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Meta-Analysis
. 2013 Mar 28;2013(3):CD002106.
doi: 10.1002/14651858.CD002106.pub4.

Dressings for superficial and partial thickness burns

Jason Wasiak  1 , Heather Cleland, Fiona Campbell, Anneliese Spinks
Affiliations
Meta-Analysis

Dressings for superficial and partial thickness burns

Jason Wasiak et al. Cochrane Database Syst Rev. .

Abstract

Background: An acute burn wound is a complex and evolving injury. Extensive burns produce systemic consequences, in addition to local tissue damage. Treatment of partial thickness burn wounds is directed towards promoting healing and a wide variety of dressings are currently available. Improvements in technology and advances in understanding of wound healing have driven the development of new dressings. Dressing selection should be based on their effects on healing, but ease of application and removal, dressing change requirements, cost and patient comfort should also be considered.

Objectives: To assess the effects of burn wound dressings on superficial and partial thickness burns.

Search methods: For this first update we searched The Cochrane Wounds Group Specialised Register (searched 8 November 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 10); Ovid MEDLINE (2008 to October Week 4 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, November 07, 2012); Ovid EMBASE (2008 to 2012 Week 44); AND EBSCO CINAHL (1982 to 2 November 2012).

Selection criteria: All randomised controlled trials (RCTs) that evaluated the effects of burn wound dressings on the healing of superficial and partial thickness burns.

Data collection and analysis: Two authors extracted the data independently using standardised forms. We assessed each trial for internal validity and resolved differences by discussion.

Main results: A total of 30 RCTs are included in this review. Overall both the quality of trial reporting and trial conduct were generally poor and meta analysis was largely precluded due to study heterogeneity or poor data reporting. In the context of this poor quality evidence, silver sulphadiazine (SSD) was consistently associated with poorer healing outcomes than biosynthetic (skin substitute) dressings, silver-containing dressings and silicon-coated dressings. Burns treated with hydrogel dressings appear to heal more quickly than those treated with usual care.

Authors' conclusions: There is a paucity of high-quality evidence regarding the effect of different dressings on the healing of superficial and partial thickness burn injuries. The studies summarised in this review evaluated a variety of interventions, comparators and clinical endpoints and all were at risk of bias. It is impossible to draw firm and confident conclusions about the effectiveness of specific dressings, however silver sulphadiazine was consistently associated with poorer healing outcomes than biosynthetic, silicon-coated and silver dressings whilst hydrogel-treated burns had better healing outcomes than those treated with usual care.

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Conflict of interest statement

