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Studying the healing and long-term outcomes of two partial thickness wound models using different wound dressings
Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Safe and effective wound dressing treatments are important for proper wound healing. Such procedures therefore need to be evidence-based regarding the most important outcome measures such as healing time, less discomfort for the patient, duration of hospital care and, importantly, less scarring. As the relation between longer healing times and more severe scarring is known, it is important to find dressing treatments that reduces such complications by providing fast and proper wound healing. In this thesis, four established wound dressing treatments (hydrofibre covered with film; porcine xenografts and polyurethane foam, with and without silver), were evaluated for two types of acute, partial thickness wounds: split thickness skin graft (STSG) donor sites and partial thickness burn wounds in two randomised, controlled clinical trials (RCT) with longterm scar follow ups. The relations between factors thought to influence wound healing and scarring as sex, infection, wound extent and depth, healing time and skin grafting were also investigated in these two wound models.

Methods: Data from these trials were collected on sex, infection rates, wound depth and extent, need of skin grafting, healing times and scarring frequency together with demographic data. Scars were evaluated at 8 years in Study II and III and at 6 and 12 months after injury in Study V.

Results: Two dressing treatments; hydrofibre covered with film and porcine xenografts gave significantly faster healing of the STSG donor sites than the standard of care (SOC) dressing, the polyurethane foam. The hydrofibre was thereafter implemented as the new SOC at the department. The long-term scar follow up showed that the hydrofibre group was most satisfied with their donor site scar, providing further evidence for the implementation of this dressing strategy. From the observer’s perspective no differences were found between these treatment groups. For partial thickness burns the treatment with a silvercontaining foam dressing showed significantly shorter healing time, whereas for the scars, no difference between dressing groups could be detected. A number of factors were identified that affected healing time: for donor sites only male sex was associated with shorter healing time. Sex was also the only factor that influenced donor site scarring, where female patients, both subjectively and objectively, were rated with higher scores (worse outcome). For partial thickness burns a larger extent of the burn wound, presence of deep dermal burns, and the need of skin grafting, all had a negative impact on both healing time and final scar. The final scar was also significantly affected by longer wound healing times and infection.

Conclusion: The results suggest that the use of hydrofibre dressings covered with film on donor sites resulted in positive short-term and long-term outcomes. Regarding partial thickness burns, silver foam dressing resulted in faster healing but as for the final scar, no difference could be seen. Several factors were associated with longer healing times and more severe scarring such as: female sex, larger burns, deep dermal burns, skin grafting, and infection. Longer healing times were related to more severe scarring.

Abstract [sv]

Bakgrund: Säkra och effektiva förbandsbehandlingar är av stor klinisk betydelse. Därför behövs evidensbaserade sårbehandlingar med fokus på de viktigaste utfallen som läkningstid, minskning av patientens lidande, vårdtid och mindre ärrbildning. Eftersom förhållandet mellan längre läkningstid och mer allvarlig ärrbildning är känt är det viktigt att hitta sårbehandlingar som minskar komplikationer, ger snabb läkning av såret och acceptabla ärr. I denna avhandling utvärderades etablerade sårbehandlingar (hydrofiber täckt med film, xenotransplantat från gris och polyurethanskumsförband, med och utan silver), för två typer av akuta delhudskador; tagställen för delhudstransplantatet och dermala brännskador, i två randomiserade kontrollerade kliniska studier. Förhållandet mellan påverkansfaktorer såsom kön, infektion, sårdjup, såromfattning, läkningstid och hudtransplantation och utfall för läknings- och ärresultat har också undersökts.

Metoder: Data för kön, infektionsfrekvens, sårdjup och omfattning, behov av hudtransplantat, läkningstid och ärrbildning från två randomiserade kontrollerade studier samlades in tillsammans med demografisk data. Ärren utvärderades efter 8 år i studie II och III samt vid 6 och 12 månader efter skada i studie V.

