International Surgery Journal

Supreeth K et al. Int Surg J. 2025 May;12(5):729-736

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Original Research Article

A comparative study between hydrocolloid dressing and conventional

vaseline gauze dressing in healing of donor site wound in split skin graft
Supreeth K., Bhoomika R.*

Department of General Surgery, Kempegowda Institute of Medical Sciences & RI, Bangalore, Karnataka, India

Received: 16 March 2025

Revised: 16 April 2025
Accepted: 19 April 2025

*Correspondence:
Dr. Bhoomika R.,
E-mail: [email protected]

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: One of the frequently performed procedures by plastic surgeons, and general surgeons is skin graft. Pain
in the donor region is a typical patient complaint. Paraffin dressing usually covers the area of the skin graft donor
location. Split-skin grafting is commonly used by surgeons to treat skin abnormalities in the event of ulcers, deep burns
and subsequent trauma. Epidermis harvesting and upper 1/3rd of dermis resulting in a wound called donor site wound
(DSW) are needed for the technique of split-skin graft harvesting. These wounds pose a sort of burden to patients during
the procedure and after the wound healing process. These injuries tend to cause immense discomfort, are at risk of
infection, and may cause scratching of the patient (pruritus) and cosmetic inconvenience. Care and management of local
donor site wound (DSW) should aim to create an environment that promotes early epithelialization for the patient with
shortened hospital stay period with minimal pain and discomfort. This study was done to evaluate effectiveness of
hydrocolloid dressing in comparison to paraffin gauze dressing in healing of split skin graft donor site wound, and in
comparing the parameters like pain, pruritis, requirement of analgesics of donor site wound.
Methods: The study was done on 50 patients, 25 as study group who received effectiveness of hydrocolloid dressing
and 25 as paraffin gauze dressing.
Results: Statistics proved that study group (hydrocolloid dressing) had lesser pain than control group (paraffin gauze
dressing).
Conclusions: The hydrocolloid dressing on skin graft donor area reduces pain in post-operative period.

Keywords: Hydrocolloid, Dressing, Paraffin gauze, Post-operative pain, Skin graft, Pruritis

INTRODUCTION The hydrocolloids

Dressings The term hydrocolloid is used to describe a dressing family

comprising a matrix of hydrocolloids composed of
Dressings have been used to promote the healing process materials such as gelatin, carboxymethylcellulose, and
since antiquity. An understanding of tissue repair and pectin. Hydrocolloid dressings are available as wagers or
knowledge of the properties of available dressings is as pastes or powders for adhesive use. The matrix absorbs
needed for the choice of which dressing to use for a water, swells, and liquefies to form a sticky gel upon
particular wound. To help in wound care, there are already contact with wound exudates. The absorption ability of the
hundreds of dressings on the market. products varies and may or may not leave residue in the
wound. They are distinguished from films by the capacity
There is always no simple best option, and it is important of hydrocolloids to absorb wound exudates. Otherwise,
to consider the pros and cons of each dressing modality.1 they share many positive characteristics, including limited

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 Supreeth K et al. Int Surg J. 2025 May;12(5):729-736

transmission of moisture and gas and bacterial mechanical trauma to donor site wound, microbial
impermeability. contamination and tissue desiccation. Hence closed wound
dressing is always preferred over open method which is
Skin grafting obsolete as mentioned earlier.7

