The impact of decreasing acute burn re-epithelialisation time utilising Negative Pressure Wound Therapy on morbidity:...

Negative pressure wound therapy (NPWT) that is applied to an acute, paediatric burn at the initial debridement may decrease re-epithelialisation time by approximately 22 %. The clinical significance of this reduction is unknown. In addition, the implication of burn variables such as depth in conjunction with NPWT have not been considered. The aim of this study was to model the effect NPWT may have on burn morbidity by reducing re-epithelialisation time by 22 % when stratified by depth.

This modelled study used retrospective data from a single Australian quaternary paediatric burns unit. Data were from 2014 - 2016, the final period before NPWT was introduced into routine, acute burn care. Burn depths were defined as superficial partial thickness (SPT), deep dermal partial thickness (DPT), and full thickness (FT). The outcome was the effect reducing time to re-epithelialisation by 22 % had on therapeutic morbidity, stratified via depth.

Overall, 803 participants were included. The odds ratio of being referred to scar clinic increased by 7.6 (95 % CI 4.4 - 13.1; p < 0.001) for each incremental increase in burn depth. For DPT burns, the mean time to re-epithelialisation was 21.4 days (SE 0.7), and 134 (65.7 %) participants were referred to scar outpatient clinic. Modelled data demonstrated a 67.2 % (95 % CI 58.8 - 75.6) probability of scar outpatient clinic referral at day 21. When reducing re-epithelialisation time by 22 %, DPT burns re-epithelialised on day 16, which reduced the probability of scar outpatient clinic referral by 22.3 % (44.9 %, 95 % CI 35.6 - 54.3 %, p < 0.001). Reducing time to re-epithelialisation by 22 % had minimal impact on SPT and FT burn morbidity.

The addition of NPWT as an acute, paediatric burn care adjunct is likely to have a clinically significant impact on DPT burn morbidity.