SUMMARY. A study is made of 46 patients, 20 with second-degree bums and the remaining 26 with graft donor sites. A comparison was made between a number of patients who received a new cicatrization dressing (Varihesive Gel Control) with habitual treatment (Opsite wound), and the remaining patients of the series who received only Variliesive Gel Control. The treated zone was examined every 24 hours; the dressing was only changed where necessary, as the result of complications. Mean cicatrization time using Variliesive Gel Control was 7.4 days among the second-degree burn patients, and 7.1 days for the donor sites; patients subjected to the habitual treatment presented a mean cicatrization time of 14.3 days in the case of second-degree burns, and of 13.8 days for the donor sites. In addition, complications were fewer when Variliesive Gel Control was applied.

Second-degree burns are still very frequent; domestic accidents, lack of safety measures, neglect in certain working environments, and the materials commonly employed in folklore activities in this country all contribute to the marked incidence of second-degree burns in our society.
These and other reasons make third-degree bums also very frequent. Most of these lesions will need grafting, and thus the donor sites will have to be heated.
The importance of second-degree lesions and donor sites has led us to explore the possibility of applying more effective and rapid treatment protocols that at the same time offer fewer complications than the methods currently available.

A cicatrization study was carried out in 46 patients; 20 had suffered second-degree superficial bums, while the remaining 26 patients presented skin graft donor sites.

The 26 patients in this group consisted of 18 males (69.2%) and 8 females (30.8%). The donor sites were distributed as follows: left thigh (10 cases, 38.4%), right thigh (7 cases, 26.9%), left leg (5 cases, 19.2%), right leg (2 cases, 7.6%) and abdomen (2 cases, 7.6%).
Donor site size varied between 0.5 and 5% of total body surface (mean, 2%).

The 20 patients in this group consisted of 13 males (65%) and 7 females (35%). The burns were distributed as follows: right arm (4 cases, 20%), left leg Q cases, 15%), abdomen Q cases, 15%), right breast (2 cases, 10%), right foot (2 cases, 10%), right thigh (2 cases, 10%), trunk (2 cases, 10%), left arm (I case, 5%), left thigh (I case, 5%).
Burn size varied between 0.3% and 4% of total body surface (mean, 1.5%).

The material used in the applying of established procedures was Opsite wound.
The new cicatrization dressing used in the present study was Varihesive Gel Control. This consists of hydroactive, flexible gauze that acts by humid occlusion. It is available in the form of laminas 2-3 mm thick and consists of two layers: an external layer of water-tight polyurethane foam impermeable to both gases and bacteria, and an internal layer made of semi-synthetic hydrocolloids (sodium carboxymethylcelluose, pectin and gelatin) in a mixture of inert polymers that guarantee its adherence while retaining the gel within their structure. This layer is in contact with the wound, and is protected by silicone paper that preserves the integrity of the components as long as the dressing is applied.
The composition of this material makes it particularly useful in the case of moderately or highly exudative wounds.

The patients presenting donor sites were treated immediately after harvesting the grafts; in no case were vasoconstrictors of any kind employed. The patients with second-degree superficial burns were treated immediately on admittance, and in no case had more than an hour passed between burn and treatment.
Habitual therapy and/or Variliesive Gel Control was applied in both groups - with posterior reinforcement in the form of compressive bandages. In the group with donor sites, the new dressing was used alone in 13 cases (50%); in the other 13, Varihesive Gel Control was associated with habitual treatment (50% of the wound surface being treated by each method).
In the group with second-degree superficial bums, Varihesive Gel Control was applied in 10 cases (50%), and the remaining 10 patients were subjected to the combined therapy approach.
In all patients the treated zone was examined every 24 hours until total cicatrization. Treatment protocol was only changed in the case of complications. In the case of infection, the corresponding cultures were prepared. Cicatrization progress was evaluated by inspection and observation in all cases.
Likewise, patient pain was rated both in changing dressings and during the days until cicatrization, for both types of treatment employed. The pain scale was as follows:

0 - no discomfort
I - slight discomfort only
2 - low-intensity pain
3 - intense pain
4 - unbearable pain.

