Evaluation of the clinical curative effect of applying vacuum sealing drainage therapy in treating deep partial-thickness burn wound at the initial stage / 中华烧伤杂志

<p><b>OBJECTIVE</b>To evaluate the clinical curative effect of applying vacuum sealing drainage (VSD) therapy in treating deep partial-thickness burn wound at the initial stage prospectively, and to provide the basis for its clinical application.</p><p><b>METHODS</b>Twenty-two patients with about 10% TBSA burn of the lower limbs, and in which partial-thickness wound exceeded 1% TBSA in each limb, were admitted to our hospital within 3 hours after burn from May 2009 to March 2010. Wounds in each patient were divided into VSD treatment group (treated with VSD therapy) and control group (treated with 10 g/L silver sulfadiazine cream) based on the principles of symmetry of location, identical deepness, and similarity in size etc. The amount of water evaporation, the swelling intensity, the status of bacterial colonization, the degree of pain, the healing time, and the quality of healing of wounds in 2 groups were observed and compared. Data were processed with t test and rank-sum test.</p><p><b>RESULTS</b>The observation was completed in 21 patients. All of the wounds were treated within 4 hours post burn (PBH). The amount of water evaporation of the normal skin and burn wounds before dressing coverage in VSD treatment group was respectively close to that in control group (with t value respectively 1.310, -0.911, P values all above 0.05); the amount of water evaporation on the surface of dressing in VSD treatment group [(44.3+/-3.9) mLxh(-1)xm(-2)] was less than that in control group [(66.1+/-6.4) mLxh(-1)xm(-2), t=-11.39, P<0.01]. In VSD treatment group, the circumference of proximal thigh increased (3.48+/-0.35) and (2.51+/-0.21) cm on post burn day (PBD) 3, 7 as compared with that on PBH 5, which was respectively smaller than that [(8.02+/-0.41), (3.99+/-0.32) cm] in control group (with t value respectively 4.110, 3.569, P values all below 0.01). Positive bacteria' culture rate on PBD 10 of each group was respectively lower than that at admission (with Z value respectively -3.220, -3.870, P values all below 0.01), and there was no significant statistical difference between 2 groups at admission or on PBD 10 (with Z value respectively -0.894, 0.000, P values all above 0.05). The wound surface in VSD treatment group was weak acidic (pH value 7.12+/-0.06) on PBD 10, and it was neutral (pH value 7.41+/-0.13) in control group. The wound pain degree in control group on PBD 1, 3, 7 was respectively higher than that in VSD treatment group (with t value respectively -16.132, -21.230, -16.453, P values all below 0.01). There was no significant statistical difference between 2 groups in healing time of wounds (t=1.186, P>0.05). The healing quality of wounds in VSD treatment group (100.00%, 100.00%) 2 or 3 months after burn was better than that in control group (19.05%, 85.71%) (with Z value respectively -11.638, -3.870, P values all below 0.01).</p><p><b>CONCLUSIONS</b>Early application of VSD therapy cannot expedite the healing process of deep partial-thickness burn wounds, but it can improve the healing quality. It is one of the effective methods to deal with deep partial-thickness burn wounds, which is worthy of clinical attention and further research.</p>

Effect of different dressing materials in various combinations on wound microenvironment of donor site in burn patients / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the effect of dressing materials in various combinations on burn wound microenvironment and healing condition.</p><p><b>METHODS</b>Two hundred donor sites with wounds of 0.3 mm in depth in 186 burn patients, who needed skin grafting and admitted to our ward were enrolled in study, and they were divided into A (with dressing composed of alginate + cotton pad for donor area), B (with dressing composed of vaseline gauze + cotton pad for donor area), C (with dressing composed of alginate + foam dressing for donor area), D (with dressing composed of vaseline gauze + foam dressing for donor area) groups according to random table method. Effect of dressings on wound evaporation and pH value were observed. Bacterial colonization, degree of pain complained by patients after dressing change, and wound healing time in each group were compared.</p><p><b>RESULTS</b>One hundred and eighty-four patients complied with the study, while 2 patients were excluded due to untimely falling-off of the dressing. Wound evaporation in A, B, C, D groups was (35.5 +/- 3.2), (31.3 +/- 2.8), (23.1 +/- 2.9), (18.1 +/- 2.3) mL x h(-1) x m(-2) respectively, among them B group showed optimal effect of keeping humidity (P < 0.01). Wound pH value in A, B, C, D groups was 7.22 +/- 0.06, 7.41 +/- 0.03, 7.05 +/- 0.03, 7.34 +/- 0.06, respectively, among them it was highest in B group. The positive rate of bacteria in D group was highest (22.4%), and lowest in C group (4.0%). Pain was lightest in C group (score was 0.98 +/- 0.12), and most serious in B group (score was 8.14 +/- 0.82). The shortest wound healing time was seen in C group (6.7 +/- 0.8 d), and longest in D group (15.6 +/- 3.5 d).</p><p><b>CONCLUSIONS</b>Application of various dressings on similar wounds can produce different wound microenvironment, which is closely related to wound healing time. Compared with pH value, humidity is the more important factor for wound healing.</p>

