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Expert Review of Dermatology

ISSN: 1746-9872 (Print) 1746-9880 (Online) Journal homepage: http://www.tandfonline.com/loi/ierg20

Banana leaves: an alternative wound dressing


material?

Wolfram Hoetzenecker, Emmanuella Guenova & Matthias Moehrle

To cite this article: Wolfram Hoetzenecker, Emmanuella Guenova & Matthias Moehrle (2013)
Banana leaves: an alternative wound dressing material?, Expert Review of Dermatology, 8:5,
439-440, DOI: 10.1586/17469872.2013.835925

To link to this article: https://doi.org/10.1586/17469872.2013.835925

Published online: 10 Jan 2014.

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Editorial

Banana leaves: an alternative wound


dressing material?
Expert Rev. Dermatol. 8(5), 439–440 (2013)

Wolfram “…we possess a plethora of modern wound-dressing materials.


Hoetzenecker However, their use is often restricted in developing countries
Department of Dermatology, because modern wound dressings are expensive, especially when
University Hospital of Zurich, used over a long time.”
Zurich, Switzerland

Banana leaves have been used through Their leaves are an unlimited source of
the ages as wound dressings in certain biomaterial in these countries and have
Emmanuella countries as part of an ancient practice. been used as decorations, wrappings,
Recent studies scientifically assessed for plate mats, writing surfaces and in cook-
Guenova
the first time the wound-dressing proper- ing. Banana leaves are about 18 
Author for correspondence:
Department of Dermatology,
ties of banana leaves in research and clini- 36 inches in size and have a smooth and
University Hospital of Zurich, cal settings. These studies determined the waxy surface that does not stick. Banana
Zurich, Switzerland best sterilization methods for banana leaf dressings are usually prepared by
Tel.: 0041 44 255 3083
emmanuella.guenova@usz.ch
leaves and compared banana leaves with cutting out the midrib of the leaf. These
standard wound dressings in clinical tri- leaves are then pre-treated differently
als. As a result of these investigations, before applied on the patient’s wounds.
Matthias Moehrle banana leaves may be considered an alter- In some reports, banana leaves are first
Praxisklinik Tübingen–Haut & native dressing material easily available in coated with a paste made of cooking
Venen. Dr. Arno Bern and Prof.
tropical countries at a low cost. fine flour. These dressings are then dried
Dr. Matthias Moehrle,
Tuebingen, Germany Wound dressings are local therapeutic for 24 h and sterilized before use.
agents intended to create an optimal envi- Others directly apply banana leaves on
ronment for wound healing, with specific patient’s wounds without any pre-
properties according to the type and phys- treatment [4]. As a natural product,
iologic healing stage of the wounds. Mod- banana leaves must be sterilized before
ern wound dressing include alginates, use to remove the pathogenic flora.
hydrocolloids, hydrogels, enzymatic dress- Untreated leaves are heavily contami-
ings and many others [1]. The ideal wound nated with 7000 to 5  105 colony-
dressing should combine the following fea- forming units (CFU), mainly consisting
tures: a moist environment at the wound of aerobic spore-forming bacilli (Bacillus
interface, a barrier function to microorgan- spp.), Gram-positive cluster-forming
isms and non-adherent, non-toxic, non- cocci (mainly Micrococcus spp.) and
allergenic, non-sensitizing properties [2,3]. molds [5]. Of importance, contaminants
Modern dressings possess most of these likely include potentially pathogenic
requirements. However, these dressings are organisms, such as anaerobic spore-
expensive, especially when required over a forming bacilli (e.g., Clostridium spp.).
long period of time. As a consequence, According to generally accepted stand-
their use is limited in developing countries. ards, wound dressings as a class of medi-
cal device are classified as ‘critical’,
Banana leaves as a wound-dressing meaning they must be sterile. In a recent
material study, we compared different thermal
Banana trees grow throughout the decontamination (cooking in boiling,
tropics in approximately 107 countries. chemical disinfection, sterilization) to

KEYWORDS: alternative • banana leaves • decontamination techniques • wound dressing


