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.