Polylactic Acid Membrane for the Treatment of Pediatric Burn Injuries: An Adoptable Practice to Improve Burn Management.

Abstract

Background: Polylactic acid membrane (PLAM) is a one-time application alloplastic skin substitute that has been utilized as an adjunct for pediatric burns for a multitude of indications. Literature has established its utility in mixed superficial and deep dermal burns, with advantages related to decreased need for procedures requiring general anesthesia and decreased overall healthcare cost (Eur Burn J 2021;3(1):1-9). Additionally, its application has been comparable in wound healing outcomes to established standard of care practices (Burns 2023;49(7):1585-1591, Wound Repair Regen 2006;14(3):321-4). Our study analyzes the impact of integrating PLAM into pediatric burn management at a single burn center. We hypothesize that the integration of PLAM into our practice would result in improved outcomes related to wound care needs, surgical efficiency, hospital length of stay, and overall wound healing.

Methods: We conducted a retrospective study of all pediatric (<18 years of age) patients with second- and third-degree burns treated at a single American Burn Association (ABA)-verified pediatric burn center from December 2019 to April 2024. All burn etiologies were included, and isolated first-degree burns were excluded. Our retrospective cohort was separated into two distinct treatment periods (pretherapy Era 1 and posttherapy Era 2) based on time before and after the introduction of PLAM at our institution (March 1, 2022). Data on patient demographics, burn characteristics, hospitalization treatments, operative details, surgical outcomes, and time to wound healing were analyzed.

Results: A total of 331 pediatric patients met the inclusion criteria. A total of 155 patients were included in our pretherapy Era 1 and 176 patients in our posttherapy Era 2. The average age was 5.6 years old, and the majority of patients were male (62.2%) and White (55.0%). Baseline characteristics between our two cohorts were comparable across age, gender, race, ethnicity, BMI, mechanism of burn, and total body surface area (TBSA) burned. The need for sedated burn care significantly decreased after the introduction of PLAM (72.9% vs 59.4%, P = 0.010), and the average number of days of sedation decreased as well (3.7 vs 2.1 days, P < 0.001). Forty-one percent of all patients underwent surgical intervention for their burns with a significant increase in the number of patients receiving surgery in the posttherapy era (32.9% vs 48.3%, P < 0.001). Additionally, time from burn to surgery shortened in Era 2 (9.1 vs 7.2 days, P < 0.001). There was a statistically significant reduction in median procedure time in Era 2 (26 vs 13 minutes, P < 0.001). Finally, we observed significant reductions in median length of hospital stay (5 vs 4 days, P = 0.004), postoperative length of stay (1 vs 0 days, P = 0.017), the need for sedated postoperative dressing changes (54.9% vs 18.8%, P < 0.001), and need for home nursing visits (51.0% vs 17.1%, P < 0.001) in Era 2.

Conclusions: The integration of PLAMs into pediatric burn management provides significant benefits. Our study highlights the decreased need for sedated burn care, improved operative efficiency, decreased time to surgical intervention, shortened hospital stays, the decreasing demand for home nursing visits, and minimized need for additional surgeries, with healing outcomes comparable to current standard of care practices. These findings suggest potential cost savings for healthcare systems, improved healthcare efficiency, and increased patient satisfaction.