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Burn Wound Healing: Clinical Complications, Medical Care, Treatment, and Dressing Types: The Current State of Knowledge for Clinical Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031338. [PMID: 35162360 PMCID: PMC8834952 DOI: 10.3390/ijerph19031338] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/13/2022] [Accepted: 01/21/2022] [Indexed: 02/01/2023]
Abstract
According to the World Health Organization (WHO), it is estimated that each year approximately 11 million people suffer from burn wounds, 180,000 of whom die because of such injuries. Regardless of the factors causing burns, these are complicated wounds that are difficult to heal and are associated with high mortality rates. Medical care of a burn patient requires a lot of commitment, experience, and multidirectional management, including surgical activities and widely understood pharmacological approaches. This paper aims to comprehensively review the current literature concerning burn wounds, including classification of burns, complications, medical care, and pharmacological treatment. We also overviewed the dressings (with an emphasis on the newest innovations in this field) that are currently used in medical practice to heal wounds.
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Rahimi F, Rezayatmand R. Use of a biosynthetic wound dressing to treat burns: a systematic review. J Wound Care 2021; 29:S16-S22. [PMID: 33320760 DOI: 10.12968/jowc.2020.29.sup12.s16] [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] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Accelerating the process of wound healing, reducing infection risks, and decreasing pain and discomfort in the burn area are important goals of burn treatment. To achieve these goals, the use of biosynthetic wound dressings has increased in recent years. Suprathel (PolyMedics Innovations, Germany) is a biosynthetic wound dressing used to treat both partial-thickness burns and split-thickness skin graft (STSG) donor sites, full-thickness wounds, large-scale abrasions, and scar revisions. METHOD This study is a systematic review of empirical evidence reported on the application of the biosynthetic wound dressing in burns up to 2017. Keywords such as 'Suprathel', 'effectiveness', 'safety', and 'cost' were searched in PubMed, Cochrane, Scopus and Embase databases. RESULTS A total of 14 publications were identified, based on the inclusion and exclusion criteria. The findings reported in the literature reviewed were classified in terms of safety, effectiveness and cost-effectiveness of use of the biosynthetic wound dressing. Regarding safety and effectiveness, the dressing was found to yield desirable results, particularly for partial thickness burns and STSG donor sites. As of 2017 no health economics assessments have been carried out. CONCLUSION Despite the desirable advantages of the biosynthetic wound dressing with respect to its effectiveness, safety and ease of use, its major limitation was found to be its cost. However, in the absence of comprehensive studies on the quantification of all factors, there is scant scientific evidence for making reliable conclusions from this systematic review.
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Affiliation(s)
- Farimah Rahimi
- Health Management and Economics Research Center, Isfahan University of Medical Science, Isfahan, Iran
| | - Reza Rezayatmand
- Health Management and Economics Research Center, Isfahan University of Medical Science, Isfahan, Iran
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Matthaiou DK, Blot S, Koulenti D. Candida burn wound sepsis: The "holy trinity" of management. Intensive Crit Care Nurs 2018; 46:4-5. [PMID: 29548615 DOI: 10.1016/j.iccn.2018.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Dimitrios K Matthaiou
- Department of Critical Care Medicine, Attikon University Hospital, University of Athens, Medical School, Athens, Greece
| | - Stijn Blot
- Faculty of Medicine & Health Science, Ghent University, Ghent, Belgium.
| | - Despoina Koulenti
- Burns, Trauma and Critical Care Research Centre, University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Glik J, Kawecki M, Kitala D, Klama-Baryła A, Łabuś W, Grabowski M, Durdzińska A, Nowak M, Misiuga M, Kasperczyk A. A new option for definitive burn wound closure - pair matching type of retrospective case-control study of hand burns in the hospitalised patients group in the Dr Stanislaw Sakiel Centre for Burn Treatment between 2009 and 2015. Int Wound J 2017; 14:849-855. [PMID: 28220597 DOI: 10.1111/iwj.12720] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/17/2017] [Indexed: 11/30/2022] Open
Abstract
Nearly 80% of all burns include the hands of affected individuals. Skin grafting is the gold standard in burns treatment, but in the case of the burn wound bed, it may require the necessity of utilising skin substitutes to facilitate closure. The aim of this study is to assess the impact of a porcine-derived wound dressing (Oasis™) for application to hand burns compared to a synthetic dressing (Suprathel™). Comparative assessments were made, including the time to heal, quality of healing and pain intensity. A retrospective, unblinded, matching pair case-control of hand burns was performed. A control group of 24 patients was treated with Suprathel dressing, and a study group of six patients underwent application of the Oasis dressing. The wound healing process was evaluated by taking histopathological specimens and also utilising the Bates-Jensen Wound Assessment Tool. A 10-cm Visual Analogue Scale (VAS) was used for pain assessment. Other parameters measured included dressing loss because of infection and the need of rehabilitation. The progress of wound healing on the fourth day in the study group was 30%. A decrease in the level of pain was recorded on the fourth day after surgery. There was a decrease of 5% in the risk of rehabilitation in the treatment group.
