Suprathel, a new skin substitute, in the management of donor sites of split-thickness skin grafts: results of a clinical study

OBJECTIVE: A prospective, randomized, two center clinical study was conducted to evaluate the impact on wound healing of Suprathel in donor sites of split-thickness skin grafts. Suprathel represents an absorbable, synthetic wound dressing with properties of natural epithelium. METHODS: 22 burn patients who were treated with split-thickness skin grafts, and with a mean age of 39.6 years were included in the study. Donor sites of skin grafts were randomly selected; partly treated with Jelonet and partly treated with Suprathel. First gauze change was carried out the fifth day postoperatively followed by regular wound inspection until complete re-epithelization. The study focused on patient pain score, healing time, analysis of wound bed, ease of care, and treatment costs. RESULTS: There was no significant difference between the two materials tested regarding healing time and re-epithelization. There was a significantly lower pain score for patients treated with Suprathel (p=0.0002). Suprathel became transparent when applied and allowed close monitoring of wound healing. In contrast to Jelonet, Suprathel showed excellent plasticity with better attachment and adherence to wound surfaces. Throughout the healing process it detached from wounds without damaging the new epithelial surface. In addition, wound areas treated with Suprathel required less frequent dressing changes. It also demonstrated excellent ease of care. This, altogether with the significant pain reduction, presented a positive feedback by patients and healthcare professionals who both rated Suprathel as their treatment preference. Though Jelonet is more cost effective as dressing material, the study revealed an overall reduction in total treatment costs achieved with Suprathel. CONCLUSION: Suprathel represents a solid, reliable epidermal skin substitute with impact on wound healing, patient comfort and ease of care. The material effectiveness contributes to the reduction of overall treatment costs.     

Suprathel, a new skin substitute, in the management of partial-thickness burn wounds: results of a clinical study

OBJECTIVE: A prospective, randomized, bicentric, nonblinded, clinical study was conducted to evaluate the impact on wound healing of Suprathel in partial-thickness burn injuries. Suprathel represents an absorbable, synthetic wound dressing with properties of natural epithelium. METHODS: Thirty patients suffering from second-degree burn injuries were included in the study, with a mean of age 40.4 years old. Burn injuries were randomly selected, partly treated with Omiderm and partly treated with Suprathel. The first gauze change was applied the fifth day postoperatively, followed by regular wound inspection until complete reepithelization. The study focused on patient pain score, healing time, analysis of wound bed, ease of care, and treatment costs. RESULTS: There was no significant difference between the 2 materials tested regarding healing time and reepithelization. There was a significant lower pain score for patients treated with Suprathel (P = 0.0072). Suprathel becomes transparent when applied, thus allowing close monitoring of wound healing. In contrast to Omiderm, Suprathel shows better attachment and adherence to wounds. During the course of healing, it detaches smoothly, without damaging the reepithelized wound surface. Moreover, it reduces the frequency of dressing changes required. Ease of care of Suprathel has been rated outstanding by patients and healthcare professionals. When interviewed, patients reported Suprathel as their treatment preference. As dressing material, Omiderm is more cost-effective than Suprathel. CONCLUSION: Suprathel represents a reliable epidermal skin substitute, with a good impact on wound healing and pain reduction in partial-thickness burn injuries. Although it is less cost-effective than Omiderm, the significant increase of patient comfort makes this material represent a reliable and solid treatment alternative when dealing with partial-thickness burn injuries. Further studies with this synthetic dressing on other types of wounds are warranted.     

Suprathel(®) causes less bleeding and scarring than Mepilex(®) Transfer in the treatment of donor sites of split-thickness skin grafts

Split-thickness skin grafts are routine in the treatment of deep dermal burns and various other wounds. Healing of the donor site of the graft has an impact on the total recovery of the patient. We conducted a prospective clinical study at Tampere University Hospital to compare the effect of two adhesive wound dressings, Suprathel(?) and Mepilex(?) Transfer. The donor sites of 22 split-thickness skin grafts were studied, each of which was covered with Suprathel(?) and Mepilex(?) Transfer dressings side by side. Significantly less pain and bleeding was associated with Suprathel(?) treatment compared with Mepilex(?) Transfer (p < 0.05). Suprathel(?) produced a better scar at the three months' follow-up as measured using the Vancouver Scar Scale (VSS). The results show that Suprathel(?) is a better dressing for the donor sites than Mepilex(?) Transfer.     

