orabase and Burns

Silver sulfadiazine is commonly used to treat local burn wounds. Aquacel-Ag is a hydrogen fiber dressing containing ionic silver that reduces burn wound infection and promotes antimicrobial activity. It is necessary to compare the efficacy of the two in the healing of burns.. The aim of this study was to systematically evaluate the effect of Aquacel-Ag on burn wound healing.. A computerized search of CNKI, VIP, Wanfang, SinoMed, PubMed, Cochrane Library, EMbase, Science Direct, Web of Science, Wiley Online Library, and Open Access Library databases was performed from January 1, 2000 to December 31, 2021 for randomized controlled clinical trials. The trials on Aquacel-Ag dressing and silver sulfadiazine in the treatment of burns were selected. Meta-analysis was performed using Review Manager 5.0 software.. Eleven articles were finally included, with 794 burn patients. Meta-analysis results showed that compared with patients treated with silver sulfadiazine, burn patients treated with Aquacel-Ag dressing had shorter wound healing time [MD = -2.49, 95% CI (-5.64-0.65), p = 0.12], significantly lower tumor necrosis factor-α (TNF-α) level [MD = -0.52, 95% CI (-0.82-0.22), p = 0.0008], higher wound healing rate [MD = 8.41, 95% CI (3.39-13.43), p = 0.001], fewer dressing changes [MD = -3.27, 95% CI (-4.90-1.63), p < 0.0001].. Aquacel-Ag dressing can shorten wound healing time and effectively reduce inflammatory reactions in burn patients compared with silver sulfadiazine, but their safety still needs further exploration and analysis.

Topics: Anti-Infective Agents, Local; Bandages; Burns; Carboxymethylcellulose Sodium; Humans; Silver; Silver Sulfadiazine; Wound Healing

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.. To assess the effects of topical interventions on wound healing in people with facial burns of any depth.. 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 We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional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.. Randomised controlled trials (RCTs) that evaluated the effects of topical treatment for facial burns were eligible for inclusion in this review.. Two review authors independently performed study selection, data extraction, risk of bias assessment and GRADE assessment of the certainty of the evidence.. 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.. 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.

Topics: Administration, Topical; Anti-Infective Agents; Bias; Burns; Carboxymethylcellulose Sodium; Facial Injuries; Humans; Randomized Controlled Trials as Topic; Skin, Artificial; Wound Healing

Despite advances in treatment of burn injuries and their consequent pain, wound care is the main source of the pain associated with burn injury. This two-part article explores burn pain and its treatment from a nursing perspective. Last month, Part 1 provided an overview of burn injury and addressed the wound care-related causes of burn pain, as well as its assessment and treatment. Part 2, presented here, provides a more in-depth discussion of pain management; topical medications and the psychological aspects of burn pain are also discussed.

Topics: Acute Disease; Analgesia; Analgesics; Anti-Infective Agents, Local; Burns; Carboxymethylcellulose Sodium; Causality; Drug Monitoring; Drug Therapy, Combination; Humans; Mafenide; Nurse's Role; Pain; Polyesters; Polyethylenes; Practice Guidelines as Topic; Relaxation Therapy; Silver Sulfadiazine; Skin Care; Stress Disorders, Post-Traumatic

Glycerolized Nile tilapia skin (NTS) showed promising results when used for burn treatment in phases II and III randomized controlled trials. This pilot study aims to evaluate the effectiveness of lyophilized NTS (LNTS) as a temporary skin substitute for superficial partial-thickness burns by comparing it with silver-impregnated sodium carboxymethylcellulose dressing. This was a randomized, prospective, open-label, and controlled pilot study conducted in Fortaleza, Brazil, from April 2019 to December 2019. The 24 participants had ≥18 and ≤70 years of age and superficial partial-thickness burns affecting up to 10% of TBSA. Primary outcomes were the number of dressings performed and pain intensity, assessed via the Visual Analogue Scale and the Electronic von Frey. Secondary outcomes were the level of pain-related anxiety, assessed via the Burns Specific Pain Anxiety Scale, and analgesic consumption. In the test group, the number of dressings and the patient-reported pain after dressing-related procedures were lower. Analgesic intake, pain-related anxiety, and both patient-reported and objectively measured pain before dressing-related procedures were similar for the treatment groups. No adverse effects were detected. LNTS shares the same characteristics of an "'ideal'" wound dressing demonstrated by glycerolized NTS in previous studies. Also, it demonstrated noninferiority for burn management when compared with silver-impregnated sodium carboxymethylcellulose dressing. The safety and efficacy of LNTS demonstrated in this pilot study may allow the development of larger phases II and III RCTs in a near future.

Topics: Adult; Aged; Analgesics; Animals; Bandages; Brazil; Burns; Carboxymethylcellulose Sodium; Cichlids; Female; Humans; Male; Middle Aged; Pain Measurement; Pilot Projects; Prospective Studies; Silver; Skin, Artificial; Wound Healing

This prospective, randomized controlled trial study compared the effects of four dressings for adult partial thickness burns, focusing on re-epithelialization time and cost effectiveness. Adults with partial thickness burns meeting inclusion criteria were randomized to either Biobrane™, Acticoat™, Mepilex® Ag, or Aquacel® Ag. Primary endpoint for analysis was >95% re-epithelialization. Incremental cost-effectiveness ratios were calculated based on dressing costs. Dominance probabilities between treatment arms were calculated from bootstrap resampling trial data. One hunderd thirty-one partial thickness burn wounds in 119 patients were randomized. Adjusting for sex, age, smoking status, burn mechanism, TBSA, and first aid adequacy, Mepilex® Ag had a reduced time to re-epithelialization compared to Biobrane™ (IRR: 1.26; 95% CI: 1.07-1.48, P < .01). Economic analysis showed that there was a 99%, 71%, and 53% probability that Mepilex® Ag dominated (cheaper and more effective) Biobrane™, Acticoat™, and Aquacel® Ag, respectively. Mepilex® Ag achieved faster re-epithelialization and better cost effectiveness. Patient satisfaction and comfort seems better with Biobrane™ although not reflected within the end outcome of the healed wound. It is the patients' (after extensive education) and clinicians' choice, level of experience, and availability of products in praxis that will guide the decision as to which the product is used individually on which patient.

