Efficacy of debridement and wound cleansing with 2% hydrogen peroxide on graft take in the chronic-colonized burn wounds; a randomized controlled clinical trial
Introduction
Nowadays the standard treatment for deep partial thickness and full-thickness burn is early excision and grafting [1], [2]. However because of patients’ general condition, limitation of autologous donor site in the patients with extensive burn wounds [2], poor equipment, and large number of admissions in some centres, this technique is not always possible; and this leads to high-incidence of chronic burn wounds specially in developing countries. The significant problem in delayed grafting technique is microbial colonization of the granulation tissue that reduces graft take, while increasing complications, mortalities, length of hospital stay, and cost [3]. The problem now arises in how to go about applying skin graft on chronic-granulation tissue, which is controversial among burn surgeons [3].
Wound cleansing is an important part of the management of acute traumatic, and the usefulness of antiseptics on intact skin is well established and broadly accepted. However, the use of antiseptics as prophylactic anti-infective agents for open wounds, such as burns has been an area of controversy for several years [4], [5].
Although having concentration dependent cytotoxicity [5], due to interesting characteristics of hydrogen peroxide; such as broad spectrum antiseptic activity [6], angiogenesis and healing accelerator effects [7], [8], [9], we sought to evaluate the effect of debridement and cleansing of infected burn wounds with hydrogen peroxide 2% soaked gauze on the graft take of chronic burn wounds in a randomized controlled clinical trial.
Section snippets
Materials and methods
From January 2009 to September 2011, in a prospective clinical trial, 49 subjects (98 limbs) with chronic with chronic burn wounds (The wounds with more than two weeks after granulation tissue formation, which do not have enough adhesion to the wounds’ bed and can be dissected easily by minimal digital pressure of the burn surgeon), and highly colonized (due to positive wound tissue culture, ≥105 colony forming unit/gram of the tissue) in both limbs included in this study. All of the patients
Statistical analysis of the data
Collected data were presented as mean and standard deviation (mean ± S.D.). Statistical comparisons between groups were carried out by using SPSS 19.0 software using Wilcoxon Signed Ranks Test. For the comparison differences were considered as statistically significant at P ≤ 0.05.
Results
The study group was composed of 98 limbs in 49 patients with mean age of 26.44 ± 5.66 and burn in 28.3 ± 7.23%TBSA; the median time interval between burn trauma and surgery was 54 days (interquartile range: 43–65) in the patients. The patients’ limbs were divided into hydrogen peroxide and control groups. The most common causes of the burn wounds chronicity in the selected patients was delayed admission due to poor compliance of the patients (44.8%). Moreover, due to different reasons the burn
Discussion
Burns are among the most dramatic injuries in the world which consume large amount of medical resource, because of long hospitalization and rehabilitation and costly wound and scar therapies [10], [11], [12]. Nowadays early excision and grafting (E&G) is the standard treatment for deep partial thickness and full-thickness burn [1], [2], but E&G is not feasible in many cases, specially in developing countries, which leads to chronicity of burn wounds.
Chronicity of the burn wounds is so frequent
Conclusion
Our study showed that, administration of hydrogen peroxide appears to be safe, and significantly increases the mean success rate graft take in chronic-colonized wounds. Therefore, it can be recommended in management of chronic-colonized burn wounds management. Due to its interesting anti-microbial, angiogenesis and healing accelerating effects, and advantages over topical antibiotics.
Conflict of interest
None declared.
Acknowledgements
We would like to thank Department of Surgery, Shiraz Burn Research Center, and Ghotbeddin Burn Hospital personnel for their cooperation in this work. It should be mentioned that, this survey is based on the thesis of Dr. Mandana Kiasat for finishing general surgery residency, in Shiraz University of Medical Science.
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