Split-thickness Skin Graft Donor Sites Research Articles

Tissue Sealants and Adhesives May Reduce Postoperative Pain

Split-thickness skin graft donor sites tend to bleed, and fibrin sealant has been used to speed time to hemostasis. Use of sealant has been anecdotally reported to reduce donor site pain. In this study, 50 patients who had split skin grafts harvested from the thigh were randomized to receive two forms of postoperative treatment to the donor site: either a self-adhesive fabric dressing or fibrin …

Comparison of scalp and abdomen as split-thickness skin graft donor sites for aural stenosis repair

To evaluate and compare the scalp and the abdomen as split-thickness skin graft donor sites for aural stenosis repair. A total of 34 patients with aural stenosis were included in the study. All the patients underwent meatoplasty using split-thickness skin grafts. Among them, the skin graft donor site was the scalp in 11 patients and the abdomen in the other 23 patients. The surgical team followed the patients in the outpatient department for at least 6 months after surgery. Evaluations concerned healing of the donor site, hair regeneration of the donor site, survival of split-thickness skin grafts, reoccurrence of aural stenosis and hair growth in the ear canal. The incidences of reoccurrence of aural stenosis in the two groups were compared. Subjective scar evaluation of the donor sites was performed using the Patient Scar Assessment Scale (PASA). The scale items were pain, itching, color, stiffness, thickness and irregularity. All the scalp and abdominal donor sites healed well with no sign of infection. Hair regrowth and reepithelialization was observed at all the scalp donor sites. Pink discoloration was observed at the scalp donor sites in six patients 2-3 months after surgery and disappeared 6-9 months after surgery. Scars were observed at the scalp donor sites in two patients 6 months after surgery. No alopecia was observed at the scalp donor sites. The scars and pink discoloration were hidden in the hair. Scars and/or discoloration were observed at all the abdominal donor sites 12 months after surgery. All the scalp and abdominal skin grafts survived with no sign of infection. Hair growth was observed in the ear canals in two patients in the scalp group. The incidences of reoccurrence of aural stenosis were 0 % (0/23) in the abdominal group and 9.1 % (1/11) in the scalp group, respectively (Chi square test, p > 0.05). The PASA values about color, stiffness, thickness and irregularity were higher in the abdominal group than in the scalp group (Mann-Whitney U test, p < 0.001). The PASA values about pain and itching were the same (Mann-Whitney U test, p > 0.05). The scalp meets most requirements of an ideal donor site of skin grafts for aural stenosis. The advantages of scalp as a donor site include easy accessibility in the operative field, simple postoperative care, low risk of infection, rapid wound healing, minimal interference with rehabilitation, and minimal scar formation.

A prospective, randomised study of a novel transforming methacrylate dressing compared with a silver-containing sodium carboxymethylcellulose dressing on partial-thickness skin graft donor sites in burn patients.

This prospective, randomised study compares a new transforming methacrylate dressing (TMD) with a silver-containing carboxymethylcellulose dressing (CMC-Ag) after application to split-thickness skin graft (STSG) donor sites. This was an unblinded, non-inferiority, between-patient, comparison study that involved patients admitted to a single-centre burn unit who required two skin graft donor sites. Each patient's donor sites were covered immediately after surgery: one donor site with TMD and the other with CMC-Ag. The donor sites were evaluated until healing or until 24 days post-application, whichever came first. Study endpoints were time to healing, daily pain scores, number of dressing changes, patient comfort and physicians' and patients' willingness to use the dressings in the future. Nineteen patients had both the dressings applied. No statistically significant difference was noted in time to healing between the two dressings (14·2 days using TMD compared with 13·2 days using CMC-Ag). When pain scores were compared, TMD resulted in statistically significantly less pain at three different time periods (2-5 days, 6-10 days and 11-15 days; P < 0·001 at all time periods). Patients also reported greater comfort with TMD (P < 0·001). Users rated TMD as being less easy to use because of the time and technique required for application. Reductions in pain and increased patient comfort with the use of the TMD dressing, compared with CMC-Ag, were seen as clinical benefits as these are the major issues in donor site management.

