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Skin thickness of the anterior, anteromedial, and anterolateral thigh: a cadaveric study for split-skin graft donor sites. Arch Plast Surg 2014; 41:673-8. [PMID: 25396179 PMCID: PMC4228209 DOI: 10.5999/aps.2014.41.6.673] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 09/22/2014] [Accepted: 09/23/2014] [Indexed: 11/24/2022] Open
Abstract
Background The depth of graft harvest and the residual dermis available for reepithelization primarily influence the healing of split-skin graft donor sites. When the thigh region is chosen, the authors hypothesize based on thickness measurements that the anterolateral region is the optimal donor site. Methods Full-thickness skin specimens were sampled from the anteromedial, anterior, and anterolateral regions of human cadavers. Skin specimens were cut perpendicularly with a custom-made precision apparatus to avoid the overestimation of thickness measurements. The combined epidermal and dermal thicknesses (overall skin thickness) were measured using a digital calliper. The specimens were histologically stained to visualize their basement membrane, and microscopy images were captured. Since the epidermal thickness varies across the specimen, a stereological method was used to eliminate observer bias. Results Epidermal thickness represented 2.5% to 9.9% of the overall skin thickness. There was a significant difference in epidermal thickness from one region to another (P<0.05). The anterolateral thigh region had the most consistent and highest mean epidermal thickness (60±3.2 µm). We observed that overall skin thickness increased laterally from the anteromedial region to the anterior and anterolateral regions of the thigh. The overall skin thickness measured 1,032±435 µm in the anteromedial region compared to 1,220±257 µm in the anterolateral region. Conclusions Based on skin thickness measurements, the anterolateral thigh had the thickest epidermal and dermal layers. We suggest that the anterolateral thigh region is the optimal donor site for split-skin graft harvests from the thigh.
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Dhanraj P. A Clinical Study Comparing Helicoll with Scarlet Red and OpSite in the Treatment of Split Thickness Skin Graft Donor Sites-A Randomized Controlled Trial. Indian J Surg 2013; 77:385-92. [PMID: 26730031 DOI: 10.1007/s12262-013-0850-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 01/16/2013] [Indexed: 11/30/2022] Open
Abstract
Split thickness skin graft (STSG) is a key method in the reconstructive ladder for covering skin defects used widely by surgeons from all specialties. The donor site is often a source of delayed healing, associated with considerable pain and discomfort even more than the recipient wound. The aim of this prospective randomized controlled study was to compare Helicoll® (EnColl Corp., Fremont, CA, USA), a type I pure collagen dressing, to OpSite® (Smith & Nephew, USA) dressing and to Scarlet Red® (Kendall HealthCare, USA) dressing in the treatment of standardized STSG donor sites. Thirty patients, over a 3-month period, underwent various reconstructive procedures, necessitating the use of STSGs. Following a simple randomized clinical protocol, the analysis of data included donor site pain, healing time of the donor site, initial absorption of the applied dressing and rate of infection with the three different dressings to form the basis of this paper. Patients in the Helicoll group reported significantly less pain, less infection rate and required no dressing change when compared with the OpSite (Johnson & Johnson, Langhorne, PA, USA) or the Scarlet Red groups. Healing time of the donor site in the Helicoll group was shorter than that in the Scarlet Red group; however, it was comparable to the OpSite group. This study indicates that Helicoll, as a donor site dressing, is successful in providing pain-free mobility with a measurable healing rate.
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Affiliation(s)
- Prema Dhanraj
- Department of Plastic Surgery, University of Texas Medical Branch/Shriners, Galveston, TX 77550 USA ; Department of Plastic & Reconstructive Surgery, Christian Medical College (CMC) Hospital, Vellore, 632 004 Tamil Nadu India ; 58/1 Banashankari Extn, 13th main, J.P. Nagar, 1st phase, Bangalore, KA 560078 India
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Vaghela KR. Plastic surgery and burns disasters. What impact do major civilian disasters have upon medicine? Bradford City Football Club stadium fire, 1985, King's Cross Underground fire, 1987, Piper Alpha offshore oil rig disaster, 1988. J Plast Reconstr Aesthet Surg 2009; 62:755-63. [DOI: 10.1016/j.bjps.2008.11.099] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 11/15/2008] [Accepted: 11/17/2008] [Indexed: 10/21/2022]
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High-valve vapor-permeable film dressing versus fine mesh gauze dressing on skin graft donor areas in diabetic patients: a prospective randomized controlled trial. EUROPEAN JOURNAL OF PLASTIC SURGERY 2008. [DOI: 10.1007/s00238-008-0273-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Qin Y. The gel swelling properties of alginate fibers and their applications in wound management. POLYM ADVAN TECHNOL 2008. [DOI: 10.1002/pat.960] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Merz J, Schrand C, Mertens D, Foote C, Porter K, Regnold L. Wound Care of the Pediatric Burn Patient. ACTA ACUST UNITED AC 2003; 14:429-41. [PMID: 14595202 DOI: 10.1097/00044067-200311000-00004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pediatric burn care requires an extensive knowledge of the pathophysiology of burns. Critical to a positive patient outcome is the correlation of burn size and depth with appropriate fluid administration, respiratory management, nutritional support, and wound care. Due to the nature of the injury where patients' recovery times are lengthy, consideration of the child's psychosocial needs must also be part of the total plan of care.
