Hyland Ela J, D'Cruz Rachel, Menon Seema, Harvey John G, La Hei Erik, Lawrence Torey, Waddell Kelly, Nash Mitchell, Holland Andrew Ja
The Children's Hospital Burns Research Institute and Burns Unit, The Children's Hospital at Westmead Sydney, Australia.
Sydney Medical School, The University of Sydney NSW, Australia.
Int J Burns Trauma. 2018 Jun 20;8(3):63-67. eCollection 2018.
The management of pediatric mid-dermal burns is challenging. Anecdotal evidence suggests Biobrane™ (UDL Laboratories, Inc., Sugar Land, TX) may expedite epithelization, reducing the requirement for skin grafting. Our standard management for burns of this depth is Acticoat™ (Smith and Nephew, St. Petersburg, Fl, USA). No publications are known to compare Biobrane™ to Acticoat™ for treatment of mid-dermal burns.
A prospective, randomised controlled pilot study was conducted, comparing Biobrane™ to Acticoat™ for mid-dermal burns affecting ≥ 1% Total Body Surface Area (TBSA) in children. Mid-dermal burns were confirmed using Laser Doppler Imaging within 48 hours of injury. Participants were randomized to Biobrane™ with an Acticoat™ overlay or Acticoat™ alone.
10 participants were in each group. Median age and TBSA were similar; 2.0 (Biobrane™) and 1.5 years (Acticoat™), 8% (Biobrane™) and 8.5% TBSA (Acticoat™). Use of Biobrane™ had higher infection rates (6 children versus 1) (P = 0.057) and more positive wound swabs, although not significant (7 children versus 4) (P = 0.37). Healing time was shorter in the Biobrane™ group, this was not significant (19 days versus 26.5 days, P = 0.18). Median dressing changes were similar (5 versus 5.5) (P = 0.56). Skin grafting requirement was greater in the Acticoat™ group (7 versus 4 children, P = 0.37) and similar in % TBSA (1.75% TBSA).
This pilot study suggests that the use of Biobrane™ for mid-dermal burns in children may be associated with increased risk of infection but appears to decrease the time to healing and therefore the need for skin grafting compared to Acticoat™ alone.
小儿中厚皮烧伤的治疗颇具挑战性。有传闻证据表明，生物膜（Biobrane™，UDL实验室公司，得克萨斯州舒格兰市）可能会加快上皮形成，减少皮肤移植的需求。我们对于这种深度烧伤的标准治疗方法是使用爱康肤银敷料（Acticoat™，施乐辉公司，美国佛罗里达州圣彼得斯堡）。尚无已知文献比较生物膜与爱康肤银敷料治疗中厚皮烧伤的效果。
开展了一项前瞻性随机对照试验研究，比较生物膜与爱康肤银敷料治疗小儿中厚皮烧伤（烧伤面积≥总体表面积的1%）的效果。在受伤后48小时内使用激光多普勒成像确认中厚皮烧伤。参与者被随机分为接受生物膜加爱康肤银敷料覆盖组或仅接受爱康肤银敷料组。
每组有10名参与者。中位年龄和烧伤面积相似；生物膜组为2.0岁，爱康肤银敷料组为1.5岁；生物膜组烧伤面积为总体表面积的8%，爱康肤银敷料组为8.5%。使用生物膜组的感染率更高（6例患儿 vs 1例）（P = 0.057），伤口拭子检测阳性的情况也更多，不过差异不显著（7例患儿 vs 4例）（P = 0.37）。生物膜组的愈合时间较短，但差异不显著（19天 vs 26.5天，P = 0.18）。中位换药次数相似（5次 vs 5.5次）（P = 0.56）。爱康肤银敷料组的皮肤移植需求更大（7例患儿 vs 4例）（P = 0.37），移植面积占总体表面积的比例相似（1.75%）。
这项初步研究表明，小儿中厚皮烧伤使用生物膜可能会增加感染风险，但与仅使用爱康肤银敷料相比，似乎能缩短愈合时间，从而减少皮肤移植的需求。
