Graft Donor Site 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.

A Delayed Seroma of a Facial Full-Thickness Skin Graft Donor Site: A Case Report

A Delayed Seroma of a Facial Full-Thickness Skin Graft Donor Site: A Case Report

Qualitative somatosensory evaluation of recipient and donor sites of subepithelial connective tissue grafts: a preliminary study.

The subepithelial connective tissue graft (SCTG) plus coronal advanced flap is commonly evaluated by clinical parameters, but potential sensory changes (patients' perception of painful or painless sensations) need to be further explored. This preliminary study aimed to qualitatively evaluate the somatosensory profile of recipient and palatal donor sites of SCTG. Sensory tests were applied at SCTG recipient and donor sites at baseline, after 3 and 6 months. A single calibrated examiner applied Douleur Neuropathique 4 questionnaire (DN4), qualitative sensory test (QualST), discriminating the areas as hypersensitive, hyposensitive or normosensitive, and two-point acuity test. Descriptive statistics, non-parametric Kruskal Wallis test for QualST evaluation and ANOVA for Two-point test (p < 0.05) were used. QualST revealed that recipient areas presented no significant differences in tactile, pressure and thermal tests. Brush test revealed hyposensitivity after 3 months (p = 0.03). In donor areas, only thermal evaluation showed a significant difference (p = 0.01), being hypersensitive after 3 months and hyposensitive after 6 months. At baseline, all evaluations in recipient and donor areas were normosensitive. According to DN4, no patient reported pain in recipient and donor sites. Non-painful sensory perception was reported as numbness in recipient (3.14% of patients) and donor (18.4%) areas. No significant differences were found for two-point acuity test values. Somatosensory variations were observed in donor and recipient areas using qualitative tests, with no detection of painful sensations, only non-painful sensations of numbness and electric shock. This preliminary study demonstrated that alterations of hypo- and hypersensitivity may occur in donor and recipient areas of gingival grafts. However, when present, these alterations were non-painful and did not impact oral functions. ReBEC #RBR-7zz3b6p.

Full Thickness Nasal Reconstruction With Paired Pericranial and Paramedian Forehead Flaps.

The reconstruction of full-thickness nasal defects poses a significant challenge following oncologic resection. This study aims to share a technique using paired pericranial forehead flap (PCF) with contralateral paramedian flap (PMF) for such defects. Patient outcomes were reviewed, and the advantages and disadvantages of the reconstructive technique are discussed. A retrospective review of a single surgeon practice was done between 2019 and 2024. Cases of nasal reconstruction with a paired PCF and PMF following oncologic resection were reviewed. Defect characteristics, reconstructive technique, and postoperative complications were evaluated. A literature review summarizing the evolution of this technique from inception to April 2024 was conducted using PubMed. The literature review identified 7 reports describing the use of a paired PCF and PMF for nasal reconstruction. The modifications and enhancements described in each study are summarized. The case series included 13 patients requiring oncologic resection for squamous cell carcinoma (8 patients) or basal cell carcinoma (5 patients). Every case required reconstruction of at least 2 nasal subunits, primarily involving the nasal tip, alae, and columella. Reconstruction was performed with the ipsilateral PCF, contralateral PMF, and structural grafts. Auricular cartilage grafts were universally used for structural support, with additional costal cartilage grafts and a split calvaria bone graft in select cases. The technique showed good functional and esthetic outcomes without any notable graft failures or donor site complications. The combination of an ipsilateral PCF and contralateral PMF is an effective strategy for reconstructing full-thickness nasal defects involving multiple nasal subunits.

Recent Updates on the Management of Split-thickness Skin Graft Donor Sites.

This article is a narrative review of split-thickness skin graft donor site (STSG-DS) management since the international guidelines were created in 2018. Although many new interventions have been developed, there is a lack of quality, multicentered clinical trials to produce updated evidence-based recommendations. Electronic databases, including Google Scholar, Web of Science, Medline, and PubMed, were searched by two independent researchers for literature regarding STSG-DS management published from 2018 through 2022, using specific terms in the text, title, and abstract. The primary endpoint assessed was STSG-DS healing, as measured by wound epithelialization. Thirty-one articles were selected, including three systemic review/meta-analyses, five case series, 14 randomized controlled clinical trials, six observational studies, and three nonrandomized trials. Novel interventions for STSG-DS management included in this article describe applications of human amniotic membranes, acellular dermal matrices, cell suspensions and growth factors, biomaterials, electromagnetic radiation, and natural products. Various interventions have shown promise for STSG-DS management since the creation of the 2018 international guidelines; however, studies with more standardized protocols and endpoints are needed to produce up-to-date, evidence-based recommendations and improve outcomes for patients undergoing split-thickness skin grafting.

