As Moorhead defined burn as "Infected wounds caused by heat" over 40 years ago, it still remains true. Up to 1960´s the high mortality of the major burns, 50% or over, has not been improved. With the wide-spread use of 0.5% silver nitrate solution and 10% mafenide hydrochloride (Sulfamylon) since the latter half of 1960´s the mortality :of the major burns has been reduced by as much as 50%. .
The advantages of 0.5% silver nitrate solution are effective Bacterial control, relatively safe, and painless on application, but the disadvantages are unable to penetrate the deep tissues, needs heavy dressings and staining skin and sheets.
Sulfamylon cream penetrates the deep tissues better and does not need the heavy dressings and also does not stain the skin, but causes pain on application, has sensitivity reactions and develops the resistant strains.
As R.L. Bouterie and D.H. `McLean tried 0.5% silver nitrate cream with the idea of utilizing the advantages of both silver nitrate solution and sulfamylon cream, authors have used the same 0.5% silver intrate cream on 33 patients admitted to our burn unit.
The four ingredients used to prepare the cream were: water soluble base 90%, silver nitrate 0.5%, petrolatum 5. 0% and water 4.5%.
When a burn patient is admitted, the extent and degree of burn are measured and the debridement was done under the aseptic condition.
The 0.5% silver nitrate cream was applied over the wound with gloved hands to a thickness
of 4-5 mm. The wound cultures were taken upon admission and every 3-4 days thereafter.
In 10% of cases, staphylococcus aureus grew. Streptococcus was grown in 5%. Pseudomonas
grew in 10%.
With 0.5% silver nitrate cream there were less drastic changes in serum electrolytes and the stains to skin and sheets were much less. It is relatively painless on application and there was no evidences of allergy or side effects.
The hospital cost to the patient was much reduced with the use of this 0. 5% silver nitrate cream.
|