Beckett Allison R, Larson Kaitlin J, Brooks Ronald M, Lintner Alicia C, Patterson Scott B, Roberts Mike L, Blache Anna L, Kahn Steven A
Department of Surgery, Division of Acute Care Surgery and Burns, Arnold Luterman Regional Burn Center, University of South Alabama Medical Center, Mobile.
J Burn Care Res. 2019 Apr 26;40(3):327-330. doi: 10.1093/jbcr/irz027.
Lubricating agents facilitate effective harvesting of split-thickness skin grafts. Multiple agents, including water-based gel, mineral oil, glycerin, and poloxamer 188, have been utilized in this capacity. The agent selected is typically at the discretion of the provider and institution, as a single "ideal" lubricant remains to be objectively established. Furthermore, a recent discontinuation of Shur-Clens® Skin Wound Cleanser1 (a wound cleansing solution consisting of the surfactant poloxamer 188) has prompted the search for a suitable substitute for many providers. The purpose of this study is to directly compare five lubricants (including a novel surgical lubricant-based solution) to select a preferred agent. Four practitioners blindly tested five lubricants while harvesting a split-thickness skin graft on a porcine skin model (glycerin, mineral oil, saline, poloxamer 188, and a novel lubricant solution created with surgical lube and sterile water). The results were recorded on a Likert scale where 1 indicated poor performance and 5 indicated excellent performance. Data were pooled, and means were compared with analysis of variance and post hoc Tukey test. The cost of each lubricating solution was also reported. Mean scores for each of the solutions were as follows: dry control = 1.1 ± 0.1; glycerin = 2.62 ± 1.02, saline = 3.88 ± 0.81, mineral oil = 3.75 ± 1.00, novel water-based lubricant solution = 4.63 ± 0.71, and poloxamer 188 = 3.88 ± 0.81. All solutions were superior to dry control (P < .01). Glycerin was noted to have statistically lower scores than all of the other solutions (P < .01). The novel water-based surgical lubricant solution had significantly higher mean scores than both glycerin (P < .01) and mineral oil (P < .05). Each solution was compared according to dollars per 100cc with glycerin and Shur-Clens® representing the most expensive options at almost $3/100cc and saline the least expensive at less than $0.15/100cc. In a porcine skin model, the novel water-based surgical lubricant solution had the best performance. It was statistically superior to glycerin and mineral oil and was also found to be the most cost-effective option in terms of overall performance compared with relative cost. Glycerin had the worst performance with statistically lower scores than all other solutions. Glycerin was also found to be the least cost-effective due to a large discrepancy between high cost and low overall performance. Saline performed better than expected. These results may be skewed due to the inherently greasy nature of the butcher shop porcine skin, creating limitations and decreasing the fidelity of the model. In a search for the "ideal" lubricant, other models should be further studied.
润滑制剂有助于有效获取中厚皮片。多种制剂，包括水基凝胶、矿物油、甘油和泊洛沙姆188，已被用于此用途。所选用的制剂通常由提供者和机构自行决定，因为单一的“理想”润滑剂仍有待客观确定。此外，最近Shur-Clens®皮肤伤口清洁剂1（一种由表面活性剂泊洛沙姆188组成的伤口清洁溶液）停产，促使许多提供者寻找合适的替代品。本研究的目的是直接比较五种润滑剂（包括一种新型手术润滑剂基溶液）以选择一种首选制剂。四名从业者在猪皮模型上获取中厚皮片时对五种润滑剂进行了盲测（甘油、矿物油、生理盐水、泊洛沙姆188以及一种用手术润滑剂和无菌水配制的新型润滑剂溶液）。结果采用李克特量表记录，1表示性能差，5表示性能优异。汇总数据，并通过方差分析和事后Tukey检验比较均值。还报告了每种润滑溶液的成本。每种溶液的平均得分如下：干燥对照 = 1.1±0.1；甘油 = 2.62±1.02，生理盐水 = 3.88±0.81，矿物油 = 3.75±1.00，新型水基润滑剂溶液 = 4.63±0.71，泊洛沙姆188 = 3.88±0.81。所有溶液均优于干燥对照（P <.01）。甘油的得分在统计学上低于所有其他溶液（P <.01）。新型水基手术润滑剂溶液的平均得分显著高于甘油（P <.01）和矿物油（P <.05）。根据每100cc的美元价格比较每种溶液，甘油和Shur-Clens®是最昂贵的选择，接近3美元/100cc，生理盐水最便宜，低于0.15美元/100cc。在猪皮模型中使用新型水基手术润滑剂溶液时性能最佳。在统计学上它优于甘油和矿物油，并且与相对成本相比，在整体性能方面也是最具成本效益的选择。甘油的性能最差，得分在统计学上低于所有其他溶液。由于成本高且整体性能低之间存在较大差异，甘油也是最不具成本效益的。生理盐水的表现优于预期。由于肉铺猪皮固有的油腻性质，这些结果可能存在偏差，从而造成局限性并降低模型的逼真度。在寻找“理想”润滑剂的过程中，应进一步研究其他模型。
