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Abstract & Commentary
Source: Glesinger R, et al. Randomized controlled trial of silver sulfadiazine, biafine, and saline-soaked gauze in the treatment of superficial partial-thickness burn wounds in pigs. Acad Emerg Med 2004;11:339-342.
The most commonly used local treatment for burns is 1% silver sulfadiazine (SSD) cream. It has been shown to speed re-epithelialization, reduce bacterial contamination, and slow wound contracture. Biafine is an emulsion-containing alginate that also has been used in the treatment of superficial partial-thickness burns. It has been shown to increase the interleuken (IL)-1 to IL-6 ratio, and to be chemotactic for macrophages. No prior study had compared these treatments in the care of partial-thickness burns.
This Israeli study was a randomized, controlled trial comparing SSD, biafine, and saline-soaked gauze in the treatment of inflicted superficial partial-thickness burns in pigs. Eight standardized burns involving 30-50% of the dermal depth were inflicted on each of four pigs. The necrotic epidermis was not debrided after the burn was induced. Each burn was assigned randomly to one of the three treatment groups.
An investigator cleaned the wounds with an antiseptic solution and saline and then re-dressed the wounds every other day. Assessment of wound re-epithelialization was performed visually using a standardized method when the dressings were changed. The primary outcome measure was the time to complete re-epithelialization of the burn, with secondary outcomes including the decrease in the open area of the wound and the incidence of clinical infection (defined as the presence of erythema, warmth, and/or purulence at the wound site).
A total of 32 wounds were inflicted, with 12 randomized to the SSD arm, 12 to the biafine arm, and 8 to the saline-soaked gauze arm. There was no difference in time to complete re-epithelialization among the groups. Complete wound healing was noted after 13.3 + 1.3 days in the SSD group, 13.5 + 0.9 days in the biafine group, and 13.5 + 1.0 days in the saline-soaked gauze group. The treatment arm was not a determining factor for the decrease in burn area after controlling for pig number and burn location. No clinical wound infection was noted in any of the inflicted wounds.
Commentary by Jacob W. Ufberg, MD
This is a very interesting study that is not yet ready for clinical application. These burns were inflicted by a standardized method using a heated aluminum bar in laboratory animals in a controlled setting. In the ED, not all burns are of the same type or size, and some patients may be more prone to wound infections due to hygiene, wound care, co-morbidity, and other factors.
One of the primary purposes of SSD and biafine is the theoretical ability to help prevent superinfection. There is no way to know from this small animal study whether patients treated with saline-soaked gauze would have higher infection rates in a real-world setting. It is much easier to extrapolate the results regarding wound-healing rates from the laboratory to the ED, but only a larger human study will give us that answer definitively.
Dr. Ufberg, Assistant Professor of Emergency Medicine, Assistant Residency Director, Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, PA, is on the Editorial Board of Emergency Medicine Alert.