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Affiliation(s)
- Justyna Glik
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland.,Department of Chronic Wounds Management Organization, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Marek Kawecki
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland.,Department of Health Sciences, Technical-Humanistic Academy, Bielsko-Biała, Poland
| | - Diana Kitala
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland
| | | | - Wojciech Łabuś
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland
| | - Marek Grabowski
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland
| | - Agata Durdzińska
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland
| | - Mariusz Nowak
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland
| | - Marcelina Misiuga
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland
| | - Aleksandra Kasperczyk
- Department of Biochemistry, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Zabrze, Poland
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Abboud EC, Legare TB, Settle JC, Boubekri AM, Barillo DJ, Marcet JE, Sanchez JE. Do silver-based wound dressings reduce pain? A prospective study and review of the literature. Burns 2015; 40 Suppl 1:S40-7. [PMID: 25418437 DOI: 10.1016/j.burns.2014.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Silver-containing dressings are a mainstay in the management of burn injury and acute and chronic wounds. In addition to antimicrobial activity, there is anecdotal evidence that silver dressings may modulate or reduce wound pain. Pain is subjective and difficult to quantify, and most studies of silver-containing dressings evaluate pain as a secondary rather than a primary outcome. Nevertheless, a dressing with a proven ability to reduce pain independent of systemic analgesics would have great utility. In this study, we compared patient-reported pain levels in patients previously randomized to receiving silver-nylon dressings vs. conventional gauze dressings in a study of surgical site infection. Compared to gauze dressings, patients in the silver dressing group reported less pain between postoperative days 0 and 9 (p<0.02). Post hoc analysis of analgesic use did not reach statistical significance between the groups. The study was completed with a literature review of the effect of silver on pain. Silver-based dressings may reduce wound pain by providing an occlusive barrier or by other as-yet undefined mechanisms. The role of silver in pain relief, however, cannot be definitively stated until well-designed prospective randomized studies evaluating pain as a primary endpoint are carried out.
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Affiliation(s)
- Elia Charbel Abboud
- University of South Florida, Department of Surgery, Morsani College of Medicine, Tampa, FL, USA.
| | - Timothy B Legare
- University of South Florida, Department of Surgery, Morsani College of Medicine, Tampa, FL, USA
| | - Judson C Settle
- University of South Florida, Department of Surgery, Morsani College of Medicine, Tampa, FL, USA
| | - Amir M Boubekri
- University of South Florida, Department of Surgery, Morsani College of Medicine, Tampa, FL, USA
| | - Dave J Barillo
- Disaster Response/Critical Care Consultants, LLC, Mount Pleasant, SC, USA
| | - Jorge E Marcet
- University of South Florida, Department of Surgery, Morsani College of Medicine, Tampa, FL, USA
| | - Jaime E Sanchez
- University of South Florida, Department of Surgery, Morsani College of Medicine, Tampa, FL, USA
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Xia W, Mao C, Luo X, Xu J, Chen X, Lin C. A 13-year retrospective study evaluating the efficacy of using air-fluidised beds for toxic epidermal necrolysis patients. Australas J Dermatol 2015; 57:205-9. [PMID: 25817418 DOI: 10.1111/ajd.12318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 01/16/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Toxic epidermal necrolysis (TEN) is a potentially life-threatening dermatological disease involving large areas of skin loss with systemic symptoms. This study evaluated the efficacy of air-fluidised bed therapy for TEN patients. METHODS Of 27 people with TEN, 11 used air-fluidised beds (the air-fluidised group) and 16 used standard beds (the control group). Days to complete re-epithelialisation, re-epithelialisation rate, incidence of complications, mortality, pain measured by visual analogue score and the incidence of cutaneous infection were compared in these groups. RESULTS The mean body surface area of involvement was 77.0 ± 11.8% and baseline mean severity-of-illness score for TEN (SCORTEN) was 2.81 ± 1.08. The re-epithelialisation rate in the air-fluidised group was 100% but was only 56.3% in the control group (P < 0.05). There was a significant difference in the time taken to complete re-epithelialisation between the air-fluidised group (13 days [95% CI: 9.0-17.0]) and the control group (21 days [16.5-25.5], P < 0.05). Furthermore, the incidence of complications was 18% in the air-fluidised group versus 75% in the control group, including fewer cutaneous infections (P < 0.05). There was a significant reduction in pain among the air-fluidised group compared with the control group (P < 0.05). There were no deaths in the air-fluidised group while 19% of the control group died. CONCLUSION Air-fluidised beds can reduce the time to complete re-epithelialisation, relieve pain and increase the re-epithelialisation rate of TEN patients, but there was no significant difference between them in mortality rate in our study.
