Kevin N. Foster

Randomized clinical study of Hydrofiber dressing with silver or silver sulfadiazine in the management of partial-thickness burns.

This prospective, randomized study compared protocols of care using either AQUACEL® Ag Hydrofiber® (ConvaTec, a Bristol-Myers Squibb company, Skillman, NJ) dressing with silver (n = 42) or silver sulfadiazine (n = 42) for up to 21 days in the management of partial-thickness burns covering 5% to 40% body surface area (BSA). AQUACEL® Ag dressing was associated with less pain and anxiety during dressing changes, less burning and stinging during wear, fewer dressing changes, less nursing time, and fewer procedural medications. Silver sulfadiazine was associated with greater flexibility and ease of movement. Adverse events, including infection, were comparable between treatment groups. The AQUACEL® Ag dressing protocol tended to have lower total treatment costs (

Effects of oxandrolone on outcome measures in the severely burned: a multicenter prospective randomized double-blind trial.

1040 vs.

Aquacel Ag® in the management of partial-thickness burns: Results of a clinical trial

1180) and a greater rate of re-epithelialization (73.8% vs 60.0%), resulting in cost-effectiveness per burn healed of

Phase I/II Clinical Evaluation of StrataGraft: A Consistent, Pathogen-Free Human Skin Substitute

1,409.06 for AQUACEL® Ag dressing and

Scald burns in young children--a review of Arizona burn center pediatric patients and a proposal for prevention in the Hispanic community.

1,967.95 for silver sulfadiazine. A protocol of care with AQUACEL® Ag provided clinical and economic benefits compared with silver sulfadiazine in patients with partial-thickness burns.

Efficacy and safety of a fibrin sealant for adherence of autologous skin grafts to burn wounds: Results of a phase 3 clinical study

Severe burns induce pathophysiologic problems, among them catabolism of lean mass, leading to protracted hospitalization and prolonged recovery. Oxandrolone is an anabolic agent shown to decrease lean mass catabolism and improve wound healing in the severely burned patients. We enrolled 81 adult subjects with burns 20% to 60% TBSA in a multicenter trial testing the effects of oxandrolone on length of hospital stay. Subjects were randomized between oxandrolone 10 mg every 12 hours or placebo. The study was stopped halfway through projected enrollment because of a significant difference between groups found on planned interim analysis. We found that length of stay was shorter in the oxandrolone group (31.6 ± 3.1 days) than placebo (43.3 ± 5.3 days; P < .05). This difference strengthened when deaths were excluded and hospital stay was indexed to burn size (1.24 ± 0.15 days/% TBSA burned vs 0.87 ± 0.05 days/% TBSA burned, P < .05). We conclude that treatment using oxandrolone should be considered for use in the severely burned while hepatic transaminases are monitored.

Stratagraft Skin Substitute Is Well-tolerated and Is Not Acutely Immunogenic in Patients With Traumatic Wounds: Results From a Prospective, Randomized, Controlled Dose Escalation Trial

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.

Tracheobronchial Markers of Lung Injury in Smoke Inhalation Victims

BACKGROUND Large wounds often require temporary allograft placement to optimize the wound bed and prevent infection until permanent closure is feasible. We developed and clinically tested a second-generation living human skin substitute (StrataGraft). StrataGraft provides both a dermis and a fully-stratified, biologically-functional epidermis generated from a pathogen-free, long-lived human keratinocyte progenitor cell line, Neonatal Immortalized KeratinocyteS (NIKS). METHODS Histology, electron microscopy, quantitative polymerase chain reaction, and bacterial growth in vitro were used to analyze human skin substitutes generated from primary human keratinocytes or NIKS cells. A phase I/II, National Institute of Health-funded, randomized, safety, and dose escalation trial was performed to assess autograft take in 15 patients 2 weeks after coverage with StrataGraft skin substitute or cryopreserved cadaver allograft. RESULTS StrataGraft skin substitute exhibited a fully stratified epidermis with multilamellar lipid sheets and barrier function as well as robust human beta defensin-3 mRNA levels. Analysis of the primary endpoint in the clinical study revealed no differences in autograft take between wound sites pretreated with StrataGraft skin substitute or cadaver allograft. No StrataGraft-related adverse events or serious adverse events were observed. CONCLUSIONS The major finding of this phase I/II clinical study is that performance of StrataGraft skin substitute was comparable to cadaver allograft for the temporary management of complex skin defects. StrataGraft skin substitute may also eliminate the risk for disease transmission associated with allograft tissue and offer additional protection to the wound bed through inherent antimicrobial properties. StrataGraft is a pathogen-free human skin substitute that is ideal for the management of severe skin wounds before autografting.

Impact of a pediatric residential burn camp experience on burn survivors' perceptions of self and attitudes regarding the camp community.

Arizona Burn Center staff observed an increasing number of pediatric scald burn admissions. Therefore, a retrospective study was conducted to identify scald demographics and etiologies. Focus groups were subsequently conducted to determine burn prevention knowledge in the target community. Arizona Burn Center scald admission variables (ages 0–5 years) reviewed included age, sex, ethnicity, TBSA, body parts burned, occurrence month and location, caregiver present, child and caregiver activities when injured, payor source, length of stay, parental language, and zip code. High-risk zip code area focus groups were then conducted. There were a total of 170 pediatric patients, aged 0 to 5 years, admitted to the burn center during 2005 to 2006. Of this total, 124 of the patients were admitted for scald burns, accounting for 59% of all pediatric burn admissions. Scald burn patient’s demographics included male (52%), female (48%) with a mean age of 1.7 years. Majority ethnicity was Hispanic (63%). The mean TBSA was 8% with mean length of stay of 8 days. The remaining pediatric admissions for children aged 0 to 5 were for burns caused by fire or flame 15%, contact with a hot object 13%, friction burns 7%, chemical burns 3%, and electrical burns 3%. Demographics for the combined etiologies included an identical sex breakdown with male (52%) and female (48%). The majority ethnicity in the nonscald group was also Hispanic at 59% with a mean length of stay of 7 days and an average TBSA of 9.5%. Main etiologies of scald burns included hot water (25%), soup (24%), and coffee or tea (21%). Most common child behaviors were pulling hot substance from stove (24%), from countertop (13%), and having liquid spilled on them (13%) typically while caregiver was cooking. Mean TBSA was 8% with mean length of stay (8 days). Scalds occurred in the kitchen (83%) and mainly in child’s home (94%). Mother was primary caregiver (78%). Payor source was Medicaid (86%) and the average admission cost was

The reported effects of bullying on burn-surviving children.

60,075. Only 36% of parents spoke Spanish as their primary language. Scalds (43%) usually occurred during year’s first quarter (P < .001). Focus group participants (85%) reported receiving no prior burn prevention education and preferred to receive prevention instruction in small groups through established community agencies. Results suggest that culturally sensitive, bilingual scald prevention education, targeting Hispanics, is needed to create awareness of the frequency, severity, and danger associated with pediatric scalds.