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The immunological mechanisms that are triggered by Low-Intensity Pulsed Ultrasound (LIPUS) in wound healing are unknown. In the present study, experimental groups were used to assess the treatment of chronic venous ulcers with 30mW/cm(2) SATA peripheral LIPUS three times per week compared to a daily treatment of 1% silver sulfadiazine (SDZ). The ulcers of the SDZ group (n=7) (G1) and LIPUS group (n=9) (G2) were photographed five times three months, and the images were analyzed using ImageJ software to quantify the total area (S), fibrin/sphacel area (yellow) and granulation area (red). The healing process was evaluated by the wound healing rate (WHR), granulation tissue rate (GTR) and fibrin/sphacel tissue rate (FTR). The ulcers were biopsied on days 1 and 45 and stained for collagen fiber quantification (picrosirius) and CD68(+) protein and VEGF (vascular endothelial growth factor) expression using HRP-streptavidin (horseradish peroxidase-streptavidin). On day 90, G2 had a mean 41% decrease in the ulcer area, while no decrease was observed in G1 (p<0.05). An increased tendency toward positive labeling of collagen fibers and VEGF (p>0.05) was observed in G2 compared to G1, and the number of CD68(+) cells was greater in G2 than in G1 (p<0.05). LIPUS presents superior activity compared to SDZ in stimulating the inflammatory and proliferative (angiogenesis and collagenesis, respectively) phases of chronic venous wound healing., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Background: An acute burn wound is a complex and evolving injury. Extensive burns produce systemic consequences, in addition to local tissue damage. Treatment of partial thickness burn wounds is directed towards promoting healing and a wide variety of dressings are 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 on 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 on superficial and partial thickness burns., Search Methods: For this first update we searched The Cochrane Wounds Group Specialised Register (searched 8 November 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 10); Ovid MEDLINE (2008 to October Week 4 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, November 07, 2012); Ovid EMBASE (2008 to 2012 Week 44); AND EBSCO CINAHL (1982 to 2 November 2012)., Selection Criteria: All randomised controlled trials (RCTs) that evaluated the effects of burn wound dressings on the healing of superficial and partial thickness burns., Data Collection and Analysis: Two authors extracted the data independently using standardised forms. We assessed each trial for internal validity and resolved differences by discussion., Main Results: A total of 30 RCTs are included in this review. Overall both the quality of trial reporting and trial conduct were generally poor and meta analysis was largely precluded due to study heterogeneity or poor data reporting. In the context of this poor quality evidence, silver sulphadiazine (SSD) was consistently associated with poorer healing outcomes than biosynthetic (skin substitute) dressings, silver-containing dressings and silicon-coated dressings. Burns treated with hydrogel dressings appear to heal more quickly than those treated with usual care., Authors' Conclusions: There is a paucity of high-quality evidence regarding the effect of different dressings on the healing of superficial and partial thickness burn injuries. The studies summarised in this review evaluated a variety of interventions, comparators and clinical endpoints and all were at risk of bias. It is impossible to draw firm and confident conclusions about the effectiveness of specific dressings, however silver sulphadiazine was consistently associated with poorer healing outcomes than biosynthetic, silicon-coated and silver dressings whilst hydrogel-treated burns had better healing outcomes than those treated with usual care.

The objective of the present study was to formulate stable silver sulfadiazine (SSD) nanosuspensions and nanogels suitable for topical delivery with a view to increase bactericidal activity in burn therapy. SSD nanosuspensions were formulated using the microprecipitation-high-pressure homogenization technique. An optimized microsuspension of 0.5% SSD formulated with 6% Cremophor EL and 4% Lauroglycol 90 was subjected to 30 cycles of 1,000-bar pressure to give a nanosuspension with an average particle size of 367.85 nm. Transmission electron microscopy studies revealed that ovoid- to rectangular-shaped SSD particles were present as clusters. It was evident through X-ray diffraction studies that SSD was present in amorphous state both in microprecipitate and in nanosuspension. SSD (0.5%) nanogels were prepared using 1% Carbopol 974 P for topical delivery of nanosized SSD. In vitro release studies demonstrated that SSD release was faster from solutions and nanosuspensions compared to gel formulation owing to the influence of the gel matrix on SSD release. The bacterial inhibitory efficiency of SSD nanosuspension was as good as that of SSD solution against Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. In vivo studies revealed that a nanogel containing 0.5% SSD was more effective in wound healing compared to 0.5% and 1% marketed cream.

Despite the fact that advances of burn treatment have led to reduction in the morbidity caused by burns, burn infection is still a serious problem. In this study, we designed blended synthetic and natural polymers nanofiber scaffolds using polyurethane (PU) and gelatin, which were prepared by an electrospinning method. Silver-sulfadiazine (SSD) was co-mixed to the blended polymer solution for being incorporated into the nanofibers after the electrospinning, followed by examination of burn-wound healing effect. The nanofiber scaffolds containing SSD should not only serve as a substrate for skin regeneration, but may also deliver suitable drugs, within a controlled manner during healing. The SSD release was able to prevent the growth of a wide array of bacteria and accelerate the wound healing by preventing infection. Therefore it could accelerate the burn-wound closure rate. We confirmed that PU/gelatin nanofiber scaffolds containing SSD lead to enhanced regeneration of burn-wounds.

This product focus seeks to give an overview of the management of wound bioburden in relation to the use of antimicrobial dressings, according to recent guidelines and best practice statements. Identification of critical colonisation/localised infection and the role of biofilms is a key aspect of effective wound management. Silver antimicrobial dressings are efficient in reducing bacteria in wounds, but must be used appropriately to prevent overuse. Silver sulphadiazine has traditionally been used for the treatment of burns or Pseudomonas infection in leg ulceration, often in a cream formation. This article will be looking specifically at the effective use of Urgotul SSD in three critically colonised/non healing wounds.

Aim/purpose: The aim of this study was to compare clinical outcome of children with scald burns treated with a hydrofiber dressing (Aquacel(®), Convatec Inc.) with the former standard of care with silver sulfadiazine (Flammazine(®); Solvay Pharmaceuticals), considering surgical intervention and length of stay (LOS)., Methods: A retrospective study of all consecutive children from zero to four years with primary scald burns up to 10% admitted to the Burn Centre of the Maasstad Hospital Rotterdam between January 1987 and January 2010 were reviewed. For data collection a prospective computerized database was used. For comparison the study period was divided into two periods representing the period before and after the introduction of the hydrofiber dressing (HFD), respectively 1987-1999 (period 1) and 1999-2010 (period 2)., Results: Over the whole study period 27.3% of 502 patients treated with silver sulfadiazine (Ag-SD) underwent surgery, while before the introduction of HFD 30.5% of 338 Ag-SD treated patients were operated upon. After the introduction of the HFD 20.7% of 164 patients treated with Ag-SD eventually underwent skin grafting, a significant difference with the 11.6% of 302 patients whose wounds were dressed with HFD (p<0.01)., Conclusions: Compared to silver sulfadiazine treatment a reduced number of surgical interventions was observed in mixed partial thickness scald burns up to 10% TBSA burned in children aged 0-4 years after the introduction of hydrofiber dressings. The mode of treatment with this wound dressing also limited hospital length of stay., (Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.)

