Split-thickness Skin Graft Harvest Research Articles

In vivo efficacy proof of concept of a large-size bioprinted dermo-epidermal substitute for permanent wound coverage.

Introduction: An autologous split-thickness skin graft (STSG) is a standard treatment for coverage of full-thickness skin defects. However, this technique has two major drawbacks: the use of general anesthesia for skin harvesting and scar sequelae on the donor site. In order to reduce morbidity associated with STSG harvesting, researchers have developed autologous dermo-epidermal substitutes (DESs) using cell culture, tissue engineering, and, more recently, bioprinting approaches. This study assessed the manufacturing reliability and in vivo efficacy of a large-size good manufacturing practice (GMP)-compatible bio-printed human DES, named Poieskin®, for acute wound healing treatment. Methods: Two batches (40cm2 each) of Poieskin® were produced, and their reliability and homogeneity were assessed using histological scoring. Immunosuppressed mice received either samples of Poieskin® (n = 8) or human STSG (n = 8) immediately after longitudinal acute full-thickness excision of size 1 × 1.5cm, applied on the skeletal muscle plane. The engraftment rate was assessed through standardized photographs on day 16 of the follow-up. Moreover, wound contraction, superficial vascularization, and local inflammation were evaluated via standardized photographs, laser Doppler imaging, and PET imaging, respectively. Histological analysis was finally performed after euthanasia. Results: Histological scoring reached 75% ± 8% and 73% ± 12%, respectively, displaying a robust and homogeneous construct. Engraftment was comparable for both groups: 91.8% (SD = 0.1152) for the Poieskin® group versus 100% (SD = 0) for the human STSG group. We did not record differences in either graft perfusion, PET imaging, or histological scoring on day 16. Conclusion: Poieskin® presents consistent bioengineering manufacturing characteristics to treat full-thickness cutaneous defects as an alternative to STSG in clinical applications. Manufacturing of Poieskin® is reliable and homogeneous, leading to a clinically satisfying rate of graft take compared to the reference human STSG in a mouse model. These results encourage the use of Poieskin® in phase I clinical trials as its manufacturing procedure is compatible with pharmaceutical guidelines.

Old dog, new tricks: split-thickness skin graft harvesting from the postauricular scalp using a Silver manual dermatome.

Abstract Click here for the corresponding questions to this CME article.

Systematic literature review of topical local anaesthesia or analgesia to donor site wounds.

BackgroundTopical local analgesic and anaesthetic agents have been used both pre- and immediately post-harvest on split-thickness skin graft (STSG) donor site wounds (DSW). There is no systematic review of their effectiveness in providing post-harvest analgesia, or of the possible toxic effects of systemic absorption. This study is designed to address the question of which agent, if any, is favoured over the others and whether there are any safety data regarding their use.MethodsSystematic literature review of randomised controlled trials of topical agents applied to STSG DSWs, with a view to providing analgesia. Studies identified via search of Cochrane and EBSCO databases. No restrictions on language or publication year. Primary outcomes: pain at the time of (awake) STSG, and post-harvest pain (up to first dressing change). Secondary outcome was serum medication levels relative to published data on toxic doses. Cochrane risk of bias assessment tool utilised in assessment of included studies. At least 2 reviewers screened and reviewed included studies. A narrative review is presented.ResultsThere were 11 studies meeting inclusion criteria. Overall methodological quality and patient numbers were low. Topical eutectic mixture of lidocaine and prilocaine pre-harvest affords good local anaesthesia in awake STSG harvesting. Topical bupivacaine (5 studies) or lidocaine (1 study) gave significantly better post-harvest anaesthesia/analgesia than placebo. Topical morphine performs no better than placebo. Topical local anaesthetic agents at reported doses were all well below toxic serum levels.ConclusionsTopical local anaesthetics (lidocaine or bupivacaine) provide good analgesia, both during and after STSG harvest, at well below toxic serum levels, but there are no good data determining the best local anaesthetic agent to use. There is no evidence morphine performs better than placebo.

