see: Split Thickness Skin Graft

and: Case Example Split Thickness Skin Graft STSG Zimmer Dermatome

PURPOSE

1. To outline care of the transparent film dressing used in the treatment of split thickness skin graft donor sites.

EQUIPMENT

1. Fluid aspiration:
   1. 20-gauge sterile needle
   2. 20 cc sterile syringe
   3. Small piece of transparent film dressing
   4. Clean gloves
2. Changing transparent film:
   1. Sterile 4 x 4 gauze dressing
   2. Skin Prep
   3. Transparent film dressing (large enough to cover wound)
   4. Clean gloves

PROCEDURE

1. Postoperative Day 1:
   1. Wash hands.
   2. Put on clean gloves.
   3. Remove Ace wrap or gauze leaving transparent film in place.
   4. Position patient to facilitate dependent pooling of exudate.
   5. Assess need to aspirate fluid (when fluid accumulation is large enough to cause dressing to be tight or bulging in the dependent area).
   6. If aspiration is needed, refer to 3.a. of this procedure.
   7. If purulence or evidence of cellulitis of surrounding tissue is noted, notify the physician and obtain wound culture. Future dressings to be ordered per physician.
   8. Leave site without gauze or Ace wrap covering.
2. Subsequent postoperative days
   1. Every shift:
      1. Position patient to facilitate dependent pooling of exudate.
      2. Assess site for reaccumulation of fluid.
      3. If purulence or evidence of cellulitis of surrounding tissue is noted, notify physician and obtain wound culture. Future dressing to be ordered per physician.
   2. . Aspirate fluid accumulation as needed (ie, fluid accumulation is large enough to cause dressing to be tight or bulging in the dependent area).
3. Managing excessive fluid accumulation
   1. Fluid aspiration (aspirate fluid only as needed to keep dressing from leaking):
      1. Wash hands.
      2. Put on clean gloves.
      3. Position patient to facilitate dependent pooling of exudate.
      4. Aspirate accumulated fluid with needle and syringe.
      5. Patch needle hole with new piece of transparent film.
      6. Leave site without gauze or Ace wrap covering.
   2. Managing leakage (exudate may seep out of edges of transparent film dressing). If this occurs:
      1. Pat dressing and surrounding skin dry.
      2. Apply Skin Prep to skin surrounding leaking edge and allow to dry.
      3. Patch leaking edge with additional piece of transparent film.
   3. Changing transparent film dressing (if transparent film dressing becomes completely dislodged from donor site):
      1. Wash hands.
      2. Put on clean gloves.
      3. Gently pat donor site and surrounding skin dry with sterile 4 x 4 gauze.
      4. Apply Skin Prep to skin surrounding donor site and allow to dry.
      5. Place new piece of transparent film dressing on donor site. Transparent film dressing should be large enough to cover donor site with at least a 1 inch border of healthy intact skin surrounding donor site.

PRECAUTIONS, CONSIDERATIONS, AND OBSERVATIONS

1. Transparent film dressings are initially applied in the operating room and covered with gauze or Ace wrap to promote hemostasis and minimize exudate.
2. Do not remove transparent film unless a leak cannot be managed. Changing the transparent film dressing is associated with increased risk of infection.
3. The transparent film dressing should be removed 7 to 14 days after surgery. After removal, cleanse the site gently with saline solution and pat dry.
4. Aspirate exudate only when the volume is large enough to cause the dressing to be tight or bulging, which could lead to leaking. The presence of exudate is not harmful to the donor site. Exudate contains substances that promote wound healing.

REFERENCES

James JH, Watson ACH. The use of opsite, a vapor-permeable dressing, on skin graft donor sites. Br J Plas Surg. 1975;28:107-110.

Madden MR, Nolan E, Finkelstein, JL, Yurt RW, Smeland J, Goodwin CW, Hefton J, Staiano-Coico L. Comparison of an occlusive and a semi-occlusive dressing and the effect of the wound exudate upon keratinocyte proliferation. J Trauma. 1989;29:924-931.

Rakel B, Bermel M, Abbott L, Baumler S, Burger M, Dawson C, Heinle J, Ocheltree I. Split-thickness skin graft donor site care: a quantitative synthesis of the research. Appl Nurs Res. 1998;11:174-182.