The Effects of Aloe Vera Cream

44 WOUNDS www.woundsresearch.com

Skin grafting is a reconstructive procedure in plastic surgery designed toaccelerate the healing of wounds, such as burns and trauma wounds.The donor sites created after harvesting a split-thickness skin graft

present an additional wound to manage. The management of the donor siteafter removing the skin graft is an important patient comfort issue. A suitablewound dressing helps to achieve wound healing and to satisfy patients barring any complications, such as infection or pain. A suitable dressingshould also facilitate physiological recovery.1,2 There are two dressing strategies for wound healing after skin grafting: dressing with high humidityat the wound harvesting surface (moist dressing) and non-moist dressing(dry dressing).2–4 Dressing material that adheres to the wound causes bleeding, and removing the dressing is often painful. A moist dressing has a

The Effects of Aloe Vera Cream onSplit-thickness Skin Graft Donor SiteManagement: A Randomized,Blinded, Placebo-controlled Study

Ghasemali Khorasani, MD;1 Ali Ahmadi, MD;1,2 Seyed JalalHosseinimehr, PhD;3 Amirhossein Ahmadi, PharmD;4

Ahmadreza Taheri, MD;1 Hamidreza Fathi, MD1

WOUNDS 2011;23(2):44–48

From the 1Department of Surgery,Faculty of Medicine, TehranUniversity of Medical Sciences,Tehran, Iran; 2Faculty of Medicine,Mazandaran University of MedicalSciences, Sari, Iran; 3Department ofRadiopharmacy, Faculty ofPharmacy, Traditional andComplementary Medicine ResearchCenter, Mazandaran University ofMedical Sciences, Sari, Iran;4Research Student Committee,Mazandaran University of MedicalSciences, Sari, Iran

Address correspondence to:Ghasemali Khorasani, MDImam Khomeini HospitalKeshasvarz BoulevardTehran, IranPhone: +98 21 66418885E-mail: [email protected]

Abstract: Purpose. Split-thickness skin graft donor site management isan important patient comfort issue. The present study examined theeffects of aloe vera cream compared to placebo cream and gauzedressing on the rates of wound healing and infection at the donor site.Methods. Forty-five patients were enrolled in this randomized clinicaltrial and divided into three groups: control (without topical agent),placebo (base cream without aloe vera), and aloe vera cream groups.All patients underwent split-thickness skin grafting for various reasons, and the skin graft donor site wounds were covered with sin-gle-layer gauze without any topical agent, with aloe vera, or with place-bo cream. The donor sites were assessed daily postoperatively untilcomplete healing was achieved. Results. Mean time to complete re-epithelization was 17 ± 8.6, 9.7 ± 2.9, and 8.8 ± 2.8 days for control, aloe vera, and placebo groups, respectively. Mean wound healing time in the control group was significantly different from thealoe vera and placebo groups (P < 0.005). The healing rate was notstatistically different between aloe vera and placebo groups.Conclusion. This study showed a significantly shorter wound care timefor skin graft donor sites in patients who were treated with aloe veraand placebo creams. The moist maintenance effect of these creamsmay contribute to wound healing.

ORIGINAL RESEARCHDO DO

44DO

44 WOUNDSDO

WOUNDSDO NOT

NOT NOT Mazandaran University of Medical

NOT Mazandaran University of Medical

Address correspondence to:

NOT

Address correspondence to:Ghasemali Khorasani, MD

NOT

Ghasemali Khorasani, MDImam Khomeini Hospital

NOT

Imam Khomeini HospitalKeshasvarz Boulevard

NOT

Keshasvarz Boulevard

Phone: +98 21 66418885

NOT

Phone: +98 21 66418885E-mail: [email protected]

NOT

E-mail: [email protected]

healing time in the control group was significantly different from the

NOT healing time in the control group was significantly different from thealoe vera

NOT aloe verastatistically different between

NOT

statistically different between Conclusion.

NOT

Conclusion.for skin graft donor sites in patients who were treated with

NOT

for skin graft donor sites in patients who were treated with and placebo creams. The moist maintenance effect of these creams

NOT

and placebo creams. The moist maintenance effect of these creams

DUPLIC

ATE

DUPLIC

ATE

DUPLIC

ATE

Cream on

DUPLIC

ATE

Cream onSplit-thickness Skin Graft Donor Site

DUPLIC

ATE

Split-thickness Skin Graft Donor SiteManagement: A Randomized,

DUPLIC

ATE

Management: A Randomized,Blinded, Placebo-controlled Study

DUPLIC

ATE

Blinded, Placebo-controlled Study

Ghasemali Khorasani, MD;

DUPLIC

ATE

Ghasemali Khorasani, MD; Ali Ahmadi, MD;

DUPLIC

ATE

Ali Ahmadi, MD;Amirhossein Ahmadi, PharmD;

DUPLIC

ATE

Amirhossein Ahmadi, PharmD;Ahmadreza Taheri, MD;

DUPLIC

ATE

Ahmadreza Taheri, MD;1

DUPLIC

ATE

1 Hamidreza Fathi, MD

DUPLIC

ATE

Hamidreza Fathi, MD

. Split-thickness skin graft donor site management is

DUPLIC

ATE

. Split-thickness skin graft donor site management isan important patient comfort issue. The present study examined the

DUPLIC

ATE

an important patient comfort issue. The present study examined thealoe vera

DUPLIC

ATE

aloe vera cream compared to placebo cream and gauze

DUPLIC

ATE

cream compared to placebo cream and gauzedressing on the rates of wound healing and infection at the donor site.

