Fine Mesh Gauze Research Articles

The antimicrobial spectrum of Xeroform®

Introduction/backgroundXeroform® is a petrolatum-based fine mesh gauze containing 3% bismuth tribromophenate. Bismuth, similar to other metals, has antimicrobial properties. Xeroform® has been used for decades in burn and plastic surgery as a donor site dressing and as a covering for wounds or partial thickness burns. Despite this, the antimicrobial spectrum of Xeroform® remains largely unknown. We examined the in-vitro efficacy of Xeroform® against common burn pathogens using zone-of-inhibition methodology in a commercial research facility. Methods/designPure strains of 15 common burn pathogens including Methicillin-resistant Staphylococcus aureus (MRSA), Methicillin-sensitive Staphylococcus aureus (MSSA), Staphylococcus epidermidis, Pseudomonas aeruginosa, Enterobacter cloacae, Escherichia coli, Candida albicans, Vancomycin resistant Enterococcus, Acinetobacter baumennii, Klebsiella pneumonia, Extended spectrum beta-lactamase producing Klebsiella, Beta hemolytic Streptococcus pyogenes, Proteus mirabilis, Serratia marcescens, and Salmonella enterica ssp. Enterica were inoculated at a strength of 106–1010 CFU/ml onto appropriate agar plates. A sterile 1 in2 Xeroform® square was placed in the center of each plate, and the Zone of Inhibition (ZOI) was measured following 18–24h of incubation at 37°C.A second bismuth pharmaceutical (bismuth subsalicylate, Pepto-Bismol®) was then tested using the same methodology against the same strains of MRSA, MSSA, E. coli, K. pneumonia and S. marcescens. Finally, 3% w/v bismuth tribromophenate in glycerol suspension was tested against 13 burn pathogens for antimicrobial activity independent of the Xeroform® dressing by measure of Zone of Inhibition. Results/findingsFor Xeroform®, none of the fifteen pathogens had a measurable zone of inhibition on any plate. Bismuth subsalicylate showed a zone of inhibition for MSSA in 3 plates (mean of 47.2mm), in one of three plates for MRSA (13.8mm), and in one of three plates for S. marcesens (89.6mm). There was no zone of inhibition seen for K. pneumonia or E. coli. Bismuth tribromophenate, when not bound to Xeroform® showed activity against 12 of 13 pathogens. Conclusions/implicationsWhile bismuth subsalicylate, and bismuth tribromophenate unbound to Xeroform® demonstrate antimicrobial activity, it appears that Xeroform® dressings do not. The utility of Xeroform® in burn medicine may relate more to use as an impervious dressing than to antimicrobial effect. Donor sites are clean surgical wounds and clean partial thickness burns may have minimal colonization present. In such circumstances, an inactive and impervious dressing may be all that is necessary to promote wound healing.

A quantitative analysis of the effects of different harvesting, preparation, and injection methods on the integrity of fat cells

The percentage of intact fat cells membrane obtained by even a well-known technique remains poorly studied. The purposes of this study were to evaluate and compare the structural effects of various harvesting, preparation, and injection methods on human fat cell integrity. We enrolled 20 healthy females in this study, ages ranged from 20 to 41 years with an average age of 31 ± 0.5 years. We harvested fat tissues from the abdomen and thigh of donors using two different methods: conventional and syringe liposuction; we treated the aspirated fat specimens within 30 min of harvesting by fine-mesh gauze or using centrifugation. We injected the prepared fat through small or large needle, and then obtained a specimen from each different method. We analyzed all fat graft samples by routine histological examination. There was a significant difference in the percentage of intact fat cells wall was observed in syringe aspiration (75.95 ± 0.31 %) versus vacuum liposuction (56.43 % ± 0.67). There was a significant difference in the percentage of intact fat cells when using centrifugation versus fine-mesh gauze preparation. Also there was a significant difference in the percentage of intact fat cells observed when using large versus small needle for injection. The highest intact adipocyte counts were in syringe suction, no centrifuge, and using large cannula, while the fewest intact adipocyte counts were in conventional liposuction, using centrifuge, and using small cannula. Level of Evidence: Level IV, prognostic study

