Discussion
The data obtained through this survey has enabled us to identify and
report for the first time that pain is a real and practical challenge
associated with donor site wounds. Donor sites tend to be confused with
burn wounds and are thought to experience a similar healing phenomenon.
As a result, a number of dressings and living skin equivalent constructs
that are marketed for burn wounds are also used to treat donor site
wounds [9]. The healing of asplit skin graft donor site wound is
influenced by various factors such as the anatomical site and the method
of harvesting [8].Dressings developed for burn wounds require
antibacterial activity so as to reduce the incidence of infection. But
in the case ofdonor site wounds the risk of infectionis not the major
cause of a slower rate of healing. It is the sensation of pain, which
impairs and slows the healing of these donor sites.
The results of this survey have confirmed that pain is the greatest
challenge when dealing with donor site wounds. However, there are
fewclinical options availablethat have been developed to minimize pain.
Instead the developmentof dressings with antibacterial and hemostatic
properties appears to have taken priority.
The sensation of pain can affect all four phases of healing of acute and
chronic wounds starting with hemostasis, inflammation, proliferative,
and maturation or remodeling [8, 10- 13]. And the ability to
control, reduce and even eliminate pain depends on the treatment
protocol during each of these phases. It has been observed that the
severity and duration of the inflammatory response determines the
healing rate and the extent of scarring due to the release of cytokines
[13] that will vary depending on the size, depth, location, age,
etiology and other concomitant factors associated with the wound. It has
been reported in cases of skin tears and chronic wounds that the use of
moist dressings with, for example, hydrogels, that cover the wound
completely and exclude all air, are able to reduce the level of pain to
a significant extent [8, 10, 13]. The use of inherently porous
woven, knitted and foam structures that contain significant amounts of
air activate the nociceptors and live nerve endings and cause
significant amounts of pain.
Another important and desirable property that was identified by the
survey relates to the ease and pain free removal of a dressing. It has
been reported that if wounds become dry and scabs are formed, then
dressing removal is associated with pain and trauma unless saline is
utilized to assist in the removal of the dressing. Interestingly there
are a number of dressings that claim to reduce pain based on patients’
perceptions but there has been as yet no scientific measurement or
assessment of pain.
Further clinical trials and observations are needed in order to develop
a standard therapeutic procedure for the management of donor site
wounds.