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Clinical Evaluation Comparing the Efficacy of Aquacel Ag with Vaseline Gauze versus 1% Silver Sulfadiazine Cream in Toxic Epidermal Necrolysis

Huang, Shu-Hung MD; Lin, Cen-Hung MD; Chang, Kao-Ping MD; Wu, Sheng-Hua MD; Lin, Sin-Daw MD; Lai, Chung-Sheng MD; Ou, Su-Fei; Lee, Su-Shin MD

Advances in Skin & Wound Care: May 2014 - Volume 27 - Issue 5 - p 210–215
doi: 10.1097/01.ASW.0000445919.06416.32
Features: Original Investigations

OBJECTIVE: The purpose of this study was to determine whether using Aquacel Ag (ConvaTec, Skillman, New Jersey) with Vaseline (Unilever, London, England) gauze instead of silver sulfadiazine cream (SSD) as the wound care protocol to treat toxic epidermal necrolysis (TEN) can improve wound healing, pain control, and reduction of labor costs.

DESIGN: A retrospective chart review.

SETTING: A burn center with 2 plastic surgeons and 11 nursing staff.

PATIENTS: A pathologist diagnosed TEN in 35 patients admitted to the burn center from 1995 to 2009.

MAIN OUTCOME MEASURES: Parameters included the patient’s profile, dressing choice, severity-of-illness score for TEN, time to 95% re-epithelialization, visual analog scale pain scores before second dressing change, and labor cost. The exclusion criterion was wound care with neither Aquacel Ag with Vaseline nor SSD exclusively.

RESULTS: Twenty patients were enrolled in this study. In the group using Aquacel Ag with Vaseline gauze, the visual analog scale score was significantly less than that of the SSD group (P = .02). Labor costs were significantly lower in the Aquacel Ag with Vaseline gauze group (P < .01). Commencement of specific dressing to 95% re-epithelialization (P = .09) and time spent in the second dressing change (P = .05) had no statistical significance between the 2 groups.

CONCLUSIONS: This study showed that Aquacel Ag with Vaseline gauze decreased pain and labor costs but did not shorten wound healing time. Thus, Aquacel Ag with Vaseline gauze can be an efficient method for treating TEN wounds.

Shu-Hung Huang, MD, is a Plastic Surgeon at the Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; a Student at the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; an Assistant Professor at the Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and a Plastic Surgeon at the Division of Plastic Surgery, Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan. Cen-Hun Lin, MD, is a Surgical Resident at the Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. Kao-Ping Chang, MD, PhD, is a Chief of the Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; and Associate Professor at the Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Sheng-Hua Wu, MD, is a Student at the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and an Anesthesiologist at the Department of Anesthesia, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. Sin-Daw Lin, MD, is a Plastic Surgeon at the Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; and a Professor at the Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Chung-Sheng Lai, MD, PhD, is a Plastic Surgeon at the Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; and a Professor at the Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Su-Fei Ou is the Head Nurse of the Plastic Surgery Ward of Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. Su-Shin Lee, MD, is a Plastic Surgeon at the Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; and is Associate Professor at the Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

Acknowledgments: This study was supported by a grant from the Kaohsiung Medical University Hospital (KMUH 98-8G-40), the Kaohsiung Municipal Ta-Tung Hospital (KMTTH 99-006), and the National Science Council (NSC 100-2314-B-037-021-MY2).

The authors have disclosed that they have no financial relationships related to this article.

Submitted April 12, 2013; accepted in revised form October 18, 2013.

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