Skin grafting is a cornerstone of reconstructive surgery and remains one of the most effective methods for covering burns, traumatic wounds, chronic ulcers, and post-excisional soft tissue defects [1-3]. Among the available grafts, split-thickness skin grafts (STSGs), comprising the epidermis and a variable portion of the dermis, are most commonly used because they provide reliable graft take, cover large defects, and are associated with relatively low donor-site morbidity [4,5].

While successful graft uptake at the recipient site is the primary goal of surgery, healing of the donor site is equally important, as it significantly influences postoperative pain, mobility, hospital stay, cosmetic outcome, and patient satisfaction [6]. The donor site is essentially a superficial partial-thickness wound that heals through re-epithelialization from residual dermal appendages such as hair follicles and sweat glands. Under normal conditions, healing is usually completed within 10–21 days; however, it may be delayed by factors including advanced age, diabetes mellitus, poor nutritional status, smoking, graft thickness, donor site location, and postoperative wound care [7-10].

Delayed donor-site healing can result in pain, infection, prolonged wound discharge, pigmentation changes, hypertrophic scarring, and delayed recovery, emphasizing the importance of appropriate donor-site management [10]. Although conventional Vaseline (paraffin) gauze remains one of the most widely used dressings because of its low cost and easy availability, it is often associated with painful dressing changes, wound soakage, and slower healing [11]. Consequently, several advanced dressings have been introduced to create a moist wound environment, reduce pain, and promote faster epithelialization [12].

Collagen dressings provide a biological scaffold that supports cell migration, angiogenesis, and tissue repair, whereas haemocoagulase promotes rapid haemostasis by enhancing fibrin formation and reducing capillary bleeding [13]. Their combined use may improve donor-site healing by reducing pain, controlling wound exudate, and facilitating epithelialization [15-16]. Although newer approaches such as platelet-rich plasma, minced skin grafting, and modified harvesting techniques have shown promising results, no dressing has yet been established as the universal standard for donor-site care [17-18].

Given the continued lack of consensus, this study was undertaken to evaluate donor-site healing following split-thickness skin graft harvesting and to compare conventional Vaseline gauze dressing with a haemocoagulase-collagen composite dressing. The study assessed postoperative pain, wound soakage, re-epithelialization, and donor-site complications to determine whether the haemocoagulase-collagen dressing offers a clinical advantage over conventional management [19-20].

AIM AND OBJECTIVES

Aim

To evaluate Study of Donor Site Healing Following Harvesting of Split Skin Graft.

Objectives

• To compare donor site healing between patients treated with conventional Vaseline gauze dressing and those treated with haemocoagulase-collagen composite dressing following split-thickness skin graft harvesting.
• To assess postoperative donor site outcomes, including pain, wound soakage, re-epithelialization, and complications.
• To evaluate the patient- and procedure-related factors that influence donor site healing following split-thickness skin graft harvesting.

MATERIALS AND METHODS

Study Design

This was a prospective, hospital-based interventional study conducted to evaluate donor site healing following split-thickness skin graft (STSG) harvesting. The study compared two donor site dressing techniques to determine their effectiveness in promoting wound healing.

Study Setting

The study was carried out in the Department of General Surgery, Muzaffarnagar Medical College and Hospital, Muzaffarnagar, Uttar Pradesh.

Study Duration

The study was conducted over a period of 18 months, comprising 12 months of patient recruitment and data collection, followed by 6 months of data analysis and interpretation.

Study Population

The study included patients undergoing split-thickness skin graft harvesting for various surgical indications during the study period.

Sample Size and Sampling

A total of 60 patients were enrolled based on the average number of eligible cases treated at the institution over the preceding three years. Eligible patients who fulfilled the selection criteria were included using purposive sampling.

Study Groups

Participants were randomly allocated into two equal groups (30 patients each):

• Group A: Donor site dressed with conventional sterile Vaseline gauze.
• Group B: Donor site treated with 5–10 drops of topical haemocoagulase solution followed by application of a sterile moist collagen sheet.

Inclusion Criteria

Patients were included if they:

• Were 18–60 years of age.
• Underwent split-thickness skin graft harvesting.
• Had a donor site measuring approximately 10 × 10 cm to 25 × 40 cm.
• Provided written informed consent to participate in the study.

Exclusion Criteria

Patients were excluded if they had:

• Diabetes mellitus.
• Anaemia.
• Hypoproteinaemia.
• Donor site wounds larger than the predefined size.

Data Collection

Demographic details, clinical findings, operative details, and postoperative outcomes were recorded using a predesigned case record proforma. Patients were followed to assess donor site pain, wound soakage, re-epithelialization, and postoperative complications.

