An Inexpensive Bismuth-Petrolatum Dressing for Treatment of Burns.

Burn injuries worldwide are a significant cause of both mortality and morbidity, with 265,000 deaths and 11,271 lost disability-adjusted life years seen in 2004.1 Moreover, 90% of burn injuries occur in low- and middle-income countries (LMICs), with at least half in Southeast Asia alone, due to overcrowding, the use of traditional cooking practices, flammable clothing, and domestic combustibles. Children under 5 years are most vulnerable to burn injuries, and millions of burns survivors must cope with lifelong disabilities and contracture deformities due to lack of adequate and timely wound care resources.2 In LMICs, access to adequate burn care is limited by both lack of healthcare infrastructure and prohibitive costs of available treatment.3–5 A cost analysis of a hospital in Turkey revealed that the mean cost for treating victims of flame burn was US $368 per 1% burn surface area; furthermore, although intensive care unit care was the most significant cost driver (27%), dressings constituted 15% of the cost of care.6 Specifically, partial-thickness burns require frequent and expensive changes of moisture-retaining antimicrobial dressings.3 Without dressings, burns are more susceptible to infections, desiccation, trauma, and delayed epithelialization, thereby causing progression to deep partial- or full-thickness burns.7–9 The treatment of choice for superficial partial-thickness burns, and split-thickness skin graft donor sites, is Xeroform petrolatum gauze.10–12 Xeroform consists of a mixture of petroleum jelly and bismuth tribromophenate that is processed into a homogenized suspension using a colloid mill and impregnated into fine mesh sterile gauze.13 Petroleum jelly creates an occlusive, nonadhesive barrier that enables the wound to retain moisture.11 Bismuth tribromophenate is antimicrobial, possibly mediated by bismuth ions accumulating in and disrupting microbial organelles.14 Xeroform is preferred over other occlusive dressings such as DuoDERM, Biobrane, Kaltostat, Aquacel, Mepilex, and Jelonet because it is stable, is easily stored at room temperature, facilitates rapid re-epithelialization, and is available at a lower cost than other dressing types.10,12,15 Several studies have explored lower-cost alternatives for use in LMICs, such as topical amniotic membrane, honey, boiled potato peel, and papaya.16–18 Amniotic membrane is available from cesarean sections at no cost but has a limited shelf life and requires sterile procurement, human immunodeficiency virus and hepatitis testing, and storage with antibiotics in a cold room or freezer.16 Although honey and papaya, and to a lesser extent potato peel, were shown to confer some antimicrobial benefit on burn wounds, their effect on wound healing is less reproducible than conventional dressings.17,18 We propose an inexpensive method of producing a dressing with comparable properties to Xeroform, made with readily available materials by hand without a colloid mill, for use in low-resource settings. We hypothesize that this alternative dressing would be a viable, economic alternative to Xeroform with comparable antimicrobial efficacy, biocompatibility, and wound healing. The ultimate goal is to optimize an inexpensive, handmade dressing that can be custom-produced at the bedside for use in burn units in low-resource settings.