Suprapubic skin as a skin graft donor site for micrograft application in vasculopaths

Suprapubic skin as a skin graft donor site for micrograft application in vasculopaths

[Translated article] Postoperative Wound Care in Dermatologic Surgery: Update And Narrative Review

Dermatologic surgery is associated with a very low risk of complications. There is no widely accepted, evidence-based protocol with recommendations for postoperative wound care after dermatologic surgery. In this narrative review, we will be discussing the evidence on surgical wound care products and procedures. Overall, we found relatively few studies and, in many cases, a lack of statistically significant differences, possibly because of the low rate of complications. We’ll be discussing the evidence on when we should initiate wound care procedures and their frequency, the type of ointment and antiseptics that should be applied, and the type of dressings that should be used. Despite the very few studies available on postoperative wound care following dermatologic surgery, there is sufficient evidence as to not recommend the use of prophylactic topical antibiotics. We also analyze the currently available evidence on surgical wound care in special situations, such as management of skin grafts, partial skin graft donor sites, xenografts/biomembranes, and surgical wounds to the legs.

COMPARATIVE STUDY BETWEEN THE EFFECTIVENESS OF AMNION-CollaGee [COLLAGEN–GELATIN–ELASTIN] AS A BIOLOGICAL PRODUCT WOUND DRESSING AND CONVENTIONAL DRESSING ON THE DONOR SITE OF THE SPLIT THICKNESS SKIN GRAFT IN ANIMALS MODEL (RATS)

Abstract Background The clinical application of amniotic membrane wound healing products is limited partially due to handling challenges. Amnion-CollaGee sponge dressing (ACS) provides better alternatives to traditional therapy in facilitating wound healing. Objective To optimize the effectiveness of ACS as a healing agent in donor-site split-thickness skin graft (STSG) based on in vitro outcomes. Followed by comparing wound healing rates, pain sensitivity, and risks of infection between investigator ACS dressing with currently conventional Duoderm dressing (DD) via in vivo analysis. Materials and methods Seven male Sprague-Dawley rats underwent STSG harvesting, with 1x1cm grafts taken from both the right and left sides of the animals' backs. The wounds on the right side (Group 1) were dressed with ACS, while the wounds on the left side (Group 2) were dressed with DD. The donor site wounds were assessed on the seventh, fourteenth, and twenty-first days of the experiment. Primary outcomes measured were rate of healing, pain sensitivity, potential risks of infection. Secondary outcomes were lesion vascularity, pigmentation and histopathological features. Results The size of the wounds treated with ACS was statistically smaller compared to that treated with DD. On day 21st, both types of dressings showed complete healing, thus, contributing to better aesthetic value. Additionally, superior pain suppression was witnessed at ACS-treated graft sites compared to DD. Histopathological reports displayed better post-traumatic wound site inflammatory control, less tissue scarring, and abundant collagen growth in the ACS wing compared to the DD counterpart. Conclusion The biological ACS dressing appeared to facilitate rapid wound healing rates, reduce the risk of exposed wound infections, and enhance pain suppression in rodent models. ACS based dressing agents are future interventional breakthroughs in graft donor site wound management.

Dynamic optical coherence tomography for imaging acute wound healing.

