Silver containing hydrofiber dressing promotes wound healing in paediatric patients with partial thickness burns

Chinese expert consensus on the Management of Pediatric Deep Partial-Thickness Burn Wounds (2023 edition)

Burns are a main cause of accidental injuries among children in China. Because of the unique wound repair capacity and demand for growth in pediatric patients, the management of pediatric deep partial-thickness burn wounds involves a broader range of treatment options and controversy. We assembled experts from relevant fields in China to reach a consensus on the key points of thermal-induced pediatric deep partial-thickness burn-wound management, including definition and diagnosis, surgical treatments, nonsurgical treatment, choice of wound dressings, growth factor applications, infectious wound treatment, scar prevention and treatment. The committee members hope that the Expert Consensus will provide help and guiding recommendations for the treatment of pediatric deep partial-thickness burn wounds.

Treatment of experimentally induced partial-thickness burns in rats with different silver-impregnated dressings

PURPOSE

To evaluate the morphometric, macroscopic and microscopic aspects of experimentally induced partial-thickness burns in rats treated with different silver-based dressings.

METHODS

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).

RESULTS

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.

CONCLUSIONS

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.

Pediatric deep burn management after split-thickness autologous skin transplantation: A comparative study

Treatment of pediatric deep burns remains a challenge for healthcare personnel. After skin grafting, several treatment options are available, but comparative studies of the different options are scarce. Here, we compared the effectiveness of 2 postoperative dressings used to treat deep pediatric burns after split-thickness skin grafting.At the Department of Paediatrics, University of Pécs, 16 children received skin transplantation after the deep second and third-degree injuries between January 1, 2012 and December 31, 2020 whose results have been analyzed, in this cohort study. We compared the traditionally used Grassolind or Mepitel net and Betadine solution (comparison group) with Aquacel Ag foam and Curiosa gel (intervention group).Seven children were included in the comparison and 9 children in the intervention group. In the control group, the average number of anesthesia was 6.29, while the number of dressing changes was 4.29. After complete wound closure, the dressing's final removal was on the 13th day, while the mean length of hospitalization was 21.89 days. On average, in the intervention group, 3.56 anesthesia was induced, and 0.66 dressing changes were needed after transplantation. Complete healing (dressing removal) was on the 10th day, and the mean length of hospitalization was 12.38 days.In the intervention group, the need for anesthesia significantly decreased by 43% (P = .004), and they required 84% fewer dressing changes after transplantation (P = .001). Moreover, the dressing could be removed 3 days earlier, and the length of hospitalization was reduced by 45% on average.

First-Line Interactive Wound Dressing Update: A Comprehensive Review of the Evidence

Wound management is a significant and growing issue worldwide. Knowledge of dressing products and clinical expertise in dressing selection are two major components in holistic wound management to ensure evidence-based wound care. With expanding global market of dressing products, there is need to update clinician knowledge of dressing properties in wound care. Optimal wound management depends on accurate patient assessment, wound diagnosis, clinicians’ knowledge of the wound healing process and properties of wound dressings. We conducted a comprehensive review of the physical properties of wound dressing products, including the advantages and disadvantages, indications and contraindications and effectiveness of first-line interactive/bioactive dressing groups commonly used in clinical practice. These include semipermeable films, foams, hydroactives, alginates, hydrofibers, hydrocolloids, and hydrogels. In making decisions regarding dressing product selection, clinicians need to ensure a holistic assessment of patient and wound etiology, and understand dressing properties when making clinical decisions using wound management guidelines to ensure optimal patient outcomes. This review has highlighted there is lack of high quality evidence and the need for future well designed trials.

Antibiotic ointment versus a silver-based dressing for children with extremity burns: A randomized controlled study

INTRODUCTION

Antibiotic or silver-based dressings are widely used in burn wound care. Our standard method of dressing pediatric extremity burn wounds consists of an antibiotic ointment or nystatin ointment-impregnated nonadherent gauze (primary layer), followed by rolled gauze, soft cast pad, plaster and soft casting tape (3M™ Scotchcast™, St. Paul, MN). The aim of this study was to compare our standard ointment-based primary layer versus Mepitel Ag^® (Mölnlycke Health Care, Gothenburg, Sweden) in the management of pediatric upper and lower extremity burn wounds.

METHODS

Children with a new burn injury to the upper or lower extremities, who presented to the burn clinic were eligible. Eligible children were enrolled and randomized, stratified by burn thickness, to be dressed in an ointment-based dressing or Mepitel Ag®. Study personnel and participants were not blinded to the dressing assignment after randomization. Dressings were changed approximately once or twice per week, until the burn wound was healed or skin-grafted. The primary outcome was time to wound healing and p-value < 0.05 was considered significant.

RESULTS

Ninety-six children with 113 upper or lower extremity burns were included in the analysis. Mepitel Ag® (hazard ratio [HR] 0.57 (95% Confidence Interval (CI) 0.40-0.82); p = 0.002) significantly reduced the rate of wound healing, adjusting for burn thickness and fungal wound infection. The incidence of fungal wound infections and skin grafting was similar between the two groups. Children randomized to standard ointment dressings were significantly less likely to require four or more burn clinic visits than those in the Mepitel Ag^® (4% versus 27%; p = 0.004).

CONCLUSION

Our study shows that our standard ointment-based dressing significantly increases the rate of wound healing compared to Mepitel Ag^® for pediatric extremity burn injuries.

LEVEL OF EVIDENCE

Treatment study; Level 1.

Early resuscitation and management of severe pediatric burns

Pediatric burns are a leading cause of injury and mortality in children in the United States. Prompt resuscitation and management is vital to survival in severe pediatric burns. Although management principles are similar to their adult counterparts, children have unique pathophysiologic responses to burn injury thus an understanding of the differences in fluid resuscitation requirements, airway management, burn and wound care is essential to optimize their outcomes.

Treatment of partial thickness hand burn injuries in children with combination of silver foam dressing and zinc-hyaluronic gel: Case reports

RATIONALE

Burns is a common type of traumatic injury in childhood. Nowadays, several wound dressings are available to treat the second-degree hand burns conservatively.

PATIENT CONCERNS, DIAGNOSES

At the authors' institute, 37 children were treated conservatively with a special dressing at first intervention containing Aquacel Ag foam and Zn-hyaluronic gel to determine their effectiveness on partial thickness hand burns.

INTERVENTIONS

The dressing was checked on the second day, and removed on the sixth or seventh day (unless it had spontaneously separated).

OUTCOMES

None of the 37 children treated with this dressing were diagnosed with wound infection. The authors observed the epithelialization of the burned areas on the 6-7th day after primary conservative treatment. The dressing efficiently promotes epithelialization in all cases. Further advantage of Zn-hyaluronic gel is to enhance cell regeneration and inhibits dressing fixation into the wound.

LESSONS

Based on the authors' experience, with this special combination of wound dressing, a gentle, child-friendly, cost-effective treatment and excellent wound healing observed with favourable cosmetic results.