Successful Stabilization of Fragile Epithelium in an Infection-Complicated Burn Wound Using a Stepwise Dry Dressing Technique: A Case Report

Successful healing of burn wounds requires the maturation of anchoring fibrils (type VII collagen) for stable re-epithelialization. However, infection with Staphylococcus aureus can trigger the release of matrix metalloproteinase-9, resulting in the degradation of these fibrils and subsequent instability of the epithelium. We report the case of a 57-year-old woman who sustained a deep second-degree contact burn complicated by a methicillin-resistant S. aureus infection. Despite adequate infection control, the neo-epithelium remained fragile and susceptible to recurrent breakdown, likely due to proteolytic degradation at the dermal-epidermal junction. To address this, a “stepwise dry dressing” technique was implemented, incorporating a silicone-coated nylon mesh covered with a semi-permeable polyurethane film. This approach offered mechanical protection against shear forces while preserving an optimal moisture balance to prevent maceration. By minimizing environmental stress, this regimen promoted the maturation of anchoring fibrils. Complete stable epithelialization was achieved within 3 months, without recurrence or hypertrophic scarring at the 1-year follow-up. This case suggests that protecting nascent anchoring fibrils from proteolytic and mechanical stress via a specialized dry dressing strategy is important for ensuring durable closure in unstable, infected burn wounds.