Download SPLIT-THICKNESS SKIN GRAFT DONOR SITES

Wound Management Guide
Update sheet
SPLIT-THICKNESS SKIN GRAFT DONOR SITES
Evidence Base for the use of Mefix on Donor Sites.
Skin rafting is one of the most commonly used techniques in plastic and reconstructive
surgery. Split-thickness skin grafts (SSG) contain the epidermis and a portion of the dermis.
They can be used to close any wound in the body that has a blood supply sufficient to support
the viability of the graft (recipient site)
Naturally the process of skin grafting involves the creation of a superficial wound that is the
donor site. When possible, grafts and removed from the inner aspect of the upper arm and
upper thigh, which leaves a less conspicuous scar, though they may also be harvested from
the buttocks or the abdomen.
Healing a donor site wounds is primarily through re-epithelialisation of the raw, exposed
dermis. Although classified as an epithelialising wound the donor site produces more fluid
than other superficial wounds. Epithelial cells in the hair follicles, sebaceous and sweat
glands migrate across the surface of the donor site and form a new layer of epithelium. This
process is completed in 10-21 days (Fowler and Dempsey, 1998)
Tulle dressings (jelonet, Bactigras) have been traditionally used, although they are said to be
semi-permeable and to have low adherence. Fowler & Dempsey (1998) suggest drying out
may cause dressing material to adhere to the wound surface and become incorporated into
the granulation tissue.
Alginates (Kaltostat) have also been standard dressings in plastic surgery for SSG donor sites
for many years. Giele et al (2001) examined the effectiveness, comparative comfort and ease
of care of alginates and adhesive retention tape (Mefix). Retention dressings were found to
be more comfortable; they also required less nursing care and attention. The retention
dressings allowed the patients’ more freedom of mobility and able to conduct a greater range
of daility activities, especially washing. There was no significant difference in wound healing
or in complications. They conducted adhesive retention tape applied directly to the split skin
graft donor site wound is an effective, cheap and comfortable dressing requiring little post
operative care.
The adhesive retention tape is applied directly to the donor site wound. The adhesive
adheres to the normal skin at the margins of the wound, but not to the moist wound itself.
This is the reason for ensuring that there is an overlap of tape of at least 2 cm around the
wound. The blood and exudates from the wound escape through the pores of the tape and
Are absorbed into the overlying gauze. When this ooze ceases, generally after 24 – 48
hours, the gauze can be easily removed leaving the tape adherent to the skin and donor site.
Post Operative Care
The primary dressing (mefix) must be left intact for 10 to 14 days. Secondary pressure
dressings may be removed after 48 hours and renewed if the wound continues to ooze.
Patients often find it more comfortable to elevate the donor site area.
The patient will require reassurance that wound odour at the donor site is due to stale blood
within the dressing as this cab be embarrassing and offensive. The adhesive is not water
soluble therefore patients are able to shower and bathe within an adhesive retention tape
dressing in place ensuring the dressing is dried thoroughly with a towel or left to air dry.
Only remove the dressing before the agreed date and change to an anti-microbial agent if
necessary.
The adhesive is oil soluble. Oil is therefore applied to the external surface of the dressing and
allowed to soak in. The dressing then generally easily lifts off, alternatively the dressing may
be left until it self seoarates.
After Care
The majority of donor sites should heal within minimal scarring or morbidity and no
impairment of sensation. After care information given to the patient should include protection
of the area from extremes of temperature, trauma and sun exposure and advice on
moisturizing the skin with non-perfumed, water based creams or oils to keep the donor site
scar soft and supple. Total sun block (factor 25 or higher) should be used if the newly healed
donor site is likely to be exposed to direct sunlight.
Conclusion
The George Elliot Hospital NHS Trust Plastic Surgery Unit use adhesive retention tape as the
dressing of choice for split-thickness skin graft donor sites. The evidence base supports this
as the ideal donor site dressing it optimizes wound healing, is cheap and easy to use.
Retention tape keeps pain levels to a minimum when compared with other donor site
dressings; it also causes minimal interference with the patient’s hygiene and mobility. Though
there are guidelines, which need to be followed for optimum benefit to the patient. Patients’,
carers and nursing staff need to be aware of the general do’s and do’nts when a donor site is
dressed with retention tape.
References
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Fowler A. and Dempsey A., (1998) Split-thickness skin graft donor sites. Journal of
wound care Sept 7, 8.
Gielle H, Tong A and Huddleston S., (2001) Adhesive retention dressings are more
comfortable that aiginate dressings on split skin graft donor sites – a randomized
controlled trial, Ann R Coll Surg Engl; 83; 431 – 434.
Gielle. H, (1997) Retention dressings on a new option for donor site dressings. Aust
Journal of Dermatology (Aug 38) 3.166.
Hormbrey E. Pandya and Gielle (2003) Adhesive retention dressing are more
comfortable than alginate dressings on split skin graft donor sites.
Kilinc, Sensoz, Osmedir (2001) Which dressing for split thickness skin graft donor
sites? Ann Plastic Surgery 46: 409.
Smith, J>W> and Aston, S.J. (1991) Grabb and Smith’s Plastic Surgery Fourth Edition,
Little Brown.
Young. T. and Fowler, A. (1998) Nursing Management of Skin Grafts and Donor Sites,
British Journal of Nursing, Vol 7, 6, 324-326.
Wound Management Guide
September 2005