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Systematic Review of Skin Graft Donor-Site Dressings

Voineskos, Sophocles H. M.D.; Ayeni, Olubimpe A. M.D., M.P.H.; McKnight, Leslie M.Sc.; Thoma, Achilleas M.D., M.Sc.

Plastic & Reconstructive Surgery: July 2009 - Volume 124 - Issue 1 - pp 298-306
doi: 10.1097/PRS.0b013e3181a8072f
Special Topics: Outcomes Article
Discussion

Background: Debate continues about what split-thickness skin graft donor-site dressing provides the best outcomes for patients at the lowest cost. The goal of this systematic review was to determine which donor-site dressings are associated with the best outcomes for the following: pain, infection rate, healing quality, healing rate, quality of life, and cost.

Methods: A comprehensive literature review and assessment was undertaken by two independent reviewers. Articles were selected using specific inclusion criteria. Split-thickness skin graft donor-site dressings were classified as either moist or nonmoist based on the state of the dressing upon initial application. Methodological quality of randomized controlled trials was assessed using the Jadad scale.

Results: Seventy-five relevant articles were included in the final analysis, three of which were review articles. The most commonly measured outcome was healing rate (64 of 72), followed by pain (58 of 72), infection rate (40 of 72), healing quality (40 of 72), and cost (15 of 72). No studies measured quality of life. The majority of articles were randomized controlled trials (35 of 75), followed by observational studies (22 of 75), unsystematic clinical observations (15 of 75), and review articles (three of 75). It was difficult to compare moist and nonmoist dressings in this review because of the methodological heterogeneity of the included articles. The available evidence suggests, however, that moist dressings are superior in terms of pain.

Conclusions: Some weak evidence exists that supports “wet dressings.” To determine the best split-thickness skin graft donor-site dressing, more methodologically sound randomized controlled trials are needed. Trials with parallel economic evaluations should be undertaken to answer this question.

Hamilton, Ontario, Canada

From the Faculty of Health Sciences, Department of Clinical Epidemiology and Biostatistics, and Surgical Outcomes Research Center (SOURCE), McMaster University, and the Department of Surgery, Division of Plastic and Reconstructive Surgery, St. Joseph’s Healthcare.

Received for publication September 12, 2008; accepted January 26, 2009.

Presented at the 62nd Annual Meeting of the Canadian Society of Plastic Surgeons, in St. John’s, Newfoundland, June 24 to 28, 2008.

Disclosure:No funding was received for the preparation of this manuscript. None of the authors have a financial interest in any of the products or devices mentioned in this article.

Achilleas Thoma, M.D., M.Sc., 101-206 James Street South, Hamilton, Ontario, Canada L8P 3A9, athoma@mcmaster.ca

©2009American Society of Plastic Surgeons