uiltljfi9tilnuu original article · original article,j? u u r fi s u n r : g r r a * ar a fi g n...
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a dv a)uiltlJfi9tilnuu Original Article
,J? u u r fi s u n r : g r r a * ar a fi g n fro fi a n ry-r r d o rJ g n ri r u
Iorslfn:sorurndounr:rfilu fru Bactigras
Clinical Comparative study of Paraffin-Paper and Antibiotic Impregnated
Tulle Gras (Bactigras) for Split Thickness Skin Graft
Donor Site Treatment
rrirf nrnqfinruar6a n.u.n{ru.rruffauR::u
I:{ilr,ruragfiumfi
ff.rmiogflurrfi
Seri Pakpoomkamonlert M.D.
Department of Surgery
Uthaithani Hospital
Uthai Thani
Sawanpracharak Medical Journal
VoLz No.a May - August aoro
ra rrrfiJ tsu r Yn dr a rar:flfi z qrYufi 2 ilqunmu - fioumil 25iB
UilNOUO
iorgrJ:va.rrf : rdadnurtiliflutfiElunr:drurua donor site :sfi-j1.riE#.:r6ruIocr1fiuilu
Bactigras ri'u nr:lfr n:sonundaunr:rfl ud<aoruiifrnut : nriru.,:rurinan::el l:w^raruraqri'erorfi
a augrJuuunrr?ffu : nr:6nurrilieurfiEJuuuuhlfi.r.,:nrir
ncirufraodro : ffJradrurfiinrdntnrtda.:ornnr:anrdadzr unyfia.:airm-qfirnri.:rdar.lqnrirg
#.:urpirdaur^rqun1nil zssz fi.,:m'auwMuu zssg .r"ru:u 32 nu?Gnrtf;nul : [r-i.:rrnradann-nfirmu-,:rdarJqnriraaonrfluno.:drurrh q n-u drufi t yir
rrar alrr Ejttraiu Bactigras rrardrud e nh uzu nln a'lff n:ynr un 6 aunr:r fl unanrtf;nur : ,*od-rlrfrrsnxorulndaurnn:Tfilu'lftrarursrade]rhn,ir1s.+ a-unJiEJurfiE,u
riu rs.g i'u p < o.oo11 fi:rriun.lrrur6uilraua-rrjroio tu,:-ud 2, g,4Ltar 8 fiafln'jr (p = 0.04,0.012,0.012 uas o.o1e nrurirriu) uardfladunalilElrmireltunr:riruruafiaun'ir 12.r uliaurfiElun1u z.+ p <
o.oo1 ) rdaufieruriuu^udilrfrru Bactigras
14O rsid nrnofinunrtn d?::d'il:sslinrirrtar:
?or:oiuavapJ : olnnlrfinurdnu'irnrt'lfin:cor1t*tndauilr:rfluflrrttrud donor site
ug.ra mr EJ rir n,ir ilr n uru a ria s n'ir rirlfiir s n'ir uanl:su fn n'h nr:'lfr uul.i u
Bactigras Io flhivlu ttzua fi or r{o
n'tfl]nnu
v a v A o . ., ^---^^^..^d ar: nr:n-nfiruuttfradanrils nr:YlrUrJa donor site n:cFltUtnAAUT{1i1YIU
Bactigras
Abstract
Obiective
Setting
Design
Subiects
Method
Results
Conclusion
To compare the effect of using Bactigras and Paraffin-paper dressing
for split thickness donor site treatment.
Department of Surgery, Uthaithani Hospital.
Comparative ProsPective StudY
The study included 32 adult patients. split-thickness skin grafting
procedures were carried out on these patients for the management of
necrotizing fasciitis and cellulitis.This study was conducted throughout
a 12-month period, during May 2009 - April 2010.
The donor area was divided into 2 parts one area was dressed with
paraffin paper and the second area with vaseline-impregnated fine
mesh gauze (Bactigras)
The results indicated that patients treated with paraffin - paper had
higher rate of healing (9.4 days vs 13.3 day P < 0.001), experienced
less pain in day 2, 3, 4 and I after surgerY (P = 0.04, 0-012, O.O12
and 0.016 respectively) and low level of score for dressing (21 vs 2.4
P < 0.001) compared with patient treated with Bactigras.
