Feldman D L, Rogers A, Karpinski R H
Department of Surgery, St. Luke's/Roosevelt Hospital Center, New York, New York.
Surg Gynecol Obstet. 1991 Jul;173(1):1-5.
Many new dressings have been introduced for use on split-thickness skin graft donor sites in an effort to reduce pain at the donor site and decrease healing time, while maintaining a low infection rate and cost. To assess these factors in two such dressings, Biobrane (temporary wound dressing) (Winthrop) and Duoderm (hydrocolloid dressing) (Convatec), we compared them with a conventional fine mesh gauze dressing, xeroform, in a prospective, randomized study of 30 donor sites in the same number of patients. Wounds were considered healed when they were 100 per cent re-epithelialized and required no further dressings. Patient self-assessment of pain was quantified on a scale of zero to ten, with ten being the most severe pain. Donor sites dressed with xeroform had a healing time of 10.5 days, which was significantly better (p less than 0.05) than Duoderm (15.3 days) or Biobrane (19.0 days), although the protocol for Duoderm use (wound visualization at seven day intervals) extended the apparent healing times in this group. Duoderm was the most comfortable dressing (0.53 grade) when compared with Biobrane (1.44) and xeroform (2.41, p less than 0.05). No infections occurred in donor sites dressed with xeroform, but two developed in patients using Biobrane. One patient with a Duoderm dressing had a donor site infection during a drug-related neutropenic reaction. Xeroform was the least expensive dressing to use ($1.16 per patient), followed by Duoderm ($54.88 per patient) and Biobrane ($102.57 per patient). The results of our study confirm the usefulness of xeroform as a donor site dressing as it promotes relatively rapid healing, is easy to use and is inexpensive. We found Duoderm to be ideal for smaller donor sites when pain could be significantly reduced with minimal increase in cost. Biobrane is too costly and the infection rate too high for it to be used routinely as a skin graft donor site dressing.
为了减轻供皮区疼痛、缩短愈合时间，同时保持低感染率和低成本，人们引入了许多新型敷料用于中厚皮片供皮区。为评估两种此类敷料——生物膜（临时伤口敷料）（温思罗普公司）和多爱肤（水胶体敷料）（康维德公司）的这些因素，我们在一项前瞻性随机研究中，将它们与传统的细网眼纱布敷料（干纱布）进行了比较，该研究涉及30个供皮区，患者数量相同。当伤口完全重新上皮化且无需进一步换药时，视为伤口愈合。患者对疼痛的自我评估采用0至10分制，10分为最剧烈疼痛。用干纱布包扎的供皮区愈合时间为10.5天，明显优于多爱肤（15.3天）或生物膜（19.0天）（p小于0.05），尽管多爱肤的使用方案（每7天观察伤口一次）延长了该组的表面愈合时间。与生物膜（1.44分）和干纱布（2.41分，p小于0.05）相比，多爱肤是最舒适的敷料（0.53分）。用干纱布包扎的供皮区未发生感染，但使用生物膜的患者中有两例发生感染。一名使用多爱肤敷料的患者在药物相关的中性粒细胞减少反应期间供皮区发生感染。干纱布是使用成本最低的敷料（每位患者1.16美元），其次是多爱肤（每位患者54.88美元）和生物膜（每位患者102.57美元）。我们的研究结果证实了干纱布作为供皮区敷料的有效性，因为它能促进相对快速的愈合，使用方便且成本低廉。我们发现，当疼痛能显著减轻且成本增加微乎其微时，多爱肤对于较小供皮区是理想选择。生物膜成本太高且感染率太高，不能常规用作皮肤移植供皮区敷料。
