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Adegboye O, Adams S. Minimal scarring in a premature neonate. JPRAS Open 2023; 38:124-128. [PMID: 37869731 PMCID: PMC10587665 DOI: 10.1016/j.jpra.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/01/2023] [Indexed: 10/24/2023] Open
Abstract
Background Scar formation and management is one of the major issues in plastic surgery. Scars are a chronic burden to patients, their families, and the wider healthcare system and while non-surgical and surgical options have been shown to reduce scarring and its impact, there are currently no therapeutic options to completely heal scars or to avoid scarring. Early gestation animals have been reported to heal skin wounds without scarring. Case presentation We report on a premature, underweight-for-age neonate of 30 weeks' gestation that suffered a combination of deep partial thickness abrasions and full thickness wounds following birth trauma, who eventually healed with minimal skin scarring. Conclusion This case highlights that more research is needed to understand the mechanism and timelines of foetal skin healing, so the knowledge can be used to develop better therapeutic options to treat skin scars in adults.
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Affiliation(s)
- Oluwatobi Adegboye
- Faculty of Biology, Medicine, and Health, The University of Manchester, United Kingdom
| | - Saleigh Adams
- Division of Plastic, Reconstructive and Maxillo-Facial Surgery, The University of Cape Town, South Africa
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2
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Mistry R, Issa F. No statistically significant difference in long term scarring outcomes of pediatric burns patients treated surgically vs. those treated conservatively. Front Surg 2022; 9:727983. [PMID: 36157426 PMCID: PMC9500338 DOI: 10.3389/fsurg.2022.727983] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/23/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Paediatric burns are a common clinical presentation. The long-term scar outcomes in paediatric burns patients are relatively unknown as most are discharged after 6 weeks follow up, apart from the small number that are followed up by scar services depending on geographical availability. We aimed to determine whether the long-term scarring outcomes are significantly different in those who had surgical treatment with Versajet® debridement and Biobrane®, vs. those treated conservatively with non-adherent Mepitel® and Acticoat® dressings, in a cohort of paediatric burns patients. Methods The parents of all paediatric burns patients admitted to Stoke Mandeville Hospital from October 2014 to September 2017 were contacted by telephone to fill in the paediatric Brisbane Burn Scar Impact Profile (BBSIP), the only patient reported outcome measure (PROM) specifically aimed at children. The results from the questionnaires underwent statistical analysis to see if there was a significant difference in questionnaire scores between children treated surgically vs. those treated conservatively. Results A total of 107 children were admitted in the timeframe, responses were received from 34 patients with 13 having been treated surgically and 21 having been treated conservatively. In all 58 questions that make up the BBSIP, there was no statistically significant difference observed in the scores of those treated surgically vs. those treated conservatively. For 31 questions on the BBSIP, the lowest score indicating the best outcome was observed in all patients in both groups. Discussion Surgical management for burns is always the last resort. Our results could be interpreted to suggest clinicians need not fear the longer-term impact a scar may have when deciding whether to treat a paediatric burns patient surgically or conservatively. This study is the first to assess longer-term scar outcomes using the BBSIP. A larger data set and comparison with other burn units in the UK may help to provide more information on scar outcomes between different methods of surgical and conservative treatment. We found no statistically significant difference in the long-term scar outcomes as assessed by the BBSIP in paediatric burn patients treated with Versajet® debridement and Biobrane®, vs. those treated conservatively with non-adherent Mepitel® and Acticoat® dressings.
