Consensus on the management of pediatric deep partial-thickness burn wounds (2023 edition)
-
Abstract: Burns are a main cause of accidental injuries among children in China. Because of the unique wound repair capacity and demand for growth in pediatric patients, the management of pediatric deep partial-thickness burn wounds involves a broader range of treatment options and controversy. We assembled experts from relevant fields in China to reach a consensus on the key points of thermal-induced pediatric deep partial-thickness burn-wound management, including definition and diagnosis, surgical treatments, nonsurgical treatment, choice of wound dressings, growth factor applications, infectious wound treatment, scar prevention and treatment. The committee members hope that the Expert Consensus will provide help and guiding recommendations for the treatment of pediatric deep partial-thickness burn wounds.
-
Key words:
- Deep partial sickness burns /
- Pediatric /
- Wound management /
- Expert consensus
-
参考文献
(63) [1] ISBI Practice Guidelines Committee; Steering Subcommittee; Advisory Subcommittee. ISBI practice guidelines for burn care. Burns. 2016;42:953–1021. doi: 10.1016/j.burns.2016.05.013 [2] ISBI Practice Guidelines Committee; Advisory Subcommittee; Steering Subcommittee. ISBI practice guidelines for burn care, part 2. Burns. 2018;44:1617–706. doi: 10.1016/j.burns.2018.09.012 [3] Wang P. Pediatrics, The 8th edn. People's Medical Publishing House, 2013. [4] Herndon DN. Treatment of Burns. China Science and Technology Press, 2020. [5] Yang Z. Treatment Burns. Shanghai Scientific & Technical Publishers, 1985. [6] Li A. Li Ao Burn Science. Shanghai Scientific & Technical Publishers, 2001. [7] Gravante G, Delogu D, Giordan N, Morano G, Montone A, Esposito G. The use of Hyalomatrix PA in the treatment of deep partial-thickness burns. J Burn Care Res. 2007;28:269–74. doi: 10.1097/BCR.0B013E318031A236 [8] Kaźmierski M, Mańkowski P, Jankowski A, Harasymczuk J. Comparison of the results of operative and conservative treatment of deep dermal partial-thickness scalds in children. Eur J Pediatr Surg. 2007;17:354–61. doi: 10.1055/s-2006-924646 [9] Shin JY, Yi HS. Diagnostic accuracy of laser Doppler imaging in burn depth assessment: systematic review and meta-analysis. Burns. 2016;42:1369–76. doi: 10.1016/j.burns.2016.03.012 [10] Cirillo MD, Mirdell R, Sjöberg F, Pham TD. Improving burn depth assessment for pediatric scalds by AI based on semantic segmentation of polarized light photography images. Burns. 2021;47:1586–93. doi: 10.1016/j.burns.2021.01.011 [11] Cubison TC, Pape SA, Parkhouse N. Evidence for the link between healing time and the development of hypertrophic scars (HTS) in paediatric burns due to scald injury. Burns. 2006;32:992–9. doi: 10.1016/j.burns.2006.02.007 [12] Lonie S, Baker P, Teixeira RP. Healing time and incidence of hypertrophic scarring in paediatric scalds. Burns. 2017;43:509–13. doi: 10.1016/j.burns.2016.09.011 [13] Resch A, Staud C, Radtke C. Nanocellulose-based wound dressing for conservative wound management in children with second-degree burns. Int Wound J. 2021;18:478–86. doi: 10.1111/iwj.v18.4 [14] Vloemans AF, Hermans MH, van der Wal MB, Liebregts J, Middelkoop E. Optimal treatment of partial thickness burns in children: a systematic review. Burns. 2014;40:177–90. doi: 10.1016/j.burns.2013.09.016 [15] Lau CT, Wong KK, Tam P. Silver containing hydrofiber dressing promotes wound healing in paediatric patients with partial thickness burns. Pediatr Surg Int. 2016;32:577–81. doi: 10.1007/s00383-016-3895-0 [16] Saba SC, Tsai R, Glat P. Clinical evaluation comparing the efficacy of aquacel ag hydrofiber dressing versus petrolatum gauze with antibiotic ointment in partial-thickness burns in a pediatric burn center. J Burn Care Res. 2009;30:380–5. doi: 10.1097/BCR.0b013e3181a2898f [17] Yang XF, Cai XF, Guan XT. Summary of early surgical treatment of pediatric deep partial-thickness burns. Chinese Pediatrics of Integrated Traditional and Western Medicine. 2014;3:248–9. [18] Chi Y, Yin H, Chen X, Hu Q, Liu W, Feng L, et al. Effect of precise partial scab removal on the repair of deep partial-thickness burn wounds in children: a retrospective study. Transl Pediatr. 