Wide variation exists in the local treatment of donor site wounds after split-skin grafting, ranging from classic gauze dressings to modern silicone dressings.
In a multicenter randomized trial of 289 patients, hydrocolloid dressings led to a shorter healing time than other commonly used dressing materials for donor site wounds (DSWs) after split-skin grafting. Standard gauze dressings were found to increase the risk of infection, Dr. Fleur E. Brölmann said in presenting the study results at the Veith symposium on vascular medicine sponsored by the Cleveland Clinic.
Dr. Fleur E. Brölmann
A 14-center, six-armed, randomized clinical trial (stratified per center) compared six wound dressing materials in adults with DSWs larger than 10 cm2 for any indication. Primary outcomes were complete re-epithelialization and pain using a visual analog scale (VAS; 4 weeks). Secondary outcomes included itching (VAS; 4 weeks), adverse events, and scarring after 12 weeks as measured using the Patient and Observer Scar Assessment Scale (POSAS), said Dr. Brölmann, who is a Ph.D. candidate at the Academic Medical Center in Amsterdam.
Between October 2009 and December 2011, patients were randomized to either alginate (45 patients), film (49), gauze (50), hydrocolloid (47), hydrofiber (47), or silicone (48).
Time to complete re-epithelialization using hydrocolloid dressings (median 16 days) was 7 days shorter than with any other dressing, a significant difference, she said in her presentation titled "How To Treat Donor Site Wounds: An Evidence Based Approach."
Overall pain scores were low and slightly but significantly lower using film dressings. The infection rate among patients treated with gauzes was twice as high as in those receiving other dressings (18% vs. 9%; relative risk, 2.39; 95% confidence interval, 1.14-5.01). Patients receiving films were least satisfied with overall scar quality.
"This trial shows that hydrocolloid dressings led to the shortest healing time of DSWs among the dressings investigated, while gauzes should be avoided due to increased risk of infection," Dr. Brölmann said. Based on these results, hydrocolloid is the first-choice dressing for DSWs, and should be the standard of care, she added.