Enzo Osti1. 1. Emergency Department, Via Galleria San Donato 4, 30027 San Donà di Piave, Venice, Italy. enzoosti@virgilio.it
Abstract
HYPOTHESIS: A transparent adhesive film possessing selective permeability combined with a hydrogel (Burnshield) may be effective in burn patients to reduce skin maceration, improve medication, control pain more effectively, and reduce the incidence of late complications (hypertrophic scars). DESIGN: This is a prospective study; the mean follow-up in all patients was 28.4 months (range, 14-35 months). The external part of the film is impermeable to fluid and microorganisms, but allows transpiration of water vapor from the cutis. The permeability to water vapor of a semipermeable film in contact with liquids is measured in grams per meters squared every 24 hours at 37 degrees C, and is defined as the moisture vapor transmission rate. In this study, a film with a moisture vapor transmission rate of 1600 g/m(2) every 24 hours at 37 degrees C was used. PATIENTS: For about 2 years, this type of therapy was used in the first aid treatment of 48 burn patients, 4 of whom were lost during therapy and 4 of whom were unavailable for follow-up. INTERVENTIONS: The patients were treated with hydrogel and a semipermeable film at first medication, and some were treated in this way during subsequent medications. MAIN OUTCOME MEASURES: The mean reepithelialization time of all patients was 17 days (range, 4-60 days); 8 (20%) of 40 patients with complications were treated with a gel (Same Plast Gel). Late complications were observed: hypertrophic scars in 2 patients (5%) and dyschromic lesions in 6 (15%). RESULTS: The most frequent complication, which occurred at various stages during medication, was skin maceration (15 [34%] of 44 patients). Other complications recorded during therapy were infections in 2 patients (5%), vertigo in 1 patient (2%), and abundant fibrin production in 1 patient (2%). In some of the patients, associated diseases and/or conditions were found: hepatic cirrhosis, diabetes mellitus, epilepsy, and pregnancy (33rd week) (each found in 1 patient each). Four patients were sent to the burn unit, 3 with second-degree burns of the hand and 1 with first-/second-degree burns of the abdomen and thigh, with 12% of the total body surface area burned. CONCLUSIONS: In the reepithelialization phase, complications were recorded in 8 of the 40 patients: 7 (18%) had residual inflammation and 1 (2%) had a hypertrophic scar. During the follow-up, late complications were recorded in 2 (5%) of the 40 patients. A gel was used in 8 patients: in 6 of the 7 patients with residual inflammation, the complication resolved, while in 1, despite therapy, the residual inflammation evolved into hypertrophic scarring. Treatment with the gel in the 2 patients with late lesions reduced the thickness and extent of the lesions, with minimal aesthetic and functional damage.
HYPOTHESIS: A transparent adhesive film possessing selective permeability combined with a hydrogel (Burnshield) may be effective in burn patients to reduce skin maceration, improve medication, control pain more effectively, and reduce the incidence of late complications (hypertrophic scars). DESIGN: This is a prospective study; the mean follow-up in all patients was 28.4 months (range, 14-35 months). The external part of the film is impermeable to fluid and microorganisms, but allows transpiration of water vapor from the cutis. The permeability to water vapor of a semipermeable film in contact with liquids is measured in grams per meters squared every 24 hours at 37 degrees C, and is defined as the moisture vapor transmission rate. In this study, a film with a moisture vapor transmission rate of 1600 g/m(2) every 24 hours at 37 degrees C was used. PATIENTS: For about 2 years, this type of therapy was used in the first aid treatment of 48 burn patients, 4 of whom were lost during therapy and 4 of whom were unavailable for follow-up. INTERVENTIONS: The patients were treated with hydrogel and a semipermeable film at first medication, and some were treated in this way during subsequent medications. MAIN OUTCOME MEASURES: The mean reepithelialization time of all patients was 17 days (range, 4-60 days); 8 (20%) of 40 patients with complications were treated with a gel (Same Plast Gel). Late complications were observed: hypertrophic scars in 2 patients (5%) and dyschromic lesions in 6 (15%). RESULTS: The most frequent complication, which occurred at various stages during medication, was skin maceration (15 [34%] of 44 patients). Other complications recorded during therapy were infections in 2 patients (5%), vertigo in 1 patient (2%), and abundant fibrin production in 1 patient (2%). In some of the patients, associated diseases and/or conditions were found: hepatic cirrhosis, diabetes mellitus, epilepsy, and pregnancy (33rd week) (each found in 1 patient each). Four patients were sent to the burn unit, 3 with second-degree burns of the hand and 1 with first-/second-degree burns of the abdomen and thigh, with 12% of the total body surface area burned. CONCLUSIONS: In the reepithelialization phase, complications were recorded in 8 of the 40 patients: 7 (18%) had residual inflammation and 1 (2%) had a hypertrophic scar. During the follow-up, late complications were recorded in 2 (5%) of the 40 patients. A gel was used in 8 patients: in 6 of the 7 patients with residual inflammation, the complication resolved, while in 1, despite therapy, the residual inflammation evolved into hypertrophic scarring. Treatment with the gel in the 2 patients with late lesions reduced the thickness and extent of the lesions, with minimal aesthetic and functional damage.
Authors: Danielle dos Santos Tavares Pereira; Maria Helena Madruga Lima-Ribeiro; Ralph Santos-Oliveira; Carmelita de Lima Bezerra Cavalcanti; Nicodemos Teles de Pontes-Filho; Luana Cassandra Breitenbach Barroso Coelho; Ana Maria dos Anjos Carneiro-Leão; Maria Tereza dos Santos Correia Journal: J Biomed Biotechnol Date: 2012-02-14