Burn Wound Injury Dressing Selection: Difference between revisions
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* [[Burn Wound Assessment|Burn wound injury assessment]] | * [[Burn Wound Assessment|Burn wound injury assessment]] | ||
* [[Assessment of infection in burn wounds]] | * [[Assessment of Infection in Burn Injuries|Assessment of infection in burn wounds]] | ||
* [[Burn Wound Treatment: Cleansing and Solutions|Burn wound injury cleansing techniques and solutions]] | * [[Burn Wound Treatment: Cleansing and Solutions|Burn wound injury cleansing techniques and solutions]] | ||
* [[Non-surgical Debridement of Burn Injuries| | * [[Non-surgical Debridement of Burn Injuries|Non-surgical debridement of burn injuries]] | ||
==== Current Standard of Care ==== | ==== Current Standard of Care ==== | ||
The current standard of care for large and deep burn wounds is (1) early surgical excision and (2) wound closure<ref name=":1">Merwarth | The current standard of care for large and deep burn wounds is (1) early surgical excision and (2) wound closure.<ref name=":1">Merwarth D. Management of Burn Wounds Programme. Introduction to Dressing Selection for Burn Wound Injuries Course. Plus, 2024.</ref> Wound closure can be achieved by skin grafting or temporary biological coverage for deep partial and full thickness burns. | ||
==== Alternatives to Early Excision and Wound Closure ==== | |||
==== Alternatives to Early Excision | |||
# '''Surgical debridement followed by wound cleansing and regular dressing changes''' | # '''Surgical debridement followed by wound cleansing and regular dressing changes''' | ||
#* preferred option for burns of indeterminate depth | #* preferred option for burns of indeterminate depth, where there are areas of deep partial thickness, full thickness or superficial burn injury | ||
#* | #* by performing ongoing wound care and allowing the more superficial areas to re-epithelialise, those areas that need debridement and skin grafting can be more easily defined | ||
# '''Local wound cleansing and dressing changes''' | # '''Local wound cleansing and dressing changes''' | ||
#* | #* indicated when surgery is not feasible or after debridement without grafting or temporary closure | ||
#* | #* common for smaller burn areas, including full thickness burns | ||
#* | #* standard for most superficial partial thickness burns | ||
# '''Surgery not feasible''' due to patient status, or resource availability | |||
# '''Grafting or skin substitutes not appropriate''' due to (1) contaminated wounds, (2) native skin is too damaged or of too small an area to provide a skin graft, or (3) skin substitutes are not available | ==== Exceptions to Standards of Care ==== | ||
# '''Surgery is not feasible''' due to patient status, or resource availability | |||
# '''Grafting or skin substitutes are not appropriate''' due to (1) contaminated wounds, (2) native skin is too damaged or of too small an area to provide a skin graft, or (3) skin substitutes are not available | |||
Burn wounds which (1) do not undergo surgical debridement, or that (2) underwent surgical debridement without application of a skin graft or temporary | Burn wounds which (1) do not undergo surgical debridement, or that (2) underwent surgical debridement without application of a skin graft or temporary cover with a skin substitute will require ongoing dressing changes throughout the course of healing.<ref name=":1" /> | ||
== Role of Wound Dressings == | == Role of Wound Dressings == | ||
In all cases | In all cases where burn wounds are not grafted immediately, routine burn wound care and dressing changes are needed. The determination of dressings and frequency of interventions are based on a variety of factors that are described below.<ref name=":1" /> | ||
'''Effective burn wound dressings | '''Effective burn wound dressings''':<ref name=":1" /><ref>Legrand M, Barraud D, Constant I, Devauchelle P, Donat N, Fontaine M, Goffinet L, Hoffmann C, Jeanne M, Jonqueres J, Leclerc T. [https://www.sciencedirect.com/science/article/pii/S2352556820300382#sec0210 Management of severe thermal burns in the acute phase in adults and children]. Anaesthesia Critical Care & Pain Medicine. 2020 Apr 1;39(2):253-67.</ref> | ||
