Legend.
Comparison of degree of pain described by patients when treated with Biobrane
and Scarlet Red on paired donor sites. Pain scale ranges from 0 to 11, with 0
signifying no pain and 11 maximal pain.
Legend.
Exudate scores comparing Biobrane and Scarlet Red on paired donor sites.
Higher number indicates greater amounts of exudate.
(Use
of biobrane for extensive posterior donor site wounds; Hansbrough JBCR
16:3:335)
2) Comparison of the Management of
Superficial Mid-Dermal Burns with Biobrane Skin Substitute versus Topical
Antibiotics
Outpatient Management
of Partial-Thickness Burns: Biobrane versus 1% Silver Sulfadiazine
(Outcome and Cost Effectiveness)
A randomized, prospective study
comparing the use of Biobrane (group 1) with the use of 1% silver sulfadiazine
(group 2) in treating 56 partial-thickness burn wounds was carried out in 52
outpatients with burns that comprised less than 10% of their total body
surface area. The two groups were similar in age, gender, race, and extent of
burn. Wounds of patients in group 1 (30) were compared with those of group 2
(26) for healing time, pain, compliance with scheduled visits, and costs.
Infected and skin-grafted wounds were excluded from healing time analysis.
Infection rates of the two groups were similar (three of 30 vs. two of 26).
One patient in each group underwent skin grafting. Healing times of group 1
wounds were significantly less than those of group 2 (10.6± 0.8 vs. 15.0±
1.2 days. P < .01). Using a pain scale of 1 to 5, Biobrane treated patients
averaged lower pain scores at 24 hours after the burn (1.6± 0.8 vs. 3.6±
1.3, P < .001) and used less pain medication. Compliance with scheduled
outpatient visits was also improved in the Biobrane treated group (88.6% vs.
63.2% attendance, P < .001). Idealized total treatment costs averaged $434
for patients in group 1 compared with $504 for patients in group 2. We
conclude that when used on properly selected wounds, Biobrane therapy can
significantly decrease pain and total healing time without increasing the cost
of outpatient burn care. Improved patient compliance may be an added benefit.
[Gerding
RI, Emerman CL, Effron D, Lukens T, Imbembo AL, Fratianne RB: Outpatient
management of partial thickness burns. Biobrane versus 1% silver sulfadiazine.
Ann Emerg Med February 1990:19:121-124.]
Comparison of healing time,
pain, cost effectiveness
(Management of small partial thickness burns)
| |
Number |
Pain (1-10)
|
Healing
Time/Days |
Charges
till healed |
|
Biobrane
|
26
|
1.6± .8*
|
11± .8*
|
$435± 14*
|
|
SSD
|
26
|
3.6± 1.3
|
15± 1.2
|
$504± 24
|
SSD = 1% Silver
Sulfadiazine
(Significant group difference)
*
Significance Decrease in pain, healing time and cost with Biobrane
Comparison
of healing time, pain, patient mobility, length of stay
(Superficial 2o burns [15-25%] TBS)
LOS
= length of stay mainly due to pain control.
Mobility - time to independent mobility
* Significant difference
Conclusion:
The synthetic skin substitute significantly decreased healing time, pain, LOS
and increased mobility.
(Use of biobrane in management of scalds. Demling R. J Burn Care Rehab 1995:
16;339
Biosynthetic Skin Substitute vs. 1%
Silver Sulfadiazine for Treatment of Inpatient Partial-Thickness Thermal Burns
Robert L. Gerding, MD, Anthony L.
Imbembo, MD and Richard B. Fratianne, MD.
When used appropriately on
superficial or moderate-depth partial-thickness burns, Biobrane significantly
decreased total healing time to complete re-epithelialization, reduced pain,
and was associated with decreased nursing time and costs when compared to 1%
silver sulfadiazine cream. Care must be used in selecting wounds for Biobrane
therapy. They must be fresh, non-infected, and free of eschar and debris with
a most, sensate surface that demonstrates capillary blanching and refill.
Wounds must be inspected regularly for non-adherence and signs of infection.
Early fluid accumulation requires prompt aspiration. Biobrane should be
removed if fluid re-accumulates or the Biobrane becomes non-adherent at any
time after 48 hours. When used appropriately, Biobrane offers significant
advantages over conventional therapy of acute partial-thickness burns. J
Trauma 1988: 28:1265.
