Healing Of Skin Graft Donor Sites Research Articles

Role of Cyclical Negative Pressure Wound Therapy in Healing of Skin Graft Donor Site

Aim of this case report is to assess the role of cyclical negative pressure wound therapy (CNPWT) in management of skin graft donor site healing. Clinical examination of the donor site before and after the use of cyclical negative pressure wound therapy (CNPWT) was done. Cyclical negative pressure wound therapy (CNPWT) is effective in healing of donor site wound. Cyclical negative pressure wound therapy (CNPWT) may be used in donor site healing.

Role for platelet rich plasma as an adjuvant therapy in wound healing and burns

Abstract Background Platelet rich plasma (PRP) contains high concentrations of growth factors. Intuitively, these were thought to be of potential benefit in healing of chronic wounds, skin grafts and graft donor sites. This was echoed in retrospective studies and an individual case basis but had not been randomized. Methods A systematic search was carried out by two individuals, independently, on the MEDLINE, EMBASE and COCHRANE databases, according to PRISMA guidelines. All data analysis and statistics was pooled and analysed using the Cochrane RevMan Software. Results Split thickness grafts have been described by numerous authors, but PRP use did not offer a significant advantage in graft take in pooled results (MD 5.83, 95% CI − 0.69 to 12.25, random-effects, p = 0.08). The analysis of included randomized controlled trials has shown favourable split-thickness skin graft donor site healing in the PRP group (MD − 5.55, 95% CI − 7.40 to − 3.69, random-effects, p = < 0.00001) compared to the control group. For carpal tunnel syndrome, the pooled results showed no difference in functional scores vs steroid injections (SMD − 0.68, 95% CI − 1.47 to 0.10, randomeffects, p = 0.09) or indeed splinting groups. Conclusions With the current body of evidence, we conclude that the use of PRP as an adjuvant therapy in skin grafts, burns, carpal tunnel surgery or scars cannot be rationalised. A potential use of PRP is in donor site management but the cost of this would be difficult to justify. Level of evidence: Not ratable.

Impact of Local Insulin Injection on Split Thickness Skin Graft Donor Site Healing

Impact of Local Insulin Injection on Split Thickness Skin Graft Donor Site Healing

"Impact of Local Insulin Injection on Split Thickness Skin Graft Donor Site Healing"

"Impact of Local Insulin Injection on Split Thickness Skin Graft Donor Site Healing"

Skin Graft Donor Site Healing among Elderly Patients with Dermatoporosis - A Case Series.

We reviewed donor site wound healing among morbid ≥65-year-old patients after split-thickness skin graft (STSG) harvesting. Patients were treated for a pretibial laceration or hematoma in Kymenlaakso Central Hospital, Finland, between 2015 and 2019. Twelve morbid patients with a mean Charlson Comorbidity Index of 7.1 (range 4-12) and a mean age of 80.6 years (range 69-91) were studied. Nine patients were female. Eight had a chronic cutaneous fragility syndrome, eg, dermatoporosis. All donor site areas were located on the thigh and were less than 2% TBSA. One donor site infection occurred. STSG integration on the pretibial wound bed was successful with all patients, and none of the patients needed further operative treatment. Graft thickness varied between 0.010 to 0.014 inches. STSG donor sites healed within the normal range of 21 days in 50% of patients. Among two patients, healing took 25 days, and among four, 37 to 97 days. All donor sites healed via local wound care without the need for regrafting. 4Our study indicates that harvesting STSG from elderly and morbid patients with poor skin condition is safe and does not result in significant complications. Prolonged donor site healing can occur, which can be managed with regular local wound care.