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Affiliation(s)
- Riyam Mistry
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
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Vyrva O, Smock E, Pessa J, Thirkannad SM. Outcomes of the glove-gauze regimen for managing burn injuries of the hand. J Hand Surg Eur Vol 2020; 45:737-741. [PMID: 32178564 DOI: 10.1177/1753193420910054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We studied the efficacy of the glove-gauze regimen in treating superficial, partial-thickness and small full-thickness hand burns. Outcome measures included healing time, need for surgical intervention, need for formal physical therapy, restoration of range of motion, return to function and incidence of infection. All patients (n = 123) successfully completed the regimen with an average healing time of 3.7 weeks. None required surgical debridement and seven (6%) required formal physical therapy. One hundred and eighteen patients (96%) regained full range of motion and 122 (99%) returned to their previous level of work. We believe that the glove-gauze regimen provides a simplified and effective means of managing hand burns. We conclude from our patients that the glove-gauze regimen is an effective treatment that can ensure uneventful healing of superficial, partial-thickness and small full-thickness burns. A majority of our patients healed with full range of motion and function without formal physical therapy.Level of evidence: IV.
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Affiliation(s)
- Oleksandra Vyrva
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA
| | - Elliott Smock
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA
| | - Joel Pessa
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA
| | - Sunil M Thirkannad
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA
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Bairagi A, Griffin B, Tyack Z, Vagenas D, McPhail SM, Kimble R. Comparative effectiveness of Biobrane®, RECELL® Autologous skin Cell suspension and Silver dressings in partial thickness paediatric burns: BRACS randomised trial protocol. BURNS & TRAUMA 2019; 7:33. [PMID: 31696127 PMCID: PMC6822367 DOI: 10.1186/s41038-019-0165-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 07/26/2019] [Indexed: 05/05/2023]
Abstract
BACKGROUND Mixed partial thickness burns are the most common depth of burn injury managed at a large Australian paediatric hospital specialty burns unit. Prolonged time until re-epithelialisation is associated with increased burn depth and scar formation. Whilst current wound management approaches have benefits such as anti-microbial cover, these are not without inherent limitations including multiple dressing changes. The Biobrane® RECELL® Autologous skin Cell suspension and Silver dressings (BRACS) trial aims to identify the most effective wound management approach for mixed partial thickness injuries in children. METHODS All children presenting with an acute burn injury to the study site will be screened for eligibility. This is a single-centre, three-arm, parallel group, randomised trial. Children younger than 16 years, with burns ≥ 5% total body surface area involving any anatomical location, up to 48 h after the burn injury, and of a superficial partial to mid-dermal depth, will be included. A sample size of 84 participants will be randomised to standard silver dressing or a Regenerative Epithelial Suspension (RES™) with Biobrane® or Biobrane® alone. The first dressing will be applied under general anaesthesia and subsequent dressings will be changed every 3 to 5 days until the wound is ≥ 95% re-epithelialised, with re-epithelialisation time the primary outcome. Secondary outcomes of acute pain, acute itch, scar severity, health-related quality of life, treatment satisfaction, dressing application ease and healthcare resource use will be assessed at each dressing change and 3, 6 and 12 months post-burn injury. DISCUSSION The findings of this study can potentially change the wound management approach for superficial partial to mid-dermal burns in children locally and worldwide. TRIAL REGISTRATION The Australian New Zealand Clinical Trials Registry (ACTRN12618000245291) approved prospective registration on 15 February 2018. Registration details can be viewed at https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374272&isReview=true.
