Burn Dressings

Burn Dressings

• Clean, moist is the goal
• Eschar must be removed as soon as possible or it will be infected

Dressing	Indications	Special considerations
Biobrane	Partial thickness burns at time of admission; clean, fresh scald burns or donors; must be pink, moist, sensate, blanching	Apply shiny side out; secure with benzoin steristrips; no antimicrobial activity; wrap with Kerlix and Ace, to be examined in 24 hrs; fluid accumulations may be aspirated with tuberculin syringe
Xeroform	Clean partial thickness wounds or donor sites	Promotes epithelial migration on clean, well vascularized wounds. Minimal antimicrobial activity; use with bacitracin or bactroban
Bacitracin	Partial thickness burns, anti-Staph agent; also topical agent for superficial facial burns	No penetrating ability; good to remove tar and asphalt (especially around eye). Combine with NS wet-to-dry to increase debriding; do not use on eschar
Santyl (Collagenase)	Deep partial thickness wounds with eschar	Layer needs to be "nickel" thick; Use with bacitracin and xeroform (BX); Santyl also dries wounds, and is best mixed with something moist
Bactroban (mupirocin)	Staph infections, impetigo, facial burns	Apply thin layer and use with Xeroform
Mepilex (Ag)	Partial thickness wounds/donors; low to moderate exuding wounds that need to be covered for extended time	May be left intact without dressing change for 3-7 days. Has increased antimicrobial activity as compared to Polymem
Polymem	Partial thickness wounds; cleanses, fills, absorbs, moistens. Santyl-Polymem is good for deep partial thickness wounds, but this dressing must be changed daily and has no inherent antibacterial properties	May be left intact up to 7 days if Polymem alone
Sloppy (5% Mafenide acetate)	Used for new grafts	With fine mesh gauze covered with sloppy moistened burn pads; wet downs as needed
Burows (Domboros, Aluminum acetate)	Gram-negative bacilli (pseudomonas)	Creates acidic, drying environment due to its hyperosmolar features; Somewhat toxic to tissues, but more important for skin grafts to take. Fine mesh gauze are covered with Burows moistened burn pads; 2 packets dissolved in 1 L sterile water
Silvadene (silver sulfadiazine)	Full thickness burns. Post traumatic wound infection or cellulitis. Keeps burns moist as opposed to Santyl-Bacitracin-Xeroform, and may be used in the first few days if there are areas of partial thickness burns around full thickness that silvadene is applied to (healing of partial thickness takes a few days to start)	Nonpainful with antibacterial spectrum similiar to Sulfamylon. Does not penetrate dry, leathery eschar. Some gram-negative resistant Enterobacter. Neutropenia may occur within 24-48 hrs. CONTRAINDICATED: 1) Partial thickness which may heal (Silvadene inhibits keratinocytes), 2) Sulfa allergy, 3) Causes kernicterus - pregnant women approaching term, premature infants, newbborns during first 2 months of life
Sulfamylon (Mafenide)	Full thickness burns with eschar (including leathery eschar); deep cartilage burns (ears, nose); alternate to Silvadene in marked leukopenia; sulfamylon liquid (5% soln) for wetting heavily contaminated meshed skin grafts or excised but not grafted areas (not for eschar)	Penetrates eschar, significantly reduces pseudomonas. Painful 20 minutes after application. NOT a sulfa drug, ok in sulfa allergy. May cause metabolic acidosis. CONTRAINDICATIONS: 1) Hypersensitivity reaction, 2) Near the eyes, 3) Large burns in children - causes hyperpnea via inhibition of carbonic anhydrase
Dakins and glycerin (half-and-half, D&G)	Rarely used now. Wetting agent similar to Sulfamylon liquid.	0.5% Chloramine-T (similar to bleach) and 50% glycerin. Must be stored in the dark. Oxidized form has no bacteriocidal activity - must smeel strongly of bleach. CONTRAINDICATIONS: 1) Eschar, 2) Invasive infection
Scarlet red	Rarely used now. Barrier dressing to prevent desiccation of underlying wound	Must be clean wound since it has no antibacterial activity (as opposed to Xeroform)
Xenograft (pigskin)	Biologic dressing that protects wounds free of eschar, wounds awaiting epithelial migration for closure, or wounds needing application of autograft	Examine daily and removed if evidence of fluid accumulation or purulent material underneath; may be changed q48-72 hrs. Generally pts develop antibodies to graft after 7-10 days
Allograft (cadaver)	Temporary closure of wounds free of eschar, awaiting autograft; May be used to cover fragile autograft	Viable for up to 5 days after harvesting; must be stored in biologic refrigerator at 4 degrees C