LOCAL TREATMENT OF BURNS WITH HONEYCOMB EXPANDED POLYURETHANE (LIGASANO)

Annals of Burns and Fire Disasters - vol. XXI - n. 1 - March 2008

LOCAL TREATMENT OF BURNS WITH HONEYCOMB EXPANDED POLYURETHANE (LIGASANO)

Napoli B., Benigno A., D’Arpa N., Amico M., Conte F.

Plastic Surgery and Burns Therapy Operating Unit, ARNAS, Civic Hospital, Palermo, Italy

SUMMARY. The results are presented of the local treatment of burns with honeycomb expanded polyurethane. This method of treatment can be used both for the medication of burns of limited extent but variable depth and as a mattress for patients confined to bed. In the first case, the purpose of the treatment, which makes use of the product’s absorbent and debriding capacity, is either to cure the lesion or to pave the way for the surgical operation. In the second case use is made of the product’s exudate-draining and anti-pressure sore activity, which prevents the lesion from becoming deeper.

Introduction

Honeycomb expanded polyurethane (white Ligasano) has two main action mechanisms:

  • friction on the lesion-medication interface, causing mechanical debridement of non-viable tissues
  • absorption of excess exudates

These features, together with the possibility of replacing it at longer time intervals (every 4-6 days), make honeycomb expanded polyurethane an appropriate method of treatment that is particularly suitable for the treatment of burns of limited extent.

However, when used as a mattress on which the patient is laid, Ligasano can also be applied in cases of extensive burns.

Materials and method

Sixteen patients with non-extensive burns of varying depth were treated (11 adults, 3 elderly, 2 children). Two adult patients with extensive burns were placed on a Ligasano mattress. Nine patients in the first group were out-patients.

An assessment is made of the period of healing and out-patient treatment. The follow-up results and the quality of healing are reported.

Results

Only one patient in the first group healed after surgery (Figs. 1a-f).



Fig. 1aNecrosis due to electrocution of left hallux.

Fig. 1a - Necrosis due to electrocution of left hallux.





Fig. 1bApplication of 15% salicylate Vaseline.

Fig. 1b - Application of 15% salicylate Vaseline.





Fig. 1cApplication of white Ligasano.

Fig. 1c - Application of white Ligasano.





Fig. 1dProgressive wound debridement.

Fig. 1d - Progressive wound debridement.





Fig. 1eRepair with skin graft.

Fig. 1e - Repair with skin graft.





Fig. 1fThree-month check-up

Fig. 1f - Three-month check-up



Table I presents the characteristic of the other 15 patients in the same group, who were healed by topical medical therapy alone.



Age/sex Cause Thickness Site Management Healing (days) Number of out-patient visits Sequelae
Adult/m Fire Partial Neck Hospitalization 4 1 –
Adult/m Water Partial Foot Hospitalization 10 3 –
Elderly/f Fire Full Shoulder Hospitalization 25 3 –
Elderly/f Fire Full Hands Hospitalization 21 1 –
Child/m Water Partial Thorax Hospitalization 30 * Hypertrophy
Adult/m Oil Full Foot Hospitalization 20 * Hypertrophy
Adult/m Fire Full Forearm Out-patient 44 7 –
Adult/m Friction Full Leg Out-patient 75 13 –
Child/m Fire Partial Leg Out-patient 30 7 –
Adult/f Contact Partial Leg Out-patient 14 4 –
Adult/f Contact Partial Leg Out-patient 49 7 –
Elderly/f Oil Full Leg Out-patient 22 5 –
Adult/m Fire Full Leg Out-patient 14 4 –
Adult/f Fire Partial Breast Out-patient 30 6 –
Adult/m Electrocution Full Thigh Out-patient 29 7 –
* These two patients’ scars required protracted treatment.
Table I - Characteristics of patients healing after local therapy


Of the two patients placed on a Ligasano mattress, its intense exudate-draining capacity was used in one and in the other its anti-pressure sore and debridement function (Figs. 2a-e).



Fig. 2aDeep dermal burn in trunk and buttocks.

Fig. 2a - Deep dermal burn in trunk and buttocks.





Fig. 2bDecubitus on white Ligasano mattress.

Fig. 2b - Decubitus on white Ligasano mattress.





Fig. 2cInitial stage of lesion debridement.