Objective: To assess the efficacy of Aloe Vera gel compared with 1% silver sulfadiazine cream as a burn dressing for the treatment of superficial and partial thickness burns., Methods: This Interventional Comparative study was carried out at the Burn unit and Plastic surgery department, Nishtar Hospital Multan, Pakistan from July 2008 to December 2010. A total of 50 patients with superficial and partial thickness burns were divided into two equal groups randomly by consecutive sampling method, one group was dressed with Aloe Vera gel while the other was treated with 1% silversulphadiazine cream, and the results regarding duration of wound epithelialization, pain relief and cost of treatment were compared., Results: In patients treated with Aloe Vera gel, healing of burn wounds were remarkably early than those patients treated with 1% silver sulfadiazine. All the patients of Aloe Vera group were relieved of pain earlier than those patients who were treated with SSD., Conclusion: Thermal burns patients dressed with Aloe Vera gel showed advantage compared to those dressed with SSD regarding early wound epithelialization, earlier pain relief and cost-effectiveness.

Diabetes-related chronic cutaneous lesions are a serious and common problem, as well as a major cause for hospital admissions, although no general consensus has been reached on the best available treatment for this frequent pathological condition. The primary objective of this review is to analyze the most recent evidence supporting the clinical use of a formulation containing hyaluronic acid (HA) and silver sulfadiazine (SSD) in the diabetic patient. This formulation has been widely used in cutaneous lesions of various etiology, both acute and chronic. The mechanisms underlying tissue repair are altered in the diabetic patient with respect to a healthy individual, namely for a diminished response of the keratinocytes and a reduced capacity of the endothelial cells to form new vessels (neoangiogenesis). Since HA favours the tissue repair process through various mechanisms, among these an increased angiogenic response and an activation of the keratinocytes, its application in diabetic lesions is a rational choice. SSD has been widely used in acute cutaneous lesions, particularly in burns, where it is considered the "gold standard" by which other treatments are measured. The efficacy of SSD in terms of antibacterial activity spectrum on various types of microorganisms, with a favourable safety profile, supports the potential use of SSD in diabetic lesions, where the presence of infection caused by bacteria resistant to most available antibiotics, but not to SSD, is rather frequent. In conclusion, the combined use of HA and SSD in the diabetic patient proves a rational choice and is potentially capable of improving the general clinical situation, on the basis of the synergic effect to control infection and accelerate the tissue repair process.

The TIME acronym (tissue, infection/inflammation, moisture balance and edge of wound) was first developed more than 10 years ago, by an international group of wound healing experts, to provide a framework for a structured approach to wound bed preparation; a basis for optimising the management of open chronic wounds healing by secondary intention. However, it should be recognised that the TIME principles are only a part of the systematic and holistic evaluation of each patient at every wound assessment. This review, prepared by the International Wound Infection Institute, examines how new data and evidence generated in the intervening decade affects the original concepts of TIME, and how it is translated into current best practice. Four developments stand out: recognition of the importance of biofilms (and the need for a simple diagnostic), use of negative pressure wound therapy (NPWT), evolution of topical antiseptic therapy as dressings and for wound lavage (notably, silver and polyhexamethylene biguanide) and expanded insight of the role of molecular biological processes in chronic wounds (with emerging diagnostics and theranostics). Tissue: a major advance has been the recognition of the value of repetitive and maintenance debridement and wound cleansing, both in time-honoured and novel methods (notably using NPWT and hydrosurgery). Infection/inflammation: clinical recognition of infection (and non infective causes of persisting inflammation) is critical. The concept of a bacterial continuum through contamination, colonisation and infection is now widely accepted, together with the understanding of biofilm presence. There has been a return to topical antiseptics to control bioburden in wounds, emphasised by the awareness of increasing antibiotic resistance. Moisture: the relevance of excessive or insufficient wound exudate and its molecular components has led to the development and use of a wide range of dressings to regulate moisture balance, and to protect peri-wound skin, and optimise healing. Edge of wound: several treatment modalities are being investigated and introduced to improve epithelial advancement, which can be regarded as the clearest sign of wound healing. The TIME principle remains relevant 10 years on, with continuing important developments that incorporate new evidence for wound care., (© 2012 The Authors. International Wound Journal © 2012 Blackwell Publishing Ltd and Medicalhelplines.com Inc.)

Purpose: Firewalking is a common Taoist cleansing ceremony in Taiwan, but burns associated with the practice have rarely been reported. We analyzed the patients with plantar burns from one firewalking ceremony., Materials and Methods: In one firewalking ceremony, 12 Taoist disciples suffered from contact burns to the soles of their feet while walking over burning coals. Eight of them had at least second-degree burns over areas larger than 1% of their total body surface areas (TBSAs). The age, sex, medical history, date of injury, time taken to traverse the fire pit, depth and TBSA of the burns, treatment, length of stay, and outcome were recorded and analyzed., Results: Deep, disseminated second- to third-degree burns were noted and healing took as long as three weeks in some patients. Because disseminated hypertrophic scars form after burns, the soles involved regain much of their tensile strength while walking. The patients experienced only a few difficulties in their daily lives three months after injury., Conclusion: From our experience treating patients with deep disseminated second- to third-degree plantar burns caused by firewalking, we conclude that they should be treated conservatively, with secondary healing rather than a skin graft., (Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.)

Purpose: For patients with anal canal and advanced rectal cancer, chemoradiation therapy is a curative modality or an important adjunct to surgery. Nearly all patients treated with chemoradiation experience some degree of radiation-induced dermatitis (RID). Prevention and effective treatment of RID, therefore, is of considerable clinical relevance. The present phase III randomized trial compared the efficacy of silver clear nylon dressing (SCND) with that of standard skin care for these patients., Methods and Materials: A total of 42 rectal or anal canal cancer patients were randomized to either a SCND or standard skin care group. SCND was applied from Day 1 of radiation therapy (RT) until 2 weeks after treatment completion. In the control arm, sulfadiazine cream was applied at the time of skin dermatitis. Printed digital photographs taken 2 weeks prior to, on the last day, and two weeks after the treatment completion were scored by 10 blinded readers, who used the common toxicity scoring system for skin dermatitis., Results: The radiation dose ranged from 50.4 to 59.4 Gy, and there were no differences between the 2 groups. On the last day of RT, when the most severe RID occurs, the mean dermatitis score was 2.53 (standard deviation [SD], 1.17) for the standard and 1.67 (SD, 1.2; P=.01) for the SCND arm. At 2 weeks after RT, the difference was 0.39 points in favor of SCND (P=.39). There was considerable intraclass correlation among the 10 observers., Conclusions: Silver clear nylon dressing is effective in reducing RID in patients with lower gastrointestinal cancer treated with combined chemotherapy and radiation treatment., (Copyright © 2012 Elsevier Inc. All rights reserved.)

As a superstition, homemade decoctions are believed to be beneficial for several diseases. This kind of medical therapy, however, can lead to serious adverse effects. In this report, we present three cases from a single family. Each of the family members developed phytophotodermatitis after the application of a fig leaf decoction. The most severe effect was in the case of a 13-year-old boy who had been bathed with the fig leaf decoction; the two other cases were the parents who prepared and applied the medicine to their child's skin to heal the boy's congenital mental-motor retardation. Silver sulfadiazine was used for wound care. The mother was discharged 6 days after admission, the father, after 8 days, and the boy, after 14 days. Burnlike wounds in all three cases healed completely.