A new temporary synthetic skin substitute

Eighteen months of experience with a new synthetic temporary skin substitute (Omiderm, Omikron Scientific Ltd., Rehovot, Israel) is presented. The substitute is a thin, transparent, flexible membrane. It is used when a biological dressing would otherwise have been used. Our experience consists of laboratory studies and 75 clinical cases including donor sites application, chronic wounds, ulcers, partial thickness and full thickness burns. The membrane is very elastic, permitting free movement and physiotherapy during the healing process. The material protects the wound and prevents either the accumulation of fluid under it or wound desiccation. It does not interfere with the normal healing process. It reduces pain, prevents bacterial invasion and is very easy to handle. Complications, such as haematoma formation or infection, were quite few. We recommend its use in routine daily practice.     

A clinical comparison of pure knitted silk and a complex synthetic skin substitute for the treatment of partial thickness burns

Currently, many dressings are commercially available for the treatment of burn wounds. Some of these wound dressings remain on the wound, prevent painful dressing changes, and reduce tissue scarring. Nevertheless, still a wound dressing that is cost-effective, produces good wound healing properties, and has a high patient satisfaction is needed. Standard care of superficial burn wounds differs between burn centres. This study aimed to determine a dressing with easy appliance, accurate pain control, favourable outcome, and cost-effectiveness. Therefore, we compared the widely used but expensive Suprathel with the rather new but much cheaper Dressilk in the clinical setting. In a prospective clinical study, the healing of partial thickness burn wounds after simultaneous treatment with Suprathel and Dressilk was examined in 20 patients intra-individually. During wound healing, pain, infection, exudation, and bleeding were evaluated. A subjective scar evaluation was performed using the Patient and Observer Scar Scale. Both dressings were easy to apply, remained on the wound in place, and were gradually cut back as reepithelisation proceeded and showed similar times to wound closure. Dressing changes were not necessary, and neither infections nor bleeding was detected. Overall exudation and pain were highest in the beginning but declined during the wound-healing phase without significant differences. In the follow-up scar evaluation after 12 months, patients reported overall high satisfaction. Overall, the modern dressings Suprathel and Dressilk (solely made out of pure silk) led to safe wound healing without infection and rapidly reduced pain. There was no need for dressing changes, and they had similar clinical outcomes in scar evaluation. Therefore, both dressings seem to be ideal for the treatment of superficial burns. Because acquisition costs remain one of the main factors in the treatment of burns, Dressilk, which is ~20 times cheaper than Suprathel, remains a good option for the treatment of partial thickness burns.     

A new option for definitive burn wound closure – pair matching type of retrospective case–control study of hand burns in the hospitalised patients group in the Dr Stanislaw Sakiel Centre for Burn Treatment between 2009 and 2015

Nearly 80% of all burns include the hands of affected individuals. Skin grafting is the gold standard in burns treatment, but in the case of the burn wound bed, it may require the necessity of utilising skin substitutes to facilitate closure. The aim of this study is to assess the impact of a porcine‐derived wound dressing (Oasis™) for application to hand burns compared to a synthetic dressing (Suprathel™). Comparative assessments were made, including the time to heal, quality of healing and pain intensity. A retrospective, unblinded, matching pair case‐control of hand burns was performed. A control group of 24 patients was treated with Suprathel dressing, and a study group of six patients underwent application of the Oasis dressing. The wound healing process was evaluated by taking histopathological specimens and also utilising the Bates‐Jensen Wound Assessment Tool. A 10‐cm Visual Analogue Scale (VAS) was used for pain assessment. Other parameters measured included dressing loss because of infection and the need of rehabilitation. The progress of wound healing on the fourth day in the study group was 30%. A decrease in the level of pain was recorded on the fourth day after surgery. There was a decrease of 5% in the risk of rehabilitation in the treatment group.     