In the event of ulcers, deep burns and subsequent trauma, Meshed vaseline gauze is most commonly used in closed
split-skin grafting is generally used by surgeons to cover wound dressings, dressing will be firmly adherent and
skin defects. The technique of split-skin graft harvesting more prone to cause injury to the regrown epithelium at
requires epidermis harvesting and upper 1/3rd of dermis the time of its removal.7,8
resulting in a wound called donor site wound (DSW). Such
wounds appear to cause tremendous pain, are at risk of The use of polyurethane film, a semi permeable dressing
infection, can cause patient scratching (pruritus) and maintains a moist environment allowing diffusion of
cosmetic inconvenience. Local donor site wound (DSW) oxygen and water vapors while providing a barrier to
treatment and management should strive to establish an wound exudates. It has claimed to reduce the healing time
atmosphere that encourages early epithelialization with and donor site pain and pruritis.9,10
minimal pain and discomfort for the patient with reduced
hospital stay length.2 Our study aims at comparing the efficacy of use of these
newer dressings with meshed vaseline gauze dressing in
Although the process of split skin grafting is more or less the management of split thickness skin graft donor site
standardized, donor site wound management varies wound.
dramatically and is a debatable issue. Therefore, patients
complain of pain after split skin grafting, which is much Objectives of the study
more severe in the wound region of the donor site relative
to the receiver site. A variety of materials and products To evaluate effectiveness of hydrocolloid dressing in
have been recognized for the dressing and treatment of comparison to paraffin gauze dressing in healing of split
Donor Site Wound (DSW) to resolve this issue. skin graft donor site wound, rate of re-epithelialization,
pain, pruritis and duration of analgesics required
The most common dressing used at the donor site wound (NSAIDS).
is the use of fine meshed gauze usually smeared with
petroleum jelly or bismuth. But if dressings of this kind get METHODS
soaked due to wound discharge through their entire
thickness, it will become a means of bacterial invasion. In Source of data
addition, displacement of donor site dressing generates
shearing forces that impede epithelial cellular migration IPD of General Surgery Department at KIMS Hospital,
and cause patient distress in terms of pain. Dressing at the Bangalore
time of its removal would be strongly adherent and more
likely to cause damage to the re-grown epithelium. Methods of collection of data

Need for study Study design: Randomized prospective comparative study

For centuries wounds have been dressed in order to protect Study period: October 2018 to April 2020 (1.5 years).
the wound from the harmful external environment.
Hemostasis aided by a dressing limits blood loss of the Place of study: Department of General Surgery, KIMS
dissemination of microbes and toxins, limits edema, Hospital, Bangalore.
reduces pain and improves gas and solute exchange
between blood and tissue.1 The sample size has been estimated using the GPower
software v. 3.1.9.2
Split skin grafting is been commonly employed by
surgeons for covering skin defects in case of healing Considering the effect size to be measured (d) at 81% for
ulcers, burns wounds and following trauma.2,3 The wound Two-tailed Hypothesis with 95% Confidence Interval,
tends to cause enormous pain and are at risk of getting power of the study at 80% and the margin of the error at
infected can cause itching (pruritis).4-6 5%, the total sample size needed is 50. Each group will
comprise of 25 samples [25 × 2 = 50 samples].
Split skin graft donor site wound has been managed with
closed or open dressings with the open being obsolete now. Inclusion criteria
The closed occlusive dressing results in very good
outcome with considerable reduction in duration of wound Adult patients with >18 years, patient willing to give
healing, good quality of the epithelium which is informed consent, DSW after SSG harvest for any
regenerated along with comfort to the patient. Closed indication, size measuring not more than 20*20 cms and
wound dressing also has an advantage of preventing healing ulcers less than 2% of body surface area.

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 Supreeth K et al. Int Surg J. 2025 May;12(5):729-736

Exclusion criteria Assessment of pain using VAS (visual analogue scale) is

measured as (0–10).
Patient not willing to give informed consent, age less than
18 years, immunocompromised state and malignancy, Pruritus over donor area can also be assessed using simple
local irradiation. numeric scale from (0-10). Assessed in a patient held diary
similar way as pain assessment daily at the end of one
After obtaining approval and clearance from the week.
institutional ethics committee, the patients fulfilling the
inclusion criteria will be enrolled for the study after Duration of need of analgesics and type of analgesics
obtaining informed consent. (NSAIDs): 0 = no need, 1 =1-3 days, 2 =4-7 days, 3 =8-10
days, 4 ≥10 days.
After harvesting split skin graft using humby’s knife of
thickness 0.2 to 0.3mm, DSW is mopped with a sterile mop Outcome measures
and is covered with saline gauze for hemostasis.
Re-epithelialization of the total wound surface, assessment
Then hydrocolloid dressing is put over the donor site with of pain using VAS, Pruritis over donor area, duration of
tincture benzoin as an adhesive to normal skin edges then need of analgesics and type of analgesics (NSAIDS).
covered with normal cotton roll and followed by gauze roll
dressing. Statistical analysis

