K. B. Savoie1, M. Bachier-Rodriguez1, R. B. Interiano1, A. Rotenberry2, L. S. Herring2, J. W. Eubanks1,2, R. F. Williams1,2 1University Of Tennessee Health Science Center,General Surgery,Memphis, TN, USA 2Le Bonheur Children’s Hospital,Pediatric Surgery And Trauma,Memphis, TN, USA
Introduction:
The shift in treatment of pediatric burns with silver-impregnated dressings has led to an increase in outpatient therapy. During these clinic visits, hypergranulation has been identified as a source of poor wound healing leading to increased clinic visits and the need for subsequent skin grafts. Therefore, we examined all pediatric burn patients treated with silver-impregnated dressings to determine factors associated with severe hypergranulation.
Methods:
A review of all pediatric burn patients from an urban pediatric hospital was performed from 2011 to 2013. Our primary outcome was severe hypergranulation of the burn, defined as significant granulation tissue resulting in the need for treatment with silver nitrate. Severe burns were classified as those requiring surgical consultation in the emergency room, admission, enteral nutrition, or central line placement. A Chi-Square test was used to compare categorical variables and a Mann-Whitney U test was employed for continuous variables. Backwards elimination was used to build a model for multivariable analysis.
Results:
A total of 597 patients were identified. The majority of patients were male, black, and had public insurance. Scald burns were the most common type of burn (59%). Thirty-two patients developed severe hypergranulation (5.4%). On bivariate analysis, thermal and chemical burns, lower extremity burns, and severe burns were associated with severe hypergranulation. In multivariable analysis, thermal and chemical burns and lower extremity burns remained significant predictors of severe hypergranulation (see table). Lower extremity burns remained significant when assessing for effect modification with total body surface area of the burns.
Conclusion:
In pediatric burn patients, thermal and chemical burns, as well as lower extremity burns, result in an increase likelihood of hypergranulation, which may lead to changes in therapy or additional surgical intervention. These patients may require different initial therapy to decrease the rate of granulation tissue and thus increase burn wound healing.
