Comparison of Mepitel Ag vs Antibiotic Ointment Used With Soft Cast Technique for Treatment of Pediatric Burns
Condition: Burns
MeSH terms: Burns
Study type: Interventional

Summary: 
      The aim of this study is to compare Mepitel Ag to Triple antibiotic ointment impregnated
      Adaptic gauze when used with the soft cast technique to assess overall time to healing, yeast
      infection rate and parents perception of pain level at time of dressing change on a scale of
      1-10. The hypothesis is that Mepitel Ag in combination with the soft cast technique improves
      wound healing in pediatric partial to deep partial thickness hand and foot burns by
      decreasing the length of healing time, decreasing the risk of yeast infection, and decreasing
      pain associated with dressing changes.
    

Detailed description: 
      There is currently no gold standard dressing when it comes to treating hand or foot burns,
      specifically in the pediatric population. Our institution currently utilizes the soft cast
      technique (SCT) on all of our hand and foot burns. The SCT uses triple antibiotic ointment
      (TAO) impregnated Adaptic gauze, kling or kerlex, cast padding, gypsoma plaster, soft cast
      material, and coban. This dressing is applied one to two times during the first 2 weeks post
      injury. The underlying dressing is changed to nystatin impregnated Adaptic gauze, kling or
      kerlex, cast padding, gypsoma plaster, soft cast material, and coban for the remainder of
      treatment time or until surgery is indicated for debridement and grafting of wounds. The soft
      cast technique provides optimal positioning of the wounded hand or foot, allows for a moist
      wound environment, and offers protection of the injured extremity as the wound heals. The
      literature reveals that early surgical intervention performed in the first 7 to 10 days post
      injury has been shown to help achieve maximal function while decreasing the risk of
      hypertrophic scar formation.

      A review of the current literature demonstrates silver sulfadiazine (SSD) to be the most
      frequently used dressing for burn wound treatment in many clinics nationwide. The use of SSD
      is associated with once to twice daily painful dressing changes and wound exposure that "may
      lead to disruption of newly formed epithelium, wound colonization, subsequent wound infection
      and deepening of the burn". One major benefit of the SCT is the reduction in required
      dressing changes, as the soft cast can stay in place for 7-10 days while maintaining optimal
      hand or foot positioning. This eliminates the need for painful dressing changes. Occasionally
      in our clinic, we have observed yeast infections under the soft cast when patients require
      serial casting. Other complications include occasional drying out of the adaptic gauze, which
      leads to painful dressing removal and interruption of the newly epithelialized wound bed.
      Mepitel Ag, a new soft silicone dressing produced by Molnlycke Health Care, combines Safetac
      technology with a silver compound to provide a broad spectrum of antimicrobial coverage,
      lasting up to 8 days, while minimizing damage to the new epithelium and creating a moist
      wound environment. The safetac technology "protects the wound and the skin. It prevents an
      outer dressing from sticking to the wound, therefore minimizes trauma and pain". The highly
      pliable nature and antimicrobial properties of the dressing make it an ideal alternative to
      TAO and SSD for the treatment of pediatric partial to deep partial thickness hand and foot
      burns.
    

Intervention name(s): triple antibiotic ointment dressing; Mepitel Ag
Intervention type(s): Device; Device
Intervention description(s): used for control group under soft cast; used for variable/experimental group under soft cast
Intervention MeSH terms: Anti-Bacterial Agents
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: pediatric hand burn; pediatric foot burn; mepitel Ag; soft cast technique for burn wound heaing