Annals of Burns and Fire Disasters - vol. XII - n° 2 - June 1999

USE OF MEPITEL* ON GRAFTED AREAS IN BURN PATIENTS

Deved M, Sengezer M, Kopal C.

SUMMARY. Autografting is the best procedure for replacing skin defect due to deep dermal burn. Currently, textile dressings are frequently preferred for grafts. This dressing material does not however fix the graft sufficiently well and may damage the graft, also causing maceration and pain in the graft area during dressing changes. In this study, a silicone-coated polyamide dressing material was used for graft dressing and its effects on graft take rate were investigated. Silicone-coated polyamide (Mepitel/SCA Molnlycke) is an elastic transparent, non-adherent, porous material. Mepitel's porous structure permits wound exudate to pass directly into absorbent dressings. Mepitel adheres to dry skin but not to moist wounds. In this study, conducted between May 1997 and May 1998, eighteen patients (mean age, 23 yr; mean total body surface area burned, 12%) were treated at the GUlhane Military Medical Academy Burn Centre in Turkey. All the patients had Mepitel dressings applied over their grafts. Suction compresses were changed on post-operative day 4 without Mepitel being removed. The compresses were changed until post-operative day 8-12, but not Mepitel. The grafts were easy to observe because of Mepitel's transparence, and exudate was evacuated by its porous structure. Graft take was above 90% in all cases. Minimal graft loss was observed in patients receiving Mepitel as a graft dressing. In conclusion, Mepitel was found to be effective for graft take and facilitated the observation of haernatorna and serorna.

Introduction

Between August 1997 and August 1998, eighteen patients (mean age, 23 yr; mean burned TBSA 12%) were treated at the G51hane Military Medical Academy Burn Centre (Turkey). All the patients were treated with a Mepitel dressing for their graft. Suction compresses were changed on post-operative day 4, without removal of Mepitel. The compresses were changed until post-operative day 8-12, but not Mepitel. The graft was easy to observe because of its transparence, and evacuation was facilitated by its porous structure (Figs 1, 2).

Fig. la - Full-thickness burn wound in left lower extremity Fig. 1b - Wound following tangential excision and grafting, with use of Mepitel dressing Fig. lc - Wound on post-operative day 5. Fig. 1d - Completely healed wound on post-operative day 10. Fig. 2a - Granulated burn wound on right upper extremity. Fig. 2b - Immediate post-operative appearance of grafted wound with Mepitel dressing. Fig. 2c - Wound on post-operative day 10

Results

A graft take range of over 90% was observed in all the grafts, with minimal graft loss in patients receiving a Mepitel graft dressing. Dressing changes were painless except in four patients when Mepitel did not adhere sufficiently. Only three patients had a collection of exudate from suppuration, but the collection was easily evacuated owing to the porous structure, without removal of Mepitel.
No allergic reaction, maceration, or graft damage was observed.

Discussion

Skin grafting is standard care in deep dermal burns and also reduces burn-related mortality and morbidity. Graft take is therefore is very important. In this study, as we have said, we used Mepitel, an elastic, transparent, porous, non-absorbent material, for graft dressing which improves graft take rate and reduces pain during dressing changes in children.
An ideal wound dressing should provide a moist, warm, non-toxic, antibacterial, painless, inexpensive environment for the freshly grafted skin. Most surgeons prefer petrolatum-impregnated gauze, but this has many disadvantages. A textile dressing may cause maceration and damage to the graft, as well as pain, especially during the first dressing changes, and it does not fix the graft adequately. However, Mepitel, which adheres to dry skin but not to moist graft and wound, was capable of fixing the graft in flat areas and did not cause maceration or graft damage during compress changes.
Traditionally, all grafts except those in the face are covered with a topical antimicrobial, using the closed technique. Polysporin/mycostatin ointment is one of the most common agents. These medications are generally used on a fine mesh gauze. Bulky gauze dressings and compressive bandages are required for further protection and pressure. However, some fine-mesh commercial gauzes with various kinds of medication are also available. Some of these contain Vaseline and antimicrobial agents. Although Mepitel does not contain any antimicrobial agent, drainage of suppurative material and the application of antimicrobial agents can be achieved easily, without removal of Mepitel. Chlorhexidine or petrolatumimpregnated mesh gauzes are other common over-graft dressing materials.
The main goals in the care of patients with partialthickness burns or grafted burn wounds are the achievement of optimal levels of functionality and cosmesis, with improved wound healing and pain-free dressing changes Mepitel has been reported to promote wound healing in patients with partial-thickness burn wounds. We also observed shorter healing periods for grafted burn wounds in comparison with wounds treated with traditional dressings. Gotschal et al. reported that Mepitel significantly reduced pain during dressing changes in burned children. Although Mepitel has not been reported to have any effect on the bacterial colonization of burn wounds, it was observed that children treated with Mepitel did not show signs of systemic infection! We observed fewer cases of wound infection in patients treated with Mepitel.
Although Mepitel has many advantages, it is difficult to apply in concave areas (neck, axilla) and expensive. It has been reported that Mepitel represents a significant advance in the treatment of partial-thickness burn wounds. However, although Mepitel may be considered expensive, it has been reported that overall hospital costs are lower thah those of traditional dressing materials.
In conclusion, the non-adherent porous dressing Mepitel was found to be highly effective for graft take and facilitated observation of haernatomas and seromas.

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