Optimizing Donor Site Pain after Skin Grafting: An Analysis of Optimal Donor Site Dressings

Abstract

Research Question: Will patients who undergo a thigh split thickness skin graft (STSG) for a wound defect, who are given a 3M Tegaderm Absorbent dressing for the skin graft donor site, have better pain control and lower donor site morbidity than patients who undergo a thigh STSG, who are given an Aquacel Ag (alginate ag) with an abdominal (ABD) gauze pad dressing for the skin graft donor site?

Background and Significance: STSG harvesting is a common procedure performed for patients who have an acute wound due to a traumatic injury, surgical complication, or other pathological causes. However, many patients stated suffering from moderate pain from the STSG donor site. Current literature has shown there is no establishment of a standard postoperative donor site dressing protocol. Some studies have shown when comparing the Aquacel Ag (alginate ag) with ABD pad dressing to another moist postoperative dressing for the donor site, there have been documented cases of longer wound healing times and increased risk of postoperative infection. The goal of this research effort was to evaluate the 3M Tegaderm Absorbent against the Aquacel Ag dressing efficacy in reducing donor site morbidity.

Materials and Methods: A prospective, randomized, and nonblind clinical trial was performed. STSG were harvested from either the right or left thigh ¿ measuring 0.014 inches. After procuring the graft, a mixture of 0.25% Marcaine and 1% lidocaine with epinephrine was injected into the dermis of the donor site intraoperatively. Upon operating wound surgeon, the patient either received a 3M Tegaderm absorbent (Mapula) or Aquacel Ag (Chen) dressing to the donor site at the time of surgery. All patients were seen, in clinic, at standard one-week postoperation and given a patient survey to fill out describing their donor site pain and wound evaluation and documentation, and the primary surgical dressing was removed and replaced with the Aquacel Ag. Another standard two-week post-operation was scheduled in the clinic for survey administration, pain control (if necessary), wound evaluation and documentation. At six- and twelve-week postoperation visits, phone call follow up was done by trained medical personnel with IRB approved phone scripts and study participants emailed photos of donor site graft sites for proper evaluation by Dr. Mapula or Dr. Chen. With every single postoperation visit, narcotic pain medication is asked and filled, based on clinical expertise of Dr. Mapula or Dr. Chen, and documented in the excel file for type of medication, how much administered, and when the individual patient discontinued use in the acute postoperation period.

Results: We anticipated the 3M Tegaderm Absorbent dressing to have better postoperative pain control, better wound healing outcomes, and shorter time for full re-epithelialization of the donor site tissue.

Conclusion: Although final conclusions cannot be made at this time due to ongoing data analysis, favorable preliminary data suggest proving our original hypothesis correct regarding the 3M Tegaderm Dressing in reducing donor site morbidity. Regardless of outcome, this study is hopeful in producing a more standardized approach in STSG care and may spark additional studies to include more chronic, co-morbid patients suffering from long-term wounds.