Comments on “A systematic review of the scalp donor site for split-thickness skin grafting”

Abstract Introduction The scalp is an appealing donor site for split-thickness skin grafting (STSG) of burns due to its concealment upon hair regrowth and healing potential; however, it is often reserved for massive burns with limited donor sites. This study aims to understand scalp donor site (SDS) outcomes and complications to elucidate viability of the SDS as a first-line option for coverage of burns. Methods A systematic review across five databases was conducted. Original research reporting cohort outcomes of STSG coverage of burns using the SDS was included. Donor site healing time, graft thickness, graft take, and complications were analyzed. Thereafter, a retrospective chart review of patients who had SDS-STSGs for burns from 2010–2018 was done. Outcomes and complications were compared to non-SDS-STSGs (NSDS-STSGs) in criteria-matched controls. Results Systematic Review: 1489 articles were reviewed. 15 cohort studies met inclusion criteria, yielding 1761 patients who has SDS-STSG (mean age=17 yrs, mean TBSA=37%). Alopecia and folliculitis occurred in 5% and 3% of patients, respectively; folliculitis was associated with certain hair types. Other complications (eg. hypertrophic scarring, hair transfer) were seen in less than 1.5% of patients. Rapid donor site healing times (mean=8 days) and capacity for re-harvest (mean=2 harvests/patient) were noted. Retrospective Review: 30 patients underwent grafting with SDS-STSGs, 23 of whom also received NSDS-STSGs and were thus self-controls; criteria-matched controls were found for the remaining 7. Graft thickness and graft take did not differ between SDS and NSDS groups, while donor site healing time was faster for SDSs vs NSDSs (9 vs 11 days, p=0.02). SDS complications included: alopecia (n=2), delayed healing (3), and folliculitis (1). NSDS complications included: delayed healing (n=1), dyspigmentation (2), and hypertrophic scarring (3). These complications could not be attributed to age, ethnicity, graft thickness, number of graft harvests, comorbidity burden, TBSA, or inhalational injury status. Conclusions The scalp donor site may represent a viable first-line option for split-thickness skin grafting of burns. Our cohort suggests that scalp donor sites pose comparable risks to non-scalp donor sites. Further studies elucidating the role of hair type in SDS-STSG complications are required to optimize outcomes with patient-specific donor site selection. Applicability of Research to Practice In select patients, the scalp may be considered as a first-line donor site for split-thickness skin grafting of burns, with potentially faster donor site healing time and comparable risks to non-scalp donor sites. Some scalp-specific complications may be linked to differences in hair type.

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Minced skin grafting for promoting epithelialization of the donor site after split-thickness skin grafting

Burns ◽

10.1016/j.burns.2016.10.011 ◽

2017 ◽

Vol 43 (4) ◽

pp. 819-823 ◽

Cited By ~ 5

Author(s):

Toru Miyanaga ◽

Yasuo Haseda ◽

Akihiko Sakagami

Keyword(s):

Donor Site ◽

Skin Grafting ◽

Thickness Skin ◽

Split Thickness Skin Grafting

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A systematic review of the scalp donor site for split-thickness skin grafting

Archives of Plastic Surgery ◽

10.5999/aps.2020.00479 ◽

2020 ◽

Vol 47 (6) ◽

pp. 528-534

Author(s):

Suk Joon Oh

Keyword(s):

Donor Site ◽

Age Distribution ◽

Total Body Surface Area ◽

Skin Grafting ◽

Late Complications ◽

Total Rate ◽

Thickness Skin ◽

Pubmed Database ◽

Split Thickness Skin Grafting ◽

Scalp Skin

Split-thickness skin grafting (STSG) is the gold standard for coverage of acute burns and reconstructive wounds. However, the choice of the donor site for STSG varies among surgeons, and the scalp represents a relatively under-utilized donor site. Understanding the validity of potential risks will assist in optimizing wound management. A comprehensive literature search was conducted of the PubMed database to identify studies evaluating scalp skin grafting in human subjects published between January 1, 1964 and December 31, 2019. Data were collected on early and late complications at the scalp donor site. In total, 27 articles comparing scalp donor site complications were included. The selected studies included analyses of acute burn patients only (21 of 27 articles), mean total body surface area (20 of 27), age distribution (22 of 27), sex (12 of 27), ethnicity (5 of 27), tumescent technique (21 of 27), depth setting of the dermatome (24 of 27), number of harvests (20 of 27), mean days of epithelization (18 of 27), and early and late complications (27 of 27). The total rate of early complications was 3.82% (117 of 3,062 patients). The total rate of late complications was 5.19% (159 of 3,062 patients). The literature on scalp skin grafting has not yet identified an ideal surgical technique for preventing donor site complications. Although scalp skin grafting provided superior outcomes with fewer donor site complications, there continues to be a lack of standardization. The use of scalp donor sites for STSG can prevent early and late complications if proper surgical planning, procedures, and postoperative care are performed.

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Comparison of the effectiveness of Ropivacaine soaked vs bupivacaine soaked dressing for pain relief at split thickness skin graft donor site.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.09.4585 ◽

2020 ◽

Vol 27 (09) ◽

pp. 1952-1957

Author(s):

Abdul Malik Mujahid ◽

Farrukh Aslam Khalid ◽

Kashif Mehmood Sheikh ◽

Muhammad Sheraz Raza ◽

Husnain Khan ◽

...