A topical combination (silvathymosin) of natural proangiogeneic protein thymosin β4 (Tβ4) and antimicrobial silver sulfadiazine was hypothesized to promote the healing of large, full-thickness, clean or infected wounds in rats. Silvathymosin showed the fastest wound healing (85%) followed by silver sulfadiazine (84%) and Tβ4 (72%). In the infected groups, the healing pattern was different, as Tβ4 and silvathymosin groups did not show similar wound healing. Wound histopathology and VEGF and KI67 immunohistochemical assessment of angiogenesis was consistent and correlated well with the tempo of healing of the acute wounds. These preliminary data demonstrate the more rapid acute wound healing properties of the combination formulation of thymosin β4 and silver sulfadiazine as compared to these agents alone. This novel agent could prove an effective treatment modality for debilitating chronic wounds and decubitus ulcers., (© 2012 New York Academy of Sciences.)

Background: The face is a very frequent site of burn injuries. This multicenter, randomized, controlled trial thus investigates the effectiveness of cerium nitrate-silver sulfadiazine in the treatment of facial burns compared with silver sulfadiazine., Methods: Adult patients with acute facial burns admitted to Dutch burn centers were randomized to treatment with either cerium nitrate-silver sulfadiazine or silver sulfadiazine. Primary outcome was need for surgery and time to wound healing. Aesthetic and functional outcome was assessed at 3, 6, and 12 months after burn., Results: From March of 2006 until January of 2009, 179 patients were randomized and 154 could be included. The two groups of patients (cerium nitrate-silver sulfadiazine group, n=78; silver sulfadiazine group, n=76), were comparable regarding sex, age, percentage total body surface area burned, and cause. During admission, four patients died, leaving 77 and 73 patients for primary analyses, respectively. Surgery was required in 13 (16.9 percent) compared with 15 patients (20.5 percent) (p=0.57; odds ratio, 0.8; 95 percent CI, 0.3 to 1.8), respectively. Median time to wound healing was 11.0 days in the cerium nitrate-silver sulfadiazine group (interquartile range, 7.0 to 15.0) and 9.0 days for silver sulfadiazine group (interquartile range, 5.0 to 15.75) (p=0.17). There were no significant differences in functional and aesthetic outcome., Conclusions: No differences were found in effectiveness of both treatments. The vast majority of facial burns do not require surgery, and treatment with cerium nitrate-silver sulfadiazine and silver sulfadiazine leads to satisfactory outcome, both aesthetically and functionally., Clinical Question/level of Evidence: Therapeutic, II.

Background: The 2 most commonly used topical agents for partial thickness burns are silver sulfadiazine (SSD) and collagenase ointment (CO). Silver sulfadiazine holds antibacterial properties, and eschar separation occurs naturally. Collagenase ointment is an enzyme that cleaves denatured collagen facilitating separation but has no antibacterial properties. Currently, there are no prospective comparative data in children for these 2 agents. Therefore, we conducted a prospective randomized trial., Methods: After institutional review board approval, patients were randomized to daily debridement with SSD or CO. Primary outcome was the need for skin grafting. Patients were treated for 2 days with SSD with subsequent randomization. Polymyxin was mixed with CO for antibacterial coverage. Debridements were performed daily for 10 days or until the burn healed. Grafting was performed after 10 days if not healed., Results: From January 2008 to January 2011, 100 patients were enrolled, with no differences in patient characteristics. There were no differences in clinical course, outcome, or need for skin grafting. Wound infections occurred in 7 patients treated with CO and 1 patient treated with SSD (P = .06). Collagenase ointment was more expensive than SSD (P < .001). However, total hospital charges did not differ., Conclusion: There are no differences in outcomes between topical SSD or CO in the management of childhood burns results., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: For decades silver-containing antibiotics such as silver sulfadiazine (SSD) have been applied as standard topical therapy for patients with partial-thickness burns and venous stasis ulcers. This evidence-based review intends to answer the following research question: in ambulatory patients with partial-thickness burns or stasis dermatitis ulcers, does the use of topical SSD compared with nonantibiotic dressings improve mortality, wound healing, re-epithelialization, or infection rates?, Methods: MEDLINE, EMBASE, Cochrane Library, and other databases were searched. We considered trials that enrolled patients of any age with partial-thickness burns or venous stasis ulcers and randomized them to either topical SSD or placebo, saline-soaked gauze, paraffin gauze, sterile dry dressing, or nonantibiotic moist dressing. Outcomes included mortality, wound healing, speed of re-epithelialization, and infection rates., Results: For burns, our search revealed 400 potential articles. No human studies met the inclusion criteria. Only 7 animal studies (1 mouse, 4 rat, and 2 pig) were relevant to the proposed question. These animal studies provided conflicting results. Whereas some support the use of SSD for treatment of partial-thickness burns, others question its effectiveness. For stasis dermatitis ulcer, the search identified 50 articles for review, of which 20 abstracts were reviewed, and one article met the inclusion criteria. This study did not show any significant improvement in the rate of complete healing in SSD group compared with placebo either at 4 weeks (relative risk 6.2, 95% confidence interval 0.8-48) or at 1 year (relative risk 5.2, 95% confidence interval 0.6-41.6) of follow-up., Conclusion: There is insufficient evidence to either support or refute the routine use of SSD for ambulatory patients with either partial-thickness burns or stasis dermatitis ulcers to decrease mortality, prevent infection, or augment wound healing in human beings., (Copyright © 2010 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)

Background/purpose: To assess the value of topical silver sulfadiazine (SSD) cream in the treatment of babies with a giant omphalocele., Methods: From 1991 to 2008 inclusive, 20 infants with giant omphalocele (defined as >10 cm diameter) were treated with SSD, leaving a large ventral hernia to be repaired at a later date., Results: There were 12 boys and 8 girls. Thirteen had prenatal ultrasound diagnosis at a mean gestational age of 23 weeks. The mean gestational age at delivery was 37 weeks, and mean birth weight was 2.5 kg. Nineteen had other anomalies and/or medical problems, 18 of them multiple. The most common was pulmonary hypoplasia (70%). Mechanical ventilation and/or oxygen treatment was required in 15 (75%) for a mean of 10 weeks. SSD was used as primary sac treatment in 5 and secondary treatment in 15 (after Silon pouch 11, Op-site 3, povidone-iodine 1). Six omphalocele sacs were ruptured within the first 5 days of life. SSD was used for a mean of 6 months at a cost of $1 per day. Complications included 2 instances of staphylococcal sepsis and 1 jejunal perforation inside a Silon pouch. Six (30%) died from pulmonary hypoplasia at a mean age of 18 weeks. There were 14 (70%) survivors who went home after a mean of 14 weeks. Of the 14 survivors, 12 had ventral hernias repaired (18 operations with 2 recurrences), and 2 remain with their original ventral hernia., Conclusions: Initial topical coverage with SSD is associated with excellent outcomes for infants with giant omphalocele who cannot undergo immediate closure., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objectives: This study was performed to evaluate the burn wound-healing efficacy of crocodile oil from Crocodylus siamensis by employing deep second-degree burns in a Wistar rat model., Methods: Twenty-four rats were assigned equally into four groups using a random-number table, and two burns were created on the dorsum of each animal except for the sham group. The three treatment groups received with saline solution (12 burns, served as negative control), silver sulfadiazine (12 burns, served as positive control), or crocodile oil (12 burns). Silver sulfadiazine cream was used as standard care, and the treatments were repeated twice daily for 28 days. After day 28 the animals were euthanized and the wounds were removed for quantitative real-time polymerase chain reaction, histologic, and immunohistochemical study., Results: Crocodile oil accelerated the wound-healing process as indicated by a significant decrease in wound closure time in comparison to the burn control and silver sulfadiazine treatment groups. Histologic results showed well-organized and distributed skin structure and collagen deposition in the animals treated with crocodile oil. Transforming growth factor-β1 (TGF-β1), a key cytokine promoting scarring, was also observed to play a role in the burn wound healing. Immunohistochemical staining results showed the negative expression of TGF-β1 and Smad3 in the 28-days-postburn skin of crocodile oil group versus positive in the epidermis of burn controls. Compared to the burn control group, expressions of TGF-β1 and Smad3 mRNA decreased significantly (p < 0.01) in the 28-days-postburn skin of the crocodile oil group., Conclusions: Our results showed that crocodile oil could enhance cutaneous burn wound healing and reduce scar formation in rats, which might be related to TGF-β1/Smad3 signaling., (© 2012 by the Society for Academic Emergency Medicine.)

