Epidermolysis Bullosa: The Challenges of Wound Care

Carol Schober-Flores

Disclosures

Dermatology Nursing. 2003;15(2) 

In This Article

Noninfected Wounds

Mepitel, Mepilex, and Mepilex Border (Molnlycke Health Care) feature a unique dressing technology called "Safetac." These products are silicone based which results in decreased trauma and pain during dressing changes. Mepitel is the dressing of choice for a wound with minimal drainage. It is a nonadherent dressing to moist wound beds but adheres ultra-gently to dry skin (Bayer Health Care Partners, 2000). It conforms well to body contours without causing friction. This dressing reduces pain and trauma during dressing changes because of its nonadherent nature. It can be left in place for 7 days as long as the wound is not infected. For a wound with minimal drainage, it is recommended to apply a topical ointment to promote moist wound healing (see Figure 4). This product is fenestrated; therefore, ointments can be applied over it on a daily basis without changing the Mepitel dressing. Do not, however, apply an ointment on intact skin because the Mepitel dressing may not stay in place. Once Mepitel is placed on the wound and an ointment is applied, it is recommended to cover it with a nonadherent secondary bandage to either absorb drainage or prevent the outer bandages from adhering to the wound bed in between the fenestrations. The last step is to apply Elastomull® or Kerlix® and then burn netting to keep this product in place. It is recommended, however, to change the outer bandages and reapply the topical ointments on a daily basis.

Topical ointments can be applied directly over the Mepitel dressing.

Mepilex is a foam dressing that is also nonadherent (see Figure 5). It can be used with or without topical ointments. If the wound is dry, it is recommended to apply a topical ointment to it. If it is draining, this product is a good absorbent dressing. It keeps drainage away from intact skin, thus minimizing maceration or skin breakdown occurring from the drainage. It is also a good protective dressing resulting in decreased trauma and blistering from activities of daily living. Remember, dressings are used not only to promote healing but also to minimize trauma and friction; therefore, such dressings should be used to reduce or prevent blistering in individuals diagnosed with EB. Again it is recommended to keep this product in place with Elastomull or Kerlix and burn netting. Never use tape on an individual with EB (see Figure 6). Due to the extreme fragility of the skin, tape will only result in blistering. If tape is required, Mepiform® (Molnlycke) is recommended instead. Mepiform is actually used for hypertrophic or keloid scars but works wonderfully as tape for individuals with EB. Care, however, should be taken when it is removed. It is recommended to wet this product first and then slowly remove.

Mepilex foam dressing.

Never apply dressings with strong adhesives in individuals diagnosed with EB.

Mepilex Border (see Figure 7) is a combination of Mepitel and Mepilex together with a Mepiform Border to keep the dressing in place. This product works well for those hard-to-dress areas such as the axilla or for isolated lesions located on the trunk. This dressing can also be left in place for up to a week as long as the wound is not infected. Before removing this dressing, it is recommended to wet it first due to the Mepiform border and slowly remove. An ideal time to remove this product is during bath time.

Mepilex Border: Consists of Mepitel, Mepilex layer, and Mepiform Border.

Normlgel impregnated gauze is another product supplied by Molnlycke (see Figure 8). It does not have the same Safetac qualities as the previously mentioned products, but can be used successfully with an individual diagnosed with EB. Normlgel gauze is basically gauze that is impregnated with a hydrogel. It is used for a dry wound with minimal to no drainage. Its purpose is to replace the topical ointment that is applied over the Mepitel dressing (see Figure 9). It is recommended to change this dressing daily while leaving the Mepitel in place at least initially. Do not let this dressing dry out because it can adhere to the wound bed through the fenestrations of the Mepitel dressing. If the wound bed remains moist with daily changes, the frequency of dressing changes can decrease to every other day. If a dressing is adhering to the wound bed, it is recommended to wet it with saline/water or lubricate it with an ointment first. If it still is adhering to the wound bed, cut around it and relubricate it. Do not force it off (see Figure 10). It will eventually fall off on its own as the wound re-epithializes.

Normlgel: Gauze impregnated with a hydrogel.

Mepitel with Normlgel impregnated gauze.

Never forcibly remove a dressing. If it is adhering, wet it, lubricate it, and cut around it.

Another effective product is Dual Dress (Bio Med Sciences, 2001) (see Figures 11-12). The Dual Dress products are two layered dressings consisting of a foam material bonded to a blue Silon® membrane. These products will not adhere to the skin with their removal. Dual Dress Thin is a thin foam dressing, whereas, the Dual Dress Extra is a thick foam product for better absorption and protection. These products work very similarly to the Mepilex foam product.

Dual-Dress Extra

Dual Dress: A thin or thick foam dressing.

Telfa/Telfa Clear, Vaseline Gauze, and Exudry are some other dressing products which can be used for noninfected wounds in individuals with EB. Except for the Vaseline Gauze, it is recommended to apply topical ointments to these products to prevent them from adhering to the wound bed. Although they are nonadherent, caution should be used with these products because they tend to either "bunch" up or slip. This can result in blister formation from friction or reinstitute the inflammatory phase from adherence of the outer gauze to the wound bed.

Apligraf (Novartis) is a bilayered human skin allograft, which is grown from neonatal foreskin (see Figure 13). This product contains living human keratinocytes, bovine collagen, and fibroblasts. The exact mechanism of action remains hypothetical, but it is presumed to form a type of living bandage over the wound that is grafted (Fivenson & Falabella, 2000). Apligraf tends to heal wounds quickly, as well as decrease or eliminate the blister formation in sites grafted temporarily. Depending on the type of EB, studies have shown Apligraf to remain intact for 6 months for the less-severe types of EB and 3 months for the more severe types of EB. This "bioengineered skin" shows some promise in certain cases of EB, but as of yet, is not FDA approved to be used with EB.

Apligraf bioengineered skin.

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