* | * absorb and manage drainage | ||
* | * minimise the risk of [[Wound Care Terminology#B|burn wound conversion]] | ||
* | * maintain a moist wound environment | ||
* | * minimise peri-wound maceration | ||
* | * prevent excessive evaporation from the wound surface that can (1) cause the wound to become desiccated and (2) result in hypothermia | ||
* | * provide topical antimicrobial protection | ||
* | * minimise contamination from the external environment | ||
* | * decrease oedema | ||
* | * protect the wound | ||
* | * be care provider friendly (ie. easy to apply and/or remove) | ||
* | * reduce pain during (1) removal and application of the dressings and (2) during functional activities | ||
* | * allow movement and function | ||
<blockquote> | <blockquote> | ||
==== Clinical Pearl: Benefits of Moist Wound Healing ==== | ==== Clinical Pearl: Benefits of Moist Wound Healing ==== | ||
Multiple studies have demonstrated that application of moist wound dressings immediately after injury minimises the risk of burn wound conversion. | Multiple studies have demonstrated that the application of moist wound dressings immediately after injury minimises the risk of burn wound conversion. The positive effects of a moist wound environment on wound healing include:<ref name=":1" /> | ||
* | * increased keratin migration and re-epithelialisation | ||
* | * increased collagen synthesis | ||
* | * increased autolytic debridement | ||
* | * decreased necrosis | ||
* | * decreased pain | ||
* | * decreased inflammation | ||
* | * decreased scarring | ||
* | * facilitation of cell-to-cell signaling | ||
* | * providing a means of delivering topical treatment | ||
* | * improved wound aesthetics after healing | ||
</blockquote> | </blockquote> | ||
== Determining Dressing Care Plan == | == Determining the Dressing Care Plan == | ||
==== Determining Dressing Change Frequency ==== | ==== Determining Dressing Change Frequency ==== | ||
Based on burn wound or patient status, and on type of dressing:<ref name=":1" /> | Based on the burn wound or patient status, and on the type of dressing:<ref name=":1" /> | ||
* | * status of the burn wound (or patient): dressing changes will be daily or more than planned in the following situations: | ||
** | ** the dressing used is not antimicrobial, or the agent has short-acting antimicrobial properties | ||
** | ** verified or suspected infection | ||
** | ** significant areas of un-debrided eschar | ||
** drainage is not contained by the dressing | |||
** | ** there are any other concerns | ||
** | ** it is important to monitor for conversion | ||
* | * need to balance concern for the wound and the desire to leave the wound undisturbed and not introduce risk for additional contamination | ||
** | ** minimise risk of damage to healing tissue | ||
* | * type of dressing or topical agent | ||
** | ** ability of the dressing to maintain a moist environment | ||
==== Determining Dressing and Topical Agent ==== | ==== Determining Dressing and Topical Agent ==== | ||
Consider the following areas: | |||
* [[Burn Wound Assessment#Classification by Depth|depth]] and [[Wound Healing#Wound Healing Stages in Adults|stage of healing]] of burn wound | |||
* [[Assessment of Infection in Burn Injuries|indications of infection]] | |||
* amount of wound drainage | |||
* clinical assessment of progress, or lack of progress, in wound healing | |||
* ease of dressing application and removal | |||
* availability of dressings and topical agents | |||
* cost of topical agents and dressings | |||
* | * dressings change as wound progresses (or doesn’t progress) | ||
== Burn Wound Dressing Options == | == Burn Wound Dressing Options == | ||
This section includes a summary of gauze and gauze-like dressings | This section includes a summary of gauze and gauze-like dressings and possible solutions, creams, and ointments that can be used in the treatment of burn wound injuries. Please see [[Advanced Dressing Selection for Burn Wound Injuries|this article]] for more information on advanced dressings for burn care. | ||
{| class="wikitable" | {| class="wikitable" | ||
|+Table 1. | |+Table 1. Solutions used on dressings. | ||
