Rahim Jindani1, Shiara M.
Ortiz-Pujols2, Carrie Nielsen2,
Bruce A. Cairns2, Martin W. King*1,
3
1College of Textiles, North Carolina State University,
Raleigh, NC, USA
2Department of Surgery, University of North Carolina
at Chapel Hill, Chapel Hill, NC, USA
3College of Textiles, Donghua University, Shanghai,
China.
ABSTRACT
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Objective: Split thickness skin grafts area common
reconstructive procedure for the management of deep burn injuries. The
management of donor sites, created after harvesting autografts,
presentshealthcare providers with a number of challenges, which need to
be addressed. A survey was conducted to find consensus amongst the
healthcare community regarding the management of donor site wounds.
Method: A survey was conducted at the Southern Burn Regional
Meeting in November 2012 to explore participants’ opinions about their
perceptions and management practices of donor sites.
Results: In total, 79 participants from 31 different burn
institutions from 14 states took part. Based on the answers to the
survey’s questions, an “ideal” donor site dressing should have the
following properties: the ability to alleviate pain, be antibacterial,
be non-adhesive, be hemostatic and be able to prevent wound desiccation.
In addition, ease of removal, minimal care, and the dressing’s ability
to drain exudate were considered additional requirements. The results of
the survey revealed that the most commonly used donor site dressings
were Aquacel Ag® and Mapilex Ag®.
Conclusion: This survey provides insight into the desired
properties for an ”ideal” donor site dressing, and the need to reduce
and/or alleviate pain was clearly articulated as the number one
priority. To date, no wound care product has been developed that is
designed to reduce or eliminate donor site pain. Future developments in
donor site wound dressings need to focus on meeting these requirements
and the properties identified and prioritized by the above mentioned
survey questionnaire.
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Introduction
Debridement and split thickness skin grafts are routinely performed for
the management of deep burns and other non-healing wounds. The
management of donor sites created after harvesting an autograft, present
healthcare providers with a number of challenges, especially with
respect to controlling painand blood loss. To date, there is no standard
procedure or gold standard with respect to the management of donor sites
and current options do not appear to fully address these challenges.
Donor sites are often the most painful component of burn surgery. They
produce considerable amounts of exudate that necessitate daily dressing
changes, which in turn can contribute to an additional level of pain.
Failure to remove the exudate on a daily basis increases the risk of
bacterial infection at the site. There are several topical agents that
can be used to manage these sites; however all have associated adverse
effects that can make them less than optimal. For example,
Bacitracin/Neomycin ointments can cause contact dermatitis when exposed
to light [1-3].
Silver-based products have long been used for wound care because of
their antibacterial and medicinal properties. Otheroptions for the
management of donor sites include allografts and porcine-derived
xenografts[4]. Tissue engineered products,such as
Epicel®, AlloDerm®,
TransCyte™, and Dermagraft®, have
been developed that rely on epidermal cells or dermal progenitor cells
that have been cultured in a controlled environment [5, 6]. These
products support the healing process by providing a matrix to promote
the regeneration of dermal tissue.
In order to better understand current clinical practices used in the
treatment and management of donor site management, we conducted a survey
at the Southern Regional BurnConference held in Norfolk, VA between
November 16-18, 2012. The aim of the survey wasto identify the range of
different approaches as well as the preferred therapies used among burn
center personnel. It was also anticipated that key clinical problems and
challenges in the management of donor sites would be identified, which
would lead to the future development of new dressings that would better
address these issues.
Methods
In order to design the survey, first an in-depth literature search was
conducted to learn more about the reported issues and challenges
surrounding the management of donor sites, in order to design the
survey. The survey consisted of nine open-ended and closed questions and
the types of dressings used, if any, in the management of donor sites.
The Southern Regional Burn Conference was selected as the site for the
distribution of the survey since it is the largest regional meeting of
its kind in the USA, attracting participants from 31 burn centers in 14
states, ranging from Washington, DC to Florida and as far west as Texas.
There were no incentives offered or rewards given for completion of the
survey. Prior to administering the questionnaire it was reviewed and
approved by the Institutional Review Board at the University of North
Carolina - Chapel Hill.
Survey
The survey questions were developed taking into consideration some of
the topics raised in a previous questionnaire that was developed to
understand the characteristics of an ideal burn wound dressing and the
problems associated with donor sites for various skin types [7]. The
questions aimed at exploring different aspects of donor site therapy and
management, including what commercially available products are currently
being used and what other aspects of clinical care are considered
problematic. The questions were either multiple choice orinvolved
ranking on a scale of 1 (“most important”) to 5 (“not important”),
or they were open-ended questions that would provide more detailed
information.A hard copy of the survey was distributed to each attendee
at one of the sessions of the conference, and the participants were
given as much time as they needed to provide independent answers to the
questions before handing in their completed questionnaire.