Treatment of burns – role of dressings with Safetac
Burn wounds are extremely painful, frequently highly traumatic and can lead to permanent scarring, disfigurement or even death1. Management is based on the amount, depth and severity of burns and by the designations of superficial, partial and full-thickness injuries2. The main objectives of burns treatment is to remove devitalised tissue, promote healing, prevent wound infection and graft loss, maintain function of the affected body part, and achieve wound closure as soon as possible3.
Silver sulphadiazine (SSD) treatments have been used as standard treatment for over thirty years. However, a number of side effects of treatment (leucopenia, hypersensitivity, allergic reactions, wound bed discoloration, microorganism resistance and pain during application and removal) have been documented4, therefore alternative efficacious treatments would be welcome.
Mepilex® Ag proved to be a superior alternative in a comparative, randomized, controlled trial versus SSD in the treatment of partial-thickness thermal burns5. In a trial comprising 101 subjects (Mepilex Ag, n=49; SSD, n=51) mean healing rates were 71.7% versus 60.8% at final visit and the numbers of dressing changes were 2.2 versus 12.4 in the Mepilex Ag-treated and SSD-treated groups, respectively. A significant difference in mean pain scores, in favour of Mepilex Ag, was noted at dressing application (p=0.018) and during dressing wear (p=0.048). The mean total cost of treatment was $309 (Mepilex Ag) compared to $513 (SSD).
In two comparative studies versus SSD Mepitel® also exhibited significantly faster healing times6,7, less dressings used (p<0.05)6, less eschar formation (p<0.05), less pain at dressing change (p<0.05) and significantly lower mean daily hospital charges7 compared to SSD. Mepitel successfully produced a moist wound environment, promoted wound healing, and was easy and relatively painless to use6,7. Other dressings with Safetac® technology have also been reported to be of use in burn wound management including Mepitel® One, Mepilex® Border, Mepilex® Border Lite and Mepilex® Transfer.
Skin grafting is a surgical procedure that is used to quickly restore skin integrity in wounds that are large and cannot be directly closed by suturing8. Historically, this has been achieved through clips, skin glue or staples, with the latter being painful to remove. Dressings can also be used and ideally should prevent mechanical displacement, allow wound exudate to drain and antibacterial solutions to reach the wound, and not adhere to the graft and open areas of the wound9.
Mepitel was shown to be an effective alternative to a conventional fixation dressing treatment on newly grafted burns9. When used with cotton wool gauze as secondary dressing, both removing the primary Mepitel dressing and secondary dressing were painless and combined with good graft take. Pain free results were also obtained from 53% patients (n=38) when Mepitel was used in comparison with paraffin gauze as a primary dressing (all gauze patients experienced some pain).
The use of Mepitel instead of ‘tie-over’ dressings for lower-limb split skin grafts has also been successfully used. The method involves inserting tacking sutures or skin adhesive around the edge of the spilt thickness skin graft, applying paraffin gauze over the graft, followed by a layer of saline soaked gauze of foam; this is then covered with Mepitel dressing overlapping
the edges of the graft by 2–3 cm. This technique has the advantages over the traditional ‘tie-over’ dressing of providing homogenous tension over the grafts, preventing shear on the skin graft site and reducing tension and the potential for soft tissue damage10.
A donor site is an area of the body from which skin has been harvested to provide a skin graft8. In a study involving 40 patients Mepilex Transfer resulted in a decrease in the number of painful dressing changes on donor sites after being introduced11. In a case study series, two skin graft donor site wounds completely healed with no reported pain and healthy peri-wound skin after treatment with Mepitel.