Authors (including presenting author) :
LIU SK(1), Poon TCC(1)
Affiliation :
(1)Department of Surgery, Queen Mary Hospital
Introduction :
Skin is indeed a complex organ with multiple functions. Its function can be simply described as a protective barrier that has an aesthetic component. Its complexity, however, becomes evident during loss of skin integrity in trauma, burns, or various skin diseases. Usage of biological dressings in burn wound care was reported to produce reduction of pain, protection against physical trauma; heat and moisture retention. Superficial partial-thickness burns affect the epidermis and the papillary dermis but heal in about 14 days. Patients with superficial partial-thickness burns are usually treated using conventional methods, which involve regular dressing changes. However, it may cause painful procedures, risk of wound infection and prolong hospital stay.
Objectives :
To evaluate the efficacy of biological dressings in enhancing clinical and patient-centered outcomes for burn wound healing, with a focus on reducing pain scores, accelerating wound healing time, and improving overall patient satisfaction levels
Methodology :
Usage of porcine skin and human amniotic membrane (HAM) have been started in Burn Unit, Queen Mary Hospital. These biological dressings are provided by Skin Bank, the Prince of Wales Hospital. These biological dressings are stored in a refrigerator at 4°C under glycerol preservation. Health care personnel (plastic surgeon and burn nurse) received corresponding training in application. Eligible patients with superficial partial-thickness burns were identified by plastic surgeons. Biological dressings were applied either at the bedside or in the operating theatre, depending on wound complexity and patient stability.
Following biological dressing placement as the primary layer, wounds were secured with a medicated tulle gras and wet-to-dry gauze. Outer dressings were replaced every 24–48 hours to assess wound adherence, epithelialization, and signs of infection (e.g., erythema, purulence). Ambulatory patients meeting discharge criteria (stable wound progression, adequate pain control) were released early with scheduled outpatient follow-up. A prospective review was conducted to evaluate the clinical and patient-reported outcomes including numerical background pain score (0-10) and procedural pain score (0-10), wound healing time(days), signs of wound infection, length of hospital stay (days) and patient satisfaction level (1-4) were collected.
Result & Outcome :
Total 26 burn patients (aged from 11 months to 76 yrs old; Female=14 Male=12) with superficial partial thickness burn were applied biological dressing from July 2023 to December 2024 in Department of Surgery, Queen Mary Hospital. 23 patients received porcine skin, 2 of them received HAM and 1 of them received both. Involved TBSA ranged from 0.5% to 80%; etiology of burn injury: Scald=19; Flame=6; Other=1. 77% of patients (n=20) had biological dressing applied by burn nurses while remaining patients had these applications by plastic surgeon in operation theatre. The largest burn wound size with biological dressing applied was 46%. Procedural pain was significantly reduced from 7.40 to 2.75 (p<.001) with Cohen's d = 3.35; Background Pain also significantly reduced from 2.55 to 1.75 (p=.0068) with Cohen's d = 0.68. The wound healing mean time after application= 7.62 days. 37% of patients (n=10) could be discharged earlier and managed in out-patient setting before fully epithelization. Patients’ satisfaction mean score is 3.56. Nil cases for wound infection or complication were noted afterward.
Compared to conventional treatments, our review demonstrated that biological dressing accelerated re-epithelialization, reduced pain intensity and shorter hospital stays. Shortening wound healing time can also minimize the occurrence of hypertrophic scar, which enhances quality of life among burn victims. To maximize their impact, we advocate for broader implementation of biological dressings across regional burn care facilities.
