Silver Confers No Additional Benefit to Re-Epithelialization of Pediatric Partial Thickness Burns: Results of a Randomized Controlled Trial.

Abstract

Silver dressings are widely used in the treatment of partial thickness burns due to their antimicrobial properties. However, silver ions may delay wound healing, and their clinical benefit in uncomplicated partial thickness pediatric burns remains unclear. This study compared Aquacel Ag (a silver-containing dressing) with Aquacel (an identical dressing without silver) to determine whether the addition of silver improves re-epithelialization, infection rates, or scar quality. In this prospective, randomized, single-blind controlled trial, children under 16 years presenting within 72 hours of injury with <15% TBSA partial thickness burns were randomized to receive either Aquacel Ag or Aquacel. The primary outcome was percentage of re-epithelialization at first follow-up (within 10 days). Secondary outcomes included time to complete re-epithelialization, infection rates, and Vancouver Scar Scale (VSS) scores at 3 and 6 months. Statistical analysis included t-tests, Wilcoxon tests, and Kaplan-Meier survival analysis. Seventy-five patients were included in the final analysis (Aquacel Ag: n=37; Aquacel: n=38). No significant differences were observed in mean percentage re-epithelialization at first follow-up (Aquacel Ag: 91.5% vs. Aquacel: 85.2%, P =0.13) or median time to complete re-epithelialization (11.9 vs. 13.0 days, P =0.31). No clinically significant infections occurred in either group. VSS scores at 3 and 6 months were similar. Aquacel Ag did not demonstrate superior outcomes compared to Aquacel in the treatment of uncomplicated partial thickness pediatric burns. Given its higher cost and potential for increased pain, the routine use of silver in this context may not be justified.