Improved wound healing and cosmetic outcomes with silver nanoparticle dressings in pediatric burn patients

Abstract

Burns are challenging injuries requiring effective wound management, and while silver nanoparticle dressings show promise in promoting healing, there is a lack of clinical research on their use in pediatric burn patients. Thus, we aimed to investigate their effects on accelerating wound healing in children. We performed a retrospective study on 60 pediatric burn patients. The patients were grouped into control (30 cases, conventional wound management) and observation (30 cases, silver nanoparticle dressings + conventional management) groups. The clinical efficacy, wound healing time, impediments, Vancouver Scar Scale (VSS) score, scar hyperplasia degree, and satisfaction of patients with different burn sites and degrees were analyzed. Wound healing time and treatment effective rate of patients with different burn sites and degrees in the observation group was significantly higher than control (P < .05). The complication incidence, VSS scores for scar color, vascularity, pliability and thickness, and the proportion of severe hyperplasia were lower in the observation group, while the proportion of mild hyperplasia was higher (P < .05). Family satisfaction was also higher than control (P < .05). Correlation analysis revealed that shorter healing times were associated with improved scar outcomes, such that each 1-day reduction in healing time was linked to lower VSS thickness scores and a decreased likelihood of severe hyperplasia. This retrospective study suggests that silver nanoparticle dressings may be associated with faster wound healing, fewer complications, improved cosmetic outcomes, and higher family satisfaction in pediatric burn patients. Prospective randomized studies are warranted to confirm these findings.

1. Introduction

Burns are known to be challenging injuries, with wound healing playing a crucial role in the overall recovery of the patient.^[1] The susceptibility of burn wounds to bacterial colonization and subsequent infection poses a significant threat, potentially leading to delayed wound healing and, in severe cases, invasive infections, thereby increasing the risk of mortality.^[2] Furthermore, the slow healing process of burn sites can often result in atrophy and deformity, negatively impacting patients’ quality of life and the functional and aesthetic aspects of the burn site.^[3] Hence, effective wound management is pivotal in the treatment of burns, as it not only fosters wound healing but also mitigates the occurrence of complications.^[4]

In the context of burn treatment, it is notable that the use of intravenous medication for achieving antimicrobial effects may be compromised due to vascular obstruction at the wound site. As a result, there is a pressing need to explore and develop alternative wound management strategies that are both effective and rational.^[5,6] Silver nanoparticle dressings have emerged as a recent innovation in the realm of burn wound treatment, exhibiting the capacity to facilitate the drainage of necrotic tissue, enhance local blood circulation, and contribute to wound repair and healing.^[7–9] Despite these promising attributes, clinical research specifically evaluating silver nanoparticle dressings in pediatric burn patients remains limited, and evidence regarding their impact on wound healing and cosmetic outcomes in this population is still insufficient.

As such, this retrospective study aims to address this deficiency by specifically investigating the use of silver nanoparticle dressings in pediatric burn patients. The primary objective is to assess the potential of silver nanoparticle dressings in expediting wound healing and enhancing cosmetic outcomes in this patient cohort. By shedding light on the impact of silver nanoparticle dressings in pediatric burn patients, this study endeavors to furnish valuable insights for the development of effective clinical strategies for wound care in this demographic. Furthermore, the retrospective nature of this study allows for the examination of existing patient data, providing a comprehensive understanding of the outcomes associated with the use of silver nanoparticle dressings in pediatric burn patients over a specific period. This detailed reflective analysis is poised to offer valuable contributions to the existing body of knowledge concerning wound management in pediatric burn patients.

2. Materials and methods

2.1. Study population

We retrospectively reviewed the medical records of 60 pediatric burn patients admitted to our hospital between January 2020 and August 2023. Based on the actual treatment documented in the records, patients were categorized into 2 groups: those who received conventional wound management (control group, n = 30) and those who received silver nanoparticle dressings in addition to conventional management (observation group, n = 30). Treatment protocols were carried out at the discretion of the attending physicians according to institutional guidelines, and no interventions were assigned by the investigators. All subsequent analyses were performed retrospectively using these medical records.

