The use of modern dressings in managing split-thickness skin graft donor sites: a single-centre randomised controlled trial.

OBJECTIVE: To identify the most appropriate, most suitable and most efficient dressing for split-thickness skin graft (STSG) donor sites. Comparing the wound healing rate, pain severity and duration, as well as the dressing change frequency in four randomised patient groups. METHODS: A single-centre non-blinded randomised controlled trial was carried out during 2010-2014. All patients treated for skin defects/lesions (due to burns, trauma or ulcers) using STSG were included in the study. All patients were randomly allocated in four different donor site treatment groups; polyurethane (PU group, Mepilex); polyurethane with silicone membrane (PUSM group; Mepilex border,); transparent, breathable film (TBF group; Mepitel film) and cotton gauze dressings (CG group) using Excel 2007. We evaluated: wound healing time, pain severity and duration, the frequency of dressing change, donor site re-epithelialisation, donor site complications (signs of inflammation or infection). Patients were assessed on postoperative days: 1, 3, 6, 9, 12, 15, 18 and 21. RESULTS: After random allocation of study participants the number of patients in each group were: PU group n=25; PUSM group n=24; TBF group n=24; CG group n=25. The groups were homogenous according to gender, age, main pathology, donor site area and wound size. The STSG donor site healing time varied from 9 to 21 days. The mean healing time in the CG group was 14.76 days, whereas in the PU, PUSM, and TBF group it was significantly shorter; 12.25 days, 11.63 days and 10 days, respectively. Patients in the TBF group demonstrated the most rapid healing time with 66.7% of STSG donor sites healed by postoperative day 9. The pain duration interval in modern dressing groups (PU, PUSM and TBF groups) was 0-9 days, whereas it was 6-18 day in the CS group. Pain intensity mean on postoperative day 1 was 2.21 in the PU group; 1.67 in the PUSM group; 1.46 in the TBF group and 3.04 in the CG group. The average pain duration in Group PU, PUSM, and TBF was 4.08 days; 2.5 days; 2.29 days, respectively. The average number of times each dressing was changed in each group was, 2.83 times in the PU group and PUSM group and 1.46 times in the TBF group. The CG dressing group were changed once when the donor site wound re-epithelialised. There was one patient in the PU group who experienced signs of infection, was treated accordingly and excluded from the study. CONCLUSION: The fastest healing time was demonstrated by patients in the TBF group. The pain was not as severe and for a shorter period of time in modern dressing study groups. However, the pain was lightest and felt shortest in TBF dressing group. The modern dressings PU and PUSM had to be changed more frequently than TBF.

Quantitative analysis of detected sentinel lymph nodes and the incidence of micrometastases using two different methods of surgical melanoma treatment--pilot study.

UNLABELLED: The aim of our study was to compare the number of detected sentinel lymph nodes and the incidence of micrometastases between two groups of patients with cutaneous melanoma. METHODS: 100 patients were divided in to two groups: group V and group D. Group V patients (50) with melanoma underwent a single-stage surgery--radical excision of the tumour with sentinel lymph node biopsy (study group "V"). Group D patients (50) with melanoma underwent two-stage surgery; initially primary diagnostic excision of the tumour (0.5 cm from margins of the lesion) followed by a radical re-excision of the post-operative scar and sentinel lymph node biopsy (study group "D"). RESULTS: Study groups "V" and "D" were tested for homogeneity with regard to age, melanoma thickness, location of melanoma, type of melanoma, and ulceration. The groups were found to be homogenous. The average number of removed sentinel lymph nodes in group "D" was 1.0 more than in group "V" (p < 0.05). The averages were 3.7 and 2.7 respectively with a SD of 1.8. The relationship between the SL node staining and type of surgery was (p < 0.05). 49.6% stained radioactive sentinel lymphnodes at the time of surgery was found in group "V", while 33.9% in group "D". CONCLUSIONS: Using two different early-stage cutaneous melanoma management techniques significantly more sentinel lymph nodes (p = 0.006) were detected using the two-stage surgery approach. However, there was no significant difference between the two approaches regarding the number of sentinel lymph nodes with micrometastases that were detected and excised.