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Affiliation(s)
- Weidong Xia
- Burn and Wound Healing Centre, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Cong Mao
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, China
| | - Xu Luo
- Burn and Wound Healing Centre, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Jianjun Xu
- Burn and Wound Healing Centre, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Xiaofeng Chen
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, China
| | - Cai Lin
- Burn and Wound Healing Centre, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou
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Abboud EC, Settle JC, Legare TB, Marcet JE, Barillo DJ, Sanchez JE. Silver-based dressings for the reduction of surgical site infection: Review of current experience and recommendation for future studies. Burns 2014; 40 Suppl 1:S30-9. [DOI: 10.1016/j.burns.2014.09.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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White R. An approach to assessing evidence that can inform clinical decision-making. J Wound Care 2011; 20:15-19. [PMID: 29480745 DOI: 10.12968/jowc.2011.20.sup2.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Following the Cochrane meta-analyses findings, doubts are being expressed about efficacy of silver dressings. However, the need for topical antimicrobials has not diminished, and the evidence for non-silver agents is no better than that for silver. This article describes an alternative system to Cochrane for analysing the evidence base, and suggests a practical approach to making a case for silver to procurement managers.
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Coban YK, Erbatur S, Aytekin AH. A useful combination in the treatment of toxic epidermal necrolysis: Octenoidine dihydrocholoride solution and Aquacel-Ag. Burns 2010; 37:545-6. [PMID: 21146312 DOI: 10.1016/j.burns.2010.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 11/01/2010] [Indexed: 10/18/2022]
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Børsheim E, Chinkes DL, McEntire SJ, Rodriguez NR, Herndon DN, Suman OE. Whole body protein kinetics measured with a non-invasive method in severely burned children. Burns 2010; 36:1006-12. [PMID: 20392565 PMCID: PMC2948638 DOI: 10.1016/j.burns.2010.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 12/02/2009] [Accepted: 01/26/2010] [Indexed: 12/16/2022]
Abstract
UNLABELLED Persistent and extensive skeletal muscle catabolism is characteristic of severe burns. Whole body protein metabolism, an important component of this process, has not been measured in burned children during the long-term convalescent period. The aim of this study was to measure whole body protein turnover in burned children at discharge (95% healed) and in healthy controls by a non-invasive stable isotope method. Nine burned children (7 boys, 2 girls; 54±14 (S.D.)% total body area burned; 13±4 years; 45±20 kg; 154±14 cm) and 12 healthy children (8 boys, 4 girls; 12±3 years; 54±16 kg; 150±22 cm) were studied. A single oral dose of (15)N-alanine (16 mg/kg) was given, and thereafter urine was collected for 34 h. Whole body protein flux was calculated from labeling of urinary urea nitrogen. Then, protein synthesis was calculated as protein flux minus excretion, and protein breakdown as flux minus intake. At discharge, total protein turnover was 4.53±0.65 (S.E.)g kg body weight(-1) day(-1) in the burned children compared to 3.20±0.22 g kg(-1) day(-1) in controls (P=0.02). Expressed relative to lean body mass (LBM), the rates were 6.12±0.94 vs. 4.60±0.36 g kg LBM(-1) day(-1) in burn vs. healthy (P=0.06). Total protein synthesis was also elevated in burned vs. healthy children, and a tendency for elevated protein breakdown was observed. CONCLUSION Total protein turnover is elevated in burned children at discharge compared to age-matched controls, possibly reflecting the continued stress response to severe burn. The oral (15)N-alanine bolus method is a convenient, non-invasive, and no-risk method for measurement of total body protein turnover.
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Affiliation(s)
- Elisabet Børsheim
- Shriners Hospitals for Children/Galveston, Department of Surgery, University of Texas Medical Branch, Galveston, TX 77550, USA.
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Paquet P, Piérard GE. Topical treatment options for drug-induced toxic epidermal necrolysis (TEN). Expert Opin Pharmacother 2010; 11:2447-58. [DOI: 10.1517/14656566.2010.515587] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Severely burned patients typically experience a systemic response expressed as increased metabolism, inflammation, alteration of cardiac and immune function, and associated hyperglycemia. Hyperglycemia has been associated with an increased risk of morbidity and mortality in critically ill patients. Until recently and for many years, hyperglycemia has been expectantly managed and considered a normal and desired response of an organism to stress. However, findings reported from recent studies now suggest beneficial effects of intensive insulin treatment of critically ill patients. The literature on the management of hyperglycemia in severely burned patients is sparse, with most of the available studies involving only small numbers of burned patients. The purpose of this article is to describe the pathophysiology of hyperglycemia after severe burns and to review the available literature on the outcome of intensive insulin treatment and other anti-hyperglycemic modalities in burned patients in an evidence-based medical approach.
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Ozil C, Vialle R, Thevenin-Lemoine C, Conti E, Annequin D. Use of a combined oxygen/nitrous oxide/morphine chlorydrate protocol for analgesia in burned children requiring painful local care. Pediatr Surg Int 2010; 26:263-7. [PMID: 19921515 DOI: 10.1007/s00383-009-2537-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2009] [Indexed: 11/24/2022]
Abstract
PURPOSE We present the results of the use of a protocol of inhalational oxygen/nitrous oxide mixtures associated with oral opioids on a prospective cohort of 33 children undergoing local care for acute but limited burned skin lesions. METHODS All the children were orally administered 0.4 mg/kg morphine chlorydrate, and nitrous oxide was administered as an equimolar mixture (50% N2O, 50% O2) via a face mask during the procedure. Pain and comfort of the patient were evaluated by the use of a validated behavioural score. After the end of the procedure, child and parent satisfactions were noted. RESULTS Mean age was 3 years 6 months (10 months-11 years). A successful detersion procedure was performed in all the cases. Behavioural score was 6 in 15 cases out of 33, comprising between 7 and 9 in 15 patients and 10 in three patients. Subjective satisfaction of pain management was noted in 16 out of 20 patients after the procedure. Subjective satisfaction of the parents was noted in all the cases. DISCUSSION Our study demonstrates that the use of a simple protocol of inhalational oxygen/nitrous oxide mixtures associated with oral opioids could be safe and effective. This association was well tolerated without any adverse effect.
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Affiliation(s)
- Camille Ozil
- Burned Care Unit, Department of Surgery and Anaesthesia, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris6, 26, avenue du Docteur Arnold Netter, 75571 Paris Cedex 12, France
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Kamolz LP. Burns: learning from the past in order to be fit for the future. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:106. [PMID: 20236479 PMCID: PMC2875484 DOI: 10.1186/cc8192] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Many advances have been made in the understanding and treatment of burns. Advances in burn surgery and critical care have decreased mortality and morbidity. Survival from severe burns is no longer the exception, but unfortunately death still occurs. Williams and colleagues have determined in their recent paper the predominant causes of death in order to develop new treatment avenues and future trajectories suitable to increase survival and overall outcome. A lot of burn deaths may be preventable with better airway management and a more precise and adequate volume management, but the leading cause of death in patients suffering from severe burns, which has to be faced, is sepsis. Sepsis due to multidrug-resistant organisms will continue to impede efforts to increase survival, and new strategies that go beyond the surgical and clinical techniques, which are already implemented, have to be developed in order to fight these organisms and their related complications.
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Al-Mousawi AM, Mecott-Rivera GA, Jeschke MG, Herndon DN. Burn teams and burn centers: the importance of a comprehensive team approach to burn care. Clin Plast Surg 2009; 36:547-54. [PMID: 19793550 DOI: 10.1016/j.cps.2009.05.015] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Remarkable advances in burn care have been made over recent decades, and it is recognized that the organized efforts of burn teams are required to continue enhancing survival rates and quality of life for patients. Patients with major burns are unique, representing one of the most severe models of trauma, and therefore necessitate treatment in the best specialized facilities available for that endeavor. Burn centers have developed to meet these intricate needs but can only function most productively and efficiently through well-organized, multifaceted, patient-centered teams in the areas of both clinical care and research.
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Affiliation(s)
- Ahmed M Al-Mousawi
- Department of Surgery, The University of Texas Medical Branch, Galveston, 77555, USA
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Giessler GA, Mayer T, Trupkovic T. [Burn trauma--Part 2. Anesthesiological, surgical and intensive care management]. Anaesthesist 2009; 58:474-84. [PMID: 19384454 DOI: 10.1007/s00101-009-1535-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
After initial stabilization of burn victims at the scene and in the trauma room, a tight cooperation and communication between anesthesiologists, plastic surgeons and intensive care specialists is needed for further therapy. Interdisciplinary communication about preoperative planning, timing of necrectomy and intensive care therapy is vital regarding functional and aesthetic outcome and survival rate. During burn surgery attention has to be paid to excessive blood loss and the danger of hypothermia. The main problems of intensive care therapy involve the evaluation of volume status, high demands for analgesia and sedation, high incidence of septic multiorgan failure and therapy and prophylaxis of the effects of hypermetabolism.
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Affiliation(s)
- G A Giessler
- Abt. für Plastische, Hand- und Rekonstruktive Mikrochirurgie, Berufsgenossenschaftliche Unfallklinik Murnau, Professor Kuentscher Str. 8, 82418 Murnau am Staffelsee, Deutschland.
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Affiliation(s)
- Jonathan L. Meakins
- Nuffield Department of Surgery, University of Oxford, Oxford, United Kingdom
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