Cellophane--a dressing for split-thickness skin graft donor sites

Cellophane paper has been used as a dressing for split-thickness skin graft donor sites in 251 patients between October 1985 and December 1989. Twelve donor sites in 10 patients were observed in detail to assess the usefulness of this material. The results of the study are presented and the merits and disadvantages of this dressing material have been discussed. In the opinion of the authors the cellophane paper dressing was found to be most satisfactory. It is also cheaper than the newly available dressing materials for the skin donor area.     

Which dressing for split-thickness skin graft donor sites?

There is currently little agreement among surgeons regarding the dressing of choice for split-thickness skin graft donor sites, though many are available. In this article, I review the five major groups of dressings, open, semiopen, occlusive, semiocclusive, and biological. The different dressings in each group are described in terms of physiological basis for use, advantages, disadvantages, and practical application. Conclusions are reached regarding which donor site dressings might come closest to optimal for common clinical situations.     

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     

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 comparison of the haemostatic effect of Vivostat patient-derived fibrin sealant with oxidised cellulose (Surgicel) in multiple surgical procedures

AIM: To evaluate the haemostatic properties of Vivostat patient-derived fibrin sealant in a broad range of surgical procedures. METHOD: In a prospective, randomised, multicentre, clinical study, typical surgical wounds of 69 patients (cardiothoracic, general, obstetric and gynaecologic, and vascular), requiring intervention to control bleeding, were treated with either Vivostat-derived sealant (n = 35) or Surgicel (n = 34) as required and the time taken to arrest bleeding was assessed. RESULTS: Compared with Surgicel, the mean time to haemostasis of Vivostat-derived sealant was significantly shorter (1.6 vs. 3.3 min, p < 0.0001) and more patients were successfully treated (i.e. no additional haemostatic measures required; 94 vs. 65%, p = 0.003). CONCLUSION: Vivostat-derived sealant is a more reliable and rapidly effective surgical haemostat than Surgicel.     

Physical characteristics of Vivostat patient-derived sealant. Implications for clinical use.

This study compared the physical characteristics of Vivostat patient-derived sealant with two conventional fibrin sealants, Tissucol and Beriplast. Vivostat sealant exhibited greater elasticity without compromising tensile strength. Vivostat sealant polymerised at low temperatures (4 and 25 degrees C) or at high temperature (70 degrees C) exhibited similar viscoelastic properties as when polymerised at normal physiological temperature (37 degrees C). Vivostat fibrin I solution can be stored at room temperature for up to 8 h without affecting the mechanical properties of the derived sealant. These physical characteristics of Vivostat patient-derived sealant suggest that it may have suitable stability and performance characteristics for use in a wide range of surgical procedures.     

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.     

大张表皮片覆盖预防断层皮片供区瘢痕

目的介绍一种用自体大张表皮片即时覆盖断层皮片供区以预防其瘢痕生长的方法。方法用鼓式或电动取皮机切取断层皮片，厚度在0．3～0.5mm之间，用电动取皮机切取大张表皮片，厚度0．07～0．12mm（0．0028in～0．0048in），供皮区一般首选在背部、腰部、臀部或头皮，其次是胸腹和四肢；将表皮片覆盖在断层皮片供区，边缘用纳米银纱布条压紧，外加缝合或钉皮钉固定。表皮片供区和移植区内层均用油纱布，外层纳米银纱布覆盖，以缝线包压法包扎。结果从1999年11月至2003年11月共用于118例的133个整形部位。断层皮片供区移植表皮片后，无瘢痕生长，平坦，光滑，外观接近正常皮肤，但无毛囊和汗腺。表皮片供区短时间内潮红，无瘢痕增生，3个月以后逐渐接近正常皮肤。结论大张表皮片移植覆盖断层皮片供区是一种预防断层皮片供区瘢痕生长的好方法，值得推广和应用。     

Comparison of synthetic adhesive moisture vapor permeable and fine mesh gauze dressings for split-thickness skin graft donor sites

SAM and fine mesh gauze dressings were compared on 60 consecutive skin graft donor sites. SAM dressings are significantly better than fine mesh gauze dressings for healing of split-thickness skin graft donor sites; healing occurs much more rapidly with much less pain. In patients known to be colonized with Pseudomonas, care should be taken when using SAM dressings, although it is not an absolute contraindication. There were no clinically significant differences between Tegaderm and Op-Site.     

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.     

Use of lyophilized bovine collagen for split-thickness skin graft donor site management

Donor site management after split-thickness skin graft applications can have problems such as late healing and pain. Many dressing methods and medical applications are reported to solve these problems but none of them were ideal. In this study we aimed to promote epithelisation and remove pain earlier with using lyophilized bovine collagen (gelfix spray). According to our results, epithelisation time for the gelfix group was earlier than control group (9.09 days mean and 11.2 days mean for control group (p<0.05)). Pain relief was determined by visual analogue pain scale. In the gelfix group, there was pain relief up to 40 h from the operation. There were no differences between groups for scarring 30 and 90 days after surgery.     

The effect of fibrin sealant on the healing of laser-resurfaced skin

Background: Fibrin sealant is an effective hemostatic agent and a useful tissue sealant. Studies have also suggested that fibrin sealant may accelerate the normal wound-healing process. Objective: This study was designed to ascertain whether fibrin sealant would enhance wound healing after CO₂ laser resurfacing in a guinea pig model. Methods: The CO₂ laser was used to create equal areas of skin resurfacing on both sides of 14 Dunkin Hartley guinea pigs. Fibrin sealant was applied to the treatment side, whereas bacitracin was applied to the control side. Biopsies of these areas were performed on days 1, 3, 7, and 10. A histologic evaluation was performed with the use of a grading scale that compared acute and chronic inflammation, granulation tissue, collagen deposition, and epidermal regeneration. Results: The wounds treated with fibrin sealant demonstrated a statistically significant reduction in the degree of acute and chronic inflammation as well as collagen deposition. At day 7, fibrin sealant was noted to enhance neovascularization and result in a slight delay in reepithelialization. All wounds were completely reepithelialized at day 10. No wound infections or other complications were noted as a result of the application of fibrin sealant. Conclusions: Although wound healing was not accelerated, the application of fibrin sealant after CO₂ laser resurfacing diminished the acute and chronic inflammatory response, enhanced neovascularization, and reduced collagen accumulation. Further research is needed to assess whether the effects of fibrin sealant noted in this study result in improved cosmetic healing after CO₂ laser resurfacing. (Aesthetic Surg J 2001;21:509-517.)     

Modification of split-thickness skin graft: cosmetic donor site and better recipient site

The author reports an alternative method of caring for the donor sites of split-thickness skin graft that involves the immediate return of superficial thin-layer split skin graft to the donor sites while using the deep split-thickness skin graft for replacement over the defects. The proposed method would decrease the morbidity associated with other established techniques of donor site management, including prolonged healing time, fluid loss, discomfort, pain, and undesirable cosmetic results. As for the recipient site, satisfactory cosmetic effects and less pigmentation changes could be achieved with this type of simple modification of a laminated graft.