Burn Service of Western Australia, Princess Margaret Hospital for Children, Royal Perth Hospital, Perth, Western Australia, Australia.
Burns. 2012 Sep;38(6):830-9. doi: 10.1016/j.burns.2011.12.020. Epub 2012 Feb 8.
Scald is the most common cause of burn in children in Australia. The time taken by the burn wound to heal impacts on scar outcome. Commonly scald injuries are treated conservatively; in our unit the practice is that if healing does not occur within 10 days, surgery is used to aid healing with the aim of improving scar outcome. This randomised controlled pilot study compares early treatment regimens to facilitate tissue salvage and reduce the incidence of definitive surgery at 10 days following scald injury.
All paediatric patients with partial thickness scald injury were clinically assessed between July 1, 2009 and June 30, 2010. A burn of 2% TBSAB or more and deemed not to heal within 10 days, were considered for the trial. These patients were randomised to one of three treatment arms: the local standard treatment (Intrasite™, Acticoat™ and Duoderm(®) dressings every 2-3 days) with surgery at 10 days, Biobrane(®) only or Biobrane(®) and autologous cell suspension using the ReCell(®) kit. The primary outcome was surgery performed after 10 days; secondary outcomes were rates of healing, pain experienced, and scar outcomes.
15% of scald presentations in the 12 month period met the eligibility criteria. 13 patients were recruited into the pilot study; early intervention was associated with a decreased time to healing with fewer dressing changes, less pain and better scar outcomes.
Investment of surgical resources in the acute stages within 4 days of injury saved on nursing time, dressing, analgesic and scar management costs.
在澳大利亚，烫伤是儿童烧伤的最常见原因。烧伤创面的愈合时间会影响疤痕的结果。通常，烫伤伤处采用保守治疗；在我们的单位，实践是如果在 10 天内没有愈合，就会进行手术以帮助愈合，目的是改善疤痕结果。这项随机对照试点研究比较了早期治疗方案，以促进组织保存并减少 10 天内烫伤伤处进行确定性手术的发生率。
2009 年 7 月 1 日至 2010 年 6 月 30 日期间，对所有患有部分厚度烫伤伤处的儿科患者进行了临床评估。烧伤面积达到 2%TBSAB 或以上，且预计在 10 天内无法愈合的患者，被认为符合试验条件。这些患者被随机分配到以下三个治疗组之一：局部标准治疗（每隔 2-3 天使用 Intrasite™、Acticoat™和 Duoderm®敷料），在 10 天进行手术；仅使用 Biobrane®或使用 ReCell®试剂盒的 Biobrane®和自体细胞悬浮液。主要结局是 10 天后进行的手术；次要结局是愈合率、疼痛程度和疤痕结果。
在 12 个月的时间内，有 15%的烫伤伤处符合入选标准。有 13 名患者入组参加了试点研究；早期干预与愈合时间缩短、换药次数减少、疼痛减轻和更好的疤痕结果相关。
在受伤后 4 天内投入手术资源进行急性治疗，可节省护理时间、敷料、镇痛和疤痕管理成本。