Hydrogen transport through a membrane module based on a palladium foil

Experimental data are presented and a mathematical model is suggested for hydrogen transport through a palladium membrane module. The basic working element of the module is a piece of palladium foil secured between two pieces of fine-mesh metallic gauze to prevent the rupture of the foil because of the difference between the outer pressures applied. It is demonstrated that, under the experimental conditions considered, the effect of the supporting metallic gauzes can be neglected. An expression is reported for the hydrogen flux through the foil as a function of the foil thickness and applied pressures. In the particular case of fairly high pressures, the hydrogen flux obeys the well-known Sieverts law, being limited by proton diffusion in the palladium lattice. At low pressures, the hydrogen flux is limited by adsorption-desorption processes on the foil surface. The preexponential factor in the Sieverts law for pure palladium membranes has been refined on the basis of experimental data for the membrane module.

An evaluation of five different dressing materials on split‐thickness skin graft donor site and full‐thickness cutaneous wounds: an experimental study

The objective of this study was to investigate the healing effect of five different products on split-thickness skin graft (STSG) donor sites and full-thickness cutaneous wounds (FTCWs) using an occlusive dressing model. Six groups were included: 1 control and 5 experimental groups, with a total of 24 rats, using an occlusive dressing model. STSG donor sites and FTCWs were established in two separate areas, to the right and left on the animals' backs. Wound sites were dressed with one of the following materials: fine mesh gauze, microporous polysaccharide hemosphere (MPH), clinoptilolite, alginate, hydrogel or biosynthetic wound dressing (Biobran(®) ). These materials were compared in terms of healing rate, healing quality and histopathological findings. Occlusive dressings were applied to each wound on days 0, 3, 5, 7, 10 and 14. Area measurements were taken using images of each dressing. The alginate and clinoptilolite groups gave the best healing rate results for both STSG donor sites (P = 0·003) and FTCWs (P = 0·003). MPH came third in each group. The alginate group produced better results in terms of healing quality criteria, followed by hydrogel, MPH, clinoptilolite and Biobran(®) , in that order. Statistically significant results were obtained in all groups compared to the control group (P < 0·0007). Rapid and good healing quality for both the STSG donor sites and FTCWs were obtained with alginate. Healing with clinoptilolite and MPH was rapid, but poor quality, while slower but good healing quality was obtained with hydrogel. Slower and worse quality healing was obtained with Biobran(®) .

Negative Pressure Wound Therapy After Severe Open Fractures: A Prospective Randomized Study

To evaluate the impact of negative pressure wound therapy (NPWT) after severe open fractures on deep infection. Prospective randomized study. Academic level I trauma center. Fifty-nine patients with 63 severe high-energy open fractures were enrolled in this study, with data available on 58 patients with 62 open fractures. Twenty-three patients with 25 fractures randomized to the control group and underwent initial irrigation and debridement followed by standard fine mesh gauze dressing, with repeat irrigation and debridement every 48-72 hours until wound closure. Thirty-five patients randomized to the NPWT group and had identical treatment except that NPWT was applied to the wounds between irrigation and debridement procedures until closure. The presence or absence of deep wound infection or osteomyelitis, wound dehiscence, and fracture union were primary outcome measures. Control patients developed 2 acute infections (8%) and 5 delayed infections (20%), for a total of 7 deep infections (28%), whereas NPWT patients developed 0 acute infections, 2 delayed infections (5.4%), for a total of 2 deep infections (5.4%). There is a significant difference between the groups for total infections (P = 0.024). The relative risk ratio is 0.199 (95% confidence interval: 0.045-0.874), suggesting that patients treated with NPWT were only one-fifth as likely to have an infection compared with patients randomized to the control group. NPWT represents a promising new therapy for severe open fractures after high-energy trauma.

