Impact of Topical Heparin on Healing of Skin Graft Donor Site in Burn Patients

Abstract

Abstract Background The ability of topical heparin application to improve the healing outcome of burn wounds has been demonstrated by several studies. However, its impact on healing of skin graft donor site was not studied. Aim The present study was done to compare the healing outcome (healing time, pain, itching, scarring and complications) of topical heparin treatment with topical conventional treatment in the donor areas after skin grafting in burn patients. Methods This prospective, interventional, controlled, single-blinded clinical study was done on 40 patients with 2nd or 3rd degree burns of any etiology and <30% of body surface area requiring skin grafting, aged 18-65 years, of both sexes. Each patient was subjected to harvesting of two grafts. Patients served as their own controls. One donor area was treated with topical heparin and the other was treated with the topical conventional treatment. Immediately after graft harvesting, all donor areas were treated conventionally. Starting from the 2nd day, each donor area was treated once daily according to its group allocation. The topical heparin donor area was treated with heparin diluted in saline in a concentration of 250 IU/ml in a dose of 4200 IU/1% total body surface area (TBSA). The area was covered with gauze soaked with the solution for 5 days. The conventional treatment (control) donor area was covered by gauze soaked with an equivalent amount of normal saline on top of Vaseline gauze. Heparin was to be discontinued if the platelet count before each session was < 100,000 /mm3 and/or APTT exceeded double the reference value. Pain was assessed twice daily for 5 days. The patients’ donor areas were followed-up postoperatively for 8 weeks for healing time in days, itching over the wound and scarring using Vancouver Scar Scale. Complications in the form of wound site bleeding or infection were recorded. An analgesic was given twice daily for 5 days then as needed. Results There were no statistically significant differences between the two donor areas regarding the site and size. The healing time was significantly shorter in the heparin donor areas (P < 0.00001) with less scarring reported as significantly lower scores of the Vancouver scar scale compared with the control donor areas for each component and the total score (P < 0.05). Pain, itching and infection rate were insignificantly less in the heparin area. Bleeding was not observed in any of the areas in all cases and the daily values of platelet count and APTT in the five treatment days did not differ significantly compared with the preoperative values. None of the patients showed a platelet count < 100,000 /mm3 or APTT exceeding double the reference value. Conclusion Topical heparin treatment, compared with topical conventional treatment, of the donor areas after skin grafting in burn patients resulted in better clinical outcome manifested as significantly shorter wound healing time and significantly less scarring with no treatment-related complications.