Assessing Optimal Timing of Synthetic Electrospun Fiber Matrix Application in the Management of Infected Burn Wound.

Authors:
Arpana Jain

Body of Abstract:
Background:Burn injuries frequently present with contaminated wound environments where adjunctive therapies are essential; however, many commercially available products remain susceptible to infection. Synthetic Electrospun Fiber Matrix (SEFM) is a fully resorbable, synthetic material engineered to mimic the structure of the human Extracellular Matrix. The optimal timing of SEFM application after burn injury remains unclear, particularly in high-risk infected burn wounds. This study evaluated whether early application (<14 days) versus late application (>14 days) influenced complications and healing outcomes.

Methods:A retrospective analysis was performed on 33 patients who received application of SEFM to treat a total of 62 unique burn injury sites. The collected variables included demographics, burn size and depth, wound infection, time to skin graft, complications (bacterial infection, fungal infection, amputation, and unplanned re-operation), mortality, and length of stay. The treatment sites were grouped by application timing: Early (<14 days, n=26) and Late (>14 days, n=36). A focused subgroup analysis was conducted on wounds with known burn infection (n=17). Fisher’s Exact Test was used to determine statistical significance for complication rates (p<0.05). RESULTS:THE COHORT OF 33 PATIENTS WAS 57.6% MALE, WITH MEAN AGE OF 46.2 YEARS (22-84 YEARS). IT INCLUDED 63.6% WHITE AND 12.2% AFRICAN AMERICANS. MEAN TBSA WAS 11.9% (SD 4.4%). MOST OF THE PATIENTS HAD SINGLE APPLICATION OF SEFM (98%) AT A MEDIAN TIME TO APPLICATION OF 14 DAYS. IN THE OVERALL DATASET, THE RATE OF BACTERIAL INFECTION WAS SIGNIFICANTLY LOWER IN THE EARLY APPLICATION GROUP (0.0%) COMPARED TO THE LATE GROUP (16.7%; P = 0.0354). IN THE HIGH-RISK SUBGROUP, WHERE THE WOUNDS HAD A KNOWN INFECTION PRIOR TO SEFM APPLICATION, PATIENTS RECEIVING EARLY APPLICATION (<14 DAYS) DEMONSTRATED A LONGER MEDIAN HEALING TIME (57 DAYS VS. 26 DAYS FOR LATE APPLICATION. THE EARLY APPLICATION GROUP EXPERIENCED A 0% INCIDENCE RATE ACROSS ALL MEASURED COMPLICATIONS (INCLUDING AMPUTATION, BACTERIAL, AND FUNGAL INFECTION), WHEREAS THE LATE APPLICATION GROUP SHOWED HIGH RATES OF COMPLICATIONS (UP TO 45.5 % FOR BACTERIAL INFECTION). WHILE NOT STATISTICALLY SIGNIFICANT DUE TO THE SMALL SAMPLE SIZE, THE ZERO-COMPLICATION FINDING IN THE EARLY GROUP IS NOTABLE. CONCLUSION:THE STATISTICALLY SIGNIFICANT ASSOCIATION BETWEEN DELAYED SEFM APPLICATION (> 14 DAYS) AND INCREASED RISK OF BACTERIAL INFECTION ACROSS THE WHOLE COHORT SUGGESTS A STRONG PROTECTIVE BENEFIT OF EARLY INTERVENTION. FURTHERMORE, THE 0% COMPLICATION RATE OBSERVED IN THE HIGHLY VULNERABLE INFECTED SUBGROUP FOLLOWING EARLY APPLICATION PROVIDES COMPELLING EVIDENCE THAT WHILE EARLY TIMING MAY NOT SHORTEN THE OVERALL HEALING TIME OF A COMPLEX, INFECTED WOUND, IT APPEARS CRUCIAL FOR COMPLICATION PREVENTION AND MORBIDITY REDUCTION.