Examination of the dressing of donor site wound is made Statistical Package for Social Sciences [SPSS] for
on 6th,10th and 14th post-operative day for any soakage. Windows Version 22.0 Released 2013. Armonk, NY: IBM
Corp., will be used to perform statistical analyses.
Any soakage on 6th post-operative, will do super padding
of dressing. Chi Square Test was used to compare the Pruritis and type
of analgesics used between 02 groups.
On 14th post-operative day donor site wound is opened to
assess the re-epithelialisation status. And any other relevant test, if found appropriate during the
time of data analysis will be dealt accordingly.
Assessment tools
RESULTS
Scale of measurement for re-epithelialization
According to the Table 1, on the basis of age the mean age
1= complete epithelialization (60-100%), 2= scattered or of the paraffin gauze is 48.56 and SD is 16.45, while is the
spotty epithelialization (60%-80%), 3= no hydrocolloid dressing the mean of age is 53.80 and SD is
epithelialization or infected (<50%). Wound inspected on 16.58. The p value is 0.31.
6th,10th,14th POD.

Table 1: Distribution on the basis of age and sex.

Paraffin gauze dressing Hydrocolloid dressing

Variable Category P value
Mean SD Mean SD
Mean and SD 48.56 16.45 53.80 16.58
Age (years) 0.31a
Range 26-75 20-78
N % N %
Males 20 80% 21 84%
Sex 0.71b
Females 5 20% 4 16%

Table 2: Comparison of aetiology between 2 study groups using chi square Test.

Paraffin gauze dressing Hydrocolloid dressing

Variable Category 2 value P value
N % N %
Cellulitis 1 4 0 0
Aetiology Diabetic foot 11 44 18 72 4.490 0.11
Traumatic 13 52 7 28

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 Supreeth K et al. Int Surg J. 2025 May;12(5):729-736

According to the Table 2, hydrocolloid dressing: the patients and Diabetic foot is 11 (44%) patients. The chi-
aetiology for the required skin graft included in square value is 4.490 and the p value is 0.11.
hydrocolloid group, trauma in 07 (28%) patients,
cellulites in 00 (00%) patients, Diabetic foot in 18 (72%) According to the Table 3, the p value of comparison of
patients. Paraffin gauze: in paraffin gauze group aetiology presence of comorbidity condition between 2 study groups
include trauma in 13 (52%) patients, cellulites in 01 (04%) is 0.04 which is highly significant.

Table 3: Comparison of presence of comorbidity condition between 2 study groups using chi square test.

Paraffin gauze dressing Hydrocolloid dressing P

Variable Category 2 value
N % N % value
T2DM 4 16 8 32
HTN 1 4 0 0
T2DM+HTN 2 8 8 32
T2DM+HTN+IHD 3 12 0 0
Comorbid
T2DM+IHD 0 0 2 8 16.512 0.04*
conditions
T2DM+CKD 0 0 1 4
T2DM+Hypothyroidism 1 4 0 0
T2DM+HTN+IHD+CKD 1 4 0 0
Nil 13 52 6 24
*Statistically significant.

Table 4: Comparison of mean Hb (gm%) and serum albumin levels between 2 study groups using independent
student t test.

Parameters Group N Mean SD Mean diff t P value

Paraffin gauze dressing 25 11.20 2.00
Hb -0.52 -0.890 0.38
Hydrocolloid dressing 25 11.72 2.13
Serum Paraffin gauze dressing 25 3.28 0.35
-0.05 -0.500 0.62
Albumin Hydrocolloid dressing 25 3.34 0.39

Table 5: Comparison of donor site between 2 study groups using chi square test.

Paraffin gauze dressing Hydrocolloid dressing

Variable Category 2 value P value
N % N %
Left thigh 12 48 10 40
Donor site 0.325 0.57
Right thigh 13 52 15 60

Table 6: Comparison of graft size (in CMS) between 2 study groups using chi square test.

Paraffin gauze dressing Hydrocolloid dressing

Variable Category 2 Value P value
N % N %
10 x 10 cm 14 56 11 44
10 x 15 cm 2 8 0 0
10 x 20 cm 1 4 0 0
Graft size 15 x 15 cm 5 20 0 0 21.646 0.001*
15 x 20 cm 2 8 0 0
20 x 10 cm 0 0 1 4
20 x 20 cm 1 4 13 52
*Statistically significant.

According to the Table 4, paraffin gauze: the mean of The comparisons of serum albumin levels between 2 study
paraffin gauze dressing of Hb (gm %) is 11.20 and SD is groups are- paraffin gauze: the mean of paraffin gauze
2.00. Hydrocolloid dressing: the mean of hydrocolloid dressing of Serum Albumin levels is 3.28 and SD is 0.35.
dressing of Hb (gm%) is 11.72 and SD is 2.13. The value Hydrocolloid dressing: the mean of hydrocolloid dressing
of independent student t test between the comparison of of serum albumin levels is 3.34 and SD is 0.39. The value
two groups is -0.890. The p value of two groups is 0.38. of independent student t test between the comparison of
two groups is -0.500. The p value of two groups is 0.62.

