Topical treatment of burn wounds with chloroxidating solution and silver sulfadiazine: a comparative study


Mian, E.U.; Gianfaldoni, R.; Mian, M.

Drugs under Experimental and Clinical Research 17(4): 243-252

1991


The present paper reports the results of clinical and laboratory tests carried out on two homogeneous groups of ten burn patients subjected to local therapy, either with isotonic chloroxidating solution Amuchina* or with 1% silver sulfadiazine cream at the Burns Centre of the Pisa University Dermatological Clinic. The local systemic behaviour of the patients examined was evaluated for the containment of septic complications at the burn site. In the group subjected to treatment with chloroxidating solution, septis appeared to have a lower incidence in the evolution of dermatitis in the phase of escharolysis, in the formation of granulation tissue, and in the attachment of cutaneous grafts. The systemic involvement (temperature curve, etc.) appeared to be more marked for some patients treated with silver sulfadiazine in response to septic aggression of the burn wounds. On the basis of data referring to the development of the wound granulation and the temperature curve, as well as the microbial presence and the subjective tolerance of the medication, the comparison was favourable, making all necessary allowances, to topical treatment with electrolytic chloroxidating solution; other comparative data were at the limit of significance.

DRUGS
EXPTL.
OLIN.
RES.
XVII(4)
243
252
(1991)
TOPICAL
TREATMENT
OF
BURN
WOUNDS
WITH
CHLOROXIDATING
SOLUTION
AND
SILVER
SULFADIAZINE:
A
COMPARATIVE
STUDY
MIAN
E.U.,
GIANFALDONI
R.,
MIAN
M.
Dermatological
Clinic
of
the
University
of
Pisa,
Pisa,
Italy.
Summary:
The
present
paper
reports
the
results
of
clinical
and
laboratory
tests
carried
out
on
two
homogeneous
groups
of
ten
burn
patients
subjected
to
local
therapy,
either
with
isotonic
chloroxidating
solution
Amuchina*
or
with
1%
silver
sulfadiazine
cream
at
the
Burns
Centre
of
the
Pisa
University
Dermatological
Clinic.
The
local
systemic
behaviour
of
the
patients
examined
was
evaluated
for
the
containment
of
septic
complications
at
the
burn
site.
In
the
group
subjected
to
treatment
with
chloroxidating
solution,
sepsis
appeared
to
have
a
lower
incidence
in
the
evolution
of
dermatitis
in
the
phase
of
escharolysis,
in
the
formation
of
granulation
tissue,
and
in
the
attachment
of
cutaneous
grafts.
The
systemic
involvement
(temperature
curve,
etc.)
appeared
to
be
more
marked
for
some
patients
treated
with
silver
sulfadiazine
in
response
to
septic
aggression
of
the
burn
wounds.
On
the
basis
of
data
referring
to
the
development
of
the
wound
granulation
and
the
temperature
curve,
as
well
as
the
microbial
presence
and
the
subjective
tolerance
of
the
medication,
the
comparison
was
favourable,
making
all
necessary
allowances,
to
topical
treatment
with
electrolytic
chloroxidating
solution;
other
comparative
data
were
at
the
limit
of
significance.
Introduction
Topical
burn
treatment
is
a
still
unresolved
and
debated
problem.
Among
the
assumptions
of
topical
burn
therapy,
a
primary
role
is
attributed
to
control
of
microbial
contamination
at
and
around
the
burned
site
(1).
Several
factors
render
microbial
control
a
delicate
practice:
The
actual
efficacy
of
the
antimicrobial
agent
in
controlling
the
microbial
flora,
which
are
multiple,
opportunistic,
selected
and
potentially
resistant
to
'
Manufactured
by
Amuchina
SpA,
Genoa,
Italy.
0378-6501/91/4/00341
+
10
$02.00/0
the
action
of
the
antiseptic
agents.
The
uncertain
bioavailability
of
the
topical
anti-
septic
agents,
which
must
act
on
an
irregular
and
unfavourable
field
(necrotic
layers,
irroration
defects,
contaminations).
