Biological versus non-biological dressings in the management of split-thickness skin-graft donor sites: a systematic review and meta-analysis.

OBJECTIVE: There are currently no definitive guidelines regarding the management of split-thickness skin-graft (STSG) donor sites. The literature reports biological and non-biological dressings as the two main groups; however, there is no conclusive evidence regarding the ideal type. A systematic review and meta-analysis of existing clinical trials was performed to compare biological and non-biological dressings in managing STSG donor sites. METHOD: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards was used to conduct this study. Electronic databases including MEDLINE, Embase, CINAHL and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched by two authors (SR and BL). Data analysis was performed with RevMan 5.3. RESULTS: In total, 10 studies, consisting of eight randomised controlled trials and two observational assessments, were identified. Wound healing time was faster with biological dressings compared to non-biological dressings (mean difference -5.44 days; p<0.05). A higher epithelialisation rate was also noted for biological dressings. There was no difference in the infection rate between the two study groups (odds ratio [OR] 0.39; 95% confidence interval [CI] 0.15-1.04) or wound exudation (OR 0.31; 95% CI 0.01-8.28). The pain level experienced during dressing changes in both groups was reported to be similar. CONCLUSION: The rate of epithelialisation and wound healing is greater for STSG donor sites when treated with biological dressings, but they offer no difference in terms of reducing pain, limiting infection or exudation.

Assessing the complications and effectiveness of open carpal tunnel release in a tertiary care centre in a developing country.

INTRODUCTION: Open surgical release for carpal tunnel syndrome is not devoid of complications and its quantitative assessment with the Boston questionnaire in a developing country had not been conducted, where, lack of facilities and surgical technique can influence the outcome. PRESENTATION OF CASE: This was a prospective study in which all cases of carpal tunnel syndrome undergoing open release between June 2007 and June 2012 and who returned for follow up were included. Each patient was requested to fill out the Boston questionnaire twice both pre and post op at 3 months. All complications were recorded as well as bio-data of patients and co morbidities. Follow up was at 2 weeks and at 3 months. Those reporting complications at 3 months were further followed up until 6 months. 373 patients were included in the study. Twenty four patients developed complications. Of these, 12 experienced pain resulting from reflex sympathetic dystrophy. Three patients developed wound dehiscence, 2 cases acquired infections, 4 patients developed immediate post-operative haemorrhage and in 3 patients there was late recurrence of median nerve compression. The symptom severity score pre-operatively was 3.30 (±0.60) and it improved to 1.65 (±0.75) post-operatively indicating a significant change (p<0.0001). The preoperative functional status score was 2.58 (±0.75) and post-op it became 1.60 (±0.80) again implying a good improvement with an effect size of 1.3. DISCUSSION: All of the complications produced were well managed. The complication incidence was low. The open release procedure produced good improvement in hand function and in decreasing the symptom severity. CONCLUSION: Conducting open release for carpal tunnel syndrome in a tertiary referral centre in a developing country offers a good outcome.