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According to the above Table 5, it is revealed that the are- paraffin gauze: the graft size in 10 x 10 cm is 14
comparison of donor site between 2 study groups are- (56%), 10 x 15 cm is 02 (08%), 10 x 20 cm is 01 (04%),
paraffin gauze: the patient of left thigh donor is 12 (48%) 15 x 15 cm is 05 (20%), 15 x 20 cm is 02 (08%), 20 x 10
and right-side donor is 13 (52%), hydrocolloid dressing: cm is zero and 20 x 20 cm is 01 (4%). Hydrocolloid
the patient of left thigh donor is 10 (40%) and right-side dressing: the graft size in 10 x 10 cm is 11 (44%), 20 x 10
donor is 15 (60%). The chi-square value is 0.325 and the p cm is 01 (04%) and 20 x 20 cm is 13 (52%). The chi-square
value is 0.57. value is 21.646 and the p value is 0.001 which is
statistically significant.
According to the Table 6, it is revealed that on the basis of
comparison of graft size (in CMS) between 2 study groups
Table 7: Comparison of intensity of pain between 2 study groups using chi square test.

Paraffin gauze dressing Hydrocolloid dressing

Variable Category 2 value P value
N % N %
Mild 2 8 11 44
Pain Moderate 13 52 12 48 11.604 0.003*
Severe 10 40 2 8
*Statistically significant.

Table 8: Comparison of presence of pruritus over donor area between 2 study groups using chi square test.

Paraffin gauze dressing Hydrocolloid dressing

Variable Category 2 value P value
N % N %
Mild 6 24 16 64
Pruritus Moderate 15 60 8 32 8.476 0.01*
Severe 4 16 1 4
* - Statistically significant.

Table 9: Comparison of mean duration of need of analgesics during post-operative period (in days) between 2 study
groups using independent student t test.

Parameters Group N Mean SD Mean Diff t P value

Analgesics Paraffin gauze dressing 25 5.12 0.93
1.40 5.741 <0.001*
consumption Hydrocolloid dressing 25 3.72 0.79
* - Statistically significant.

Table 10: Comparison of re-epithelialization between 2 study groups using chi square test.

Category Paraffin gauze dressing Hydrocolloid dressing

Variable 2 Value P value
(%) N % N %
40-50 2 8 0 0
50-60 5 20 0 0
Re-epithelialization 60-70 12 48 3 12 23.600 <0.001*
70-80 6 24 14 56
80-90 0 0 8 32
* - Statistically significant.

According to the Table 7, it is revealed that on the basis of According to the Table 8, it is revealed that on the basis of
comparison of comparison of intensity of pain between 2 comparison of presence of pruritus over donor area
study groups are- paraffin gauze: the mild group patients between 2 study groups are- paraffin gauze: the mild group
is 02 (08%), moderate group of patients is 13 (52%) and patients is 06 (24%), moderate group of patients is 15
severe group of patients is 10 (40%). Hydrocolloid (60%) and severe group of patients is 04 (16%).
Dressing: the mild group patients is 11 (44%), moderate Hydrocolloid dressing: the mild group patients is 16
group of patients is 12 (48%) and severe group of patients (64%), moderate group of patients is 08 (32%) and severe
is 02 (08%). The chi-square value is 11.604 and the p value group of patients is 01 (04%). The chi-square value is
is 0.003 which is statistically significant. 8.476 and the p value is 0.01 which is statistically
significant.