The aim of this study was to investigate acute wound healing with dynamic optical coherence tomography (D-OCT). From 22 patients with 23 split skin graft donor sites, vessels at four wound edges, the wound bed, and adjacent and unaffected skin of the contralateral leg were measured by D-OCT at six time points from surgery to 4 weeks of healing. Changes in vessel orientation, density, diameter, morphology and pattern in horizontal, vertical and 3D images were analysed for wound healing and re-epithelialization. At 300 μm depth, there were significant differences of blobs and serpiginous vessels between normal and wounded skin. The wound had significantly more vertically oriented vessels, a higher degree of branching, vessel density and diameter compared with healthy skin. 3D images showed increased angiogenesis from healthy skin towards the wound centre, significantly higher vessel density at the wound than at normal skin and the highest at the interface. During wound healing blobs, coils and serpiginous vessels occurred significantly more frequently in lesional than healthy skin. Vessel density was greatest at the beginning, decreased and then increased by 4 weeks post-surgery. D-OCT helps to evaluate acute wound healing by visualizing and quantifying blood vessel growth in addition to re-epithelialization.

How Does a Skin Graft Donor Site Heal?

How Does a Skin Graft Donor Site Heal?

Recombinant human platelet-derived growth factor-BB-soaked gelatin sponge reduces patient pain in palatal graft donor sites

The free gingival graft (FGG) remains a gold standard for treating mucogingival defects and increasing the width of keratinized tissue. However, patients receiving FGG surgery report substantial post-operative discomfort, bleeding, and swelling, more so than those receiving connective tissue grafts, for example, and some of these post-operative sequelae can be difficult to manage. Various techniques are utilized in achieving hemostasis, but no current techniques effectively reduce the pain and discomfort to the patient. Ten FGGs were harvested from the palates of 10 patients to treat mucogingival deficiencies elsewhere in each patient. Immediately (&lt;1 min) after harvesting the FGG, a gelatin sponge soaked in recombinant human platelet-derived growth factor-BB (rhPDGF-BB) was placed into the wound site and sutured in place with absorbable sutures. Patients were followed up on days 3, 7, and 14 for assessing pain levels utilizing patient-reported outcome measures (PROMs), which incorporate the visual analog scale and the quantification of analgesics consumed. Clinically, the rhPDGF-BB/gelatin sponge-treated FGG palatal donor sites began to heal by day 3 of follow-up, and the healing was completed during the visit on day 14. No adverse effects, including swelling or bleeding, were observed at any of the post-surgical time points. According to the visual pain score, patients experienced minor discomfort, but no dissatisfaction was reported. Patients whose palatal FGG donor site was treated with a gelatin sponge soaked in rhPDGF-BB reported little or no post-surgery discomfort and low morbidity at the donor site within 2 weeks. These findings are in sharp contrast to the well-known substantial discomfort most patients experience following the harvesting of a palatal FGG. The data suggest that treating FGG palatal donor sites with rhPDGF-BB-soaked gelatin sponge can improve patient experience.

Donor Limb Functional Restoration via a Novel Clinical Care Pathway following Fibula Free Flap Harvest for Head and Neck Reconstruction.

Patients undergoing head and neck skeletal reconstruction (HNR) often require free tissue transfer from the extremities to ensure proper restoration of form and function. This requires a team-based, highly reliable medical system centered around the patient needs. Surgical intervention across multiple sites and harvesting of donor tissue results in short- and long-term physical impairments. There is a paucity of research objectively measuring impairments resulting from the graft donor site. There is a lack of research that objectively measures impairments and protocols for the management of these patients postoperatively. Patients undergo little, if any, formal approach to dealing with the vast impairments, which are sequelae to this surgery. This leads to large discrepancies in proposed functional progressions, return to duty timelines, and utilization of rehabilitative resources. At a major military medical center, an innovative clinical care pathway for patients undergoing HNR using free tissue transfer was implemented using a multidisciplinary model that focuses on early engagement with rehabilitation. This model, paired with a single surgery, will attempt to return service members to duty months earlier than the traditional approach. This report describes the conceptual framework and implementation of a new criteria-based, multidisciplinary clinical care pathway for HNR patients. The collaboration amongst the multidisciplinary care team has optimized the holistic health of the patient and communication with their support network, yielding faster return to normalization of daily life activities. The long-term goal is to further develop and formalize this pathway to best serve this patient population.

