Management of split-thickness skin graft donor site: A prospective clinical trial for comparison of five different dressing materials (original) (raw)
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Dermatology, 2013
Split-thickness skin grafts (STSG) are a widely used procedure in dermatological surgery . Postoperative defects after tumor excision as well as chronic wounds needing a stimulation of epithelialization are often covered with STSG. Furthermore, the procedure is extensively used by plastic surgeons to cover sometimes extensive defects (e.g. burns). Harvesting of the graft leaves a second, superficial wound; in the subjective perception of the patient this is often more disturbing than the site treated with the graft, due to pain, irritation and the discomfort caused by bulky or leaking dressings.
Journal of Personalized Medicine
Background: Split-thickness skin grafting (STSG) is a frequently used reconstructive technique, and its donor site represents a standardized clinical model to evaluate wound dressings. We compared hydroactive nanocellulose-based, silver-impregnated and ibuprofen-containing foam wound dressings. Methods: A total of 46 patients scheduled for elective surgery were evaluated on the STSG donor site for wound healing (time-to-healing, Hollander Wound Evaluation Scale), pain level (Visual Analogue Scale), and handling (ease of use), as well as scar quality (Patient Scar Assessment Scale, Vancouver Scar Scale) after 3, 6 and 12 months. Results: Almost all dressings compared equally well. We observed statistically relevant differences for pain level favoring the ibuprofen-containing dressing (p = 0.002, ΔAIC = 8.1), and user friendliness in favor of nanocellulose (dressing removal: p = 0.037, ΔAIC = 2.59; application on patient: p = 0.042, ΔAIC = 2.33; wound adhesion: p = 0.017, ΔAIC = 4.16;...
Plast Reconstr Surg, 2011
BACKGROUND: The almost single disadvantage of conventional polyurethane film dressings, uncontrolled leakage, is probably as often described as its numerous advantages for split-thickness skin graft donor sites. This shortcoming can be overcome by perforating the polyurethane dressing, which permits controlled leakage into a secondary absorbent dressing. The study was conducted to compare the polyurethane dressing system and Aquacel, a hydrofiber wound dressing, which also seems to fulfill all criteria of an ideal donor-site dressing. METHODS: This prospective, randomized, double-blind clinical trial included 50 adult patients. Skin graft donor sites were divided equally for the application of Aquacel and polyurethane dressing. The dressings were kept unchanged for 10 days. After removal of the dressing at day 10, the epithelialization rate of both sites was evaluated. Pain scores were assessed according to a 0 to 5 numeric pain scale every postoperative day and during dressing removal. RESULTS: On postoperative day 10, 86.4 percent of the polyurethane dressing donor sites showed complete reepithelialization compared with 54.5 percent of the Aquacel-treated donor sites (p<0.001). Polyurethane dressing was significantly less painful until and during removal of the dressing (p<0.001). There was no significant difference with respect to scar formation. CONCLUSIONS: Overall, polyurethane dressing was superior to Aquacel. Further attributes of the polyurethane dressing such as ease of application, low labor input, high patient comfort, and protection against secondary wound infection qualify this dressing system as an ideal wound covering for donor sites. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
International Wound Journal, 2014
This study was intended 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 planned, 1 control and 5 experimental groups, with a total of 24 rats, using an occlusive dressing model. STSG donor 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 for each wound on days 0, 3, 5, 7, 10 and 14. Area measurements were performed with photographs for each dressing. The alginate and clinoptilolite groups gave the best healing rate results for both STSG donor (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, significantly successful 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 ® .
Annals of the Royal College of Surgeons of England, 2001
A prospective randomised trial examining the effectiveness, comparative comfort and ease of care of two different split skin graft donor site dressings was performed. One of the dressings was an alginate (Kaltostat®), and the other an adhesive retention tape (Mefix®). Alginates are the standard plastic surgical dressing, whereas the use of adhesive retention tapes as a donor site dressing presents a novel use of a readily available product. A total of 30 consecutive patients requiring split skin grafts were randomised to receive either alginate or retention donor site dressings. Dressings were assessed by interview and questionnaire at 24 h and 48 h and at 2 weeks, and by wound review at 2 weeks. Retention dressings were found to be more comfortable. They also required less nursing care and attention. The retention dressings allowed the patients easier mobility and a greater range of daily activities, especially washing. There was no significant difference in wound healing nor in complications. Adhesive retention tape applied directly to the split skin graft donor site wound is an effective, cheap and comfortable dressing requiring little postoperative care.
British Journal of Plastic Surgery, 2003
Painful split-skin-graft donor sites remain a common problem for patients. We undertook a prospective randomised trial to examine the comparative comfort and ease of care of two different donor-site dressings. One dressing is the alginate Kaltostat, the standard plastic-surgical dressing in the UK and abroad, and the other is the adhesive retention tape Mefix, a novel use of a readily available dressing. We randomised 50 patients requiring split-skin grafts to receive either alginate (Kaltostat) or retention (Mefix) donor-site dressings. Dressings were assessed by interview and questionnaire at 24, 72 h and 2 weeks, and by wound review at 2 weeks. Retention dressings were found to be more comfortable, required less nursing intervention and allowed patients easier mobility with a greater range of daily activities, especially washing, without compromising wound healing. We recommend adhesive retention dressings as cost-effective comfortable dressings, which readily conform to any donor site.
SPECIAL TOPIC Outcomes Article Systematic Review of Skin Graft Donor-Site Dressings
2015
Background: 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. Methods: A comprehensive literature review and assessment was undertaken by two independent reviewers. Articles were selected using specific inclusion cri-teria. Split-thickness skin graft donor-site dressings were classified as eithermoist or nonmoist based on the state of the dressing upon initial application. Meth-odological quality of randomized controlled trials was assessed using the Jadad scale. Results: 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...
Systematic review of skin graft donor-site dressings
Plastic and Reconstructive Surgery, 2009
Background: 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. Methods: A comprehensive literature review and assessment
A fibre‐free alginate dressing in the treatment of split thickness skin graft donor sites
Journal of the European Academy of Dermatology and Venereology, 1998
Background Alginate dressings are gaining acceptance in wound management although comparative published data with conventional treatment is inconclusive.Aims The aim of this randomised controlled study was to compare a fibre‐free alginate dressing (Comfeel SeaSorb) with conventional treatment of standardised split‐thickness skin graft donor sites in 17 patients regarding initial absorption of blood and healing.Results The alginate dressing absorbed 40% (P < 0.05) more blood, measured as total iron content of used dressings, during the first 10 post‐wounding minutes than fine mesh gauze, resulting in less subsequent bleeding. Light microscopic examination of punch biopsies obtained from 10 wounds on post‐operative day 6 demonstrated that nine wounds treated with the alginate dressing compared with seven wounds treated conventionally with paraffin‐impregnated gauze (Jelonet®) were completely epithelialised, a statistically non‐significant difference (P= 0.46).Conclusions In conclus...