Resultat: Två sårbehandlingar; hydrofiber täckt med film och xenotransplantat från gris visade signifikant snabbare reepitalisering av tagställen än standardförbandet (polyuretanskum). Hydrofibern implementerades som den nya standardbehandlingen på kliniken. Den långsiktiga ärruppföljningen avslöjade att gruppen med hydrofiber var den mest nöjda med sina tagställes-ärr, vilket gav ytterligare styrka till genomförandet av behandlingen. Ur observatörsperspektivet hittades inga skillnader mellan dessa grupper. För dermala brännskador gav behandlingen med silverinnehållande skumförband signifikant bättre läkningsresultat, för ärrbildning upptäcktes inte någon skillnad mellan grupperna. Ett antal faktorer som påverkade läkningstider identifierades; för tagställen gav endast manligt kön kortare läkningstider. Kön var också den enda faktorn som påverkade tagställets ärrresultat där kvinnor, både subjektivt och objektivt, bedömdes med högre poäng (sämre utfall). För dermala brännskador var det faktorer såsom en större omfattning av brännskadorna, närvaron av djupa dermala brännskador och behovet av hudtransplantation som hade negativ påverkan på både läkningstider och slutliga ärr-resultat. Det slutliga ärrutfallet påverkades också signifikant av längre läkningstider och infektion.

Konklusion: Data tyder på att användningen av hydrofiber täckt med film på tagställen gav positiva resultat både på kort- och lång sikt. När det gäller förband för dermala brännskador resulterade silverskumförband i snabbare läkning men vad gäller ärr kunde ingen skillnad hittas. Flera faktorer var relaterade till längre läkningstider och mer ärrbildning som kvinnligt kön, större omfattning av brännskador, djupa dermala brännskador, hudtransplantation och infektion. Längre läkningstider var relaterat till mer allvarlig ärrbildning.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2019. , p. 98
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1704
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-161746DOI: 10.3384/diss.diva-161746ISBN: 9789175190082 (print)OAI: oai:DiVA.org:liu-161746DiVA, id: diva2:1368819
Public defence
2019-11-15, Granitsalen, Hus 448, Campus US, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2019-11-08 Created: 2019-11-08 Last updated: 2019-11-08Bibliographically approved
List of papers
1. Dressing the split-thickness skin graft donor site: a randomized clinical trial
Open this publication in new window or tab >>Dressing the split-thickness skin graft donor site: a randomized clinical trial
2014 (English)In: Advances in Skin & Wound Care, ISSN 1527-7941, E-ISSN 1538-8654, Vol. 27, no 1, p. 20-25Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The primary objective of this study was to compareAquacel (ConvaTec, Skillman, New Jersey), Allevyn (Smith &Nephew, St Petersburg, Florida), and Mediskin I (Mo¨ lnlycke, HealthCare AB, Gothenburg, Sweden) in the treatment of split-thicknessskin graft donor sites.

DESIGN: This study was performed as a prospective randomized,3-arm, clinical study.

SETTING: A clinical study performed at a hand and plastic surgerydepartment with burn unit.

PARTICIPANTS: The study included 67 adults with a total of73 donor sites, which were on the thigh, not reharvested, andranged between 30- and 400-cm2 area.

INTERVENTIONS: Subjects were randomly assigned to treatmentwith Aquacel, Allevyn, or Mediskin I.

MAIN OUTCOME MEASURES: The donor site was assessed onpostoperative days 3, 14, and 21 for healing, infection, pain,impact on everyday life, ease of use, and cost.

MAIN RESULTS: The obtained results demonstrate significantlyfaster re-epithelialization for patients treated with Aquacel orMediskin I compared with Allevyn. Regarding infections, therewere no significant differences between the groups. Patientswearing Aquacel experienced significantly less pain changing thedressing and less impact on everyday life than the patientswearing Allevyn. Aquacel was shown to be significantly easier forthe caregiver to use than Allevyn and Mediskin I. There is asignificant difference in cost of treatment between the dressings,whereas Mediskin I is the most expensive.

CONCLUSION: The authors’ results support the use of Aquacel in thetreatment of split-thickness skin graft donor sites. Aquacel has alow cost per unit, is user friendly, gives short healing time, andminimizes patient discomfort.