Inclusion criteria were as follows: clinically diagnosed pediatric burn patients aged ≤12 years; burn depth ranging from superficial partial thickness to deep partial thickness; stable vital signs and clear consciousness without severe shock; no contraindications to the treatment methods under study; and informed consent obtained from the patients’ guardians. Exclusion criteria were as follows: abnormal heart, kidney, liver, or lung function; comorbid metabolic, immunological, or hematological disorders that could interfere with the study; patients with mental illness; and poor compliance.

This study was approved by the Ethics Committee of The Fifth Hospital of Huangshi City in accordance with regulatory and ethical guidelines pertaining to retrospective research studies. Informed consent was waived for this retrospective study due to the exclusive use of de-identified patient data, which posed no potential harm or impact on patient care.

2.2. Intervention methods

2.2.1. Control group

The control group received conventional wound management according to institutional protocols for partial thickness burns (5%–15% total body surface area [TBSA]). After initial cleansing with 10% povidone-iodine solution, patients underwent infection control (intravenous cefazolin 25 mg/kg/day if indicated), tetanus prophylaxis (0.5 mL IM for nonimmunized), and fluid resuscitation for shock (Parkland formula). Wound debridement was performed every 48 hours using sterile technique. 1% silver sulfadiazine cream (Sun Pharmaceutical, India) was applied uniformly at 2 mm thickness after each debridement, with prior layer removal. Exposure therapy was used for facial burns; other sites received sterile petroleum jelly gauze (Vaseline®), covered by absorbent cotton and elastic bandages. Treatment duration was standardized to 15 days across all cases.^[10]

2.2.2. Observation group

In addition to the procedures followed in the control group, the observation group utilized silver nanoparticle dressings. Specifically, Silver nanoparticle dressings (Acticoat™ Flex 3, Smith & Nephew, nanocrystalline silver concentration: 108 μg/cm²) were applied. The dressing releases silver ions sustainedly (bioavailability: up to 62% in vitro; peak concentration: 45–80 ppm within 24 hours) via a triple-layer structure (polyester mesh coated with nanocrystals).^[11,12] Dressings covered the entire wound and were changed daily per manufacturer guidelines and a total treatment duration of 15 days.

According to institutional practice during the study period, all wound management procedures (debridement, dressing application, and assessments) were performed exclusively by trained burn nurses in the inpatient setting, and family members did not participate in wound care.

2.3. Outcome measures

Baseline data: including gender, age, TBSA), cause of burn, burn site, and burn severity for both groups; Wound healing assessment: Primary Method: According to routine hospital practice, pediatric burn patients underwent daily clinical examination by 2 independent burn specialists, who documented healing progression using standardized photography. These assessments, performed as part of standard care rather than the procedures of this retrospective study, were subsequently retrieved from medical records for analysis. Healing progression was documented using standardized digital photography (Canon EOS 90D with macro lens) under consistent lighting/positioning. Quantitative Criteria: Epithelialization: ≥1/3 of wound surface covered by new epithelium (confirmed by absence of fibrinopurulent exudate and visual pink-tissue transition); Granulation: Presence of healthy vascularized tissue (≥50% wound bed) without necrosis; Supporting Metric: Wound area reduction calculated via ImageJ software (NIH) using serial tracings of wound margins.^[10] Healing Definition: Fulfillment of both epithelialization and granulation criteria. Treatment efficacy classification: Effective: Meeting healing definition within 15-day treatment period; Ineffective: Failure to meet criteria by day 15; Effective rate = (Number of effective cases/ Total cases) × 100%.^[13] Wound healing time; Complications: including infection, local necrosis, and high fever. The occurrence rates of complications in both groups were calculated as the percentage of cases with complications out of the total cases; Scarring assessment: evaluation of scar conditions using the Vancouver Scar Scale (VSS) before and after treatment, which includes scar color, vascularity, thickness, and pliability, scoring from 0 to 3, with higher scores indicating poorer scar conditions;^[14] Degree of scar hyperplasia: assessment of scar hyperplasia in both groups 3; months after treatment. Severe hyperplasia refers to scar thickness >0.5 cm, hardness at +++ or above, and significant pain and itching sensation; moderate hyperplasia refers to scar thickness between 0.2 and 0.5 cm, hardness at ++, and pain and itching sensation; mild hyperplasia refers to scar thickness below 0.2 cm with mild itching sensation;^[15] Satisfaction: assessment of the satisfaction of the patients’ families regarding the scars using a self-made satisfaction survey at 3 months after treatment, with a total score of 100. A score of 90 to 100 indicates very satisfied, 70 to 89 indicates satisfied, and below 69 indicates dissatisfied. The satisfaction rate was computed as the percentage of very satisfied and satisfied cases out of the total cases.^[16]