Cuidado de la herida quirúrgica tras cirugía dermatológica. Una actualización y revisión narrativa

Dermatologic surgery is associated with a very low risk of complications. There is no widely accepted, evidence-based protocol with recommendations for postoperative wound care after dermatologic surgery. In this narrative review, we will be discussing the evidence on surgical wound care products and procedures. Overall, we found relatively few studies and, in many cases, a lack of statistically significant differences, possibly because of the low rate of complications. We’ll be discussing the evidence on when we should initiate wound care procedures and their frequency, the type of ointment and antiseptics that should be applied, and the type of dressings that should be used. Despite the very few studies available on postoperative wound care following dermatologic surgery, there is sufficient evidence as to not recommend the use of prophylactic topical antibiotics. We also analyze the currently available evidence on surgical wound care in special situations, such as management of skin grafts, partial skin graft donor sites, xenografts/biomembranes, and surgical wounds to the legs.

Clinical evaluation of the efficiency and safety of the Tromboguard® hemostatic dressing for donor sites of split-thickness skin graft: A multicenter study

Worldwide, burns are the fourth most frequent type of injury. The treatment of burn wounds requires a lot of experience and an interdisciplinary approach including both surgical treatment and pharmacological wound care. The most common management of burn wounds is debridement and wound closure through the use of skin grafts. The purpose of the study was to evaluate the hemostatic and antibacterial effects of the commercially available Tromboguard® foam dressing with an active layer containing alginates and chitosan. The site of application of the product was the donor fields for skin grafts. Findings proved that a polyurethane foam dressing with an active chitosan-alginate layer is a useful option for achieving rapid hemostasis, antimicrobial protection and effective healing at split-thickness skin graft donor sites. Substances present in the active layer promote clot formation and the wound healing process.

Comparison of Ba-Hao burn ointment gauze and petrolatum gauze in split graft donor site healing: A randomized, prospective, and self-control study.

To assess patient comfort, wound healing, and scarring at the 6-month follow-up of split-skin graft donor sites treated with Ba-Hao burn ointment (BHBO) gauze, a compound preparation of traditional Chinese medicine since 1970s, compared with petrolatum gauze. Thirty patients admitted to the Department of Burns of the First Affiliated Hospital of Anhui Medical University between September 2021 and September 2022 participated in this randomized, prospective, self-control clinical study. After harvesting the split skin, donor sites were divided into two parts along the midline. BHBO gauze was applied to half of the donor wounds, and petrolatum gauze was applied to the other half. The wound healing time, pain scores on the postoperative Days 3, 6, and 9, and Vancouver Scar Scale (VSS) score at the 6-month follow-up were assessed. The wound healing time was significantly shorter in the BHBO group than in the control group (10.07 ± 1.48 days vs. 11.50 ± 1.74 days, p < 0.001). On postoperative Days 3 and 6, the pain scores quantified by visual analog scores were significantly lower in the BHBO group than in the control group (5.33 ± 1.54 and 4.17 ± 1.51, respectively vs. 7.57 ± 1.41 and 5.20 ± 1.47, respectively). The difference in the visual analog scale score on postoperative Day 9 between the groups was not significant (p > 0.05). Microbiological assessment revealed the absence of bacterial contamination in both groups. At the 6-month follow up, the VSS score was significantly lower in the BHBO group (6.67 ± 1.92) than in the control group (9.57 ± 1.55). BHBO resulted in faster donor-site healing, reduced postoperative pain, and improved scar quality at the 6-month follow-up than petrolatum gauze alone.

An Overview on the Big Players in Bone Tissue Engineering: Biomaterials, Scaffolds and Cells.

Presently, millions worldwide suffer from degenerative and inflammatory bone and joint issues, comprising roughly half of chronic ailments in those over 50, leading to prolonged discomfort and physical limitations. These conditions become more prevalent with age and lifestyle factors, escalating due to the growing elderly populace. Addressing these challenges often entails surgical interventions utilizing implants or bone grafts, though these treatments may entail complications such as pain and tissue death at donor sites for grafts, along with immune rejection. To surmount these challenges, tissue engineering has emerged as a promising avenue for bone injury repair and reconstruction. It involves the use of different biomaterials and the development of three-dimensional porous matrices and scaffolds, alongside osteoprogenitor cells and growth factors to stimulate natural tissue regeneration. This review compiles methodologies that can be used to develop biomaterials that are important in bone tissue replacement and regeneration. Biomaterials for orthopedic implants, several scaffold types and production methods, as well as techniques to assess biomaterials' suitability for human use-both in laboratory settings and within living organisms-are discussed. Even though researchers have had some success, there is still room for improvements in their processing techniques, especially the ones that make scaffolds mechanically stronger without weakening their biological characteristics. Bone tissue engineering is therefore a promising area due to the rise in bone-related injuries.

