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Sanchez-Puigdollers A, Toll A, Morgado-Carrasco D. Postoperative Wound Care in Dermatologic Surgery: Update And Narrative Review. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00488-5. [PMID: 38857845 DOI: 10.1016/j.ad.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/24/2024] [Accepted: 05/08/2024] [Indexed: 06/12/2024] Open
Abstract
Dermatologic surgery is associated with a very low risk of complications. There is no widely accepted, evidence-based protocol with recommendations for postoperative wound care after dermatologic surgery. In this narrative review, we will be discussing the evidence on surgical wound care products and procedures. Overall, we found relatively few studies and, in many cases, a lack of statistically significant differences, possibly because of the low rate of complications. We'll be discussing the evidence on when we should initiate wound care procedures and their frequency, the type of ointment and antiseptics that should be applied, and the type of dressings that should be used. Despite the very few studies available on postoperative wound care following dermatologic surgery, there is sufficient evidence as to not recommend the use of prophylactic topical antibiotics. We also analyze the currently available evidence on surgical wound care in special situations, such as management of skin grafts, partial skin graft donor sites, xenografts/biomembranes, and surgical wounds to the legs.
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Affiliation(s)
- A Sanchez-Puigdollers
- Servicio de Dermatología, Hospital Sagrat Cor, Barcelona, España; Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, España
| | - A Toll
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, España
| | - D Morgado-Carrasco
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, España; Servicio de Dermatología, Hospital de Figueres, Fundació Salut Empordà, Figueres, Girona, España.
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Chernova UV, Varakuta EY, Koniaeva AD, Leyman AE, Sagdullaeva SA, Plotnikov E, Melnik EY, Tran TH, Rutkowski S, Kudryavtseva VL, Buznik VM, Bolbasov E. Piezoelectric and Dielectric Electrospun Fluoropolymer Membranes for Oral Mucosa Regeneration: A Comparative Study. ACS APPLIED MATERIALS & INTERFACES 2024. [PMID: 38607352 DOI: 10.1021/acsami.4c01867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Wound healing of the oral mucosa is an urgent problem in modern dental surgical practice. This research article presents and compares the findings of the investigations of the structural, physicochemical, and biological characteristics of two types of polymeric membranes used for the regeneration of oral mucosa. The membranes were prepared from poly(tetrafluoroethylene) (PTFE) and a copolymer of vinylidene fluoride and tetrafluoroethylene (VDF-TeFE) and analyzed via scanning electron microscopy, atomic force microscopy, X-ray diffraction analysis, and Fourier transform infrared spectroscopy. Investigation results obtained indicate that both types of membranes are composed of thin fibers: (0.57 ± 0.25) μm for PTFE membranes and (0.43 ± 0.14) μm for VDF-TeFE membranes. Moreover, the fibers of VDF-TeFE membranes exhibit distinct piezoelectric properties, which are confirmed by piezoresponse force microscopy and X-ray diffraction. Both types of membranes are hydrophobic: (139.7 ± 2.5)° for PTFE membranes and (133.5 ± 2.0)° for VDF-TeFE membranes. In vitro assays verify that both membrane types did not affect the growth and division of mice fibroblasts of the 3T3-L1 cell line, with a cell viability in the range of 88-101%. Finally, in vivo comparative experiments carried out using Wistar rats demonstrate that the piezoelectric VDF-TeFE membranes have a high ability to regenerate oral mucosa.
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Affiliation(s)
- Ulyana V Chernova
- School of Nuclear Science & Engineering, National Research Tomsk Polytechnic University, I-634050 Tomsk, Russian Federation
| | - Elena Yu Varakuta
- The Human Anatomy Department, Siberian State Medical University, I-634050 Tomsk, Russian Federation
| | - Anastasiia D Koniaeva
- The Human Anatomy Department, Siberian State Medical University, I-634050 Tomsk, Russian Federation
| | - Arina E Leyman
- The Human Anatomy Department, Siberian State Medical University, I-634050 Tomsk, Russian Federation
| | - Sofia A Sagdullaeva
- The Human Anatomy Department, Siberian State Medical University, I-634050 Tomsk, Russian Federation
| | - Evgenii Plotnikov
- Research School of Chemistry and Applied Biomedical Sciences, National Research Tomsk Polytechnic University, I-634050 Tomsk, Russian Federation
| | - Evgeniy Yu Melnik
- Research School of Chemistry and Applied Biomedical Sciences, National Research Tomsk Polytechnic University, I-634050 Tomsk, Russian Federation
| | - Tuan-Hoang Tran
- Research School of Chemistry and Applied Biomedical Sciences, National Research Tomsk Polytechnic University, I-634050 Tomsk, Russian Federation
| | - Sven Rutkowski
- Weinberg Research Center, School of Nuclear Science & Engineering, National Research Tomsk Polytechnic University, I-634050 Tomsk, Russian Federation
| | - Valeriya L Kudryavtseva
- School of Engineering and Materials Science, Queen Mary University of London, E14NS London, United Kingdom
| | - Vyacheslav M Buznik
- Faculty of Chemistry, Tomsk State University, I-634050 Tomsk, Russian Federation
| | - Evgeniy Bolbasov
- School of Nuclear Science & Engineering, National Research Tomsk Polytechnic University, I-634050 Tomsk, Russian Federation
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Xianchao D, Yi L, Chang L, Zhixin Y. Comparison of Biatain Ag and Biatain Alginate Ag dressings on skin graft donor sites: a prospective clinical trial. J Wound Care 2023; 32:cxcv-cc. [PMID: 37703218 DOI: 10.12968/jowc.2023.32.sup9a.cxcv] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE The aim of this study was to compare Biatain Ag and Biatain Alginate Ag (both Coloplast, Denmark) as skin graft donor site dressings. METHOD A single-centre, prospective, randomised clinical study was conducted. In patients who had undergone a skin graft operation, adjacent split-thickness skin graft donor sites were dressed with Biatain Ag and Biatain Alginate Ag, respectively. The primary outcomes were time to re-epithelialisation and pain score after the operation. The secondary outcomes were scar scores of the donor site after the operation, haematoma rates, infection rates, and exudation rates before wound healing. Results were compared using the Wilcoxon test and the Chi-squared test. RESULTS A total of 16 paired wounds in 16 patients were studied. The donor sites dressed with Biatain Ag needed more time for >90% re-epithelialisation than those dressed with Biatain Alginate Ag. On day 3 postoperatively, the pain scores with Biatain Ag were significantly less severe than those with Biatain Alginate Ag. On days 6, 9 and 12, the pain scores of both dressings did not differ significantly. The scar scores of the donor site dressed with Biatain Ag were significantly worse than those dressed with Biatain Alginate Ag at 6 months. With respect to infection rates, no significant differences were detected between these two groups. However, the exudation rates of the donor site dressed with Biatain Ag were significantly lower than those dressed with Biatain Alginate Ag. CONCLUSION As skin graft donor site dressings, both Biatain Ag and Biatain Alginate Ag have advantages.
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Affiliation(s)
- Ding Xianchao
- Department of Burn and Plastic Surgery, Affiliated hospital of Jiangsu University, Zhenjiang, Jiangsu Province, PRC
| | - Luo Yi
- Department of Burn and Plastic Surgery, Affiliated hospital of Jiangsu University, Zhenjiang, Jiangsu Province, PRC
| | - Liu Chang
- Department of Burn and Plastic Surgery, Affiliated hospital of Jiangsu University, Zhenjiang, Jiangsu Province, PRC
| | - Yan Zhixin
- Department of Burn and Plastic Surgery, Affiliated hospital of Jiangsu University, Zhenjiang, Jiangsu Province, PRC
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Peters E, Hanssens V, De Henau M, Dupont Y, Spinnael J, Giunta G, Zeltzer A, De Baerdemaeker R, Hamdi M. Using an Elastomeric Skin Protectant to Manage Donor Site Wounds of Split-thickness Skin Grafts: A Case Series. Adv Skin Wound Care 2023; 36:1-5. [PMID: 37530580 DOI: 10.1097/asw.0000000000000021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
ABSTRACT Split-thickness skin grafting (STSG) is a common surgical procedure to manage acute and chronic wounds. A plethora of dressings exists to treat STSG donor site wounds (DSWs). Recently, a new elastomeric skin protectant was adopted (Cavilon Advanced Skin Protectant; 3M) in the treatment of incontinence-associated dermatitis. In this report, the authors assess the effects of this elastomeric skin protectant as an alternative wound dressing for STSG donor sites.The authors report a single-center prospective case series that was performed to establish a treatment protocol. Nine consecutive patients with different indications for treatment with an STSG from May to September 2018 were included. Collected data included general patient information, comorbidities, complications, blood loss, pain during dressing change, and the duration of DSW healing.This case series showed promising results in terms of duration of DSW healing when applying the elastomeric skin protectant. The authors also observed less blood loss and less pain during dressing changes. No infections were seen during the trial.
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Affiliation(s)
- Ellen Peters
- At Universitair Ziekenhuis Brussels, Belgium, Ellen Peters, MD, is Resident, Plastic, Reconstructive, and Aesthetic Surgery; Valerie Hanssens, MSc, is Nurse Specialist Wound Care; Melissa De Henau, MD, is Medical Doctor; Yamina Dupont, MD, is Resident, Plastic, Reconstructive, and Aesthetic Surgery; Jeannine Spinnael, BSN, is Nurse Specialist Wound Care; Gabriele Giunta, MD, Assaf Zeltzer, MD, PhD, and Randy De Baerdemaeker, MD, are Staff Members, Plastic, Reconstructive, and Aesthetic Surgery; and Moustapha Hamdi, MD, PhD, is Chief, Department of Plastic, Reconstructive, and Aesthetic Surgery. The authors have disclosed no financial relationships related to this article. Submitted February 8, 2022; accepted in revised form October 21, 2022; Published ahead of print July 31, 2023
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Ousey K, Rippon MG, Rogers AA, Totty JP. Considerations for an ideal post-surgical wound dressing aligned with antimicrobial stewardship objectives: a scoping review. J Wound Care 2023; 32:334-347. [PMID: 37300859 DOI: 10.12968/jowc.2023.32.6.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Most surgical wounds heal by primary or secondary intention. Surgical wounds can present specific and unique challenges including wound dehiscence and surgical site infection (SSI), either of which can increase risk of morbidity and mortality. The use of antimicrobials to treat infection in these wounds is prevalent, but there is now an imperative to align treatment with reducing antimicrobial resistance and antimicrobial stewardship (AMS). The aim of this review was to explore the published evidence identifying general considerations/criteria for an ideal post-surgical wound dressing in terms of overcoming potential wound healing challenges (including infection) while supporting AMS objectives. METHOD A scoping review examining evidence published from 1954-2021, conducted by two authors acting independently. Results were synthesised narratively and have been reported in line with PRISMA Extension for Scoping Reviews. RESULTS A total of 819 articles were initially identified and subsequently filtered to 178 for inclusion in the assessment. The search highlighted six key outcomes of interest associated with post-surgical wound dressings: wound infection; wound healing; physical attributes related to comfort, conformability and flexibility; fluid handling (e.g., blood and exudate); pain; and skin damage. CONCLUSION There are several challenges that can be overcome when treating a post-surgical wound with a dressing, not least the prevention and treatment of SSIs. However, it is imperative that the use of antimicrobial wound dressings is aligned with AMS programmes and alternatives to active antimicrobials investigated.