Statistical Analysis

Data were entered and analysed using SPSS version 20. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Comparisons between the two groups were performed using appropriate statistical tests. A p-value < 0.05 was considered statistically significant.

RESULTS

Age Distribution of Patients in the Two Study Groups

Table 1: Age Distribution of Patients in the Two Study Groups

Most patients in both groups were aged 31–40 years, comprising 46.67% of Group A and 43.33% of Group B. The 20–30 years age group was the next most common, followed by patients aged 41–50 years. Only one patient in Group A belonged to the 51–60 years age group, while no patients in Group B were in this age range. Overall, the age distribution was similar between the two groups, and the difference was not statistically significant (p = 0.6188), indicating that the groups were comparable with respect to age (Table 1).

Gender Distribution of Patients in the Two Study Groups

Table 2: Gender Distribution of Patients in the Two Study Groups

The gender distribution was comparable between the two study groups. In Group A, females slightly outnumbered males, accounting for 53.33% and 46.67% of patients, respectively. In Group B, males were more common than females (60.00% vs. 40.00%). However, this difference was not statistically significant (p = 0.3006), indicating that the two groups were well matched with respect to gender (Table 2).

Comparison of Mean Donor Site Area Between the Two Study Groups

Table 3: Comparison of Mean Donor Site Area Between the Two Study Groups

The mean donor site area was slightly larger in Group B (265.40 ± 76.56 cm²) than in Group A (246.43 ± 83.99 cm²). However, this difference was not statistically significant (p = 0.3725), indicating that the donor site areas were comparable between the two groups at baseline (Table 3).

Comparison of Visual Analogue Scale (VAS) Pain Score at 48 Hours Between the Two Study Groups

Table 4: Comparison of Visual Analogue Scale (VAS) Pain Score at 48 Hours Between the Two Study Groups

Patients in Group B experienced significantly less pain at 48 hours after surgery than those in Group A. The mean VAS score was 3.23 ± 1.71 in the haemocoagulase-collagen group compared with 4.33 ± 2.36 in the Vaseline gauze group. This difference was statistically significant (p = 0.0464), indicating that the haemocoagulase-collagen dressing provided better postoperative pain relief (Table 4).

Comparison of Ambulation Start Day Between the Two Study Groups

Table 5: Comparison of Ambulation Start Day Between the Two Study Groups

Patients in Group B began ambulation slightly earlier than those in Group A. The mean time to ambulation was 1.40 ± 0.49 days in the haemocoagulase-collagen group compared with 1.70 ± 0.69 days in the Vaseline gauze group. Although ambulation tended to occur earlier in Group B, the difference was not statistically significant (p = 0.0613), indicating comparable postoperative recovery between the two groups (Table 5).

Comparison of Time to Pain-Free Ambulation Between the Two Study Groups

Table 6: Comparison of Time to Pain-Free Ambulation Between the Two Study Groups

Patients treated with the haemocoagulase-collagen dressing achieved pain-free ambulation significantly earlier than those treated with conventional Vaseline gauze. The mean time to pain-free ambulation was 2.83 ± 1.10 days in Group B compared with 3.70 ± 1.22 days in Group A. This difference was statistically significant (p = 0.0060), suggesting that the haemocoagulase-collagen dressing facilitated earlier functional recovery following split-thickness skin graft harvesting (Table 6).

Comparison of Donor Site Re-epithelialization Status on Postoperative Day 15 Between the Two Study Groups

Table 7: Comparison of Donor Site Re-epithelialization Status on Postoperative Day 15 Between the Two Study Groups

By postoperative day 15, complete donor site re-epithelialization was observed in 70.00% of patients in Group B compared with 63.33% in Group A. The remaining patients showed partial re-epithelialization (30.00% in Group B and 36.67% in Group A). Although a greater proportion of patients in the haemocoagulase-collagen group achieved complete healing by day 15, the difference between the two groups was not statistically significant (p = 0.5838) (Table 7).

Comparison of Donor Site Re-epithelialization Status on Postoperative Day 21 Between the Two Study Groups

Table 8: Comparison of Donor Site Re-epithelialization Status on Postoperative Day 21 Between the Two Study Groups

Assessment of donor site healing on postoperative day 21 showed that the majority of patients in both groups had achieved complete re-epithelialization. Complete healing was observed in 80.00% of patients in Group A and 90.00% of patients in Group B, while partial re-epithelialization persisted in 20.00% and 10.00% of patients, respectively. Although the haemocoagulase-collagen group demonstrated a higher rate of complete healing, the difference was not statistically significant (p = 0.278), indicating comparable re-epithelialization outcomes between the two groups by day 21 (Table 8).