Comparison between Aquacel and Aquacel Foam dressing on split-thickness skin graft donor site.

To compare the effectiveness of two commonly used moist dressings, Aquacel and Aquacel Foam (both ConvaTec Ltd., UK), in managing split-thickness skin graft (STSG) donor site wounds. Patients undergoing STSG harvesting for reconstruction were eligible for this quasi-experimental study. After reconstruction surgery, the Aquacel (A) or Aquacel Foam (AF) dressings were applied on the donor site wound. The STSG donor site was assessed by two trained research nurses daily. Clinical outcomes including pain on dressing removal, use of intravenous analgesics, signs and symptoms of wound infection, incidence of exudate leakage and percentage healed were recorded in a standardised form. Cost of the dressing change was retrieved from the hospital billing system. Of 50 patients recruited, 25 received dressing A and 25 received the AF dressing for their STSG donor site wound. The average pain score on dressing removal was significantly lower in the AF dressing group compared with the A dressing group (0.8±0.8 versus 3.1±1.5, respectively (p=0.04)). Regression analysis demonstrated that compared with dressing A, the AF dressing was associated with a lower average pain score (beta: -2.27, standard error: 0.33; p<0.001), lower likelihood of pro re nata (PRN) intravenous analgesic use (odds ratio (OR)=0.21, 95% confidence interval: 0.06-0.71; p=0.01) and lower likelihood of exudate leakage (OR=0.11, p=0.01). The differences in time to wound healing, infection and cost were not statistically significant between the two groups. In this study, the AF dressing demonstrated superior performance in pain response on dressing removal for STSG donor site wounds compared with dressing A. Large-scale randomised controlled trials should be conducted to confirm the findings.

465 Split-thickness Skin Graft Harvest under Local Anaesthetic: A Single Pass Technique

Abstract Adequate local anaesthetic, in harvesting a split thickness skin graft (SSG), involves multiple passes of a needle across the length and width of the marked donor site. We describe a technique using hyaluronidase to uniformly anaesthetise an SSG donor site with one injection, in one pass of one needle. Mix 10mls 1% Lidocaine solution with Adrenaline 1:200,000 with 1 vial Hyaluronidase 1 Unit/ml solution. The mixture is buffered with 1 ml NaHCO3 to neutralise acidity and minimise pain.Mark out the SSG donor siteUsing a 27G long needle (sterican), enter perpendicular to the skin in the middle of the proximal aspect of the donor site. Inject some local anaesthetic subdermally, creating a mound.Change the angle of the needle to 180 degrees and continue to inject the remaining anaesthetic along one half of the width of the donor site.Using a rolled 4x4 swab, apply firm advancing pressure to distribute the mound across the remaining width and length of marked donor site.As the mound advances, the hyluronidase/anaesthetic mixture will distribute uniformly across the donor site within the same plane. The skin blanches secondary to the adrenaline during its distribution. The technique described is a fast, reproducible way to improve patient comfort through the elimination of repeated passes of a needle, distribute the anaesthetic uniformly across the donor site, and facilitate the acquisition of an SSG of uniform thickness The technique described is a fast, reproducible way to improve patient comfort through the elimination of repeated passes of a needle, distribute the anaesthetic uniformly across the donor site, and facilitate the acquisition of an SSG of uniform thickness

Use of a topical mix of lidocaine and prilocaine during split-thickness skin graft harvest improves postoperative recovery—A prospective randomized controlled trial