2021;10:3014–22. doi: 10.21037/tp [19] Chinese Burn Association. National expert consensus on the clinical application of eschar dermabrasion in burn wounds (2021 version). Zhonghua Shao Shang Za Zhi. 2021;37:501–7. [20] Huang YC, Zhu XM, Liu XM, Qing GP. Observation of the application of heterogeneous decellularized dermal matrix dressing in pediatric burns. Shaanxi Yi Xue Za Zhi. 2016;45:1154–5. [21] Desai MH, Rutan RL, Herndon DN. Conservative treatment of scald burns is superior to early excision. J Burn Care Rehabil. 1991;12:482–4. doi: 10.1097/00004630-199109000-00016 [22] Puchała J, Spodaryk M, Jarosz J. Oparzenia u dzieci: od urazu do wyleczenia: Wydawnictwo UJ, 1998. [23] Čapek KD, Culnan DM, Desai MH, Herndon DN. Fifty years of burn Care at Shriners Hospitals for children. Galveston Ann Plast Surg. 2018;80:S90–4. doi: 10.1097/SAP.0000000000001376 [24] QL XU. Effect of treating pediatric special site burns on late function with a holistic concept. In: Proceedings of the 11th National Symposium on Burn Injury Treatment. Harbin, 2014, 17. [25] Kraft R, Herndon DN, Al-Mousawi AM, Williams FN, Finnerty CC, Jeschke MG. Burn size and survival probability in paediatric patients in modern burn care: a prospective observational cohort study. Lancet. 2012;379:1013–21. doi: 10.1016/S0140-6736(11)61345-7 [26] Li TR, Li WT, Tuo XY, Yang LL, Xiu YP, Qian XY, et al. Application of vacuum sealing drainage on superficial degree Ⅱ burn and scald wound: a clinical study in pediatrics. Clin J Med Offic. 2016;1:23–5. [27] Koehler S, Jinbo A, Johnson S, Puapong D, de Los RC, Woo R. Negative pressure dressing assisted healing in pediatric burn patients. J Pediatr Surg. 2014;49:1142–5. doi: 10.1016/j.jpedsurg.2014.02.040 [28] Ren Y, Chang P, Sheridan RL. Negative wound pressure therapy is safe and useful in pediatric burn patients. Int J Burns Trauma. 2017;7:12–6. [29] de Jesus LE, Martins AB, Oliveira PB, Gomes F, Leve T, Dekermacher S. Negative pressure wound therapy in pediatric surgery: how and when to use. J Pediatr Surg. 2018;53:585–91. doi: 10.1016/j.jpedsurg.2017.11.048 [30] Frear CC, Griffin B, Cuttle L, McPhail SM, Kimble R. Study of negative pressure wound therapy as an adjunct treatment for acute burns in children (SONATA in C): protocol for a randomised controlled trial. Trials. 2019;20:130. doi: 10.1186/s13063-019-3223-9 [31] Frear CC, Zang T, Griffin BR, McPhail SM, Parker TJ, Kimble RM, et al. The modulation of the burn wound environment by negative pressure wound therapy: insights from the proteome. Wound Repair Regen. 2021;29:288–97. doi: 10.1111/wrr.v29.2 [32] Pedrazzi NE, Naiken S, La Scala G. Negative pressure wound therapy in Pediatric burn patients: a systematic review. Adv Wound Care (New Rochelle). 2021;10:270–80. doi: 10.1089/wound.2019.1089 [33] Chinese Burn Association, Editorial Board of Chinese Journal of burns. National expert consensus on the application of negative pressure closed drainage technology in burn surgery (2017 edition). Zhonghua Shao Shang Za Zhi. 2017;33:129–35. [34] Hyland EJ, D'Cruz R, Menon S, Chan Q, Harvey JG, Lawrence T, et al. Prospective, randomised controlled trial comparing VersajetTM hydrosurgery and conventional debridement of partial thickness paediatric burns. Burns. 2015;41:700–7. doi: 10.1016/j.burns.2015.02.001 [35] Li MY, Mao YG, Guo GH, Liu DW. Application of a hydrosurgery system in debridement of various types of burn wounds. Zhonghua Shao Shang Za Zhi. 2016;32:574–6. [36] Gee Kee E, Kimble RM, Cuttle L, Stockton K. Comparison of three different dressings for partial thickness burns in children: study protocol for a randomised controlled trial. Trials. 2013;14:403. doi: 10.1186/1745-6215-14-403 [37] Selvarajah D, Bollu BK, Harvey J, Jacques M, Jehangir S, Fuller ES, et al. Acticoat versus biobrane: a retrospective review on the treatment of paediatric mid-dermal torso burns. Int J Burns Trauma. 2019;9:82–7. [38] Cuttle L, Naidu S, Mill J, Hoskins W, Das K, Kimble RM. A retrospective cohort study of Acticoat versus Silvazine in a paediatric population. Burns. 