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Affiliation(s)
- Karen Ousey
- Professor Skin Integrity, Director for the Institute of Skin Integrity, and Infection Prevention, University of Huddersfield, UK
- Department of Nursing and Midwifery, Adjunct Professor, School of Nursing, Faculty of Health at the Queensland University of Technology, Australia
- Visiting Professor, Royal College of Surgeons of Ireland, Ireland
- Chair, International Wound Infection Institute UK
- President Elect, International Skin Tear Advisory Panel, US
| | - Mark G Rippon
- Visiting Clinical Research Associate, Huddersfield University, Huddersfield, UK
- Consultant, Dane River Consultancy Ltd, Cheshire, UK
| | - Alan A Rogers
- Independent Wound Care Consultant, Flintshire, North Wales, UK
| | - Joshua P Totty
- NIHR Clinical Lecturer in Plastic Surgery, Hull York Medical School, UK
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desJardins-Park HE, Gurtner GC, Wan DC, Longaker MT. From Chronic Wounds to Scarring: The Growing Health Care Burden of Under- and Over-Healing Wounds. Adv Wound Care (New Rochelle) 2022; 11:496-510. [PMID: 34521257 PMCID: PMC9634983 DOI: 10.1089/wound.2021.0039] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 09/03/2021] [Indexed: 12/26/2022] Open
Abstract
Significance: Wound healing is the largest medical market without an existing small molecule/drug treatment. Both "under-healing" (chronic wounds) and "over-healing" (scarring) cause a substantial biomedical burden and lifelong consequences for patients. These problems cost tens of billions of dollars per year in the United States alone, a number expected to grow as the population ages and the prevalence of common comorbidities (e.g., diabetes) rises. However, no therapies currently exist to produce the "ideal" healing outcome: efficient wound repair through regeneration of normal tissue. Recent Advances: Ongoing research continues to illuminate possible therapeutic avenues for wound healing. By identifying underlying mechanisms of wound repair-for instance, tissue mechanics' role in fibrosis or cell populations that modulate wound healing and scarring-novel molecular targets may be defined. This Advances in Wound Care Forum issue includes reviews of scientific literature and original research from the Hagey Laboratory for Pediatric Regenerative Medicine at Stanford and its alumni, including developing approaches for encouraging wound healing, minimizing fibrosis, and coaxing regeneration. Critical Issues: Wound healing problems reflect an enormous and rapidly expanding clinical burden. The issues of both under- and over-healing wound outcomes will continue to expand as their underlying causes (e.g., diabetes) grow. Targeted treatments are needed to enable wound repair with functional tissue restoration and decreased scarring. Future Directions: Basic scientists will continue to refine understanding of factors driving undesirable wound outcomes. These discoveries are beginning to be translated and, in the coming years, will hopefully form the foundation for antiscarring drugs and other wound therapeutics.
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Affiliation(s)
- Heather E. desJardins-Park
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery; Stanford, California, USA
- Institute for Stem Cell Biology and Regenerative Medicine; Stanford University School of Medicine, Stanford, California, USA
| | - Geoffrey C. Gurtner
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery; Stanford, California, USA
| | - Derrick C. Wan
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery; Stanford, California, USA
| | - Michael T. Longaker
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery; Stanford, California, USA
- Institute for Stem Cell Biology and Regenerative Medicine; Stanford University School of Medicine, Stanford, California, USA
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Elblbesy MA, Hanafy TA, Shawki MM. Polyvinyl alcohol/gum Arabic hydrogel preparation and cytotoxicity for wound healing improvement. E-POLYMERS 2022. [DOI: 10.1515/epoly-2022-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
The application of pure polyvinyl alcohol (PVA) hydrogel as wound dressing faces many restrictions due to its insufficient elasticity, stiff membrane, and very limited hydrophilicity. These drawbacks can be limited through cross-linking with other natural biopolymers such as gum Arabic (GA). PVA hydrogels blended with six different GA concentrations were prepared. The characterization of these hydrogels was performed by Fourier transform infrared spectrophotometer, X-ray diffraction, and scanning electron microscope. The swelling ratio (% SR) percentage has been calculated. The possible cytotoxicity was determined using a sulforhodamine B assay. Wound healing test was performed on human skin fibroblast cells. Our results indicated that by increasing GA concentration in PVA hydrogel, the % SR increases and the cytotoxicity effect decreases. The results indicate also a significant gradual decrease in the wound area with time as the GA concentration increases in the PVA hydrogel. Therefore, GA improves the biological applications of PVA hydrogel.
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Affiliation(s)
- Mohamed A. Elblbesy
- Medical Biophysics Department, Medical Research Institute, Alexandria University , Alexandria city , Egypt
- Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, University of Tabuk , Tabuk , Saudi Arabia
| | - Taha A. Hanafy
- Department of Physics and Nanotechnology Research Laboratory, Faculty of Science, University of Tabuk , Tabuk , Saudi Arabia
- Department of Physics, Faculty of Science, Fayoum University , El Fayoum , 63514 , Egypt
| | - Mamdouh M. Shawki
- Medical Biophysics Department, Medical Research Institute, Alexandria University , Alexandria city , Egypt
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A prospective comparative study on the effectiveness of two different non-adherent polyurethane dressings on split-thickness skin graft donor sites. J Tissue Viability 2022; 31:531-536. [DOI: 10.1016/j.jtv.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 11/18/2022]
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Chalwade C, Kumar V, Suresh A. Use of Minced Residual Skin Grafts to Improve Donor Site Healing in Split-Thickness Skin Grafting. Cureus 2022; 14:e23453. [PMID: 35481322 PMCID: PMC9034767 DOI: 10.7759/cureus.23453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/05/2022] Open
Abstract
Background The morbidity of the donor site in split-thickness skin graft (STSG) may include abnormal pigmentation, delayed healing, and unfavorable scarring. Studies are usually focused on improving the healing of the recipient site, so donor site management becomes a secondary consideration. An optimal solution should be sought for donor site management to improve healing and minimize morbidity. Methods In this study, we used minced residual skin grafts over half of the donor site (cases) and compared the healing duration and scar quality with the other half (control). Healing duration was measured in days and the scar quality was assessed by the Patient and Observer Scar Assessment Scale (POSAS) at 90 days, 180 days, and 360 days. Results The healing time was reduced with the application of minced residual skin grafts on the donor site. The scar quality was significantly better in the case group as compared to the control group at 90 days, 180 days, and 360 days (p<0.05). Conclusion Mincing residual skin grafts and replacing them back to the donor site reduces the healing time and improves the quality of the scar.
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Review of History of Basic Principles of Burn Wound Management. Medicina (B Aires) 2022; 58:medicina58030400. [PMID: 35334576 PMCID: PMC8954035 DOI: 10.3390/medicina58030400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 01/09/2023] Open
Abstract
Thermal energy is an essential and useful resource to humans in modern society. However, a consequence of using heat carelessly is burns. Burn injuries have various causes, such as exposure to flame, radiation, electrical, and chemical sources. In this study, we reviewed the history of burn wound care while focusing on the basic principles of burn management. Through this review, we highlight the need for careful monitoring and customization when treating burn victims at each step of wound care, as their individual needs may differ. We also propose that future research should focus on nanotechnology-based skin grafts, as this is a promising area for further improvement in wound care.
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Şahin E, Rizalar S, Özker E. Effectiveness of negative-pressure wound therapy compared to wet-dry dressing in pressure injuries. J Tissue Viability 2022; 31:164-172. [PMID: 35022147 DOI: 10.1016/j.jtv.2021.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 12/20/2021] [Accepted: 12/23/2021] [Indexed: 02/03/2023]
Abstract
This study aims to compare the effects of Negative-Pressure Wound Therapy (NPWT) and wet-to-dry dressing on Stages 3 and 4 pressure injuries (PI), This study is a randomized controlled trial. A total of 30 patients with Stages 3 and 4 pressure injuries were included in the study. The patients were divided into two groups: NPWT group and the wet-to-dry dressing group. All patients received 3 rounds of treatment. Data were collected with a Patient Identification Form, Pressure Ulcer Scale for Healing (PUSH) Tool and the findings of the Three-Dimensional Wound Measurement (3DWM) device. We found that granulation tissue formation was more significant in the experimental group (p < .05), and that there was more significant wound shrinkage (p < .05) with a more significant decrease in the PUSH Tool scores (p < .05). The wounds were assessed with the tool and the 3DWM system. Device measurements were found to be correlated with PUSH Tool findings (p < .05). There was a significant correlation between device-measured granulation findings and PUSH Tool score results of the experimental group's third measurements (p < .05). We conclude that NPWT is an effective treatment method for pressure injuries, and 3DWM device is a useable wound assessment tool.
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Affiliation(s)
- Ezgi Şahin
- Başkent University Istanbul, Health Research Application Hospital, Istanbul, Turkey
| | - Selda Rizalar
- Health Science University, Hamidiye Nursing Faculty, Department of Surgical Nursing , Istanbul, Turkey.
| | - Emre Özker
- Acibadem Mehmet Ali Aydinlar University, Health Science School, Istanbul, Turkey
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Gupta S, Jain RK. Application of autologous platelet-rich plasma to graft donor sites to reduce pain and promote healing. J Wound Care 2022; 31:86-90. [PMID: 35077214 DOI: 10.12968/jowc.2022.31.1.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Platelet-rich plasma (PRP) is widely used for wound healing in medical care because of the numerous growth factors it contains. Traditionally, donor sites are left to heal with a primary dressing so wounds are not left open. However, a delay in healing accompanied by pain at a donor site is often seen. This study primarily throws light on the use of autologous PRP over split-thickness skin graft (STSG) donor sites to promote healing and reduce pain. METHOD The patients enrolled in this study in 2018-2019 were divided into two groups: the intervention group received autologous PRP applied topically at the donor site; in the control group, the wound was dressed traditionally. Pain scales were measured in the immediate postoperative period at six hours, 10 hours and 16 hours. The dressing was opened on the postoperative day 14 and observed for healing by an independent observer. RESULTS A total of 100 patients were included in the study. Patients in the PRP group showed statistically significant faster healing at postoperative day 14 compared with the control group (p<0.05), who required dressings for 3-4 weeks postoperatively. Pain scale scores in the postoperative period were significantly less in the PRP group at six hours postoperatively compared with the control group (p<0.05). There was a reduced incidence of hypertrophic scar formation in the small number of patients in the PRP group who had developed hypertrophic scar previously. CONCLUSION Application of PRP is a safe, cost-effective and easy method to achieve faster healing in graft donor site areas that are troublesome to both patients and doctors. It also reduces postoperative pain at donor sites. The authors recommend PRP is used more often in the management of donor sites for STSGs.
