Donor Site Dressings Research Articles

Suprathel Versus Hypafix in the Management of Split-Thickness Donor Site Wounds in the Elderly: A Randomised Controlled Trial

(1) Background: Effective wound management aims for expedited healing, improved functional and scar outcomes, and reduced complications including infection. Delayed wound healing remains a prevalent problem in the elderly. Suprathel is a synthetic absorbable skin substitute and an attractive option in partial thickness wounds. The objective of this randomised controlled study was to assess the effect of skin substitute dressings on elderly split-skin graft (STSG) donor sites, evaluating time to heal, pain, itch and scar outcome. (2) Methods: 40 patients over 65 undergoing split-thickness skin grafting for non-melanoma skin cancer excision were randomised to STSG donor site dressings with either Suprathel or Hypafix. Patients were followed up weekly until healed and at 13 weeks post-procedure. (3) Results: There was no significant difference in time to healing, pain, itch, or scar outcome at 13 weeks between the two groups. The mean time to healing was 31.7 days for the skin substitute group and 27.3 days for the adhesive tape control group (p = 0.182). (4) Conclusions: Both dressings are appropriate for STSG donor sites. Hypafix remains a cost-effective dressing of choice for donor sites. Benefits demonstrated in other studies using skin substitutes have not translated into the elderly population. There remains scope in developing dressings that reduce elderly donor site morbidity.

Effects of Medicinal Plants Extracts in Healing Split-Thickness Skin Graft Donor Site Wounds: A Systematic Review of Randomized Clinical Trials

The literature on Split-Thickness Skin Graft (STSG) donor site dressings has not yet identified an ideal dressing, and most products tested by researchers for wound dressing are prohibitively expensive in Low- and Middle-income settings. Clinical trials using biological dressings have offered an alternative option for managing STSG donor sites wound. The aim of this systematic review is to find evidences regarding the effectiveness of medicinal plants on STSG donor site wound healing. A total of 249 papers were identified in the initial search. After removing duplicates and applying the inclusion and exclusion criteria, 6 Randomized Clinical Trials were deemed relevant and included in the final review. Over twenty years four medicinal plants have entered clinical trial to enhance STSG donor site wound healing. The medicinal plants reviewed have large effect size regarding time to complete wound healing and wound score. However, the effect size of Aloe vera regarding time to complete wound healing and pain control vary from study to study. No patient quality of life was assessed neither cost-effectiveness of these products. Medicinal plants are potential cost effective antimicrobial and wound healing products for STSG donor site wound dressing. However, more clinical researches including patient quality of life among outcome measures are needed.

A Pilot Study Using a Collagen/Oxidized Regenerative Cellulose Dressing for Split- Thickness Skin Graft Donor Sites to Reduce Pain and Bleeding Complications

BACKGROUND: Standardized treatment of split-thickness skin graft (STSG) donor sites is not established. Bleeding can necessitate premature dressing changes, interrupting the healing process and increasing pain. PURPOSE: A collagen/oxidized regenerated cellulose (C/ORC) dressing was used on the donor site. The authors hypothesized that the collagen matrix could decrease bleeding-related complications, reduce pain, and foster epithelialization. METHODS: The C/ORC matrix was applied to the donor site after hemostasis was achieved. Dressings were removed between postoperative days 4 and 7, and the patients’ pain levels, bleeding complications, and percentage healed were recorded. RESULTS: Thirty-nine patients were treated with the C/ORC donor site dressing. Of these, 35 patients (89.7%) were receiving at least prophylactic anticoagulation, and no bleeding complications were recorded. The average area of donor sites was 123.8 cm2 (range, 20-528 cm2). Utilizing the Numerical Rating Scale, 25 patients (64.1%) reported no pain with dressing removal while 5 (12.8%) reported a decrease in pain. The percentage of epithelialization as assessed by treating clinician was at least equivalent to other modalities. CONCLUSIONS: The application of a C/ORC matrix to STSG donor wound sites resulted in no bleeding complications and excellent pain control while promoting epithelialization in the patients studied. Following this study, the C/ORC dressing has been incorporated into the authors’ standard protocol.