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According to the above Table 9, comparison of mean congenital skin deficiencies. Skin graft for burns and
duration of need of analgesics during post-operative period traumatic wound injury, such as external fixation, was
(in days) between 2 study groups are- paraffin gauze: the performed in this study for cases transferred from
mean in paraffin gauze dressing is 5.12 and SD is 0.93. orthopedics.17 In terms of average healing time for
Hydrocolloid dressing: the mean of hydrocolloid group is Hydrocolloid and paraffin gauze dressing, this was the
3.72 and SD is 0.79. The value of student t-test between typical skin graft indication among the studied sample.
the comparisons of two groups is 5.741. The p-value of Many studies have shown that there is no statistically
two groups is <0.001 which is highly significant. significant difference in the mean time between
hydrocolloid dressing and paraffin gauze dressing for
According to the above Table 10, we can compare the re- wound healing.
epithelialization between paraffin group and hydrocolloid
group. Our sample population consisted of a male population of
21 (84%) and a female population of 4 (16%). The mean
Paraffin gauze: in paraffin gauze the category of re- age of the sample population was 53.80 for the mean age
epithelialization in 40-50% group of patients is 02 (08%), of hydrocolloid dressing, and 16.58 for SD. The age
50-60% is 05 (20%), 60-70% is 12 (48%), 70- 80% is 06 distribution of the sample population was clustered
(24%) and 80-90% is zero. between the ages of 50 and 65 years of age.

Hydrocolloid dressing: in hydrocolloid dressing the Because of the hydrocolloid's physical property, this
category of re-epithelialization in 60-70% is 03 (12%), 70- quicker healing is impermeable to liquid bacteria and
80% is 14 (56%) and 80-90% is 08 (32%). viruses. Exudates are consumed quicker by the inner layer
of hydrocolloid. A consistently high rate of moisture vapor
The chi-square value for Comparison of Re- transmission is given by the breathable outer layer.
epithelialization between 2 study groups is 23.600. The p Together, these features reduce the risk of damage to
value for comparison of re-epithelialization between 2 healthy peri-wound skin and provide extended wear for up
study groups is 0.001 which is statistically significant. to seven days in an ideal moist wound environment.

DISCUSSION The level of pain on day 3 is mild in 09 patients in the

hydrocolloid group and 01 patients in the paraffin group,
Due to its easy application, convenience, low risk of while pain on day 5 is moderate in 03 patients (12%) and
infection, and minimal cost, surgeons have been using 04 patients (16%) in the paraffin group, while in extreme
paraffin gauze dressing as the primary option for the pain there is only 02 (8%) in the hydrocolloid group and
coverage of split-skin donor sites for many years. In 07 (28%) in the paraffin group. There are no patients in
several different essential ways, however, it has been Hydrocolloid dressing on the 6th day of dressing, but there
found inferior; it is a painful, adherent dressing. Thus, the are 04 (16 percent) patients in the paraffin community in
donor sites do not tend to heal easily. Hydrocolloids can mild pain and extreme pain in 05 (20 percent) patients.
be used on wounds with low to moderate exudation and After evaluating the data, we can conclude that there is no
are available in various shapes and sizes. They are easy to patient on the 6th day in the Hydrocolloid group, but in the
apply. This enables them to be used where higher paraffin group there is a patient with mild pain and extreme
versatility is needed.10 pain. So, we can assume that the group of hydrocolloids is
stronger than the group of paraffin’s.
Therefore, the purpose of this study was to evaluate the
effect of hydrocolloid dressing on split thickness skin It was noted that the patient handled the hydrocolloid
grafting donor sites in terms of pain and wound healing dressings much better than paraffin gauze dressings, as
versus paraffin gauze dressing.11 pain evaluation was an objective in this study. The pain
evaluated on the basis of Visual Descriptive Scale (VDS)
The results of the study indicate that the majority of the on the 6th post-surgical day during dressing removal,
study sample was male. Their ages were between the ages results show, no hydrocolloid group patients. Moderate
of (50-65) years. This sample characteristic homogeneity pain in 04 (16%) and extreme pain in 05 (20%) patients in
can help to encourage wound healing.13 the paraffin gauze group.

Women in the younger group had substantially greater (i.e. Compared to the paraffin gauze group, the cost of
slower healing) wounds than men.14,15 treatment was higher in the hydrocolloid group. However,
it was noted that more analgesics were required by the
Skin grafting is a surgical technique that involves paraffin gauze community, and early mobilization was
removing, or transplanting, skin from one region of the affected. On the basis of the above analysis, it can be
body to another area of the body. If a portion of the body concluded that hydrocolloid dressings achieve faster donor
has lost its protective covering of the skin due to burns, site epithelialization and are supportive dressings,
injury, or disease, this operation may be performed.16 reducing discomfort when the dressing is removed.
Traumatic wounds, release of scar contracture, as well as

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Due to its ease of application, convenience, low risk of 2. Braza ME, Fahrenkopf MP. Split-Thickness Skin
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