Comparative Analysis: Five Articles on Wound Dressing Effectiveness

This report provides a comparative analysis of five research articles focusing on wound healing and scar quality, specifically evaluating the effectiveness of various dressing materials such as Biobrane, Dressilk, and silk-based dressings. The articles explore patient outcomes, scar evaluation methods (VSS, POSAS), wound infection rates, and the long-term aesthetic appearance of scars following treatment of burns and superficial wounds. The analysis highlights the advantages and disadvantages of each dressing type, with silk dressings often favored for their ability to promote faster re-epithelialization, reduce pain during dressing changes, and minimize scarring. The report also discusses the use of objective scar evaluation tools and emphasizes the importance of considering factors like cost-effectiveness and infection prevention when selecting the optimal dressing material. The findings suggest that silk dressings are highly efficient in treating large wounds, minimizing pain, and promoting superior healing outcomes. The report concludes with a summary of key themes and a comparative overview of the five articles, offering valuable insights for healthcare professionals and researchers in the field of wound care.

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Comparison of 5 Given Articles
Pain
The study by Schulz et al.,(2018) evaluated the quality of scars in long run after the skin
graft treatment and identified majority of patients had no pain and itching during recovery.
Another study by Schulz et al., (2014) which compared the three dressings identified no
significant differences for three types of dressing materials during initial 16 days of recovery. On
16th day the pain had decreased (Approx. 2 out of 10 in scale). Highest pain occurred on 4th day
after the surgery (Approx. 6 out of 10 in all three dressing materials). Both types of dressings
Dressilk and Biobrane show equal pain reduction during healing (Schiefer et al.,2016) . Also,
Suprathel and Biobrane dressings detach gradually from the wounds during re-epithelization and
prevent painful changes of dressing (Schiefer et al., 2019). However, there are no significant
differences in the pain healed by these two dressings. Another study by Schiefer et al., (2017)
evaluated the quality of scar after treatment of facial and hand burns with biobrane or Dressilk
and identified that there was no difference between these two materials. Pain was nearly normal
during recovery.
Wound Infection
Due to transparent matrix, biobrane is widely used in assessment and monitoring of
wounds and the results showed only rare and mild signs of wound infection during later duration
of wound healing (Schulz et al.,, 2018). The donor sites which were covered with Dressilk
showed less infection than those covered with Biobrane (Schulz et al., 2014). Small mild
infections were observed in dressings covered with Biobrane. However, there were no infections
in areas treated with Dressilk (Schiefer et al., 2016; Schiefer et al., 2019). According to Schiefer
et al., (2017), Dressilk works effectively with colistin against the infections. In majority of the
cases 90% wounds healed without any surgery or therapy. In cases where the burn was deeper
than the level assessed initially, and where it went infected superficially, the silk was partly
removed. However after 4thday, silk was again used to cover the area.
Scar Evaluation

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Regarding scar evaluation, most of the patients described the scars just like normal skin
with help of objective and subjective evaluation tools. The quality of scars was measured using
VSS and POSAS tools (Schulz et al.,, 2018; Schiefer et al., 2016). However, the treatments
identified no significant differences in POSAS and VSS scores in the scars treatment done
through any of the dressings (Schulz, 2018). VSS identifies the factors like scar pigmentation,
vascularization, height and pliability. POSAS uses both the physician and patient evaluation. The
patient evaluation measures the itching, pain, stiffness, relief, thickness and color. The physician
evaluation measures thickness, relief, pigmentation, surface area and scar vascularity. The tools
for the objective evaluation of scars are also there. For example: Cutometer, TewaMeter and
Mexameter. The study by Schulzet al., (2018) elaborated all these three objective tools with help
of tables based on raw data like scar elasticity, pliability, trans epidermal loss of water in each
dressing and the skin left untreated . In most of the cases, stable scars and complete re-
epithelialization was recorded in all the different types of dressings (Schulz, 2016). After
removing Biobrane on 10th day after the burn, evident scars were identified which became pale
and soft after 10 months. In another study, after 12 months of follow up, VSS was used for scar
evaluation. 2 out of 17 patients showed scars after the application of silk. In cases treated with
nylon mesh, 6 patients out of 7 showed scars (Schiefer et al., 2019). In study by Schiefer et al.,
(2017), subjective evaluation of scars is done by using POSAS and VSS tools. There was found
no statistical difference between the two types of dressings.
Gaps comparing five articles
In Schulz et al (2014), three dressing materials Biobrane, PolyMem and Dressilk were
compared by measuring the clinical symptoms on the basis of Verbal Rating Scale. This scale
was not advanced or highly accurate. However, the verbal scale assessed Dressilk as ideal
dressing material used by the surgeons and patients to facilitate effective healing environment
and safer recovery. In study conducted by Schiefer et al., 2016), in addition to verbal reporting
scale, VSS and POSAS tools were also used to assess the scar appearance. For pain and healing,