One-Side Mattress Suturing Technique for Tie-Over Dressing

Sir: For a skin graft to be immobilized and survive on its wound bed, a tie-over dressing is the most optimal and certain technique. However, the stitch mark surrounding the skin graft is unfortunately a common problem. In addition, the wide marginal scar surrounding the graft is also a problem. To solve these problems and achieve good results with inconspicuous scars, we have devised a new tie-over dressing with a unique suturing technique called the one-side mattress suture. First, a suture needle is used to penetrate the skin graft, 3 to 7 mm inside of its margin, and a large amount of dermis and tissue toward the epidermis of the surrounding skin is encircled. Then, the needle is used to penetrate the graft again at 0.5 to 1 mm from the margin. Finally, the thread is tied a little loosely and kept long (Fig. 1). We named this technique the one-side mattress suture because it gives vertical mattress suture to the skin graft and dermal suture to the surrounding skin. After that, the sutures are tied over a piece of fine mesh and sufficient fluffed gauze on the skin graft as usual. The dressing is kept for approximately 7 days.Fig. 1.: (Left) One-side mattress suture. (Right) One-side mattress suture for a deep wound bed. In the one-side mattress suture, we make vertical mattress suture to the skin graft and dermal suture to the surrounding skin. The sutures are not exposed on the surrounding skin. The threads should be tied a little loosely. A, surrounding skin; B, skin graft.Between 2003 and 2007, we performed 69 skin grafts to exposed sites using one-side mattress sutures: face, n = 20; neck and chest, n = 9; forearm and dorsum of the hand, n = 18; and leg and dorsum of the foot, n = 22. In all cases, grafts were taken full, without conspicuous stitch marks or wide marginal scar line. Although a multitude of techniques have been improved for immobilization of skin grafts,1–5 the tie-over suturing technique is the most common, economical, and reliable method. However, this traditional tie-over technique frequently leaves stitch marks. Suturing in little bites or with loose ligation to avoid stitch marks would lead to a gap between the margin of the skin graft and the surrounding skin, which results in a wide scar. The continuous vacuum system5 requires bothersome management to check the air-tightness. The tape-assisted technique is uncertain in producing approximate pressure and frequently causes skin inflammation. To solve these problems and avoid remarkable stitch marks, we improved the tie-over with one-side mattress suture, in which the sutures are not exposed on the surrounding skin. This technique not only avoids stitch marks but also gives precise approximation of the edge of a skin graft to the wound edge of the recipient site, even if the wound bed is deep, which leads to minimal marginal scarring (Fig. 1). In the traditional tie-over, even with a loose ligation, the tie-over tension of the thread leads to stress to the skin and causes stitch marks and bad coaptation. In contrast, with the one-side mattress suture technique, the thread tension does not produce stitch marks and gives appropriate pressure to the very edge of the graft to fit the recipient margin and leads to minimal scarring (Fig. 2).Fig. 2.: Comparison of the stress produced by the traditional tie-over and that produced by the one-side mattress suture tie-over. A, surrounding skin; B, skin graft; C, fluffed gauze. Arrows indicate thread tension. (Left) Traditional suture with tie-over stress. (Right) One-side mattress suture with tie-over stress. With the traditional style, the thread tension by tie-over leads to stress to the skin and causes stitch marks and bad coaptation. With the one-side mattress suture, the thread tension by tie-over does not produce stitch marks and gives appropriate pressure to the very edge of the graft to fit the surrounding skin margin.Although the demerit of this technique is that it is a little complex, the technique would quickly become convenient with a little training for all plastic surgeons. We conclude that the one-side mattress suture technique is the optimal method for all exposed site skin grafting. Akiyoshi Kajikawa, M.D., Ph.D. Kazuki Ueda, M.D., Ph.D. Yoko Katsuragi, M.D. Masaki Momiyama, M.D. Yuichiro Yana M.D. Department of Plastic and Reconstructive Surgery Fukushima Medical University Fukushima, Japan

High-valve vapor-permeable film dressing versus fine mesh gauze dressing on skin graft donor areas in diabetic patients: a prospective randomized controlled trial

The use of split-thickness skin grafts (STSG) as a reconstructive technique in the diabetic foot is common. Studies on the ideal dressing for donor-site care have not included subjects such as diabetics who have wound-healing problems. The aim of this study was to determine the efficacy of high-valve water vapor transmission rate (WVTR) polyurethane film dressing in the management of the STSG donor site compared to the clinical standard fine mesh gauze dressing in diabetic patients. Twenty diabetic patients were observed for healing, scarring, and pain. Healing times were recorded. Pain was monitored using a visual analog pain scale and recorded. Scarring of the donor sites was assessed using the Vancouver scar scale 6 months after surgery. The WVTR dressing was found to be significantly better than mesh gauze dressing for the healing of STSG donor sites. Healing occurred more rapidly and with less pain. Moreover, it has some advantages of dry wound dressings such as ease of application and follow-up. Dressings should retain enough moisture to stimulate good healing and yet should not cause maceration to the surrounding skin, and also should not cause allergic reactions. In this study it was shown that high-valve WVTR polyurethane film dressing provided many qualities of the ideal split-thickness skin graft donor-site dressing.

