Mextra Superabsorbent as a New Skin Graft Donor Site Dressing

Dr Devlin Elliott1

1Greenslopes Plastics Department, Greenslopes, Brisbane, Australia

Abstract:

Introduction:There are a variety of products on the market that can be used for donor site dressing. Mextra Superabsorbent is a dressing with high retention and absorption capacity that reduces the risk of leakage and maceration. The fluid-repellent backing material, and polyacrylate superabsorbent particles reduce strike through resulting in fewer dressing changes. The dressing is soft and comfortable which makes it easy to apply. Applications include highly exuding wounds, such as venous leg ulcers, diabetic foot ulcers or skin graft donor sites.

Results:Our preliminary findings with Mextra Superabsorbent are positive. We’ve noticed we are able to leave the dressing on for the full two weeks until the wound has healed without the need for reinforcement or replacement. The dressing allows for excellent healing and maintains its structure and integrity without becoming bulky upon exudate absorption.

Discussion:Mextra Superabsorbent as a donor site dressing has many added benefits. Patients report that the dressing is comfortable and there is reduced pain on removal in comparison to conventional dressings. Reduced dressing changes and leakage have resulted in lower costs and better patient satisfaction.

Conclusions: Mextra Superabsorbant is an effective option for a donor site dressing with several significant benefits. Increased absorptive capacity allows for reduced dressing changes, avoids maceration and promotes effective wound healing.


Biography:

Otago University Graduate

PGY4

Current Plastics PHO Greenslopes Hospital

Improving Skin Graft Donor Site Scarring with Mepilex Transfer Ag

Dr Devlin  Elliott1

1Greenslopes Plastics Department, Greenslopes , Brisbane, Australia

Abstract:

Introduction:Skin graft donor site scarring can be problematic in selective patients. Donor sites require optimum conditions free from excessive exudate and infection to maximize healing potential and final cosmesis. Mepilex Transfer Ag utilizes silver sulfate to reduce infection, has foam technology to absorb exudate and transfer to a second layer and Safetac technology supporting less painful healing.

Results:Our preliminary findings with Mepilex Transfer Ag suggest better wound healing with reduced scarring. A no backing film allows us to leave the dressing on for two weeks even if an outer layer needs to be replaced. We found patients reported minimal pain and trauma with dressing changes and had more optimum conditions for healing resulting in better scarring long-term.

Discussion:Mepilex Transfer Ag is an effective dressing to enhance donor site healing. Soft silicone adhesive technology means less pain and tissue trauma with dressing changes and improves scarring. The dressing is thin and highly comfortable for difficult to dress wounds.

Conclusions:Skin graft donor site scarring can be optimized with Mepilex Transfer Ag. This dressing only needs to be applied once, and optimizes the environment for tissue healing as well as reducing any further tissue trauma with removal.


Biography:
Otago University Graduate
PGY4
Current Plastics PHO Greenslopes Hospital

Improving Graft Take to Burns on the Hand with Acticoat Flex 3

Dr Devlin Elliott1

1Greenslopes Plastics Department, Greenslopes, Brisbane, Australia

Abstract:

Introduction:Full thickness burns on the hand require debridement and skin grafting. Negative pressure wound therapy (NPWT) can be used to help with graft stability and take with a variety of non-adhesive interface dressings being used. Prior interface dressings in our unit displayed signs of maceration and graft instability. Acticoat Flex 3 contours to maintain contact with the wound surface, has broad spectrum antimicrobial activity and allows exudate transport through the dressing.

Case:A 22 year-old male had a full thickness friction type burn to the dorsum of his dominant hand when it was caught in the conveyor belt at work. The ring and little finger were involved as well as the fourth web space. A split skin graft was taken from the thigh, inset and then Acticoat Flex 3 was used under a VACC negative pressure dressing.

Results:Day three post procedure, the patient had excellent graft take, nil signs of infection and minimal exudate. The graft was very secure and stable with no signs of shearing damage or graft loss. A thermoplastic splint was used and the patient healed well and is currently working with the hand therapists. Our unit has noticed increased graft take and less macerated graft beds since using Acticoat flex 3 under NPWT.

Conclusions: Acticoat Flex 3 is an effective interface dressing when using NPWT and helps to increase graft take, stability and reduce infection in burn patients.


Biography:

Otago University Graduate
PGY4
Current Plastics PHO Greenslopes Hospital

Influence of bacterial colonisation of the burn wound on successful graft take in minor burns

Dr Dharshini Selvarajah1, Professor John Harvey1, Dr Susan Jehangir1, Ms Julie Jones1, Ms  Sharon Welsh1, Ms Madeleine Jacques1

1The Children’s Hospital Westmead, Sydney, Australia

Abstract:

Background:Advances in burns dressings, surveillance with early detection of bacterial colonisation and the appropriate use of antibiotics, has significantly reduced the incidence of graft loss, improved healing and reduced scarring in burns. The aim of this study is to determine the influence of bacterial colonisation and the use of antibiotics on graft take in minor burns (<10% total body surface area).

