The effects of topical mafenide acetate application on skin graft survival in bacterial contaminated wounds

  • Burns. 2024 Mar;50(2):433-443. doi: 10.1016/j.burns.2023.10.002.
M Baver Acaban  1 ,  Alper Sarı  2 ,  Hatice Oruç Demirbağ  3 ,  Gülden Ersöz  4 ,  Savaş Aktaş  3
Affiliations
  • 1. Plastic, Reconstructive and Aesthetic Surgery Department of Mersin University Medical Faculty, Mersin, Turkey. Electronic address: [email protected].
  • 2. Plastic, Reconstructive and Aesthetic Surgery Department of Mersin University Medical Faculty, Mersin, Turkey.
  • 3. Histology and Embryology Department of Mersin University Medical Faculty, Mersin, Turkey.
  • 4. Infectious Diseases and Clinical Microbiology Department of Mersin University Medical Faculty, Mersin, Turkey.
PMID: 37985270 DOI: 10.1016/j.burns.2023.10.002
Abstract

Background: Infection related skin graft loss still remains as a common problem even with the use of systemic Antibiotics. Mafenide acetate (Sulfamylon) is a topical antimicrobial agent with a wide spectrum of antimicrobial activity. Since mafenide acetate has the ability to penetrate the burn eschar, it was preferred in the treatment of infected full-thickness skin grafts. We investigated the effects of topical Mafenide acetate application on graft survival in an experimental model of contaminated wound beds in rats.

Materials and methods: Twenty-eight male Wistar albino rats were included in the study. A full-thickness skin graft (FTSG) was harvested from the back region and the wound bed was inoculated with Pseudomonas aeruginosa. The same FTSG was sutured in place. Rats were divided into 4 groups. In groups 1 and 2, wound care was performed with gauze and hydrofiber dressings respectively. In groups 3 and 4, Mafenide acetate soaked hydrofiber and Mafenide acetate soaked gauze dressings were used respectively. The dressings were closed for 4 days in all groups. The rats in groups 1 and 2 received dressing changes every day. The dressing of the rats in group 3 was changed once every two days. The dressing of the rats in group 4 was changed twice a day.

Results: In groups 3 and 4, the graft survival rates decreased significantly from day 7 to day 14 in all groups. Histologically, detachment at the dermoepidermal junction, disorganization of Collagen along with increased numbers of fibroblasts and a decrease in graft adhesion to the wound bed were determined in Mafenide acetate-treated groups.

Conclusion: In rats treated with Mafenide acetate, graft survival was higher on day 7 and gradually decreased towards day 14. Application of a 2.5% solution of Mafenide acetate longer than 7 days on inoculated skin grafts in a rat model causes significant cytotoxicity and graft loss.

Keywords
Hydrofiber wound dressing; Mafenide acetate; Pseudomonas aeruginosa; Skin graft.
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