PurposeTo provide evidence of efficacy and postoperative benefit of topical anesthesia (TA) for harvesting split-thickness skin graft (STSG) in an Asian population. Materials and methodsPatients with well-granulating wounds with skin grafting were randomized into TA or general anesthesia (GA) groups. In the TA group, an eutectic mixture of lidocaine and prilocaine (EMLA) was applied. Perioperative heart rate, postoperative donor site pain, adverse effects, patients’ satisfaction, duration of surgery, and operation room (OR) stay duration were recorded. ResultsThirty-nine patients (19 males, 20 females; mean age 54.9 ± 17.8) were included. Twenty underwent TA and 19 underwent GA for STSG. The TA group patients had tolerable pain during skin graft harvesting (VAS, 0.85 ± 1.5). Average EMLA exposure duration was 180.3 ± 65.8 min, and the amount applied was 1.72 ± 0.43 g/10 cm2. The TA group had lower donor site pain score at one hour postoperatively (1.34 ± 1.49 vs 3.08 ± 1.90, p = 0.005), lower OR stay duration (36.5 ± 6.5 min vs 65.1 ± 17.2 min, p < 0.001) and less adverse effects than the GA group. ConclusionHarvesting STSG under TA with EMLA is an effective and efficient approach for most Asian patients with less early postoperative donor site pain and fewer adverse effects.

In the Shave of Time: A Mineral Oil Skin Lubrication Substitute.

Lubricants such as mineral oil are commonly applied to the skin and dermatome before harvesting a split-thickness skin graft. Lubrication of the skin-device interface allows smoother glide of the dermatome and prevents skipping, resulting in obtaining a uniform and continuous skin graft. At our institution, mineral oil is the predominant lubricant used. Recently, during a complex lower extremity reconstruction involving a fasciocutaneous propeller flap for lateral ankle defect and skin grafting of the flap donor site, we were surprised to discover that our institution no longer carried mineral oil because of a national shortage. The procedure occurred during the coronavirus disease of 2019 pandemic, which may have affected the available supply. As normal saline did not appear to be an adequate mineral oil substitute,1 sterile water-soluble ultrasound lubricant was used at the skin-dermatome interface. The split-thickness skin graft was harvested without skipping or premature termination, and the donor site healed well. We used sterile ultrasound lubricant in two additional split-thickness skin graft procedures with similar excellent results. The nine characteristics of an ideal lubricant for split-thickness skin graft harvesting include cost-effectiveness, pain reduction, hemostasis, lubrication, solubility, no side effects, enhancement of wound healing, practicability, and antiseptic effect.2 Mineral oil, despite its frequent use, achieves very few of these ideal qualities and thus could be replaced with another lubricant with more optimal properties. Wettstein et al. demonstrated the effectiveness of saline irrigation as a lubricant in their series of 42 split-thickness skin grafts.1 Likewise, Engelhardt et al. noted that catheter gel lubricant with lidocaine and chlorhexidine additives was an effective agent that achieved all nine ideal qualities except for enhancement of wound healing.2 Ultrasound gel, similar to catheter lubricant, is cost-effective, water soluble, without known side effects, practical, and a lubricant. In the event that mineral oil is unavailable, as in our situation, sterile water-soluble ultrasound gel is an effective lubricant for split-thickness skin graft harvesting with which all surgeons should be familiar. ACKNOWLEDGMENT This study was deemed exempt by institutional board review. DISCLOSURE Neither author has a financial interest to declare in relation to the content of this article. No funding was received for this work. Matthew E. Braza, M.D.Spectrum Health/Michigan State UniversityCollege of Human Medicine Plastic Surgery Ewa Komorowska-Timek, M.D.Spectrum Health/Michigan State UniversityCollege of Human Medicine Plastic Surgery, and Advanced Plastic SurgeryGrand Rapids, Mich.

124 Autologous Skin Cell Suspension Achieves Closure of Donor Site Wounds Facilitating Early Re-harvesting for Large TBSA burn Injuries