We conclude that paraffin - paper dressing is superior to the standard
mesh paraffin gauze (Bactigras) dressing for split-thickness donor
site area in promotion of epithelialization, pain relief, ease of treatment
and very low cost.
split tfticlfiegs skin gmfting, donor site dressing, pamffin - paper' Bactigras'Key words
UYIUl
d.; a ;un 7 aLUl] 2 yt.Fl.-fl.Fl. 2553
ruEourfiounr:guauruofigncr'nfi':rni':rdorJqnrirolaal{n::orurna'ourrs.rilu rir BactigruClinical Compaative Study of praffin_paper md Antibiotic Impregnated
Iulle Gras (Bactigr6) for Split Thicknqss Skin Graft Donor Site TrJatmenr
nrffi fi rmri.: nfi arJn n rir a (sptit h id<-ress
skin grafting : STSG) rfluafii{tt1Jag(,)Inso,)-
ri'r umilr uzunfi Onrr-ahJ(oonor site) fnair.,:n?iu6uil? or urlyai.r.::aEJurJn rfl udlriar a.,:rru
hiri'u{rJru n1?auaurJn dorner site 6.onr:
vir'lrl'uzuar,n u r5rfi qn aoRl?yu?rrnfiau'l#rfi erv d r 4t4 a Xuaflnrtrl [flu n1Tfrldaaaafl n1:fiorriia(z-4)
{a4d rda nlfi n?rfi nrudsJrjh 4nrd'utfiA lil?htfinr :6 nr r#a rfi rudu yir'lfr uar nriru{u rd adr ertfr
rd o u fi r.: a n r5r{u (re-epithet iat ization )
rhEfforkifi n ttrua E uai1 EI Lras:1 n1 n fl
(s-8)
Feldman 16'ur-i.r nr:yi1 LU{a donor site
rtlu s ndru(') nriuu:nrflun1:?iluzunrLUUrilFl
(dry open) Irramrsrfrruonfrr,rmiari.rn-ud uzua
runctffty'l da{ ou u,{ a'lfr q ruHQ fi ?i?{ ob-doa.r F11 rflnrfi sad.,: riia.irdr eJd.: raEn'Lfi uzuamr a
tdu n{ruarr Hydrocoiloio lfiuri Duoderm(r1)
Unr Aquac";(te'ts)
' JJan A'rufi firilu n1:yi1rzun uuu d.,:fl n
lsen r i occtusive; In atfiuaiu f.: m:rsffi ar nr rt
rfrdup) ifid{rlurinr6uilanuruarurn r#.:ornfl eooo ftfififinurnr:riruzua,id,J^.{
nrirufraalti]ut[uufi',:ltln(semi open) donor site arir.,:oiardo.,: n.rnjt Moist Exposedtutl 1952 finr:rjrnrunlutnfiaufu Burn ointment(MEBo) ilrtfimruiralns(wax paper) el'rilnrlnrlo',:iln1flil:carmfiurua riruzuauruurflln nu,irurJnmslu s+ {u uas.^4^--^-- 6 t , d o ulvlaana1fl'l:[auil?Fl 0iarurilnr:dmn4rnra rru'jruruarflulu:yrJsurrdn,hrn:lfr Sofratrlle@)
A OV ,uuFrlJlLultu Paraffin gauze, Sofratulle, fl zotolur]rsrmalnufinr:finuri'aE e rfiorBactigras, Biobrane mt xeroform (a bismuth 1fiuri t-ipioo-Colloid Absorbent Dressingpetrolatum 9ouz6;{tor (Urgocett), Atginate (Argisite M) ttffy chitin/
,dn{rufi d1fl tflunl:d1 uruauuuiln Potyacrytic ncio d.,ror6mloraaudrmalulafi
(occlusive) n4erdfirri'nn'r:rfratfruzuarjrudu lamrunr:-dquvi,,:rnfi MTEC nudrzualnf,r6srriutfir-aEdqo{'urlrrmdo.:1fipr'ufirov:rrud'rrflu rto s nlu u^unrHrirnrErtu ro-rs {u
