Novel technique of burn dressing: The two sides of the bedpad

INTRODUCTION

Wound dressings, sterility of dressing rooms, and dressing patterns have evolved with time and have led to improvement in the outcome of the wounds. In this article, we present a novel technique of bedpad utilization for the dressing of burn wounds. We utilize the differential surface properties of the bedpad for dressing the burn wounds. We tried to observe the response of the wound to the two surfaces, the adherent and non-adherent side of the bedpad.

MATERIAL AND METHODS

This was a prospective study. Thirty patients who presented with burn injury to casualty were studied. After parent counseling, consents were taken. After primary care, the bedpads smeared with nanocrystalline silver nitrate were used to dress the patient. In the same patient, we used both sides of the bedpad in different areas to eliminate patient-related bias. We used the same pattern of dressing for all patients, where a specific region of burnt surface on the body was dressed with either absorbent or non-absorbent side. The areas were selected randomly. The patients were dressed daily in the same manner under sterile conditions. If the areas dressed with absorbent side bled while removal of the dressing, the dressing was modified and the non-absorbing surface was placed in contact with the burn surface. Weekly swab tests were sent from both areas separately (the one area dressed with an absorbent surface and the other with non-absorbent surface).

RESULTS

There were 30 patients, in which 18 were second-degree superficial burns, 11 were second-degree superficial to deep, one was an infected burn, and two needed split skin grafting in the second stage. Superficial burns healed in 8–18 days whereas deep burns healed in 18–21 days. Wound beds for grafting were prepared in 18–21 days.

Following observations were made in the dressing patterns and the wound behavior.

1. On the day of the burn, if the burn wound is dressed with a non-absorbent side in contact with the wound surface, there is an exudation of fluid due to water loss from the burn surface [Figures 1 and 2].

   

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   Figure 1:

   Initial wound.

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   Figure 2:

   Use of the absorbent side (white side) for the thigh and non-absorbent side (blue side) for the leg.

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2. On the day of admission, if the burnt surface is dressed with an absorbent side, less exudation of fluid is seen.

3. For second-degree superficial wounds, the non-absorbent surface of the bedpads provides a moist, non-adherent layer of dressing and helps in painless, sterile and dressing. Furthermore, the healing granulation or the neo-epidermal layer is not disturbed due to the non-adherent nature of the dressing. Later, once the healing process has begun, the dressing with a non-adherent layer can be done on a less frequent basis changing from the daily dressing pattern.

4. Second-degree deep burns generally go through a phase of infection followed by a healing process. The absorbent surface provides a good mechanical debridement [Figure 3].

   

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   Figure 3:

   Improvement in the wound.

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5. Once the infective phase of the second-degree deep burn transits to the healing phase, healthy granulation tissue develops. Continuation of the use of an absorbent layer of beyond this point of transition of the wound led to bleeding while removal of the dressing [Figure 4].

   

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   Figure 4:

   Transition point (bleeding on removal of the absorbent side).

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6. So once the transition point of the second-degree deep burns is reached, a transition in the pattern of dressing was made and non-absorbent side was used. It helped in following ways:

   • Helped to improve the granulation tissue and healing

   • Less bleeding

   • Less disturbance to the granulation tissue [Figures 5 and 6].

   

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   Figure 5:

   Change of dressing to non-absorbent and non-adherent surface of thigh after transition point.

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   Figure 6:

   Improved wound and ready for skin grafting.

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7. Wounds which were small healed with the non-absorbent dressing. Wounds which were large and needed grafting were helped by non-absorbent dressing in a way to prepare the wound for grafting, thus hastening the process of healing [Figures 7 and 8].

   

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   Figure 7:

   Raw area prepared for skin grafting.

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   Figure 8:

   Skin graft taken on 95% wound surface.

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8. Observations based on percentage of burns, age, gender, time required for healing, and surgical intervention were captured. The same are tabulated [Tables 1 and 2].

9. No significant changes in the swab culture pattern of the wound dressed on either side.

DISCUSSION

Burn injury has become a major part of plastic surgery and the management of burns has improved. The LD50 (the burn size lethal to 50% of the population) for thermal injuries has risen from 42% body surface area (BSA) during the 1940s and 1950s to more than 90% BSA for young thermally injured patients.^[1] This can be attributed to various factors such as timely improved resuscitation, pulmonary care, intensive unit care, and also regular dressings and wound care.^[2] An ideal dressing should include the following characteristics:^[3,4]

• Maintain a moist environment

• Manage excess exudate

• Allow gaseous exchange

• Provide thermal insulation and protection

• Non-allergic, non-sensitizing

• Impermeable to micro-organisms

• Acceptable to patient, pain minimizing

• Cost-effective

• Non-inflammable

• Non-adherent

Pain is an important aspect in dressing especially in burns wound management. Gauze dressings which are most commonly used, may dry, and adhere to the wound bed, causing bleeding and pain during removal.^[5] The present dictum is to keep the wound bed moist.^[6] Bedpads are pads widely used in hospitals to prevent the bed from getting soiled with urine.^[7] They have excellent fluid-absorbing capacity and are used in cases of urinary incontinence, pediatric wards, and in intensive care unit. Bedpads have been used for years for the treatment of pediatric burns.^[8]

These bedpads have two different surfaces. One is the absorbent, and the other is the non-absorbent side [Figures 9 and 10]. It is made up of three layers. The three layers are:^[9]

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Figure 9:

Non-absorbent side of bedpad.

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Figure 10:

Absorbent side of bedpad.

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1. Innermost layer - It is made up of non-woven cotton. It helps in maximum dispersion of absorbent fluid.

2. Intermediate layer - It is made up of long virgin pulp fibers and helps in additional absorption of fluids.

3. Outer layer - It is made up of polyethylene. It is waster impermeable and non-adherent layer.

We utilized this property of variable surfaces with variable absorbing capacity, the absorbent surface and the non-absorbent surface of the bed-pad for dressing as described. Polyethylene is inert, impervious, non-antigenic, non-adherent, and non-allergic. Gore and Umakumar found the background pain and dressing removal pain was less when polyethylene drape was used.^[10] In his study, Vartak et al. found that polyethylene dressing application and removal are almost painless.^[11]

Our observations were that when both sides of the dressing material, when used appropriately can give maximum pain relief and effective wound healing.

CONCLUSION

Bedpads are quite cheap sources for dressing with dual surfaces having different properties. The absorbent surface can be used in the transudative, exudative phase for more absorption of the fluid and infective material and also acts as a mechanical debrider. The non-absorbent side of the bedpad acts as a smooth dressing which helps in healing by not disturbing the granulation tissue and also helps in healing. The non-absorbent side can be used for superficial burns, deep burns with raw areas, and post burn raw areas being prepared for grafting. Thus, bedpad acts as a dual utility cheap, affordable, and easy to use product in cases of burn patients.