Journal of Korean Burn Society absorption ratio in was 341.6±59.

3% in
Vol. 15, No. 1, 20-23, 2012 InofoamⓇ group and 349.0±41.8% in
MedifoamⓇ group. There were no significant
Comparison of InofoamⓇ and MedifoamⓇ differences in wound healing duration,
forDonor Site Dressing after Split Thickness swelling ratio, and pain score between the two
Skin groups (P＞0.05).

Graft in Burn Patients Conclusion: The present study shows that the
efficacy of a recently used polyurethane foam
Yong Hoon Son, M.D., Young Ho Jang, M.D., InofoamⓇ for donor site dressing is as
Ph.D.1,Hyun-Dong Chae, M.D.2, Im Hee Shin, effective as that of MedifoamⓇ. (J Korean
Ph.D.3, Sang Gyung Kim, M.D., Ph.D.4 and Mi Burn Soc 2012;15:20-23)
Young Lee, M.D., Ph.D.5 Departments of Burn
Surgery, 1Anesthesiology and Pain Medicine, Key Words: Dressing materials, Split thickness
Pureun Hospital Burn Center, Departments of skin graft, Wound healing
2Surgery, 3Medical Statistics, 4Laboratory
Medicine, Catholic University of Daegu School Intro
of Medicine, 5Department of Preventive
Medicine, Keimyung University School of After split-skin graft operation, donor area as

Medicine, Daegu, Korea. well as burn area causes pain and discomfort

to patient. If several skin graft operations are

Purpose: InofoamⓇ is a hydrocellular material
developed recently for wound dressing. In the
present study, the efficacy of InofoamⓇ for
donor site dressing after split thickness skin
graft (STSG) was evaluated and compared with
that of MedifoamⓇ.
required for wide burn area and if healing of
donor area is delayed, timely operation may
not be performed. Recently, the concept of
moist environment wound healing has been
introduced, which maintains wound under

moist condition, increases water vapor

Methods: The study was conducted on 15
permeability, prevents infection against
patients with third degree of burn underwent
STSG from Nov. 2011 to Feb. 2012. Donor bacteria invasion and growth, maintains
sites were divided into groups of InofoamⓇ proper temperature, helps absorb effusion,
and MedifoamⓇ. The duration of wound and accelerates epithelial cell growth 1.2).
healing, pain score and exudate absorption
For donor area dressing, hydro colloid
ratio were compared between the two groups.
material, hydro cellular material, and hydro
Results: The duration of wound healing time
was 10.7±2.2days in InofoamⓇ group, fiber material are used. Depending on each
10.5±2.0 days in MedifoamⓇ group (P＞0.05). agent, diverse effects are shown in terms of
On postoperative 1 day, the exudate healing period, pain, and cost 3-6). In the
meantime, wound contacting layer of hydro November 2011 to February 2012. Purpose of

polyurethane foam agent frequently used for the study was explained to patients and

donor area dressing, is structured of guardians for consent. In case of side effects

micropore to prevent wound healing factor or or stop request by patients or guardians, it

epithelization from progree into foam. was agreed to stop the study. For skin graft

MedifoamⓇ has a 20 μm of micropore, and operation, a necessary amount of skin was

InofoamⓇ a 200 μm 5,7). In this study, collected from two area with thickness of

healing period, osmotic fluid absorptivity, and 9/1,000 inch. According to foam agent used,

pain of donor area are compared by using it was classified into two groups: one group

MedifoamⓇ and InofoamⓇ after skin graft with InofoamⓇ (I group) and the other group

operation to investigate the effect of with MedifoamⓇ (M group). After collecting

structural difference between two hydro skin, two skin areas collected were

polyurethane foam agents on donor area calculated. InofoamⓇ (Won Biogen, Korea)

dressing. and MedifoamⓇ (Il Dong & Biopol, Korea)

were cut 1 cm wider in length and width than

Target and Method the collected skin, being weighed, and

covering donor area to be fixed by compress.

Targets were patients who received split-skin Every 24 hours two foam agent dressings

graft operation for burn of third degree were done and their weights were measured.

Effusion absorption rate of each agent was

calculated in percentage using agent weight

including effusion while removing dressing

based on the weight before dressing.