2007;33:701–7. doi: 10.1016/j.burns.2007.02.012 [39] Fraser JF, Cuttle L, Kempf M, Kimble RM. Cytotoxicity of topical antimicrobial agents used in burn wounds in Australasia. ANZ J Surg. 2004;74:139–42. doi: 10.1046/j.1445-2197.2004.02916.x [40] Liu Y, Zhang J. Management of pediatric deep partial-thickness burn wounds. Zhonghua Shao Shang Za Zhi. 2021;37:797–800. [41] Committee on Burn Injury and Tissue Repair of Association of Medical Exchanges Across the Taiwan Straits. Expert consensus on the application of nitrous oxide and oxygen mixed inhalation for sedation and analgesia technology in burn surgery (2021 version). Zhonghua Shao Shang Za Zhi. 2021;37:201–6. [42] Davies MR, Rode H, Cywes S, van der Riet RL. Burn wound management. Prog Pediatr Surg. 1981;14:33–61. [43] Guo Y, Cai LL, Yu JJ, Lyu GZ. Clinical observation of aseptic biological wound protection membrane in the treatment of pediatric deep partial-thickness burn wounds. Chinese Journal of Injury Repair and Wound Healing (Electronic Edition). 2013;8:56–7. [44] Gee Kee EL, Kimble RM, Cuttle L, Khan A, Stockton KA. Randomized controlled trial of three burns dressings for partial thickness burns in children. Burns. 2015;41:946–55. doi: 10.1016/j.burns.2014.11.005 [45] Bowler PG, Jones SA, Walker M, Parsons D. Microbicidal properties of a silver-containing hydrofiber dressing against a variety of burn wound pathogens. J Burn Care Rehabil. 2004;25:192–6. doi: 10.1097/01.BCR.0000112331.72232.1B [46] Wu JJ, Zhang F, Liu J, Yao HJ, Wang Y. Effect of silver-containing hydrofiber dressing on burn wound healing: a meta-analysis and systematic review. J Cosmet Dermatol. 2023;22:1685–91. doi: 10.1111/jocd.v22.5 [47] Wang J, Yang B, Zhang XH, Liu SH, Wu W. The effectiveness of silver-containing hydrofiber dressing compared with topical silver sulfadiazine cream in pediatric patients with deep partial-thickness burns: a retrospective review. Wound Manag Prev. 2022;68:29–36. doi: 10.25270/wmp [48] Gao Y, Li JH, Guo ZQ, Zhang XH. Application of hydrogel dressing Aquacel-ag in the treatment of partial thickness burns of the head and face in children. Chinese Journal of Aesthetic and Plastic Surgery. 2017;28:485–7. [49] Xu W, Liu Y, Yue J. Repair of burn wounds. Hubei Science & Technology Press, 2013. [50] Song DH, Li Y, Liu JS, Hao QY, Zhang XZ, Yu Y. Observation on the effect of silver ion alginate dressing on deep Ⅱ degree burn wounds on limbs of children. Infect Inflamm Rep. 2016;17:199–202. [51] Chen ZL, Wu GS, Zhu SH, Xia ZF. Observation of alginate dressing and polyurethane foam dressing in the treatment of wound in the skin donor site on the head of patients with large burns. Zhonghua Shao Shang Za Zhi. 2015;31:135–7. [52] Erol S, Altoparlak U, Akcay MN, Celebi F, Parlak M. Changes of microbial flora and wound colonization in burned patients. Burns. 2004;30:357–61. doi: 10.1016/j.burns.2003.12.013 [53] Klasen HJ. A historical review of the use of silver in the treatment of burns. Ⅱ. Renewed interest for silver. Burns. 2000;26:131–8. doi: 10.1016/S0305-4179(99)00116-3 [54] Lu LC, Chang FY, Lv GZ, Lan SH. Effectiveness and safety of compound Polymyxin B ointment in treatment of burn wounds: a meta-analysis. J Burn Care Res. 2022;43:453–61. doi: 10.1093/jbcr/irab099 [55] Malone M, Johani K, Jensen SO, Gosbell IB, Dickson HG, McLennan S, et al. Effect of cadexomer iodine on the microbial load and diversity of chronic non-healing diabetic foot ulcers complicated by biofilm in vivo. J Antimicrob Chemother. 2017;72:2093–101. doi: 10.1093/jac/dkx099 [56] Jeschke MG, van Baar ME, Choudhry MA, Chung KK, Gibran NS, Logsetty S. Burn injury. Nat Rev Dis Primers. 2020;6:11. doi: 10.1038/s41572-020-0145-5 [57] Heyneman A, Hoeksema H, Vandekerckhove D, Pirayesh A, Monstrey S. The role of silver sulphadiazine in the conservative treatment of partial thickness burn wounds: a systematic review. Burns. 2016;42:1377–86. doi: 10.1016/j.burns.2016.03.029 [58] Development Group of Chinses Expert Consensus on Clinical Prevention and Treatment of Scar. Chinese expert consensus report on clinical prevention and treatment of scar. Chinese Journal of Injury Repair and Wound Healing (Electronic Edition). 