Randomized clinical trial of donor-site wound dressings after split-skin grafting

Background The aim was to study which dressing material was best for healing donor-site wounds (DSWs) after split-skin grafting as there is wide variation in existing methods, ranging from classical gauze dressings to modern silicone dressings. Methods This 14-centre, six-armed randomized clinical trial (stratified by centre) compared six wound dressing materials in adult patients with DSWs larger than 10 cm2. Primary outcomes were time to complete re-epithelialization and pain scores measured on a visual analogue scale (VAS) over 4 weeks. Secondary outcomes included itching (VAS, over 4 weeks), adverse events and scarring after 12 weeks rated using the Patient and Observer Scar Assessment Scale (POSAS). Results Between October 2009 and December 2011, 289 patients were randomized (of whom 288 were analysed) to either alginate (45), film (49), gauze (50), hydrocolloid (49), hydrofibre (47) or silicone (48) dressings. Time to complete re-epithelialization using hydrocolloid dressings was 7 days shorter than when any other dressing was used (median 16 versus 23 days; P < 0 center dot 001). Overall pain scores were low, and slightly lower with use of film dressings (P = 0 center dot 038). The infection rate among patients treated with gauze was twice as high as in those who had other dressings (18 versus 7 center dot 6 per cent; relative risk 2 center dot 38, 95 per cent confidence interval 1 center dot 14 to 4 center dot 99). Patients who had a film dressing were least satisfied with overall scar quality. Conclusion This trial showed that use of hydrocolloid dressings led to the speediest healing of DSWs. Gauze dressing should be discontinued as they caused more infections. Registration number: NTR1849 (http://www.trialregister.nl).