Randomized clinical trial of donor-site wound dressings after split-skin grafting

Author:

Brölmann F E1,Eskes A M12,Goslings J C3,Niessen F B4,de Bree R5,Vahl A C6,Pierik E G7,Vermeulen H12,Ubbink D T13

Affiliation:

1. Department of Quality Assurance and Process Innovation, The Netherlands

2. Amsterdam School of Health Professions, The Netherlands

3. Trauma Unit, Department of Surgery, Academic Medical Centre, University of Amsterdam, The Netherlands

4. Department of Plastic and Reconstructive Surgery, The Netherlands

5. Department of Otolaryngology/Head and Neck Surgery, VU University Medical Centre, The Netherlands

6. Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

7. Department of Surgery, Isala Klinieken, Zwolle, The Netherlands

Abstract

Abstract Background The aim was to study which dressing material was best for healing donor-site wounds (DSWs) after split-skin grafting as there is wide variation in existing methods, ranging from classical gauze dressings to modern silicone dressings. Methods This 14-centre, six-armed randomized clinical trial (stratified by centre) compared six wound dressing materials in adult patients with DSWs larger than 10 cm2. Primary outcomes were time to complete re-epithelialization and pain scores measured on a visual analogue scale (VAS) over 4 weeks. Secondary outcomes included itching (VAS, over 4 weeks), adverse events and scarring after 12 weeks rated using the Patient and Observer Scar Assessment Scale (POSAS). Results Between October 2009 and December 2011, 289 patients were randomized (of whom 288 were analysed) to either alginate (45), film (49), gauze (50), hydrocolloid (49), hydrofibre (47) or silicone (48) dressings. Time to complete re-epithelialization using hydrocolloid dressings was 7 days shorter than when any other dressing was used (median 16 versus 23 days; P < 0·001). Overall pain scores were low, and slightly lower with use of film dressings (P = 0·038). The infection rate among patients treated with gauze was twice as high as in those who had other dressings (18 versus 7·6 per cent; relative risk 2·38, 95 per cent confidence interval 1·14 to 4·99). Patients who had a film dressing were least satisfied with overall scar quality. Conclusion This trial showed that use of hydrocolloid dressings led to the speediest healing of DSWs. Gauze dressing should be discontinued as they caused more infections. Registration number: NTR1849 (http://www.trialregister.nl).

Publisher

Oxford University Press (OUP)

Subject

Surgery

Reference39 articles.

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2. Split-thickness skin graft donor sites;Fowler;J Wound Care,1998

3. Which dressing for split-thickness skin graft donor sites?;Feldman;Ann Plast Surg,1991

4. A prospective study comparing Biobrane, Duoderm and xenoform for skin graft donor sites;Feldman;Surg Gynecol Obstet,1991

5. The ideal split-thickness skin graft donor-site dressing: a clinical comparative trial of a modified polyurethane dressing and aquacel;Dornseifer;Plast Reconstr Surg,2011

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