An updated overview and clarification of the principle role of debridement.

Routine care of non-healing acute and chronic wounds often comprises either cleaning or debridement. Consequently, debridement is a basic necessity to induce the functional process of tissue repair, which makes it a central medical intervention in the management of acute and chronic, non-healing wounds.

The influence of surgical treatment for chronic leg ulcers on the quality dynamics of the patient's life.

THE AIM OF THE STUDY: This study was undertaken to assess the effectiveness of skin grafting and the influence on the quality of the lives of patients who have large chronic venous ulcers. METHODS AND MATERIALS: We have performed the perspective analysis of the course of the disease and of treatment results after 6 months. Two groups of patients were involved in the study. Group O contains patients who have been treated by performing skin graft surgery, while group C contains patients who have been treated only by conservative means. All patients studied have been treated during the period of 2001-2005 at the Department of Plastic Surgery and Burns and at the Clinic of Skin and Venereal Diseases (CSVD) of Kaunas Medical University Hospital (KMUH). During the visit patients had to complete a questionnaire (enclosed with patient's history of treatment), according to which we evaluated the influence of large chronic venous leg ulcers on the quality of patients' lives. This questionnaire has been developed in accordance with the questionnaire for the evaluation of quality of life prepared by prof. dr. M. E. Hyland. RESULTS: At the beginning of the study all patients of O and C groups suffered from pain in the legs. However, at the end of the study, pain decreased only in patients of O group (p < 0.05), while in C group pain practically remained the same. At the beginning of the study, the ulcers deprived many patients from both groups of sleep for most of the night (37-41%). During the repeated questioning it turned out that ulcers only deprived 2.5% of patients in group O of sleep for most of the night, whereas in group C this rose to 19.35%. CONCLUSIONS: Skin grafting positively influences the quality of patients' lives significantly (p < 0.05). Skin grafting has decreased the limitation of function and improved the dysphoric mood. The coverage of ulcers by autografts of skin thickness, had decreased the leg pain within 6 months, significantly more than by conservative treatment alone (p < 0.05). The amount of patients' personal expenditure on the care and treatment of ulcers, increased within the period of 6 months for 11.2% of patients in whom large CVUL were treated conservatively. The amount of personal expenses decreased to 12.8% of patients in whom skin grafting was applied (p > 0.05).

Major full thickness skin burn injuries in premature neonate twins.

Burns in neonates have been reported following the use of pulse oximeters, various electrodes, chemical disinfecting agents and phototherapy blankets. Burn injuries in premature neonates are very rare and there have been no reports on major full skin thickness injuries. This case reports on preterm neonate male twins delivered at a Community Hospital. After the delivery they were placed on water warmers for 15-20 min and then transported into incubators. Burn injuries were noticed 1h after the delivery. Infant One, weight 1500 g, had an injury of 20% TBSA on his dorsum, waist and buttocks. The other infant, weight 1835 g, had an injury of 14% TBSA on the same areas. The infants were transported to the University Hospital. At the seventh day after the injury they recovered from respiratory distress and surgical procedures started. The eschar was excised deep to fascia and wounds were grafted with 0.1mm thickness skin grafts harvested from the thigh and cut into islets. Autografts were protected by overlay with fresh allograft harvested from the twins' father. Surgery procedures were performed in two steps, each second day, not exceeding 10% of total body area during excision. Donor sites healed at the eighth day after the surgery. Burn wounds healed gradually by way of spontaneous replacement of allograft and wound closure by spontaneous epithelization from the autograft islets. Eighteen days after the surgery all the grafted wounds were found epithelized. We conclude that in premature neonates relatively low temperatures may cause deep burn injuries. We recommend the delivery of preterm childbirths at well equipped facilities with staff qualified in nursing of premature neonates.