A systematic review of foam dressings for partial thickness burns.

BACKGROUND: Partial thickness burns are the most common form of thermal burns. Traditionally, dressing for these burns is simple gauze with silver sulfadiazine (SSD) changed on a daily basis. Foam dressings have been proposed to offer the advantage of requiring less frequent dressing change and better absorption of exudates. OBJECTIVE: To compare the impact of silver-containing foam dressing to traditional SSD with gauze dressing on wound healing of partial thickness burns. METHODS: We performed a systematic literature search using PubMed, EMBASE, CINAHL, Web of Science, Cochrane Library database and Google Scholar for trials comparing traditional SSD dressings to that of silver-containing foam dressing on wound healing in partial thickness burns <25% of the body surface area. We excluded studies that enrolled burns involving head, face, and genitals; burns older than or equal to 36 h, non-thermal burns, and immunocompromised patients. Quality of trials was assessed using the GRADE criteria. The main outcome, complete wound healing, is reported as percentages of wound with complete epithelialization after the follow up period. Relative risks of complete healing are also reported with respective 95% CI. Time to healing and pain score before, during, and after dressing change at each follow up visit are compared between the groups (means with standard deviation or medians with quartiles). RESULTS: We identified a total of 877 references, of which three randomized controlled trials (2 combined pediatric and adult trials and 1 adult trial) with a total of 346 patients met our inclusion criteria. All three trials compared silver-containing foam dressing to SSD and gauze on partial thickness burns. Moderate quality evidence indicated no significant difference in wound re-epithelialization between the groups across all three trials as confidence intervals for the relative risks all crossed 1. Although pain scores favored foam dressing at the first dressing change (7 days), there was no significant difference between the groups at the end of the treatment period at 28 days. Time to wound healing was also similar across the three trials with no statistical difference. Infection rates favored the foam-dressing group, but data were inconsistent. CONCLUSION: Moderate quality evidence indicates that there is no significant difference in wound healing between silver-containing foam dressing and SSD dressing. However, foam has the added benefit of reduced pain during the early treatment phase and potentially decreased infection rates.

Bent Out of Shape: A Case of Abdominal Pain.

Spontaneous colon perforation is a known complication of vascular Ehlers-Danlos syndrome (vEDS) in the pediatric age group. The diagnosis of vEDS is often missed until the child presents to the pediatric emergency room with a complication like spontaneous arterial or colon rupture. These patients require immediate imaging and surgical attention to decrease morbidity and mortality. We present the case of a 9-year-old boy with abdominal pain and retching. An abdominal computed tomography revealed free air under the diaphragm, and surgical exploration showed perforation of the sigmoid colon. Ultimately, he was diagnosed with vEDS. We review the literature and discuss the clinical presentation, diagnosis, and life-threatening crises associated with vEDS.