Keyword(s):

Pain Relief ◽

Rating Scale ◽

Donor Site ◽

Skin Grafting ◽

Tissue Loss ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Group A ◽

The Mean ◽

Group B

Objectives: To compare the mean pain score of ropivacaine soaked dressing versus bupivacaine-soaked dressing for pain relief at the donor site among patients requiring split thickness skin grafting after burns and tissue loss. Study Design: (RCT) Randomized control trial. Setting: Department of Plastic Surgery Jinnah Burn and Reconstructive Surgery Center Lahore. Period: January 1, 2019 to June 31, 2019. Material & Methods: Total 120 patients meeting the inclusion criteria were enrolled and divided randomly into Group-A and Group-B based on lottery method. Group A was dressed with ropivacaine soaked dressing while group-B with bupivacaine-soaked dressing. Patients were asked about pain four hours after the dressing using the verbal rating scale of 0-10. Result: Total 120 patients were included and randomly divided in to two groups. The mean age of ropivacaine group (Group A) patients was 40.82±13.20 years and bupivacaine group (Group-B) patients was 39.70±12.20 years. 56(46.67%) patients were males and 64(53.33%) patients were females. Male to female ratio was 0.8:1. The mean size of the defect for Group-A patients was 10.43±2.92 and Group B patients was 10.13±2.91. The Mean Visual Rating Scale (VRS) at the baseline for ropivacaine was 7.95 ± 1.04 and for bupivacaine was 8.0167 ±.791 (p =0.695) and VRS (verbal rating scale) at 4 hours of ropivacaine group patients was 1.27±1.13 and in bupivacaine group patients was 2.58±1.61. The statistically significant difference is found between the two study groups for VRS at 4 hours (p-value=0.001). Conclusion: Ropivacaine soaked dressing showed significantly better outcome than bupivacaine-soaked dressing at the donor site among patients requiring split thickness skin grafting after burns and tissue loss.

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Necrotising fasciitis—A rare complication of split-thickness skin graft donor area

Journal of Surgical Dermatology ◽

10.18282/jsd.v2.i3.141 ◽

2017 ◽

Vol 2 (3) ◽

Author(s):

Rahul Bamal ◽

Rakesh Kain

Keyword(s):

Rare Complication ◽

Donor Site ◽

Skin Grafting ◽

Necrotising Fasciitis ◽

Split Thickness Skin Graft ◽

Successful Management ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Donor Area ◽

Graft Donor

<p class="Default">Split-thickness skin grafting (STSG) is commonly used to cover raw areas of various aetiologies. Donor sites are known to get infected sometimes, but necrotising fasciitis is not often reported. We report here a case of donor-site necrotising fasciitis and its successful management. There is a need for surgeons to stay vigilant for this rare but probable complication of skin grafting.</p>

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Immediate regraft of the remnant skin on the donor site in split-thickness skin grafting

Archives of Craniofacial Surgery ◽

10.7181/acfs.2019.00150 ◽

2019 ◽

Vol 20 (2) ◽

pp. 94-100

Author(s):

Young Ji Park ◽

Woo Sang Ryu ◽

Jun Oh Kim ◽

Gyu Hyeon Kwon ◽

Jun Sik Kim ◽

...

Keyword(s):

Donor Site ◽

Skin Grafting ◽

Thickness Skin ◽

Split Thickness Skin Grafting

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Reducing split-thickness skin grafting donor site agony; faster healing and decreased pain-role of platelet-rich plasma

Asian Journal of Transfusion Science ◽

10.4103/ajts.ajts_39_17 ◽

2021 ◽

Vol 15 (2) ◽

pp. 195

Author(s):

GhisulalM Choudhary ◽

RakeshKumar Jain ◽

Gajendra Gupta ◽

AdityaN Patil ◽

GautamD Prakash ◽

...

Keyword(s):

Platelet Rich Plasma ◽

Donor Site ◽

Skin Grafting ◽

Thickness Skin ◽

Split Thickness Skin Grafting

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The reverse dorsal metacarpal artery flap in finger reconstruction: A reliable choice

Indian Journal of Plastic Surgery ◽

10.4103/ijps.ijps_37_17 ◽

2018 ◽

Vol 51 (01) ◽

pp. 054-059 ◽

Cited By ~ 2

Author(s):

Jyoshid R. Balan ◽

Shaji Mathew ◽

Pradeep Kumar ◽

Harsh Vardhan ◽

Anto Francis ◽

...

Keyword(s):

Road Traffic ◽

Donor Site ◽

Skin Grafting ◽

Associated Injuries ◽

Range Of Movement ◽

Flap Transfer ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Dorsal Metacarpal Artery ◽

Finger Skin

ABSTRACT Background: The finger skin and soft-tissue defects are reconstructive challenges due to their nature and the intricate extensor apparatus and flexors it protects. The reverse dorsal metacarpal artery (RDMA) is a time-tested option for the reconstruction of the same. Materials and Methods: A total of 14 cases of RDMA flap for finger defects involving proximal to distal phalanx were performed. Thirteen of these patients were male and one patient female and the most common mode of injury was occupational in nature followed by road traffic accident. The overall appearance was assessed for the flap and the donor site. The associated injuries and the range of motion were noted. Results: All but one flap survived completely. One patient had partial distal flap loss, which was tackled with split-thickness skin grafting. The flap size varied from 3.5 cm × 1.5 cm to 9 cm × 2 cm with mean of 6.64 cm × 1.72 cm. The mean age of the patients was 33.4 years. All the patients had acceptable aesthesis. The donor site had no complications and healed with linear scar. Conclusions: RDMA flap is a reliable flap for finger defects reconstruction. The range of movement mainly depends on the associated injury rather than flap transfer alone and to prove this we require doing analysis of range of movement in patients with flap done alone or with associated injuries.

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