a J^ .l --. etoatnfraufifirta',:rrnrarirlfrrildauuzualfiirEr Arfirrl.r,raa.:lfifi rasaan?1aJr6uil?a(23)
r.irulfr ltransparent dressin g) fi ot adr a n o n:r ru
r6u il r a z a,,: u zu a u oi n u.i r'[ d u r.i u f.,: r n :r rfdqrrfi u rinfl rmdat uacrfi *JIa n16fi o ffi r,+,rs1
n riru aBrfir Er rflu n1:lff{a4flrnrn(biological dressing) rtiU type I bovine
collagep(tor [Lne egg membrane(,r, un#Ffiaora av & J , "6anr: lffrfi arfi atra.:{rhuro{ rdu rnri.,:fi dor
oafl il1eJ1nlfi uarm:ndrh.ter.,:6ud donor siteNA
u a nqr nii rfi a n orrftymril?rur ru rda pr
.- -?- a v I v rled o .uarul !fiao.:rna.: ritnn 16frnr:ilta1:?i? U
frrrur6aoru'Hu.r{, rdu fl rgzo finr:'lfirTTnarqu epinephrine ilafiuzua(,') tl teeO
ulrar alginate u-,6[frlrs,zor unrfl eooo finr:'lfrar: chitosan dtrfl uaqrniuriornuJdan{.or]
fi q ru a r ri6 rir EJ frr,J r n' o nl fi 6 un s ru' q n f;frr udd s
ruafrr5s[nso::rumfi(r,)
r1o 1 riu rin a uvr n fn'rlil Er-.: fi EJ ilt{i 6
nr:rf.rr6ruIas1{ pararfin guaze m?o antibiotic
impregnated tulle gras rdu Sofratulle uarBacti gras (2a)
uri fi {a rf, EJ 6 a fr rh El il-n fi ar nrriu
rdarGuurfi uuifiquauara donor sire dfiu'rnorn n:vonun{rt nau urualn s:au uactl or rnlf[n
nr:n-orfirmf.:lilr.lqnriruiruu split thickness fl a.:fiunr:rdrrnq nn#':riT d'n 1;Ud 3)
skin graft "[ul:.,:nHruraqvr-norfi +oni, n=tlru^u#udauo u^urYo z druoctlnfirEJud&raaaeZas
amuortl Fhirrgtrotou trfll*R1nil 2ssz fi.:6au frrnato::runtmuril:sttlfu 5-10 f,utfitlaunu
LrJga?ru zssg nr:6n*.flfiiun',raq6u1na1n lfia{urlrrrda.:frfiruaanu.o']nfrLL:n LLas
n6u'fl::1fl1:oitlo::rJra.,:INna'tu'taqrTaorfi fln"fuuanfirafrrfior'lfiutilunail:ru.*,d,
rrnrrhJeuqn:1flyn1ur1uay6eroma.,:n'r:6nu drstiril16oouav'firinnr:tndaulm?fl4{ut{a
nrilrYrodr.,:6a frrlraduriunminur ufi.:riT rr-or{rleflfia.:finuurdelthjrilor
,duoolnn.rarr{udr. uacfia.tairrirrfirurit rrruaou6.:{ud + rlal*rrTo 1;Ud a, s) tLrua
A
i:nil:vsir m n:rru6 nga.: Lli{a arun'l?\ta.:rJ?
ffi o-u6,o a or d'r uil:rm e{r dfi r fl nr fl ir u,{ avYt z ifi'lu{rlrunurdaariu{rJruoJtfi iunr:rTrrfi rmu-.:
frrufi nrTnfirmri.,: (?tld t ; IorurTaarrrnrnfd - A @ u -c 61y.!l-y---^ t
nurdarnu truaornm#.: ta5ooJ[fi frrfratqurjr) w Yqe
tJlFrq [lnfr donor site [ncnnn?gtJ'l[]1LtuuA v a - A.-
rfiar{rru udaotqun'ir nr:air n nfiuzuaastdTa
ornrfurni.,:rL,.la donor site aanrfluaa'odeu
M'r1 riu terld zl drudr florumauuud'',:r6u
6 o'lfiuaiunrrir a ru4ru urair r{a lantibiotic
impregnated tulle grasflunl:finr*T fLfirrriuau A.at
Bactigras u5um smith&nephew {",: rl d?u t{du
fl a\: chlorhexidi ne acetate tll ord rm a rfl u#, utn
