Single-Application Biobrane Versus Nanocrystalline Silver Dressings for Bilateral Mid-Dermal Petrol Flash Burns: An Intra-Patient Split-Limb Case Report.

Biobrane (Smith & Nephew, Hull, UK) is a biosynthetic bilaminate dressing used for superficial partial-thickness burns, where it provides single-application coverage until re-epithelialisation. Comparative data in adults with mixed-depth burns are limited, and within-patient comparisons are rare. We report a man in his early 50s with type 2 diabetes mellitus who sustained 21% total body surface area (TBSA) circumferential mixed superficial and mid-dermal burns to both lower limbs in a petrol flash explosion. At primary debridement the left limb was covered with a single application of Biobrane and the right with a silicone contact layer and nanocrystalline silver dressings. This created an unplanned intra-patient comparison in near-symmetrical wounds. The Biobrane limb required no further surgery and remained free of clinical infection. It healed by day 32. The silver-dressed limb required two further debridements. It developed a polymicrobial wound infection with non-multiresistant methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa, needing systemic antibiotics. It healed later and was the site of persistent pain that continued after wound closure and required ongoing neuropathic analgesia. These complications drove a prolonged 23-day admission. The Biobrane limb outperformed the silver-dressed limb on every metric assessed: operations, infection, healing time, and pain. This case suggests that single-application biosynthetic coverage may offer analgesic and operative advantages in adult mixed-depth burns. It also highlights persistent pain as an underappreciated burden of silver-based dressing regimens.