Amniotic Membrane Dressing Versus Nitrofurazone-impregnated Dressing in the Treatment of Second-degree Burn Wounds

A Randomized Clinical Trial

Jafar Kazemzadeh, MD; Awat Yousefiazar, MSc; Afshin Zahedi, MD

Disclosures

Wounds. 2021;33(8) 

In This Article

Discussion

The appropriate dressing should be selected based on its effect on healing, ease of application and removal, frequency of dressing changes, and patient comfort. According to various studies, including an RCT,[21–23] the use of biosynthetic dressing (ie, amniotic membrane) can accelerate healing and reduce pain during dressing changes. Tehrani et al[22] showed that an amniotic membrane dressing has antibacterial effects on mesenchymal and epithelial surfaces. A case study by Muhammadi et al[23] described a patient who received skin grafts to previously existing burns in both limbs. After grafting the skin, the authors covered one limb with amniotic membrane and used a conventional dressing (gauze moistened by saline) on the other. A significant difference was observed in skin graft take; the amniotic membrane was found to be a more effective dressing for management of chronic burn injuries, owing to its antimicrobial effects.[23] These findings are consistent with the current results regarding the extent of wound healing (epithelialization) and the absence of infection at the site of wound.

Muhammadi et al[24] reported a median healing time of 6 days for limb repair managed using amniotic membrane among 50 patients. Pain severity was found to be significantly lower in the amniotic membrane group. In addition, amniotic membrane required only 1 dressing change; the amniotic membrane remained on the site of the second-degree burn wound in all cases to complete the wound healing process. These findings are consistent with the results of the current study in that pain intensity, frequency of dressing change, and VSS on day 14 was lower in patients with amniotic membrane dressing, the latter indicating wound healing over a shorter period.

Mostaque et al[21] compared silver sulfadiazine with amniotic membrane; the main difference was one amniotic membrane dressing was used vs repeated dressings and long-term washing of wounds in the silver sulfadiazine group. These findings are consistent with the results of the current study as it relates to the significant difference between the 2 groups in dressing change frequency (P = .001). The lower frequency of dressing changes and subsequently less manipulation of the healing wound reduces both the pain and dressing change-related anxiety of the patient, resulting in better patient tolerance and more adherence.[21]

In addition, results of the current study were similar to Mostaque et al[21] with regard to the duration of epithelialization, which was lower in patients treated with the amniotic membrane dressing. The difference in the epithelialization period can be a function of biological and pharmacological properties of the amniotic membrane, which reduces leakage from the wound site, helps decrease wound debris, and creates a barrier against microbe penetration. Also similar to Mostaque et al,[21] the number of days spent in hospital in the current study was less in the amniotic dressing group than in the control group.

Due to cultural beliefs that impede use of xenograft and allograft biologic dressings in Islamic countries, Adly et al[16] conducted a study that examined amniotic membrane dressings (N = 46); the amniotic membrane dressing was more effective and more acceptable than polyurethane membrane in terms of patient pain severity. Likewise, in the current study, pain intensity was reported to be significantly lower in the amniotic dressing group than in the nitrofurazone group (P = .02), accounting for the lower consumption of opioid and analgesic drugs in the amniotic group compared with the nitrofurazone group. These findings also were in agreement with results of a clinical trial conducted by Hosseini et al[25] that compared biological with conventional dressings. The lower severity of pain reported in the amniotic membrane dressing group could be attributed to the effect of different cytokines in the amniotic membrane (such as transforming growth factor-β) as well as decreased frequency of dressing changes, which would lessen pain and lead to higher satisfaction rates in patients using amniotic membrane dressings.[26]

Witt et al[20] found amniotic membrane dressing use resulted in rapid epithelialization of the burn without the risk of metalloprotein accumulation in both acute and chronic wounds. In their retrospective study (N=370), Ullah et al[27] found that amniotic membrane dressing use decreased the infection rate by suppressing bacteria, reduced plasma oozing from the wound, and created adhesion that developed a dry environment in the wound that lead to reduced infection rate and dressing change frequency as well as shorter duration of hospitalization. These results are consistent with the findings of the current study in terms of fewer hospital days and decreased scarring and pain in comparison with nitrofurazone.

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