Dr Shivani Aggarwala1,2, Dr Andrea Issler-Fisher1,2, Professor Peter Haertsch1,2, Professor Peter Maitz1,2
1Concord Burns Unit, Sydney, Australia, 2University of Sydney, Camperdown, Australia
Early debridement of burn eschar is associated with a reduction in burn related mortality but is not appropriate in all circumstances. Older patients (over 65 years old) constitute a vulnerable group where a conservative approach may be more appropriate.
Age has been consistently shown to be a strong predictor of in-hospital mortality. Older patients generally present with multiple comorbidities, reduced functional reserve capacity and consequently a diminished ability to adapt to circumstances of increased physiological demand such as post burn injury. They are often in a higher risk category for general anaesthesia. Aggressive, early debridement and skin grafting in modifying the host inflammatory response and reducing the risk of infection still remains highly controversial in the elderly population. Often post-surgical complications such as pneumonia, malnutrition and poor mobility outweigh the benefits of early debridement and grafting.
Flammacerium is an ideal biological dressing in such cases where early operative management is not suitable. Flammacerium is a combination of silver sulphadiazine and cerium nitrate and forms a firm eschar over the wound, protecting it from bacterial ingress whilst keeping the underlying wound moist and promoting healing. It binds and denatures the lipid protein complex (LPC), the burn wound toxin thought to cause immunosuppression and a significant contributor of late mortality in burn injuries.
This case series presents patients over 65 years of age with burn injuries greater than TBSA 20% in which conservative treatment with flammaserium proved to be safe and efficacious with minimal morbidity and no mortality.
Shivani is an unaccredited registrar currently working at Concord Burns Unit. She has a keen interest in Burns and reconstructive surgery.