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both the dressings were considered similar in this study. Schiefer et al.,(2017) identified in
objective scar evaluation, the trans epidermal water loss after 6 months depicted difference
between two types of dressings named Biobrane and Dressilk. In subjective evaluations, there
were identified no significant differences between the two dressings. Schulz et al.,(2018)
compared the Biobrane dressing with BioSynthetic Skin Dressing through subjective and
objective evaluation tools and found similar scar quality in both. The study by Schiefer et al.,
(2019) demonstrated the feasibility of pure silk in treating the superficial wound burns and
stated that silk is an effective component in healing the wounds due to large superficial burns.
Conclusion
In pain, there is no significant difference between the different types of dressings used in healing
process. In terms of wound infection, Dressilk is more effective than Biobrane or other dressings
in preventing the infection. There are less chances of occurrence of scars after the healing, in
dressings using silk when compared with other types of dressing materials. In summary, the silk
is highly efficient as a dressing material for treating large size wounds. It prevents pain in
dressing changes and enables faster re-epithelialization. Though dressilk is more cost effective
than the Biobrane and Suprathel, so, most of the partial thickness superficial burns or facial
burns are treated with silk.
In all the five articles, the themes have been created with similarities like Patient Outcomes for
different types of dressings, Scar Evaluation Tools, Wound Healing, Cost Effectiveness,
Exudation, Active Bleeding and Pain during healing, Objective and Subjective Scar Evaluation.
All the five articles have discussed mainly about three things: The effectiveness of different
types of dressings materials in the process of healing, Evaluation of long term scar quality of
superficial wounds and Scar Evaluation Scales like Verbal, VSS and POSAS. All the five articles
finally favoured the effectiveness and safety of silk based dressing materials for healing
superficial burns.

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References
Schulz,A., Rothermund,I., Lefering,R., Fuchs,P., & Schiefer,J.(2018). Long-term Scar Quality
after Treatment of Standardized Partial-Thickness Skin Graft Donor Sites.
ADVANCES IN SKIN & WOUND CARE. 31(3). 109-117.
Schulz,A., Depner,C., Lefering,R., Kricheldroff,J., KAstner,S., Fuchs,P. & Demir,E.(2014). A
prospective clinical trial comparing BiobraneW DressilkW and PolyMemW
dressings on partial-thickness skin graft donor sites. Burns. 42(2016). 345-355.
Schiefer,J., Arens,E., Grigutsch, D., Rath,R.,Hoffmann,A., Fuchs,P. & Schulz,A.(2016). A
prospective intra-individual evaluation of silk comparedtoBiobrane for the treatmentof
superficial burns of the hand and face. Burns. 43(2017). 539-548.
Schiefer,J.,Daniels,M., Grigutsch,D., Fuchs,P.& Schulz,A.(2019). Feasibility of Pure Silk for the
Treatment of Large Superficial Burn Wounds Covering Over 10% of the Total Body
Surface. Journal of Burn Care & Research. 1-10. Retrieved from
https://academic.oup.com/jbcr/advance-article-abstract/doi/10.1093/jbcr/
irz131/5571586
Schiefer,J.,Daniels,M., Rath,R., Ahrens,E., Stromps,J., Graff,I., Grigutsch,D., Fuchs,P.&
Schulz,A.(2017). Evaluation of scar quality after treatment of superficial burns ofthe
hands and face with Dressilk or Biobrane—An intra-individual comparison. Burns.
44(2018). 305-317.