Surgery>>>>>Burns
Question 12#

A 14-year-old girl sustains a steam burn measuring 6 by 7 inches over the ulnar aspect of her right forearm. Blisters develop over the entire area of the burn wound, and by the time the patient is seen 6 hours after the injury, some of the blisters have ruptured spontaneously. All of the following therapeutic regimens might be considered appropriate for this patient EXCEPT:

A. Application of silver sulfadiazine cream (Silvadene) and daily washes, but no dressing
B. Application of mafenide acetate cream (Sulfamylon), but no daily washes or dressing
C. Homograft application without sutures to secure it in place, but no daily washes or dressing
D. Heterograft (pigskin) application with sutures to secure it in place and daily washes, but no dressing

Correct Answer is D

Comment:

A number of different acceptable regimens exist for treating small, superficial second-degree burn injuries. In all cases, the necrotic epithelium is first debrided. Topical antibacterial agents then may be applied and the wounds treated open or closed with dressings changed daily or every other day. Biologic dressings (homografts or heterografts) may be applied to superficial second-degree burns at the time of initial debridement. Typically, these dressings quickly adhere to the wounds, relieve pain, and promote rapid epithelialization. These dressings should not be sutured in place, however, because suturing creates the potential for a closedspace infection and for conversion of a second degree to a full-thickness injury. If a biologic dressing does not adhere, it should be removed immediately, and the wound should then be treated with topical antibacterial agents.