PURPOSE: Proper wound care of the split-thickness skin graft donor sites is critical to reduce time to complete re-epithelialization, thus allowing for re-use of the donor site, and to prevent significant morbidity(1). Optimal donor-site dressings promote wound healing by preventing desiccation, removing excess exudate, allowing gaseous exchange, and accelerating re-epithelialization. Products for coverage of split thickness wounds can be loosely divided into occlusive/semi-occlusive vs non-occlusive. No large-scale studies have been performed to directly compare these classes of dressings, and smaller studies have shown no difference in infection rates(2). We used a semi-occlusive, flexible polyamide net coated with soft silicone dressing (Mepitel, Molnlycke Health Care Peachtree Corners, GA) and compared it to a non-occlusive, bismuth impregnated dressing (Xeroform, McKesson 6555 State Hwy 161, Irving, TX) to assess any differences in pain, time to re-epithelialization, and infection rate. Our hypothesis is that these parameters do not significantly differ between these two options.
METHOD: This is a single-center, prospective study of 50 patients comparing Mepitel vs Xeroform donor site coverings. Patients with a donor site >8 cm were included based on fine point discrimination in adults for the posterolateral thigh averaging 3-4 cm(3). Patients under the age of 18, with chronic pain, or opioid addiction were excluded. For every patient, half of the donor site was covered with Mepitel and the other half with Xeroform. The primary outcomes were patient reported differences in pain sensation between the two dressings using a standardized pain scale questionnaire, infection prevalence, and percent of wound re-epithelialization. All were measured by an independently trained Burn provider on post-op days five and 12. Data was analyzed with an independent T-test.
RESULTS: Differences in patient reported pain sensation (on a scale of 0-10) between the Mepitel and Xeroform dressings were not significantly different on post-op days five (p= 0.554), or post-op day 12 (p= 0.917). Mean percent re-epithelialization of donor site wounds with Mepitel dressing on post-op day 5 and 12 were measured as 21.2% and 94.2%, respectively. Measurements for donor site wounds with Xeroform dressing were recorded as 22.1% and 89.2%, respectively. There was no significant difference in percent re-epithelialization between the two dressings on post-op day 5 (p= 0.960), or post-op day 12 (p= 0.561). No participants developed an infection over their clinical course.
CONCLUSION: Mepitel and Xeroform were comparable with regards to pain sensation, split-thickness skin graft donor site re-epithelialization, and wound infection rate.
REFERENCES:
1. McCain D, Sutherland S. Nursing essentials: skin grafts for patients with burns. Am J Nurs. 1998;98:34–38; quiz 39
2. Hassanpour SE, Moosavizadeh SM, Yavari M, Hallaj Mofrad HR, Fadaei A. Comparison of three different methods of dressing for partial thickness skin graft donor site. World J Plast Surg. 2013;2(1):26-32.
3. Michael F. Nolan, Limits of Two-point Discrimination Ability in the Lower Limb in Young Adult Men and Women, Physical Therapy, Volume 63, Issue 9, 1 September 1983, Pages 1424–1428, https://doi.org/10.1093/ptj/63.9.1424