Methods:A retrospective review was undertaken of all children with minor burns who underwent skin grafting at The Children’s Hospital at Westmead (CHW) between April 2017 and April 2018. The presence of bacterial colonisation of the burn wound, the use of antibiotics, and the result of skin grafting was determined from the medical records.

Preliminary Results (5 months):

Of 59 children with burns who required grafting during the study period, 24 (40%) patients were identified to have bacterial colonisation. Complete graft take was higher in the non-colonised group compared to the colonised group; 35 (100%) vs 17 (71%), p=0.0010.

Of the 24 colonised children, 18 (75%) received antibiotics. Of these there was complete graft take in 15 (83%).  Graft loss occurred in 3 (16%). Of 6 who did not receive antibiotics, there was complete graft take in 2(33%) and graft loss in 4 (66%). Complete graft take was higher in the antibiotic group compared to the non- antibiotic group, p=0.038.

Conclusions:Bacterial colonisation has a significant effect on graft outcomes. Timely use of appropriate antibiotics to treat bacterial colonisation can improve graft outcomes in minor burns.


Biography:

Dr Dharshini Selvarajah – Burns Registrar from the Children’s Hospital Westmead

Retrospective audit of analgesia for 1ST SSG Surgery in the Victorian adult burns service The Alfred Hospital 2014-2017

Dr Kerry Mclaughlin1, Dr Kevin Pan1, Dr Kieran Bates1

1The Alfred, Prahran, Australia

Abstract:

Background:Management of Burns pain is challenging.1,2,3,4,5,6 Patients report that donor surgical site is the most debilitating.7,8 and often neuropathic in nature. There has been increasing interest in treating the neuropathic component of burns pain.9 Globally there is a drive to reduce the reliance on opioid based analgesic regimes.5
Poorly controlled acute pain is a risk factor for chronic pain10 and its associated reduction in physical, psychological and social functioning.11,12
Aims:Comparison of pain scores pre and post 1st SSG surgery in patients with burns injury.
Method:All patients with ≥10% burn requiring SSG admitted to the Victorian Adult Burns Service over a 4 year period were identified by the burns registry. Data was collected 24hrs pre SSG to 24hrs post SSG and included size of burn, pain scores, opioid and antineuropathic use including ketamine and lignocaine infusions.

Data:138 patients with >10%TBSA burns
20 Patients received lignocaine at time of SSG
The lignocaine group had larger TBSA burn 33.3% vs 27.7%, had longer hospital stays 43.5 days vs 33.4 days and more surgical encounters 5.45 vs 4.22
The difference between pre and post op pain scores was compared. The non-lignocaine group showed a significant post-operative increase (1.68, SE=0.32, p<0.001). The difference was lower for the lignocaine group (0.18, SE=0.79, p=0.822).
Preoperative pain scores were comparatively higher in the lignocaine group 4.83 Vs 2.88 suggesting this group had harder to manage pain. This supports the hypothesis that there is a trend towards improvement in pain management in the lignocaine group.

Conclusion:Lignocaine infusion may reduce burns associated pain.
We propose a prospective randomised placebo controlled trial to assess the efficacy of IV lignocaine on donor site pain related to burns injury.
Bibliography
1. James DL, Jowza M, Principles of Burn Pain Management Clin Plastic Surg. 2017;44:737–747
2. Hyeong Tae Yang. Improvement of burn pain management through routine pain monitoring and pain management protocol. Burns(2013);39:619–624
3. Retrouvey H, Shahrokhi S. Pain and the Thermally Injured Patient—A Review of Current Therapies Journal of Burn Care & Research2015;36(2):315–323
4. Alencar de Castro RJ, Leal PL, Sakata RK. Pain Management in Burn Patients Rev Bras Anestesiol. 2013;63(1):149-158


Biography:

Kerry McLaughlin works as  a VMO Pain Specialist and Anaesthetist at the Alfred Hospital. Burns pain management is her areas of specialist interest.

Cohort Series and Systematic Literature Review: Intentional Self- and Peer- Inflicted Aerosol Skin Injuries ‘Frosties’

Dr Christopher Maguire1, Dr Bhaveshkumar Patel1,2,3, Dr Craig McBride1,2,3

1Pegg Leditschke Children’s Burns Centre, South Brisbane, Australia, 2School of Medicine, Griffith University, Brisbane, Australia, 3Centre for Children’s Burns and Trauma Research, University of Queensland, Brisbane, Australia

Abstract:

Background: ‘Frosties’ are deliberate cold skin burns caused by an aerosol device.

