Lisiecki J L, Buta M R, Taylor S, Tait M, Farina N, Levin J, Schulz J, Sangji N, Friedstat J, Hemmila M R, Wang S, Levi B, Goverman J
Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
Ann Burns Fire Disasters. 2023 Sep 30;36(3):243-250. eCollection 2023 Sep.
Autografting with split-thickness skin grafts (STSG) remains an essential procedure in burn and reconstructive surgery. The process of harvesting STSG, however, leaves behind a donor site, an exposed area of partial-thickness dermis left to heal by secondary intention. There has yet to be a consensus amongst surgeons regarding optimal management of the donor site. The ideal donor site dressing is one that allows for expeditious healing while minimizing pain and infection. Despite numerous studies demonstrating the superiority of moist wound healing, many surgeons continue to treat STSG donor sites dry, with petroleum-based gauze. In this study, two burn centers performed a retrospective review of burn patients whose STSG donor sites were treated with either Xeroform or Mepilex Ag dressings. Infections were documented and in a subgroup analysis of patients, postoperative pain scores were noted and total opiate usage during hospitalization was calculated. Analysis revealed an overall infection rate of 1.2% in the Mepilex Ag group and 11.4% in the Xeroform group (p<0.0001). Patients with Xeroform donor site dressings had increased odds of donor site infection (OR=10.8, p=0.002). In subgroup analysis, there were no significant differences in maximum pain scores between Mepilex Ag and Xeroform groups, nor were there differences in opiate usage. STSG donor sites dressed with silver foam dressings have a lower rate of donor site infection relative to those dressed with petroleum-based gauze. Moist donor site dressings such as foam dressings (including Mepilex Ag) should be the standard of care in STSG donor site wound care.
自体移植中厚皮片（STSG）仍然是烧伤和重建手术中的一项重要手术。然而，采集STSG的过程会留下供皮区，即部分厚度真皮的暴露区域，需通过二期愈合来愈合。外科医生对于供皮区的最佳处理方法尚未达成共识。理想的供皮区敷料应能促进快速愈合，同时将疼痛和感染降至最低。尽管众多研究表明湿性伤口愈合具有优越性，但许多外科医生仍继续使用凡士林纱布对STSG供皮区进行干性处理。在本研究中，两个烧伤中心对接受Xeroform或Mepilex Ag敷料治疗的STSG供皮区烧伤患者进行了回顾性研究。记录感染情况，并在患者亚组分析中记录术后疼痛评分，计算住院期间的总阿片类药物使用量。分析显示，Mepilex Ag组的总体感染率为1.2%，Xeroform组为11.4%（p<0.0001）。使用Xeroform供皮区敷料的患者发生供皮区感染的几率更高（OR=10.8，p=0.002）。在亚组分析中，Mepilex Ag组和Xeroform组之间的最大疼痛评分无显著差异，阿片类药物使用量也无差异。与使用凡士林纱布的供皮区相比，使用银泡沫敷料的STSG供皮区感染率更低。湿性供皮区敷料，如泡沫敷料（包括Mepilex Ag）应成为STSG供皮区伤口护理的标准治疗方法。