Clinical Potential of a Silk Sericin-Releasing Bioactive Wound Dressing for the Treatment of Split-Thickness Skin Graft Donor Sites

An ethyl alcohol-precipitated silk sericin/PVA scaffold that controlled the release of silk sericin was previously developed and applied for the treatment of full-thickness wounds in rats and demonstrated efficient healing. In this study, we aimed to further evaluate the clinical potential of this scaffold, hereafter called "silk sericin-releasing wound dressing", for the treatment of split-thickness skin graft donor sites by comparison with the clinically available wound dressing known as "Bactigras®". In vitro characterization and in vivo evaluation for safety of the wound dressings were performed. A clinical trial of the wound dressings was conducted according to standard protocols. The sericin released from the wound dressing was not toxic to HaCat human keratinocytes. A peel test indicated that the silk sericin-releasing wound dressing was less adhesive than Bactigras®, potentially reducing trauma and the risk of repeated injury upon removal. There was no evidence of skin irritation upon treatment with either wound dressing. When tested in patients with split-thickness skin graft donor sites, the wounds treated with the silk sericin-releasing wound dressing exhibited complete healing at 12 ± 5.0days, whereas those treated with Bactigras® were completely healed at 14 ± 5.2days (p = 1.99 × 10(-4)). In addition, treatment with the silk sericin-releasing wound dressing significantly reduced pain compared with Bactigras® particularly during the first 4 postoperative days (p = 2.70 × 10(-5) on day 1). We introduce this novel silk sericin-releasing wound dressing as an alternative treatment for split-thickness skin graft donor sites.

The Efficacy of Combined Herbal Extracts Gel in Reducing Scar Development at a Split-Thickness Skin Graft Donor Site

The aim of this study was to evaluate the efficacy of combined herbal extracts in a gel preparation (Cybele(®) Scagel) in reducing scar development at a split-thickness skin graft donor site. A prospective, randomized, double-blind control study was performed to evaluate the efficacy of Scagel in 15 patients who underwent a split-thickness skin graft operation. Both Scagel and placebo were applied equally to the donor site within 1month after complete epithelialization. Scar assessments using the Vancouver Scar Scale (VSS) and patient self-evaluation were taken at 2, 4, 8, and 12weeks. Of the 15 patients, 10 were enrolled and evaluated in this study. There was no significant difference in each parameter of the VSS. The total VSS was significantly lower in the Scagel group compared to the placebo group after 4weeks (p=0.003, 0.003, and <0.001 at 4, 8, and 12weeks, respectively). The patient satisfaction score in the Cybele(®) Scagel group was significantly higher (p=0.002) at the 12-week evaluation. Application of combined herbal extracts in gel preparation might reduce scar development at split-thickness skin graft donor sites. There was a positive trend in the reduction of postinflammatory hyperpigmentation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

98 SURGICAL MANAGEMENT OF GENITOPERINEAL HIDRADENITIS SUPPURATIVA IN MEN

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery (II)1 Apr 201398 SURGICAL MANAGEMENT OF GENITOPERINEAL HIDRADENITIS SUPPURATIVA IN MEN Mang Chen and Richard Santucci Mang ChenMang Chen Pittsburgh, PA More articles by this author and Richard SantucciRichard Santucci Detroit, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1476AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To report our successful experience in treating genital and perineal hidradenitis suppurativa. We describe our method of diseased tissue resection and wound defect coverage with local flaps and split-thickness skin grafts (STSG). METHODS From 2004 thru 2012, we treated 6 patients with genital and perineal hidradenitis suppurativa with radical resection of diseased tissue. Three patients underwent local flap coverage of their wound defect. Three others had more extensive disease requiring STSG coverage. Two patients with penile skin involvement required STSG for penile shaft reconstruction. RESULTS All patients achieved good cosmetic results. Operative variables such as disease severity, blood loss, and length of hospital stay was dependent on severity of disease and patient comorbidities. No wound complications occurred at the STSG donor site. STSG take on the scrotum and penis ranged from 60-100%. Wound complications from local flap closure were clinically insignificant and includes small (2cm or less) areas of wound breakdown with no evidence of infection. CONCLUSIONS Genital and perineal hidradenitis suppurativa is a debilitating and disfiguring disease. The use of radical resection and reconstruction with skin flaps and grafts provides a viable treatment option for these patients. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e39-e40 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mang Chen Pittsburgh, PA More articles by this author Richard Santucci Detroit, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A Clinical Study Comparing Helicoll with Scarlet Red and OpSite in the Treatment of Split Thickness Skin Graft Donor Sites-A Randomized Controlled Trial.

