Mepilex Ag versus Xeroform as Dressings for Split-Thickness Skin Graft Donor Sites
Sarah Taylor, MSN, Margaret Tait, BS, Stewart Wang, MD, PhD, Benjamin Levi, MD, Jeffrey Lisiecki, MD.
University of Michigan, Ann Arbor, MI, USA.
Purpose: Split-thickness skin grafting (STSG) is one of the most common procedures in reconstructive and burn surgery; the optimal management of the donor site remains a source of debate and inconsistency in the care of these patients. The optimal donor site dressing is one that minimizes pain and the risk of infection. In this study, we aim to compare postoperative pain and the rate of donor site infection between bismuth tribromophenate gauze (Xeroform) dressings and silver-impregnated foam dressings (Mepilex Ag, Mölylnke, Gothenburg, Sweden) for STSG donor sites in burn patients.
Methods: We performed retrospective chart review of 212 patients with burn injuries treated in our burn unit in 2017. Patients who underwent debridement and autografting with STSG were classified by donor site dressing type (either Xeroform or Mepilex Ag). Infections were documented by clinical assessment and managed appropriately when noted. Maximum pain scores on postoperative days 1, 3, and 5 were recorded, using a patient-reported 10-point scale (pain scores for children under age 7 were recorded using FLACC scores). Univariate statistics were used to compare groups, and Barnard's unconditional test was performed to compare the incidence of donor site infection between the groups.
Results: There were eighty-six cases of autografting with STSG. Of these, 37 had donor sites dressed with Mepilex Ag (43%), while 49 had donor sites dressed with Xeroform (57%). No infections were observed in donor sites dressed with Mepilex Ag (0%); five patients with Xeroform on their donor sites developed donor site infection (10%, p=0.03). There were no significant differences in maximum pain scores between Mepilex Ag and Xeroform groups on postoperative days 1, 3, and 5 (7.00 vs. 6.76, p=0.69; 6.30 vs. 6.15, p=0.81; and 5.71 vs. 5.81, p=0.89). Patients in the Mepilex Ag and Xeroform groups were similar in age, gender and length of stay (LOS). The Mepilex Ag group had somewhat lower percent total body surface area (TBSA) burned (6.8% vs. 10.4%, p=0.03). There were no significant differences in age, gender, LOS, percent TBSA, or pain scores in those who had infections and those who did not.
Conclusions: Donor sites dressed with Mepilex Ag have a lower rate of donor site infection relative to those dressed with Xeroform in burn patients undergoing autografting with split-thickness skin grafts, though maximum pain scores on postoperative days 1, 3, and 5 remain similar.
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