Suprathel® or Mepilex® Ag for treatment of partial thickness burns in children: A case control study

Suprathel's usability and effectiveness for the treatment of paediatric partial thickness burns: a 10-year retrospective cohort study

Suprathel has been introduced in our centre since 2014 for superficial to deep partial thickness burns. To evaluate healing outcomes and usability of Suprathel in our paediatric population, we conducted a retrospective cohort study, including all paediatric patients treated with Suprathel for burn wounds since its introduction. The studied population consisted of 92 patients, with a mean age of 4 years [3 months -17 years]. The median wound healing time for the entire cohort was 12.5 days, with no significant differences between the age groups. If wounds were found to be colonized during treatment, the majority of pathogens were Staphylococcus aureus (55.8 %). Seven percent of the patients required a split-thickness skin graft after approximately ten days. The use of Suprathel as epidermal dressing for treatment of partial thickness burns in the paediatric population demonstrates favourable adherence to the wound bed, and reduces the need for frequent dressing changes; the lack of increased wound infections underscore its benefits in paediatric burn care. Our findings suggest no significant differences in outcomes based on the timing of application, wound location, or wound bed preparation, and confirms its efficacy in mobile areas such as the hands.

Does the dressing matter in pediatric partial-thickness burns: a systematic review and meta-analysis

Superficial partial thickness burns typically receive nonoperative treatment, whereas deep partial thickness burns, which are prone to hypertrophic scarring, are usually managed through debridement followed by autologous split-thickness skin grafting. Various therapies have been developed to prevent wound infection and to enhance wound healing in pediatric partial-thickness burns. However, the choice of dressing by the surgeon can be influenced by various factors. It is worth noting that there is no standardized approach across all burn centers, leading to variations in care practices. To optimize pediatric patient care, a systematic review was conducted following PRISMA guidelines to review existing treatment options for partial thickness burns in children. Outcomes of interest were wound healing time, dressing changes, length of hospital stay, wound infections, need for grafting despite treatment, and hypertrophic scarring. A total of 68 studies with 8199 patients were included. The mean age of the included patients was 3.1 years, and the mean total body surface area of the burns was 15.6 %. Treatment groups included topical agents, bandages, skin analogues, or unclassified. Considering all treatment outcomes evaluated in this systematic review of the literature, non-silver dressings and skin analogues may have some benefit over topical agents in terms of wound healing time, length of hospital stay, hypertrophic scarring, pain management, and cost saving. Dressing changes, wound infections, and need for grafting did not significantly change between various treatments.

Polylactic Acid Membrane for the Treatment of Pediatric Burn Injuries: An Adoptable Practice to Improve Burn Management

BACKGROUND

Polylactic acid membrane (PLAM) is a one-time application alloplastic skin substitute that has been utilized as an adjunct for pediatric burns for a multitude of indications. Literature has established its utility in mixed superficial and deep dermal burns, with advantages related to decreased need for procedures requiring general anesthesia and decreased overall healthcare cost (Eur Burn J 2021;3(1):1-9). Additionally, its application has been comparable in wound healing outcomes to established standard of care practices (Burns 2023;49(7):1585-1591, Wound Repair Regen 2006;14(3):321-4). Our study analyzes the impact of integrating PLAM into pediatric burn management at a single burn center. We hypothesize that the integration of PLAM into our practice would result in improved outcomes related to wound care needs, surgical efficiency, hospital length of stay, and overall wound healing.

METHODS

We conducted a retrospective study of all pediatric (<18 years of age) patients with second- and third-degree burns treated at a single American Burn Association (ABA)-verified pediatric burn center from December 2019 to April 2024. All burn etiologies were included, and isolated first-degree burns were excluded. Our retrospective cohort was separated into two distinct treatment periods (pretherapy Era 1 and posttherapy Era 2) based on time before and after the introduction of PLAM at our institution (March 1, 2022). Data on patient demographics, burn characteristics, hospitalization treatments, operative details, surgical outcomes, and time to wound healing were analyzed.

RESULTS

A total of 331 pediatric patients met the inclusion criteria. A total of 155 patients were included in our pretherapy Era 1 and 176 patients in our posttherapy Era 2. The average age was 5.6 years old, and the majority of patients were male (62.2%) and White (55.0%). Baseline characteristics between our two cohorts were comparable across age, gender, race, ethnicity, BMI, mechanism of burn, and total body surface area (TBSA) burned. The need for sedated burn care significantly decreased after the introduction of PLAM (72.9% vs 59.4%, P = 0.010), and the average number of days of sedation decreased as well (3.7 vs 2.1 days, P < 0.001). Forty-one percent of all patients underwent surgical intervention for their burns with a significant increase in the number of patients receiving surgery in the posttherapy era (32.9% vs 48.3%, P < 0.001). Additionally, time from burn to surgery shortened in Era 2 (9.1 vs 7.2 days, P < 0.001). There was a statistically significant reduction in median procedure time in Era 2 (26 vs 13 minutes, P < 0.001). Finally, we observed significant reductions in median length of hospital stay (5 vs 4 days, P = 0.004), postoperative length of stay (1 vs 0 days, P = 0.017), the need for sedated postoperative dressing changes (54.9% vs 18.8%, P < 0.001), and need for home nursing visits (51.0% vs 17.1%, P < 0.001) in Era 2.

