| Dressing [1] |
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)
|
| 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 |
May be left intact up to 7 days
|
| 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. |
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 patients 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
|
