Cerium Nitrate in Burns: Avoiding the Need for Surgery

Jeremy Bishay¹, Dinuksha De Silva¹, Isobel Yeap¹, Aruna Wijewardana¹, Bishoy Soliman¹, Tim Wang¹,
¹Severe Burns Injury Unit, Royal North Shore Hospital, St Leonards , NSW, Australia

Abstract

Purpose:
The standard of care for full thickness burns is early surgical debridement and grafting. However, this is not always feasible due to concomitant illness, lack of surgical facilities and lack of donor sites. Topical cerium nitrate has been used for over 40 years to help facilitate the chemical debridement of burns. Cerium is a Lanthanide rare earth element associated with low toxicity (1). It was first used for the topical treatment of burns by William Monafo in 1976, proposing it has antibacterial properties. There is now considerable evidence to demonstrate its ability to convert the eschar into a dry, tensile and protective crust reducing the risk of bacterial ingress. The advantages of cerium nitrate include reducing mortality, avoiding the need for extensive surgery, and improving pain outcomes.

Methodology:
First, we present a literature review on the outcomes of cerium nitrate in the management of burns patients, highlighting a 30% reduction in mortality following a single application (1). Second, we present the case of a 24 year old male with 62% TBSA burns who did not require any debridement or grafting to his deep dermal-full thickness back burns following the application of topical cerium nitrate 4 days following injury.

Results and conclusion:
Cerium nitrate remains a useful adjunct in the management of burns today. It is a safe and effective topical treatment for the management of deep dermal or full-thickness burns not undergoing immediate debridement and grafting.

References:
(1)Deldar, R, D’Arpa, P, Moffatt, L, Leung, K, Shupp, J 2022, ‘Cerium Nitrate Treatment in the Management of Burns’, Advances in Wound Care, vol. 11, no. 8, pp. 443-454.

Biography

Jeremy Bishay is a Senior Resident Medical Officer at the Severe Burns Injury Unit of Royal North Shore Hospital with an interest in Plastic and Reconstructive Surgery.