Bismuth/petroleum gauze plus high density polyethylene vs. bismuth/petroleum gauze: A comparison of donor site healing and patient comfort

IntroductionSkin grafting continues to be a fundamental component of burn treatment and inherently, a donor site must be created and treated. Burn surgeons agree that specific dressings may have a significant affect on donor site healing, but we have no consensus as to which dressing provides maximum benefit. MethodsRetrospective analysis of prospectively collected data from an observational, within-patient controlled assessment of a practice pattern intervention. The project compared donor sites treated with high-density polyethylene plus an overlying layer of bismuth/petroleum gauze to donor sites treated with bismuth/petroleum gauze alone. The primary endpoint was patient reported pain using a standard visual analog scale from 0 (no pain) to 10 (worst possible pain). A 2-point reduction in pain was considered clinically significant. Healing was defined as complete detachment of the dressings and> 95% wound re-epitheliazation. ResultsA total of 30 patients were observed and analyzed. Both dressings were associated with a mean pain rating of 6 out of 10 (STD= ± 2) and a median pain rating of 6 out of 10 (range = 0–10). Additionally, both dressings were associated with a mean healing time of 20 days (SEM=1.1). The subjective dressing preference showed that a majority of patients had no preference between the two modalities (n = 20). However, when an actual preference was stated (n = 10), bismuth/petroleum gauze alone was preferred by 9 out of 10 patients. ConclusionClinically and subjectively, we found no discernible differences between the 2 dressing regimens. Thus, bismuth/petroleum gauze alone is the more cost effective dressing choice. Our burn center continues to use bismuth/petroleum gauze alone as its standard of care for donor site dressings and will continue to try to define the optimal donor site dressing.

The Effect of Inhalation Aromatherapy on Sedation Level, Analgesic Dosage, and Bispectral Index Values during Donor Site Dressing in Patients with Burns: A Randomized Clinical Trial.

To determine the effect of inhalation aromatherapy on sedation level, analgesic dosage, and bispectral index (BIS) values during donor site dressing in patients with burns. This trial was conducted on 62 patients with burns requiring donor site dressing who were admitted to the Burn Center of Imam Reza Hospital, Mashhad, Iran. In the intervention group, the patients inhaled damask rose 40% and lavender 10% essential oils during donor site dressing change, whereas in the control group, the site was dressed using routine protocol. Sedatives and analgesics were prescribed until the levels of brain activity achieved light sedation. The brain activity and sedation levels were measured before and after the donor site dressings using the BIS. Data were analyzed using the analysis of covariance and the two-way analysis of variance with repeated measures. All 62 patients completed the study. The required doses of ketamine (P < .001), fentanyl (P = .003), morphine (P < .001), and propofol (P < .001) were significantly lower in the intervention group. The BIS was also significantly lower in the intervention group (P < .001). Heart rate decreased significantly during the aromatherapy, as well as after analgesic and sedative consumption (P < .001). The inhalation of damask rose and lavender essential oils is an effective intervention to reduce the doses of sedative and analgesic drugs administered as well as BIS during donor site dressing change in patients with burns.

The Ideal Donor Site Dressing: A Comparison of a Chitosan-Based Gelling Dressing to Traditional Dressings.

Donor site wound management is critical in split-thickness skin graft surgeries. These sites typically recover in 7 to 14 days due to the dermal-imbedded keratinocytes that promote skin regeneration. An ideal donor site dressing can help to mitigate pain, reduce infection risk, promote hemostasis, and accelerate healing times. Additionally, this dressing would be easy to apply in the operating room, easily managed, and cost-effective. Chitosan-based gelling dressings (CBGD) possess many of these qualities that make an ideal donor site dressing. We conducted a retrospective chart review of patients who received CBGD as part of their postoperative wound care plan. We collected data on infections, hemostasis, dressing failure, and hospital course over a 14-month period where CBGD was used as the donor site dressing. One hundred and fourteen patients were evaluated. We found an infection rate of 7%, a bleed-through rate of 1.8%, and a re-application rate of 9.6%. The average CBGD cost per patient was $75.15. CBGD has acceptable infection rates, and pain scores as traditional donor site dressings. However, it possesses several qualities of a suitable donor site dressing notably swift healing rates, impressive hemostatic property, and low cost. Our study supports the idea that CBGD is a suitable donor site dressing for split-thickness skin graft surgeries.

