A prospective trial comparing Biobrane, Duoderm and xeroform for skin graft donor sites

Many new dressings have been introduced for use on split-thickness skin graft donor sites in an effort to reduce pain at the donor site and decrease healing time, while maintaining a low infection rate and cost. To assess these factors in two such dressings, Biobrane (temporary wound dressing) (Winthrop) and Duoderm (hydrocolloid dressing) (Convatec), we compared them with a conventional fine mesh gauze dressing, xeroform, in a prospective, randomized study of 30 donor sites in the same number of patients. Wounds were considered healed when they were 100 per cent re-epithelialized and required no further dressings. Patient self-assessment of pain was quantified on a scale of zero to ten, with ten being the most severe pain. Donor sites dressed with xeroform had a healing time of 10.5 days, which was significantly better (p less than 0.05) than Duoderm (15.3 days) or Biobrane (19.0 days), although the protocol for Duoderm use (wound visualization at seven day intervals) extended the apparent healing times in this group. Duoderm was the most comfortable dressing (0.53 grade) when compared with Biobrane (1.44) and xeroform (2.41, p less than 0.05). No infections occurred in donor sites dressed with xeroform, but two developed in patients using Biobrane. One patient with a Duoderm dressing had a donor site infection during a drug-related neutropenic reaction. Xeroform was the least expensive dressing to use ($1.16 per patient), followed by Duoderm ($54.88 per patient) and Biobrane ($102.57 per patient). The results of our study confirm the usefulness of xeroform as a donor site dressing as it promotes relatively rapid healing, is easy to use and is inexpensive. We found Duoderm to be ideal for smaller donor sites when pain could be significantly reduced with minimal increase in cost. Biobrane is too costly and the infection rate too high for it to be used routinely as a skin graft donor site dressing.