The
high
absorption
potential
of
the
burned
area,
which
may
limit
the
use
of
possibly
toxic
topical
antiseptics.
The
sensitivity
of
the
burn
site
(necrotic,
phlogistic
or
regenerative)
to
the
irritative
and
"his-
tophobic"
action
of
the
topical
antiseptics
and,
conversely,
the
ability
of
the
antiseptics
to
exert
their
action
while
respecting
the
burned
tissue
in
both
its
morphological
and
functional
aspects
(the
principle
of
"histophilia")
(2,
3).
©
1991
Bioscience
Ediprint
Inc.
243
Mian
E.U.,
Gianfaldoni
R.,
Mian
M.
244
Due
to
the
introduction
of
increasing
numbers
of
new
therapeutic
proposals,
topical
antimicrobial
therapy
is
continuously
changing.
Among
the
more
recently
proposed
agents,
the
following
should
be
mentioned:
gentamicin
(3,
4),
silver
nitrate,
mafenide
acetate
(5,
6),
chlorhexidine
(7-9,
11),
povidone
iodine
preparations
(10,
11,
13),
tobra-
mycin
(4,
12)
and
silver
sulfadiazine
(11,
15,
16).
The
therapeutic
effectiveness
of
such
agents
is
generally
evaluated
in
uncontrolled
trials.
The
aim
of
the
present
study
was
to
assess
the
therapeutic
efficacy
of
the
topical
isotonic
chloroxi-
dating
therapy
(traditionally
proposed
by
the
authors'
study
group)
(1,
2)
in
comparison
with
a
standard
treatment
with
silver
sulfadiazine,
which
is
generally
recognized
as
effective
at
the
inter-
national
level.
Materials
and
methods
The
present
study
was
carried
out
on
patients
admitted
to
the
Burns
Centre
of
the
Pisa
University
Dermatological
Clinic.
The
Clinic
possesses
air
filtering
and
air
conditioning,
with
a
temperature
which
is
maintained
at
30-32°C,
and
a
humidity
between
30%
and
50%.
The
entire
quantity
of
air
is
changed
5-10
times
every
hour,
depending
on
the
need.
The
study
included
twenty
patients,
ten
of
whom
were
treated
with
chloroxidating
solution
(Amuchina
5-10%)
and
the
other
ten
with
micronized
silver
sulfadiazine
in
a
creamy
excipient.
Treatment
with
Amuchina
was
carried
out
by
means
of
the
appli-
cation
of
compresses
with
a
5%
isotonic
solution,
changed
every
8
h,
and
balneotherapy
by
immer-
sion,
in
an
isotonic
chloroxidating
solution
for
1
h,
of
the
whole
body
or
of
the
single
segments
affected
by
burns,
at
intervals
of
2
—3
days.
Treatment
with
micronized
silver
sulfadiazine
was
carried
out
by
means
of
the
application
of
the
cream
preparation
containing
the
active
principle
at
a
concentration
of
1%
on
the
burned
skin
every
12
h,
with
subsequent
protection
from
the
external
environment
by
means
of
dry
sterilised
gauzes.
Before
each
application,
the
residual
cream
was
eliminated
by
means
of
physiological
solution.
The
experimental
protocol
included
the
following
evaluations
of
sepsis:
"
general
or
local
signs:
VES
haemochromocytometric
test
temperature
curve
immunological
screening
sensory
test
*
pathological
signs:
tumour
rubor
calo7
septic
pigmentation
other
septic
lesions
hydroelectrolytic
and
metabolic
equilibrium
*
clinical
course:
general
and
local
complications
*
re-epithelization
index
*
escharolysis,
granulation,
attachment
of
auto-grafts
*
microbiological
tests:
culture
bacterial
identification
bacterial
count
antibiogram
outcome
(consequences)
"
subjective
evaluation
While
the
evaluation
of
certain
parameters
was
carried
out
routinely
every
day
or
even
several
times
a
day
(temperature
curve;
hydroelectrolytic
homeostasis;
renal
function,
hepatic
function,
etc.)
the
clinical
evaluations
were
constantly
updated.