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Affiliation(s)
- Jean Merz
- Shriners Hospital for Children, 3229 Burnet Ave, Cincinnati, OH 24229, USA.
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Abstract
Skin grafting is a surgical procedure used to quickly restore skin integrity in large wounds or those wounds which cannot be directly closed by suturing. The procedure of skin grafting necessitates the creation of a second wound; the donor site. Although often viewed as secondary importance by surgeons once skin has been harvested from the area, it is the donor site which frequently causes complications such as pain/discomfort and slow healing (Wilkinson, 1997). Because skin graft sites and donor sites are viewed as part of a specialist practice, their wound management is regarded as being 'something different'. However, the donor site is a partial-dermal thickness wound and should be seen as such, rather than a 'special' wound. This may help to lessen the anxiety felt by both patient and nurse in dealing with donor site wounds.
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Hormbrey E, Pandya A, Giele H. Adhesive retention dressings are more comfortable than alginate dressings on split-skin-graft donor sites. BRITISH JOURNAL OF PLASTIC SURGERY 2003; 56:498-503. [PMID: 12890465 DOI: 10.1016/s0007-1226(03)00195-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Painful split-skin-graft donor sites remain a common problem for patients. We undertook a prospective randomised trial to examine the comparative comfort and ease of care of two different donor-site dressings. One dressing is the alginate Kaltostat, the standard plastic-surgical dressing in the UK and abroad, and the other is the adhesive retention tape Mefix, a novel use of a readily available dressing. We randomised 50 patients requiring split-skin grafts to receive either alginate (Kaltostat) or retention (Mefix) donor-site dressings. Dressings were assessed by interview and questionnaire at 24, 72 h and 2 weeks, and by wound review at 2 weeks. Retention dressings were found to be more comfortable, required less nursing intervention and allowed patients easier mobility with a greater range of daily activities, especially washing, without compromising wound healing. We recommend adhesive retention dressings as cost-effective comfortable dressings, which readily conform to any donor site.
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Affiliation(s)
- E Hormbrey
- Department of Plastic Surgery, Radcliffe Infirmary, Oxford, UK
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Pannier M, Martinot V, Castède JC, Guitard J, Robert M, Le Touze A, Magalon G, Rives JM, Pinheiro L, Romana MC, Carlioz H, Debeugny P, Février P. [Efficacy and tolerance of Algosteril (calcium alginate) versus Jelonet (paraffin gauze) in the treatment of scalp graft donor sites in children. Results of a randomized study]. ANN CHIR PLAST ESTH 2002; 47:285-90. [PMID: 12420619 DOI: 10.1016/s0294-1260(02)00122-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Split skin graft is frequently needed in the treatment of burned patients. Scalp is often free of burns. Due to its good skin quality and important surface, scalp is a very interesting skin donor site, specially in case of children. A controlled, randomised clinical trial was carried out in 10 French Plastic Surgery or Burns Units. It assessed the efficacy and the acceptability of calcium alginate dressing (Algosteril) versus paraffin gauze dressing (Jelonet) in the treatment of scalp donor sites in children. 67 children (mean age 54 months) entered the study, 34 in the alginate group and 33 in the control group. Follow-up visits were on day 2/d3, d5/d6, Day complete healing, d30 and d60 after surgery. The two groups were comparable on inclusion (demographic characteristics, burn nature and surface, donor site surface and thickness of split skin graft). The mean healing time was 10 and 11 days for Algosteril and Jelonet group respectively (ns). The quality of the newly formed tissue was estimated to permit a sooner skin reharvesting in the Algosteril group than in the control group (p = 0.003). Bleeding through dressing was significantly less important in the Algosteril group (p = 0.02). Changes were considered by investigators less painful with Algosteril on day complete healing (p = 0.0096). Hair growth is homogenous in both groups on day 30 and day 60 (ns). These results showed that scalp is a very interesting skin donor site and that Algosteril is of a real interest in donor site treatment.