Abstract Introduction Management of extensive burn injuries is complicated often resulting in significant morbidity and mortality. Current standard of care includes use of split-thickness skin grafts (STSG) to obtain definitive closure; however, this treatment is often limited by donor site availability, which requires repeated re-harvesting of donor sites to obtain definitive closure in large total body surface area injuries. Additionally, this limitation often leads to increased risk of infection, hypertrophic scarring, and extended hospital length of stay. Autologous skin cell suspension (ASCS) prepared using the autologous cell harvesting device is an FDA approved point-of-care regenerative medicine technology that significantly reduces donor skin requirements to achieve definitive closure in acute thermal burn injuries across small and large burns. A prospective uncontrolled observational study (IDE 15945—NCT02992249) was conducted in which patients with life-threatening burn injuries were treated with ASCS. In this study, clinical outcomes were evaluated when ASCS was used in combination with wide meshed autografts for burn site treatment. Within the study, a subset of donor sites was also treated with ASCS and the purpose of the current work was to evaluate the clinical outcomes obtained to better understand impact on healing times and effect of re-harvesting in this compromised patient population. Methods ASCS was applied to the donor site after harvesting of split-thickness skin grafts. Clinical outcomes out to one year were evaluated, including the percentage of re-epithelialization, long-term cosmetic outcomes, and adverse events. Results Subjects (n=96) from 22 burn centers received ASCS as part of their donor site treatment regimen (n=528). Mean subject baseline demographics were: 30.2 years of age, 54.0 ± 17.4% TBSA injury, and 89.4 ± 32.9 Baux score with 37% of subjects having a score greater than 100. Percentage of donor sites healed, defined as &amp;gt;95% re-epithelialization, was 37.1% and 82.7% after week 1 and week 2, respectively. Approximately 20% of the donor sites treated with ASCS were re-harvested multiple times following initial healing (up to four times). Of these donor sites 39.3% (n=84), 81.0% (n=79), and 85.7% (n=77) were healed by week 1, week 2, and week 4, respectively. Scar assessments conducted on 427 donor sites after one year showed the majority had matched or mildly mismatched color, pigment, and texture. Safety analyses of adverse events (AEs) following ASCS treatment were unlikely or unrelated to the device. Conclusions This study demonstrates successful use of ASCS to achieve closure of donor site wounds in patients with extensive burn injuries.

Effect of Subcutaneous Adrenaline/Saline/Lidocaine Injection on Split-Thickness Skin Graft Donor Site Wound Healing.

Subcutaneous injection of tumescent solution, which contains local anesthetic, adrenaline, and saline, before split-thickness skin graft harvesting, shows a significant hemostatic effect. This method can reduce the initial bleeding from the donor site. The aim of this study is to assess the benefits of controlling the bleeding from donor sites by tumescent injection. A randomized, controlled trial was performed to compare the wound healing of split-thickness skin graft donor sites treated with or without tumescent injection. This randomized, controlled trial examined donor site healing days as the main measure of outcome. postoperative pain, donor site ulceration, and scar quality were evaluated as secondary outcome measures. Patients planned for split-thickness skin graft harvest were randomly assigned to receive either pre-harvest subcutaneous injection of local anesthetic, adrenaline, and saline solution (tumescent solution) (Group 1) or post-harvest application of adrenaline solution-soaked gauze to the skin graft donor sites (Group 2). Donor sites were treated with calcium alginate dressings after graft harvesting. On the 10th postoperative day, the dressings were removed and donor site healing were measured. Follow-up evaluation of scar quality was performed 6 months after surgery. Postoperative pain was evaluated on the 1st day after operating. Forty-five patients (26 males; average age 61.8 years) completed the late follow-up evaluation (6 months postoperatively), with 26 patients in group 1 and 19 in group 2. There were no significant differences between the two groups in any of the outcome measures. Tumescent technique provides sufficient hemostasis in split skin graft donor sites, especially the initial bleeding just after graft harvesting, without any negative effects. Larger series should be studied to evaluate the effect in donor site wound healing.

Split-thickness Skin Graft Harvest under Local Anesthetic: A Single Pass Technique.