The
microbiological
data
were
based
on
cutaneous
swabs
taken
at
the
burn
site
and/or
that
of
sus-
pected
lesion,
by
rubbing
the
swab
over
a
fixed
area
of
about
1
cm
2
(microbial
count
standar-
dization)
on
day
2,
and
subsequently
on
days
7
and
14
and
after
one
month.
Further
tests
were
carried
out
subsequently
at
15-day
intervals,
if
the
conditions
of
the
patient
and
of
the
lesion
so
Chloroxidating
solution
vs.
silver
sulfadiazine
for
burn
treatment
required.
General
therapy
was
carried
out
in
accordance
with
the
usual
guidelines
for
the
treatment
of
burns:
fluid
therapy
in
cases
of
shock,
gastroprotective
drugs,
polyvitaminic
complexes,
and
thrombo-
embolic
prevention.
Antibiotic
therapy
was
not
carried
out
for
small-extension
burns,
whereas
an
antibiotic
prophylaxis
with
cephalosporins
was
followed
for
patients
at
greater
risk,
in
both
study
groups.
A
specifically
chosen
antibiotic
therapy
was
administered
only
when
clear
signs
of
a
generalized
septic
involvement
were
indicated
by
the
microbiological
data.
In
order
to
avoid
influen-
cing
the
results
of
the
study,
all
forms
of
immuno-
therapy
were
excluded,
whether
active
or
passive,
with
the
exception
of
antitetanic
seroprophylaxis.
Patients
The
patients
subjected
to
the
two
local
therapies
were
divided
into
two
separate
groups.
Both
groups
were
sufficiently
homogeneous
as
regards
type
of
burn,
age,
sex
and
clinical
characteristics.
The
patients
were
affected
by
total
or
partial
thickness
burns
with
a
relatively
limited
extension,
in
view
of
the
nature
of
the
present
study
(Tables
I
and
II).
The
patients
selected
were
not
to
have
an
anamnesis
of
any
particular
pre-existing
morbidity,
in
general
or
of
any
organ,
or
metabolic
conditions
which
in
any
way
might
influence
the
results
of
the
study.
Those
burn
patients
were
also
excluded
who
came
from
other
institutes
and
had
not
had
correct
treatment
during
the
First
Aid
phase.
Results
Group
treated
with
chloroxidating
solution
No
particular
cases
of
hydroelectrolytic
or
meta-
bolic
disequilibrium,
or
of
other
complications,
in
general
or
in
any
particular
organ,
were
found
during
hospitalization.
A
complete
restitution
ad
integrum
spontanea
was
obtained
with
granu-
lation
tissue
in
five
patients;
in
one
case
(patient
no.
3),
the
exuberant
granulation
required
a
re-
duction
of
the
chloroxidating
solution
concentration
(2.5%),
in
order
to
limit
the
proliferative
tendency.
For
the
other
four
patients
with
full
thickness
burns
in
particular
positions
(face
and
limb
articulation),
the
granulation
tissue
was
covered
by
means
of
cutaneous
auto-grafts
during
the
fourth
week
(after
a
mean
of
30
days),
with
an
optimal
attachment.
The
signs
of
general
involvement
of
the
organism
included
an
increase
in
VES,
leukocytosis,
an
in-
crease
in
body
temperature,
and
humoral
and
cellular
indexes
of
immune
deficit,
which
were
found
to
a
significant
extent
for
patients
6,
7,
8
and
9,
who
presented
more
extensive
burns
caused
by
alcohol,
and
thus
generally
full
thickness.
In
the
case
of
patient
no.
4,
there
was
a
rise
in
body
temperature
(38.5-39.5)
from
the
beginning
of
hospitalization.
This
continued
until
the
detachment
of
the
eschar,
which
was
favoured
by
daily
balneotherapy
and
removal
of
the
compresses
every
4
h.
