Xeroform gauze versus silver sulfadiazine for mixed-depth pediatric scald injuries: A retrospective study

Silver sulfadiazine 1 % cream had historically been the mainstay initial treatment for scald wounds at our institution. However, we transitioned to using closed dressings of only petrolatum-impregnated 3 % bismuth tribromophenate gauze (Xeroform) for all partial-thickness burns. Xeroform adheres to the wound while allowing the exudates to drain and acts as a scaffold for re-epithelialization, after which it falls off without traumatizing the wound bed, theoretically allowing viable tissue to declare itself while requiring less frequent dressing changes.

A retrospective chart review was conducted of patients aged ≤5 years with mixed-depth scald injuries between the years 1) 2004 and 2008, during which silver sulfadiazine was the standard initial choice and 2) 2015 and 2018, when only Xeroform was used as the standard.

The study included 347 patients, among whom 200 were treated with silver sulfadiazine and 147 were treated with Xeroform alone. The 2 groups had similar burn sizes and rates of skin grafting (silver group 30/200 [15.0 %] and Xeroform group 20/147 [17.7 %]) However, the Xeroform group showed longer time from injury to grafting (24 vs. 9.9 days, p = 0.002) but showed a significantly smaller mean graft size than the silver group (147 vs. 336 cm², p = 0.027).

These findings suggest that using Xeroform may promote better wound healing than using silver sulfadiazine. In addition, patients with Xeroform can be discharged with their dressings in place for grafting in the outpatient setting, during which time they are in closed dressings without frequent changes and associated discomfort.