Dr Nicholas Tang1
1Royal Melbourne Hospital, 300 Grattan St, Australia
Background: Hypergranulation tissue has been described in the literature as a deterrent to complete wound healing following skin-grafting to burns1. ‘Kenacomb Ointment’, a combination of triamcinolone acetonide, neomycin sulfate, gramicidin and nystatin, is often used following skin-grafting for management of hypergranulation tissue. This likely stems from the hypothesized effect of topical steroids on granulation tissue as well as its anti-microbial properties. Its use has been widely accepted in the treatment of burns, however evidence regarding its efficacy and side effects is lacking.
Methods: We performed a literature search of Medline, Pubmed, Embaseand the Google Scholar library for ‘Kenacomb’ with granulation tissue and burns. Clinical studies on the topical use of these medications on wounds were included.
Discussion: There is much lacking in current literature, with no articles describing the use of ‘kenacomb’ in burns management and only a handful of case reports or series’ describing the use of topical steroids in the management of hypergranulation tissue. At the same time there are a number of case reports and series’ describing the severe side effects of ototoxicity and nephrotoxicity following topical administration of Neomycin to burn wounds.
Conclusion: There is a paucity of clinical evidence in the literature that advocates for the use of topical ‘Kenacomb’ on burns wounds and, given its potential side effect profile, further research is required to assess its safety for ongoing clinical use.
1. Jewell L, Guerrero R, Quesada AR, Chan LS, Garner WL. Rate of healing in skin-grafted burn wounds. Plast Reconstr Surg. 2007 Aug;120(2):451-6.
Nicholas Tang is currently a HMO at the Royal Melbourne Hospital