The use of “composite dressing” for covering split-thickness skin graft donor sites

To evaluate the effect of a new dressing method for clean wound coverage, two kinds of dressing materials are combined together to cover nine wounds in nine patients. All the wounds are split-thickness skin graft donor sites located in the anterior thighs. The size of the wounds ranges from 6 cm × 4 cm to 10 cm × 8 cm (42 cm² on average). A central fenestration is created in the polyurethane film layer for draining the wound discharge, and a piece of 2.5 cm × 2.5 cm carboxymethyl cellulose dressing is fixed on top of the fenestration for protecting the underlying wound. Dry gauze is used to cover the composite dressing, which is replaced daily. The wound condition is checked and recorded everyday until the patient is discharged. Further management and follow-up for the wound is performed at the outpatient department or by telephone. All wounds healed smoothly on the postoperative 6th to 7th day. No wound infection was noted, including one patient who had diabetes mellitus. Five patients responded to follow-up for at least 5 months and no hypertrophy scar formation was noted. From clinical experiences, we know that this new method is practical and cost-effective for covering small-sized, split-thickness skin graft donor-site wounds.     

The epithelialization of split skin graft donor sites —a test model for the efficacy of topical wound therapeutic agents

Summary Wound areas on the upper thigh following split thickness skin grafts can be standardized. They are, therefore, suitable as wound models for comparative investigations into the kinetics of epithelialization using various wound therapeutic agents. In a prospective clinical study, the epithelialization time in two split thickness graft donor sites was examined in an intraindividual comparison on 16 patients. Zinc oxide and potassium/calcium chloride hydrogel were used as the comparative substances. The results confirm the suitability of the study design for the testing of efficacy of topical wound therapeutic agents. The model can be standardized, is practical, and does not require additional stress to the patient.     

Amnion in the treatment of pediatric partial-thickness facial burns

BACKGROUND: Wound coverage for second-degree burns remains a clinical challenge. Human amniotic membranes have been used for many years in the treatment of burns; however, no large prospective clinical trials have been published. In this article, we present a novel and standardized procurement and processing method for amnion and investigate, whether the use of this biological dressing is safe and may represent a new therapeutic option for children with partial-thickness facial burns compared to standard topical treatment. METHODS: Patients with partial-thickness burns of the face, neck and head admitted between 2003 and 2005 were included in this study. They were divided into two groups to receive either amnion (n=53) or topical antimicrobials (n=49). Demographics (age, gender, ethnicity, TBSA, burn areas), length of hospital stay (LOS), rate of infections (RI), time to total healing, and frequency of dressing changes were compared between the two groups. The long-term outcome was assessed in nine patients in the amnion group and eight patients in the topical group, who returned for up to 12-month follow-up visits. RESULTS: Patients in the amnion group had significantly less dressing changes then in the control group (p<0.05). Time to healing, length of stay and the development of hypertrophic scarring was not different between the groups. Use of amnion was not associated with an increased risk of local infection. CONCLUSION: This study indicates that amnion is safe and has advantages as wound coverage for second-degree facial burns compared to the standard topical ointments. Further studies with the use of amniotic membranes on the trunk and the extremities, as well as for coverage of grafted third-degree burns, have yet to be performed.     

Sling sutures for skin graft donor sites

A technique is described using sling sutures for skin graft donor sites in order to take the maximum amount of skin graft from difficult sites with a powered dermatome or a skin graft knife.     

Gene expression profiling of negative-pressure-treated skin graft donor site wounds

Negative-pressure wound therapy (NPWT) is widely used to improve skin wound healing. Although NPWT has been studied as a treatment for wound closure and healing, the molecular mechanisms explaining its therapeutic effects remain unclear. To investigate the effect of NPWT on gene expression, and to discover the genes most dominantly responding to this treatment during skin wound healing, we applied negative pressure on split-thickness skin graft donor sites from the first postoperative day (POD) to the seventh POD. Biopsies were collected from 4 NPWT-treated and 2 control patients. Two biopsy samples were taken from each patient: one from intact skin before graft harvesting, and one on the seventh POD from the donor site wound. Genome-wide microarrays were performed on all samples. Gene expression changes on the seventh POD were compared between NPWT and control patients, and were analyzed for statistical significance. In addition, we analyzed wound exudates for volume, and for concentrations of leukocytes, erythrocytes, and haemoglobin. NPWT induced major changes in gene expression during healing. These changes ranged from 10-fold induction to 27-fold suppression. The genes most induced were associated with cell proliferation and inflammation, and the most down-regulated genes were linked to epidermal differentiation. Our results provide the first insight into the molecular mechanisms behind NPWT, and suggest that NPWT enhances specific inflammatory gene expression at the acute phase associated with epithelial migration and wound healing. However, its continued use may inhibit epithelial differentiation.     

