A Comparative Study To Evaluate The Efficacy Of Silver-containing Soft Silicon Foam Dressing And Silver Sulfadiazine Cream In Deep Second Degree Burn Treatment

BackgroundDeep second degree burns are the common and among the most frequently reportedthermal injuries. There are two methods to treat them, conservative treatment(long-termdressing changing) and surgery(skin grafting). The process of wound healing is slow iftaken the former choice, and the quality of healing is poor. The surgical treat, it willincrease the economic burden of the patients. Silver sulfadiazine (SSD) creams have beenused as the standard treatment for deep partial thickness burns management for over30years. However, there are a number of side effects of this treatment, such as leucopenia,discoloration of the wound bed, hypersensitivity and allergic reactions, and pain duringapplication and removal of the material, even hindering the process of wound healing.Currently, a variety of silver-containing dressings have been developed to offer practicalbenefits such as accelerated wound healing and alleviated pain. Silver-containing foamdressings seem to process a number of characters of the “ideal” dressing. For example,they have good exudate management, and are gas-permeable and are easy for application.Besides, they can prevent infection, help to provide a moisty environment at the surface ofthe wounds while keeping warm, and can be easily cut or shaped while do not shedparticles or fibers on the wounds. One of them is a silver-containing foam dressing with asoft silicone wound contact layer. In this article, we have compared the silver-containingsoft silicone foam dressing with the SSD in order to clarify the dressing’s clinical efficacyon deep second degree burn treatment.ObjectiveTo observe the difference between the silver-containing soft silicone foam dressing andthe SSD of the treatment on deep partial thickness burns, and clarify the silver-containingsoft silicone foam dressing’s clinical efficacy on deep second degree burn.Methods1. Patient selectionAfter the approval of the following4hospitals’Ethics Committee,78patients wereenrolled. They were treated in Changhai hospital, the third people’s hospital of Wuxi,the first people’s hospital of Zhengzhou and the hospital affiliated to Kunming Medicine college during September2011and March2013, and who were eligible for the inclusioncriteria were divided into two groups (the control group and the test group) according tothe random number table.2. Wound debridementThe wounds were disinfected by0.05%chlorhexidine acetate solution.Afterremoving the burned epidermis, wash the wounds thoroughly by saline. The controlgroup was treated with silver sulfadiazine creams; meanwhile, the test group wastreated with the silver-containing soft silicone foam dressing.3. Wounds observationThe percentage of the wound healing, the healing time, the differences of the woundpain and the results of the bacterial culture, the dressing change times, the skin aroundthe wound and the easy of the usage of the dressing were compared between two groupsthrough the methods of t-test, Mann-Whitney U test, repeated measures ANOVA, test ofsphericity, chi-square test and Fisher’s exact test. The subjects’dressing-using relativeadverse reaction and abnormal results of laboratory results during the observation werealso monitored.Results1. Patient demographicThree were78subjects assigned to this study, and35patients were treated in the testgroup,43in the other one. The main population of this trial was middle-aged (mean age35.8years), male (75.6%). The average time post injury was18hours, and the averagetotal burn area was10%TBSAas well as the average test burn area was2%TBSA. Thecausative factors are scald and flame（84.6%）.2. There was no significant difference between the age, gender, burn reasons, total burnarea, time post injury and the test area in these two groups.3. Patients’outcomeMost of the test wounds were healed (85.9%), and among them78.2%of thewounds healed completely in3to4weeks. In the remaining subjects,6people tooksurgery and the last5people completed the trial because of reaching the terminal visit.4. The wound healing time and rateThe average healing time in the treatment group was shorter than that in the othergroup:[22（22，23）days vs.23（22，29）days, P=0.027]. Except the7thday [30.0%(8.0%,60.0%)vs.13.3(3.3%,40.0%)，P=0.072], the other healing rate of the visit times in the test group were higher than in the control group[the14thday was82.0%(50.0%,87.0%) vs.52.0%(35.0%,71.0%), P=0.022；the21stday was97.0%(95.0%,98.3%) vs.95.0%(79.5%,96.7%), P=0.008；the28thday was100%(100%,100%) vs.100%(96.5%,100%), P=0.021].5. Microbiological AnalysisThere was a total of6times with positive results. Four of them were Pseudomonasaeruginosa positive, one Methicillin-resistant Staphylococcus aureus, and one wasHemolytic staphylococcus. There was no obvious difference between the test and thegroup in the results of the bacterial culture.6. The outcome of the skin around the woundsThere was a total of17times with unhealthy symptom, including4times ofswelling and13times of drug impregnated.All of them were in the control group andthere were no significant difference between the test group and the control group.7. The ease of the dressing usageBoth the clinicians and patients considered the ease of the application and theflexibility of the dressing in the test group was superior to the control group. Besides,the visual analogue scales of the wound pain in the test group were better than the otherone. And this advantage was especially significant in the beginning of the trial, andgradually decreased with the time.8. Safety of the dressingThe vast majority of the patients did not show dressing-related adverse reaction suchas liver and kidney dysfunction during the experiment.ConclusionsCompared with the SSD cream, the silver-containing soft silicone foam dressing showedthe following advantages in treating the deep second degree burn.1. The wound healing time wan shorten, and the healing rate was improved.2. It is safe for use, and its ability to anti infection is of no difference with silversulfadiazine cream, and with no obvious adverse reaction such as liver and kidneydysfunction.3. The ease of use and application is better than silver sulfadiazine cream, and it canimprove the comfort of the wound during wearing, reduce the anxiety and painfeeling when changing dressing, especially during the removal time.