356 A Comparison of Donor Site Dressing Protocols In Burn Patients Requiring Split-thickness Skin Grafting

Abstract

For nearly 150 years, surgeons have been harvesting skin for transplantation. Yet, to date, no definitive evidence-based accord has been reached on how to care for the donor site. It is widely accepted that the ideal dressing should be easy to use, reduce pain, scarring, healing time, and cost while managing exudate. The purpose of this study was to compare the safety and efficacy of two commonly used dressing regimens. This was a single center, prospective interventional single-blinded randomized trial of patients requiring autografting. Patients were randomized 1:1 into either a calcium alginate dressing (CA) or a silver impregnated silicone foam dressing (AG). Outcome measures included time to 95% re-epithelialization, pain using the 5 point Wong-Baker scale, scarring via the patient observer scar scale (POSAS), ease of use (application, removal, management of exudate, ability to remain in place, time) and both patient and clinician preference. Summary descriptive statistics were calculated and analysis was conducted using Mann-Whitney and exact Chi-square tests for each follow-up evaluation. The criterion for statistical significance was set at p = 0.05, two tailed. Forty patients were enrolled. There were no significant differences between groups for sex, age, race, BMI, TBSA, donor size at study inception. Pain on post-op day (POD) 1, prior to the dressing change was significantly less for CA 2.25 vs 3.5 AG (p<.05). Clinician satisfaction with the dressing staying in place on POD 1 was higher for AG (p<.05). At Day 28 POSAS patient scores for stiffness were noted to be worse for the AG group 4.69 vs 2.56 CA (p=.015). At POD 90 there were no significant differences between groups for any of the POSAS patient scales. The POSAS observer scales were performed by a blinded clinician, there were no significant differences between groups at any time point. Number of or adverse events during the study did not differ across groups. The two treatment arms proved to be equivalent in efficacy and safety. More importantly, this study provides an effective framework to evaluate donor site dressings. Focus on pain control, ease of use, and provider and patient satisfaction are particularly important. A large multi-center trial is recommended to develop evidence based guidelines for donor site care.