PMID- 35512410 OWN - NLM STAT- MEDLINE DCOM- 20230831 LR - 20230916 IS - 1930-613X (Electronic) IS - 0026-4075 (Linking) VI - 188 IP - 9-10 DP - 2023 Aug 29 TI - Evaluation of Topical Off-The-Shelf Therapies to Improve Prolonged Field Care of Burn-Injured Service Members. PG - 3034-3044 LID - 10.1093/milmed/usac114 [doi] AB - INTRODUCTION: Burns are common injuries on the battlefield. Given austere environments, surgical debridement of injured service members is often not feasible in these settings. Delays in surgical debridement create a risk of infection and deranged healing for burn patients. As such, this study attempts to identify the best commercially available off-the-shelf (OTS) therapies with field-deployable potential to improve prolonged field care (PFC) of burn-injured soldiers. METHODS: Deep partial-thickness (DPT) burns (25 cm2) were created on the dorsum of 5 anesthetized pigs utilizing a thermocouple burn device at 100 degrees C for 15 seconds. Nonsurgical debridement was done 1-hour after burn creation using sterile saline water and gauze to remove excess eschar tissue. Animals were then randomized into 5 experimental groups, and OTS therapies were applied to 6 of the 12 created DPT burns. The remaining 6 burns were treated with 1% silver sulfadiazine cream (Ascend Laboratories, LLC, Parsippany, NJ) as the PFC standard of care (SOC) controls. The 5 randomized OTS therapies were: irradiated sterile human skin allograft (IHS), biodegradable temporizing matrix (BTM), polylactic acid skin substitute, hyaluronic acid ester matrix (HAM), and decellularized fish skin graft (FSG). Wounds were serially assessed on post-burn days 3, 7, 14, 21, and 28. Assessments were conducted using a combination of photographs, histology, and quantitative bacteriology. Endpoints included burn wound progression, re-epithelialization, wound contraction, scar elevation index, and colony-forming units (CFU). RESULTS: The analysis demonstrated that by day 3, the FSG prevented burn wound progression the most efficiently. In terms of wound healing, the results showed re-epithelialization percentages close to 100% by day 28 for all treatment groups. No statically significant differences were observed. Quality of healing analyses demonstrated that the BTM-treated wounds had contracted less and the difference to the IHS-treated wounds was statistically significant (P < .05). As regards to antimicrobial properties, the CFU results showed no statistically significant differences between the OTS therapies and the SOC on days 3, 7, and 14. CONCLUSIONS: The impact of Food and Drug Administration-approved OTS therapies was compared to the current PFC SOC for the treatment of DPT burns in a porcine model. Several topical options exist for the management of burns prior to definitive treatment in the operating room and warrant further evaluation. These therapies are actively used on civilian burn counterparts and have far-forward, field-deployable potential for use at the point of injury so that injured service members may not need evacuation to higher roles of care and combat power may be preserved. Our results demonstrated that all the studied OTS therapies performed well when compared to the SOC in terms of burn wound progression, wound healing, quality of healing, and quantitative bacteriology. CI - Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2022. This work is written by (a) US Government employee(s) and is in the public domain in the US. FAU - Varon, David E AU - Varon DE AUID- ORCID: 0000-0002-5323-6194 AD - United States Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA. FAU - Carlsson, Anders H AU - Carlsson AH AD - Metis Foundation, San Antonio, TX 78216, USA. FAU - Cooper, Laura E AU - Cooper LE AD - United States Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA. FAU - Chapa, Javier AU - Chapa J AD - United States Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA. FAU - Valdera, Franklin A AU - Valdera FA AD - United States Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA. FAU - Christy, Sean AU - Christy S AD - United States Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA. FAU - Christy, Robert J AU - Christy RJ AD - United States Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA. FAU - Chan, Rodney K AU - Chan RK AD - United States Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA. FAU - Nuutila, Kristo J AU - Nuutila KJ AD - United States Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA. LA - eng PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. PL - England TA - Mil Med JT - Military medicine JID - 2984771R RN - W46JY43EJR (Silver Sulfadiazine) SB - IM MH - Humans MH - Animals MH - Swine MH - *Silver Sulfadiazine/therapeutic use MH - *Wound Healing MH - Skin MH - Cicatrix MH - Bandages EDAT- 2022/05/06 06:00 MHDA- 2023/08/31 06:41 CRDT- 2022/05/05 17:54 PHST- 2022/02/23 00:00 [received] PHST- 2022/04/28 00:00 [accepted] PHST- 2023/08/31 06:41 [medline] PHST- 2022/05/06 06:00 [pubmed] PHST- 2022/05/05 17:54 [entrez] AID - 6581068 [pii] AID - 10.1093/milmed/usac114 [doi] PST - ppublish SO - Mil Med. 2023 Aug 29;188(9-10):3034-3044. doi: 10.1093/milmed/usac114.