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The effect of moist and moist exposed dressings on healing and barrier function restoration of partial thickness wounds

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Abstract

Improved healing of full- and partial-thickness cutaneous wounds in wet and moist environments is due primarily to retention of biological fluids over the wound preventing desiccation of denuded dermis or deeper tissues. This also allows faster and unimpeded migration of keratinocytes over the wound surface and enables the naturally occurring cytokines and growth factors to exert their beneficial effect on wound contracture and reepithelialization. Despite all these documented benefits creating and maintaining a sealed moist environment over large surface areas such as large skin graft donor sites or extensive burns is technically difficult if not impossible. The preliminary investigation carried out between 1999 and 2000 studied the healing of a split-thickness skin graft (STSG) following application of moist exposed burn ointment (MEBO). This compound provides a moist environment without the need of an overlying occlusive dressing, and compares favorably with Sofra-Tulle semi-open dressing. Healing of STSG donor sites was then evaluated from January to September 2001 in a prospective study comparing the effect of Tegaderm, a semipermeable membrane occlusive dressing, and MEBO, two different types of moist dressings. Wound healing was evaluated by measuring transepidermal water loss (TEWL), and scar quality was assessed by two independent observers using a visual analogue scale. Faster healing was observed clinically with MEBO application. Physiological 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, simple ointment application was definitely more practical than application of the occlusive self-adhesive membrane.

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References

  1. Ang ES, Lee ST, Gan CS, See P, et al (2000) The role of alternative therapy in the management of partial thickness burns of the face experience with the use of moist exposed burn ointment (MEBO) compared with silver sulfadiazine. Ann Acad Med Singapore 29:7

    CAS  PubMed  Google Scholar 

  2. Atiyeh BS, Ioannovich J, Al Amm CA (2000) Pansements de sites donneurs de greffe de peau mince: resultats preliminaires d'une etude clinique limitee comparative de "MEBO" et de "Sofra-Tulle. Brulures Rev Fr Brulol 1:155

    Google Scholar 

  3. Atiyeh BS, Ghanimeh G, Kaddoura IL, Al Amm C, Ioannovich J (2001) Split thickness skin graft donor site dressing: Preliminary results of controlled clinical comparative study of MEBO and Sofra-Tulle. Ann Plast Surg 46:87

    CAS  PubMed  Google Scholar 

  4. Atiyeh BS, Al-Amm CA, El-Musa KA, Sawwaf A, Dham R (2002) Scar quality and physiologic barrier function restoration following moist and moist exposed dressings of partial thickness wounds. Dermatol Surg (in press)

  5. Bolton LL, Monte K, Pirone LA (2000) Moisture and healing: beyond the jargon. Ostomy Wound Manage 46 [1A Suppl]:51S

  6. Breuing K, Erikson E, Liu P, Miller DR (1992) Healing of partial thickness porcine skin wounds in a liquid environment. J Surg Res 52:50

    CAS  PubMed  Google Scholar 

  7. Chen WYJ, Rogers AA, Lydon MJ (1992) Characterization of biologic properties of wound fluid collected during early stages of wound healing. J Invest Dermatol 99:559

    Google Scholar 

  8. Darmstadt GL, Dinulos JG (2000) Neonatal skin care. Pediatr Clin North Am 47:757

    CAS  PubMed  Google Scholar 

  9. Dyson M, Young S, Pendle L, Webster DF, et al (1988) Comparison of the effects of moist and dry conditions on dermal repair. J Invest Dermatol 91:434

    Google Scholar 

  10. Ehrlich HP (1990) Fetal wound healing: a biochemical study of scarless healing. Plast Reconstr Surg 85:495

    PubMed  Google Scholar 

  11. Erikson E, Perez N, Slama J, Page CP, et al (1996) Treatment of chronic, nonhealing abdominal wound in a liquid environment. Ann Plast Surg 36:80