2.4. Statistical methods

Data were examined using SPSS 25.0 statistical software. For categorical data, (n (%]) was used. If the sample size was ≥40 and the theoretical incidence T was ≥5, the chi-square test was employed with the basic formula, and the test statistic was χ². If the sample size was ≥40 but the theoretical frequency was 1 ≤ T < 5, the corrected chi-square test formula was used. If the sample size was <40 or the theoretical frequency T<1, the Fisher exact probability method was utilized for statistical analysis.

Normality was assessed using the Shapiro–Wilk test. For normally distributed data, results were expressed as mean ± standard deviation and compared using the Student t test. For non-normallydistributed data, appropriate transformations were applied to approximate normality before analysis with a Student t test. A two-tailed P-value < .05 was considered statistically significant. To account for multiple endpoints and reduce the risk of type I error, Bonferroni correction for multiple comparisons was applied where appropriate, with the adjusted significance threshold set at P < .05/n for each family of endpoints (e.g., adjusted α = 0.0125 for the 4 VSS subscales, adjusted α = 0.0125 for the 4 subgroup efficacy and healing time comparisons, and adjusted α = 0.0167 for the 3 scar hyperplasia categories).

Pearson correlation analysis was used for continuous outcomes (VSS scores) to calculate correlation coefficients (r) and regression slopes (β) with 95% confidence intervals (CI) per 1-day delay in healing. For ordinal outcomes (hyperplasia severity), Spearman’s rank correlation (ρ) was computed. Additionally, logistic regression analyzed the odds ratio for severe hyperplasia per delayed healing day, adjusted for burn depth and location. All medical records were complete for the variables analyzed; no missing data were encountered for the primary and secondary outcomes in the 60 cases reviewed.

3. Results

3.1. Comparison of baseline data between the two groups

As shown in Table 1, the observation group comprised 18 male and 12 female patients, aged 4 to 12 years with a mean age of (9.25 ± 1.30) years. The mean TBSA) burned was (8.92 ± 2.15) % (range: 5%–15%). The causes of burns included thermal burns in 19 cases, chemical burns in 6 cases, and electrical burns in 5 cases. In this group, limb burns accounted for 14 cases, and trunk burns accounted for 16 cases, with 16 cases of superficial partial thickness burns and 14 cases of deep partial thickness burns. The control group included 19 male and 11 female patients, aged 3 to 12 years with a mean age of (9.14 ± 1.28) years. The mean TBSA burned was (8.85 ± 2.08) % (range: 5%–15%). The causes of burns comprised thermal burns in 21 cases, chemical burns in 5 cases, and electrical burns in 4 cases. Limb burns were reported in 13 cases, and trunk burns in 17 cases, with 15 cases of superficial partial thickness burns and 15 cases of deep partial thickness burns. No statistically significant differences were detected in baseline characteristics (gender, age, TBSA, burn causes, burn sites, and burn severity) between the 2 groups (all P > .05). However, given the relatively small sample size, the possibility of residual imbalance cannot be excluded.