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Affiliation(s)
- Samarth Gupta
- Department of Plastic, Reconstructive and Burns Surgery, SMS Hospital Jaipur, India
| | - Rakesh Kumar Jain
- Department of Plastic, Reconstructive and Burns Surgery, SMS Hospital Jaipur, India
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Craig CK, Williams JW, Carter JE, Holmes JH. Bismuth/Petroleum Gauze plus High Density Polyethylene vs. Bismuth/Petroleum Gauze: A Comparison of Donor Site Healing and Patient Comfort. Burns 2022; 48:1917-1921. [DOI: 10.1016/j.burns.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 11/28/2022]
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Jain RK, Choudhary GM, Gupta G, Patil AN, Prakash GD, Jain AK. Reducing split-thickness skin grafting donor site agony; faster healing and decreased pain-role of platelet-rich plasma. Asian J Transfus Sci 2021; 15:195-198. [PMID: 34908754 PMCID: PMC8628236 DOI: 10.4103/ajts.ajts_39_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 08/31/2017] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The split-thickness skin graft harvested donor site is associated with prolonged healing, discomfort, and pain. Platelet-rich plasma (PRP) contains platelet-derived growth factors and has been widely used in chronic wounds and skin graft donor sites. PRP application is known to accelerate wound epithelialization rates, and also reduce postoperative wound site pain. MATERIALS AND METHODS We assessed 20 patients admitted to our hospital service who underwent split-thickness skin grafting (STSGs) with proximal half of the donor site treated with PRP. The dressing was conducted on postoperative day 7, 14, and 21. The donor site healing was assessed with serial photographs and donor site pain measured by numerical rating scale. RESULTS Complete healing of wounds (epithelialization) was present in 12 (60%) patients dressed with PRP. Pain on opening dressing was an average of 3.5 in PRP dressed wounds and 6.35 in control wounds. Patients dressed without PRP, none of them had complete epithelialization. All patients had partial healing and were less than the donor site dressed with PRP. Based on these results, skin graft donor site with PRP showed accelerated healing and reduced pain and discomfort compared to control without PRP. CONCLUSION PRP is a beneficial adjunct for reducing donor site pain and increased healing of donor site following STSG harvest.
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Affiliation(s)
- Rakesh Kumar Jain
- Department of Plastic Surgery, SMS Hospital and Medical College, Jaipur, Rajasthan, India
| | - Ghisulal M Choudhary
- Department of Plastic Surgery, SMS Hospital and Medical College, Jaipur, Rajasthan, India
| | - Gajendra Gupta
- Department of Pathology, Santokba Durlabji Hospital, Jaipur, Rajasthan, India
| | - Aditya N Patil
- Department of Plastic Surgery, SMS Hospital and Medical College, Jaipur, Rajasthan, India
| | - Gautam D Prakash
- Department of Plastic Surgery, SMS Hospital and Medical College, Jaipur, Rajasthan, India
| | - Ayush K Jain
- Department of Plastic Surgery, SMS Hospital and Medical College, Jaipur, Rajasthan, India
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Teoh JH, Tay SM, Fuh J, Wang CH. Fabricating scalable, personalized wound dressings with customizable drug loadings via 3D printing. J Control Release 2021; 341:80-94. [PMID: 34793918 DOI: 10.1016/j.jconrel.2021.11.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/14/2021] [Accepted: 11/10/2021] [Indexed: 12/13/2022]
Abstract
In recent times, 3D printing has been gaining traction as a fabrication platform for customizable drug dosages as a form of personalized medicine. While this has been recently demonstrated as oral dosages, there is potential to provide the same customizability and personalization as topical applications for wound healing. In this paper, the application of 3D printing to fabricate hydrogel wound dressings with customizable architectures and drug dosages was investigated. Chitosan methacrylate was synthesized and mixed with Lidocaine Hydrochloride and Levofloxacin respectively along with a photoinitiator before being used to print wound dressings of various designs. These designs were then investigated for their effect on drug release rates and profiles. Our results show the ability of 3D printing to customize drug dosages and drug release rates through co-loading different drugs at various positions and varying the thickness of drug-free layers over drug-loaded layers in the wound dressing respectively. Two scale-up approaches were also investigated for their effects on drug release rates from the wound dressing. The influence that each wound dressing design has on the release profile of drugs was also shown by fitting them with drug release kinetic models. This study thus shows the feasibility of utilizing 3D printing to fabricate wound dressings with customizable shapes, drug dosage and drug release rates that can be tuned according to the patient's requirements.
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Affiliation(s)
- Jia Heng Teoh
- Department of Chemical and Biomolecular Engineering, National University of Singapore, 117585, Singapore
| | - Sook Muay Tay
- Department of Surgical Intensive Care, Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Jerry Fuh
- Department of Mechanical Engineering, National University of Singapore, 117575, Singapore
| | - Chi-Hwa Wang
- Department of Chemical and Biomolecular Engineering, National University of Singapore, 117585, Singapore.
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16
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Legemate CM, Lucas Y, Oen IMMH, van der Vlies CH. Regrafting of the Split-Thickness Skin Graft Donor-Site: Is It Beneficial? J Burn Care Res 2021; 41:211-214. [PMID: 31630196 DOI: 10.1093/jbcr/irz166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Split-thickness skin grafting remains a fundamental treatment for patients with deep burns and other traumatic injuries. Unfortunately, the donor site wound that remains after split skin graft (SSG) harvesting may also cause problems for the patient; they can lead to discomfort and scars with a poor cosmetic outcome. Regrafting of the donor site is one of the methods described to improve donor site healing and scarring. In this report, we describe a case of a 26-year-old woman with a self-inflicted chemical burn (0.5% TBSA) who underwent split skin grafting. During surgery, only part of the donor site was regrafted with split skin graft remnants. This part healed faster and had a better scar quality at 3 months postsurgery. Nevertheless, the appearance and patients' opinion on the regrafted part deteriorated after 12 months. With this case report, we aim to create awareness of the long-term consequences of regrafting, which may differ from short-time results. Patients expected to have poor reepithelialization potential may benefit from regrafting of the SSG on the donor site. But in healthy young individuals, timewise there would be no benefit since it can lead to an aesthetically displeasing result.
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Affiliation(s)
- Catherine M Legemate
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Burn Center, Maasstad Hospital, AC Rotterdam, the Netherlands
| | - Ymke Lucas
- Burn Center, Maasstad Hospital, AC Rotterdam, the Netherlands
| | - Irma M M H Oen
- Burn Center, Maasstad Hospital, AC Rotterdam, the Netherlands
| | - Cornelis H van der Vlies
- Burn Center, Maasstad Hospital, AC Rotterdam, the Netherlands.,Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Trauma Research Unit, Rotterdam, The Netherlands
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17
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Amer Y, Bridges C, Marathe K. Epidemiology, Pathophysiology, and Management Strategies of Neonatal Wound Care. Neoreviews 2021; 22:e452-e460. [PMID: 34210809 DOI: 10.1542/neo.22-7-e452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Guidelines for neonatal skin care are scarce, and there is no consensus on the best management practices for neonatal skin breakdown. This review presents the pathology and phases of wound healing, reasons for neonatal skin fragility, and approaches to recognition of commonly encountered neonatal wounds. This review also provides general strategies for neonatal wound prevention, care, dressing, and management to avoid further damage to the fragile neonatal skin. The importance and role of retaining moisture in expediting wound healing is discussed, as well as updated classifications on how to grade and assess pressure ulcers and the role of negative pressure wound therapy and silver dressings. Lastly, this review discusses prevention and treatment options for surgical wounds, intravenous extravasation wounds, congenital wounds, and thermal injuries, in addition to how to differentiate these wounds from the common diaper dermatitis and contact dermatitis.
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Affiliation(s)
- Yomna Amer
- School of Medicine, University of Louisville, Louisville, KY
| | - Catherine Bridges
- Department of Dermatology, University of Cincinnati, Cincinnati, OH.,Department of Dermatology, Cincinnati Children's Hospital, Cincinnati, OH
| | - Kalyani Marathe
- Department of Dermatology, Cincinnati Children's Hospital, Cincinnati, OH
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18
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Srivastava A, Maniakas A, Myers J, Chambers MS, Cardoso R. Reconstruction of intraoral oncologic surgical defects with Integra ® bilayer wound matrix. Clin Case Rep 2021; 9:213-219. [PMID: 33489162 PMCID: PMC7813028 DOI: 10.1002/ccr3.3501] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/05/2020] [Accepted: 10/19/2020] [Indexed: 12/01/2022] Open
Abstract
Utilization of biologic skin substitutes for the management of soft tissue defects as an alternative to autologous skin grafts has expanded over the past 2 decades. The purpose of this case series study was to report our experience with Integra® bilayer wound matrix for reconstruction of intraoral oncologic defects. Case records of 6 patients with intraoral oncologic defects reconstructed with Integra® bilayer wound matrix were retrospectively reviewed. The surgical defect location, size, and time to removal of surgical splint varied. Clinically, normal oral epithelialization was noted for all patients. One patient demonstrated a small area of dehiscence and bone exposure after adjuvant radiation therapy which resolved with minimal intervention. Integra bilayer wound matrix is a viable and versatile option for reconstruction of intraoral oncologic surgical defects. Further exploration of wound healing with Integra® matrix, surgical techniques, and cost-effectiveness is advocated.
