Wound management in burn centres in the United Kingdom

Abstract

Despite advances in the use of topical and parenteral antimicrobial therapy, and the practice of early tangential excision, infection of the burn wound remains a leading cause of morbidity and mortality. The aim of this study was to survey and compare wound management and antibiotic usage in burn surgery in all UK burn centres. A postal questionnaire was used, followed up by telephone. Answers were obtained from all 39 units treating burns in the UK. A written policy on antibiotic usage was used by 13 centres. Excisions were covered routinely by prophylactic antibiotic therapy in 18 units, and three of these used antibiotic cover during all procedures in which the wound was manipulated. No routine antibiotic cover was given in 21 units. All units obtained surface swab cultures, but only two performed punch biopsy of the wounds. Quantitative bacteriology (counting colony forming units) was employed by three centres. Most units cleaned the burn with saline (17 of 39) or chlorhexidine (eight of 39) but combinations of these and other agents were also used. Nearly half (17 of 37) of those who replied had not seen any cases of proven or suspected toxic shock syndrome in the past 2 years. Four units gave prophylaxis against Staphylococcus aureus, and four gave antibiotics against Streptococcus pyogenes, despite recommendations in the literature. Twenty-nine units gave no prophylaxis. This study has revealed that there is no consensus on antibiotic usage amongst centres treating burns in the UK and that most units rely on surface swab cultures to monitor infection.

Histological assessment of tangentially excised burn eschars

“…This approach, however, is not without hazard. While generally producing better functional and cosmetic results than expectant conservative management, a high price is paid in terms of surgical and anesthetic trauma, bleeding, the sacrifice of remaining viable healthy tissue and the need for larger donor site areas (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16).…”

Octylcyanoacrylate for the Treatment of Contaminated Partial‐thickness Burns in Swine A Randomized Controlled Experiment

“…Because of its relatively low toxicity and ease of use, silver sulfadiazine (SSD) is currently the most widely used topical antimicrobial agent. 10 Popular alternatives to the topical antimicrobial agents for the treatment of partial-thickness burns are the synthetic occlusive dressings. Potential advantages of occlusive dressings include the ability to reduce wound healing time, 11,12 reduction in the amount of pain experienced by patients with burns, 11,13 improved cosmetic outcome, ease of care, and low cost.…”

“…The burned areas were then covered with a gauze bandage roll (Conform, Kendall Company) and an adhesive elastic bandage (Elastoplast, Beiersdorf-Jobst, Inc., Rutherford College, NC). Silver sulfadiazine was chosen as a comparative treatment since it is currently the most commonly used topical agent for burns, 10 while PU film is representative of the occlusive dressings.…”

Comparison of topical zinc oxide and silver sulfadiazine in burn wounds: an experimental study

“…In the topical treatment of burn wounds, 1% silver sulfadiazine (SSD) pomade is the most commonly used agent worldwide. [1] SSD has been shown to decrease bacterial contamination, to hasten epithelization and to delay wound contraction. [2][3][4][5][6][7][8] However, SSD is also known to delay wound healing and separation of scar tissue, to cause atrophic and hypertrophic scars, especially more than three weeks after the applications, to have renal toxicity, to cause leukopenia, and to carry a risk for resistance.…”