Dressings for superficial and partial thickness burns (Protocol)

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1 Wasiak J, Cleland H, Campbell F This is a reprint of a Cochrane protocol, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 007, Issue 3

2 T A B L E O F C O N T E N T S HEADER ABSTRACT BACKGROUND OBJECTIVES ACKNOWLEDGEMENTS REFERENCES SOURCES OF SUPPORT i

3 [Intervention Protocol] Dressings for superficial and partial thickness burns J Wasiak, H Cleland, F Campbell Contact address: Jason Wasiak, Senior Research Officer, Victorian Adult Burns Service, The Alfred Hospital, Commercial Road, Prahran, Melbourne, Victoria, 3004, AUSTRALIA. J.Wasiak@alfred.org.au. Editorial group: Cochrane Wounds Group. Publication status and date: Unchanged, published in Issue 3, 008. Citation: Wasiak J, Cleland H, Campbell F. Dressings for superficial and partial thickness burns. Cochrane Database of Systematic Reviews 007, Issue 3. Art. No.: CD0006. DOI: 0.00/ CD0006.pub. A B S T R A C T This is the protocol for a review and there is no abstract. The objectives are as follows: The objective of this review is to assess the effects of burn wound dressings used in the treatment of superficial and partial thickness burns. B A C K G R O U N D In the United Kingdom about 50,000 people suffer a burn injury each year (Hettiaratchy 004). These UK figures are representative of most of the developed world countries although some, such as the US, have a higher incidence (Brighman 996). Burns are also a major problem in the developing world with over million burn injuries thought to occur each year in India alone (population 500 million) but this may be a substantial underestimate (Hettiaratchy 004). Mortality rates associated with burn injuries are also considerably higher because of the few clinical resources to manage such injuries. Burns have several causes, most being due to flame injuries with scalds the next most common. Less common in developed countries are those caused by electrical and chemical injuries. Young children up to four years are a particularly vulnerable group comprising 0% of all people with burn injuries, most of these being scalds. Most burns occur in people aged 5-64 years and are mainly flame burns with up to a third work related. Statistics show that the number of productive years lost from burns is greater than that from cancer or heart disease because of the early age at which burn victims are involved (Brighman 996). Patients suffering a burn can present with a wide spectrum of injury severity depending on the depth of the wound and the proportion of the body affected. A burn may be superficial, involving just the epidermal layer of the skin. Partial thickness burns involve damage to deeper structures within the skin such as blood vessels, nerves and hair follicles whilst full thickness burns involve all layers of the skin and may involve the structures beneath such as muscle and bone. Accurate assessment of burn depth is important in making the right decision about treatment. The vast majority of burns are either superficial or partial thickness burns in which the upper dermis and epidermis of the skin are destroyed and blistering is common. The exposed superficial nerves make these injuries extremely painful. Whilst causing considerable pain and distress, these types of burns can heal without the need for surgical intervention and, if only involving relatively small areas, can be managed safely in an outpatient environment. The careful management of these types of wounds will have a considerable influence on the time taken for the wound to heal and therefore its exposure to infection. Ensuring that the wound is managed in a way that promotes healing will also influence the long term quality and appearance of the scar. Superficial and par-

4 tial thickness wounds can progress to a deeper burn if the wound dries out or becomes infected. The goals of out-patient superficial partial thickness burn management include: rapid wound healing, infection prevention, patient comfort, compliance, cost containment and maximization of function for the duration of the treatment. Numerous dressing materials are available for treating such burns, the most common being a combination of paraffin- impregnated gauze and an absorbent cotton wool layer (Hudspith 004). Silver sulphadiazine (SSD) cream has also been commonly used in burn wound management since 968 to minimize the risk wound infection. These conventional dressings however tend to adhere to the wound surface (Thomas 995) and their need for frequent changes traumatizes newly epithelialised surfaces and delays healing. Silver sulphadiazine cream itself is also thought to delay wound healing due to a toxic effect on regenerating keratinocytes (Haertsch 003). The limitations of conventional dressings, improvements in technology and advances in our understanding of wound healing have led to an enormous expansion in the range of dressing options that can be used on minor burns. Characteristics of the optimal dressing should include; ease of application and removal, minimal dressing changes, patient comfort, rapid healing and regimentation. Wound healing studies have shown that a moist environment and an occlusive dressing increase the rate of epithelialization of partial thickness wounds (Winter 96). The range of dressings now available can be sub -categorised into different types based upon the materials used in their manufacture (Queen 987). These sub-categories can include; films, foams, composites, sprays and gels. Also available as an alternative to traditional gauze dressings are the biological skin replacements and the bioengineered skin substitutes, including autologous cultured and non-cultured products, and the newer biosynthetic skin dressings that are available to produce physiological wound closure until the epidermal layer has repaired. Despite the increase in the types of dressings available, the evidence suggests that the traditional dressings of paraffin impregnated gauze and absorbent cotton wool are still most commonly used although recommendations about specific types still remains unclear (Hudspith 004). The purpose of this review is to establish whether any type of dressing from the many now available is more effective in promoting healing and minimizing discomfort and infection for patients with partial and partial thickness burns. O B J E C T I V E S The objective of this review is to assess the effects of burn wound dressings used in the treatment of superficial and partial thickness burns. A C K N O W L E D G E M E N T S The authors would like to acknowledge the contribution of Kate Seers who co authored the earlier version of this protocol: Dressings and topical agents for burns. The authors would like to thank Sally Bell-Syer, Nicky Cullum and Greg Duncan for their useful comments on the development of this protocol. R E F E R E N C E S Additional references Brighman 996 Brigham PA, McLoughlin E. Burn incidence and medical care use in the United States: Estimates, trends, and data sources. Journal of Burn Care and Rehabilitation 996;7 (): DerSimonian 986 DerSimonian R, Laird N. Meta-analysis in clinical trials. Controlled Clinical Trials 986;7(3): Haertsch 003 Haertsch PA. Burn injuries. Australian Doctor 003;August: Hettiaratchy 004 Hettiaratchy S, Dziewulski P. ABC of Burns. BMJ 004; 38: Higgins 003 Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 003;37: Hudspith 004 Hudspith S, Rayatt S. ABC of Burns. BMJ 004;38: Queen 987 Queen D, Evans JH, Gaylor JDS, Courtney JM, Reid WH. Burn wound dressings - a review. Burns 987;3(3): 8 8. Schulz 995 Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 73;5:408.

5 Thomas 995 Tomas SS, Lawrence JC, Thomas A. Evaluation of hydrocolloids and topical meications in minor burns. Journal of Wound Care 995;4(5):8 0. Winter 96 Winter GD. Formation of a scab and the epithelialization of superifical wounds in the skin of a young domestic pig. Nature 96;93:93 4. Indicates the major publication for the study S O U R C E S O F S U P P O R T External sources of support Royal College of Nursing UK Internal sources of support No sources of support supplied 3

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