Introduction

Management of partial-thickness burns of the face requires extensive healthcare resources, especially in the endotracheal-intubated patient, to control pain, avoid infection, and minimize scarring.1-4

Standard care for partial-thickness burns is the frequent application of antibiotic ointments and cleansing to avoid exudate buildup and infection.3,4 This process is not only time consuming but requires considerable analgesia and involves the potential for endotracheal tube dislodgement with patient movement.

Immediate wound closure of the partial-thickness facial burn can now be achieved using a rapidly adherent, bioactive, bilayered skin substitute*.1,5 The authors have previously demonstrated the use of this skin substitute on facial burns to decrease pain and improve healing in a smaller group of patients who had mainly just facial burns.

The purpose of this study was to determine whether the use of a bioactive skin substitute for partial-thickness facial burns in the presence of major burns, especially those requiring intubation, was not only beneficial but also cost effective relative to standard care for the facial burn.

Methods

Major burn patients with partial-thickness burns at least mid-dermal in depth were randomized into either standard care with topical antibiotics or closure with a skin substitute. Outcome parameters measured were patient pain during face care using the 0-to-10 pain scale (0 = no pain; 10 = worst pain)6 and time to 95-percent reepithelialization. The cost-analysis parameters measured were nursing costs, determined by nursing time spent on facial care; supplies, including the cost of the skin substitute and topical antibiotics; and medication costs, mainly analgesics and sedatives. An antibiotic ointment was used on the partial-thickness face burn except on burned ears where silver sulfadiazine was used. The antibiotic ointments and creams were applied and removed twice a day according to the study's protocol.3,4 The skin substitute was applied at the initial burn treatment procedure according to the protocol developed for its use. This protocol requires initial debridement of the burn using conscious sedation to obtain a clean wound bed after which the skin substitute is thawed, removed, cut to fit, and applied. This biologically active product is stored at -70° F in the burn center prior to application.

After the skin substitute is applied, an initial light gauze dressing is applied. This dressing is removed 12 to 24 hours after the gauze is removed from the closed facial burn. Wound care includes removing a plasma exudate, which collects at the seams of the skin substitute. In addition, fluid is rolled from beneath the skin substitute to improve adherence. The process is usually only required at the first assessment at 12 to 24 hours.

In this study, the burn center nurse coordinator and nurse research assistant collected the data regarding patient pain, nursing time, medications, etc. on a daily basis. Current hospital, pharmacy and burn center costs, not charges, were used. Nursing time for facial care was readily distinguished from care for the total burn area.

Statistical Analysis

Statistical differences between groups were determined by ANOVA using the Dunnetts t-test to compare groups at different time periods. Statistical significance was considered to be a p value less than 0.05.

Results

Patient care data. A total of 34 patients with major burns, including a partial-thickness facial burn, were randomized into one of the two groups. One group was treated with topical antibiotic agents, with facial care as needed. The other group's wounds were debrided and closed with the skin substitute. This group received subsequent care as needed. Eighteen patients, nine from each group, required initial endotracheal intubation. Patient characteristics are presented in Tables 1 and 2.