Skin Graft Donor Site Dressings Research Articles

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<0.05), but there was no significant difference between groups B and C (P<0.05). There was no significant difference between the three groups in infection and pain at rest, activity, and dressing time (P<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.

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.

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.

Site donneur de greffe de peau mince : quel pansement utiliser ?

The management of split-thickness skin graft donor sites is targeted towards promoting the healing process, reducing pain. This has been an inconclusive topic. The aim of this study was to list and to discuss the French practices in term of split-thickness skin graft (STSG) donor site dressing. Multicentric national study by questionnaire (Google Drive(®)) for the attention of the plastic and/or pediatric surgeons. The type of dressing used on skin and sclap and the rhythm of dressing changes were analyzed. The study included 26 surgical centers on 40 contacted. The alginate is mainly used (Algostéril(®)) (17/26). It is left in position until healing (13/17). Five other types of dressings have been reported: paraffin gauze (3/26), lipidocolloides (1/26), Mepitel(®) (1/26), Mepilex(®) (1/26), indifferent use of gauze or alginate dressings (4/26). Twenty-two out of 26 centers make no difference in dressing choice between skin and scalp. Medical practices did not differ between adult or pediatric departments. Cost-effectiveness has become an important issue in wound management, requiring judicious use. The lack of consensus regarding split-thickness skin graft donor site dressing and our clinical practices force us to reconsider the best therapeutic option. This study coupled with the analysis of the literature highlights the difficulties of the practitioner in choosing the best dressing. The alginate seems to get the preference of our practices by its ease of use, its absence of change (reduces pain by limiting manipulations) and its moderate cost.

A randomized comparison study of Aquacel Ag and Alginate Silver as skin graft donor site dressings

ObjectiveThis study was conducted to compare pain, healing time, infection rate, and cosmetic outcome between Aquacel Ag (convatec) and Alginate Silver (coloplast) as donor site dressings. Materials and MethodsWe conducted a prospective randomized controlled trial of donor site dressings, comparing Aquacel Ag with Alginate Silver. Patients were randomly allocated to donor site dressing with one of these materials. Outcome measures included pain scores at rest and during dressing changes, time to re-epithelialization, cosmetic outcome and infection rate. Results were assessed for significance using the independent t-test (non-parametric data) and the chi-square test (parametric data). ResultsA total of 20 subjects were enrolled in this study. Subjects included in both groups were comparable with no significant differences in demographic data of age, gender, location of burn and type of burns (P>0.05 evaluated by paired t-test) between both group. The pain scores were found to be higher in Aquacel Ag group than in Alginate Silver group. Time to re-epithelialization was longer in Aquacel Ag group than in Alginate Silver group. There were no significant differences between the two treatment groups with respect to cosmetic outcome and infection rate. ConclusionsBased on these results, we find that Alginate Silver is better than Aquacel Ag to cover the skin graft donor site.

Comparative Clinical Study of Bactigras and Telfa AMD for Skin Graft Donor-Site Dressing

The Bactigras® paraffin tulle coated with chlorhexidine is normally used for the treatment of donor-site wounds in burn patients who received split-thickness skin grafts in several centers. It has some disadvantages, such as adhesion to wound surfaces and pain from the irritation caused by this dressing. The Telfa AMD®, a non-adherent wound dressing which consists of absorbent cotton fibers impregnated with polyhexamethylene biguanide enclosed in a sleeve of thermoplastic polymers, is a new option for donor-site wound care which causes less adherence to the wound. The purpose of this study was to compare clinical efficacy of these two dressings for the management of donor-site wounds. Thirty-two patients who received split-thickness skin grafts by donor site harvesting from the thigh were enrolled in this study and randomized into two groups receiving either the Bactigras® or the Telfa AMD® wound treatment. Re-epithelialization, pain, infection and cost-effectiveness analyses were compared between both groups. The results showed that there was no significant difference in age, area of donor sites or length of hospital stays between the groups (p > 0.05). However, the day of re-epithelialization (≥90%) was significantly shorter in patients treated with the Telfa AMD® compared to the Bactigras® group (14.00 ± 3.05 vs. 9.25 ± 1.88 days for Bactigras® and Telfa AMD® groups, respectively, p < 0.001). The average pain score was also significantly lower in the Telfa AMD® group (1.57 ± 0.55 vs. 4.70 ± 1.16, p < 0.001). There was no difference in the cost of treatment between the groups (4.64 ± 1.97 vs. 5.72 ± 2.54 USD, p = 0.19). This study indicated that the Telfa AMD® was an effective dressing for the treatment of donor-site wounds.

