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Berry CE, Abbas DB, Griffin M, Lintel H, Guo J, Kameni L, Churukian AA, Fazilat AZ, Chen K, Gurtner GC, Longaker MT, Momeni A, Wan DC. Deferoxamine topical cream superior to patch in rescuing radiation-induced fibrosis of unwounded and wounded skin. J Cell Mol Med 2024; 28:e18306. [PMID: 38613357 PMCID: PMC11015393 DOI: 10.1111/jcmm.18306] [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: 02/10/2024] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Topical patch delivery of deferoxamine (DFO) has been studied as a treatment for this fibrotic transformation in irradiated tissue. Efficacy of a novel cream formulation of DFO was studied as a RIF therapeutic in unwounded and excisionally wounded irradiated skin. C57BL/6J mice underwent 30 Gy of radiation to the dorsum followed by 4 weeks of recovery. In a first experiment, mice were separated into six conditions: DFO 50 mg cream (D50), DFO 100 mg cream (D100), soluble DFO injections (DI), DFO 1 mg patch (DP), control cream (Vehicle), and irradiated untreated skin (IR). In a second experiment, excisional wounds were created on the irradiated dorsum of mice and then divided into four treatment groups: DFO 100 mg Cream (W-D100), DFO 1 mg patch (W-DP), control cream (W-Vehicle), and irradiated untreated wounds (W-IR). Laser Doppler perfusion scans, biomechanical testing, and histological analysis were performed. In irradiated skin, D100 improved perfusion compared to D50 or DP. Both D100 and DP enhanced dermal characteristics, including thickness, collagen density and 8-isoprostane staining compared to untreated irradiated skin. D100 outperformed DP in CD31 staining, indicating higher vascular density. Extracellular matrix features of D100 and DP resembled normal skin more closely than DI or control. In radiated excisional wounds, D100 facilitated faster wound healing and increased perfusion compared to DP. The 100 mg DFO cream formulation rescued RIF of unwounded irradiated skin and improved excisional wound healing in murine skin relative to patch delivery of DFO.
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Affiliation(s)
- Charlotte E. Berry
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of SurgeryStanford University School of MedicineStanfordCaliforniaUSA
| | - Darren B. Abbas
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of SurgeryStanford University School of MedicineStanfordCaliforniaUSA
| | - Michelle Griffin
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of SurgeryStanford University School of MedicineStanfordCaliforniaUSA
| | - Hendrik Lintel
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of SurgeryStanford University School of MedicineStanfordCaliforniaUSA
| | - Jason Guo
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of SurgeryStanford University School of MedicineStanfordCaliforniaUSA
| | - Lionel Kameni
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of SurgeryStanford University School of MedicineStanfordCaliforniaUSA
| | - Andrew A. Churukian
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of SurgeryStanford University School of MedicineStanfordCaliforniaUSA
| | - Alexander Z. Fazilat
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of SurgeryStanford University School of MedicineStanfordCaliforniaUSA
| | - Kellen Chen
- Department of SurgeryThe University of Arizona College of MedicineTucsonArizonaUSA
| | - Geoffrey C. Gurtner
- Department of SurgeryThe University of Arizona College of MedicineTucsonArizonaUSA
| | - Michael T. Longaker
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of SurgeryStanford University School of MedicineStanfordCaliforniaUSA
- Institute for Stem Cell Biology and Regenerative MedicineStanford UniversityStanfordCaliforniaUSA
| | - Arash Momeni
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of SurgeryStanford University School of MedicineStanfordCaliforniaUSA
| | - Derrick C. Wan
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of SurgeryStanford University School of MedicineStanfordCaliforniaUSA
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Patenall BL, Carter KA, Ramsey MR. Kick-Starting Wound Healing: A Review of Pro-Healing Drugs. Int J Mol Sci 2024; 25:1304. [PMID: 38279304 PMCID: PMC10816820 DOI: 10.3390/ijms25021304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/28/2024] Open
Abstract
Cutaneous wound healing consists of four stages: hemostasis, inflammation, proliferation/repair, and remodeling. While healthy wounds normally heal in four to six weeks, a variety of underlying medical conditions can impair the progression through the stages of wound healing, resulting in the development of chronic, non-healing wounds. Great progress has been made in developing wound dressings and improving surgical techniques, yet challenges remain in finding effective therapeutics that directly promote healing. This review examines the current understanding of the pro-healing effects of targeted pharmaceuticals, re-purposed drugs, natural products, and cell-based therapies on the various cell types present in normal and chronic wounds. Overall, despite several promising studies, there remains only one therapeutic approved by the United States Food and Drug Administration (FDA), Becaplermin, shown to significantly improve wound closure in the clinic. This highlights the need for new approaches aimed at understanding and targeting the underlying mechanisms impeding wound closure and moving the field from the management of chronic wounds towards resolving wounds.