Background: Aloe vera is a cactus-like perennial succulent belonging to the Liliaceae Family that is commonly grown in tropical climates. Animal studies have suggested that Aloe vera may help accelerate the wound healing process., Objectives: To determine the effects of Aloe vera-derived products (for example dressings and topical gels) on the healing of acute wounds (for example lacerations, surgical incisions and burns) and chronic wounds (for example infected wounds, arterial and venous ulcers)., Search Methods: We searched the Cochrane Wounds Group Specialised Register (9 September 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3), Ovid MEDLINE (2005 to August Week 5 2011), Ovid MEDLINE (In-Process & Other Non-Indexed Citations 8 September 2011), Ovid EMBASE (2007 to 2010 Week 35), Ovid AMED (1985 to September 2011) and EBSCO CINAHL (1982 to 9 September 2011). We did not apply date or language restrictions., Selection Criteria: We included all randomised controlled trials that evaluated the effectiveness of Aloe vera, aloe-derived products and a combination of Aloe vera and other dressings as a treatment for acute or chronic wounds. There was no restriction in terms of source, date of publication or language. An objective measure of wound healing (either proportion of completely healed wounds or time to complete healing) was the primary endpoint., Data Collection and Analysis: Two review authors independently carried out trial selection, data extraction and risk of bias assessment, checked by a third review author., Main Results: Seven trials were eligible for inclusion, comprising a total of 347 participants. Five trials in people with acute wounds evaluated the effects of Aloe vera on burns, haemorrhoidectomy patients and skin biopsies. Aloe vera mucilage did not increase burn healing compared with silver sulfadiazine (risk ratio (RR) 1.41, 95% confidence interval (CI) 0.70 to 2.85). A reduction in healing time with Aloe vera was noted after haemorrhoidectomy (RR 16.33 days, 95% CI 3.46 to 77.15) and there was no difference in the proportion of patients completely healed at follow up after skin biopsies. In people with chronic wounds, one trial found no statistically significant difference in pressure ulcer healing with Aloe vera (RR 0.10, 95% CI -1.59 to 1.79) and in a trial of surgical wounds healing by secondary intention Aloe vera significantly delayed healing (mean difference 30 days, 95% CI 7.59 to 52.41). Clinical heterogeneity precluded meta-analysis. The poor quality of the included trials indicates that the trial results must be viewed with extreme caution as they have a high risk of bias., Authors' Conclusions: There is currently an absence of high quality clinical trial evidence to support the use of Aloe vera topical agents or Aloe vera dressings as treatments for acute and chronic wounds.

Background: Bacterial biofilm is recognized as a major detriment to wound healing. The efficacy of traditional wound care against biofilm has never been studied. The authors evaluated the effect of clinical strategies against biofilm-infected wounds in a quantitative, in vivo model., Methods: Using a rabbit ear biofilm model, wounds were inoculated with Pseudomonas aeruginosa or left as uninfected controls. Inoculated wounds acted as untreated controls or underwent treatment: every-other-day sharp débridement (I), lavage (II), Silvadene (III), or lavage and Silvadene (IV), or initial débridement with daily lavage and Silvadene (V). Wounds were harvested on days 12 and 18. Histological wound healing parameters and viable bacterial counts were measured. Biofilm structure was studied with scanning electron microscopy., Results: Uninfected controls healed better than P. aeruginosa biofilm-infected wounds across all parameters (p = 0.01). Groups IV and V demonstrated improved healing (p = 0.05) and decreased bacterial count (p = 0.05) compared with untreated P. aeruginosa biofilm, whereas groups I through III showed no differences in either. Scanning electron microscopy following a group V treatment showed temporary disruption of biofilm structure, which reformed in 24 hours., Conclusions: Pseudomonal biofilm markedly impairs wound healing, shown quantitatively using our in vivo model. Despite common practice, wound care strategies cannot restore biofilm wounds to a healing phenotype when used alone or infrequently. The durability of biofilm extends nonhealing wound chronicity, thus requiring aggressive, multimodal therapy aimed at reducing bacterial burden. The authors' novel, rigorous study validates critical principles applicable to all clinical wound care.

Introduction: Burns are widespread in the developed world, and expensive burn dressings are not universally available. Most burn patients suffer from a partial thickness burn that can be treated conservatively. Nevertheless, the ideal dressing for the burn wound has not been identified. We performed an animal experiment to compare the healing of partial thickness burns treated with silver sulfadiazine (SSD) and olive oil., Methods: A randomized controlled animal experiment was conducted on 3 anesthetized domestic pigs in which 51 partial thickness burns were created using a metal bar heated to 400°C and applied to the dorsum of the animals for 20 seconds. The burns were treated every other day with SSD cream (n = 16), purified olive oil (n = 20), or no topical therapy at all (n = 15). Assessment of wound healing was done by drawing and scanning the margins of the wound at the endpoint of the experiment. The remaining open wound area was then calculated using Scion Image version beta 4.0.2 (Scion, Frederick, Md), and the results were analyzed using a 1-way ANOVA test., Results: Burns treated with SSD healed faster than control burns (P < .05). There were no differences in the healing rates of wounds treated with olive oil versus controls or SSD. There were no wound infections in any of the 3 study groups., Conclusions: Treatment of partial thickness burns with purified olive oil did not result in faster healing when compared with SSD or dry gauze in a porcine model., (Copyright © 2012. Published by Elsevier Inc.)

An open, parallel, randomized, comparative, multicenter study was implemented to evaluate the cost-effectiveness, performance, tolerance, and safety of a silver-containing soft silicone foam dressing (Mepilex Ag) vs silver sulfadiazine cream (control) in the treatment of partial-thickness thermal burns. Individuals aged 5 years and older with partial-thickness thermal burns (2.5-20% BSA) were randomized into two groups and treated with the trial products for 21 days or until healed, whichever occurred first. Data were obtained and analyzed on cost (direct and indirect), healing rates, pain, comfort, ease of product use, and adverse events. A total of 101 subjects were recruited. There were no significant differences in burn area profiles within the groups. The cost of dressing-related analgesia was lower in the intervention group (P = .03) as was the cost of background analgesia (P = .07). The mean total cost of treatment was $309 vs $513 in the control (P < .001). The average cost-effectiveness per treatment regime was $381 lower in the intervention product, producing an incremental cost-effectiveness ratio of $1688 in favor of the soft silicone foam dressing. Mean healing rates were 71.7 vs 60.8% at final visit, and the number of dressing changes were 2.2 vs 12.4 in the treatment and control groups, respectively. Subjects reported significantly less pain at application (P = .02) and during wear (P = .048) of the Mepilex Ag dressing in the acute stages of wound healing. Clinicians reported the intervention dressing was significantly easier to use (P = .03) and flexible (P = .04). Both treatments were well tolerated; however, the total incidence of adverse events was higher in the control group. The silver-containing soft silicone foam dressing was as effective in the treatment of patients as the standard care (silver sulfadiazine). In addition, the group of patients treated with the soft silicone foam dressing demonstrated decreased pain and lower costs associated with treatment.

