Management of partial skin thickness burn wounds with Inadine dressings

In a prospective randomized trial, 213 consecutive patients with less than 10 per cent BSA partial thickness burns were treated as out-patients with either Bactigras (n= 102) (tulle gras dressing with 0.5 per cent Chlorhexidine Acetate B.P.) or Inadine (n = 111) (rayon dressing with 10 per cent povidone iodine ointment). Inadine caused less bleeding on dressing removal but not significantly less. Inadine treated patients required less analgesia, a reduced treatment time, a smaller number of hospital visits and less time off work/normal activities (P = 0.01). Inadine should be more widely used in the management of partial thickness burn wounds.     

Closure of laparotomy wounds: skin staples versus sutures.

To investigate the routine use of a skin stapling device for the closure of midline abdominal wounds, 48 patients were randomized to receive skin staples or subcuticular polydioxanone sutures. The mean (range) time for closure with staples was 8.0 (3.4-14.8) s cm-1 while subcuticular closure took 12.7 (9.6-28.0) s cm-1. The mean time saved per patient with skin staples was 77 s. Wound pain and requirements for analgesia were significantly lower in the sutured group. The mean cost per patient was 1.41 pounds for subcuticular closure and 7.72 pounds for stapling; the latter also incurred an additional cost of 6.27 pounds for staple removal. No clear benefit derives from the use of staples in the closure of abdominal wounds.     

A comparative trial of skin donor site dressings

Summary Skin donor sites dressed with Opsite—an adhesive polyurethane surgical drape, permeable to gases and water vapour only—heal faster and with less pain than those covered with the conventional paraffin gauze dressing. This is largely due to the moist environment which is present under the Opsite drape.     

Fixation of skin transplants in burns with SurfaSoft and staples. An analysis of the results

The use of SurfaSoft and staples enables a rapid and adequate fixation of (meshed) skin grafts, even when large wounds and anatomically difficult areas are involved. The smooth, porous and transparent structure of SurfaSoft makes frequent inspection of the transplanted skin possible and allows dressing changes to be carried out from the first day after operation onwards. Analysis of 232 skin transplantations shows that on a surgical wound bed the mean take rate is 71% when full sheet or meshed transplants are used. A mean take rate of 96% can be achieved when expanded autograft and specially prepared allografts are used together for covering large wound areas. Transplantation of meshed skin on a granulating wound surface results in a mean take rate of 82%.     

Australasian survey of split skin graft donor site dressings

BACKGROUND: There is an ever increasing array of products available for wound dressings. The aim of the present study was to establish which dressings should be used as standard controls for future studies; what factors are regarded as most important in assessing a dressing; what the level of satisfaction is with the available products; what the strengths and weaknesses of the commonly used dressings are; and what dressings would be preferred if cost were no issue. METHODS: A postal survey was sent to every plastic and reconstructive surgeon registered in Australasia (n = 217). A total of 53% responded. RESULTS: The most commonly used dressing type overall is the calcium alginates, despite the fact that they were not the highest performing dressings. This is also the most commonly used in Australia. In contrast scarlet red is still used most commonly in New Zealand. The level of satisfaction with the most commonly used dressing varied very little. The factor regarded most important was patient comfort level. A profile of the commonly used dressing was constructed. Calcium alginates and or scarlet red should be used as the control for new product comparisons. CONCLUSIONS: Most of the respondents were satisfied with their preferred dressing and were not interested in trying alternative dressings.     

Clinical experience with glycerol-preserved donor skin treatment in partial thickness burns

The development of glycerol-preserved donor skin by the Dutch National Skin Bank has led to the clinical use of this skin in 57 patients with partial thickness burns treated in the Burns Centre of the Red Cross Hospital in Beverwijk. Practical aspects, as well as clinical results, are presented in this article, leading to the conclusion that glycerol-preserved donor skin is a very easy to store and easy to use as an alternative for the 'conventional' cryopreserved donor skin.     

Comparison of Biobrane and Scarlet Red dressings for treatment of donor site wounds

Two methods of autograft donor site management were tested in 31 patients with burn injuries. Two donor sites of equivalent size were respectively covered with Biobrane and Scarlet Red, two commercial dressing materials available for donor wound coverage. Pain, the amount and type of exudate developing underneath the dressing, adherence, and cellulitis were evaluated on a daily basis, and healing time was determined. Biobrane proved superior to Scarlet Red with respect to control of pain, accumulation of exudate, and healing time; the materials were equal with regard to adherence to the wound, the character of exudate, and the appearance of cellulitis.     

Effectiveness of biological dressings made of porcine skin in the treatment of burns

The observation and estimation of results of treatment of 145 patients with burns have shown high efficiency of a biological dressing of porcine skin treated with chemical anticeptics (formaldehyde).     

