A Study of Epithelization in Blistered Burns

Gimbel, Nicholas S.

doi:10.1001/archsurg.1957.01280110142019

Cited by 35 publications

(5 citation statements)

References 4 publications

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“…In the current study, the overall effects of early postburn epidermal debridement on reepithelialization and infection were clearly detrimental, resulting in increased wound infection rates and delayed reepithelialization. These results are in agreement with earlier studies by Gimbel et al 36 and Wheeler and Miller, 37 as noted above. Similar effects of epidermal debridement on infection and reepithelialization have also been noted in partial-thickness burns that were contaminated with Staphylococcus aureus organisms.…”

Section: 21supporting

confidence: 94%

“…In this study, burns that were left intact reepithelialized 40% more rapidly than burns in which the blisters were aspirated or unroofed. 36 Similar effects of burn blister debridement have also been reported in guinea pigs in which blister debridement resulted in wound dehydration and progression of burn depth injury. 37 Forage also noted more rapid reepithelialization, less pain, and better cosmetic results when burns blisters were left intact.…”

Section: Discussionmentioning

confidence: 55%

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The Effects of Epidermal Debridement of Partial‐thickness Burns on Infection and Reepithelialization in Swine

Singer

Thode

McClain

2000

Academic Emergency Medicine

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Abstract. Objective: Early postburn debridement of burn blisters is controversial. This study was conducted to compare rates of infection and reepithelialization in debrided vs nondebrided second-degree burns in swine. Methods: This was a prospective, blinded, controlled, experimental trial using isoflurane-anesthetized swine. Standardized partial-thickness burns were inflicted by applying an aluminum bar preheated to 80ЊC to the backs and flanks of two young pigs for 20 seconds. In half of the burns the necrotic epidermis was manually debrided. All burns were randomly treated with octylcyanoacrylate spray (OCA) or dry gauze (C). Full-thickness biopsies were taken at 7, 10, and 14 days for blinded histopathologic evaluation. The primary outcomes were the proportions of infected burns at days 7 and 10 and the proportion of completely reepithelialized burns at day 14. Burns were considered infected in the presence of intradermal neutrophils containing bacteria (intraobserver agreement, = 1.00). A secondary outcome was the proportion of burns with the presence of scar tissue (abnormal collagen under polarized light; intraobserver correlation, = 0.93). Chi-square tests were used for group comparisons. This study had 90% power to detect a 40-percentage-point difference in infection rates (␣ = 0.05). Results: A total of 126 biopsies from 42 burns were available for review. Infection rates were higher in the debrided burns both at day 7 (55% vs 4.5%, p < 0.001) and at day 10 (65% vs 9%, p < 0.001) after injury. The proportion of nondebrided burns that were completely reepithelialized was higher at days 10 (68% vs 0%, p < 0.001) and 14 (100% vs 65%, p = 0.003). The presence of scar tissue was more common in debrided burns (75% vs 4.5%, p < 0.001). Burns treated with OCA had fewer infections than controls (4% vs 55%, p < 0.001). Fewer OCA-treated debrided burns were reepithelialized at 14 days than those that were not debrided (30% vs 100%, p = 0.001). Conclusions: Under the current study conditions, early postburn epidermal debridement of second-degree burns resulted in more infections and slower reepithelialization rates in swine. The effects of early postburn epidermal debridement in humans should be explored.

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Section: 21supporting

confidence: 94%

Section: Discussionmentioning

confidence: 55%

The Effects of Epidermal Debridement of Partial‐thickness Burns on Infection and Reepithelialization in Swine

Singer

Thode

McClain

2000

Academic Emergency Medicine

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“…In a comparison of healing rates in 14 volunteers with partial-thickness burns, Gimbel et al (1957) found that blisters left intact healed faster than those that were debrided. However, these findings do not take into account the evidence-based need for wound beds to remain moist (Lloyd et al 2012) or the recent development of 'skin-substitute' type dressings (Sargent 2006).…”

Section: Resultsmentioning

confidence: 99%

Treatment for burn blisters: debride or leave intact?

Murphy

Amblum²

2014

Emergency Nurse

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This article presents findings from a systematic literature review of whether blisters arising from minor burns should be de-roofed or left intact. It discusses the risks of infection, healing outcomes, discomfort, choice of dressings and costs associated with each method, and reveals that debriding blisters larger than the patient's little fingernail while leaving smaller ones intact is generally agreed to be the best option. The article also explains external factors that influence the choice of whether to debride or leave blisters intact, reviews policy at the trust where one of the authors works in the context of the research and makes recommendations for practice.

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“…Records show that these included bark, fruit, grass, herbs, leaves, meat, pitch, resins, sponge, and tars. 1–6 In the light of modern standards, some of the substances could qualify as occlusive dressings. To be occlusive, a dressing should be relatively impermeable to moisture vapor.…”

Section: Origin Of Occlusive Therapymentioning

confidence: 99%