A Comprehensive Solution for Wound Management in Skin Grafting Procedures: Transforming Powder Dressing

Introduction: Skin grafting is critical for treating severe skin defects and chronic wounds1, particularly those resulting from burns, trauma, and infections. Effective strategies in preparation for grafting, graft fixation, and donor site coverage are essential for the success of grafting procedures. Traditional methods like negative pressure wound therapy (NPWT), graft bolstering or other conventional dressings2 often involve significant discomfort3 and frequent dressing changes, which can limit their effectiveness.Methods:The efficacy of Transforming Powder Dressing (TPD) was evaluated by reviewing published case studies and a randomized clinical trial where TPD was utilized in skin graft procedures (pre-grafting, post- grafting and donor sites). 4,5,6,7   TPD, an extended wear powder dressing comprised of biocompatible polymers similar to those used in contact lenses, transforms on hydration to provide a moist, oxygen permeable barrier that covers and protects the wound.Results:Preparation: Three case studies with large complex wounds failing to progress with NPWT and other standard of care (SOC) were converted to TPD. Wounds were ready for grafting by days 18, 70 and 18. Marked acceleration of granulation was observed in all three cases, patients reported reduced pain, and there were reduced dressing changes compared to SOC.    Graft Fixation: In a series of eight patients TPD was utilized to secure split-thickness skin grafts (STSG) and bio-engineered substitutes without the need for bolstering, NPWT, sutures, staples or glues or with reduced peripheral sutures. TPD stabilized the graft site by preventing fluid buildup and simplified post-operative care, particularly in non-surgical settings.   Donor Site Coverage: In a randomized prospective study comparing TPD to a silver-containing carboxymethylcellulose dressing (CMC-Ag) at STSG donor sites in 19 burn patients, TPD resulted in statistically significantly less pain at three different time points (2-5 days, 6-10 days, and 11-15 days; p 0.001) and greater comfort. No complications were observed.  Discussion: TPD presented a safe, effective and comprehensive solution in skin graft procedures by optimizing the wound environment and granulation tissue prior to grafting, simplifying graft fixation and enhancing donor site management. A reliable and less invasive alternative to traditional methods, TPD is a valuable tool in both surgical and clinical settings.  References:1. Kirsner, R. S., Bernstein, B., Bhatia, A., Lantis, J., Le, L., Lincoln, K., Liu, P., Rodgers, L., Shaw, M., & Young, D. (2015). Clinical Experience and Best Practices Using Epidermal Skin Grafts on Wounds. Wounds : a compendium of clinical research and practice, 27(11), 282–292. 2. Harries, R. L., Bosanquet, D. C., & Harding, K. G. (2016). Wound bed preparation: TIME for an update. International wound journal, 13 Suppl 3(Suppl 3), 8–14. 3. Upton, D., & Andrews, A. (2015). Pain and trauma in negative pressure wound therapy: a review. International wound journal, 12(1), 100–105. 4. Eldridge, K. E.; Gleaves, J. M. (2009) “A new treatment in Mesh Skin Graft Procedures Using a Novel Powder Dressing for Clipless, Sutureless, Skin Graft Fixation” Poster Presentation, Society for Advanced Woundcare Meeting, Grapevine, Texas. *Altrazealtm Transforming Powder Dressing 5. Assadian O, Arnoldo B, Purdue G, Burris A, Skrinjar E, Duschek N, Leaper DJ. A prospective, randomised study of a novel transforming methacrylate dressing compared with a silver-containing sodium carboxymethylcellulose dressing on partial-thickness skin graft donor sites in burn patients. Int Wound J. 2015 Jun;12(3):351-6. doi: 10.1111/iwj.12136. Epub 2013 Aug 6. PMID: 23919667; PMCID: PMC7950751 6. Saxe, J.M. Mabrouh, M. “A Novel Pre-Grafting Wound Management Technique to Promote Granulation in Complex Painful Wounds” WOCNext 2022 Meeting, Fort Worth, TX, June 5-8, 2022 7. Martin, B.D. “Comparison in management of large, open combat wounds in service personnel using negative pressure wounds therapy as standard of care and a novel powder dressing”. 2009 SAWC Meeting Grapevine, Texas