The following was observed where Varihesive Gel Control was employed: in the donor sites cicatrization time varied between 5 and 9 days (mean, 7.1 days). In the second-degree bum areas, cicatrization time varied between 6 and I I days (mean, 7.4 days).
Among the patients treated according to habitual protocol, cicatrization time for the donor sites varied between 9 and 16 days (mean, 13.8 days), versus between 10 and 18 days (mean, 14.3 days) among the second-degree bum patients.

With Variliesive Gel Control, and according to our pre-established pain scale, values among both the donor sites and bum patients varied between 0 and 2 (mean, 1. 1).
In the case of the habitual treatment protocol, the values were 1-4 (mean, 3.2).
The results described above are given in Figs. I and 2.

Fig. 1 Comparison of cicatrization time Fig. 2 Comparison of pain

In the case of Varihesive Gel Control, the dressing had to be changed in only 15 of the 46 patients involved (only one change per patient): in 6 cases as a result of the appearance of exudate; in 5 due to haematoma retention; and in the remaining 4 cases because of infection. In the latter, the corresponding cultures were prepared, revealing Staphylococcus epidermidis and Clostridium sp.
It should be stressed, however, that these complications - when adequately managed - did not markedly affect cicatrization time. On employing habitual treatment protocols, changes were required every 5-7 days; 11 cases of infection were noted, together with 7 haematomas and one case of allergy to the cream used.

The great incidence and importance of second-degree lesions and donor sites have stimulated the investigation of new and better cicatrization dressings.
Theoretically better wound healing can be achieved when the wound is kept moist and infection is avoided (Quinn, 1987). Different synthetic and biological wound dressings have been tried during the last few years, but with variable results (Baxter, 1970; Davies, 1984; Hermans, 1987).
The proper dressing for such wounds should fulfil all the following requirements: it should be cheap, alleviate pain, prevent infection, be easy to handle with no or few changes during the healing period, make mobilization easy and early, have no toxicity or allergenic effect, not result in any hypertrophic scarring, and lead to quick and solid epithelialization.
In our series of 46 patients, Varihesive Gel Control satisfied all these requirements. Mean cicatrization time needed in burn areas and in donor sites was almost half the time of habitual treatments. We only had 4 cases of infection. It was very easy to handle and of low cost.

RESUME Les Auteurs ont étudié 46 patients, dont 20 atteints de brélure du deuxi&me degré et 26 avec des sites donneurs de greffe. Us ont effectué une comparaison entre les patients qui ont requ un nouveau pansement pour la cicatrisation (Varihesive Gel Control), associ& au traitement habituel (Opsite wound), et les autres patients de la série qui ont requ seulement Varihesive Gel Control. La zone traitée a W examinée toutes les 24 heures et les pansements ont &é changés seulement en cas de nécessité, A cause de complications. Le temps moyen de cicatrisation avec 1'emploi de Varihesive Get Control était 7,4 jours pour les patients avec des brélures du deuxi&me degré et 7.1 jours pour les sites donneurs; an contraire les patients qui ont requ le traitement habituel ont presenté un temps moyen de cicatrisation de 14,3 jours dans le cas des brélures du deuxi&me degré et de 13,8 jours pour les sites donneurs. En outre il y a eu moins de complications avec 1'emploi di Variliesive Gel Control.

BIBLIOGRAPHY

1. Baxter C.R.: Homografts and heterografts as a biological dressing in the treatment of thermal injury. First Annual Meeting of the Society of German Plastic Surgeons, Munich, 28 September 1970.
2. Davies J.W.L.: Synthetic materials for covering bum wounds. Progress towards perfecton. Part 1: Short term materials. Bums, 10: 94-99, 1984.
3. Hermans M.H.E.: Hydrocolloid dressing (Duoderm) for the treatment of superficial and deep partial thickness bums. Scand. J. Plast. Reconstr. Surg., 21: 283-291, 1987.
4. Queen D., Evans J.H., Gaylor J.D. et al.: Bum wound dressing - a review. Burns, 13: 218-223, 1987.