1
|
Badereldien YA, Al-Mekhlafi GA. Hydrogel-Based Dressings and Multidisciplinary Care in Severe Pediatric Burns: A Case Report of Successful Healing and Hypertrophic Scar Prevention. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e944021. [PMID: 39233392 PMCID: PMC11384673 DOI: 10.12659/ajcr.944021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
BACKGROUND Pediatric burn injuries are a global health concern, particularly in infants and toddlers, who face increased risks owing to their higher water content. Despite substantial medical treatment, the mortality rates remain challenging, especially in severe cases. This study explored non-surgical interventions for pediatric burn injuries, aiming to enhance care and alleviate the burden on affected children. CASE REPORT A 16-month-old boy with 30% mixed second- and third-degree burns presented with a scald injury. Initial measures included dressing and analgesia. The Plastic Surgery team led the treatment. Upon admission, the patient experienced convulsions due to hyponatremia in the burn unit and was subsequently transferred to the Pediatric Intensive Care Unit (PICU). Burn care management included the use of hyaluronic acid and occupational therapy. Scheduled dressing changes, including the use of glycerin-based dressings, resulted in satisfactory wound healing. Split skin grafting from the right thigh was performed to prevent elbow joint contracture. Preventive measures against hypertrophic scarring were also implemented. The patient was discharged after follow-up appointments. Consent for publication of case details and photographs was obtained from the patient's father. CONCLUSIONS The presented non-surgical approach, incorporating hyaluronic acid, Bactigras, Elasto-Gel, and a multidisciplinary team, can effectively treat mixed partial- and full-thickness burn injuries in pediatric populations. Split-thickness grafts may be required in functional areas. Therefore, a comprehensive management strategy that considers tissue damage, electrolyte balance, and infection is crucial. This report underscores the importance of meticulous assessment and correction of overall patient condition, especially in pediatric cases of electrolyte imbalance.
Collapse
|
2
|
Larson BM, Elkady D, Sharma S, Beaucock B, Lou RB, Khandelwal A. Comparative results of autologous skin cell suspension combined with a contact layer dressing versus autologous skin cell suspension and a poly-lactic acid dressing in larger total body surface burns. Burns 2024; 50:1832-1839. [PMID: 38704317 DOI: 10.1016/j.burns.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/22/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Contact layer dressing (CLD) is standard after autologous skin cell suspension (ASCS); however, the authors wondered whether a poly-lactic acid dressing (PLAD) results in superior outcomes and cost savings. MATERIAL AND METHODS Retrospective cohort study including greater than 10% total body surface area (TBSA) burns treated with ASCS and either PLAD or CLD. Primary outcomes were infection and length of stay (LOS). RESULTS 71 patients (76% male, 24% pediatric, mean age 37 years) were included. Twenty-eight patients (39%) received CLD and 43 (61%) received PLAD. Wound infections were decreased in PLAD (7 vs 32%, p = 0.009). When controlling for area grafted (cm2) and TBSA, logistic regression revealed odds of post-operative infection was 8.1 times higher in CLD (p = 0.015). PLAD required antibiotics for fewer days (mean 0.47 vs 4.39, p = 0.0074) and shorter LOS (mean 17 vs 29 days, p < 0.001). Mean adjusted charges per %TBSA was $18,459 in PLAD vs. $25,397 in CLD (p = 0.0621). CONCLUSION In the first analysis of its kind, this study showed polylactic acid dressing combined with autologous skin cell suspension led to a decrease in postoperative infections, length of hospital stay, and total patient charges.
Collapse
Affiliation(s)
| | - Djoni Elkady
- Loyola University Medical Center, Chicago, IL, United States
| | - Steffi Sharma
- Adult and Pediatric Burn Institute, Akron Children's Hospital, Akron, OH, United States
| | - Beverly Beaucock
- Adult and Pediatric Burn Institute, Akron Children's Hospital, Akron, OH, United States
| | - Richard B Lou
- Adult and Pediatric Burn Institute, Akron Children's Hospital, Akron, OH, United States
| | - Anjay Khandelwal
- Adult and Pediatric Burn Institute, Akron Children's Hospital, Akron, OH, United States.