人组织工程全层皮肤在烧伤创面中厚供皮区的应用

目的观察人组织工程全层皮肤(ActivSkin)在中厚供皮区临床应用效果.方法 9例患者,年龄17～43岁.其中5例1%～6%总体表面积烧伤,深Ⅱ度～Ⅲ度;4例烧伤后瘢痕.每例患者2个部位创面,均使用自体中厚皮片修复.切取皮片后供区遗留创面随机分为试验组和对照组,行自体对照观察.试验组创面采用ActivSkin修复,对照组创面采用凡士林油纱覆盖.术后观察创面疼痛、愈合时间及治愈率;术后7～30 d每日观察创面愈合情况,1、3、6个月定期随访.结果试验组创面术后疼痛明显减轻,愈合时间为9.67±2.92 d,比对照组16.56±2.96 d提前,差异有统计学意义(P＜0.05);治愈率均为100%.术后随访试验组创面供皮区愈合后未见水疱、残余创面发生,瘢痕形成减轻;对照组创面4例于术后3个月内有水泡形成,残余创面发生. 结论ActivSkin可减轻中厚供皮区创面疼痛,加速愈合,并能预防供皮区愈合后水疱、残余创面发生,降低瘢痕形成.     

Management of partial thickness facial burns (comparison of topical antibiotics and bio-engineered skin substitutes).

This study compared the effect of standard topical antibiotic management versus a biological skin substitute wound closure for mid-partial thickness burns of the face. Adult patients with mid-dermal facial burns produced by flash flames or flame exposure were studied using a randomized prospective study design. Total daily burn care time, pain (0-10 scale) and healing time were monitored. Immediately after partial thickness debridement, the entire face burn, including ears, was closed with a bioengineered skin substitute coated with fibronectin (TransCyte) or treated by the open technique using bacitracin ointment applied 2-3 times daily. 21 patients were studied, with 10 patients in the skin substitute group. We found a significant decrease in wound care time 0.35 +/- 0.1 versus 1.9 +/- 0.5 h, decrease in pain of 2 +/- 1 versus 4 +/- 2 and re-epithelialization time 7 +/- 2 versus 13 +/- 4 days in the skin substitute group compared to topical antibiotics. We can conclude that a bioengineered skin substitute significantly improves the management and healing rate of partial thickness facial burns, compared to the standard open topical ointment technique.     

Topkin<Superscript>®</Superscript>—Eine resorbierbare Folie aus Lactid-Caprolacton

The resorbable film Topkin (Biomet-Merck), which consists of a copolymer composed of D,D-lactide and ε-caprolactone was applied to 71 split skin donor sites and 42 split skin grafting sites as wound coverage. The split skin donor sites had an area of up to 900 cm², and the recipient soft tissue defects covered up to 1200 cm². For comparison 29 grafting sites were covered with grease gauze dressings. In the split skin donor sites, there were two complications (hematoma, local infection). In split skin grafting sites five complications (one hypertrophic granulation, two residual defects, one local infection, and one scar formation) were observed. Of the 29 patients whose split skin grafting sites were treated with conventional grease gauze bandages, 8 experienced wound healing problems (four residual defects, three superficial graft necroses, and one local infection). Substantial scarring was observed in four wounds. There was no significant difference in wound healing time between treatment with the film and treatment with grease gauze. The maximal pain ratings during the film treatment was 10.9 for the split skin donor sites and 2.9 for the contaminated wounds. Time expenditure for care of the wounds was 4 min/day in the first 20 patients and, after modification of the regime, 2 min/day in the remaining patients.     