! | ! | ||
!'''Benefits''' | !'''Benefits''' | ||
Line 103: | Line 102: | ||
|'''Saline''' | |'''Saline''' | ||
| | | | ||
* | * Non-antimicrobial | ||
* | * Non-cytotoxic | ||
| | | | ||
|- | |- | ||
|'''Mafenide Acetate''' | |'''Mafenide Acetate''' | ||
| | | | ||
* | * Broad-spectrum | ||
* Common for treatment of pseudomonas | * Common for the treatment of pseudomonas | ||
| | | | ||
* | * No antifungal coverage | ||
* | * Monitor for metabolic acidosis | ||
|- | |- | ||
|'''Sodium Hypochlorite'''<ref name=":0">Babalska ZŁ, Korbecka-Paczkowska M, Karpiński TM. [https://www.mdpi.com/1424-8247/14/12/1253 Wound antiseptics and European guidelines for antiseptic application in wound treatment]. Pharmaceuticals. 2021 Dec 2;14(12):1253.</ref> | |'''Sodium Hypochlorite'''<ref name=":0">Babalska ZŁ, Korbecka-Paczkowska M, Karpiński TM. [https://www.mdpi.com/1424-8247/14/12/1253 Wound antiseptics and European guidelines for antiseptic application in wound treatment]. Pharmaceuticals. 2021 Dec 2;14(12):1253.</ref> | ||
| | |Broad spectrum | ||
| | | | ||
* | * Cytotoxic at full (Dakin’s) and half-strength | ||
* | * Mixed reports of cytotoxicity at 0.025% concentration | ||
|- | |- | ||
|'''Hypochlorous acid''' | |'''Hypochlorous acid''' | ||
| | | | ||
* | * Broad-spectrum | ||
* | * Non-cytotoxic | ||
| | | | ||
|- | |- | ||
|'''Povidone-Iodine'''<ref name=":0" /> | |'''Povidone-Iodine'''<ref name=":0" /> | ||
| | |Broad-spectrum | ||
| | |Cytotoxic at full strength | ||
|- | |- | ||
|'''Acetic acid'''various reports of strengths, 0.25% up to 5% | |'''Acetic acid''' (various reports of strengths, 0.25% up to 5%) | ||
| | | | ||
* | * Broad-spectrum | ||
* Used primarily for treatment of pseudomonas | * Used primarily for the treatment of pseudomonas | ||
| | | | ||
|} | |} | ||
{| class="wikitable" | {| class="wikitable" | ||
|+Table 2. Creams and | |+Table 2. Creams and ointments used on dressings | ||
! | ! | ||
!'''Benefits''' | !'''Benefits''' | ||
Line 146: | Line 145: | ||
|'''Silver sulfadiazine'''<ref>Oaks RJ, Cindass R. [https://www.ncbi.nlm.nih.gov/books/NBK556054/ Silver sulfadiazine]. StatPearls, 2022; NCBI Bookshelf (a service of the National Library of Medicine, NIH. © 2022, StatPearls LLC. Bookshelf ID: NBK556054PMID: 32310514</ref><ref name=":2">PATEL R, DESAI R, PATEL A, SHAH S, PRAJAPATI B, PATEL V, ALEXANDER A. [https://www.researchgate.net/profile/Bhupendra-Prajapati/publication/372422278_Burn_assessment_A_critical_review_on_care_advances_in_burn_healing_and_pre-clinical_animal_studies/links/64b90cc595bbbe0c6e4a4a9b/Burn-assessment-A-critical-review-on-care-advances-in-burn-healing-and-pre-clinical-animal-studies.pdf Burn assessment: A critical review on care, advances in burn healing and pre-clinical animal studies]. Journal of Research in Pharmacy. 2023 Jul 1;27(4).</ref> | |'''Silver sulfadiazine'''<ref>Oaks RJ, Cindass R. [https://www.ncbi.nlm.nih.gov/books/NBK556054/ Silver sulfadiazine]. StatPearls, 2022; NCBI Bookshelf (a service of the National Library of Medicine, NIH. © 2022, StatPearls LLC. Bookshelf ID: NBK556054PMID: 32310514</ref><ref name=":2">PATEL R, DESAI R, PATEL A, SHAH S, PRAJAPATI B, PATEL V, ALEXANDER A. [https://www.researchgate.net/profile/Bhupendra-Prajapati/publication/372422278_Burn_assessment_A_critical_review_on_care_advances_in_burn_healing_and_pre-clinical_animal_studies/links/64b90cc595bbbe0c6e4a4a9b/Burn-assessment-A-critical-review-on-care-advances-in-burn-healing-and-pre-clinical-animal-studies.pdf Burn assessment: A critical review on care, advances in burn healing and pre-clinical animal studies]. Journal of Research in Pharmacy. 2023 Jul 1;27(4).</ref> | ||
| | | | ||
* Effective against gram + or gram – bacteria, and some yeast | * Effective against gram-positive (gram +) or gram-negative (gram –) bacteria, and some yeast | ||
| | | | ||
* Transient leukocytopenia | * Transient leukocytopenia | ||
* Avoid eyes and mucosal membranes | * Avoid eyes and mucosal membranes | ||
Contraindications: | |||
* | * Sulfa allergies, pregnant women, and infants <2 months of age | ||
* Toxic to keratinocytes, delays re- | * Toxic to keratinocytes, delays re-epithelialisation | ||