Topics: Adult; Anti-Infective Agents, Local; Bandages; Burns; Carboxymethylcellulose Sodium; Coated Materials, Biocompatible; Female; Humans; Male; Middle Aged; Prospective Studies; Silver Compounds; Sitosterols; Wound Healing; Wound Infection

This prospective, randomised study compares a new transforming methacrylate dressing (TMD) with a silver-containing carboxymethylcellulose dressing (CMC-Ag) after application to split-thickness skin graft (STSG) donor sites. This was an unblinded, non-inferiority, between-patient, comparison study that involved patients admitted to a single-centre burn unit who required two skin graft donor sites. Each patient's donor sites were covered immediately after surgery: one donor site with TMD and the other with CMC-Ag. The donor sites were evaluated until healing or until 24 days post-application, whichever came first. Study endpoints were time to healing, daily pain scores, number of dressing changes, patient comfort and physicians' and patients' willingness to use the dressings in the future. Nineteen patients had both the dressings applied. No statistically significant difference was noted in time to healing between the two dressings (14·2 days using TMD compared with 13·2 days using CMC-Ag). When pain scores were compared, TMD resulted in statistically significantly less pain at three different time periods (2-5 days, 6-10 days and 11-15 days; P < 0·001 at all time periods). Patients also reported greater comfort with TMD (P < 0·001). Users rated TMD as being less easy to use because of the time and technique required for application. Reductions in pain and increased patient comfort with the use of the TMD dressing, compared with CMC-Ag, were seen as clinical benefits as these are the major issues in donor site management.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Burns; Carboxymethylcellulose Sodium; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Male; Middle Aged; Occlusive Dressings; Prospective Studies; Silver Compounds; Skin Transplantation; Surgical Wound Infection; Transplant Donor Site; Wound Healing; Young Adult

Studies comparing contemporary silver dressings in burns are scarce.. In a prospective, randomized, controlled study, counting 50 patients/research group, we compared two frequently used silver dressings, Acticoat™ and Aquacel(®) Ag, in the management of partial thickness burns with a predicted healing time between 7 and 21 days as assessed by laser Doppler imaging between 48 and 72h after burn. Variables investigated were related to baseline research group characteristics, wound healing, bacteriology, economics, nurse, and patient experience.. Both research groups were comparably composed taking into account gender, age and burn characteristics. Similar results were obtained as to healing time and bacterial control with both silver dressings. A statistically significant difference in favor of the Aquacel(®) Ag dressing was found for average ease of use (p<0.001), average ease of application (p=0.001), patient pain (p<0.001), patient comfort with the dressing (p=0.017), silver staining (p<0.001), and cost effectiveness (p<0.001).. Both silver dressings resulted in comparable healing times and bacterial control but the Aquacel(®) Ag dressing significantly increased comfort for patients as well as nurses and was significantly more cost-effective than the Acticoat™ dressing for the given indication.

Topics: Adolescent; Adult; Anti-Infective Agents, Local; Burns; Carboxymethylcellulose Sodium; Child; Cost-Benefit Analysis; Female; Humans; Laser-Doppler Flowmetry; Male; Metal Nanoparticles; Middle Aged; Occlusive Dressings; Pain; Pain Measurement; Polyesters; Polyethylenes; Silver Compounds; Time Factors; Treatment Outcome; Wound Healing; Wound Infection; Young Adult

The primary objective of this study was to compare Aquacel (ConvaTec, Skillman, New Jersey), Allevyn (Smith & Nephew, St Petersburg, Florida), and Mediskin I (Mölnlycke, Health Care AB, Gothenburg, Sweden) in the treatment of split-thickness skin graft donor sites.. This study was performed as a prospective randomized, 3-arm, clinical study.. A clinical study performed at a hand and plastic surgery department with burn unit.. The study included 67 adults with a total of 73 donor sites, which were on the thigh, not reharvested, and ranged between 30- and 400-cm area.. Subjects were randomly assigned to treatment with Aquacel, Allevyn, or Mediskin I.. The donor site was assessed on postoperative days 3, 14, and 21 for healing, infection, pain, impact on everyday life, ease of use, and cost.. The obtained results demonstrate significantly faster re-epithelialization for patients treated with Aquacel or Mediskin I compared with Allevyn. Regarding infections, there were no significant differences between the groups. Patients wearing Aquacel experienced significantly less pain changing the dressing and less impact on everyday life than the patients wearing Allevyn. Aquacel was shown to be significantly easier for the caregiver to use than Allevyn and Mediskin I. There is a significant difference in cost of treatment between the dressings, whereas Mediskin I is the most expensive.. The authors' results support the use of Aquacel in the treatment of split-thickness skin graft donor sites. Aquacel has a low cost per unit, is user friendly, gives short healing time, and minimizes patient discomfort.

Topics: Adult; Aged; Aged, 80 and over; Burn Units; Burns; Carboxymethylcellulose Sodium; Female; Follow-Up Studies; Humans; Injury Severity Score; Male; Middle Aged; Occlusive Dressings; Polyurethanes; Prospective Studies; Risk Assessment; Skin Transplantation; Surgical Wound Infection; Transplant Donor Site; Treatment Outcome; Wound Healing; Young Adult

: The purpose of this investigation was to determine the effectiveness of silver sulfadiazine as compared with Aquacel Ag in patients with superficial partial-thickness burns.. : Twenty-four subjects who sustained superficial partial-thickness burns who were between the ages of 19 and 53 years with time of injury from 0 to 4 days were randomly assigned into a control group (silver sulfadiazine) and experimental group (Aquacel Ag; ConvaTec, Skillman, New Jersey). Wound measurements were assessed at the time of the initial examination and every 4 days afterward until the area was re-epithelialized 100%. To ensure objectivity, the burn area was measured digitally with the software program by Aspyra (Aspyra LLC; Blue Springs, Missouri) to prevent discrepancies in wound measurements.. : Significant differences between the silver sulfadiazine and Aquacel Ag group were noted in pain (silver sulfadiazine: 4.70 ± 2.22, Aquacel Ag: 2.92 ± 1.12) and the number of treatments (silver sulfadiazine: 10.27 ± 7.46, Aquacel Ag: 4.10 ± 1.38).. : Utilization of Aquacel Ag in superficial-partial thickness burns could lead to a decrease in the number of treatments required to re-epithelialize burns 100% with less pain as compared with silver sulfadiazine.

