Zulfadiazina De Plata En Quemaduras

376

Turkish Journal of Trauma & Emergency Surgery

Experimental Study Deneysel Çalışma

Ulus Travma Acil Cerrahi Derg 2012;18 (5):376-383

Comparison of topical zinc oxide and silver sulfadiazine in

burn wounds: an experimental study

Yanık yarası tedavisinde topikal çinko oksit ile

gümüş sülfadiazinin karşılaştırılması: Deneysel çalışma

Kemal ARSLAN,1 Ömer KARAHAN,1 Ahmet OKUŞ,1 Yaşar ÜNLÜ,2

Mehmet Ali ERYILMAZ,1 Serden AY,1 Barış SEVİNÇ1

Presented at the 8th Turkish Congress of Trauma and Emergency Surgery

(September 14-18, 2011, Antalya, Turkey).

Departments of 1General Surgery, 2Pathology,

Konya Training and Research Hospital, Konya, Turkey.

8. Ulusal Travma ve Acil Cerrahi Kongresi’nde sunulmuştur

(14-18 Eylül 2011, Antalya).

Konya Eğitim ve Araştırma Hastanesi, 1Genel Cerrahi Kliniği,

2Patoloji Bölümü, Konya.

Correspondence (İletişim): Kemal Arslan, M.D. Necip Fazıl Mah., Ateşbazı Sok., Meram Yeniyol, 42040 Meram, Konya, Turkey.

Tel: +90 - 332 - 323 67 09 e-mail (e-posta): arslanka74@hotmail.com

AMAÇ

Bu çalışmada, yanık yaralarında yaygın olarak kullanılan

çinko oksit ve gümüş sülfadiazinin tedavi etkileri karşılaştırıldı.

GEREÇ VE YÖNTEM

Yeni Zelanda cinsi 20 tavşanda pirinç propla yanık yarası

oluşturuldu. Tavşanlar rastgele iki gruba ayrıldı. Yanıklar

günlük uygulamayla birinci grupta çinko oksitle (Grup O),

ikinci grupta (Grup S) gümüş sülfadiazinle tedavi edildi.

Yara iyileşmesi klinik ve histopatolojik olarak takip edildi.

Yara ölçümleri yapıldı ve %50 ve %80 reepitelizasyona

ulaştığı günler belirlendi.

BULGULAR

Ortalama %50 ve %80 reepitelizasyona ulaşma süreleri

Grup O’da sırasıyla 21,4 ve 25,4 gün, Grup S’de 25,8 ve

30,2 gündü (p<0,001). Yara kolonizasyonu ise 1, 2, 3, 4, 5

ve 6. haftalarda ortalama olarak Grup O’da daha düşüktü.

Fark 2, 3, 4 ve 6. haftalarda anlamlı idi (p<0,001). Histopatolojik

değerlendirme sonucunda Grup O’da epidermis,

dermis ve skar dokusunun kalınlıkları sırasıyla 0,12, 3,80

ve 2,44 mm idi. Grup S’de ise 0,16, 4,76 ve 3,16 mm olarak

bulundu (p<0,001).

SONUÇ

Bu deneysel çalışmada, çinko oksit yanık tedavisinde epitelizasyon,

epidermis maturasyonu ve skar oluşumunda gümüş

sülfadiazinden daha etkili bulunmuştur.

Anahtar Sözcükler: Çinko oksit; gümüş sülfadiazin; parsiyel kalınlıktaki

yanık.

BACKGROUND

We aimed to compare the effects of topical zinc oxide and

topical silver sulfadiazine in the treatment of partial-thickness

burn wounds.

METHODS

The study was conducted with 20 New Zealand rabbits, and

burn wounds were created by a brass probe. The animals

were randomly divided into two groups. The burns were

treated with zinc oxide (Group O) or silver sulfadiazine

(Group S) with daily application. The wound healing process

was followed both clinically and histopathologically.

We determined the days at which 50% and 80% re-epithelization

was observed.

RESULTS

The mean time for 50% and 80% re-epithelization was 21.4

and 25.4 days in Group O and 25.8 and 30.2 days in Group

S, respectively (p<0.001). The mean score for wound colonization

was lower in Group O. The difference was statistically

significant at weeks 2, 3, 4, and 6 (p<0.001). In the

histopathological examination, the thicknesses of the epidermis,

dermis and scar tissue were 0.12 mm, 3.80 mm and

244 mm in Group O, and 0.16 mm, 4.76 mm and 3.16 mm

in Group S, respectively (p<0.001).

CONCLUSION

In this experimental burn study, zinc oxide was more effective

than silver sulfadiazine in terms of epithelization,

dermis maturation and scar formation.