    PubMed  Google Scholar 

  12. Feldman D, Rogers A, Karpinski R (1991) A prospective trial comparing Biobrane, Duoderm and Xeroform for skin graft donor sites. Surg Gynecol Obstet 173:1

    CAS  Google Scholar 

  13. Feldman L (1991) Which dressing for split-thickness skin graft donor sites? Ann Plast Surg 27:288

    CAS  PubMed  Google Scholar 

  14. Geng XL, Bu XC, Gao FQ, Liu YL (1989) Study on the bacterial count in the subeschar living tissues of burn wounds. Chin J Burns Wounds Surf Ulcers 1:49

    Google Scholar 

  15. Grinnel F (1994) Fibroblasts, myofibroblasts, and wound contraction. J Cell Biol 124:401

    CAS  PubMed  Google Scholar 

  16. Huang QS, Zhou G, Su BP, Huang EX (1995) A comparative study of fibronectin and MEBO in the treatment of experimental rabbit corneal alkaline burn. Chin J Burns Wounds Surf Ulcers 1:18

    Google Scholar 

  17. Ioannovich J, Tsati E, Tsoutsos D, Frangia K, et al (2000) Moist exposed burn therapy: evaluation of the epithelial repair process (an experimental model). Ann Burns Fire Disast 8:3

    Google Scholar 

  18. Jain A, Rutter N, Cartlidge PH (2000) Influence of antenatal steroids and sex on maturation of the epidermal barrier in the preterm infant. Arch Dis Child Fetal Neonatal Ed 83:F112

    CAS  PubMed  Google Scholar 

  19. Jonkman MF (1989) Epidermal wound healing between moist and dry. Thesis, University of Groningen, Groningen

  20. Jonkman MF, Hoeksma EA, Nieuwenhuis P (1990) Accelerated epithelialization under a highly vapor-permeable wound dressing is associated with increased precipitation of fibrin (ogen) and fibronectin. J Invest Dermatology 94:477

    CAS  Google Scholar 

  21. Kelton P Jr (1992) Skin grafts. Sel Read Plast Surg 7:1

    Google Scholar 

  22. Li L (1990) Experiment on inhibiting constriction of the ileum from a white mouse. Chin J Burns Wounds Surf Ulcers 1:50

    Google Scholar 

  23. Nemeth AJ (1991) Faster healing and less pain in skin biopsy sites treated with an occlusive dressing. Arch Dermatol 127:1679

    CAS  PubMed  Google Scholar 

  24. Palenske J, Morhenn VB (1999) Changes in the skin's capacitance after damage to the stratum corneum in humans. J Cutan Med Surg 3:127

    CAS  PubMed  Google Scholar 

  25. Qu YY, Wang YP, Qiu SC, et al (1996) Experimental research on the anti-infective mechanism of MEBO. Chin J Burns Wounds Surf Ulcers 1:19

    Google Scholar 

  26. Qu YY, Wang YP, Qiu SC, et al (1997) Experimental research on the mechanism of the effect of MEBO. Chin J Burns Wounds Surf Ulcers 4:4

    Google Scholar 

  27. Reuterving CO, Agren MS, Soderberg TA, Tengrup I, et al (1989) The effects of occlusive dressings on inflammation and granulation tissue formation in excised wounds in rats. Scand J Plast Reconstr Surg 23:89

    CAS  Google Scholar 

  28. Rutter N (2000) Clinical consequences of an immature barrier. Semin Neonatol 5:281

    Google Scholar 

  29. Sawada Y, Yotsuyanagi T, Sone K (1990) A silicone gel sheet dressing containing an antimicrobial agent for split thickness donor site wounds. Br J Plast Surg 43:88

    CAS  PubMed  Google Scholar 

  30. Silverman RA, Lender J, Elmets CA (1989) Effects of occlusive and semiocclusive dressings on the return of barrier function to transepidermal water loss in standardized human wounds. J Am Acad Dermatol 20:755

    CAS  PubMed  Google Scholar 

  31. Svensjo T, Pomahac B, Yao F, Slama J, et al (2000) Accelerated healing of full-thickness skin wounds in a wet environment. Plast Reconstr Surg 106:602