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Affiliation(s)
- Akanksha Srivastava
- Department of Restorative Dentistry and ProsthodonticsThe University of Texas School of DentistryHoustonTXUSA
| | - Anastasios Maniakas
- Department of Head and Neck SurgeryDivision of SurgeryThe University of Texas M.D. Anderson Cancer CenterHoustonTXUSA
| | - Jeffrey Myers
- Department of Head and Neck SurgeryDivision of SurgeryThe University of Texas M.D. Anderson Cancer CenterHoustonTXUSA
| | - Mark S. Chambers
- Section of Oral Oncology and Maxillofacial ProsthodonticsDepartment of Head and Neck SurgeryDivision of SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Richard Cardoso
- Section of Oral Oncology and Maxillofacial ProsthodonticsDepartment of Head and Neck SurgeryDivision of SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
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19
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Lin ET, Lin BS, Tsai LC, Chen WK, Wang YJ, Chiang HM, Chang CC. Functional recovery in human partial thickness skin wounds after application of multicomponent hydrolipidic film (MAS063DP): A prospective, open-label, comparative clinical trial. Wound Repair Regen 2020; 29:87-96. [PMID: 33047411 DOI: 10.1111/wrr.12866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/06/2020] [Accepted: 08/13/2020] [Indexed: 11/26/2022]
Abstract
Acute and minor skin wounds are common in daily life. However, in clinical practice, after initial management in the acute phase, the wounds are managed mainly through observation, and the patients are usually lost to follow-up. Considering a multicomponent hydrolipidic dressing (MAS063DP) long-known for its safe application in eczema and recently in laser-induced wounds, we aimed to evaluate its ability in functional recovery of impaired skin integrity during wound healing. Sixteen patients (N = 16) were enrolled and completed (n = 8 vs n = 8) this prospective, open-label, vehicle-controlled clinical trial with 12-week follow-up. Transepidermal water, skin viscoelasticity and bioimpedance analysis were measured initially, at the 1st, 4th, 8th, and 12th weeks. Improvements in these parameters were greater in the MAS063DP group (from 31.4 ± 9.0 to 16.4 ± 4.3 g/m2 h, P < .001; from 77 ± 16% to 88 ± 9%, P < .05; from 4182 ± 3823 to 2644 ± 1772 Ω) than in the white petrolatum group. No significant adverse events occurred, and all participants were more satisfied with the intervention. In this study, MAS063DP can restore skin integrity and reinstitute physiologic function as a feasible and safe intervention more markedly than management through observation during the healing process by providing protective hydrolipidic layer on the skin with simultaneous anti-inflammatory and antioxidant activities from its key ingredients such as glycyrrhetinic acid, Vitis vinifera, telmesteine, and vitamins C and E.
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Affiliation(s)
- Erh-Ti Lin
- Department of Education, China Medical University Hospital, Taichung, Taiwan, Republic of China.,Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan, Taiwan, Republic of China
| | - Li-Cheng Tsai
- Department of Education, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Wei-Kung Chen
- Department of Emergency, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Yen-Jen Wang
- Department of Dermatology, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China
| | - Hsiu-Mei Chiang
- Department of Cosmeceutics and Graduate Institute of Cosmeceutics, China Medical University, Taichung, Taiwan, Republic of China
| | - Chang-Cheng Chang
- Aesthetic Medical Center, China Medical University Hospital, Taichung, Taiwan, Republic of China.,Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan, Taiwan, Republic of China.,Department of Cosmeceutics and Graduate Institute of Cosmeceutics, China Medical University, Taichung, Taiwan, Republic of China
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20
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Evaluation of Dried Amniotic Membrane on Wound Healing at Split-Thickness Skin Graft Donor Sites: A Randomized, Placebo-Controlled, Double-blind Trial. Adv Skin Wound Care 2020; 33:636-641. [PMID: 33021598 DOI: 10.1097/01.asw.0000695752.52235.e3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the effect of amniotic membrane (AM) at split-thickness skin graft (STSG) donor sites. METHODS This double-blind randomized controlled trial was conducted on 35 eligible participants referred to the burn unit of Vasei Hospital of Sabzevar, Iran, during 2017 and 2018. Each STSG donor site was divided into two sides, and the respective halves were covered with either a dried AM or petrolatum gauze (control). Outcomes were evaluated on postprocedure days 10, 20, and 30 using the Vancouver Scar Scale. RESULTS The mean age of the patients was 39.4 ± 13.97 years, and 62.8% (n = 22) were male. There was no statistically significant difference in wound healing rate on day 10 (P = .261), 20 (P = .214), or 30 (P = .187) between groups. The intervention group had significantly better epithelialization than the control group on day 10 (investigator 1, 1.62 ± 0.59 vs 1.40 ± 0.88 [P = .009); investigator 2, 1.22 ± 0.84 vs 0.91 ± 0.85 [P = .003]), as well as pain reduction (P < .001 during the follow-up period). However, there was no statistically significant difference between groups in terms of pigmentation or vascularization (P > .05). CONCLUSIONS Findings suggest that the use of AM is not superior to petrolatum gauze in terms of STSG healing rate; however, AM achieved better pain reduction and epithelialization on day 10.
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21
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Hasegawa M, Inoue Y, Kaneko S, Kanoh H, Shintani Y, Tsujita J, Fujita H, Motegi SI, Le Pavoux A, Asai J, Asano Y, Abe M, Amano M, Ikegami R, Ishii T, Isei T, Isogai Z, Ito T, Irisawa R, Iwata Y, Otsuka M, Omoto Y, Kato H, Kadono T, Kawakami T, Kawaguchi M, Kukino R, Kono T, Koga M, Kodera M, Sakai K, Sakurai E, Sarayama Y, Tanioka M, Tanizaki H, Doi N, Nakanishi T, Hashimoto A, Hayashi M, Hirosaki K, Fujimoto M, Fujiwara H, Maekawa T, Matsuo K, Madokoro N, Yatsushiro H, Yamasaki O, Yoshino Y, Tachibana T, Ihn H. Wound, pressure ulcer and burn guidelines - 1: Guidelines for wounds in general, second edition. J Dermatol 2020; 47:807-833. [PMID: 32614097 DOI: 10.1111/1346-8138.15401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/19/2020] [Indexed: 01/22/2023]
Abstract
The Japanese Dermatological Association prepared the clinical guidelines for the "Wound, pressure ulcer and burn guidelines", second edition, focusing on treatments. Among them, "Guidelines for wounds in general" is intended to provide the knowledge necessary to heal wounds, without focusing on particular disorders. It informs the basic principles of wound treatment, before explanations are provided in individual chapters of the guidelines. We updated all sections by collecting references published since the publication of the first edition. In particular, we included new wound dressings and topical medications. Additionally, we added "Question 6: How should wound-related pain be considered, and what should be done to control it?" as a new section addressing wound pain, which was not included in the first edition.
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Affiliation(s)
- Minoru Hasegawa
- Department of Dermatology, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Japan
| | - Yuji Inoue
- Suizenji Dermatology Clinic, Kumamoto, Japan
| | - Sakae Kaneko
- Department of Dermatology, School of Medicine, Shimane University, Izumo, Japan
| | - Hiroyuki Kanoh
- Department of Dermatology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | | | - Jun Tsujita
- Department of Dermatology, Social Insurance Inatsuki Hospital, Fukuoka Prefecture Social Insurance Hospital Association, Fukuoka, Japan
| | - Hideki Fujita
- Department of Dermatology, School of Medicine, Nihon University, Tokyo, Japan
| | - Sei-Ichiro Motegi
- Department of Dermatology, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | | | - Jun Asai
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshihide Asano
- Department of Dermatology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | | | - Masahiro Amano
- Department of Dermatology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Ryuta Ikegami
- Department of Dermatology, JCHO Osaka Hospital, Osaka, Japan
| | - Takayuki Ishii
- Division of Dermatology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Taiki Isei
- Department of Dermatology, Osaka National Hospital, Osaka, Japan
| | - Zenzo Isogai
- Division of Dermatology and Connective Tissue Medicine, Department of Advanced Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takaaki Ito
- Department of Dermatology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Ryokichi Irisawa
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Yohei Iwata
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masaki Otsuka
- Division of Dermatology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yoichi Omoto
- Department of Dermatology, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Hiroshi Kato
- Department of Geriatric and Environmental Dermatology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Takafumi Kadono
- Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tamihiro Kawakami
- Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masakazu Kawaguchi
- Department of Dermatology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | | | - Takeshi Kono
- Department of Dermatology, Nippon Medical School Chiba Hokusoh Hospital, Inzei, Japan
| | - Monji Koga
- Department of Dermatology, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Masanari Kodera
- Department of Dermatology, JCHO Chukyo Hospital, Nagoya, Japan
| | - Keisuke Sakai
- Department of Dermatology, Minamata City General Hospital & Medical Center, Minamata, Japan
| | | | | | | | - Hideaki Tanizaki
- Department of Dermatology, Osaka Medical College, Takatsuki, Japan
| | - Naotaka Doi
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Takeshi Nakanishi
- Department of Dermatology, Shiga University of Medical Science, Otsu, Japan
| | - Akira Hashimoto
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masahiro Hayashi
- Department of Dermatology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Kuninori Hirosaki
- Department of Dermatology, Hokkaido Medical Care Center, Sapporo, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Fujiwara
- Department of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.,Department of Dermatology, Uonuma Kikan Hospital, Minamiuonuma, Japan
| | - Takeo Maekawa
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | | | - Naoki Madokoro
- Department of Dermatology, MAZDA Hospital, Aki-gun, Japan
| | | | - Osamu Yamasaki
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yuichiro Yoshino
- Department of Dermatology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Takao Tachibana
- Department of Dermatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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22
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Efficacy of a Natural Topical Skin Ointment for Managing Split-Thickness Skin Graft Donor Sites: A Pilot Double-blind Randomized Controlled Trial. Adv Skin Wound Care 2020; 33:1-5. [PMID: 32544119 DOI: 10.1097/01.asw.0000666916.00983.64] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of a new topical skin ointment with natural ingredients (aloe vera, honey, and peppermint) for dressing skin graft donor sites. DESIGN A double-blind, placebo-controlled, randomized clinical trial. PATIENTS AND INTERVENTION Researchers enrolled patients who were referred for split-thickness skin graft after burns or surgical wounds on the scalp or face area. For each patient, a thin layer of skin (depth, 0.04 mm; approximate size, less than 15 × 7 cm) was harvested from the thigh by a plastic surgeon with an electric or manual dermatome. The donor sites were divided and randomized to receive either natural ointment or petroleum jelly as a topical agent to dressing. Topical agents were applied on donor site wounds on days 0, 4, 7, and 14. MAIN OUTCOME MEASURES Wound size, pain, erythema, pruritus, patient discomfort, complications, and physician satisfaction were evaluated at each visit. MAIN RESULTS Among 28 patients, there was no significant difference between the two treatment agents regarding the rate of wound healing (P = .415), pain (P = .081), pruritus (P = .527), and patient discomfort (P = .616). The ointment was superior to petroleum jelly in reducing wound erythema (P = .001) and was associated with significantly better treatment satisfaction (P < .001). CONCLUSIONS The natural topical ointment investigated in this study may be an acceptable alternative to petroleum jelly in caring for split-thickness donor skin graft donor site wounds to effectively promote wound healing, prevent infection and scarring, reduce pain, and comfort the patient.