Table 1.

Comparison of baseline data between the 2 groups.

Variable	Observation group (n = 30)	Control group (n = 30)	χ2/t	P
Gender (n [%])
Male	18 (60.00)	19 (63.33)	0.071	.791
Female	12 (40.00)	11 (36.67)
Age ($\overline{X}$ ± SD)	9.25 ± 1.30	9.14 ± 1.28	0.330	.742
TBSA ($\overline{X}$ ± SD)	8.92 ± 2.15	8.85 ± 2.08	0.132	.895
Burn Cause (n [%])
Thermal burns	19 (63.33)	21 (70.00)	0.302	.860
Chemical burns	6 (20.00)	5 (16.67)
Electrical burns	5 (16.67)	4 (13.33)
Burn Site (n [%])
Limb burns	14 (46.67)	13 (43.33)	0.067	.795
Trunk burns	16 (53.33)	17 (56.67)
Burn depth (n [%])
Superficial partial thickness	16 (53.33)	15 (50.00)	0.067	.796
Deep partial thickness	14 (46.67)	15 (50.00)

Data are presented as mean ± standard deviation (SD) for continuous variables and as number (percentage) for categorical variables. TBSA = total body surface area. Grouping was based on the actual treatment received in routine clinical care, without randomization or matching. Comparisons between groups were performed using the chi-square test for categorical variables and an independent t test for continuous variables.

P > .05 indicates no statistically significant difference.

3.2. Comparison of treatment effectiveness rates in patients with different burn sites and severity between the two groups

As shown in Table 2, the treatment effective rate for limb burns was 92.86% in the observation group and 53.85% in the control group, while for trunk burns, it was 81.25% in the observation group and 47.06% in the control group. Similarly, for superficial partial thickness burns, the effective rates were 93.75% in the observation group and 60.00% in the control group, and for deep partial thickness burns, the corresponding rates were 78.57% and 40.00%. The effective rates for patients with different burn sites and severity were higher in the observation group compared to the control group, with statistically significant differences (P < .05), indicating improved treatment outcomes in pediatric burn patients using silver nanoparticle dressings.

Table 2.

Comparison of treatment effectiveness of patients with different burn sites and degrees between the 2 groups.

Group	Burn Site (n [%])		Burn Depth (n [%])
	Limb burns	Trunk burns	Superficial partial thickness	Deep partial thickness
Observation group (n = 30)	13 (92.86)	13 (81.25)	15 (93.75)	11 (78.57)
Control group (n = 30)	7 (53.85)	8 (47.06)	9 (60.00)	6 (40.00)
χ 2	5.342	4.164	5.044	4.441
P	.021	.041	.025	.035

Data are presented as number (%). Treatment effectiveness was defined according to clinical healing outcomes as recorded in medical charts. Comparisons between groups were performed using the chi-square test.

P < .05 was considered statistically significant.

3.3. Comparison of wound healing time in patients with different burn sites and severity between the two groups

As presented in Table 3, the observation group exhibited shorter healing times for limb burns, trunk burns, superficial partial thickness, and deep partial thickness burns compared to the control group, with statistically significant differences (P < .05). These results suggest that the use of silver nanoparticle dressings can expedite wound healing in pediatric burn patients.

Table 3.

Comparison of wound healing time in patients with different burn sites and severity between the 2 groups ($\overline{\mathit{X}}$ ± SD).

Group	Burn site		Burn depth
	Limb burns	Trunk burns	Limb burns	Trunk burns
Observation group (n = 30)	20.22 ± 2.18	23.56 ± 2.35	21.50 ± 2.24	24.56 ± 2.55
Control group (n = 30)	23.30 ± 2.25	25.78 ± 2.40	24.64 ± 2.38	26.98 ± 2.62
t	5.385	3.653	5.262	3.625
P	.001	.001	.001	.001

Data are presented as mean ± standard deviation (SD). Healing time was measured in days from admission to complete epithelialization. Comparisons between groups were performed using independent t tests.

