EVALUATION OF AMNIOTIC MEMBRANE IN THE DRESSING OF SECOND-DEGREE BURN

EVALUATION OF AMNIOTIC MEMBRANE IN THE DRESSING OF SECOND-DEGREE BURN

¹ Srwa Rasul Ahmed   ²Atiya Kareem Mohammed* and ³Mezjda Ismail Mohammed Rashaan

1. Department of adult nursing, College of Nursing, University of Sulaimani, City of Sulaimani, Iraq;
2. Department of fundamentalsnursing, College of Nursing, University of Sulaimani, City of Sulaimani, Iraq.

Corresponding author: : should be addressed to Atiya Kareem Mohammed, Department of Maternal Neonatal Nursing, College of Nursing, University of Sulaimani, New Sulaimani, 46001, Sulaymaniyah, Iraq; E.mail: atiya.mohammed@univsul.edu.iq

ORCID

ABSTRACT

 Background:mniotic membrane dressing is the most effective for burn wounds. It was less

expensive and reduced the level of pain and duration of wound healing due to a burning wound.

Objectives To evaluate an Amniotic Membrane in the dressing of second-degree burn. the main objective of this study is to identify the Amniotic Membrane mention its medical advantages, and clarify the roles and benefits in the management and healing of different kinds, and degrees of burn wounds.

Methods

A quasi-experimental study was conducted at the Maternity Teaching Hospital in Sulaimaniyah/ Iraq. Participants were 101patients with 2nd-degree burns divided purposively divided into an experimental group that applied Physiological dressing with human amniotic membrane and a control group that followed traditional way or routine hospital care prospectively followed their wound pain level and the number of dressings for both groups, from 3rd April to the end of September 2022. Descriptive and inferential statistics were used for data analysis.

Result

The mean age of the burn case in the control group was 29.7 ± 20.7 years, while the mean age of the study group was 25.6 ± 17.3 years. The study group was composed of 39.6% female patients and 60.4% male patients. There was no significant difference between the two groups regarding gender. 34% of the study group were employed and 62.0% of the study group were housewives. The findings show that statistically significant variations are present between the groups regarding the pain score. There was a significant difference regarding the pain without a dressing change.

 Conclusion This quasi-experimental study found a significant effect of the Amniotic Membrane in the Dressing of Second Degree Burn To decrease the pain and healing duration.

Keywords: Burn, superficial Second-degree burn, Amniotic Membrane, wound care.

Received: 03 September 2021, Accepted: 15 December 2021, Available online: 20 January 2022

INTRODUCTION

METHODOLOGY

Study Design:

A quasi-experimental design was employed in this study to assess the effectiveness of amniotic membrane dressing on superficial second-degree burns. The patients were prospectively followed to monitor their wound healing progress.

Sampling Method:

A non-probability purposive sampling method was used to select the study participants. The experimental group, comprising 50 patients, received amniotic membrane dressing and was selected from the Emergency Hospital for Burn and Plastic Surgery. The control group, consisting of 51 patients, underwent traditional dressing and was matched closely to the experimental group in terms of age and other characteristic factors.

Inclusion Criteria:

Patients with superficial second-degree burns, both male and female, who visited the Suleimani Emergency Hospital for Burn and Plastic Surgery and were above 2 years old were included in the study.

Exclusion Criteria:

Patients with first-degree burns and third-degree or more severe burns, those below 2 years old, and individuals with medical conditions such as diabetes, immune diseases, or any blood disorders were excluded from the study.

Collection and Preparation of Amniotic Membrane:

Fresh human amniotic membrane was obtained from the placenta of healthy mothers at the time of delivery, specifically during cesarean sections. Donor mothers were preoperatively tested negative for HCV, HBV, and HIV. The amnion was carefully separated from the chorion and cleaned of blood by thorough washing with tap water. The amniotic membrane was then washed with 0.9% sodium chloride solution using aseptic procedures. Afterward, it was stored in a sterile container with 100cc of NaCl containing crystalline penicillin and Gentamycin in a refrigerator. Before usage, the amniotic membrane was tested for any contamination, and if found negative, it was stored in the refrigerator at 4°C for up to 15 days. If unused for 7 days, an additional 5 cc of the prepared NaCl and antibiotic solution was added to the container.