CONCLUSIONS

The integration of PLAMs into pediatric burn management provides significant benefits. Our study highlights the decreased need for sedated burn care, improved operative efficiency, decreased time to surgical intervention, shortened hospital stays, the decreasing demand for home nursing visits, and minimized need for additional surgeries, with healing outcomes comparable to current standard of care practices. These findings suggest potential cost savings for healthcare systems, improved healthcare efficiency, and increased patient satisfaction.

Factors Influencing Surgical Care and Outcome of Pediatric Burn Injuries and the Use of Synthetic Skin Substitutes

Burn trauma is one of the most common causes of inpatient treatment in children and is associated with severe physical and psychological consequences. Synthetic skin substitutes are designed to reduce the risk of infection, minimize wound pain, and reduce the frequency of dressing changes. However, data regarding premature detachment of these materials is scarce. The aim of this study was to identify factors associated with early detachment and subsequent consequences for surgical treatment. A retrospective analysis of 392 children with superficial and deep partial thickness burns undergoing inpatient treatment with the application of a skin substitute (Suprathel) was performed. Patient age, wound localization and progression, as well as burned total body surface area (TBSA%) were investigated as possible risk factors for early detachment of wound dressings and surgical intervention. Premature material detachment was significantly associated with burn localization (P < .001) and correlated with burn depth progression (r = 0.23, <0.001) and patient age (r = 0.22, <0.001). Surgical revision after material detachment was required in 13% of patients. Patient age and burn localization seem to increase the risk of premature material detachment. In addition, we observed increased premature detachment of Suprathel® in areas that elicited higher wound progression rates. Identifying these areas might prove pivotal in the improvement of pediatric burn trauma management.

Comparison of the effectiveness of three different skin substitutes for the treatment of pediatric burns

Early debridement of partial-thickness burns and coverage with skin substitutes is currently the standard of care in children, although there is currently no "gold standard" skin substitute. Our aim is to compare the effectiveness of three different skin substitutes, analyzing the medium- and long-term outcomes.

METHODS

A retrospective study was conducted on burn patients under 18 years admitted to our Burn Unit between 2015 and 2021, who were divided into 3 groups according to the type of skin substitute used (EZ-derm®, Biobrane®, and Suprathel®). Demographic and clinical data and short- and long-term outcomes were analyzed. Effectiveness was analyzed by escharectomy and grafting rate during acute management and long-term follow-up reintervention rate. A total of 378 patients were included (179 EZ-derm® group, 107 Biobrane® group, and 92 Suprathel® group). No differences in demographics or burn characteristics were observed between the groups. Patients treated with Suprathel® had a significantly shorter hospital stay (median 4 days (IQR 2-9)), a lower rate of escharectomy and grafting during acute management (21.1%), and a lower long-term follow-up reintervention rate (18.5%) when compared to the EZ-derm® group (median stay 9 days (IQR 6-13); escharectomy and graft 24.6% and reintervention 26.8%) and to the Biobrane® group (median stay 9 days (IQR 7-14); escharectomy and graft 32.1% and reintervention 26.2%).

CONCLUSION

Treatment of partial-thickness burns with Suprathel® is associated with a shorter hospital stay, lower need for escharectomy and grafting, and lower need for long-term reintervention. Therefore, it should be considered the treatment of choice for pediatric partial-thickness burns.

WHAT IS KNOWN

• Different types of skin substitutes are available for the treatment of skin burns in paediatric patients.

WHAT IS NEW

• Suprathel® is linked to a reduction in hospital stays, a lower need for escharectomy and grafting, and a lower likelihood of requiring long-term re-interventions.