|Full and deep-partial thickness burns: | |Full and deep-partial thickness burns: | ||
* | * before debridement | ||
* | * after debridement, if graft and/or temporary coverage is not performed | ||
|- | |- | ||
|'''Mafenide acetate''' <ref name=":2" />'''(sulfamyalon)''' | |'''Mafenide acetate'''<ref name=":2" /> '''(sulfamyalon)''' | ||
| | | | ||
* Effective against gram + and gram – bacteria | * Effective against gram + and gram – bacteria | ||
Line 169: | Line 168: | ||
* Prolonged use, or use over large total body surface area (TBSA) may cause metabolic acidosis and respiratory complications | * Prolonged use, or use over large total body surface area (TBSA) may cause metabolic acidosis and respiratory complications | ||
* Cytotoxic to fibroblasts and keratinocytes | * Cytotoxic to fibroblasts and keratinocytes | ||
* Delays re- | * Delays re-epithelialisation | ||
| | | | ||
* Use can be painful, especially on more superficial burns | * Use can be painful, especially on more superficial burns | ||
* No longer standard of care for use with burn wounds, except for: | * No longer the standard of care for use with burn wounds, except for: | ||
** very short-term use | ** very short-term use | ||
** very small burns | ** very small burns | ||
** deep | ** deep partial or full thickness burns to the ears | ||
|- | |- | ||
|'''Antibiotic ointments''' | |'''Antibiotic ointments''' | ||
| | | | ||
# '''[https://www.drugs.com/pro/triple-antibiotic-ointment.html Triple antibiotic]''' (eg [https://www.neosporin.com/products/topical-antibiotics/original-antibiotic-ointment Neosporin]): typically bacitracin, neomycin and polymyxin B: effective for gram + and gram – microbes | # '''[https://www.drugs.com/pro/triple-antibiotic-ointment.html Triple antibiotic]''' (eg [https://www.neosporin.com/products/topical-antibiotics/original-antibiotic-ointment Neosporin]): typically bacitracin, neomycin and polymyxin B: effective for gram + and gram – microbes | ||
# '''[https://medlineplus.gov/druginfo/meds/a614052.html Bacitracin]''': effective for gram + bacteria, | # '''[https://medlineplus.gov/druginfo/meds/a614052.html Bacitracin]''': effective for gram + bacteria, but NOT gram – or yeast | ||
# '''[https://www.healthline.com/health/mupirocin-topical-ointment#important-warnings Mupirocin]''': effective against gram + microbes, including MRSA | # '''[https://www.healthline.com/health/mupirocin-topical-ointment#important-warnings Mupirocin]''': effective against gram + microbes, including MRSA | ||
# '''[https://medlineplus.gov/druginfo/meds/a619033.html Gentamicin]''': broad-spectrum coverage; not commonly used for burn wounds | # '''[https://medlineplus.gov/druginfo/meds/a619033.html Gentamicin]''': broad-spectrum coverage; not commonly used for burn wounds | ||
|Change the antibiotic used | |Change or discontinue the antibiotic used when: | ||
* lack of effectiveness | * lack of effectiveness | ||
Line 190: | Line 189: | ||
|Recommended primarily for superficial partial thickness burn wounds | |Recommended primarily for superficial partial thickness burn wounds | ||
|- | |- | ||
|'''Medical | |'''Medical grade honey'''<ref>Tashkandi H. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8496555/ Honey in wound healing: An updated review]. Open life sciences. 2021 Oct 6;16(1):1091-100.</ref> | ||
| | | | ||
* Broad-spectrum activity | * Broad-spectrum activity | ||
* Maintains moist environment | * Maintains moist environment | ||
* Less toxic and less costly than | * Less toxic and less costly than silver products | ||
* Antimicrobial by acidity and osmotic gradient | * Antimicrobial by acidity and osmotic gradient | ||
| | | | ||
|Minimal evidence for use with burn wounds, | |Minimal evidence for its use with burn wounds, but research shows positive outcomes on superficial partial thickness burns | ||
|- | |- | ||
