THE TREATMENT OF SUPERFICIAL BURNS WITH BIOLOGICAL AND SYNTHETIC MATERIAL: FROZEN AMNION AND BIOBRANE

Lorusso R, Geraci V., Masellis M.

Divisione di Chirurgia Plastica e Terapia delle Ustioni, Ospedale Civico, U.S.L. 58, Palermo, Italia

SUMMARY. An analysis is made of the manner of recovery, the capacity for preventing infection and the operative and economic advantages when using frozen amniotic membrane and a biosynthetic membrane (Biobranc), in the treatment of superficial bums. The parameters considered include: - type of burn - assessment of bacterial pollution at time of admission and at subsequent medications - assessment of adherence - time and manner of recovery. The results obtained from the comparative examination of burned surfaces which were similar from the point of view of type and depth of lesion made it possible to appreciate the effectiveness of the two epidermis substitutes as regards manner and quality of recovery. It is pointed out that amniotic membrane is economic and readily available, especially if repeated medications are necessary.

The ideal substitute of the epidermis must possess many of the properties of human skin, i.e. it must be adherent, elastic, resistant and haemostatic.
It must also constitute a barrier against bacterial contamination; it must be easy to apply and to remove; it must be sterilizable; and it must allow exchanges of water vapour permitting the appropriate degree of humidification at the level of the lesion in order to prevent dehydration and consequent deepening of the wound. It must be atoxic, devoid of antigen power, and sterile. Other important factors are ready availability and low cost. Adherence is perhaps one of the most important factors, as close contact with the deepithelized surface reduces pain and infection and promotes reepithelization.
We have found all these characteristics in amniotic membrane in some 8 years of topical therapy and of surface burns. The preparation, sterilization application of amnion have been standardized, the results have confirmed our expectations.
For some years various types of synthetic epidermis substitute have been available. We accordingly decided to compare the advantages of a blosynthetic membrane (Biobrane) and those of amnion.

Materials and methods

Eleven patients suffering from second degree superficial and deep bums, without bulla epidermis, were treated with applications of amnion and Biobrane (Tab. 1).
The two substitutes were applied to contiguous surfaces or in burned areas which appeared to have similar depth on hospitalization. The following contrastive parameters were analysed: type of bacterial contamination before application of the dressings, adherence, presence and quantity of secretions in relation to the type of burn, to BSA, to days of hospitalization and to recovery according to type of dressing (Tab. 2).
Bacterial contamination was determined by using smear swabs on a surface of approximately one square centimetre before dressings were applied. After debridement the surfaces were not treated with antiseptic or antibiotic substances.
The treated surface was examined on day 2 in order to evaluate adherence, the presence of secretions and the necessity of substituting non-adhering membranes, after taking a microbial flora swab. The same procedure was repeated on day 4. If deeper burn areas were detected during successive medications, these were treated with antiseptic-antibiotic proteolitic substances and covered with vaseline gauze.
In all cases, except two in which there were areas of deep second degree burn, the complete adherence of the dressing and the rarity of secretions, which in any case were serous, did not require the use of further swabs.
Evaluation, on the basis of progressive positive signs, of the adhesive qualities of the two materials indicated the excellent adherence to the burned surface of porous Biobrane, which was comparable to that of amnion. In all cases treated with amnion or Biobrane only one dressing was necessary for complete healing.

 

Case 1 Photo 1 Case 1 Photo 2 Case 1 Photo 3 Case 1 Photo 4

 

Case 2 Photo 1 Case 2 Photo 2 Case 2 Photo 3 Case 2 Photo 4

Conclusions

A comparative study of amnion and Blobrane as epidermis substitutes in superficial burns of similar type and depth indicated their therapeutic efficiency in both quality and speed of healing.

A proven system of supply and preservation of amniotic membrane, and an efficient sterilization technique, make amnion much more competitive from the economic point of view. This is even more evident when dressings have to be frequently repeated and when extensive burn areas have to be covered.

RÉSUMÉ. Les Auteurs analysent, dans le cadre du traitement des brûlures superficielles, la manière de guérison, la capacité de prévenir l'infection et les avantages opérationnels et économiques de l'emploi soit de la membrane amniotique congélée soit d'une membrane biosynthétique (Biobrane). Les paramètres considérés sont: - le type de brûlure - lévaluation de la pollution bactérienne au moment de l'hospitalisation et des pansements successifs - l'évaluation et la manière de guérison. Les résultats obtenus par l'examen comparatif des surfaces brûlées sont semblables du point de vue du type et de la profondeur de la lésion, et ils ont permis d'apprécier l'efficacité des deux substituts de l'épiderme pour ce qui concerne la manière et la qualité de guérison. On souligne que la membrane amniotique est facilement disponible et économique, surtout s'il faut effectuer des pansements répétés.

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BIBLIOGRAPHY

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