| |
Collapse
|
3
|
Rehan M, Iqbal T, Tariq MH, Khan MS, Tul Ain Q, Sarwar MU, Waheed U. BACTERIAL NANOCELLULOSE DRESSING COMPARED WITH HYDROCOLLOID DRESSING FOR THE TREATMENT OF PARTIAL-THICKNESS SECOND-DEGREE BURNS: A PROSPECTIVE, RANDOMIZED CONTROL TRIAL. ANNALS OF BURNS AND FIRE DISASTERS 2024; 37:226-232. [PMID: 39350893 PMCID: PMC11372272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/14/2023] [Indexed: 10/04/2024]
Abstract
The management of burn wounds is a major challenge throughout the globe. Superficial and partial-thickness burns generally do not need any surgical intervention, however, severe cases of burn injury require dressings (antimicrobial) and surgery in the worst-case scenario. The present study was conducted to assess the efficacy of bacterial nanocellulose dressing versus hydrocolloid dressing. All patients presenting with partial-thickness second-degree burns from June 2021 to May 2022 were screened for this randomized control trial; 65 burn patients were included in each group of this trial. The control group of patients was treated with hydrocolloid dressing and the experimental group with bacterial nanocellulose dressing sheets. Every third day, the wound was assessed. Other data collected included age, sex, %TBSA burned, signs of infection, time for epithelialization, and length of hospital stay. Statistical analyses were performed to see the significance of differences between the treatment groups by adjusting for size and depth of burn, and the patient's age. There were 130 patients (65 in each group). The median age for the whole group was 17.4 years, and 51.53% (n=67) were males. The average TBSA was 22.4%, with a minimum of 10% and a maximum of 31%. Eleven of the patients had their burns excised, and four were given skin grafts in the control group. In the case of the experimental group, four excisions were performed, and one skin graft. Wound-related pain scores were low (mean of 2.6) for the bacterial nanocellulose group and higher for the hydrocolloid group. Hydrocolloid dressing is more cost effective than bacterial nanocellulose dressing. However, the pain scores were high, and healing time was less in the bacterial nanocellulose group. Moreover, the hydrocolloid group is more prone to infection due to frequent dressing changes.
Collapse
Affiliation(s)
- M Rehan
- Department of Burn and Reconstructive Surgery, National Burn Care Centre, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - T Iqbal
- Department of Burn and Reconstructive Surgery, National Burn Care Centre, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - M H Tariq
- Department of Burn and Reconstructive Surgery, National Burn Care Centre, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - M S Khan
- Department of Burn and Reconstructive Surgery, National Burn Care Centre, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - Q Tul Ain
- Department of Burn and Reconstructive Surgery, National Burn Care Centre, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - M U Sarwar
- Department of Burn and Reconstructive Surgery, National Burn Care Centre, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - U Waheed
- Department of Burn and Reconstructive Surgery, National Burn Care Centre, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| |
Collapse
|
4
|
Schiefer JL, Aretz FG, Fuchs PC, Lefering R, Yary P, Opländer C, Schulz A, Daniels M. Comparison of Long-Term Skin Quality and Scar Formation in Partial-Thickness Burn Wounds Treated with Suprathel ® and epicite hydro® Wound Dressings. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1550. [PMID: 36363504 PMCID: PMC9698741 DOI: 10.3390/medicina58111550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/12/2022] [Accepted: 10/26/2022] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Scar formation after burn trauma has a significant impact on the quality of life of burn patients. Hypertrophic scars or keloids can be very distressing to patients due to potential pain, functional limitations, or hyper- or hypopigmentation. In a previous study comparing Suprathel® and the new and cheaper dressing epicitehydro®, we were able to show that pain reduction, exudation, and time until wound-healing of partial-thickness burn wounds were similar, without any documented infections. No study exists that objectively measures and compares skin and scar quality after treatment with Suprathel® and epicitehydro® at present. Materials and Methods: In this study, the scar quality of 20 patients who had been treated with Suprathel® and epicitehydro® was objectively assessed using the Cutometer®, Mexameter®, and Tewameter®, as well as subjectively with the Patient and Observer Scar Assessment Scale, 3, 6, and 12 months after burn injury. Results: In all performed measurements, no significant differences were detected in scar formation after treatment of partial-thickness burn wounds with the two dressings. Conclusions: Both the newer and less expensive wound-dressing epicitehydro® and the well-known wound-dressing Suprathel® resulted in stable wound closure and showed good cosmetic results in the follow-up examinations.
Collapse
Affiliation(s)
- Jennifer Lynn Schiefer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, 58455 Witten, Germany
| | - Friederike Genoveva Aretz
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, 58455 Witten, Germany
| | - Paul Christian Fuchs
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, 58455 Witten, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, Witten/Herdecke University, 51109 Cologne, Germany
| | - Pouyan Yary
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, 58455 Witten, Germany
| | - Christian Opländer
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, Witten/Herdecke University, 51109 Cologne, Germany
| | - Alexandra Schulz
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, 58455 Witten, Germany
| | - Marc Daniels
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, 58455 Witten, Germany
| |
Collapse
|
5
|
Palackic A, Duggan RP, Campbell MS, Walters E, Branski LK, Ayadi AE, Wolf SE. The Role of Skin Substitutes in Acute Burn and Reconstructive Burn Surgery: An Updated Comprehensive Review. Semin Plast Surg 2022; 36:33-42. [PMID: 35706557 PMCID: PMC9192152 DOI: 10.1055/s-0042-1743455] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractBurns disrupt the protective skin barrier with consequent loss of cutaneous temperature regulation, infection prevention, evaporative losses, and other vital functions. Chronically, burns lead to scarring, contractures, pain, and impaired psychosocial well-being. Several skin substitutes are available and replace the skin and partially restore functional outcomes and improve cosmesis. We performed a literature review to update readers on biologic and synthetic skin substitutes to date applied in acute and reconstructive burn surgery. Improvement has been rapid in the development of skin substitutes in the last decade; however, no available skin substitute fulfills criteria as a perfect replacement for damaged skin.
