Management of Pediatric Skin-Graft Donor Sites

Abstract

Skin grafts are used to treat many types of skin defects in children, including burns, traumatic wounds, and revision of scars. The objective of this prospective randomized controlled trial was to compare the effectiveness of three dressing types for pediatric donor sites: foam, hydrofiber, and calcium alginate. Children attending a pediatric Burns & Plastics Service from October 2010 to March 2013, who required a split-skin graft, were recruited to the trial. Patients were randomly assigned to the two experimental groups, foam or hydrofiber, and to the control group, calcium alginate. Data were gathered on the management of exudate, assessment of pain, time to healing, and infection. Fifty-seven children aged 1 to 16 years (mean = 4.9 years) were recruited to the trial. Fifty-six patients had evaluable data and one participant from the control group was lost to follow-up. Most children required skin grafting for a burn injury (78%). The median size of the donor site was 63.50 cm (8-600 cm). There was a statistically significant difference in time to healing across the three dressing groups (x [2, n = 56] = 6.59, P = .037). The calcium alginate group recorded a lower median value of days to healing (median = 7.5 days) compared to the other two groups, which recorded median values of 8 days (hydrofiber) and 9.5 days (foam). The greatest leakage of exudate, regardless of dressing type, occurred on day 2 after grafting. No statistically significant difference was found in leakage of exudate, pain scores, or infection rates across the three groups. Calcium alginate emerged as the optimum dressing for pediatric donor site healing in this trial.

Advances in keratinocyte delivery in burn wound care

“…Besides its widespread use in the food and paper-printing industry, it has gained much popularity as a biomaterial due to its non-immunogenicity, low cost, and simple gelation method. Alginate is FDA approved for medical applications and is commercially available as alginate based dressings such as Kaltostat® which are widely used in burn treatment [9] , [148] Alginate dressings are also commonly used for the coverage of donor sites post-skin harvest and has also been successful in the treatment of paediatric burn patients [149] .…”

Vitamin D and calcium signaling in epidermal stem cells and their regeneration

“…Improved wound healing of patients with diabetic foot ulcers with vitamin D supplementation compared to placebo is supported by a randomized clinical trial of oral vitamin D supplementation[ 37 ]. Likewise, calcium alginate dressings are superior to other wound care products[ 38 ] indicating the clinical role of calcium signaling in wound repair. Like vitamin D signaling, calcium signaling is expected to play an important role for activation, migration and differentiation of the SCs regenerating the epidermis.…”

Effectiveness of a Regenerative Epithelial Suspension (RES), on the pigmentation of split-thickness skin graft donor sites in children: the dRESsing pilot randomised controlled trial protocol

“…2 3 In the case of scar dyspigmentation, the spectrum of abnormal colour is either hyperpigmented, hypopigmented or dyschromic (hyperpigmented areas interspersed with hypopigmentation). 4 Of the numerous trials that have evaluated re-epithelialisation of paediatric STSG donor sites, [5][6][7][8][9] none have specifically focused on donor site dyspigmentation. As a result, current management options for donor site dyspigmentation are guided by treatments for scar dyspigmentation.…”