Full-thickness skin columns: A method to reduce healing time and donor site morbidity in deep partial-thickness burns

The current standard of care for the coverage of large wounds often involves split thickness skin grafts (STSGs) which have numerous limitations. One promising technique that has gained traction is fractional autologous skin grafting using full-thickness skin columns (FTSC). Harvesting occurs orthogonally by taking numerous individual skin columns containing the epidermis down through the dermis and transferring them to the wound bed. The purpose of this porcine study was to investigate the efficacy of implanting FTSCs directly into deep partial-thickness burn wounds, as well as examining donor site healing at the maximal harvest density. It was hypothesised that by utilising FTSCs, the rate of healing in deep partial thickness burns can be improved without incurring the donor morbidity seen in other methods of skin grafting. Deep partial-thickness burns were created on the dorsum of female red duroc swine, debrided 3 days later and FTSCs were implanted at varying expansion ratios directly into the burn wounds. At day 14, 1:50 expansion ratio showed significantly faster re-epithelialisation compared to the debrided burn control and 1:200. Donor sites (at 7%–10% harvest density) were 100% re-epithelialised by day 7. Additionally, the maximal harvest density was determined to be 28% in an ex vivo model, which then five donor sites were harvested at 28% density on a red duroc swine and compared to five STSG donor sites. At maximal harvest density, FTSC donor sites were significantly less hypopigmented compared to STSGs, but no significant differences were observed in re-epithelialisation, contraction, blood flow or dermal thickness. In conclusion, implantation directly into deep partial-thickness burns is a viable option for the application of FTSCs, favouring lower expansion ratios like 1:50 or lower. Little difference in donor site morbidity was observed between FTSC at a maximal harvest density of 28% and STSGs, exceeding the optimal harvest density.     

Optimizing Suprathel®-therapy by the use of Octenidine-Gel®

Objective

A prospective, randomized, non-blinded, clinical study was conducted to evaluate the feasibility and practicability as well as pain reduction and ease of handling of Flammazine^® versus Octenidine-Gel^® as a primary local antiseptic before synthetic skin substitute application in partial-thickness burns.

Methods

Thirty patients with a median age of 42 years suffering from second-degree burns were included in the study. Burns were randomly selected, one area was treated with Flammazine^®/gauze, another area in the same patient was treated with Octenidine-Gel^®/gauze as initial antiseptic treatment. Within 24 h the first gauze change was performed followed by wound inspection, disinfection and synthetic skin substitute application. The study focused on patient pain score, analysis of wound bed and ease of handling of the two local antiseptic agents.

Results

There was a significant difference between Flammazine^® versus Octenidine-Gel^® regarding patient pain score and ease of handling. Octenidine-Gel^® was less painful (p < 0.05) and easier to handle (p < 0.05). There was no significant difference for wound bed evaluation between the two antiseptic agents. A tendency for better wound bed preparation was seen with the use of Octenidine-Gel^®.

Conclusion

Based on the findings of this study Octenidine-Gel^® is recommended as a local antiseptic agent, because when compared to Flammazine^®, Octenidine-Gel^® proved to be better in terms of ease of care, simplicity application, with gentler and faster detachment of the gel from wound surfaces and consequently far less pain during dressing changes.     

Split-thickness skin graft donor site management: a randomized controlled trial comparing polyurethane with calcium alginate dressings

Split‐thickness skin grafting (SSG) is a common reconstructive technique for the treatment of patients with deep burns and other traumatic injuries. The management of the donor site after harvesting an SSG remains controversial because of a variety of dressings available for use. The aim of this randomized controlled trial was to compare the effectiveness of a polyurethane dressing, Allevyn?, to a calcium alginate, Kaltostat®. From August 2009 to April 2010, 36 patients were randomized to Allevyn? or Kaltostat® for donor site management following split skin graft surgery. Pain intensity and adverse events were the primary outcomes assessed. Secondary outcome measures included time for wound healing, ease of application and removal and overall patient satisfaction. Time to first dressing change was earlier in those randomized to Allevyn? compared with Kaltostat® (5·5 days versus 8·11 days, P = 0·014). In patients randomized to Allevyn?, excessive exudate lead to a significantly increased number of dressing changes before day 10 (14 days versus 7 days, P = 0·018). The total number of dressing changes applied was also greater in those with Allevyn? compared with Kaltstat® (P = 0·007). There were no significant differences between the two treatment groups with respect to time to wound healing, level of pain intensity, length of stay, staff and patient satisfaction levels. This trial showed Allevyn? to be associated with increase demands on nursing time, increased cost of dressing products, medical consumables and wastes. Kaltostat® remains the dressing of choice for initial donor site dressing in this burns unit.     

