Analysis of donor site healing following harvesting of split skin graft

AIM : To Study 1. The problems encountered during the process of donor site healing following harvesting of split skin grafts; Pain, Ambulation, Reepithelisation, Donor Site Infection. 2. Comparative study between Closed and Open dressing (Haemocoagulase + Collagen) for the skin graft donor site and its influence on the above factors associated with donor site healing MATERIALS AND METHODS: Closed dressing with sterile Vaseline gauze and Open dressing using Botroclot with sieved moist collagen were applied to two different subsets of 50 donor sites following Split Skin Grafts in each group (TOTAL -100) Inclusion Criteria: • All donor sites of the Split Skin Grafts • All patients were treated with vitamin and protein supplements and appropriate antibiotics. • Blood transfusion to keep Haemoglobin minimum at 10gm% Exclusion Criteria : Patients with Diabetes mellitus, Hypoproteinemia, Anemia were excluded from study. Large donor site raw areas were excluded from study in both groups. Factors Analysed: • Pain, • Early Ambulation, • Re epitheliation of the donor site wounds after 2 weeks, • Cost factor analysis, • Complications. Period of Study - November 2009 To January 2012. OBSERVATION AND RESULTS: PAIN: In our study, among the patients the who had the conventional donor site dressing with meshed Vaseline gauze had a median pain score of 5 observed in 23 patients. Minimum pain score in this group was 3 noted in 2 patients. Maximum pain score was 6 experienced in 4 patients. Pain score of 4 was noted in 21 patients. In comparision the Combination Dressing group with Haemocoagulase and Collagen Dressing had different results. The median pain score was 2 experienced in 27 patients. Minimum pain score was 1 noted in 6 patients. Maximum pain score noted in the collagen dressing group was 4 observed in 4 patients. The remaining 13 patients experienced a pain score of 3. Pain was drastically reduced in the Collagen Dressing patients. AMBULATION: Since the pain score was high in the closed dressing subset of patients, it limited their mobilization and 22 patients were ambulant only on postoperative day 3. Only 10 patients were ambulant on the 2nd post operative day. The remaining 18 patients ambulated well only on the 4th postoperative day. Due to the decreased pain in the collagen dressing for the donor site patients ambulated early and 27 patients were ambulant from 1 st postoperative day. Subsequently 21 patients were ambulant on 2nd post operative day. The remaining 2 patients ambulated on the 3rd postoperative day. Early ambulation was noted in the in patients with the collagen dressing RE EPITHELISATION: Donor site reepithelisation was assessed in the closed dressing by the loosening of the dressings average time taken for the donorsites to reepitheliase was 20 -23 days. Due to complications of donor site infection the donor site healing extended to 29 -31 days in about 6 patients. Donor site reepithelisation was noted between 15-17 days in the collagen dressing group. In 2 patients donor site healing was delayed to 21-23 days due to donor site infection which was treated by conservative methods due to the ease of inspection of donor site and had the advantage of early identification of donor site complications. In 1 patient there was displacement of collagen sheet from the donorsite and it was converted to closed dressing and excluded from study. The healing time noted in that patient was 23 days. COST FACTOR ANALYSIS: The cost for the conventional Closed Dressings was Rs .150 inclusive of the over padding needed in review period. The cost factor for application 25x40 cm Collagen Sheet to the donor site was Rs.450. DONOR SITE COMPLICATIONS: Infection Donor site infection was noted in 6 patients of the Closed Dressing group. It was managed with conservative dressings with Framycetin. Donor site dressings on periodic review showing excessive soakage with foul smell were opened end wound swabs taken Donor site infection noted in 2 patients in the Collagen Dressing group, conservative dressings done to treat with the infection in these patients. Collagen Displacement- 1 patient in the study group had shearing of collagen sheet when applied to donor site in the postoperative period. Wound was cleaned and Closed Dressing applied and patient was excluded from the study. CONCLUSION: Haemocoagulase with Collagen sheet application for donor site have the following advantages. • Less pain over the donor site compared to the conventional Closed Dressing with Vaseline gauze. • Early ambulation due to reduced pain after the application of Collagen Sheet to the donor site. • Reepithelisation complete for most patients and time of reepithelisation is similar to the standard expensive dressings for the donor site. • Inspection of the donor site wound can be done easily and complications can be recognized early. • A Comfortable Dressing due to the decreased bulk of dressing and ease to wear the garments over the dressing. • Less complications and better outcome compared to the conventional closed dressing