None

Figures

1
1
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 Hydrocolloid dressing vs chlorhexidine‐impregnated gauze dressing, Outcome 1 Withdrawal due to wound infection.
2.1
2.1. Analysis
Comparison 2 Hydrocolloid dressing vs silver sulphadiazine, Outcome 1 Number of dressing changes.
2.2
2.2. Analysis
Comparison 2 Hydrocolloid dressing vs silver sulphadiazine, Outcome 2 Level of pain.
3.1
3.1. Analysis
Comparison 3 Polyurethane film dressing vs paraffin gauze dressing, Outcome 1 Wound infection.
4.1
4.1. Analysis
Comparison 4 Polyurethane film dressing vs chlorhexidine‐impregnated paraffin gauze dressing, Outcome 1 Wound infection.
5.1
5.1. Analysis
Comparison 5 Hydrogel dressing vs usual care, Outcome 1 Wound healing: number of people healed at 6 days.
5.2
5.2. Analysis
Comparison 5 Hydrogel dressing vs usual care, Outcome 2 Wound healing: number of people healed at 9 days.
5.3
5.3. Analysis
Comparison 5 Hydrogel dressing vs usual care, Outcome 3 Wound healing: number of people healed at 21 days.
5.4
5.4. Analysis
Comparison 5 Hydrogel dressing vs usual care, Outcome 4 Wound healing: number of people healed at 12 days.
5.5
5.5. Analysis
Comparison 5 Hydrogel dressing vs usual care, Outcome 5 Wound healing: number of people healed at 15 days.
5.6
5.6. Analysis
Comparison 5 Hydrogel dressing vs usual care, Outcome 6 Wound healing: number of people healed at 18 days.
5.7
5.7. Analysis
Comparison 5 Hydrogel dressing vs usual care, Outcome 7 Assessment of pain at baseline.
5.8
5.8. Analysis
Comparison 5 Hydrogel dressing vs usual care, Outcome 8 Pain 30 minutes after treatment.
5.9
5.9. Analysis
Comparison 5 Hydrogel dressing vs usual care, Outcome 9 Overall assessment of pain at end of study.
5.10
5.10. Analysis
Comparison 5 Hydrogel dressing vs usual care, Outcome 10 Infection with Pseudomonas aeruginosa requiring antibiotic therapy.
6.1
6.1. Analysis
Comparison 6 Silicon nylon dressing vs silver sulphadiazine, Outcome 1 Number of dressing changes.
7.1
7.1. Analysis
Comparison 7 Biosynthetic skin substitute (Biobrane) vs silver sulphadiazine, Outcome 1 Pain.
7.2
7.2. Analysis
Comparison 7 Biosynthetic skin substitute (Biobrane) vs silver sulphadiazine, Outcome 2 Need for surgery.
8.1
8.1. Analysis
Comparison 8 Antimicrobial‐releasing biosynthetic dressings vs silver sulphadiazine, Outcome 1 Wound infection.
9.1
9.1. Analysis
Comparison 9 Silver‐impregnated dressing vs silver sulphadiazine, Outcome 1 Wound healing time (days).
9.2
9.2. Analysis
Comparison 9 Silver‐impregnated dressing vs silver sulphadiazine, Outcome 2 Wound healing: number of people healed at 7 days.
9.3
9.3. Analysis
Comparison 9 Silver‐impregnated dressing vs silver sulphadiazine, Outcome 3 Wound healing: number of people healed at 10 days.
9.4
9.4. Analysis
Comparison 9 Silver‐impregnated dressing vs silver sulphadiazine, Outcome 4 Wound healing: number of people healed at 15 days.
9.5
9.5. Analysis
Comparison 9 Silver‐impregnated dressing vs silver sulphadiazine, Outcome 5 Wound healing: number of people healed at 17 days.
9.6
9.6. Analysis
Comparison 9 Silver‐impregnated dressing vs silver sulphadiazine, Outcome 6 Wound healing: number of people healed at 21 days.
9.7
9.7. Analysis
Comparison 9 Silver‐impregnated dressing vs silver sulphadiazine, Outcome 7 Healing rate (% wound area).
9.8
9.8. Analysis
Comparison 9 Silver‐impregnated dressing vs silver sulphadiazine, Outcome 8 Pain.
9.9
9.9. Analysis
Comparison 9 Silver‐impregnated dressing vs silver sulphadiazine, Outcome 9 Need for surgery.
9.10
9.10. Analysis
Comparison 9 Silver‐impregnated dressing vs silver sulphadiazine, Outcome 10 Number of infections.
9.11
9.11. Analysis
Comparison 9 Silver‐impregnated dressing vs silver sulphadiazine, Outcome 11 Number of wound dressings.
9.12
9.12. Analysis
Comparison 9 Silver‐impregnated dressing vs silver sulphadiazine, Outcome 12 Nursing time (minutes).
10.1
10.1. Analysis
Comparison 10 Fibre dressing vs silver sulphadiazine, Outcome 1 Wound healing time (days).
10.2
10.2. Analysis
Comparison 10 Fibre dressing vs silver sulphadiazine, Outcome 2 Pain at day 1.
10.3
10.3. Analysis
Comparison 10 Fibre dressing vs silver sulphadiazine, Outcome 3 Pain at day 3.
10.4
10.4. Analysis
Comparison 10 Fibre dressing vs silver sulphadiazine, Outcome 4 Pain at day 7.
10.5
10.5. Analysis
Comparison 10 Fibre dressing vs silver sulphadiazine, Outcome 5 Number of dressing changes.
10.6
10.6. Analysis
Comparison 10 Fibre dressing vs silver sulphadiazine, Outcome 6 Number of infections.
10.7
10.7. Analysis
Comparison 10 Fibre dressing vs silver sulphadiazine, Outcome 7 Need for surgery.
See this image and copyright information in PMC

Update of

References

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References to studies awaiting assessment

Mabrouk 2012 {published data only}
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