Systematic Review of Skin Graft Donor-Site Dressings

Debate continues about what split-thickness skin graft donor-site dressing provides the best outcomes for patients at the lowest cost. The goal of this systematic review was to determine which donor-site dressings are associated with the best outcomes for the following: pain, infection rate, healing quality, healing rate, quality of life, and cost. A comprehensive literature review and assessment was undertaken by two independent reviewers. Articles were selected using specific inclusion criteria. Split-thickness skin graft donor-site dressings were classified as either moist or nonmoist based on the state of the dressing upon initial application. Methodological quality of randomized controlled trials was assessed using the Jadad scale. Seventy-five relevant articles were included in the final analysis, three of which were review articles. The most commonly measured outcome was healing rate (64 of 72), followed by pain (58 of 72), infection rate (40 of 72), healing quality (40 of 72), and cost (15 of 72). No studies measured quality of life. The majority of articles were randomized controlled trials (35 of 75), followed by observational studies (22 of 75), unsystematic clinical observations (15 of 75), and review articles (three of 75). It was difficult to compare moist and nonmoist dressings in this review because of the methodological heterogeneity of the included articles. The available evidence suggests, however, that moist dressings are superior in terms of pain. Some weak evidence exists that supports "wet dressings." To determine the best split-thickness skin graft donor-site dressing, more methodologically sound randomized controlled trials are needed. Trials with parallel economic evaluations should be undertaken to answer this question.

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.

The use of silver coated dressings on donor site wounds: a prospective, controlled matched pair study

Acticoat, a new silver-coated dressing, produces a moist healing environment along with the sustained release of ionic silver for improved microbial control. These properties suggest that Acticoat might be a useful donor site dressing. However, there are no human studies which assess Acticoat for this use. The purpose of this study was to compare the healing of human skin graft donor sites dressed with Acticoat, to the healing of those dressed with Allevyn, an occlusive moist-healing environment material, which is our standard donor site dressing. In burn patients who had undergone burn excision and grafting, identical side-by-side split thickness donor site wound pairs were dressed with Allevyn and Acticoat. Re-epithelialization was directly assessed daily by a single observer from post-operative day 6 onward, and by four independent observers who rated the extent of re-epithelialization by viewing standardized digital images of the wounds that had been obtained on post-operative days 6, 8, 10,and 12. Donor sites were swabbed for bacterial culture on days 3, 6, and 9. Subsequently, each study donor site scar was rated by a blinded observer using the Vancouver Scar Scale at 1, 2, and 3 months. Sixteen paired sites in 15 patients (3 female, 12 male) were studied. Donor sites dressed with Allevyn were >90% re-epithelialized at a mean of 9.1±1.6 days while donor sites dressed with Acticoat required a mean of 14.5±6.7 days to achieve >90% re-epithelialization ( P=0.004). The Allevyn sites had significantly greater estimated re-epithelialization at days 6, 8, 10 and 12 than the Acticoat sites based on the observations of the digital images. There were no significant differences in the incidence of positive bacterial cultures with either dressing at days 3, 6, and 9. Donor sites dressed with Acticoat had significantly worse scars at 1 and 2 months but this difference resolved by 3 months. Our findings do not support the use of Acticoat as a skin graft donor site dressing.

Retention dressings: a new option for donor site dressings.

Split skin graft donor site dressings should be cheap, easy to apply and remove, reduce pain, provide a moist wound healing environment, be easy to care for and cause minimal interference in the patient's daily activities. Adhesive retention dressings seem to provide these features and are a new option for donor site dressings.

A comparative study of three new occlusive dressings for healing of graft donor sites versus conventional therapy

A comparative study of four skin graft donor site dressings was undertaken. This was a prospective and cross-over study of 25 consecutive patients with burns up to 40% TBSA treated with split skin grafts. Each donor site was divided into four sections and covered with different dressings in order to evaluate their effectiveness in healing, the time required for complete epithelialization, patient acceptance and any intolerance or local infection. The results showed that the occlusive hydrocolloid dressing significantly decreases (p<0.01) the mean time required for complete healing (7.45 days) compared with a semiocclusive hydrocolloid (10.29 days), a polyurethane sheet (9.4 days) and the conventional dressing (10.04 days).

Optimal wound healing under Op-Site dressing.

Op-Site is a popular skin-graft donor-site dressing. The formation of hematomas or seromas with their troublesome consequences is effectively prevented by the incorporation of a closed drainage system.

Use of semipermeable polyurethane membrane for skin graft dressings.

The use of semipermeable polyurethane membrane (Op-site) for skin graft donor-site dressings is now well-accepted. We have used Op-site for skin graft coverage in 25 patients with good results. The dressing modality is not only easy to do, even in anatomically difficult areas, but it also maintains a moist environment, allows daily graft observation, and provides a barrier for exogenous bacteria.