Silver Ion Hydrocolloid Gauze and Self-Adhesive Polyurethane Foam Dressing Combination Therapy Can Better Promote Healing of Skin Graft Donor Area Than Traditional Therapy: A Case Control Study

The management of skin graft donor area has been a troublesome problem in reconstructive surgery. Currently, no guidelines exist for the management of skin graft donor areas, and the disposal methods vary from clinician to clinician. With the goal of providing a better basis for improved patient care, the authors conducted a case control study to investigate whether a combination of silver ion hydrocolloid gauze and self-adhesive polyurethane foam dressing (AG+foam group) was effective in healing skin graft donor sites. Forty-eight patients requiring intermediate-thickness skin graft between January 2014 and December 2015 were included in the study. Inclusion criteria included a skin graft measuring at least 40 cm2 to be harvested from the ipsilateral thigh and patient age of 14 years to 60 years. All patients were treated differently according to the experience of their own doctor. Donor sites were covered with silver ion hydrocolloid gauze and self-adhesive polyurethane foam dressing (AG+foam group, n = 23]) or petrolatum gauze, sterile gauze, and compression bandage (control group, n = 25]). Wounds healed faster (mean, 12.7 days ± 2.4 standard deviation vs 22.0 days ± 5.8; P < .001), with fewer dressing changes (median [interquartile range, IQR], 2 [IQR, 2-3] vs 4 [IQR, 2.5-5]; P = .002), and with reduced pain on first dressing change (median visual analog scale score, 5 [4-6] vs 7 [6-7.5]; P < .001) in the AG+foam group compared with the control group. The Patient and Observer Scar Assessment Scales and overall scar ratings were better in the AG+foam group than in the control group (P < .001 for all). The AG+foam group had no infections; 2 infections occurred in the control group. Combined use of AG+foam dressing may enhance skin graft donor site healing, alleviate pain, and require fewer dressing changes.

Highly Hydrophilic Polyurethane Foam Dressing Versus Early Hydrophilic Polyurethane Foam Dressing on Skin Graft Donor Site Healing in Patients with Diabetes: An Exploratory Clinical Trial.

To compare the effects of early hydrophilic polyurethane (EHP) foam dressing and highly hydrophilic polyurethane (HHP) foam dressing on wound healing in patients with diabetes. Twenty patients with diabetes with skin graft donor sites on the lateral thigh were enrolled in this study. Each donor site was divided into two equal-sized areas for the application of HHP or EHP foam dressing. The study endpoint was the time required for healing, defined as complete epithelialization of the donor site without discharge. All possible adverse events were also documented. Donor site healing was faster in 15 patients on the HHP half and 1 patient on the EHP half. In four patients, healing rates were the same between the HHP and EHP areas. Donor sites treated with HHP and EHP foam dressings healed in 17.2 ± 4.4 and 19.6 ± 3.7 days (P = .007), respectively. During the study period, no adverse event associated with the dressings occurred in either group. The HHP foam dressing might provide faster healing than EHP foam dressing for skin graft donor sites in patients with diabetes.

Medical and cosmeceutical applications for enhancement of partial-thickness skin graft donor-site healing

Introduction: After partial-thickness skin graft (PTSG) harvesting, a dermal surface is exposed and an iatrogenic wound is created. Application of various agents has been studied for enhancement of healing process in PTSG donor area. The ideal agent should accelerate healing, provide comfort to the patient, not allow infection, and be easily applicable and cheap. Materials and Methods: The Cochrane Central Register of Controlled Trials, PubMed, Scopus. and EMBASE databases were screened for words (“skin graft” + “donor”), by using time limits between 1989 and 2018. This study involved a total of 5 systematic reviews and 43 original articles which met the inclusion criteria. Articles were reviewed and parameters such as healing time, pain, infection rate, cosmetic result, and cost were extracted. Results: Systematic reviews favor moist dressing materials over dry ones considering healing time and patient comfort. Hydrocolloids provide rapid wound healing, and dressing changes do not cause any disruption to the newly regenerated epithelium. Alginates seem to have a longer healing time than hydrocolloid materials. Polyurethane films are characterized by rapid epithelialization and painless monitoring as well as low costs. The epithelialization time of MEBO®, a cosmeceutical product, is reported to be faster than polyurethane films. Local and systemic drug applications warrant further research before routine clinical usage. Conclusion: Dressing materials are the most commonly used and appropriate group according to the studies performed to date. It is seen that moist dressing materials are more favorable. Although there is not a subgroup with a clear superiority, it can be seen that the hydrofiber and polyurethane film groups are one step ahead in terms of ease of use, patient comfort, epithelialization speed, and scar quality. Polyurethane films have a cost advantage to the hydrofiber group.

