Plastic Wrap Versus Occlusive Dressings for the Management of Skin Ulcers:
Comparison of Two Symmetrical Wounds in Two Individual Patients
Jun Takahashi1*, Masaharu Miyagawa2, Osamu Yokota3,4, Harusuke Aoki1 and Takesuke Aoki1
1Department of Psychiatry, Minakuchi Hospital, Minakuchi-cho, Koka City, Shiga, Japan
2Minamikusatsu Keyaki Clinic, Japan
3Department of Psychiatry, Kinoko Espoir Hospital, Japan
4Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
- *Corresponding Author:
- Jun Takahashi
Department of Psychiatry
Minakuchi Hospital, 2-2-43 Honmachi
Minakuchi-cho, Koka City, Shiga 528-0031, Japan
Received date: February 01, 2017; Accepted date: March 14, 2017; Published date: March 20, 2017
Citation: Takahashi J, Miyagawa M, Yokota O, Aoki H, Aoki T (2017) Plastic Wrap Versus Occlusive Dressings for the Management of Skin Ulcers: Comparison of Two Symmetrical Wounds in Two Individual Patients. Dermatol Case Rep 2: 118
Copyright: © 2017 Takahashi J, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original
author and source are credited.
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To compare the efficacy of plastic wrap (typically used for foods) as a dressing material to treat skin ulcers versus occlusive dressings, each dressing was randomly allocated to simultaneously treat two wounds at symmetrical locations in two individual patients. In case 1, two wounds with full-thickness skin loss on the neck were treated. A wound measuring 6.2 cm2 that was treated with plastic wrap healed in 9 weeks. A hydrocellular polyurethane dressing decreased the size of a wound measuring 9.3 cm2 to 3.8 cm2 in 12 weeks. The surface area reduction rate was 0.7 cm2/ week with plastic wrap and 0.5 cm2/week with the hydrocellular polyurethane dressing. In case 2, two shallow skin ulcers in both femoral regions resulting from skin grafting were treated. The plastic wrap dressing was randomly allocated to a wound measuring 25.1 cm2 that healed in 18 weeks. The other wound measuring 18.5 cm2 was treated with hydrocolloid dressing and epithelialized completely in 13 weeks. The healing rate of each treatment was approximately equal at 1.4 cm2/week. No adverse events developed in either case. These results are limited because of the case study design but suggest that the plastic wrap dressing treatment is as effective as the occlusive dressing technique in the treatment of chronic wounds.
Chronic wound; Comparative study; Food wrap; Plastic
wrap; Skin ulcer
Plastic wrap, typically used for foods, has been effectively used as
a dressing material to treat chronic wound including pressure ulcers in
Japan [1-6] but not yet widely applied in other countries. Because of its
efficacy, low cost [2,4], and ease of use, this treatment has been gradually
accepted in many Japanese hospitals and care facilities.
The plastic wrap dressing treatment procedure is as follows [5,6]:
After cleansing with copious saline or tap water, the wound is covered
with non-sterile plastic wrap (made of polyvinyl chloride, polyvinylidene
chloride, or polyethylene) and fixed with non-woven adhesive tape.
Because of the weak adhesive strength of this tape, part of the dressing
comes off easily if exudate accumulates under it, while the excess exudate
drains to outside the wound. Tapes with strong adhesive power are
unsuitable for use in this treatment. The dressings must be changed once
or several times per day depending on the exudate amount. Frequently
exchanging the dressings can prevent local skin troubles including
maceration. If much exudate drains around the wound, a thin paper
diaper can be applied to absorb it and protect the skin. Accordingly,
the plastic wrap dressing occludes the wound incompletely unlike the
occlusive dressing technique using modern dressings. This incomplete
wound occlusion maintains an adequately moist environment, prevents
pressure increases, facilitates autolytic debridement, and prevents wound
infection. Thus, the plastic wrap dressing treatment is consistent with the
theory of moist wound healing and wound bed preparation.
Since a few comparative studies concerning plastic wrap dressings are
available [4-6], the Japanese Dermatological Association and Japanese
Society of Pressure Ulcers guidelines approve plastic wrap dressing as
a treatment for pressure ulcers [7,8]. However, control groups in these
studies were treated with occlusive dressings, gauze dressing with
ointments, and/or sprays including pharmaceuticals. No study to date
has compared the plastic wrap dressing to occlusive dressing only.
This paper describes the results of a study comparing the efficacy of plastic wrap dressing versus occlusive dressing for the management
of skin ulcers simultaneously present on symmetrical locations in an
individual patient. This study was performed in accordance with the
Declaration of Helsinki and its amendments and was approved by our
institute’s institutional review board. After a full explanation of the study
was provided, written informed consent was obtained from the patients
and their family members.
