522 Skin Graft Donor-site Morbidity: A Systematic Literature Review
Bibliographic record
Abstract
Abstract Introduction Although split-thickness skin grafts (STSGs) are part of standard treatment for burn, traumatic, and chronic wounds, the harvesting of STSGs creates iatrogenic injuries at the donor sites. This review summarizes the scientific literature on morbidity associated with STSG donor sites. Methods A systematic literature search from 2014 to 2019 was performed in MEDLINE, Embase, and Chemical Abstracts to identify English-language articles reporting on the clinical-study findings, complications, management, financial burden, and patient-reported outcomes pertaining to STSG donor sites. Results Of 1426 articles identified, 44 met eligibility criteria and were included in the analysis. Most studies (n=31; randomized controlled trials [RCTs], n=26; observational studies, n=5) compared the outcomes of donor-site wounds that were treated with different dressings. Several studies (n=9; RCTs, n=5; observational studies, n=4) evaluated new agents or methods to improve donor-site outcomes. Only 3 studies focused on patient- or physician-reported outcomes. No studies reported on the length of hospital stay or the financial burden associated with donor-site wounds. Among the studies that indicated donor site location (n=34), the thigh was the most common. The most frequently reported donor-site outcome was the mean time to wound healing (n=21), which was 4.7±0.2 to 28.2±5.6 days. In some studies (n=13), the pain score assessed by visual analog scale (0–10 scoring, 0 being no pain and 10 being extreme pain) was 1.46 to 10.0 on postoperative day (POD) 1 and was 0.2 to 8.0 between POD 10 and 12. In a few studies (n=5), donor-site scar assessment using the Vancouver Scar Scale (0–13 scoring, 0 being normal skin and 13 being the worst scar) showed scores ranged from 0 to 10.9 at postoperative year 1. One study reported a 48.3% incidence of donor-site scar hypertrophy at 8 years. Infection rates were generally low but ranged from 0%-50%. Less frequently reported outcomes included pruritus, stiffness, and patient esthetic dissatisfaction. Conclusions This systemic literature search revealed a wide range of healing variation noted in STSG donor-site outcomes. Despite optimal wound care, donor sites required days to heal and were frequently associated with morbidities, including pain and scarring. Less frequently, donor sites were linked with severe morbidities, such as wound infection. Since majority of articles were RCTs with short follow-up, more research is warranted to assess the long-term outcome of hypertrophic scarring, another serious complication. These negative outcomes impose a substantial burden on patients and may impact their quality of life. Applicability of Research to Practice The elimination or reduction of STSG donor sites and their associated morbidity have long been identified by patients and providers as an unmet need deserving urgent attention.
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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 | 0.007 | 0.030 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.007 |
| Bibliometrics | 0.015 | 0.014 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
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".