majority of patients benefited from early cold therapy, yet only 1 in 3 patients received analgesics. A mean healing time of 8.78 (SD: 2.64) days was observed, with the extent of the burn showing a strong correlation (r: 0.63) to TTRE. Most treatments were managed outpatient, evidenced by a negligible average hospital stay (0.96 days), with recorded no complications. Conclusions: Our findings endorse PHMB as a promising treatment for superficial second-degree burns in young patients, due to the observed stable and rapid wound closure without the association of increased risks. Continued exploration into the optimal application of prehospital interventions and the comprehensive benefits of PHMB in pediatric burn management is necessary. Future research should assess long-term outcomes, including functionality, scar quality, and patient satisfaction.

Timing of surgery in acute deep partial-thickness burns: A study protocol

For deep partial-thickness burns no consensus on the optimal treatment has been reached due to conflicting study outcomes with low quality evidence. Treatment options in high- and middle-income countries include conservative treatment with delayed excision and grafting if needed; and early excision and grafting. The majority of timing of surgery studies focus on survival rather than on quality of life. This study protocol describes a study that aims to compare long-term scar quality, clinical outcomes, and patient-reported outcomes between the treatment options. A multicentre prospective study will be conducted in the three Dutch burn centres (Rotterdam, Beverwijk, and Groningen). All adult patients with acute deep-partial thickness burns, based on healing potential with Laser Doppler Imaging, are eligible for inclusion. During a nine-month baseline period, standard practice will be monitored. This includes conservative treatment with dressings and topical agents, and excision and grafting of residual defects if needed 14-21 days post-burn. The subsequent nine months, early surgery is advocated, involving excision and grafting in the first week to ten days post-burn. The primary outcome compared between the two groups is long-term scar quality assessed by the Patient and Observer Scar Assessment Scale 3.0 twelve months after discharge. Secondary outcomes include clinical outcomes and patient-reported outcomes like quality of life and return to work. The aim of the study is to assess long-term scar quality in deep partial-thickness burns after conservative treatment with delayed excision and grafting if needed, compared to early excision and grafting. Adding to the ongoing debate on the optimal treatment of these burns. The broad range of studied outcomes will be used for the development of a decision aid for deep partial-thickness burns, to fully inform patients at the point of consent to surgery and support optimal person-centred care.

Flexible Organic Photovoltaic-Powered Hydrogel Bioelectronic Dressing With Biomimetic Electrical Stimulation for Healing Infected Diabetic Wounds

Electrical stimulation (ES) is proposed as a therapeutic solution for managing chronic wounds. However, its widespread clinical adoption is limited by the requirement of additional extracorporeal devices to power ES-based wound dressings. In this study, a novel sandwich-structured photovoltaic microcurrent hydrogel dressing (PMH dressing) is designed for treating diabetic wounds. This innovative dressing comprises flexible organic photovoltaic (OPV) cells, a flexible micro-electro-mechanical systems (MEMS) electrode, and a multifunctional hydrogel serving as an electrode-tissue interface. The PMH dressing is engineered to administer ES, mimicking the physiological injury current occurring naturally in wounds when exposed to light; thus, facilitating wound healing. In vitro experiments are performed to validate the PMH dressing's exceptional biocompatibility and robust antibacterial properties. In vivo experiments and proteomic analysis reveal that the proposed PMH dressing significantly accelerates the healing of infected diabetic wounds by enhancing extracellular matrix regeneration, eliminating bacteria, regulating inflammatory responses, and modulating vascular functions. Therefore, the PMH dressing is a potent, versatile, and effective solution for diabetic wound care, paving the way for advancements in wireless ES wound dressings.

Consensus on the treatment of second-degree burn wounds (2024 edition)

Second-degree burns are the most common type of burn in clinical practice and hard to manage. Their treatment requires not only a consideration of the different outcomes that may arise from the dressing changes or surgical therapies themselves but also an evaluation of factors such as the burn site, patient age and burn area. Meanwhile, special attention should be given to the fact that there is no unified standard or specification for the diagnosis, classification, surgical procedure, and infection diagnosis and grading of second-degree burn wounds. This not only poses great challenges to the formulation of clinical treatment plans but also significantly affects the consistency of clinical studies. Moreover, currently, there are relatively few guidelines or expert consensus for the management of second-degree burn wounds, and no comprehensive and systematic guidelines or specifications for the treatment of second-degree burns have been formed. Therefore, we developed the Consensus on the Treatment of Second-Degree Burn Wounds (2024 edition), based on evidence-based medicine and expert opinion. This consensus provides specific recommendations on prehospital first aid, nonsurgical treatment, surgical treatment and infection treatment for second-degree burns. The current consensus generated a total of 58 recommendations, aiming to form a standardized clinical treatment plan.

Effect of silver sulfadiazine on mature mixed bacterial biofilms on voice prostheses

BACKGROUND

Biofilm formation on voice prostheses disrupts the function and limits the lifespan of voice prostheses. There is still no effective clinical strategy for inhibiting or removing these biofilms. Silver sulfadiazine (SSD), as an exogenous antibacterial agent, has been widely used in the prevention and treatment of infection, however, its effect on voice prosthesis biofilms is unknown. The purpose of this study was to explore the effect of SSD on the mature mixed bacterial biofilms present on voice prostheses.

METHODS

Quantitative and qualitative methods, including the plate counting method, real-time fluorescence quantitative PCR, crystal violet staining, the 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide) (XTT) reduction assay, scanning electron microscopy, and laser confocal microscopy, were used to determine the effect of SSD on the number of bacterial colonies, biofilm formation ability, metabolic activity, and ultrastructure of biofilms in a mature mixed bacterial (Staphylococcus aureus, Streptococcus faecalis and Candida albicans) voice prosthesis biofilm model. The results were verified in vitro on mature mixed bacterial voice prosthesis biofilms from patients, and the possible mechanism of action was explored.

RESULTS

Silver sulfadiazine decreased the number of bacterial colonies on mature mixed bacterial voice prosthesis biofilm, significantly inhibited the biofilm formation ability and metabolic activity of mature voice prosthesis biofilms, inhibited the formation of the complex spatial structure of voice prosthesis biofilms, and inhibited the synthesis of polysaccharides and proteins in the biofilm extracellular matrix. The degree of inhibition and removal effect increased with SSD concentration.

CONCLUSIONS

Silver sulfadiazine can effectively inhibit and remove mature mixed bacterial voice prosthesis biofilms and decrease biofilm formation ability and metabolic activity; SSD may exert these effects by inhibiting the synthesis of polysaccharides and proteins among the extracellular polymeric substances of voice prosthesis biofilms.

Chinese expert consensus on the Management of Pediatric Deep Partial-Thickness Burn Wounds (2023 edition)

Burns are a main cause of accidental injuries among children in China. Because of the unique wound repair capacity and demand for growth in pediatric patients, the management of pediatric deep partial-thickness burn wounds involves a broader range of treatment options and controversy. We assembled experts from relevant fields in China to reach a consensus on the key points of thermal-induced pediatric deep partial-thickness burn-wound management, including definition and diagnosis, surgical treatments, nonsurgical treatment, choice of wound dressings, growth factor applications, infectious wound treatment, scar prevention and treatment. The committee members hope that the Expert Consensus will provide help and guiding recommendations for the treatment of pediatric deep partial-thickness burn wounds.

