An Alternative Method to Minimize Pain in the Split-Thickness Skin Graft Donor Site

Abstract

In the art of plastic surgery, the reconstruction of tissue defects to obtain cosmetic and functional recovery is the major concern. Skin grafting is the most frequently used procedure for reconstructing defects of various size and anatomical localizations. On the other hand, donor-site problems associated with this invaluable procedure are inevitable. Various methods are used in the postoperative management of the partial-thickness donor site created during the harvest of a split-thickness skin graft. Each technique has the potential for complications of fluid loss, excessive pain, prolonged period of healing and immobilization, hypertrophic scarring, and undesirable pigmentation. Donor-site pain is probably the most disturbing complication in the early postoperative period. The aim of this article is to point out the significance of donor-site pain, which has not been emphasized thoroughly in the literature, and to introduce flap skin as a potential graft donor site for patients in whom reduction of donor-site morbidity is of primary concern. The principal goal of the technique described in this article is to eliminate donor-site pain by harvesting the graft from the flap that is insensate after the elevation. In 15 patients, the overlying skin of the flap that had been used for reconstructive purposes was used as the donor site (group I). In the remaining 23 patients, the posterolateral thigh was used as the donor site (group II). Donor-site discomfort was recorded during the first 8 days postoperatively using a visual analogue scale. To analyze the data, we used the Friedman test, Dunn's multiple comparison test, and Mann-Whitney U test. It was observed that the visual analogue scale of both of the groups showed a significant decrease within days (group I, p < 0.0001; group II, p < 0.0001). The mean pain scores were significantly lower in group I than in group II (p < 0.0001). When donor-site pain is of primary concern, this procedure provides uneventful and comfortable healing while avoiding postoperative pain in the donor site. For that reason, this technique might be used in appropriate cases to minimize donor-site pain.

Advances in Skin Regeneration Using Tissue Engineering

“…Skin autograft technique was used in India in premodern times [16]. A thin layer of skin that includes the full epidermis and a portion of the dermis, known as split-thickness graft, is shaved from the donor site, such as inner thighs and buttocks, using a dermatome, and is then placed on the wound site [17]. The healing of wound depends on thickness of the underlying dermis in the graft.…”

Stem Cells for Skin Tissue Engineering and Wound Healing

“…11 A dermatome, which is a surgical instrument that holds a razor-sharp blade parallel to the skin surface, is used to “shave” a thin layer of skin from the donor site (most commonly a conspicuous area such as inner thighs and buttocks) that includes the full epidermis and portion of the dermis, or what is commonly known a split-thickness graft. 12 The skin graft is then placed on the wound site. If large areas need to be covered, such as in cases of extensive burns, the graft is meshed to enable stretching it over the larger area (typically using an expansion ratio of 1:3).…”

Advanced therapies of skin injuries

“…Skin grafting with autografts is extremely well-established and evolved technique [11]. Surgeons "shave" a thin layer of skin with the dermatome (a surgical instrument that holds a razorsharp blade parallel to the skin surface) from the donor site (most commonly a non-conspicuous area such as inner thighs and buttocks) that includes the full epidermis and portion of the dermis, or what is commonly known a split thickness graft [12]. The skin graft is then placed on the wound site.…”