Acceleration of wound healing by a live yeast cell derivative

Acceleration of the normal rate of burn wound healing would serve to decrease the morbidity and possibly the mortality of burn victims. A live yeast cell derivative (LYCD) has previously been reported to stimulate wound epithelialization and this study was designed to evaluate that hypothesis. Twenty-six human skin graft donor sites in nine patients were compared in a double-blind, randomized, single-center inpatient study. Thin donor sites were used as a model for superficial wound healing. Statistically significant earlier angiogenesis and epithelialization occurred in donor sites treated with LYCD ointment as compared with donor sites in the same patients treated simultaneously with ointment base. Stinging pain was noted by seven patients, but in all cases the pain was mild and required no analgesia.     

Multicentre comparative clinical study of a new wound dressing: PA286 (Inerpan)

Summary 10 French burn centres participated in a prospective, randomised clinical trial comparing a new wound dressing, PA286 (trademark Inerpan) with the dressings commonly used in each centre, such as vaseline gauze, vaseline gauze with antibiotics, silver sulphadiazine cream and polyurethane film. A total of 460 patients with second degree burns, skin donor sites, meshed skin grafts and losses of skin substance were included in the study. Each patient acted as his, or her, own control. Two similar lesions in terms of site, depth and surface area were compared, one being treated with Inerpan, the other one with a control dressing. The following parameters were studied: healing time, intensity of pain, local safety, and frequency of dressing changes. Analysis of the results showed that healing time and importance of local events such as exudate and suppuration did not differ significantly. Intensity of pain experienced by the patient and frequency of dressing renewals were significantly lower with Inerpan then with control dressings.

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The effect of sucralfate,an agent for gastroprotection on the healing of split thickness skin graft donor sites

Skin is the most commonly used tissue for the transplantation. A meticulous care of the donor site is needed to prevent scarring, delayed healing, and pain. Various agents and dressing materials have been reported to help healing of skin graft donor sites. Sucralfate is an extensively used agent, which provides acute gastroprotection and acceleration of chronic ulcer healing. In this study, we assessed the effects of topical sucralfate on the healing of the split thickness skin graft donor sites in a prospective comparative way. The study was carried out on 32 randomly chosen patients undergoing surgery for various causes and requiring split thickness skin graft resurfacing. The upper halves of the skin graft donor sites on the thighs were simply covered with paraffin gauze and the lower half was covered with sucralfate-soaked paraffin gauzes. The day of full epithelization varied from 6 to 9 days and 8–12 days on the sucralfate-applied areas and on the control sites, respectively. The mean value of the healing was 7.01 days in the studied lower halves and 10.8 days in the upper halves. The healing rate was strikingly faster and less painful on the sucralfate-applied areas. We were able to discharge patients earlier than usual, and patients’ comfort increased. It seems that sucralfate is a promising topical agent to increase the healing rate and decrease the incidence of associated problems such as pain and hypertrophic scar.     

Healing at skin graft donor sites dressed with chitosan.

Chitosan is a derivative of chitin, extracted from the exoskeleton of lobsters, crabs and shrimps. As a semi-permeable biological dressing, it maintains a sterile wound exudate beneath a dry scab, preventing dehydration and contamination of the wound to optimise conditions for healing. In this study, evaluation of healing at split skin graft donor sites, dressed half with chitosan and half with a conventional dressing, showed that chitosan facilitated rapid wound re-epithelialisation and the regeneration of nerves within a vascular dermis. In addition, digital colour separation analysis of donor site scars demonstrated an earlier return to normal skin colour at chitosan-treated areas.     

A Comparison of Full and Split Thickness Skin Grafts in Radial Forearm Donor Sites

To formally evaluate the functional and aesthetic outcomes between full versus split thickness skin graft coverage of radial forearm free flap donor sites. A retrospective chart review of 47 patients who underwent pedicled or free radial forearm free flap reconstruction from May 1997 to August 2004 was performed. Comparisons were made between patients who had donor site coverage with split thickness skin grafts (STSG) or full thickness skin grafts (FTSG). There was no statistically significant difference between the STSG and FTSG in the number of post-operative dressings, incidence of tendon exposure, time to healing at the skin graft donor site, and time to healing at the skin graft recipient site. The questionnaire data showed there was a trend toward higher scores with the radial forearm scar aesthetics and satisfaction in the FTSG group. Full thickness skin graft coverage of radial forearm free flap donor site is superior to split thickness skin graft coverage in terms of aesthetic outcome, and has no statistically significant difference in terms of tendon exposure, time to healing at the skin graft donor site, time to healing at the skin graft recipient site, or post operative pain.     

