DUODERME IN THE TREATMENT OF DONOR SITES: A REPORT

Annals of the MBC - vol. 3 - n' 3 - September 1990

DUODERME IN THE TREATMENT OF DONOR SITES: A REPORT

Hermans M.H.E.

Convatec Northern Europe, The Netherlands

SUMMARY. In a prospective study in two burn centres and one rehabilitation centre DuoDERM E, a new hydrocolloid dressing, was tested as a dressing for the treatment of donor sites. The result of these tests prove that DuoDERM E provides fast reepithelialization of the wounds, good cosmetic results and patient comfort.

Introduction

Although donor sites usually heal without many problems, they are very painful to the patient. Pain relief can be obtained using occlusive dressings. With one of these dressings, DuoDERM, fast healing, good quality of the healed wounds and pain reduction is reported in many articles (2, 4, 8, 11).
The clinical use of DuoDERM in highly exudative wounds such as donor sites however sometimes causes practical problems, as leakage of the gel which is produced by the dressing makes it necessary to change the dressing quite often.
The gel produced by DuoDERM E has different physical properties. The aim of the two clinical studies described in this report was to assess these properties and their influence on the quality of wound healing, the healing time, the number of dressings necessary before healing is complete and patient comfort.

Materials

DuoDERM E is a second generation hydrocolloid dressing in which a stronger binding of the gel to the dressing matrix is obtained by incorporating the same hydrocolloids as in DuoDERM in a difterent polymer. From a theoretical point of view, less leakage will occur and less frequent dressing changes will be necessary. The outer layer of DuoDERM E is made of a polyurethane foam which is impermeable for oxygen, vapour, gases and micro-organisms. The dressing is adherent to normal skin. When applied over healthy skin, the wound side of the dressing adheres very well: in general no additional bandages are needed to keep DuoDERM E in place.

Methods

Patients in the Bum Centre of the H6pital de la Conception in Marseilles (France), the Rehabilitation Centre H6pital Leon 136rard in Hy&res (France) and the Burn Centre of the Stuivenberg Hospital in Antwerp (Belgium) participated in this study.
Donor sites were covered with DuoDERM E immediately after harvesting the skin, overlapping the wound on each side with at least 2.5 em, so that there would be enough healthy skin available for adherence.
DuoDERM E is not transparent. For that reason it is not possible to determine exactly the rate of reepithelialization without removing the dressing. Two different regimes were used for dressing changes. In the French centres dressings were changed at a 5 days' interval. Thus, the number of dressings until reepithelialization could be calculated. In the Antwerp Burns Centre a new dressing was applied every day after post-operative day 5 to enable the investigator to assess the moment of complete reepithelialization as accurately as possible. In both studies pre-operative disinfection was performed with Betadine. In both centres donor sites were made with an electrical or air-driven dermatome, set to 0.012 inch.
Data to be evaluated during the trial were age and sex of the patient, localization of the donor site, TI1SA (only for the patients in the burn centres), reepithelialization time (Belgian centre), the amount of dressings necessary (French centres) and patient comfort. In all three centres the donor sites were evaluated after three months.

Results
Burns Centre of Marseilles and Rehabilitation Centre of Hyres

20 patients (10 male, 10 female), of whom 13 were from the Burns Centre in Marseilles and 7 from the Rehabilitation Centre in Hy6res, with 28 donor sites, participated in the trial. One patient was operated upon on two different dates and in 7 patients two donor sites were created during the same operation.
The average age of the patients was 41.1 years (min. 15, max. 80). The average TBSA on admission in the patients from the Burn Centre was 12.8% (min. 4%, max. 20%).


Fig. 1 The gel of DuoDERM E stays located around the wound, without leakage.	Fig. 2 Post-operative day 10, second dressing, in situ for 5 days. Although the wound environment is moist, there is only a very thin layer of gel.

The localizations of the donor sites are stated in Tab. 1. The average size of the donor sites was 231 sq. cm (min. 24, max. 500).
The reepithelialization time was less than 10 days in 17 donor sites (63%), less than 15 days in 10 donor sites (33%) and longer than 15 days (17 days) in I donor site (4%). On average 2.3 sheets of DuoDERM E were necessary to achieve complete reepithelialization (min. 2, max. 5).
Pain during dressing changes and overall comfort of the dressing are described in Tab. 2.

