Dialkylcarbamoyl chloride-coated versus alginate dressings after pilonidal sinus excision: a randomized clinical trial (SORKYSA study)

Abstract

Background Disease of the pilonidal sinus is a common condition that affects mainly young adults. Options for management include excision of the sinus tracts, leaving the wound open to heal by secondary intention. The aim of this study was to compare wound healing with dialkylcarbamoyl chloride (DACC)‐coated dressings versus alginate dressings. Methods This multicentre trial randomized consecutive patients undergoing surgery for pilonidal disease to postoperative wound care with either DACC‐coated or alginate dressings. The primary outcome was the proportion of wounds healed after 75 days. Secondary outcomes were the local status of wounds during the healing process, the quality assessment of the dressings by the patient, and the time needed to return to usual activities. Results A total of 246 patients were included: 120 in the DACC‐coated group and 126 in the alginate group. In per‐protocol analysis, there were significantly more patients with completely healed wounds after 75 days in the DACC group than in the alginate group: 78 of 103 (75·7 per cent) versus 58 of 97 (60 per cent) respectively (odds ratio 2·55, 95 per cent c.i. 1·12 to 5·92; P = 0·023). During follow‐up, wounds with alginate dressings had more fibrin than those with DACC‐coated dressings, but the difference was not significant (P = 0·079). There was no difference between the two arms in patients' assessment of the dressings. Conclusion The number of wounds completely healed at 75 days was significantly higher for DACC‐coated compared with alginate dressings. However, the preplanned, clinically significant improvement in healing of 20 per cent was not reached. Registration number: NCT02011802 ( https://clinicaltrials.gov/).

Use of Dialkyl Carbamoyl Chloride in the Prevention and Treatment of Biofilm in Wounds

“…During dermatological follow-up, alginate-coated lesions showed a greater amount of slough compared to lesions coated with DACC. In relation to healing, the group with DACC had greater success, evolving to healing in up to 75 days 14 .…”

“…Considering therapies with low risk of generating microbial resistance, new products have been developed for the topical treatment of wounds, with the objective of promoting the interruption of the initial adhesion process of microorganisms to the wound bed, among these, the DACC stands out, a fatty acid derivative that acts as a passive antibacterial, in order to sequester the bacteria into the dressing through hydrophobic bonds on the microorganism's extracellular surface, promoting irreversible adherence to the DACC substrate [12][13][14] .…”

“…From the analysis of the results, there is a consensus regarding the benefits of using DACC for the management of biofilms in wounds. Furthermore, its use can accelerate the healing process when compared to the use of alginate, and it can be used as a prophylactic coverage for the development of infection 14 .…”

Utilização Do Cloreto De Dialquil Carbamoil Na Prevenção E Tratamento De Biofilme Em Feridas

“…Considerando terapias com baixo risco de gerar resistência microbiana, novos produtos vêm sendo desenvolvidos para tratamento tópico das feridas, com o objetivo de promover a interrupção do processo de adesão inicial dos microrganismos ao leito da lesão, dentre esses, destaca-se o DACC, um derivado de ácido graxo que age como antibacteriano passivo, de modo a sequestrar a bactéria para dentro do curativo por meio de ligações hidrofóbicas da superfície extracelular do microrganismo, promovendo aderência irreversivel ao substrato do DACC [12][13][14] .…”

“…A partir da análise dos resultados, observa-se um consenso em relação aos benefícios do uso de DACC para o manejo de biofilmes em feridas. Ademais, sua utilização pode acelerar o processo cicatricial quando comparado à utilização de alginato, e pode ser usado como cobertura profilática ao desenvolvimento de infecção 14 .…”