مقايسه سه روش پانسمان با آجي‌كوت، مپي‌تل و گاز وازلين در سرعت ترميم و اسكار باقي‌مانده در محل دهنده پيوند پوست نيمه ضخامت در بيماران سوختگي

Comparison of the three dressing methods on the speed of repair and remaining scar on partial-thickness skin graft donor sites in burn patients

زمينه و هدف: ترميم سريع نواحي اهداكننده پوست در پيوند پوست نيمه ضخامت در بيماران سوختگي اهميت حياتي براي بيمار دارد. هدف مطالعه‌ي حاضر بررسي اثر پانسمان‌هاي نانوسيلور در افزايش سرعت ترميم و كاهش عوارض در زخم‌هاي غيرعفوني محل اهداكننده پيوند پوست بوده است. روش بررسي: اين مطالعه كارآزمايي باليني روي 10 بيمار سوختگي مراجعه‌كننده به بيمارستان شهيد مطهري تهران از مهر تا اسفند 1396 انجام شد. محل دهنده پيوند پوست در هر بيمار به‌طور تصادفي به سه قسمت تقسيم و با آجي‌كوت (Agicoat)، مپي‌تل (Mepitel) و گاز وازلين پوشانده شد. سپس زخم‌ها از نظر سرعت ترميم، درد هنگام پانسمان و اسكار به‌جا مانده در اين سه گروه ارزيابي و مقايسه شدند. يافته‌ها: ميانگين مدت زمان ترميم در دو گروه آجي‌كت و مپي‌تل مشابه و به‌طور معناداري نسبت به گروه وازلين كوتاه‌تر بوده است (0/005P=). مقايسه‌ي درد بين گروه‌ها نشان داد كه در روز چهارم ميانگين درد در گروه آجي‌كت و مپي‌تل نسبت به گروه وازلين به‌طور معناداري كمتر بوده است (0/004P=). همچنين ميانگين درد گروه مپي‌تل نيز نسبت به گروه وازلين با اختلاف معناداري كمتر بوده (0/002P=) اما تفاوت از نظر مدت زمان ترميم و درد بين دو گروه آجي‌كت و مپي‌تل معنادار نبوده است. مقايسه‌ي ميانگين درد در روز هشتم و ميانگين Visual analogue scale (VAS) شش ماه پس از پيوند بين گروه‌ها اختلاف معناداري نشان نداد. نتيجه‌گيري: زخم پوش آجي‌كوت در كاهش درد و افزايش سرعت ترميم مؤثر بوده ولي اين اثر مشابه پانسمان بدون نقره مپي‌تل بوده است.

Background: Rapid repair of skin donor sites in partial-thickness skin grafts in burn is critical to the patient. Severe pain during dressing change and scarring also reduce the quality of life and treatment. Recently, nano-silver particles are available which have a high surface to volume ratio and remain effective even at a very low concentration and minimize the chance for tissue toxicity due to silver. Our aim in this study was to evaluate the effect of nano-silver dressings on increasing the rate of repair and reduction of complications in non-infectious wounds of skin graft donor sites. Methods: This was comparison study that involved patients admitted to a single-center burn unit who required a skin graft donor site. 10 burn patients with thermal injury and 10-30% of total body surface area (TBSA) who referred to Shahid Motahari Hospital, Tehran, in 2016 were studied. Each patient was compared to herself. After anesthesia, the site of the skin graft was randomly divided into three sections in each patient and was covered with Agicoat®, Mepitel and vaseline gauze. On the 4th and 8th of the day, the pain was recorded during the dressing change on the basis of the visual analogue scale (VAS). After 6 months, the patients were evaluated for the remainder of the scars based on VSS (Vancouver scar scale). Results: The mean time to repair in both groups were similar and significantly shorter than that of vaseline (P=0.005). The pain comparison between groups showed that on the fourth day, the mean pain in the Agicoat group and Mepitel was significantly less than the Vaseline group (P=0.004). Also, the mean pain of the epileptic group was significantly lower than that of the Vaseline group (0.002). However, there was no significant difference between the duration of regeneration and pain between the two groups of Agicoat and Mepitel, but there was no significant difference between the mean pain on the 8th day and the mean VAS 6 months after the graft. Conclusion: Agicoat dressing has been effective in reducing pain and increasing the repair speed, but this effect was similar to that of the silver-free Mepitel dressing. Expensive silver nano-crystal dressings limit their use. The silver nanocrystal did not have much effect on improving the remaining scar. However, more studies are needed in this regard.