Collapse
Affiliation(s)
- Alen Palackic
- Department of Surgery, Division of Burn and Trauma Surgery, University of Texas Medical Branch, Galveston, Texas
- Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Robert P. Duggan
- Department of Surgery, Division of Burn and Trauma Surgery, University of Texas Medical Branch, Galveston, Texas
| | | | - Elliot Walters
- Department of Surgery, Division of Burn and Trauma Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Ludwik K. Branski
- Department of Surgery, Division of Burn and Trauma Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Amina El Ayadi
- Department of Surgery, Division of Burn and Trauma Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Steven E. Wolf
- Department of Surgery, Division of Burn and Trauma Surgery, University of Texas Medical Branch, Galveston, Texas
| |
Collapse
|
6
|
Navarro E, Mazirka P, Thigpin T, Carson J. The use of Lactic-Acid-Based Copolymer (LABC) as a dressing on split thickness skin grafts in partial and full thickness burn. BURNS OPEN 2022. [DOI: 10.1016/j.burnso.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
7
|
Nischwitz SP, Popp D, Shubitidze D, Luze H, Zrim R, Klemm K, Rapp M, Haller HL, Feisst M, Kamolz LP. The successful use of polylactide wound dressings for chronic lower leg wounds: A retrospective analysis. Int Wound J 2021; 19:1180-1187. [PMID: 34750983 PMCID: PMC9284639 DOI: 10.1111/iwj.13713] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/12/2021] [Accepted: 10/20/2021] [Indexed: 12/28/2022] Open
Abstract
Chronic wounds are a challenging medical entity for patients, medical professionals and healthcare systems. Frequently, patients present themselves to wound specialists after months or even years of unsuccessful treatment. Recent developments have resulted in a multitude of different advanced wound dressings created to treat complex, chronic wounds, one of which is the polylactide dressing Suprathel. This study aimed at investigating the healing potential of Suprathel in chronic wounds and differentiating between old and “young”, diabetic and non‐diabetic chronic wounds. A prospective, multicentric, non‐controlled intervention study was conducted, treating patients with chronic lower leg ulcers (>3 months) with Suprathel and assessing them weekly. Afterwards, a retrospective analysis was performed analysing the wound size initially, after 4 and after 8 weeks of treatment. Furthermore, a differentiation between diabetic and non‐diabetic, and chronic wounds older and younger than 12 months, was assessed. A significant reduction in wound size was observed in the study population after 8 weeks of treatment. The effect size in the diabetic wound and the old chronic wound group even reached more than one, with the other groups still showing a large effect of the intervention. This study shows that Suprathel is a valuable tool in the armamentarium of a wound specialist. Not only could we show a positive effect on chronic wounds, we could even demonstrate a significant wound size reduction in chronic wounds of old and young, as well as diabetic wounds, with the treatment of older chronic and diabetic wounds yielding an even larger effect size. Further randomised, controlled studies are necessary to show the full potential of advanced wound dressing materials in large patient cohorts.
Collapse
Affiliation(s)
- Sebastian P Nischwitz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,COREMED - Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
| | - Daniel Popp
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - David Shubitidze
- Clinic for Vascular and Endovascular Surgery, AMEOS Klinikum St. Clemens, Oberhausen, Germany
| | - Hanna Luze
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,COREMED - Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
| | - Robert Zrim
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,International University of Monaco, Monaco
| | - Klaus Klemm
- Clinic for Vascular Surgery, Vascular and Endovascular Surgery, Marienhospital Stuttgart, Vinzenz von Paul Kliniken, Stuttgart, Germany
| | - Matthias Rapp
- Clinic for Orthopedics, Trauma Surgery and Sports Traumatology - Burn Center, Marienhospital Stuttgart, Stuttgart, Germany
| | | | - Manuel Feisst
- Institute of Medical Biometry, University Heidelberg, Heidelberg, Germany
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,COREMED - Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
| |
Collapse
|
8
|
Resch A, Staud C, Radtke C. Nanocellulose-based wound dressing for conservative wound management in children with second-degree burns. Int Wound J 2021; 18:478-486. [PMID: 33465280 PMCID: PMC8273580 DOI: 10.1111/iwj.13548] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/19/2020] [Accepted: 12/31/2020] [Indexed: 01/08/2023] Open
Abstract
The initial care of burn wounds and choice of dressing are pivotal to optimally support the healing process. To ensure fast re-epithelialisation within 10-14 days and prevent complications, an optimal healing environment is essential. An innovative dressing based on nanocellulose was used for the treatment of burns in children. Children (0-16 years) with clean, partial-thickness burn wounds, 1 to 10% of the total body surface area were included. Complete re-epithelialisation was achieved within 7-17 days, with 13 patients showing re-epithelialised >95% by day 10. Satisfying results concerning time to re-epithelialisation and material handling were obtained. The possibility to leave the dressing on the wounds for 7 days showed a positive effect in the treatment of children, for whom every hospital visit may cause massive stress reactions. The nanocellulose-based dressing is a promising tool in conservative treatment of burns. Reducing the frequency of dressing changes supports a fast and undisturbed recovery; moreover, the dressing provides an optimal moist healing environment. The time to re-epithelialisation is comparable to frequently used materials, and cost reduction effect can be achieved without loss of quality. Possible pain and distress levels are kept to a minimum; therefore, flexibility and compliance of the patients and their parents are enhanced.
