Aquacel® Ag dressing versus Acticoat™ dressing in partial thickness burns: A prospective, randomized, controlled study in 100 patients. Part 1: Burn wound healing

doi:10.1016/j.burns.2013.07.008

Burns

Volume 40, Issue 3, May 2014, Pages 416-427

https://doi.org/10.1016/j.burns.2013.07.008 Get rights and content

Abstract

Introduction

Studies comparing contemporary silver dressings in burns are scarce.

Methods

In a prospective, randomized, controlled study, counting 50 patients/research group, we compared two frequently used silver dressings, Acticoat™ and Aquacel^® Ag, in the management of partial thickness burns with a predicted healing time between 7 and 21 days as assessed by laser Doppler imaging between 48 and 72 h after burn. Variables investigated were related to baseline research group characteristics, wound healing, bacteriology, economics, nurse, and patient experience.

Results

Both research groups were comparably composed taking into account gender, age and burn characteristics. Similar results were obtained as to healing time and bacterial control with both silver dressings. A statistically significant difference in favor of the Aquacel^® Ag dressing was found for average ease of use (p < 0.001), average ease of application (p = 0.001), patient pain (p < 0.001), patient comfort with the dressing (p = 0.017), silver staining (p < 0.001), and cost effectiveness (p < 0.001).

Conclusion

Both silver dressings resulted in comparable healing times and bacterial control but the Aquacel^® Ag dressing significantly increased comfort for patients as well as nurses and was significantly more cost-effective than the Acticoat™ dressing for the given indication.

Introduction

Contemporary burn management is no longer solely aimed at patient survival but also focuses on optimal functional and esthetic outcome [1]. From a practical point of view, in order to avert hypertrophic scarring and functional impairment, burn care revolves around two major therapeutic options: one being conservative therapy applying dressings for burns with the potential to heal within 21 days, and the other being early excision and grafting, aiming to obtain early wound closure for burns that otherwise would take longer than 3 weeks to heal [2], [3], [4], [5], [6], [7].

Despite the fact that it was introduced in 1968, 1% silver sulfadiazine (SSD) still is somewhat considered to be the gold standard for the management of burns [8], [9], [10]. However, more recent literature has revealed that the use of SSD on burn wounds needs to be reconsidered, as a number of studies have shown delay in time to wound healing [4], [10]. Other disadvantages of SSD include the need for daily (often painful) dressing changes and difficulties with assessing the burn wound due to formation of a messy pseudo eschar.

In recent years, several new silver impregnated dressings have been developed and put on the market to overcome the shortcomings of SSD. Most of these dressings are (semi) occlusive, require less dressing changes and demonstrate a prolonged antibacterial effect due to a sustained release of silver ions [5], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27].

In view of the lack of comparative studies on contemporary silver dressings in burn care, this study, focusing on wound healing, bacteriology, economics, nurse and patient experience, aimed to compare two frequently used silver dressings, the nanocrystalline silver dressing Acticoat™ and the Hydrofiber^® silver dressing Aquacel^® Ag, in the management of partial thickness burns with an objectively diagnosed healing potential between 7 and 21 days.

Section snippets

Materials

Aquacel^® Ag Hydrofiber^® dressing (Convatec Inc.) consists of sodium carboxymethylcellulose to which silver ions have been incorporated at a concentration of 1.2%. Upon contact with wound exudate, the Hydrofiber^® dressing hydrates and subsequently swells to form a coherent gel that sequesters and retains bacteria, and conforms to the wound surface. Once hydrated, silver ions are available to kill bacteria, both within the dressing matrix and at the wound-dressing interface. In cases of

Results

The study started in November 2006. More than 400 patients were assessed for eligibility and the last of the 100 patients was enrolled in July 2010 (Fig. 3). An overview of the statistical results for superficial and mid-dermal burns combined is presented in Table 2. Statistical results for mid-dermal burns only are presented in Table 3.

Adverse events

From a clinical point of view it is important to report that eight study burns took more than 21 days to heal where the predicted healing time by LDI measurement was between 14 and 21 days.

In the Aquacel^® Ag group, one patient needed 25 days and another 26 days before wound healing in burns that in both patients had a healing potential estimated to be less than 3 weeks. In both these Aquacel^® Ag group-allocated patients wound care was performed with Aquacel^® Ag until wound closure but the

Discussion

The purpose of this study was to compare a nanocrystalline silver dressing (Acticoat™) and a Hydrofiber^® silver dressing (Aquacel^® Ag) in the management of partial thickness burns with an objectively diagnosed healing potential between 7 and 21 days. This clinical trial was a prospective, randomized, controlled study. There was no blinding for several reasons: due to the different structure and distinctive characteristics of both silver dressings investigated in this trial, it is easy to

Acknowledgements

The Department of Plastic and Reconstructive Surgery, Wound Healing and Tissue Engineering Unit, Gent University Hospital, Gent, Belgium, received an unrestricted research grant from ConvaTec Inc. for this study, an argument which might be used to question the results and the strength of the research we performed. However we want to emphasize that it was an unrestricted research grant. ConvaTec Inc. was in no way involved in the study design, nor the collection or analysis or interpretation of

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Aquacel® Ag dressing versus Acticoat™ dressing in partial thickness burns: A prospective, randomized, controlled study in 100 patients. Part 1: Burn wound healing

Abstract

Introduction

Methods

Results

Conclusion

Introduction

Section snippets

Materials

Results

Adverse events

Discussion

Acknowledgements

Burns

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J Pediatr Surg

Burns

Burns

Burns

Burns

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Aquacel^® Ag dressing versus Acticoat™ dressing in partial thickness burns: A prospective, randomized, controlled study in 100 patients. Part 1: Burn wound healing