Reducing the Pain

According to the American Burn Association, one million burn injuries occur annually in the United States, resulting in an estimated 45,000 hospitalizations. Every day, 435 children birth to age 19 receive treatment in emergency rooms for burn-related injuries and two children die as a result of being burned^.1 The most common cause of hospitalization from burns for children under five is scalding from hot liquids, including bath water, steam, coffee, cooking liquids, and hot foods^.2 The majority of these injuries are partial thickness burns (PTBs) or second degree burns. What marks a PTB is the destruction of all of the epidermal layers of skin, extending into, but not through, the dermis.

When burn surgeons treat PTBs, they face a number of challenges that can impact patient comfort and outcomes, including exudate and dressing management, patient comfort and mobility, the potential for scarring and development of scar contractures, pain to the patient, and potential infection. Currently, there are a number of different management options for PTB’s although the most common treatment modality remains the use of gauze dressings applied in conjunction with silver sulfadiazine ointment.

A burn care technology introduced earlier this year is for use in covering a PTB for up to 21 days without the need for painful dressing changes.³ Design of the dressing, known as Aquacel Ag Burn dressing, is specifically for the management of PTBs as well as donor sites.

The innovative dressing, designed using Hydrofiber Technology, a proprietary wound dressing technology developed by ConvaTec. Hydrofiber Technology is patented carboxymethylcellullose gelling technology with a distinctive mechanism of action that can rapidly absorb fluid⁴, holding it within the structure of the fibers. Hydrofiber Technology also provides a physiological moist wound healing environment. This combination makes it possible to promote healing and tissue regeneration⁵ over an extended period without the need to change dressings.

Unlike Aquacel Ag Burn dressing, conventional gauze dressings are unable to rapidly absorb and retain fluid and promote a physiological moist wound-healing environment over several days or weeks. As a result, patients with PTBs must often undergo dressing changes as frequently as twice daily. In this process, clinicians must remove the dressing, which can re-traumatize the wound surface. The clinicians must then debride or scrape off any burned skin so that a layer of healthy cells is able to support the growth of new skin cells. This procedure can result in severe pain and discomfort for patients. In many cases, patients receive treatment with morphine or other painkillers to control the severe pain caused by this process.

Frequent dressing changes also increase the risk of infection from a range of pathogens. Infection can delay healing and can lead to more serious complications, which then require their own further treatment. Aquacel Ag Burn dressing, designed specifically for PTBs, meets the needs of burn surgeons and nurses. The dressing forms a moist gel that conforms to the wound surface and begins to work immediately to absorb and retain burn exudate while minimizing space where bacteria can thrive.⁶ The dressing has demonstrated antimicrobial activity against a range of wound pathogens, including some antimicrobial-resistant bacteria, as demonstrated in vivo. ^{7, 8}

1. Aquacel’s hydroentangled dressing is comprised of Hydrofiber (sodium carboxymethylcellulose) with nylon thread used to stitch bond the product along the length. The dressing contains 1.2% water with ionic silver. The silver in the dressing kills a broad spectrum of wound bacteria. 2. Under the supervision of a healthcare provider, the Aquacel Ag Burn Hydrofiber Dressing is indicated mainly for the management of Partial thickness (second degree) burns and wounds that are prone to bleeding, such as wounds that have been mechanically or surgically debrided and donor sites. 3. Shown in glove format, the dressing absorbs high amounts of wound fluid and bacteria and creates a soft, cohesive gel that intimately conforms to the wound surface, maintains a moist environment and aids in the removal of non-viable tissue from the wound (autolytic debridement).

Reinforced with Nylon stitching to offer patients increased comfort and range of motion are Aquacel Ag Burn flat and glove dressings. Enhanced flexibility and mobility for burn patients is especially important to ensure that the wound heals properly and prevents contracture that can limit range of motion. As a result, Aquacel Ag Burn dressing has greater flexibility, less shrinkage and improved rehydration time compared to AQUACEL Ag dressings as demonstrated in vitro.⁹ Design of the dressing is to maintain wet and dry integrity, facilitate ease of removal, impart greater flexibility, and minimize shrinkage. As a result, Aquacel Ag Burn dressing is better positioned to support all of the necessary steps in the body’s healing process for PTBs, which occur in sequence over several phases. As the wound heals, Aquacel Ag Burn dressing is able to be detached without a risk of re-trauma to a wound bed.¹⁰ In PTBs covered with gauze dressing, the healing process can cause tissue in-growth into the gauze matrix, potentially increasing the risk of pain and re-trauma to the wound bed each time a dressing requires removal.¹¹