• wound-dressing properties • wound healing

www.expert-reviews.com 10.1586/17469872.2013.835925 Ó 2013 Informa UK Ltd ISSN 1746-9872 439


Editorial Hoetzenecker, Guenova & Moehrle

identify the optimal procedure for reducing the natural micro- dressings for acute surgical wounds, especially in dermatological
bial load of the leaves without significantly affecting their bene- surgery, is limited. In a recent study, we assessed the ‘on-site
ficial wound-dressing properties [5]. Steam sterilization use’ of sterilized banana leaves on patients with dermatological
(autoclaving) resulted in the complete inactivation of meso- surgery in Uganda, Africa [5]. Approximately 100 patients were
philic bacteria and sterile banana leaves. Interestingly, other treated with banana leaf dressings after surgery and followed-up
easily applicable methods, such as boiling in water, also reduce for 2 weeks. Due to logistic reasons, data from only 43 patients
the bacterial load on the leaves to an extent that renders them were recorded during the follow-up phase. However, these
suitable for use on surgical wounds. This might be of impor- results demonstrate banana leaves as a safe and effective dress-
tance, if proper sterilization equipment is not available, for ing material in patients with surgical skin wounds. Importantly,
example, in certain African countries. banana leaf dressings are 1500- to 5000-times less expensive
As described in ancient reports, smallpox patients were than collagen or biosynthetic dressings, respectively [9].
treated lying on a base of banana leaves in India because they
cool the skin and do not stick to the patient’s wounds [4]. “…wounds treated with banana leaves healed
Banana leaves were first reported in the literature as a wound- in the same period of time as wounds treated
dressing material used on burn patients in 1980 [6]. Gore and with Vaseline gauze dressings.”
Akolekar extended these preliminary reports and published sev-
eral clinical trials in which they compared the use of banana Today, we possess a plethora of modern wound-dressing
leaves on burn patients with petroleum jelly gauze (Vaseline materials. However, their use is often restricted in developing
gauze) [4,7]. Banana leaf dressing resulted in rapid epithelization countries because modern wound dressings are expensive, espe-
and was associated with less pain during dressing changes than cially when used over a long time. Thus, there is a need for
Vaseline gauze. These results are in line with data from a cheap and affordable wound-dressing materials in those coun-
mouse model of skin transplantation [5]. In this wound model tries. Beside banana leaves, boiled potato peels have been
punch biopsies were performed on the shaved back skin of described to be efficacious in an experimental wound model in
mice. The removed skin was then replaced and the resulting rats and in patients with burn wounds [8]. Similar to banana
wound was either dressed with sterilized banana leaves or Vase- leaves, potatoes are easily available in most developing countries
line gauze. In line with results from clinical trials, wounds and might be suitable as an alternative wound-dressing mate-
treated with banana leaves healed in the same period of time as rial. However, further studies are urgently needed to assess the
wounds treated with Vaseline gauze dressings. Importantly, bac- safety profile and the physical and biological properties of alter-
terial swab tests revealed normal mouse skin flora in wounds native wound-dressing materials. Finally, alternative wound
dressed with banana leaves with no signs of infection. These dressings need to be tested in clinical trials and compared with
studies add important knowledge because banana leaves as modern wound dressings in controlled studies in order to get
wound dressings have never been studied from a scientific them licensed as medical devices.
point of view.

“…banana leaf dressings are 1500- to 5000-times Financial & competing interests disclosure
less expensive than collagen or biosynthetic The authors have no relevant affiliations or financial involvement with
dressings, respectively.” any organization or entity with a financial interest in or financial conflict
with the subject matter or materials discussed in the manuscript. This
The use of various biological dressings has been tested for includes employment, consultancies, honoraria, stock ownership or options,
some chronic conditions, such as venous leg ulcers and expert testimony, grants or patents received or pending or royalties.
burns [4,6–8]. However, experience with the use of biological No writing assistance was utilized in the production of this manuscript.

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440 Expert Rev. Dermatol. 8(5), (2013)