Do Functional Keratin Dressings Accelerate Epithelialization in Human Partial Thickness Wounds?

A Randomized Controlled Trial on Skin Graft Donor Sites

Andrew Davidson, MBChB; N. Hamesh Jina, MBChB; Clive Marsh, PhD; Martin Than, MBBS; Jeremy W. Simcock, MD

Disclosures

ePlasty. 2013;13 

In This Article

Results

Thirty-seven patients were enrolled into the study. There were no adverse events relating to either Treatment or Control dressing. Eleven patients were not able to be assessed on postoperative day 7 leaving 26 participants available for analysis, 15 were older than 50 years (median age = 73 years) and 11 were 50 years old or younger (median age = 35). Reasons for not completing assessment were as follows: did not attend follow-up clinic (5), attended clinic too late to be included in assessment (2), dressings changed early by on-ward nursing staff (2), and incomplete consent process (2).

Percentage of epithelization varied markedly across the patients overall. This difference was predominantly associated with age (see Table 1 and Fig 1). In the older (>50 years) group, the majority of each wound was unhealed (median epithelialization percentage, 5%). In this group, there was a significant (P = .023) difference between the epithelialization in the Control portion and the Treatment portion of the wound. The corresponding medians of the Control group and Treatment group were 5% and 10% epithelialization, respectively.

Figure 1.

Difference in epithelialization of adjacent sides of donor site wound Treatment vs Control.

In the younger (≤50 years) group, epithelization was almost complete at 7 days (median epithelialization percentage, 80%). There was no significant difference between Treatment and Control portions of the wound.

Figure 1 shows the difference in epithelialization, approximately 7 days after surgery, for all patients measured. This illustrates the difference between the responses of older (>50 years) to younger (≤50 years) patients. Figure 2 shows a typical outcome for the older group: side "A" (Treatment) shows early epithelialization from the epidermal appendages (5% epithelialization) whereas side "B" (Control) has not started to epithelize (0% epithelialization). The Treatment side demonstrates coagulated blood on the surface of the wound as the Treatment dressing is not designed to be hemostatic (unlike the Control dressing). The wound was gently washed with normal saline and adherent slough or blood indicated that the region had not epithelialized; this was taken into account by the blinded assessor.

Figure 2.

Photograph showing epithelialization of a typical donor site 7 days after surgery.

Qualitatively, the Treatment dressing was observed to handle the high exudate load during the first 2 days from the donor sites well. Sixteen of 27 patients followed up had questionnaires completed by nurses of which 6 felt that the side-allocated Treatment dressing was less painful to remove, one found the Control dressing side less painful, and the rest noted no difference. Subjectively nurses typically commented that the Treatment dressings were easier, less painful, and less traumatic to remove than the Algisite.

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