Comparison of Three Different Methods of Dressing for Skin Graft Donor Site

Background: There are various methods to dress the Skin Graft Donor Site (SGDS), but some are very expensive and not available in Iran. This study aimed to compare three different dressings for the management of the SGDS.Methods: Ninety-six patients participated in the study, and they were randomly divided into three groups. Donor sites were dressed with one of these methods: Vaseline gauze or method A, mupirocin 2% or method B, and nitrofurazone or method C. In each method, the dressing layer was covered by 5 layers of dry gauze. The three groups were compared regarding the epithelialization time, infection, pain, and cost.Results: The epithelialization time was significantly longer in group A compared with groups B and C (P&lt;0.05), but there was no significant difference between groups B and C (P&lt;0.05). There was no significant difference between the three groups in infection and pain at rest, activity, and dressing time (P&lt;0.05). There was a substantial difference between the three groups in the cost of dressing as method A was cheaper.Conclusion: Due to the lower cost of Vaseline gauze and no significant difference in infection, dressing adhesion to the skin, and amount of pain between three dressing methods, Vaseline gauze is a preferred method to skin graft donor site dressing.

Clinical trial to compare between different dressing methods on split thickness graft donor site (conventional method VS Ca alginate Vs Hydrocolloid sheet)

Abstract Background According WHO Egypt has high incidence in RTA and burn. Controversy between studies and reviews on the best dressing on donor site, while evidence support the use of moist wound dressings other centers believe that the impregnated gauze is cost effective. Objective Comparison between 3 types of dressings: The Conventional method (Vaseline gauze), Calcium alginate and Hydrocolloid sheets to determine which donor-site dressings are associated with the best outcomes for faster healing rate, less Pain, decreased Infection rate, healing quality and cost-effectiveness. Patients and Methods This study was conducted on 60 patients 35 males (58.33%) and 25 females (41.67%) in Ahmed Maher Teaching hospital divided into 20 patients in each, the conventional by Vaseline gauze group, the hydrocolloid using group and the Ca alginate group. Results The hydrocolloid showed highly significant overall results in faster epithilization and healing rate with mean 9.35 days ± 1.8 days and significant pain reduction post operatively and comfort during dressings and it was satisfactory in the reduction in change frequency as most patients healed between 7 – 10 days and in most cases the requirement for dressing change was every 5 days. Conclusion Modern wound dressings should become the standard of care in Egyptian burn centers and hydrocolloid is advised when multiple reharvesting for huge skin defects and increase satisfaction with considerable cost effectiveness. Vaseline gauze showed the worst results, but cost effectiveness by direct method is doubted if compared by the indirect and global cost of analgesics, hospital stay and medical stuff burden of dressing frequency.

A prospective study on efficacy of topical bupivacaine in split skin grafting donor site in immediate postoperative pain relief

Objective: The objective of this study was to compare the effectiveness of bupivacaine-soaked gauze dressing and conventional dressing for pain relief in patients requiring split-thickness skin graft for reconstruction of various defects. Methodology: Fifty patients requiring split-thickness skin grafting for various soft-tissue defects were divided into two groups with 25 patients in each group. In Group A, skin graft donor site dressing was kept moist with 10 mL/100 cm2 of 0.25% bupivacaine solution-soaked gauze, and in Group B, dressing was moistened with the same amount of normal saline-soaked gauze. Outcome was measured by comparing pain scores and calculating rescue analgesia requirements in the two groups in the first 24 h. Significance was determined by comparing analgesia-sparing effect of each dressing using Chi-square test. Results: In Group A, 1 out of 25 (4%) patients required rescue analgesia. In Group B, 23 out of 25 (92%) patients required rescue analgesia (P Conclusion: Bupivacaine-soaked dressing should be considered as a potent alternative to traditional saline dressings for the skin graft donor site.

