CBM Wound Care & Dressing Selection 3 — Questions and Answers
Question 1: Negative pressure wound therapy (NPWT) in burn care is MOST commonly used to:
- Debride full-thickness eschar
- Secure skin grafts and bolster adherence (Correct answer)
- Provide topical antibiotic delivery
- Reduce hypertrophic scarring post-healing
Correct answer: Secure skin grafts and bolster adherence
NPWT (wound VAC) is widely used post-grafting to immobilize the graft, remove exudate, and promote graft take.
Question 2: Which dressing is typically used for small, superficial partial-thickness burns in an outpatient setting due to its ease of use and reduced dressing change frequency?
- Dakin's solution-soaked gauze changed twice daily
- Silver-impregnated contact layer changed every 7–14 days (Correct answer)
- Dry sterile gauze changed daily
- Povidone-iodine gauze changed every 12 hours
Correct answer: Silver-impregnated contact layer changed every 7–14 days
Silver-impregnated contact layers like Mepilex Ag or Aquacel Ag allow infrequent changes while providing antimicrobial protection.
Question 3: Enzymatic debridement agents such as collagenase (Santyl) work by:
- Killing bacteria through oxidative mechanisms
- Selectively digesting necrotic collagen while sparing viable tissue (Correct answer)
- Absorbing slough into a gel matrix
- Promoting autolytic debridement via occlusion
Correct answer: Selectively digesting necrotic collagen while sparing viable tissue
Collagenase selectively cleaves denatured collagen in necrotic tissue, facilitating debridement without harming viable surrounding tissue.
Question 4: When assessing a burn wound for signs of local infection versus normal healing, which finding is MOST concerning for infection?
- Mild erythema at wound margins up to 0.5 cm
- Serosanguineous exudate
- Conversion of partial-thickness wound to full-thickness appearance (Correct answer)
- Presence of granulation tissue at wound edges
Correct answer: Conversion of partial-thickness wound to full-thickness appearance
Wound conversion from partial-thickness to full-thickness is a hallmark sign of local infection and bacterial invasion.
Question 5: In pediatric burn patients, which factor most significantly increases the risk of dressing-related complications?
- Higher body surface area to weight ratio affecting fluid evaporation (Correct answer)
- Greater pain tolerance requiring fewer pain medications
- Thicker dermis reducing wound depth
- Slower metabolic rate reducing healing time
Correct answer: Higher body surface area to weight ratio affecting fluid evaporation
Children have a high BSA-to-weight ratio, leading to greater transepidermal water loss and heat loss through dressings.
Question 6: Cadaveric allograft (homograft) is used in burn wound management primarily as a:
- Permanent skin replacement
- Temporary biological wound cover to protect the wound bed (Correct answer)
- Source of dermal matrix only
- Method to stimulate hypertrophic scar formation
Correct answer: Temporary biological wound cover to protect the wound bed
Cadaveric allograft serves as a temporary biological dressing that protects the wound, reduces infection, and prepares the bed for autografting.
Question 7: Silver nitrate 0.5% solution used as a topical burn agent has which notable disadvantage?
- Poor eschar penetration
- Causes severe metabolic alkalosis
- Leaches electrolytes from the wound, causing hyponatremia and hypochloremia (Correct answer)
- Is highly nephrotoxic even at low concentrations
Correct answer: Leaches electrolytes from the wound, causing hyponatremia and hypochloremia
Silver nitrate 0.5% solution is hypotonic and draws electrolytes out of the wound, requiring close monitoring for hyponatremia and hypochloremia.
CBM Wound Care & Dressing Selection 3
Negative pressure wound therapy (NPWT) in burn care is MOST commonly used to: