New Topical Agents for Treatment of Partial-thickness Burns in Children: A Review of Published Outcome Studies

Wanda Dorsett-Martin, DVM; Barbara Persons, MD; Annette Wysocki, PhD, RNC; William Lineaweaver, MD, FACS

Disclosures

Wounds. 2008;20(11) 

In This Article

Abstract and Introduction

Abstract

Evidence-based choices for treating burns in children are not well defined. Skin substitutes and contemporary dressings offer potential advantages over traditional treatment with topical antimicrobial agents in treating partial-thickness burns. Newer treatment modalities may reduce morbidity, financial burdens, and scarring by accelerating healing.
Reports of pediatric burn management from 1997 to 2007 were reviewed to compare agent performance with outcome measures such as healing time, pain moderation, cosmetic results, and hospital costs. Transcyte™ (Smith & Nephew, London), Biobrane® (Bertek Pharmaceuticals Inc, Morgantown, WV), beta-glucan collagen, and Mepitel® (Mölnlycke, Göteborg, Sweden) have been reported as superior to silver sulfadiazine (SSD) in achieving faster healing times and decreased pain in pediatric patients.
Initial reports describing the outcomes achieved with these new agents indicate that they may offer clinical advantages in the treatment of partial-thickness burns in children. Increased costs of the new products appeared to be offset by decreases in hospital stay, nursing care time and pain medications. The existing literature is not conclusive, and prospective trials with standardized outcome measures are needed to better define the role of these agents.

Introduction

Children, especially those younger than 2 years, are at high risk for burn injury.[1] Of 126,642 records of acute burn hospital admissions in the United States between 1995 and 2005, approximately 32% were younger than 20 years of age.[1] In the 6-year period from 1997 to 2002, there was an annual average of 78,000 children (birth-4 years old) treated in US ambulatory settings for injuries resulting from contact with a hot object or substance.[2] Natural curiosity, impulsiveness, lack of awareness of potential dangers, and limited ability to respond to a precarious situation in a prompt, appropriate manner, are factors leading to the high occurrence of burns in the pediatric population.[3,4]

Scalding is the leading cause of burns in children younger than 3 years, and fire is the major cause of burns in older children.[5] Scald injuries usually occur in the home as a result of cooking accidents or use of excessively hot water during bathing.[6,7] Accidental and neglect-related burns, although common, are not the only problem for the medical community; child abuse is the cause for many admissions.[5] Approximately 20% of pediatric burns are caused intentionally by a caregiver or parent.[8]

The sheer volume of burn incidents, especially within a vulnerable population such as children, necessitates major medical resources dedicated to burn care. The ever-increasing financial pressures associated with health care also contribute to the need for effective, cost-efficient treatment options for burns.[9]

Treatment of partial-thickness burns customarily involves early debridement of nonviable tissue. After debridement, the wound may be dressed with any of numerous dressings, which can be either biological, nonbiological, or a combination of these elements, in an effort to stimulate healing and provide protective covering for the wound. Pediatric burns traditionally have been treated with daily cleansing of the burn wound and application of topical antimicrobial agents.[10] Numerous carriers can be useful for burn treatment. According to Palmieri and Greenhalgh,[11] such carriers include ointments, creams, biological and nonbiological dressings with the topical antimicrobials of choice being mafenide, neomycin, bacitracin, and silver sulfadiazine (SSD).

Coverage of the burn site with autografts is the optimum treatment for full-thickness or deep partial-thickness burns. Early treatment with skin grafts may not always be possible in a metabolically compromised patient or in large body surface area burns where adequate donor sites may not be available. Allografts (eg, cadaver skin) are useful as a temporary graft because they provide a protective barrier to a burn wound and can be supplied using skin banks. High cost, limited availability, and the possibility of disease transmission are all drawbacks of allografts.[12] In most cases, skin grafting is unnecessary for the treatment of partial-thickness burns, unless the burn transitions to full thickness. While there is a need for a dressing and/or skin substitute that facilitates rapid healing of partial-thickness burns with minimal pain and scarring, this ideal dressing does not exist.

The objective for skin substitutes is complete restoration of both anatomical architecture and functional physiology of skin after wound treatment and healing.[13] Extra considerations for dressings specifically designed for pediatric patients include: 1) resistance to soiling of wounds with urine and feces in infants and toddlers; and 2) achieving adherence of dressings due to ever changing shear forces produced during play behavior of naturally active toddlers.[7] A large and increasing number of agents are available with varying claims of meeting these objectives.

The goals of this review are to provide a general overview of dressings and skin substitutes used in pediatric care of partial-thickness burns and if possible, to determine by the use of comparison studies, the most current, efficacious treatment of partial-thickness burns in children. Additionally, by reviewing the current practices, the authors will suggest possible directions for future research in this area.

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