Experience in using Biobrane™ in the treatment of severe burns in children at the Bulgarian National Burn Center
M. Argirova1, A. Viktorova1, Y. Zayakova1, D.C. Premuselli1
1 Department of Burns & Plastic Surgery, UMHATEM “N. I. Pirogov”, Sofia, Bulgaria
Objectives: Excision of burn eschar in large burns is a key component of treatment as well as prevention of infection. Early excision and autografting of burns patients is the gold standard for acute burn care. Children suffering from large burns undergo serial stages of operations depending on the extent of injury and often require temporary coverage with an allograft or skin substitutes. Allograft serves as an effective option for temporary burn wound covering. Due to its shortcomings, we started using a biosynthetic dressing Biobrane™. The aim of this study was to evaluate the therapeutic effect of Biobrane™ in the treatment of excised deep dermal and full-thickness burns as temporary biosynthetic wound coverage.
Methods: Between January 2017 and December 2021, a retrospective review of children with extensive deep dermal and full-thickness burns was performed. A total of 54 patients, aged 1-14 years, were included in this study. Demographic data were collected from the hospital records. The early excision (tangential, fascial) was carried out in stages, each procedure being limited to 10-30% TBSA. After excision and meticulous hemostasis, all wounds were covered with Biobrane™, as a temporary wound coverage. Biobrane™ was placed firmly in contact with the excised surface and held in place with surgical staples. In the cases with subsequent skin autografting, Biobrane™ was applied on autograft areas, donor sites and superficial burns as well. The clinical efficiency of the skin substitute was analyzed according to the following parameters: adherence, presence of fluid collection, rejection, infection and follow-up wound evaluation.
Results: The scalds were the most common mechanism of injury (84.8%). The percentage of TBSA was ranged from 20% to 68%. Biobrane™ reduced pain, decreased exudative protein loss, limited bacterial growth, protected the underlying tissues and enhanced the healing of partial-thickness wounds and donor sites. Upon removal of Biobrane™, the granulation tissue was appropriate for skin autografting. Hematoma formation was observed in 7 cases without the need to change Biobrane™. Infected exudate underneath Biobrane™ was reported in 3 cases 10 days after the placement. Biobrane™ was not removed until the wounds were successfully autografted.
Conclusion: Biobrane™ is effective and easy to use as a temporary wound coverage after early excision in extensive burns. The permeable silicone outer layer allows the use of antimicrobial agents and the drainage of fluids. Biobrane™ protects excised burn wounds from bacterial contamination and dehydration, at the same time preparing the wound for autografting.

**Experience in using Biobrane™ in the treatment of severe burns in children at the Bulgarian National Burn Center**
**M. Argirova1, A. Viktorova1, Y. Zayakova1, D.C. Premuselli1**
1 Department of Burns & Plastic Surgery, UMHATEM “N. I. Pirogov”, Sofia, Bulgaria
**Objectives:** Excision of burn eschar in large burns is a key component of treatment as well as prevention of infection. Early excision and autografting of burns patients is the gold standard for acute burn care. Children suffering from large burns undergo serial stages of operations depending on the extent of injury and often require temporary coverage with an allograft or skin substitutes. Allograft serves as an effective option for temporary burn wound covering. Due to its shortcomings, we started using a biosynthetic dressing Biobrane™. The aim of this study was to evaluate the therapeutic effect of Biobrane™ in the treatment of excised deep dermal and full-thickness burns as temporary biosynthetic wound coverage.
**Methods:** Between January 2017 and December 2021, a retrospective review of children with extensive deep dermal and full-thickness burns was performed. A total of 54 patients, aged 1-14 years, were included in this study. Demographic data were collected from the hospital records. The early excision (tangential, fascial) was carried out in stages, each procedure being limited to 10-30% TBSA. After excision and meticulous hemostasis, all wounds were covered with Biobrane™, as a temporary wound coverage. Biobrane™ was placed firmly in contact with the excised surface and held in place with surgical staples. In the cases with subsequent skin autografting, Biobrane™ was applied on autograft areas, donor sites and superficial burns as well. The clinical efficiency of the skin substitute was analyzed according to the following parameters: adherence, presence of fluid collection, rejection, infection and follow-up wound evaluation.
**Results:** The scalds were the most common mechanism of injury (84.8%). The percentage of TBSA was ranged from 20% to 68%. Biobrane™ reduced pain, decreased exudative protein loss, limited bacterial growth, protected the underlying tissues and enhanced the healing of partial-thickness wounds and donor sites. Upon removal of Biobrane™, the granulation tissue was appropriate for skin autografting. Hematoma formation was observed in 7 cases without the need to change Biobrane™. Infected exudate underneath Biobrane™ was reported in 3 cases 10 days after the placement. Biobrane™ was not removed until the wounds were successfully autografted.
**Conclusion:** Biobrane™ is effective and easy to use as a temporary wound coverage after early excision in extensive burns. The permeable silicone outer layer allows the use of antimicrobial agents and the drainage of fluids. Biobrane™ protects excised burn wounds from bacterial contamination and dehydration, at the same time preparing the wound for autografting.

P.133 Experience in using biobrane™ in the treatment of severe burns in children at the bulgarian national burn center

Dear friends and colleagues,

We will be pleased to welcome you in Turin (Italy) for the 19th European Burns Association´s Congress in 2022. Italy is honored to hold the meeting of the European Burns Association for the second time, after Verona in 1995. Turin is easily reachable from everywhere in Europe, either travelling by car, train or choosing flight connections. During the meeting, held in the renewed industrial center of the main Italian historical automotive factory (i.e. Lingotto-FIAT), we will meet international burn specialists, focusing on standards of care, progresses in burn treatment, strategies to face disaster situations, with a special attention to education of younger colleagues. However, in your spare time, you might enjoy the sweet days of Italian late summer, simply wandering in the green parks and gardens along the two rivers which cross the city, or you might decide to discover the numerous art galleries, churches, palaces, libraries, walking across elegant squares and large boulevards, passing through centuries of art and history; finally, you may choose to immerse yourself in some of the most exciting museum experiences, such as the Cinema Museum and the Turin’s Egyptian museum.

Looking forward to seeing you all in Turin for the 19th European Association´s Congress in 2022!
Maurizio Stella, Congress President, Turin Burn Centre