Elsevier

Burns

Volume 39, Issue 6, September 2013, Pages 1131-1136
Burns

Efficacy of debridement and wound cleansing with 2% hydrogen peroxide on graft take in the chronic-colonized burn wounds; a randomized controlled clinical trial

https://doi.org/10.1016/j.burns.2013.01.019Get rights and content

Abstract

Background

Severe burns are associated with dramatic outcomes which are potentially detrimental. Nowadays the standard treatment for deep partial thickness and full-thickness burn is early excision and grafting, which is not always feasible this leads to chronicity and microbial colonization of burn wounds. Interesting properties of hydrogen peroxide 2% soaked gauze convinced us to use it in management of chronic burn wounds.

Methods

From January 2009 to September 2011, in a prospective clinical trial, 49 patients (98 limbs) with chronic-colonized burn wounds in both limbs were included in this study. Tissue cultures were taken from all the wounds. For the right, after debridement of granulation tissue and washing with hydrogen peroxide 2% soaked gauze for 5 min followed by normal saline irrigation, grafting was done; debridement and skin grafting was performed in the conventional method in left limb wounds. The success rate of graft take was compared between two groups, after 21 days by the surgeon using the formula:.Grafttakesurfacearea(cm2)×100%Totalgraftedarea(cm2)

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 most common causes of the burn wounds chronicity was delayed admission associated with poor compliance. (44.8%) Staphylococcus was the most frequent isolate bacterial wounds colonization in our patients. (59.2%) Mean graft take was 82.85% in right limbs, and 65.61% in left limbs; which was significantly different (P < 0.05).

Conclusions

Our study showed that, administration of hydrogen peroxide intraoperatively 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 burn wounds management.

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.

References (35)

  • Anna Drosou et al.

    Antiseptics on wounds: an area of controversy

    Wounds

    (2003)
  • C.D. Brown et al.

    A review of topical agents for wounds and methods of wounding

    J Dermatol Surg Oncol

    (1993)
  • R.P. Gruber et al.

    The effect of commonly used antiseptics on wound healing

    Plast Reconstr Surg

    (1975)
  • Nele Brusselaers et al.

    Severe burn injury in europe: a systematic review of the incidence, etiology, morbidity, and mortality

    Crit Care

    (2010)
  • Sung Soo Kim et al.

    Effects of human amniotic membrane grafts combined with marrow mesenchymal stem cells on healing of full-thickness skin defects in rabbits

    Cell Tissue Res

    (2009)
  • Deirdre Church et al.

    American society for microbiology

    Clin Microbiol Rev

    (2006)
  • Sanjay Dhar et al.

    Microbiological profile of chronic burn wounds among patients admitted in burn unit

    JK Science

    (2007)
  • Cited by (30)

    • Clinical Evidence of Current Irrigation Practices and the Use of Oral Antibiotics to Prevent and Treat Periprosthetic Joint Infection

      2021, Orthopedic Clinics of North America
      Citation Excerpt :

      Historically, hydrogen peroxide has been demonstrated to be widely effective in vivo in killing bacteria, through numerous pathways, including oxidative stress.18–20 Clinical studies have demonstrated mixed results across multiple surgical specialties, especially when used in isolation.21–23 Recent studies in total joint arthroplasty have demonstrated more success when used in combination with other antimicrobial irrigation fluids, specifically povidone-iodine.

    • Therapeutic Potential of Reactive Oxygen Species: State of the Art and Recent Advances

      2021, SLAS Technology
      Citation Excerpt :

      In this context, extensive research was done with respect to fibroblasts and epithelial cells. A few proangiogenic and wound healing products have recently been developed (e.g., topical creams such as Mycosinate from Nektr Technologies, LHP from Bioglan, and Crystacide from Mipharm SpA; hydrogen peroxide-releasing hydrogels;8 soaked gauzes;9 and enriched honeys10), and some of them have already undergone clinical investigation (Table 1). On the other hand, the application of hydrogen peroxide in other target tissues seems far from being realizable, because its biological effect has still not been fully unraveled.

    • Hydrogen peroxide and cutaneous biology: Translational applications, benefits, and risks

      2019, Journal of the American Academy of Dermatology
      Citation Excerpt :

      However, H2O2 resulted in air-filled bullae in most patients after healing, possibly from released oxygen lifting the epidermis, suggesting that H2O2 should not be applied to newly healed skin.45 In a later study, bilateral burns were debrided and grafted (N = 49).46 One limb was washed with 2% H2O2-soaked gauze for 5 minutes before grafting, which significantly increased grafting success compared with saline (83% graft take for H2O2 vs 66% for saline).46

    View all citing articles on Scopus
    View full text