Characterization of growth hormone enhanced donor site healing in patients with large cutaneous burns.

BACKGROUND: Human growth hormone is an anabolic agent that attenuates injury-induced catabolism and stimulates protein synthesis. Recombinant human growth hormone (rhGH) administered therapeutically to patients with massive burns has been shown to increase the rate of skin graft donor site healing. It has been postulated that growth hormone affects wound healing and tissue repair by stimulating the production of insulin-like growth factor-1 (IGF-1) by the liver to increase circulating IGF-1 concentrations. The mechanism by which it improves wound healing, however, remains in question. The authors hypothesize that rhGH up-regulates IGF-1 receptors and IGF-1 levels both systemically and locally in the wound site to stimulate cell mitosis and increase synthesis of laminin, collagen types IV and VII, and cytokeratin. This hypothesis was tested in nine patients with burns covering > 40% of total body surface area. OBJECTIVE: The authors assessed the efficacy of rhGH in promoting several major building materials in the donor site of patients with massive burns. METHODS: Ten massively burned patients with full-thickness burns covering more than 40% of total body surface area were participants in a placebo-controlled prospective study to determine the efficacy of 0.2 mg/kg/day rhGH on donor site wound healing and to identify some of the major components involved in wound healing and its integrity. RESULTS: Donor sites in burn patients receiving rhGH showed an increased coverage by the basal lamina of 26% for placebo to 68% coverage of the dermal-epidermal junction. Insulin-like growth factor-1 receptors and laminin, types IV and VII collagen, and cytokeratin-14 all increased significantly. Healing times of the donor sites were significantly decreased compared with patients receiving placebo. CONCLUSION: Results indicate that growth hormone or its secondary mediators may directly stimulate the cells of the epidermis and dermis during wound healing to produce the structural proteins and other components needed to rebuild the junctional structures.     

Use of skin staples to fix film dressings on scalp donor wounds in patients with burns

Split-thickness skin grafts (STSGs) from the scalp have been used in large burns. The donor site wounds are usually covered using occlusive dressings, such as film dressings because they contribute to reduce donor site pain and infection under exudative crust and to enhance re-epithelialization. However, it is not always easy to fix such film dressings to the scalp because of the presence of hair. In this paper, we report the use of skin staplers to fix the film dressings. Eight donor sites in four patients were dressed in this way. The patients had 50-78% of the body burned, all of them survived. The mean healing time for the donor sites was 6.8 days. Three patients had their scalps re-harvested several times (range two to three times). There were no infections nor secondary skin ulcers at the donor sites. The technique of this dressing is very simple and speedy, thus we recommend the use of skin staplers to fix the film dressing to scalp donor wounds in patients with burns.     

Silver sulphadiazine and the healing of partial thickness burns: a prospective clinical trial

A clinical trial was devised to determine whether the healing of partial thickness burns was retarded by the use of silver sulphadiazine cream (SSD) compared with simple, non-bacteriocidal dressings. Biopsy-confirmed partial thickness burns of at least 2% confluent area were dressed according to a strict protocol to compare the rate of epithelialisation of the control dressing, tulle gras, with that obtained with the use of silver sulphadiazine. The same comparative dressing regimen was carried out on a series of split thickness graft donor sites. Twenty such donor sites and fifteen burn areas were admitted to the trial. The mean time to healing of SSD-treated burn areas was longer than that for tulle gras; the difference when analysed by paired t-test was statistically significant (p less than 0.05). There was very little difference in the compared healing rates of the donor sites, which implies that SSD does not retard epithelialisation of dermal depth injuries but rather that the delayed healing is a unique response of the partial thickness burn wound to the presence of SSD. A review of the relevant literature is included in the discussion.