DUPLIC

ATE

dressing on the rates of wound healing and infection at the donor site.Forty-five patients were enrolled in this randomized clinical

DUPLIC

ATE

Forty-five patients were enrolled in this randomized clinicaltrial and divided into three groups: control (without topical agent),

DUPLIC

ATE

trial and divided into three groups: control (without topical agent),placebo (base cream without

DUPLIC

ATE

placebo (base cream without

DUPLIC

ATE

All patients underwent split-thickness skin grafting for various

DUPLIC

ATE

All patients underwent split-thickness skin grafting for various reasons, and the skin graft donor site wounds were covered with sin-

DUPLIC

ATEreasons, and the skin graft donor site wounds were covered with sin-gle-layer gauze without any topical agent, with DUPL

ICATE

gle-layer gauze without any topical agent, with bo cream. The donor sites were assessed daily postoperatively untilDUPL

ICATE

bo cream. The donor sites were assessed daily postoperatively untilcomplete healing was achieved. DUPL

ICATE

complete healing was achieved. re-epithelization was 17 ± 8.6, 9.7 ± 2.9, and 8.8 ± 2.8 days for DUPL

ICATE

re-epithelization was 17 ± 8.6, 9.7 ± 2.9, and 8.8 ± 2.8 days for control, DUPL

ICATE

control, aloe veraDUPLIC

ATEaloe vera

healing time in the control group was significantly different from theDUPLIC

ATEhealing time in the control group was significantly different from theDUPL

ICATE

Vol. 23, No. 2 February 2011 45

greater effect on wound healing and pain relief than adry dressing.5 Various types of dressing materials havebeen recognized based on ease of use, cost, optimal heal-ing environment, and pain relief, eg, paraffin gauze dress-ing,6 hemicelluose dressing (Veloderm®, BTC srl, Torino,Italy),1 lipido-colloid wound dressing (Urgotul®,Laboratoires Urgo, Chenôve, France),7 polyurethane film,8

carboxymethyl cellulose dressing (Aquacel®, ConvaTec,Skillman, NJ),9 ionic-containing hydrofiber dressing,10

alginate (Kaltostat®, ConvaTec),3 and polyvinyl pyrroli-done-iodine liposome hydrogel.11 These dressing materi-als induce moisture on the wound surface by absorbingand maintaining water. In 2009, Voineskos et al4 conduct-ed a comprehensive systematic review of skin graftdonor site dressings. They concluded that the evidencesupporting moist wound dressings is weak, and moremethodologically sound, randomized, controlled trialsare needed to determine the optimal dressing for split-thickness skin graft donor sites. Trials with parallel evalu-ations are necessary to answer this question.4 Althoughnumerous dressings have been studied, there is not oneperfect dressing for use on the donor site that is easy touse, provides patient comfort, prevents infection, is inex-pensive, and promotes faster re-epithelization.

Aloe vera (family: Liliaceae) has been used in tradi-tional medicine for a long time. Aloe vera gel, which isobtained by breaking or slicing its leaf, is the principlepart of the plant that is used in herbal medicine. Aloevera contains many important nutrients including aminoacids, B group vitamins, polysaccharides, and other nutri-ents that support general health. It also has many phar-macological properties including antioxidant, woundhealing, antibacterial, antifungal, antiviral, andimmunomodulating effects.12,15,16 The topical skin gel pro-vides healing support for the skin. Recently, the authorsdemonstrated that aloe vera cream treatment couldreduce healing time in patients with burn injury compared to silver cream,17 and it has been demonstrat-ed that this cream facilitates wound healing in posthemorrhoidectomy patients.18

In light of the potential uses for aloe vera in wound

healing, the present clinical study was aimed to examinethe effect of aloe vera cream in comparison with gauzedressing and placebo cream on the rate of donor sitewound healing.

Materials and Methods Aloe vera cream preparation. Pure spray-dried

aloe vera powder was used for preparing the aloe veracream. White liquid paraffin (2 g), stearyl alcohol (7.5 g),cetyl alcohol (7.5 g), solid white paraffin (3 g), andpropylene paraben (0.015 g) were mixed and heated toa boil (oil phase). Aloe vera powder (0.5 g) and 70 mLdeionized water was added to the mixture with propylene glycol (7 g), sodium luryl sulfate (3 g), andmethyl paraben (0.025 g). The mixture was heated untilit reached an aqueous state (liquid phase). Next, the oiland liquid were mixed continuously while being gradu-ally cooled. The uniform cream (500 g), once it hadcooled, was stored in a plastic package. The cream con-tained 0.5% of the aloe vera gel powder. The preparationwas carried out under sterile conditions. The cream wastested for contaminating microbes, and none werefound. Patients and study protocol. Permission to perform

the study was granted from the Ethical Committee atTehran University of Medical Sciences (no. 130-362 ), andwas carried out in the Plastic Surgery ward at ImamKhomeini Hospital (Tehran, Iran) during 2009 and 2010.The inclusion criterion was undergoing skin graft har-vest of the thigh due to trauma, tumor, or scar. Patientswere aged between 12 and 70 years. Exclusion criteriawere diabetes mellitus, immunodeficiency state, preg-nancy, and kidney disease. The patients and attendantswere given information regarding the drug (aloe veracream) and written informed consent was obtained fromall patients. Forty-five patients were enrolled into thisstudy. After the patients were administered general anes-thesia, the donor site was prepared with 10% povidone-

KEYPOINTS

• Aloe vera topical skin gel has been found to providehealing support for the skin• Aloe vera has pharmacological properties includingantioxidant, wound healing, antibacterial, antifun-gal, antiviral, and immunomodulating effects

KEYPOINTS

• The test cream contained 0.5% of the aloe vera gelpowder• Study patients were those who had a skin graft har-vest from the thigh because of trauma, tumor, orscar• The aloe vera and placebo groups received aloe orbase cream on single-layer gauze three times daily,respectively; no topical treatment or dressing wasapplied in the control group

Khorasani et alDO immunomodulating effects.

