Management of skin graft donor site in pediatric patients with tumescent technique and AQUACEL® Ag foam dressing

Abstract

Abstract Split thickness skin graft donor sites are challenging to manage in children because of patient fear and anxiety. Therefore, strategies that minimize the frequency of dressing change are beneficial. This paper describes a technique to simplify wound care for split thickness skin graft donor sites. A tumescent solution of saline containing 0.25% bupivacaine with epinephrine is infiltrated into the graft donor site. Skin grafts are harvested with an electric dermatome. The donor sites are dressed with AQUACEL® Ag Foam, which is a sodium carboxymethylcellulose hydrofiber dressing that contains silver ions. A total of 17 split thickness skin grafts were performed with this technique. Patient age ranged from 2.4 year to 16.9 years (average 12 years). The AQUACEL® Ag Foam dressings were removed at an average of 23 days (range 11 to 31 days) at which time complete donor site epithelialization was seen in 13/17 (76.5%) patients. The remaining 4 patients had < 5% of the donor site that had not epithelialized; these went on to heal uneventfully with a brief period of petrolatum gauze dressing changes. Two patients had foul smelling discharge under the dressing that resolved promptly with dressing removal. The above technique allows the primary dressing to stay in place long enough for epithelialization to take place. The obviation of dressing changes in the early post-operative period results in patient comfort and care giver convenience.