Dressings for treating superficial and partial thickness burns

Wasiak J, Cleland H, Campbell F

Published Online:

October 6, 2010

Superficial burns are those which involve the epidermal skin layer and partial thickness burns involve deeper damage to structures such as blood vessels and nerves. There are many dressing materials available to treat these burns but none have strong evidence to support their use. Evidence from small trials, many with methodological limitations, suggests that superficial and partial thickness burns may be managed with hydrocolloid, silicon nylon, antimicrobial (containing silver), polyurethane film and biosynthetic dressings. There was no evidence to support the use of silver sulphadiazine.

Abstract (click to read)

Background:

An acute burn wound is a complex and evolving injury. Extensive burns produce, in addition to local tissue damage, systemic consequences. Treatment of partial thickness burn wounds is directed towards promoting healing, and a wide variety of dressings is currently available. Improvements in technology and advances in understanding of wound healing have driven the development of new dressings. Dressing selection should be based on their effects of healing, but ease of application and removal, dressing change requirements, cost and patient comfort should also be considered.

Objectives:

To assess the effects of burn wound dressings for superficial and partial thickness burns.

Search strategy:

We searched the Cochrane Wounds Group Specialised Register (Searched 29/5/08); The Cochrane Central Register of Controlled Trials (CENTRAL) - The Cochrane Library Issue 2 2008; Ovid MEDLINE - 1950 to May Week 3 2008; Ovid EMBASE - 1980 to 2008 Week 21 and Ovid CINAHL - 1982 to May Week 4 2008.

Selection criteria:

All randomised controlled trials (RCTs) that evaluated the effects of burn wound dressings for superficial and partial thickness burns.

Data collection and analysis:

Two authors using standardised forms extracted the data independently. Each trial was assessed for internal validity with differences resolved by discussion.

Main results:

A total of 26 RCTs are included in this review and most were methodologically poor. A number of dressings appear to have some benefit over other products in the management of superficial and partial thickness burns. This benefit relates to time to wound healing, the number of dressing changes and the level of pain experienced. The use of biosynthetic dressings is associated with a decrease in time to healing and reduction in pain during dressing changes. The use of silver sulphadiazine (SSD) as a comparator on burn wounds for the full duration of treatment needs to be reconsidered, as a number of studies showed delays in time to wound healing and increased number of dressing applications in patients treated with SSD dressings.

Authors' conclusions:

There is a paucity of high quality RCTs on dressings for superficial and partial thickness burn injury. The studies summarised in this review evaluated a variety of interventions, comparators and clinical endpoints. Despite some potentially positive findings, the evidence, which largely derives from trials with methodological shortcomings, is of limited usefulness in aiding clinicians in choosing suitable treatments.

This record should be cited as:

Wasiak J, Cleland H, Campbell F. Dressings for superficial and partial thickness burns. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD002106. DOI: 10.1002/14651858.CD002106.pub3

Assessed as up to date:

May 28, 2008

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Primary Review Group:

Wounds Group

PEARLS - Practical Evidence About Real Life Situations (click to read)

Clinical question:

Does honey increase the rate of healing in acute and chronic wounds?

Bottom line:

Honey may improve healing times in mild to moderate superficial and partial burns compared with conventional dressings (gauze and film dressings). Honey dressings do not significantly increase rates of healing of venous leg ulcers at 12 weeks when used as an adjunct to compression bandaging. There is insufficient evidence to determine the effect of honey compared with other treatments for burns or in other acute or chronic wound types.

Caveat:

All the included burns trials have originated from a single centre which may have an impact on the replicability of findings.

Context:

Honey is a viscous, supersaturated sugar solution derived from nectar gathered and modified by the honey bee, Apis mellifera. Honey has been used since ancient times as a remedy in wound care. More recently, trials have evaluated the effects of using honey to help wound healing in both acute wounds (eg, burns, lacerations) and chronic wounds (eg, venous leg ulcers, pressure ulcers).

Cochrane Systematic Review:

Jull AB et al. Honey as a topical treatment for wounds. Cochrane Reviews 2008, Issue 4. Article No. CD005083. DOI: 10.1002/14651858.CD002106.pub2. This review contains 19 trials involving 2554 participants.

Authored by:

Brian R McAvoy

Cochrane Primary Health Care Field

Health topics:

Skin > Wounds > Burns: local wound care

Wounds > Burns > Local wound care

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Dressings for treating superficial and partial thickness burns

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