Original Research Article
Year: 2017 | Month: December | Volume: 7 | Issue: 12 | Pages: 63-67
Comparison of the Nanocrystalline Silver (NCS) Dressing Over Paraffin Gauze Dressing on Split-Thickness Skin Graft Donor Site
Budhi Nath Adhikari 1, Sushma Khatiwada 2
Name of the Institution (research) = Tribhuwan University Teaching Hospital (TUTH), Maharajgunj, Kathmandu, Nepal
1Consultant Plastic Surgeon, at Chitwan Medical College, Bharatpur-10, Chitwan, Nepal
2Lecturer of Clinical Anatomy at Chitwan Medical College, Kailashnagar, Chitwan, Nepal
Corresponding Author: Budhi Nath Adhikari
ABSTRACT
Background: Different dressing methods are used in split thickness skin grafting donor sites; none has a superior effect than other. The time tested paraffin gauze dressing is still preferred by many surgeons because it is easy available, cheaper and maintains moist environment; however the wound may get macerated, is prone for infection, is painful and takes longer time to heal. Nanocrystalline silver (NCS) method is one of the upcoming wound dressing technique with antimicrobial, pro-healing, and anti-inflammatory properties.
Methods: 76 patients planned for SSG were randomized into 2 similar groups to compare the healing time, pain and infection outcome of the conventional paraffin dressing to the newer NCS dressing. Diabetic patients or patients under analgesics or immunosuppressant, harvest for malignant ulcers and reharvests from previously used donor sites or defaulters were excluded from the study.
Results: 94.29 % cases healed by day 13 in NCS group whereas only 16.67 % cases in Paraffin group healed by day 13. However, 97.14 % cases healed by day 18 in NCS group whereas 88.9% cases in Paraffin group healed by day 18. Mean healing time in NCS group was 13.14 days (± 1.70) and 15.78 days (± 2.24) in Paraffin group which was highly significant (p <0.0000).
Although the mean pain score were consistently low on all assessment days in NCS group as compared to Paraffin group, it did not reach the level for statistical significance on any day of assessment. There was no infection in both the groups.
Discussion: Healing time of paraffin gauze dressing in our study is within the range (4 – 20 days) as described by previous authors. Quicker re epithelizaion rate with various silver and polyurethane dressing preparations as shown by various authors is consistent with our result. We used semi occlusive nano crystalline silver dressing to incorporate both their advantages.
Despite the plethora of new materials on the market, we are still using paraffin gauze dressings for donor site wounds. Even though the anti-inflammatory and antibacterial properties of nanocrystalline silver has been established since many decades, the fear of the yet unproved toxic effect of silver on healing wounds, cost factor and lack of direct comparing studies and recommendations has been the major factor for its infrequent use. We conclude that NCS dressing is a preferred dressing for split-thickness donor site areas over conventional paraffin gauze dressing. Our study may provide impetus for better future structured studies to formulate recommendations for donor site wound healing.
Key words: Donor Site, Paraffin gauze, Silver dressing, Nanocrystalline silver, Skin grafting, Re-epithelialization.