High-voltage electric stimulation of the donor site of skin grafts accelerates the healing process. A randomized blinded clinical trial

Introduction

Severe burns benefit from skin grafting, and grafting surgery is of great importance in the treatment of these injuries. As a result, there is formation of an additional wound at the donor site, which is painful and susceptible to infection. However, the therapeutic approach to these problems at donor sites for skin grafting is insufficiently explored in the literature.

湿性敷料促进供皮区创面愈合的临床研究

目的　观察湿性敷料对供皮区创面愈合的作用。方法　对 4 2例患者行大腿外取皮 ,将供皮区创面分为治疗组即用湿性敷料覆盖及对照组即用凡士林纱布覆盖 ,分别观察治疗组和对照组供皮区创面的愈合时间。结果　创面愈合的平均时间 ,治疗组为 (10 .2± 2 .7)天 ,对照组为 (12 .4± 1.5 )天 ,两者比较P <0 .0 1差异有显著意义。结论　湿性敷料能促进供皮区创面的愈合。     

碱性成纤维细胞生长因子对取皮创面的临床治疗观察

目的　报道重组碱性成纤维细胞生长因子对取皮创面愈合的影响。方法　 30例患者取皮后创面应用碱性成纤维细胞生长因子 (治疗组 )及生理盐水 (对照组 ) ,创面暴露。结果　治疗组 (11.73± 0 .9)天比对照组 (15 .2 3±3.8)天在愈合时间上有显著差异 (P <0 .0 1)。结论　碱性成纤维细胞生长因子能促进取皮后供区的愈合 ,使用方便 ,疗效满意     

A bacterial barrier dressing for skin donor sites

Although most skin donor sites heal uneventfully, some surgically prepared open areas become contaminated and are converted to full-thickness wounds. Accordingly, a synthetic bacterial barrier dressing (Hydron Burn Bandage) applied as a spray or a preformed sheet was compared with fine mesh gauze application on skin donor sites in a series of 50 burned children. Six of 19 control wounds demonstrated some bacterial contaminants. Only 2 out of 22 donor sites covered within 5 h after preparation contained any detectable bacterial contaminants. The Hydron bandage applied to skin donor sites adhered well, was easily removed at about 12 days and produced a barrier to bacterial contamination during the healing period.     

Evaluation of liposomal bupivacaine infiltration at reconstructive skin graft donor sites in adolescent and young adult burn patients: A retrospective analysis

BackgroundPostoperative pain at skin graft donor sites is frequently undertreated in burn patients, which can impair reconstructive outcomes and result in harmful psychological consequences. We find a critical need to explore and promote non-opioid, multimodal analgesics. Donor site infiltration of the local anesthetic liposomal bupivacaine in adolescent and young adult burn patients has not been previously investigated. Therefore, the goal of this study was to evaluate intraoperative liposomal bupivacaine infiltration for postoperative donor site pain control in adolescent and young adult burn patients undergoing reconstructive skin graft procedures.MethodsThis retrospective analysis included patients aged 14–25 years, who underwent at least two reconstructive skin graft procedures, one that received donor site infiltration of the standard treatment (bupivacaine hydrochloride) and one that received donor site infiltration of liposomal bupivacaine. The final sample included 30 patients with a total of 44 liposomal bupivacaine cases and 53 standard treatment cases analyzed.ResultsIn the authors’ five-year experience, the use of liposomal bupivacaine compared to standard treatment was associated with statistically significant decreases in 0–4 h postoperative pain scores (mean 1.4/10 versus 2.3/10, p = 0.04) and 0–24 h postoperative pain scores (mean 1.7/10 versus 2.4/10, p = 0.02). Neither analgesic was associated with adverse events. Differences in length of stay and inpatient postoperative opioid usage were not regarded as significant.ConclusionIn this retrospective analysis, the authors report the first results that suggest intraoperative liposomal bupivacaine donor site infiltration may be associated with statistically improved patient outcomes in adolescent and young adult burn patients. However, the reported differences are most likely not clinically significant, establishing the necessity for further evaluation of using liposomal bupivacaine in this unique patient population.     