|'''Cadexomer Iodine'''<ref>Stuermer EK, Plattfaut I, Dietrich M, Brill F, Kampe A, Wiencke V, Ulatowski A, Geffken M, Rembe JD, Naumova EA, Debus SE. [https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2021.664030/full In vitro activity of antimicrobial wound dressings on P. aeruginosa wound biofilm]. Frontiers in Microbiology. 2021 May 14;12:664030.</ref> | |'''Cadexomer Iodine'''<ref>Stuermer EK, Plattfaut I, Dietrich M, Brill F, Kampe A, Wiencke V, Ulatowski A, Geffken M, Rembe JD, Naumova EA, Debus SE. [https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2021.664030/full In vitro activity of antimicrobial wound dressings on P. aeruginosa wound biofilm]. Frontiers in Microbiology. 2021 May 14;12:664030.</ref> | ||
Line 213: | Line 212: | ||
|'''Polyhexamethylene biguanide'''<ref name=":0" /> '''(PHMB)-impregnated dressing''' | |'''Polyhexamethylene biguanide'''<ref name=":0" /> '''(PHMB)-impregnated dressing''' | ||
| | | | ||
* Broad-spectrum antimicrobial agent | * Broad-spectrum antimicrobial agent used against gram + and gram – bacteria, yeast and fungi | ||
* Less cytotoxic vs other antimicrobial agents | * Less cytotoxic vs other antimicrobial agents | ||
| | | | ||
Line 224: | Line 223: | ||
* Bacteriostatic against enteric microbes (C. diff, E. coli) | * Bacteriostatic against enteric microbes (C. diff, E. coli) | ||
* Not cytotoxic | * Not cytotoxic | ||
|Contraindicated with allergy | |Contraindicated in patients with Bismuth allergy | ||
| | | | ||
|} | |} | ||
Line 231: | Line 230: | ||
==== Guidelines for Blister Management ==== | ==== Guidelines for Blister Management ==== | ||
<blockquote>"In all of the literature that I've looked at over the past couple of decades, [blister management] hasn't changed. The approach to managing blisters is kind of a 50-50 split between that side of the issue that thinks that all blisters should be unroofed and debrided immediately and completely, and the side that thinks you should leave blisters alone and allow things to happen naturally." | <blockquote>"In all of the literature that I've looked at over the past couple of decades, [blister management] hasn't changed. The approach to managing blisters is kind of a 50-50 split between that side of the issue that thinks that all blisters should be unroofed and debrided immediately and completely, and the side that thinks you should leave blisters alone and allow things to happen naturally."<ref name=":1" /> - Diane Merwarth, Physical Therapist, Wound Care Specialist</blockquote> | ||
'''Blisters should be deroofed (unroofed) in the following situations''':<ref name=":1" /> | '''Blisters should be deroofed (unroofed) in the following situations''':<ref name=":1" /> | ||
Line 237: | Line 236: | ||
# During surgical cleansing and debridement | # During surgical cleansing and debridement | ||
# When the blister itself is disrupted | # When the blister itself is disrupted | ||
#* | #* it has become a portal for entry of microbes | ||
#* | #* there is a risk of microbes trapped under loose skin | ||
# When appearance is questionable | # When appearance is questionable | ||
#* | #* thick, cloudy or opaque fluid | ||
#* | #* bloody or discoloured | ||
'''Blisters should be left intact in the following situations''':<ref name=":1" /> | '''Blisters should be left intact in the following situations''':<ref name=":1" /> | ||
# If blisters are small and not disrupted | # If blisters are small and not disrupted | ||
# When not affecting function | # When they are not affecting function | ||
'''Blisters | '''Blisters should be drained but NOT deroofed in the following situations''':<ref name=":1" /> | ||
# Large taut blisters with clear fluid | # Large taut blisters with clear fluid |
Latest revision as of 04:34, 10 April 2024
Top Contributors - Stacy Schiurring and Jess Bell
Burn Wound Injury Standard of Care[edit | edit source]
Please see this document for a growing list of wound care terminology and definitions.
For a review of other steps in burn wound care, please see the following articles:
- Burn wound injury assessment
- Assessment of infection in burn wounds
- Burn wound injury cleansing techniques and solutions
- Non-surgical debridement of burn injuries
Current Standard of Care[edit | edit source]
The current standard of care for large and deep burn wounds is (1) early surgical excision and (2) wound closure.[1] Wound closure can be achieved by skin grafting or temporary biological coverage for deep partial and full thickness burns.
