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Abstract
An important factor in the healing of superficial and moderate partial thickness burn is early and effective coverage with a dressing that
protects the wound from trauma and dessication and is non-adherent. In our country cost is also a very important factor. Disturbed by the
pain and anxiety experienced by the patients during and after dressing changes, search for a new dressing material was begun for partial
thickness burn wounds and the banana leaf dressing (BLD) was subsequently developed and optimised by June 1996.
An open controlled study was carried out to compare banana leaf dressing and boiled potato peel bandage (BPPB), the dressing being
used in our Burn Unit since 1994. Thirty patients all less than 40 years of age, with burn size less than 50% TBSA, involving comparable
body areas with partial thickness burn, were included in the study.
BLD along with a topical agent was applied over the right sided extremity while BPPB was applied with the same topical agent on the
left sided extremity. Dressing was changed every day.
The pain during dressing change, feeling of comfort and ease of handling dressing was assessed by awarding scores by the patients and
care givers for each type of dressing. Analysis of the scores revealed that both BLD and BPPB caused easily tolerable, minimal pain during
dressing change in majority of the patients.
The days taken for epithelialisation, eschar formation and the need for skin grafting over deep partial thickness burns, did not reveal any
significant difference between the areas treated by BLD and those by BPPB. So both the dressings were observed to have equal efficacy
in protecting the wounds and aiding healing.
Thus, the efficacy of BLD and BPPB was parallel in all respects. But BLD is 11 times cheaper than BPPB. Banana plants can be easily
grown, the leaves are easily available throughout the year. The leaves of banana are large thus offering larger surface area and the surface is
non-adherent, waxy and cool. The dressing can be prepared very easily with little training. It is also the cheapest dressing available today.
We strongly recommend the use of banana leaf dressing for all partial thickness burn wounds in our environment.
© 2003 Elsevier Ltd and ISBI. All rights reserved.
Table 1
Age of patients and extent of burns Fig. 2. Right lower extremity (banana leaf dressing) on second post-burn
Age (years) Extent (%) day.
10 20 30 40 50 Total
3 – 6 2 1 – 9
12 2 1 – – – 3
20 – 4 3 – 1 8
30 – 1 3 3 2 9
40 – – – 1 – 1
Total 2 12 8 5 3 30
Table 2
Body areas under trial
Area BLD BPPB
Upper extremity 23 23
Lower extremity 11 11
Total 34 34
Fig. 3. Right lower extremity (banana leaf dressing) on 13th post-burn
BLD: banana leaf dressing; BPPB: boiled potato peel bandage. day.
490 M.A. Gore, D. Akolekar / Burns 29 (2003) 487–492
Table 5
Scores awarded during dressing change
Score No. of patients BLD BPPB
1 2 3 1 2 3
4. Discussion
Fig. 5. Left lower extremity (boiled potato peel bandage) on 13th post-burn
day.
The ideal dressing for burn wound should be painless
when applied, non-adherent, non-antigenic, non-allergic,
In 12 out of 34 extremities in BLD group and 11 out non-toxic, cheap and easily available.
of 34 extremities in BPPB group, variable extent of eschar Living skin autografts are the best but homografts are a
formation was observed, indicating presence of deep partial good substitute as temporary dressing [2], xenografts are the
thickness burn wound over some portions of the area under next choice. In our country, homografts as well as xenografts
study. are very sparingly available. Burnt patients are numerous
Range and mode of days of first detection of eschar for- and the need for a cheap and easily available dressing for
mation and the number of areas requiring skin grafting are their partial thickness wounds is real and acute.
tabulated in Table 4. Boiled potato peel bandage developed by Keswani and
Out of 12 extremities with eschar formation from BLD co-workers [3–6] was well accepted by most of our pa-
group, 5 eventually healed without the need for skin grafting tients and the wound healing was satisfactory. Discomfort
and 7 extremities needed skin grafting over areas of variable was however experienced by some patients, and the cost of
extent. dressing and the time consuming method of preparation of
the potato peel bandages [7],1 stimulated the search for a
Table 4 cheaper alternative that is easier to prepare. This lead to the
Eschar formation and areas needing skin grafting development of banana leaf dressing in June 1996.