Management of the Burn Wound

Current approaches to burn management are based on an understanding of the biology and physiology of human skin and the pathophysiology of the burn wound. The clinical evaluation and initial care of a burn wound is described and includes an assessment of burn depth, determining the need for escharatomy and daily burn wound care. Burns can be topical or surgical. Topical burn wounds require choice in the use of antibiotics. Considerations and techniques for surgical burn wound management are described and include early excision and grafting, wound excision, skin grafting, graft and donor-site dressings, postoperative wound care, biologic dressings and skin substitutes, allograft and xenograft skin, cultured epidermal autografts, and skin substitutes. Figures show the two distinct layers of the skin, various types of burns, and both fascial and tangential excision of burn wounds. This review contains 12 figures, 11 tables, and 61 references. Keywords: Burn wound, graft, partial-thickness, full-thickness, dermis, epidermis, sloughing, dressing

Management of the Burn Wound

Current approaches to burn management are based on an understanding of the biology and physiology of human skin and the pathophysiology of the burn wound. The clinical evaluation and initial care of a burn wound is described and includes an assessment of burn depth, determining the need for escharatomy and daily burn wound care. Burns can be topical or surgical. Topical burn wounds require choice in the use of antibiotics. Considerations and techniques for surgical burn wound management are described and include early excision and grafting, wound excision, skin grafting, graft and donor-site dressings, postoperative wound care, biologic dressings and skin substitutes, allograft and xenograft skin, cultured epidermal autografts, and skin substitutes. Figures show the two distinct layers of the skin, various types of burns, and both fascial and tangential excision of burn wounds. This review contains 12 figures, 11 tables, and 61 references. Keywords: Burn wound, graft, partial-thickness, full-thickness, dermis, epidermis, sloughing, dressing

Abstract 63: Mepilex Ag versus Xeroform as Dressings for Split-Thickness Skin Graft Donor Sites

PURPOSE: Split-thickness skin grafting (STSG) is one of the most common procedures in reconstructive and burn surgery; the optimal management of the donor site remains a source of debate and inconsistency in the care of these patients. The optimal donor site dressing is one that minimizes pain and the risk of infection. In this study, we aim to compare postoperative pain and the rate of donor site infection between bismuth tribromophenate gauze (Xeroform) dressings and silver-impregnated foam dressings (Mepilex Ag, Mölylnke, Gothenburg, Sweden) for STSG donor sites in burn patients. METHODS: We performed retrospective chart review of 212 patients with burn injuries treated in our burn unit in 2017. Patients who underwent debridement and autografting with STSG were classified by donor site dressing type (either Xeroform or Mepilex Ag). Infections were documented by clinical assessment and managed appropriately when noted. Maximum pain scores on postoperative days 1, 3, and 5 were recorded, using a patient-reported 10-point scale (pain scores for children under age 7 were recorded using FLACC scores). Univariate statistics were used to compare groups, and Barnard’s unconditional test was performed to compare the incidence of donor site infection between the groups. RESULTS: There were eighty-six cases of autografting with STSG. Of these, 37 had donor sites dressed with Mepilex Ag (43%), while 49 had donor sites dressed with Xeroform (57%). No infections were observed in donor sites dressed with Mepilex Ag (0%); five patients with Xeroform on their donor sites developed donor site infection (10%, p=0.03). There were no significant differences in maximum pain scores between Mepilex Ag and Xeroform groups on postoperative days 1, 3, and 5 (7.00 vs. 6.76, p=0.69; 6.30 vs. 6.15, p=0.81; and 5.71 vs. 5.81, p=0.89). Patients in the Mepilex Ag and Xeroform groups were similar in age, gender and length of stay (LOS). The Mepilex Ag group had somewhat lower percent total body surface area (TBSA) burned (6.8% vs. 10.4%, p=0.03). There were no significant differences in age, gender, LOS, percent TBSA, or pain scores in those who had infections and those who did not. CONCLUSIONS: Donor sites dressed with Mepilex Ag have a lower rate of donor site infection relative to those dressed with Xeroform in burn patients undergoing autografting with split-thickness skin grafts, though maximum pain scores on postoperative days 1, 3, and 5 remain similar.