Outcome of Facial Burn Injuries Treated by a Nanofibrous Temporary Epidermal Layer

BACKGROUND

The face is commonly affected in thermal injuries, with a demand for proper recognition and the correct choice of treatment to guarantee optimal aesthetic and functional outcomes. It is highly vascularized and often heals conservatively, highlighting the particular relevance of conservative treatment modalities, many of which require daily re-applications or dressing changes, which can be painful and tedious for both the patient and the healthcare providers. Motivated by encouraging results of a novel temporary nanofibrous epidermal layer, we herein present a case series of this technology in a case series of patients suffering from facial burns and treated in our Burn Center.

PATIENTS AND METHODS

Patients with superficial partial-thickness facial burns and mixed pattern burns, which were treated with SpinCare™, an electrospun nanofibrous temporary epidermal layer, between 2019 and 2021, at our institution were analyzed retrospectively. The Manchester scar scale (MSS) and numeric rating scale (NRS) were used for scar, pain, and outcome evaluation at different time points by five independent board-certified plastic surgeons with profound experience in burn surgery.

RESULTS

Ten patients (m = 9; f = 1) were treated and evaluated retrospectively. The mean age was 38.8 ± years (SD ± 17.85). The mean healing time was 6.4 days (SD ± 1.56). The mean follow-up was 16.4 months (SD ± 11.33). The mean MSS score was 5.06 (SD ± 1.31), and the mean NRS Score for pain was significantly reduced from initially 7 to 0.875 upon application (mean (pre-application) 7 ± 0.7 and (application) 0.875 ± 1.26; p ≤ 0.0001). Patients reported a NRS score of 10 in terms of functional and cosmetic outcomes at their final follow-up appointment. No adverse effects were observed.

CONCLUSIONS

The application of a nanofibrous temporary epidermal layer such as SpinCare™ represents a relatively easy-to-use, well-tolerated, and effective alternative for the treatment of partial-thickness facial burns.

Antibacterial activity, quality and stability study of creams with new potential silver(I) complexes and in vivo case report

The aim of this study was to evaluate the antibacterial activity, quality and stability of creams (at 1 % concentration) prepared with synthesized silver(I) complexes: [Ag(Nam)₂]NO₃·H₂O ( AgNam), [Ag₂(HGly)₂]_n(NO₃)_2n (AgGly) (Nam - nicotin-amide, Gly - glycine) and silver(I) sulfadiazine (AgSD), which is commercially available. Antibacterial activity was evaluated by agar well diffusion method and in in vivo case. The pure silver(I) complexes as well as all three tested creams loaded with AgGly, AgSD and AgNam showed antibacterial potential. Moreover, the creams loaded with AgGly and AgNam showed higher antibacterial effects against S. aureus and B. subtilis than the cream loaded with AgSD. In terms of appearance, all cream samples were opaque and odourless, and no phase separation was observed. Creams were soluble in water (o/w emulsions) and they had a pseudoplastic behaviour. The pH of the creams was in the range of 4.87-5.75. No visible changes were observed in the case of commercially used AgSD cream during one month testing period at conditions -16 ± 1 °C; 6 ± 1 °C and 56 % relative humidity; 20 ± 1 °C and 58 % relative humidity and 40 ± 1 °C and 75 % relative humidity. However, creams containing AgGly and AgNam changed their colour depending on the tested conditions.

The Potential of Medicinal Plants and Natural Products in the Treatment of Burns and Sunburn-A Review

Treating burns remains a challenge for modern medicine, especially in developing countries that cannot afford expensive, advanced therapies. This review article summarises clinical and animal model studies of botanical preparations and their mixtures in treating burn wounds and sunburn. Articles available in electronic databases such as PubMed, Scopus, Web of Science, Science Direct and Google Scholar, published in English in 2010-2022, were considered. In the described clinical trials, it was shown that some herbal preparations have better effectiveness in treating burn wounds, including shortening the healing time and reducing inflammation, than the conventional treatment used hitherto. These herbal preparations contained extracts from Albizia julibrissin, Alkanna tinctoria, Aloe vera, Arnebia euchroma, Betula pendula and Betula pubescens, Centella asiatica, Hippophaë rhamnoides, Juglans regia, Lawsonia inermis, and mixtures of Matricaria chamomilla and Rosa canina. Research on animal models shows that many extracts may potentially benefit the treatment of burn wounds and sunburn. Due to the diverse mechanism of action, antibacterial activity, the safety of use and cost-effectiveness, herbal preparations can compete with conventional treatment. The growing interest in alternative medicine and herbal medicine encourages further research. Not only single preparations but also their mixtures should be taken into account because the research conducted so far often suggests a synergistic effect of the ingredients.

Enhanced Antimicrobial Activity of Silver Sulfadiazine Cosmetotherapeutic Nanolotion for Burn Infections

Burns are highly traumatizing injuries that can be complicated by various microbial infections, leading to morbidity and mortality. The ultimate goal of burn therapy is to prevent any microbial infection and rapid wound healing with epithelization. The current study aimed to develop and investigate the potential of nanoemulsion-based cosmetotherapeutic lotion of silver sulfadiazine (SSD) for increased antimicrobial activity to treat burn injuries. Silver sulfadiazine is the standard topical treatment for burn patients, but is allied with major limitations of poor solubility, low bioavailability, and other hematologic effects, hindering its pharmaceutical applications. The nanoformulation was fabricated through the ultrasonication technique and optimized by selecting various parameters and concentrations for the formation of water-in-oil (w/o) emulsion. The optimized formulation depicts a smaller particle size of 213 nm with an encapsulation efficiency of approx. 80%. Further, nanoemulsion-based SSD lotion by utilizing argan oil as a cosmetotherapeutic agent was prepared for scar massaging with improved permeation properties. The designed cosmeceutical formulation was characterized in terms of physical appearance, refractive index, particle size, encapsulation efficiency, and biocompatibility. The compatibility of the formulation ingredients were determined through FTIR (Fourier Transform Infrared Spectroscopy). The formulated nanolotion containing SSD demonstrated superior antimicrobial activities against different bacterial strains in comparison to commercialized burn creams.

Topical Antimicrobial Agents for the Prevention of Burn-Wound Infection. What Do International Guidelines Recommend? A Systematic Review

Background

Choosing adequate topical antimicrobial agents in burn patients still represents a challenge. Therefore, this systematic review was conducted to compile and evaluate current recommendations in international clinical practice guidelines (CPGs) to develop more consistent clinical guidance.

Methods

A systematic search for CPGs was conducted independently by two reviewers using PubMed, EMBASE, Google Scholar, and external citations. The quality of the selected CPGs was evaluated separately using the AGREE II instrument, and intraclass correlation coefficients were calculated. Statistical analysis was performed using R V 1.4.1 statistical software.

Results

Eleven CPGs were included in the study. Most guidelines tend to recommend silver-containing dressings over antiseptics or antibiotics, regardless of the depth of the burn. Silver sulfadiazine is the most recommended topical antimicrobial in low-resource settings. An overall mean appraisal AGREE II score of 68.2% was obtained. The global intraclass correlation coefficient was 0.62 (95% confidence intervals 0.54-0.69), which corresponds to a substantial global concordance between both appraisers.

Conclusions

Great heterogeneity was found between recommendations and CPGs. The three determining factors considered to issue a recommendation were the clinical scenario, burn-wound depth, and burn severity. There is consensus among the guidelines to use topical antimicrobials as a tool to prevent infection, and most of these recommend the use of silver-containing dressings for most scenarios. However, there is currently no ideal topical antimicrobial agent that can be recommended for all clinical scenarios. The development of more consistent recommendations is warranted to standardize clinical practice.