A 35-year-old Japanese man was admitted to a psychiatric hospital in a psychotic state. Before admission, he had a cold with a sore throat
and was under the delusion that he was possessed by the devil on his
neck. This delusion made him press on his neck with both fists for
several days, after which two symmetric skin ulcers developed (Figure 1). Both wounds were covered with plastic wrap until the black eschars
were macerated 2 days later, followed by surgical debridement. Both
ulcers reached the subcutaneous fatty tissue. The right-side wound (9.3
cm2) (Figure 2A) was randomly allocated to hydrocellular polyurethane
dressing. The distorted left-side wound consisted of three parts. The
largest (6.2 cm2) part was included in this study (circled in Figure 2B)
and subjected to plastic wrap dressing treatment.
Figure 1: Patient described in case 1 on the day of admission.
Figure 2: The wounds after surgical debridement in case 1. (A) The right-side wound was treated with the hydrocellular polyurethane dressing. (B) The leftside wound was treated with the plastic wrap dressing treatment. The largest
part enclosed with the circle was included in this study.
The wound treated with plastic wrap dressing healed completely
in 9 weeks. The other wound treated with hydrocellular polyurethane
dressing was reduced to 3.8 cm2 when the observation ended at 12
weeks due to the patient’s discharge. The surface area reduction rate of
the wound treated with plastic wrap dressing was 0.7 cm2/week, while
that of the hydrocellular polyurethane dressing was 0.5 cm2/week. The
plastic wrap dressing and hydrocellular polyurethane dressing were
exchanged twice per day and twice per week on average, respectively.
No adverse events developed in either wound. During the observation
period, the patient’s general health and nutritional status were good and
his Braden Scale  score was 22. Laboratory findings were normal. He
did not press on the wounds after the second admission day because his
psychotic symptoms improved immediately.
A 60-year-old female with schizophrenia and type II diabetes developed two skin ulcers on the front of both femoral regions due to
split-thickness skin grafting for burn injuries on her feet. Both ulcers were treated with gauze dressings and ointment containing alprostadil
alfadex. Following the skin graft operation, her auditory hallucinations
worsened and she was admitted to a psychiatric hospital 2 months postoperatively.
Both ulcers were limited to the dermis. The proliferation of
granulation tissue and partial epithelialization were observed in both
wounds. By random allocation, the right-side wound measuring 18.5
cm2 (Figure 3A) was treated with hydrocolloid dressing, while the leftside
wound measuring 25.1 cm2 (Figure 3B) was treated with the plastic
Figure 3: The wounds in case 2. (A) The right-side wound was treated with the hydrocolloid dressing. (B) The left-side wound was treated with the plastic wrap dressing.
The wound treated with the plastic wrap dressing took 18 weeks
to epithelialize completely; in contrast, the wound treated with
hydrocolloid dressing was healed in 13 weeks. The healing rate achieved
by both treatments was approximately equal at 1.4 cm2/week. The plastic
wrap dressings and the hydrocolloid dressings were changed once or
twice per day and twice per week, respectively. During the observation
period, the patient’s health was good, her Braden Scale score was
21, and laboratory findings were normal except for slightly elevated
haemoglobin A1C levels (6.6–6.9%). No adverse events occurred with
Discussion and Conclusion
These findings are limited because of the case study design
but suggest that the plastic wrap dressing treatment is as effective
as the occlusive dressing. Since this study compared two wounds
at symmetrical locations on two individual patients, the factors
influencing the healing of both wounds were identical except for the
difference in dressing materials. The plastic wrap dressings required
more frequent changing than the occlusive dressings in both cases.
However, the frequent dressing changes did not significantly increase
the caregiver burden due to the simplicity of the plastic wrap dressing
Wounds treated with plastic wrap dressing must not be tightly
sealed. The incomplete occlusion of the wound maintains an adequately
moist environment for wound healing and mitigates its lack of air
permeability. Dressings should be changed frequently and necrotic
tissue autolyzed as needed. If these principles are followed, the plastic
wrap dressing treatment can heal stage III/IV pressure ulcers that
cannot be treated with occlusive dressings due to excessive exudate
and/or infection [1,3,5]. If not, the wound may deteriorate, leading to
serious wound infection and sepsis . Even if plastic wrap dressing
treatment is effective, plastic wrap is not a medical material.
Ethical discussions are needed and further investigations are
necessary to confirm the efficacy and safety of plastic wrap dressing
treatment. In addition, further comparative studies including a larger
number of participants and wounds are needed to clarify the efficacy of
plastic wrap dressing.
This work was partially supported by a research grant from Minakuchi Hospital.
Conflict of Interest Statement
The authors disclose no conflicts of interest.
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