DISCUSSION
Management of a bad healing wounds with presence of hypergranulation is
often difficult and discouraging.
Many treatments have been proposed such as surgical debridement,
electrocauterization, Lasers (CO2 and KTP) 9 and silver-nitrate pencils
application 10-12.
All of these treatments tend to mechanically remove the granulation
tissue causing pain, absorption of chemicals and an additional
inflammatory response11-12.
Despite these side effects, the most common treatment is the application
of silver-nitrate pencils.
This procedure is particularly painful for patients and leads to promote
an inflammatory response and the production of a large amount of
cellular debris following the caustication13.
Therefore, in case of treating split thickness donor site, many authors
prefer non-traumatic dressings using various materials such as
polyurethan foams, hydrocolloids or alginate fibers. This pain free
method demonstrated a good capacity in controlling hypergranulation.
However is more expensive and takes time to promote wound healing
14-15-16-17-18-19.
There are few studies 20-21-22-23 and no guidelines regarding using
topical steroids in wound healing particularly in graft’s donor site
treating.
Steroids act via suppression of angiogenesis grow factors and reduction
of local inflammation. This mechanism leads to a transformation of a
self-increasing chronic inflammation in a physiological healing
process24.
In addition, since the wound pain is amplificated by inflammation
through the production of TNF-α and protease, the corticosteroids can
also increase the triggering threshold of nociceptors.
Furthermore, combining steroids with topical antibiotics, prevent local
bacterial contaminations that can potentially disturb the healing
process.
In our experience this treatment demonstrated an optimal capacity of
decreasing hypergranulation and exudate and promoting a quick and pain
free complete healing specially compared with other methods such as
silver-nitrate application (that is quite painful and takes longer
healing time), and use of advanced dressings that show good healing
performances but are quite expensive.
Corticosteroids are wide spread products, easy to use and have low
prices.
Further studies are required to validate these results and to compare
topical steroids applications directly with other methods on a larger
sample size.