Sepehr S. Lajevardi1, Peter K.M. Maitz2
1 Burns Unit, Concord Repatriation General Hospital, Concord, NSW, 2137, firstname.lastname@example.org
2 Burns Unit, Concord Repatriation General Hospital, Concord, NSW, 2137, email@example.com
Biobrane® (Smith&Nephew, USA) is a biosynthetic xenograft composite skin substitute and its use has become widespread for the management of partial thickness burns. Biobrane is most commonly applied in the operating theatre and under general anaesthesia, using skin staples. The most challenging anatomical regions to apply Biobrane are the face and the hands. We describe our method of applying Biobrane outside the theatre environment (outpatient department, emergency department, burns ward or ICU) with the use of oral and inhaled analgesia, using Histoacryl® (Braun, USA) skin glue.
After assessing a burn wound as partial thickness depth, suitabile for application of Biobrane and obtaining consent, the patient is given Oral Oxycodone (5-10mg), Oral Paracetamol (1g) twenty minutes before the start of the procedure. Inhaled Methoxyflurane (3mls) is used for further analgesia during the procedure.
Sterile technique is used and the wound is debrided using Prontosan® (Braun, USA) soaked gauze to remove all free epidermis. Appropriately sized Biobrane sheet is then applied to the exposed dermis. One side is then lifted and Histoacryl glue is applied in a thin strip on the unburned skin about 5 to 10 mm away from the debrided edge, and the Biobrane is put back down and held in place for 10 seconds until dry. This is repeated for all other edges but maintaining moderate tension to the sheet.
We have found this method of application of Biobrane and use of analgesia to be effective for use outside theatre environment with good results for management of partial-thickness burns.
Dr Sepehr Lajevardi is a Plastics Surgical Trainee with Royal Australasian College of Surgeons. He is undertaking a PhD in early management of burns at The University of Sydney and has an interest in improving the care of burns patients before transfer to a burns unit.