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, including Methicillin-resistant Staphylococcus aureus (MRSA)
• 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 bioburden in the burn wound surface
• when patient has confirmed or suspected infection, use in combination with a systemic treatment

When selecting an antimicrobial dressing for a burn wound, it is important to review the product information/inserts for recommendation on dressing change frequency, dressing application procedures, use of solutions (eg. sterile water), and any potential contraindications. The wound care professional's clinical judgement, use of up-to-date evidence, and on-going bedside assessment are also vital in creating and updating a wound care plan. Please review this article section on determining a dressing care plan as needed.

"... the different dressings perform differently on every patient and on different burn wounds. So again, it's the art of matching the dressing to the wound and then assessing it and trying to figure out the best combination and approach based on that particular patient and the response of their burn wound to each dressing. Even the same type of dressing produced by different manufacturers will respond differently to a given burn wound or a different patient." -Diane Merwarth, Physical Therapist, Wound Care Specialist

Antimicrobial Advanced Dressings for Burn Wound Care

Table 1. Antimicrobial Advanced Dressings (this is a limited list of available products on the market)

	Benefits	Risks	Burn-specific Considerations
Silver-Based	General silver-based dressings considerations: 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

Non-antimicrobial advanced dressings are indicated for burns (1) nearing the end of their healing phase, and/or (2) are superficial with a minimal infection risk. These dressings are designed to be left in place for several days to allow maximum opportunity for the patient's own body to heal in an uninterrupted moist wound environment.

Non-antimicrobial advanced dressing options for burn wound care:

• alginates
• collagen-based products
• foams
• hydrocolloids
• hydrogels
• silicone sheets
• transparent films

Negative Pressure Wound Therapy for Burn Wounds

What is Negative Pressure Wound Therapy?

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Negative pressure would therapy is an emerging method of managing burn wounds and donor recipient sites. Negative pressure therapy has been used more extensively over new skin graft recipient sites than over the open burn wound injury itself. Recall that the standard of care in burn management is to close the burn wound via surgical procedure or/and skin graft placement.

Clinical Pearl: Skin Grafts and Burn Wound Care

Donor site, recipient site, types of skin grafts

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

Do to the more aggressive nature of negative pressure therapy, specific treatment strategies are recommended for its use on burn wounds:

1. the use of a non-adherent layer between the wound surface and the VAC foam to reduce tissue trauma and pain while the negative pressure is in place and during dressing changes
2. use of a lower pressure intensity as what is standard for non-burn-type wounds
3. use of anesthesia or sedation during negative pressure dressing changes for adequate pain management

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