106 Heads or Tails? Scalp versus Non-scalp Donor Sites for Split-thickness Skin Grafting of Burns: A Systematic Review and Retrospective Review
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.018 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.006 |
| Bibliometrics | 0.011 | 0.013 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".