Topics: Adult; Anti-Infective Agents, Local; Bandages; Burns; Carboxymethylcellulose Sodium; Female; Humans; Male; Middle Aged; Pain; Prospective Studies; Silver; Silver Sulfadiazine; Wound Healing

This study was conducted to compare pain, healing time, infection rate, and cosmetic outcome between Aquacel Ag (convatec) and Alginate Silver (coloplast) as donor site dressings.. We conducted a prospective randomized controlled trial of donor site dressings, comparing Aquacel Ag with Alginate Silver. Patients were randomly allocated to donor site dressing with one of these materials. Outcome measures included pain scores at rest and during dressing changes, time to re-epithelialization, cosmetic outcome and infection rate. Results were assessed for significance using the independent t-test (non-parametric data) and the chi-square test (parametric data).. A total of 20 subjects were enrolled in this study. Subjects included in both groups were comparable with no significant differences in demographic data of age, gender, location of burn and type of burns (P > 0.05 evaluated by paired t-test) between both group. The pain scores were found to be higher in Aquacel Ag group than in Alginate Silver group. Time to re-epithelialization was longer in Aquacel Ag group than in Alginate Silver group. There were no significant differences between the two treatment groups with respect to cosmetic outcome and infection rate.. Based on these results, we find that Alginate Silver is better than Aquacel Ag to cover the skin graft donor site.

Topics: Adult; Alginates; Burns; Carboxymethylcellulose Sodium; Drug Carriers; Female; Humans; Incidence; Male; Middle Aged; Occlusive Dressings; Pain Measurement; Prospective Studies; Silver Compounds; Surgical Wound Infection; Transplant Donor Site; Wounds and Injuries

The face is the central point of the physical features; it transmits expressions and emotions, communicates feelings and allows for individual identity. Facial burns are very common and are devastating to the affected patient and results into numerous physical, emotional and psychosocial sequels. Partial thickness facial burns are very common especially among children. This study compares the effect of standard moist open technique management and a moist closed technique for partial thickness burns of the face.. Patients with partial-thickness facial burns admitted in the burn unit, Ain Shams University, Cairo, Egypt in the period from April 2009 to December 2009 were included in this study. They were divided into two groups to receive either open treatment with MEBO(®) (n=20) or coverage with Aquacel(®) Ag (n=20). Demographics (age, gender, ethnicity, TBSA, burn areas), length of hospital stay (LOS), rate of infections, time to total healing, frequency of dressing changes, pain, cost benefit and patient discomfort were compared between the two groups. The long-term outcome (incidence of hypertrophic scarring) was assessed for up to 6 months follow-up period.. There were no significant differences in demographics between the two groups. In the group treated with the Aquacel(®) Ag, the mean time for re-epithelialization was 10.5 days, while it was 12.4 days in the MEBO(®) group (p<0.05). Frequency of changes, pain and patient discomfort were less with Aquacel(®) Ag. Cost was of no significant difference between the two groups. Scar quality improved in the Aquacel(®) Ag treatment group. Three and 6 months follow-up was done and long-term outcomes were recorded in both groups.. Moist occlusive dressing (Aquacel(®) Ag) significantly improves the management and healing rate of partial thickness facial burns with better long-term outcome compared to moist open dressing (MEBO(®)).

Topics: Adolescent; Adult; Bandages; Burns; Carboxymethylcellulose Sodium; Child; Child, Preschool; Egypt; Facial Injuries; Female; Humans; Male; Middle Aged; Occlusive Dressings; Pain Measurement; Silver Compounds; Sitosterols; Wound Healing; Young Adult

Nylon-reinforced silver sodium carboxymethylcellulose (AQUACEL(®) Ag BURN) dressings were developed to be pliable and conforming for the management of partial-thickness burns. This study evaluated the AQUACEL(®) Ag BURN glove for the management of hand burns.. This 21-day, phase II, prospective, non-comparative study included 23 patients with partial-thickness hand burn of at least two fingers. The AQUACEL(®) Ag BURN glove was applied to one hand and could remain in place up to 21 days until clinically indicated to change the glove. Dressings were evaluated 1, 2, 4, 6, 8, 14, and 21 days after initial application. Safety was the primary study endpoint.. Sixteen (70%) hand burns re-epithelialized fully over a mean of 15.6 days. Initial application was easy/very easy for 20 (87%) patients. Mean time for initial dressing application was 5.4 min. At final evaluation, most patients gave ratings of excellent/good for conformability (91%), overall glove performance (74%), and appropriateness of sizes (83%). Mean pain score from 0 (none) to 10 (worst imaginable) was 3.43 at baseline; during the study, mean scores were 1.15 at rest and 2.29 during movement. Of 61 glove removals, most (72%) were easy/very easy, and 12% had fallen off. Adverse events (wound site or elsewhere) occurred in 15 (65%) patients. Treatment-related adverse events were wound pain (17%), maceration (9%), and stiff fingers (4%).. The AQUACEL(®) Ag BURN glove was well tolerated in the management of partial-thickness hand burn. Many patients used only one glove. When glove changes were required, they were usually quick and easy.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bandages; Burns; Carboxymethylcellulose Sodium; Drug Carriers; Female; Hand Injuries; Humans; Male; Middle Aged; Pain Measurement; Patient Compliance; Patient Satisfaction; Prospective Studies; Silver Compounds; Wound Healing

Silver sulfadiazine has been used as a topical burn wound treatment for many years. Pain associated with dressing changes is a common problem in burn wounds. Aquacel Ag, a hydrofiber dressing coated with ionic silver has been reported to reduce burn wound infection and promote antimicrobial activity. The purpose of this study was to show the benefits of Aquacel Ag for the treatment of partial thickness burns. This prospective randomized study was conducted in 70 patients who had partial thickness burns less than 15% of total body surface area and were treated at Siriraj outpatient burn clinic during December 2006-February 2008. Patients were divided into two groups: Aquacel Ag-treated group with dressing changes every 3 days (35 patients) and 1% silver sulfadiazine-treated group, with daily dressing changes (35 patients). There was no difference in demographic data including age, gender, burn percentage between groups. Time-to-wound healing pain score during dressing change and cost of treatment were compared between both groups. Time-to-wound closure was significantly shorter in the Aquacel Ag-treated group (10 +/- 3 versus 13.7 +/- 4 days, P < 0.02) as well as pain scores at days 1, 3 and 7 (4.1 +/- 2.1, 2.1 +/- 1.8, 0.9 +/- 1.4 versus 6.1 +/- 2.3, 5.2 +/- 2.1, 3.3 +/- 1.9, respectively, P < 0.02). Total cost of treatment was 52 +/- 29 US dollars for the Aquacel Ag-treated group versus 93 +/- 36 US dollars for the silver sulfadiazine-treated group. This study showed that Aquacel Ag increased time to healing, decreased pain symptoms and increased patient convenience because of limiting the frequency of replacement of the dressing at lower total cost. This study confirms the efficacy of Aquacel Ag for the treatment of partial thickness burns at an outpatient clinic.

