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.
Hansbrough
W
W
University of California, San Diego 92103, USA.
Doré
C
C
Hansbrough
J F
JF
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