 

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2014
Keywords
split-thickness skin grafting, donor sites, wound dressing
National Category
Other Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-103995 (URN)10.1097/01.ASW.0000437786.92529.22 (DOI)000335388100005 ()24343389 (PubMedID)
Available from: 2014-02-05 Created: 2014-02-05 Last updated: 2019-11-08Bibliographically approved
2. Scarring At Donor Sites After Split-Thickness Skin Graft: A Prospective, Longitudinal, Randomized Trial
Open this publication in new window or tab >>Scarring At Donor Sites After Split-Thickness Skin Graft: A Prospective, Longitudinal, Randomized Trial
Show others...
2018 (English)In: Advances in Skin & Wound Care, ISSN 1527-7941, E-ISSN 1538-8654, Vol. 3, no 4, p. 183-188Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this study was to evaluate scarring at split-thickness skin graft donor sites 8 years after surgery.

METHODS: At surgery, 67 patients were randomized to hydrofiber, polyurethane foam, or porcine xenograft treatment. Scars were evaluated with the Patient and Observer Scar Assessment Scale.

RESULTS: Results showed significant differences in observed scar outcomes at donor sites, leaving the polyurethane foam–treated and the porcine xenograft–treated patients with the least satisfying scars. Multivariable regression analysis showed that the group treated with the xenografts had worse scores for overall opinion of the scar than did the other groups (P = .03), the most important factor being pigmentation. There was no correlation between duration of healing time and quality of the scar.

CONCLUSIONS: There were significant differences among the groups, with the hydrofiber group being the most satisfied with the appearance of their scar.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
National Category
Surgery Otorhinolaryngology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-146085 (URN)10.1097/01.ASW.0000530684.31491.5f (DOI)000435188200008 ()29561343 (PubMedID)
Available from: 2018-03-27 Created: 2018-03-27 Last updated: 2019-11-08Bibliographically approved
3. Superiority of silver-foam over porcine xenograft dressings for treatment of scalds in children: A prospective randomised controlled trial
Open this publication in new window or tab >>Superiority of silver-foam over porcine xenograft dressings for treatment of scalds in children: A prospective randomised controlled trial
Show others...
2019 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 45, no 6, p. 1401-1409Article in journal (Refereed) Published
Abstract [en]

Aim: Our aim was to compare two different regimens for the treatment of children with partial-thickness scalds. These were treated with either a porcine xenograft (EZderm (R), Molnlycke Health Care, Gothenburg, Sweden) or a silver-foam dressing (Mepilex (R) Ag, Molnlycke Health Care, Gothenburg, Sweden). Methods: We organised a prospective randomised clinical trial that included 58 children admitted between May 2015 and May 2018 with partial-thickness scalds to The Burn Centre in Linkoping, Sweden. The primary outcome was time to healing. Secondary outcomes were pain, need for operation, wound infection, duration of hospital stay, changes of dressings, and time taken. Results: The patients treated with silver-foam dressing had a significantly shorter healing time. The median time to 97% healing for this group was 9 (7-23) days compared to 15 (9-29) days in the porcine xenograft group (p = 0.004). The median time to complete healing for the silver-foam group was 15 (9-29) days and for the porcine xenograft group 20.5 (11-42) days (p = 0.010). Pain, wound infection, duration of hospital stay, and the proportion of operations were similar between the groups. Number of dressing changes and time for dressing changes were lower in the silver-foam dressing group (p = 0.03 for both variables). Conclusions: We compared two different treatments for children with partial-thickness scalds, and the data indicate that wound healing was faster, fewer dressing changes were needed, and dressing times were shorter in the silver-foam group. (C) 2019 Elsevier Ltd and ISBI. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2019
Keywords
Burns; Partial thickness burns; Scalds; Children; Wound dressings; Healing
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-160409 (URN)10.1016/j.burns.2019.04.004 (DOI)000483339500017 ()31230798 (PubMedID)
Available from: 2019-09-23 Created: 2019-09-23 Last updated: 2019-11-08

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Karlsson, Matilda

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