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Affiliation(s)
- Anjana Bairagi
- Centre for Children’s Burns and Trauma Research, Centre for Children’s Health Research, Brisbane, Queensland, Australia
- Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bronwyn Griffin
- Centre for Children’s Burns and Trauma Research, Centre for Children’s Health Research, Brisbane, Queensland, Australia
- Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Zephanie Tyack
- Centre for Children’s Burns and Trauma Research, Centre for Children’s Health Research, Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- Research Methods Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Steven M. McPhail
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Roy Kimble
- Centre for Children’s Burns and Trauma Research, Centre for Children’s Health Research, Brisbane, Queensland, Australia
- Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
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5
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Hyland EJ, D’Cruz R, Menon S, Harvey JG, La Hei E, Lawrence T, Waddell K, Nash M, Holland AJA. Biobrane™ versus acticoat™ for the treatment of mid-dermal pediatric burns: a prospective randomized controlled pilot study. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2018; 8:63-67. [PMID: 30042865 PMCID: PMC6055079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/12/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The management of pediatric mid-dermal burns is challenging. Anecdotal evidence suggests Biobrane™ (UDL Laboratories, Inc., Sugar Land, TX) may expedite epithelization, reducing the requirement for skin grafting. Our standard management for burns of this depth is Acticoat™ (Smith and Nephew, St. Petersburg, Fl, USA). No publications are known to compare Biobrane™ to Acticoat™ for treatment of mid-dermal burns. METHODS A prospective, randomised controlled pilot study was conducted, comparing Biobrane™ to Acticoat™ for mid-dermal burns affecting ≥ 1% Total Body Surface Area (TBSA) in children. Mid-dermal burns were confirmed using Laser Doppler Imaging within 48 hours of injury. Participants were randomized to Biobrane™ with an Acticoat™ overlay or Acticoat™ alone. RESULTS 10 participants were in each group. Median age and TBSA were similar; 2.0 (Biobrane™) and 1.5 years (Acticoat™), 8% (Biobrane™) and 8.5% TBSA (Acticoat™). Use of Biobrane™ had higher infection rates (6 children versus 1) (P = 0.057) and more positive wound swabs, although not significant (7 children versus 4) (P = 0.37). Healing time was shorter in the Biobrane™ group, this was not significant (19 days versus 26.5 days, P = 0.18). Median dressing changes were similar (5 versus 5.5) (P = 0.56). Skin grafting requirement was greater in the Acticoat™ group (7 versus 4 children, P = 0.37) and similar in % TBSA (1.75% TBSA). CONCLUSION This pilot study suggests that the use of Biobrane™ for mid-dermal burns in children may be associated with increased risk of infection but appears to decrease the time to healing and therefore the need for skin grafting compared to Acticoat™ alone.
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Affiliation(s)
- Ela J Hyland
- The Children’s Hospital Burns Research Institute and Burns Unit, The Children’s Hospital at WestmeadSydney, Australia
| | - Rachel D’Cruz
- The Children’s Hospital Burns Research Institute and Burns Unit, The Children’s Hospital at WestmeadSydney, Australia
| | - Seema Menon
- The Children’s Hospital Burns Research Institute and Burns Unit, The Children’s Hospital at WestmeadSydney, Australia
| | - John G Harvey
- The Children’s Hospital Burns Research Institute and Burns Unit, The Children’s Hospital at WestmeadSydney, Australia
- Sydney Medical School, The University of SydneyNSW, Australia
| | - Erik La Hei
- The Children’s Hospital Burns Research Institute and Burns Unit, The Children’s Hospital at WestmeadSydney, Australia
| | - Torey Lawrence
- The Children’s Hospital Burns Research Institute and Burns Unit, The Children’s Hospital at WestmeadSydney, Australia
| | - Kelly Waddell
- The Children’s Hospital Burns Research Institute and Burns Unit, The Children’s Hospital at WestmeadSydney, Australia
| | - Mitchell Nash
- The Children’s Hospital Burns Research Institute and Burns Unit, The Children’s Hospital at WestmeadSydney, Australia
| | - Andrew JA Holland
- The Children’s Hospital Burns Research Institute and Burns Unit, The Children’s Hospital at WestmeadSydney, Australia
- Sydney Medical School, The University of SydneyNSW, Australia
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Raymond SL, Zecevic A, Larson SD, Ruzic A, Islam S. Delayed Healing Associated with Silver Sulfadiazine Use for Partial Thickness Scald Burns in Children. Am Surg 2018. [DOI: 10.1177/000313481808400628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Burns are a leading cause of injury in children. Management principles vary widely, with no consensus about the best treatment. The purpose of this study was to compare outcomes of three different dressings for pediatric partial-thickness scald burns. A retrospective, single-center study was conducted for patients 0–16 years old with a diagnosis of acute partial-thickness scald burn between July 2007 and December 2012. Data regarding prehospital, inpatient, and outpatient course were collected. Cohort was stratified into topical antimicrobial (TA) ointment, silver sulfadiazine (SS), and biosynthetic dressing (BD) groups for analysis. The primary outcome of interest was time to full healing. One hundred and seventy-seven patients met all study criteria. Overall, mean total body surface area burned was 8.3 per cent. TAwas used in 24 per cent cases, SS in 32 per cent, and BD in 44 per cent. The groups were comparable in terms of presenting burn characteristics and hospital course with the exception of the BD group being associated with greater extent of injury. Patients treated with SS had a significantly longer time to full healing and increased requirement of compression garments for scar therapy. Based on these data, the authors have amended their practice and presently use BD or TA dressings to improve healing.