Allogeneic skin substitutes applied to burns patients

Early re-surfacing of burn wounds remains the ideal but is limited by the availability of skin graft donor sites. Cultured grafts overcome these problems and autologous keratinocytes can be grown in culture and placed on a dermal substitute, but this results in delay and requires two operations. We developed an organotypic skin substitute, which achieves cover in one procedure, and have previously found allogeneic cell survival up to 2.5 years after grafting onto clean elective wounds (tattoo removal). Here, we report a short series using the same model applied to burns patients with less than 20% total body surface area affected. The skin substitutes consisted of allogeneic dermal fibroblasts embedded in a collagen gel overlain with allogeneic epidermal keratinocytes, and were grafted to patients with tangentially excised burns. A side-by-side comparison with meshed split-thickness autografts was performed. No grafts became infected. The allogeneic skin substitute showed little effective take at 1 week, and by 2 weeks only small islands of keratinocytes survived. These sites were subsequently covered with meshed split-thickness autograft, which took well. It is concluded that further development of this model is needed to overcome the hostile wound bed seen in burns patients.     

Comparison of E-Z Derm and Jelonet dressings for partial skin thickness burns

A prospective, randomized trial of 32 patients with partial skin thickness burns is reported comparing E-Z Derm with Jelonet as a burn dressing. The bacterial colonization rate, need for surgical treatment, time for spontaneous healing, analgesic requirements and frequency of dressing changes were assessed in each group. No statistically significant differences were found between the two groups, for any of these factors.     

缝合打包跨供区加压法植皮修复皮瓣移植供区创面

目的探讨缝合打包跨供区加压法植皮修复皮瓣移植供区创面的手术方法和临床疗效。方法应用缝合打包跨供区加压改良植皮方法修复皮瓣转移供区皮肤缺损48例,其中手指岛状皮瓣移植供区创面17例,手背皮瓣移植供区7例,前臂皮瓣移植供区10例,足部皮瓣移植供区创面6例,小腿皮瓣移植供区创面8例。供区创面1.5 cm×1.0 cm~18.0 cm×15.0 cm。急诊手术26例,均为创伤性皮肤软组织缺损行皮瓣转移术供区创面;择期手术22例,肿物切除创面行皮瓣转移修复术供区8例,瘢痕切除创面行皮瓣转移术供区10例,肢(指)体坏死解脱后创面行皮瓣修复术供区4例。结果 48例植皮及皮瓣全部成活,45例获得6~29个月的随访,供区植皮质地柔软,外观饱满,无色素沉着及摩擦溃疡瘢痕,两点辨别觉达8~13 mm,平均10.8 mm,肢体功能恢复满意。结论缝合打包跨供区加压法植皮修复皮瓣转移供区创面,手术简便、安全,植皮成活率高,术后外形满意,是一种较为实用的方法。     

胸脐皮瓣修复深度烧伤创面疗效观察

目的观察胸脐皮瓣早期修复深度烧伤创面的临床应用效果。方法笔者应用胸脐皮瓣(分别采用带蒂转移、岛状转移、游离移植以及与多种皮瓣联合转移的方式)修复39例深度烧伤患者创面,观察皮瓣的成活情况、色泽、弹性,有无瘢痕挛缩导致的功能障碍及供瓣区愈合情况。结果创面彻底清创后未发生明显感染。胸脐皮瓣面积最大为55 cm×27 cm,最远达到同侧腋中线,且皮瓣可跨越腹中线,最远达对侧10 cm,皮瓣全部成活。33例患者随访1-46个月,皮瓣色泽及弹性良好,无瘢痕挛缩导致的功能障碍,供瓣区部位隐蔽,无明显瘢痕形成。结论胸脐皮瓣根据创面大小及部位采用不同的转移方式,是早期修复深度烧伤创面较理想的方法。     

Occlusive versus semi-open dressings in the management of skin graft donor sites.

In a prospective, randomised study we compared the efficacy of a new occlusive dressing (Granuflex-E) with a semi-open dressing (tulle gras) in the management of skin-graft donor sites. The study examined 10 patients with burns, each with two donor sites. Each patient acted as his or her own control. The donor sites were mirror images of each other, the anterior surface of the thighs. One donor site was dressed with Granuflex-E and the other with tulle gras. The sites dressed with the occlusive dressing healed significantly faster and were more comfortable than the sites with the semi-open dressing.     

Adhesive retention dressings are more comfortable than alginate dressings on split skin graft donor sites--a randomised controlled trial.

A prospective randomised trial examining the effectiveness, comparative comfort and ease of care of two different split skin graft donor site dressings was performed. One of the dressings was an alginate (Kaltostat), and the other an adhesive retention tape (Mefix). Alginates are the standard plastic surgical dressing, whereas the use of adhesive retention tapes as a donor site dressing presents a novel use of a readily available product. A total of 30 consecutive patients requiring split skin grafts were randomised to receive either alginate or retention donor site dressings. Dressings were assessed by interview and questionnaire at 24 h and 48 h and at 2 weeks, and by wound review at 2 weeks. Retention dressings were found to be more comfortable. They also required less nursing care and attention. The retention dressings allowed the patients easier mobility and a greater range of daily activities, especially washing. There was no significant difference in wound healing nor in complications. Adhesive retention tape applied directly to the split skin graft donor site wound is an effective, cheap and comfortable dressing requiring little postoperative care.