Lots of conflicting views on this topic. In the absence of infection, I'd personally keep things simple, and go for something Jelonet or Mepitel.
I'd also consider the depth of the initial injury (i.e. the burn) and try to get a feel for the depth of the resultant granulation tissue, but my answer is unlikely to change from the aforementioned.
I would give the wound a through clean with prontosan and then cover it something like Mepilex or Kaltostat. To keep a bit moisture will encourage keratinocyte migration. Try to avoid the dressings that will adhere and difficult to remove. If the wound is infected, antimicribial dressing will be considered.
Topical use of Oxytetracycline/Hydrocortisone combination ointment is back in the market in UK with the trade name of Terracortyl is quite good for oergralulations!!
I have changed my dressings for these types of wounds, and also others. I clean carefully, then dry the skin and apply Micropore tape to totally cover the wound.(3M is the manufacturer). I then apply a vitamin A and antioxidants gel and because the micropore is in fact porous, the vitamin A gets to the skin cells and helps them grow faster and better. I use Environ AVST Gel or Moisture Gel. The wounds rapidly complete epithelialisation and in my 40 year experience of treating burns I think this is the greatest advance for partial thickness burns. It is simple, inexpensive and makes tissues heal with less scarring. I know most doctors won't try this but I wish they would. A trial is in progress and will be reported in time.
You need to think why there is granulation tissue - Has it just not healed yet, or has it healed and broken down again? Simple over-granulated areas respond well to topical steroids, such as Terracortril, Trimovate or hydrocortisone. If the wound is excessively dry, then a hydrocolloid (Granuflex, Duoderm, Comfeel) will moisten it well, although sometimes a little too much for prettiness! If the healed burn wound is breaking down, particularly if it is painful, then rule out an infection (eg Staph aureus) and if no infection and if the wound has small crusty plaques, think about erosive pustular dermatosis, which responds very well to short course of a high-potency topical corticosteroid (clobetasol "Dermovate"). I described this in a series of problematic burn cases and we continue to see cases, about a couple per year, in burns.
The cochrane review process, which is arguably the best evidence based medicine available, states that honey dressings may heal partial thickness burns 4-5 days quicker than conventional dressings. (http://www.cochrane.org/CD005083/WOUNDS_honey-as-a-topical-treatment-for-acute-and-chronic-wounds)
I believe that the fewer legs/ end-points in an algorithm, the easier it is (and the more consistent the outcomes), particular when the dressings are commonly guided by junior doctors and managed by nurses.
Yes, I agree that honey has seen a bit of a resurgence over the last decade. However, I must add the following 'qualifiers' to Will Holmes' comment:
1) "The differences in wound types and comparators make it impossible to draw overall conclusions about the effects of honey on wound healing.
2) "The evidence for most comparisons is low or very low quality" - hence, "it is not clear if honey is better or worse than other treatments for burns, mixed acute and chronic wounds, pressure ulcers, Fournier's gangrene, venous leg ulcers, minor acute wounds, diabetic foot ulcers..."
I agree with Ciaran O'Boyle and Chelliaya Ramanathan: a hydrocolloid/ Kaltostat (for being 'pro-keratinocytic, as Zhe Li mentioned) and a steroid-based ointment must be considered.
As an extension of Desmond Fernandes' comment, what about using topical hyaluronic acid and glycerol (in conjunction with Vitamin A/ antioxidants that were mentioned)? I feel that this would encourage migration of keratinocytes and encourage mitosis. Perhaps a hydrocolloid dressing could be applied on top to stop the agents from being wiped off. What do people think?
Best decision depends on the location and expansion of the lesion. For example if it is not very large and is located on trunk, you can continue wet dressing but if it is on the face it should be treated with skin graft to avoid secondary contraction. If it is not clear let me have more information about it.
Thank you all for your answers. Interesting the variety of methods we use for this common problem. For years we have been using betadine solution on the granulating areas, allowing it to dry and covering with Mepitel as a non-stick dressing. This is done daily. I was told years ago that the betadine will kill fibroblasts, but allow keratinocytes to grow, however I do not have a reference. On the rare occasions that this does not work, we use topical steroids. I have always been amazed how effective the steroid cream is, that I wonder whether we should be using it as first line. Honey we found years ago was messy and it stung the children.
The plan depend upon the duration and site of the lesion. If it is more than 20 days duration affecting PRIME areas of the body for example FACE than early grafting may be undertaken. If the lesion is on trunk/limbs and upto 10 cm in diameter we can wait for natural healing to complete and meanwhile than any NON ADHERENT dressing to avoid trauma to the EPITHELIAL ISLANDS may be used.
Dr. Kimble, How are you?. Personally I can say that Aquacel Ag Burn (Dessing developed with Medicel Technology -hydroentangled-) is the best dessing for burns and for partial thickness wounds (independent of damage mechanims. This kind of Hydrofiber engage the Medicel technology and is extremely friendly with skin and mantain the non Sticky principle: Those elements heal with inmediatly effects, the pain and suffer of the dressing´s changes.
We treat patients with Bullous Epidermollisys with Aquacel Ag Burn and Aquacel Burn.
Any concept for your patient depends that: What are your objective (incorporate obviously patient´s objective and and caregivers´objective!
Anythingelse that i can do for supporting and adding value for your job, please let me know.
Best Regards,
Martha Uruena-Cartagena., MD
Specialized in Antiaging and Molecular Biology
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