lu drud z d.: r{l u sl"r uu ri.,:dlfit o'tt fi nur o Jlfi
n:vrnum1fir unr:rfilu(Paraffin-pape0 firu
da'u rra,ru a n:,rnudlfi 6 o n:tnT r*dviarur'Lu
qrfi a steri te dt'[t''[u nr:rir d'or4 n n{r a qi rrf,r
Ior er uunaanrur rioulfr fi'a uuunfldq',:fi a uuu
aseptic technique rrar'lfin::1n:mtafi ntora
u ai u n :s on r*'[fi r{l u ; rd a u{l uti a.: n r.: :rr. u tL
rmda.,:unstdan r#ril orntenlurtl:'lfilulna'Ifr
,laAvdaufr 1 aunntilaaofltav{1e{uzu1nosttas
rul d uu rir n ord ar rur:a rncaa nlfi tvirfl rln u
hizunruualu Bactigras uatfirnaqdfi ouruuafl
fi nhudurvrfiu rrarrirtfrrfi ornmruttuilrn
Inu roflrrtrard'iT r{lufra'-:rildeturrara rdu
^)-V a a a -- ^--- ^^ Xn:fifi fi ritmfi o.:m5ardanaofl il1fl uanornfrvd o a
'3ru.:anlurirfia.:orniaqEl.:u r{4il141 HIUOUllL:il{En tilil Lu'el{'11' lt l' J q
9ALravtJlno{Flntt9Jauuu
AaaalIt4oFnurun$41?f,YlQcFl ua$0Ja donor
site fi tm ruredil n-u fidlad ruriu nr:inr*r'[ue u dr u A {Yr al:.,:r{sruraortuoril [ptuilrrdqmfi1 Lo{1t1fi :o
^i, trtta"f"fttfl u1u1a urarnr:'lfi'':rudr a
d.: {i6'udrt6.,t rua nr:fi nur sioqrn weeter(')
Ior fl'lfi LLtiun:sotrurndau fir anr:r$lu dr rur
r..hre1ndlfi urruwJu Batigras dlfiaqr{tur-nt'ir
6rrir nr:i6''gffior fl fi {fl sril:ta.: ri'rd a trf:Eu tfi su
ruanr:inuruara oonor. site'[uuti:crrrraad
Lu{afi1g nmrut6uilroma\:utla uasnllilEnn',i1u
'[ u n r : rir ur at a u a-',: r.i I rTn :, n'i r',:i 6 rY.: r 6 r.r
Iofl'lfirriu Bactigras rYuifinT :lfifl:trl1t*
rn6aunr:rfilu
a44?fin1:flnul
nr : 6 n r*r drfl u n'r : fi n r*rtrltr.: n rir
rdarlanrirfl LLuu srsc urarhiraEilfriunl:iUr
rird'errir srsc rurriau siruru 3z nu tfia',:
01nfl1:141H?!4.:tUJAtUfl Ufi AlUuAAfl ttuolEl
fltd z auYud 2 y{.a.-d.n. 2ssg
*6orrfiuunr:quauarniignd'efirrni.rrdorranrirsre,l{n:soruraf;olnr:rflu fil nactigrasClinical Compafative Study of prafhn_pa1er md Antibiotic lrnpregnaed
Tulle Gras (Bactigras) for Split Thickness Skin Gmft Donor Site TJatrnenr
u-ufi n'ir fi nr :fi n rda, a.,: u ru n mia rura r d aln EJ d.l.: * a,rToufitaki rmadaufi 2 ecnnl[nyaaflaufi ua&-:? ilyTt n:cFt.turr.t:lfilu fi? a uf;r uJdau n:sa1unr:rfilu?'u'Lm ri unu ufir[l n n arvriu fir fr nfl n fiil{uiu 16 ru ril or uar a 6 n pr iolU'r fi I fi a-{ e.i1 n-trr
(grJd o1 uruadeufi r ri.ruiurdrudaulfiau
y &yo{aryafildrjrilrimr:rcfnr.,:afr 6 rfl u
qiruru rir radEJ LmsrilSuurfi uu n?TJ rrnnFi.rir
:vfi 'j1{do{n{rufirer pair t-test rilHuor:crt-u
nmrrfiaxiufi iaElas gs
mn.,: 15 nu alflrafiu 52.6 fl (40-76 il)