DO immunomodulating effects.vides healing support for the skin. Recently, the authors

DO vides healing support for the skin. Recently, the authorsdemonstrated that

DO demonstrated that reduce healing time in patients with burn injury

DO reduce healing time in patients with burn injury compared to silver cream,

DO

compared to silver cream,ed that this cream facilitates wound healing in

DO

ed that this cream facilitates wound healing in posthemorrhoidectomy patients.

DO

posthemorrhoidectomy patients.In light of the potential uses for

DO

In light of the potential uses for

NOT thickness skin graft donor sites. Trials with parallel evalu-

NOT thickness skin graft donor sites. Trials with parallel evalu-ations are necessary to answer this question.

NOT ations are necessary to answer this question.numerous dressings have been studied, there is not one

NOT numerous dressings have been studied, there is not oneperfect dressing for use on the donor site that is easy to

NOT perfect dressing for use on the donor site that is easy touse, provides patient comfort, prevents infection, is inex-

NOT

use, provides patient comfort, prevents infection, is inex-pensive, and promotes faster re-epithelization.

NOT

pensive, and promotes faster re-epithelization.Liliaceae

NOT

Liliaceae) has been used in tradi-

NOT

) has been used in tradi-tional medicine for a long time.

NOT

tional medicine for a long time. Aloe vera

NOT

Aloe veraobtained by breaking or slicing its leaf, is the principle

NOT

obtained by breaking or slicing its leaf, is the principlepart of the plant that is used in herbal medicine.

NOT

part of the plant that is used in herbal medicine. contains many important nutrients including amino

NOT

contains many important nutrients including aminoacids, B group vitamins, polysaccharides, and other nutri-

NOT

acids, B group vitamins, polysaccharides, and other nutri-ents that support general health. It also has many phar-NOT

ents that support general health. It also has many phar-macological properties including antioxidant, woundNOT

macological properties including antioxidant, woundhealing, antibacterial, antifungal, antiviral, andNOT

healing, antibacterial, antifungal, antiviral, andimmunomodulating effects.NOT

immunomodulating effects.vides healing support for the skin. Recently, the authorsNOT

vides healing support for the skin. Recently, the authors

DUPLIC

ATE

and polyvinyl pyrroli-

DUPLIC

ATE

and polyvinyl pyrroli-These dressing materi-

DUPLIC

ATE

These dressing materi-als induce moisture on the wound surface by absorbing

DUPLIC

ATE

als induce moisture on the wound surface by absorbingconduct-

DUPLIC

ATE

conduct-ed a comprehensive systematic review of skin graft

DUPLIC

ATE

ed a comprehensive systematic review of skin graftdonor site dressings. They concluded that the evidence

DUPLIC

ATEdonor site dressings. They concluded that the evidencesupporting moist wound dressings is weak, and moreDUPL

ICATE

supporting moist wound dressings is weak, and moremethodologically sound, randomized, controlled trialsDUPL

ICATE

methodologically sound, randomized, controlled trialsare needed to determine the optimal dressing for split-DUPL

ICATE

are needed to determine the optimal dressing for split-thickness skin graft donor sites. Trials with parallel evalu-DUPL

ICATE

thickness skin graft donor sites. Trials with parallel evalu-AlthoughDUPL

ICATE

Although

healing, the present clinical study was aimed to examine

DUPLIC

ATE

healing, the present clinical study was aimed to examinecream in comparison with gauze

DUPLIC

ATE

cream in comparison with gauzedressing and placebo cream on the rate of donor site

DUPLIC

ATE

dressing and placebo cream on the rate of donor site

Materials and Methods

DUPLIC

ATE

Materials and Methods cream preparation.

DUPLIC

ATE

cream preparation.powder was used for preparing the

DUPLIC

ATE

powder was used for preparing the cream. White liquid paraffin (2 g), stearyl alcohol (7.5 g),

DUPLIC

ATE

cream. White liquid paraffin (2 g), stearyl alcohol (7.5 g),cetyl alcohol (7.5 g), solid white paraffin (3 g), and

DUPLIC

ATE

cetyl alcohol (7.5 g), solid white paraffin (3 g), andpropylene paraben (0.015 g) were mixed and heated to

DUPLIC

ATE

propylene paraben (0.015 g) were mixed and heated toa boil (oil phase).

DUPLIC

ATE

a boil (oil phase). Aloe vera

DUPLIC

ATE

Aloe veradeionized water was added to the mixture with DUPL

ICATE

deionized water was added to the mixture with propylene glycol (7 g), sodium luryl sulfate (3 g), andDUPL

ICATE

propylene glycol (7 g), sodium luryl sulfate (3 g), andmethyl paraben (0.025 g). The mixture was heated until

DUPLIC

ATE

methyl paraben (0.025 g). The mixture was heated untilit reached an aqueous state (liquid phase). Next, the oil

DUPLIC

ATE

it reached an aqueous state (liquid phase). Next, the oiland liquid were mixed continuously while being gradu-

DUPLIC

ATE

and liquid were mixed continuously while being gradu-ally cooled. The uniform cream (500 g), once it had

DUPLIC

ATE

ally cooled. The uniform cream (500 g), once it hadcooled, was stored in a plastic package. The cream con-

DUPLIC

ATE

cooled, was stored in a plastic package. The cream con-tained 0.5% of the

DUPLIC

ATE

tained 0.5% of the was carried out under sterile conditions. The cream was

DUPLIC

ATE

was carried out under sterile conditions. The cream wastested for contaminating microbes, and none were

DUPLIC

ATE

tested for contaminating microbes, and none werefound.