2017;12:401–6. [59] Chinese Association of Plastics and Aesthetics Scar Medicine Branch. National expert consensus on early management of scars (2020 version). Zhonghua Shao Shang Za Zhi. 2021;37:113–25. [60] Akita S, Akino K, Imaizumi T, Tanaka K, Anraku K, Yano H, et al. The quality of pediatric burn scars is improved by early administration of basic fibroblast growth factor. J Burn Care Res. 2006;27:333–8. doi: 10.1097/01.BCR.0000216742.23127.7A [61] Liang ZQ, Li HM, Meng CY. Repair of second degree facial burns in children using recombinant human epidermal growth factor. Journal of Clinical Rehabilitative Tissue Engineering Research. 2007;11:1974–5. [62] Zheng ZZ, Liu JF, Xie WG, Wu RZ, Zhou HP, Wan SY. Application of recombinant human epidermal growth factor in the treatment of children with Ⅱ degree burn. Journal of Huazhong University of Science and Technology. 2003;32:667–8. [63] Ninan N, Forget A, Shastri VP, Voelcker NH, Blencowe A. Antibacterial and anti-inflammatory pH-responsive tannic acid-Carboxylated agarose composite hydrogels for wound healing. ACS Appl Mater Interfaces. 2016;8:28511–21. doi: 10.1021/acsami.6b10491 -
Table 1. 2001 edition of the grading criteria from the Oxford Center for Evidence-based Medicine
Evidence grade Definition Ⅰa Systematic reviews of homogeneous RCTs Ⅰb Single RCT (with narrow confidence interval) Ⅰc Full or no case series Ⅱa Systematic reviews of homogeneous cohort studies Ⅱb Single cohort studies (including low-quality RCT, e.g. follow-up rate < 80%) Ⅱc Outcome studies, ecological studies Ⅲa Systematic reviews of homogeneous case–control studies Ⅲb Single case control Ⅳ Case series studies (including low-quality cohort and case–control studies) Ⅴ Expert opinions based on experience without rigorous argument 
下载: 导出CSV
Table 2. A summary of 18 consensus recommendations
Consensus recommendations Key words Recommendation level Key notes Clinical Issue 1: Definition and diagnosis of pediatric deep partial-thickness burn wounds 1 Definition and diagnosis Highly recommended Subjective + specialist physical examination Clinical Issue 2: Surgical treatments of pediatric deep partial-thickness burn wounds 2 Surgical principle Highly recommended 24 hours, 15% TBSA 3 Surgical option Highly recommended 15% TBSA, eschar grinding or tangential excision 4 Surgical timing Recommended 3 to 5 days, one week, two weeks 5 Surgical indication Highly recommended 3 to 4 weeks 6 Surgical scope Highly recommended Surgery on the functional sites Clinical Issue 3: Nonsurgical treatment of pediatric deep partial-thickness burn wounds 7 Fresh and clean wound Recommended Preservation of epidermis + drainage 8 Soiled/infected/large wounds Highly recommended Topical antibacterial 9 Pain management Highly recommended Comfort Clinical Issue 4: Dressing for pediatric deep partial-thickness burn wounds 10 Frequency of dressing changes Highly recommended Combined with the characteristics of wound and dressing 11 Coverings for wounds at special sites Highly recommended Face and perineum 12 Selection of coverings for nonsurgical treatment Highly recommended Modern wound dressing Clinical Issue 5: Treatment of infectious pediatric deep partial-thickness burn wounds 13 Timing of pathogenic examination of wound Recommended Wound bacterial culture + drug sensitivity 14 Timing of pathogenic examination of medium to large-area burn wounds Highly recommended The first dressing change + regular collection 15 Timing of pathogenic examination of infected wounds Highly recommended Signs of infection/3–5 days after anti-inflammatory therapy 16 Frequency of dressing change for infected wounds Highly recommended Dynamic evaluation and timely adjustment 17 Wounds with high risk of infection Highly recommended Topical antibacterial and dynamic adjustment Clinical Issue 6: Prevention and treatment of scars from pediatric deep partial-thickness burn wounds 18 Scar prevention Highly recommended Informed, early and comprehensive
下载: 导出CSV
-
图(1) / 表(2)
计量
- 文章访问数: 35
- HTML全文浏览量: 16
- PDF下载量: 1
- 被引次数: 0
