Successful Management of 2nd Degree Scald Burns to Bi-Lateral Lower Legs in a 92-Year-Old Female,Expedited Healing and Avoidance of Hospitalization

Introduction: A 92-year-old female suffered blistering, painful, 2nd-degree (15% BSA) scald burns to both legs fromboiling water. The pain was 10 (0-10 scale). The patient presented to her local hospital. The burns are managed with oil emulsion gauze. The next day, the patient saw her primary care physician. The patient’s legswrapped with petrolatum impregnated dressings and referred the patient to home health. Orders were to apply silver sulfadiazine (SS). In addition, an oral antibiotic was prescribed.

Methods: One day after the physician visit, the patient was seen by home health nursing. The petrolatum impregnateddressing dried, sticking to the burns; removal took more than an hour and was very painful. The SS was not available, so the home health nurses started to manage the burns with hypochlorous acid wound soaks, barrier cream on peri-wound skin, polymeric membrane dressing* rolls (PMDs)* on the burns, which were held in place with a tubular bandage. Dressings were to be changed 3x per week.

Results: After two days of PMDs, inflammation was reduced, the pain was 3 (0-10 scale), and the patient could nowsleep. The SS was now available and applied on the left lower extremity but was removed 2 hours laterby the on-call nurse due to the patient reporting severe burning sensation; PMDs were reapplied. On day 10post injury, 8 days after PMD was initiated, the physician’s office did not recover a 3cm x 3cm area of theburn, which was necrotic at the next dressing change. At the next dressing change, the necrotic area wascovered again with PMDs. PMDs debrided the necrotic area, which closed in 102 days. All the rest of theburns closed in 60 days.

Discussion: Wound management with PMDs reduced total care cost by eliminating the expenses of typical hospital admission for sharp, painful debridement and grafting procedures. With the PMDs, the burns healedfaster than would have been expected with previous approaches to burn management. There is no betterproduct than PMDs for managing these burns. PMDs are best practices for burn management.