Alternatives to Early Excision and Wound Closure[edit | edit source]
- Surgical debridement followed by wound cleansing and regular dressing changes
- preferred option for burns of indeterminate depth, where there are areas of deep partial thickness, full thickness or superficial burn injury
- by performing ongoing wound care and allowing the more superficial areas to re-epithelialise, those areas that need debridement and skin grafting can be more easily defined
- Local wound cleansing and dressing changes
- indicated when surgery is not feasible or after debridement without grafting or temporary closure
- common for smaller burn areas, including full thickness burns
- standard for most superficial partial thickness burns
Exceptions to Standards of Care[edit | edit source]
- Surgery is not feasible due to patient status, or resource availability
- Grafting or skin substitutes are not appropriate due to (1) contaminated wounds, (2) native skin is too damaged or of too small an area to provide a skin graft, or (3) skin substitutes are not available
Burn wounds which (1) do not undergo surgical debridement, or that (2) underwent surgical debridement without application of a skin graft or temporary cover with a skin substitute will require ongoing dressing changes throughout the course of healing.[1]
Role of Wound Dressings[edit | edit source]
In all cases where burn wounds are not grafted immediately, routine burn wound care and dressing changes are needed. The determination of dressings and frequency of interventions are based on a variety of factors that are described below.[1]
Effective burn wound dressings:[1][2]
- absorb and manage drainage
- minimise the risk of burn wound conversion
- maintain a moist wound environment
- minimise peri-wound maceration
- prevent excessive evaporation from the wound surface that can (1) cause the wound to become desiccated and (2) result in hypothermia
- provide topical antimicrobial protection
- minimise contamination from the external environment
- decrease oedema
- protect the wound
- be care provider friendly (ie. easy to apply and/or remove)
- reduce pain during (1) removal and application of the dressings and (2) during functional activities
- allow movement and function
Clinical Pearl: Benefits of Moist Wound Healing[edit | edit source]
Multiple studies have demonstrated that the application of moist wound dressings immediately after injury minimises the risk of burn wound conversion. The positive effects of a moist wound environment on wound healing include:[1]
- increased keratin migration and re-epithelialisation
- increased collagen synthesis
- increased autolytic debridement
- decreased necrosis
- decreased pain
- decreased inflammation
- decreased scarring
- facilitation of cell-to-cell signaling
- providing a means of delivering topical treatment
- improved wound aesthetics after healing
Determining the Dressing Care Plan[edit | edit source]
Determining Dressing Change Frequency[edit | edit source]
Based on the burn wound or patient status, and on the type of dressing:[1]
- status of the burn wound (or patient): dressing changes will be daily or more than planned in the following situations:
- the dressing used is not antimicrobial, or the agent has short-acting antimicrobial properties
- verified or suspected infection
- significant areas of un-debrided eschar
- drainage is not contained by the dressing
- there are any other concerns
- it is important to monitor for conversion
- need to balance concern for the wound and the desire to leave the wound undisturbed and not introduce risk for additional contamination
- minimise risk of damage to healing tissue
- type of dressing or topical agent
- ability of the dressing to maintain a moist environment
Determining Dressing and Topical Agent[edit | edit source]
Consider the following areas:
- depth and stage of healing of burn wound
- indications of infection
- amount of wound drainage
- clinical assessment of progress, or lack of progress, in wound healing
- ease of dressing application and removal
- availability of dressings and topical agents
- cost of topical agents and dressings
- dressings change as wound progresses (or doesn’t progress)
Burn Wound Dressing Options[edit | edit source]
This section includes a summary of gauze and gauze-like dressings and possible solutions, creams, and ointments that can be used in the treatment of burn wound injuries. Please see this article for more information on advanced dressings for burn care.
