The boiled potato peel as a burn wound dressing: a preliminary report

This paper discusses the suitability of potato peel as a burn wound dressing in developing countries. Clinical trials have demonstrated that epithelial growth occurs under the potato peel dressing in superficial partial thickness skin loss burns. In deep partial, full skin thickness burns and in the late granulating burn wound the results are not so favourable. More experience is required.     

Evaluation of boiled potato peel as a wound dressing

In a series of experiments full thickness skin defects in 68 rats were covered with dressings made of boiled potato peels according to the method developed in Bombay. The wounds closed within 14 days and histologically complete repair of epidermis was found. The cork layer of the potato peel prevents dehydration of the wound and protects against exogenous agents. Experiments with homogenates revealed that a complete structure of the peel is necessary. Steroidal glycosides may have contributed to the favourable results.     

Management of partial skin thickness burn wounds with Inadine dressings

In a prospective randomized trial, 213 consecutive patients with less than 10 per cent BSA partial thickness burns were treated as out-patients with either Bactigras (n= 102) (tulle gras dressing with 0.5 per cent Chlorhexidine Acetate B.P.) or Inadine (n = 111) (rayon dressing with 10 per cent povidone iodine ointment). Inadine caused less bleeding on dressing removal but not significantly less. Inadine treated patients required less analgesia, a reduced treatment time, a smaller number of hospital visits and less time off work/normal activities (P = 0.01). Inadine should be more widely used in the management of partial thickness burn wounds.     

A systematic review of silver-containing dressings and topical silver agents (used with dressings) for burn wounds

Silver preparations are commonly used for burns, but evidence of their effectiveness remains poorly defined. The aim of the study was to evaluate the effectiveness of silver-containing dressings and topical silver for preventing infection and promoting healing in burns wounds through a meta-analysis of the available evidence. The Cochrane Central Register of Controlled Trials and relevant databases were searched. Drug companies and experts in this field were also contacted. Randomised controlled trials (RCTs) of silver dressings or topical silver (used with dressings) compared with non-silver dressings were eligible for inclusion. We identified 14 RCTs involving 877 participants. One small trial of a silver-containing dressing showed significantly better healing time compared to the control [MD -3.6; 95% CI -4.94 to -2.26 for partial thickness burns and MD -3.9; 95% CI -4.54 to -3.26 for superficial burns]. Topical silver showed significantly worse healing time compared to the non-silver group [WMD 3.96; 95% CI 2.41-5.51] and showed no evidence of effectiveness in preventing wounds infection [WMD 2.48; 95% CI 0.39-15.73]. Our review suggests that silver-containing dressings and topical silver were either no better or worse than control dressings in preventing wound infection and promoting healing of burn wounds.     

Comparison of wound healing and patient comfort in partial‐thickness burn wounds treated with SUPRATHEL and epictehydro wound dressings

Among the available dressings for partial‐thickness burn wound treatment, SUPRATHEL has shown good usability and effectiveness for wound healing and patient comfort and has been used in many burn centres in the last decade. Recently, bacterial nanocellulose (BNC) has become popular for the treatment of wounds, and many studies have demonstrated its efficacy. epicite^hydro, consisting of BNC and 95% water, is a promising product and has recently been introduced in numerous burn centres. To date, no studies including direct comparisons to existing products like SUPRATHEL have been conducted. Therefore, we aimed to compare epicite^hydro to SUPRATHEL in the treatment of partial‐thickness burns. Twenty patients with partial‐thickness burns affecting more than 0.5% of their total body surface area (TBSA) were enrolled in this prospective, unicentric, open, comparative, intra‐individual clinical study. After debridement, the wounds were divided into two areas: one was treated with SUPRATHEL and the other with epicite^hydro. Wound healing, infection, bleeding, exudation, dressing changes, and pain were documented. The quality of the scar tissue was assessed subjectively using the Patient and Observer Scar Scale. Wound healing in patients with a mean TBSA of 9.2% took 15 to 16 days for both treatments without dressing changes. All wounds showed minimal exudation, and patients reported decreased pain with the only significant difference between the two dressings on day 1. No infection or bleeding occurred in any of the wounds. Regarding scar evaluation, SUPRATHEL and epicite^hydro did not differ significantly. Both wound dressings were easy to use, were highly flexible, created a safe healing environment, had similar effects on pain reduction, and showed good cosmetic and functional results without necessary dressing changes. Therefore, epicite^hydro can be used as an alternative to SUPRATHEL for the treatment of partial‐thickness burn wounds.     