Topics: Adult; Ambulatory Care; Anti-Infective Agents, Local; Body Surface Area; Burns; Carboxymethylcellulose Sodium; Cost-Benefit Analysis; Female; Hospital Costs; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Pain; Prospective Studies; Silver Sulfadiazine; Skin Care; Thailand; Time Factors; Travel; Treatment Outcome; Wound Healing

A newly developed, carboxymethylcellulose based hydrofibre dressing, Aquacel, was tested for the treatment of partial thickness burns. In this study 84 patients with mainly partial thickness burns were included, 76 patients received 1 or 2 days pre-treatment with a topical antimicrobial agent. Clinical behaviour showed a strong resemblance with cadaver skin treatment with respect to adherence to the wound. Adverse reactions, incidence of clinical wound infection, healing time and the need for wound excision and grafting were analysed, as was the final outcome using the 'Vancouver Scar Scale'. The mean size of the wounds treated with the hydrofibre dressing was 6.0% body surface area (min: 1%, max: 18%). Two patients clinically showed signs of a wound infection during treatment, but in general wound cultures were low or negative. In 42 patients (50%) the wounds healed completely within 10 days, in six patients (7%) small defects remained that healed by further treatment with a topical antimicrobial cream. In 36 patients (43%) excision and grafting of the remaining deeper parts of the wounds was performed as this is the standard therapy in the centre for all burned areas that have not healed within 2-3 weeks post-injury. The extent of the surgical procedures was limited since 66.1% of the wound area had healed already at the end of the hydrofibre treatment. In 54 patients the outcome of the treatment after 2-3 months was analysed by means of the Vancouver Scar Scale, which showed favourable results in general, and especially for patients who did not require surgery. Compared to earlier experience with allograft skin it was concluded that hydrofibre dressing is a safe, suitable and easy to use material for treatment of partial thickness burns.

Topics: Adolescent; Adult; Biocompatible Materials; Burns; Carboxymethylcellulose Sodium; Child; Child, Preschool; Debridement; Female; Follow-Up Studies; Humans; Infant; Injury Severity Score; Male; Middle Aged; Occlusive Dressings; Reference Values; Skin Transplantation; Time Factors; Treatment Outcome; Wound Healing

Overcoming bacterial infections and promoting wound healing are significant challenges in clinical practice and fundamental research. This study developed a series of enzymatic crosslinking injectable hydrogels based on silk fibroin (SF), carboxymethyl cellulose (CMC), and agarose, with the addition of polydopamine functionalized graphene oxide (GO@PDA) to endow the hydrogel with suitable conductivity and antimicrobial activity. The hydrogels exhibited suitable gelation time, stable mechanical and rheological properties, high water absorbency, and hemostatic properties. Biocompatibility was also confirmed through various assays. After loading the antibiotic vancomycin hydrochloride, the hydrogels showed sustained release and good antibacterial activity against methicillin-resistant Staphylococcus aureus (MRSA). The fast gelation time and desirable tissue-covering ability of the hydrogels allowed for a good hemostatic effect in a rat liver trauma model. In a rat full-thickness burn wound model, the hydrogels exhibited an excellent treatment effect, leading to significantly enhanced wound closure, collagen deposition, and granulation tissue formation, as well as neovascularization and anti-inflammatory effects. In conclusion, the antibacterial electroactive injectable hydrogel dressing, with its multifunctional properties, significantly promoted the in vivo wound healing process, making it an excellent candidate for full-thickness skin wound healing.

Topics: Animals; Anti-Bacterial Agents; Antioxidants; Burns; Carboxymethylcellulose Sodium; Fibroins; Hemostasis; Hemostatics; Hydrogels; Methicillin-Resistant Staphylococcus aureus; Rats; Sepharose; Skin; Wound Healing

To evaluate the morphometric, macroscopic and microscopic aspects of experimentally induced partial-thickness burns in rats treated with different silver-based dressings.. Wistar rats were used, divided into six treatments: saline (NaCl 0.9%); silver sulfadiazine 1%; Silvercel; Mepilex Ag; Aquacel Ag and Acticoat. The animals were monitored daily and euthanized at 7, 14 and 30 days after injury induction (DAI).. At 7 DAI, necrosis/crust was greater in control, silver sulfadiazine and Mepilex Ag treatments, granulation tissue was induced by Aquacel Ag, polymorphonuclear infiltrate (PMN) infiltration was intensified by Mepilex Ag; mononuclear infiltrate (MN) infiltration and angiogenesis were increased by Silvercel. At 14 DAI, hemorrhage was decreased by Silvercel and Mepilex Ag, PMN infiltration increased by Acticoat. At 30 DAI, angiogenesis was greater in the Acticoat treatment and fibroblasts were increased by Acticoat and Mepilex Ag. Collagen was induced at 14 DAI by silver sulfadiazine and Aquacel Ag and, at 30 DAI, by silver sulfadiazine and Silvercel treatments.. Silvercel and Acticoat presented better results than the other products. However, all the dressings were better than the control at some point during the process, and may contribute to the healing of partial thickness burns. Silvercel and Aquacel Ag treatments induced better cosmetic outcomes regarding wound closure and scarring.