Objective: A prospective, randomized, controlled single center study was designed to evaluate clinical efficacy of a polyhexanide containing bio-cellulose dressing (group B) compared to a silver-sulfadiazine cream (group A) in sixty partial-thickness burn patients., Patients and Methods: Local ethics committee approval was obtained and patients consented. Parameters were: pain reduction (VAS), healing time and wound bed condition, comparing day 0 (start) versus day 14 (end), as well as, ease of dressing use and treatment costs., Results: All completed the study (n=30/n=30) and were included in the ITT analysis, with a total of 72 burns (group A: n=38, group B: n=34). We noted no differences in healing time. Pain reduction was significantly faster and better in group B (p<0.01). There were fewer dressing changes in group B, compared to group A. Ease of use for the bio-cellulose dressing was rated better compared to group A. In group B, € 95.20 was saved for a 10 day treatment period, compared to group A., Conclusion: Group B demonstrated a better and faster pain reduction in the treated partial-thickness burns, compared to group A. The results indicate the polyhexanide containing bio-cellulose dressing to be a safe and cost effective treatment for partial-thickness burns., (Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.)

Background: Controlling infection and promoting healing should be aims of pressure ulcer treatment along with improving a patient's general condition and relieving pressure. Many pressure ulcers present with cavities, tracks or a combination of these. A new silver mesh dressing (Tegaderm Ag Mesh dressing) has the ability to contour around and conform to irregular surfaces of a wound bed., Objective: To evaluate the efficacy of a silver mesh dressing compared with silver sulfadiazine cream for pressure ulcer treatment., Material and Method: A prospective, randomized, clinical trial was conducted in patients with pressure ulcers grade III or IV. The patients were divided randomly by computer into two 20 patient-groups. The study period was eight weeks for each patient. Demographic data, wound size, wound photography, and bacterial wound culture were recorded at the beginning of the study and every two weeks thereafter. Wound beds were covered with silver sulfadiazine cream in the control group and silver mesh dressing in the experimental group. Dressings were changed twice a day in the control group and every three days in the experimental group., Results: Forty-five patients enrolled in the present study but only 40 patients finished the study. Twenty patients in each group finished the eight-week study. The mean healing rates and the percentage of reduction in PUSH score at eight-week were better in the study group than in the control group but they were not statistically significant. Better changing in bacteriological study after the treatment was shown in both groups. The estimated average cost of the treatment in the mesh group was 263 USD per patient while it was 1812 USD in the cream one (p = 0.0001). Silver mesh dressing can be adapted very well on the bed, can control infection, and promote wound healing. Wound reduction was greater in the experimental group than the control group. The cost of treatment, using silver mesh was cheaper than using silver sulfadiazine cream significantly., Conclusion: Silver mesh dressings is one of the choices for pressure ulcer treatment with good healing rate, minimal care and lower overall cost.

This prospective study was conducted on 102 children with second-degree thermal burns to assess qualitative differences between topical silver sulfadiazine (SD) and oven-dried, radiation-sterilized human amnion as wound dressing. The patients were divided into silver SD and amniotic membrane (AM) group by random sampling technique. The variables compared 1) the number of days admitted in the hospital, 2) the number of dressing changes, 3) time needed for epithelialization, 4) comfort and pain of the patients during dressing, 5) comfort and pain of the patients between dressings, 6) activities during treatment, 7) acceptability of the modules by the patients or attending guardians, and 8) comfort of the doctor during application. Patients' ages ranging from 1 day to 12 years and admitted to inpatient burn unit within 72 hours of occurrence were included in this study. Fifty-one burned children enrolled in each group. The mean hospital stay is significantly lower in AM group (P < .01). The number of dressing changes in AM group was significantly low (P < .001). The mean time taken for epithelial coverage of superficial second-degree burns is significantly lower in AM than in SD group (P < .001) and also those of deep second-degree burns (P < .001). Application was painless in AM than SD group (P < .001). State of pain in-between application shows significant difference (P < .001). Application of AM was comfortable to the attending doctor (P < .001). Significant activity of the patients was observed during treatment (P < .01) with AM. AM was accepted by the patients or parents (P < .001). This study indicates that radiation-sterilized, oven-dried AM is a better treatment option because its use reduces hospital stay and the number of dressing changes. Epithelialization of the wound is quicker. The use of AM is painless and odorless. The procedure is easy and comfortable to the doctor, and it is well accepted. Most of the patients remain ambulatory during treatment.

Objective: A prospective, randomized, non-blinded, clinical study was conducted to evaluate the feasibility and practicability as well as pain reduction and ease of handling of Flammazine® versus Octenidine-Gel® s a primary local antiseptic before synthetic skin substitute application in partial-thickness burns., Methods: Thirty patients with a median age of 42 years suffering from second-degree burns were included in the study. Burns were randomly selected, one area was treated with Flammazine®/gauze, another area in the same patient was treated with Octenidine-Gel®/gauze as initial antiseptic treatment. Within 24 h the first gauze change was performed followed by wound inspection, disinfection and synthetic skin substitute application. The study focused on patient pain score, analysis of wound bed and ease of handling of the two local antiseptic agents., Results: There was a significant difference between Flammazine® versus Octenidine-Gel® regarding patient pain score and ease of handling. Octenidine-Gel® was less painful (p < 0.05) and easier to handle (p < 0.05). There was no significant difference for wound bed evaluation between the two antiseptic agents. A tendency for better wound bed preparation was seen with the use of Octenidine-Gel®., Conclusion: Based on the findings of this study Octenidine-Gel® is recommended as a local antiseptic agent, because when compared to Flammazine®, Octenidine-Gel® proved to be better in terms of ease of care, simplicity application, with gentler and faster detachment of the gel from wound surfaces and consequently far less pain during dressing changes., (Copyright © 2010 Elsevier Ltd and ISBI. All rights reserved.)

In 1976, the combination of cerium nitrate and silver sulfadiazine was introduced as a topical therapy for burn wounds. Experience with a locally prepared combination agent has shown physical change of the eschar and delayed subeschar bacterial colonization. A potential systemic complication of this treatment is the development of methemoglobinemia (Met-Hba) due to the oxidizing nature of Ce(NO(3))(3). Met-Hba has a spectrum of clinical consequences, ranging from headache and cyanosis to cardiac ischemia, hypotension, and even death. Given the frequent use of this combination agent at our burn center, a retrospective review was conducted to evaluate the incidence of Met-Hba. A query of pharmacy records revealed 170 patients from January 2005 to October 2009 that had received this treatment. Eighteen patients (∼10%) developed Met-Hba as noted on arterial blood gas (methemoglobin>3%) and only three patients (∼2%) had methemoglobin levels >10%. In the majority of cases, there were no clinical symptoms of Met-Hba. Most patients' relative hypoxia resolved with cessation of treatment; however, five patients required treatment with methylene blue. The presence of Met-Hba associated with this topical therapy can be diagnosed early by vigilant monitoring, thereby reducing morbidity and mortality. In our experience, cerium combined with silver sulfadiazine is a valuable and safe treatment for deep partial and full-thickness burn wounds., (© 2011 by the Wound Healing Society.)