Prospective randomised controlled trial of Algisite\u2122 M, Cuticerin\u2122, and Sorbact\xae as donor site dressings in paediatric split-thickness skin grafts

BackgroundThis is a parallel three-arm prospective randomised controlled trial (RCT) comparing Algisite™ M, Cuticerin™, and Sorbact® as donor site dressings in paediatric split-thickness skin grafts (STSG). All three were in current use within the Pegg Leditschke Children’s Burn centre (PLCBC), the largest paediatric burns centre in Queensland, Australia. Our objective was to find the best performing dressing, following on from previous trials designed to rationalise dressings for the burn wound itself.MethodsAll children for STSG, with thigh donor sites, were considered for enrolment in the trial. Primary outcome measures were days to re-epithelialisation, and pain. Secondary measures were cost, itch, and scarring at 3 and 6 months. Patients and parents were blinded to group assignment. Blinding of assessors was possible with the dressing in situ, with partial blinding following first dressing change. Blinded photographic assessments of re-epithelialisation were used. Scar assessment was blinded. Covariates for analysis were sex, age, and graft thickness (as measured from a central biopsy).ResultsThere were 101 patients randomised to the Algisite™ M (33), Cuticerin™ (32), and Sorbact® (36) arms between April 2015 and July 2016. All were analysed for time to re-epithelialisation. Pain scores were not available for all time points in all patients. There were no significant differences between the three arms regarding pain, or time to re-epithelialisation. There were no significant differences for the secondary outcomes of itch, scarring, or cost. Regression analyses demonstrated faster re-epithelialisation in younger patients and decreased donor site scarring at 3 and 6 months with thinner STSG. There were no adverse effects noted.ConclusionsThere are no data supporting a preference for one trial dressing over the others, in donor site wounds (DSW) in children. Thinner skin grafts lead to less donor site scarring in children. Younger patients have faster donor site wound healing.Trial registrationAustralia and New Zealand Clinical Trials Register (ACTRN12614000380695).Royal Children’s Hospital Human Research Ethics Committee (HREC/14/QRCH/36).University of Queensland Medical Research Ethics Committee (#2014000447).

Meta-analysis and Systematic Review of Skin Graft Donor-site Dressings with Future Guidelines.

Background:Many types of split-thickness skin graft (STSG) donor-site dressings are available with little consensus from the literature on the optimal dressing type. The purpose of this systematic review was to analyze the most recent outcomes regarding moist and nonmoist dressings for STSG donor sites.Methods:A comprehensive systematic review was conducted across PubMed/MEDLINE, EMBASE, and Cochrane Library databases to search for comparative studies evaluating different STSG donor-site dressings in adult subjects published between 2008 and 2017. The quality of randomized controlled trials was assessed using the Jadad scale. Data were collected on donor-site pain, rate of epithelialization, infection rate, cosmetic appearance, and cost. Meta-analysis was performed for reported pain scores.Results:A total of 41 articles were included comparing 44 dressings. Selected studies included analysis of donor-site pain (36 of 41 articles), rate of epithelialization (38 of 41), infection rate (25 of 41), cosmetic appearance (20 of 41), and cost (10 of 41). Meta-analysis revealed moist dressings result in lower pain (pooled effect size = 1.44). A majority of articles (73%) reported better reepithelialization rates with moist dressings.Conclusion:The literature on STSG donor-site dressings has not yet identified an ideal dressing. Although moist dressings provide superior outcomes with regard to pain control and wound healing, there continues to be a lack of standardization. The increasing commercial availability and marketing of novel dressings necessitates the development of standardized research protocols to design better comparison studies and assess true efficacy.

Use of a novel chitosan-based dressing on split-thickness skin graft donor sites: a pilot study.