rirna*onrsdrudtrifin*riurri,fu tudrud e e{anr:finuruzunoyn n rflnaa naufi t.t or rir nrrru ayol Ft rriJa^^^-U - u va u)Tr nuunTtarHnurnur6cuufr rnufr ruraHrEJafi yt
e
ile n ovu-u fi nlor Ej yr ri1 ur a 6 n ria u n::rulu{u d1, 2, s, 4 uar g fi#.,:rirrin InEJtn visual
analog pain scate alnnsuuu O 6o1ilr6u
oufi.,: ro 6a r6ururndao s) uuuuhfrnn ? 1 il u 1 n i r utu nr :?i1 Lt r,l n fi n-{,.j,r n"'a Io EJ
l,'rarLrndnriaEJn::il1fr'nc[uu:yfi,ir$ 1 doyirira oufi.,: s 6a rjtarn +) urutiufinn'nvrtntnilau rziu 16oo oo n uru a6a r#o rmyn 6uLLnr s; rruuriufi nfllyr F,t-?a Eir.: up{a'[u ffiac
.,rr ur* o., fi ,; ;r; u'n;;r;q td A aLritiutflioai'ilridtiuaru(') fir-hcrdru'lmqjnniu fiflorfiza Bactigras'[{rear 12-1s +u ra6er9 rle5) u uu r uin-lu t o rYu r a".o ajr rr-n lor s frr]r er mia ru r fidrrur:nd:srmfionunuzunlfi uzua gratt araua.,uavlilfrt{ rda {rJr ann-uflruociloufi rn u'lfru-ufin{ufiuzuadrud t uriu Bacrigras fiqnaanao n ra{aufi e.rn u-or {ilr u il1olr?e Ltzuad n n#.: r +vv,uu4Jy
? ufi a't r{1 rt n ttnsu ufr nnr lr tfr a uzu a yi.: aa,: da um'rHtt#r
:ru:rrufro ry
nlu uuuu-ufi nil:sn ou dr a
t ; uuuflufinr-uduaramlu utlnrfluaa.,:dru
daud r tfirYuiiuriu Bactigras ilaoaonro.l,.d
aufieJn dtufi z mn-.:ornrflnrrzuntufud e
ra-tairn-nu1fi nr:uii'rmaufr .:uayhir6urfi EJr
rilorfilnrRarnrfl 2) ut_tuu-ufinnrtrut6u
13.8 ?"u 6rrnoaanaonfirJFr rrr.rafiflnfiaaq
nxqrutndaurrr:rfilu uzual{narmra e-t t aiuiu.
t a d s g. + i u u n n rir.,: niu a d r.,: fi u-a dr riru n r.,:
afi6 1e < o.oo1) 1r,r:r.,:n' 1 rraruruuflnd rf:srrirnrrrur6rilror'lur-urr:nma-ta,irriorrnrafi
iJorfireJ Bactigras fi:sn-un?rilliuilan rodEl
3.BB unc uzunn'tlnrfir u n:ynruindauyrr:rfilu
fi :co-uFrmrJriurJrn r"dn g.ze triunnrir,:riu(P = o.o8) rrst"lui'uid z, g,4 ttns g ma-.:ajrrior
J-euzu a fr il o d: u n:sFt1 utn 6 ournrr:r filuded!rJ:vouFt?,ttJrouil?a toda 3.7g, 9.44, 2.75,2.44 LLay t.gg nraln'rpt-u rirn.irurundflr,firaBactigras aelr.:firiarirn"rynr.:afrfi (p = 0.04,
0.012,0.012 une 0.016 nrruahrr-u; (nlr.r{n2l
riru iu prm ru ar n.ir a'[u nr:tir rm nu a-.,:
ilr oinr In EJy{ arur a 6 n fl-a fl n::il nu.ir rir rq6snrr:J EJrnir EJtunr:yir uruadfl o,fias Bactigras
.Ce, - -g- -ry't1flu 2.4 ttnsttrJafrIJndrun:vottunfiouArtU
lryr:rslu Mr nu e. t un n rir,,: riu o dr.,: fi ritr rir niru
yn.:dAfi (p < o.oot; 1mr:r.:fi B uasrrzuunru^'{n2)
o d Y,&, - {--.---Lunr:Enut n:.,:u LetlluR1?sFtnttal a\:
ttr{a Lravfl1?st6anaan Lri Ltnnrllnnun{6{0{rOvvtu
dau -Luiuurtns?a 14 ?u iln{rJ1rlol v{u?1
& ' dvL$J AYl{ d A{ dr u il a nuilun1:fl 1 Elta\: Ltt{ a
rmfiaufiu (grlii a1
?o1:6u
[r'Ja donor site tfluuzuaasalndv G', u
