State Adult Burns Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia.
Fiona Wood Foundation, Australia; University of Western Australia, Austraila.
Burns. 2024 Feb;50(1):41-51. doi: 10.1016/j.burns.2023.10.016. Epub 2023 Nov 2.
The split-thickness skin graft (STSG) donor site is the commonest used during burn surgery which has its own complications and as such the focus should be on minimizing it. Modifications to practice in our unit which we believe aid this include limiting the amount of STSG taken and the harvest of super-thin STSGs, with 0.003-0.005 in. (0.08-0.13 mm) being the commonest dermatome settings used. A patient-reported survey via a mobile phone link to a questionnaire was sent to 250 patients who had a STSG for an acute burn between 1st August 2020 and 31st July 2021. Patient demographics were collected from electronic records including the thickness of the FTSG taken when recorded. Patient responses were statistically analyzed and logistic regression with backwards elimination was performed to explore which contributing factors led to an improved experience of the donor site. Questionnaire responses were obtained from 107 patients (43%). These were between one and two and a half years after the injury. Concerning early donor site issues, itch was a problem for 52% of patients, pain was a problem for 48% of patients. Less common problems (fewer than 25% of patients) were leaking donor sites, wound breakdown, and over-granulation. Regarding long-term outcomes, increased, decreased or mixed pigmentation at the donor site was reported by 32% patients at the time of the survey. Hyper-vascular donor sites were reported by 24% patients. Raised or uneven feeling donor sites were reported by 19% patients, firm or stiff donor sites by 13% patients, and altered sensation by 10% patients. At the time of the survey, 70% responders reported their donor site looked "the same or about the same as my normal skin". Of these, 62 reported how long it took for this to happen, and it equates to a third looking normal at 6 months and half looking normal at a year. For the 32 patients who reported their donor site looking abnormal, 72% were "not bothered" by it. Patients with super-thin grafts (0.003-0.005 in.) were significantly more likely to have normal sensation, normal stiffness, and be less raised at their donor sites than those who had thin grafts (0.006-0.008 in.). This survey gives important information on patients' experiences of donor site morbidity that may form part of an informed consent process and allow tailored advice. Furthermore, it suggests that super-thin grafts may provide a superior donor site experience for patients.
供皮区是烧伤手术中最常使用的部位，它有自己的并发症，因此应重点尽量减少这些并发症。我们单位对实践的改进包括限制所取的刃厚皮片的数量和超薄刃厚皮片的采集，最常用的是 0.003-0.005 英寸（0.08-0.13 毫米）的取皮鼓。我们通过手机链接向 2020 年 8 月 1 日至 2021 年 7 月 31 日期间接受急性烧伤的 250 名患者发送了一份基于患者报告的调查问卷。从电子记录中收集了患者的人口统计学资料，包括记录的供皮区所取的全厚皮片的厚度。对患者的回复进行了统计学分析，并进行了向后消除的逻辑回归分析，以探讨哪些影响因素导致供皮区的体验得到改善。从 107 名患者（43%）处获得了调查问卷回复。这些患者在受伤后一到两年半的时间里进行了回复。关于早期供皮区的问题，瘙痒是 52%的患者的问题，疼痛是 48%的患者的问题。不太常见的问题（少于 25%的患者）是供皮区渗液、伤口破裂和过度肉芽形成。关于长期结果，在调查时，32%的患者报告供皮区的色素沉着增加、减少或混合。24%的患者报告供皮区血管增多。19%的患者报告供皮区感觉隆起或不平，13%的患者报告供皮区感觉坚硬或僵硬，10%的患者报告感觉改变。在调查时，70%的应答者报告他们的供皮区“看起来与正常皮肤相同或大致相同”。其中，62 名患者报告了这种情况需要多长时间才能发生，三分之一的患者在 6 个月时看起来正常，一半的患者在 1 年时看起来正常。对于报告供皮区外观异常的 32 名患者，72%的患者“不介意”。接受超薄移植（0.003-0.005 英寸）的患者在供皮区的感觉正常、硬度正常和隆起程度较低方面明显优于接受薄移植（0.006-0.008 英寸）的患者。这项调查提供了关于患者供皮区发病率的重要信息，这些信息可能构成知情同意过程的一部分，并允许提供有针对性的建议。此外，它表明超薄移植可能为患者提供更好的供皮区体验。