Split-thickness skin graft (STSG) donor site dressings can play an integral role in reducing donor site morbidity. This study tested a novel, chitosan-based wound dressing, Opticell Ag, as an STSG donor site dressing for wounds <10% total body surface area (TBSA). Between January and December 2016, the chitosan-based dressing was placed on participating patients' donor sites immediately following graft harvest and covered with a transparent occlusive dressing. Pain was evaluated on postoperative day one, before dressing change between days 5-7, and before and after dressing removal between days 10-14 using the Visual Analog Scale (VAS). The extent of re-epithelialisation was determined between day 10-14 and at one month, and healing quality was also evaluated at one month post-operatively using the Vancouver Scar Scale (VSS). A total of 19 patients were recruited, of which 16 completed the study. Patients experienced mild-to-moderate pain in their donor sites when the chitosan-based dressing was used. Pain decreased significantly between postoperative day one and days 10-14, as well as between days 5-7 and 10-14. The mean percentage of re-epithelialisation on days 10-14 was 92% and by one month was 99%. The mean VSS at one month was 3.2±1.4. There were no statistically significant differences between patients' re-epithelialisation rates or VSS scores. There were unplanned dressing changes in four patients. No donor site infections or other adverse events were identified. The chitosan-based dressing tested in this study is safe, effective, and associated with reasonable pain control and acceptable healing quality. The results suggest that it is a promising STSG donor site dressing.

503 The Use of Piscine Allograft in the Treatment of Superficial Burns and Split Thickness Skin Graft Donor Sites

Fish skin is similar to human skin due to evolutionary homology. When processing mammalian xenografts harsh detergents are used that remove soluble skin components leaving behind an inert matrix of structural proteins only. As no disease transmission risk exists between codfish skin and humans, costly viral screening and viral-inactivation with detergents is not performed preserving the natural three-dimensional structure of the fish skin that is lost in other products derived from mammalian tissues. Due to its source, fish skin is naturally rich in anti-inflammatory omega-3 polyunsaturated fatty acids. In the human body, omega-3 polyunsaturated fatty acids are precursors to the resolvins, protectins, and maresins collectively known as Specialized Pro-resolving Mediators (SPMs). These SPMs are important in re-establishing homeostasis and resolution in wounds and favourable effects on host defence, pain and their ability to induce anti-inflammatory and pro-resolving signalling pathways. As superficial burns and split-thickness skin graft donor sites are notoriously painful, we decided to investigate the utility of fish skin dressings in a pilot study prior to performing a Randomised Controlled Trial. Ten patients with partial thickness burns were treated with fish skin dressings. Time to healing was recorded, and pain was assessed by using a visual analogue pain score after application of the dressing. A further ten patients who required the harvesting of a split-thickness skin graft were treated with fish skin as the donor site dressing. Pain was assessed with a visual analogue scale on the first post-operative day, and epithelialization was assessed calculating non-epithelialized areas with image software at day 14. All twenty patients had full healing of all wounds within three weeks, and pain scores were low. Fish skin dressings facilitate good wound healing and are very comfortable for the patient. Any patient with superficial burns or skin graft donor sites could benefit from this treatment.

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

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.

Split-thickness skin graft donor-site dressings: is it possible to establish the ideal dressing based on a literature review?

A Revista Brasileira de Cirurgia Plástica é o órgão oficial de divulgação da Sociedade Brasileira de Cirurgia Plástica (SBCP), tem como objetivo registrar a produção científica em Cirurgia Plástica, fomentar o estudo, aperfeiçoamento e atualização dos profissionais da especialidade.