Collapse
Affiliation(s)
- Annika Resch
- Division of Plastic and Reconstructive Surgery, Department of SurgeryMedical University of ViennaViennaAustria
| | - Clement Staud
- Division of Plastic and Reconstructive Surgery, Department of SurgeryMedical University of ViennaViennaAustria
| | - Christine Radtke
- Division of Plastic and Reconstructive Surgery, Department of SurgeryMedical University of ViennaViennaAustria
| |
Collapse
|
9
|
Haller HL, Blome-Eberwein SE, Branski LK, Carson JS, Crombie RE, Hickerson WL, Kamolz LP, King BT, Nischwitz SP, Popp D, Shupp JW, Wolf SE. Porcine Xenograft and Epidermal Fully Synthetic Skin Substitutes in the Treatment of Partial-Thickness Burns: A Literature Review. ACTA ACUST UNITED AC 2021; 57:medicina57050432. [PMID: 33946298 PMCID: PMC8146423 DOI: 10.3390/medicina57050432] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 12/24/2022]
Abstract
Background and Objectives: Porcine xenografts have been used successfully in partial thickness burn treatment for many years. Their disappearance from the market led to the search for effective and efficient alternatives. In this article, we examine the synthetic epidermal skin substitute Suprathel® as a substitute in the treatment of partial thickness burns. Materials and Methods: A systematic review following the PRISMA guidelines has been performed. Sixteen Suprathel® and 12 porcine xenograft studies could be included. Advantages and disadvantages between the treatments and the studies’ primary endpoints have been investigated qualitatively and quantitatively. Results: Although Suprathel had a nearly six times larger TBSA in their studies (p < 0.001), it showed a significantly lower necessity for skin grafts (p < 0.001), and we found a significantly lower infection rate (p < 0.001) than in Porcine Xenografts. Nonetheless, no significant differences in the healing time (p = 0.67) and the number of dressing changes until complete wound healing (p = 0.139) could be found. Both products reduced pain to various degrees with the impression of a better performance of Suprathel® on a qualitative level. Porcine xenograft was not recommended for donor sites or coverage of sheet-transplanted keratinocytes, while Suprathel® was used successfully in both indications. Conclusion: The investigated parameters indicate that Suprathel® to be an effective replacement for porcine xenografts with even lower subsequent treatment rates. Suprathel® appears to be usable in an extended range of indications compared to porcine xenograft. Data heterogeneity limited conclusions from the results.
Collapse
Affiliation(s)
| | - Sigrid E. Blome-Eberwein
- Lehigh Valley Health Network 1200 S. Cedar Crest Blvd. Kasych 3000, Allentown, PA 18103, USA; (S.E.B.-E.); (S.E.W.)
| | - Ludwik K. Branski
- Department of Surgery—Burn Surgery, The University of Texas Medical Branch and Shriners Hospitals for Children, 301 University BLVD, Galveston, TX 77555, USA;
| | - Joshua S. Carson
- Department of Surgery, UF Health Shands Burn Center, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610, USA;
| | - Roselle E. Crombie
- Connecticut Burn Center, Yale New Haven Heal System, 267 Grant St, Bridgeport, CT 06610, USA;
| | - William L. Hickerson
- Memphis Medical Center Burn Center, 890 Madison Avenue, Suite TG032, Memphis, TN 38103, USA;
| | - Lars Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University, 8053 Graz, Austria; (L.P.K.); (S.P.N.); (D.P.)
| | - Booker T. King
- Division of Burn Surgery, Department of Surgery, 101 Manning Drive CB #7206, Chapel Hill, NC 27599, USA;
| | - Sebastian P. Nischwitz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University, 8053 Graz, Austria; (L.P.K.); (S.P.N.); (D.P.)
| | - Daniel Popp
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University, 8053 Graz, Austria; (L.P.K.); (S.P.N.); (D.P.)
| | - Jeffrey W. Shupp
- The Burn Center, Department of Surgery, MedStar Washington Hospital Center, 110 Irving St NW, Washington, DC 20010, USA;
| | - Steven E. Wolf
- Lehigh Valley Health Network 1200 S. Cedar Crest Blvd. Kasych 3000, Allentown, PA 18103, USA; (S.E.B.-E.); (S.E.W.)
