Meeting the clinical challenges of burns management
Meeting the clinical challenges of burns management: a review
Butcher M. Burns. British Journal of Nursing. 2011; 20(15) (Tissue Viability Supplement): 44-51
- Irrespective of size and severity, the ongoing topical management of a burns wound is dependent on the anticipated method of wound repair. Dressing materials are used to provide the optimum environment to facilitate wound healing with minimal scarring if this is possible, or to provide a temporary protective skin substitute until such time as formal skin reconstruction can be undertaken.
- If the burn is assessed as being superficial or partial thickness it is likely to heal, provided an optimum wound environment is maintained.
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- A moist wound environment is essential to aid the autolysis of damaged tissue, promote migration of epithelial cells, prevent desiccation of exposed dermis and keep exposed nerve endings moist thereby reducing pain.
- The need to effectively manage wound pain can lead to a cascade of cost implications ranging from the need for additional wound care products, more frequent nursing visits and interventions, additional pharmacy costs, to prolonged hospital in-patient stays and wound chronicity.
- To address some of the major clinical challenges faced by the clinician when managing the burn wound.
- Identifies how the Mölnlycke Health Care range of dressings with Safetac® are designed to meet these needs.
- Provides evidence of the effectiveness of these products in this challenging field of wound care.
- Pain, which can be a significant factor throughout burn-wound healing, can have physical, psychological, emotional and financial consequences.
- Many traditional approaches to burn wound management have limitations which can compromise wound healing outcomes.
- Dressings with Safetac technology are available to meet the clinical requirements of conservative, surgical and post-healing burns-management strategies. These dressings involve the use of ‘soft’ silicone, a material that adheres readily to intact dry skin but does not stick to the surface of a moist wound and does not cause damage upon removal.
Dressing the superficial/partial thickness burn
- In a randomized controlled trial Mepilex Ag achieved faster healing rates (71.7% versus 60.8% at final visit) and were discharged from hospital almost 3 days earlier on average compared to silver sulfadiazine (SSD) (n= 101). The Mepilex Ag group achieved statistically better average pain scores at dressing application (p=0.018) and during dressing wear (p=0.048) than those treated with SSD. Analysis of the cost of treatment showed that Mepilex Ag was significantly more cost effective than SSD (Silverstein et al, 2010).
- 18 patients with partial thickness burns treated with Mepilex Ag demonstrated antimicrobial protection that left the wounds with a clean appearance. Additionally, Mepilex Ag did not adhere to the wound, thereby giving clinicians the opportunity to either examine the wound or leave the dressing in situ for up to 7 days (Meites et al, 2008).
- In a randomized controlled trial 76 children with previously untreated burns less than one day old were randomized to treatment with Mepitel + chlorhexidine gauze (n=41) or SSD cream + paraffin gauze + absorbent gauze (n=35) (Bugmann et al, 1998). Mepitel-treated wounds were associated with significantly (p<0.01) faster healing time compared to those treated with SSD (7.6 days and 11.3 days, respectively). Moreover, the mean number of dressings used was significantly (p<0.05) less in the Mepitel-treated group compared to the control group (3.64 and 5.13, respectively). Mepitel was also reported to be easy to use and atraumatic on removal.
- Wounds treated with Mepitel healed significantly (p=0.0002) faster (median time for complete healing was 10.5 days (Mepitel) and 27.6 days (SSD)), exhibited less eschar formation (p<0.05), and were associated with less pain at dressing change (p<0.05) compared to the SSD-treated wounds. Mepitel-treated wounds were also associated with significantly lower mean daily hospital charges (n=63) (Gotschall et al, 1998).
- In a case study series involving 10 patients with hand burn injuries, Mepitel One was associated with low pain levels on application, while in situ, and on removal. The dressing was also rated highly in terms of ease of application and conformability (Mason and Edwards, 2010).
Managing the full thickness burn – Post surgery: managing the donor site
- Foam dressings have the ability to absorb and retain large amounts of exudate. They can produce faster rates of healing, less post-operative scarring and enhanced patient comfort over traditional tulle gras dressings and alginate dressings.
- The effectiveness of Mepilex Transfer in the management of large donor sites was evaluated in 40 patients with burns resulting in a decrease in the number of painful dressing changes (Kirsi et al, 2004).
– Post surgery: managing the skin graft site
- Mepitel is commonly used to aid graft take, because it allows the free passage of exudate through its open mesh, adheres to the surrounding skin and not to the wound tissue, and facilitates atraumatic and pain-free removal.
- Significant scarring occurs in around 50% of individuals following deep burns. Mepiform®, a soft silicone scar dressing with Safetac, has been evaluated in a number of studies for the treatment of hypertrophic scars. It was well tolerated, as well as improving scar quality and patient comfort (Cain et al, 2001).
- The pioneering introduction of dressings that use Safetac technology has brought about significant benefits to patients by minimizing the risk of trauma and pain associated with the use of adhesive and adherent dressings.
- The extension of this technology to a variety of dressing materials provides atraumatic characteristics to a range of products developed to meet the needs of patients and clinicians, and the differing presentations and priorities encountered in the clinical environment.
- Evidence indicates that there are real benefits in terms of healing, patient wellbeing and health economics to support the use of Safetac technology-based products in managing the burns injured individual.