Rahim Jindani1, Shiara M. Ortiz-Pujols2, Carrie Nielsen2, Bruce A. Cairns2, Martin W. King*1, 31College of Textiles, North Carolina State University, Raleigh, NC, USA2Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA3College of Textiles, Donghua University, Shanghai, China.ABSTRACT______________________________________________________________________________________________________Objective: Split thickness skin grafts area common reconstructive procedure for the management of deep burn injuries. The management of donor sites, created after harvesting autografts, presentshealthcare providers with a number of challenges, which need to be addressed. A survey was conducted to find consensus amongst the healthcare community regarding the management of donor site wounds.Method: A survey was conducted at the Southern Burn Regional Meeting in November 2012 to explore participants’ opinions about their perceptions and management practices of donor sites.Results: In total, 79 participants from 31 different burn institutions from 14 states took part. Based on the answers to the survey’s questions, an “ideal” donor site dressing should have the following properties: the ability to alleviate pain, be antibacterial, be non-adhesive, be hemostatic and be able to prevent wound desiccation. In addition, ease of removal, minimal care, and the dressing’s ability to drain exudate were considered additional requirements. The results of the survey revealed that the most commonly used donor site dressings were Aquacel Ag® and Mapilex Ag®.Conclusion: This survey provides insight into the desired properties for an ”ideal” donor site dressing, and the need to reduce and/or alleviate pain was clearly articulated as the number one priority. To date, no wound care product has been developed that is designed to reduce or eliminate donor site pain. Future developments in donor site wound dressings need to focus on meeting these requirements and the properties identified and prioritized by the above mentioned survey questionnaire.________________________________________________________________________________________________________IntroductionDebridement and split thickness skin grafts are routinely performed for the management of deep burns and other non-healing wounds. The management of donor sites created after harvesting an autograft, present healthcare providers with a number of challenges, especially with respect to controlling painand blood loss. To date, there is no standard procedure or gold standard with respect to the management of donor sites and current options do not appear to fully address these challenges.Donor sites are often the most painful component of burn surgery. They produce considerable amounts of exudate that necessitate daily dressing changes, which in turn can contribute to an additional level of pain. Failure to remove the exudate on a daily basis increases the risk of bacterial infection at the site. There are several topical agents that can be used to manage these sites; however all have associated adverse effects that can make them less than optimal. For example, Bacitracin/Neomycin ointments can cause contact dermatitis when exposed to light [1-3].Silver-based products have long been used for wound care because of their antibacterial and medicinal properties. Otheroptions for the management of donor sites include allografts and porcine-derived xenografts[4]. Tissue engineered products,such as Epicel®, AlloDerm®, TransCyte™, and Dermagraft®, have been developed that rely on epidermal cells or dermal progenitor cells that have been cultured in a controlled environment [5, 6]. These products support the healing process by providing a matrix to promote the regeneration of dermal tissue.In order to better understand current clinical practices used in the treatment and management of donor site management, we conducted a survey at the Southern Regional BurnConference held in Norfolk, VA between November 16-18, 2012. The aim of the survey wasto identify the range of different approaches as well as the preferred therapies used among burn center personnel. It was also anticipated that key clinical problems and challenges in the management of donor sites would be identified, which would lead to the future development of new dressings that would better address these issues.MethodsIn order to design the survey, first an in-depth literature search was conducted to learn more about the reported issues and challenges surrounding the management of donor sites, in order to design the survey. The survey consisted of nine open-ended and closed questions and the types of dressings used, if any, in the management of donor sites. The Southern Regional Burn Conference was selected as the site for the distribution of the survey since it is the largest regional meeting of its kind in the USA, attracting participants from 31 burn centers in 14 states, ranging from Washington, DC to Florida and as far west as Texas. There were no incentives offered or rewards given for completion of the survey. Prior to administering the questionnaire it was reviewed and approved by the Institutional Review Board at the University of North Carolina - Chapel Hill.SurveyThe survey questions were developed taking into consideration some of the topics raised in a previous questionnaire that was developed to understand the characteristics of an ideal burn wound dressing and the problems associated with donor sites for various skin types [7]. The questions aimed at exploring different aspects of donor site therapy and management, including what commercially available products are currently being used and what other aspects of clinical care are considered problematic. The questions were either multiple choice orinvolved ranking on a scale of 1 (“most important”) to 5 (“not important”), or they were open-ended questions that would provide more detailed information.A hard copy of the survey was distributed to each attendee at one of the sessions of the conference, and the participants were given as much time as they needed to provide independent answers to the questions before handing in their completed questionnaire.