Management of skin-grafted burn wounds with Xeroform and layers of dry coarse-mesh gauze dressing results in excellent graft take and minimal nursing time.
The goals of postoperative treatment for split-thickness skin grafts (STSGs) are to maintain graft integrity, prevent graft and wound desiccation, and minimize infections. As we documented in a telephone survey of 16 burn centers, dressings for skin grafts usually consist of multiple layers of coarse-mesh gauze; the dressings receive frequent applications of aqueous solutions that contain antimicrobial agents to control bacterial growth and to maintain a moist environment at the wound surface. We prospectively studied the efficacy of our standard dressing of one layer of Xeroform (Kendall Inc., Mansfield, Mass.), which consists of fine-mesh gauze impregnated with bismuth tribromophenate, applied to the STSG surface followed by layers of dry gauze dressings wrapped in Kerlix (Kendall Inc.); the entire dressings were left intact until postoperative day 5. We evaluated 142 STSGs on 100 patients, mean age 29.2 years (range 0.3 to 79 years), with burns of 0.5% to 60% total body surface area (mean 9.1%). Meshed or sheet STSGs of 0.5% to 18% total body surface area (mean 3.14%) were placed on deep partial- or full-thickness excised wounds. Xeroform, followed by coarse-mesh gauze dressing, was applied after skin grafts were completed. The entire dressing was left intact until the initial takedown-to-graft at 5 days. Patients' grafts were evaluated on postoperative day 5 for the percentage of "take" and subgraft fluid collected; this evaluation was then repeated every other day for 10 days. On postoperative day 5 evaluations, mean skin graft take in all patients was 98.54% +/- 0.72%. Xeroform and coarse-mesh gauze dressings used to cover STSGs and left intact for 5 days until the initial dressing change, resulted in highly successful graft outcomes, with minimal postoperative nursing care compared with other dressing methods for skin grafts.
University of California, San Diego 92103, USA.
W
W
Hansbrough
C
C
Doré
J F
JF
Hansbrough
D000293:Adolescent; D000328:Adult; D000368:Aged; D000891:Anti-Infective Agents, Local; D001458:Bandages; D002056:Burns / Q000451:nursing / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010636:Phenols; D011182:Postoperative Care; D011446:Prospective Studies; D016038:Skin Transplantation / Q000451:nursing*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
D000891:Anti-Infective Agents, Local; D010636:Phenols; C004554:2,4,6-tribromophenol