Microbial Cellulose Wound Dressing in the Treatment of Skin Tears in the Frail Elderly
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Abstract: In a randomized trial of predominantly category II and III skin tears in a population of frail elderly nursing home residents, standard wound care (24 residents) with Xeroform™ and a secondary dressing (Tegaderm™) was compared with a single application of a microbial cellulose membrane Dermafill (27 residents). Outcomes included the time to wound closure, pain reduction, and ease of use. While wound area was slightly larger in the microbial cellulose treated group, the healing time was equivalent to controls. However, pain control, ease of use, and patient and nursing staff satisfaction were superior to control with the use of the microbial cellulose wound dressing.
Address correspondence to:
Dennis J. Levinson, MD
2555 S. King Dr.
Chicago, IL 60616
Skin tears are painful, partial-thickness wounds that are a result of fragile dermal and epidermal attachment. An estimated 1.5 million skin tears occur annually in the institutionalized elderly in the United States.1 In a single urban long-term care facility, Malone and colleagues2 reported an annual incidence of 0.92 tears per patient with approximately 80% occurring in the upper extremity. In addition to advanced age, trauma, sensory and cognitive impairment, poor nutrition, immobility, and previous skin tears, are often cited as risk factors.3 Based on the category of tear, treatment can vary from surgical tape and nonadherent dressings to absorbent dressings such as hydrogel, foam, and nylon-impregnated gauze.4 Experts recommend the use of nonadherent dressings to minimize tissue trauma and pain when the dressing is removed.5 In this randomized study we report initial results on the use of a transparent semi-permeable, occlusive, microbial cellulose dressing derived from Acetobactor xylinum in the treatment of skin tears in a frail elderly population.
Materials and Methods
Fifty-one consecutive residents, who presented with skin tears during the trial period from a single nursing home, were randomly assigned to one of two treatment groups. The study was approved by the Institutional Review Board, and either the patient or a relative gave informed consent. To insure consistency in wound management, the nursing home staff were briefed on the skin tear treatment protocol and were given instruction on how to use the microbial cellulose dressing prior to the inception of the study. Upon identification of a new skin tear and assessment of the wound area, the wound was cleansed thoroughly with sterile saline and randomly assigned to either receive treatment with either microbial cellulose or a standard dressing, which consisted of Xeroform™ gauze (Covidien, Mansfield, MA) secured with a layer of Tegaderm™ (3M, St. Paul, MN) as a secondary dressing. The protocol was the standard of care in the facility. Standard dressings were changed every 3 days until fully epithelized. Microbial cellulose dressings were applied and covered with a protective stockinet. In most cases, only one application was required since the cellulose membrane adheres to the wound and biodegrades with epithelization. Wounds were inspected daily for loosening and drainage. The primary outcome was the time to complete wound closure. Pain management was evaluated using a numeric pain rating scale (VAS) where 0 represents “no pain” and 10 “worst possible pain.”
At the conclusion of the study, comparative data on ease of use and nursing satisfaction were assessed using a structured questionnaire. Statistical parameters included Student’s t-test with Levene’s test for normal distribution with ANOVA (SPSS, Chicago, IL).
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