Objectives: To examine our own cohort, and those previously published, to identify the key features and inform appropriate early clinical interventions.

Results: The median age was 13 years; 70.5% female. Adequate first aid was not reported in any patient. Where recorded, the median time to presentation was six days. Where severity of injury was recorded, 13 of 37 cases (35.1%) were full thickness and ten patients received a split thickness skin graft (STSG). Two subgroups of patients were identified; cluster injuries and psychological distress.

Discussion: Cluster injuries occur as the result of a mutual ‘test of courage’. Solo injuries may point to underlying psychological distress. Frostie severity is under-appreciated and in consequence first aid and/or presentation are delayed or absent. Frosties frequently result in significant burn injuries and often require skin grafting.


Biography:

Dr Christopher Maguire is currently a Senior House Officer in Paediatric Surgery at Lady Cilento Children’s Hospital. He also holds the rank of Captain in the Australian Army Medical Core, and is the sitting Chair of the Australian Medical Association of Queensland’s Council of Doctors in Training.

The first cut is not the deepest: variability in split-thickness skin grafts harvested using a powered calibrated dermatome

Dr Craig McBride1, Ms Margit Kempf1,2, Professor Roy Kimble1,2, Associate Professor Kellie Stockton1,2

1Pegg Leditschke Children’s Burns Centre, Centre for Children’s Burns and Trauma Research, University of Queensland, South Brisbane, Australia, 2Surgical Team: Infants, Toddlers, Children (STITCh); Lady Cilento Children’s Hospital, South Brisbane, Australia

Abstract:

Introduction:In 1938 Padgett and Hood introduced the calibrated dermatome. A year later Padgett stated that his method enabled surgeons, for the first time, to cut skin grafts at “…a predetermined level…”. This belief has been largely unchallenged since, but is it true?

Methods:Cohort study of 140 split-thickness skin grafts, harvested at 0.007 inches by four surgeons. A central biopsy was taken, blocked and cut, and measured for mean thickness.

Results:The median thickness was 0.00694 inches. Only 50% of central STSG biopsies had a mean thickness between 0.005 and 0009 inches. Patient age and sex, the individual surgeon, the age of the dermatome blade, or the index number of the graft harvested (first, second, etc) did not predict a thicker or thinner STSG.

Conclusion: STSGs taken using a powered calibrated dermatome are not uniform. There are no pre- or intra-operative factors that can predict this and allow compensation. These results may have implications in comparative studies using re-epithelialisation of the donor site wound as an outcome measure of treatment effectiveness.


Biography:

Craig McBride is a children’s surgeon here in Brisbane. He doesn’t like taking things for granted, or being told what to believe.

Seaweed, sheep’s wool and spider webs: randomised controlled trial of split-thickness skin graft donor site dressings in children’s burns.

Dr Craig McBride1,2, Professor Roy Kimble1,2, Associate Professor Kellie Stockton1,2

1Pegg Leditschke Children’s Burns Centre, Centre for Children’s Burns and Trauma Research, University of Queensland, Queensland, Australia, 2Surgical Team: Infants, Toddlers, Children (STITCh); Lady Cilento Children’s Hospital, South Brisbane, Australia

Abstract:

Trial Design
This is a parallel 3-arm prospective randomised controlled trial comparing Algisite™ M, Cuticerin™, and Sorbact® as donor site dressings in paediatric split-thickness skin grafts. The setting is the largest paediatric burns service in Queensland, Australia.

Methods:All children for split-thickness skin grafting, with buttock or thigh donor sites, were considered for enrolment in the trial. Primary outcome measures were days to re-epithelialisation, and pain. Partial blinding of assessors was possible, with blinded photographic assessments of re-epithelialisation.

Results:There were 33 patients randomised to the Algisite™ M arm, 32 to the Cuticerin™ arm, and 36 to the Sorbact® arm between April 2015 and July 2016.
There were no significant differences between the three arms regarding pain, or time to re-epithelialisation. There were no significant differences with respect to the secondary outcomes of itch, scarring, or cost. Regression analyses demonstrated faster healing in younger patients, and decreased donor site scarring at 3 and 6 months with thinner split-thickness skin grafts.

Conclusion:There are no data from this trial to support a preference for one of these three dressings. Thinner skin grafts lead to less donor site scarring. Younger patients have faster donor site wound healing.

Trial Registration and Funding
Australia and New Zealand Clinical Trials Register (ACTRN12614000380695).
Royal Children’s Hospital Human Research Ethics Committee (HREC/14/QRCH/36).
University of Queensland Medical Research Ethics Committee (#2014000447).
The trial was funded in part by a grant from Abigo Medical AB. This company had no part in the trial design, conduct, analysis, or publication.


Biography:

Craig McBride is a children’s burns surgeon. He’s experimenting with being a clinical researcher.

About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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