Xeroform gauze is superior to silver sulfadiazine cream in promoting zone of stasis healing for mixed-depth scald burns in children

TITLE: Xeroform gauze is superior to silver sulfadiazine cream in promoting zone of stasis healing for mixed-depth scald burns in children INTRODUCTION: Silver sulfadiazine 1% cream changed daily was historically the mainstay initial treatment at our pediatric burn center. Over recent years, we transitioned to using closed Xeroform dressings (3% bismuth tribromophenate in petrolatum-soaked gauze) in the initial care of partial thickness burns. The purpose of this study is to compare patient outcomes between Xeroform only and silver sulfadiazine. METHODS: A retrospective chart review was conducted of patients age 5 years with mixed-depth scald injuries between: 1) years 2004-2008, when silver sulfadiazine was standard care, and 2) 2015-2018, when Xeroform only had become standard. Data collected included demographics, burn total body surface area (TBSA), length of hospital stay, and necessity, size, and timing of skin grafting. RESULTS: Three hundred forty-seven patients were included, of whom 200 were treated with silver sulfadiazine and 147 with Xeroform only. Burn TBSA and rates of skin grafting were similar between the groups; however, the mean area of the skin graft was significantly smaller for the Xeroform group (147cm2 vs. 336cm2, p=0.027). Of note, time from injury to grafting was significantly longer in the Xeroform group (24d vs. 9.9d, p=0.002), with a larger proportion of these patients returning for outpatient grafting. CONCLUSION: These results suggest that initial treatment with a closed dressing of Xeroform gauze may promote zone of stasis healing resulting in smaller graft sizes compared to silver sulfadiazine cream. Fewer dressing changes combined with later skin grafting could allow burn wounds to demarcate and heal more effectively, benefiting both graft and donor sites