Meta-analysis and Systematic Review of Skin Graft Donor-site Dressings with Future Guidelines

Serebrakian, Arman T.; Pickrell, Brent B.; Varon, David E.; Mohamadi, Amin; Grinstaff, Mark W.; Rodriguez, Edward K.; Nazarian, Ara; Halvorson, Eric G.; Sinha, Indranil

doi:10.1097/gox.0000000000001928

Cited by 78 publications

(30 citation statements)

References 57 publications

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“…In other words, there seems to be a worse agreement in the judgment of donor-site scars compared to the recipient site. [26][27][28][29] Caregivers should be aware of these options, which may increase scar quality.…”

Section: Discussionmentioning

confidence: 99%

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Course of scar quality of donor sites following split skin graft harvesting: Comparison between patients and observers

Legemate

Ooms

Trommel

et al. 2020

Wound Repair Regeneration

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There exists little to no data on the development of donor‐site scars that remain after split skin graft harvesting. The objectives of this study were to (a) examine changes in characteristics of donor‐site scar quality over time and (b) assess the agreement between patient‐reported and observer‐reported donor‐site scar quality in a burn population. A prospective cohort study was conducted including patients who underwent split skin grafting for their burn injury. Patients and observers completed the Patient and Observer Scar Assessment Scale (POSAS) for the first harvested donor site at 3 and 12 months post‐surgery. This study included 80 patients with a median age of 34 years. At 3 months post‐surgery, the patients scored the POSAS items itch and color as most deviant from normal skin, both improved between 3 and 12 months (3.1 vs 1.5 and 5.0 vs 3.5, respectively [P < .001]). Other scar characteristics did not show significant change over time. The patients' overall opinion score improved from 3.9 to 3.2 (P < .001). Observers rated the items vascularization and pigmentation most severe, only vascularization improved significantly between both time points. Their overall opinion score decreased from 2.7 to 2.3 (P < .001). The inter‐observer agreement between patients and observers was considered poor (ICC < 0.4) at both time points. Results of current study indicate that observers underestimate the impact of donor‐site scars. This has to be kept in mind while guiding therapy and expectations. LEVEL OF EVIDENCE: II, prospective cohort study.

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Section: Discussionmentioning

confidence: 99%

“…However, most studies on the outcomes of these treatment options focus on early and rapid re-epithelialization but lack data on patient reported (long term) scar appearance. 26 Further research is, therefore, necessary to investigate which patients benefit from these techniques.…”

Section: Discussionmentioning

confidence: 99%

Course of scar quality of donor sites following split skin graft harvesting: Comparison between patients and observers

Legemate

Ooms

Trommel

et al. 2020

Wound Repair Regeneration

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“…In this thesis, we focus on donor sites created when the surgeon harvests split thickness skin grafts. In Study I, skin grafts are harvested from the thigh with the dermatome (skin harvesting "machine") set to 0.012 inches, which produces medium/intermediate thick grafts, and creates a wound approximately 0.2 -0.3 mm deep This should leave the epidermal appendages (glands and follicles) of the dermis almost intact [29,30]. The most commonly-used donor site is the thigh [30].…”

Section: Description Of the Wound Models Of This Thesismentioning

confidence: 99%

“…Closed moist dressings are further claimed to lower the risk of contamination from the surroundings [63]. Five systematic reviews on donor site dressings were found and in four of them the authors conclude that a moist wound environment is associated with better outcomes, as in faster re-epithelialisation, less pain, and fewer infections [30,[64][65][66][67].…”

Section: Dressing Treatmentsmentioning

confidence: 99%

Studying the healing and long-term outcomes of two partial thickness wound models using different wound dressings

