Biomedical subjects
W Hansbrough
Publications and source records attributed to W Hansbrough.
The use of biobrane II and specialty airflow beds (FluidAir Plus and Kinair for effective coverage of extensive posterior donor site wounds.
Posterior skin graft donor sites furnish large areas of skin for wound coverage, but the sites frequently are management problems. The wounds tend to become moist and to develop excessive drainage and fluid accumulation that may interfere with adherence of dressings, including our preferred donor site dressing, Biobrane II (red label, large pore). We studied the use of specialty airflow beds for improving the outcome of posterior donor sites. We evaluated 50 patients aged 1 to 69 years (mean 29.45 years) with posterior skin graft donor sites of the back, thigh, or buttocks that were covered with Biobrane II. Sites ranged in size from 3% to 13% body surface area (mean 8.34%). Forty patients were placed on a FluidAir Plus bed, and 10 were placed on air-filled pillow therapy beds (five on KinAir III, five on Therapulse) (Kinetic Concepts, Inc.) All patients were kept in the supine position. We evaluated six criteria: drainage, fluid accumulation under Biobrane, infection, days until Biobrane separated, days until epithelialization, and days of specialty bed usage. We related these criteria to nursing-care actions that interfere with airflow and prevent the drying action of the bed, such as use of a "linen saver" under the patient in the area of the donor site, a foam wedge under the back, and dressings applied over the Biobrane. Most donor sites had no complications. Donor site infections developed in six patients. Five of these patients had fluid accumulation under the Biobrane, necessitating early removal. Fluid accumulated under the Biobrane in 21 patients; nine of these incidences were related to a nursing-care action that impeded airflow.(ABSTRACT TRUNCATED AT 250 WORDS)
Nursing care of donor site wounds.
The list of ideal donor site characteristics includes many items related to nursing care such as the ability of the dressing to minimize pain, permit patient mobility, and simplify postoperative care. Biobrane must adhere to the donor site wound bed and be allowed to dry without fluid accumulation. Coarse-mesh gauze wraps applied over the Biobrane in the operating room help maintain contact between Biobrane and the wound bed, protect the donor site from traumatic dislodgment in the early postoperative period, and serve to wick wound drainage in the first 24 hours. Twenty-four hours after surgery the nurse removes the outer dressing. The Biobrane is usually adherent to the wound, and the site is left open to dry. The primary goal of nursing care is to maintain sufficient airflow around the site. Nursing care of Biobrane-covered donor sites is uncomplicated but requires adherence to certain procedures to promote optimal donor site healing.
Management of skin-grafted burn wounds with Xeroform and layers of dry coarse-mesh gauze dressing results in excellent graft take and minimal nursing time.
The goals of postoperative treatment for split-thickness skin grafts (STSGs) are to maintain graft integrity, prevent graft and wound desiccation, and minimize infections. As we documented in a telephone survey of 16 burn centers, dressings for skin grafts usually consist of multiple layers of coarse-mesh gauze; the dressings receive frequent applications of aqueous solutions that contain antimicrobial agents to control bacterial growth and to maintain a moist environment at the wound surface. We prospectively studied the efficacy of our standard dressing of one layer of Xeroform (Kendall Inc., Mansfield, Mass.), which consists of fine-mesh gauze impregnated with bismuth tribromophenate, applied to the STSG surface followed by layers of dry gauze dressings wrapped in Kerlix (Kendall Inc.); the entire dressings were left intact until postoperative day 5. We evaluated 142 STSGs on 100 patients, mean age 29.2 years (range 0.3 to 79 years), with burns of 0.5% to 60% total body surface area (mean 9.1%). Meshed or sheet STSGs of 0.5% to 18% total body surface area (mean 3.14%) were placed on deep partial- or full-thickness excised wounds. Xeroform, followed by coarse-mesh gauze dressing, was applied after skin grafts were completed. The entire dressing was left intact until the initial takedown-to-graft at 5 days. Patients' grafts were evaluated on postoperative day 5 for the percentage of "take" and subgraft fluid collected; this evaluation was then repeated every other day for 10 days. On postoperative day 5 evaluations, mean skin graft take in all patients was 98.54% +/- 0.72%. Xeroform and coarse-mesh gauze dressings used to cover STSGs and left intact for 5 days until the initial dressing change, resulted in highly successful graft outcomes, with minimal postoperative nursing care compared with other dressing methods for skin grafts.