Scar quality and physiologic barrier function restoration after moist and moist-exposed dressings of partial-thickness wounds.
BACKGROUND
There is growing evidence of improved healing of full- and partial-thickness cutaneous wounds in wet and moist environments. Retention of biologic fluids over the wound prevents desiccation of denuded dermis or deeper tissues and allows faster and unimpeded migration of keratinocytes over the wound surface. It allows also the naturally occurring cytokines and growth factors to exert their beneficial effect on wound contracture and re-epithelialization. Despite all of these documented benefits, applying the moist healing principles to large surface areas, in particular to large burns, is hindered by the major technical handicap of creating and maintaining a sealed moist environment over these areas.


METHODS
From January to September 2001, healing of partial-thickness skin graft donor sites was studied in a prospective comparative study of two types of moist dressings, Tegaderm (3M Health Care, St. Paul, MN), a semipermeable membrane occlusive dressing, and moist exposed burn ointment (MEBO) (Julphar; Gulf Pharmaceutical Industries, United Arab of Emirates), an ointment that can provide a moist environment without the need of an overlying occlusive dressing. Healing was assessed both clinically and with serial measurements of transepidermal water loss (TEWL) and moisture. Following healing, scar quality was evaluated by two members of the team separately using a visual analog scale. Results were statistically analyzed.


RESULTS
Faster healing was observed clinically with MEBO application. Physiologic healing as determined by TEWL measurements occurred at an extremely significant earlier stage for MEBO, and this was associated with better scar quality, demonstrating a positive relationship between function and cosmetic appearance. Moreover, the ointment is definitely easier to apply than the occlusive self-adhesive membrane, which requires some degree of dexterity and expertise.


CONCLUSIONS
MEBO application is an effective and valid alternative to conventional occlusive dressings. Moreover, the observed improved anatomic and physiologic healing indicates that MEBO may have a positive effect on healing more that the mere fact of passive moisture retention.
Atiyeh
Bishara S
BS
Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
El-Musa
Kusai A
KA
Dham
Ruwayda
R
D000328:Adult; D002921:Cicatrix / Q000503:physiopathology; D006801:Humans; D009779:Occlusive Dressings; D009824:Ointments / Q000494:pharmacology*; D011446:Prospective Studies; D012855:Sitosterols / Q000494:pharmacology*; D016038:Skin Transplantation; D013997:Time Factors; D014945:Wound Healing / Q000187:drug effects* / Q000502:physiology
D009824:Ointments; D012855:Sitosterols; C472006:moist exposed burn ointment