Randomized clinical trial of negative pressure wound therapy as an adjunctive treatment for small‐area thermal burns in children

• Published in: British journal of surgery 2020-12, Vol.107 (13), p.1741-1750
• Main Authors: Frear, C. C., Cuttle, L., McPhail, S. M., Chatfield, M. D., Kimble, R. M., Griffin, B. R.
• Format: Article
• Language: English
• Subjects: Adolescent; Burn treatment; Burns - therapy; Child; Child, Preschool; Childrens health; Clinical trials; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Infant; Kaplan-Meier Estimate; Male; Negative-Pressure Wound Therapy; Occlusive Dressings; Polyesters - therapeutic use; Polyethylenes - therapeutic use; Pressure ulcers; Proportional Hazards Models; Randomized Clinical Trial; Randomized Clinical Trials; Re-Epithelialization; Silicones - therapeutic use; Single-Blind Method; Treatment Outcome; Wound Healing
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.11993

Background The efficacy of negative pressure wound therapy (NPWT) in the acute management of burns remains unclear. The purpose of this trial was to compare standard Acticoat™ and Mepitel™ dressings with combined Acticoat™, Mepitel™ and continuous NPWT to determine the effect of adjunctive NPWT on re‐epithelialization in paediatric burns. Methods This two‐arm, single‐centre RCT recruited children with acute thermal burns covering less than 5 per cent of their total body surface area. The primary outcome was time to re‐epithelialization. Blinded assessments were performed using photographs captured every 3–5 days until discharge. Secondary measures included pain, itch, grafting, perfusion and scar management referrals. Results Some 114 patients were randomized. Median time to re‐epithelialization was 8 (i.q.r. 7–11) days in the NPWT group and 10 (8–14) days in the control group. In a multivariable model, NPWT decreased the expected time to wound closure by 22 (95 per cent c.i. 7 to 34) per cent (P = 0·005). The risk of referral to scar management was reduced by 60 (18 to 81) per cent (P = 0·013). Four participants in the control group and one in the NPWT group underwent grafting. There were no statistically significant differences between groups in pain, itch or laser Doppler measures of perfusion. Adverse events were rare and minor, although NPWT carried a moderate treatment burden, with ten patients discontinuing early. Conclusion Adjunctive NPWT hastened re‐epithelialization in small‐area burn injuries in children, but had a greater treatment burden than standard dressings alone. Registration number: ACTRN12618000256279 ( http://ANZCTR.org.au). Antecedentes La eficacia del tratamiento de las heridas con presión negativa (negative pressure wound therapy, NPWT) en el tratamiento agudo de las quemaduras sigue sin estar claro. El propósito de este ensayo clínico fue comparar los apósitos estándar del tipo Acticoat™ y Mepitel™ con la combinación de Acticoat™, Mepitel™ y NPWT continua para determinar el efecto de la adición de NPWT en la reepitelización de las quemaduras en pediatría. Métodos Ensayo controlado y aleatorizado, con dos brazos y unicéntrico, que reclutó niños con quemaduras térmicas agudas que afectaban < 5% de la superficie corporal total. El resultado primario fue el tiempo hasta la reepitelización. Se realizaron evaluaciones a ciegas utilizando fotografías tomadas cada 3‐5 días hasta el alta hospitalaria. Las medidas secundarias incluían dolor