Abstract and Introduction
Abstract
Background: 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.
Objective: 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.
Materials and Methods: 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]).
Results: 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.
Conclusions: Combined use of AG+foam dressing may enhance skin graft donor site healing, alleviate pain, and require fewer dressing changes.
Introduction
Autologous split-thickness skin grafting is a common procedure in plastic surgery, burn management, and reparative and reconstructive surgery. Often, the thigh is chosen as the donor site because it has the largest surface area of any limb, is easily accessible, and has firm underlying structures; additionally, any scarring can be hidden beneath clothing.[1] Nevertheless, healing of the donor site has associated problems, including donor site pain,[2] and problems related to donor site healing are enhanced when a large area is used for skin graft harvest.[3] Sometimes, the grafted skin is completely healed while the donor site remains under dressing; delayed healing at the donor site prolongs hospitalization and increases the pain incurred by the patient as well as the cost of treatment.[1] Wound infection or delayed healing can also result in hypertrophic scarring, which affects appearance.[4] Dressing of intermediate-thickness skin graft donor site wounds has been investigated in a number of studies; however, the optimal dressing remains elusive.[5]
The traditional and widely used method for dressing donor sites involves petrolatum gauze, sterile cotton pads, and compression bandages. However, the development of advanced dressings designed to improve wound healing has resulted in increased use of many different types of dressings made from a wide range of materials.[6–16] When prevention of infection is a primary consideration, wound dressings containing silver may be advantageous.[17]
Silver ion hydrocolloid gauze is an advanced dressing with a wet touch layer that will not stick to the wound, while the self-adhesive polyurethane foam dressing encourages moist wound healing, can absorb liquid, and provides a moisturizing effect. Currently, these products are widely used in the management of a variety of wounds, with good results achieved in healing difficult wounds (eg, leg ulcers).[18–21] Self-adhesive polyurethane foam dressings can be used as the outer dressing, and they are effective for dressing donor sites.[22] Previous studies investigating silver ion–containing dressings for donor sites suggest they can reduce pain at the wound site and promote skin reepithelization[23] as well as provide superior wound healing, decreased bleeding, and improved appearance after healing.[24]
Therefore, the present authors hypothesized that using the silver ion hydrocolloid gauze and self-adhesive polyurethane foam dressing in combination (AG+foam) for dressing the donor site of autologous intermediate-thickness skin grafts harvested from the ipsilateral thigh would promote wound healing and prevent pain at dressing change. This study aimed to compare the combined use of these products with traditional external dressing method of petrolatum gauze, sterile cotton pad, and compression bandage. The results could assist clinicians and wound care nurses by providing evidence for an advanced dressing method for skin graft donor sites.