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23
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Younis AS, Abdelmonem IM, Mohamed YR, Alnaggar HE, Villanueva G, Thompson JY, Areia C, El-Dessokey HA, Nabhan AF. Hydrogel dressings for donor sites of split-thickness skin grafts. Hippokratia 2020. [DOI: 10.1002/14651858.cd013570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ahmed S Younis
- Ain Shams University; Department of Orthopaedic Surgery; Abbasia Square Cairo Egypt
| | - Ibrahim M Abdelmonem
- Ain Shams University; Department of Orthopaedic Surgery; Abbasia Square Cairo Egypt
| | - Yasser R Mohamed
- Ain Shams University; Department of Orthopaedic Surgery; Abbasia Square Cairo Egypt
| | - Hamdy E Alnaggar
- Ain Shams University; Department of Orthopaedic Surgery; Abbasia Square Cairo Egypt
| | | | - Jacqueline Y Thompson
- University of Birmingham; Birmingham Acute Care Research Group, Institute of Inflammation and Ageing; Edgbaston Birmingham UK B15 2TT
| | - Carlos Areia
- University of Oxford, John Radcliffe Hospital; Nuffield Department of Clinical Neurosciences; Headley Way Oxford UK OX3 9DU
| | | | - Ashraf F Nabhan
- Ain Shams University; Department of Obstetrics and Gynaecology, Faculty of Medicine; 16 Ali Fahmi Kamel Street Heliopolis Cairo Egypt 11351
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24
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Li J, Yu F, Chen G, Liu J, Li XL, Cheng B, Mo XM, Chen C, Pan JF. Moist-Retaining, Self-Recoverable, Bioadhesive, and Transparent in Situ Forming Hydrogels To Accelerate Wound Healing. ACS APPLIED MATERIALS & INTERFACES 2020; 12:2023-2038. [PMID: 31895528 DOI: 10.1021/acsami.9b17180] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In the management of accelerating wound healing, moist environments play an important role. Compared with other scaffolds of various forms, hydrogels can maintain a moist environment in the wound area. They are cross-linked hydrophilic polymeric networks that resemble natural soft tissues and extracellular matrices. Among them, injectable hydrogels have attracted great attention in wound repair, as they can be injected into irregular-shaped skin defects and formed in situ to shape the contour of different dimensions. The excellent compliance makes hydrogels easy to adapt to the wound under different conditions of skin movement. Here, we oxidized hydroxyethyl starch (O-HES) and modified carboxymethyl chitosan (M-CMCS) to fabricate an in situ forming hydrogel with excellent self-recoverable extensibility-compressibility, biocompatibility, biodegradability, and transparency for accelerating wound healing. The oxidation degree of O-HES was 74%. The amino modification degree of M-CMCS was 63%. M-CMCS/O-HES hydrogels were formed through the Schiff base reaction. The physicochemical properties of M-CMCS/O-HES hydrogels with various ratios were investigated, and M-CMCS/O-HES hydrogel with a volume ratio of 5:5 exhibited appropriate gelation time, notable water-retaining capacity, self-recoverable conformal deformation, suitable biodegradability, and good biocompatibility for wound-healing application. Then, skin wound-healing experimental studies were carried out in Sprague-Dawley rats with full-thickness skin defects. Significant outcomes were achieved in the M-CMCS/O-HES hydrogel-treated group including higher wound closure percentage, more granulation tissue formation, faster epithelialization, and decreased collagen deposition. These findings demonstrate that using the obtained M-CMCS/O-HES hydrogels is a promising therapeutic strategy for wound healing.
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Affiliation(s)
- Jun Li
- Department of Orthopedics , Shanghai Tenth People's Hospital Affiliated to Tongji University , 301 Yanchang Road , Shanghai 200072 , China
| | - Fan Yu
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Chemistry, Chemical Engineering and Biotechnology , Donghua University , 2999 North Renmin Road , Shanghai 201620 , China
| | - Gong Chen
- School of Environmental and Materials Engineering, College of Engineering , Shanghai Polytechnic University , Shanghai 201209 , China
| | - Jia Liu
- Department of Orthopedics , Shidong Hospital of Yangpu District , 999 Shiguang Road , Shanghai 200438 , China
| | - Xiao-Long Li
- Department of Orthopedics , Changhai Hospital, Naval Military Medical University , Shanghai 200433 , China
| | - Biao Cheng
- Department of Orthopedics , Shanghai Tenth People's Hospital Affiliated to Tongji University , 301 Yanchang Road , Shanghai 200072 , China
| | - Xiu-Mei Mo
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Chemistry, Chemical Engineering and Biotechnology , Donghua University , 2999 North Renmin Road , Shanghai 201620 , China
| | - Cheng Chen
- School of Environmental and Materials Engineering, College of Engineering , Shanghai Polytechnic University , Shanghai 201209 , China
| | - Jian-Feng Pan
- Department of Orthopedics , Shanghai Tenth People's Hospital Affiliated to Tongji University , 301 Yanchang Road , Shanghai 200072 , China
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25
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Slaninka I, Fibír A, Kaška M, Páral J. Use of autologous platelet-rich plasma in healing skin graft donor sites. J Wound Care 2020; 29:36-41. [DOI: 10.12968/jowc.2020.29.1.36] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To demonstrate that the use of platelet-rich plasma (PRP) enhances both the quality of healing and the time required for wound healing at a skin graft donor site. Methods: Patients who had dermo-epidermal skin grafts taken from the thigh area were included in a prospective, randomised clinical study. PRP was applied to one donor site and then covered with Vaseline-impregnated, open-weave gauze and gauze, while the contralateral donor site on the other thigh served as a control and was covered with the open-weave gauze and gauze without PRP. Results: A total of 24 patients took part in the study, of which three developed infections and were thus removed from the study. Use of PRP reduced the wound healing time of the dermo-epidermal graft donor sites by a mean 17.8% and median 18 days. On average, the treated donor sites healed in 14.9 days compared with 18.4 days for the control group. The median was 14 days compared with 18 days in the control group (p=0.026). In one patient, healing was slower on the side where PRP was applied. In 20 patients, healing of the donor site was accelerated where PRP was applied. Conclusion: The study demonstrated a beneficial effect of PRP, as healing time was shortened. Using PRP to heal wounds could be beneficial for patients for whom commonly available wound healing therapies have failed, as well as for high-risk patient groups for whom problematic wound healing may be expected.
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Affiliation(s)
- Igor Slaninka
- Department of Surgery, Faculty of Medicine of Charles University and University Hospital Hradec Králové, Czech Republic
- Department of Surgery, Faculty of Medicine of Charles University in Hradec Králové, Czech Republic
| | - Aleš Fibír
- Department of Surgery, Faculty of Medicine of Charles University and University Hospital Hradec Králové, Czech Republic
- Department of Surgery, Faculty of Medicine of Charles University in Hradec Králové, Czech Republic
| | - Milan Kaška
- Department of Surgery, Faculty of Medicine of Charles University and University Hospital Hradec Králové, Czech Republic
- Department of Surgery, Faculty of Medicine of Charles University in Hradec Králové, Czech Republic
| | - Jiří Páral
- Department of Surgery, Faculty of Medicine of Charles University and University Hospital Hradec Králové, Czech Republic
- Department of Surgery, Faculty of Medicine of Charles University in Hradec Králové, Czech Republic
- Department of Military Surgery, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czech Republic
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Chowdhry SA. Use of oxidized regenerated cellulose (ORC)/collagen/silver-ORC dressings to help manage skin graft donor site wounds. JPRAS Open 2019; 22:33-40. [PMID: 32158895 PMCID: PMC7061655 DOI: 10.1016/j.jpra.2019.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/08/2019] [Indexed: 11/24/2022] Open
Abstract
Harvesting donor site explants for split-thickness skin grafting creates an iatrogenic wound that presents additional challenges to clinicians due to morbidities such as persistent bleeding, pain, infection, and delayed epithelialization. Although there have been several randomized controlled trials to compare wound dressing effectiveness, there is still a lack of standardization for donor site wound dressings. A retrospective comparison of 59 patients that underwent split-thickness skin graft reconstructions between January 2017 and September 2018 was performed. Donor sites of Group 1 patients (n = 29) were treated with a transparent film dressing and transitioned to petrolatum gauze dressings if exudate management became problematic; Group 2 patients (n = 30) were treated with oxidized regenerated cellulose/collagen/silver-oxidized regenerated cellulose (ORC/C/Ag-ORC) dressings. Evaluations of time to epithelialization, number of dressings required, signs of inflammation, and objective pain were compared between groups. Group 1 was comprised of 18 female and 11 male patients, whereas Group 2 was comprised of 14 females and 16 males. There were no significant differences between groups when comparing age, sex, comorbidities, or donor site size (area or depth). Patients in Group 2 had a significantly shorter time to complete re-epithelialization (P < .0001), fewer dressing changes (P < .0001), and less objective pain as measured by the need for opioid pain mediation (P < .0001) when compared to Group 1. The percentage of patients with signs of inflammation was also lower for Group 2, although this difference was not statistically significant (P = .0797). Although prospective, controlled studies are still needed, data from this study suggest that ORC/C/Ag-ORC dressings could become a more effective alternative for the management of donor site wounds, especially in patients with known risk factors for wound healing.
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Affiliation(s)
- Saeed A Chowdhry
- Rosalind Franklin University of Medicine and Science, Chicago Medical School, 4400W 95th St, Suite 102, Oak Lawn, Chicago, IL 60453, United States
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Wlaschin KF, Ninkovic J, Griesgraber GW, Colak Atan S, Young AJ, Pereira JM, Solberg MJ, Smith G, Parks PJ, McNulty AK, Langer-Anderson DL. The impact of first-aid dressing design on healing of porcine partial thickness wounds. Wound Repair Regen 2019; 27:622-633. [PMID: 31276609 DOI: 10.1111/wrr.12747] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/18/2019] [Accepted: 06/30/2019] [Indexed: 11/30/2022]
Abstract
Literature describes that a well-maintained moist wound healing environment leads to faster healing by preventing scabbing and drying of the wound. A moist wound speeds healing by allowing for unimpeded movement of newly dividing epidermal cells in the wound. Contrary to what is described in literature and practiced by clinicians, first-aid dressings used at home by consumers advertise breathability and absorptivity as benefits. This manuscript examines the effects of dressing breathability and highly absorptive pads on healing and wound appearance in a porcine dermatome wound model, designed to mimic an abrasion injury. Partial thickness wounds were covered with an experimental silicone-polymer film dressing and various over-the-counter bandages for time frames ranging from 4 to 11 days. The progression of healing was quantified by histology and wound-size reduction measurements. The thickness and persistence of a scab or serocellular crust (SCC) over the injury was measured using both pixel density and optical coherence tomography to supplement visual observations, demonstrating new tools for quantification of SCC over wounds. The results of the experiments illustrate the impact of dressing features on the rate of wound reepithelialization and the formation of SCC. Both a low moisture vapor transmission rate (MVTR) and the absence of an absorptive layer were important in speeding wound healing. Surprisingly, use of a dressing with a low MVTR and a highly absorptive pad healed significantly more slowly than a comparative dressing with a low MVTR and no absorptive pad, even though both dressings had very little scab formation over the wound. This study shows that breathability and absorbency of dressings play independent roles in providing an optimal healing environment, and that these properties can vary widely among commercially available dressings.