Benefits | Risks | |
---|---|---|
Saline |
|
|
Mafenide Acetate |
|
|
Sodium Hypochlorite[3] | Broad spectrum |
|
Hypochlorous acid |
|
|
Povidone-Iodine[3] | Broad-spectrum | Cytotoxic at full strength |
Acetic acid (various reports of strengths, 0.25% up to 5%) |
|
Benefits | Risks | Burn-specific Considerations | |
---|---|---|---|
Silver sulfadiazine[4][5] |
|
Contraindications:
|
Full and deep-partial thickness burns:
|
Mafenide acetate[5] (sulfamyalon) |
|
|
|
Antibiotic ointments |
|
Change or discontinue the antibiotic used when:
|
Recommended primarily for superficial partial thickness burn wounds |
Medical grade honey[6] |
|
Minimal evidence for its use with burn wounds, but research shows positive outcomes on superficial partial thickness burns | |
Cadexomer Iodine[7] | Most effective against MSSA and MRSA |
Benefits | Risks | Burn-specific Considerations | |
---|---|---|---|
Polyhexamethylene biguanide[3] (PHMB)-impregnated dressing |
|
Recommended for superficial partial thickness burn wounds | |
Bismuth
(eg. Xeroform gauze) |
|
Contraindicated in patients with Bismuth allergy |
Burn Wound Injury Areas of Special Concern[edit | edit source]
Guidelines for Blister Management[edit | edit source]
"In all of the literature that I've looked at over the past couple of decades, [blister management] hasn't changed. The approach to managing blisters is kind of a 50-50 split between that side of the issue that thinks that all blisters should be unroofed and debrided immediately and completely, and the side that thinks you should leave blisters alone and allow things to happen naturally."[1] - Diane Merwarth, Physical Therapist, Wound Care Specialist
Blisters should be deroofed (unroofed) in the following situations:[1]
- During surgical cleansing and debridement
- When the blister itself is disrupted
- it has become a portal for entry of microbes
- there is a risk of microbes trapped under loose skin
- When appearance is questionable
- thick, cloudy or opaque fluid
- bloody or discoloured
Blisters should be left intact in the following situations:[1]
- If blisters are small and not disrupted
- When they are not affecting function
Blisters should be drained but NOT deroofed in the following situations:[1]
- Large taut blisters with clear fluid
- Blisters continuing to increase in size
- Blisters are preventing function
Deroofing is the process whereby the 'roof' of the blister is removed under clean (aseptic) conditions to expose the viable tissue beneath. [8]
All photos provided by and used with kind permission from Diane Merwarth, PT
Resources[edit | edit source]
Clinical Resources:[edit | edit source]
- Wound Antiseptics and European Guidelines for Antiseptic Application in Wound Treatment
- American Burn Association Guidelines for Burn Care Under Austere Conditions
Optional Additional Reading:[edit | edit source]
- Allorto NL. Primary management of burn injuries: Balancing best practice with pragmatism. South African Family Practice. 2020 Jan 1;62(1):1-4.
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 Merwarth D. Management of Burn Wounds Programme. Introduction to Dressing Selection for Burn Wound Injuries Course. Plus, 2024.
- ↑ Legrand M, Barraud D, Constant I, Devauchelle P, Donat N, Fontaine M, Goffinet L, Hoffmann C, Jeanne M, Jonqueres J, Leclerc T. Management of severe thermal burns in the acute phase in adults and children. Anaesthesia Critical Care & Pain Medicine. 2020 Apr 1;39(2):253-67.
- ↑ 3.0 3.1 3.2 Babalska ZŁ, Korbecka-Paczkowska M, Karpiński TM. Wound antiseptics and European guidelines for antiseptic application in wound treatment. Pharmaceuticals. 2021 Dec 2;14(12):1253.
- ↑ Oaks RJ, Cindass R. Silver sulfadiazine. StatPearls, 2022; NCBI Bookshelf (a service of the National Library of Medicine, NIH. © 2022, StatPearls LLC. Bookshelf ID: NBK556054PMID: 32310514
- ↑ 5.0 5.1 PATEL R, DESAI R, PATEL A, SHAH S, PRAJAPATI B, PATEL V, ALEXANDER A. Burn assessment: A critical review on care, advances in burn healing and pre-clinical animal studies. Journal of Research in Pharmacy. 2023 Jul 1;27(4).
- ↑ Tashkandi H. Honey in wound healing: An updated review. Open life sciences. 2021 Oct 6;16(1):1091-100.
- ↑ Stuermer EK, Plattfaut I, Dietrich M, Brill F, Kampe A, Wiencke V, Ulatowski A, Geffken M, Rembe JD, Naumova EA, Debus SE. In vitro activity of antimicrobial wound dressings on P. aeruginosa wound biofilm. Frontiers in Microbiology. 2021 May 14;12:664030.
- ↑ North Bristol NHS Trust. The de-roofing of burns blisters. Available from: https://www.mysurgerywebsite.co.uk/website/SWUK001/files/The%20De-roofing%20of%20Burns%20Blisters_NBT002996.pdf (accessed 2 April 2024).