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Three Part Question

In [adults with partial thickness burns] is [de-roofing or aspirating the blisters better than conservative management] in [minimising infection and promoting healing] ?

Clinical Scenario

A thirty-year old chef attends the emergency department, having sustained burns to his forearm from hot fat. Clinical examination reveals blistering to the area and some erythema. You are not sure whether to leave, aspirate, or completely deroof the blisters, and wonder if there is any research to point you in the right direction.

Search Strategy

Using multifile searching - CINAHL - 1982 May Week 2 2006, EMBASE - 1980 2006 Week 20 and Ovid MEDLINE - 1966 to May Week 2 2006
The Cochrane Library Issue 2 2006
[exp Blister/ OR blister$.mp. OR burn blister.mp.] AND [aspiration.mp. OR deroof$.mp. OR debride$.mp. OR drain$.mp.] 153 unique records
Cochrane:Blister [MeSH] 64 records – none relevant

Search Outcome

153 records of which 1 was relevant

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Swain et al, 1987, UK	202 patients with partial thickness thermal burns. Left intact vs aspirated vs exposed	Controlled trial	Infection rates at 10 days	15% vs 73% vs 78% (p<0.05)	Small numbers Randomisation unclear and numbers inconsistent
			Pain reduction (aspiration vs deroofing)	34% vs 0%
			Pain increase (aspiration vs deroofing)	19% vs 43%

Comment(s)

There seems to be a paucity of good clinical evidence related to this subject, despite several review articles. The sole paper found involved a small sample, but showed infection rates to be higher if blisters are aspirated or deroofed, and that pain scores were higher in the group which underwent deroofing.

Clinical Bottom Line

Based on the current available evidence, blisters should wherever possible be left intact to reduce the risk of infection, but if anatomical position necessitates intervention for functional purposes, aspiration appears to result in less pain than deroofing.

References

1. Swain AH, Berge SA, Wakeley CJ et al. Management of blisters in minor burns. Br Med J (Clin Res Ed). 1987;295:181.