Topics: Animals; Bandages; Burns; Carboxymethylcellulose Sodium; Rats; Rats, Wistar; Silver; Silver Sulfadiazine

An ideal dressing should ensure that the wound remains moist with exudates but not macerated. Currently, there is no dressing available to suit all wounds, at all stages of the healing process. Although silver-containing dressings are the gold standard for burn wound care, few high-level trials have been completed comparing the clinical utilities of these dressings. In our study, five different types of wound dressings: carboxymethyl cellulose hydrofiber dressing with ionized silver (CMCH-Ag), polyethylene-polyethylene terephthalate aqua fiber dressing with elementary silver (PPAF-Ag), calcium alginate (CA), calcium + zinc alginate (CZA), and 0.2% nitrofurazone-embedded (NF) gauze dressings were compared in regard to histopathological parameters. Children aged between 0 and 18 years with small or middle-sized partial-thickness burns that affected less than 30% of the total body surface area were included in this study. The study groups (CMCH-Ag, PPAF-Ag, CA, and CZA) and the control group (NF) were randomly attained. Wound healing was evaluated by punch biopsies on the 21st day. The thickness of the stratum corneum and the epithelium, the number of papillae, and the papillary length were calculated and compared. The histological parameters of healing, except the stratum corneum thickness, did not show any statistical significance among the groups (P > .05). The dressings that included silver, calcium, or zinc showed useful and similar effects in noninfective burn wounds when compared with nitrofurazone-only dressings. Thus, it may be concluded that silver-containing wound dressings should not be considered as the gold standard in noninfective partial-thickness burn wounds in children.

Topics: Adolescent; Alginates; Bandages; Burns; Carboxymethylcellulose Sodium; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Nitrofurazone; Polyethylene Terephthalates; Silver; Wound Healing; Zinc

Topics: Accidents, Traffic; Axilla; Burns; Carboxymethylcellulose Sodium; Cicatrix; Humans; Male; Wound Healing; Young Adult

Few burn dressings can self-regulate the optimal humidity levels that are required for wound healing, while also providing good anti-adhesive properties to prevent damage that can occur when wound dressings are changed. Consequently, a water-soluble carboxymethylcellulose sodium/sodium alginate/chitosan (CMC-Na/SA/CS) composite hydrogel has been developed as a potential burn wound dressing, with orthogonal testing revealing an optimal ratio of CMC-Na, SA, and CS as 2, 3, and 1 wt % for hydrogel preparation, respectively. The resultant hydrogel has been formulated into composite wound dressings that were then used for the treatment of deep second degree burn wounds in Sprague-Dawley (SD) rats. Analysis of the physical properties of this dressing revealed that it exhibits good water vapor permeability properties that promote the healing of deep second-degree burn wounds. The pro-healing mechanism of the dressing has been investigated Vascular endothelial growth factor (VEGF) expression was upregulated and basic fibroblast growth factor (bFGF) expression was downregulated in the early periods of wound healing, with upregulation of bFGF then occurring at a later stage of wound healing. At the same time, the wound dressing decreased the levels of tumor necrosis factor-α and interleukin-6, thus validating its beneficial effect on the wound healing process at a biomolecular level. In conclusion, this new hydrogel dressing was shown to exhibit excellent self-regulatory and anti-adhesive properties that synergistically promote the healing of burn wounds in rats, thus providing promising results that may have clinical applications. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1471-1482, 2019.

Topics: Alginates; Animals; Burns; Carboxymethylcellulose Sodium; Chitosan; Disease Models, Animal; Hydrogels; Male; Rats; Rats, Sprague-Dawley; Tissue Adhesions; Wound Healing; Wounds and Injuries

Perineural adherences represent a problem after surgery involving peripheral neural system. Fat-grafting with adipose derived stem cells (ASCs) with their pro-regenerative characteristics can be important to prevent the neural damage or to facilitate the neural regeneration. Our idea was to use the fat-grafting as an anti-adherence device and test its efficacy on a postsurgical scar animal model and comparing to an antiadhesive gel. 32 athymic mice were operated under magnification, we exposed both sciatic nerves. We randomly divided all sciatic nerves into four experimental groups: burning (1), burning + carboxy-methylcellulose and poly- ethylene oxide (CMC-PEO) (2) + human adipose fat tissue (3), control group (4). Bio-mechanical evaluation was performed to measure the peak force required to pull out the nerve from the muscular bed.. in the CMC-PEO group the peak pull out force was 0.37 Newton. In the fat grafted group we registered a peak pull out force of 0.35 N (t Student 0.913). In burning group the force necessary to tear the nerve apart was markedly superior (0.46 N). In control group, we reported the minimal strength (0.31 N) to slide the nerve from the tissue. Histologically, in the group treated with fat-grating, a thinner scar layer was highlighted. Considering the results of this study we can support the efficacy in animal experimental model of fat graft as an anti-adherence device in peripheral nerve surgery.

Topics: Adhesiveness; Adipose Tissue; Animals; Burns; Carboxymethylcellulose Sodium; Cicatrix; Disease Models, Animal; Humans; Mice; Mice, Nude; Nerve Regeneration; Polyethylene Glycols; Sciatic Nerve

Alginate is a natural rich anionic polysaccharide (APS), commonly available as calcium alginate (CAPS). It can maintain a physiologically moist microenvironment, which minimises bacterial infection and facilitates wound healing at a wound site. Patients with burn injuries suffer from pain and an inflammatory response. In this study, we evaluated the CAPS dressing and traditional dressing containing carboxymethyl cellulose (CMC) for wound healing and scar tissue formation in a burn model of rat and swine. In our pilot study of a burn rat model to evaluate inflammatory response and wound healing, we found that the monocyte chemoattractant protein (MCP)-1 and transforming growth factor (TGF)-β were up-regulated in the CAPS treatment group. Next, the burn swine models tested positive for MCP-1 in a Gram-positive bacterial infection, and there was overproduction of TGF-β during the burn wound healing process. Rats were monitored daily for 1 week for cytokine assay and sacrificed on day 28 post-burn injury. The swine were monitored over 6 weeks. We further examined the pain and related factors and inflammatory cytokine expression in a rodent burns model monitored everyday for 7 days post-burn. Our results revealed that the efficacy of the dressing containing CAPS for wound repair post-burn was better than the CMC dressing with respect to natural wound healing and scar formation. The polysaccharide-enriched dressing exerted an antimicrobial effect on burn wounds, regulated the inflammatory response and stimulated anti-inflammatory cytokine release. However, one pain assessment method showed no significant difference in the reduction in levels of adenosine triphosphate in serum of rats after wound dressing in either the CAPS or CMC group. In conclusion, a polysaccharide-enriched dressing outperformed a traditional dressing in reducing wound size, minimising hypertrophic scar formation, regulating cytokines and maximising antimicrobial effects.