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Affiliation(s)
- M Pannier
- Service des brûlés, hôpital Hôtel-Dieu, Nantes, France.
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Innes ME, Umraw N, Fish JS, Gomez M, Cartotto RC. The use of silver coated dressings on donor site wounds: a prospective, controlled matched pair study. Burns 2001; 27:621-7. [PMID: 11525858 DOI: 10.1016/s0305-4179(01)00015-8] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Acticoat, a new silver-coated dressing, produces a moist healing environment along with the sustained release of ionic silver for improved microbial control. These properties suggest that Acticoat might be a useful donor site dressing. However, there are no human studies which assess Acticoat for this use. The purpose of this study was to compare the healing of human skin graft donor sites dressed with Acticoat, to the healing of those dressed with Allevyn, an occlusive moist-healing environment material, which is our standard donor site dressing. In burn patients who had undergone burn excision and grafting, identical side-by-side split thickness donor site wound pairs were dressed with Allevyn and Acticoat. Re-epithelialization was directly assessed daily by a single observer from post-operative day 6 onward, and by four independent observers who rated the extent of re-epithelialization by viewing standardized digital images of the wounds that had been obtained on post-operative days 6, 8, 10,and 12. Donor sites were swabbed for bacterial culture on days 3, 6, and 9. Subsequently, each study donor site scar was rated by a blinded observer using the Vancouver Scar Scale at 1, 2, and 3 months. Sixteen paired sites in 15 patients (3 female, 12 male) were studied. Donor sites dressed with Allevyn were >90% re-epithelialized at a mean of 9.1+/-1.6 days while donor sites dressed with Acticoat required a mean of 14.5+/-6.7 days to achieve >90% re-epithelialization (P=0.004). The Allevyn sites had significantly greater estimated re-epithelialization at days 6, 8, 10 and 12 than the Acticoat sites based on the observations of the digital images. There were no significant differences in the incidence of positive bacterial cultures with either dressing at days 3, 6, and 9. Donor sites dressed with Acticoat had significantly worse scars at 1 and 2 months but this difference resolved by 3 months. Our findings do not support the use of Acticoat as a skin graft donor site dressing.
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Affiliation(s)
- M E Innes
- The Ross Tilley Burn Center, Sunnybrook and Women's College Health Sciences Center, 2075 Bayview Ave., Ont., M4N 3M5, Toronto, Canada
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Abstract
The medical literature describes numerous in vitro and in vivo wound-healing models. The selection of an animal model depends on a number of factors including availability, cost, ease of handling, investigator familiarity, and anatomical/functional similarity to humans. Small mammals are frequently used for wound healing studies, however, these mammals differ from humans in a number of anatomical and physiological ways. Anatomically and physiologically, pig skin is more similar to human skin. The many similarities between man and pig would lead one to believe that the pig should make an excellent animal model for human wound healing. The purpose of this paper is to review the existing literature for evidence of this supposition and determine how well the various models correlate to human wound healing. Studies of wound dressings, topical antimicrobials, and growth factors are examined. Over 180 articles were utilized for this comparative review. Our conclusion is that the porcine model is an excellent tool for the evaluation of therapeutic agents destined for use in human wounds.
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Affiliation(s)
- T P Sullivan
- University of Miami School of Medicine, Department of Dermatology, Miami, Florida 33101, USA
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Abstract
This final article in the series looks at the functioning of seaweed-derived dressings at a cellular level, as well as the importance of choosing appropriate secondary dressings
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Affiliation(s)
- S Thomas
- Surgical Materials Testing Laboratory, Princess of Wales Hospital, Bridgend, Mid-Glamorgan, UK
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Lyall PW, Sinclair SW. Australasian survey of split skin graft donor site dressings. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 2000; 70:114-6. [PMID: 10711473 DOI: 10.1046/j.1440-1622.2000.01767.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is an ever increasing array of products available for wound dressings. The aim of the present study was to establish which dressings should be used as standard controls for future studies; what factors are regarded as most important in assessing a dressing; what the level of satisfaction is with the available products; what the strengths and weaknesses of the commonly used dressings are; and what dressings would be preferred if cost were no issue. METHODS A postal survey was sent to every plastic and reconstructive surgeon registered in Australasia (n = 217). A total of 53% responded. RESULTS The most commonly used dressing type overall is the calcium alginates, despite the fact that they were not the highest performing dressings. This is also the most commonly used in Australia. In contrast scarlet red is still used most commonly in New Zealand. The level of satisfaction with the most commonly used dressing varied very little. The factor regarded most important was patient comfort level. A profile of the commonly used dressing was constructed. Calcium alginates and or scarlet red should be used as the control for new product comparisons. CONCLUSIONS Most of the respondents were satisfied with their preferred dressing and were not interested in trying alternative dressings.