Data Collection and Assessment:

Patients were closely monitored from the start of their treatment until complete wound healing. Assessment of wound healing, pain severity, dressing change frequency, epithelialization rate, length of hospitalization, and other relevant information was documented using pen and paper checklists and charts. Pain severity was assessed using visual analog scales for children (1 day to 12 years old) and verbal rating scales or numerical rating scales for adult patients (12 years and older). The rate of wound healing (epithelialization) was evaluated through observation. Follow-up evaluations were conducted monthly for up to six months after complete healing.

Study Instruments:

The study utilized a checklist to collect demographic information (age, sex, level of education, occupation, height, weight, BMI, address, residence, and marital status) and assessed pain severity using visual analog scales for children and verbal or numerical rating scales for adults. Data on dressing change frequency, epithelialization rate, length of hospitalization, and severity of pain were collected through the checklist during and after hospitalization.

Data Analysis:

Descriptive and inferential statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 21. The significance of the tests was determined based on probability levels, with highly significant at p ≤ 0.001, significant at p ≤ 0.05, and not significant at p > 0.05.

Ethical Approval and Permissions:

The study was approved by both the scientific committees of the College of Nursing and ethical committees of the College of Medicine, University of Sulaimani. Additionally, permission to conduct the study was obtained from the Sulaimani Directorate of Health, and inquiries were made at Sulaimani Maternity Teaching Hospital and Sulaimani Emergency Hospital.

RESULTS

The study found that the average age of the burn case in the control group was 29.7 ± 20.7 years, while the average age of the study group was 25.6 ± 17.3 years. There was a significant difference in age between the two groups (P = 0.29). Additionally, the study found that more than half of the patients in the study group were female (32%) while more than half of the patients in the control group were male (29%). There was no significant difference between the groups regarding educational level (P = 0.47). The study found that more than half of the patients in the study group were students (38%) while more than half of the patients in the control group were unemployed (15.7%). Furthermore, more than half of the patients in the study group were housewives only (18%) while more than half of the patients in the control group were employed (23.5%). There was no significant difference between the groups regarding marital status (P = 0.04). As presented in Table (1).

Table (2) The study found that 82% of the study group was burned by scald and that there were no significant differences between the causes of burns between the two groups of the study. The majority of the study group, 52%, were burned at the lower limp site, which was significantly higher than the proportion, 35.3%, among the control group. Face (neck, head) and trunk burns were both represented at 11.8% of the study group, which was significantly higher than the proportion, of 4.6%, among the control group. However, there were no significant differences between the management of the patients in the control group and the study group.

shows that about half of the sample (59.4%) were dressings >_5 in the control group, while the lowest dressing (5.9%) of them were dressing between 1-5, in the control group compared with (76%) respectively of the patient of the study group. The number of Dressing changes (40.6%) is a correct percentage of those who have Daily dressing, while the lowest percentage (5.9%) was Twice a day. The findings show that statistically significant variations are present between the groups regarding the dressings change (P< 0.001).

shows that the majority of the study group (38%) was daily dressing, which was significantly higher than the proportion (5.9%) among the control group. According to the every second-day change dressing was significantly higher in the control group (49%), compared to the study group (24%). while the lowest percentage (5.9%) was Twice a day. The findings show that statistically significant variations are present between the groups regarding the pain score (P< 0.001), introduced by Table (3).

This table is about the pain score during the first dressing time in the Study participant in both groups (Amniotic group and Traditional group) during the dressing and without dressing. The highest proportion of the samples in both groups had Severe pain during dressing change 70.6% and 68% in the Traditional group compared to the Amniotic group. Mild pain has got the lowest proportion (2%) in the Traditional group, while 0% in the Amniotic group, no statistical differences have been found (P 0.31).

The highest proportion of the samples in both groups had Mild pain without dressing change 50.1% and 37.3% in the Amniotic group compared to the Traditional group, the Sever pain has got the lowest proportion (4.1%) in the Amniotic group, while 13.7% in the Traditional group. Significant differences were found between both groups (p=0.02). As presented in table (5).

