Evaluation of Topical Off-The-Shelf Therapies to Improve Prolonged Field Care of Burn-Injured Service Members

Abstract

Introduction Burns are common injuries on the battlefield. Given austere environments, surgical debridement of injured service members is often not feasible in these settings. Delays in surgical debridement create a risk of infection and deranged healing for burn patients. As such, this study attempts to identify the best commercially available off-the-shelf (OTS) therapies with field-deployable potential to improve prolonged field care (PFC) of burn-injured soldiers. Methods Deep partial-thickness (DPT) burns (25 cm2) were created on the dorsum of 5 anesthetized pigs utilizing a thermocouple burn device at 100°C for 15 seconds. Nonsurgical debridement was done 1-hour after burn creation using sterile saline water and gauze to remove excess eschar tissue. Animals were then randomized into 5 experimental groups, and OTS therapies were applied to 6 of the 12 created DPT burns. The remaining 6 burns were treated with 1% silver sulfadiazine cream (Ascend Laboratories, LLC, Parsippany, NJ) as the PFC standard of care (SOC) controls. The 5 randomized OTS therapies were: irradiated sterile human skin allograft (IHS), biodegradable temporizing matrix (BTM), polylactic acid skin substitute, hyaluronic acid ester matrix (HAM), and decellularized fish skin graft (FSG). Wounds were serially assessed on post-burn days 3, 7, 14, 21, and 28. Assessments were conducted using a combination of photographs, histology, and quantitative bacteriology. Endpoints included burn wound progression, re-epithelialization, wound contraction, scar elevation index, and colony-forming units (CFU). Results The analysis demonstrated that by day 3, the FSG prevented burn wound progression the most efficiently. In terms of wound healing, the results showed re-epithelialization percentages close to 100% by day 28 for all treatment groups. No statically significant differences were observed. Quality of healing analyses demonstrated that the BTM-treated wounds had contracted less and the difference to the IHS-treated wounds was statistically significant (P < .05). As regards to antimicrobial properties, the CFU results showed no statistically significant differences between the OTS therapies and the SOC on days 3, 7, and 14. Conclusions The impact of Food and Drug Administration-approved OTS therapies was compared to the current PFC SOC for the treatment of DPT burns in a porcine model. Several topical options exist for the management of burns prior to definitive treatment in the operating room and warrant further evaluation. These therapies are actively used on civilian burn counterparts and have far-forward, field-deployable potential for use at the point of injury so that injured service members may not need evacuation to higher roles of care and combat power may be preserved. Our results demonstrated that all the studied OTS therapies performed well when compared to the SOC in terms of burn wound progression, wound healing, quality of healing, and quantitative bacteriology.

Full‐thickness skin columns: A method to reduce healing time and donor site morbidity in deep partial‐thickness burns

“…Deep partial‐thickness burn wounds were created by placing a thermocouple‐regulated brass heating device with a contact area of 56.25 cm 2 (7.5 × 7.5 cm) and mass of 300 g maintained at 100°C at a constant pressure onto the pig's dorsum for 15 s to achieve deep partial‐thickness burns. This is a well‐studied method refined in our lab to produce consistent deep partial‐thickness burns, with burn depth proven histologically in previous studies, some of which have not yet been published 22,23 . The temperature of 100°C was maintained using a heating pad and T‐type thermocouple (Omega, Stamford, CT) connected to a Digi‐Sense temperature controller (Cole‐Parmer, Vernon Hills, IL) and applied with an average force (including gravitational force) of 0.5 N/cm 2 for 15 s. The device is enclosed in a Teflon exterior with a handle to provide safe handling and usage.…”

“…This is a well-studied method refined in our lab to produce consistent deep partial-thickness burns, with burn depth proven histologically in previous studies, some of which have not yet been published. 22,23 The temperature of 100 C was maintained using a heating pad and T-type thermocouple (Omega, Stamford, CT) connected to a Digi-Sense temperature controller (Cole-Parmer, Vernon Hills, IL) and applied with an average force (including gravitational force) of 0.5 N/cm 2 for 15 s. The device is enclosed in a Teflon exterior with a handle to provide safe handling and usage. Ten 7.5 Â 7.5 cm rectangular deep partial-thickness burns are made in the paravertebral region with the aforementioned burn device, as seen in Figure 1.…”

Burn Wound Care Strategies for the Battlefield and Austere Settings

“…These include irradiated human skin allograft (GammaGraft™), decellularized fish skin graft (Kerecis ® Omega3), biodegradeable temporizing matrix (BTM; NovoSorb ® BTM), polylactic acid skin substitute (Suprathel ® ), and hyaluronic acid ester matrix (Hyalomatrix ® ). These products were all found to be comparable to 1% silver sulfadiazine in terms of wound healing, wound progression, and quantitative bacteriology in deep partial-thickness burns in swine [45]. GammaGraft TM was used in the Combat Support Hospital in Baghdad during the recent conflict in a manner similar to fresh or cryopreserved allograft [46].…”