The efficacy of 5% Sulfamylon (R) solution for the treatment of contaminated explanted human meshed skin grafts

Large TBSA burns have a deficiency of skin graft donor sites necessitating meshed skin autografts, cultured epithelial autografts or biosynthetic skin substitutes. Because these do not effect immediate complete biological clo sure of the wound, the burn victim remains at risk for life-threatening inf ection. Topical antimicrobials can protect colonization of these grafts fro m becoming invasive sepsis, However, many of these agents are cytotoxic to new partially keratinized epithelial cells. This study using a model of epi thelialization kinetics of human meshed skin grafts explanted to athymic 'n ude' rats evaluated: (1) the effect of bacterial colonization on the rate o f closure of meshed graft interstices; (2) the efficacy of 5% Sulfamylon(R) solution for bacterial control and (3) the effect on interstitial closure rates caused by control of bacterial proliferation. Results showed the rate of interstitial closure was progressive over 7 days in noncontaminated gra fts treated with moistened saline dressings. Areas of total closure of a 1: 1.5 meshed graft were seen as early as 5 days. When grafts were inoculated with 10(2) or 10(3) Pseudomonas aeruginosa organisms and treated with salin e moistened dressings, the resultant bacterial load rose to 10(6) organisms , less than 3% of the interstices closed and grafts were destroyed. With th e same organism level of contamination, bacterial levels were eradicated wi th topical 5% Sulfamylon(R) solution, interstitial closure rates returned t o normal and areas of total meshed graft closure were seen by day 4. These data demonstrate the efficacy of 5% Sulfamylon(R) solution on epithelializa tion kinetics of contaminated meshed skin grafts. (C) 1999 Elsevier Science Ltd and ISBI. All rights reserved.