The Effectiveness of an Alloplastic Epidermal Substitute in the Treatment of Burn Wounds in Children: A Comparative Clinical Study of Skin Substitutes and Silver and Paraffin Gauze Dressings

Background: Children make up a large percentage of those affected by burns worldwide, with most of them suffering from severe injuries that necessitate skilled medical attention. Despite medical progress, there is still no ideal dressing for the treatment of burn wounds in children. The aim of the study was to assess the impact of epidermal substitutes in the treatment of burn wounds in children. Materials and Methods: This retrospective study evaluates the use of three dressings in the treatment of pediatric burns at a major Polish burn center. A patient database was used to identify children who received treatment with silver dressings, paraffin dressings or epidermal substitutes from 2009 to 2023. A demographic analysis was performed to collect the following information: causes of burns, procedural details and patient outcomes. Results: There were 439 patients aged between 1 month and 18 years. For severe burns, the number of interventions was lowest among children with epidermal substitute application (p = 0.039). Paraffin gauze resulted in the greatest number of skin grafts, whereas alloplastic replacement produced the least amount of transplantation (p < 0.005) regardless of the severity of the burn. Conclusions: Epidermal substitutes offer a good dressing option for burn wounds to improve their treatment and reduce the need for skin graft coverage. In the future, extended comparative or randomized trials are needed to confirm our results.

Suprathel Versus Hypafix in the Management of Split-Thickness Donor Site Wounds in the Elderly: A Randomised Controlled Trial

(1) Background: Effective wound management aims for expedited healing, improved functional and scar outcomes, and reduced complications including infection. Delayed wound healing remains a prevalent problem in the elderly. Suprathel is a synthetic absorbable skin substitute and an attractive option in partial thickness wounds. The objective of this randomised controlled study was to assess the effect of skin substitute dressings on elderly split-skin graft (STSG) donor sites, evaluating time to heal, pain, itch and scar outcome. (2) Methods: 40 patients over 65 undergoing split-thickness skin grafting for non-melanoma skin cancer excision were randomised to STSG donor site dressings with either Suprathel or Hypafix. Patients were followed up weekly until healed and at 13 weeks post-procedure. (3) Results: There was no significant difference in time to healing, pain, itch, or scar outcome at 13 weeks between the two groups. The mean time to healing was 31.7 days for the skin substitute group and 27.3 days for the adhesive tape control group (p = 0.182). (4) Conclusions: Both dressings are appropriate for STSG donor sites. Hypafix remains a cost-effective dressing of choice for donor sites. Benefits demonstrated in other studies using skin substitutes have not translated into the elderly population. There remains scope in developing dressings that reduce elderly donor site morbidity.

Acute healing outcomes in paediatric partial thickness burns using Epiprotect® and Biobrane®: A retrospective comparative study

AIM

To compare the acute healing outcomes of Biobrane® and Epiprotect® in paediatric partial thickness (PT) burns.

METHODS

All paediatric patients (age <18 years) with PT burns managed using either Biobrane® or Epiprotect® over a 5-year period at our burns unit were included. The primary outcome was time to complete healing. Secondary outcomes included adherence, infection rates, length of hospital stay, duration of acute follow-up and return to the theatre.

RESULTS

Among the 99 patients included, 38 received Epiprotect® and 61 received Biobrane®. The mean total body surface area (TBSA) was 6% (range 1%-15%) and median age was 21 months (range 5-169 months). Median time to healing in the Epiprotect® group was 19.5 days and 16 days in the Biobrane® group (P = .14). The median hospitalisation length was the same for both products (2 days, P = .85). Infection rate was lower in the Epiprotect® group (2.6% vs 16.4%, P = .048). There was no difference in adherence rate. These trends were preserved when depth sub-groups were analysed. Adherence and infection rates were not affected by post-operative antibiotics (P > .99 and P = .65, respectively) in either group. The rate of return to the theatre for further surgery was 13.2% for both products (P > .99).

CONCLUSION

Our findings demonstrate that acute healing outcomes with Epiprotect® in paediatric PT burns are comparable to those with Biobrane®, with significantly lower infection rates for Epiprotect®. These results suggest that Epiprotect® is a viable alternative to Biobrane®. Nevertheless, further prospective randomised studies are required to investigate the short- and long-term outcomes.

Alloplastic Epidermal Skin Substitute in the Treatment of Burns

The goal of burn wound treatment is to ensure rapid epithelialization in superficial burns and the process of rebuilding the lost skin in deep burns. Topical treatment plays an important role. One of the innovations in the field of synthetic materials dedicated to the treatment of burns is epidermal skin substitutes. Since the introduction of Suprathel®, the alloplastic epidermal substitute, many research results have been published in which the authors investigated the properties and use of this substitute in the treatment of wounds of various origins, including burn wounds. Burn wounds cause both physical and psychological discomfort, which is why ensuring comfort during treatment is extremely important. Alloplastic epidermal substitute, due to its biodegradability, plasticity, no need to remove the dressing until healing, and the associated reduction in pain, is an alternative for treating burns, especially in children.