Comparison of skin graft donor site management using oxidised regenerated cellulose (ORC)/collagen/silver-ORC with absorptive silicone adhesive border and transparent film dressing vs semi-occlusive dressings.

Split-thickness skin grafts (STSG) are widely used in wound reconstruction. However, donor site wounds are created as a result. Traditionally, moist wound healing and transparent film dressings have been used to promote donor site wound healing. This retrospective study evaluated the use of oxidised regenerated cellulose (ORC)/collagen/silver-ORC dressing (ORC/C/Ag-ORC) with an absorptive silicone adhesive border dressing and transparent film dressing (treatment) compared with petrolatum-based gauze dressing (control) over donor site wounds. Patients underwent an STSG procedure between January and December 2020. Donor sites received treatment (n = 10) or control (n = 10) dressings. Dressing changes occurred as necessary. Time to epithelialisation, narcotic pain medication requirements, and the number of office/hospital visits were examined. Twenty patients were managed (9 males, 11 females, average age: 49.7 ± 13.9 y). Patient comorbidities included hypertension, diabetes, and hyperlipidemia. Wound types included traumatic and cancer excision. Time to epithelialisation was significantly reduced in the treatment group (11.1 ± 1.4 d vs 18 ± 2.4 d, P < 0.0001). The number of office visits for dressing changes was significantly lower in the treatment group (0.1 ± 0.3 vs 2 ± 0.7, P < 0.0001). No patients in the treatment group required a hospital visit, compared with 3 patients in the control group. One patient in the treatment group required narcotic pain medication, compared with 5 in the control group. In this patient population, the use of ORC/C/Ag-ORC, an absorptive silicone adhesive border dressing, and transparent film dressing resulted in a shorter time to epithelialisation and less analgesic requirement compared with petrolatum-based gauze dressing use.

Use of oxidised regenerated cellulose/collagen dressings versus standard of care over multiple wound types: A systematic review and meta-analysis.

Oxidised regenerated cellulose (ORC)/collagen dressings help maintain physiologically moist wound environments conducive to wound healing. While evidence supporting ORC/collagen dressing use exists, comprehensive assessment is needed. This systematic review/meta-analysis evaluated the performance of ORC/collagen dressings compared with standard dressings. A systematic literature search was performed using PUBMED, EMBASE, and QUOSA Virtual Library. Published studies and conference abstracts were assessed between 1 January 1996 and 27 July 2020. Comparative studies in English completed by 31 December 2019, with a study population ≥10 were included. Patient demographics, wound healing, and protease concentrations were extracted. A random-effect model was used to assess the effect of ORC/collagen dressings. Twenty studies were included following removal of duplicates and articles not meeting inclusion criteria. A statistically significant effect in favour of ORC/collagen dressings was found for wound closure (P = 0.027) and percent wound area reduction (P = 0.006). Inconclusive evidence or limited reporting prevented assessment of time to complete healing, days of therapy, number of dressing applications, pain, matrix metalloproteinase, elastase, plasmin, and gelatinase concentration. Statistically significant increase in wound closure rates and percent wound area reduction were observed in patients receiving ORC/collagen dressings compared with standard dressings in this systematic review/meta-analysis.

Comparing Negative Pressure Wound Therapy with Instillation and Conventional Dressings for Sternal Wound Reconstructions.

BACKGROUND: Muscle flap reconstruction has become a mainstay of therapy following treatment of sternal wound complications; however, success depends on removing wound exudate and infectious material from the wound before reconstruction and closure. Importantly, time to closure is a key factor affecting morbidity/mortality and cost-to-treat for this wound type. METHODS: A retrospective analysis of 30 patients who were treated for sternal wound complications between June 2015 and October 2017 was performed. After surgical debridement, group 1 patients (n = 15) received negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d), instilling 1/8-strength Dakin's solution with a 20-minute dwell time followed by 2 hours of NPWT (-125 mm Hg); group 2 patients (n = 15) were treated with wet-to-moist dressings soaked in 1/8-strength Dakin's solution. After muscle flap reconstruction and closure with sutures, group 1 patients received closed incision negative pressure therapy, and group 2 patients received Benzoin and wound closure strips. Data collected included time to closure, therapy duration, number of debridements/dressing changes, drain duration, and complications. RESULTS: There was a significantly shorter time to closure (P < 0.0001) for group 1 when compared with group 2. In addition, there were fewer therapy days (P = 0.0041), fewer debridements/dressing changes (P = 0.0011), and shorter drain duration (P = 0.0001) for group 1 when compared with group 2. CONCLUSIONS: We describe a novel regimen consisting of adjunctive NPWTi-d, along with debridement and systemic antibiotics, followed by closed incision negative pressure therapy after muscle flap reconstruction and closure, to help manage preexisting sternal wounds that had failed to close following a previous cardiac procedure.

