7th Brazilian Conference on Stomal Therapy

October 21-25, 2007 Curitiba Paran

USE OF CELLULOSIC MEMBRANE IN GRAFT DONOR SITES

Silveira, Jocilene de Mesquita1
Castro, Maria Eurida de2
Pinheiro, Alessandra Rocha Moror3
Filho, Marcus Vinicius Ponte de Souza4

INTRODUCTION
A graft donor site is an elective lesion, flat and with little exudate, and its possible intercurrences like critical
colonization and infection represent a challenge to the interdisciplinary team during the tissue regeneration process.
There are transparent and permeable membranes or films available in the marketplace that is indicated to occlude this
kind of lesion. The transparency of such membranes makes it easy to visualize the lesion and its characteristics 1, and
permits early identification of complications during the treatment. The cellulosic membrane synthesized by
Acetobacter xylinum2, a gram negative bacillus, has a physical chemical structure that promotes functions similar to
those of the corneal layer of the epidermis, providing protection to lesion tissues, and is indicated as a temporary skin
substitute3, bringing benefits to the patient and optimizing tissue regeneration.

OBJECTIVES

To describe the effects of the cellulosic membrane synthesized by Acetobacter xylinum used as a temporary
skin substitute at the graft donor site;
To report the interdisciplinary team experience in treating such lesion.

METHODS
This is a clinical case study carried out at the surgery department and monitored at the Specialties Clinic of a Public
Hospital in the city of Fortaleza, state of Cear, from April to June 2007. Male patient, age 68, diabetic, cardiac, with
fasciitis on the left leg, for which the plastic surgeon indicated a graft. Skin selected to be graft donor: size: 18 cm x
15 cm, taken from the front and side of the left thigh.
The dressing selected for the donor site was composed of a cellulosic membrane synthesized by the gram negative
baccilus Acetobacter xylinum (Photo1) for tissue regeneration. The dressing effectiveness and the lesion evolution
were monitored by free observation and photographic records. Before the study began, we explained orally to the
patient its objectives and methods, and asked him to authorize it in writing, according to the National Health Council
Resolution 196/96 on ethics applied to research using human subjects.

Graduate Degree in Stomal Therapy Assisting Nurse and specialist in infection control at a Private Hospital. (Address): Rua
Deoclcio de Arajo, 245, Lagoa Redodnda district; Phone: 55 85 3278-2032 55 85 9902-0190; (city): Fortaleza, (state): Cear;
email: jocilenems@oi.com.br
2
Graduate Degree in Stomal Therapy and PhD Professor
3
Nurse - Coordinator of the Interdisciplinary Commission for Lesion Prevention and Treatment working towards a graduate
degree in Stomal Therapy Public Hospital
4
Masters Degree in Surgery. Member of the Interdisciplinary Commission for Lesion Prevention and Treatment Public Hospital

Photo 1 Cellulosic membrane

PROCEDURES
The first donor site dressing was performed during the surgery by the plastic surgeon, and dressing changes were
carried out by the surgeon and/or nurse. Primary dressing consisted of the cellulosic membrane and the secondary
was made of simple cotton gauze and crepe bandage. During the 40-day period in which the treatment was conducted
at the hospital (both stay and outpatient clinic), the cellulosic membrane was totally replaced once and two localized
changes on the lesion were performed (interaction of the cellulosic membrane and/or colonization) (Photo 2).

Photo 2: Localized change

RESULTS AND DISCUSSIONS

With the use of the cellulosic membrane, a gradual epithelization occurred in 50% of the area in 20 days, in 30% of
the area during the following 10 days, and 20% in the last 10 days with the use of Essential Fatty Acid (EFA) to
regulate epidermal proliferation. 4 (Photo 3).
The membrane promoted haemostasis, analgesia, and exudate dehydration, with the formation of a scab that protected
the epithelium until it was regenerated. We did not observe any adverse reactions to the product, nor trauma in the
epithelization when the dressing was changed. We noted that the patients risk factors (co-morbities), the size of the
donor site (18 x 15 cm) and the presence of localized colonization (slow dehydration of the localized exudate
inhibiting scab formation) contributed to the total period of 40 days for the total regeneration of the tissue and
localized EFA replacement.

Photo 3 Gradual epithelization of the donor site

CONCLUSIONS
We have concluded that the use of this cellulosic membrane in a graft donor site may be an effective alternative as a
new temporary skin substitute, albeit comparative studies will have to be carried out with other patients monitored by
specialized interdisciplinary teams.

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in: JORGE, S.A.; DANTAS, S.R.P.E Abordagem multiprofissional do tratamento de feridas (Multiprofessional approach in wound treatment). So Paulo:
Atheneu, 2003. Chapter 8, p.81-99
2
SOUZA, D.M. DE; GARCIA-CRUZ, C.H. Produo fermentativa de polissacardeos extracelulares por bactrias (Extracellular polyssaccharides
fermentative production by bacteria) Semina: Cincias Agrrias, Londrina, v.25, n.4, Oct.-Dec 2004, p.331-340
3
PEIXOTO, R.; SANTOS, D.L.N. dos. Biofill: uso e avaliao clnica de uma pelcula celulsica em leses cutneas. (Biofill: use and clinical assessment
of a cellulosic film for cutaneous lesions). Rev. bras. cir; 78(2): 141-5, Mar-Apr 1988.
4
DECLAIR, V. Efeitos do triglicerdeos de cadeia media na acelao do processo de cicatrizao de feridas. (Effects of medium chain triglycerides in the
acceleration of the wound healing process). Rev. Nutrio Enteral e Esportiva, n.5, 1994. p.4-8.