Comparison of Donor-Site Healing under Xeroform and Jelonet Dressings: Unexpected Findings

Abstract

Split-thickness skin grafts remain central to the strategy of burn wound treatment. The dressing used to cover the donor wound site has a significant effect on healing parameters. The purpose of this study was to compare split-thickness skin graft donor site reepithelialization under Xeroform and Jelonet dressings. A dermatome was used to cut two consecutive strips of skin from 25 paired donor sites on the thigh, calf, or back of 19 participants. Standardization of the harvest method was achieved by using the same surgeon to harvest the compared skin graft strips, with attention to consistency of dermatome skin-thickness setting, downward pressure, and angle of dermatome approach. A strip of Xeroform or Jelonet was applied to one of each pair of wounds. Epidermal and dermal thickness was measured from biopsy specimens cut at the midpoint of each split-thickness graft strip. The day of final dressing separation was declared the day of complete donor reepithelialization (healing). The mean healing time for Xeroform and Jelonet was 10.4 +/- 2.6 days (n = 25) and 10.6 +/- 2.8 days (n = 25) (p = 0.76) at sites cut to a mean depth of 0.23 +/- 0.08 mm and 0.23 +/- 0.09 mm (p = 0.89), respectively. There was no correlation between graft thickness and healing time for sites dressed with Xeroform (r = 0.17) or Jelonet (r = 0.02). Donors sites reharvested 10 to 21 days after a prior harvest healed an average of 3.1 days earlier than virgin sites (8.4 +/- 1.6 versus 11.5 +/- 2.6 days, p < 0.001), although reharvested grafts were on average 0.05 mm thicker (p = 0.10). The mean thickness of reepithelialized donor-site epidermis (0.13 +/- 0.04 mm, n = 30) was found to be twice the thickness of virgin epidermis from the same sites (0.06 +/- 0.02 mm, n = 38, p < 0.001). Thirty-six grafts harvested with dermatomes set to cut 8/1000 inch (0.20 mm) deep ranged from 0.12 to 0.42 mm thick, with only eight of these grafts measuring within +/-10 percent of the desired thickness setting. Before donor dressing separation, Xeroform and Jelonet dressings were judged to be more comfortable by nine patients and one patient, respectively, whereas no difference was detected by six patients. The authors now use Xeroform as the preferred donor dressing.

Management of Split-Thickness Skin Graft Donor Sites: A Randomized Controlled Trial of Calcium Alginate versus Polyurethane Film Dressing

“…In order to standardize the technique for this randomized controlled study comparing polyurethane film with alginate dressings for STSG donor sites, the harvesting of the skin graft was performed under local anesthesia, and the graft was taken with a thickness of 0.2 mm (8/1,000 inch) as described in the protocol. Although the final thickness of the graft is also influenced by other factors than the settings on the dermatome (such as dermatome speed and pressure when harvesting, lubrication, skin tension) [21], this technique creates fairly uniform wounds, as the operation was performed by the same two surgeons with the same equipment.…”

Comparison of the Ionic Silver-Containing Hydrofiber* and Paraffin Gauze Dressing on Split-Thickness Skin Graft Donor Sites

“…1-3 Novel wound dressing materials are being developed and investigated to achieve the ideal donor site dressing. [1][2][3]5,15 The principal aims of the donor site dressing are to promote re-epithelialization and the healing process, to reduce bacterial infection and contamination, to provide optimal moisture environment, be highly absorbent, nonadherent, and cause the least pain and discomfort with ease of …”

Acticoat Versus Allevyn as a Split-Thickness Skin Graft Donor-Site Dressing

“…Therefore, the observed differences between Acticoat and Allevyn cannot be attributed to the known healing process differences between the dressings maintaining a moist environment on the one hand and the dry dressings on the other. 9 The clinical observations show that both dressings are applied and changed easily and require minimal consumables. For the purpose of the study, the patients selected were over 10 years of age, to have bigger donor sites and evaluate the pain more adequately.…”