No
particular
systemic
involvement
was
noted
in
the
case
of
patient
10,
whose
burns,
while
covering
20%
of
the
body
surface,
had
been
caused
by
gas
and
were
thus
mainly
of
intermediate
depth.
No
local
signs
of
infection
of
wounds
were
noted
clinically
in
patients
with
less
extensive
burns;
in
the
cases
of
patients
6,
7
and
10,
on
the
contrary,
a
bluish-green
exudation
with
a
peculiar
smell
appeared,
which
is
characteristic
of
Pseudomonas
aeruginosa
infection.
Continual
humid
medication
was
interrupted
for
these
patients,
with
limitation
of
the
compress
to
the
daytime
(physiokinesis,
etc.),
and
an
exposed
medication
during
the
night.
Patient
no.
8
exhibited
a
satisfactory
course
with
rapid
granulation,
and
subsequent
repair
with
auto-
grafts;
however,
when
the
patient
had
almost
reached
the
phase
of
discharge,
some
temporary
pustulous,
erosive
lesions
appeared,
which
were
245
Antibody
prophylaxis
Auto-grafts
Latency
(days)
Period
of
hospitalization
(days)
no
none
15
no
1
auto-graft
28
45
no
none
14
no
none
24
no
none
27
no
1
auto-graft
26
57
no
1
auto-graft
30
55
yes
1
auto-graft
33
44
yes
2
auto-grafts
30
68
yes
none
53
29.40
40.20
.01
ue0,
1
"H
!
u
oPl
ei
uu!
O
"f
T3
u
e!Vg
Sites
right
upper
limb
left
leg
left
upper
limb,
trunk
chest,
face
upper
limbs,
face
face,
neck,
limbs
face,
chest
chest,
upper
limbs,
thighs
widespread
lower
limbs.
left
upper
limb
Table
I
Group
treated
with
chloroxidating
solution'
%
Body
surface
No.
Name
Sex
Age
Cause
Degree
Total
II
III
1
M.O.
M
25
sulfuric
acid
1
4
5
2
A.F
M
12
steam
0
8
8
3
P.P.
Ni
42
water
7
1
8
4
C.M.
Ni
3.5
water
7
3
10
5
D.I.M
M
40
gas
7
6
13
6
C.F
F
14
alcohol
3
15
18
7
C.V.
F
47
alcohol
5
15
20
8
B.F.
F
34
alcohol
20
13
33
9
M.F.
F
38
alcohol
20
30
50
10
D.G.O.
M
65
gas
10
10
20
Mean
values
32.05
8
10.50
18.50
This
group
included
ten
patients
between
3
1
/
2
and
65
years
of
age
(mean
age
32
years)
with
second
and
third
degree
burns
extending
over
5%-50%
of
the
body
surface.
and
mainly
involving
the
upper
limbs
and
the
face.
The
causes
included
alcohol
(40%).
water
(20%).
gas
(20%)
and
chemical
substances
and
steam
(boraciferous
tumaroles).
As
regards
the
clinical
course,
all
patients
recovered:
five
due
to
spontaneous
re-epithelization,
and
the
other
five
after
an
operation
of
cutaneous
auto-graft,
at
mean
time
of
30
days
after
the
burn
episode.
Wide-spectrum
antibiotic
prophylaxis
was
carried
out
for
patients
8
and
9
from
the
beginning
of
hospitalization.
The
period
of
hospitalization
varied
from
14
to
68
days.
Table
II
Group
treated
with
silver
sulladiazinea.
No.
Name
Sex
Age
Cause
%
Body
surface
Degree
Total
II
III
1
C.G.
F
34
water
0
5
5
2
B.S.
M
20
alcohol
2
4
6
3
P.P.
F
34
water
8
2
10
4
M.M.
M
40
contact
with
a
press
2
10
12
5
C.F.
M
2.5
soup
15
0
15
6
P.M.
M
74
alcohol
10
10
20
7
M.A.
M
35
flames
20
18
38
8
J.S.V.