Analgesic efficacy of sufentanil in dressings after surgical treatment of burn wounds

BackgroundThe aim of this study was to assess the analgesic efficacy of sufentanil in dressings after surgical treatment of burn wounds.Patients and methodsTwenty adult patients, who underwent surgical treatment of third–degree burn wounds under general anesthesia, were included. Two of the patients underwent surgery twice. During surgery, patients received 50–100 μg fentanyl every 20–30 min and, after surgery, patients received 100 mg ketoprofen twice daily. Additionally, ten patients (group 1) received 50 μg sufentanil added to the burn wound dressings soaked in octenidine and phenoxyethanol while 10 patients (group 2) received 25 μg sufentanil added to the same dressings. The rescue analgesic, which was administered when pain intensified, was 5 mg subcutaneous morphine. Plasma sufentanil concentrations were assayed at 1, 2, 3, and 6 h after surgery completion and when pain was reported, along with pain intensity evaluation.ResultsSufentanil was not detected in the serum of any patients. Rescue morphine was given during the postoperative period (24 h) in one patient in group 1 (who underwent surgery twice) and three patients in group 2. The mean sufentanil concentration in dressings was higher in group 1 (0.13 ± 0.03) than group 2 (0.06 ± 0.03 μg/mL; p < 0.001). The group 1 patient who received rescue morphine had a sufentanil concentration of 0.10 μg/mL, which was the lowest concentration in group 1. Group 2 patients who received rescue morphine had sufentanil concentrations of at least two–fold lower (0.03–0.05 μg/mL). No adverse effects were observed.ConclusionsSufentanil in dressings after burn wound surgery provides effective and safe analgesia and the sufentanil concentration in dressings should be ≥0.10 μg/mL in a solution of octenidine and phenoxyethanol.     

Comparison of the efficacy of silver-based antimicrobial burn dressings in a porcine model of burn wounds

PurposeA variety of silver-based antimicrobial dressings are available on the market and are commonly used to prevent infection. Such prophylaxis is particularly important in treating burns, yet there is a paucity of evidence confirming the efficacy of commercially available dressingsin vivo. We describe here an in vivo porcine model of burns, which we use to test the antimicrobial efficacy of three common wound dressings and a control.ProceduresDomestic Yorkshire-cross pigs were medicated for pain management before inflicting burns with a heated brass rod. The wounds were artificially challenged with a mixture of two pathogens commonly associated with burn wound infection:Staphylococcus aureus and Pseudomonas aeruginosa. The following dressing materials were sutured in place: gauze, nanocrystalline silver, silver-plated nylon, and polyethylene/polyester coated with high-oxidation silver salts. After 1 and 3 days, the wounds were assessed for erythema, swelling, and re-epithelialization, tissue was biopsied to determine the recovery of the challenge microorganisms, and histology was performed. We also examined the number of microorganisms present on the dressings themselves.ResultsHistology indicated that 30 s was sufficient to produce burns extending into the deep dermal layer. After 3 days, nanocrystalline silver and silver-plated nylon led to slightly reduced swelling relative to simple gauze, although none of the dressings significantly affected erythema or wound re-epithelialization. All the dressings led to decreased recovery of the challenge organisms from the burn tissue, relative to simple gauze. However, the magnitude of the reduction was greatest for nanocrystalline silver (log₁₀ reduction = 4–5); additionally, only nanocrystalline silver gave a statistically significant decrease (P = 0.02). Notably, the antimicrobial effect for all dressings was reduced by Day 3 relative to Day 1. Similar trends were observed for microbial retention on the dressings themselves.ConclusionNanocrystalline silver-based wound dressings generally outperformed silver-plated nylon and high-oxidation silver salts in thisin vivo model of burn wounds. Relative to prophylactic use, it may be advisable to change the dressings more frequently when treating an infected wound.     