Abstract: Efficacy, Safety and Costs of 0.1% Timolol Gel in Healing Split-Thickness Skin Grafts Donor Sites. A Case-Control Study

INTRODUCTION: Split-thickness skin graft is one of the most commonly performed procedures in plastic and burn surgery, and effectively creates a secondary wound at risk for infection or delayed wound healing. The aim of this study was to assess the efficacy and safety of topical 0.1% timolol gel in promoting wound healing in split-thickness skin graft donor sites. METHODS: We designed a prospective case control study to evaluate the effects of 0.1% timolol gel in healing skin graft donor sites when compared to paraffin gauze. A total of 42 burn patients were treated with either daily dressings with 0.1% timolol gel (1 fingertip unit every 2 cm2) and paraffin gauzes (case group), or to dressings every 4 days with paraffin gauzes (control group). Healing time, infection rate and patient’s pain perception were assessed by a blinded physician. Costs were also evaluated in both groups. Vancouver Scar Scale (VSS) and patient satisfaction VAS were recorded at the 6 months follow up. RESULTS: A statistically significant improvement in terms of healing time was found in the timolol group (mean 6.4 days vs 12.7 days in the control group). The infection rate was the same. Significantly decreased pain perception was recorded in the case group. Total cost of the treatment was significantly higher in the case group. At the 6 months follow up VSS and patient VAS were significantly lower in the case group. CONCLUSION: The role of topical beta-blockers in promoting wound healing is currently emerging in the international literature.1,2 Various experimental approaches to optimize the healing of split-thickness skin graft donor sites have been described,3,4 including back-grafting,5 however, no clearly superior and easily applicable method has gained wide acceptance in daily practice. 0.1% timolol gel may represent a commercially available, safe and simple, painless and moderately expensive treatment for improving skin graft donor site healing. Reference Citations: 1. Ali A, Herndon DN, Mamachen A, et al. Propranolol attenuates hemorrhage and accelerates wound healing in severely burned adults. Crit Care. 2015; 19: 217. 2. Braun LR, Lamel SA, Richmond NA, Kirsner RS. Topical timolol for recalcitrant wounds. JAMA Dermatol. 2013; 149: 1400–1402. 3. Voineskos SH, Ayeni OA, McKnight L, Thoma A. Systematic review of skin graft donor-site dressings. Plast Reconstr Surg. 2009; 124: 298–306. 4. Dressings and Care of Skin Graft Sites: A Review of Clinical Evidence and Guidelines. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2013 Dec. 5. Goverman J, Kraft CT, Fagan S, Levi B. Back Grafting the Split-Thickness Skin Graft Donor Site. J Burn Care Res. 2017; 38: e443-e449.

Three donor site dressings in pediatric split-thickness skin grafts: study protocol for a randomised controlled trial.

BackgroundFor children requiring split-thickness skin grafting for burn injury, the optimum donor site dressing is an ongoing subject of debate. The most common dressings in use, both regionally and worldwide, are calcium alginates. We will compare an alginate with two other dressings, all of which are in current use in the Pegg Leditschke Paediatric Burns Centre (PLPBC), to determine which dressing performs the best.Methods/DesignThis is a randomised, prospective single center parallel three-arm trial comparing three donor site wound (DSW) dressings: Algisite™ M, a calcium alginate dressing; Cuticerin™, a smooth acetate gauze impregnated with water-repellent ointment (petrolatum, paraffin and Eucerite®) and Sorbact®, a gauze mesh coated with a dialkylcarbamoyl chloride (DACC) and amorphous hydrogel.Primary outcomes are days to complete DSW healing, and pain. Previously validated measures will be used for all outcomes. Secondary outcomes are: itch; scar appearance at three, six and 12 months; ease of dressing application and removal and dressing costs and utility. Results will be analysed on an intention-to-treat basis. Donor site thickness will be measured with a small biopsy from the center of the graft, to document the depth of the DSW across the groups.DiscussionThis study will provide comprehensive short- and long-term data on DSW dressings in pediatric split-thickness skin grafting. The best-performing dressing will become the preferred dressing for the PLPBC. We will provide rigorous data against which other dressings can be compared in future, recognising that alginates are the most common DSW dressing currently in use. Our study design replicates a real-world scenario in order to identify clinically significant differences between the three dressings.Trial registrationThis trial was prospectively registered on 8 April 2014 with the Australia and New Zealand Clinical Trials Register (identifier: ACTRN12614000380695).Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0557-9) contains supplementary material, which is available to authorized users.