Topics: Alginates; Animals; Bandages, Hydrocolloid; Burns; Carboxymethylcellulose Sodium; Disease Models, Animal; Glucuronic Acid; Hexuronic Acids; Pilot Projects; Rats; Swine; Wound Healing

Monitoring patients with burn wounds for infection is standard practice because failure to rapidly and specifically identify a pathogen can result in poor clinical outcomes, including death. Therefore, a method that facilitates detection and identification of pathogens in situ within minutes of biopsy would be a significant benefit to clinicians. Mass spectrometry is rapidly becoming a standard tool in clinical settings, capable of identifying specific pathogens from complex samples. Imaging mass spectrometry (IMS) expands the information content by enabling spatial resolution of biomarkers in tissue samples as in histology, without the need for specific stains/antibodies. Herein, a murine model of thermal injury was used to study infection of burn tissue by Pseudomonas aeruginosa. This is the first use of IMS to detect P. aeruginosa infection in situ from thermally injured tissue. Multiple molecular features could be spatially resolved to infected or uninfected tissue. This demonstrates the potential use of IMS in a clinical setting to aid doctors in identifying both presence and species of pathogens in tissue.

Topics: Animals; Biomarkers; Burns; Carboxymethylcellulose Sodium; Disease Models, Animal; Gelatin; Mice; Optical Imaging; Pseudomonas aeruginosa; Pseudomonas Infections; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization

The aim of this study was to compare the clinical outcomes of different treatment strategies for children with partial-thickness scalds at two burn centers. At the first burn center, these burns were treated with a hydrofiber dressing (Aquacel. A two-center retrospective study was conducted of children admitted between January 2009 and December 2013 for partial-thickness scalds up to 10% TBSA who were treated primarily with a hydrofiber dressing or silver sulfadiazine (Burn Center Rotterdam) vs. cerium nitrate-silver sulfadiazine (Burn Center Groningen). The Dutch Burn Repository R3 and the electronic medical records of the study population were used for data extraction. The primary outcome was the time to wound healing. The secondary outcomes were the length of hospital stay, wound infection, and surgical treatment.. The time to wound healing differed between the groups (HR=1.46, 95%CI 1.17-1.82); the shortest time to wound healing was observed in the patients treated with CN-SSD (median 13 days), compared with 15 days for the patients treated with hydrofiber and 16 days for the patients treated with SSD (p<0.01). The length of stay was significantly shorter for the hydrofiber patients (medians: hydrofiber 3 days, SSD 10 days and CN-SSD 7 days; p<0.01), but their outpatient treatment period was significantly longer (medians: hydrofiber 12 days, SSD 6 and CN-SSD 4 days; p<0.01). The proportion of surgeries and the mean time to surgery was similar between the burn centers.. This study compared different burn centers' treatment strategies for children with partial-thickness scalds and found a shorter time to wound healing in the CN-SSD group. Patients treated with hydrofiber had a shorter clinical period in comparison with the SSD and CN-SSD patients. The results of CN-SSD are promising and warrant further study. A prospective study is needed to gain full insight into the merits and drawbacks of the treatment strategies. This will allow clinicians to make full use of the strengths of particular treatments to benefit specific patients.

Topics: Adolescent; Anti-Infective Agents, Local; Burns; Carboxymethylcellulose Sodium; Cerium; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Length of Stay; Male; Netherlands; Proportional Hazards Models; Retrospective Studies; Silver Sulfadiazine; Trauma Severity Indices; Wound Healing

Various types of wound dressings have been designed for different purposes and functions. Controlling bacterial burden in a wound during the early phase is important for successful wound repair. Once bacterial burden is under control, the active promotion of wound healing is another important factor for efficient wound healing. This study investigated the potential of three silver-containing dressings, namely KoCarbonAg(®) , Aquacel(®) Ag and Acticoat 7, in reducing bacterial survival and promoting wound healing. The ability of these dressings to block the entry of bacteria from external environment and retain intrinsic bacteria was studied in vitro. In addition, the study used a rat model to compare the healing efficiencies of the three dressings and investigate the quantity of collagen synthesis in vivo. In vitro results indicated that the silver-containing dressings prevented bacterial growth in wounds by blocking the entry of external bacteria and by retaining the bacteria in the dressing. In vivo study indicated that reduction in bacterial burden accelerated wound healing. Wounds treated by the silver-containing dressings showed better healing than those treated with gauze. Moreover, KoCarbonAg(®) further accelerated wound healing by promoting collagen synthesis and arrangement.

Topics: Animals; Bandages; Burns; Carboxymethylcellulose Sodium; Rats; Silver; Wound Healing

Perineural scar formation is responsible for pain and loss of function after surgical procedures. Neurolysis and application of anti-adhesion gels are required to restore a gliding surface. We tested a carboxymethylcellulose (CMC) and polyethylene oxide (PEO) gel on mouse sciatic nerve to describe its safety and efficacy.. Adult mice underwent a surgical procedure in which we burned the muscular bed of the sciatic nerve bilaterally (Burned group) and applied anti-adhesion gel to 1 of the nerves (Burned+gel group). After 3 weeks, we studied scar tissue by biomechanical and histological evaluation.. Both histological and biomechanical analysis showed that the gel reduced perineural scarring. The difference between the Burned and Burned+gel groups was statistically significant.. CMC-PEO gel can reduce perineural scar tissue. In histological section, scar tissue was present in both groups, but in the Burned+gel group a gliding surface was identified between scar and nerve.