Therapeutic effects of silver nylon dressings with weak direct current on Pseudomonas aeruginosa-infected burn wounds

The therapeutic and prophylactic effects of nylon dressings coated with metallic silver in a direct current circuit have been examined in a rat model of fatal burn wound sepsis. Male Sprague-Dawley rats weighing 325 +/- 25 grams with 20% full-thickness scald injuries were used. Therapeutic effects were examined at 4 or 24 hours after surface inoculation with a lethal dose of Pseudomonas aeruginosa (Strain 59-1244). When used as a surface anode with an implanted silver needle cathode, the silver nylon was therapeutic at currents between 0.4 and 40 microA when applied at either test time and continued for 5 days (p less than 0.001). When used as a cathode, silver nylon was not effective. Nylon cloth without a silver metal coating was not effective without applied current or when used as an anode. Silver nylon dressings placed at 4 hours after inoculation but without applied current showed significant effectiveness (p less than 0.01). This effect, however, was significantly less than that seen with silver nylon used as an anode (p less than 0.001). Barrier prophylactic effects were examined by placing silver nylon or uncoated nylon on burn wounds before inoculation with Pseudomonas aeruginosa. The uncoated nylon had no barrier effect. Silver nylon was found protective but applied current was not required for significant (p less than 0.001) barrier effect. These results indicate silver nylon dressings may be a valuable antimicrobial burn wound covering device.     

Bandages of boiled potato peels

The use of potato peels as a dressing for burn wounds has been reported previously. A technique of preparing bandage rolls with boiled potato peels is now presented, which makes dressing of a burn wound more convenient.     

烧伤创面应用生长因子后的DNA分析

将基因重组的人表皮细胞生长因子（ｒｈ－ＥＧＦ）、酸性成纤维细胞生长因子（ｒ－ａＦＧＦ）、碱性成纤维细胞生长因子（ｒ－ｂＦＧＦ）和牛脑提取液（ｂＢＥ）外用于烧伤创面，旨在探讨皮肤组织和细胞ＤＮＡ的含量及周期变化。实验结果显示：烧伤创面经应用ｒｈ－ＥＧＦ，ｒ－ａＦＧＦ，ｒ－ｂＦＧＦ和ｂＢＥ后第５天与生理盐水组（ＮＳ）相比，创面愈合率、表皮细胞和全厚层皮肤组织的ＤＮＡ含量均高于ＮＳ组（Ｐ＜０．０１）；全厚层皮肤ＤＮＡ的流式细胞仪分析表明，应用生长因子各组的Ｓ期细胞数百分比均高于ＮＳ组（Ｐ＜０．０１），细胞分裂增殖旺盛，Ｇ期细胞不断进入Ｓ期，使Ｓ期细胞数增加，ＤＮＡ的合成和含量增加。提示：烧伤创面外用细胞生长因子可促进表皮细胞的增殖，加速创面的愈合。     

水凝胶敷料联合复方紫草油在Ⅱ度烧伤创面中的应用

目的:探讨水凝胶敷料(斯茯)联合复方紫草油在治疗Ⅱ度烧伤创面中的作用。方法:选择2013年2月~2014年2月在我院接受治疗的Ⅱ度烧伤患者共80例,随机分为治疗组和对照组,分别统计并比较创面愈合时间、疼痛程度、治疗费用、3个月瘢痕生长、不同时期基底分泌物细菌培养阳性率。结果:水凝胶敷料联合复方紫草油治疗组创面愈合时间缩短、疼痛程度明显降低、治疗费用减少、3个月瘢痕生长降低、细菌培养阳性率降低(P0.05)。结论:应用水凝胶敷料可有效缩短创面愈合时间,降低患者换药疼痛程度、创面感染率及3个月瘢痕生长率。     

烧伤创面应用生长因子后的DNA分析

将基因重组的人表皮细胞生长因子(rh-EGF)、酸性成纤维细胞生长因子(r-aFGF)、碱性成纤维细胞生长因子(r-bFGF)和牛脑提取液(bBE)外用于烧伤创面,旨在探讨皮肤组织和细胞 DNA 的含量及周期变化。实验结果显示:烧伤创面经应用 rh-EGF,r-aFGF,r-bFGF 和 bBE 后第5天与生理盐水组(NS)相比,创面愈合率、表皮细胞和全厚层皮肤组织的 DNA 含量均高于 NS 组(P<0.01);全厚层皮肤 DNA 的流式细胞仪分析表明,应用生长因子各组的 S 期细胞数百分比均高于 NS 组(P<0.01),细胞分裂增殖旺盛,G 期细胞不断进入 S 期,使 S 期细胞数增加,DNA 的合成和含量增加。提示:烧伤创面外用细胞生长因子可促进表皮细胞的增殖,加速创面的愈合。     

Acetic acid dressings used to treat pseudomonas colonised burn wounds: A UK national survey