Satisfaction and Functional Outcome of Surgical Treatment in Patients with Brachial Plexus Injury: A Decade of Retrospective Comparative Study

Background

Brachial plexus injury (BPI) is a severe peripheral nerve injury resulting in physical disability. Few studies have investigated the postoperative functional status. We aimed to evaluate the satisfaction with surgical treatment in patients with BPI referred to the Panzdah-e Khordad Hospital, Tehran, Iran from 2011 to 2021.

Methods

In this descriptive-analytical retrospective comparative study, physical examination, along with BrAT, and DASH questionnaires were used to evaluate the patients' status. Then the collected data on the patients' functional status and movements were collected. To compare the mean of quantitative variables before and after the surgery, the dependent t-student was used.

Results

Generally, the patients stated that they still had considerable difficulty doing most of the items of the questionnaires. Nevertheless, there was a significant difference between the following variables before and after surgery; shoulder abduction goniometry (0-150) and force (M0:M5), shoulder external rotation goniometry (0-90) and force (M0:M5)), shoulder forward flexion goniometry (0-180) and force (M0:M5)), elbow flexion goniometry (0- 150), elbow extension force (M0:M5), and wrist and finger muscle force (M0:M5) (P<0.001).

Conclusion

Posterior approach in BPI surgery was associated with good outcomes in terms of shoulder external rotation and abduction. However, patients still suffered from difficulties in daily activities.

Medicinal Herbs from Phyto-informatics: An aid for Skin Burn Management

Skin burn injury is the most common cause of trauma that is still considered a dreadful condition in healthcare emergencies around the globe. Due to the availability of a variety of regimes, their management remains a dynamical challenge for the entire medical and paramedical community. Indeed, skin burn injuries are accompanied by a series of several devastating events that lead to sepsis and multiple organ dysfunction syndromes. Hence the challenge lies in to develop better understanding as well as clear diagnostic criteria and predictive biomarkers which are important in their management. Though there are several regimes available in the market, there are still numerous limitations and challenges in the management. In this review article, we have discussed the various biomarkers that could be targeted for managing skin burn injuries. Instead of focusing on allopathic medication which has its adverse events per se, we have discussed the history, ethnopharmacology properties, and prospects of identified phytomedicines from a well-established herbal informatics model. This review article not only discusses the benefits of scrutinized phytocompounds but also leads to develop novel druggable Phyto-compounds to target skin burn injury at lower cost with no adverse effects.

Review of History of Basic Principles of Burn Wound Management

Thermal energy is an essential and useful resource to humans in modern society. However, a consequence of using heat carelessly is burns. Burn injuries have various causes, such as exposure to flame, radiation, electrical, and chemical sources. In this study, we reviewed the history of burn wound care while focusing on the basic principles of burn management. Through this review, we highlight the need for careful monitoring and customization when treating burn victims at each step of wound care, as their individual needs may differ. We also propose that future research should focus on nanotechnology-based skin grafts, as this is a promising area for further improvement in wound care.

Preparation of Silver Ion Antimicrobial Dressings and Prevention and Treatment of Central Venous Catheter-Related Infection on Burn Wounds of Critically Burned Patients

To further understand the characteristics of Ag+ antimicrobial dressings and its application value in the prevention and treatment of infections in burn patients, in the study, the Ag+ gel dressings were prepared and their physical and chemical characteristics were analyzed, and relationship between the gel dressing and central venous catheter (CVC)-related infections was further explored. The results showed that silver nitrate was made into nano silver particles, and its structure was clearly visible under microscope, and nano silver was further applied to preparation of Ag+ antibacterial dressings. Fibrocytes were clearly visible in Ag+ gel dressing and arranged uniformly, which indicated that Ag+ gel dressing had good compatibility with biological materials and had no obvious toxicity. Further clinical trials showed that Ag+ gel dressing can effectively reduce CVC-related infections. From 1 to 4 weeks of the experiment, the bacterial infection rate in burn wounds and blood of the treatment group (TG), which applied Ag+ gel dressing, was lower than the control group (P < 0.05). During the treatment, the burn healing rate of the TG was also greatly higher than the control group (P < 0.05). In addition, the burn wound exudate in the TG was greatly less than the control group (P < 0.05). In summary, the Ag+ gel dressing prepared has good biological and physical and chemical properties, which have bright prospects in the prevention and treatment of burn wounds and CVC-related infections. This study provides an experimental basis for clinical application of Ag+ gel dressing.

Silver Sulfadiazine Cream Treatment Results in More Wound Contraction and More Itch in a Standardized Porcine Scald Model

A variety of dressings is available for the treatment of partial-thickness wounds, but none has strong evidence supporting their beneficial effect on healing. This may be due to variation in the type and depth of wounds in clinical studies. The aim of this study was to use a standardized porcine wound model to compare three dressings commonly used in burn centers for partial-thickness burns. Partial-thickness scalds were made on the flanks of pigs. Wounds were treated with silver sulfadiazine (SSD, flammazine), a hydrofiber dressing, or glycerol-preserved allogeneic (pig) skin. The healing process was monitored for 8 weeks. Macroscopic parameters were the itching behavior, the cosmetic appearance of the scars, and contraction. Microscopic parameters were the inflammatory response, myofibroblast influx, and the numbers of nerves. All wounds were closed on day 14 and wound infection did not occur. Treatment with SSD resulted in significantly more wound contraction compared to treatment with glycerol-preserved pig skin. Animals treated with SSD suffered more from itching (scratching) during the first 2 weeks after wounding. The number of nerves in healing wounds of these animals was significantly higher compared to wounds treated with hydrofiber dressing or allogeneic skin. In our standardized porcine partial-thickness wound model, treatment with SSD resulted in less favorable wound healing. Compared to treatment with glycerol-preserved allogeneic skin, SSD resulted in more contraction.

The Efficacy of Silver-Based Electrospun Antimicrobial Dressing in Accelerating the Regeneration of Partial Thickness Burn Wounds Using a Porcine Model

(1) Background: Wounds with damages to the subcutaneous are difficult to regenerate because of the tissue damages and complications such as bacterial infection. (2) Methods: In this study, we created burn wounds on pigs and investigated the efficacy of three biomaterials: polycaprolactone-gelatin-silver membrane (PCLGelAg) and two commercial burn dressings, Aquacel^® Ag and UrgoTul^TM silver sulfadiazine. In vitro long-term antibacterial property and in vivo wound healing performance were investigated. Agar diffusion assays were employed to evaluate bacterial inhibition at different time intervals. Minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) and time-kill assays were used to compare antibacterial strength among samples. Second-degree burn wounds in the pig model were designed to evaluate the efficiency of all dressings in supporting the wound healing process. (3) Results: The results showed that PCLGelAg membrane was the most effective in killing both Gram-positive and Gram-negative bacteria bacteria with the lowest MBC value. All three dressings (PCLGelAg, Aquacel, and UrgoTul) exhibited bactericidal effect during the first 24 h, supported wound healing as well as prevented infection and inflammation. (4) Conclusions: The results suggest that the PCLGelAg membrane is a practical solution for the treatment of severe burn injury and other infection-related skin complications.