Topics: Animals; Biomechanical Phenomena; Burns; Carboxymethylcellulose Sodium; Disease Models, Animal; Mice; Mice, Inbred ICR; Peripheral Nervous System Diseases; Polyethylene Glycols; Surface-Active Agents

Burn injury is one of the most common reasons for admission in paediatric population. There is currently no international consensus on the best wound dressing material. Aquacel Ag, a new silver containing hydrofiber dressing material has been reported to produce good clinical results. Yet, only a limited number of studies exist in the paediatric population. This study aims to review our experience of burn management over the past 5 years and to evaluate the effectiveness of Aquacel Ag in the management of partial thickness burns.. A retrospective review of all patients admitted for burn injury between January 2010 and December 2014 was conducted. Patients' demographics, mechanism of injury, body surface areas involved, treatment applied, and clinical outcomes were analyzed. Patients with superficial injury, full thickness burns that required surgical debridement, burn area less than 2 % or more than 25 % of total body surface area, or incomplete clinical data were excluded from the comparative study.. A total of 119 patients were identified. 114 (96 %) was due to domestic injury, of which 108 (91 %) was food-related. The most commonly affected areas were limbs (n = 89, 74.8 %), followed by trunk (n = 62, 74.8). 84 patients fulfilled the inclusion criteria and were recruited into the study. 31 patients received Aquacel Ag dressing and 53 patients received standard paraffin gauze dressing. The two groups showed no statistical difference in age, sex, percentage of total body surface area involved, and infection rate. Outcomes of patients treated with Aquacel Ag were compared with patients treated with standard dressing. The mean hospital stay was significantly shorter for the Aquacel Ag group (14.26 vs 23.45, p = 0.045). Aquacel Ag group required much less frequent dressing change (5.67 vs 20.59, p = 0.002). 5 patients in standard dressing group developed hypertrophic scar and required prolonged pressure garment, whereas only one hypertrophic scar was observed in the Aquacel Ag group.. Aquacel Ag appears to promote early burn wound healing with less hypertrophic scar formation.

Topics: Administration, Topical; Bandages; Burns; Carboxymethylcellulose Sodium; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Length of Stay; Male; Retrospective Studies; Silver; Trauma Severity Indices; Treatment Outcome; Wound Healing

Topics: Bandages; Burns; Carboxymethylcellulose Sodium; Child; Humans; Silver

Occlusive dressings for second-degree hand burns in children must prevent infection and promote healing. For good management of analgesia, these treatments often require children to be hospitalized. Our goal was to find an alternative to conventional care protocol that would reduce the number of dressings and therefore the length of hospitalization. We report our experience with the use of Aquacel(®) Burn.. Non-randomized monocentric prospective study was conducted from 2012 to 2014. The glove was used in the operating room within 72hours after the burn in children younger than 15 years old with isolated superficial to deep 2nd degree hand burns. Once the glove was perfectly stuck to the burn, the children could go back home. We saw them 10 to 12 days after the accident to be sure there was no indication of skin graft.. Twenty gloves were used in 16 children aged from 16 months to 13 years. The average length of stay (ALOS) was five days to put the glove on and one day to remove it. Four hands were grafted.. Once we get used to the product, Aquacel(®) Burn gloves have reduced the ALOS before skin graft in cases of isolated hand burns in children.

Topics: Adolescent; Burns; Carboxymethylcellulose Sodium; Child; Child, Preschool; Female; Hand Injuries; Humans; Infant; Length of Stay; Male; Occlusive Dressings; Prospective Studies

The aim of this study was to compare clinical outcome of children with scald burns treated with a hydrofiber dressing (Aquacel(®), Convatec Inc.) with the former standard of care with silver sulfadiazine (Flammazine(®); Solvay Pharmaceuticals), considering surgical intervention and length of stay (LOS).. A retrospective study of all consecutive children from zero to four years with primary scald burns up to 10% admitted to the Burn Centre of the Maasstad Hospital Rotterdam between January 1987 and January 2010 were reviewed. For data collection a prospective computerized database was used. For comparison the study period was divided into two periods representing the period before and after the introduction of the hydrofiber dressing (HFD), respectively 1987-1999 (period 1) and 1999-2010 (period 2).. Over the whole study period 27.3% of 502 patients treated with silver sulfadiazine (Ag-SD) underwent surgery, while before the introduction of HFD 30.5% of 338 Ag-SD treated patients were operated upon. After the introduction of the HFD 20.7% of 164 patients treated with Ag-SD eventually underwent skin grafting, a significant difference with the 11.6% of 302 patients whose wounds were dressed with HFD (p<0.01).. Compared to silver sulfadiazine treatment a reduced number of surgical interventions was observed in mixed partial thickness scald burns up to 10% TBSA burned in children aged 0-4 years after the introduction of hydrofiber dressings. The mode of treatment with this wound dressing also limited hospital length of stay.

Topics: Analysis of Variance; Anti-Infective Agents, Local; Burns; Carboxymethylcellulose Sodium; Child, Preschool; Drug Carriers; Female; Humans; Infant; Length of Stay; Male; Netherlands; Occlusive Dressings; Patient Readmission; Retrospective Studies; Silver Sulfadiazine; Skin Transplantation; Wound Healing

Topics: Anti-Infective Agents, Local; Burns; Carboxymethylcellulose Sodium; Female; Humans; Male; Occlusive Dressings; Silver Sulfadiazine; Skin Transplantation

Firewalking is a common Taoist cleansing ceremony in Taiwan, but burns associated with the practice have rarely been reported. We analyzed the patients with plantar burns from one firewalking ceremony.. In one firewalking ceremony, 12 Taoist disciples suffered from contact burns to the soles of their feet while walking over burning coals. Eight of them had at least second-degree burns over areas larger than 1% of their total body surface areas (TBSAs). The age, sex, medical history, date of injury, time taken to traverse the fire pit, depth and TBSA of the burns, treatment, length of stay, and outcome were recorded and analyzed.. Deep, disseminated second- to third-degree burns were noted and healing took as long as three weeks in some patients. Because disseminated hypertrophic scars form after burns, the soles involved regain much of their tensile strength while walking. The patients experienced only a few difficulties in their daily lives three months after injury.. From our experience treating patients with deep disseminated second- to third-degree plantar burns caused by firewalking, we conclude that they should be treated conservatively, with secondary healing rather than a skin graft.

