Introduction:
Burn wound care represents a multidisciplinary approach of treatment with increasing focus on long-term functionality, cosmesis and patient quality of life. The holistic shift allows for increased patient input into the treatment decision process. However, this patient centric approach comes with inherent challenges, as patients may refuse proven, standard of care practices in lieu of more lifestyle convenient therapies. Herein, we report a retrospective case series review, utilizing advanced therapy wound products to conservatively manage burn injuries that would have otherwise benefited from early excisional debridement and split-thickness skin grafting (STSG).

Methods:
Ranging from deep partial- to full-thickness burn wounds, treatment was provided to patients that refused surgical intervention and STSG. Upon discharge, patients were assessed and identified for complication risk, allowing for a tailored treatment strategy. In cases in which ongoing debridement was deemed clinically necessary, clostridial collagenase was prescribed for daily application. Infection was managed with adjunctive antibiotics. During treatment transition, or if debridement was deemed unnecessary, infection risk was managed with nanocrystalline silver dressings. At weekly intervals, patients reported to the outpatient clinic for evaluation and assessed for healing progression. Patient treatments were administered, and progress monitored to closure.

Results:
Patients with burn wounds less than five percent total body surface area, healing in greater than three weeks due to refusal of surgical intervention with STSG, did not display increased complications. In fact, electing for conservative burn wound management, exhibited reduced hospital stays with earlier return to patient lifestyle preferences (work, social, and recreational). Moreover, an increased incidence of infection or hypertrophic scarring was not realized in these patients when utilizing standard scar management techniques, compression and silicone dressings.

Conclusion:
Patient treatment refusal to best practice intervention has a significant impact on burn healing outcomes. Timely restoration of protective skin function is of the upmost importance to minimizing infection and scarring complications. This case series review presents a unique approach of utilizing advanced therapy products to achieve optimal burn healing to patients refusing standard of care practices. Allowing for acknowledgement of patient input without sacrificing clinical care. Furthermore, maintaining reduced infection and scarring complications. These findings provide the foundation to supporting a greater examination to the concordance of practice in management of patients refusing surgical debridement and STSG.