P < .05 was considered statistically significant.

3.4. Comparison of complication occurrence rates between the two groups

As illustrated in Table 4, the observation group reported a complication occurrence rate of 3.33%, with only one case of high fever, whereas the control group had a higher occurrence rate of complications at 20.00%, including 2 cases of infection, 2 cases of local necrosis, and 2 cases of high fever. The complication occurrence rate was lower in the observation group compared to the control group, with statistically significant differences (P < .05), indicating a reduction in complication occurrence rates in pediatric burn patients using silver nanoparticle dressings. Nevertheless, given the modest sample size, these results should be interpreted cautiously, as the absolute numbers of complications were small.

Table 4.

Comparison of complication occurrence rates between the 2 groups (n [%]).

Group	Infection	Local necrosis	High fever	Total
Observation group (n = 30)	0 (0.00)	0 (0.00)	1 (3.33)	1 (3.33)
Control group (n = 30)	2 (6.67)	2 (6.67)	2 (6.67)	6 (20.00)
χ 2				4.043
P				.044

Data are presented as number (%). Complications included infection, local necrosis, and high fever. Comparisons between groups were performed using the chi-square test.

P < .05 was considered statistically significant.

3.5. Comparison of scar conditions before and after treatment in both groups

As shown in Table 5, there were no statistically significant differences in the VSS scores for thickness, color, vascularity, and pliability between the 2 groups before treatment (P > .05). However, following treatment, the observation group exhibited lower VSS scores for thickness (1.96 ± 0.12), color (1.12 ± 0.12), vascularity (1.10 ± 0.24), and pliability (1.32 ± 0.30) compared to the control group (2.45 ± 0.16, 1.78 ± 0.14, 1.42 ± 0.15, 1.68 ± 0.20), with statistically significant differences (P < .05). These findings suggest that the use of silver nanoparticle dressings in pediatric burn patients can facilitate the recovery of scar tissue thickness, color, vascularity, and pliability.

Table 5.

Comparison of scar conditions before and after treatment in both groups ($\overline{\mathit{X}}$ ± SD).

Group	Thickness		Color		Vascularity		Pliability
	Before treatment	After treatment	Before treatment	After treatment	Before treatment	After treatment	Before treatment	After treatment
Observation group (n = 30)	2.72 ± 0.20	1.96 ± 0.12	2.76 ± 0.20	1.12 ± 0.12	2.85 ± 0.14	1.10 ± 0.24	2.65 ± 0.22	1.32 ± 0.30
Control group (n = 30)	2.75 ± 0.18	2.45 ± 0.16	2.75 ± 0.24	1.78 ± 0.14	2.80 ± 0.20	1.42 ± 0.15	2.60 ± 0.25	1.68 ± 0.20
χ 2	0.611	13.419	0.175	19.605	1.122	6.193	0.822	5.469
P	.544	<.001	.861	<.001	.267	<.001	.414	<.001

Data are presented as mean ± standard deviation (SD). Comparisons between groups and time points were performed using the chi-square test. To account for multiple comparisons, P values were adjusted using the Bonferroni correction (adjusted α = 0.0125 for the 4 VSS subscales); reported values remained statistically significant after correction.

P < .05 was considered statistically significant.

3.6. Comparison of scar hyperplasia degree between the two groups

As indicated in Table 6, the observation group had a higher proportion of mild hyperplasia (63.33%), a lower proportion of severe hyperplasia (10.00%), and a moderate proportion of moderate hyperplasia (26.67%). In contrast, the control group had a lower proportion of mild hyperplasia (36.67%), a higher proportion of severe hyperplasia (33.33%), and a moderate proportion of moderate hyperplasia (30.00%). These differences were statistically significant (P < .05), indicating that the use of silver nanoparticle dressings in pediatric burn patients can reduce the degree of scar hyperplasia, with no statistically significant difference in the proportion of severe hyperplasia between the 2 groups (P > .05).

