Treating pain on skin graft donor sites: Review and clinical recommendations

Abstract

Split-thickness skin grafting (STSG) is the most common reconstructive procedure in managing burn injuries. Harvesting split-thickness skin creates a new partial thickness wound referred to as the donor site. Pain at the donor site is reported to be one of the most distressing symptoms during the early post-operative period. Here, we a) identify strategies for managing donor site pain, b) assess the quality of individual studies and c) formulate evidence-based recommendations based on the amount and consistency of evidence. Our analysis revealed five distinct approaches to minimize donor site pain. These include: continuous subcutaneous local anesthetic infusion (3 studies), subcutaneous anesthetic injection (5 studies), topical agents (6 studies), non-pharmacological interventions (3 studies), and wound dressings (18 studies). Available RCTs typically evaluated pain on standardized scales (i.e. Visual analog scale, numerical rating scale), and compared the experimental group with standard care. Recommended treatments include: a) subcutaneous anesthetic injection of adrenaline–lidocaine, b) ice application, c) topical agents such as lidocaine and bupivacaine, and d) hydrocolloid- and polyurethane-based wound dressings accompanied with fibrin sealant. Methodologically sound RCTs examining the efficacy of modified tumescent solution, ropivacaine, plasma therapy, noncontact ultrasound, and morphine gels are lacking and should be a priority for future research.