Karlsson

2019

Linköping University Medical Dissertations

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Background: Safe and effective wound dressing treatments are important for proper wound healing. Such procedures therefore need to be evidence-based regarding the most important outcome measures such as healing time, less discomfort for the patient, duration of hospital care and, importantly, less scarring. As the relation between longer healing times and more severe scarring is known, it is important to find dressing treatments that reduces such complications by providing fast and proper wound healing. In this thesis, four established wound dressing treatments (hydrofibre covered with film; porcine xenografts and polyurethane foam, with and without silver), were evaluated for two types of acute, partial thickness wounds: split thickness skin graft (STSG) donor sites and partial thickness burn wounds in two randomised, controlled clinical trials (RCT) with longterm scar follow ups. The relations between factors thought to influence wound healing and scarring as sex, infection, wound extent and depth, healing time and skin grafting were also investigated in these two wound models. Methods: Data from these trials were collected on sex, infection rates, wound depth and extent, need of skin grafting, healing times and scarring frequency together with demographic data. Scars were evaluated at 8 years in Study II and III and at 6 and 12 months after injury in Study V.

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“…Unfortunately, if an alginate or hydrofiber dressing is left in situ throughout healing, the dressing is likely to dry out and possibly adhere to the wound bed [3]. Furthermore, two systematic reviews of donor-site dressing found no clear evidence to support the choice of any particular dressing [4, 5] except that they must be moist; occlusive or semi-occlusive dressings both fall into this category.…”

Section: Introductionmentioning

confidence: 99%

CICAFAST: comparison of a biological dressing composed of fetal fibroblasts and keratinocytes on a split-thickness skin graft donor site versus a traditional dressing: a randomized controlled trial

Poinas

Perrot²,

Lorant

et al. 2019

Trials

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BackgroundWound repair is one of the most complex biological processes of human life. Allogeneic cell-based engineered skin substitutes provide off-the-shelf temporary wound coverage and act as biologically active dressings, releasing growth factors, cytokines and extracellular matrix components essential for proper wound healing. However, they are susceptible to immune rejection and this is their major weakness.Thanks to their low immunogenicity and high effectiveness in regeneration, fetal skin cells represent an attractive alternative to the commonly used autologous and allogeneic skin grafts.Methods/designWe developed a new dressing comprising a collagen matrix seeded with a specific ratio of active fetal fibroblasts and keratinocytes. These produce a variety of healing growth factors and cytokines which will increase the speed of wound healing and induce an immunotolerant state, with a slight inflammatory reaction and a reduction in pain.The objective of this study is to demonstrate that the use of this biological dressing for wound healing at the split-thickness skin graft (STSG) donor site, reduces the time to healing, decreases other co-morbidities, such as pain, and improves the appearance of the scar.This investigation will be conducted as part of a randomized study comparing our new biological dressing with a conventional treatment in a single patient, thus avoiding the factors that may influence the healing of a graft donor site.DiscussionThis clinical trial should enable the development of a new strategy for STSG donor-wound healing based on a regenerative dressing. The pain experienced in the first few days of STSG healing is well known due to the exposure of sensory nerve endings. Reducing this pain will also reduce analgesic drug intake and the duration of sick leave.Our biological dressing will meet the essential need of surgeons to “re-crop” from existing donor sites, e.g., for thermal-burn patients. By accelerating healing, improving the appearance of the scar and reducing pain, we hope to improve the conditions of treatment for skin grafts.Trial registrationClinicalTrials.gov, ID: NCT03334656. Registered on 7 November 2017.

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Meta-analysis and Systematic Review of Skin Graft Donor-site Dressings with Future Guidelines

Cited by 78 publications

References 57 publications

Course of scar quality of donor sites following split skin graft harvesting: Comparison between patients and observers

Course of scar quality of donor sites following split skin graft harvesting: Comparison between patients and observers

Studying the healing and long-term outcomes of two partial thickness wound models using different wound dressings

CICAFAST: comparison of a biological dressing composed of fetal fibroblasts and keratinocytes on a split-thickness skin graft donor site versus a traditional dressing: a randomized controlled trial

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