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Skin Graft Fixation Using Hydrofiber (Aquacel® Extra)

Yen, Ya-Hui Msc*†; Lin, Chih-Ming MD; Hsu, Honda MBChB†‡; Chen, Ying-Chen BSc§; Chen, Yi-Wen BSc§; Li, Wan-Yu BSc§; Hsieh, Chia-Nan BSc§; Huang, Chieh-Chi MD†‡

doi: 10.1097/SAP.0000000000001432
Burn Surgery and Research

Background The traditional method of skin graft fixation is with tie-over bollus dressing. The use of splints in the extremities for skin graft fixation is a common practice. However, these splints are heavy and uncomfortable and contribute considerably to our overall medical waste. Hydrofiber (Aquacel® Extra) has a strong fluid absorption property and fixates well to the underlying wound once applied. In this study, we used hydrofiber for fixation, avoiding the use of splints after skin grafting.

Methods A total of 56 patients reconstructed with split-thickness skin graft that was fixated only with hydrofiber between March 2015 and March 2016 were included in this retrospective study.

Results There were 44 men and 12 women with a mean age of 61 ± 18 years. The defect size ranged from 1 × 1 cm for fingertips to 30 × 12 cm for lower limb defects. The average defect size was 61 ± 78 cm2. The mean skin graft take was 96% ± 6%. Because splints were not required, we saved around 48 kg of medical waste over the space of 1 year.

Conclusions The use of hydrofiber for skin graft fixation was effective and technically very simple. Splints were not required with this method, decreasing the medical waste created and increasing patient comfort. We suggest that this is an excellent alternative for skin graft fixation while at the same time decreasing our carbon footprint as surgeons.

From the *Department of Nursing, Taichung Tzu Chi Hospital, Taichung;

School of Medicine, Tzu Chi University, Hualien; and

Division of Plastic Surgery and

§Department of Nursing, Dalin Tzu Chi Hospital, Dalin, Taiwan.

Received October 21, 2017, and accepted for publication, after revision January 29, 2018.

Conflicts of interest and sources of funding: none declared.

This study received no external funding or support and the hydrofiber (Aquacel® Extra) dressing was obtained through the normal hospital purchasing system.

Reprints: Honda Hsu, MBChB, Dalin Tzu Chi Hospital, 2 Ming Sheng Rd, Dalin 622, Taiwan. E-mail:

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