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.

Intravenous arginine and human skin graft donor site healing: A randomized controlled trial

Intravenous arginine and human skin graft donor site healing: A randomized controlled trial

Intravenous arginine and human skin graft donor site healing: A randomized controlled trial

Background and aims Studies evaluating the effect of arginine supplementation in human wound healing are inhomogeneous with conflicting results. This study aims to clarify the role of arginine supplementation in the healing of human skin graft donor sites. Methods 35 subjects undergoing skin autografting were randomly assigned to receive intravenous arginine ( n = 16) or placebo ( n = 19) for 5 days in a dose of 30 g of arginine or an isovolumetric amount of placebo (25.2 g of alanine). Wound healing was evaluated at the donor sites by objectifying angiogenesis, reepithelialization and neutrophil influx. Plasma amino acid concentrations were measured to evaluate our intervention. Results The two groups were comparable in age, morbidity and nutritional, metabolic and inflammatory state. Plasma arginine and alanine levels increased significantly upon supplementation in the two groups, respectively. No differences were found between the arginine supplementation group and the placebo group in the studied parameters. Placebo vs. arginine; mean ± SD: neutrophil influx on day 2: 6.67 ± 3.0 vs. 6.57 ± 3.3, p = 0.66; angiogenesis on day 10: 8.0 ± 2.8 vs. 8.9 ± 3.1; reepithelialization in % on day 10: 81 ± 8.5 vs. 85 ± 7.1. Conclusion Intravenous arginine supplementation does not improve angiogenesis, reepithelialization or neutrophil influx in healing of human skin graft donor sites.

Characterization of Growth Hormone Enhanced Donor Site Healing in Patients with Large Cutaneous Burns

Human growth hormone is an anabolic agent that attenuates injury-induced catabolism and stimulates protein synthesis. Recombinant human growth hormone (rhGH) administered therapeutically to patients with massive burns has been shown to increase the rate of skin graft donor site healing. It has been postulated that growth hormone affects wound healing and tissue repair by stimulating the production of insulin-like growth factor-1 (IGF-1) by the liver to increase circulating IGF-1 concentrations. The mechanism by which it improves wound healing, however, remains in question. The authors hypothesize that rhGH up-regulates IGF-1 receptors and IGF-1 levels both systemically and locally in the wound site to stimulate cell mitosis and increase synthesis of laminin, collagen types IV and VII, and cytokeratin. This hypothesis was tested in nine patients with burns covering > 40% of total body surface area. The authors assessed the efficacy of rhGH in promoting several major building materials in the donor site of patients with massive burns. Ten massively burned patients with full-thickness burns covering more than 40% of total body surface area were participants in a placebo-controlled prospective study to determine the efficacy of 0.2 mg/kg/day rhGH on donor site wound healing and to identify some of the major components involved in wound healing and its integrity. Donor sites in burn patients receiving rhGH showed an increased coverage by the basal lamina of 26% for placebo to 68% coverage of the dermal-epidermal junction. Insulin-like growth factor-1 receptors and laminin, types IV and VII collagen, and cytokeratin-14 all increased significantly. Healing times of the donor sites were significantly decreased compared with patients receiving placebo. Results indicate that growth hormone or its secondary mediators may directly stimulate the cells of the epidermis and dermis during wound healing to produce the structural proteins and other components needed to rebuild the junctional structures.

Microbiology and Healing of the Occluded Skin-Graft Donor Site

Delayed healing of skin-graft donor sites may be costly and life-threatening, especially in patients with large body surface area burns. A donor site dressing should maximize the ability of the wound to heal without increasing the risk of local infection, systemic infection, or both. Specifically, the possibility of a secondary infection may either slow the healing process or ultimately convert the donor site into a full-thickness skin loss. A number of materials ranging from gauze to biologicals have been investigated for use as donor site dressings. The use of hydrocolloids for donor sites has been widely studied and has shown improved healing rates over the rates reported for conventional dressings. Our recent study using hydrocolloids confirmed earlier research that showed fewer infections and more rapid donor site healing.