Management of Skin Donor Sites

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Definition: Skin donor sites are areas that have had split thickness skin grafts harvested for coverage of surgically-excised burn wounds. Depending on availability of donor sites, skin grafts are preferentially harvested away from the recipient sites. In patients with extensive wounds, donor and recipient sites may be in close proximity. The initial management of donor sites differs from graft recipient sites in that it is nearly always preferable for donor sites to keep their original operative dressings until complete donor site healing has occurred (several weeks) while graft recipient sites require dressing changes.

1. Donor skin harvest sites will be documented on the Burn Post-operative Dressing and Activities Instructions Sheet. The type of wound dressing material and the need for dressing changes will be noted by the surgical team and is dependent on the Burn Attending.
2. The following are indications the surgical team desires that wound care of new donor sites will differ from that of the other postoperative wound sites:
• Mepilex has been placed on the site. Mepilex is kept in place for 7 days, unless saturated and then can be changed out sooner. Kerlix should be removed at 24 hours to assess level of saturation and a burn net applied to keep dressing in place.
• Acticoat, Xeroform or other dressing material has been stapled around a site marked as a donor site on the post-op instruction sheet. (Occasionally, staples are used to keep recipient site dressings from shearing away from a skin graft site - these staples will typically be at the upper or outer edge of a large dressing and the staples will be more widely spaced).
3. Donor sites should be kept dry and open to air as much as possible. Post-operative Kerlix dressings should be removed on POD#1 in order to expose the donor site dressing material to air (xeroform or acticoat); the donor site dressing adherent to the wound should then be kept in place and compressed with Bandnet. If there is excessive exudate, a fresh Kerlix dressing can be put on for 12 -24 hours and then removed. Do not moisten donor Acticoat dressings unless there are specific orders by the surgical team.
   • Note: DO NOT REMOVE adhered xeroform unless noted by the burn attending.
4. If a portion of a donor site has become exposed due to slippage of the dressing material, a new piece of the dressing may be applied to the exposed portion of the donor site.
5. Tight adherence of the donor site dressing material to the wound bed is desired and shearing should be avoided. Poor adherence of the donor site dressing to the wound bed may indicate a wound infection.
6. Donor site dressing materials should become dry and hardened during the post-operative recovery period. If the material (Mepilex, Acticoat, Xeroform, etc) remains or becomes soft, a wound infection may be developing.

Increased pain, redness, swelling and drainage from the donor site are concerning for wound infection; the surgical team should be asked to evaluate.