United States Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA.
Metis Foundation, San Antonio, TX 78216, USA.
Mil Med. 2023 Aug 29;188(9-10):3034-3044. doi: 10.1093/milmed/usac114.
Burns are common injuries on the battlefield. Given austere environments, surgical debridement of injured service members is often not feasible in these settings. Delays in surgical debridement create a risk of infection and deranged healing for burn patients. As such, this study attempts to identify the best commercially available off-the-shelf (OTS) therapies with field-deployable potential to improve prolonged field care (PFC) of burn-injured soldiers.
Deep partial-thickness (DPT) burns (25 cm2) were created on the dorsum of 5 anesthetized pigs utilizing a thermocouple burn device at 100°C for 15 seconds. Nonsurgical debridement was done 1-hour after burn creation using sterile saline water and gauze to remove excess eschar tissue. Animals were then randomized into 5 experimental groups, and OTS therapies were applied to 6 of the 12 created DPT burns. The remaining 6 burns were treated with 1% silver sulfadiazine cream (Ascend Laboratories, LLC, Parsippany, NJ) as the PFC standard of care (SOC) controls. The 5 randomized OTS therapies were: irradiated sterile human skin allograft (IHS), biodegradable temporizing matrix (BTM), polylactic acid skin substitute, hyaluronic acid ester matrix (HAM), and decellularized fish skin graft (FSG). Wounds were serially assessed on post-burn days 3, 7, 14, 21, and 28. Assessments were conducted using a combination of photographs, histology, and quantitative bacteriology. Endpoints included burn wound progression, re-epithelialization, wound contraction, scar elevation index, and colony-forming units (CFU).
The analysis demonstrated that by day 3, the FSG prevented burn wound progression the most efficiently. In terms of wound healing, the results showed re-epithelialization percentages close to 100% by day 28 for all treatment groups. No statically significant differences were observed. Quality of healing analyses demonstrated that the BTM-treated wounds had contracted less and the difference to the IHS-treated wounds was statistically significant (P < .05). As regards to antimicrobial properties, the CFU results showed no statistically significant differences between the OTS therapies and the SOC on days 3, 7, and 14.
The impact of Food and Drug Administration-approved OTS therapies was compared to the current PFC SOC for the treatment of DPT burns in a porcine model. Several topical options exist for the management of burns prior to definitive treatment in the operating room and warrant further evaluation. These therapies are actively used on civilian burn counterparts and have far-forward, field-deployable potential for use at the point of injury so that injured service members may not need evacuation to higher roles of care and combat power may be preserved. Our results demonstrated that all the studied OTS therapies performed well when compared to the SOC in terms of burn wound progression, wound healing, quality of healing, and quantitative bacteriology.
烧伤是战场上常见的损伤。在严峻的环境下，对受伤军人进行外科清创术在这些环境中往往不可行。外科清创术的延迟会增加烧伤患者感染和愈合不良的风险。因此，本研究试图确定具有现场部署潜力的最佳市售现成（OTS）疗法，以改善烧伤军人的长期现场护理（PFC）。
使用热电偶烧伤装置在 5 只麻醉猪的背部以 100°C 加热 15 秒，造成深部分度（DPT）烧伤（25 cm2）。烧伤后 1 小时，使用无菌生理盐水和纱布进行非手术清创，以去除多余的焦痂组织。然后，动物被随机分为 5 个实验组，将 OTS 疗法应用于 12 个创建的 DPT 烧伤中的 6 个。其余 6 个烧伤用 1%磺胺嘧啶银乳膏（Ascend Laboratories，LLC，Parsippany，NJ）作为 PFC 标准护理（SOC）对照进行治疗。5 种随机 OTS 疗法为：辐照无菌人皮肤同种异体移植物（IHS）、可生物降解的临时基质（BTM）、聚乳酸皮肤替代物、透明质酸酯基质（HAM）和脱细胞鱼皮移植物（FSG）。在烧伤后第 3、7、14、21 和 28 天，对伤口进行连续评估。使用照片、组织学和定量细菌学的组合进行评估。终点包括烧伤创面进展、上皮再形成、创面收缩、瘢痕隆起指数和菌落形成单位（CFU）。
分析表明，在第 3 天，FSG 最有效地阻止了烧伤创面的进展。就伤口愈合而言，所有治疗组在第 28 天的上皮再形成百分比接近 100%。未观察到统计学上的显著差异。愈合质量分析表明，BTM 治疗的伤口收缩较少，与 IHS 治疗的伤口有统计学意义（P < .05）。至于抗菌性能，CFU 结果显示，在第 3、7 和 14 天，OTS 疗法与 SOC 之间无统计学显著差异。
在猪模型中，比较了美国食品和药物管理局批准的 OTS 疗法与目前的 PFC SOC 对 DPT 烧伤的治疗效果。在手术室进行确定性治疗之前，有几种局部治疗选择可用于烧伤的治疗，值得进一步评估。这些疗法在民用烧伤患者中得到了积极的应用，并且具有远在前线的现场部署潜力，可在受伤时使用，以便受伤的军人可能无需转移到更高的护理级别，并保留战斗力。我们的结果表明，与 SOC 相比，所有研究的 OTS 疗法在烧伤创面进展、伤口愈合、愈合质量和定量细菌学方面都表现良好。