PREVALENCE, TREATMENT, AND SURVIVAL OF BURNED WILDLIFE PRESENTING TO REHABILITATION FACILITIES FROM 2015 TO 2018

In recent decades, wildfires have increased in frequency and geographic scale across the globe. The human health implications and ecological succession after wildfires are well documented and studied, but there is a lack of empirical research about the direct effects of wildfires on wildlife. Recent wildfires have demonstrated the need to better understand animal burn injuries and innovations in veterinary burn treatment. An online survey was distributed to wildlife rehabilitation facilities internationally to collect baseline information about the number and type of burned wildlife cases admitted, treatments used, and survivorship of wildlife affected by wildfires. Approximately 80% (n = 49) of all respondents (n = 61) reported admitting cases of burned wildlife from 2015 to 2018. Respondents included facilities from six different countries and roughly 43% of facilities reported having a veterinarian on staff. Electrical burns were most commonly reported with 89% of respondents stating that they had seen electrical burns while 38% of respondents reported seeing wildfire-source thermal burns in wildlife patients. Respondents were asked about their frequency of use of different treatment methods. Bandages, colloid fluids, and opioids were used at significantly higher rates at facilities with veterinarians compared with facilities that did not report having a veterinarian; however, survival of burned wildlife patients did not significantly differ based on the factor of having a veterinarian on staff. Long-term and short-term complications were commonly reported for wildlife burn patients; 88% of facilities reported scarring, 81% reported alopecia, and 61% reported sepsis. Burned animals admitted to facilities were reported to have equal odds of dying and surviving. Burn care recommendations have changed considerably in recent decades. This study provided a unique opportunity to compare contemporary recommendations in human medicine with current methods used in wildlife rehabilitation facilities to identify potential areas of further investigation and improvement for wildlife medicine.

Effects of ginsenoside Rb1 on second-degree burn wound healing and FGF-2/PDGF-BB/PDGFR-β pathway modulation

Background

Panax notoginseng (Burk.) F. H. Chen (P. notoginseng) is a traditional Chinese medicine that has been used therapeutically for cardiovascular diseases, inflammatory diseases and traumatic injuries as well as for external and internal bleeding due to injury. Ginsenoside Rb1, a crucial monomeric active constituent extracted from P. notoginseng, has attracted widespread attention because of its potential anti-inflammatory, bacteriostatic, and cell growth-promoting effects. In this study, the therapeutic effects of ginsenoside Rb1 on second-degree burn in rats and the potential underlying mechanisms were explored.

Methods

A rat model of second-degree burn injury was established, and skin wound healing was monitored at different time points after ginsenoside Rb1 treatment. HE staining was performed to identify burn severity, and biological tissues were biopsied on days 0, 7, 14, and 24 after treatment. Skin wound healing at different time points was monitored by macroscopic observation. Furthermore, IHC, WB, and RT-PCR were utilized to determine the protein and mRNA expression levels of PDGF-BB, PDGFR-β, and FGF-2 in wound tissues after treatment.

Results

HE staining showed that after 24 days of ginsenoside Rb1 treatment, skin tissue morphology was significant improved. Macroscopic observation demonstrated that in ginsenoside Rb1-treated rats, the scab removal time and fur growth time were decreased, and the wound healing rate was increased. Collectively, the results of IHC, WB and RT-PCR showed that PDGF-BB, PDGFR-β, and FGF-2 expressions peaked earlier in ginsenoside Rb1-treated rats than in model rats, consistent with the macroscopic observations.

Conclusion

Collectively, these findings  indicated that ginsenoside Rb1 promotes burn wound healing via a mechanism possibly associated with upregulation of FGF-2/PDGF-BB/PDGFR-β gene and protein expressions.

Dinuclear silver(i) complexes with a pyridine-based macrocyclic type of ligand as antimicrobial agents against clinically relevant species: the influence of the counteranion on the structure diversification of the complexes

New dinuclear silver(i) complexes with N,N',N'',N'''-tetrakis(2-pyridylmethyl)-1,4,8,11-tetraazacyclotetradecane (tpmc), [Ag2(NO3)(tpmc)]NO3·1.7H2O (1), [Ag2(CF3SO3)2(tpmc)] (2), and [Ag2(tpmc)](BF4)2 (3) were synthesized and characterized by NMR (1H and 13C), IR and UV-Vis spectroscopy, cyclic voltammetry and molar conductivity measurements. The molecular structures of the complexes were determined by single-crystal X-ray diffraction analysis. The spectroscopic and crystallographic data showed that the structure of the complexes strongly depends on the nature of the counteranion of silver(i) salt used for their synthesis. The antimicrobial activity of complexes 1-3 was examined against Gram-positive and Gram-negative bacteria and different species of unicellular fungus Candida spp. The ability of these complexes to inhibit the formation of Candida biofilms and to eradicate the already formed biofilms was tested in the standard microtiter plate-based assay. In addition, a bioelectrochemical testing of the antimicrobial activity of complex 1 against early biofilm was also performed. The obtained results indicated that complexes 1-3 showed increased activity toward Gram-negative bacteria and Candida spp. and could inhibit the formation of biofilms. In most cases, these complexes had positive selectivity indices and showed similar or even better activity with respect to the clinically used silver(i) sulfadiazine (AgSD). The values of the binding constants for complexes 1-3 to bovine serum albumin (BSA) were found to be high enough to indicate their binding to this biomolecule, but not so high as to prevent their release upon arrival at the target site. Moreover, the positive values of partition coefficients for these complexes indicated their ability to be transported through the cell membrane. Once inside the cell, complexes 1-3 could induce the formation of the reactive oxygen species (ROS) in C. albicans cells and/or interact with DNA. Taken together, silver(i) complexes with the tpmc ligand could be considered as novel antimicrobial compounds with favourable pharmacological properties, being safer than AgSD.

Management of facial burns: an update

PURPOSE OF REVIEW

This article reviews literature on the recent progress made on management of facial burns. The discussion focuses on those aspects of the management in which recent studies brought new ideas, and reviews some that failed to change practices in the management of facial burns.

RECENT FINDINGS

Recent innovations and models have been proposed in an attempt to reduce the incidence of unnecessary intubations in patients with burns to the face and with suspected inhalational injury. However, the decision to secure the airway is still a challenging one. A new escharotomy method based on facial subunits principles has been described, while the practice of early tangential excision is still debated in the literature. Tarsorrhaphy without occluding the eyes has also been described in the management of peri-oral burns. Self-retaining and expandable stents for the nose have also been demonstrated to be effective in preventing nasal stenosis. 3D printed face masks have been more recently developed to improve the current wound-care methods used in facial scar management.

SUMMARY

This article highlights recent developments in the management of facial burns in areas such as acute facial burn care, subsequent wound care and facial scar management. It highlights areas wherein progress has been made, as well as the need for further studies in certain areas.

Variation in definitions of burn wound infection limits the validity of systematic review findings in burn care: A systematic review of systematic reviews

INTRODUCTION

Systematic reviews (SR) of high-quality randomised controlled trials can identify effective treatments for burn wound infections (BWIs). Clinical heterogeneity in outcome definitions can prevent valid evidence synthesis, which may limit the reliability of the findings of SRs affected by this heterogeneity. This SR aimed to investigate whether there is variation BWI definitions across studies in SRs of burn care interventions and its impact on identification of effective treatments for patients with burn injuries.

METHODS

A systematic search of five databases was conducted. Included SRs were: in English, published from January 2010 to October 2018, assessed intervention effects for patients with a burn injury, and reported data about BWI.

RESULTS

Twenty-nine SRs, which included 248 studies reporting BWI outcomes, were included in our final dataset. Three SRs used a definition of BWI to select studies for inclusion. Fourteen reported BWI definitions from included studies in the review results. There was heterogeneity of BWI definition in their included studies; across 29 SRs, 32 different BWI indicators were used, with the median across SRs ranging from 1 to 7 (range 1-14). Fourteen SRs accounted for BWI definition heterogeneity in their conclusions, indicating that the issue impacted whether a conclusion could be drawn, and limited the validity of the SR findings.

