Burn is one of the major health problems around the world, especially in developing countries. Extensive burn injuries are not only life-threatening, but also have serious physical, psychological and economic effects on the patients, their families and society. Burn lesions are the third leading cause of unintentional injury deaths at all age groups and the second cause of trauma in children younger than 4 years of age. Approximately, two million people are given medical services for treatment of burn injuries every year in the United States [1]. According to relevant statistics in Iran, eight people with an average age of 35.7 die because of burning. Burn mortality rates in Iran is almost 3 times higher than Eastern Mediterranean countries and 2 times higher than global rate. Burn injuries lead to depression of immune potential, which may result in secondary infections [2.3]. A number of 152 people visited the Burn Center in Vaseei Hospital in Sabzevar in 2013. This figure increased to 190 people from the beginning of 2014 to the end of December 2014, which indicates an increase in the number of hospital refferals and burn statistics in Sabzevar.
Wounds are defined as a disruption of the normal structure and function of skin and underlying soft tissue. It is vital to maintain skin integrity, protect it against dehydration and bleeding, and prevent penetration of microorganisms into the skin. Skin wounds are caused by various physical, chemical and biological factors and are divided into chronic and acute wounds according to type and duration of repair [4].
Nutritional deficiencies can have adverse effects on wound and trauma injury healing. In this regard, researchers who study tissue repair dynamics have shown that several nutritional factors (e.g. vitamins, minerals and proteins) are effective in would healing and repairing [5].
Since tissues at the burned site are dead and block blood supply, white blood cells (WBC), antibodies and antibiotics cannot pass through bloodstream. This provides a suitable situation for growth of microorganisms. Therefore, topical antibiotics should be used to control infection at burned sites. Topical treatment helps to cleanse and close and open and dirty wound. Three common topical antibiotics used to heal burns are silver sulfadiazine, silver nitrate and Mafenide acetate. Silver with bactericidal and bacteriostatic activities has been used as an efficacious therapeutic agent for healing burn injuries over 50 years [6].
Epithelial tissue is an important and vital barrier to external factors. Damage to such barrier can lead to loss of water and electrolytes as well as metabolic disturbances. Epithelial tissue has a great capacity for repair and restoration. This capability is dependent on presence of epidermal stem cells in the basal layer and interfollicular epidermis. However, these cells are slow-cycling and have longer cell cycle time than delay tissue repair. On the other hand, time is an important factor in extensive burns [7].
Vitamin C is a water-soluble micronutrient required for various biological functions and is essential for wound healing and resistance to infection. It is also a potent antioxidant effective in maintaining vascular integrity and tone [8.3].
Vitamin C infusion appears to be a useful in resuscitation of burn patients and minimizes fluid requirement. Oral Vitamin C is administered for burn patients younger than 13 years old (250–500 mg/day) and older than 13 years old (≤ 1000 mg/day) [9]. Topical vitamin C reduces inflammatory reactions [10].
Some studies on pigs have shown an increase in vitamin C levels in the skin by administration of 10% vitamin C solution [11]. It is also acknowledged that different materials such as kiwi and jujube are effective in burn wound healing since they content high levels of vitamin C (12.2). Various studies have acknowledged the effects of fatty acids and antioxidants (e.g. vitamin C) in accelerating wound healing [12].
Silver sulfadiazine dressing may cause false scar since the dressing adheres firmly to the wound surface, has toxic effects on keratinocyte repair, and delays wound healing [13].
Many patients in burn community have started using more high-dose vitamin C during complicated burn resuscitations[14]. The identification of the mechanisms regulating gene expression of oxidative stress markers, in the presence or absence of vitamin C, is important to understand the processes that influence the recovery of burn patients [3]. High-dose vitamin C therapy was associated with reduced in-hospital mortality in patients with severe burns under a minimum threshold of 10 g within the first 2 days of admission [15].
Since a large body of evidence confirms the effects of oral vitamin C on wound healing process and the effects of topical use of fruits containing vitamin C on burn wounds, the present study aimed to evaluate the effects of topical vitamin C solution on burn wound in second degree burn patients.