SPLIT-THICKNESS SKIN-GRAFT DONOR SITE MANAGEMENT - A RANDOMIZED PROSPECTIVE TRIAL COMPARING A HYDROPHILIC POLYURETHANE ABSORBENT FOAM DRESSING WITH A PETROLATUM GAUZE DRESSING

Objective: Traditionally, skin graft donor sites have been covered wit h fine-mesh gauze dressings, and a dry eschar has been allowed to form . Newer dressings that can provide a moist wound environment may facil itate reepithelialization. We compared a hydrophilic semipermeable abs orbent polyurethane foam dressing that provides a moist wound environm ent with a petrolatum gauze dressing for donor sites. Design: Prospect ive randomized trial; follow-up at 14 days. Setting: Department of hea d and neck surgery in a tertiary care center. Patients: Sixty-eight el igible patients received one of the two dressings. Harvested skin graf ts were 0.375-mm (0.015-in) chick; donor site surface areas were recor ded. At postoperative day 14, the dressings were removed, and wound ep ithelialization was scored: 1, none; 2, scattered or spotty; and 3, co mplete. Donor site and operative site pain intensities were assessed b y a visual numeric scale: none (0) to the worst (100) experienced over the preceding 24-hour period. Pain scores were available for 58 patie nts. Main Outcome Measures: Dressings were compared based on these cri teria: healing at 14 days, infection, and donor site and operative sit e pain. Results: A healing score of 3 was seen in 37% (14/38) of patie nts with hydrophilic semipermeable absorbent polyurethane foam dressin gs and in 17% (5/30) of patients with petrolatum gauze dressings (P=.0 6) by day 14. Overall, however, mean healing scores were similar in bo th groups. Mean healing scores for the patients who received a hydroph ilic semipermeable absorbent polyurethane foam dressing was 2.3 (SD=0. 6) vs 2.2 (SD=0.6) for patients who received the petrolatum gauze dres sing (P=.20). Numbers of days required for complete epithelialization in these groups were 20.6 (SD=10.1) and 19.3 (SD=5.1), respectively (P =.49). One infection occurred in the group who received the petrolatum gauze dressing. The mean maximum pain intensity scores were lower for those who were given the hydrophilic semipermeable absorbent polyuret hane foam dressing on postoperative days 1 through 3 (P=.003, .03, and .04, respectively). Pain increased with a larger donor site surface a rea for the patients with the petrolatum gauze dressing but not for th e patients with the hydrophilic semipermeable absorbent polyurethane f oam dressing. Conclusions: The hydrophilic semipermeable absorbent pol yurethane foam dressing appears to have potential advantages over the petrolatum gauze dressing: it produces less initial patient donor site discomfort and tends to produce more complete donor site healing by p ostoperative day 14.