CONCLUSIONS

There is variation in BWI definition across SRs and within the studies included in SRs of interventions assessing BWI outcomes. This heterogeneity has prevented conclusions about intervention effects being drawn, and only half of the SR authors have accounted for it in their findings. Reviews that have collated this data without reference to the heterogeneity should be viewed with caution, since it may limit the validity of evidence for the identification of effective treatments for BWI. The use of a newly developed core indicator set to support consistent reporting of indicators and standardisation of BWI outcome reporting will enable effective evidence synthesis.

Antibacterial Thiamine inspired silver (I) and gold (I) N-heterocyclic carbene compounds

Three new coinage metal carbene complexes of silver and gold were synthesized from a thiamine inspired proligand. The compounds were characterized by HRMS, NMR spectroscopy (1H, 19F, 31P and 13C), FT-IR and elemental analysis. The coordination environment around the metal centers was correlated to the diffusion coefficients obtained from DOSY-NMR experiments and was in agreement with the nuclearity observed in the solid-state by single crystal X-ray crystallography. The silver and gold carbene compounds were subjected to MIC studies against a panel of pathogenic bacteria, including multidrug resistant strains, with the gold carbene derivative showing the most potent antimicrobial activity against Gram-positive methicillin resistant Staphylococcus aureus (MRSA).

Global burn care and the ideal burn dressing reloaded - A survey of global experts

PURPOSE

Burn care is a highly relevant medical specialty in every part of the world. Different infrastructure, healthcare systems and access to medical supplies lead to different needs, treatment strategies and outcomes. A fundamental tool in a burn care provider's armamentarium is the use of different dressings. Several studies have investigated the question of the ideal burn dressing, but none could achieve a proper global perspective. With advanced dressings being on the rise, we conducted this study to get a global understanding of the actual use and idea of the ideal burn dressing.

OBJECTIVE

The objective of this study was to investigate the understanding of an 'ideal burn dressing' on a global scale.

MATERIALS AND METHODS

A questionnaire about burn care and the ideal burn dressing has been created and translated to five of the most spoken languages world-wide (English, Spanish, French, Chinese, Indonesian). It has been uploaded to an online survey platform and sent out to burn experts worldwide. The voluntary participation was possible for a period of four weeks.

RESULTS

In total, 196 respondents from 49 countries participated in the study, yielding a response rate of 24.5%. The most important burn dressing characteristics in a cumulative ranking were (1) lack of adhesion (80.54%), (2) pain-free dressing change (79.87%), (3) requirement of fewer dressing changes, while in a linear ranking they were (1) anti-infective (35.14% 1st), pain-reduction (24.14% 2nd), and high absorbency (23.49% 3rd). Silver-based dressings are the most used dressings for superficial (45.21%) and deep (52.78%). 94.81% believe that the choice of burn dressing affects the outcome.

CONCLUSION

This investigation has delivered valuable insights into the global perspective of the ideal burn dressing. Yet, the question of the ideal burn dressing is still inconclusive. Wound dressing research is of fundamental interest for patients, healthcare providers and healthcare systems.

Risk Factors for Wound Infection in Outpatients With Lower Extremity Burns

BACKGROUND

We sought to evaluate risk factors for wound infection in patients with lower extremity (LE) burn.

METHODS

Adults presenting with LE burn from January 2014 to July 2015 were included. Data regarding demographics, injury characteristics, and outcomes were obtained. The primary outcome was wound infection. Multivariate logistic regression analysis was performed to identify independent risk factors for wound infection.

RESULTS

317 patients were included with a mean age of 43 years and median total body surface area of .8%; 22 (7%) patients had a component of full-thickness (FT) burn; and 212 (67%) patients had below-the-knee (BTK) burn. The incidence of wound infection was 15%. The median time to infection was 5 days, and majority (61%) of the patients developed wound infection by day 5. Patients who developed wound infection were more likely to have an FT burn (22% vs. 5%, P < .001) and BTK burn (87% vs. 64%, P = .002), without a difference in other variables. Multivariate logistic regression analysis showed age (Odds ratio (OR) 1.02 and CI 1.00-1.04), presence of FT burn (OR 5.33 and CI 2.09-13.62), and BTK burn (OR 3.42 and CI 1.37-8.52) as independent risk factors for wound infection (area under the curve = .72).

CONCLUSION

Age, presence of FT burn, and BTK burn are independent risk factors for wound infection in outpatients with LE burns.

Burn Care in the Greek and Roman Antiquity

The last century brought about more rapid new developments in the treatment of burns, which significantly lowered the mortality of burn injuries. However, burns were already treated in antiquity, where the threshold from spirituality to scientific medicine originated. The existing literature on burn treatment is very limited and there are many cross-references, some of them incorrect. The aim of this work by an interdisciplinary team of historians and physicians is to offer a more precise reproduction of the burn treatment of Greek and Roman antiquity using original texts in context and with a modern scientific background. There are many sources from ancient doctors on the subject of burn treatment, as well as the treatment of burned-out wounds and frostbite, which have not yet been mentioned. The literature research also showed an understanding of scientific contexts in ancient medicine, such as antiseptics or rheology. Interestingly, there was a change in burn medicine from everyday Greek medicine to Roman military medicine with other burn patterns. The care of patients using analgetics and the therapy of burn shock arose from the literature. The ancient world is considered to be the foundation of medicine, but it is believed to have been based mainly on shamanism rather than science. However, already more than two millennia ago, burns were correctly assessed and treated according to today’s scientific standards and scientific relationships were recognized.

Management of Thermal Injuries in Donkeys: A Case Report

Simple Summary

Reports or descriptions of medical management of thermal injuries in donkeys is lacking. Four donkeys sustained burn injuries during the wildland–urban interface fire in Valparaiso, Chile, in 2014. The donkeys received first aid care at the scene of the fire, and then were hospitalized and treated for three months for thermal injuries, of various degrees of severity, in several body parts. The clinical findings and treatment of four of the donkeys are described in this paper. All donkeys recovered and were retired to an animal shelter.

Abstract

Burn injuries are uncommon in large animals and there are no reports of these injuries in donkeys. Burns cause local and systemic effects. Extensive thermal injuries can be challenging to manage and the extent of the burn surface affected will directly impact the severity of the illness and the prognosis. Burns are classified according to the depth of injury into four categories, from first-degree burns, and the least affect to fourth-degree burns, which are the more severely affected patients. This case report describes the medical management of four donkeys that sustained various degrees of external burn injuries during the wildland–urban interface fire in Valparaiso, Chile. The donkeys were treated topically for several weeks and closely monitor for inadequate nutritional intake. Water based topical medications are preferred in burn cases because they can be easily applied and removed without interfering with wound healing. Of note, the caloric demands of these cases can be achieved by increasing the amount of grain, adding fat (i.e., vegetable oil), and free-choice alfalfa hay. All donkeys recovered and were retired to an animal shelter.

