Clinical Study of Nanofibrillar Cellulose Hydrogel Dressing for Skin Graft Donor Site Treatment

Abstract

Objective: Skin graft donor site management is a concern particularly for elderly patients and patients with poor wound healing competence, and also because donor sites are a source of pain and discomfort. Although different types of dressings exist, there is no consensus regarding optimal dressing type on donor site care to promote healing, reduce pain, and improve patients' comfort. Approach: This prospective, single-center clinical trial evaluated the performance of nanofibrillar cellulose (NFC) wound dressing (FibDex^® by UPM-Kymmene Corporation) for treatment of donor sites compared with a polylactide-based copolymer dressing. The study enrolled 24 patients requiring skin grafting with mean age of 49 ± 18. The primary outcome measure was wound healing time. Secondary outcomes, the epithelialization, subjective pain, the scar appearance assessed using the Patient and Observer Scar Assessment Scale (POSAS), and skin elasticity and transepidermal water loss (TEWL), were evaluated at 1 and 6 months postoperatively. Results: No statistically significant differences were observed between NFC and copolymer dressings regarding wound healing time, epithelialization, experience of pain, or TEWL. Significant differences were observed in the POSAS results for thickness and vascularity in the Observer score, in the favor of NFC over copolymer dressing. Moreover, skin elasticity was significantly improved with NFC dressing in terms of viscoelasticity and elastic modulus at 1 month postoperatively. Innovation: NFC dressing is a new, green sustainable product for wound treatment without animal or human-origin components. Conclusion: NFC dressing provides efficient wound healing at skin graft donor sites and is comparable or even preferable compared with the copolymer dressing.

Keywords: clinical study; nanofibrillar cellulose; patient; skin graft donor site treatment; wound dressing.

Raili Koivuniemi, PhD

Figure 1.

Flow chart of the clinical study. A total of 24 patients were enrolled in the study and were treated with NFC dressing, whereas 17 patients had an intra-individual comparison of NFC dressing and copolymer dressing. NFC, nanofibrillar cellulose; POSAS, Patient and Observer Scar Assessment Scale.

Figure 2.

The detachment of NFC dressing from the donor site. (A) An experienced staff gently removes the dressing when the material is able to be detached without breaking the newly formed skin. (B) The epithelialized skin graft donor site after detachment of NFC dressing.

Figure 3.

Wound healing time in days presented as mean (standard deviation). Indep., independent samples.

Figure 4.

Skin graft donor site treatment with NFC and copolymer dressings of patient 28. (A, B) The skin graft donor site in operation. A transparent NFC dressing was placed on the left thigh (A), and white copolymer dressing was placed on the right thigh (B). (C, D) POD 2. Both dressings were dry and well attached to the donor site. (E, F) POD 7. Dressings were still dry and attached. (G, H) POD 9. Small pieces of both dressings were detached from the edges. (I, J) POD 14. Both dressings detached on the same day (POD 14), revealing an epithelialized donor site. (K, L) POD 21. One hundred percent of NFC dressing-treated donor site was epithelialized, whereas the epithelialization percentage for the copolymer-treated donor site was 97%. POD, postoperative day.

Figure 5.

Skin graft donor sites after the treatment with NFC dressing on the left thigh (A) and the copolymer dressing on the right thigh (B) on the same patient on POD 28 after the detachment of the dressings (NFC on POD 15, copolymer on POD 17). Residual wounds were found on both donor sites.

Figure 6.

Epithelialization of the donor site skin at 1 and 6 months after treatment with NFC dressing and copolymer dressing.