Dressing BLD BPPB In India, banana leaves are universally used as plates for
serving meals. The leaves are also used as lining for cook-
Areas (nos.) 12 11
ing vessels as they have a waxy surface and are impervious
Range (days) 3–5 3–6
Mode (days) 3 4 1 Boiled potato peel bandages are manufactured commercially at Reha-
Skingrafting areas (nos.) 7 8
bilitation Centre, Chembur, Mumbai.
M.A. Gore, D. Akolekar / Burns 29 (2003) 487–492 491
to water. Patients with smallpox were asked to lie on ba- thickness wounds of all our patients. The main reason for
nana leaves because of their coolness and non-adherence to this choice was the low cost and the ease of preparation
wounds. of BLD. Since the completion of study in 1997, more than
After the thought of using banana leaves as dressing was 2000 patients have been treated successfully in our unit with
conceived, developed and tested on patients, the review of banana leaf dressing.
literature revealed a single reference about the use of banana This is the only reported study of its kind and hence our
leaves on burns wounds from Thailand by Chongchet [8] observations cannot be compared with those from any other
but no objective assessment has been provided. study.
This open controlled trial was carried out by applying Banana leaves are easily available in most parts of India,
BLD and BPPB on comparable body areas with partial thick- in cities, towns and villages. It is not difficult to have a patch
ness burns in the same patient and using the same topical of land with banana plantation within the hospital premises
microbial agent (povidone iodine ointment). Both dressing with a busy Burn Unit. The preparation of BLD is very
materials were sterilised by autoclaving before use and were simple and can be easily learnt by previously treated patients,
changed every day till healing (superficial partial thickness) relatives of patients and literate or illiterate individuals.
by natural process or by skin grafting (deep partial thick-
ness) was achieved. 4.1. Banana leaf dressing: problems and solutions
The age of patients ranged from 11 months to 38 years
and the extent of burns from 7 to 48% TBSA.
The days taken for epithelialisation, eschar formation and 1. Banana leaf dressing being totally non-adherent, tends to
the need for skin grafting over deep partial thickness burns, slip. It thus needs careful, firm bandaging.
did not reveal any significant difference between the areas 2. Prepared banana leaf dressing cannot be stored for more
treated by BLD and those by BPPB. The average number than 7–10 days. Fungal growth is seen on the leaves on
of days needed for epithelialisation could be compared well prolonged storage and they need to be discarded. Our
to the observations by Keswani and co-workers [3–5] using policy is to prepare dressings enough to last for 3–4 days
BPPB and with Chongchet [8] using sterile steamed banana only. Sterilisation by ␥-irradiation was observed to in-
leaves. Subramanyam [9] observed that in majority of the crease the shelf life of BLD upto 2–3 months.
patients, the wounds dressed with BPPB healed between 3. If paucity of personnel or time does not permit prepa-
11 and 15 days. Ramakrishnan and Jayaraman [10] have ration of BLD by the above-described method, the ba-
reported healing of superficial partial thickness burns by 10th nana leaves can be autoclaved and used just after cutting
day using amniotic membrane. So, both the dressing were the thick midrib without the bandage cloth backing. The
observed to have equal efficacy in protecting the wounds backing makes the banana leaf dressing more convenient
and in aiding epithelialisation. to handle.
Various clinical trials using synthetic dressings for partial
thickness burn wounds have shown the healing time needed 4.2. Cost comparison
to be 9.8 days (range 6–10 days) using Biobrane [11] and
12 days for both Granuflex E [12] and Bactigras.
Table 6 shows comparison between the cost of different
Thus banana leaf compared favourably with the other
commonly used dressings for partial thickness burn wounds.
available dressing materials in terms of healing time.
