Advanced Dressing Selection for Burn Wound Injuries

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Introduction

Burn wound advanced dressings are designed to maintain a moist environment while being left in place for multiple days. The dressing's ability to be left in place for a greater amount of time, decreases the frequency of dressing changes that up to that point were being done on all wounds including burn wounds.

Characteristics and Guidelines of Antimicrobial Advanced Dressings:

General Characteristics include:

• broad spectrum against many microbes
• manage light to moderate surface bioburden
• none are able to independently eradicate spreading or systemic infection, however can be an adjunct dressing when used in combination with systemic treatments
• lower occurrence of bacterial resistance

Guildelines for Use of Antimicrobial Advanced Dressings:

• for at risk patients
• use with evidence of increasing bioburnden in the burn wound
• when patient has confirmed or suspected infection, use in combination with a systemic treatment

Antimicrobial Advanced Dressings for Burn Wound Care

Table 1. Antimicrobial Advanced Dressings

	Benefits	Risks	Burn-specific Considerations
Silver-Based	Multiple formulations and types of silver-based dressings avaiilable Most silver-based dressings are effective for up to 7-days	cytotoxic to fibroblasts and keratinocytes, resulting in delayed re-epithelialization	Recommended to discontinue use when signs/symptoms of infection are no longer present
	Nanocrystalline Silver (Acticoat): broad spectrum for bacteria, yeast, and fungi	Can cause harmless and non-permanent skin staining (argyria) NOT compatible with MRI or radiation, must be removed prior to these procedures	Was developed specifically for the management of burn wounds
	Ionic Silver: available in multple forms of dressings (ie: foams, hydrogels, hydrocolloids, etc)		each dressing type will perform differently on burn wounds
	Silver-based Foam Dressings: Non-adherent foams (Allevyn Gentle Ag, Mepilex Ag) foam is pieced together and cut-to-fit to cover burn wound surface	Slightly adherent to intact skin Tape use is not recommended due to poor adherence to foam and potential trauma to the periwound Mepilex Transfer Ag: minimal drainage will cause the dressing to adhere to wound surface, causing potential damage to wound bed	Bordered foam dressings (Allevyn Ag border, Mepilex AG border) are NOT recommended for burn wounds
	Silver-based fabric-type dressings (TRITEC Silver, Assist Silver, Silverlon Wound & Burn Dressing) can be cut-to-fit to burn shape (except for Assist Silver) can be applied dry or moistened depending of product used
	Collagen-ORC (oxidized regenerated cellulose) with silver: collagen facilitates granulation tissue indicated for acute AND chronic wounds
	Hydrofiber with Silver HIGHLY absorbent		Has specific protocols for use
Gentian Violet/Methylene Blue Dressing	less expensive than silver dressings		Limited evidence for use with burn wounds

Silver-based Dressing Protocols:

• most silver-based dressings are designed to manage moisture in the burn wound, however some require re-wetting (Anticoat, Silverlon), or can contribute to moisture in the burn wound (hydrogels)

Non-antimicrobial Advanced Dressings for Burn Wound Care

	Benefits	Risks	Burn-specific Considerations
Alginates
Collagen-based products
Films
Foams
Hydrocolloids
Hydrocolloids
Silicone Sheets

Negative Pressure Wound Therapy for Burn Wounds

What is Negative Pressure Wound Therapy?

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Benefits of Use in Burn Wounds:

• facilitates moist wound environment
• decreases tissue oedema
• increases blood flow to wound
• stimulates angiogenesis (the development of new blood vessels)
• promotes granulation tissue formation

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