Dr Tasciana Gordon1
1Greenslopes Hospital, , Australia
The presence of blisters indicates a partial thickness burn. Blister fluid contains chemokines and is thought to play a role in the early stages of neovascularisation. However, blisters may also lead to increased inflammation and vasoconstriction which can impair healing and cause a pressure effect on the micro-circulation.
A literature search was conducted using search engines Medline, Trip Database and Pubmed. Exclusion criteria were articles in a non-English language, those published prior to 2015, studies that compared dressings, studies not involving burn patients and the inability to obtain the full text. Key words included ‘burn blister’, ‘management of blister’, ‘burn treatment’, ‘deroofing’ and ‘aspiration’.
Twelve studies were identified with conflicting recommendations and clinical application. The larger studies showed: De-roofing blisters is associated with higher rates of pain measured by increase in the Visual Analogue Pain Scale and there was a greater incidence of infection. Dressing changes were more frequent compared with leaving the blister intact or compared with aspiration. However, neither aspiration nor de-roofing resulted in poorer aesthetic outcomes.
The smaller studies suggested no difference in infection rate when de-roofing was compared with leaving blisters intact with superficial partial thickness burns. One study looked at the properties within the blister and identified greater neovascularisation with endothelial cell growth and circulating angiogenic cells when the blister was left intact.
Based on current clinical evidence blisters should be left intact where possible. De-roofing has a greater incidence of pain, infection and the need for a greater number and frequency of dressings. Aspiration has been shown to be superior to de-roofing particularly if spontaneous rupture is likely based on location, size and fragility of the blister wall. Intact skin is the best “natural dressing”.
Dr. Tasciana Gordon is currently working as a plastic and reconstructive surgical Principal House Officer at Greenslope’s Hospital in Queensland, Australia.