Debridement of Sulfur Mustard Skin Burns: A Comparison of Three Methods.

Published on Jan 30, 2020in Journal of Burn Care & Research1.845
· DOI :10.1093/JBCR/IRZ140
David J. Barillo29
Estimated H-index: 29
,
Claire R. Croutch6
Estimated H-index: 6
(MRIGlobal)
+ 3 AuthorsFrances Reid2
Estimated H-index: 2
(MRIGlobal)
Sources
Abstract
: Sulfur mustard burns are characterized by delayed symptoms, slow healing, and recurrence after closure. Incomplete debridement at the level of the basement membrane is the postulated cause. Graham pioneered laser debridement of mustard burns. For field or mass-casualty use, saline wet-to-wet or antibiotic-soak debridement is more practical. In this study, we compared laser, saline, and antibiotic debridement in a porcine model of deep partial thickness injury. Deep dermal sulfur mustard burns were produced in 18 anesthetized Gottingen minipigs using 10 uL saturated vapor cap exposure time of 90 minutes. Debridement was started 48 hours post injury and consisted of a single laser treatment; 5 days of 5% aqueous mafenide acetate wet-to-wet dressings; or 7 to 12 days of saline wet-to-wet dressings. Wounds were treated with daily silver sulfadiazine for 30 days, and then assessed by histopathology, silver ion analysis, colorimetry and evaporimetry. All wounds healed well with no sign of infection. Antibiotic debridement showed no advantage over saline debridement. There were no significant differences between groups for colorimetry or evaporimetry. Histopathology was graded on a mustard-specific scale of 1-15 where higher values indicate better healing. Mean histology scores were 13.6 for laser, 13.9 for mafenide and 14.3 for saline. Saline debridement statistically outperformed laser (p<0.05), but required the longest debridement time. Laser debridement had the benefit of requiring a single treatment rather than daily dressing changes, significantly decreasing need for wound-care and personnel resources. Development of a ruggedized laser for field use is a countermeasures priority.
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Newest
#1John S. GrahamH-Index: 18
#2Robert S StevensonH-Index: 4
Last. Ann M. SchiavettaH-Index: 1
view all 7 authors...
Abstract Background Sulfur mustard (2,2′-dichlorodiethyl sulfide; HD) is a potent vesicating chemical warfare agent that poses a continuing threat to both military and civilian populations. Significant cutaneous HD injuries can take several months to heal, necessitate lengthy hospitalizations, and result in long-term complications. There are currently no standardized or optimized methods of casualty management. New strategies are needed to provide for optimal and rapid wound healing. Objective T...
Source
#1John S. GrahamH-Index: 18
#2Robert S StevensonH-Index: 4
Last. Robyn B. LeeH-Index: 14
view all 7 authors...
Objective: The objective was to examine the efficacy of several treatment regimens in improving wound healing of cutaneous sulfur mustard (HD) injuries. Methods: Wound healing studies were conducted in weanling pigs. Superficial dermal HD injuries were debrided at 48 hours postexposure using an erbium-doped yttrium aluminum garnet (Er:YAG) laser, followed by application of a treatment adjunct. A variety of noninvasive bioengineering methods were conducted during the postsurgical observation peri...
#1D. Evison (SU: Salisbury University)H-Index: 1
#2R. F. R. Brown (SU: Salisbury University)H-Index: 1
Last. P. Rice (SU: Salisbury University)H-Index: 1
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Summary The chemical warfare agent, sulphur mustard (SM), is a potent blistering agent in man. Skin exposure can produce partial-thickness burns which take up to three months to heal. The aim of this study was to investigate the use of early laser ablation as a means of accelerating this exceptionally slow rate of healing. Four circular partial-thickness SM burns were induced on the dorsum of nine large white pigs (under general anaesthesia). At 72h post-exposure, three burns per animal were abl...
Source
#1Joachim W. Fluhr (FSU: University of Jena)H-Index: 39
#2Kenneth R. Feingold (UCSF: University of California, San Francisco)H-Index: 138
Last. Peter M. Elias (UCSF: University of California, San Francisco)H-Index: 150
view all 3 authors...
Abstract: Permeability barrier function is measured with instruments that assess transepidermal water loss (TEWL), either with closed- or open-loop systems. Yet, the validity of TEWL as a measure of barrier status has been questioned recently. Hence, we tested the validity of this measure by comparing TEWL across a wide range of perturbations, with a variety of methods, and in a variety of models. TEWL rates with two closed-chamber systems (VapoMeter and H4300) and one closed-loop system (MEECO)...
Source
#1John S. GrahamH-Index: 18
#2Kevin T. Schomacker (Harvard University)H-Index: 33
Last. Katherine S. Squibb (UMB: University of Maryland, Baltimore)H-Index: 26
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Abstract The consequences of receiving a cutaneous sulfur mustard (SM) burn are prolonged wound healing and secondary infection. This study was undertaken to find a treatment that promotes quick healing with few complications and minimal disfigurement. Multiple deep SM burns (4 cm diameter) were generated on the ventrum of weanling pigs and treated at 48 h. Four treatments were compared: (1) full-thickness CO 2 laser debridement followed by skin grafting; (2) full-thickness sharp surgical tangen...