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Affiliation(s)
- Steven L. Raymond
- From the Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Antonia Zecevic
- From the Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Shawn D. Larson
- From the Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Ana Ruzic
- From the Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Saleem Islam
- From the Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
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7
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Schiefer JL, Rath R, Ahrens E, Grigutsch D, Gräff I, Stromps JP, Fuchs PC, Schulz A. Evaluation of scar quality after treatment of superficial burns of the hands and face with Dressilk or Biobrane—An intra-individual comparison. Burns 2018; 44:305-317. [DOI: 10.1016/j.burns.2017.07.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/05/2017] [Accepted: 07/28/2017] [Indexed: 12/27/2022]
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8
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Schiefer JL, Arens E, Grigutsch D, Rath R, Hoffmann A, Fuchs PC, Schulz A. A prospective intra-individual evaluation of silk compared to Biobrane for the treatment of superficial burns of the hand and face. Burns 2017; 43:539-548. [DOI: 10.1016/j.burns.2016.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/07/2016] [Accepted: 09/08/2016] [Indexed: 11/16/2022]
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9
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Biobrane versus topical agents in the treatment of adult scald burns. Burns 2017; 43:195-199. [DOI: 10.1016/j.burns.2016.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/20/2016] [Accepted: 07/22/2016] [Indexed: 11/22/2022]
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Trevatt AEJ, Kirkham EN, Allix B, Greenwood R, Coy K, Hollén LI, Young AER. Lack of a standardised UK care pathway resulting in national variations in management and outcomes of paediatric small area scalds. Burns 2016; 42:1241-56. [PMID: 27156791 DOI: 10.1016/j.burns.2016.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/12/2015] [Accepted: 04/01/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION There is a paucity of evidence guiding management of small area partial thickness paediatric scalds. This has prevented the development of national management guidelines for these injuries. This research aimed to investigate whether a lack of evidence for national guidelines has resulted in variations in both management and outcomes of paediatric small area scalds across England and Wales (E&W). METHODS A national survey of initial management of paediatric scalds ≤5% Total Body Surface Area (%TBSA) was sent to 14 burns services in E&W. Skin graft rates of anonymised burns services over seven years were collected from the international Burns Injury Database (iBID). Average skin grafting rates across services were compared. Length of stay and proportion of patients receiving general anaesthesia for dressing application at each service were also compared. RESULTS All 14 burns services responded to the survey. Only 50% of services had a protocol in place for the management of small area burns. All protocols varied in how partial thickness paediatrics scalds ≤5% TBSA should be managed. There was no consensus as to which scalds should be treated using biosynthetic dressings. Data from iBID for 11,917 patients showed that the average reported skin grafting rate across all burns services was 2.3% (95% CI 2.1, 2.6) but varied from 0.3% to 7.1% (P<0.001). Service provider remained associated with likelihood of skin grafting when variations in the %TBSA case mix seen by each service were controlled for (χ(2)=87.3, P<0.001). The use of general anaesthetics across services varied between 0.6 and 35.5% (P<0.001). The median length of stay across services varied from 1 to 3 days (P<0.001). DISCUSSION A lack of evidence guiding management of small-area paediatric scalds has resulted in variation in management of these injuries across E&W. There is also significant variation in outcomes for these injuries. Further research is indicated to determine if care pathways and outcomes are linked. An evidence-based national policy for the management of small area paediatric scalds would ensure that high quality, standardised care is delivered throughout E&W and variations in outcome are reduced.
