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Aquacel Ag® in the Management of Partial-Thickness Burns: Results of a Clinical Trial

Caruso, Daniel M. MD*; Foster, Kevin N. MD*; Hermans, Michel H.E. MD†; Rick, Christina RN, BSN†

Journal of Burn Care & Rehabilitation: January/February 2004 - Volume 25 - Issue 1 - pp 89-97
Aba Papers

Aquacel® Hydrofiber® is a moisture retentive topical dressing that has been demonstrated to be safe and efficacious for the management of partial-thickness burns, showing parity for most dressing related aspects to cadaver skin for this indication. Recently, 1.2% w/w silver has been added to the Aquacel ® Hydrofiber®, to create Aquacel Ag®. This new material releases silver within the dressing for up to two weeks, and it is this duration that differentiates it from other sustained release silver delivery products indicated for burn management. The dressing was tested in a phase II noncomparative trial in superficial, mid dermal, and mixed partial-thickness burns. Percentage and speed of reepithelialization were satisfactory and appear to be similar at least to results noted with silver sulfadiazine, although, no direct comparisons were performed in this study. Pain reduction between baseline and postburn day number three and five was statistically significant. Conformability, general ease of use and other functional dressing properties were rated very positively. Overall, Aquacel Ag® combines several properties known to be beneficial for the management of partial-thickness burns and is a very good choice for superficial and mid-thickness burn injuries.

Partial-thickness (second degree) burns are among the most frequently occurring injuries and, although not specifically reported in the literature, those involving mixed depths within one confluent injury are probably the most common. Whereas the treatment protocol for first and third degree (full-thickness) burns is clearly defined, the algorithm for mixed partial-thickness burn wounds presents a dilemma. Historically, superficial areas, which will heal on their own within approximately two weeks, are virtually always treated with one or more topical antimicrobials and/or dressings. 1 Deeper areas that will not heal in a relatively short time, or heal at all without surgical intervention, will require excision and grafting which is often performed within two to three days after presentation. 2 However, aggressive early excision has some disadvantages in where there is neither distinct demarcation between zones of injury that will or will not heal normally without grafting, or precise guidelines on how far or deeply to excise. Furthermore, some areas initially determined not to require surgical closure may later deepen by “spontaneous conversion.”3–5 This conversion may be due to incomplete assessment on first examination or because of other mechanisms such as infection and/or desiccation. Consequently, the patient will require a second surgical intervention to have those areas excised and grafted. Conversely, it is not uncommon that areas previously deemed to have a poor prognosis for healing without surgery may some days later turn out to be only superficial and heal in a relatively short period of time.

A resolution for this dilemma is to utilize moisture retentive, or occlusive dressings over an entire area with mixed, partial-thickness burns for 10 to 17 days to prevent desiccation 6–8 and encourage spontaneous healing of superficial areas as well as those that are indeterminate between superficial or deeper partial-thickness. Thereafter, slow or nonhealing areas as well as sections overlying highly mobile anatomical regions requiring surgical closure are more clearly defined for secondary (late) excision and grafting. 2 Aquacel® Hydrofiber® Dressing (ConvaTec International, Princeton, NJ) was clinically tested using this type of approach in a noncomparative trial. The results for management of minor superficial, deep and mixed partial-thickness burns were very satisfactory. 9 Healing time was short, the number of dressing changes low, and the percent of patients requiring secondary excision and grafting was limited. Management of small, partial-thickness burns with moisture retentive (synthetic or biological) dressings have long proven to be safe and effective, but some physicians are still reluctant because of concerns about infection. However, for smaller partial-thickness burns this fear is unfounded which has been demonstrated in this study as well as several other clinical trials. 10,11

Pure silver (as opposed to silver compounds such as silver sulfadiazine or silver nitrate) has received renewed interest and research for use as a prophylactic antimicrobial agent for burns. Because pure silver has minimal toxicity, side effects (which are associated with a number of silver compounds 12) are greatly reduced 13 and no evidence of the development of resistant organisms has been reported. 14 Aquacel Ag® combines the proven effects of Aquacel® with those of silver: 1.2% w/w silver has been added to the dressing. The product provides a sustained release of silver into the dressing, for up to 14 days and is designed to address the issues with infection in burn care while offering proper dressing properties per se.

*Maricopa Medical Center, Phoenix, Arizona; and †ConvaTec International, Princeton, New Jersey.

Address correspondence to Daniel M. Caruso, MD, FACS, Director, Arizona Burn Center, Maricopa Medical Center, 2601 E. Roosevelt, Phoenix, Arizona 85008.

Supported in part by ConvaTec, a division of E.R. Squibb & Sons, L.L.C.

Presented at the meeting of the American Burn Association, Miami Beach, Florida, April 1 to 4, 2003.

©2004The American Burn Association