Use of a Collagen/Oxidized Regenerative Cellulose Dressing for Split-thickness Skin Graft Donor Site to Reduce Pain and Bleeding Complications

Background: Split-thickness skin grafts (STSG) are standard of care reconstructive procedures for trauma/burn-related skin loss, yet associated donor sites remain the most painful aspect of patients’ hospitalization. Donor site treatment variability persists per provider preference/dressing availability. Complications can necessitate early dressing changes, interrupting healing and intensifying discomfort. This study examined effects of applying collagen/oxidized regenerated cellulose (ORC)* to donor sites, hypothesizing opportunities for decreasing complications, reducing pain, and facilitating healing cost-effectively.

Methods: A retrospective review, 12/2015-07/2016, evolved into an IRB-approved multi-center prospective study, 05/2017-01/2020. Effects of collagen/ORC matrix when applied after hemostasis intraoperatively were evaluated on removal at day four-ten utilizing this methodology.

Results: Prospectively, thirty-nine patients were treated. Donor sites’ mean area was 123.8cm2. Thirty-five patients received anticoagulants. Utilizing the Numerical Rating Scale (NRS) and noninferiority +/-1, thirty-two patients (82.1%) described no pain increase during postoperative dressing removal, while seventeen of these patients (53.1%) rated pain “0” pre-, during, post-dressing changes. Healing, defined by epithelialization percentage, was >90% in twenty-six patients by their first dressing change. The retrospective arm consisted of six patients. Five patients (83.3%) described no pain increase during dressing removal while three (60%) rated pain “0” pre-, during, and post- dressing changes. Epithelialization was >90% in two patients at follow-up, five with subsequent visits were >95%. No retrospective/prospective patients required early dressing changes secondary to bleeding/leakage. Cost was < $30 for 123cm2. Our surgeons reported healing at least equivalent to other modalities. An unexpected secondary outcome was that comorbidities that typically impede wound healing did not have a negative effect.

Conclusion: The collagen/ORC matrix applied to STSG donor sites reduced bleeding complications and pain associated with dressing changes while promoting epithelialization economically in forty-five patients studied, despite comorbidities. Dressing changes were minimalized as dressing remained until at least day four. The Trauma department standardized this treatment hospital-wide as they believed this dressing improves outcomes.

Trademarked Items (if applicable): *Promogran ‚Ñ¢Matrix, 3M Acelity, Inc., San Antonio, Texas, USA

References (if applicable): 1. Brölmann FE, Eskes AM, Goslings JC, Niessen FB, de Bree R, Vahl AC, Pierik EG, Vermeulen H, Ubbink DT, REMBRANDT. Randomized clinical trial of donor-site wound dressings after split-skin grafting. Br J Surg. 2013 Apr;100(5):619-27.
2. Dornseifer U, Lonic D, Gerstung TI, Herter F, Fichter AM, Holm C, Schuster T, Ninkovic M. The ideal split-thickness skin graft donor-site dressing: a clinical comparative trial of a modified polyurethane dressing and aquacel. Plast Reconstr Surg. 2011 Oct;128(4):918-24.
3. Malpass KG, Snelling CF, Tron V. Comparison of donor-site healing under Xeroform and Jelonet dressings: unexpected findings. Plast Reconstr Surg. 2003;112(2):430.