M
12
alcohol
5
20
25
9
C.V
M
25
hexane
5
20
25
10
G
M
M
45
flames
7
25
32
Mean
values
32.15
7.40
11.40
18.80
Chl
or
o
xi
d
ati
n
g
sol
uti
on
vs
.
sil
ver
s
ulf
adi
a
zi
n
e
f
or
b
urn
t
r
eat
m
ent
Sites
Antibody
Auto-grafts
Latency
Period
of
prophylaxis
(days)
hospitalization
(days)
right
thigh
no
none
15
hands,
face
no
none
45
trunk,
left
thigh
no
none
14
left
upper
limb
no
2
auto-grafts
70
24
lower
limbs
no
none
27
upper
limbs,
face
yes
none
57
chest,
upper
limbs,
face
yes
1
auto-graft
32
55
thighs,
left
forearm
no
1
auto-graft
32
44
lower
limbs,
hands
no
2
auto-grafts
48
68
trunk,
upper
limbs
yes
2
auto-grafts
29
53
42.20 42.80
a
This
group
included
ten
patients
whose
age
varied
from
2
1
/
2
to
74
years,
with
burns
extending
over
5%-38%
of
the
body
surface,
mainly
involving
the
limbs.
The
main
causes
were
again
alcohol
and
water,
followed
by
flames,
chemical
substances,
gas,
steam,
soup,
and
contact
with
a
press
with
hot
plates.
Six
patients
were
subjected
to
a
surgical
operation
for
cutaneous
auto-grafts
after
a
mean
period
of
34
days
from
the
burn
episode,
in
the
cases
of
patients
7,
8,
9
and
10.
A
longer
period
was
necessary
for
patient
4,
who
presented
a
full
thickness
burn
on
the
left
upper
limb,
requiring
two
operations
of
escharectomy.
The
periods
of
hospitalization
varied
from
16
to
83
days.
Chloroxidating
solution
vs.
silver
sulfadiazine
for
burn
treatment
indicative
of
staphylococcus
infection.
The
microbiological
tests
(Table
Ill)
carried
out
by
means
of
culture
of
material
gathered
with
surface
swabs
over
standardized
extensions
revealed
an
absence
of
microbial
development
in
the
samples
taken
on
the
second
day,
for
all
patients.
On
the
seventh
day,
the
presence
of
Pseudomonas
aeruginosa
was
detected
in
patients
6,
7
and
10,
with
a
microbial
count,
respectively,
of
280000,
350
000
and
260
000
micr./ml.
In
the
case
of
patient
no.
6,
the
presence
was
also
found
of
Staphylococcus
aureus
(40%)
and
Enterobacter
aerogenes
(20%),
as
well
as
Pseudomonas.
On
the
fourteenth
day,
a
reduction
in
the
microbial
count
was
detected
in
all
three
patients
to
values
between
120
000
and
150
000
micr./ml,
due,
once
again,
to
the
presence
of
Pseudomonas
aeruginosa.
At
the
control
after
30
days,
all
samples
were
negative
except
for
patient
no.
8,
due
to
the
appearance
of
colonies
of
Staph.
aureus
on
the
eroded
areas
mentioned
above,
with
a
microbial
count
of
320
000
micr./ml.
While
no
excessive
disturbances
to
repair
were
noted
for
wounds
infected
by
Pseudomonas
aeruginosa,
which
appears
to
live
in
harmony
with
progressive
re-epithelization,
staphylococcus
in-
fection
not
only
severely
hinders
repair,
but
also
undermines
the
integrity
of
the
healthy
or
repaired
skin
layer.
In
the
case
observed,
the
authors
added
a
spe-
cifically
chosen
systemic
antibiotic
treatment
to
the
emergency
topical
treatment
already
mentioned,
following
the
indications
of
the
antibiogram,
until
the
late
complication
was
solved.
In
the
case
of
patient
no.
