Comparison of Mepitel Ag vs Antibiotic Ointment Used With Soft Cast Technique for Treatment of Pediatric Burns

There is currently no gold standard dressing when it comes to treating hand or foot burns,
specifically in the pediatric population. Our institution currently utilizes the soft cast
technique (SCT) on all of our hand and foot burns. The SCT uses triple antibiotic ointment
(TAO) impregnated Adaptic gauze, kling or kerlex, cast padding, gypsoma plaster, soft cast
material, and coban. This dressing is applied one to two times during the first 2 weeks post
injury. The underlying dressing is changed to nystatin impregnated Adaptic gauze, kling or
kerlex, cast padding, gypsoma plaster, soft cast material, and coban for the remainder of
treatment time or until surgery is indicated for debridement and grafting of wounds. The soft
cast technique provides optimal positioning of the wounded hand or foot, allows for a moist
wound environment, and offers protection of the injured extremity as the wound heals. The
literature reveals that early surgical intervention performed in the first 7 to 10 days post
injury has been shown to help achieve maximal function while decreasing the risk of
hypertrophic scar formation.

A review of the current literature demonstrates silver sulfadiazine (SSD) to be the most
frequently used dressing for burn wound treatment in many clinics nationwide. The use of SSD
is associated with once to twice daily painful dressing changes and wound exposure that "may
lead to disruption of newly formed epithelium, wound colonization, subsequent wound infection
and deepening of the burn". One major benefit of the SCT is the reduction in required
dressing changes, as the soft cast can stay in place for 7-10 days while maintaining optimal
hand or foot positioning. This eliminates the need for painful dressing changes. Occasionally
in our clinic, we have observed yeast infections under the soft cast when patients require
serial casting. Other complications include occasional drying out of the adaptic gauze, which
leads to painful dressing removal and interruption of the newly epithelialized wound bed.
Mepitel Ag, a new soft silicone dressing produced by Molnlycke Health Care, combines Safetac
technology with a silver compound to provide a broad spectrum of antimicrobial coverage,
lasting up to 8 days, while minimizing damage to the new epithelium and creating a moist
wound environment. The safetac technology "protects the wound and the skin. It prevents an
outer dressing from sticking to the wound, therefore minimizes trauma and pain". The highly
pliable nature and antimicrobial properties of the dressing make it an ideal alternative to
TAO and SSD for the treatment of pediatric partial to deep partial thickness hand and foot
burns.

Inclusion Criteria:

- Children's Hospital Colorado burn patients

- Age 31 days to 18 years

- Newly diagnosed partial to deep partial or full thickness hand or foot burns,
including bilateral or unilateral injury

Exclusion Criteria:

- silver allergy

- silicone allergy

- electrical burn

- chemical burn

- past medical history of immunodeficiency disorders such as diabetes mellitus

- h/o AIDs or HIV,

- h/o pregnant women

- prisoners

- decisionally challenged