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Affiliation(s)
- Alexander E J Trevatt
- St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, United Kingdom
| | | | - Bradley Allix
- Whipps Cross University Hospital, Whipps Cross Road, Leytonstone, London E11 1NR, United Kingdom
| | - Rosemary Greenwood
- Healing Foundation Children's Burn Research Centre, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, BS2 8BJ United Kingdom
| | - Karen Coy
- Healing Foundation Children's Burn Research Centre, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, BS2 8BJ United Kingdom
| | - Linda I Hollén
- Healing Foundation Children's Burns Research Centre, University of Bristol, Bristol BS8 2BN, United Kingdom
| | - Amber E R Young
- Healing Foundation Children's Burn Research Centre, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, BS2 8BJ United Kingdom.
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11
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The safety of general anaesthesia in paediatric patients undergoing the application of Biobrane® for small scalds. Burns 2015; 41:1221-6. [PMID: 25724104 DOI: 10.1016/j.burns.2015.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/02/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Each year more than 5000 children present to English and Welsh hospitals for the management of scalds; 60% of these are small scalds of less than 10% body surface area. There are no agreed UK care pathways for this injury. One method of management is to use a biosynthetic wound dressing after thorough wound cleaning. In children, this usually utilises general anaesthesia. This study investigates the incidence of adverse events during anaesthesia for the application of biosynthetic dressings in children with small-area scalds. METHODS The medical records of 500 consecutive admissions to a tertiary care paediatric burn centre between July 1st 2007 and June 30th 2012 were analysed. The primary outcome was any patient-related adverse event incurred as a result of the general anaesthesia. Secondary outcomes included delays in discharge and any recovery sequelae to the adverse events. RESULTS There were 21 (4.2%) documented adverse events associated with 500 episodes of anaesthesia. Of these, the majority (52%) were documented as self-resolving laryngospasm. All episodes were temporary with no recovery sequelae and did not delay discharge from the post-anaesthetic recovery area. CONCLUSIONS The use of general anaesthesia in this setting for the application of biosynthetic dressings in children with small-area scalds has a low incidence of anaesthesia-related complications with no associated long-term sequelae. This incidence is similar to that quoted for adverse events related to anaesthesia for other procedures and is lower than that reported for procedures using sedation.
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12
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Rashaan ZM, Krijnen P, Klamer RRM, Schipper IB, Dekkers OM, Breederveld RS. Nonsilver treatment vs. silver sulfadiazine in treatment of partial-thickness burn wounds in children: A systematic review and meta-analysis. Wound Repair Regen 2014; 22:473-82. [DOI: 10.1111/wrr.12196] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 05/08/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Zjir M. Rashaan
- Department of Surgery; Leiden University Medical Center; Leiden The Netherlands
- Burn Center; Red Cross Hospital Beverwijk; Beverwijk The Netherlands
| | - Pieta Krijnen
- Department of Surgery; Leiden University Medical Center; Leiden The Netherlands
| | - Rachel R. M. Klamer
- Department of Surgery; Leiden University Medical Center; Leiden The Netherlands
| | - Inger B. Schipper
- Department of Surgery; Leiden University Medical Center; Leiden The Netherlands
| | - Olaf M. Dekkers
- Department of Clinical Epidemiology; Leiden University Medical Center; Leiden The Netherlands
- Department of Endocrinology; Leiden University Medical Center; Leiden The Netherlands
| | - Roelf S. Breederveld
- Department of Surgery; Leiden University Medical Center; Leiden The Netherlands
- Burn Center; Red Cross Hospital Beverwijk; Beverwijk The Netherlands
- Association of Dutch Burn Centers; Beverwijk The Netherlands
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13
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Bernabe KQ, Desmarais TJ, Keller MS. Management of Traumatic Wounds and a Novel Approach to Delivering Wound Care in Children. Adv Wound Care (New Rochelle) 2014; 3:335-343. [PMID: 24761364 DOI: 10.1089/wound.2013.0465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 08/06/2013] [Indexed: 01/19/2023] Open
Abstract