Fig. 2c - Initial stage of lesion debridement.





Fig. 2dAdvanced stage of lesion debridement (day 12).

Fig. 2d - Advanced stage of lesion debridement (day 12).





Fig. 2eClinical healing (day 20).

Fig. 2e - Clinical healing (day 20).



Discussion

Honeycomb expanded polyurethane (Ligasano) is used in the local treatment of burns of limited extent, prior to surgical repair, or to facilitate healing. The following indications have to apply in this second case:

  • dermal burns in critical areas
  • full-thickness burns in non-operable patients
  • burns following a skin graft operation
  • burns in out-patients

Analysis of individual cases also enabled us to make the following considerations:

  • Ligasano can be used in the local treatment of burns of varying aetiology (electrical, thermal, friction) and of different depth (partial- and full-thickness)
  • it can also be used to treat paediatric burns
  • it often happens that burns treated at length with other methods (especially collagenase) are finally cured thanks to the use of Ligasano treatment; Ligasano can also be used in association with collagenase or salicylate Vaseline (also with biotics) when it is desired to achieve a more rapid debridement or necrosectomy2,3 or with rifamycin for local use if it is desired to exploit the latter’s anti-inflammation and anti-oedema effect
  • in out-patients it makes it possible to apply dressings at some distance of time (every 4-6 days), thus reducing handling manoeuvres and making treatment more comfortable; the speed with which burns heal, as also the action mechanism, also depends on the site because burns in particular mobile areas (neck, hands) heal more rapidly than others
  • in many cases there is an evident development of scabs duing the process towards clinical healing, probably because of the greater local absorbing-dehydrating effect; in these cases a brief hydrating treatment of the scar is sufficient
  • when there is a tendency towards scar hypertrophy this is countered by using the routine treatment protocol (hydration, masso/presso therapy, silicone). The long-term results are usually good
  • when Ligasano is used in mattress form, mainly for the purpose of draining the exudates, the objective assessment of its degree of imbibition (done by squeezing by hand), associated with the patients’ subjective sensation that they are “floating on water”, is the main indication for changing it. When the purpose is to exploit its anti-pressure sore action (it prevents further deepening of the lesions) and that of debridement and re-epithelialization (it reduces the quantity and time of infusion and bladder catheterization), a feeling of “lying on emery paper” replaces the much more painful sensation caused by dressing changes.

Conclusions

The local treatment of burns has the following purposes:

  • to favour removal of necrotic tissue, which is the main source of bacterial multiplication
  • to produce, thanks to absorption and control of exudates, an environment for the lesion that promotes a rapid infection-free recovery

Honeycomb expanded polyurethane’s characteristics make it possible to achieve both these purposes.

The anti-infectious action of mechanical debridement can be increased with the association of enzymatic treatment (collagenase) or chemical treatment (salicylate Vaseline) while the anti-infectious action due to absorption of the exudates can be increased by the association of antiseptics and antibiotics for local use.

The debridement of nonviable tissue, the absorption of the exudates, and the anti-infectious action lead to re-epithelialization or the formation of a suitable area for surgical repair using a free skin graft.


RÉSUMÉ. Les Auteurs décrivent leur expérience avec le traitement local des brûlures moyennant le polyuréthane expansé en nid d’abeille. Cette méthode peut être utilisée soit pour les médications des brûlures d’étendue limitée mais de profondeur variable soit en forme de matelas, pour le décubitus des patients. Dans le premier cas le but du traitement, qui exploite l’action absorbante ou de débridement du produit, peut être ou la guérison de la lésion ou la préparation à l’intervention chirurgicale. Dans le deuxième cas on exploite l’action de drainage de l’exsudat et l’action contre les escarres de décubitus, qui empêche l’approfondissement des lésions.


Bibliography

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  3. Maviglio P., Mavilio D., De Donno G., Fiume D.: The use of salicylate vaseline in the debridement of burns. Annals of the Mediterranean Burns Club, 3: 75-8, 1990.
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This paper was received on 6 December 2007.
Address correspondence to: Dr B. Napoli, Plastic Surgery and Burns Therapy Operating Unit, ARNAS, Civic Hospital, Palermo, Italy. Tel.: 091 6663631; fax: 091 596404; e-mail: mbcpa@medbc.com