Introduction:
Wound bioburden is a well-known factor for burn wound morbidity, and attempts to decrease wound bioburden with debridement and systemic antimicrobials are not always effective. Debridement often leaves behind residual microbes that can initiate regrowth in as little as 5 minutes, and reform biofilm with 24 hours. Systemic antimicrobials are often ineffective, and increase the risk of antimicrobial resistance. They may also lead to unpleasant side effects in the liver, kidney, and gastrointestinal tract. Current standard-of-care topical antimicrobials such as silver nitrate and silvadene are effective in killing microbes on the burn wound, but these options also ultrathin bioresorbable antimicrobial wound matrix (matrix) that is made from biocompatible polyelectrolytes that balance surface charge on a dysregulated wound surface for optimal cell migration. As a result, the matrix provides a template for cellular growth, supports vascularization and granulation tissue formation in split thickness grafts, and controls burn wound bioburden by employing non-cytotoxic levels of nanoparticulate silver. Of note, the matrix bioresorbs within 7 days, circumventing painful removal, and has been used in more than 70,000 human wound applications with no reported adverse events to date.

Methods:
Six patients, four of which had thermal burns, and two with radiation burns, were treated with the matrix as the contact layer after debridement. The matrix was used in conjunction with complex biologics, skin grafts, donor sites, and contracture release surgery.

Results:
All patients went on to heal completely and there was no incidence of infection. The matrix was well tolerated by all patients, and decreased pain levels significantly in the two patients with radiation burns.

Conclusions:
The clinical evidence to date suggests that this microfilm matrix could be an important adjunct for the burn surgeon in the protocols for managing a wide variety of complex burns.