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Affiliation(s)
| | | | - Matthew R. Ramsey
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA (K.A.C.)
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Stynes G, Haertsch P, O'Hara J, Knight R, Issler-Fisher AC, Maitz PKM. Alginate dressings continuously for fourteen days on uncontaminated, superficial, partial thickness burns. J Burn Care Res 2022:6743261. [PMID: 36181757 DOI: 10.1093/jbcr/irac143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Indexed: 01/27/2023]
Abstract
Calcium alginate dressings are commonly used on split-thickness skin donor sites, where they are typically removed after 14 days. Alginates have been used previously on superficial, partial thickness burns, but changed every 3-4 days. In this study, alginates were applied to superficial, partial thickness burns on adults within 36 hours of injury, then left intact for up to 14 days. Wound healing (≥95% wound epithelialisation) and pain were measured. Twenty-one burns were reviewed on ten patients. Per the initial protocol, six patients were reviewed every 3-5 days, with removal of only secondary dressings, until day 13-14, when the alginate dressings were removed. One patient was reviewed every 3-5 days until day 10, when a clinic nurse removed the alginate dressing. Restrictions on movement during the COVID pandemic necessitated a protocol change, with only one review at approximately day 14 for removal of alginate and secondary dressings; three patients were reviewed in this manner. Burns on all patients were 100% epithelialised at the time of final review and there were no complications, such as scarring, infection, or need for grafting. Following initial debridement and dressings, patients reported minimal pain. Dressing costs appeared to be significantly decreased. This protocol may be particularly useful for patients managed in rural and remote locations, with telemedicine support if required.
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Affiliation(s)
- Gil Stynes
- Burns Unit, Concord Repatriation General Hospital, Hospital Rd, Concord NSW 2139, Australia.,University of Sydney, Camperdown, NSW.,ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia.,Department of Surgery, Wollongong Hospital, 252 Loftus St, Wollongong 2500, NSW, Australia
| | - Peter Haertsch
- Burns Unit, Concord Repatriation General Hospital, Hospital Rd, Concord NSW 2139, Australia.,University of Sydney, Camperdown, NSW.,Department of Surgery, Wollongong Hospital, 252 Loftus St, Wollongong 2500, NSW, Australia
| | - Justine O'Hara
- Burns Unit, Concord Repatriation General Hospital, Hospital Rd, Concord NSW 2139, Australia.,University of Sydney, Camperdown, NSW
| | - Robert Knight
- Department of Surgery, Wollongong Hospital, 252 Loftus St, Wollongong 2500, NSW, Australia
| | - Andrea C Issler-Fisher
- Burns Unit, Concord Repatriation General Hospital, Hospital Rd, Concord NSW 2139, Australia.,University of Sydney, Camperdown, NSW.,ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia
| | - Peter K M Maitz
- Burns Unit, Concord Repatriation General Hospital, Hospital Rd, Concord NSW 2139, Australia.,University of Sydney, Camperdown, NSW.,ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia
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Ozhathil DK, Wolf SE. Prevention and treatment of burn wound infections: the role of topical antimicrobials. Expert Rev Anti Infect Ther 2022; 20:881-896. [PMID: 35188850 DOI: 10.1080/14787210.2022.2044795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Infections related to the skin are the principal drivers of morbidity and mortality following severe burn, therefore a diverse armamentarium of topical antimicrobial agents were developed over the history of burn care. The last 30 years witnessed dramatic changes in the application of surgical intervention and utilization of topical therapies. AREAS COVERED We explore well-known topical antimicrobial products used in burn care. First, we investigate how fundamental changes in the practice of burn surgery influenced the choice of topical therapies used. Then, we examine antimicrobial creams and ointments commonly recognized due to their long record of use in burn care. Next, we dive into antimicrobial solutions commonly used as adjuncts to surgical intervention. Finally, we explore representative antimicrobial dressings, an ever-advancing roster of products opening the door to the next era in burn care. We also describe how these new agents relate to already established tools in present-day burn care. EXPERT OPINION In the current day, though the wisdom of early excision and wound closure remains valid, we continue to strive to minimize aggressive wound excision and disfiguring donor tissue collection while securing rapid wound closure. To this end, antimicrobial therapies are titrated to optimize operative outcomes and provide non-operative wound care when appropriate. Antimicrobial agents bridge the gap with the next generation of skin substitute and skin replacement therapies.
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Affiliation(s)
- Deepak K Ozhathil
- Department of Surgery, University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, Texas
| | - Steven E Wolf
- Division Chief, Burns, Trauma & Acute Care surgery, Department of Surgery, University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, Texas 77555-1220
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Chappell TC, Nair NU. Engineered lactobacilli display anti-biofilm and growth suppressing activities against Pseudomonas aeruginosa. NPJ Biofilms Microbiomes 2020; 6:48. [PMID: 33127888 PMCID: PMC7599214 DOI: 10.1038/s41522-020-00156-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 10/07/2020] [Indexed: 12/13/2022] Open
Abstract
Biofilms are an emerging target for new therapeutics in the effort to address the continued increase in resistance and tolerance to traditional antimicrobials. In particular, the distinct nature of the biofilm growth state often means that traditional antimcirobials, developed to combat planktonic cells, are ineffective. Biofilm treatments are designed to both reduce pathogen load at an infection site and decrease the development of resistance by rendering the embedded organisms more susceptible to treatment at lower antimicrobial concentrations. In this work, we developed a new antimicrobial treatment modality using engineered lactic acid bacteria (LAB). We first characterized the natural capacity of two lactobacilli, L. plantarum and L. rhamnosus, to inhibit P. aeruginosa growth, biofilm formation, and biofilm viability, which we found to be dependent upon the low pH generated during culture of the LAB. We further engineered these LAB to secrete enzymes known to degrade P. aeruginosa biofilms and show that our best performing engineered LAB, secreting a pathogen-derived enzyme (PelAh), degrades up to 85% of P. aeruginosa biofilm.
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Affiliation(s)
- Todd C Chappell
- Department of Chemical & Biological Engineering, Tufts University, Medford, MA, USA
| | - Nikhil U Nair
- Department of Chemical & Biological Engineering, Tufts University, Medford, MA, USA.