9,
affected
by
extensive
burns
(50%),
local
chloroxidating
therapy
was
limited
to
the
limbs
and
to
the
face,
whereas
in
other
cases
exposed
medication
was
preferred;
of
course,
this
patient,
too,
was
subjected
to
isotonic
chloroxidating
balneotherapy
at
an
almost
daily
frequency.
From
the
subjective
point
of
view,
a
pleasant
sense
of
relief
was
reported
by
patients
on
the
application
of
the
compress
or
on
immersion
into
the
bath,
and
these
measures
may
be
taken
in
order
to
soothe
pain
on
burnt
tissue,
and
to
obtain
an
undoubted
advantage
in
softening
the
crusty
lesions
or
newly-formed
dry
skin,
which
hinder
the
rehabilitative
physiotherapeutic
measures
that
are
adopted
from
the
beginning
of
hospitalization.
Group
treated
with
silver
sulfadiazine
Patients
4,
5,
6,
7
and
10
exhibited
a
significant
deviation
of
the
parameters
of
VES,
leukocytosis,
rise
in
temperature,
and
humoral
immune
deficit,
especially
during
the
second
week
after
the
burn
episode.
Patient
6
also
experienced
hallucinatory
psychic
phenomena
with
prompted
treatment
with
psycho-drugs.
Brick-red
pigmentation,
caused
by
infection
by
a
virulent
strain
of
Ps.
aeruginosa,
was
observed
in
the
first
week
for
patients
4
and
6,
with
signs
of
oedema
and
phlogistic
reddening
at
the
peri-
lesional
site.
In
the
cases
of
patients
7
and
10,
a
bluish-green
exudate
was
observed,
mixed
with
the
topical
preparation.
In
patient
no.
5,
a
child
2
1
/
2
years
of
age,
there
was
a
high
rise
in
temperature,
in
spite
of
the
absence
of
any
cutaneous
clinical
signs
indicating
septic
involvement.
The
high
temperature
gradually
descended
with
the
detachment
of
the
eschar
and
progressive
re-epithelization.
After
microbiological
confirmation,
patients
4
and
7
received
a
specifically
chosen
antibiotic
therapy,
and,
locally,
thorough
washing
with
disinfectant
soap,
suitable
antibiotics
(antibiog
ram),
and
exposed
medication.
No
particular
hydroelectrolytic
or
metabolic
dis-
equilibrium
was
observed
in
this
group,
apart
from
what
was
to
be
expected
for
the
type
of
burn.
In
cases
4,
6,
7
and
10,
the
burn
wound
presented
a
slow
lysis
of
the
eschar,
and
a
nonhomogeneous
proliferation
of
granulation
tissue.
At
certain
points
of
the
burn
areas
of
patients
4.
6
and
9,
phenomena
of
deepening
were
also
observed,
with
a
"passage
249
Mian
E.U.,
Gianfaldoni
R.,
Mian
M.
250
of
degree",
and
the
formation
of
marble-coloured,
torpid
wound
residues.
The
microbiological
tests
(Table
IV),
which
were
negative
on
the
second
day,
revealed
the
presence
on
the
fourth
day,
for
patient
no.
4,
of
a
microbial
count
of
380
000
micr./m1
of
a
mixed
flora,
com-
posed
of
Acinetobacter
calcoaceticus,
Staph.
aureus
and
Ps.
aeruginosa.
The
control
carried
out
on
the
fourteenth
day,
after
the
measures
described
above,
revealed
the
absence
of
microbial
develop-
ment.
In
patient
no.
6,
the
microbial
count
on
the
seventh
day
was
460
000
micr./ml,
comprised
of
Ps.
aeruginosa.
On
the
fourteenth
day,
the
microbial
count
had
decreased
to
340
000
mics./ml,
this
time
composed
of
Proteus
rettgeri,
and
at
the
control
after
one
month,
the
development
of
colonies
of
Staph.
aureus
was
observed,
with
a
count
of
320
000
micr./ml.
The
control
after
45
days
was
negative.
The
patient
made
a
full,
spontaneous
recovery
after
one
month
of
hospitalization
and
two
months
of
out-patient
treatment.