Table 6.

Comparison of scar hyperplasia degree between the 2 groups (n [%]).

Group	Mild hyperplasia	Moderate hyperplasia	Severe hyperplasia
Observation group (n = 30)	19 (63.33)	8 (26.67)	3 (10.00)
Control group (n = 30)	11 (36.67)	9 (30.00)	10 (33.33)
χ 2	4.267	0.082	4.812
P	.038	.774	.029

Data are presented as number (%). Scar hyperplasia was classified as mild, moderate, or severe according to Vancouver Scar Scale (VSS) assessment. Comparisons between groups were performed using the chi-square test.

P < .05 was considered statistically significant.

3.7. Comparison of family satisfaction between the two groups

As illustrated in Table 7, the observation group had 63.33% very satisfied family members, 33.33% satisfied, and 3.33% dissatisfied, whereas the control group had 40.00% very satisfied family members, 36.67% satisfied, and 23.33% dissatisfied. Notably, family satisfaction was higher in the observation group than in the control group, with statistically significant differences (P < .05), suggesting that the use of silver nanoparticle dressings in pediatric burn patients can enhance family satisfaction.

Table 7.

Comparison of family satisfaction between the 2 groups (n [%]).

Group	Very satisfied	Satisfied	Dissatisfied	Total satisfaction
Observation Group (n = 30)	19 (63.33)	10 (33.33)	1 (3.33)	29 (96.67)
Control Group (n = 30)	12 (40.00)	11 (36.67)	7 (23.33)	23 (76.67)
χ 2				5.192
P				.023

Data are presented as numbers (%). Family satisfaction was classified as very satisfied, satisfied, or dissatisfied; total satisfaction was defined as the sum of very satisfied and satisfied responses. Comparisons between groups were performed using the chi-square test.

P < .05 was considered statistically significant.

3.8. Correlation between healing time and scar outcomes

For VSS parameters, Pearson correlation revealed significant associations: thickness showed R = 0.83 (95% CI: 0.72–0.91) with β = +0.41 points per day delay (P < .001), while pliability demonstrated R = 0.81 (95% CI: 0.71–0.84) with β = +0.38 points per day delay (P < .001). Regarding hyperplasia severity, Spearman’s correlation (ρ = 0.7, P < .001) and logistic regression suggested that each 1-day healing delay increased the odds of severe hyperplasia by approximately 24% (odds ratio = 1.24; 95% CI: 1.08–1.42; P = .003) (Table 8).

Table 8.

Healing time vs scar outcomes.

Outcome metric	Correlation	Effect Size (β or OR) per 1-d delay	95% CI	P-value
VSS Thickness	R = 0.83	β = +0.41 per d	0.72–0.91	<.001
VSS Pliability	R = 0.81	β = +0.38 per d	0.71–0.84	<.001
Severe Hyperplasia	OR = 1.24	OR = 1.24 per d	1.08–1.42	.003

Data are presented as correlation coefficients (r), regression slopes (β), odds ratios (OR), and 95% confidence intervals (CI). For continuous outcomes (VSS thickness and pliability), Pearson correlation and linear regression were used. For ordinal outcomes (hyperplasia severity), Spearman’s correlation was applied. Logistic regression was used to estimate the odds ratio (OR) for severe hyperplasia per 1-day delay in healing. Reported values are approximate and should be interpreted cautiously given the retrospective design and limited sample size.

4. Discussion

The burn wound is often contaminated, posing a threat of wound infection throughout the treatment process.^[17] For severely burned patients, the destruction of the body’s physiological defence barriers, compromised systemic immune function, extensive presence of necrotic tissue, invasion by external and endogenous microflora, as well as the rich protein exudate in the wound and local circulatory disturbances, increase susceptibility to infection.^[18,19] Children have delicate skin, and without timely and proper treatment after a burn, not only can it lead to the spread of infection, but it can also result in scarring, affecting the aesthetic outcome.^[20,21] Therefore, promoting wound healing as quickly as possible and improving cosmetic outcomes after injury are crucial aspects of treatment.

