The Use of a New Wound Alginogel for the Treatment of Partial-thickness Hand Burns
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Abstract: The following retrospective analysis reports on patients with partial-thickness wounds admitted to the burn unit of the General Hospital of Athens who were treated with a new alginogel and were later compared to the burn center’s standard treatment. Methods. Patient information from January–December 2008 was analyzed for the number of days until healing and wound bacterial loads. Wound healing was characterized as a quick onset of epithelialization and low occurrence of inflammation. Results. A limited number of wounds (15%) were found to be positive for wound swabs and accordingly few signs of inflammation were reported. The organisms that were retrieved from the alginogel treated wounds were Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus hominis, and Acinetobacter baumanii. Conclusion. These data are discussed and compared with the experience of the burn unit and its standard treatment.
Disclosure: Mr. Van den Plas was an employee of Flen Pharma at the time this manuscript was developed and written.
Deep partial- and full-thickness hand burns are common and a source of potentially significant morbidity.1 After stabilization of the burned area, the aim of subsequent care is to restore wound coverage and movement within 14–21 days of injury, as it is important to make the hand functional at the conclusion of treatment.2,3 Ideally, functional restoration should include both fine pinch and power grip but will ultimately be determined by the individual patient's needs.4 A nonoperative approach to most hand burns is advocated, and principles of early wound care, including antimicrobial therapy and escharotomy, must be considered.5 Several dressing types can be used to achieve this goal, optionally in combination with a skin graft.
The gold standard in hand burn treatment is to achieve prompt closure of the wound while avoiding inflammation, cover with a dressing that does not limit hand and finger movement, and provide a warm, moist environment with antimicrobial protection. Classical moisturizing creams (eg, Bepanthol®) provide warmth and moisture, but do not offer antibacterial protection. Silver sulphadiazine and other silver based dressings provide antimicrobial treatment but may delay re-epithelialization and wound healing.6–8 Additionally, there are reports on development of resistance in bacteria.9,10 Povidone-iodine is a commonly used local antiseptic in wound care. The drawback of its use is that it does not generate a moist environment, at least during the initial days of healing.11 Since the early 1960s it has been advocated that proper moisturization is integral to wound healing.12 Efforts have been made to integrate iodine in moisturizing ointments13 but with limited success to date. In short, an ideal dressing should protect the wounds from infection, should restore moisture balance of the wound, and at the same time should minimally disturb wound healing. More recently, a new product has been introduced to the market that efficiently provides these characteristics.
The new product (Flaminal® Hydro, Flen Pharma NV, Kontich, Belgium) is a hydro-active, broad-spectrum alginogel with a biologic antimicrobial system based on two enzymes—glucose oxidase and lactoperoxidase—that are stabilized by guaiacol. The biological antimicrobial system is incorporated into a viscous alginate-polyethyleneglycol-water mixture. The alginate polymers have balanced proportions of guluronic and mannuronic acids, as well as sodium and calcium ions.
1. Cartotto R. The burned hand: optimizing long-term outcomes with a standardized approach to acute and subacute care. Clin Plast Surg. 2005;32(4):515–527.
2. Hoeksema H, Van de Sijpe K, Tondu T, et al. Accuracy of early burn depth assessment by laser Doppler imaging on different days post burn. Burns. 2009;35(1):36–45.
3. Tredget EE. Management of the acutely burned upper extremity. Hand Clin. 2000;16(2):187–203.
4. Robson MC, Smith DJ Jr., VanderZee AJ, Roberts L. Making the burned hand functional. Clin Plast Surg. 1992;19(3):663-671.
5. Feldmann ME, Evans J, O SJ. Early management of the burned pediatric hand. J Craniofac Surg. 2008;19(4):942–950.
6. Atiyeh BS, Costagliola M, Hayek SN, Dibo SA. Effect of silver on burn wound infection control and healing: review of the literature. Burns. 2007;33(2):139–148.
7. Burd A, Kwok CH, Hung SC, et al. A comparative study of the cytotoxicity of silver-based dressings in monolayer cell, tissue explant, and animal models. Wound Repair Regen. 2007;15(1):94–104.
8. Van Den Plas D, De Smet K, Lens D, Sollie P. Differential cell death programmes induced by silver dressings in vitro. Eur J Dermatol. 2008;18(4):416–421.
9. Landsdown AB, Williams A. Bacterial resistance to silver in wound care and medical devices. J Wound Care. 2007;16(1):15–19.
10. Silver S, Phung le T, Silver G. Silver as biocides in burn and wound dressings and bacterial resistance to silver compounds. J Ind Microbiol Biotechnol. 2006;33(7):627–634.
11. Ioannovich J, Tsati E, Tsoutsos D, Frangia K, Papalois A. Moist exposed burn therapy. Evaluation of the epithelial repair process (an experimental model). Ann Burns Fire Disasters. 2000;8(1):3–9.
12. Winter GD. Formation of a scab and the rate of epithelialization of superficial wounds in the skin of the young domestic pig. Nature. 1962;193:293–294.
13. Vogt PM, Reimer K, Hauser J, et al. PVP-iodine in hydrosomes and hydrogel—a novel concept in wound therapy leads to enhanced epithelialization and reduced loss of skin grafts. Burns. 2006; 32(6):698–705.
14. De Smet K, Van den Plas D, Lens D, Sollie P. Pre-clinical evaluation of a new antimicrobial enzyme for the control of wound bioburden. WOUNDS. 2009;21(3):65–73.
15. Heimbach D, Engrav L, Grube B, Marvin J. Burn depth: a review. World J Surg. 1992;16(1):10–15.
16. Devgan L, Bhat S, Aylward B, Spence SJ. Modalities for the assessment of burn wound depth. J Burns Wounds. 2006;15(5):e2.
17. Watts A, Tyler MP, Perry ME, Roberts AH, McGrouther DA. Burn depth and its histological measurement. Burns. 2001;27(2):154–160.
18. Lacarrubba F, Patania L, Micali G. Open label evaluation of an alginates hydrogel in the treatment of leg ulcers. Ital J Dermatol Venereol. 2005;140(1):83–88.
19. Vandenbulcke K, Horvat LI, De Mil M, Slegers G, Beele H. Evaluation of the antibacterial activity and toxicity of 2 new hydrogels: a pilot study. Int J Low Extrem Wounds. 2006;5(2):109–114.
20. de la Brassinne M, Thirion L, Horvat LI. A novel method of comparing the healing properties of two hydrogels in chronic leg ulcers. J Eur Acad Dermatol Venereol. 2006;20(2):131–135.
21. Agnihotri N, Gupta V, Joshi RM. Aerobic bacterial isolates from burn wound infections and their antibiograms—a five-year study. Burns. 2004;30(3):241–243.
22. Song W, Lee KM, Kang HJ, Shin DH, Kim DK. Microbiologic aspects of predominant bacteria isolated from the burn patients in Korea. Burns. 2001;27(2):136–139.
23. Salehifar E, Khorasani G, Ala S. Time-related concordance between swab and biopsy samples in the microbiological assessment of burn wounds. WOUNDS. 2009;21(3):84–88.
