Comparison of the Results of Operative and Conservative Treatment of Deep Dermal Partial-Thickness Scalds in Children

Abstract

Deep dermal partial-thickness scalds remain one of the most common types of injuries in childhood. Local treatment of those wounds, alternatively described as IIb degree, is still very controversial. Some authors advise conservative treatment of such wounds, pointing to their ability to self-reepithelialise, which is possible but significantly prolonged. Other investigators postulate operative treatment, i.e., tangential necrectomy and split-thickness autologous skin grafting, which may shorten the time of wound healing. Arguments call for contra-arguments, and the problem still seems to be unresolved. There is indeed a lack of acceptable standardisation of the local treatment for deep dermal partial-thickness scalds in the paediatric population. The results of both conservative and operative treatment of 114 children aged between 3 months and 17 years, treated for deep dermal partial-thickness scalds from 1997 to 2004 are presented. The treatment of five groups of patients, divided into groups based on the extent of their burn wounds, is evaluated. The patients were treated by tangential necrectomy and skin grafting, mechanical dermabrasion, Granuflex(R) (Convatec) hydrocolloid dressings, Iruxol Mono(R) (Knoll) enzymatic dressings, or Aquacel Ag(R) (Convatec) hydrofibre dressings with silver ions. A number of parameters of wound healing were analysed. The results of this paper encouraged us to present and discuss a proposition for the standardisation of local treatment of deep dermal partial-thickness burn wounds in the paediatric population, according to the extent of injury.

A review of the applications of the hydrofiber dressing with silver (Aquacel Ag®) in wound care

“…In vitro and in vivo studies have shown that silver has a cytotoxic effect against rapidly proliferating cells, including keratinocytes and fibroblasts, and thus may delay wound epithelialization 8,13. However, clinical studies in patients with partial-thickness wounds (partial-thickness burns and skin graft donor-sites) demonstrated good wound re-epithelialization, with no delay in wound healing 27,28,32–37. Moreover, an in-vivo infected wound model demonstrated similar wound healing properties between Aquacel and Aquacel Ag ® , with significant lower bacterial loads in the Aquacel Ag ® treated group 25.…”

“…Silver-containing dressings are relatively expensive, although the higher cost is partially offset by; reduced use of secondary gauze, retention dressings, and improved wound healing together with the reduced costs of other care. Cost-effectiveness calculations comparing Aquacel Ag ® to standard of care in patients with acute and chronic wounds showed favorable results using Aquacel Ag ® 27,32,33,36–38…”

“…Other clinical studies on partial thickness burns treatment showed good wound healing, reduced pain, fewer dressing changes, and better cost-effectiveness Aquacel Ag ® compared to standard treatment 32,33,35–37. In patients with acute split-thickness skin graft donor sites and acute traumatic wounds,31,34 Aquacel Ag ® showed superior re-epithelialization rates and ease of use, and was associated with less pain on dressing removal, in comparison with standard treatment.…”

“…Aquacel Ag ® has been evaluated for use in adult and pediatric patients with partial-thickness burns 27,28,32,33,35–37. Caruso and colleagues performed a phase II non-comparative trial using Aquacel Ag ® in partial thickness burns and found a good wound re-epithelialization rate, with reduced wound pain, good conformability, and ease of use 28.…”

Flaminal® versus Flamazine® in the treatment of partial thickness burns: A randomized controlled trial on clinical effectiveness and scar quality (FLAM study)

“…Second, results were not stratified for superficial and deep partial thickness burns, because the study area was often partial thickness burns with different depth. This distinction is important because some authors postulate that standard operative treatment for the deep partial thickness burns minimizes poor scar quality, although, there is no consensus in the literature regarding timing and type of the operation, debridement technique, use of skin substitutes or application of growth factors and other humoral agents to enhance wound healing . Spontaneous wound healing of deep partial thickness burns is still possible because of the surviving keratinocytes and epidermal stem cells in the remaining dermis layer .…”