Recent evidence has consistently supported the clinical utility of silver nanoparticle dressings in burn management. A prospective clinical study from India demonstrated that nano-silver-foam dressings achieved significantly faster epithelialization and higher complete healing rates compared with silver nanoparticle gel and collagen dressings in partial thickness burns.^[22] Preclinical studies using nano-silver-loaded nanofibrous scaffolds have shown accelerated wound closure, enhanced dermal regeneration, and reduced infection risk, corroborating the biological plausibility of our findings.^[23] Similarly, a systematic review on nano-silver functionalized polysaccharide dressings summarized numerous in vitro, animal, and clinical studies, and reported consistent antibacterial, wound healing, and cosmetic benefits across different experimental designs, further confirming the therapeutic potential of nanosilver-based dressings.^[24] Research by Jennifer LS suggests that the use of silver nanoparticle dressings improves the treatment effectiveness of burn wounds.^[25] Our current research similarly found that silver nanoparticle dressings enhance clinical efficacy in pediatric burn patients. The analysis attributes this enhancement to the unique properties of silver nanoparticle dressings. These dressings, acting as a new type of wound covering, are beneficial for maintaining a dry and hygienic wound surface, expediting scab formation and shedding, reducing infection risks, improving local blood circulation, accelerating wound recovery, and yielding favorable therapeutic effects.^[7,26]

Research by SHI WB found that the use of silver nanocomposite dressings reduces scarring in burn patients.^[27] Similarly, our study found that posttreatment VSS scores for thickness, color, vascularity, and pliability were lower in the observation group than in the control group. The proportion of mild scar hyperplasia was higher in the observation group, while the proportion of severe hyperplasia was lower. Nano-silver, as an inorganic antimicrobial agent, effectively controls wound infections, improves microcirculation, actively and continuously drains and improves the local wound environment, thereby preventing or reducing infections, particularly anaerobic infections, significantly shortening healing times, reducing scar formation, and improving cosmetic outcomes.^[28]

The 28.4% reduction in deep partial thickness healing time (24.56 vs 26.98 days) in the nano-silver group corresponds mechanistically to its observed anti-scarring effects. Accelerated wound closure limits prolonged inflammation, which is a key driver of hypertrophic scarring, by reducing fibroblast-to-myofibroblast transformation and abnormal collagen cross-linking.^[29] This aligns with Finlay’s study, that the shortened healing time is related to the reduced VSS score of burns.^[30] Our correlation analysis quantitatively establishes that reduced healing time directly drives improved scarring outcomes. Every 1-day acceleration in epithelialization decreased thickness VSS scores and pliability scores, while reducing severe hyperplasia risk. Healing time demonstrated positive correlations with poorer scar outcomes across all metrics. However, given the retrospective design, limited sample size, and lack of assessment for measurement error or minimal detectable change, these correlations should be interpreted as exploratory, and the estimates may be unstable. This dose-response relationship likely reflects attenuated inflammatory phases and accelerated wound maturity, where delayed reepithelialization perpetuates TGF-β-mediated collagen overproduction.^[31] Silver dressings’ antimicrobial efficacy critically enables this cascade by preventing biofilm formation that extends inflammatory phases.^[32]

Furthermore, family satisfaction in the observation group was higher than that in the control group. This might be attributed to the reduced frequency of dressing changes associated with silver nanoparticle dressings and their non-adherent design, which prevents dressing adhesion and reduces the risk of mechanical injury during dressing changes, thereby alleviating the child’s discomfort. These dressings are easy to apply, practical, and do not require strict sterile conditions, making them ideal for achieving high recognition from the families of pediatric patients.^[33]

