Burn Wound Injury Dressing Selection

Original Editor - Stacy Schiurring based on the course by Diane Merwarth

Top Contributors - Stacy Schiurring and Jess Bell

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Burn Wound Injury Standard of Care

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
• Burn wound injury non-surgical debridement

Current Standard of Care

The current standard of care for large and deep burn wounds is (1) early surgical excision and (2) wound closure

• wound closure can be achieved by skin grafting or temporary biological coverage for deep partial and full thickness burns

Alternatives to Early Excision/Grafting and Expections to Standard of Care

1. Surgical debridement followed by wound cleansing and regular dressing changes
   • preferred option for burns of indeterminate depth until burn depth determined
   • can be the most appropriate option to allow healing of partial thickness burn size. This will allow for a smaller area of the burn wound will need a skin graft.
2. 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
3. Surgery not feasible due to patient status, or resource availability
4. 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.

Burn wounds which (1) do not undergo surgical debridement, or that (2) underwent surgical debridement without application of a skin graft or temporary covered with a skin substitute will require ongoing dressing changes throughout the course of healing.

Those burn wounds which underwent surgical debridement and grafting or temporary coverage will not be covered in this module as the determination of wound closure or coverage and the subsequent bandaging will be at the discretion of the surgeon.  LINK TO OTHER PP PAGE HERE (Burn Wound Injury Care After Skin Graft Closure)

Role of Wound Dressings

In all cases when burn wounds are not grafted immediately, routine burn wound care and dressing changes are needed. The determination of dressings and frequency of interventions is based on a variety of factors to be described below.  Effective burn wound dressings provide the following:

• Absorb and manage drainage
• Minimise risk of burn wound conversion
• Maintain a moist wound environment
• Minimise peri-wound maceration
• Prevent excessive evaporation from 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 edema
• Protect the wound
• Be careprovider 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 Pearls: 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.  The positive effects of a moist wound environment on wound healing include:

• increases keratin migration and re-epithelialization
• increases collagen synthesis
• increases autolytic debridement
• decreases necrosis
• decreases pain
• decreases inflammation
• decreases scarring
• facilitates cell-to-cell signaling
• provides means of delivering topical treatment
• improves wound aesthetics after healing

Determining Dressing Care Plan

Determining Dressing Change Frequency

Based on burn wound or patient status, and on type of dressing

• Status of burn wound (or patient) – daily or more than planned if:
  • Dressing used is not antimicrobial, or agent has short-acting antimicrobial properties
  • Verified or suspected infection
  • Monitor for conversion
  • Significant areas of undebrided eschar
  • Drainage not contained by dressing
  • Any other concerns

• Need to balance concern for wound and desire to leave wound undisturbed and not introduce risk for additional contamination
  • Minimize risk of damage to healing tissue
• Type of dressing or topical agent
  • Ability of dressing to maintain a moist environment

Determining Dressing and Topical Agent

• 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

Gauze and gauze-like dressings

Table 1. solutions used on dressings

	Benefits	Risks	Burn-specific Considerations
Saline	non-antimicrobial non-cytotoxic
Mafenide Acetate	broad-spectrum Common for treatment of pseudomonas	no antifungal coverage monitor for metabolic acidosis
Sodium Hypochlorite	broad spectrum	cytotoxic at full (Dakin’s) and half-strength mixed reports of cytotoxicity at 0.025% concentration
Hypochlorous acid	broad-spectrum non-cytotoxic
Povidone-Iodine	broad-spectrum	cytotoxic at full strength
Acetic acidvarious reports of strengths, 0.25% up to 5%	broad-spectrum Used primarily for treatment of pseudomonas

Table 2. Creams and Ointments used on Dressings

	Dressing change frequency	Benefits	Risks	Burn-specific Considerations
Silver sulfadiazine	Daily
Mafenide acetate (sulfamyalon)	Daily
Antibiotic ointments	Daily
Medical Grade honey	Daily
Cadexomer Iodine	Daily

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