Split thickness skin graft (STSG) is a key method in the reconstructive ladder for covering skin defects used widely by surgeons from all specialties. The donor site is often a source of delayed healing, associated with considerable pain and discomfort even more than the recipient wound. The aim of this prospective randomized controlled study was to compare Helicoll® (EnColl Corp., Fremont, CA, USA), a type I pure collagen dressing, to OpSite® (Smith & Nephew, USA) dressing and to Scarlet Red® (Kendall HealthCare, USA) dressing in the treatment of standardized STSG donor sites. Thirty patients, over a 3-month period, underwent various reconstructive procedures, necessitating the use of STSGs. Following a simple randomized clinical protocol, the analysis of data included donor site pain, healing time of the donor site, initial absorption of the applied dressing and rate of infection with the three different dressings to form the basis of this paper. Patients in the Helicoll group reported significantly less pain, less infection rate and required no dressing change when compared with the OpSite (Johnson & Johnson, Langhorne, PA, USA) or the Scarlet Red groups. Healing time of the donor site in the Helicoll group was shorter than that in the Scarlet Red group; however, it was comparable to the OpSite group. This study indicates that Helicoll, as a donor site dressing, is successful in providing pain-free mobility with a measurable healing rate.

Alginate Dressing and Polyurethane Film Versus Paraffin Gauze in the Treatment of Split-Thickness Skin Graft Donor Sites

To compare postoperative healing of split-thickness skin graft (STSG) donor sites using traditional dressings (paraffin gauze) or modern wound dressings (alginate dressing and polyurethane film) in a randomized controlled trial. Thirty patients were randomly assigned to treatment of an STSG donor site with an alginate dressing and a polyurethane film or nonadherent paraffin gauze. Outcome variables were pain (measured with a visual analog scale), amount of dressing changes, healing time, cosmetic outcome, treatment costs, and overall satisfaction with the procedure. There was no significant difference in pain (postoperative day 1: 2.1 vs 1.2, P = .26; postoperative days 5-7: 1.0 vs 0.9, P = .47; final removal: 1.9 vs 1.0, P = .19) and time to healing (18.1 vs 15.4 days, P = .29) between alginate/polyurethane film dressing and nonadherent paraffin gauze. The semiocclusive dressings with polyurethane film required multiple dressing changes, whereas the nonadherent paraffin gauze could be left in place until complete epithelialization. Treatment costs were substantially lower for paraffin gauze. Semiocclusive dressings with alginate dressings and polyurethane film showed no advantages over treatment with paraffin gauze. With lower costs and better patient acceptance, paraffin gauze dressings were the preferred treatment for STSG donor sites.

