A randomised clinical trial comparing a hydrocolloid-derived dressing and glycerol preserved allograft skin in the management of partial thickness burns

Abstract

Membranous dressings for the treatment of partial and mixed thickness burns are among the most innovative and promising new developments of the last years. In this study, we present data of a randomised prospective comparative study on a carboxymethylcellulose based dressing, Hydrofibre ® and glycerolized human allograft skin. In a 2 year period, 80 patients (40 for each material) were enrolled in the trial. Study wounds (<10% TBSA) that had not re-epithelialised after 14±3 days were debrided and grafted or, if small enough, managed with a topical antimicrobial agent. Mean total TBSA was 8.3±5.2%, study burn 3.7±2.0% for the Hydrofibre ® group and 7.3±4.3% total, 3.4±2.1% study burn for the allograft skin group (n.s. Wilcoxon rank sum test). No significant differences between groups were established in number of patients with superficial/deep burns. In both groups about 2/3 of the patients healed completely with the dressings applied (24/40 versus 27/40 for Hydrofibre ® versus allograft skin, respectively). However, a higher incidence of post-study excision and grafting was found in the Hydrofibre ® group (45% versus 15% in the allograft skin group, P=0.004, Mann–Whitney). At 10 weeks follow-up no significant differences were seen in scar colour, pigmentation, pliability, height or itching (Vancouver Scar Scale). Skin elasticity, measured by the Cutometer ®, was significantly better for the allograft group ( P=0.010, Wilcoxon). These differences were no longer found at 6 months and 1 year follow-up. Incidence of hypertrophy after 6 months was higher, but not significantly, in the Hydrofibre ® compared to the allograft skin group (52.5% versus 30%, P=0.09, chi-square). In view of the results from our comparative study on Hydrofibre ® versus allograft skin, we prefer the use of allograft skin for the category of larger burns of mixed depth, usually presented to burn centres. However, for partial thickness and small burns Hydrofibre ® can be the first choice in treatment.