Use of oxidized regenerated cellulose (ORC)/collagen/silver-ORC dressings to help manage skin graft donor site wounds.

Harvesting donor site explants for split-thickness skin grafting creates an iatrogenic wound that presents additional challenges to clinicians due to morbidities such as persistent bleeding, pain, infection, and delayed epithelialization. Although there have been several randomized controlled trials to compare wound dressing effectiveness, there is still a lack of standardization for donor site wound dressings. A retrospective comparison of 59 patients that underwent split-thickness skin graft reconstructions between January 2017 and September 2018 was performed. Donor sites of Group 1 patients (n = 29) were treated with a transparent film dressing and transitioned to petrolatum gauze dressings if exudate management became problematic; Group 2 patients (n = 30) were treated with oxidized regenerated cellulose/collagen/silver-oxidized regenerated cellulose (ORC/C/Ag-ORC) dressings. Evaluations of time to epithelialization, number of dressings required, signs of inflammation, and objective pain were compared between groups. Group 1 was comprised of 18 female and 11 male patients, whereas Group 2 was comprised of 14 females and 16 males. There were no significant differences between groups when comparing age, sex, comorbidities, or donor site size (area or depth). Patients in Group 2 had a significantly shorter time to complete re-epithelialization (P < .0001), fewer dressing changes (P < .0001), and less objective pain as measured by the need for opioid pain mediation (P < .0001) when compared to Group 1. The percentage of patients with signs of inflammation was also lower for Group 2, although this difference was not statistically significant (P = .0797). Although prospective, controlled studies are still needed, data from this study suggest that ORC/C/Ag-ORC dressings could become a more effective alternative for the management of donor site wounds, especially in patients with known risk factors for wound healing.

Inpatient and Outpatient Wound Treatment Recommendations: Assessing Use of Negative Pressure Wound Therapy Systems or Oxidized Regenerated Cellulose (ORC)/ Collagen/Silver-ORC Dressings.

The increase in wound prevalence means more patients with wounds are being transferred through care settings than ever before. Although the goals of therapy may be the same in both settings, wound care therapies and dressings differ in availability and appropriateness for each setting. Negative pressure wound therapy (NPWT) modalities and oxidized regenerated cellulose (ORC)/collagen (C)/silver-ORC dressings are available in both inpatient and outpatient care settings, but (to-date) lack comprehensive information regarding best practices in transitioning use of these therapies between various care settings. A panel meeting was convened to provide literature- and experience-based recommendations in transitioning wound care patients between various care settings. The use of NPWT with instillation and dwell time was recommended in wounds contaminated with debris and/or infectious materials or heavy exudate. In addition, ORC/C/silver-ORC dressing application was recommended for surface bleeding and for placement into explored areas of undermining to help promote development of granulation tissue. When transitioning a patient from inpatient to outpatient care, overall health, access to services, severity and complexity of the wound, and equipment availability should be taken into consideration. Treatment modalities to bridge the gap during care transition should be used to help maintain continuous care. For outpatient care, NPWT use was recommended for removal of infectious materials and exudate management. The ORC/C/silver-ORC dressings also may be used to help manage exudate and promote granulation tissue development and moist wound healing. In addition, practice challenges and potential solutions for patient adherence, interrupted care during patient transition, and troubleshooting after hours and weekend device alarms were discussed.