DUPLIC

ATEfound. Patients and study protocol.DUPL

ICATE

Patients and study protocol.the study was granted from the Ethical Committee atDUPL

ICATE

the study was granted from the Ethical Committee atTehran University of Medical Sciences (no. 130-362 ), andDUPL

ICATE

Tehran University of Medical Sciences (no. 130-362 ), andDUPLIC

ATEKhorasani et al

DUPLIC

ATEKhorasani et al

Khorasani et al


iodine solution. All skin grafts were harvested fromanterolateral and posterior thigh regions with an electricPadgett Dermatome (Olympus), which was adjusted to0.014 in. A nurse generated the allocation sequence, andpatients were randomly allocated to one of three groups:aloe vera cream (group A [n = 15]), placebo cream (basecream without aloe vera powder, group B [n = 15]) andthe control (without topical agent, group C [n = 15]). Thedressing was similar for all groups and at the end of skinharvesting, wounds were dressed and bandaged with a

layer of petrolatum gauze along withseveral sterile gauzes. After 2 days, thetop dressing layer was removed leav-ing the first gauze layer in place to pre-vent damage to the wounds. No treat-ment or dressing was applied in thecontrol group. The aloe vera andplacebo groups received aloe vera orbase cream on single-layer gauze threetimes daily, respectively. Donor site re-epithelization was evaluated postoper-atively on a daily basis until completere-epithelization and until separationof the single layer gauze could be per-formed without causing the patientfurther trauma or pain. The time tocomplete re-epithelization was record-

ed for each patient. Wound infection was subjectivelymeasured based on clinical signs of infection (edema,heat, pain, pus discharge, or smell). Another physician,who was blinded to the treatments, clinically assessed allpatients.

Statistical AnalysisThe data were analyzed using SPSS version 10.0 soft-

ware. Student’s t test and ANOVA test were used to com-pare the wound size and healing time between twogroups and all three groups, respectively. The significancelevel was determined less than P < 0.05. A Chi-square testwas used for descriptive analysis.

ResultsA total of 45 patients (45 donor sites) were enrolled

in this study with follow-up until complete healing(Table 1). There were 37 (82.2%) men and 8 (17.8%)women. Significant differences were not found betweengroups in relation to age or sex. Average total skin graftsize was similar between control, aloe vera, and placebogroups (Table 1). The re-epithelization time in the con-trol group was 17 ± 8.6 days (range, 8–37), while in thealoe vera group and placebo group it was 9.7 ± 2.9 days(range, 5–18) and 8.8 ± 2.8 days (range, 4–14), respec-tively (Figure 1). Mean time to wound healing was sig-nificantly different in the control group compared to thealoe vera and placebo groups (P < 0.005). There was notany significant difference in mean re-epithelization timebetween aloe vera and placebo (base) groups (P = 0.9). There were no allergic reactions or other adverse

events (eg, donor site infection) related to the dressings.

Figure 1. Mean time from application of dressing tocomplete re-epithelization.

Base group

(n = 15)

P*

Male/femaleAge (years) mean ± SDReason (%)

TraumaScarBedsoreTumorReconstruction

Area (skin harvest) mean ± SD (cm2)

13/238.2 ± 13.5

26.726.713.32013.3146 ± 104

11/435.5 ± 15.6

4026.76.7206.7140 ± 103

13/232.6 ± 15.2

602013.36.760114 ± 89

0.05*0.05*

0.05*

*Not significant

Table 1. Patient demographics.

Aloe group(n = 15)

Controlgroup

(n = 15)

Characteristic

DO DO

46DO

46 WOUNDSDO

WOUNDS

Padgett Dermatome (Olympus), which was adjusted to

DO Padgett Dermatome (Olympus), which was adjusted to0.014 in. A nurse generated the allocation sequence, and

DO 0.014 in. A nurse generated the allocation sequence, andpatients were randomly allocated to one of three groups:

DO patients were randomly allocated to one of three groups:aloe vera

DO aloe vera cream (group A [n = 15]), placebo cream (base

DO cream (group A [n = 15]), placebo cream (basecream without

DO

cream without aloe vera

DO

aloe verathe control (without topical agent, group C [n = 15]). The

DO

the control (without topical agent, group C [n = 15]). Thedressing was similar for all groups and at the end of skin

DO

dressing was similar for all groups and at the end of skinharvesting, wounds were dressed and bandaged with a

DO

harvesting, wounds were dressed and bandaged with a

NOT NOT NOT NOT

iodine solution. All skin grafts were harvested fromNOT

iodine solution. All skin grafts were harvested fromanterolateral and posterior thigh regions with an electricNOT

anterolateral and posterior thigh regions with an electricPadgett Dermatome (Olympus), which was adjusted toNOT

Padgett Dermatome (Olympus), which was adjusted to0.014 in. A nurse generated the allocation sequence, andNOT

0.014 in. A nurse generated the allocation sequence, andNOT

Mean time from application of dressing to

NOT

Mean time from application of dressing tocomplete re-epithelization.

NOT

complete re-epithelization.

DUPLIC

ATE

DUPLIC

ATE

layer of petrolatum gauze along with

DUPLIC

ATE

layer of petrolatum gauze along withseveral sterile gauzes. After 2 days, the

DUPLIC

ATE

several sterile gauzes. After 2 days, thetop dressing layer was removed leav-

DUPLIC

ATE

top dressing layer was removed leav-ing the first gauze layer in place to pre-

DUPLIC

ATE

ing the first gauze layer in place to pre-vent damage to the wounds. No treat-

DUPLIC

ATE

vent damage to the wounds. No treat-ment or dressing was applied in the

DUPLIC

ATE

ment or dressing was applied in thecontrol group. The

DUPLIC

ATE

control group. The placebo groups received

DUPLIC

ATE

placebo groups received base cream on single-layer gauze three

DUPLIC

ATE

base cream on single-layer gauze threetimes daily, respectively. Donor site re-

DUPLIC

ATE

times daily, respectively. Donor site re-epithelization was evaluated postoper-

DUPLIC

ATE

epithelization was evaluated postoper-atively on a daily basis until complete

DUPLIC

ATE

atively on a daily basis until completere-epithelization and until separation

DUPLIC

ATE

re-epithelization and until separationof the single layer gauze could be per-

DUPLIC

ATE

of the single layer gauze could be per-formed without causing the patient

DUPLIC

ATE

formed without causing the patientfurther trauma or pain. The time to

DUPLIC

ATE

further trauma or pain. The time tocomplete re-epithelization was record-

DUPLIC

ATE

complete re-epithelization was record-ed for each patient. Wound infection was subjectively

