Treatment of Burns in Adult Patients With a Concentrated Surfactant Gel

A Real-Life Retrospective Evaluation

Timothy Pittinger, MD; Danielle Curran, PA-C; Michel Hermans, MD

Disclosures

Wounds. 2020;32(12):339-344. 

In This Article

Abstract and Introduction

Abstract

Introduction: Debridement is often a necessary step in wound care. In burn care, typically, surgery or enzymes are used for this purpose.

Objective: In a real-life retrospective study, the autolytic debridement properties of a concentrated surfactant gel (CSG) were assessed.

Materials and Methods: Thirty patients who had burns that ranged from superficial partial thickness to full thickness and did not exceed 10% total body surface area were evaluated retrospectively with regard to outcomes of their treatment with CSG alone or in combination with bacitracin ointment (CSG-BA). Both materials were applied daily. The hypothesis of the study was that CSG, by providing moisture to the wound in combination with debridement via micelle action, would provide debridement without the need for surgery or enzymes and would lead to healing times similar to those for wounds treated with other modalities. Burn depth was determined visually.

Results: Of the CSG-treated burns, 88.2% were mixed partial thickness, deep partial, or full thickness, and 64.7% of these lesions reepithelialized completely or showed satisfactory healing progression within a time frame that is similar to published results with other treatment modalities. Secondary autografting was necessary in 1 lesion.

Conclusions: On average, the CSG-BA–treated burns were less deep and smaller than the CSG alone. All wounds reached complete healing or showed continued healing progress.

Introduction

For proper and rapid healing, wounds need to be clean and free of necrotic tissue. In burn care, this means that wounds of any significant depth often require debridement. Surgical modalities for debridement include excision and hydrosurgery;[1–4] both techniques, although reliable, have side effects, such as blood loss and a significant learning curve.[5,6] As an alternative to excision for deep partial- and full-thickness burns, a bromelain-based compound has been used successfully,[7] but this also is associated with a learning curve as well as significant postprocedural pain.[8,9] Less common modalities include physical disruption (eg, hydrotherapy[10]), adjuncts to autolysis (eg, honey[11,12]), and enzymes (eg, collagenase[13,14]). In the United States, these modalities are sometimes used for the debridement of more superficial partial-thickness burns.[13–15]

Surfactants provide an alternative for assisting in wound debridement. A surfactant is an organic compound (typically a macromolecule or polymer) that contains a hydrophilic as well as a hydrophobic region. In an aqueous system and in a high enough concentration, surfactants are arranged in spherical aggregates called micelles. In a wound, the hydrophobic region of the micelle traps fragments of loose tissue, such as necrotic material or microbial particles. The hydrophilic external surface of the micelle provides solubility in fluids.

Concentrated surfactant gel (CSG; PluroGel; Medline Industries, Inc) consists of micelles in a water-soluble gel matrix, which contains a high percentage of poloxamer 188 (P-188). Like other poloxamers, the viscosity of this material is a function of temperature:[16] with increasing temperature and above a critical concentration, P-188 transits from a (viscoelastic) liquid to a solid gel.[17] In other words, the rheological properties of P-188 make the gel thicker at higher temperatures,[16,18] which means that, when cold, it can easily be applied (poured) and distributed over a wound and, once in situ, the gelling under influence of the bodily heat leads to the material staying in place.

Concentrated surfactant gel helps provide a moist wound environment while softening necrosis in the wound over time. This aiding in autolytic debridement may be described as surfactant driven. Concentrated surfactant gel is biocompatible and water soluble and may be liquefied by cooling in a refrigerator, which aids in application.

A real-life retrospective evaluation was undertaken to study the effects of CSG in the management of burns. The hypothesis of the study was that the materials would aid in autolytic debridement, thus assisting the wounds in healing without the need for other debridement methods. In certain cases, CSG treatment was combined with the application of bacitracin ointment, a topical antimicrobial agent that is sometimes used in the care of partial-thickness burns.[13,19,20]

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