| |
Collapse
|
10
|
Made in Germany: A Quality Indicator Not Only in the Automobile Industry But Also When It Comes to Skin Replacement: How an Automobile Textile Research Institute Developed a New Skin Substitute. ACTA ACUST UNITED AC 2021; 57:medicina57020143. [PMID: 33562479 PMCID: PMC7914466 DOI: 10.3390/medicina57020143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 11/17/2022]
Abstract
Successful research and development cooperation between a textile research institute, the German Federal Ministry of Education and Research via the Center for Biomaterials and Organ Substitutes, the University of Tübingen, and the Burn Center of Marienhospital, Stuttgart, Germany, led to the development of a fully synthetic resorbable temporary epidermal skin substitute for the treatment of burns, burn-like syndromes, donor areas, and chronic wounds. This article describes the demands of the product and the steps that were taken to meet these requirements. The material choice was based on the degradation and full resorption of polylactides to lactic acid and its salts. The structure and morphology of the physical, biological, and degradation properties were selected to increase the angiogenetic abilities, fibroblasts, and extracellular matrix generation. Water vapor permeability and plasticity were adapted for clinical use. The available scientific literature was screened for the use of this product. A clinical application demonstrated pain relief paired with a reduced workload, fast wound healing with a low infection rate, and good cosmetic results. A better understanding of the product's degradation process explained the reduction in systemic oxidative stress shown in clinical investigations compared to other dressings, positively affecting wound healing time and reducing the total area requiring skin grafts. Today, the product is in clinical use in 37 countries. This article describes its development, the indications for product growth over time, and the scientific foundation of treatments.
Collapse
|
11
|
Bohr S, Mammadli T. Perineal Diagnostic Microbial Swabs As A Predictive Parameter In Pediatric Burn Injury. ANNALS OF BURNS AND FIRE DISASTERS 2020; 33:224-232. [PMID: 33304213 PMCID: PMC7680194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/06/2020] [Indexed: 06/12/2023]
Abstract
The aim is to evaluate the predictive usefulness of perineal diagnostic microbial swabs (PDMS) which will identify an enteric reservoir as possible source of concomitant wound infection following scald burn injury in infants. Perineal swabs were taken on admission of infants presenting with scald burn injury along with a standardized protocol of initial sterile surgical field cleansing and dressing. Complicated (CC) and uncomplicated (UC) clinical cases were discriminated based on parameters of significant microbial burn wound colonization, such as onset of fever, white blood cell count (WCC), C-reactive protein (CRP) and a concomitant need for surgical wound revision with/without guided antibiotic therapy. Relative risks (RR) / odds ratios (OR) based on microbial swab results were calculated related to anticipated wound infection. We found PDMS to be an independent predictive parameter for clinically relevant microbial wound colonization in pediatric patients (n=274; age 2.81±2.69). Most importantly, we show that in patients with initial total burn surface area (TBSA) >5%, clinically relevant burn wound infection requiring intervention can be predicted from initial perineal swab results with ORs ~10fold. Infants presenting with scald burn injury are exposed to a relevant risk of wound infection emanating from a unique microbial enteric reservoir, even with initial surgical decontamination and sterile dressing protocols, warranting further hospitalization. Based on our findings we suggest PDMS as a useful additional predictive parameter to (i) characterize the relevant enteric microbial reservoir and (ii) direct further therapeutic measures with the aim of preventing complicated wound infections, including preemptive aseptic wound dressings, guided antibiotic therapy and surgical wound revision.