Enhanced cryoprecipitate for skin graft and donor site wound healing in pigs

Due to similarities in skin characteristics, the authors hypothesise that a pig model would most accurately show the ability of autologous, enhanced cryoprecipitate (eCryo) to improve the wound healing of split‐thickness skin grafts (STSGs) and corresponding donor sites. Fifty‐two STSGs (5 × 5 cm) were fashioned and treated according to a randomised protocol with an autologous eCryo‐treated and a control group. Macroscopic assessment, histological evaluation and cellular composition were completed at days 7, 14, 21 and 28. Thirty‐two donor sites were also created and assessed in a similar manner. Histologic analysis showed enhancement of healing over all time points for eCryo‐treated donor sites. All other results showed no statistically significant improvement with the use of eCryo. Autologous cryoprecipitate appears to be a safe, inexpensive and easy‐to‐use alternative to fibrin glue, which carries risks and is, in many cases, prohibitively expensive. Further studies are necessary to evaluate the full potential of eCryo. Interestingly, eCryo application may improve donor site aesthetic appearance. We believe that a pig model most reliably simulates eCryo's behaviour in humans to accurately reflect its future clinical applicability.     

表皮生长因子不同用药方法对供皮区治疗的作用

目的　探索外用重组人表皮生长因子治疗供皮区创面的最佳用药方法 ,以指导临床应用。方法　设生理盐水治疗为自身对照 ,选择三种用rhEGF的方法 (每日 1次法 ,每日 3次法 ,每日 1次加保湿法 ) ,进行供皮区创面愈合的比较性研究。结果　和对照组相比 ,rhEGF可有效促进供皮区创面愈合 (P <0 .0 1 )。三种用药方法之间比较 ,差别具有显著性意义 (P <0 .0 5) ,每日 1次加保湿法和每日 3次法均能进一步缩短创面愈合时间。结论　从方便、经济与合理的角度考虑 ,每日 1次加保湿法为临床首选     

Occlusive versus semi-open dressings in the management of skin graft donor sites.

In a prospective, randomised study we compared the efficacy of a new occlusive dressing (Granuflex-E) with a semi-open dressing (tulle gras) in the management of skin-graft donor sites. The study examined 10 patients with burns, each with two donor sites. Each patient acted as his or her own control. The donor sites were mirror images of each other, the anterior surface of the thighs. One donor site was dressed with Granuflex-E and the other with tulle gras. The sites dressed with the occlusive dressing healed significantly faster and were more comfortable than the sites with the semi-open dressing.     

Comparing Kaltostat with Jelonet in the treatment of split-thickness skin graft donor sites

A prospective, randomised, controlled study compared Kaltostat with Jelonet in the treatment of split-thickness skin graft donor sites in 40 patients. The healing time, quality of regenerated skin, ease of removal of dressing, the rates of infection and convenience of the dressing in clinical use were compared. Dressings were changed after 8 days and healing of the donor site was assessed. The mean time from operation to observation of complete healing was 8.5 days for the donor areas dressed with Kaltostat and 11.5 days for the donor areas dressed with Jelonet. Much greather patient comfort when the dressing is first removed and much better quality of regenerated skin were seen under Kaltostat dressings. It was concluded that Kaltostat is superior to Jelonet as a dressing for split-thickness skin graft donor sites.     