Besides, pain degrees of two area were

recorded with visual analogue scale, and

infection was observed visually. Pain degrees
and effusion absorption rates of two groups
were investigated and compared from first
day to 7th day of operation. When epithelial
cells of donor area were observed visually,
healing was judged to be finished so as to
stop and open the dressing. This time was
defined as a healing period. The comparison
between two groups was based on t-test,
the change in effusion absorption rate, and
pain based on repeated measured ANOVA
test. If P value is lower than 0.05, it was
judged that there was a significant difference.
The Result
Total 15 patients were targeted. No occasion
occurred that accompanied side effect or stop
request from a patient or guardian. Average
age of patients was 53.65±12.0 year, with 14
men and one woman. Donor areas were from
13 femoral regions, one abdomen, and one
side (Table1). Skin collecting areas of donor
area were 96.3±40.8 cm2 for 1 group, and
93.6±37.6 cm2.0 for M group separately. There
was no statistical difference between two
groups in skin collecting area and healing
period. No infection occurred in all two
groups. Effusion absorption rates of 1 group
and M group were 349.8±58.7% and 349.0±
41.8% separately on 1st day. Thus, there was
no statistical difference between two groups.
Afterwards, the rates decreased continuously
for 7 days to 180.4±38.8% and 202.5±37.7%
separately on 7th day, which showed no
statistical difference between two groups (Fig.
2). Visual analogue scales after dressing were
8.9±1.6 for 1 group and 9.1±1.5 for M group
separately on 1st day. Afterwards, the rates
decreased to 4.6±3.3 and 4.5±3.4 separately
on 7th day after operation, which showed no
statistical difference between two groups
during the whole period (Fig. 3).
Consideration
There are three kinds of dressing for split-skin
graft operation: open type, semi-closed type,
and closed type. Kilinç and others 8)
presented that the closed type was most
excellent in healing of donor area and pain
reduction after comparing three types of
donor area dressings. because the closed type
dressing prevented dehydration of donor area,
mechanical trauma, and extrinsic infection. In
addition, Previously used paraffin
dressing out of the closed dressing had
problems like wound area
epithelization delay, pain and scar9). These
days, moisture dressing with hydro colloid,
hyrdo cell, and hydro fiber agent are mainly
performed, which, it is known, maintains
wound as a moisture condition, increases
water permeability, prevents infection against
bacteria invasion and growth, maintains proper
temperature, and accelerates epithelial cell
growth 1.2).
For ideal conditions for donor area treatment,
first, donor area wound healing should be
accelerated, and, bleeding, pain, infection, and
hypertrophic scar should not occur 9). Besides,
pain should be minimized, control convenient,
cost versus effect be considered. Recently, for
donor area dressing, diverse
MedifoamⓇ, AllevynⓇ,AquacelⓇ, SuprathelⓇ,
and DuodermⓇ CGF are being used, and
many comparison studies on effects of these
agents have been reported. Among them,
MedifoamⓇ, a hydro polyurethane
agent, has been used for donor area dressing
after a long wound or split-skin
operation. MedifoamⓇ consists of triple layers:
a protection layer, an absorption layer and
wound contact layer. The protection layer
made of polyurethane film has an effect to
inhibit extrinsic infection
impermeability against water, bacteria and
microorganism. The absorption layer absorbs
effusion from wound to make
moistured wound. The wound contacting layer
made of non-adherent micropores lower than
diameter 20 μm, is structured to prevent
wound healing factor or epithelium into the
foam agent 5). Utility of MedifoamⓇ on
gauze donor area has been reported several times.
Clinical trial 3) revealed that healing period of
adhesion, MedifoamⓇ out of three foams (MedifoamⓇ,
AllevynⓇ, PolymemⓇ) was the shortest 11.8
days in average, and MedifoamⓇ obtained
excellent result in effusion absorptivity and
pain control. Besides, it was reported that, in
case of AllevynⓇ, one of hydro polyurethane
foam agents, a lot of blood coagulation on
the surface was distinctively observed and
epidermal cells were fallen during dressing
exchange. Besides, the comparison 5) between
MedifoamⓇ and the hydro fiber agent
AquacelⓇ showed that these two agents
could effectively be used for donor area
dressing in terms of healing period, pain and
convenient use. In the meantime, In case of
InofoamⓇ, one of hydro polyurethane foam
agents like agents, micropore size of its wound contacting
layer is 200 μm in average, less dense than
MedifoamⓇ, and maximum effusion
absorptivity is reportedly 400∼500% 7).
Besides, as the study on InofoamⓇ, a dressing
foam agent launched relatively recently, is rare, it is
intended to compare donor area dressing
graft effect of InofoamⓇ with the result with
MedifoamⓇ. This study showed there was no
difference in effusion absorption and pain
reduction effect in case of using InofoamⓇ
and MedifoamⓇ. In healing period, these two
due to groups were about 10 days similarly, which
indicated that both agents could be used for
donor area effectively. In the meantime, Akita
proper and others4) reported that comparison
between AllevynⓇ and the hydro gel agent
NuGELⓇ revealed healing period of AllevynⓇ
for donor area was shorter, but analogue scale
of AllevynⓇ was much higher. AquacelⓇ, a
hydro colloid polyer, reacts with effusion,
changes into gel state, maintains moisture
state of the wound, and minimizes trauma
during dressing exchange, with short healing
period and pain reduction compared with
gauze dressing 10). Besides, Aquacel AgⓇ, to
which nanocrystalline Ag is added, is used for
burn, diabetic foot ulcer, and traumatic wound
due to antibacterial effect against diverse
strains, used for several days without
exchanging dressing due to antibacterial effect,
with rapid epithelization and pain reduction
11-13). SuprathelⓇ, a synthetic copolymer
made of DL-lactide, trimethylenecarbonate
and ε-caprolactone, has high permeability to
oxygen and water, When adhered to the
wound, it becomes transparent, which facilitate
observation of wound healing process. Thus, it
is used for donor area treatment on two
degree burn or after split-skin graft, reducing
pain 14). Occasionally, DuodermⓇ CGF, a
hydro colloid agent, is used, which is known to
react with wound effusion into gel, to provide
moist environment of pH 4.7, to maintain low
oxygen partial pressure on the wound surface,
to accelerate blood vessel creation and
collagen synthesis for epithelization 6).
However, in case of donor area dressing, a lot
of effusion comes out and effusion leak or
offensive odor may occur. Accordingly, the
need for frequent dressing exchanges is a
disadvantage 15). Conclusively, this study
result showed that in case of InofoamⓇ used
for recent clinic for donor area dressing after
split-skin graft operation for burn patients,
healing period, effusion absorptivity, and pain
were similar to those in case of MedifoamⓇ
used previously, the difference depending on
micropore size of wound contacting layer did
not appeared. It seems that both two agents
are suitable for donor area dressing.
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