Collapse
Affiliation(s)
- S. Bohr
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, EKM Clinics, Germany
- Department of Plastic and Hand Surgery - Burn Centre, University Clinics RWTH Aachen, Germany
- Centre for Engineering in Medicine/Surgical Services, Massachusetts General Hospital, Harvard Medical School, and Shriners Hospitals for Children, Boston, USA
| | - T. Mammadli
- Department of Plastic, Reconstructive and Aesthetic Surgery, Darmstadt-Dieburg Clinics, Germany
- Department of Plastic and Hand Surgery - Burn Centre, University Clinics RWTH Aachen, Germany
| |
Collapse
|
12
|
Dissette V, Cassino R, Bondarenko L, Motronenko V. Powder Fixed Combination With Antiseptic and Barrier Properties for Wound Management: Safety and Efficacy Aspects. INNOVATIVE BIOSYSTEMS AND BIOENGINEERING 2020. [DOI: 10.20535/ibb.2020.4.3.211699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
|
13
|
Hoogewerf CJ, Hop MJ, Nieuwenhuis MK, Oen IM, Middelkoop E, Van Baar ME. Topical treatment for facial burns. Cochrane Database Syst Rev 2020; 7:CD008058. [PMID: 32725896 PMCID: PMC7390507 DOI: 10.1002/14651858.cd008058.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Burn injuries are an important health problem. They occur frequently in the head and neck region. The face is the area central to a person's identity that provides our most expressive means of communication. Topical interventions are currently the cornerstone of treatment of burns to the face. OBJECTIVES To assess the effects of topical interventions on wound healing in people with facial burns of any depth. SEARCH METHODS In December 2019 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA Randomised controlled trials (RCTs) that evaluated the effects of topical treatment for facial burns were eligible for inclusion in this review. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, data extraction, risk of bias assessment and GRADE assessment of the certainty of the evidence. MAIN RESULTS In this first update, we included 12 RCTs, comprising 507 participants. Most trials included adults admitted to specialised burn centres after recent burn injuries. Topical agents included antimicrobial agents (silver sulphadiazine (SSD), Aquacel-Ag, cerium-sulphadiazine, gentamicin cream, mafenide acetate cream, bacitracin), non-antimicrobial agents (Moist Exposed Burn Ointment (MEBO), saline-soaked dressings, skin substitutes (including bioengineered skin substitute (TransCyte), allograft, and xenograft (porcine Xenoderm), and miscellaneous treatments (growth hormone therapy, recombinant human granulocyte-macrophage colony-stimulating factor hydrogel (rhGMCS)), enzymatic debridement, and cream with Helix Aspersa extract). Almost all the evidence included in this review was assessed as low or very low-certainty, often because of high risk of bias due to unclear randomisation procedures (i.e. sequence generation and allocation concealment); lack of blinding of participants, providers and sometimes outcome assessors; and imprecision resulting from few participants, low event rates or both, often in single studies. Topical antimicrobial agents versus topical non-antimicrobial agents There is moderate-certainty evidence that there is probably little or no difference between antimicrobial agents and non-antimicrobial agents (SSD and MEBO) in time to complete wound healing (hazard ratio (HR) 0.84 (95% confidence interval (CI) 0.78 to 1.85, 1 study, 39 participants). Topical antimicrobial agents may make little or no difference to the proportion of wounds completely healed compared with topical non-antimicrobial agents (comparison SSD and MEBO, risk ratio (RR) 0.94, 95% CI 0.68 to 1.29; 1 study, 39 participants; low-certainty evidence). We are uncertain whether there is a difference in wound infection (comparison topical antimicrobial agent (Aquacel-Ag) and MEBO; RR 0.38, 95% CI 0.12 to 1.21; 1 study, 40 participants; very low-certainty evidence). No trials reported change in wound surface area over time or partial wound healing. There is low-certainty evidence for the secondary outcomes scar quality and patient satisfaction. Two studies assessed pain but it was incompletely reported. Topical antimicrobial agents versus other topical antimicrobial agents It is uncertain whether topical antimicrobial agents make any difference in effects as the evidence is low to very low-certainty. For primary outcomes, there is low-certainty evidence for time to partial (i.e. greater than 90%) wound healing (comparison SSD versus cerium SSD: mean difference (MD) -7.10 days, 95% CI -16.43 to 2.23; 1 study, 142 participants). There is very low-certainty evidence regarding whether topical antimicrobial agents make a difference to wound infection (RR 0.73, 95% CI 0.46 to 1.17; 1 study, 15 participants). There is low to very low-certainty evidence for the proportion of facial burns requiring surgery, pain, scar quality, adverse effects and length of hospital stay. Skin substitutes versus topical antimicrobial agents There is low-certainty evidence that a skin substitute may slightly reduce time to partial (i.e. greater than 90%) wound healing, compared with a non-specified antibacterial agent (MD -6.00 days, 95% CI -8.69 to -3.31; 1 study, 34 participants). We are uncertain whether skin substitutes in general make any other difference in effects as the evidence is very low certainty. Outcomes included wound infection, pain, scar quality, adverse effects of treatment and length of hospital stay. Single studies showed contrasting low-certainty evidence. A bioengineered skin substitute may slightly reduce procedural pain (MD -4.00, 95% CI -5.05 to -2.95; 34 participants) and background pain (MD -2.00, 95% CI -3.05 to -0.95; 34 participants) compared with an unspecified antimicrobial agent. In contrast, a biological dressing (porcine Xenoderm) might slightly increase pain in superficial burns (MD 1.20, 95% CI 0.65 to 1.75; 15 participants (30 wounds)) as well as deep partial thickness burns (MD 3.00, 95% CI 2.34 to 3.66; 10 participants (20 wounds)), compared with antimicrobial agents (Physiotulle Ag (Coloplast)). Miscellaneous treatments versus miscellaneous treatments Single studies show low to very low-certainty effects of interventions. Low-certainty evidence shows that MEBO may slightly reduce time to complete wound healing compared with saline soaked dressing (MD -1.7 days, 95% CI -3.32 to -0.08; 40 participants). In addition, a cream containing Helix Aspersa may slightly increase the proportion of wounds completely healed at 14 days compared with MEBO (RR 4.77, 95% CI 1.87 to 12.15; 43 participants). We are uncertain whether any miscellaneous treatment in the included studies makes a difference in effects for the outcomes wound infection, scar quality, pain and patient satisfaction as the evidence is low to very low-certainty. AUTHORS' CONCLUSIONS There is mainly low to very low-certainty evidence on the effects of any topical intervention on wound healing in people with facial burns. The number of RCTs in burn care is growing, but the body of evidence is still hampered due to an insufficient number of studies that follow appropriate evidence-based standards of conducting and reporting RCTs.
