Nanocellulose-based wound dressing for conservative wound management in children with second-degree burns

Abstract

The initial care of burn wounds and choice of dressing are pivotal to optimally support the healing process. To ensure fast re-epithelialisation within 10-14 days and prevent complications, an optimal healing environment is essential. An innovative dressing based on nanocellulose was used for the treatment of burns in children. Children (0-16 years) with clean, partial-thickness burn wounds, 1 to 10% of the total body surface area were included. Complete re-epithelialisation was achieved within 7-17 days, with 13 patients showing re-epithelialised >95% by day 10. Satisfying results concerning time to re-epithelialisation and material handling were obtained. The possibility to leave the dressing on the wounds for 7 days showed a positive effect in the treatment of children, for whom every hospital visit may cause massive stress reactions. The nanocellulose-based dressing is a promising tool in conservative treatment of burns. Reducing the frequency of dressing changes supports a fast and undisturbed recovery; moreover, the dressing provides an optimal moist healing environment. The time to re-epithelialisation is comparable to frequently used materials, and cost reduction effect can be achieved without loss of quality. Possible pain and distress levels are kept to a minimum; therefore, flexibility and compliance of the patients and their parents are enhanced.

Keywords: burn injury; burn treatment; paediatric burns; partial thickness burns; re-epithelialisation.

FIGURE 1

Application process of the nanocellulose dressing: (a) assessment of the wound, disinfection; (b) application of the nanocellulose dressing; (c) application of the fatty gauze to maintain a moist environment

FIGURE 2

Study procedure time table: day 0—admission to the hospital and primary care of the wounds; day 3—first visit, dressing change, evaluation of the wound; day 10—second visit, dressing change, evaluation of the wound, termination of study if wound close >95%; day 17—final wound control

FIGURE 3

Demographic data of included patients, age min 5 months to max 16 years; gender 5 males (31%), 11 females (69%); TBSA ranging from 1% to 7%; localisation thorax 2 (12.5%), upper extremities 2 (12.5%), upper extremities and thorax 4 (25%), lower extremities 8 (50%)

FIGURE 4

Wound healing progress from initial presentation (day 0) at our clinic with a 2% burn wound in a 3‐year‐old child on the outer thigh, to dressing changes and wound assessment (day 3, day 10), to final follow‐up visit (day 17). On day 10, the material is transparent and easily removable due to full re‐epithelialisation of the wound

FIGURE 5

Wound healing process (day 3 to day 17) after a 1% burn in a 1‐year‐old child on the outer thigh: delayed wound healing due to displacement of the dressing within the first 3 days

FIGURE 6

Distribution of the initially included 16 patients: 1 exclusion due to indication for surgery; 3 deviations from the study protocol due to displacements of the dressing; 13 patients >95% re‐epithelialisation within 10 days

FIGURE 7

Decrease of pain levels due to progress in wound healing over the course of the study. From the initial presentation at our department to the second follow‐up visit on day 10 post‐trauma