BackgroundPressure garment therapy (PGT) is well accepted and commonly used by clinicians in the treatment of burns scars and grafts. The medium to high pressures (24–40 mmHg) in these garments can support scar minimisation, and evidence is well documented for this particular application. However, PGT specifically for burn donor sites, of which a sequela is also scarring, is not well documented. This study protocol investigates the impact of a low pressure (4–6 mmHg) interim garment on donor site healing and scarring. With a primary purpose of holding donor dressings in place, the application of the interim pressure garment (IPG) appears to have been twofold. IPGs for donor sites have involved inconsistent application with a focus on securing wound dressing rather than scar management. However, anecdotal and observational evidence suggests that IPGs also make a difference to some patient’s scar outcomes for donor sites. This study protocol outlines a randomised controlled trial designed to test the effectiveness of this treatment on reducing scarring to burn donor sites.Methods/designThis study is a single-centre, single (assessor)-blinded, randomised control trial in patients with burns donor sites to their thighs. Patients will be randomly allocated to a control group (with no compression to donor sites) or to an experimental group (with compression to donor sites) as the comparative treatment. Groups will be compared at baseline regarding the important prognostic indicators: donor site location, depth, size, age, and time since graft (5 days). The IPG treatment will be administered post-operatively (on day 5). Follow-up assessments and garment replacement will be undertaken fortnightly for a period of 2 months.DiscussionThis study focuses on a unique area of burns scar management using a low-pressure tubular support garment for the reduction of donor site scars. Such therapy specifically for donor scar management is poorly represented in the literature. This study was designed to test a potentially cost-effective scar prevention for patients with donor sites to the thigh. No known studies of this nature have been carried out to date, and there is a need for rigorous clinical evidence for low-pressure support garments for donor site scar minimisation.Trial registrationAustralian New Zealand Clinical Trials Registry identifier ACTRN12610000127000. Registered 8 Mar 2010.
Split Thickness Skin Grafting (STSG) is a well-known and established procedure for healing burn wounds throughout the world. The procedure requires the removal of the epidermal and part of the dermal layer of the skin. It leaves intact the deep reticular dermal layer which is known as the donor site, and has sufficient cells to regenerate the excised superficial layers. STSG provides wound closure and accelerated healing for the burn wound, and there is great importance surrounding the success of graft take and scar management thereafter (Demirtas et al, 2009; Atiyeh et al, 2002). The presence of donor sites, though created to assist healing of the burn site, in fact creates an additional wound for the patient which often causes further psychological stress at a traumatic time in the healing process (Andrews, Brown, Drummond, & Wood, 2010). Donor sites are consistently identified as a particularly painful wound by burn patients. Pain associated with burn surgery has been shown to delay the patients return to work and daily functional activity (Wisley et al, 2010; Druery et al, 2005; Brown et al, 2008). Thus, protection of the remaining epidermal and dermal elements of this surgical wound (donor site) is required to assist effective tissue healing with minimal scarring. One intervention that may accelerate healing and reduce scar formation is the use of Interim Pressure Garment Therapy (IPGT) which applies 4-6mmHg of pressure to the thigh. This treatment has been utilised at a major Australian burns unit in Queensland by Occupational Therapists. However, this has involved inconsistent application with a focus on securing wound dressing rather than scar management. Despite this, anecdotal and observational evidence suggests that pressure therapy also makes a difference to some patient's scar outcomes for donor sites. It is hypothesised that IPGT may improve postoperative management of donor sites through the application of a low superficial pressure that mimics normal skin tension, possibly preventing donor wound distension and subsequent micro-tears in the newly forming epidermis. Furthermore, this may reduce the effects of the inflammatory response, which may in turn give rise to a hypertrophic scar response in the later stages of the healing process. This research focuses on a unique area of burns donor site scar management. It is designed to test a low pressure tubular support garment as an intervention for the support of, and reduction of donor site scarring. No known studies of this nature have been carried out to date, suggesting there is a need for rigorous clinical evidence to support the use of these garments for donor site scar minimisation. Thereby, two studies were undertaken. The objective of the first study was to determine the pressure range (mmHg) applied by the Interim Pressure Garment Therapy (IPGT). Forty seven healthy adult volunteers were measured and fitted with a pair of Interim Pressure Garments (IPG). s33634065 ii | P a g e The garments were made onsite from a tubular knit material, simil...
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