RESUMO
The scalp has become a popular donor site for split-thickness skin grafts. This donor site does, however, have complications, including the concrete scalp deformity, which consists of hairs embedded in a thick, desiccated, exudative crust. This article presents our burn unit's experience with this complication. Fifty-six patients underwent scalp skin graft harvesting between 1984 and 1996. All grafts were quite thick and were used for resurfacing facial burns. Thirty-eight donor sites were treated with medicated gauze, and 18 were treated with the Unna cap, which is an Unna dressing applied over Aquaphor gauze (Beiersdorf, Norwalk, Conn). Eighteen of the 38 patients (32%) treated with medicated gauze developed the concrete scalp deformity. None of the patients treated with the Unna cap developed the deformity. Although useful, the deep scalp donor site has complications, including the concrete scalp deformity. However, with use of the Unna cap dressing, we have had no occurrences of this problem.
Assuntos
Bandagens , Queimaduras/cirurgia , Gelatina/farmacologia , Dermatoses do Couro Cabeludo/prevenção & controle , Couro Cabeludo/transplante , Transplante de Pele/efeitos adversos , Adolescente , Adulto , Criança , Pré-Escolar , Desbridamento , Feminino , Sobrevivência de Enxerto , Humanos , Lactente , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Couro Cabeludo/anormalidades , Dermatoses do Couro Cabeludo/terapia , Transplante de Pele/métodos , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/etiologia , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/etiologia , Doadores de Tecidos , Resultado do Tratamento , CicatrizaçãoRESUMO
Deep scalp donor sites can be difficult to manage because of the higher incidence of healing complications that can make daily wound care exquisitely painful. When faced with this problem, we prospectively studied the Unna "cap" dressing on the scalp. Group 1 received our standard treatment--Xeroform gauze (Sherwood Medical, St Louis, Mo) and daily wound care. Group 2 received the Unna cap--Aquaphor gauze (Beiersdorf, Norwalk, Conn) and Dome Paste gauze (Bayer Corp, West Haven, Conn) with wound care every 3 days. Pain, healing time, and costs were compared. Twelve patients between the age of 1 and 54 years were studied. A significant number of patients in Group 1 developed wound complications after initial healing, resulting in a longer length of stay and higher costs. Group 2 reported significantly less procedural pain, comparable healing (11 days +/- 2 SD), and fewer dressing changes, resulting in an institutional savings of $5.51 to $16.25 per patient up to postoperative day 13. This study supports use of the Unna cap as a less painful, safe, and cost-effective alternative to our standard deep scalp donor site dressing.