Abstract and Introduction
It is essential that occlusive drapes provide both an airtight, watertight seal and prevent intrusion of the external environment into a healing wound bed. Removal of an acrylic drape, however, may result in pain, reflex erythema, and a denuding of the epidermis, including the stratum corneum. Recently, a new silicone-acrylic hybrid drape was introduced for use with negative pressure wound therapy. Five unique and varied clinical cases from a burn center that used such negative pressure wound therapy dressings with the silicone-acrylic hybrid drape are presented. These cases highlight the excellent sealing capabilities of this new occlusive drape and minimal pain upon its removal. In addition, this hybrid drape may decrease waste of dressing supply because it is easily reconfigured to its original form and can be repositioned if the initial placement is suboptimal. The drape also maintains a tight seal with repositioning, making it more user-friendly to the clinical provider.
An occlusive drape provides an airtight, watertight seal that helps protect the wound from the environment and the environment from the contents of the wound. By maintaining the dressing in a stationary position, the occlusive drape decreases the magnitude of shear force exerted on the wound surface. This is beneficial for the granulating wound as well as autologous skin grafts that may be applied. By design, such drapes do not allow moisture to escape the wound bed, unless there is an attached decompressive system, such as negative pressure wound therapy (NPWT) or a porous dressing pad, surrounded by an occlusive seal (eg, with an island dressing). When these occlusive drapes are removed, the conscious patient experiences pain secondary to skin surface trauma caused by the drape adhesive. Human skin sensitivity is not equivalent and varies based on location, pigmentation, age, presence of hair, collagen strength, degree of moisture (sebum/oil content), sweat production, and previous topically applied adhesives, salves, lotions, or creams. If the skin is sensitive (often seen in elderly persons), contact cellulitis from occlusive drape removal can occur, including edema, reflex erythema, and even cutaneous tears through the epidermis. Skin maceration can occur if the occlusive dressing is left in place for extended periods. Typically, these flat, adhesive drapes have a sealant across the so-called contact surface, whereas the opposing side is nonadherent.
Occlusive, silicone-acrylic hybrid drapes have been developed for use with a variety of products that require an occlusive seal, including NPWT with instillation and dwell time (NPWTi-d) and temporary abdominal closure (Abthera Open Abdomen Negative Pressure Therapy dressings; 3M). Kilbride et al described vacuum-assisted closure as a new and improved method in the closure of giant omphaloceles in the pediatric population. Typically, an acrylic occlusive drape was used to hold the dressing in place. Clinical experience with these devices has shown that when traditional acrylic drapes are removed, discomfort and pain may result. This can occur during acute hospitalization or in a chronic setting (at home or in the outpatient clinic) when these devices are replaced. If the drape is too strong in its initial adherence (tact), the peripheral skin around the wound may be damaged with drape removal. Compared with silicone-based occlusive dressings, acrylic adhesive drapes have been shown to cause more damage to the stratum corneum,especially with repeated removal. Such damage with repeated removal is referred to as skin stripping.[4,5] Some types of acrylic drapes have been known to irritate the skin. In addition, the acrylic drape is not only more rigid than silicone but is best cut into small strips for better ease of application, which can add to preparation time. Placement of these temperamental drapes may require more time, provider dexterity, and concentration for correct dressing application, with little to no room for application error. The simple acrylic drapes are seldom easily manipulated. If any adjacent side clings to itself, it may be necessary to discard the drape; the need to use a new acrylic strip increases waste and reduces the resource supply.
In recent years, a new occlusive, single-use silicone-acrylic hybrid drape (Dermatac Drape; 3M) became available.[7,8] This drape is a manufactured silicone-acrylic hybrid sheet with regularly spaced acrylic pockets or islands (Figure 1). It has numerous benefits, including ease of application, reduced supply waste, and improved adherence, the latter of which results in less pain with drape removal and repositioning. The drape more naturally conforms to anatomic variances, especially in difficult-to-reach areas, and can be used in acute hospitalization as well as in the clinic or home setting where NPWT devices are routinely used. The addition of silicone has been shown to result in an adhesive that is gentler to the skin than acrylic.
Wounds. 2022;34(5):141-145. © 2022 HMP Communications, LLC