An Alternative Dressing Material for the Split-Thickness Skin Graft Donor Site

The split-thickness skin graft (STSG) donor sites have been treated with various and plenty of dressing techniques and materials. An ideal STSG donor site dressing should have antibacterial, hemostatic, and promoting epidermal healing properties. We have performed a prospective study to evaluate the effect of the oxidized regenerated cellulose on STSG donor site healing. Between January 2002 and January 2005, 40 patients who were operated in any kind of reconstructive operations with STSG donor sites were included in the study. One half of the wound was covered with oxidized regenerated cellulose and the other half of the same wound of the same patient was covered with fine mesh gauze treated with Furacin (nitrofurazone). The patients were grouped into 2 depending on the dressing technique: group I, semiclosed and group II, closed. The wounds were evaluated for healing time, infection, pain perception of the patient, and final esthetic results. The oxidized regenerated cellulose side of the group I was healed in a mean of 6.5 +/- 0.51 days; in group II, 5.4 +/- 0.50 days (range, 5-6 days). The fine mesh gauze treated with Furacin in group I was healed in a mean of 9.9 +/- 0.97 days (range, 8-11 days); in group II, 8.4 +/- 0.99 days (range, 7-10 days). There was a statistical significance between the oxidized regenerated cellulose side and the fine mesh gauze side (P < 0.001) in group I and group II separately. The difference between group I and group II was statistically significant in the oxidized regenerated cellulose side (P < 0.001), and the difference between group I and group II was statistically significant in the fine mesh gauze side (P < 0.005). The antibacterial, hemostatic, and absorbable property of the oxidized regenerated cellulose could ensure the utilization as an alternative STSG donor site dressing, especially because the positive influence over the wound healing was proven.

Combined chemical peeling and dermabrasion for deep acne and posttraumatic scars as well as aging face.

The combination of chemical peeling and dermabrasion for the improvement of facial wrinkles, acne, posttraumatic scars, and abnormal pigmentation was first described by Dupont in 1972 and Horton in 1984. We have been using the combined technique since 1972, and we have obtained more satisfying results than by using these techniques independently. The purpose of this paper is to summarize the results obtained using the combined technique of chemical peeling and dermabrasion and to emphasize a simple method of postoperative care that can be applied after any physical or chemical rejuvenation technique. Whereas the combined technique takes advantage of depth-controlled surgery, less bleeding, less postoperative pain, less risk of local and systemic complications, and longer lasting results, the covering of the wound with one layer of fine mesh gauze is another advantage that provides easy postoperative care.

Management of skin-grafted burn wounds with Xeroform and layers of dry coarse-mesh gauze dressing results in excellent graft take and minimal nursing time.

The goals of postoperative treatment for split-thickness skin grafts (STSGs) are to maintain graft integrity, prevent graft and wound desiccation, and minimize infections. As we documented in a telephone survey of 16 burn centers, dressings for skin grafts usually consist of multiple layers of coarse-mesh gauze; the dressings receive frequent applications of aqueous solutions that contain antimicrobial agents to control bacterial growth and to maintain a moist environment at the wound surface. We prospectively studied the efficacy of our standard dressing of one layer of Xeroform (Kendall Inc., Mansfield, Mass.), which consists of fine-mesh gauze impregnated with bismuth tribromophenate, applied to the STSG surface followed by layers of dry gauze dressings wrapped in Kerlix (Kendall Inc.); the entire dressings were left intact until postoperative day 5. We evaluated 142 STSGs on 100 patients, mean age 29.2 years (range 0.3 to 79 years), with burns of 0.5% to 60% total body surface area (mean 9.1%). Meshed or sheet STSGs of 0.5% to 18% total body surface area (mean 3.14%) were placed on deep partial- or full-thickness excised wounds. Xeroform, followed by coarse-mesh gauze dressing, was applied after skin grafts were completed. The entire dressing was left intact until the initial takedown-to-graft at 5 days. Patients' grafts were evaluated on postoperative day 5 for the percentage of "take" and subgraft fluid collected; this evaluation was then repeated every other day for 10 days. On postoperative day 5 evaluations, mean skin graft take in all patients was 98.54% +/- 0.72%. Xeroform and coarse-mesh gauze dressings used to cover STSGs and left intact for 5 days until the initial dressing change, resulted in highly successful graft outcomes, with minimal postoperative nursing care compared with other dressing methods for skin grafts.

