Treatment of burns
Treatment of burns – role of dressings with Safetac
Burn wounds are extremely painful, frequently highly traumatic and can lead to permanent scarring, disfigurement or even death (1). Management is based on the amount, depth and severity of burns and by the designations of superficial, partial and full-thickness injuries (2). The main objectives of burns treatment is to remove devitalised tissue, promote healing, prevent wound infection and graft loss, maintain function of the affected body part, and achieve wound closure as soon as possible (3).
Silver sulphadiazine (SSD) treatments have been used as standard treatment for over thirty years. However, a number of side effects of treatment (leucopenia, hypersensitivity, allergic reactions, wound bed discoloration, microorganism resistance and pain during application and removal) have been documented (4), therefore alternative efficacious treatments would be welcome.
Mepilex Ag proved to be a superior alternative in a comparative, randomized, controlled trial versus SSD in the treatment of partial-thickness thermal burns (5). In a trial comprising 101 subjects (Mepilex Ag, n=49; SSD, n=51) mean healing rates were 71.7% versus 60.8% at final visit and the numbers of dressing changes were 2.2 versus 12.4 in the Mepilex Ag-treated and SSD-treated groups, respectively. A significant difference in mean pain scores, in favour of Mepilex Ag, was noted at dressing application (p=0.018) and during dressing wear (p=0.048). The mean total cost of treatment was $309 (Mepilex Ag) compared to $513 (SSD).
In two comparative studies versus SSD Mepitel also exhibited significantly faster healing times (6,7), less dressings used (p<0.05) (6), less eschar formation (p<0.05), less pain at dressing change (p<0.05) and significantly lower mean daily hospital charges (7) compared to SSD. Mepitel successfully produced a moist wound environment, promoted wound healing, and was easy and relatively painless to use (6,7). Other dressings with Safetac technology have also been reported to be of use in burn wound management including Mepitel One, Mepilex Border, Mepilex Border Lite and Mepilex Transfer.
Skin grafting is a surgical procedure that is used to quickly restore skin integrity in wounds that are large and cannot be directly closed by suturing (8). Historically, this has been achieved through clips, skin glue or staples, with the latter being painful to remove. Dressings can also be used and ideally should prevent mechanical displacement, allow wound exudate to drain and antibacterial solutions to reach the wound, and not adhere to the graft and open areas of the wound (9).
Mepitel was shown to be an effective alternative to a conventional fixation dressing treatment on newly grafted burns (9). When used with cotton wool gauze as secondary dressing, both removing the primary Mepitel dressing and secondary dressing were painless and combined with good graft take. Pain free results were also obtained from 53% patients (n=38) when Mepitel was used in comparison with paraffin gauze as a primary dressing (all gauze patients experienced some pain).
The use of Mepitel instead of ‘tie-over’ dressings for lower-limb split skin grafts has also been successfully used. The method involves inserting tacking sutures or skin adhesive around the edge of the spilt thickness skin graft, applying paraffin gauze over the graft, followed by a layer of saline soaked gauze of foam; this is then covered with Mepitel dressing overlapping
the edges of the graft by 2–3 cm. This technique has the advantages over the traditional ‘tie-over’ dressing of providing homogenous tension over the grafts, preventing shear on the skin graft site and reducing tension and the potential for soft tissue damage (10).
A donor site is an area of the body from which skin has been harvested to provide a skin graft (8). In a study involving 40 patients Mepilex Transfer resulted in a decrease in the number of painful dressing changes on donor sites after being introduced (11). In a case study series, two skin graft donor site wounds completely healed with no reported pain and healthy peri-wound skin after treatment with Mepitel.
Insert Tale 6 – Burn Care – key studies
1 - Fowler, A. Atraumatic dressings for non-complex burns. Practice Nursing 2006; 17: 4, 193-196.
2 - Wilson, R. Massive tissue loss: burns. In: Acute and Chronic Wounds Nursing Management, 2nd Edition. Bryant, R.A. eds. Mosby, St Louis 2000: 197-220.
3 - Chavez, b. Making the case for using a silicone dressing in burn wound management. Ostomy Wound Manage 2004; 50: 6, 11-12. 7458, 158-160.
4 - White, R., Cooper, R. Silver sulphadiazine: a review of the evidence. Wounds
UK 2005;1: 2, 51-61.
5 - Silverstein, P., Meites, H., Heimbach, D., et al. Soft silicone dressing with silver versus silver sulfadiazine cream in the treatment of partial-thickness burns: a randomised controlled trial. Poster presentation at the European Wound Management Association conference, Geneva, Switzerland, 2010. 49: 9, 44-51.
6 - Bugmann, P., Taylor, S., Gyger, D. A. Silicone-coated nylon dressing reduces healing time in burned paediatric patients in comparison with standard sulfadiazine treatment: a prospective randomized trial. Burns 1998; 24: 7, 609-612.
7 Gotschall, C.S., Morrison, M.I., Eichelberger, M.R. Prospective, randomized study of the efficacy of Mepitel on children with partial-thickness scalds. J Burn Care Rehabil 1998; 19: 4, 279-283.
8 - Beldon, P. Skin grafts 2: management of donor site wounds in the community. Br J Community Nurs 2003; 8: 9 Suppl, 6-14.
9 - Vloemans, A.F., Kreis, R.W. Fixation of skin grafts with a new silicone rubber dressing (Mepitel). Scand J Plast Reconstr Surg Hand Surg 1994; 28: 1, 75-76.
10 - Bache, S.E., Kannan, R.Y., Ralston, D.R. The use of Mepitel instead of tie- over dressing for lower-limb split skin grafts. Eur J Plastic Surg 2008; 31:6,337-338.
11 - Kirsi, M., Rantalahti, R., Jyrki, V. The use of a soft silicone exudate transfer dressing for large donor sites with burn patients. Oral presentation at the 2nd Congress of the World Union of Wound Healing Societies, Paris, France 2004.