Date of Award

2022

Degree Name

Master of Science (Physiotherapy)

Schools and Centres

Physiotherapy

First Supervisor

Professor Jim Codde

Second Supervisor

A/Professor Dale Edgar

Third Supervisor

Rosemary Kendall

Abstract

Introduction

The development of scarring is a normal physiological response during burn wound healing for any except the most trivial of injuries. Burn scarring can cause considerable functional and psychological anguish in burn survivors. Prolonged wound healing has been shown to affect scarring outcomes. Superficial cutaneous wound injuries carry a risk of scarring and altered pigmentation after the wound has healed. The primary aim of this study was to explore the effects of topical silicone on the rate of wound healing in superficial wounds. Secondary aims included investigation of scar and pain outcomes.

Methods

This thesis presents two studies which explored the efficacy of topical silicone film-forming dressings (StrataXRT and Stratamed) in comparison to standard care. Two independent double-blinded, single-centre, randomised controlled studies were conducted, one focussed on donor sites of split thickness skin grafts (STSG) using StrataXRT, and the other, superficial partial thickness (SPT) face and neck burns using Stratamed. For both studies, time to healing (TTH) was the primary outcome of interest. Secondary outcomes included 1) scar assessments (modified Vancouver Scar Scale; Dermalab Combo and Patient and Observer Scar Assessment Scale) at six weeks and three months, and 2) pain intensity scale during dressing changes. In the donor site study, 30 eligible burn patients requiring surgery aged between 18 and 80 years with a donor site wound ≤ 3% total burn surface area (TBSA) were enrolled. The intervention, StrataXRT, was randomly assigned to one half of the donor site or a single donor site where multiple donor passes were required, within the same patient and applied underneath standard care calcium alginate dressings. In the facial burn patient study, 55 patients aged between 18 and 80 years with a non-epithelialised superficial partial thickness face or neck burns were randomised to receive Stratamed or standard care emollient for the topical management of their wounds.

Results

Of the 30 participants enrolled in the donor study, 24 (80%) were male. Median age was 39 years with a range from 20 years to 76 years. Donor site size ranged from 0.1% to 3% TBSA. The median TTH for the intervention group was 10 days (CI 8 - 12) and the control group was 9 days (CI 8 - 10) There was no evidence of a statistical difference observed in time to healing, pain and scar outcomes. Of the 55 participants in the face/neck study, 34 (62%) were male. Median age was 36 years with a range from 25 to 47 years. The median TTH for the intervention group was 9 days (CI 7.6 -10.4) and the control group was 7 days (CI 5.3- 8.7), this result was not significant, p = 0.056. The silicone intervention group exhibited significantly reduced scar pigmentation at six weeks in mVSS scores for the intervention group (Md = 0, IQR = 0) compared to the control group (Md = 0, IQR = 0 - 3), p = 0.043. There was no significant difference in pain between the intervention group (Md = 1.15, IQR 0.3 – 4.5) and the control group (Md = 1.5, IQR 0.6 – 3.8), z = -0.63, p = 0.53. No, adverse events were associated with the topical silicone in either study.

Conclusion These studies were unable to show any clinically applicable advantage over standard care through the use of topical silicone dressings on donor site wounds and SPT burn wounds of the face and neck. The observation that silicone film-forming dressing systems were associated with a reduction in scar pigmentation and no observed adverse events warrants further studies.

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