Alternative Treatment for Wrestlers' Hematoma-Reply

In Reply .—This letter is in response to letters you have received from Drs Jaffee and Koopmann. The technique described by Dr Jaffee certainly is interesting. It has run the test of time with his extended personal experience of 25 years. The problem it creates for the high school or collegiate wrestler, who is currently competing, is that is does not permit physical contact for 48 to 72 hours. Our motivation for using the approach described in our article reflects the reluctance on the part of the wrestlers to delay competing for any period of time. I would be somewhat skeptical that the fine-mesh gauze and collodion would represent enough protection for the auricle that will be stressed with competition. It obviously represents a very effective way of treating auricular hematoma for a nonathlete. With respect to Dr Koopmann's letter, I can only offer my apologies. I also apologize to Dr Tom

Comparison of an Occlusive and a Semi-occlusive Dressing and the Effect of the Wound Exudate upon Keratinocyte Proliferation

Three consecutive studies were performed in 58 patients evaluating the effect of occlusion on the healing of partial-thickness wounds. Mirror-image donor sites were covered with the occlusive hydrocolloid dressing (HCD) (DuoDerm) and compared to fine mesh gauze, and the HCD was subsequently compared to a semi-occlusive dressing of polyurethane film, (Op-site). In addition, partial-thickness burn wounds were covered with the HCD and the remaining burn wound was treated with silver sulfadiazine. The donor sites and burn wounds treated with HCD healed significantly faster than those covered with fine mesh gauze or silver sulfadiazine (p less than 0.001) and with less pain. The HCD and polyurethane film were equivalent. There were no clinical infections with the wounds that were occluded. The exudate collected beneath the DuoDerm and Op-site on donor sites was added to the tissue culture system and resulted in a modest increase in keratinocyte proliferation. However, the exudate from burn wounds under HCD resulted in a marked increase in cell proliferation (p less than 0.001).

The Role of Topical Treatment as a Determinant of Infection in Outpatient Burns

Up to 95% of all burned patients are treated as outpatients. While uniform guidelines exist to evaluate the severity of an outpatient's burn, treatment forms vary greatly. Furthermore, the relative merits of one treatment modality over another have not been demonstrated. This study reviews 262 patients with uncomplicated, thermal partial-thickness burns. All of these patients were treated with either a petrolatum fine-mesh gauze (FMG = 102), a topical penetrating antibacterial agent (TPA = 58), or a topical nonpenetrating antibacterial agent (TNA = 102). The size of the injury along with its location and etiology, the age of the patient, the time from injury to treatment, and comorbid factors were comparable among the major treatment groups. On follow-up, a wound was classified as infected if it exhibited erythema, tenderness, increased warmth, and edema (cellulitis). Infection rates were 2.0% (2/102) in the FMG group, 5.2% (3/58) in the TPA group, and 2.0% (2/102) in the TNA group. The differences among the rates did not reach statistical significance (P = 0.41). Given the cost of treatment, frequency of dressing changes and overall patient comfort, we advocate FMG as the optimal method for the care of uncomplicated partial-thickness outpatient burns.

A Concentration Gradient of Bacteria Within Wound Tissues and Scab

This investigation was designed to evaluate the effect of a synthetic moisture vapor permeable dressing on the size of the bacterial population of superficial wounds. Split-thickness donor sites were created in pig skin and were treated with a synthetic occlusive dressing (Tegaderm), with fine mesh gauze, or with nothing. All wounds became spontaneously infected with a variety of bacteria, predominantly with Staphylococcus epidermidis. The population of the Tegaderm wounds was always greater than that of the untreated controls, while that of the gauze treated wounds was equal to or less than that of the controls. Tegaderm dressed wounds healed more quickly than did the others. A gradient in the concentration of bacteria within the wounds was seen, with a very high concentration in the scab (10(8) cells/g), an intermediate concentration (10(6) cells/g) in the dermal layer, and the lowest concentration (10(4) cells/g) in the hypodermal level of the wound tissue. Such a gradient has not previously been reported. No evidence was seen that the level of infection declined over time for any of the dressings. Apparent bacterial clearing in earlier investigations may be due to the progressive loss of superficial wound tissues with the corresponding exclusion of the high concentration of bacteria within these layers from the tissue sampled.