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Affiliation(s)
- P W Lyall
- Department of Plastic and Reconstructive Surgery, Christchurch Hospital, New Zealand.
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Senecal SJ. PAIN MANAGEMENT OF WOUND CARE. Nurs Clin North Am 1999. [DOI: 10.1016/s0029-6465(22)02425-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Horch RE, Stark GB. Comparison of the effect of a collagen dressing and a polyurethane dressing on the healing of split thickness skin graft (STSG) donor sites. SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY 1998; 32:407-13. [PMID: 9862108 DOI: 10.1080/02844319850158499] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Recent advances in the resurfacing of burn wounds with dermal equivalents and collagen preparations have shown the efficacy of collagen. To investigate the benefits (if any), standardised split skin donor areas were chosen to compare the influence of collagen on re-epithelialisation. A bovine collagen preparation consisting of type-I collagen was prospectively compared with polyurethane film dressing in a study of 20 split thickness skin graft donor sites. The rates of epithelialisation, the discomfort experienced by the patients and the convenience of the dressings were assessed. The median time from operation to the observation of complete healing was 7.5 (+/- 2.5) days for the donor sites dressed with the collagen membrane and 12.5 (+/- 3.4) days for the the donor areas dressed with a polyurethane film (p < 0.001). The discomfort experienced by the two groups of patients was significantly less after wound coverage with collagen (p < 0.005). Haematomas or seromas that required repeated aspiration was seen under the polyurethane film dressing. The collagen dressing was more expensive than the polyurethane film, but improved wound healing compared with the polyurethane dressings.
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Affiliation(s)
- R E Horch
- Department of Plastic and Hand Surgery, Albert-Ludwigs-University Freiburg, Medical School, Germany.
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Steenfos H, Agren M. A fibre-free alginate dressing in the treatment of split thickness skin graft donor sites. J Eur Acad Dermatol Venereol 1998. [DOI: 10.1111/j.1468-3083.1998.tb00978.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gore DC. Outcome and cost analysis for outpatient skin grafting. THE JOURNAL OF TRAUMA 1997; 43:597-600; discussion 600-2. [PMID: 9356054 DOI: 10.1097/00005373-199710000-00006] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND To reduce cost, outpatient surgery is advocated when feasible; however, the potential of compromising outcome is a concern. The purpose of this review is to assess patient outcome and cost for managing operative burn injuries without hospitalization. METHODS During the past 18 months, 54 patients were identified with burns amenable to operative debridement and skin grafting without hospitalization. Twenty patients chose to be hospitalized and underwent prompt skin grafting. Operative skin grafting as an outpatient was chosen by the remaining 34 patients. Of these, four patients were subsequently hospitalized postoperatively (two for pain, one for cellulitis, and one for vomiting). RESULTS Hospitalized patients and outpatients were similar in age and extent of burn; however, those hospitalized underwent skin grafting sooner after injury (2.1 +/- 0.4 days for inpatients vs. 11.5 +/- 0.8 days for outpatients; mean +/- SEM). Inpatients also had a significantly larger area skin-grafted (286 +/- 24 cm2 for inpatients vs. 178 +/- 14 cm2 for outpatients). Graft take was very good in each group. Cost, as indexed by patient charge, was substantially less for outpatients ($2,397 +/- $222) than for inpatients ($17,220 +/- $410). CONCLUSION These results demonstrate a significant cost reduction with nonhospitalized operative care of burn injuries without any overt detriment in outcome, thus endorsing outpatient skin grafting when amenable. This review also illustrates that delaying operative intervention reduces the burn area required for grafting.
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Affiliation(s)
- D C Gore
- Medical College of Virginia, Richmond, USA
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