An observational study to evaluate improved graft acceptance and viability after single dressing on 15th postoperative day in cases of split thickness skin graft (STSG)

Narendra G. Naik; Sangram Karandikar

doi:10.18203/2349-2902.isj20185022

Authors

Narendra G. Naik Department of General Surgery, Rajiv Gandhi Medical College, Kalwa, Thane, Maharashtra, India
Sangram Karandikar Department of General Surgery, Terna Specialty Hospital and Research Centre, Navi Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-2902.isj20185022

Keywords:

Split thickness skin graft, Donor site, Recipient site, Time of dressing, Skin graft rejection

Abstract

Background: After split thickness skin graft (STSG), it’s a routine practice to change recipient site dressing on 5^th post-operative day and frequent dressing thereafter. The repeated change of recipient site dressing may interfere in graft acceptance. It’s also an effort to evaluate cost-effectiveness and graft acceptance after single dressing of recipient site at the end of 2 weeks.

Methods: In the study group, 120 patients were operated for STSG. The recipient site dressing was done on 15^th post-operative day. Observations were made regarding presence of residual ulcer at the recipient site. The results were compared with rate of residual ulcers at the recipient site in control group. The control group was comprised of 134 patients of STSG operated by the same surgeon in the previous year. Their dressing of recipient site was first changed on 5^th post-operative day and multiple times thereafter. The results in both the groups were correlated with co-morbidities affecting wound healing.

Results: The rate of residual ulcer at recipient site in both the groups was comparable with better cosmetic result and cost-effectiveness associated with the study group. In both the groups, common co-morbid factors were observed to be responsible for residual ulcers at the recipient site.

Conclusions: After appropriate preparation of recipient site and in absence of co-morbid factors, the single 1^st dressing of recipient site on 15^th post-operative day gives better cosmetic outcome. This is also cost-effective as compared to the traditional practice of frequent multiple change of recipient site dressing.

Metrics

Metrics Loading ...

References

Guest JF, Ayoub N, McIlwraith T, Uchegbu I, Gerrish A, Weidlich D, et al. Health economic burden that wounds impose on the National Health Service in the UK. BMJ Open. 2015;5(12):e009283.

Phillips CJ, Humphreys I, Fletcher J, Harding K, Chamberlain G, Macey S. Estimating the costs associated with the management of patients with chronic wounds using linked routine data. Int Wound J. 2016;13(6):1193-7.

Ottawa (ON). Canadian Agency for Drugs and Technologies in Health; 2013 Dec. Dressings and Care of Skin Graft Sites: A Review of Clinical Evidence and Guidelines. Rapid Response Report: Summary with Critical Appraisal. Available at: http://creativecommons.org/licenses/by-nc-nd/4.0/ (ID: NBK195739PMID: 24741725).

Kim SW, Kim JH, Kim JT, Kim YH. A simple and fast dressing for skin grafts: comparison with traditional techniques. J Wound Care. 2018;2:27(7):417-20.

Weber RS, Hankins P, Limitone E, Callender D, Frankenthaler RM, Wolf P et al. Split-thickness skin graft donor site management. A randomized prospective trial comparing a hydrophilic polyurethane absorbent foam dressing with a petrolatum gauze dressing. Arch Otolaryngol Head Neck Surg. 1995;121(10):1145-9.

Jansen P, Stoffels I, Klode J, Jockenhöfer F, Augustin M, Schadendorf D, et al. Postsurgical Treatment of Split Skin Graft Donor Sites in Dermatological Departments. Int J Low Extrem Wounds. 2018;17(1):22-9.

Thourani VH, Ingram WL, Feliciano DV. Factors affecting success of split-thickness skin grafts in the modern burn unit. J Trauma. 2003;54(3):562-8.

David P, Hotckiss Robert N, Wolfe WC, et al. Green’s Operative hand surgery. Third edition. Elsevier Churchill Livingstone; 2005: 1735-1736

Toon CD, Lusuku C, Ramamoorthy R, Davidson BR, Gurusamy KS. Early versus delayed dressing removal after primary closure of clean and clean-contaminated surgical wounds. Cochrane Database Syst Rev. 2015;9:CD010259.

Lee KT, Pyon JK, Lim SY, Mun GH, Oh KS, Bang SI. Negative-pressure wound dressings to secure split-thickness skin grafts in the perineum. Int Wound J. 2014;11(2):223-7.

Malone PR, Thomas JS, Blick C. A tie-over dressing for graft application in distal penectomy and glans resurfacing: the TODGA technique. BJU Int. 2011;107(5):836-40.