A concentration gradient of bacteria within wound tissues and scab

This investigation was designed to evaluate the effect of a synthetic moisture vapor permeable dressing on the size of the bacterial population of superficial wounds. Split-thickness donor sites were created in pig skin and were treated with a synthetic occlusive dressing (Tegaderm), with fine mesh gauze, or with nothing. All wounds became spontaneously infected with a variety of bacteria, predominantly with Staphylococcus epidermidis. The population of the Tegaderm wounds was always greater than that of the untreated controls, while that of the gauze treated wounds was equal to or less than that of the controls. Tegaderm dressed wounds healed more quickly than did the others. A gradient in the concentration of bacteria within the wounds was seen, with a very high concentration in the scab (10 8 cells/g), an intermediate concentration (10 6 cells/g) in the dermal layer, and the lowest concentration (10 4 cells/g) in the hypodermal level of the wound tissue. Such a gradient has not previously been reported. No evidence was seen that the level of infection declined over time for any of the dressings. Apparent bacterial clearing in earlier investigations may be due to the progressive loss of superficial wound tissues with the corresponding exclusion of the high concentration of bacteria within these layers from the tissue sampled.

An evaluation of Aquaphor Gauze dressing in burned children

Aquaphor Gauze was evaluated as a dressing for skin graft donor sites, for partial thickness burn injuries and for split thickness skin grafts. Control dressings consisted of: fine mesh gauze for skin graft donor sites, silver sulphadiazine (Silvadene) on coarse mesh gauze for the partial thickness burns, and nitrofurazonc cream (Furacin) on fine mesh gauze for the skin grafts. The Aquaphor Gauze was found to be inferior to the fine mesh gauze for donor site dressings. No statistically significant difference was identified between Aquaphor Gauze and controls for the treatment of partial thickness burns. As a dressing for skin grafts the Aquaphor Gauze was significantly superior to the control dressing as measured by graft take and reduced patient pain. We would recommend that Aquaphor Gauze be used as a dressing for skin grafts where the risk of infection is not excessive.

Improperly sterilized fine-mesh gauze associated with donor site infections in skin-grafted burn patients

Improperly sterilized fine-mesh gauze associated with donor site infections in skin-grafted burn patients

Skin wound healing determined by water loss

An in vivo method of monitoring healing was tested incorporating an Evaporimeter measuring water evaporation; reepithelialization was detected through reestablishment of the water barrier. In the first study two wounds were created with a 2-mm biospy punch on each of the backs of 15 rabbits and covered with occlusive and semiocclusive dressings. Water loss increased from a preoperative value of 6 g m −2 hr −1 to 55 g m −2 hr −1 after surgery. Water loss from the occluded site returned to baseline values in 9 days as opposed to 17 days for the semioccluded sites ( P < 0.05). The second study followed the healing of full-thickness 4 × 4-cm wounds in five rabbits treated with fine-mesh gauze and five treated with a human amnion dressing. Wound area and water loss were observed during the repair process. Visually measuring the wound area, the injuries appeared 100% healed on Day 30. The Evaporimeter continued to detect significantly increased water loss up until Day 45 when the original baseline values were reached. No differences were observed between the gauze and amnion groups. The Evaporimeter presents a simple yet accurate, noninvasive tool measuring the wound healing endpoint based on regeneration of the epidermal water barrier.

Cellulase activity in natural and temperature acclimated populations of Fundulus heteroclitus

Cellulase activity in natural and temperature acclimated populations of Fundulus heteroclitus

Scalp as Skin Graft Donor Site

Synthetic Adhesive Moisture vapor permeable (S.A.M.) dressings, Op-Site and Tegaderm, are compared to Fine Mesh Gauze (F.M.G.), as a dressing for split-thickness skin graft donor sites. Scalp as a donor site is compared to nonscalp donor sites. The combination of S.A.M. dressings and scalp as a donor site allows for rapid reuse of a donor site. Pain is substantially decreased and rate of healing is increased when this combination is used. The scalp, because of its availability, accessibility, excellent color match for facial grafting, and rapid healing, is recommended as a donor site.