Burns Centre of Antwerp

In this centre 21 patients (15 male, 6 female) with 22 donor sites participated in the trial. The average age of this group of patients was 34.4 years (min. 2, max. 79). The TBSA of the patients was 8.4% on average (min. 0.5, max. 34).
The average size of the donor sites was 115 sq. cm (min. 40, max. 322). The localizations of the donor sites are described in Tab. 1.
To be able to assess the healing time in this group, after post-operative day 5 the DuoDERM E was changed every day. The average reepithelialization time was 8.1 days (min. 5, max. 15).
Pain during dressing changes and overall comfort of the dressing are described in Tab. 2.

All centres

Three months after reepithelialization only one (1.6%) out of all 59 donor sites in both groups developed an area of hypertrophy, less than 0.5 cm in diameter.

	Burns Centre Marseilles Rehabilitation Centre Hyères	Burns Centre Antwerp
Upper arm: Forearm: Calf.. Flank: Thigh: Buttock	4 2 4 2 16 - 28	- - - - 19 3 22

Tab. I NUMBER OF LOCALIZATIONS OF THE DONOR SITES

PAIN DURING DRESSING CHANGES

Not
Painful Moderately
Painful Very
Painful

Marseilles/Hyères (N=44) 28(64%) 16(36%) ---

Antwerp (N= 100) 94(94%) 5(5%) 1(1%)

OVERALL DRESSING COMFORT

Very
Comfortable Moderately
Comfortable No
Opinion

Marseilles/Hyères (N=21) 18(86%) 3(14%) ---

Antwerp (N= 21) 9(42%) 9(42%) 3(16%)

Tab. 2 PAIN DURING DRESSING CHARGES AND OVERALL COMFORT

Clinical signs of infection did not occur in any of the donor sites. In none of the patients did treatment of the donor sites with DuoDERM E have to be stopped prior to complete reepithelialization.
Discussion

Although donor sites in general heal with fewer problems than burns, they should be regarded as wounds that deserve optimal treatment. It has been shown that the occluding of wounds leads to better healing than exposure to air (14). Therefore, occlusive dressings should also be used for the treatment of donor sites, instead of the still often used materials like tulle gauze which, upon removal, cause destruction of the woundbed and pain to the patient (13).
The study in Marseilles and Hy~res was aimed at evaluating the patient comfort aspects of the dressing and the number,of dressings necessary to obtain complete reepithelialisation. On average 2.3 sheets of DuoDERM E were necessary. Dressing changes in general were not very painful and treatment of donor sites with DuoDERM E as a whole was judged to be comfortable to moderately comfortable (Tab. 2).
In the Antwerp part of this study, the aim was to assess reepithelialization time with DuoDERM E, although other properties of the dressing were assessed too. An average reepithelialization time of 8.1 days, as found in this study, is comparable to the results with the regular DuoDERM found in other studies (3, 8, 11). In this study dressing changes were in general considered not painful (94%) and the overall patient comfort was high to moderate, although 3 patients gave no opinion (Tab. 2). In fact, these results may be negatively influenced by the fact that, for reasons of judging the wound healing process, the dressings were changed every day after post-operative day 5, which obviously interferes with the normal activities~ and overall comfort of the patients.
Treatment with DuoDERM E did not have to be stopped before reepithelialization was complete in any of the donor sites. One donor site (1.6%) out of all 59 showed a very small area of hypertrophy after three months.
Conclusion

The studies described in this article have shown that the good results in the healing of donor sites that can be obtained with DuoDERM can be equalled by the results with DuoDERM E, as this new material leads to fast and cosmetically good wound healing. The studies also have shown that with DuoDERm E these results can be obtained with a minimum of dressings and high patient comfort.
The Author wishes to thank Dr C. Echinard (Marseilles and Hy~res) and Dr R. Peeters (Antwerp) for their clinical work in these studies. Both studies were sponsored by Convatec.
Other marketed names for DuoDERM E are DuoDERM Control Gel Formula, DuoDERM CG17, Granuflex E and Varihesive E.

RÉSUMÉ. Dans une étude prospective menée chez deux centres de brûlés et un centre de réhabilitation, le DuoDERM E, un nouveau pansement hydrocolloïde, a été testé dans le traitement des zones donatrices de la peau. Les épreuves effectuées indiquent que le DuoDERM E offre une rapide réépithélialisation des plaies et une bonne qualité des résultats cosmétiques, avec un bon confort pour les patients.

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