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Affiliation(s)
| | - Jana Ninkovic
- 3M Corporate Materials Research Labs, Saint Paul, Minnesota
| | | | | | - Alexi J Young
- 3M Corporate Materials Research Labs, Saint Paul, Minnesota
| | | | | | - Graham Smith
- 3M Health Care Business Group, Saint Paul, Minnesota
| | | | - Amy K McNulty
- 3M Medical Solutions Division, Saint Paul, Minnesota
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Abstract
Developing a multiple functional wound dressing suitable for different stages of wound healing is important for patients with special wound such as burn or decubital ulcers. In this study, poly (vinyl alcohol) (PVA), dextran, and chitosan are integrated to produce ideal wound dressing where glutaraldehyde (GA) is used as the cross-linker. The result demonstrated that 6% PVA hydrogel with 0.25% chitosan was found to provide antimicrobial ability. The PVA/chitosan hydrogel combined with 4% dextran utilizing GA cross-linking also presents the high cell proliferation ability, which suggests that the hydrogel is potential as a wound dressing. In the following physical analyses, the addition of chitosan and dextran appeared to promote the thermostability, mechanical properties, water retention, and moisturizing ability in the PVA hydrogel. In conclusion, the PVA/chitosan/dextran hydrogel has promising potential such as high water content, antimicrobial property, and well cell proliferation, which can be applied to wound healing application.
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Computer-Assisted Wound Assessment and Care Education Program in Registered Nurses: Use of an Interactive Online Program by 418 Registered Nurses. J Wound Ostomy Continence Nurs 2019; 46:90-97. [PMID: 30844865 DOI: 10.1097/won.0000000000000515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this descriptive study was to evaluate use of a previously validated, online, interactive wound assessment and wound care clinical pathway in a group of RNs. Specific aims were to (a) evaluate the proportions of correct, partially correct, and incorrect algorithmic decisions and dressing selections, (b) compare response rates between nurses who are and who are not wound care certified, and (c) evaluate its ease of use, educational value, and applicability in clinical practice. DESIGN Descriptive study. SUBJECTS AND SETTING Participants were recruited using convenience and snowball sampling methods. Four hundred eighteen nurses completed all 15 assessments; nearly half held a bachelors' degree in nursing (189, 45%), more than two-thirds worked in an inpatient acute care settings (277, 68%), and 293 (70%) were not certified in wound care. METHODS After providing written informed consent and completing the participant demographics form, participants assessed 15 photographs of wounds with accompanying moisture descriptions and completed an algorithm and dressing selection for each. All responses were anonymously collected by the program. Existing, retrospective, program data were also downloaded and data from nurses who completed all assessments were extracted and analyzed. Descriptive statistics were used to analyze all variables. Selection outcomes and survey responses between nurses who were and who were not wound care certified were compared using a 2-sample Student t test assuming unequal variances. Individual responses for the first 6 wounds were compared to the last 6 wounds using a paired t test. RESULTS The mean (M) proportions of fully or partially correct (operationally defined as safe but not fully correct) algorithm and dressing choice were 81% (SE: 0.88, 95% confidence level: 1.73) and 78.1% (SE: 0.70, 95% confidence level: 1.39), respectively. Wound care-certified nurses had higher mean algorithm scores than those who were not certified (M: 89.2%, SE: 1.27 vs M: 77.8%, SE: 1.10, P < .001). Most incorrect/partially correct choices were attributable to incorrect necrotic tissue assessment (n = 845, 58%). The difference between fully correct first 6 and last 6 algorithm choices was statistically significant (M: 310, SE: 0.02 vs M: 337, SE: 9.32, P = .04). On a Likert scale of 1 (not at all) to 5 (very), average scores for ease of program and algorithm use, educational value, and usefulness for clinicians ranged from M: 4.14, SE: 0.08 to M: 4.22, SE: 0.08. CONCLUSIONS Results suggest that the algorithm is valid and has potential educational value. Initial evaluation also suggests that program refinements are needed. Evaluation of participant responses indicated potential problems with the definitions used for necrotic tissue or assessment knowledge deficits. Results also substantiate the importance of instructional design and testing online education programs. More research is needed to uncover potential gaps in nurses' wound care knowledge that may hamper evidence-based practices adoption and the need to develop effective, evidence-based education-delivery techniques.
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Momeni M, Fallah N, Bajouri A, Bagheri T, Orouji Z, Pahlevanpour P, Shafieyan S, Sodeifi N, Alizadeh A, Aghdami N, Fatemi MJ. A randomized, double-blind, phase I clinical trial of fetal cell-based skin substitutes on healing of donor sites in burn patients. Burns 2018; 45:914-922. [PMID: 30559055 DOI: 10.1016/j.burns.2018.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/23/2018] [Accepted: 10/19/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Due to limited graft donor sites in extensive burns, re-harvesting of a single donor area is very common. Given the importance of fetal fibroblasts in accelerating fetal wound healing, fetal cell-based skin substitutes have emerged as a novel therapeutic modality for regenerating damaged skin. In this trial, we aimed to evaluate the safety, feasibility and potential efficacy of application of amniotic membranes seeded with fetal fibroblasts for accelerating donor sites healing in burn patients. METHODS In this randomized, double-blind, phase I clinical trial, 10 patients with total burn surface area of 10-55% were enrolled. Three equal parts (10×10cm) were selected in donor site of each patient and covered by Vaseline gauze (control group), amniotic membrane (AM group), or amniotic membrane seeded with fetal fibroblasts (AM-F group). Adverse events, pain intensity scores, and wound sizes were recorded on days 4, 8, 11, 14, and 20 post-treatment. Also, histological assessments were done on days 0 and 14 after the surgery. RESULTS All patients underwent surgery, and no adverse events occurred during the procedure and follow-up period. Significantly lower pain intensity and higher healing rates were observed in AM-F and AM groups compared to the control group. Moreover, mean complete re-epithelializatin in AM-F and AM groups were 10.1±2.4 and 11.3±2.9 days, showing that the healing process was significantly accelerated compared to the control group with mean closure time of 14.8±1.6 days. Histological assessment showed lower inflammatory cells infiltration in AM-F and AM groups compared to control group. CONCLUSIONS This study indicated the safety of transplantation of amniotic membrane seeded with fetal fibroblasts for treatment of donor sites in burn patients; however, preliminary assessments showed no benefits for this therapeutic modality over amniotic membrane alone. Thus, to draw accurate conclusions, further trials in larger populations should be conducted. LEVEL OF EVIDENCE This study is assigned as level I.
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Affiliation(s)
- Mahnoush Momeni
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nasrin Fallah
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Amir Bajouri
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Tooran Bagheri
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Orouji
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | | | - Saeed Shafieyan
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Niloofar Sodeifi
- Department of Pathology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Ahad Alizadeh
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Nasser Aghdami
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.
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Mordyakov AE, Charyshkin AL. [Evaluation of local treatment of donor sites wounds in patients with deep burns]. Khirurgiia (Mosk) 2018:49-52. [PMID: 30531754 DOI: 10.17116/hirurgia201811149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To assess the impact of local treatment of donor sites wounds in patients with deep burns on the frequency of complications and to identify the main risk factors of complications of donor sites wounds. MATERIAL AND METHODS There were 486 patients with deep burns who underwent split-thickness skin grafting. Treatment of donor sites wounds was carried by using of moisture-controlled dressings DDB-M in the main group (n=56). Conventional approach including once imposed wet-to-dry gauze bandages was applied in the control group. RESULTS We identified the structure of complications of the donor sites wounds and the main risk factors of suppuration.
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Affiliation(s)
- A E Mordyakov
- Ul'yanovsk State University, Ul'yanovsk, Russia; Central city hospital of Ul'yanovsk, Ul'yanovsk, Russia
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Mecott-Rivera GÁ, Aguilar-Baqueiro JA, Bracho S, Miranda-Maldonado I, Franco-Márquez R, Castro-Govea Y, Dorsey-Treviño EG, García-Pérez MM. Pirfenidone increases the epithelialization rate of skin graft donor sites. Burns 2018; 44:2051-2058. [DOI: 10.1016/j.burns.2018.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/25/2018] [Accepted: 07/19/2018] [Indexed: 12/21/2022]
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Brown JE, Holloway SL. An evidence-based review of split-thickness skin graft donor site dressings. Int Wound J 2018; 15:1000-1009. [PMID: 30117716 PMCID: PMC7949554 DOI: 10.1111/iwj.12967] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 06/15/2018] [Accepted: 06/24/2018] [Indexed: 11/26/2022] Open
Abstract
This evidence-based review aimed to identify and evaluate current existing evidence relating to the efficacy of dressing materials for spit-thickness skin graft donor site wounds in relation to promoting rapid healing and reducing patient pain. A comprehensive systematic search of the literature between 2006 and 2016 identified 35 publications that were included in the review. Based on the results of the review, it was found that moist wound-healing products have a clear advantage over non-moist products in the reduction of pain and increased healing rates. This review concluded that moist wound-healing products are more effective than non-moist wound-healing products in reducing pain and promoting healing in split-thickness skin graft donor site wounds. A recommendation based on this review is that further research examine the role of secondary dressing usage in donor site wound management, and the consideration of using more than one primary dressing product during the donor site wound-healing process should be undertaken.
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Affiliation(s)
- Julie E Brown
- Tissue Viability ServiceOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Samantha L Holloway
- Centre for Medical Education, School of Medicine, College of Biomedical and Life SciencesCardiff UniversityWalesUK
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Pak CS, Park DH, Oh TS, Lee WJ, Jun YJ, Lee KA, Oh KS, Kwak KH, Rhie JW. Comparison of the efficacy and safety of povidone-iodine foam dressing (Betafoam), hydrocellular foam dressing (Allevyn), and petrolatum gauze for split-thickness skin graft donor site dressing. Int Wound J 2018; 16:379-386. [PMID: 30479060 PMCID: PMC7379600 DOI: 10.1111/iwj.13043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/31/2018] [Accepted: 11/11/2018] [Indexed: 11/28/2022] Open
Abstract
We evaluated the efficacy and safety of a povidone-iodine (PVP-I) foam dressing (Betafoam) for donor site dressing versus a hydrocellular foam dressing (Allevyn) and petrolatum gauze. This prospective Phase 4 study was conducted between March 2016 and April 2017 at eight sites in Korea. A total of 106 consenting patients (aged ≥ 19 years, scheduled for split-thickness skin graft) were randomised 1:1:1 to PVP-I foam, hydrocellular, or petrolatum gauze dressings for up to 28 days after donor site collection. We assessed time to complete epithelialisation, proportion with complete epithelialisation at Day 14, and wound infection. Epithelialisation time was the shortest with PVP-I foam dressing (12.74 ± 3.51 days) versus hydrocellular foam dressing (16.61 ± 4.45 days; P = 0.0003) and petrolatum gauze (15.06 ± 4.26 days, P = 0.0205). At Day 14, 83.87% of PVP-I foam dressing donor sites had complete epithelialisation, versus 36.36% of hydrocellular foam dressing donor sites (P = 0.0001) and 55.88% of petrolatum gauze donor sites (P = 0.0146). There were no wound infections. Incidence rates of adverse events were comparable across groups (P = 0.1940). PVP-I foam dressing required less time to complete epithelialisation and had a good safety profile.