Patient
no.
7
exhibited
the
development,
on
the
seventh
day,
of
Ps.
aeruginosa
and
Staph.
aureus,
with
a
count
of
520
000
micr./ml.
A
count
of
220
000
micr./ml
of
Staph.
aureus
was
found
on
the
fourteenth
day.
Healing
was
obtained
by
means
of
cutaneous
auto-grafts.
In
the
case
of
patient
no.
10,
Staph.
aureus
was
found
on
the
seventh
and
the
fourteenth
days,
with
a
microbial
count
which
remained
at
--300000-
350
000
micr./ml.
The
control
suddenly
became
negative
after
one
month
of
thorough
daily
washing
and
treatment
with
cloramfenicol
powder.
A
cutaneous
auto-graft
followed,
without
any
immediate
particular
cicatricial
consequences,
in
spite
of
the
protracted
septic
complication.
General
remarks:
no
objective
signs
of
either
local
or
general
intolerance
were
noted.
Patients
1
and
2
reported
a
light
burning
sensation
as
soon
as
the
cream
was
applied,
particularly
during
the
first
few
medications.
Almost
all
patients
reported
pain
when
detersion
of
burns
was
carried
out
with
gauzes
soaked
in
physiological
solution
in
order
to
remove
the
cream
previously
applied.
Conclusions
It
is
always
difficult
to
draw
conclusions
on
the
subject
of
burns,
especially
in
a
comparative
test.
The
numbers
of
patients
are
usually
limited,
and
the
homogeneity
of
study
groups
can
never
be
perfect.
A
similar
nosotogical
entity,
such
as
for
example
a
burn
extending
over
10%
of
the
body
surface,
has
its
own
individual
characteristics
depending
on
the
noxa
pathogena,
the
environment
in
which
this
noxa
had
its
effect,
the
adequacy
of
First
Aid
measures,
and
the
variables
linked
with
the
type
of
patient
(age,
previous
illnesses,
etc.).
An
attempt
was
made
in
the
present
study
to
put
together
patients
who
were
similar
not
only
in
the
degree
and
extension
of
the
burn,
but
also
in
their
an-
amnestic
and
clinical
data.
It
may
be
observed,
by
way
of
comparison,
that
as
regards
the
infection
of
the
burn
wound,
patients
treated
with
chloroxidating
solution
revealed
only
one
case
of
late
infection
from
Staph.
aureus,
while
the
wounds
infected
by
Ps.
aeruginosa
(three
out
of
ten)
healed
without
any
apparent
damage
either
in
general
or
locally
in
the
evolution
of
the
burn.
Among
patients
treated
with
silver
sulfadiazine,
the
cases
of
sepsis
not
contained
amounted
to
five,
with
a
delay
in
the
evolution
of
dermatitis,
and,
sometimes,
a
passage
of
degree
due
to
the
deepening
of
the
wound.
Granulation
was
found
to
be
quite
satisfactory,
and
sometimes
even
exuberant
in
burns
treated
with
chloroxidating
solution;
it
was
only
just
satis-
factory
for
the
group
treated
with
silver
sulfadiazine,
except
for
the
cases
mentioned,
in
which
the
whole
process
of
repair
(escharolysis,
granulation
and
cutaneous
auto-grafts)
was
significantly
delayed.
The
attachment
of
cutaneous
grafts
was
found
to
be
favourable;
the
cicatricial
consequences
cannot
be
clearly
evaluated
yet.
As
regards
the
form
of
medication and
other
techniques,
the
use
of
cream
Chloroxidating
solution
vs.
silver
sulfadiazine
for
burn
treatment
Table
V
Temperature
r'C)
of
burn
patients
with
different
treatments.
Day
No.
Name
3
7
14
21
28
Mean
Patients
treated
with
chloroxidating
solution
4
C.M.
39.20
39
38.20
37.90
37.60
38.38
6
C.R.
38.20
38.70
38.60
37.80
37.40
38.14
7
C.V.