Objective: To determine the in vivo effect of a sustained-release silver sulphadiazine powder foam dressing on the bacterial burden of venous leg ulcers (VLUs), with a view to correlating the wound closure rate with the degree of bioburden and to assess other markers of its progression towards healing., Method: Patients attending a tertiary care wound practice were screened for a VLU bacterial count of >105 colony forming units (cfu/g) per gram of tissue. Patients were treated with the above topical dressing plus multilayer compression bandaging for 12 weeks. Quantitative cultures were taken at weeks 0, 2, 4 and 8. Wounds were assessed at each weekly visit using photography and planimetry., Results: Twenty-four of the 33 screened patients met the inclusion criteria. The average baseline wound size was 12.3 cm². At week 8, the bioburden had reduced to < 105 cfu/g in 54.2% of patients, with 41.7% achieving this reduction by week 2. At week 8, the median reduction was 0.7 log¹⁰ (p < 0.001). The median percentage reductions in bioburden were 50.5%, 56.8% and 80.4% at weeks 2, 4 and 8 respectively. Over the study period, 79.2% of the patients had > 75% wound area reduction and 45.8% achieved ulcer closure in a median of 80.5 days., Conclusion: Although the wound size and bacterial counts reduced significantly, there was no statistical correlation between the two. Nevertheless, the in vivo data show that this active antimicrobial dressing was associated with a very high healing rate in these hard-to-heal wounds.

Askina Calgitrol Ag(®) (B. Braun Hospicare Ltd, Collooney Co. Sligo, Ireland), alginate silver wound dressing, is an advanced wound dressing which combines the potent broad-spectrum antimicrobial action of silver with enhanced exudate management properties of calcium alginate and polyurethane foam. The purpose of this study was to compare the efficacy of Askina Calgitrol Ag(®) and 1% silver sulfadiazine (1% AgSD) in the outpatient management of partial-thickness burn wounds at Burn Unit, Siriraj Hospital. A prospective descriptive study was conducted between January 2008 and January 2009 in Burn Unit, Division of Trauma Surgery, Siriraj Hospital, Mahidol University, Thailand. The 65 patients with partial-thickness burn wounds, less than 24 hours post-burn injury, had a total body surface area (TBSA%) less than 15% were treated at Siriraj Outpatient Burn Clinic. All patients were divided into Askina Calgitrol Ag(®) treated group (30 patients) and 1% AgSD treated group (35 patients). The data were compared by the demographics including age, gender, % TBSA burn, pain score, number of wound dressing change, nursing time and time of wound healing. Patients included in both groups were comparable with no significant differences in demographic data of age, gender, location of burn and type of burn injury (P > 0·05 evaluated by paired Student's t-test) between both group. The present results showed that average pain scores in the Askina Calgitrol Ag(®) treated group were significantly lower than the 1% AgSD treated group (2·23 ± 1·87 versus 6·08 ± 2·33, respectively) between both groups (P < 0·02). Patients treated with Askina Calgitrol Ag(®) had significantly lower number of wound dressing change (P < 0·02) and nursing time (P < 0·02) compared with 1% AgSD treated group. The Askina Calgitrol Ag(®) group needed less frequent wound dressing. Healing time was 7 ± 3·51 days after the application of Askina Calgitrol Ag(®). This was significantly shorter than that of control wounds (14 ± 4·18 days). Application of Askina Calgitrol Ag(®) leads to a good burn wound outcome. The present study confirms the effectiveness of Askina Calgitrol Ag(®) in the outpatient management of partial-thickness burn wounds., (© 2010 The Authors. Journal Compilation © 2010 Blackwell Publishing Ltd and Medicalhelplines.com Inc.)

This study reports the case of a 55-year-old woman with diabetes with a necrotizing fasciitis of the right lower limb and the perineum, first admitted at the emergency department for septic shock with cardiac arrest, and later transferred to the department of surgery. Microbiological and histopathological examination confirmed the diagnosis of necrotizing fasciitis caused by Acinetobacter baumannii. A broad-spectrum antibiotic therapy was administered and later readjusted according to the results of microbiological culture. Intensive hemodynamic support was required. Wounds were dressed daily with a 3 percent boric acid solution and a silver sulfadiazine-impregnated dressing. An extensive surgical debridement was promptly performed and repeated until complete control of the infection. Wounds were finally covered with split-thickness skin grafts. The infection was overcome 35 days after admission. The graft take was 100%. Postoperative rehabilitation was required because of the functional limitation of lower limb movements. Follow-up at 6 months showed no functional deficit and an acceptable aesthetic result. Necrotizing fasciitis is a life-threatening disorder, especially in patients with diabetes, whose clinical diagnosis may sometimes be challenging. Early recognition and treatment represent the most important factors influencing survival.

Historically, some dressings used in exomphalos major were associated with toxicity. These have been abandoned in favor of safer dressings. Silver toxicity has not been described following the use of silver dressings in infants. We, however, found disconcerting serum silver levels in 2 consecutive patients during treatment with silver salt containing dressings., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Objective: The antimetabolite drug, 5-fluorouracil, inhibits microbial growth. Coating of central venous catheters with 5-fluorouracil may reduce the risk of catheter infection. Our objective was to compare the safety and efficacy of central venous catheters externally coated with 5-fluorouracil with those coated with chlorhexidine and silver sulfadiazine., Design: Prospective, single-blind, randomized, active-controlled, multicentered, noninferiority trial., Setting: Twenty-five US medical center intensive care units., Patients: A total of 960 adult patients requiring central venous catheterization for up to 28 days., Interventions: Patients were randomized to receive a central venous catheter externally coated with either 5-fluorouracil (n = 480) or chlorhexidine and silver sulfadiazine (n = 480)., Measurements and Main Results: The primary antimicrobial outcome was a dichotomous measure (<15 colony-forming units or ≥ 15 colony-forming units) for catheter colonization determined by the roll plate method. Secondary antimicrobial outcomes included local site infection and catheter-related bloodstream infection. Central venous catheters coated with 5-fluorouracil were noninferior to chlorhexidine and silver sulfadiazine coated central venous catheters with respect to the incidence of catheter colonization (2.9% vs. 5.3%, respectively). Local site infection occurred in 1.4% of the 5-fluorouracil group and 0.9% of the chlorhexidine and silver sulfadiazine group. No episode of catheter-related bloodstream infection occurred in the 5-fluorouracil group, whereas two episodes were noted in the chlorhexidine and silver sulfadiazine group. Only Gram-positive organisms were cultured from 5-fluorouracil catheters, whereas Gram-positive bacteria, Gram-negative bacteria, and Candida were cultured from the chlorhexidine and silver sulfadiazine central venous catheters. Adverse events were comparable between the two central venous catheter coatings., Conclusions: Our results suggest that central venous catheters externally coated with 5-fluorouracil are a safe and effective alternative to catheters externally coated with chlorhexidine and silver sulfadiazine when used in critically ill patients.