    CAS  PubMed  Google Scholar 

  32. Vanstraelen P (1992) Comparison of calcium sodium alginate (KALTOSTAT) and porcine xenograft (E-Z DERM) in the healing of split-thickness skin graft donor sites. Burns 18:145

    CAS  PubMed  Google Scholar 

  33. Vogt PM, Andree C, Breuing K, Liu PY, et al (1995) Dry, moist, and wet skin wound repair. Ann Plast Surg 34:493

    CAS  PubMed  Google Scholar 

  34. Wang GS, Jian WG, Xu XS, et al (1992) The exploration of pathological changes and their mechanism of experimentally burned rabbits after treatment. Chin J Burns Wounds Surf Ulcers 3:7

    CAS  Google Scholar 

  35. Wang GS, Zhang YM, Liu RS, et al (1993) Experimental study of the effect of MEBO on blood rheology in the treatment of burned rabbits. Chin J Burns Wounds Surf Ulcers 4:30

    Google Scholar 

  36. Willis I (1973) The effects of prolonged water exposure on human skin. J Invest Dermatol 60:166

    Google Scholar 

  37. Winter GD (1965) A note on wound healing under dressings with special reference to perforated-film dressings. J Invest Dermatol 45:299

    CAS  PubMed  Google Scholar 

  38. Winter GD (1972) Epidermal wound healing. In: Maibach HI, Rovee DT (eds) Epidermal regeneration studied in the domestic pig. Year Book Medical, Chicago, pp 71–112

  39. Winter GD (1975) Epidermal wound healing under a new polyurethane foam dressing (Lyofoam). Plast Reconstr Surg 56:531

    CAS  PubMed  Google Scholar 

  40. Winter GD, Scales JT (1963) Effect of air drying and dressings on the surface of a wound. Nature 197:91

    Google Scholar 

  41. Wortzman MS (1991) Evaluation of mild skin cleansers. Dermatol Clin 9:35

    CAS  PubMed  Google Scholar 

  42. Xing D (1989) Experimental study on the actions of the moist burn ointment on promoting healing of skin wound and anti-infection. Chin J Burns Wounds Surf Ulcers 1:76

    Google Scholar 

  43. Zawacki BE (1974) Reversal of capillary stasis and prevention of necrosis in burns. Ann Plast Surg 180:90

    Google Scholar 

  44. Beausang E, Floyd H, Dunn KW, Orton GI, et al (1998) A new quantitative scale for clinical scar assessment. Plast Reconstr Surg 102:1954

    CAS  PubMed  Google Scholar 

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Acknowledgements

These findings were presented at the 16th Congress of International Society of Aesthetic Plastic Surgery (ISAPS), May 2002, Istanbul, Turkey, and at the 13th Annual Meeting of European Association of Plastic Surgeons (EURAPS), May 30–June 1, 2002, Crete, Greece. We acknowledge the contribution of Maha Al-Farhan, MPhil, MBA, in tabulating the data and performing the statistical analysis.

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Authors and Affiliations

  1. Division of Plastic and Reconstructive Surgery, American University of Beirut, Beirut, Lebanon

    B. S. Atiyeh, C. A. Al-Amm, K. A. El-Musa & A. Sawwaf

  2. Drug Research Center, Dubai, UAE

    R. Dham

Authors
  1. B. S. Atiyeh
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  2. C. A. Al-Amm
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  3. K. A. El-Musa
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  4. A. Sawwaf
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  5. R. Dham
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Correspondence to B. S. Atiyeh.

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Atiyeh, B.S., Al-Amm, C.A., El-Musa, K.A. et al. The effect of moist and moist exposed dressings on healing and barrier function restoration of partial thickness wounds. Eur J Plast Surg 26, 5–11 (2003). https://doi.org/10.1007/s00238-002-0460-y

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  • DOI: https://doi.org/10.1007/s00238-002-0460-y

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