Objective:Biological dressings like collagen are impermeable to bacteria, and create the most physiological interface between the wound surface and the environment. Collagen dressings have other advantages over conventional dressings in terms of ease of application and being natural, non-immunogenic, non-pyrogenic, hypo-allergenic, and pain-free. This study aims to compare the efficacy of collagen dressing in treating burn and chronic wounds with that of conventional dressing materials.Materials and Methods:The records of 120 patients with chronic wounds of varied aetiologies and with mean age 43.7 years were collected and analyzed. The patients had been treated either with collagen or other conventional dressing materials including silver sulfadiazine, nadifloxacin, povidone iodine, or honey (traditional dressing material). Patients with co-morbidities that could grossly affect the wound healing like uncontrolled diabetes mellitus, chronic liver or renal disease, or major nutritional deprivation were not included. For the purpose of comparison the patients were divided into two groups; ‘Collagen group’ and ‘Conventional group’, each having 60 patients. For assessment the wound characteristics (size, edge, floor, slough, granulation tissue, and wound swab or pus culture sensitivity results) were recorded. With start of treatment, appearance of granulation tissue, completeness of healing, need for skin grafting, and patients’ satisfaction was noted for each patient in both groups.Results:With two weeks of treatment, 60% of the ‘collagen group’ wounds and only 42% of the ‘conventional group’ wounds were sterile (P=0.03). Healthy granulation tissue appeared earlier over collagen-dressed wounds than over conventionally treated wounds (P=0.03). After eight weeks, 52 (87%) of ‘collagen group’ wounds and 48 (80%) of ‘conventional group’ wounds were >75% healed (P=0.21). Eight patients in the ‘collagen group’ and 12 in the ‘conventional group’ needed partial split-skin grafting (P=0.04). Collagen-treated patients enjoyed early and more subjective mobility.Conclusion:No significant better results in terms of completeness of healing of burn and chronic wounds between collagen dressing and conventional dressing were found. Collagen dressing, however, may avoid the need of skin grafting, and provides additional advantage of patients’ compliance and comfort.

A 28-year-old male presented with a soft, non-cystic, non-tender swelling of 5 ¥ 4-cm size over antero-lateral aspect of right lower chest wall for 2 months. Chest radiograph revealed a soft tissue shadow on the right lower chest wall, without area of bone destruction. Ultrasound of the abdomen and chest cavity was normal, except for a heterogeneous mass of 6 ¥ 5.4 ¥ 5.3-cm size in the right lower chest wall, indenting the antero-inferior aspect of the right lobe of liver. Computerized tomography scan revealed a well-defined extraosseous soft tissue lesion in the lower right antero-lateral chest wall, without intraperitoneal or intrathoracic extension, and no rib destruction ( Fig. 1). Fine needle aspiration cytology (FNAC) revealed densely packed small cells with round nuclei. Bone marrow aspirate examination did not show abnormal cells. Wide en bloc excision of tumour, along with the eighth and ninth ribs, and small part of diaphragm was done. Repair of defect thus produced was done using a polypropylene mesh. Grossly (Fig. 2), both the ribs removed along with the tumour were not involved. On histopathology, tumour cells were round to oval with indistinct cytoplasmic borders and featureless nuclei (Fig. 3) and were infiltrating around the eighth rib and the muscles. Histochemical staining of tumour cells with PAS (Periodic Acid Schiff) was positive for glycogen. All the soft tissue surgical margins around the tumour were free from involvement. Diagnosis of extra-osseous Ewing's sarcoma (EES) of the chest wall was made, and the patient was referred for chemotherapy and radiotherapy. After 1 year of follow-up there were no signs of relapse.Ewing's sarcoma (ES) usually arises in bones but has also been reported to be arising from sites outside the skeletal system. 1,2 EES is considered a distinct clinicopathological entity despite its striking ultrastructural similarity to Ewing's sarcoma of bone (ESB). 3 More than 150 cases of EES at different locations have been described, namely larynx, scalp, nasal fossa, neck, chest wall, lung, perineum, finger, arm, lip, toe, 1 ovaries, uterus, kidney, pancreas, colon, hard palate and lung. 2 EES, like ESB, is a poorly differentiated, highly malignant round cell tumour without cellular structural differentiation and has an aggressive clinical behaviour with a high rate of local recurrence and distant metastasis. 3,4 The diagnosis and treatment of Fig. 1. Computerized tomography (CT) scans chest and abdomen of a 28-year-old male showing a well-defined extra-osseous soft tissue lesion in the lower right antero-lateral chest wall with no rib destruction, without intraperitoneal or intrathoracic extension but only indenting the anteroinferior aspect of the right lobe of the liver.Fig. 2. (a) Excised specimen of extra-osseous Ewing's sarcoma (EES) from the right lower chest wall of a 28-year-old male; (b) gross sarcomatous appearance of cut surface same tumour.Fig. 3. Haematoxylin and eosin stained tissue (X640) showing sheet of regular, round to oval, small undifferentiated cell...