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USAGE OF OCCLUSIVE BIOLOGICAL DRESSING IN
LOSSES OF CUTANEOUS SUBSTANCE
SAULO MONTENEGRO, LAURENCE CÉSAR DE SOUZA, HERMES GALVÃO
DE SÁ FILHO
PLASTIC SURGERY SERVICE OF UNIVERSITARY HOSPITAL LAURO WANDERLEY, UFPB
RBC, 1996
Original report original language + English translation
-ENGLISH TRANSLATIONUSAGE OF OCCLUSIVE BIOLOGICAL DRESSING IN LOSSES OF CUTANEOUS
SUBSTANCE
SAULO MONTENEGRO*, LAURENCE CÉSAR DE SOUZA**, HERMES GALVÃO DE SÁ FILHO
Work made in the Plastic Surgery Service of Universitary Hospital Lauro Wanderley, UFPB.
(*) Assistant of the Plastic Surgery Service of Universitary Hospital Lauro Wanderley, UFPB. Associated member of
the Brazilian Society for Plastic Surgery.
(**) Assistant of the Plastic Surgery Service of Universitary Hospital Lauro Wanderley, UFPB.
Introduction
Various substances have been used as protective agents for cutaneous lesions characterized by the
loss of skin. With this goal there are records of the application of fresh sugar cane and honey in
ancient times (Herbs - about 1500 a.C.). Currently, several materials such as self skin grafts,
different films, plastics and pigskin were already used in the skin grafts.
Although an ideal substitute hasn't been found yet, its characteristics were already determined:
1) Adherence
2) Permeability to water steam
3) Durability
4) Bacterial barrier
5) Not magnetic
6) Haemostatic
7) Easy application and handling
8) Low cost
The skin substitutes available today can fulfil some of these requirements but are insufficient on
others.
Our study will show the experience made by the Service of Plastic Surgery of the Universitary
Hospital Lauro Wanderley in the Federal University of Paraíba (UFPB), Brazil, using the
emicellulose film VELODERM. The film was developed in the Laboratory of Pharmaceutical
Technology of UFPB as a biological dressing of fourth generation for second degree burns, skin
abrasions, trophic ulcers, skin graft donor sites and skin substance loss and cellular subcutaneous
tissue.
Materials and Methods
The VELODERM is made from a biological film with polymeric structure of 0,8 mm thickness and
constituted by carbohydrates. Its chemical polysaccharide composition structured in chains linked
by glucose monomer bridges gives to VELODERM the characteristics of the human skin:
translucent, thickness, flexibility and density.
VELODERM permeability is associated with the dimensioning of its porosity that allows the exit of
water steam and systemic exchange of gas.
The hemicellulose film create an ideal microenvironment suitable for granulation and reepithelization of the injured skin, since it is organically compatible with the properties of the human
skin and shows low solubility in aqueous medium.
The film has an excellent adherence in the injured areas making a barrier that prevents bacterial
contamination, improving sensibly the pain due to the isolation of nervous terminations of the
wound.
With its easy handling it is placed in the affected areas without further discomfort for the patient.
The areas that will receive the film must be strictly cleansed with physiological serum.
The films were applied over the entire lesion extending until 1 cm beyond the border of the injury.
After the application, the air bubbles were removed with the aid of pliers, gauzes or fingers in
circular movements. After application, the areas were covered with dry gauzes and bandages aiming
to protect them from abrupt moves or frictions during the manipulation and transportation of the
patient. This dressing is temporary and usually kept until the aesthetical recover. In cases of
children and articulation areas we kept the dressings for 24 hours. It can be used also the dressing
exposed.
In 2nd degree burns and in skin graft donor site the scab formed by the film has spontaneous
liberation, which occurs between the sixth and the fifteenth day after the application. On more
superficial wounds the scabs are withdraw around the eighth day. In the trophics ulcers of inferior
limbs the film is removed when there is the indication for application of definitive skin or is it is
removed at complete healing.
The film was applied to 48 patients with second-degree burns; skin graft donor sites, trophic ulcers
of lower members.
a) 2nd DEGREE BURNS 34 patients were treated. Some patients showed small burns; others have
the majority of the corporal area with several wounds different for depth and anatomic region. After
removing bubbles and cleansing, the film was applied in a period of time between 1 and 10 hours
after the burning.
b) SKIN GRAFT DONOR SITES Ten patients were treated and one of them had a wide area to be
covered. This patient was a victim of car accident (run over by a car). It was used an exposed
dressing (case 2) after the fifteenth day of application.
c) TROPHIC ULCER OF INFERIOR LIMBS Out of the four patients, three showed extant ulcers
and one ischemic ulcer. In the days following the application, the local aspect was monitored
without removing the film.
Results
a) 2nd DEGREE BURNS
It was observed pain reduction, some patients showed relief of a temporary stinging in the place of
application. In four patients there was formation of bubbles with secretion. The presence of
Staphylococcus aurous was identified after the culture. The bubbles were removed and after
cleansing a new film was applied. The average period in the recovering of the patients with the fall
of scabs was 13 days.
b) SKIN GRAFT DONOR SITES
There weren’t difficulties in the application and maintenance of the film over the Skin graft donor
sites. No patient complained of intense pain in the place of application. The healing occurred in an
average period of 10 days.
c) TROPHIC ULCER OF INFERIOR LIMBS
In one of the cases there was the formation of bubbles in series, and a proper and sterilized device
was used to break it allowing to remove the secretion. The analysis of the exudates didn't show
bacterial growing. The average time for the healing of the wounds was 30days.
Discussion
In all cases, the basic injury was the partial loss of skin, although caused by different agents, in
different anatomic region and in different condition of patients.
The low elasticity of the film was underlined mainly in areas of great mobility but such difficulty
was overcame by applying the VELODERM in the form of "stamps", giving more adherence to the
area of reception allowing the checking of accumulated secretions.
Except for trophics ulcers of inferior limbs it was seen that the healing time was very short allowing
a quick recover in comparison with the materials currently available on the market.
The hospitalization costs for cases of trophics ulcers of inferior limbs were reduced of 25% because
with the use of VELODERM it wasn't necessary to make aggressive expensive surgical
proceedings. This fact shows that VELODERM is a good temporary substitute of the skin.
Conclusion
Considering that one of the goals of this study was to verify if the hemicellulose film gave any
advantage in the treatment of tissue losses, in comparison with other methods of treatment, we
concluded that VELODERM was efficient in this study.
Summary
The authors analysed the experience of the Service of Plastic Surgery of the Universitary Hospital
Lauro Wanderley in the Federal University of Paraíba with the hemicellulose film VELODERM,
used as fourth generation biological dressing in 48 cases. The film was used in second-degree
burns, skin graft donor sites and trophic ulcers of inferior limbs.
Key words: Temporary skin substitute
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