Collapse
Affiliation(s)
| | - M Jenda Hop
- Burn Centre, Maasstad Hospital, Association of Dutch Burn Centres, Rotterdam, Netherlands
| | - Marianne K Nieuwenhuis
- Burn Centre, Martini Hospital, Association of Dutch Burn Centres, Groningen, Netherlands
| | - Irma Mmh Oen
- Burn Centre, Maasstad Hospital, Association of Dutch Burn Centres, Rotterdam, Netherlands
| | - Esther Middelkoop
- Plastic Reconstructive and Hand Surgery, Amsterdam Movement Sciences and Association of Dutch Burn Centers, Red Cross Hospital, Amsterdam, Netherlands
| | - Margriet E Van Baar
- Burn Centre, Maasstad Hospital, Association of Dutch Burn Centres, Rotterdam, Netherlands
| |
Collapse
|
14
|
Koivuniemi R, Hakkarainen T, Kiiskinen J, Kosonen M, Vuola J, Valtonen J, Luukko K, Kavola H, Yliperttula M. Clinical Study of Nanofibrillar Cellulose Hydrogel Dressing for Skin Graft Donor Site Treatment. Adv Wound Care (New Rochelle) 2020; 9:199-210. [PMID: 32117583 PMCID: PMC7047117 DOI: 10.1089/wound.2019.0982] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 04/29/2019] [Indexed: 11/23/2022] Open
Abstract
Objective: Skin graft donor site management is a concern particularly for elderly patients and patients with poor wound healing competence, and also because donor sites are a source of pain and discomfort. Although different types of dressings exist, there is no consensus regarding optimal dressing type on donor site care to promote healing, reduce pain, and improve patients' comfort. Approach: This prospective, single-center clinical trial evaluated the performance of nanofibrillar cellulose (NFC) wound dressing (FibDex® by UPM-Kymmene Corporation) for treatment of donor sites compared with a polylactide-based copolymer dressing. The study enrolled 24 patients requiring skin grafting with mean age of 49 ± 18. The primary outcome measure was wound healing time. Secondary outcomes, the epithelialization, subjective pain, the scar appearance assessed using the Patient and Observer Scar Assessment Scale (POSAS), and skin elasticity and transepidermal water loss (TEWL), were evaluated at 1 and 6 months postoperatively. Results: No statistically significant differences were observed between NFC and copolymer dressings regarding wound healing time, epithelialization, experience of pain, or TEWL. Significant differences were observed in the POSAS results for thickness and vascularity in the Observer score, in the favor of NFC over copolymer dressing. Moreover, skin elasticity was significantly improved with NFC dressing in terms of viscoelasticity and elastic modulus at 1 month postoperatively. Innovation: NFC dressing is a new, green sustainable product for wound treatment without animal or human-origin components. Conclusion: NFC dressing provides efficient wound healing at skin graft donor sites and is comparable or even preferable compared with the copolymer dressing.
Collapse
Affiliation(s)
- Raili Koivuniemi
- Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Tiina Hakkarainen
- Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- Department of Plastic Surgery, Helsinki Burn Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jasmi Kiiskinen
- Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | | | - Jyrki Vuola
- Department of Plastic Surgery, Helsinki Burn Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jussi Valtonen
- Department of Plastic Surgery, Helsinki Burn Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Heli Kavola
- Department of Plastic Surgery, Helsinki Burn Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marjo Yliperttula
- Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| |
Collapse
|
15
|
Ziegler T, Cakl T, Schauer J, Pögl D, Abdelkarim A, Kempny T. Treatment of Second to Third-Degree Burns in A 2-Day-Old Infant: A Case Report. World J Plast Surg 2020; 9:82-87. [PMID: 32190597 PMCID: PMC7068179 DOI: 10.29252/wjps.9.1.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Burn injuries in newborns are particularly complex cases. Since these patients are rare, there is little experience and no existing standardized treatment. This report examines a case of accidental second to third-degree burning of the heel and toes on the left foot in a new-born girl. The burns covered an estimated 1% of the total body surface area (TBSA). After an initial debridement and 32 days of non-surgical wound therapy with Adaptic® fat gauze dressings, we were able to achieve an aesthetically and functionally satisfactory result including the complete preservation of all toes. Modern wound treatment following the principle of less frequent dressing changes allows the burn wound to have better re-epithelialization. New findings in stem cell research indicate that the high proportion of mesenchymal stem cells (MSC) in postnatal blood is also involved in the regeneration and healing of burns. To our knowledge, this is the first case report dealing with initial non-surgical combustion therapy in a newborn. In order to eliminate a scar contracture, we carried out a Z-plasty one year later.