Effect of Multiradiance Low-Level Laser Therapy and Topical Silver Sulfadiazine on Healing Characteristics of Dermal Wounds in Marine Toads (Rhinella marina)

Current recommendations for wound management in amphibians are based primarily on clinical experience and on extrapolation from other taxa, whereas controlled clinical studies are lacking. Low-level laser therapy, also termed photobiomodulation, has gained popularity in veterinary medicine and may represent a valuable adjunct therapy for wound care in amphibians, though dosing and safety evaluations have not been previously reported. Silver sulfadiazine (SSD), a topical antimicrobial, is commonly utilized in amphibian medicine but little is known about its effects on wound healing in this class of animals. This pilot study evaluated the effects of repeated treatments of low-level laser therapy or topical SSD on second-intention healing characteristics of surgically induced full-thickness dermal wounds in 33 adult wild-caught marine toads. Toads were anesthetized, and a 6 mm cutaneous biopsy was performed over the right dorsum. They were then randomly assigned to one of three groups: laser therapy (LT) at 5 Hz (905 nm wavelength on a super pulsed sequence), topical SSD (SD), or control sham treatment (CT). Treatments were administered at 24 hrs after biopsy and then every 72 hrs thereafter, concurrent with a visual assessment of the wound. Toads were euthanized at one of five timepoints (day 4, 7, 13, 19, or 28) to permit scoring of histologic criteria, including lymphocytic inflammation, granulomatous inflammation, heterophilic inflammation, granulation tissue, fibrosis, and reepithelialization. Visual assessments and histologic scoring did not identify a benefit of laser therapy or SSD as compared to controls. Laser therapy and SSD, at the doses and dosing schedule utilized in this pilot study, appear to be safe and well-tolerated treatments in marine toads, but may not be warranted for uncomplicated skin wounds in this species.

The Effects of Silver Sulfadiazine on Methicillin-Resistant Staphylococcus aureus Biofilms

Methicillin-resistant Staphylococcus aureus (MRSA), the most commonly detected drug-resistant microbe in hospitals, adheres to substrates and forms biofilms that are resistant to immunological responses and antimicrobial drugs. Currently, there is a need to develop alternative approaches for treating infections caused by biofilms to prevent delays in wound healing. Silver has long been used as a disinfectant, which is non-specific and has relatively low cytotoxicity. Silver sulfadiazine (SSD) is a chemical complex clinically used for the prevention of wound infections after injury. However, its effects on biofilms are still unclear. In this study, we aimed to analyze the mechanisms underlying SSD action on biofilms formed by MRSA. The antibacterial effects of SSD were a result of silver ions and not sulfadiazine. Ionized silver from SSD in culture media was lower than that from silver nitrate; however, SSD, rather than silver nitrate, eradicated mature biofilms by bacterial killing. In SSD, sulfadiazine selectively bound to biofilms, and silver ions were then liberated. Consequently, the addition of an ion-chelator reduced the bactericidal effects of SSD on biofilms. These results indicate that SSD is an effective compound for the eradication of biofilms; thus, SSD should be used for the removal of biofilms formed on wounds.

Silver Sulfadiazine's Effect on Keratin-19 Expression as Stem Cell Marker in Burn Wound Healing

BACKGROUND

Burn wounds are one of the causes of cutaneous injury that involve both epidermal and dermal layers of skin. Silver sulfadiazine (SSD) has been widely used to treat burn wounds, however recent studies have found the treatment to have some drawbacks, such as cellular toxicity effects. Cutaneous wound regeneration is known to start from the basal layer of the epidermal epithelial cells, which are enriched with highly proliferative cells. Keratin-19 (K19) is one of the epidermal stem cell biomarkers found in the skin. This study aims to explore the expression of K19 in burn wound tissue and to investigate the effect of SSD on its expression.

METHODS

We created a burn wound model in Sprague Dawley rats and randomly divided them into control and SSD groups. Wound closure was evaluated (visitrak) overtime series followed by histological evaluation of K19 expression in the wound tissue (immunohistochemistry staining).

RESULTS

Our model successfully represents full-thickness damage caused by a burn wound. The SSD group showed a faster reduction of wound surface area (wound closure) compared to the control group with the peak at day 18 post wounding (p < 0.05). K19 expression was found in both groups and was distributed on epidermal layers, hair follicles and dermis of granulation tissue showing similar patterns.

CONCLUSION

Topical application of SSD on burn wounds showed superiority in wound closure and is likely to have no harmful effect on epidermal stem cells. However, further study is required to investigate the effect of silver species on cell viability and toxicity effects during long term treatment.

Bioengineered Hybrid Collagen Scaffold Tethered with Silver-Catechin Nanocomposite Modulates Angiogenesis and TGF-β Toward Scarless Healing in Chronic Deep Second Degree Infected Burns

Management of burn wounds with diabetes and microbial infection is challenging in tissue engineering. The delayed wound healing further leads to scar formation in severe burn injury. Herein, a silver-catechin nanocomposite tethered collagen scaffold with angiogenic and antibacterial properties is developed to enable scarless healing in chronic wounds infected with Pseudomonas aeruginosa under diabetic conditions. Histological observations of the granulation tissues collected from an experimental rat model show characteristic structural organizations similar to normal skin, whereas the open wound and pristine collagen scaffold treated animals display elevated dermis with thick epidermal layer and lack of appendages. Epidermal thickness of the hybrid scaffold treated diabetic animals is lowered to 33 ± 2 µm compared to 90 ± 2 µm for pristine collagen scaffold treated groups. Further, the scar elevation index of 1.3 ± 0.1 estimated for the bioengineered scaffold treated diabetic animals is closer to the normal skin. Immunohistochemical analyses provide compelling evidence for the enhanced angiogenesis as well as downregulated transforming growth factor- β1 (TGF-β1) and upregulated TGF-β3 expressions in the hybrid scaffold treated animal groups. The insights from this study endorse the bioengineered collagen scaffolds for applications in tissue regeneration without scar in chronic burn wounds.

Pediatric Burn Treatment Using Tilapia Skin as a Xenograft for Superficial Partial-Thickness Wounds: A Pilot Study

This study aims to evaluate the efficacy of Nile tilapia skin as a xenograft for the treatment of partial-thickness burn wounds in children. This is an open-label, monocentric, randomized phase II pilot study conducted in Fortaleza, Brazil. The study population consisted of 30 children between the ages of 2 and 12 years with superficial "partial-thickness" burns admitted less than 72 hours from the thermal injury. In the test group, the tilapia skin was applied. In the control group, a thin layer of silver sulfadiazine cream 1% was applied. Tilapia skin showed good adherence to the wound bed, reducing the number of dressing changes required, the amount of anesthetics used, and providing benefits for the patients and also for healthcare professionals, by reducing the overall work load. The number of days to complete burn wound healing, the total amount of analgesics required throughout the treatment, burn improvement on the day of dressing removal, and pain throughout the treatment were similar to the conventional treatment with silver sulfadiazine. Thus, tilapia skin can be considered an effective and low-cost extra resource in the therapeutic arsenal of pediatric superficial partial thickness burns.

Efficacy and safety of nano-silver dressings combined with recombinant human epidermal growth factor for deep second-degree burns: A meta-analysis

OBJECTIVE

The purpose of this meta-analysis was to assess the efficacy and safety of nano-silver dressing combined with recombinant human epidermal growth factor for deep second-degree burns.

METHODS

PubMed, Web of Science, EMBASE, Cochrane Library and other databases were searched to identify relevant randomised controlled trials.