Comparison of Postoperative Donor Site Complications Between the Two Study Groups

Table 9: Comparison of Postoperative Donor Site Complications Between the Two Study Groups

Overall, postoperative donor site complications were less frequent in the haemocoagulase-collagen group than in the conventional Vaseline gauze group. Donor site infection occurred in 20.00% of patients in Group A and 10.00% in Group B; however, this difference was not statistically significant (p = 0.278). Mild wound soakage was significantly more common in Group A (20.00%) than in Group B (3.33%) (p = 0.0443). Delayed healing was observed in 10.00% of patients in Group A compared with 3.33% in Group B, although the difference was not statistically significant (p = 0.3006). These findings suggest that the haemocoagulase-collagen dressing was associated with fewer donor site complications, particularly a significant reduction in wound soakage (Table 9).

DISCUSSION

The present hospital-based interventional study demonstrated that topical haemocoagulase with a collagen sheet is an effective alternative to conventional Vaseline gauze dressing for split-thickness skin graft donor-site management. Both groups were comparable in terms of age, gender, and donor-site area, minimizing baseline bias and allowing a reliable comparison of postoperative outcomes. Unlike previous studies by Otene CI et al. [21] and Miyanaga T et al. [17], which included relatively older and predominantly male populations, the present study involved a younger and more gender-balanced cohort, enhancing the applicability of the findings.

One of the most important findings was the significant reduction in donor-site pain in the haemocoagulase group. Patients treated with haemocoagulase and collagen dressing had significantly lower VAS pain scores at 48 hours and achieved pain-free ambulation earlier than those receiving conventional Vaseline gauze. These findings indicate better postoperative comfort and faster functional recovery. Similar reviews by Asuku M et al. [22] have reported variable pain outcomes with different donor-site dressings; however, the present study demonstrates a clear analgesic advantage with haemocoagulase, likely due to improved haemostasis, reduced inflammation, and the protective properties of the collagen sheet.

Although the difference in the day of initial ambulation was not statistically significant, patients in the intervention group showed a trend toward earlier mobilization, while pain-free ambulation occurred significantly sooner. Earlier mobility is associated with improved functional recovery, fewer postoperative complications, and greater patient satisfaction, highlighting the clinical benefit of haemocoagulase dressing.

Both groups demonstrated progressive re-epithelialisation, with slightly higher healing rates in the haemocoagulase group by postoperative days 15 and 21, although the differences were not statistically significant. These findings are consistent with those of Asuku M et al. [22] and Wehrens KME et al. [23], who reported that while dressing materials may influence early wound conditions, biological factors also play an important role in epithelial regeneration. Thus, haemocoagulase improved patient comfort without compromising wound healing.

Postoperative complications were generally fewer in the haemocoagulase group, with significantly reduced wound soakage and numerically lower rates of infection and delayed healing. Reduced soakage decreases dressing changes, improves patient comfort, and simplifies postoperative wound care. Similar observations have been reported by Asuku M et al. [22] and Miyanaga T et al. [17], whereas Kuwabara K et al. [18] reported minimal donor-site complications with primary closure techniques, which differ from the open donor-site management evaluated in the present study.

The comparable donor-site areas in both groups further strengthen the study by eliminating wound size as a confounding factor. Similar findings by Jun D et al. [24] and Wehrens KME et al. [23] suggest that standardized wound care has a greater influence on healing than donor-site dimensions alone.

Overall, the present study demonstrates that topical haemocoagulase combined with collagen sheet dressing provides superior postoperative pain control, earlier pain-free ambulation, reduced wound soakage, and comparable wound healing compared with conventional Vaseline gauze dressing. These advantages may reduce analgesic requirements, improve patient comfort, facilitate rehabilitation, and simplify postoperative care, making haemocoagulase with collagen dressing a safe and effective option for routine donor-site management following split-thickness skin grafting.

CONCLUSION

The present study demonstrates that topical haemocoagulase with a collagen sheet is a superior donor-site dressing compared with conventional Vaseline gauze following split-thickness skin graft harvesting. It significantly reduces postoperative pain, promotes earlier pain-free ambulation, and minimizes wound soakage, thereby improving patient comfort and early functional recovery. While re-epithelialisation and postoperative complication rates remained comparable between the two groups, haemocoagulase provided a cleaner wound environment without compromising healing. Overall, these findings support haemocoagulase dressing as a safe, effective, and patient-friendly option for routine donor-site management.

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