DUPLIC

ATE

ed for each patient. Wound infection was subjectivelymeasured based on clinical signs of infection (edema,

DUPLIC

ATE

measured based on clinical signs of infection (edema,heat, pain, pus discharge, or smell). Another physician,

DUPLIC

ATE

heat, pain, pus discharge, or smell). Another physician,who was blinded to the treatments, clinically assessed all

DUPLIC

ATE

who was blinded to the treatments, clinically assessed allpatients.

DUPLIC

ATE

patients.

Statistical AnalysisDUPLIC

ATEStatistical AnalysisDUPL

ICATE

DUPLIC

ATE

DUPLIC

ATE

0.05*DUPL

ICATE

0.05*DUPL

ICATE

DUPLIC

ATE

DUPLIC

ATE

Khorasani et al

Vol. 23, No. 2 February 2011 47

DiscussionThis study showed that aloe vera and base creams had

wound healing effects on the donor sites after harvest. Re-epithelization time was faster among patients treatedwith these creams as compared to patients who did notuse any topical agent. Conversely, a significant differencein healing times between aloe and base groups was notobserved. In cream-treated groups, the creams wereapplied continuously to the donor sites, which induced amoist wound environment compared to dry gauze dress-ing. The gauze dressing initially provided a moist woundenvironment, but gradually became desiccated due toevaporation, whereupon the fine-mesh gauze firmlybound to the wound surface, making it more painful toremove than the other moist dressings.5,19 This scenarioalso impairs the migration of epithelial cells necessary toachieve complete re-epithelization.20 In an evidence-basedreview, Joel et al21 concluded that moist dressings decreasethe days to complete healing as compared to non-moistdressings. Among the broad categories of non-moist andmoist-dressing, no differences were found in infectionrates between these two types of dressings.21 Other stud-ies showed that a maintenance (foam) dressing did not sig-nificantly reduce wound healing time compared to gauzedressing.19,20 In a systematic review, Wiechula et al2 con-cluded that moist wound healing products have definitiveclinical advantages over non-moist products in manage-ment of split-thickness skin graft donor sites. These advan-tages are related to healing, comfort, and infection rates.Although, they conceded that head-to-head studies com-paring products with moisture-retaining properties areneeded to determine the optimum moist dressing.2 Moistdressings enhance re-epithelization of partial-thicknesswounds by allowing diffusion of oxygen and water vapor,while providing a barrier to the passage of fluid or woundexudate.20 In a recent systematic review, Voineskos et al4

revealed that there is some weak evidence supporting thebeneficial effect of moist dressings on wound healing insplit-thickness skin graft donor sites. Due to methodologi-cal differences in the previous studies, the authors pro-posed that it is necessary to do parallel randomized clini-cal trials to confirm which is the optimal dressing.4 Oneadvantage of the present study was the use of placebocream in addition to aloe cream and gauze dressing, whichprovided reliable data to determine the beneficial effectsof aloe vera cream on donor site wounds.

Aloe vera preparations have many biological effectsincluding anti-diabetic, immunomodulatory, anti-inflam-matory, antioxidant, and wound healing effects.22 Aloe

vera application was associated with a significant reduc-tion in the wound healing time compared to the con-trol.13 Aloe contains various carbohydrate constituents aspolysaccharides. Polysaccharides are known to haveproperties in skin wound repair.22,23 Additionally, it isbelieved that the anti-inflammatory effect of aloe veracontributes to faster healing.14,23

Collagen is the major protein in the extracellularmatrix and provides strength and integrity to the dermisand other supporting tissues. Aloe vera enhances theproduction of collagen.24,25 Aloe vera has antimicrobialproperties, which can help to prevent wound infection.26

In recent clinical trials, application of aloe cream onwounds was associated with significant wound healingeffects in patients with burn injuries and post-hemor-rhoidectomy.17,18 These results showed aloe vera facili-tates the healing process in different wound types. In thisstudy, although the aloe cream exhibited a shorter timeto wound healing compared to gauze dressing, its effectwas not better than placebo cream. Aloe cream might bemore effective at higher concentrations than the 0.5%concentration used in the present study. Both creamsinduced a moist wound environment as compared togauze dressing, and maintaining a moist donor site is crit-ical to wound healing.4 Winter27 first described theimprovement of wound healing under moist dressings in1962, but Voineskos et al4 concluded that the evidencesupporting that “wet dressings” is weak. In the presentstudy, parallel wet and dry dressings confirmed that amoist environment promotes donor site wound healing.Both creams have several hydrophilic and lipophilicingredients such as paraffin, propylene glycol, and alco-hol that may be involved in keeping the wound surfacemoist. The cream’s simple preparation and inexpensive-ness are two advantages that might further encouragecommercial production.

ConclusionA topical cream containing aloe vera and a placebo

cream enhanced wound healing in split-thickness skingrafts when compared with a dry gauze dressing.

KEYPOINTS

• Although the aloe cream exhibited a shorter woundhealing time compared to gauze dressing, its effectwas not better than the placebo cream• Aloe cream might be more effective at higher con-centrations than the 0.5% concentration used in thepresent study

DO cal trials to confirm which is the optimal dressing.