fr anurustilu LLIJafl aan fi n nn1:FlLtaLttJa. !t* , ooe i < c'
rl:srnnfi16rrri riT "lfr rqatEaq{an L5?fi qFr
(re-epithelialization) Iot arirlfr rrzuafi nm urjru{u
tri rfl unou rfi ulil rdohi'[rluara rda er fl a.: riuo&dd
n1:fr nl?ia aafl 1:u1at0u ttnetouil? nta{Lp{a
r1o g-iul:.: n u 1 u 1 n q yl-u fi I fi fi fa q i4tfi
rirurua z lfinda Sofratulle (framycetin
sulphate) ttnE Bactigras (chlorhexidine
acetate) Ltzuailinavn nil orl{ou {rJr und'ufl1u
A I u v t v v I C--ov6 n uuu nu urJ a 11 a{ r.t'l trl Fl i.lu? uQstl 01 fl 1:
ilrnurua riu unsfinfiudurmfiu {i6'46.:1fiodtAdarY
vrr nt:Flnu1tilf uu tm uu nllu FlLLr.l a n? El
fi:rnrutiuav 14u1rl frrhfl t nu'lfi z uriu
:?;Jr1n1 28 u'111 arunr:lfi n:rot1undau
fl 1:1fiIu n:rorrudlfi tilu n:rotrufi vi a rur'[u
n.,: fi a ste ri t e dt'lfflu nr : rir nInrl n n#t a qi ufiraa.o,jt
unvmEatvn:T filuLria.:d.:oueir rfia Lnrllnn:rfiluvt"tua
1000 niil T1n1 150 ulTl Lunl:214n 1 n:.:
'lfiil:vrurru 1o-1s niru :ru:rn'l 2.0 urnria
1 nu m:d{au*hrdal:.:nmulnmm:nrir1firo',:
fi :rnrqnlfi rua6n'j'r {rJrufi .:vralo nmu t6ur-hn
ria s n'ir nr:yir uru a.,ir u n'j't f,rt?sttfl :nfr aufla El
A a au A r -4-^.--lilaEnr*rzua.,l1u-qElau tflu n1:FInU1lA{
afi 'fi'er d.: ali'Tlf, uav n ruv(23) rtJia u rfi uui'aqoaA
rirurua 3 tfla 6a Urgocell, Algisite M utac,y
Ch itin/Polyacrylic Acid Tlu'l'111{ d1 tJ na il [trJ a
firur5rnrfl'lu io-13 i'u uri r{lui'aEdfirir
tfidr 46.,r urastriar rur:a ru6 nlff ratlfr
Fr't1 ilta1 n nr: 6 nr*rda-',: d1 tJr:n 6n u1{
Taau ur.l afi a ana n La{ tda.,:or n uilu Bactigras oi atrl'[u fir u?l a { zu a:v u ru1'] Ltuanuilrtt'.la
r{l u fi r fi or :su'i r.: n I :rir u ru n vi.: a o',: uLU u'i 1 Fi 1.J
duutalri ua sar o drltl fi nr*T lfr riu rtil a a'nr*ruc
du6 n :',utY.: nlt,nia ru{aq'lrim Eulfrtrulfi
paraffin-paper ilnunu Bactigras ftrfluifi avoranrY.:1ufi0.,:ritrr-nutati46n6rtruriatrl&aa\]LFril
n r : 6 n *. d* u'j't tt u a dfl or fi r El
Paraffin-paper LLr.tamEilfi rSendtruu 6ild'tfrd v r a lgt
Bactigras uneltuua ufl ?1 0f,u1El Ln?1 nrvFllu
r n 6 ou l,n :rfl udr{tu{'a ahi 6 o rrzu a6thi atr tn?1il L6uil? n t?n1 tildsu lrarfl.:'l#nm r.rrjrudu
il nrl afilar fl il:saT vrlu'[fi uzu a uffi unrl*i iu rfa
riu r#u'lfl'[ufrrnas rrliuu rfi fl u naretar n'[u
nr:rir *ru anudr nr:'lfr n:rat*mdaurryr:rfl u
riruzuairern'ir tn:rtduaanriT flhifi oLt,Ja
rd o n"rur ru rirlfisir Bt lu'ir uriu Bactigras
n?il
nmrhuzua donor site firsn:solru
rnfiounr:rfilu'lfrr.radn'jrnr:lfi Bactigras
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