Ms Coreen, Kim Kuan Low1
1KK Women’s and Children’s Hospital, Singapore
3 patients out of 795 burns procedures in 2022 to date, aged 1 to 10 years reportedly suffered secondary breakdown with fragile fluid-filled blisters, painful blistering with loss of epithelium invariably 1month after their partial to deep thickness burn wound of their lower limb healed or stalled . All patients shared similar history where they had scratched their skin thru the dressing. All parents declined surgical intervention and preferred conservative management. This impact on cost of treatment and time element to wound healing
The aim of good clinical practice is to enable healing of a burns impetigo wound within the expected window of healing of 2 weeks.
Methodology
Management of procedural pain, Syr Paracetamaol, Syr Ibuprofen and Syr Morphine are given 1 hour before the start of dressing followed by topical Lignocaine gel 2%
Using TIME wound management model, the appropriate plan of care were applied on the wound as warranted. Use of highly absorbent and moisture-retaining foam dressings and hydrofibers available with silver for control of bacterial overburden as well as hydrocolloids and honey alginates.
Effective antiseptics and active anti-biofilm solutions and gel are used to manage the fragile wound bed till healing took place
Conclusion/Learning points
1.There is no isolated therapeutic procedure. Depending on the appearance of the wound bed, a proactive course on the management of burns impetigo wound requires an approach such as mechanical-chemical procedures such as debridement, antiseptics, and antimicrobial support enables achievement of healing ideally within the time period of 2 weeks.
2. Nutrition, itch and climate environment may have played a part in stalled healing.
3. Opportunity for future project ie reduce psychological anxiety, pain and fear experienced by patients and parents as well cost of treatment and time required due to the frequency of visit for wound dressing change