Source
#1John S. GrahamH-Index: 18
#2Kevin T. Schomacker (Harvard University)H-Index: 33
Last. Katherine S. Squibb (UMB: University of Maryland, Baltimore)H-Index: 26
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Background/purpose: Sulphur mustard (SM) is a potent incapacitating chemical warfare agent that remains a threat to war fighters and civilians worldwide. SM lesions may require weeks or months to heal, depending upon their severity. This study was undertaken to find a treatment regimen that promotes speedier healing of deep cutaneous SM burns in a weanling pig model. The principal objective of the study was to compare four treatment regimens and establish which achieved the shortest healing time...
Source
#1D.G.K. Lam (SU: Salisbury University)H-Index: 1
#2Paul Rice (SU: Salisbury University)H-Index: 19
Last. R.F.R. Brown (SU: Salisbury University)H-Index: 9
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Lewisite (dichloro (2-chlorovinyl) arsine) was first synthesised in 1918 and its potential for use in military confrontations as a vesicant agent has been widely recognised. These agents cause blistering skin reactions with resultant full thickness burns. Effective treatments to date have been delayed by the lack of suitable animal models. Porcine skin has recently been used successfully to model the development and natural history of these burn injuries. A large white pig model (n = 6) was empl...
Source
#1Robert P. Chilcott (Defence Evaluation and Research Agency)H-Index: 23
#2R.F.R. Brown (Defence Evaluation and Research Agency)H-Index: 9
Last. P Rice (Defence Evaluation and Research Agency)H-Index: 2
view all 3 authors...
The severity and progression of skin lesions resulting from exposure to the chemical warfare agents Lewisite (L) and sulphur mustard (SM) have been investigated using the non-invasive biophysical methods of evaporimetry and reflectance spectroscopy in large white pigs in vivo. Erythema (redness) expressed immediately after exposure to L or SM vapours appeared to be related to the lesion severity as demonstrated by histopathological analysis. Skin brightness correlated well with scab formation wh...
Source
#1Paul Rice (SU: Salisbury University)H-Index: 19
#2R.F.R. Brown (SU: Salisbury University)H-Index: 9
Last. N.J Bennett (Salisbury District Hospital)H-Index: 3
view all 5 authors...
Since its first use on the battlefields of Northern France during the First World War (1914–1918), sulphur mustard has remained a significant chemical threat to military forces around the world. Progress towards an effective treatment for these injuries has been slow due to the lack of suitable animal models upon which to study the toxicology and pathology. However, porcine and human skin are similar in structure and exposures to sulphur mustard vapour have been performed on porcine models to de...
Source
#1Stephen J. CarterH-Index: 5
#2Brent K. StewartH-Index: 16
Abstract : The purpose of this project has been to develop a small hand-held self-contained battery powered diagnostic ultrasound (US) unit that would be highly transportable and relatively easy to use in the context of combat casualty care. The primary goal is to decrease the incidence of exsanguination on the battlefield secondary to intra-abdominal bleeding (hemoperitoneum) from blunt abdominal trauma (BAT). The scope includes telemedicine capability allowing remote diagnosis and direction as...
Cited By2
Newest
#1Jeffrey D. Laskin (RU: Rutgers University)H-Index: 71
#2Gabriella Wahler (RU: Rutgers University)H-Index: 1
Last. Laurie B. Joseph (RU: Rutgers University)H-Index: 13
view all 7 authors...
Abstract Sulfur mustard (SM), a dermal vesicant that has been used in chemical warfare, causes inflammation, edema and epidermal erosions depending on the dose and time following exposure. Herein, a minipig model was used to characterize wound healing following dermal exposure to SM. Saturated SM vapor caps were placed on the dorsal flanks of 3-month-old male Gottingen minipigs for 30 min. After 48 h the control and SM wounded sites were debrided daily for 7 days with wet to wet saline gauze soa...
Source
#1Gabriella Wahler (RU: Rutgers University)H-Index: 1
#2Diane E. Heck (NYMC: New York Medical College)H-Index: 4
Last. Laurie B. Joseph (RU: Rutgers University)H-Index: 13
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Abstract Nitrogen mustard (NM) is a highly reactive bifunctional alkylating agent that induces inflammation, edema and blistering in skin. An important mechanism mediating the action of NM and related mustards is oxidative stress. In these studies a modified murine patch-test model was used to analyze DNA damage and the antioxidant/stress response following NM exposure in isolated epidermis. NM (20 μmol) was applied to glass microfiber filters affixed to a shaved dorsal region of skin of CD-1 mi...
Source
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