RESULTS

Twelve studies that assessed nano-silver dressing combined with recombinant human epidermal growth factor were identified. Nano-silver dressing combined with recombinant human epidermal growth factor for deep second-degree burns could significantly reduce the duration of wound healing (mean difference -5.68, 95% CI -7.38 - -3.99, P<0.00001), the wound healing rate (risk ratio [RR] 0.34, 95% CI 0.23-0.48, P<0.00001), the rate of scar hyperplasia (RR 0.67, 95% CI 0.54-0.84, P=0.0004), the wound bacterial positive rate (RR 0.50, 95% CI 0.28-0.89, P=0.02), and the adverse reactions rate (RR 0.31, 95% CI 0.16-0.58, P=0.0003).

CONCLUSION

This comprehensive meta-analysis of the available evidence suggest that the use of nano-silver dressing combined with recombinant human epidermal growth factor results in shorter duration of wound healing, reduced wound bacterial positive rates and adverse reactions rate, and improved wound healing rates.

Effects of a surfactant-based gel on acute and chronic paediatric wounds: a panel discussion and case series

On 20 November 2018, following the International Society for Paediatric Wound Care conference, a closed panel meeting took place in which the use of a surfactant-based gel (PluroGel (PMM), Medline Industries, Illinois, US) in paediatric wound care was discussed. The authors shared their experiences, thoughts, experimental data and clinical results. The panel identified the need for a product that can gently cleanse paediatric wounds and remove devitalised tissue without causing discomfort or skin reactions, as well as potentially promote healing. In adults, PMM has been shown to assist healing by hydrating the wound, controlling exudate and debriding non-viable tissue. Islands of neo-epithelium have also been reported to appear rapidly in different parts of the wound bed. No adverse effects on these proliferating cells have been observed. In vitro data suggest that PMM can remove biofilm, as well as potentially promote healing through cell salvage. The panel, therefore, set out to discuss their experiences of using PMM in the paediatric patients and to establish a consensus on the indications for its use and application in this population. This article will describe the main outcomes of that discussion and present case studies from paediatric patients with a variety of wound types, who were treated with PMM by members of the panel.

A Critical Update of the Assessment and Acute Management of Patients with Severe Burns

Significance: Burns are debilitating, life threatening, and difficult to assess and manage. Recent advances in assessment and management have occurred since a comprehensive review of the care of patients with severe burns was last published, which may influence research and clinical practice. Recent Advances: Recent advances have occurred in the understanding of burn pathophysiology, which has led to the identification of potential biomarkers of burn severity, such as protein C. There is new evidence about the potential superiority of natural colloids over crystalloids during fluid resuscitation, and new evidence about components of initial and perioperative management, including an improved understanding of pain following burns. Critical Issues: The limitations of the clinical examination highlight the need for imaging and biomarkers to assist in estimations of burn severity. Fluid resuscitation reduces mortality, although there is conjecture over the ideal method. The subsequent perioperative period is associated with significant morbidity and the evidence for preventing and treating pain, infection, and fluid overload while maximizing wound healing potential is described. Future Directions: Promising developments are ongoing in imaging technology, histopathology, biomarkers, and wound healing adjuncts such as hyperbaric oxygen therapy, topical negative pressure therapy, stem cell treatments, and skin substitutes. The greatest benefit from further research on management of patients with burns would most likely be derived from the elucidation of optimal fluid resuscitation protocols, pain management protocols, and surgical techniques from randomized controlled trials.

New polynuclear 1,5-naphthyridine-silver(I) complexes as potential antimicrobial agents: The key role of the nature of donor coordinated to the metal center

New polynuclear silver(I) complexes with 1,5-naphthyridine (1,5-naph), [Ag(NO₃)(1,5-naph)]_n (Ag1), [Ag(CF₃COO)(1,5-naph)]_n (Ag2) and [Ag(CF₃SO₃)(1,5-naph)]_n (Ag3) were synthesized by the reaction of the corresponding silver(I) salt and 1,5-naph in ethanol at room temperature. These complexes were characterized by NMR, IR and UV-Vis spectroscopy, while their crystal structures were determined by single-crystal X-ray diffraction analysis. In all these complexes, 1,5-naph acts as a bridging ligand between two Ag(I) ions, while the remaining coordination sites are occupied by oxygen atom(s) of the corresponding anion. The antimicrobial efficiency of these silver(I) complexes was evaluated against the broad panel of Gram-positive and Gram-negative bacteria and fungi. The complexes showed good to moderate antibacterial activity with the minimal inhibitory concentration (MIC) values being in the range 2.5-100 μg/mL (6.5-333.3 μM), while their antifungal activity against the investigated Candida spp. was significantly higher (MIC = 0.78-6.25 μg/mL; 2.6-20.8 μM). Moreover, complexes Ag1 and Ag2 effectively inhibited C. albicans biofilms formation, while Ag1 was also shown to inhibit the formation of mixed C. albicans/Pseudomonas aeruginosa biofilms. Toxicological evaluations on zebrafish (Danio rerio) embryos revealed that all silver(I) complexes could be applied as antifungal agents, whereas Ag3 had the best therapeutic potential showing both the lowest MIC values against the tested Candida strains and the non-toxic in vivo response in the zebrafish embryos at these doses.

Does antibiotic use accelerate or retard cutaneous repair? A systematic review in animal models

BACKGROUND

The presence of infections is one of the main factors that leads to delays in healing or non-closure of cutaneous wounds. Although the goal of antibiotic use is to treat or prevent infection, there is currently no agreement on the effectiveness of these products.

AIM

The aim of this study was to evaluate the efficacy of antibiotic use during the healing process of skin wounds in animal models not intentionally infected, as well as to analyze the advances and limitations of the studies carried out in this field.

MAIN METHODS

This systematic review was performed according to the PRISMA guidelines, using a structured search on the MedLine (PubMed) and Scopus platforms to retrieve studies published until August 29, 2018, 13:35p.m. The studies included were limited to those that used excision or incision wound models and that were not intentionally infected. The data for the animal models, antibiotic used, and the main results of the studies were extracted, and compared where possible. Bias analysis and methodological quality assessments were examined through the SYRCLE's Risk of Bias tool.

KEY FINDINGS

Twenty-seven studies were selected. Overall, the effects of the antibiotic on the wound decreased inflammatory cell infiltration and promoted an increased number of fibroblasts, extracellular matrix constituents, re-epithelialization and tissue strength. A great deal of important information about the methodology was not presented, such as: the statistical analysis used, the animal model (sex and age), antibiotic dosage, blinding and randomization of the animals chosen.

SIGNIFICANCE

Based on the results found, we believe that antibiotic therapy can be considered a viable alternative for the treatment of cutaneous wounds. However, current evidence obtained from the methodological quality analysis points towards a high risk of bias. This is due to the incomplete characterization of the experimental design and treatment protocol, which compromises the reproducibility of the studies.

Silver in Wound Care-Friend or Foe?: A Comprehensive Review

Due to its strong antimicrobial activity, silver is a commonly used adjunct in wound care. However, it also has the potential to impair healing by exerting toxic effects on keratinocytes and fibroblasts. The published literature on the use of silver in wound care is very heterogeneous, making it difficult to generate useful treatment guidelines.

METHODS

A search of high-quality studies on the use of silver in wound care was performed on PubMed. A detailed qualitative analysis of published articles was performed to evaluate the evidence for the use of silver in infected wounds, clean wounds, burns, and over closed surgical incisions.

RESULTS

Fifty-nine studies were included in this qualitative analysis. We found that, overall, the quality of the published research on silver is poor. While there is some evidence for short-term use of dressings containing nanocrystalline silver in infected wounds, the use of silver-containing dressings in clean wounds and over closed surgical incisions is not indicated. Negative-pressure wound therapy accelerates the healing of contaminated wounds, especially when silver is used as an adjunct. For burns, silver sulfadiazine slows healing and should not be used. Instead, nanocrystalline silver, or alternatives such as octenidine and polyhexanide, lead to less infection and faster healing.