Background: This study was designed to evaluate the wound healing effects of kiwifruit in the treatment of second-degree burn wounds in rats., Methods: Sixty rats were each randomly assigned to 1 of 3 groups. A deep second-degree burn was created on the lateral flank of each rat with a standard burning procedure in the form of applying a heated plaque. In the control group (group C; n = 20) burns were dressed with Vaseline sterile gauze after normal saline irrigation. In group S (n = 20), the lesions were treated with silver sulfadiazine cream after normal saline irrigation. In the third group (group K; n = 20), the burn wounds were dressed with kiwifruit. The dressings were changed twice a day in all groups. The response to treatments was assessed histologically at day 21 postburn and microbiologically on days 7 and 21. Macroscopic evaluation was performed every day to determine wound closure rate, measure burn wound area, and investigate macroscopic edema, hyperemia, and epithelialization. Histopathologic evaluation included monitoring of epithelialization, vascularization, granulation tissue formation, and inflammatory cell response., Results: On day 21, the wounds in the group K healed completely in comparison to other groups (P < .0001). There was significant reduction in wound area size in the group K in all evaluation days as compared with groups S and C (P < .0001). Microscopic evaluation revealed a high grade of neovascularization in group K lesions in contrast with groups S and C (P < .0001). Wound infection was dramatically less common in the group K compared with the other 2 groups (P < .05)., Conclusion: We suggest that the dramatic antibacterial, debridement, wound contracture, and angiogenic effect of kiwifruit induced a significant wound healing in burn ulcers and might be useful in treating chronic ulcers, such as bedsores., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Burn injury is associated with a high incidence of death and disability; yet, its management remains problematic and costly. We conducted this clinical study to evaluate the efficacy of honey in the treatment of superficial and partial-thickness burns covering less than 40% of body surface area and compared its results with those of silver sulphadiazine (SSD). In this randomised comparative clinical trial, carried out Burn Center of POF Hospital, Wah Cantt, Pakistan, from May 2007 to February 2008, 150 patients of all ages having similar types of superficial and partial-thickness burns at two sites on different parts of body were included. Each patient had one burn site treated with honey and one treated with topical SSD, randomly. The rate of re-epithelialization and healing of superficial and partial-thickness burns was significantly faster in the sites treated with honey than in the sites treated with SSD (13·47 ± 4·06 versus 15·62 ± 4·40 days, respectively: P < 0·0001). The site treated with honey healed completely in less than 21 days versus 24 days for the site treated with SSD. Six patients had positive culture for Pseudomonas aeroginsa in honey-treated site, whereas 27 patients had positive culture in SSD-treated site. The results clearly showed greater efficacy of honey over SSD cream for treating superficial and partial-thickness burns., (2010 The Authors. Journal Compilation © 2010 Blackwell Publishing Ltd and Medicalhelplines.com Inc.)

Previous systematic reviews of silver-impregnated dressings have been contradictory regarding the healing of leg wounds/ulcers. Our systematic review was restricted to randomized controlled trials. Cochrane Library, Scopus, and MEDLINE databases were searched using the term "silver" in combination with "wound" or "ulcer" (and plural versions) without date/language restriction. Study quality was assessed and meta-analysis conducted for complete wound healing, wound size reduction, and healing rates. Overall study quality was fair with most studies having some bias. Evidence for wound healing using individual studies was poor. Meta-analyses found strong evidence for wound healing based on wound size reduction but no evidence based on complete wound-healing or healing rates. Although our results provide some evidence that silver-impregnated dressings improve the short-term healing of wounds and ulcers, long-term effects remain unclear. Clinical trial data with longer follow-up times are needed to address these issues., (Copyright © 2009 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)

The virtues of silver as an antimicrobial agent have been known for some time. Various silver containing dressings are currently used for the treatment of wounds. Introduced in the late 1990s, Acticoat is a nanocrystalline silver dressing developed to overcome some shortcomings of the older dressings by providing sustained release of silver up to 7 days. We aim to determine the level of evidence available in the literature in view of recent increased usage of Acticoat. A Medline search was conducted to identify articles evaluating the use of Acticoat in burn wounds. A level of evidence adapted from the Oxford Centre for Evidence-Based-Medicine was assigned to each of these articles. Only one study was considered to be LOE 1, which is a multicentre randomised controlled trial comparing Acticoat against Silver Sulfadiazine. One further randomised control trial was downgraded to LOE 2 due to a wide confidence interval. Twenty studies (66%) were LOE 5 of which 6 were case reports and 14 were in vitro/animal studies. The available LOE 1 study demonstrates that Acticoat has better antimicrobial activity compared to another available silver dressing. Other studies suggest Acticoat has fewer adverse effects and reduces healing times. Its ease of application and low frequency of change makes it an ideal dressing in burn wounds. More well designed and properly reported randomised controlled trials are essential for informed clinical decision-making., (2009 Elsevier Ltd and ISBI. All rights reserved.)

The purpose of this randomised comparative study was to evaluate the use of silver sulphadiazine (SSD) 1% cream (Group A) with the use of Procutase (Group B) in treating burns with a TBSA <10% and a depth not greater than 2nd degree burns and thus suitable for outpatient management. The two groups were similar in age, gender, race, and extent of burn. Procutase is an ionic hydrogel composed of natural hydrophilic polymers in an active ionic solution with an inhibitor of matrix metalloproteinases MMP-1, -3 and -9 (collagenase/gelatinase). Subjects were seen in follow-up biweekly, and wounds of patients in SSD group were compared with those of Procutase group for healing time, pain score at dressing change, compliance with therapy and complication rate. The result of this study showed that Procutase treated patients had statistically significantly less pain and shorter wound healing time. Procutase can be used successfully in patients with burns that do not require hospital admission., (2009 Elsevier Ltd and ISBI. All rights reserved.)

Objective: To determine the effectiveness of Flammacérium, a topical treatment used in the treatment of burns, in the stabilisation of necrosis in non-healing wounds. The therapy is designed to prevent the risk of infection, stop necrosis from spreading and improve the patient's quality of life., Method: This retrospective survey involved patients with necrotic, non-healing wounds who had been treated with Flammacérium. In all cases, debridement was contraindicated. Available data on wound evolution were collected., Results: Ninety-nine patient files were analysed and the wound aetiologies included in the survey were classified as arterial (n=42), malignant (n=5), pressure ulcers (n=30), traumatic wounds (n=10) and other wounds (n=12). The formation of a leather-like eschar induced by topical use of Flammacérium improved pain management, decreased exudate levels and malodour, and had a positive effect on quality of life, increasing patient comfort, participation in social activity and psychological wellbeing. Following application of the cream, an eschar develops that strongly adheres to wound edges. By preventing the necrosis from spreading, this gave the practitioners more time to prepare for subsequent treatment, including skin grafting., Conclusion: Flammacérium seems to be effective in the stabilisation of necrosis in non-healing wounds in which debridement is contraindicated. However, this study is limited by its retrospective nature. A prospective study will hopefully confirm and strengthen these results.