A comparative study of three new occlusive dressings for healing of graft donor sites versus conventional therapy

Summary A comparative study of four skin graft donor site dressings was undertaken. This was a prospective and cross-over study of 25 consecutive patients with burns up to 40% TBSA treated with split skin grafts. Each donor site was divided into four sections and covered with different dressings in order to evaluate their effectiveness in healing, the time required for complete epithelialization, patient acceptance and any intolerance or local infection. The results showed that the occlusive hydrocolloid dressing significantly decreases (p<0.01) the mean time required for complete healing (7.45 days) compared with a semiocclusive hydrocolloid (10.29 days), a polyurethane sheet (9.4 days) and the conventional dressing (10.04 days).Presented at the IV European Burns Congress in Barcelona, Spain, September 25, 1991 (Abstract No. 117)     

烧伤整形植皮患者术后供皮区的护理

目的 探讨烧伤整形植皮术后供皮区的护理方法.方法 对282例患者烧伤整形植皮术后供皮区实施精心护理,干预供皮区疼痛、出血、感染等护理问题.结果282例中有2例大腿供皮区出现少量散在黄豆大小脓疱,经清创换药后愈合,另1例患儿术后7h后出现面色苍白、脉搏增快、血压下降,经急诊清创手术及输血后,生命体征恢复正常,其余7～12 d愈合.结论 重视并加强供皮区护理,可减轻患者疼痛,加快创面愈合.     

The development of squamous cell carcinomas in split-thickness skin graft donor sites

The development of squamous cell carcinoma in the donor site of a split-thickness skin graft is rare having only been described in ten previous cases. We describe one further case and review this along with the previous cases. Possible aetiologies are discussed along with advice on how to reduce the chances of this complication occurring and how to manage it should it occur. Level of Evidence: Level V, diagnostic study     

Intravenous arginine and human skin graft donor site healing: a randomized controlled trial

Background and aims

Studies evaluating the effect of arginine supplementation in human wound healing are inhomogeneous with conflicting results. This study aims to clarify the role of arginine supplementation in the healing of human skin graft donor sites.

Methods

35 subjects undergoing skin autografting were randomly assigned to receive intravenous arginine (n = 16) or placebo (n = 19) for 5 days in a dose of 30 g of arginine or an isovolumetric amount of placebo (25.2 g of alanine). Wound healing was evaluated at the donor sites by objectifying angiogenesis, reepithelialization and neutrophil influx. Plasma amino acid concentrations were measured to evaluate our intervention.

Results

The two groups were comparable in age, morbidity and nutritional, metabolic and inflammatory state. Plasma arginine and alanine levels increased significantly upon supplementation in the two groups, respectively. No differences were found between the arginine supplementation group and the placebo group in the studied parameters. Placebo vs. arginine; mean ± SD: neutrophil influx on day 2: 6.67 ± 3.0 vs. 6.57 ± 3.3, p = 0.66; angiogenesis on day 10: 8.0 ± 2.8 vs. 8.9 ± 3.1; reepithelialization in % on day 10: 81 ± 8.5 vs. 85 ± 7.1.

Conclusion

Intravenous arginine supplementation does not improve angiogenesis, reepithelialization or neutrophil influx in healing of human skin graft donor sites.     

A systematic review and meta-analysis of randomized trials evaluating the efficacy of autologous skin cell suspensions for re-epithelialization of acute partial thickness burn injuries and split-thickness skin graft donor sites

BackgroundThis systematic review evaluated the efficacy of autologous skin cell suspensions (ASCS) on the re-epithelialization of partial thickness burn injuries and skin graft donor site wounds.MethodsFour databases (EMBASE, Google Scholar, MEDLINE, Web of Science), grey literature and select journal hand-searching identified studies from 1975 - 2020. Randomized trials evaluating partial thickness burn management with non-cultured ASCS compared to any other intervention were included. Time to re-epithelialization (TTRE) was the primary outcome. Three independent researchers completed screening, data extraction and certainty of evidence assessment using Cochrane Risk of Bias Tool and Grading of Recommendations Assessment, Development and Evaluation.ResultsFive trials (n = 347) reported on adults (2 trials) and children (1 trial) with burn wounds, and adults with donor site wounds (2 trials). The effect of ASCS compared to control on TTRE in adult burn wounds was not estimable. TTRE was shorter in pediatric burn wounds (SMD -1.75 [95% CI: -3.45 to -0.05]) and adult donor site wounds (SMD-5.71 [95% CI: -10.61 to-0.81]) treated with ASCS. The certainty of evidence was very low.ConclusionCompared to standard care, ACSC may reduce pediatric partial thickness burn wound and adult split-thickness skin graft donor site TTRE.RegistrationPROSPERO CRD42019133171