COMPARISON OF
HEALING TIME, PAIN AND COST EFFECTIVENESS
* Significantly different, *
cost included materials and nursing care
Conclusion: Biobrane
decreases pain, healing time and is cost-effective
3) Experience of Synthetic Skin
Substitutes for Skin Slough Disorders
Skin coverage with biobrane
biomaterial for the treatment of patients with toxic epidermal necrolysis
Toxic epidermal necrolysis (TEN)
is an exfoliative skin disorder that may involve a large body surface area and
mucosal surfaces. The microscopic changes that occur with this condition are
similar to those that occur with superficial dermal burns, such as dermal
detachment from the underlying dermis. Complications of TEN are related to the
loss of the epithelial skin barrier and include pain, fluid and electrolyte
loss, and an increased risk of sepsis. The treatment of a patient with TEN is
best accomplished in a burn unit, where expert treatment of these
complications can be provided. Medical treatment includes the administration
of immunosuppressive therapy and the discontinuation of any previous
corticosteroid treatment. Surgical management includes the debridement of
necrotic areas. In Spain, from 1996 to 1998 is described. These patients were
treated with extensive early debridement of necrotic skin areas followed by
wound coverage with Biobrane (Dow B. Hickam, Inc. Sugarland, Tex), a temporary
semi-synthetic skin substitute. Skin coverage decreases the risk of sepsis,
without adverse side effects. This semi-synthetic material meets some
standards of an ideal skin substitute; it is easy to use, provides several
beneficial physiologic effects, and improves patients comfort. In the 8 cases
of patients with TEN that were studied, the use of Biobrane skin substitute
for the coverage of massive areas of detached skin was found to be an
important aspect of treatment.
(J Burn Care
Rehab 1999;20:406-10).
|
Patient
Number
|
% TBS
Involved
|
LOS days
Burn Center
|
Healing
Time/Days
|
Survival
% of Total
|
|
8
|
80± 19
|
28± 29
|
13± 3
|
100
|
Biobrane
is a very effective skin substitute for management of large superficial skin
sloughs as seen with TENS while decreasing wound infection.
4) Use of Biobrane Synthetic
Skin Substitute for Out-Patient Management of Superficial Mid- Partial
Thickness Burns
Biobrane - A
useful adjunct in the therapy of outpatient burns
By Robert L. Klein,
Bruce F. Rothmann, and Ruth Marshall, Akron, Ohio
Fifty-five patients with partial
thickness burns ranging from 1% to 10% of their body surfaces have been
treated with Biobrane (Woodroof Laboratories, Santa Ana, CA) dressings on an
outpatient basis. This material is a bio-synthetic skin prosthesis that was
introduced commercially in 1979. Advantages of Biobrane over other
conventional dressings in outpatient burn care have been the significant pain
relief, reduced number of dressing changes, decreased patient visits, and
satisfactory epithelization in 7 to 14 days, ease of application and removal,
and cost effectiveness. The dressing must be placed on clean wounds judged to
be partial thickness in depth. Topical antibiotics are unnecessary in the care
of these patients.
J Pediatric
Surg 1987:19:846.
|
Number
Patients
|
%
TBS Burn
|
Days
to Healing
|
Infections
|
|
54
|
1-10%
|
9±
4
|
0
|
OUTPATIENT
MANAGEMENT OF PARTIAL THICKNESS BURNS:
Biobrane versus 1%
silver sulfadiazine
(Ann Emerg Med 1990:
19; 21)
Conclusion:
Biobrane very effective for outpatient management of small partial thickness
burns
5) Use on Excised Burn Wound Beds
With or Without Meshed Graft, Donor Sites
Therapeutic efficacy
of biobrane in partial- and full-thickness thermal injury.
Thomas P. McHugh, MD,
Martin C. Robson, MD, John P. Heggers, PhD., Linda G. Phillips, MD, David J
Smith, Jr., MD and Michael C. McCollum, RN.
Cadaver allograft skin, porcine
xenograft skin, and amniotic membranes have been proved to be adequate
temporary thermal wound coverings in four clinical situations: coverage of
shallow wounds while awaiting epithelialization (SW), coverage of deep wounds
after eschar excision (DEW), coverage of widely meshed autograft while
awaiting closure of interstices (AC), and coverage of massive donor sites
(DS). This study was undertaken to evaluate the therapeutic efficacy of a new
biosynthetic bilaminate dressing, Biobrane. Two hundred one applications of
Biobrane were studied in 82 SW, 46 DEW, 19 AC, 54 DS. A total of 1224
applications were left in place until healing occurred, with a mean healing
time of 12.8 days. Sixty of SW, 10/46 DEW, 10/19 AC, and 44/54 DS remained
intact until complete healing. Only four DEW, two SW, and 0 AC applications
had to be removed because of suppuration. Twenty five of the applications (SW
and DEW) with the Biobrane glove had rare complications. (Surgery 100:4; 661.)
Results of Biobrane
Use
| |
Adherence
% |
Exudate
* |
| Excised
area |
93% |
7% |
| Excised
area (meshed graft |
100% |
0 |
| Donor
Site |
92% |
8% |
* Requiring partial
or complete removal
Comparison of
Materials Used to Cover Meshed Autograft
| Methods |
Adherence |
%
Autograft Take |
Closure
of Interstices
Days |
| |
|
|
1:1.5 |
1:3 |
1:6 |
| Fresh
Allograft |
Excellent |
97 |
6 |
10 |
16 |
| Frozen
Allograft |
Good |
90 |
7 |
11 |
17 |
| Porcine
Xenograft |
Fair |
86 |
7 |
11 |
18 |
| Biobrane |
Excellent |
94 |
6 |
11 |
14 |
| Furacin
(control) |
|
85 |
6 |
10 |
14 |