Collapse
Affiliation(s)
- Thomas Ziegler
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Klinikum Wels-Grieskirchen, Austria
| | - Thomas Cakl
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Klinikum Wels-Grieskirchen, Austria
| | - Johannes Schauer
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Klinikum Wels-Grieskirchen, Austria
| | - Dieter Pögl
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Klinikum Wels-Grieskirchen, Austria
| | - Ahmad Abdelkarim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Klinikum Wels-Grieskirchen, Austria
| | - Tomas Kempny
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Klinikum Wels-Grieskirchen, Austria
| |
Collapse
|
16
|
Ziegler T, Cakl T, Schauer J, Pögl D, Kempny T. Treatment of second to third-degree burns in a 2-day-old infant: A case report. Int J Surg Case Rep 2019; 61:195-198. [PMID: 31377542 PMCID: PMC6698275 DOI: 10.1016/j.ijscr.2019.07.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/10/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Burn injuries in newborns are particularly complex cases. Since these patients are rare, there is little experience and no existing standardized treatment. PRESENTATION OF CASE This report examines a case of accidental second to third-degree burning of the heel and toes on the left foot in a new-born girl. The burns covered an estimated 1% of the total body surface area (TBSA). After an initial debridement and 32 days of non-surgical wound therapy with Adaptic® fat gauze dressings, we were able to achieve an aesthetically and functionally satisfactory result including the complete preservation of all toes. In order to eliminate a scar contracture, we carried out a Z-plasty one year later. DISCUSSION Modern wound treatment following the principle of less frequent dressing changes allows the burn wound to have better re-epithelialization. New findings in stem cell research indicate that the high proportion of mesenchymal stem cells (MSC) in postnatal blood is also involved in the regeneration and healing of burns. To our knowledge, this is the first case report dealing with initial non-surgical combustion therapy in a newborn. CONCLUSION There is evidence that newborns have a much higher potential for wound healing than adults. Proper position in long-term immobilization of toes is important to prevent scar contracture and deformity.
Collapse
Affiliation(s)
- Thomas Ziegler
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Klinikum Wels-Grieskirchen, Austria.
| | - Thomas Cakl
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Klinikum Wels-Grieskirchen, Austria
| | - Johannes Schauer
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Klinikum Wels-Grieskirchen, Austria
| | - Dieter Pögl
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Klinikum Wels-Grieskirchen, Austria
| | - Tomas Kempny
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Klinikum Wels-Grieskirchen, Austria
| |
Collapse
|
17
|
Piaggesi A, Låuchli S, Bassetto F, Biedermann T, Marques A, Najafi B, Palla I, Scarpa C, Seimetz D, Triulzi I, Turchetti G, Vaggelas A. Advanced therapies in wound management: cell and tissue based therapies, physical and bio-physical therapies smart and IT based technologies. J Wound Care 2018; 27:S1-S137. [DOI: 10.12968/jowc.2018.27.sup6a.s1] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Alberto Piaggesi
- Prof, Director, EWMA Scientific Recorder (Editor), Diabetic Foot Section of the Pisa University Hospital, Department of Endocrinology and Metabolism, University of Pisa, Lungarno Pacinotti 43, 56126 Pisa, Italy
| | - Severin Låuchli
- Chief of Dermatosurgery and Woundcare, EWMA Immediate Past President (Co-editor), Department of Dermatology, University Hospital, Zurich, Råmistrasse 100, 8091 Zärich, Schwitzerland
| | - Franco Bassetto
- Prof, Head of Department, Clinic of Plastic and Reconstructive Surgery, University of Padova, Via Giustiniani, 35100 Padova
| | - Thomas Biedermann
- Tissue Biology Research Unit, Department of Surgery, University Children's Hospital Zurich, August Forel-Strasse 7, 8008 Zürich, Switzerland
| | - Alexandra Marques
- University of Minho, 3B's Research Group in Biomaterials, Biodegradables and Biomimetics, Avepark - Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco GMR, Portugal
| | - Bijan Najafi
- Professor of Surgery, Director of Clinical Research, Division of Vascular Surgery and Endovascular Therapy, Director of Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS: BCM390, Houston, TX 77030-3411, US
| | - Ilaria Palla
- Institute of Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Carlotta Scarpa
- Clinic of Plastic and Reconstructive Surgery, University of Padova, Via Giustiniani, 35100 Padova
| | - Diane Seimetz
- Founding Partner, Biopharma Excellence, c/o Munich Technology Center, Agnes-Pockels-Bogen 1, 80992 Munich, Germany
| | - Isotta Triulzi
- Institute of Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Giuseppe Turchetti
- Fulbright Scholar, Institute of Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Annegret Vaggelas
- Consultant, Biopharma Excellence, c/o Munich Technology Center, Agnes-Pockels-Bogen 1, 80992 Munich, Germany
| |
Collapse
|