DO cal trials to confirm which is the optimal dressing.advantage of the present study was the use of placebo

DO advantage of the present study was the use of placebocream in addition to

DO cream in addition to provided reliable data to determine the beneficial effects

DO provided reliable data to determine the beneficial effectsof

DO

of aloe vera

DO

aloe vera cream on donor site wounds.

DO

cream on donor site wounds. Aloe vera

DO

Aloe vera preparations have many biological effects

DO

preparations have many biological effectsincluding anti-diabetic, immunomodulatory, anti-inflam-

DO

including anti-diabetic, immunomodulatory, anti-inflam-matory, antioxidant, and wound healing effects.

DO

matory, antioxidant, and wound healing effects.

NOT clinical advantages over non-moist products in manage-

NOT clinical advantages over non-moist products in manage-ment of split-thickness skin graft donor sites. These advan-

NOT ment of split-thickness skin graft donor sites. These advan-tages are related to healing, comfort, and infection rates.

NOT tages are related to healing, comfort, and infection rates.Although, they conceded that head-to-head studies com-

NOT Although, they conceded that head-to-head studies com-paring products with moisture-retaining properties are

NOT

paring products with moisture-retaining properties areneeded to determine the optimum moist dressing.

NOT

needed to determine the optimum moist dressing.dressings enhance re-epithelization of partial-thickness

NOT

dressings enhance re-epithelization of partial-thicknesswounds by allowing diffusion of oxygen and water vapor,

NOT

wounds by allowing diffusion of oxygen and water vapor,while providing a barrier to the passage of fluid or wound

NOT

while providing a barrier to the passage of fluid or woundIn a recent systematic review, Voineskos et al

NOT

In a recent systematic review, Voineskos et alrevealed that there is some weak evidence supporting the

NOT

revealed that there is some weak evidence supporting thebeneficial effect of moist dressings on wound healing in

NOT

beneficial effect of moist dressings on wound healing insplit-thickness skin graft donor sites. Due to methodologi-NOT

split-thickness skin graft donor sites. Due to methodologi-cal differences in the previous studies, the authors pro-NOT

cal differences in the previous studies, the authors pro-posed that it is necessary to do parallel randomized clini-NOT

posed that it is necessary to do parallel randomized clini-cal trials to confirm which is the optimal dressing.NOT

cal trials to confirm which is the optimal dressing.advantage of the present study was the use of placeboNOT

advantage of the present study was the use of placebo

DUPLIC

ATE

DUPLIC

ATEKhorasani et al

DUPLIC

ATEKhorasani et al

concluded that moist dressings decrease

DUPLIC

ATE

concluded that moist dressings decreasethe days to complete healing as compared to non-moist

DUPLIC

ATE

the days to complete healing as compared to non-moistdressings. Among the broad categories of non-moist and

DUPLIC

ATE

dressings. Among the broad categories of non-moist andmoist-dressing, no differences were found in infection

DUPLIC

ATE

moist-dressing, no differences were found in infectionOther stud-

DUPLIC

ATE

Other stud-ies showed that a maintenance (foam) dressing did not sig-

DUPLIC

ATEies showed that a maintenance (foam) dressing did not sig-nificantly reduce wound healing time compared to gauzeDUPL

ICATE

nificantly reduce wound healing time compared to gauzeIn a systematic review, Wiechula et al DUPL

ICATE

In a systematic review, Wiechula et al2DUPLIC

ATE2 con-DUPL

ICATE

con-cluded that moist wound healing products have definitiveDUPL

ICATE

cluded that moist wound healing products have definitiveclinical advantages over non-moist products in manage-DUPL

ICATE

clinical advantages over non-moist products in manage-ment of split-thickness skin graft donor sites. These advan-DUPL

ICATE

ment of split-thickness skin graft donor sites. These advan-

application was associated with a significant reduc-

DUPLIC

ATE

application was associated with a significant reduc-tion in the wound healing time compared to the con-

DUPLIC

ATE

tion in the wound healing time compared to the con-Aloe contains various carbohydrate constituents as

DUPLIC

ATE

Aloe contains various carbohydrate constituents aspolysaccharides. Polysaccharides are known to have

DUPLIC

ATE

polysaccharides. Polysaccharides are known to haveproperties in skin wound repair.

DUPLIC

ATE

properties in skin wound repair.22,23

DUPLIC

ATE

22,23 Additionally, it is

DUPLIC

ATE

Additionally, it isbelieved that the anti-inflammatory effect of

DUPLIC

ATE

believed that the anti-inflammatory effect of contributes to faster healing.

DUPLIC

ATE

contributes to faster healing.14,23

DUPLIC

ATE

14,23

Collagen is the major protein in the extracellular

DUPLIC

ATE

Collagen is the major protein in the extracellularmatrix and provides strength and integrity to the dermis

DUPLIC

ATE

matrix and provides strength and integrity to the dermisand other supporting tissues.

DUPLIC

ATE

and other supporting tissues. Aloe vera

DUPLIC

ATE

Aloe veraproduction of collagen.

DUPLIC

ATE

production of collagen.24,25

DUPLIC

ATE

24,25 Aloe vera

DUPLIC

ATE

Aloe veraproperties, which can help to prevent wound infection.

DUPLIC

ATE

properties, which can help to prevent wound infection.In recent clinical trials, application of aloe cream onDUPL

ICATE

In recent clinical trials, application of aloe cream onwounds was associated with significant wound healingDUPL

ICATE

wounds was associated with significant wound healingeffects in patients with burn injuries and post-hemor-

DUPLIC

ATE

effects in patients with burn injuries and post-hemor-rhoidectomy.