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Singer AJ, Zhang N, Baer E. Comparison of a topical surfactant and a topical antibiotic in the rat comb burn model. Burns 2020; 46:1674-1680. [PMID: 32534891 DOI: 10.1016/j.burns.2020.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/06/2020] [Accepted: 04/24/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Burn injury progression in the secondary zone of ischemia is common leading to delayed healing and increased scarring. We hypothesized that a topical surfactant, would reduce burn injury progression in a validated rat comb burn model compared with topical antibiotic ointment. METHODS We created 40 comb burns on 20 rats which were randomized to daily topical application of the surfactant or a triple antibiotic ointment. The comb burns consisted of 4 full thickness burns with 3 unburned interspaces between the 4 burns. These unburned interspaces represented the zone of ischemia, and when left untreated, generally progress to full thickness necrosis within several days. Comb burns were assessed daily for the presence of gross necrosis of the interspaces. At 7 days the comb burns were excised and blindly evaluated for the presence of histological evidence of necrosis. The study had 80% power to detect a 25% difference in the percentages of necrotic interspaces on day 7. RESULTS There were no differences in the percentages of histologically necrotic interspaces at 7 days in burns treated with the surfactant or antibiotic ointment (85% [95%CI, 74 to 92] vs. 75% [95%CI, 63 to 84]; mean difference 10% [95%CI -4 to 24]). There were also no between group differences in the percentages of grossly necrotic interspaces on any of the seven days of the experiment. The surfactant remained intact and adherent while the antibiotic had been absorbed at each daily dressing change. CONCLUSIONS A topical surfactant did not reduce injury progression in the rat comb burn model when compared with antibiotic ointment. The surfactant was more durable than the antibiotic ointment.
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Affiliation(s)
- Adam J Singer
- Department of Emergency Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States.
| | - Nigel Zhang
- Department of Emergency Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Evyatar Baer
- Department of Emergency Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
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Daristotle JL, Lau LW, Erdi M, Hunter J, Djoum A, Srinivasan P, Wu X, Basu M, Ayyub OB, Sandler AD, Kofinas P. Sprayable and biodegradable, intrinsically adhesive wound dressing with antimicrobial properties. Bioeng Transl Med 2020; 5:e10149. [PMID: 31989038 PMCID: PMC6971445 DOI: 10.1002/btm2.10149] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/04/2019] [Accepted: 12/03/2019] [Indexed: 01/29/2023] Open
Abstract
Conventional wound dressings are difficult to apply to large total body surface area (TBSA) wounds, as they typically are prefabricated, require a layer of adhesive coating for fixation, and need frequent replacement for entrapped exudate. Large TBSA wounds as well as orthopedic trauma and low-resource surgery also have a high risk of infection. In this report, a sprayable and intrinsically adhesive wound dressing loaded with antimicrobial silver is investigated that provides personalized fabrication with minimal patient contact. The dressing is composed of adhesive and biodegradable poly(lactic-co-glycolic acid) and poly(ethylene glycol) (PLGA/PEG) blend fibers with or without silver salt (AgNO3). in vitro studies demonstrate that the PLGA/PEG/Ag dressing has antimicrobial properties and low cytotoxicity, with antimicrobial silver controllably released over 7-14 days. In a porcine partial-thickness wound model, the wounds treated with both antimicrobial and nonantimicrobial PLGA/PEG dressings heal at rates similar to those of the clinical, thin film polyurethane wound dressing, with similar scarring. However, PLGA/PEG adds a number of features beneficial for wound healing: greater exudate absorption, integration into the wound, a 25% reduction in dressing changes, and tissue regeneration with greater vascularization. There is also modest improvement in epidermis thickness compared to the control wound dressing.