Erythema Persists Longer than One Year in Split-thickness Skin Graft Donor Sites

The recovery of skin function and appearance after harvest of split-thickness skin autografts is incompletely described. We followed the kinetics of skin restoration after a partial-thickness skin excision relative to adjacent normal skin over 12 months. Standardized donor site wounds were made on the thigh using a pneumatic dermatome in 19 consecutive Caucasian patients, median age 70 years, age range 44-86 years, who were undergoing skin graft surgery for leg ulcers. Transepidermal water loss (TEWL), erythema and pigmentation were measured quantitatively using non-invasive devices. The macroscopically healed wound was compared with adjacent normal skin at 1, 3 and 12 months. At 1 month postoperatively, TEWL was 108% (p = 0.003), erythema 145% (p < 0.0005) and pigmentation 24% (p < 0.001) higher in the wounds compared with adjacent uninjured skin. The corresponding values at 3 months were 48% (p = 0.015), 89% (p < 0.0005) and 15% (p < 0.0005). After 12 months, erythema was elevated by 36% (p < 0.0005), while TEWL (p = 0.246) and pigmentation (p = 0.211) had returned to same levels as in the surrounding normal skin. Diabetes mellitus (p = 0.024) and smoking (p = 0.017) were associated with increased TEWL of normal skin, and erythema decreased with age (rs = -0.53, p = 0.020). In conclusion, erythema appears to be the significant component contributing to long-term postoperative donor site appearance. We hypothesize that this is due to increased microvasculature.

Use of Continuous Local Anesthetic Infusion in the Management of Postoperative Split-Thickness Skin Graft Donor Site Pain

Donor sites from split-thickness skin grafts (STSG) impose significant pain on patients in the early postoperative period. We report the use of continuous local anesthetic infusion as a method for the management of postoperative STSG donor site pain. Patients undergoing single or dual, adjacent STSG harvest from the thigh (eight patients) or back (one patient) were included in this study. Immediately after STSG harvest, subcutaneous catheters were placed for continuous infusion of local anesthetic. Daily donor site-specific pain severity scores were prospectively recorded in nine patients receiving local anesthetic infusion. Patient characteristics, technical aspects, and postoperative complications were identified in the study. The thigh was the anatomic location chosen for most donor sites. A single catheter was placed for donor sites limited to 4 inches in width or less. A dual catheter system was used for those wider than 4 inches. An elastomeric pump delivered continuously a total of 4 ml/hr of a solution of 0.5% bupivacaine. The average anesthetic infusion duration was 3.1 days. A substantial decrease in worst, least, and average donor site pain scores was found from the first 24 hours to the second postoperative day in our patients, a treatment trend that continued through postoperative day 3. One patient developed minor anesthetic leakage from the catheter insertion site; and in three cases, accidental dislodgement of the catheters occurred. There were no cases of donor site secondary infection. All donor sites were completely epithelialized at 1-month follow-up. Continuous local anesthetic infusion is technically feasible and may represent an option for postoperative donor site pain control after STSG harvesting. Relative cost-benefit of the technique remains to be determined.

Effect of Subcutaneous Epinephrine/Saline/Local Anesthetic Versus Saline-Only Injection on Split-Thickness Skin Graft Donor Site Perfusion, Healing, and Pain

The technique for split-thickness skin graft harvest varies among surgeons. Even though there is scientific evidence that the subcutaneous injection of modified tumescent solution reduces blood loss during burn surgery, the technique has not been unanimously adapted because of, in part, fear of healing retardation. This study prospectively examines the effect of tumescent injection on donor site perfusion, healing, and pain. Ten burn patients in need of grafting with a need for two distinctly different donor sites were included. During the grafting procedure, the two donor areas were randomly assigned to receive either modified tumescent solution or warm sterile saline solution subcutaneously before skin graft harvest with a dermatome. Perfusion, pain, pruritus, and donor site healing were measured, and a follow-up evaluation on scar quality was performed. Baseline perfusion on day 1 was significantly less in the donor site injected with modified tumescent solution (62.26 vs 95.71 perfusion units; P = .031), whereas the response to heat was similar in both sites. The physiologic response to injury (hyperemia) on days 2 and 3 was not suppressed in the modified tumescent group. Pain reported on day 1 was 2.38/10 in the tumescent site and 3.38/10 in the saline site (P = .21). On all other days, measurements showed no difference between the two sites. Donor sites healed in an average of 16.1 days with modified tumescent solution and in 16.4 days with saline. Late follow-up showed no difference in scar quality. The subcutaneous injection of modified tumescent solution before split-thickness donor site harvest has no adverse effect on donor site perfusion past day 1 or donor site healing. The addition of a local anesthetic may decrease pain for 24 hours postoperatively, but the difference in this study group was not significant. This technique should be universally recommended.

