Topical treatment for facial burns

Burn injuries are an important health problem. Burns frequently occur on the head or neck. These areas are central to a person's identity and play a vital role in communication. Other basic abilities such as hearing, smelling and breathing may become affected as a direct result of a facial burn. The authors of this Cochrane review wanted to assess the effects of topical (surface) treatments for wound healing in facial burns. Examples of topical treatments are antimicrobial creams and ointments and biological, or bioengineered (artificial), skin substitutes.

Five small studies were included in the review. Two studies compared two different antimicrobials whilst three compared antimicrobials with skin substitutes. All studies were small and at high risk of bias therefore we cannot be confident in the results and the overall evidence is of low quality. There is insufficient reliable evidence as to whether topical treatments improve outcomes for people with facial burns including improved wound healing, rates of infection, the need for surgery, improved appearance of scars, reduced pain, improved overall patient satisfaction, reduced adverse effects, improved quality of life or reduced the length of the hospital stay. More research is needed.

Authors' conclusions: 

There is insufficient high quality research and evidence to enable conclusions to be drawn about the effects of topical interventions on wound healing in people with facial burns.

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Background: 

Burn injuries are an important health problem. They occur frequently in the head and neck region - the area central to a person's identity, that provides our most expressive means of communication. Topical interventions are currently the cornerstone of treatment of partial-thickness burns to the face.

Objectives: 

To assess the effects of topical interventions on wound healing in people with facial burns of any depth.

Search strategy: 

We searched the Cochrane Wounds Group Specialised Register (searched 12 November 2012); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 10); Ovid MEDLINE (1950 to November Week 1 2012); Ovid MEDLINE - In-process & Other Non-Indexed Citations (searched November 12, 2012); Ovid EMBASE (1980 to 2012 Week 45); and EBSCO CINAHL (1982 to 9 November 2012) for relevant trials. We did not apply date or language restrictions.

Selection criteria: 

Randomised controlled trials (RCTs) that evaluated the effects of topical treatment for facial burns were eligible for inclusion in this review.

Data collection and analysis: 

Two review authors independently assessed and included the references identified by the search strategy. Included trials were assessed using a risk of bias form, and data were extracted using a standardised data extraction sheet. For dichotomous and continuous outcomes, we calculated risk ratios and mean differences, respectively, both with 95% confidence intervals (CI).

Main results: 

We included five RCTs, comprising a total of 119 participants. Two studies compared two different antimicrobial agents and three compared a biological or bioengineered skin substitute with an antimicrobial agent. All studies had small sample sizes and were at high risk of bias. Heterogeneity of interventions and outcomes prevented pooling of data. In three studies time to complete wound healing was significantly shorter for those using a skin substitute than for those using an antibacterial agent, but the quality of the evidence was low. Pain was significantly reduced with the use of skin substitutes in both studies that reported this outcome in all groups, range mean differences -2.00 (95% CI -3.82 to -0.18) to -4.00 (95% CI -5.05 to -2.95) on a 10-point scale.

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