1. Introduction
njuries caused by direct contact or contact with heat, chemical, electrical, or radiation sources are called burns [1]. Healing of burn wounds is among the problems of medical sciences [2]. In burns, the migration of keratinocytes is delayed by the accumulation of secretions and tissues on the wound surface; thus, the regeneration process of epithelial cells is postponed. Therefore, topical antibiotics must be used to control the infection in these wounds. Silver has been used for more than 50 years with bactericidal and bacteriostatic properties as a substance with excellent therapeutic effects on burn injuries. The adverse effects of silver sulfadiazine include pain, burning, itching, rash, and reversible leukopenia. Vitamin C can improve the immune system’s functioning and provide wound healing. The current study aimed to evaluate the effects of topical vitamin C solution on burn wounds in patients with grade 2 burns.
2. Materials and Methods   
In this study, 30 patients with grade 2 burns on two or more limbs symmetrically or one limb in a broad sense, in parallel, and one patient was randomly selected. Patients’ wounds were randomly divided into intervention and control groups. Initially, the study patients’ wounds were examined by an observer physician based on the Bates-Jensen Wound Assessment. In the limb or control area, on one limb or part of the wound, after routine washing and debridement with normal saline water and serum and dry with sterile gauze, 1% sulfadiazine silver ointment with sterile gloves up to 1.5-mm thick was placed. In the opposite limb or other parts of the studied limb, as the infected limb or intervention area, after washing and debridement with normal saline water and serum, the wound was dried with sterile gauze; then, 10% vitamin C solution was applied to the wound surface and ointment was applied on it. Silver sulfadiazine 1% was applied with sterile gloves with a thickness of 1.5 mm. Finally, the burned wound was treated with Vaseline and dry gauzes, respectively.
3. Results
The study sample included 30 patients referring to the burn ward of Sabzevar Vasei Hospital; of them, 8 were male and 12 were female, with a Mean±SD age of 43.03±11.90 and the BMI of 27.82±4.08 kg/m2.
The results of repeated-measures ANOVA suggested that the mean final score of the wound between the two types of treatment was statistically significant (P=0.047), i.e., the rate of wound healing was significantly different between the two groups and topical vitamin C had a significant effect on the healed wounds.
Regarding the within-group effects, the impact of time on the mean final score of the wound was statistically significant; the mean final score of the wound on the first, third, seventh, and fourteenth days was significantly different (P=0.000, F=525.156), In other words, different days or times have affected the wound healing. The ANOVA test data concerning the interactive effect of wound coverage type and time identified that the overall wound score was significant in the intervention and control groups on the first, third, seventh, and fourteenth days (P=0.000, F=8.649) (Figure1 and Table 3). 

In other words, different days in wound healing were statistically significant in both research groups (Table 1).


The obtained findings respecting the effect of topical vitamin C solution on the healing of grade 2 burn wounds revealed that this solution caused more improvement in the intervention areas than in the control regions; thus, topical vitamin C was influential on wound healing.
4. Discussion and Conclusion
The current research results suggested that the rate of wound healing was significantly different between the study groups; topical vitamin C solution presented a greater effect on wound healing, compared to the control group.
The obtained results were consistent with those of similar studies conducted. We compared our data with those of the studies by Hadi Abbaspour and Mehdi Khaksari where they reported the impactful effects of kiwi on wound healing in rats, i.e., were in line with those of our results.
A study was conducted by Lima et al. on vitamin C for the healing of skin wounds in rats [18]; comparing these studies highlighted the improvement of granular tissue in the treatment with vitamin C, i.e., consistent with the results of the above-mentioned study. Wesner and Gold entitled examined the impacts of topical vitamin C bed sores and chronic wounds; vitamin C solution could create fresh and abundant granular tissue in bedsores in patients [19]. Comparing this study with those of ours, we can point to the improvement of granular tissue at the site of receiving vitamin C solution.
Ulster et al. explored the effects of vitamin C on erythema after carbon dioxide laser [20]. Due to the greater effect of vitamin C solution in Ulster’s study, the indication for using this substance was investigated in our research.
Our study data were inconsistent with those of Mehdi Poursadegh and associates. In this study, the effect of vitamin C was investigated on tympanic membrane graft repair in tympanoplasty [21]. In the above-mentioned study, using oral vitamin C, the treatment process was studied at long intervals and only 5.2 months and 3 years later, i.e., one of the significant points of the study.

Ethical Considerations
Compliance with ethical guidelines
The present research was approved by the Graduate Council of Sabzevar School of Nursing and Midwifery (Ethics Code: IR.MEDSAB.REC.1394.60; IRCT Code: IRCT2015101224487N1).

Funding
The paper was extracted from the MSc. thesis of the corresponding author at the Department of Nursing, Faculty of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar.

Authors' contributions
Conceptualization and methodology: Hamid Robat Sarposhi; Data collection and writing – original draft: Mohammad Haddadi; Data analysis: Davood Movahedzadeh; Writing – review & editing: Elahe Jaghor.

Conflicts of interest
The authors declared no conflicts of interest.

Acknowledgements
We would like to thank the Graduate Council of Sabzevar School of Nursing and Midwifery, the esteemed officials of Vasei Hospital, and the staff of the hospital’s burn ward who contributed to this process. 


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