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Journal article

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Annals of Plastic Surgery

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Topical antimicrobials are one component in burn wound care. These agents suppress microbial growth to advantage skin cells and wound healing. Topical antimicrobials can be divided into 2 superclasses: antiseptics and antibiotics. This article reviews the 4 main classes of topical antiseptics (emulsifiers, acids, oxidizers, and heavy metals) and antiseptic-impregnated dressings in current clinical use and address the mechanisms, as well as the advantages and disadvantages, of each antiseptic for burn wound management. Despite some topical antiseptics' ability to dissolve biofilm and provide broad-spectrum antimicrobial coverage, the value of surgical excision and grafting should be emphasized. Early surgical removal of the infected tissue is the most effective method to eliminate invasive infection. In severe cases, such as severe burns and necrotizing soft tissue infections, surgical debridement can be lifesaving. Topical agents then are chosen based on the challenges of each wound, including biofilms, eschar, bioburden, the need for epithelialization, and specific microbes. Healing and fibroblast proliferation are heavily dependent on adequate nutrition. Each wound and each patient is unique, and different factors related to the wound should be considered when deciding which topical antimicrobial to use while taking into account the risks and benefits of each agent and discussing them with the patient.


Cambiaso-Daniel, Janos|Boukovalas, Stafanos|Bitz, Genevieve|Branski, Ludwik K.|Herndon, David N.|Culnan, Derek M.|

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