Topics: Adult; Anti-Infective Agents, Local; Bandages; Burns; Carboxymethylcellulose Sodium; Ceremonial Behavior; Cicatrix, Hypertrophic; Fires; Foot Injuries; Holidays; Humans; Length of Stay; Male; Middle Aged; Religious Philosophies; Silver Sulfadiazine; Taiwan; Wound Healing

For centuries silver and silver compounds have been in use to control infection and avoid septicaemia in the care of burns and chronic wounds. Renewed interest has resulted in a number of Ag based dressings that are now widely used in burns centres. Despite extensive use, a systematic study of the chemical composition, release kinetics and biochemical action of these products has yet to be published. In this work we have characterized the morphology of four commercial Ag dressings by scanning electron microscopy and the silver content was determined to range between 1.39 mg/cm(2) and 0.03 mg/cm(2). Release kinetics in three different matrices (ultra pure water, normal saline solution and a human serum substitute) were determined. The highest rates were found in serum substitute, with a maximum of 4099 μg/(hcm(2)) to a minimum of 0.0001 μg/(hcm(2)). Our results show that the mean inhibitory concentrations are exceeded for most common pathogens in serum substitute and sterile water, but the presence of high Cl(-) concentrations tend to inactivate the dressings.

Topics: Bandages; Burns; Carboxymethylcellulose Sodium; Microscopy, Electron, Scanning; Polyesters; Polyethylenes; Serum; Silver; Sodium Chloride; Water

This study investigated critical physicochemical attributes of low (LV), medium (MV) and high molecular weight (HV) sodium carboxymethylcellulose (SCMC) scaffolds in partial thickness wound healing. SCMC scaffolds were prepared by solvent-evaporation technique. Their in vitro erosion, moisture affinity, morphology, tensile strength, polymer molecular weight and carboxymethyl substitution, and in vivo wound healing profiles were determined. Inferring from rat wound size, re-epithelialization and histological profiles, wound healing progressed with HV scaffold>LV-MV scaffold>control with no scaffold. The transepidermal water loss (TEWL) from wound of rats treated by control>HV scaffold>LV-MV scaffold. HV scaffold had the highest tensile strength of all matrices and was resistant to erosion in simulated wound fluid. In spite of constituting small nanopores, it afforded a substantial TEWL than MV and LV scaffolds from wound across an intact matrix through its low moisture affinity characteristics. The HV scaffold can protect moisture loss without its excessive accumulation at wound bed which hindered re-epithelialization process. Regulation of transepidermal water movement and wound healing by scaffolds was governed by SCMC molecular weight instead of its carboxymethyl substitution degree or matrix pore size distribution, with large molecular weight HV preferred over lower molecular weight samples.

Topics: Animals; Bandages, Hydrocolloid; Burns; Carboxymethylcellulose Sodium; Chemical Phenomena; Disease Models, Animal; Male; Materials Testing; Rats; Rats, Sprague-Dawley; Skin; Spectroscopy, Fourier Transform Infrared; Tensile Strength; Wound Healing

Since using a novel silver-impregnated antimicrobial dressing (Aquacel Ag, ConvaTec, Princeton, NJ) in our pediatric patients with partial-thickness burns, hospital LOS has been significantly reduced. Here we investigated whether there was concomitant cost-effectiveness of this approach.. We retrospectively reviewed Burn Registry Data from a large Children's Hospital Burn Unit from January 2005 through August 2005 for inpatients with partial-thickness burns treated with Aquacel Ag. A comparison group was composed of patients from the same period the previous year treated with silver sulfadiazine cream (SSD, Par Pharmaceuticals, Woodcliff, NJ) and matched for age and %TBSA burned. Patients with inhalation injury or full-thickness burns were excluded. Intent-to-treat analysis was limited to patients with less than 22% TBSA burn. Direct costs and total charges were compared statistically after log transformation due to the skewedness of the data.. Total charges and direct costs were significantly lower for Aquacel Ag-treated patients (n = 38) than for SSD-treated patients (n = 39) (P = .004 and P < .001, respectively). In addition, Aquacel Ag-treated patients had a shorter LOS than SSD-treated patients.. These data strongly support our findings that the application of Aquacel Ag reduces hospital LOS which results in a significant cost savings in the care of pediatric patients with partial-thickness burns.

Topics: Anti-Infective Agents, Local; Burns; Carboxymethylcellulose Sodium; Cost-Benefit Analysis; Hospital Costs; Humans; Length of Stay; Occlusive Dressings; Registries; Retrospective Studies; Silver Compounds

Topics: Burn Units; Burns; Carboxymethylcellulose Sodium; Health Surveys; Humans; Occlusive Dressings; Professional Practice; Surveys and Questionnaires; United Kingdom

Deep dermal partial-thickness scalds remain one of the most common types of injuries in childhood. Local treatment of those wounds, alternatively described as IIb degree, is still very controversial. Some authors advise conservative treatment of such wounds, pointing to their ability to self-reepithelialise, which is possible but significantly prolonged. Other investigators postulate operative treatment, i.e., tangential necrectomy and split-thickness autologous skin grafting, which may shorten the time of wound healing. Arguments call for contra-arguments, and the problem still seems to be unresolved. There is indeed a lack of acceptable standardisation of the local treatment for deep dermal partial-thickness scalds in the paediatric population. The results of both conservative and operative treatment of 114 children aged between 3 months and 17 years, treated for deep dermal partial-thickness scalds from 1997 to 2004 are presented. The treatment of five groups of patients, divided into groups based on the extent of their burn wounds, is evaluated. The patients were treated by tangential necrectomy and skin grafting, mechanical dermabrasion, Granuflex(R) (Convatec) hydrocolloid dressings, Iruxol Mono(R) (Knoll) enzymatic dressings, or Aquacel Ag(R) (Convatec) hydrofibre dressings with silver ions. A number of parameters of wound healing were analysed. The results of this paper encouraged us to present and discuss a proposition for the standardisation of local treatment of deep dermal partial-thickness burn wounds in the paediatric population, according to the extent of injury.

Topics: Administration, Topical; Adolescent; Burns; Carboxymethylcellulose Sodium; Child; Child, Preschool; Chloramphenicol; Debridement; Dermabrasion; Dermis; Drug Combinations; Female; Follow-Up Studies; Humans; Infant; Male; Microbial Collagenase; Occlusive Dressings; Retrospective Studies; Skin Transplantation; Transplantation, Autologous; Trauma Severity Indices; Treatment Outcome; Wound Healing

Topics: Administration, Topical; Adolescent; Adult; Burns; Carboxymethylcellulose Sodium; Female; Humans; Male; Methylcellulose; Middle Aged; Occlusive Dressings; Time Factors