Honey Dressing Accelerates Split-Thickness Skin Graft Donor Site Healing.

The management of the donor site after harvesting a skin graft is an important issue, as patients often report more discomfort at the donor site than at the recipient site. There is, however, a plethora of dressings available for the treatment and management of donor sites, yet, there is no widely accepted method established for these partial thickness wounds. Honey has been found to be useful in the treatment of burns and other wounds, split-thickness skin graft donor sites are like partial thickness burn wounds and honey's healing effect on burn wound can also be expected on these types of wounds. Therefore, this study was undertaken to evaluate the effect of honey on skin graft donor sites. From 2002 to 2004, 100 patients who have undergone skin grafting for various reasons formed the material of the randomized study divided into two groups of 50 each in honey-treated group and Vaseline gauze-treated group. Graft donor site area ranged from 30 to 48cm(2), mean 32.6cm(2). In the group treated with honey, 90% of the patients had nil or only moderate pain, whereas in the group treated with Vaseline gauze,88% had nil or mild pain (p > 0.001, not significant). There were no allergic reactions in any of the patients in either group. On opening of the dressing on the 7th day, epithelialization has occurred in 48 patients as compared to 39 in group 2, i.e., donor sites treated with Vaseline gauze (p < 0.05, statistically significant). By the 10th day, all the wounds healed in honey-treated group, whereas 76% of wounds healed in Vaseline gauze-treated group (p < 0.05). At 1month follow-up, the results were comparable in both groups, with regard to patient satisfaction. In conclusion, honey-impregnated gauze causes less pain and heals donor sites wounds faster with good cosmetic result.

The development of squamous cell carcinomas in split-thickness skin graft donor sites

The development of squamous cell carcinoma in the donor site of a split-thickness skin graft is rare having only been described in ten previous cases. We describe one further case and review this along with the previous cases. Possible aetiologies are discussed along with advice on how to reduce the chances of this complication occurring and how to manage it should it occur.

Gene expression profiling of negative-pressure-treated skin graft donor site wounds

Negative-pressure wound therapy (NPWT) is widely used to improve skin wound healing. Although NPWT has been studied as a treatment for wound closure and healing, the molecular mechanisms explaining its therapeutic effects remain unclear. To investigate the effect of NPWT on gene expression, and to discover the genes most dominantly responding to this treatment during skin wound healing, we applied negative pressure on split-thickness skin graft donor sites from the first postoperative day (POD) to the seventh POD. Biopsies were collected from 4 NPWT-treated and 2 control patients. Two biopsy samples were taken from each patient: one from intact skin before graft harvesting, and one on the seventh POD from the donor site wound. Genome-wide microarrays were performed on all samples. Gene expression changes on the seventh POD were compared between NPWT and control patients, and were analyzed for statistical significance. In addition, we analyzed wound exudates for volume, and for concentrations of leukocytes, erythrocytes, and haemoglobin. NPWT induced major changes in gene expression during healing. These changes ranged from 10-fold induction to 27-fold suppression. The genes most induced were associated with cell proliferation and inflammation, and the most down-regulated genes were linked to epidermal differentiation. Our results provide the first insight into the molecular mechanisms behind NPWT, and suggest that NPWT enhances specific inflammatory gene expression at the acute phase associated with epithelial migration and wound healing. However, its continued use may inhibit epithelial differentiation.