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Affiliation(s)
- Chang Sik Pak
- Seoul National University Bundang Hospital, Seoul, South Korea
| | - Dae Hwan Park
- Daegu Catholic University Medical Center, Seoul, South Korea
| | | | - Won Jai Lee
- Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Young Joon Jun
- Seoul St. Mary's Hospital, The Catholic University of South Korea, Seoul, South Korea
| | - Kyung Ah Lee
- Inje University Haeundae Paik Hospital, Seoul, South Korea
| | | | | | - Jong Won Rhie
- Seoul St. Mary's Hospital, The Catholic University of South Korea, Seoul, South Korea
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Napavichayanun S, Ampawong S, Harnsilpong T, Angspatt A, Aramwit P. Inflammatory reaction, clinical efficacy, and safety of bacterial cellulose wound dressing containing silk sericin and polyhexamethylene biguanide for wound treatment. Arch Dermatol Res 2018; 310:795-805. [PMID: 30302557 DOI: 10.1007/s00403-018-1871-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/21/2018] [Accepted: 10/01/2018] [Indexed: 11/24/2022]
Abstract
Bacterial cellulose wound dressings containing silk sericin and PHMB (BCSP) were developed in our previous studies. It had good physical properties, efficacy, and safety. For further use as a medical material, this dressing was investigated for its efficacy and safety in split-thickness skin graft (STSG) donor-site wound treatment compared to Bactigras® (control). Moreover, the inflammatory responses to both dressings were also deeply investigated. For in vivo study, expressions of anti-inflammatory cytokines were intensely considered in the tissue interfacing area. The result showed that IL-4 and TGF-β from BCSP-treated tissue had advantages over Bactigras®-treated tissue at 14 and 21 days post-implantation. For clinical study, a single-blinded, randomized controlled study was generated. The half of STSG donor site wound was randomly assigned to cover with BCSP or Bactigras®. Twenty-one patients with 32 STSG donor site wounds were enrolled. The results showed that wound-healing time was not significantly different in both dressings. However, wound quality of BCSP was better than Bactigras® at healing time and after 1 month (p < 0.05). The pain scores of BCSP-treated wound were statistically significant lower than Bactigras®-treated wound (p < 0.05). No sign of infection or adverse event was observed after treatment with both dressings. In conclusion, the inflammation responses of the dressing were clearly clarified. The advantages of BCSP were wound-quality improvement, pain reduction, and infection protection without adverse events. It was fit to be used as the alternative treatment of STSG donor site wound.
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Affiliation(s)
- Supamas Napavichayanun
- Bioactive Resources for Innovative Clinical Applications Research Unit, Chulalongkorn University, Bangkok, Thailand.,Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, PhayaThai Road, Phatumwan, Bangkok, 10330, Thailand
| | - Sumate Ampawong
- Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Tavornchai Harnsilpong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, PhayaThai Road, Phatumwan, Bangkok, 10330, Thailand
| | - Apichai Angspatt
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, PhayaThai Road, Phatumwan, Bangkok, 10330, Thailand.
| | - Pornanong Aramwit
- Bioactive Resources for Innovative Clinical Applications Research Unit, Chulalongkorn University, Bangkok, Thailand. .,Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, PhayaThai Road, Phatumwan, Bangkok, 10330, Thailand.
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Meta-analysis and Systematic Review of Skin Graft Donor-site Dressings with Future Guidelines. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1928. [PMID: 30349793 PMCID: PMC6191241 DOI: 10.1097/gox.0000000000001928] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 07/11/2018] [Indexed: 11/26/2022]
Abstract
Background: Many types of split-thickness skin graft (STSG) donor-site dressings are available with little consensus from the literature on the optimal dressing type. The purpose of this systematic review was to analyze the most recent outcomes regarding moist and nonmoist dressings for STSG donor sites. Methods: A comprehensive systematic review was conducted across PubMed/MEDLINE, EMBASE, and Cochrane Library databases to search for comparative studies evaluating different STSG donor-site dressings in adult subjects published between 2008 and 2017. The quality of randomized controlled trials was assessed using the Jadad scale. Data were collected on donor-site pain, rate of epithelialization, infection rate, cosmetic appearance, and cost. Meta-analysis was performed for reported pain scores. Results: A total of 41 articles were included comparing 44 dressings. Selected studies included analysis of donor-site pain (36 of 41 articles), rate of epithelialization (38 of 41), infection rate (25 of 41), cosmetic appearance (20 of 41), and cost (10 of 41). Meta-analysis revealed moist dressings result in lower pain (pooled effect size = 1.44). A majority of articles (73%) reported better reepithelialization rates with moist dressings. Conclusion: The literature on STSG donor-site dressings has not yet identified an ideal dressing. Although moist dressings provide superior outcomes with regard to pain control and wound healing, there continues to be a lack of standardization. The increasing commercial availability and marketing of novel dressings necessitates the development of standardized research protocols to design better comparison studies and assess true efficacy.
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Varon DE, Smith JD, Bharadia DR, Shafique N, Sakthivel D, Halvorson EG, Nuutila K, Sinha I. Use of a novel chitosan-based dressing on split-thickness skin graft donor sites: a pilot study. J Wound Care 2018; 27:S12-S18. [PMID: 30008255 DOI: 10.12968/jowc.2018.27.sup7.s12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Split-thickness skin graft (STSG) donor site dressings can play an integral role in reducing donor site morbidity. This study tested a novel, chitosan-based wound dressing, Opticell Ag, as an STSG donor site dressing for wounds <10% total body surface area (TBSA). METHOD Between January and December 2016, the chitosan-based dressing was placed on participating patients' donor sites immediately following graft harvest and covered with a transparent occlusive dressing. Pain was evaluated on postoperative day one, before dressing change between days 5-7, and before and after dressing removal between days 10-14 using the Visual Analog Scale (VAS). The extent of re-epithelialisation was determined between day 10-14 and at one month, and healing quality was also evaluated at one month post-operatively using the Vancouver Scar Scale (VSS). RESULTS A total of 19 patients were recruited, of which 16 completed the study. Patients experienced mild-to-moderate pain in their donor sites when the chitosan-based dressing was used. Pain decreased significantly between postoperative day one and days 10-14, as well as between days 5-7 and 10-14. The mean percentage of re-epithelialisation on days 10-14 was 92% and by one month was 99%. The mean VSS at one month was 3.2±1.4. There were no statistically significant differences between patients' re-epithelialisation rates or VSS scores. There were unplanned dressing changes in four patients. No donor site infections or other adverse events were identified. CONCLUSION The chitosan-based dressing tested in this study is safe, effective, and associated with reasonable pain control and acceptable healing quality. The results suggest that it is a promising STSG donor site dressing.
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Affiliation(s)
- David E Varon
- Research Assistant; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
| | - Jessica D Smith
- Research Assistant; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
| | - Deepak R Bharadia
- Plastic Surgery Resident UCSF; Division of Plastic and Reconstructive Surgery, University of California, San Francisco, US
| | - Neha Shafique
- Research Assistant; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
| | - Dharaniya Sakthivel
- Research Assistant; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
| | - Eric G Halvorson
- Plastic Surgeon; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
| | - Kristo Nuutila
- Instructor; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
| | - Indranil Sinha
- Plastic Surgeon Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
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Clinical Evaluation of Wound Healing in Split-Skin Graft Donor Sites Using Microscopic Quantification of Reepithelialization. Adv Skin Wound Care 2018; 29:254-60. [PMID: 27171253 DOI: 10.1097/01.asw.0000481179.88936.d4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Impaired or delayed wound healing is a common health problem. However, it remains challenging to predict whether wounds in patients will heal without complication or will have a prolonged healing time. In this study, the authors developed an objective screening tool to assess wound healing using microscopic quantification of reepithelialization in a split-thickness skin graft wound model and used this tool to identify risk factors for defective wound healing. DESIGN Thirty patients (16 male and 14 female) were included in this prospective study. Anterior thigh skin biopsies from the donor site region of partial-thickness skin grafts were dressed with moisture-retentive dressings, and biopsies were examined on days 0, 2, 5, and 10 postoperatively by microscopy. Images were then transferred to a computer for image analysis and epithelial measurements (epithelial thickness and total reepithelialized surface). The effects of gender, age, body mass index, and smoking behavior on these wound healing parameters were determined. RESULTS The authors found comparable results for the computer and traditional measure methods. However, the time required to perform the measurements using the semiautomated computer method was less than half the time of the traditional method. Image capturing, enhancing, and analysis with the new method required approximately 2 minutes 30 seconds, whereas the traditional methods took up to 7 minutes per image. The total size of the reepithelialized surface (P = .047) and percentage of the biopsy resurfaced with epithelia (P = .011) at day 10 were both significantly higher in male patients compared with female patients. In patients younger than 55 years, reepithelialized areas were significantly thicker than in patients older than 55 years (P = .008), whereas the size of the reepithelialized surface showed no differences. No significant differences in reepithelialization parameters were found concerning body mass index and smoking behavior. CONCLUSIONS Both male gender and older age impair reepithelialization rate and epithelial thickness in partial-thickness skin graft donor site wounds. In contrast, body mass index and smoking behavior have not been shown to be influencing factors on reepithelialization. Thus, microscopic quantification of reepithelialization might be a suitable method for predicting complications associated with wound healing.
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Vaghardoost R, Momeni M, Kazemikhoo N, Mokmeli S, Dahmardehei M, Ansari F, Nilforoushzadeh MA, Sabr Joo P, Mey Abadi S, Naderi Gharagheshlagh S, Sassani S. Effect of low-level laser therapy on the healing process of donor site in patients with grade 3 burn ulcer after skin graft surgery (a randomized clinical trial). Lasers Med Sci 2018; 33:603-607. [PMID: 29368069 DOI: 10.1007/s10103-017-2430-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/26/2017] [Indexed: 11/27/2022]
Abstract
Skin graft is a standard therapeutic technique in patients with deep ulcers, but managing donor site after grafting is very important. Although several modern dressings are available to enhance the comfort of donor site, using techniques that accelerate wound healing may enhance patient satisfaction. Low-level laser therapy (LLLT) has been used in several medical fields, including healing of diabetic, surgical, and pressure ulcers, but there is not any report of using this method for healing of donor site in burn patients. The protocols and informed consent were reviewed according to Medical Ethics Board of Shahid Beheshti University of Medical Sciences (IR.SBMU.REC.1394.363) and Iranian Registry of Clinical Trials (IRCT2016020226069N2). Eighteen donor sites in 11 patients with grade 3 burn ulcer were selected. Donor areas were divided into 2 parts, for laser irradiation and control randomly. Laser area was irradiated by a red, 655-nm laser light, 150 mW, 2 J/cm2, on days 0 (immediately after surgery), 3, 5, and 7. Dressing and other therapeutic care for both sites were the same. The patients and the person who analyzed the results were blinded. The size of donor site reduced in both groups during the 7-day study period (P < 0.01) and this reduction was significantly greater in the laser group (P = 0.01). In the present study, for the first time, we evaluate the effects of LLLT on the healing process of donor site in burn patients. The results showed that local irradiation of red laser accelerates wound healing process significantly.
