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The purpose of this study is to better understand how to best care for burn wounds.
Participants: Patients presenting to Kamuzu Central Hospital in Lilongwe Malawi with burn wounds occuring within 72 hours of admission.
Procedures (methods): This is a prospective randomized trial. Subjects will be randomized during admission to receive either open dressing care or closed dressing care of their burn wounds.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Closed method | Active Comparator | Burn patients randomized to closed method of burn wound care. |
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| Open method | Experimental | Burn patients randomized to the open method of burn wound care. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Closed method | Procedure | Subjects will have their wounds managed by covering with gauze and changing this gauze 3 to 7 times per week. |
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| Measure | Description | Time Frame |
|---|---|---|
| Time to healing | Time from burn injury to healing (defined as at least 90% epithelialization) as determined by hospital records, outpatient clinical records and telephone contact (with subject or next-of-kin) per study protocol. | 30-day |
| Measure | Description | Time Frame |
|---|---|---|
| Mortality | Mortality within 30 days of burn injury, as determined by hospital records, outpatient clinical records and telephone contact (with next-of-kin) per study protocol. | 30-day |
| Burn wound infection rate |
| Measure | Description | Time Frame |
|---|---|---|
| Microbiologic profile of clinical infections | Qualitative microbiologic culture results and sensitivity panels from surface swabs taken from infected burn wounds (as defined by clinical criteria described in the secondary outcome "burn wound infection rate"). | 30-day |
| Number of surgical procedures |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jared Gallaher, MD | UNC Chapel Hill Department of Surgery | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 18226462 | Background | Gosselin RA, Kuppers B. Open versus closed management of burn wounds in a low-income developing country. Burns. 2008 Aug;34(5):644-7. doi: 10.1016/j.burns.2007.09.013. Epub 2008 Jan 15. | |
| 6074149 | Background | Dominguez O, Bains JW, Lynch JB, Lewis SR. Treatment of burns with silver nitrate versus exposure method: analysis of 200 patients. Plast Reconstr Surg. 1967 Nov;40(5):489-93. doi: 10.1097/00006534-196711000-00012. No abstract available. |
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| ID | Term |
|---|---|
| D002056 | Burns |
| D014947 | Wounds and Injuries |
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| Open method | Procedure | Subjects will have their burns managed by keeping the wounds exposed to the air. |
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Clinical suspicion of infection defined by presence of (a) burn wound cellulitis (erythema and/or edema AND pain and/or tenderness at the border of the wound), or (b) burn wound infection (change in appearance of the burn including focal or multifocal brown, black or violaceous discoloration OR rapid separation of the eschar OR conversion of partial thickness to full thickness burn).
| 30-day |
Number of surgical procedures required including indication and type of procedure. |
| 30-day |
| percent skin graft survival | Percent survival (defined as area surviving / total area grafted at 7 days) of skin grafts. | 30-day |
| Hospital length of stay | Length of stay during initial hospitalization. | 30-day |
| 13275898 | Background | HOLMAN SP, SHAYA ES, HOFFMEISTER FS, EDGERTON MT Jr. Studies on burns. I. The exposure method vs. occlusive dressings in the local treatment of experimental burns. Ann Surg. 1956 Jan;143(1):49-56. doi: 10.1097/00000658-195601000-00006. No abstract available. |
| 23142508 | Background | Kiser MM, Samuel JC, Mclean SE, Muyco AP, Cairns BA, Charles AG. Epidemiology of pediatric injury in Malawi: burden of disease and implications for prevention. Int J Surg. 2012;10(10):611-7. doi: 10.1016/j.ijsu.2012.10.004. Epub 2012 Nov 7. |
| 21819720 | Background | Samuel JC, Campbell EL, Mjuweni S, Muyco AP, Cairns BA, Charles AG. The epidemiology, management, outcomes and areas for improvement of burn care in central Malawi: an observational study. J Int Med Res. 2011;39(3):873-9. doi: 10.1177/147323001103900321. |