DUPLIC

ATE

rhoidectomy.17,18

DUPLIC

ATE

17,18 These results showed

DUPLIC

ATE

These results showed tates the healing process in different wound types. In this

DUPLIC

ATE

tates the healing process in different wound types. In thisstudy, although the aloe cream exhibited a shorter time

DUPLIC

ATE

study, although the aloe cream exhibited a shorter timeto wound healing compared to gauze dressing, its effect

DUPLIC

ATE

to wound healing compared to gauze dressing, its effectwas not better than placebo cream.

DUPLIC

ATE

was not better than placebo cream. more effective at higher concentrations than the 0.5%

DUPLIC

ATE

more effective at higher concentrations than the 0.5%concentration used in the present study. Both creams

DUPLIC

ATE

concentration used in the present study. Both creamsinduced a moist wound environment as compared to

DUPLIC

ATEinduced a moist wound environment as compared togauze dressing, and maintaining a moist donor site is crit-DUPL

ICATE

gauze dressing, and maintaining a moist donor site is crit-ical to wound healing.DUPL

ICATE

ical to wound healing.

Khorasani et al


Moisture maintenance on the donor site surface mayexplain the observed beneficial effects.

AcknowledgementThis work was supported by a grant (grant number

752) from Tehran University of Medical Sciences, Iran.

References1. Ferreira LM, Blanes L, Gragnani A, et al. Hemicellulose

dressing versus rayon dressing in the re-epithelialization of

split-thickness skin graft donor sites: a multicenter study. J

Tissue Viabil. 2009;18(3):88–94.

2. Wiechula R. The use of moist wound-healing dressings in

the management of split-thickness skin graft donor sites: a

systematic review. Int J Nurs Pract. 2003;9(2):S9–17.

3. Hormbrey E, Pandya A, Giele H. Adhesive retention dress-

ings are more comfortable than alginate dressings on split-

skin-graft donor sites. Br J Plast Surg. 2003;56(5):498–503.

4. Voineskos SH, Ayeni OA, McKnight L, Thoma A. Systematic

review of skin graft donor-site dressings. Plast Reconstr

Surg. 2009;124(1):298–306.

5. Giele H. Retention dressings: a new option for donor site

dressings. Australas J Dermatol. 1997;38(3):166.

6. Uygur F, Evinc R, Ulkur E, Celikoz B. Use of lyophilized

bovine collagen for split-thickness skin graft donor site

management. Burns. 2008;34(7):1011–1014.

7. Tan PW, Ho WC, Song C. The use of Urgotul in the treat-

ment of partial thickness burns and split-thickness skin

graft donor sites: a prospective control study. Int Wound J.

2009;6(4):295–300.

8. Dornseifer U, Fichter AM, Herter F, Sturtz G, Ninkovic M.

The ideal split-thickness skin graft donor site dressing:

rediscovery of polyurethane film. Ann Plast Surg.

2009;63(2):198–200.

9. Wang TH, Ma H, Yeh FL, Lin JT, Shen BH. The use of “com-

posite dressing” for covering split-thickness skin graft

donor sites. Burns. 2010;36(2):252–255.

10. Lohsiriwat V, Chuangsuwanich A. Comparison of the ionic

silver-containing hydrofiber and paraffin gauze dressing

on split-thickness skin graft donor sites. Ann Plast Surg.

2009;62(4):421–422.

11. Vogt PM, Hauser J, Rossbach O, et al. Polyvinyl pyrrolidone-

iodine liposome hydrogel improves epithelialization by

combining moisture and antisepis. A new concept in

wound therapy. Wound Repair Regen. 2001;9(2):116–122.

12. Hu Q, Hu Y, Xu J. Free radical-scavenging activity of Aloe

vera (Aloe barbadensis Miller) extracts by supercritical car-

bon dioxide extraction. Food Chem. 2005;91:85–90.

13. Maenthaisong R, Chaiyakunapruk N, Niruntraporn S,

Kongkaew C.The efficacy of aloe vera used for burn

wound healing: a systematic review. Burns.

2007;33(6):713–718.

14. Rodríguez-Bigas M, Cruz NI, Suárez A. Comparative evalua-

tion of aloe vera in the management of burn wounds in

guinea pigs. Plast Reconstr Surg. 1988;81(3):386–389.

15. West DP, Zhu YF. Evaluation of aloe vera gel gloves in the

treatment of dry skin associated with occupational expo-

sure. Am J Infect Control. 2003;31(3):40–42.

16. Rosca-Casian O, Parvu M, Vlase L, Tamas M. Antifungal activ-

ity of Aloe vera leaves. Fitoterapia. 2007;78(3):219–222.

17. Khorasani G, Hosseinimehr SJ, Azadbakht M, Zamani A,

Mahdavi MR. Aloe versus silver sulfadiazine creams for sec-

ond-degree burns: a randomized controlled study. Surg

Today. 2009;39(7):587–591.

18. Eshghi F, Hosseinimehr SJ, Rahmani N, et al. The effects of

Aloe vera cream on posthemorrhoidectomy pain and

wound healing: results of a randomized, blind, placebo-

control study. J Altern Complement Med. 2010;16(6):647-

650.

19. Persson K, Salemark L. How to dress donor sites of split

thickness skin grafts: a prospective, randomised study of

four dressings. Scand J Plast Reconstr Surg Hand Surg.

2000;34(1):55–59.

20. Weber RS, Hankins P, Limitone E, et al. Split-thickness skin

graft donor site management. A randomized prospective

trial comparing a hydrophilic polyurethane absorbent

foam dressing with a petrolatum gauze dressing. Arch

Otolaryngol Head Neck Surg. 1995;121(10):1145–1149.

21. Beam JW. Management of superficial to partial-thickness

wounds. J Athl Train. 2007;42(3):422–424.

