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0007 1226 (86) 90124 4
0007 1226 (86) 90124 4
5 I &5 IX
{<“r1986 The Trustees of British Association of Plastic Surgeons
Summary-A prospective clinical trial has shown that systemic ethamsylate’ reduces the problems
with exudation sometimes seen when OpsiteZ is used as a dressing for split skin graft donor sites.
beneath it. Collections of 5 to 15 ml were aspirated. Table 1 The composition of the control and experi-
If the volume of fluid aspirated exceeded 15 ml then mental groups
an external dressing was applied for a further 24
hours. In those cases in which the fluid had tracked Control group E.rperimental group
and drained peripherally the site of the leak was
Number 25 2s
patched with Opsite or, if large areas of the Opsite Sex ratio (M/F) 1I!‘14 12113
had become detached, the Opsite was replaced Mean cr,qr 45y(range I6 71 y) 42y(range 17 79~)
before an external dressing was applied for a
further day.
The data collected from both groups were tested
statistically by the fourfold table variant of the Chi
squared test.
Table 2 Donor sites, donor site area and time until
donor site healing
Results
There was a complete absence of donor site pain in Conrrol E.xperimentul
both groups. In those patients where it was neces- group group
sary to change the Opsite, this caused only minor Donor sile.r
discomfort. Thigh 15 13
Statistically the groups were well matched for Upper arm 8 10
age and sex (Table 1) donor site and area (Table 2) Buttock 7
and the indications for skin grafting (Table 3). Donor site areu
With few exceptions the grafts were described as Mean (cm’) 207 200
being of medium thickness. Range (cm2) 7c250 50-250
In the control group 20 of the 25 patients had the Time until donor site healing
external dressing replaced at 48 hours and in the Mean (days) 13 13
Range (days) 8 30 l&40
majority this was due to the leakage of exudate
peripherally (Table 4); in 10 cases the external
dressing was replaced on more than one occasion.
In five cases enough of the Opsite had become
detached to merit it being changed: in two patients
this happened on three occasions and these Table 3 The indications for skin grafting
patients’ donor site dressings were converted to
Vaseline gauze, dry gauze, gamgee and crepe. Conlrol E.rperimental
In only 10 of the 25 patients in the experimental group group
No thrombotic complications were encountered the effect on donor site dressing maintenance,
in either group despite the fact that those with rather than an attempt to measure the volume of
thigh donor sites or lower leg grafts were generally exudate produced.
confined to bed for at least one week post-opera- Ethamsylate reduced but did not eliminate the
tively. problems which stimulated this paper. This is a pre-
viously untried solution to the problems, and the
encouraging early result suggests that it is worthy
Discussion of further consideration.
Opsite, an occlusive polyurethane sheet which is
permeable to water vapour, theoretically provides
conditions almost ideally suited to epidermat re- Acknowledgements
generation in split skin graft donor sites. Unfortu- We would like to thank the consultants who permitted their
nately problems with haemoserous exudate patients to be included in this study, the junior staff who
recorded the findings, and Dr C. C. M. Howie for her help and
gathering beneath the Opsite have prevented its
advice during the preliminary study.
adoption as the standard donor site dressing.
Ethamsylate is a synthetic non-hormonal agent
which reduces small vessel bleeding whilst showing References
no evidence of thrombogenic effect. Although
Bailey, A. J. M. and Taylor, W. (1984). ABPI Dafa Sheet Com-
patients with a history of thrombogenic disease
pendium 1984-85, Datapharm Publications Limited.
were deliberately excluded from this trial, it has Deacock, A. R. de C. and Birley, D. M. (1969). The anti-hae-
been used without ill effect in such patients (Bailey morrhagic activity of ethamsylate (Dicynene). Brifish Journal
and Taylor, 1984). ofdnaesthesia, 41. 18.
This controlled trial showed a statistically sig- James, J. H. and Watson, A. C. H. (1975). The use of Opsite, a
vapour permeable dressing, on skin graft donor sites. British
nificant reduction in the number of external dress- Journal of Plastic Surgery, 28, 107.
ing changes, Opsite patchings and Opsite changes Ramirez, 0. M., Granick, M. S. and Futrell, J. W. (1984). Opti-
in those given ethamsylate compared with the con- mal wound healing under Op-site dressing. Plusric and Recon-
trol group. Although it was impossible to quantify structive Surgery, 73,474.
the amount of exudate lost on to the external dress-
ings when leakage occurred, the results would im-
The Authors
ply that less exudate was produced in the treated
group. J. D. Richmond, FRCS(Ed), formerly Plastic Surgery Registrar.
A. B. Sutherland, MD, FRCS(Ed), Consultant Plastic Surgeon.
As far as we are aware this is the first report of Bangour General Hospital, West Lothian, EH52 6LR.
the use of an antihaemorrhagic agent to reduce the
amount of exudate originating from split skin graft Requests for reprints to: J. D. Richmond, Home Office,
donor sites. The study was organised to measure Rathcluan House. Cupar. Fife, Scotland.