Biobrane better than conventional silver foam dressing for acute burn outcomes in children
Biobrane is more effective than the conventional silver foam dressing for reducing hospital stay and the incidence of infection in paediatric burn patients, a recent Singapore study has shown. On the other hand, it appears to have no comparative advantage for long-term scar outcomes.
Patients who were given Biobrane had a significantly shorter length of hospital stay than those who received silver foam (4.75±2.64 vs 8.88±5.09 days; p=0.01). Infection rate was also significantly lower in the Biobrane group (0 percent vs 35.3 percent; p=0.02). There was no significant difference in the time from injury to coverage between the two treatment groups (p=0.19). [Singapore Med J 2018;doi:10.11622/smedj.2017116]
“Once applied, the presence of porcine collagen within the Biobrane dressing promotes adherence of the dressing to the wound, thus reducing bacterial proliferation by minimizing dead space, which results in good antiseptic effect,” researchers explained. [Shock 2000;14:314-319]
Moreover, Hypergranulation was observed in 17.6 percent of the silver foam group, while 23.5 percent required split-thickness skin graft. No such cases were reported in any of the patients in the Biobrane group.
Burns conversion rate was also lower after Biobrane vs silver foam application (23.1 percent vs 52.9 percent). The difference was not statistically significant.
Researchers conducted long-term scar evaluations via telephone interviews and found that Biobrane and silver foam were comparable in terms of scar pain, colour, itch, irregularity, thickness and stiffness. There were high incidence rates of scar colour differences in both treatment groups (80.0 percent and 92.8 percent, respectively).
There were no reports of long-term painful scarring, scar contractures and keloids. Follow-ups were performed at an average of 23.00±2.48 months for Biobrane and 25.28±3.26 months for silver foam.
“[W]e were optimistic of better long-term scar outcomes in the Biobrane group, as we observed less wound infection and burns conversion, and no skin graft requirement or hypergranulation in these patients during treatment,” said researchers.
And while there were trends toward better outcomes with Biobrane, “the differences in long-term scar outcomes between the groups did not reach statistical significance. We hope to conduct a similar study with larger patient numbers in the future to further prove this trend,” they added.
Researchers performed a retrospective review of 20 children admitted to the paediatric burn unit of the KK Women’s and Children’s Hospital in Singapore, of whom 93.3 percent sustained scald burns and 6.7 percent had flame burns.
Thirteen participants were given the Biobrane dressing (mean age 3.64±4.01; 53.8 percent female), while 17 received the silver foam dressing (mean age 3.13±3.14 years; 35.3 percent female).
“Children have low threshold to pain and suffer psychological stress in response to frequent painful dressing changes. Children are also at higher risk for hypertrophic scarring. For these reasons, optimal wound dressing for children should be easy to apply, not be traumatic when removed, promote rapid epithelialization, and reduce burn conversion and infection,” said researchers.
The findings of the present study indicate that Biobrane may be a viable dressing option for children, but “[f]urther prospective studies with larger patient numbers and overall cost-based analysis are needed to further justify the initial financial outlay of this dressing for burns management,” they added.