Adequate local anesthetic, in harvesting a split-thickness skin graft (SSG), traditionally involves multiple passes of a needle across the length and width of the marked donor site.We describe a technique using hyaluronidase to uniformly anaesthetize an SSG donor site with one injection, in one pass, of one needle.1. Preop application of EMLA cream/AMITOP to the donor site2. Mix 10 mL 1% lidocaine solution with Adrenaline 1:200,000 with 1 vial of Hyaluronidase 1500 units. The mixture is buffered with 1 mL 8.4% sodium bicarbonate to neutralize acidity and minimize pain.3. Mark out the SSG donor site4. Using a 27-G long needle (sterican), enter perpendicular to the skin in the middle of the proximal aspect of the donor site. Inject some local anesthetic subdermally, creating a mound.5. Change the angle of the needle to 180° and continue to inject the remaining anesthetic along one half of the width of the donor site.6. Using a rolled 4 × 4 swab, apply firm advancing pressure to distribute the mound across the remaining width and length of marked donor site.7. As the mound advances, the hyluronidase/anesthetic mixture will distribute uniformly across the donor site within the same plane. The skin blanches secondary to the adrenaline during its distribution.The technique described is a fast, reproducible way to improve patient comfort through the elimination of repeated passes of a needle, distributing the anesthetic uniformly across the donor site, and facilitating the acquisition of an SSG of uniform thickness

Buried penis in adults as a complication of circumcision: Surgical management and long-term outcomes.

We aimed to evaluate the feasibility and long-term functional outcomes of surgical correction of adult buried penis patients due to complications of childhood circumcision. A retrospective analysis was performed for patients who underwent treatment for buried penis between 1997 and 2019. An autologous split-thickness skin graft (STSG) was used. Surgical management steps included circumcision, resection of the bands between the corpora and other tissues, harvesting of STSG from femoral region and graft application. Surgical and functional outcomes were the primary end points. Thirteen patients were included with a mean age of 22.4years and median body mass index 27. Patients had similar symptoms, including sexual dysfunction, inadequate penile length, impossible penetration and decreased quality of life. No early post-operative complication was seen. During a median of 44-month follow-up, post-operative long-term complications were seen in 4 (30%) patients: decreased graft sensation (n=2); graft contracture five months after surgery (n=1); and retarded ejaculation (n=1). Patients' post-operative three-month International Index of Erectile Function (IIEF) score and sexual satisfaction score (SSS) significantly increased compared with patients' pre-operative scores (IIEF; 22.8 vs. 14.1, p=.03, SSS; 8.7 vs. 3.2, p<.01). Buried penis is a rare but challenging condition. Patients had excellent graft acceptance with successful functional outcomes.

522 Skin Graft Donor-site Morbidity: A Systematic Literature Review

Abstract Introduction Although split-thickness skin grafts (STSGs) are part of standard treatment for burn, traumatic, and chronic wounds, the harvesting of STSGs creates iatrogenic injuries at the donor sites. This review summarizes the scientific literature on morbidity associated with STSG donor sites. Methods A systematic literature search from 2014 to 2019 was performed in MEDLINE, Embase, and Chemical Abstracts to identify English-language articles reporting on the clinical-study findings, complications, management, financial burden, and patient-reported outcomes pertaining to STSG donor sites. Results Of 1426 articles identified, 44 met eligibility criteria and were included in the analysis. Most studies (n=31; randomized controlled trials [RCTs], n=26; observational studies, n=5) compared the outcomes of donor-site wounds that were treated with different dressings. Several studies (n=9; RCTs, n=5; observational studies, n=4) evaluated new agents or methods to improve donor-site outcomes. Only 3 studies focused on patient- or physician-reported outcomes. No studies reported on the length of hospital stay or the financial burden associated with donor-site wounds. Among the studies that indicated donor site location (n=34), the thigh was the most common. The most frequently reported donor-site outcome was the mean time to wound healing (n=21), which was 4.7±0.2 to 28.2±5.6 days. In some studies (n=13), the pain score assessed by visual analog scale (0–10 scoring, 0 being no pain and 10 being extreme pain) was 1.46 to 10.0 on postoperative day (POD) 1 and was 0.2 to 8.0 between POD 10 and 12. In a few studies (n=5), donor-site scar assessment using the Vancouver Scar Scale (0–13 scoring, 0 being normal skin and 13 being the worst scar) showed scores ranged from 0 to 10.9 at postoperative year 1. One study reported a 48.3% incidence of donor-site scar hypertrophy at 8 years. Infection rates were generally low but ranged from 0%-50%. Less frequently reported outcomes included pruritus, stiffness, and patient esthetic dissatisfaction. Conclusions This systemic literature search revealed a wide range of healing variation noted in STSG donor-site outcomes. Despite optimal wound care, donor sites required days to heal and were frequently associated with morbidities, including pain and scarring. Less frequently, donor sites were linked with severe morbidities, such as wound infection. Since majority of articles were RCTs with short follow-up, more research is warranted to assess the long-term outcome of hypertrophic scarring, another serious complication. These negative outcomes impose a substantial burden on patients and may impact their quality of life. Applicability of Research to Practice The elimination or reduction of STSG donor sites and their associated morbidity have long been identified by patients and providers as an unmet need deserving urgent attention.

