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Burn dressings
From WikEM
Contents
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] | Indications | Special considerations |
|---|---|---|
| Biobrane | Partial thickness burns at time of admission; clean, fresh scald burns or donors; must be pink, moist, sensate, blanching | Apply 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 |
| Xeroform | Clean partial thickness wounds or donor sites | Promotes epithelial migration on clean, well vascularized wounds. Minimal antimicrobial activity; use with bacitracin or bactroban |
| Bacitracin | Partial thickness burns, anti-Staph agent; also topical agent for superficial facial burns | No 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 eschar | Layer needs to be "nickel" thick; Use with bacitracin and xeroform (BX) |
| Bactroban (mupirocin) | Staph infections, impetigo, facial burns | Apply thin layer and use with Xeroform |
| Mepilex (Ag) | Partial thickness wounds/donors; low to moderate exuding wounds that need to be covered for extended time | May be left intact without dressing change for 3-7 days. Has increased antimicrobial activity as compared to Polymem |
| Polymem | Partial thickness wounds; cleanses, fills, absorbs, moistens | May be left intact up to 7 days |
| Sloppy (5% Mafenide acetate) | Used for new grafts | With 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 red | Rarely used now. Barrier dressing to prevent desiccation of underlying wound | Must 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 autograft | Examine 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 autograft | Viable for up to 5 days after harvesting; must be stored in biologic refrigerator at 4 degrees C |
See Also
References
- ↑ MetroHealth Medical Center BICU Handbook (Not a policy manual), Cleveland, OH.
Authors
Kevin Lu, Ross Donaldson, Daniel Ostermayer, Neil Young, Claire