38.30
38.90
38.60
38
37.60
38.28
8
B.F.
38.20
38.30
38
37.60
37.20
37.86
9
M.F
38.30
38.60
38.40
37.40
37.50
38.04
Chloroxidating
mean
temp.
38.44
38.70
38.36
37.74
37.46
38.14
Patients
treated
with
silver
sulfadiazine
4
M.M.
38
38.60
38.20
38.40
37.80
38.40
5
C.F.
40.10
39.30
38.40
38
37
60
38.68
6
P.M.
37.80
38.80
39.60
39
38.10
38.66
7
M.A.
38.20 38.40
38.90
39.60
37.40
38.30
10
G.M.
38
38.70
38.40
38.20
37.70
38.40
Silver
sulfadiazine
mean
temp.
38.42
38.76
39.10
38.44
37.72
38.49
was
found
to
be
more
complicated,
as
it
always
had
to
be
preceded
by
the
inevitable
removal
of
the
previous
medication,
and
accompanied
by
deter-
sion
of
each
subsequent
application.
From
the
subjective
point
of
view,
apart
from
the
usual
pain
of
the
wounds,
it
should
be
pointed
out
that
a
certain
sensation
of
burning
was
reported
immedi-
ately
after
the
application
of
the
cream
preparation.
Among
the
laboratory
data,
the
immune
indexes
confirmed
the
usual
tendency
to
an
acquired
immune
deficiency
in
the
more
compromised
patients,
although
no
significant
differences
were
found
between
the
two
study
groups.
The
behaviour
of
the
temperature
curve,
on
the
other
hand,
should
be
pointed
out
in
those
patients
who
had
shown
a
particular
systemic
involvement
in
response
to
phenomena
of
septic
infection
of
the
burns.
As
can
be
seen
from
Table
V
and
from
Fig.
1
comparing
the
mean
values
of
the
temperature
referring
to
the
most
significant
days,
the
two
curves
show
different
behaviour
for
the
two
local
treatments
39.25
-
39-
,
38.75
-
38.5
-
38.25
38
1
37.75
-I
37.5
-1
37.25
Days
3
7
14
21
28
Fig.
1
Temperature
curve.
(Ii)
silver
sulfadiazine.
(.)
chloroxidating
solution.
examined,
with
lower
values
for
the
chloroxidating
solution.
It
is
not
simple
to
draw
conclusions
from
this
brief
study.
The
present
paper
reports
the
most
apparent
clinical
and
laboratory
impressions,
which
may
or
may
not
be
confirmed
by
further
studies
on
larger
251
Mian
E.U.,
Gianfaldoni
R.,
Mian
M.
numbers
of
patients.
Making
all
necessary
allow-
ances,
however,
it
is
possible
on
the
basis
of
the
present
comparison
carried
out
on
correctly
homologous
series
of
patients,
to
draw
a
conclusion
in
favour
of
histophilic
topical
treatment
with
chloroxidating
solution,
on
the
basis
of
data
refer-
ring
to
the
course
of
granulation,
a
comparison
of
the
temperature
curves,
microbial
presence,
and
subjective
tolerance
of
the
medication;
the
other
comparative
data
are
at
the
limit
of
significance.
The
lasting
impression
is
that
of
the
difficulty
of
treating
burns,
which,
starting
from
the
laesa
eudermia,
involves
the
organism
in
all
its
functions,
which
in
burns
affect
the
evolution
of
dermatitis
in
the
containment
of
sepsis
and
in
promoting
repair.
It
is
thus
confirmed
that
an
appropriate
topical
treatment
must
not
only
possess
a
valid
antiseptic
efficacy,
but
also
serve
a
histophilic
purpose,
so
as
not
to
add
further
damage
to
a
tissue
and
an
organism
already
seriously
stressed,
thus
nul-
lifying
the
antiseptic
properties
of
the
drug
itself.
References
(1)
Mian
E.U.
"La
malattia
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ustione."
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Un
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C.F.
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A.R.,
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W.R.,
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D.A.,
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L.M.,
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