Burn dressings

Background

  • For facial burns that are superficial partial thickness, consider bactroban if concern for impetigo or infection; otherwise glucanpro (oat beta glucan) works for clean wounds
  • Use bacitracin ophthalmic around eyes

Types

Dressing [1]IndicationsSpecial considerations
BiobranePartial thickness burns at time of admission; clean, fresh scald burns or donors; must be pink, moist, sensate, blanchingApply shiny side out; secure with benzoin steristrips; no antimicrobial activity; wrap with Kerlix and Ace, to be examined in 24 hrs; fluid accumulations may be aspirated with tuberculin syringe
XeroformClean partial thickness wounds or donor sitesPromotes epithelial migration on clean, well vascularized wounds. Minimal antimicrobial activity; use with bacitracin or bactroban
BacitracinPartial thickness burns, anti-Staph agent; also topical agent for superficial facial burnsNo penetrating ability; good to remove tar and asphalt (especially around eye). Combine with NS wet-to-dry to increase debriding; do not use on eschar
Santyl (Collagenase)Deep partial thickness wounds with escharLayer needs to be "nickel" thick; Use with bacitracin and xeroform (BX)
Bactroban (mupirocin)Staph infections, impetigo, facial burnsApply thin layer and use with Xeroform
Mepilex (Ag)Partial thickness wounds/donors; low to moderate exuding wounds that need to be covered for extended timeMay be left intact without dressing change for 3-7 days. Has increased antimicrobial activity as compared to Polymem
PolymemPartial thickness wounds; cleanses, fills, absorbs, moistensMay be left intact up to 7 days
Sloppy (5% Mafenide acetate)Used for new graftsWith fine mesh gauze covered with sloppy moistened burn pads; wet downs as needed
Burows (Domboros, Aluminum acetate)Gram-negative bacilli (pseudomonas)Creates acidic, drying environment due to its hyperosmolar features; Somewhat toxic to tissues, but more important for skin grafts to take. Fine mesh gauze are covered with Burows moistened burn pads; 2 packets dissolved in 1 L sterile water
Silvadene (silver sulfadiazine)Full thickness burns. Post traumatic wound infection or cellulitis.Nonpainful with antibacterial spectrum similiar to Sulfamylon. Does not penetrate dry, leathery eschar. Some gram-negative resistant Enterobacter. Neutropenia may occur within 24-48 hrs. CONTRAINDICATED: 1) Partial thickness which may heal (Silvadene inhibits keratinocytes), 2) Sulfa allergy, 3) Causes kernicterus - pregnant women approaching term, premature infants, newbborns during first 2 months of life
Sulfamylon (Mafenide)Full thickness burns with eschar (including leathery eschar); deep cartilage burns (ears, nose); alternate to Silvadene in marked leukopenia; sulfamylon liquid (5% soln) for wetting heavily contaminated meshed skin grafts or excised but not grafted areas (not for eschar)Penetrates eschar, significantly reduces pseudomonas. Painful 20 minutes after application. NOT a sulfa drug, ok in sulfa allergy. May cause metabolic acidosis. CONTRAINDICATIONS: 1) Hypersensitivity reaction, 2) Near the eyes, 3) Large burns in children - causes hyperpnea via inhibition of carbonic anhydrase
Dakins and glycerin (half-and-half, D&G)Rarely used now. Wetting agent similar to Sulfamylon liquid.0.5% Chloramine-T (similar to bleach) and 50% glycerin. Must be stored in the dark. Oxidized form has no bacteriocidal activity - must smeel strongly of bleach. CONTRAINDICATIONS: 1) Eschar, 2) Invasive infection
Scarlet redRarely used now. Barrier dressing to prevent desiccation of underlying woundMust be clean wound since it has no antibacterial activity (as opposed to Xeroform)
Xenograft (pigskin)Biologic dressing that protects wounds free of eschar, wounds awaiting epithelial migration for closure, or wounds needing application of autograftExamine daily and removed if evidence of fluid accumulation or purulent material underneath; may be changed q48-72 hrs. Generally patients develop antibodies to graft after 7-10 days
Allograft (cadaver)Temporary closure of wounds free of eschar, awaiting autograft; May be used to cover fragile autograftViable for up to 5 days after harvesting; must be stored in biologic refrigerator at 4 degrees C

See Also

References

  1. MetroHealth Medical Center BICU Handbook (Not a policy manual), Cleveland, OH.
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