498 Healing of Donor Sites with an Autologous Skin Cell Suspension for Large TBSA Burn Injuries: A Prospective Evaluation

Current treatment for burn injuries is the use of split-thickness skin grafts (STSG), however this treatment is often limited by donor site availability and requires reharvesting of donor sites to obtain definitive closure. In uncompromised patients it can take 7-14 days to heal, and for patients with severe injuries, this time can be delayed. The RECELL® System is a point-of-care device that allows for the preparation and application of non-cultured, autologous skin cells; however the safety and effectiveness has not been established for use in the treatment of donor sites. This study presents the use of autologous skin cell suspension (ASCS), prepared using the RECELL® System for the treatment of donor sites in patients enrolled in a prospective uncontrolled observational study (IDE 15945—NCT02992249) with life-threatening burn injuries. Following harvesting of STSGs, ASCS was applied to the donor site. Clinical outcomes were evaluated up to one year including percentage of re-epithelialization, long-term cosmetic outcomes, and adverse events. Seventy-three patients from 15 burn centers had their donor sites treated with ASCS as part of their treatment regimen. The average subject age was 29 and the average TBSA injury was 54.1 ±16.5%. The mean Baux score was 84.3 with 32% of subjects having a score greater than 100. Collectively, 430 donor sites were individually treated. In this compromised patient population 45.5% were ≥95% re-epithelialized by week 1 (n=345), and by week 2, 91% of the donor sites were ≥95% re-epithelialized (n=277), regardless of times harvested. Approximately 20% of the donor sites treated with ACSC were reharvested multiple times following initial healing (3.5% three times, and two donor sites were harvested four times) and retreated. Of donor sites harvested more than once, 51.6% (n=62), 84.6% (n=66), and 96.4% (n=55) of sites were ≥ 95% re-epithelialized by week 1, 2 and 4, respectively. One-year data was available for 300 donor sites and the majority had matched or mildly mismatched color, pigment, and texture. Adverse events included one site with a hematoma and one patient with donor sites that had fragile skin loss secondary to traumatic friction. There were no other instances of infection or delayed healing. ASCS has been successfully used to achieve closure of donor site wounds without infection or delayed healing in patients with extensive burn injuries. Application of ASCS for donor site healing may be particularly applicable for patients requiring subsequent reharvesting to achieve definitive closure.

The role of recruited minced skin grafting in improving the quality of healing at the donor site of split-thickness skin graft—A comparative study

IntroductionThe donor area of split thickness skin graft harvest usually takes 2–3 weeks to heal. A few studies have shown that application of minced skin grafting helps to reduce this time. The objective of this comparative study was to find the role of recruited minced skin grafting on the overall quality of healing at the split thickness skin graft donor area. Materials and methodsThe study included 30 patients undergoing split thickness skin graft for acute traumatic wounds. We selected two donor areas of nearly equal size on medial and lateral side of either thigh in each case. They were randomly allocated to control area and study area using an envelope technique. Minced graft was applied over the study area. Same dressing and post operative care were done for both the areas. ResultsIn our study we found average time for complete epithelialization at control area was 28.17+/−5.590days whereas it was 21.93+/−2.420days in the study area. The earlier epithelialisation time of study area compared to control area was significant on statistical analysis. Vancouver scar scale (VSS) comparison at third month and one year follow up showed significant difference of scores (1 versus 0) as the scars were hypopigmented at control area and comparatively better pigmented at study area. We found visual analogue score for Pain and pruritus to be better for study area at the end of first, second and third month. ConclusionIn this study we conclude that, recruited minced skin grafting to the donor site of split skin graft leads to better quality of healing in terms of early epithelialisation, better quality of scar, better pigmentation, less pain and pruritus, thus leading to improved quality of healing.