Design of Aquacel Ag Burn dressing is for use in managing PTBs located on any part of the body and in covering different sized wound areas. The dressing is available in a range of sizes and shapes, allowing clinicians to contour each dressing to the specific size and location of a burn area on the body. In addition to flat dressings, Aquacel Ag Burn dressings also include a glove-shaped dressing for use in managing PTBs on the hands, one of the most common locations for PTBs to occur.¹² The gloves come in a range of sizes to manage PTBs in patients from very young children to adults.

Aquacel Ag Burn dressing is also for maximum ease of use for clinicians. After a clinician evaluates, debrides, and cleans a burn area, Aquacel Ag Burn dressing can easily size and shape to conform to cover the wound surface and the dressing then secures with an overlay of gauze wrapping. Once in place, Aquacel Ag Burn dressing immediately begins to absorb the exudate. Design of the dressing is to remain in place over time. As the burn heals and exudate is absorbed, Aquacel Ag Burn dressing detaches from the wound surface.¹⁰ When the healing process is complete, the dressing removes, easily, with minimal risk of re-trauma.

Aquacel Ag Burn dressing has been tested in both flat and glove forms during clinical studies in the U.S. and in Europe.¹² Results in multiple clinical trials for Aquacel Ag Burn showed advantages related to patient pain at rest and during movement, ease of use and healing. ^12,13 Clinical outcomes may be improved in comparing Hydrofiber Technology to silver sulfadiazine and gauze when used on PTBs.¹²

ConvaTec Inc.
Skillman, NJ
convatec.com

Sources:

¹ Centers for Disease Control: “Protect the ones you love BURNS” http://www.cdc.gov/safechild/Fact_Sheets/Burns-Fact-Sheet-a.pdf

² Safe Kids USA. Press Release: “National Burn Awareness Week Reminds Parents to Keep Kids Safe ,” February 4, 2011.

³ A Phase II non-comparative evaluation of carboxymethylcellulose reinforced with nylon in the care of partial thickness burns. CW-0508-06-A083. July 29, 2008. Data on file, ConvaTec, Inc.

⁴ Waring MJ, Parsons D. Physicochemical characterisation of carboxy-methylated spun cellulose fibres. Biomaterials. 2001;22:903-912.

⁵ Bowler PG. Progression towards healing: Wound infection and the role of an advanced silver containing Hydrofiber® dressing. Ostomy Wound Manag., 2003;49: (8)(suppl);S2-S5.

⁶ Jones S, Bowler PG, Walker M. Antimicrobial activity of silver-containing dressings is influenced by dress¬ing conformability with a wound surface. WOUNDS. 2005;17(9):263:270.

⁷ The microbicidal properties of Apollo Burns Dressing. WHRI 3239 MA 132. May 21, 2009. Data on file at ConvaTec Inc.

⁸ Antimicrobial efficacy testing of Apollo Burn Dressing using a simulated wound fluid model. WHRI 13161 MA120. August 4, 2008. Data on file, ConvaTec Inc.

⁹ Scientific background report – Comparison between Aquacel Ag Burn and Aquacel Ag. WHRI3284 TA 186, November 11, 2009. Data on file, ConvaTec Inc.

¹⁰ Caruso D. M Foster K.N, Hermans M.H.E, Rick C. Aquacel Ag in the management of partial thickness burns: Results of a clinical trial, Jour of Burn Care and Res. 2004

¹¹ Hoekstra M.J. Hermans M.H.E. Richters C.D, Dutrieux R.P. A. histological comparison of acute inflammatory responses with Hydrofiber tulle dressing. Jour of Wound Care. 2002 March: 11 (3):113-117

¹² Franck Duteille, MD1; Dheerendra Kommala, MD2. (2010, March). Phase II Assessment of a New Carboxymethylcellulose (CMC) Silver Glove in the Management of Partial-Thickness/Second-Degree Hand Burn.

¹³ Caruso DM,1 Richey K,1 Johnson RM,2 Blome-Eberwein SA,3 Milner S,4 Luterman A,5 Tredget EE,6 Kommala D7. (2009). Phase II, Non-Comparative Trial of Carboxymethylcellulose Silver Dressing Reinforced With Nylon to Treat Partial Thickness Burns.