Human skin transcriptome during superficial cutaneous wound healing

Healing of the epidermis is a crucial process for maintaining the skin's defense integrity and its resistance to environmental threats. Compromised wound healing renders the individual readily vulnerable to infections and loss of body homeostasis. To clarify the human response of reepithelialization, we biopsied split-thickness skin graft donor site wounds immediately before and after harvesting, as well as during the healing process 3 and 7 days thereafter. In all, 25 biopsies from eight patients qualified for the study. All samples were analyzed by genome-wide microarrays. Here, we identified the genes associated with normal skin reepithelialization over time and organized them by similarities according to their induction or suppression patterns during wound healing. Our results provide the first elaborate insight into the transcriptome during normal human epidermal wound healing. The data not only reveal novel genes associated with epidermal wound healing but also provide a fundamental basis for the translational interpretation of data acquired from experimental models.

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(®) .

Acute development of squamous cell carcinoma in a split-thickness skin graft donor site

Acute development of squamous cell carcinoma in a split-thickness skin graft donor site

Effects of thermal water on skin regeneration

An experimental study was carried out in an animal (New Zealand white rabbit) wound model to evaluate any effects of a hypotonic, bicarbonate-calcium-magnesium mineral water (Comano thermal water) on skin regeneration, comparing the healing rate of split-thickness skin graft donor sites treated with the thermal water wet dressing versus a standard petrolatum gauze dressing versus a saline solution wet dressing. The study was performed in two steps; an overall of 22 animals were enrolled in the study. The wound healing progress was evaluated both by the surgeons and by the histologists. Sixty-four punch biopsies were examined in all. The histological samples were examined after staining with haematoxylin and eosin, Masson's and orcein staining and under a transmission electron microscope. The data were statistically analysed. The Comano thermal water proved to improve skin regeneration, not only by increasing keratinocyte proliferation and migration but also favourably modulating the regenerated collagen and elastic fibres in the dermis. We propose that the results of the topical treatment with the thermal water could be due to the favourable combination of a local wet environment with an anti-inflammatory action and that the regenerative properties of Comano thermal water observed in rabbits could also be applied for human use.

Management of split-thickness skin graft donor site: A prospective clinical trial for comparison of five different dressing materials

Management of split-thickness skin graft donor site: A prospective clinical trial for comparison of five different dressing materials

A Novel Technique for Split-Thickness Skin Donor Site Pain Control

Abstract : Pain after split-thickness skin grafting can be severe. The current management of donor site pain is limited to oral and parenteral narcotics and nonnarcotic adjuncts, topical analgesics, and regional and axial anesthesia.1 The ON-Q Postop Pain Relief System (I-Flow Corporation, Lake Forest, CA) consists of an ON-Q pump and Soaker catheter designed to deliver a continuous infusion of local anesthetic to a surgical site. The device is Food and Drug Administration approved for postoperative/postinjury pain control and has been described after laparotomy, thoracotomy, inguinal hernia repair, and rib fractures.2 4 We describe our experience at the U.S. Army Institute of Surgical Research (USAISR) with the use of subcutaneous catheter placement for continuous infusion of local anesthetic placed deep to lower extremity split-thickness skin graft donor sites. Standard excisional preparation of a skin or soft tissue wound is carried out. A split-thickness donor site is chosen, typically from the upper lateral thigh, and skin is harvested at a depth of 0.010 inches. Autografting is completed and the grafted wounds are dressed. The local anesthetic infusion catheters are then inserted in the subcutaneous space deep to the skin donor site via palpation as the included introducer and needle are advanced. Of note, when using the sharp (as opposed to the blunt tip) introducer, 2 to 3 cm of the distal end of the Soaker catheter must be trimmed to allow it to pass through the introducer and remain with its perforated portion entirely within the subcutaneous space deep to the donor site. The insertion site is placed 2 to 5 cm cephalad to the most proximal portion of the donor site. Two (optionally, only one) 10-cm catheters are passed in parallel, one medially and one laterally, to cover the entire field of a 200- cm2 donor site (Figure 1). The catheters are primed with 2 ml of 1 4% bupivacaine and attached to the ON-Q Pain Pump device, which infuses at a rate of 4 ml/hr.