The highest proportion of the samples in both groups had Severe pain without dressing change 58.8% and 24% in the Traditional group compared to the Amniotic group, the No pain has got the lowest proportion (1%) in the Amniotic group, while 0% in the Traditional group. The findings show that statistically significant variations are present between the groups regarding the pain score (P< 0.001). As presented in table (4). Of these, the pain score during the second dressing time in the Study participant in both groups (Amniotic group and Traditional group) during the dressing and without dressing. The highest proportion of the samples in both groups had Severe pain during dressing change 70.6% and 10.2% in the Traditional group compared to the Amniotic group. The No pain has got the lowest proportion (2%) in the Traditional group, while 28.6% in the Amniotic group. The findings show that statistically significant variations are present between the groups regarding the pain score (P< 0.001).

Table (1) Distribution of the study samples according to socio-demographic characteristics.

Table (2) Distribution of the study samples according to Cause and main site of Burn.

Table (3) Distribution of the study samples according to Dressing change

Table (4). Association between level of pain with the first dressing time among study groups.

  Table (5). Association between level of pain with the second dressing time among study groups.

DISCUSSION

In general, the present study evaluates the effect of the Amniotic Membrane in the Dressing of Second Degree Burn at Sulaimani Burn, Plastic and Reconstructive Surgery Hospital.

This study indicates no significant difference between the two groups regarding age, education, occupation, and marital status, among the experimental group, and the control group. In contrast, a significant distinction was observed regarding dressing change between the study group and a control group which means the experimental group and significant variations are present between the groups regarding the pain score (P< 0.001). significantly experienced decreased number of dressings and daily changes by the study group. While there was a difference at the edge of significance between both groups' pain in the first dressing change, significant difference in activity status between participants of both groups. Also, no difference was found regarding body mass index and main site of burn between the experimental group and control group.

like the study of Eskandarlou et al., (2016). This study was a clinical trial performed on 32 patients. individuals age range of 18-88 years were enrolled while 18 patients (56%) were male. The study results in contrast with the results of This cross-sectional study based on burn case reports (n = 1915) from eight emergency centres in Western Cape, South Africa (June 2012–May  2013). Children 0–4 years in urban areas had the highest burn incidence but only among adults did

male rates surpass females, with fire burns more common among men 20–39 years and hot liquid burns among men 55+ years. Men had a higher proportion of burns during weekends, from interpersonal violence and suspected use of alcohol/other substances (Blom et al., (2016). In addition, the study sample participants were contrasted by Ghalambor et al., (2000) Among 200 cases recruited for the study, (76%) were males and the remaining (24%) were females. The highest prevalence was in the age group below 10 years comprising 48% of all the cases, and 5% in the above 40-year-old group. In contrast with the present study findings, Salehi et al., (2015) A total of 42 patients were allocated in their randomized clinical trial research revealed that the most frequent sex of participants was moreover, 30 were male (71.43 %) and 12 were female (28.57 %). Mean ± SD age was 31.17 ± 13.72 years.

CONCLUSIONS

Amniotic membrane as an alternative dressing for burn wounds provides significant benefits by increasing patients' comfort by decreasing the pain sensation and improving the process of wound healing.

ETHICAL CONSIDERATIONS

The protocol of the study was presented and approved by both the scientific Committees of the College of Nursing and the ethical committees of the College of Medicine / University of Suleimani to Ethics. The protocol was reviewed by the ethics committee members and was approved.

• Approval was taken from the director of the Maternity Teaching Hospital and Suleimani Emergency Hospital for Burn and Plastic Surgery to use their help and cooperation.
• Verbal consent was obtained from all study participants. As well, the confidentiality of all personal information was guaranteed throughout the study to ensure the anonymity of the participants.

FUNDING
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.

AUTHOR’S CONTRIBUTIONS

Study concept; Writing the original draft; Data collection; Data analysis and reviewing the final edition by all authors.

DISCLOSURE STATEMENT:

This research study has no financial disclosures and no conflict of interest

ACKNOWLEDGEMENTS

We thank all Sulaimani Emergency Hospital for Burn and Plastic Surgery and Maternity Teaching Hospital staff in Sulaimaniyah city, Iraq, for their kind help and support for this study.

REFERENCES