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Affiliation(s)
- Reza Vaghardoost
- Burn Research center, Department of Plastic and Reconstructive Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Mahnoush Momeni
- Burn Research center, Department of Plastic and Reconstructive Surgery, Iran University of Medical Sciences, Tehran, Iran.
| | | | | | - Mostafa Dahmardehei
- Burn Research center, Department of Plastic and Reconstructive Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Ansari
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Parisa Sabr Joo
- Burn Research center, Department of Plastic and Reconstructive Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Sara Mey Abadi
- Burn Research center, Department of Plastic and Reconstructive Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Soheila Naderi Gharagheshlagh
- Burn Research center, Department of Plastic and Reconstructive Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Sassani
- Al Nasr Sport Club Medical Section, Dubai, United Arab Emirates
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Guogienė I, Kievišas M, Grigaitė A, Braziulis K, Rimdeika R. Split-thickness skin grafting: early outcomes of a clinical trial using different graft thickness. J Wound Care 2018; 27:5-13. [PMID: 29333934 DOI: 10.12968/jowc.2018.27.1.5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE In clinical practice, split-thickness skin graft (STSG) transplantation remains the gold standard for covering large skin defects. Currently, there is no consensus on the optimal thickness of skin grafts. The purpose of our study was to compare the early healing processes of recipient and donor wounds after STSG transplantation using grafts of different thickness. METHOD This prospective, randomised clinical trial included 84 patients that underwent STSG transplantation surgery for post-burn, post-traumatic or postoperative skin defects. Patients were randomised to receive a skin graft of either 0.2mm, 0.3mm or 0.4mm thickness. After skin transplantation, the wound healing parameters of both the recipient and donor wounds were evaluated after three days, one week, two weeks and one month. RESULTS The greatest mean epithelialisation scores and highest rate of complete wound epithelialisation were identified in the recipient and donor wounds of the 0.2mm transplant group, at all time points. When the recipient wound pain scores were evaluated, the greatest visual analogue scale (VAS) values were found in the 0.2mm transplant group. The opposite result was found for the donor wound, where the highest VAS scores were identified in the 0.4mm transplant group. There were no significant differences, at any follow-up period, when wound secretion, erythema, swelling, localised warmth and fluctuation were compared. CONCLUSION The early healing of recipient wounds after STSG transplantation with grafts of various thickness differed considerably, especially regarding wound epithelialisation and pain.
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Affiliation(s)
- Inga Guogienė
- Department of Plastic and Reconstructive Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mantas Kievišas
- Department of Plastic and Reconstructive Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Augustina Grigaitė
- Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kęstutis Braziulis
- Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rytis Rimdeika
- Professor, Head of Department; Department of Plastic and Reconstructive Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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41
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Variability in split-thickness skin graft depth when using an air-powered dermatome: A paediatric cohort study. Burns 2017; 43:1552-1560. [DOI: 10.1016/j.burns.2017.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/15/2017] [Accepted: 02/20/2017] [Indexed: 11/22/2022]
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42
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Treating pain on skin graft donor sites: Review and clinical recommendations. J Trauma Acute Care Surg 2017; 83:954-964. [DOI: 10.1097/ta.0000000000001615] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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43
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Accelerated re-epithelialization of partial-thickness skin wounds by a topical betulin gel: Results of a randomized phase III clinical trials program. Burns 2017; 43:1284-1294. [DOI: 10.1016/j.burns.2017.03.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/28/2017] [Accepted: 03/08/2017] [Indexed: 11/23/2022]
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Verma N, Kumari U, Mittal S, Mittal AK. Scanning electron microscope investigation on the process of healing of skin wounds in Cirrhinus mrigala. Microsc Res Tech 2017; 80:1205-1214. [DOI: 10.1002/jemt.22918] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/26/2017] [Accepted: 07/30/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Neeraj Verma
- Skin Physiology Laboratory; Department of Zoology, Centre of Advanced Study, Institute of Science, Banaras Hindu University; Varanasi Uttar Pradesh 221 005 India
| | - Usha Kumari
- Zoology Section; Mahila Mahavidyalaya, Banaras Hindu University; Varanasi 221 005 India
| | - Swati Mittal
- Skin Physiology Laboratory; Department of Zoology, Centre of Advanced Study, Institute of Science, Banaras Hindu University; Varanasi Uttar Pradesh 221 005 India
| | - Ajay Kumar Mittal
- Retired Professor and Former Head of the Department of Zoology; Banaras Hindu University; 9, Mani Nagar, Kandawa, Near Chitaipur Crossing, Varanasi 221 106 Uttar Pradesh, India
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Marini L. Advanced film-forming gel formula vs spring thermal water and white petrolatum as primary dressings after full-face ablative fractional CO2
laser resurfacing: a comparative split-face pilot study. J Eur Acad Dermatol Venereol 2017; 32:113-116. [DOI: 10.1111/jdv.14446] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/12/2017] [Indexed: 11/26/2022]
Affiliation(s)
- L. Marini
- FAAD-FEADV Medical and Scientific Director; SDC The Skin Doctors Center; Trieste Italy
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46
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Kazanavičius M, Cepas A, Kolaityte V, Simoliuniene R, Rimdeika R. The use of modern dressings in managing split-thickness skin graft donor sites: a single-centre randomised controlled trial. J Wound Care 2017; 26:281-291. [DOI: 10.12968/jowc.2017.26.6.281] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M. Kazanavičius
- Department of Plastic and Reconstructive Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - A. Cepas
- Student; Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - V. Kolaityte
- Student; Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - R. Simoliuniene
- Associate Professor; Department of Physics, Mathematics and Biophysics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - R. Rimdeika
- Professor, Head of the Department; Department of Plastic and Reconstructive Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Kheiri A, Amini S, Javidan AN, Saghafi MM, Khorasani G. The effects of Alkanna tinctoria Tausch on split-thickness skin graft donor site management: a randomized, blinded placebo-controlled trial. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:253. [PMID: 28482839 PMCID: PMC5422894 DOI: 10.1186/s12906-017-1741-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 04/13/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND A prospective, randomized, placebo-controlled clinical trial was conducted to compare the healing effectiveness of Alkanna tinctoria (L.) Tausch (Boraginaceae) with standard dressing on wound healing at the donor site after removal of the skin graft. METHODS Enrolled patients were randomly allocated to receive topicalA. tinctoria extract ointment (20%) or standard dressing (dressing with base ointment) daily. Wound healing was assessed using the Bates-Jenson assessment tool at the 2nd and 4th weeks after intervention. RESULTS Decreases in wound score were significantly greater in the A. tinctoria group compared with the placebo group (P <0.05). The surface areas of graft donor sites in the A. tinctoria group were significantly reduced as compared with the control group at day 28 of the intervention (P < 0.05). The proportion of patients in the A. tinctoria group achieving complete wound healing within 2 to 4 weeks was 50% and 96.66%, respectively, significantly higher than in patients receiving standard care: 0% and 23.3%, respectively. CONCLUSIONS This clinical study showed that A. tinctoria dressing accelerates wound healing after graft harvesting. TRIAL REGISTRATION IRCT ID: IRCT201511165781N2 .
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48
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Derwin R, Moore ZEH, Webster J. Hydrocolloid dressings for donor sites of split thickness skin grafts. Hippokratia 2017. [DOI: 10.1002/14651858.cd012634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Rosemarie Derwin
- Royal College of Surgeons in Ireland; School of Nursing & Midwifery; 123 St Stephens Green Dublin Ireland D.2
| | - Zena EH Moore
- Royal College of Surgeons in Ireland; School of Nursing & Midwifery; 123 St Stephens Green Dublin Ireland D.2
| | - Joan Webster
- Royal Brisbane and Women's Hospital; Nursing and Midwifery Research Centre; Butterfield Street Herston Queensland Australia 4029
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Abstract
Negative pressure wound therapy (NPWT) has become a widely used treatment for acute and chronic wounds. NPWT is indicated for a variety of complex wounds, and some studies validate its use for certain aspects of burn care. Although further research is needed to explore the benefits for burns, NPWT has proven beneficial in its use as a dressing that bolsters skin grafts, promotes integration of bilaminate dermal substitutes, promotes re-epithelialization of skin graft donor sites, and potentially reduces the zone of stasis. This article reviews the literature on NPWT in burns, based on indication/application, and describes our experience with the use of modified NPWT for large burns.
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50
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Hu Z, Guo D, Liu P, Cao X, Li S, Zhu J, Tang B. Randomized clinical trial of autologous skin cell suspension for accelerating re-epithelialization of split-thickness donor sites. Br J Surg 2017; 104:836-842. [PMID: 28379607 DOI: 10.1002/bjs.10508] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/08/2016] [Accepted: 01/11/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND Split-thickness skin graft (STSG) is used frequently, but may result in complications at the donor site. Rapid healing of donor-site wounds is critical to relieving morbidity. This study investigated whether autologous skin cell suspension could improve healing of STSG donor-site wounds. METHODS Between September 2014 and February 2016, patients requiring STSGs were randomized to receive autologous skin cell suspension plus hydrocolloid dressings (experimental group) or hydrocolloid dressings alone (control group) for the donor site. The primary outcome was time to complete re-epithelialization. Secondary outcomes included pain and itching scores measured on a visual analogue scale, and adverse events. Patients were followed for 12 weeks to evaluate quality of healing. Analysis was by intention to treat. RESULTS Some 106 patients were included, 53 in each group. Median time to complete re-epithelialization was 9·0 (95 per cent c.i. 8·3 to 9·7) days in the experimental group, compared with 13·0 (12·4 to 13·6) days in the control group (P < 0·001). Overall postoperative pain and itching scores were similar in both groups. No between-group differences in treatment-related complications were observed. Both patients and observers were more satisfied with healing quality after autologous skin cell suspension had been used. CONCLUSION The use of autologous skin cell suspension with hydrocolloid dressings accelerated epithelialization and improved healing quality of the donor site compared with hydrocolloid dressings alone. Registration number: UMIN000015000 ( http://www.umin.ac.jp/ctr).
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Affiliation(s)
- Z Hu
- Department of Burn Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - D Guo
- Department of Plastic Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - P Liu
- Department of Burn Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - X Cao
- Department of Burn Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - S Li
- Department of Plastic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - J Zhu
- Department of Burn Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - B Tang
- Department of Burn Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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