Purpose: To report a probable association of Stevens-Johnson Syndrome (SJS) with furosemide and suspected cross-sensitivity with lincomycin and silver sulfadiazine cream., Summary: A 28-year-old Hispanic male was admitted for SJS, with a prolonged hospital course and unclear etiology throughout the majority of the stay. Patient's medications prior to development of SJS symptoms were stable for 3 months and with the exception of furosemide, all were continued throughout the hospitalization while the SJS resolved. During hospitalization, the patient was unintentionally rechallenged with furosemide, after which the rash reappeared and then worsened further with use of silver sulfadiazine cream. At this point in the hospitalization, the prolonged course of the rash prior to admission and the administration of lincomycin 3 days prior to admission were revealed. This suggests the SJS was initially caused by furosemide, a nonaromatic sulfonamide diuretic, with slow progression prior to hospital admission over approximately 7 weeks, followed by an acute worsening caused by lincomycin, a sulfide antibiotic., Conclusion: Use of the Naranjo ADR Probability Scale indicates a probable relationship between SJS and furosemide in this patient. Clinicians should be aware of this rare potential adverse effect, even months after the initiation of therapy.

Silver sulfadiazine has been used as a topical burn wound treatment for many years. Pain associated with dressing changes is a common problem in burn wounds. Aquacel Ag, a hydrofiber dressing coated with ionic silver has been reported to reduce burn wound infection and promote antimicrobial activity. The purpose of this study was to show the benefits of Aquacel Ag for the treatment of partial thickness burns. This prospective randomized study was conducted in 70 patients who had partial thickness burns less than 15% of total body surface area and were treated at Siriraj outpatient burn clinic during December 2006-February 2008. Patients were divided into two groups: Aquacel Ag-treated group with dressing changes every 3 days (35 patients) and 1% silver sulfadiazine-treated group, with daily dressing changes (35 patients). There was no difference in demographic data including age, gender, burn percentage between groups. Time-to-wound healing pain score during dressing change and cost of treatment were compared between both groups. Time-to-wound closure was significantly shorter in the Aquacel Ag-treated group (10 +/- 3 versus 13.7 +/- 4 days, P < 0.02) as well as pain scores at days 1, 3 and 7 (4.1 +/- 2.1, 2.1 +/- 1.8, 0.9 +/- 1.4 versus 6.1 +/- 2.3, 5.2 +/- 2.1, 3.3 +/- 1.9, respectively, P < 0.02). Total cost of treatment was 52 +/- 29 US dollars for the Aquacel Ag-treated group versus 93 +/- 36 US dollars for the silver sulfadiazine-treated group. This study showed that Aquacel Ag increased time to healing, decreased pain symptoms and increased patient convenience because of limiting the frequency of replacement of the dressing at lower total cost. This study confirms the efficacy of Aquacel Ag for the treatment of partial thickness burns at an outpatient clinic.

Objective: To compare the effectiveness of dressing by a combination of traditional Chinese medicine (TCM)-Western medicine (WM) after TCM bath and by the silver sulfadiazine cream (SD-Ag) in treating residual deep burn wound., Methods: A total of 128 cases of residual deep burn wound between July 2003 and December 2009 were randomly divided into the TCM-WM treatment group (70 cases) and the WM control group (58 cases). In the treatment group, there were 45 males and 25 females with an average age of 38.6 years (range, 18-60 years), including 34 cases of flame burns, 28 cases of molten steel burns, and 8 cases of chemical burns with an average burn area of 57.6% total body surface area (TBSA) and an average residual wound of 7.4% TBSA. In the control group, there were 50 males and 8 females with an average of 37.9 years (range, 20-59 years), including 26 cases of flame burns, 12 cases of hot water burns, 16 cases of molten steel burns, and 4 cases of chemical burns with an average burn area of 56.5% TBSA and an average residual wound of 6.9% TBSA. There was no significant difference in general data between 2 groups (P > 0.05), so the clinical data of 2 groups had comparability. In the treatment group, the patients had a bath with TCM, and then the wounds were treated with dressing change of combined TCM-WM. In the control group, the wounds were treated with SD-Ag after cleaning the wounds with chlorhexidine solution. The pain, wound healing time, and the rate of scar formation were observed in 2 groups after treatment., Results: According to wound pain classification after medication, the results were excellent in 23 cases, good in 30 cases, fair in 17 cases in the treatment group; were excellent in 17 cases, good in 20 cases, fair in 13 cases, poor in 5 cases, and fairly poor in 3 cases in the control group. The wound healing time of the treatment group (13.45 +/- 4.74) days was significantly shorter than that of the control group [(23.87 +/- 14.45) days, P < 0.05)]. After 2 weeks of treatment, scar occurred in 15 patients (21.4%) of the treatment group and 35 patients (60.3%) of the control group, showing significant difference (P < 0.05)., Conclusion: Based on TCM bath, a combination of TCM-WM for the residual burn wounds is obviously superior to SD-Ag. It has the advantages of rapid healing, light pain, no obvious scar, and short hospitalization time.

Background: Data regarding tattoo practices in the Gulf region and response to treatment are almost non-existent in the medical literature., Objective: To study the profile of patients with permanent tattoos in the Arab world, and to evaluate their response to Q-switched ruby laser treatment., Methods: A total of 468 consecutive patients with permanent tattoos consulting us for tattoo removal were recruited in the present study. Before starting the treatment each patient was given a set of questionnaires to answer. The patients were then treated with the Q-switched ruby laser, with a time interval of 8 weeks between each laser session, until complete clearance or up to a maximum of 10 sessions., Results: A total of 292 patients out of 348 patients achieved excellent lightening to complete clearance of tattoo pigment after an average of six sittings (range 2-10 sittings). Female patients with fair complexions and amateur tattoos on the face responded best. Seventy-eight (22.4%) patients developed pigmentary changes., Conclusion: More females than males had tattoos, and at a very young age and mostly on the advice of their parents. The majority of patients wanted to remove the tattoos because of religious reasons. The Q-switched ruby laser seems to be highly effective in removing amateur blue-black tattoos in patients with colored skin.

Efficacy of preparation Sulfargin application in injured persons, suffering burns, was studied. There was established, that application of preparation Sulfargin in local treatment of burns promotes reduction of inflammatory reaction severity in the affection zone and support of functional capacities of phagocytic cells on optimal level.

The authors report the findings of in vivo studies of XF-70 (a novel, dicationic porphyrin) against Staphylococcus aureus in a murine model of a burn wound infection. Mice received a 15% total body scald burn wound, which were inoculated with S. aureus (1.8 x 10 CFU). After 24 hours, escharectomies were performed and groups (n = 8) received single or two doses (6 hours apart) of XF-70* (100 microg/wound) or silver sulfadiazine, Acticoat, or saline applied topically. Viable bacteria were quantified from homogenized burn tissue biopsies and the spleen by plating dilutions onto agar plates and CFU determination. A single dose of XF-70 reduced bacterial burden by 98.77% (untreated: 2.78 +/- 2.96 x 10 CFU/g vs XF-70 treated: 3.4 +/- 0.19 x 10 CFU/g, P < .01). Two XF-70 doses reduced the growth of S. aureus by 99.96% (1.2 +/- 0.6 x 10 CFU/g, P < .01). These results were similar to the results obtained from commonly used topical antibacterials silver sulfadiazine and Acticoat. The spleens of mice treated with saline had a robust growth of S. aureus (7.0 +/- 1.97 x 10 CFU/g) whereas those treated with one or two XF-70 doses grew only 3.5 +/- 0.002 x 10 CFU/g and 5.7 +/- 0.002 x 10 CFU/g, respectively, a significant (P < .001) reduction in S. aureus dissemination. Single and multiple doses of XF-70 were effective in controlling S. aureus growth in burn wounds and inhibited systemic dissemination of S. aureus. Early treatment of burn wounds with XF-70 may be effective in slowing bacterial dissemination to other tissues.