New barrier dressing reduces pain, costs in partial-thickness burns

August 1, 2006

Las Vegas - A nonwoven hydrofiber dressing with silver (Aquacel Ag) requires fewer dressing changes and fewer procedural medications, says Daniel M. Caruso, M.D., speaking at the annual meeting of the American Burn Association, here.

Although silver sulfadiazine has been the gold standard for treating partial-thickness burns, dressings need to be changed at least once a day and the treatment is associated with pain.

"Aquacel is a dressing that adheres to the wound and closes it off. As a barrier dressing, it is associated with significantly less pain," says Dr. Caruso, chairman, department of surgery, and medical director of the Arizona Burn Center at Maricopa Medical Center in Phoenix.

Newer hydrofiber dressings retain moisture to promote a superior wound-healing environment and provide a cooling sensation on burns when the dressing is moistened with saline.

The hydrofiber dressing with a 1.2 percent ionic silver reservoir inside the fibers has microbicidal activity against aerobic and anaerobic bacteria, yeasts and filamentous fungi, Dr. Caruso tells Dermatology Times.

"It has a broad spectrum of antimicrobial activity. It mimics that of Acticoat," he says. "The silver adds a layer of protection."

Randomized study

The study included 82 patients aged six months to 80.6 years with partial-thickness burns of 5 percent to 40 percent total body surface area.

They were recruited from eight burn centers throughout the United States. They were randomized to a protocol of care that included either the hydrofiber dressing or silver sulfadiazine.

The hydrofiber dressing was applied with 4 cm to 5 cm of overlap to allow for shrinkage, and was meant to be left in place for 21 days. Silver sulfadiazine was applied to 1/16 in. thickness; outer dressings were discretionary and dressing frequency varied according to the practice of the individual burn centers.

The primary endpoint of the study was cost-effectiveness. Other endpoints included the need for dressing changes and procedural medications and the rate of re-epithelialization.

Fewer procedural medications

Fewer types of procedural medications were required in patients who received the hydrofiber dressing (2.4 vs. 3.4; P =.018), who also required fewer opiates (1.5 vs. 2.1; P =.022).

There was no significant difference in full re-epithelialization at 21 days between groups and the median time to full re-epithelialization was similar.

A normal scar height was significantly more likely in the group treated with hydrofiber dressing compared with silver sulfadiazine (80 percent vs. 57 percent, P =.042).

Overall adverse events, the rate of infection, and the use of antibiotics were comparable between the groups.

Fewer dressing changes

Dressing changes were less frequent in the patients randomized to the Aquacel dressing.

"Once the dressing hardens and sticks, there are no more dressing changes," Dr. Caruso says.

The number of dressing changes with the hydrofiber dressing depends on the thickness of the burn, he explains. If the wound is supersaturated, it may have to be removed at the first follow-up visit at 24 to 48 hours.

On average, the hydrofiber dressing was changed every 0.5 days and the silver sulfadiazine was changed 1.2 times per days (P <.001). The mean total number of dressing changes was 7.7 in patients treated with the hydrofiber dressing vs. 19.1 in the silver sulfadiazine group (P <.001).

Less nursing time was also required per dressing change (35 vs. 53 minutes).