Tumescent versus non-tumescent technique in skin graft healing: a cross-sectional study

Abstract

Background: Skin grafting, especially burn surgery, is associated with great blood loss. Tumescent technique is the subdermal injection of fluid containing a vasoconstrictor prior to burn wound surgery to reduce blood loss. Adrenaline is used to harvest skin grafts due to its vasoconstriction effect which limits blood loss. Although adrenaline is widely used, its local and systemic effects vary from patient to patient. The object of the present study was to observe the efficacy of tumescent technique, using adrenaline, versus non-tumescent technique in the healing of split thickness skin graft donor day 10.Methods: Two treatment groups of patients, tumescent (group A, n = 45) and non-tumescent technique (group B, n = 45), who fulfilled the inclusion criteria were randomly assigned. Tumescent technique involved administration of 1 mg (1:1000) adrenaline in 500 mL of saline. No prior administration of agent was performed in non-tumescent technique. Split-thickness skin grafting was carried out followed by regular inspection of the donor site. Healing rate was recorded at the postoperative day 10 by performing wound tracing technique and evaluated by performing unpaired t-test. P <0.05 was considered as statistically significant. Results: The mean age of patients was 29.98±12.6 years in group A and 45.36±10.23 years in group B. Age distribution was concentrated between 18 and 38 years. On postoperative day 10, complete epithelialization was observed in 15.56 % and 6.66% of patients in group A and B, respectively. Compared to the patients in group B, patients who underwent tumescent technique (group A) had higher healing rate (>80%, p=0.0134). Evidence of infection in the donor site was absent in both the groups.Conclusions: Tumescent technique by using adrenaline is more effective than non-tumescent technique in the healing of donor site and can be implemented preoperatively in split-thickness skin grafting.