Key messages
- We do not know if hydrogel dressings (designed to keep wounds moist) are better than other dressings for helping donor site wounds to heal after split-thickness skin grafts (skin taken from another part of the body).
- We did not find any studies comparing hydrogel dressings with creams, ointments, or other solutions applied directly to the wound.
- More and better designed studies are needed to answer this question.
What are donor site wounds and split-thickness skin grafts?
Donor site wounds result from removing part of the skin from a healthy, unaffected region and transferring it to help heal areas with damaged or lost skin. These wounds are a result of a standard surgical procedure called skin grafting. A partial or split-thickness skin graft is a thin layer of skin shaved from an area such as the thigh and buttocks, that usually heals well in about two weeks.
Which dressings are used on donor site wounds?
Dressings to cover donor site wounds vary considerably regarding how they work, their cost, and ease of application. Hydrogel dressings are made of natural or synthetic materials that allow oxygen and nutrients to pass through them. They provide a moist environment for healing, which may prevent the dressing from sticking to the wound, causing further damage. They do not need to be changed as frequently as other dressings and are often used on wounds that are slow to heal or that require a lot of moisture to promote healing, such as burns. There are many other types of dressings including paraffin gauze, absorbent dressings, hydrocolloid, and antimicrobial impregnated dressings.
What did we want to find out?
We wanted to find out if hydrogel dressings effectively help heal donor site wounds after partial skin grafts. We were particularly interested in investigating the effects of different types of dressings on donor site wounds of split thickness skin grafts.
What did we do?
We searched for studies that compared hydrogel dressings with other treatments for healing donor site wounds after partial skin grafts. We analysed the results and rated our confidence in the combined evidence based on the size and quality of the included studies.
What did we find?
We found two studies with 162 participants.
- One study with 101 participants was conducted at a children’s burns unit and compared a hydrogel dressing (gauze mesh coated with hydrogel) with an alginate (algae- or seaweed-based) dressing or Cuticerin (a smooth acetate gauze impregnated with water-repellent ointment).
- The second study, with 61 participants, took place in three surgery departments and compared a hydrogel dressing that contained an antiseptic (octenidine - to reduce the chance of infection) with a dressing with no octenidine.
We did not find any studies that compared hydrogel dressings with treatments directly applied to the wound (like creams or ointments).
People in the studies were chosen randomly to receive treatment with hydrogel dressings or another dressing.
Main results
Hydrogel dressings versus other types of dressings
Hydrogel dressings may increase time to wound healing by about 1.7 days compared with alginate (1 study, 69 participants) or Cuticerin dressings (1 study 68 participants). We are not sure about the results for hydrogel dressings compared with other dressings for pain at the donor site and wound complications, including scarring and itching. The study did not report health‐related quality of life or wound infection and did not report any unwanted effects of the dressings.
Octenidine-based hydrogel dressing versus octenidine-free hydrogel dressing
We are unsure of the effect of octenidine-based hydrogel dressings versus octenidine-free hydrogel dressings for time to wound healing, wound infection and unwanted effects. The study did not report donor site pain, health‐related quality of life, or wound complications.
Limitations of the evidence
Our confidence in the evidence is limited because there are not enough studies to be certain about the results of our outcomes. The studies were of poor quality and did not provide data about everything that we were interested in.
How up-to-date is this evidence?
The evidence is up-to-date to 20 July 2022.
There is insufficient evidence to determine the effect of hydrogel dressings on donor site wounds of split thickness skin grafts compared with other types of dressings. There is a need for adequately powered and well-designed RCTs, with adequate sample sizes, types of populations and subgroups, types of interventions, and outcomes, that compare hydrogel dressings with other treatment options in the treatment of donor site wounds of split-thickness skin grafts.
Donor site wounds of split-thickness skin grafts can be a major cause of morbidity. Choosing the appropriate dressing for these wounds is crucial to successful healing. Various types of dressing are available, including hydrogel dressings. A review of current evidence is required to guide clinical decision-making on the choice of dressing for the treatment of donor sites of split-thickness skin grafts.
To assess the effects of hydrogel dressings on donor site wounds following split-thickness skin grafts for wound healing.
In July 2022 we searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL EBSCO Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta‐analyses, and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication, or study setting.
Randomised controlled trials (RCTs) comparing hydrogel dressings with other types of dressing, topical treatments or no dressing, or with different types of hydrogel dressings in managing donor site wounds irrespective of language and publication status.
Two review authors independently carried out data extraction, risk of bias assessment using the Cochrane risk of bias tool, RoB 1, and quality assessment according to GRADE methodology.
We included two studies (162 participants) in this review. One study with three arms and 101 participants (15 months' duration) was conducted in a children's hospital, and compared hydrogel dressings in the form of Sorbact with Algisite, an alginate dressing and Cuticerin, a smooth acetate gauze impregnated with water-repellent ointment. Another study with two arms and 61 participants (19 months' duration) was conducted in three surgery departments and compared an octenidine-containing hydrogel dressing with an identical non-antimicrobial hydrogel dressing. We identified no studies that compared hydrogel dressings with another therapy such as a topical agent (a topical agent is a cream, an ointment or a solution that is applied directly to the wound), or no dressing, or a combination of hydrogel dressings and another therapy versus another therapy alone. Both studies were at high risk of attrition bias and the second study was also at unclear risk of selection bias.
Amorphous hydrogel dressings versus other types of dressings
Amorphous hydrogel dressings may increase time to wound healing when compared with alginate (mean difference (MD) 1.67 days, 95% confidence interval (CI) 0.56 to 2.78; 1 study, 69 participants; low-certainty evidence) or Cuticerin dressings (MD 1.67 days, 95% CI 0.55 to 2.79; 1 study, 68 participants; low-certainty evidence). The effect of amorphous hydrogel dressings compared with other types of dressings is uncertain for pain at the donor site and wound complications, including scarring and itching (very low-certainty evidence). No adverse events were reported in any of the groups. The study did not report health‐related quality of life or wound infection.
Octenidine-based hydrogel dressing versus octenidine-free hydrogel dressing
The effect of octenidine-based hydrogel dressings versus octenidine-free hydrogel dressings is uncertain for time to wound healing (MD 0.40, 95% CI 0.28 to 0.52; 1 study, 41 participants) and wound infection, as the certainty of the evidence is very low. The certainty of the evidence is also very low for adverse events, with two participants in the intervention group and one participant in the comparison group reporting adverse events (risk ratio (RR) 0.58, 95% CI 0.06 to 5.89; 1 study, 41 participants). The study did not report donor site pain, health‐related quality of life, or wound complications.