Significance: The costs and morbidity of pediatric traumatic wounds are not well known. The literature lacks a comprehensive review of the volume, management, and outcomes of children sustaining soft tissue injury. We briefly review the existing literature for traumatic wounds such as open fractures and burns. Such injuries require dedicated wound care and we propose a novel approach for more efficient and more effective delivery of dedicated pediatric wound care. Recent Advances: New pediatric literature is emerging regarding the long-term effects of wound care pain in traumatic injuries-especially burns. A variety of wound dressings and alternative management techniques exist and are geared toward reducing wound care pain. Our institution utilizes a unique model to provide adequate sedation and pain control through a dedicated pediatric wound care unit. We believe that this model reduces the cost of wound care by decreasing emergency department and operating room visits as well as hospital length of stay. Critical Issues: First, medical costs related to pediatric traumatic wound care are not insignificant. The need for adequate pain control and sedation in children with complex wounds is traditionally managed with operating room intervention. Afterward, added costs can be from a hospital stay for ongoing acute wound management. Second, morbidities of complex traumatic wounds are shown to be related to the acute wound care received. Future Directions: Further guidelines are needed to determine the most effective and efficient care of complex traumatic soft tissue injuries in the pediatric population.
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Affiliation(s)
- Kathryn Q. Bernabe
- Division of Pediatric Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Thomas J. Desmarais
- Division of Pediatric Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Martin S. Keller
- Division of Pediatric Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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14
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Damodaran G, Syed M, Leigh I, Myers S, Navsaria H. Clinical application of skin substitutes. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17469872.3.3.345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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15
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Halim AS, Khoo TL, Mohd Yussof SJ. Biologic and synthetic skin substitutes: An overview. Indian J Plast Surg 2011; 43:S23-8. [PMID: 21321652 PMCID: PMC3038402 DOI: 10.4103/0970-0358.70712] [Citation(s) in RCA: 208] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The current trend of burn wound care has shifted to more holistic approach of improvement in the long-term form and function of the healed burn wounds and quality of life. This has demanded the emergence of various skin substitutes in the management of acute burn injury as well as post burn reconstructions. Skin substitutes have important roles in the treatment of deep dermal and full thickness wounds of various aetiologies. At present, there is no ideal substitute in the market. Skin substitutes can be divided into two main classes, namely, biological and synthetic substitutes. The biological skin substitutes have a more intact extracellular matrix structure, while the synthetic skin substitutes can be synthesised on demand and can be modulated for specific purposes. Each class has its advantages and disadvantages. The biological skin substitutes may allow the construction of a more natural new dermis and allow excellent re-epithelialisation characteristics due to the presence of a basement membrane. Synthetic skin substitutes demonstrate the advantages of increase control over scaffold composition. The ultimate goal is to achieve an ideal skin substitute that provides an effective and scar-free wound healing.
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Affiliation(s)
- Ahmad Sukari Halim
- Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
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16
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Greenwood JE. A Randomized, Prospective Study of the Treatment of Superficial Partial-Thickness Burns: AWBAT-S Versus Biobrane. EPLASTY 2011; 11:e10. [PMID: 21369369 PMCID: PMC3045219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The aim of this study was to prospectively evaluate AWBAT-S in comparison with Biobrane for the treatment of superficial partial-thickness burns using the patient as his or her own control. Primary outcome measures included length of hospital inpatient stay and patient-reported perception of pain. Secondary outcome measures included time to healing, clinical outcome of burn sites (scarring) and a comparison of cost of care for patients treated with AWBAT-S versus Biobrane.
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Affiliation(s)
- John E Greenwood
- Adult Burn Service, Royal Adelaide Hospital, North Terrace, Adelaide,
South Australia, Australia
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