Dear Readers:

     How would you dress a wound if you were in a setting without “modern” wound care? A MEDLINE search found evidence of moist wound healing (MWH) alternatives from countries with limited resources that reduce pain, healing time, or costs of care when compared to gauze or other alternatives. Though more sufficient randomized controlled trials (RCTs) are needed, this evidence merits consideration. Moist wound healing alternatives explored in controlled clinical studies include banana leaves,¹ boiled potato peels,¹ honey,² plastic food wrap,³ or amniotic membranes.² Practitioners in settings with reimbursement challenges or limited access to “modern” dressings may wish to test this evidence for MWH alternatives that improve both patient comfort and healing time in their own settings. The discovery of MWH has stimulated wound care innovation for more than 200 years.⁴ This Evidence Corner highlights the innovative contributions of clinical practitioners who have responded to challenging resource limitations by deriving their own evidence-based MWH modalities to improve patient outcomes.

     Laura Bolton, PhD, FAPWCA
     Adjunct Associate Professor
     Department of Surgery, UMDNJ
     WOUNDS Editorial Advisory Board Member and Department Editor

Banana Leaf Dressing or Vaseline Gauze?

     Reference: Gore MA, Akolekar D. Banana leaf dressing for skin graft donor areas. Burns. 2003;29(5):483–486.

     Rationale: Petroleum jelly or Vaseline® impregnated gauze (VG) is the most commonly used dressing for skin graft donor sites, but it often adheres to wounds causing patients significant pain and anxiety. Banana leaves are large, economical, nonadherent, and plentiful as a wound dressing option.

     Objective: Conduct a controlled trial to compare efficacy of banana leaf dressings (BLD) with VG dressing for use on skin graft donor sites.

     Methods: A prospective, controlled, same-patient controlled study at a Malaysian Hospital compared split-thickness skin graft donor site healing, ease of use, and pain using BLD or VG. Similar fresh donor site areas on each of the 30 patients were dressed with a BLD or VG and left in place for up to 8 days after surgery. The BLD consisted of a banana leaf pasted to bandage cloth with flour paste that was dried for 24 hours, rolled, packed into a paper bag, and autoclaved. Patients were blinded to the dressing on each site until the first dressing change, when a 0–10 visual analogue scale (VAS) was used to record patient-reported pain before and during dressing change. The VAS was also used to record clinicians’ ratings of ease of dressing removal. Qualified professionals recorded the day when BLD- and VG-dressed skin graft donor site areas were completely epithelized.

     Results: Donor site areas dressed with BLD epithelized completely in a mean of 8.67 days compared to 11.73 days in VG-dressed areas. Patients reported less pain with the BLD (1.1) in place than VG (9.47), and on BLD removal (0.97) than VG (6.9). Ease of BLD dressing removal was rated 1.1 compared to 9.53 with VG. All differences were statistically significant (P < 0.001).

     Authors’ Conclusions: BLD was less adherent and painful, easier to remove, and facilitated more rapid healing than VG. BLD was recommended for use on all skin graft donor sites.

Honey on Burn Wounds

     Reference: Wijesinghe M, Weatherall M, Perrin K, Beasley R. Honey in the treatment of burns: a systematic review and meta-analysis of its efficacy. N Z Med J.