Randomized controlled trial of the absorbency of four dressings and their effects on the evaporation of burn wounds / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Wound dressings are divided into traditional and new types. The new dressings are thought to accelerate wound healing. The purpose of this study was to supplement the scanty data on the absorbency of the new dressings and their effects on evaporation from the burn surface.</p><p><b>METHODS</b>The water absorption rate of four dressings (carbon fiber dressing, hydrogel dressing, silver nanoparticle dressing, and vaseline gauze) were measured by the immersion-weight gain method. A total of 120 inpatients with 10% superficial partial-thickness burn wounds were randomly assigned to four groups, each with 30 participants. Carbon fiber dressing, hydrogel dressing, and silver nanoparticle dressing were used in groups A, B, and C as the primary dressing, and traditional vaseline gauze was used in group D as the control. Multi-spot evaporation from normal skin and naked wound, and from wounds covered with each of the four dressings was measured post-burn on days 1, 3, 5, and 7 by an EP-I evaporimeter under conditions of 21 degrees C - 22 degrees C ambient temperature and 74% - 78% humidity.</p><p><b>RESULTS</b>The absorption rates of the four dressings were 988% with carbon fiber dressing, 96% with silver nanoparticle, 41% with vaseline gauze, and 6% with hydrogel. Evaporation from the naked burn wounds was about 1/3 higher than from normal skin (P < 0.01). Compared with wounds without applied dressing, evaporation from dressed wounds decreased and was time-dependent (P < 0.01). The evaporation of wounds with carbon fiber dressing was the lowest ((13.40 +/- 2.82) mlxh(-1)xm(-2), P < 0.01) on day 1 post-burn, compared with the other groups.</p><p><b>CONCLUSION</b>All four dressings have water retention capacity while carbon fiber dressing has the highest absorption rate and shows the best containment and evaporation from the burn wound.</p>

Effect of silver nanoparticle dressing on second degree burn wound / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the influence of silver nanoparticle dressing on prevention of infection and healing of the second degree burn wound.</p><p><b>METHODS</b>One hundred and ninety-one burn patients with second degree including superficial and deep burn wound were randomly divided into three groups. Group A including 65 cases was treated by silver nanoparticle dressing on wounds, and group B (63 cases) and group C (63 cases) were treated by 1% silver sulfadiazine cream and vaseline gauze on their wounds, respectively. Dressing was changed daily, and wound swab bacterial cultures were performed before and after dressing change, and also wound healing times were recorded in each patient.</p><p><b>RESULTS</b>Group A and B were similar in their bacterium colonizations on wound after treatment with the silver nanoparticle dressing and 1% silver sulfadiazine cream, and they had a similar effect on reducing bacterium colonization on wound after treatment, while in vaseline gauze group bacterium colonization on wound increased after treatment. In group A the wound healing time of superficial second degree was significantly shorter than those in group B and group C (P < 0.01). In deep second degree wounds the healing time in group A was much shorter than that in group C (P < 0.01), but had no significant difference when compared with group B (P > 0.05).</p><p><b>CONCLUSION</b>Silver nanoparticle dressing can be used on second degree burn wound and can decrease the risk of wound infection and accelerate wound healing.</p>

Evaluation of effectiveness and safety of a new hydroxyethyl starch used in resuscitation of burn shock / 中华烧伤杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness and safety of hydroxyethyl starch (HES 130/ 0.4, 60 g/L) in resuscitation during shock stage of burns.</p><p><b>METHODS</b>Sixty-six burn patients who were admitted to hospital within 2 hours after burn injury requiring fluid resuscitation were enrolled into this study, and they were randomized into HES( n = 33, with HES as a component of fluid resuscitation) and plasma (P, n = 33, with plasma as a component of fluid resuscitation) groups. HES or plasma was given as colloid within 48 postburn hours (PBH), and only albumin [( 111 +/- 4) , ( 105 +/- 5 ) g for each group] were given to the patients during 3 to 7 postburn days (PBD). Heart rate, blood pressure, central venous pressure (CVP) , urine output per hour were measured, gain/loss of body fluid during the first and second 24 PBH were recorded, serum total protein, albumin, hemoglobin( Hb) , prothrombin time (PT) , fibrinogen; platelet ( PLT) , as well as liver and renal function, allergy and bleeding tendency were determined and observed at corresponding time-points.</p><p><b>RESULTS</b>There were no obvious differences in heart rate, blood pressure, CVP and urine output per hour within 24 PBH between the two groups (P > 0.05). Also there was no difference in gain/loss of body fluid during the first and second 24 PBH. The content of hemoglobin on 1 ,3, 7,14 PBD ,and the PT, the content of fibrinogen, the number of PLT on 1,3,14 PBD also exhibited no difference between the two groups (P > 0.05). The serum contents of total protein and albumin in HES group were [(31 +/- 3) g/L, (30 +/- 3)g/L ] on 1 PBD, and [(20.4 +/- 3.6) g/L, (18.4 +/-2.3) g/L] on 3 PBD, which were obviously lower than those in P group [(45 +/- 4) g/L, (39 +/- 3) g/L on 1 PBD, and 1 (24.5 +/- 4.3) g/L, (21.3 +/- 3.9) g/L) on 3 PBD, (P <0. 01). Though the serum content of albumin on 7 PBD was similar in the two groups (P > 0.05), the serum total protein in HES group (40 +/- 4) g/L was markedly lower than that in P group [(45 +/- 4) g/L, P < 0.01] . Within 7 PBD, no abnormal bleeding was found in the two groups, and the liver function and renal function were similar. There were 4 cases showing allergic reaction in plasma group while none in HES group.</p><p><b>CONCLUSION</b>New type of HES can partially substitute plasma and be used in fluid resuscitation for burn patients. However, plasma protein replenishment should still be emphasized.</p>