The therapeutic effects of nano-silver dressings may involve multiple mechanisms, including antimicrobial activity, anti-inflammatory properties, modulation of the wound microenvironment, and promotion of tissue repair. In a study by Kowalski G, it was found that the use of silver nanoparticle dressings accelerates wound healing in burn patients.^[34] In that study, the observation group used silver nanocomposite dressings composed of cotton fibers impregnated with silver nanoparticles. Once the dressing covers the wound, the silver nanoparticles exert continuous antimicrobial effects. When the pathogens come into contact with the silver nanoparticles, protein denaturation occurred, leading to precipitation. In addition, silver interacted with thiol-containing enzymes to form stable complexes, thereby inhibiting enzymatic activity and controlling infection.^[7,35] Beyond their antimicrobial effects, silver nanocomposite dressings demonstrated favorable physical properties such as good air permeability, which contributed to an improved local wound microenvironment. Combined with the sustained antimicrobial activity of silver nanoparticles, these features facilitated faster wound healing.^[36] Moreover, the clinical study noted that patients in the observation group experienced fewer complications, likely because the antibacterial activity of silver nanoparticle dressings was not compromised by wound exudate or sweat, thus preventing secondary infections and associated complications.^[37] Taken together, these potential mechanisms provide a biologically plausible explanation for the favorable outcomes observed in our cohort and suggest that silver nanoparticle dressings hold promising potential for clinical application in the management of pediatric burn injuries.

This retrospective study has inherent limitations, including non-randomized treatment allocation and the observational design, which precludes causal inference. The potential for selection bias cannot be excluded, as treatment decisions were made by attending physicians based on clinical judgment rather than random assignment. Moreover, the apparent similarity in baseline distributions may reflect the homogeneity of the study population and restricted inclusion criteria in our center, but potential unmeasured confounding cannot be excluded. Although baseline characteristics showed no statistically significant differences between groups, the relatively small sample size limited the statistical power to detect potential imbalances, raising the possibility of type II error. The moderate sample size restricted subgroup analyses, and the follow-up period was insufficient to evaluate long-term scar maturation. In addition, given the number of endpoints assessed, there is also a risk of inflated type I error; although Bonferroni correction for multiple comparisons was applied, the possibility of residual false-positive findings cannot be entirely excluded. Furthermore, comprehensive safety profiling and cost-effectiveness analysis of silver nanoparticle absorption kinetics were not performed, and the single-center design may limit generalizability. Future prospective, multi-center randomized trials with pharmacokinetic monitoring and extended scar surveillance are warranted to validate these findings.

5. Conclusions

In conclusion, this retrospective study suggests that the use of silver nanoparticle dressings in pediatric burn patients may be associated with faster wound healing, fewer complications, improved cosmetic outcomes, and greater family satisfaction. These findings indicate a potential therapeutic role for silver nanoparticle dressings, which warrants confirmation in future prospective, randomized studies.

Acknowledgments

The authors would like to express their gratitude to all the participants who were involved in this study.

Author contributions

Conceptualization: Jun Tang, Zhentian Wu, Ruohong Ding.

Data curation: Jun Tang, Zhentian Wu, Xin Cheng, Rujin Li, Wenchuan Shen, Hong Zhang, Ruohong Ding.

Formal analysis: Jun Tang, Zhentian Wu, Xin Cheng, Rujin Li, Wenchuan Shen, Hong Zhang, Ruohong Ding.

Investigation: Jun Tang, Zhentian Wu, Xin Cheng, Rujin Li, Wenchuan Shen, Hong Zhang, Ruohong Ding.

Methodology: Jun Tang, Zhentian Wu, Xin Cheng, Rujin Li, Wenchuan Shen, Hong Zhang, Ruohong Ding.

Project administration: Ruohong Ding.

Supervision: Ruohong Ding.

Writing – original draft: Jun Tang, Zhentian Wu.

Writing – review & editing: Jun Tang, Zhentian Wu, Xin Cheng, Rujin Li, Wenchuan Shen, Hong Zhang, Ruohong Ding.