CONCLUSIONS

In infected wounds, silver is beneficial for the first few days/weeks, after which nonsilver dressings should be used instead. For clean wounds and closed surgical incisions, silver confers no benefit. The ideal silver formulations are nanocrystalline silver and silver-coated polyurethane sponge for negative-pressure wound therapy. Silver sulfadiazine impairs wound healing. Proper use of silver-containing dressings is essential to optimize wound healing.

Flaminal® versus Flamazine® in the treatment of partial thickness burns: A randomized controlled trial on clinical effectiveness and scar quality (FLAM study)

Although partial thickness burns are the most frequently reported burn injuries, there is no consensus on the optimal treatment. The objective of this study was to compare the clinical effectiveness and scar quality of Flaminal® Forte to silver sulfadiazine (Flamazine®) in the treatment of partial thickness burns. In this two-arm open label multicenter randomized controlled trial, adult patients with acute partial thickness burns and an affected total body surface area of less than 30% were randomized between Flaminal® Forte and Flamazine® and followed for 12 months. Dressing changes in the Flamazine® group were performed daily, and in the Flaminal® group during the first 3 days post burn and thereafter every other day until complete wound healing or surgery. Forty-one patients were randomly allocated to Flaminal® Forte and 48 patients to Flamazine®. The primary outcome was time to wound healing, which did not differ between the groups: median 18 days with Flaminal® Forte (range 8-49 days) versus 16 days with Flamazine® (range 7-48 days; p = 0.24). Regarding the secondary outcomes during hospital admission, there were no statistically significant differences between the groups concerning need for surgery, pain scores, pruritus, or pain-related and anticipatory anxiety. More patients in the Flaminal® group developed wound colonization (78% versus 32%, p < 0.001), but the treatment groups did not differ regarding the incidence of local infections and use of systemic antibiotics. In terms of scar quality, no statistically significant differences between both treatment groups were found regarding subjective scar assessment (Patient and Observer Scar Assessment Scale (POSAS)), scar melanin and pigmentation (DermaSpectrometer®), and scar elasticity and maximal extension (Cutometer®) during 12 month postburn. In conclusion, time to wound healing did not differ, but the use of Flaminal® Forte seemed favorable because less dressing changes are needed which lowers the burden of wound care.

Silver triethanolamine-loaded PVB/CO films for a potential liquid bandage application

Many studies have reported that silver has excellent antibacterial properties. However, silver ions can easily react with oxygen to form Ag2O, thus leading to a color change and a reduction in its anti-microbial characteristics. In this study, silver triethanolamine- (ST) loaded PVB/CO solution was prepared as a potential candidate liquid bandage. PVB/CO/ST retained high transparency after exposure to light for 12 months, which allowed convenient inspection of the wound bed without removal of the dressing. The PVB/CO/ST film exhibited favorable properties, such as speed of drying, excellent tensile strength and elongation characteristics and water vapor transmission rate (WVTR). It was comfortable and waterproof, and therefore effective at preventing bacterial invasion, providing effective biosafety. PVB/CO/ST solution-treated wounds exhibited accelerated healing and reduced inflammation in a nude mouse mode. Our data suggested that PVB/CO/ST solution could serve as a promising liquid bandage for treatment of minor trauma.

Silver(I) complexes with 4,7-phenanthroline efficient in rescuing the zebrafish embryos of lethal Candida albicans infection

Five novel silver(I) complexes with 4,7-phenanthroline (4,7-phen), [Ag(NO₃-O)(4,7-phen-μ-N4,N7)]_n (1), [Ag(ClO₄-О)(4,7-phen-μ-N4,N7)]_n (2), [Ag(CF₃COO-O)(4,7-phen-μ-N4,N7)]_n (3), [Ag₂(H₂O)_0.58(4,7-phen)₃](SbF₆)₂ (4) and {[Ag₂(H₂O)(4,7-phen-μ-N4,N7)₂](BF₄)₂}_n (5) were synthesized, structurally elucidated and biologically evaluated. These complexes showed selectivity towards Candida spp. in comparison to the tested bacteria and effectively inhibited the growth of four different Candida species, particularly of C. albicans strains, with minimal inhibitory concentrations (MICs) in the range of 2.0-10.0 μM. In order to evaluate the therapeutic potential of 1-5, in vivo toxicity studies were conducted in the zebrafish model. Based on the favorable therapeutic profiles, complexes 1, 3 and 5 were selected for the evaluation of their antifungal efficacy in vivo using the zebrafish model of lethal disseminated candidiasis. Complexes 1 and 3 efficiently controlled and prevented fungal filamentation even at sub-MIC doses, while drastically increased the survival of the infected embryos. Moreover, at the MIC doses, both complexes totally prevented C. albicans filamentation and rescued almost all infected fish of the fatal infection outcome. On the other side, complex 5, which demonstrated the highest antifungal activity in vitro, affected the neutrophils occurrence of the infected host, failed to inhibit the C. albicans cells filamentation and showed a poor potential to cure candidal infection, highlighting the importance of the in vivo activity evaluation early in the therapeutic design and development process. The mechanism of action of the investigated silver(I) complexes was related to the induction of reactive oxygen species (ROS) response in C. albicans, with DNA being one of the possible target biomolecules.

Novel pharmacotherapy for burn wounds: what are the advancements

INTRODUCTION

The prognosis for severe burns has improved significantly over the past 50 years. Meanwhile, burns have become an affliction mainly affecting the less well-developed regions of the world. Early excision and skin grafting has led to major improvements in therapeutic outcomes.

AREAS COVERED

The purpose of this article is to survey the use of pharmacotherapy to treat different pathophysiological complications of burn injury. The author, herein, discusses the use of drug treatments for a number of systemic metabolic disturbances including hyperglycemia, elevated catabolism, and gluconeogenesis.

EXPERT OPINION

Advancements in personalized and molecular medicine will make an impact on burn therapy. Similarities between severe burns and other critically ill patients will lead to cross-fertilization between different medical specialties. Furthermore, advances in stem cells and tissue regeneration will lead to improved healing and less lifelong disability. Indeed, research in new drug therapy for burns is actively progressing for many different complications.

Comparative study of silver-sulfadiazine-impregnated collagen dressing versus conventional burn dressings in second-degree burns

Background:

The advantages of biological skin dressings like collagen are well-known. It makes wound impermeable to bacteria and creates the most physiological interface between the wound surface and the environment. Silver-sulfadiazine-impregnated collagen (SIC) is a type 1 collagen impregnated with silver sulfadiazine (SSD)-loaded alginate microspheres to deliver SSD in a controlled fashion to manage infected burn wounds for an extended period of time with lesser dressing changes.

Materials and Methods:

In this study, we used SIC for the treatment of second-degree burn wounds in 25 patients and compared with similar burn wounds in 25 patients treated with conventional dressings.

Results:

For SIC-treated group, we observed improved wound healing in all the patients after 7 days except two patients who required skin grafting, and none of them had any serious complications. For conventionally treated group, improved wound healing was seen in 14 patients, whereas the rest of the patients required prolong dressing or skin grafting. All the patients who were treated with SIC were satisfied with healing of wound and pain relief.

Conclusion:

Second-degree burn wounds are well-treated with SIC in the form of good healing, control of infection, and reducing pain without any serious complications when compared with conventional dressing.