22. Hamman JH. Composition and applications of Aloe vera

leaf gel. Molecules. 2008;13(8):1599–1616.

23. Jia Y, Zhao G, Jia J. Preliminary evaluation: the effects of Aloe

ferox Miller and Aloe arborescens Miller on wound heal-

ing. J Ethnopharmacol. 2008;120(2):181–189.

24. Chithra P, Sajithlal GB, Chandrakasan G. Influence of Aloe

vera on collagen turnover in healing of dermal wounds in

rats. Indian J Exp Biol. 1998;36(9):896–901.

25. Chithra P, Sajithlal GB, Chandrakasan G. Influence of Aloe

vera on the glycosaminoglycans in the matrix of healing

dermal wounds in rats. J Ethnopharmacol.

1998;59:179–186.

26. Agarry O, Olaleye MT, Bello-Michael CO. Comparative

antimicrobial activities of aloe vera gel and leaf. Afr J

Biotechnol. 2005;4(12):1413–1414.

27. Spear M, Bailey A. Treatment of skin graft donor sites with

a unique transparent absorbent acrylic dressing. Plast

Surg Nurs. 2009;29(4):194–200.

DO DO

48DO

48 WOUNDSDO

WOUNDS


DO 11. Vogt PM, Hauser J, Rossbach O, et al. Polyvinyl pyrrolidone-


DO iodine liposome hydrogel improves epithelialization by

combining moisture and antisepis. A new concept in

DO combining moisture and antisepis. A new concept in

wound therapy.

DO wound therapy.


DO



DO


bon dioxide extraction.

DO

bon dioxide extraction.


DO


NOT ment of partial thickness burns and split-thickness skin

NOT ment of partial thickness burns and split-thickness skin

graft donor sites: a prospective control study

NOT graft donor sites: a prospective control study. Int Wound J

NOT . Int Wound Jgraft donor sites: a prospective control study. Int Wound Jgraft donor sites: a prospective control study

NOT graft donor sites: a prospective control study. Int Wound Jgraft donor sites: a prospective control study


NOT



NOT


rediscovery of polyurethane film.

NOT

rediscovery of polyurethane film. Ann Plast Surg

NOT

Ann Plast Surg

2009;63(2):198–200.

NOT

2009;63(2):198–200.


NOT



NOT


Burns

NOT

Burns. 2010;36(2):252–255.

NOT

. 2010;36(2):252–255.


NOT


silver-containing hydrofiber and paraffin gauze dressingNOT

silver-containing hydrofiber and paraffin gauze dressing

on split-thickness skin graft donor sites. NOT

on split-thickness skin graft donor sites.

2009;62(4):421–422.NOT

2009;62(4):421–422.

11. Vogt PM, Hauser J, Rossbach O, et al. Polyvinyl pyrrolidone-NOT


iodine liposome hydrogel improves epithelialization byNOT


DUPLIC

ATE

DUPLIC

ATE

. 2003;56(5):498–503.

DUPLIC

ATE

. 2003;56(5):498–503.


DUPLIC

ATE


Plast Reconstr

DUPLIC

ATE

Plast Reconstr


DUPLIC

ATE


. 1997;38(3):166.

DUPLIC

ATE. 1997;38(3):166.

6. Uygur F, Evinc R, Ulkur E, Celikoz B. Use of lyophilizedDUPLIC

ATE6. Uygur F, Evinc R, Ulkur E, Celikoz B. Use of lyophilized

bovine collagen for split-thickness skin graft donor siteDUPLIC

ATEbovine collagen for split-thickness skin graft donor site

. 2008;34(7):1011–1014. DUPLIC

ATE. 2008;34(7):1011–1014.

7. Tan PW, Ho WC, Song C. The use of Urgotul in the treat-DUPLIC

ATE7. Tan PW, Ho WC, Song C. The use of Urgotul in the treat-

ment of partial thickness burns and split-thickness skinDUPLIC

ATEment of partial thickness burns and split-thickness skin


DUPLIC

ATE


wound healing: a systematic review.

DUPLIC

ATE

wound healing: a systematic review.


DUPLIC

ATE



DUPLIC

ATE


Plast Reconstr Surg

DUPLIC

ATE

Plast Reconstr Surg. 1988;81(3):386–389.

DUPLIC

ATE

. 1988;81(3):386–389.


DUPLIC

ATE



DUPLIC

ATE


Am J Infect Control

DUPLIC

ATE

Am J Infect Control. 2003;31(3):40–42.

DUPLIC

ATE

. 2003;31(3):40–42.


DUPLIC

ATE


ity of Aloe vera leaves.

DUPLIC

ATE

ity of Aloe vera leaves. Fitoterapia

DUPLIC

ATE

Fitoterapia


DUPLIC

ATE


Mahdavi MR. Aloe versus silver sulfadiazine creams for sec-DUPL

ICATE

Mahdavi MR. Aloe versus silver sulfadiazine creams for sec-

ond-degree burns: a randomized controlled study. DUPL

ICATE

ond-degree burns: a randomized controlled study.

Today

DUPLIC

ATE

Today. 2009;39(7):587–591.

DUPLIC

ATE

. 2009;39(7):587–591.


DUPLIC

ATE



DUPLIC

ATE



DUPLIC

ATE


control study.

DUPLIC

ATE

control study.

650.

DUPLIC

ATE

650.


DUPLIC

ATE



DUPLIC

ATE


four dressings.

DUPLIC

ATEfour dressings.

20. Weber RS, Hankins P, Limitone E, et al. Split-thickness skinDUPLIC

ATE20. Weber RS, Hankins P, Limitone E, et al. Split-thickness skin

The Effects of Aloe Vera Cream

Documents

Transcript of The Effects of Aloe Vera Cream