Dressings for superficial and partial thickness burns

 

Abstract

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 methods

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.

 

Plain language summary

Dressings for treating superficial and partial thickness burns

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.

 

摘要

背景

敷料用於淺層與局部皮層燒傷

急性燒燙傷傷口是一種複雜且會持續變化的傷害。除了局部的組織損傷以外，大面積燒傷會導致全身性的傷害。淺層與局部皮層燒傷的治療重點在於促進傷口的痊癒，目前也已有各式各樣的敷料可供使用。隨著科技進步以及對於傷口復原的認識增加，帶動了新型敷料的發展。敷料的選擇應該取決於其治療傷口的功效、方便使用和移除、敷料更換要求、成本，除此之外病人的舒適度亦需納入考量。

目標

評估敷料用於淺層與局部皮層燒傷的功效。

搜尋策略

我們搜尋了Cochrane Wounds Group Specialised Register (搜尋日期：29/5/08); The Cochrane Central Register of Controlled Trials (CENTRAL)  The Cochrane Library,2008年，第２期，; Ovid MEDLINE �1950年至2008年5月第3周; Ovid EMBASE1980 年到2008年第21周以及Ovid CINAHL1982年至2008年5月第4周。

選擇標準

所有評估傷燒傷口敷料用於淺層與局部皮層燒傷之功效的隨機對照試驗 (Randomised Controlled Trials；RCTs) 。

資料收集與分析

兩位作者分別以標準化表格來摘錄資訊。每項研究都評估了內在效度，如有意見不同時則以討論方式來解決。

主要結論

本份回顧共納入了26項RCTs，但大多數研究在方法學上的品質不佳。有些敷料顯示對於淺層與局部皮層燒傷的照護有所助益，所謂的助益包括傷口痊癒所需時間、敷料更換的數目以及患者感覺疼痛的程度。使用生物合成敷料可以縮短傷口痊癒的時間並且減輕更換敷料時的疼痛。由於某些研究顯示出磺胺嘧啶銀 (SSD) 敷料會延緩傷口痊癒的時間且會增加敷料用量，因此對於燒燙傷全套療程以SSD當成對照組的方式需要再重新考慮

作者結論

在敷料用於淺層與局部皮層燒傷的主題上缺乏高品質的RCTs。本份回顧中所摘錄的研究評估了各式各樣的介入、對照方式以及臨床評估指標。雖然有部分正面的發現，但由於產生這些實證的試驗本身在方法學上有缺失，因此對醫師在治療方式決策上能提供的協助有限。

翻譯人

本摘要由成功大學附設醫院邱曉萱翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

淺層燒燙傷 (superficial burns) 是指傷及皮膚的表皮層，而局部皮層燒傷 (partial thickness burns) 則更深地損傷到諸如血管或神經等組織。坊間有許多治療這種燒燙傷的敷料，卻欠缺強而有力的實證來證明這些敷料的功效。從小規模試驗(其中許多有方法學缺失)所得出的實證顯示，水膠體 (hydrocolloid) 、矽膠尼龍 (silicon nylon) 、抗生素 (含有銀) 、聚氨酯薄膜 (polyurethane film) 以及生物合成 (biosynthetic) 等材質的敷料可能有助於淺層與局部皮層燒傷的傷口照護，但沒有證據支持SSD敷料的功效。