Key Words: Zinc oxide; silver sulfadiazine; partial-thickness burn.

doi: 10.5505/tjtes.2012.45381

In the treatment of burns, the aim is to treat burns,

prevent infections and achieve the best functional and

aesthetic results in a shorter time with lower costs.

While healing burn wounds, a topical agent should

decrease the rates of mortality and morbidity by preventing

bacterial contamination and sepsis. The agent

should also be easily accessible. An ideal agent with

those properties has yet to be marketed. In the topical

treatment of burn wounds, 1% silver sulfadiazine

(SSD) pomade is the most commonly used agent

worldwide.[1] SSD has been shown to decrease bacterial

contamination, to hasten epithelization and to delay

wound contraction.[2-8] However, SSD is also known to

delay wound healing and separation of scar tissue, to

cause atrophic and hypertrophic scars, especially more

than three weeks after the applications, to have renal

toxicity, to cause leukopenia, and to carry a risk for

resistance.[9-19]

Zinc is an essential element for the human body,

and at the meeting of the World Union of Wound Healing

Societies in Paris in 2004, it was accepted as having

potential benefits in wound healing.[20] There are

studies showing the benefits of systemic and topical

use of zinc in wound healing. It is also reported that

zinc accelerates the wound healing process when applied

on open wounds.[21]

To our knowledge, no study exists in the literature

comparing the effects of local application of SSD and

oxide zinc ointment (OZO) in burn wounds. Therefore,

the present study was designed to compare the

effects of topical SSD and OZO in experimental partial-

thickness burns in rabbits.

MATERIALS AND METHODS

Study design

Permission was obtained from the ethical board

of Meram Medical School of Selçuk University. The

study was designed under the criteria of the Health

Guide for the Care and Use of Laboratory Animals

by the National Institutes of Health (NIH Publication

No: 86-23, Revised 1985 Bethesda). The research was

conducted at the Experimental Research Center of

Selçuk University. The weight of rabbits ranged from

3200-3600 g. The rabbits were accommodated in a

12/12 hour light and dark cycle at 22-26°C and fed

with a standard rabbit diet. As an analgesic, 100 mg/5

ml of ibuprofen was administered via drinking water

after the formation of burns. The rabbits were accommodated

individually and approached with appropriate

equipment to prevent contamination.

Before the study, punch biopsies as samples were

obtained from eight rabbits to determine the thicknesses

of normal epidermis and dermis. Mean values

obtained from these samples were accepted as normal

values.

Partial-thickness burns were formed in 20 adult

New Zealand rabbits. The rabbits were divided into

two groups. OZO 20% was used in Group 1 (Group

OZO), and SSD 1% was used in Group 2 (Group

SSD). The healing period was followed up clinically

and histopathologically.

Five parameters were used in the determination of

wound healing:

1. Days when 50% and 80% of re-epithelization

was observed.

2. The score for wound colonization.

3. The histopathologic thickness of the epidermis.

4. The histopathologic thickness of the dermis.

5. The histopathologic thickness of the scar issue.

Burn formation

Anesthesia was achieved by a single dose of intramuscular

6 mg/kg of xylazine hydrochloride (Rompun,

Bayer, 23.32 mg/ml) and 50 mg/kg of ketamine

hydrochloride (Ketalar, Parke-Davis, 50 mg/ml). The

back region of the rabbits was shaved and cleaned

with 10% of povidone-iodine solution (Kim-Pa, Poviiodeks,

10% povidone-iodine). A specially designed

brass probe with 10 cm² of surface area (2.5x4 cm diameter)

was used for the formation of burns (Fig. 1a).

Having been sterilized in boiling water for 5 minutes,

the probe was applied to the skin of anesthetized rabbits

for 15 seconds with no pressure. Using this procedure,

second-degree partial-thickness burns were

formed (Figs. 1b, c). After the formation of burns, all

the rabbits were placed and kept in individual cages.

Local treatment

Group O was treated with OZO and Group S with

SSD. OZO was formed with 20% zinc oxide and 80%

Vaseline. OZO can be found commercially as 20% of

Oxide de Zinc (ORO zinc cream, ORO drugs). SSD

was formed from 1% SSD and 99% paraben, and can

commercially be found as 1% Silvadiazin cream (Toprak

Drug Co.). According to our treatment protocol,

the drugs were administered as a thin layer on the

wounds once per day. Then, all wounds were protected

with non-stick cotton and sterile gauze with adhesive

elastic bandage (Setanet® No: 3) and changed on a

daily basis (Fig. 1d).

Assessment of wound healing

This study was continued for six weeks after the

formation of burns. Each

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