Tumescent non-tumescent technique for split thickness skin graft harvesting

Background: Split-thickness skin graft failures can be attributed to flaws in the recipient bed which has to be well prepared. Tissues with limited blood supply such as bone, tendons, cartilage or sites with necrotic tissue or infection do not accept skin grafts. Adrenaline is used to harvest skin grafts due to its vasoconstriction effect which limits blood loss. The aim of our study was to determine skin graft take after tumescent technique compared to a non-tumescent technique for harvesting.Methods: Two treatment groups of patients who fulfilled the inclusion criteria were randomly assigned. Forty patients underwent split-thickness skin graft harvesting with tumescent technique and forty patients underwent non-tumescent split-thickness skin graft harvesting. The recipient site was opened in both groups on the fifth day after surgery and take rate assessed. The donor site was assessed on day ten and if not healed, followed up for three weeks.Results: There was a statistically significant association between skin graft take rate and skin grafting technique (p=0.011). The mean graft take rate was 2.5% higher in the tumescent group compared to the non-tumescent group (96.3% compared to 94%). On day 10, there was no difference in percentage healing of donor sites between the tumescent and non-tumescent groups, p=0.562.Conclusions: Tumescent technique significantly reduced intraoperative blood loss. It is safe, inexpensive and easy to use. The subdermal adrenaline/saline injection creates a smooth, dense surface which assists debridement and donor harvesting.

Topical Aloe Vera Gel for Accelerated Wound Healing of Split-Thickness Skin Graft Donor Sites: A Double-Blind, Randomized, Controlled Trial and Systematic Review.

Aloe vera has been used to treat wounds since ancient times. However, data regarding the efficacy of aloe vera for burns and split-thickness skin graft donor sites are inconclusive. A double-blind, randomized, controlled trial was conducted. Patients who underwent split-thickness skin graft harvesting from the thigh were included. Split-thickness skin graft donor sites were divided into two groups: the aloe vera group and the placebo group. The visual analogue scale score was used to evaluate pain, and complete epithelialization was assessed. The authors searched electronic databases and included only international clinical trials published in the English language. Twelve patients with 24 donor sites participated. Times to complete epithelization for the aloe vera and placebo groups were 11.5 ± 1.45 and 13.67 ± 1.61 days, respectively (p < 0.05). Visual analogue scale scores after wound dressing for the aloe vera and placebo groups were 17.18 ± 13.17 and 18.63 ± 11.20, respectively. No statistical significance was found between groups. Five articles met the inclusion criteria: four involved burns and one involved split-thickness skin graft donor sites. Three studies of burn wounds demonstrated improved epithelization and one did not. The split-thickness skin graft donor-site study indicated that wound healing time for the control group was significantly different from that of the aloe vera and placebo groups. The healing rate was not statistically different between groups. Topical aloe vera gel significantly demonstrated accelerated split-thickness skin graft donor-site healing but did not show significant pain relief. Therapeutic, I.

364 A Blinded Comparison of Lubricants to Facilitate Split Thickness Skin Graft Harvest in a Porcine Skin Model

364 A Blinded Comparison of Lubricants to Facilitate Split Thickness Skin Graft Harvest in a Porcine Skin Model

Comparative efficacy of ropivacaine and levobupivacaine in combined femoral and lateral femoral cutaneous nerve block with adjuvant magnesium for post-operative analgesia