The cost of banana leaf dressing of 15 cm × 60 cm size is
Microbiological study also did not show any difference
89.2 paise.
in the incidence of colonisation, colony counts or the types
So, banana leaf dressing is 11 times cheaper than boiled
of microbes grown over the areas being treated by these two
potato peel bandage, 160 times cheaper than Sofratulle
dressings.
(Soframycin impregnated gauze), 1750 times cheaper than
Analysis of the scores awarded revealed that both BLD
Kollagen (collagen sheet), and 5200 times cheaper than
and BPPB caused easily tolerable, minimal pain during
Skintemp (biosynthetic dressing).
dressing change in majority of the patients. Though 4 out
of 21 patients expressed some discomfort with BPPB, the
difference was not statistically significant. The remaining Table 6
nine patients (younger than 3 years of age) were observed Cost comparison between various dressings
to be comfortable with the dressings. They continued their
Dressing Size Price Unit price
routine activities like running, playing, etc. without any (cm × cm) (Rs.) (paise/cm2 )
evidence of pain or distress. The health care professionals Sofratulle 10 × 10 16.00 16
carrying out the dressing procedures, evaluated both BLD Kollagen 10 × 10 175.00 175
and BPPB as equally simple and easy to handle. Skintemp 10 × 7.5 390.00 520
Thus the efficacy of BLD and BPPB was parallel in all (biosynthetic dressing)
respects. These observations resulted in the decision to stop BPPB 15 × 300 50.00 1.11
BLD 15 × 60 00.892 0.1
the use of BPPB at our unit and to use BLD over partial
492 M.A. Gore, D. Akolekar / Burns 29 (2003) 487–492
5. Conclusion [2] Zaroff LI, Duckett JW, et al. Multiple uses of viable cutaneous
homografts in the burned patient. Surgery 1966;59:368.
1. Banana leaf dressing is a suitable and effective dressing [3] Patil AR, Keswani MH. Bandages of boiled potato peel dressings.
for partial thickness burn wounds. Burns 1985;11:44–5.
[4] Keswani MH, Vartak AM, Patil AR. Histological and bacteriological
2. The efficacy of banana leaf dressing for partial thickness
studies of burn wounds treated with boiled potato peel dressings.
burn wounds is comparable to that of boiled potato peel Burns 1990;16:137–43.
bandage. [5] Keswani MH, Patil AR. The boiled potato peel as a burn wound
3. Banana leaf dressing is the cheapest of the available dressing; a preliminary report. Burns 1985;11:220–4.
dressings for partial thickness burn wound cover. [6] Personal discussion with Dr. M.H. Keswani—the originator of boiled
potato peel dressing.
4. The preparation method is very simple and can be eas-
[7] Observation of Procedure, Rehabilitation Centre, Chembur, Mumbai.
ily taught and learnt. This can provide an opportunity to [8] Chongchet V. The use of sterile, steamed banana leaves in the local
achieve economic independence and successful rehabili- treatment of burns. Burns 1980;6:264–5.
tation of burn victims. [9] Subramanyam M. Honey dressing versus boiled potato peel dressing
in the treatment of burns: a prospective randomized study. Burns
Thus BLD is non-adherent, non-toxic, non-antigenic, 1996;22:491–3.
cheap, simple to prepare and easily available, effective and [10] Ramakrishnan KM, Jayaraman V. Management of partial thickness
acceptable alternative for management of partial thickness burn wounds by amniotic membrane; a cost effective treatment in
developing countries. Burns 1997;23(Suppl 1):533–6.
burn wounds.
[11] Hanbrough JF, Zapata-Sirvent R, Caroll WJ, et al. Clinical experience
with Biobrane biosynthetic dressing in the treatment of partial
References thickness burns. Burns 1984;10:415–9.
[12] Wright A, Mackechnie DWM, Paskins JR. Management of partial
[1] Ahuja RB. Managing burns in India; focusing on newer strategies. thickness burns with “Granuflex E” dressings. Burns 1993;19:128–
Indian J Burns 1995;3:1. 30.