In the complex three dimensional surfaces of head and face anatomy, it is often challenging to place a semi occlusive dressing which is durable and doesn’t need frequent dressing changes. Moulded, addition-cured silicone serves as a semi occlusive dressing, durable on average for more than eleven days without a dressing change. It achieves the right amount of pressure and immobilisation for the graft to heal and allows direct visualisation of it.

In addition to the benefits for wound healing, the absence of dressing changes leads to a reduction of visits to the outpatient clinic, with resulting medico-economic savings and less logistical effort for the mostly elderly patients (mean age of 80.5 years in our study population) and physicians.

By analysing the patients with graft loss, there was no relation between the preoperative defect size and graft loss. In particular the patient with the largest FTSG had no problems with wound healing.

Up to now, silicone as a dressing is mostly used as a gel sheet for preventing and treating hypertrophic and keloid scars, and has proved useful and safe, although the exact mechanism is not completely understood yet [5, 6].

In our technique, the silicone is used as a transparent semi occlusive dressing that is moulded on complex wounds and leads to a moist chamber with increased temperature and improved hydration. Furthermore, it holds the FTSG in place and shearing forces are reduced which is especially important in FTSG.

Limitations in the method are possible complications from the material, such as intolerance or rashes, which were not seen in our study, possibly due to the small number of patients. Therefore, rare complications didn’t show up. In case of wound infection, bleeding or necrosis which makes removal of the dressing necessary, thread pull also has to be done, since the dressing holds on to the threads.

In comparison to traditional dressings with a bolster, such as petroleum or paraffin impregnated gauze with an overlying pressure dressing to secure the graft in place, it is not possible to monitor the graft without a dressing change and the application is rather complicated and time consuming. The application of the addition-cured silicone takes only a few seconds and the cartridge can be used several times with a new mixing tip for each patient.

The costs at our institution for a 50 ml cartridge are 8.01 € and 0.39 € for a mixing tip. The mixing tips are available in different sizes; the tip we use contains 1,6 ml and has to be discarded after use on one patient. The mean defect size in our collective is 4.42 cm2. Arithmetically 1.25 ml silicone cover 5 cm2 wound surface with a thickness of 2.5 mm, so that a 50 ml cartridge can be used 17.54 times.

This results in average cost of 0.85 € per application including the mixing tip for a wound surface of 5 cm2. In relation, bigger silicone dressings are more cost effective because of the high proportion of the mixing tip in the total cost.

In comparison, a traditional bolster dressing with Paraffin impregnated gauze (Lomatuell, 5 cm2) and overlying compress would cost 0.74 € at our institution. In bigger defects, an additional chromic suture can be necessary for the bolster dressing to hold effectively. This would exceed the costs of the moulded silicone dressing as chromic suture material is expensive (e.g. Prolene 4.0, 75 cm, 2.48 €).