Background and Aims:Patients with burns may require multiple surgeries, but poor general condition and underlying protein energy malnutrition make them unsuitable candidates for general or spinal anaesthesia. This study evaluated the role of magnesium sulphate as an adjuvant with levobupivacaine and ropivacaine used in combined femoral and lateral femoral cutaneous nerve (LFCN) blocks in burn patients with relative sparing of thigh portion.Methods:This prospective, randomised, double-blind study included 54 adult patients of 18–65 years age, undergoing split-thickness skin graft harvest from the thigh, allotted to three equal groups of 18 each. Group L patients received femoral nerve (FN) block with 15 mL of 0.5% levobupivacaine and 8 mL for LFCN block; Group LM patients received 14 mL of 0.5% levobupivacaine along with 1.0 mL of 15% magnesium sulphate for FN block, 7.5 mL of 0.5% levobupivacaine with 0.5 mL of 15% of magnesium sulphate to LFCN block and Group R patients received 15 mL of 0.5% ropivacaine for FN block and 8 mL of 0.5% ropivacaine for LFCN block. Time to block onset and complete surgical block, duration of analgesia, total analgesic dose and the overall analgesia satisfaction score were measured in the first 24 h post-operatively. Quantitative data were analysed with ANOVA and qualitative data subjected to Chi-square tests. Intergroup comparison was performed with independent t-test.Results:The duration of post-operative analgesia did not differ with the addition of magnesium (P = 0.610). Time to onset of the block was significantly decreased with the addition of magnesium (P = 0.0341), but time to complete surgical block onset was similar across the groups.Conclusion:Both ropivacaine and levobupivacaine have good perioperative analgesic efficacy. Magnesium as an analgesia adjuvant with levobupivacaine does not prolong the duration of post-operative analgesia.

K-wire assisted split-thickness skin graft harvesting from the anterior trunk

Split thickness skin graft (STSG) harvesting from the anterior chest and abdominal wall skin is quite a difficult process. The main reason for the difficulty to perform this process is the unsuitable anatomic characteristics of the anterior trunk, such as irregular wavy-like surface over the ribs and lax abdominal wall skin resulting in collapse due to lack of adequate underneath supporting structures when a downward force is applied by the skin graft dermatome. Lower extremity and especially the thigh are generally chosen as the donor site where the STSGs are easily harvested from. However, extensive lower extremity burns, with or without other region burns, preclude harvesting auto STSGs from this invaluable anatomic site. We harvested K-wire assisted STSGs from the anterior chest and abdominal wall skin of 7 patients with lower extremity burns and also a patient that sustained motor vehicle collision. We encountered no problems in any of our patients both intra and postoperatively by using K-wire assisted STSG harvesting. All of the STSGs donor sites healed uneventfully without complications. In our opinion, K-wire assisted STSG harvesting must always be in the tool-box of any surgeon who deals with extensive burns with or without lower extremity burns and extensive traumas of lower extremities.

Reduction of pain via platelet-rich plasma in split-thickness skin graft donor sites: a series of matched pairs.

In the past decade, autologous platelet-rich plasma (PRP) therapy has seen increasingly widespread integration into medical specialties. PRP application is known to accelerate wound epithelialization rates, and may also reduce postoperative wound site pain. Recently, we observed an increase in patient satisfaction following PRP gel (Angel, Cytomedix, Rockville, MD) application to split-thickness skin graft (STSG) donor sites. We assessed all patients known to our university-based hospital service who underwent multiple STSGs up to the year 2014, with at least one treated with topical PRP. Based on these criteria, five patients aged 48.4±17.6 (80% male) were identified who could serve as their own control, with mean time of 4.4±5.1 years between operations. In both therapies, initial dressing changes occurred on postoperative day (POD) 7, with donor site pain measured by Likert visual pain scale. Paired t-tests compared the size and thickness of harvested skin graft and patient pain level, and STSG thickness and surface area were comparable between control and PRP interventions (p>0.05 for all). Donor site pain was reduced from an average of 7.2 (±2.6) to 3 (±3.7), an average reduction in pain of 4.2 (standard error 1.1, p=0.0098) following PRP use. Based on these results, the authors suggest PRP as a beneficial adjunct for reducing donor site pain following STSG harvest.