IntroductionWound infection following burn injury can be clinically challenging to manage. Its presence in a thermally compromised patient can detrimentally affect the ability of the wound to heal leading not only to wound progression but ultimately contribute to a large part of the economic health burden expenditure in the National Health Service. Despite meticulous wound care and infection control measures the colonisation of burn wounds by bacterial pathogens has and continues to be the case.There has been a growing interest in the use of antimicrobial applications when managing localised burn wound infections due to a constantly increasing number of antibiotic-resistant organisms.AimTo survey which antimicrobial dressings are currently being used across UK burns services when managing localised pseudomonas wound infections.MethodsWe conducted a nationwide telephone survey of UK burns services during October 2019 to determine which topical antimicrobial agent was used to treat local pseudomonas burn wound infections.ResultsSix burns services (31.6%) used acetic acid-soaked dressings, one of which alternates acetic acid with sodium hypochlorite solution. Silver-based dressings were also used by six burns services (31.6%) – again, one department alternates silver-based dressings with sodium hypochlorite solution. Betadine-soaked, gauze-based dressings were used across five burns services (26.3%) and the remaining two burns services (10.5%) used sodium hypochlorite solution and non-medicated dressings respectively.ConclusionWe identified a significant difference in the UK burns services’ approach to pseudomonas burn wound infections.Our literature review demonstrates that a daily dressing regime of 2.5–3% acetic acid is a well-tolerated treatment regime in burn patients and that it is in use in UK burns services. There are no current randomised controlled trials that evaluate the usage of acetic acid. The variation in usage suggests that there is scope for further study in order to develop evidence to generate a UK wide approach based on national standardised guidelines.     

Electron-microscopic observation on silver deposition in burn wounds treated with silver sulphadiazine cream

The absorption and distribution of silver has been studied in 8 burned patients treated with silver sulphadiazine cream by electron-microscopic examination. Biopsies were taken from the burn wounds and from epithelized areas surrounding wounds. Only I of 2 patients treated for 21 days was observed to have silver deposits in the cytoplasm of both the epidermal cells and sweat glands. The silver deposits appeared as roughly round and oval bodies of varied size. The results indicated that very little of the silver moiety in silver sulphadiazine cream penetrated the body through the wound.     

Comparison of efficacy of silver-nanoparticle gel,nano-silver-foam and collagen dressings in treatment of partial thickness burn wounds

IntroductionThis study was carried out to compare the efficacy of silver nanoparticle gel (SG), nanosilver foam (SF) and collagen (C) dressings in partial thickness burn wounds.MethodsThis was a single-center, prospective cohort study carried out over a period of 1 year on patients with 15–40% partial thickness thermal burns ≤48 h. Each patient received all three dressings (silver-nanoparticle gel, nanosilver foam, collagen) simultaneously at 3 randomly selected areas which were comparable in terms of burn depth and surface area. Efficacy of the dressings was assessed in terms of healing rates, time taken and ease of application, pain at dressing change, cost, wound-swab culture and scar quality (at 3 months).ResultsA total of 20 patients were included. In SF group, number of patients with 60%–80% re-epithelialization on day10 (SG: 10/20; C: 10/20; SF: 16/20; p = 0.042) and complete healing on day14 (SF: 11/20, C: 6/20, SG: 4/20; p = 0.032) was significantly higher. The time for dressing change was similar at admission (p = 0.918) and day 10 (p = 0.163), although majority of the patients in SF group needed less than 10 min. The time taken (<10 min) was significantly lower in SF group by 14th day (SF: 18/20 C: 6/20 SG: 6/20; p < 0.001). The ease of application rated by clinicians as “extremely easy” was significantly better in SF group (SG: 78%, C: 80%, SF: 95%; p = 0.011). There was a significantly faster decrease in pain scores in SF group by 5th day (VAS score SF: 6, C: 8; SG: 8; p = 0.038), however, pain scores were comparable at 2 weeks. The scar quality (p = 0.82), cost (p = 0.09) and infection rates (SG: 7/20; C: 4/20; SF: 3/20; p = 0.05) were comparable. The need for skin-graft cover was lower in SF group (SG: 5/20; C: 3/20; SF: 1/20).ConclusionNanosilver-foam dressings were found to be more efficacious for re-epithelialization, healing, ease of application, tolerance when compared to silver nanoparticle gel and collagen dressings in partial-thickness burns. All were found to be safe.