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.

Comparisons of Impact of Vein Grafting with Different Indications on Outcomes of Reconstruction with Free Flaps.

Prior studies have shown an increased risk of complications and flap loss with the use of vein grafts in microsurgery. We hypothesize that indication for use of a vein graft can affect flap complications and loss rates. We performed a retrospective review of all patients at our institution from 2010 to 2020 who underwent free flap reconstruction and required use of a vein graft. Indications for vein grafting included: salvage of flap during primary operation after microvascular compromise, augmentation of flow during primary operation, lengthening of the flap pedicle during the primary operation, and salvage of the flap during a secondary salvage operation after microvascular compromise. A total of 79 patients met the study inclusion criteria. There were significant differences among the vein graft indication groups and the following: area of reconstruction (p = 0.002), vein graft length (p = 0.018), vessels grafted (p = 0.001), vein graft donor site (p = 0.011), and total flap loss (p = 0.047). Of the four indications for vein grafting, salvage of the flap during secondary salvage operation after microvascular compromise had the highest rate of total flap loss (26.7%). There were no significant associations between other flap complications and vein graft indications. Vein graft use in the primary reconstructive setting is efficacious, with low risk of thrombosis. Use in secondary procedures, however, is associated with higher rates of total flap loss, likely due to the thrombotic process, which was initiated prior to the use of the graft resulting in the salvage procedure and not secondary to the graft itself.

Midterm Donor Site Morbidity After Vascularized Free Fibula Flap Harvesting.

Vascularized fibula grafts (VFGs) have become one of the most preferred grafts for the reconstruction of bone defects. However, despite the many advantages over other graft options, recipient and donor site morbidities are also common. Donor site morbidity has been reported at rates ranging from 5% to 67%. The aim of this study was to present a single-center series examining the clinical, functional, and radiologic aspects of donor site morbidity following VFG harvesting. The study included 69 patients who underwent biological reconstruction with VFG for bone tumors, avascular necrosis of the femoral head, or bone defects after trauma. Patients were evaluated functionally, clinically, and radiologically for donor site morbidity. Donor site morbidity was observed in 33 of 69 patients (48%). The most complications were sensation deficits around the feet and ankles (20 of 69; 29%). Knee laxity was more common in patients who underwent osteoarticular fibular resection (P = .006). We found VFG to be an effective method for the reconstruction of large bone defects, but associated with a relatively high rate of complications. Complications requiring surgical intervention were rare and the majority of patients did not have long-term functional limitations. Level IV, retrospective case series.

Clinical outcomes of arthroscopic superior capsule reconstruction in patients aged over 70 with irreparable rotator cuff tears

BackgroundArthroscopic superior capsule reconstruction (SCR) was developed to restore superior shoulder stability, muscle balance, and function after irreparable posterior–superior rotator cuff tears. The purpose of this study was to investigate whether favorable clinical outcomes after SCR for irreparable rotator cuff tears would be obtained in patients older than 70 years. MethodsA total of 173 consecutive shoulders in 162 patients who underwent arthroscopic SCR using autografts of fascia lata for irreparable rotator cuff tears were allocated to three groups according to patient age at the time of surgery: Group 1, <55 years old (11 shoulders); Group 2, 55 to 70 years old (85 shoulders); and Group 3, >70 years old (77 shoulders). American Shoulder and Elbow Surgeons (ASES) and Japanese Orthopaedic Association (JOA) scores, active shoulder range of motion (ROM), and visual analog scale (VAS) were evaluated before surgery and at the final follow-up. Postoperative complications, including graft tears in MRI and donor-site morbidity, were assessed. ResultsThe mean follow-up was 3 years and 9 months. Both ASES and JOA scores and active ROM (elevation, external rotation, and internal rotation) increased significantly after arthroscopic SCR in all three groups (P < .001), and VAS decreased significantly. All three groups had low graft tear (6%–10%) and donor site morbidity (0%–1%) rates, with no significant difference among the groups. ConclusionArthroscopic SCR can lead to functional improvement and pain relief with a low rate of complications regardless of patient age.