We compared the results of a complex dressing consist of Melolin and Flexigrid versus standard fine mesh gauze dressing. The findings of this study indicated that use of these dressings achieves better results in graft donor sites. Traditional Fine mesh gauze dressing, which is a type of non-adhesive dressing, had been the primary choice used by surgeons for graft donor sites for decades, due to its low costs and ease of use (6). However, this type of dressing is commonly dried and requires frequent replacements, which in-turn causes bleeding and further trauma to the donor site. Increased trauma induced by maintenance of this dressing would ultimately interfere with the healing process and increase the re-epithelialization period with increased risks of hypertrophic scar formation (3, 4, 6). In addition, since these dressings do not absorb exudates, they commonly result in accumulation of fluid between the wound and the dressing with an increased risk of infection. New classes of dressings used on graft donor sites are of multiple classes. They include those impregnated with silver, transparent films, hydrocolloids, alginates, hydrogels and petrolatum gases (1). Silver impregnated dressings, such as Mepilex and Acticoat are commonly used for both graft donor sites and partial thickness burns (1, 9). The material used in Acticoat include silver Nano-crystals, which have an advantage of reduced need for replacement in addition to their antibacterial qualities (1, 5, 9). On the contrary, the high cost and lack of transparency of these dressings are some disadvantages. Biobrane is another new type of dressing,which provides long-term coverage. However, due to obstructive nature of this dressing, it is only used in partial thickness burns, where superficial infection has been clearly ruled out (1). Relative high cost of this dressing reduced its use among surgeons. In this study, we evaluated the effectiveness of a complex dressing. Melolin is a dressing composed of two layers. It consists of a non-adhesive, highly absorbent cotton and polyester fiber pad with a hydrophobic backing layer. The polyester layer has numerous small pores that allow exudates to exit and to be absorbed by the absorbent cotton layer (1, 2, 5). These small pores, due to their size, allow passage of exudates and water vapor, but do not allow introduction of microbial organisms. This dressing does not adhere to the wound site and would not increase trauma to the donor site new epithelium when replacing (10). Flexigrid is a type of semi-permeable transparent film, which allows passage of vapor (5, 11, 12), but is not permeable to water itself; hence it does not adhere to moist surfaces (12). The unique properties of these two dressings inhibit bacterial entry (8, 12), resulting in a sterile environment resistant to infection. Furthermore, the mentioned features of this dressing, such as providing a moist environment, antimicrobial properties, non-adhesiveness and reduced need for replacements result in a decreased length of epithelialization and consequently lower lengths of hospitalization. One of the other advantages of transparent Flexigrid makes the wound bed completely visible over the dressing; hence, in the event of fluid accumulation or infection, proper medical management can take place. In a study for non-surgical treatments of lesions of the finger, using Flexigrid was shown to significantly increase the rate of granulation tissue growth and formation of new epithelium by providing an optimal environment. In this studyconducted on 200 lesions of fingertips, after treatment course of 20 days with Flexigrid, appearance and growth of new epithelium were shown to be close to normal (13). Infection rate is significantly decreased using new dressing method compared to the Fine mesh gauze dressing (14). In this complex dressing, the absorbent cotton layer in Melolin absorbs the wound secretions, while the transparent Flexigrid allows close monitoring of the wound without removing the dressing (12). This quality along with bacterial resistance results in significantly reduced infection rates. The final cost imposed on patients in the investigation group decreased by 25% compared to the traditional dressings. Even though, the actual cost of dressing is slightly less for the traditional dressing; expedited repair of epithelium, reduced need to change the dressing, reduced need for hospital stay and reduced complications prove to decrease the total cost significantly when using this complex dressing. Moreover, other beneficial effects of Melolin and Flexigrid, such as reduced pain and more aesthetically pleasing results would further enhance the cost-effectiveness of this dressing. Pain is considered as one of the most common complaints in patients after surgical treatment of burn wounds with the graft donor sites often eliciting more pain than the receiving sites (4). One of the goals of the new class of burn donor site dressings is to reduce the pain severity of donor site after surgical treatment. The dressings used in this study, due to their non-adhesive properties, induce minimal trauma to the donor sites and require a reduced number of replacements, reducing pain levels after the surgery. In our study, pain score (VAS) had a significant decrease versus the control group (P < 0. 05). In a study aimed to treat painful diabetic neuropathy, Flexigrid was shown to be effective in lowering pain levels statistically significantly (15). In another study, where five different dressings for graft donor sites were compared, combination of Flexigrid with another resultedin minimal pain and cost to patients and used as the dressing of choice for donor graft sites (16). Overall, new dressings applied to donor graft sites aim at reducing common complications associated with traditional Fine mesh gauze dressings. The advantages demonstrated by this approach include: 1- shortened period of healing, 2- reduced pain 3- reduced costs 4- reduced infection rates and 5- aesthetically best results. The benefits of this method as mentioned above make it as an optimal candidate in graft donor sites in the management of burn patients.
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