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Affiliation(s)
- John L. Daristotle
- Fischell Department of BioengineeringUniversity of MarylandCollege ParkMaryland
| | - Lung W. Lau
- Sheikh Zayed Institute for Pediatric Surgical InnovationJoseph E. Robert Jr. Center for Surgical Care, Children's National Medical CenterWashingtonDistrict of Columbia
| | - Metecan Erdi
- Department of Chemical and Biomolecular EngineeringUniversity of MarylandCollege ParkMaryland
| | - Joseph Hunter
- Fischell Department of BioengineeringUniversity of MarylandCollege ParkMaryland
| | - Albert Djoum
- Department of Chemistry and BiochemistryUniversity of MarylandCollege ParkMaryland
| | - Priya Srinivasan
- Sheikh Zayed Institute for Pediatric Surgical InnovationJoseph E. Robert Jr. Center for Surgical Care, Children's National Medical CenterWashingtonDistrict of Columbia
| | - Xiaofang Wu
- Sheikh Zayed Institute for Pediatric Surgical InnovationJoseph E. Robert Jr. Center for Surgical Care, Children's National Medical CenterWashingtonDistrict of Columbia
| | - Mousumi Basu
- Sheikh Zayed Institute for Pediatric Surgical InnovationJoseph E. Robert Jr. Center for Surgical Care, Children's National Medical CenterWashingtonDistrict of Columbia
| | - Omar B. Ayyub
- Department of Chemical and Biomolecular EngineeringUniversity of MarylandCollege ParkMaryland
| | - Anthony D. Sandler
- Sheikh Zayed Institute for Pediatric Surgical InnovationJoseph E. Robert Jr. Center for Surgical Care, Children's National Medical CenterWashingtonDistrict of Columbia
| | - Peter Kofinas
- Department of Chemical and Biomolecular EngineeringUniversity of MarylandCollege ParkMaryland
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De Silva CC, Israni N, Zanwar A, Jagtap A, Leophairatana P, Koberstein JT, Modak SM. “Smart” polymer enhances the efficacy of topical antimicrobial agents. Burns 2019; 45:1418-1429. [DOI: 10.1016/j.burns.2019.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 04/02/2019] [Accepted: 04/11/2019] [Indexed: 01/04/2023]
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Khansa I, Schoenbrunner AR, Kraft CT, Janis JE. Silver in Wound Care-Friend or Foe?: A Comprehensive Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2390. [PMID: 31592393 PMCID: PMC6756674 DOI: 10.1097/gox.0000000000002390] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/19/2019] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Ibrahim Khansa
- From the Division of Plastic and Reconstructive Surgery, Nationwide Children’s Hospital, Columbus, Ohio
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Anna R. Schoenbrunner
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Casey T. Kraft
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jeffrey E. Janis
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Antibiotic ointment versus a silver-based dressing for children with extremity burns: A randomized controlled study. J Pediatr Surg 2019; 54:1391-1396. [PMID: 29983189 DOI: 10.1016/j.jpedsurg.2018.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/25/2018] [Accepted: 06/03/2018] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Antibiotic or silver-based dressings are widely used in burn wound care. Our standard method of dressing pediatric extremity burn wounds consists of an antibiotic ointment or nystatin ointment-impregnated nonadherent gauze (primary layer), followed by rolled gauze, soft cast pad, plaster and soft casting tape (3M™ Scotchcast™, St. Paul, MN). The aim of this study was to compare our standard ointment-based primary layer versus Mepitel Ag® (Mölnlycke Health Care, Gothenburg, Sweden) in the management of pediatric upper and lower extremity burn wounds. METHODS Children with a new burn injury to the upper or lower extremities, who presented to the burn clinic were eligible. Eligible children were enrolled and randomized, stratified by burn thickness, to be dressed in an ointment-based dressing or Mepitel Ag®. Study personnel and participants were not blinded to the dressing assignment after randomization. Dressings were changed approximately once or twice per week, until the burn wound was healed or skin-grafted. The primary outcome was time to wound healing and p-value < 0.05 was considered significant. RESULTS Ninety-six children with 113 upper or lower extremity burns were included in the analysis. Mepitel Ag® (hazard ratio [HR] 0.57 (95% Confidence Interval (CI) 0.40-0.82); p = 0.002) significantly reduced the rate of wound healing, adjusting for burn thickness and fungal wound infection. The incidence of fungal wound infections and skin grafting was similar between the two groups. Children randomized to standard ointment dressings were significantly less likely to require four or more burn clinic visits than those in the Mepitel Ag® (4% versus 27%; p = 0.004). CONCLUSION Our study shows that our standard ointment-based dressing significantly increases the rate of wound healing compared to Mepitel Ag® for pediatric extremity burn injuries. LEVEL OF EVIDENCE Treatment study; Level 1.
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Hill DM, Sinclair SE, Hickerson WL. Rational Selection and Use of Antimicrobials in Patients with Burn Injuries. Clin Plast Surg 2017; 44:521-534. [DOI: 10.1016/j.cps.2017.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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