Discussion

The data obtained through this survey has enabled us to identify and report for the first time that pain is a real and practical challenge associated with donor site wounds. Donor sites tend to be confused with burn wounds and are thought to experience a similar healing phenomenon. As a result, a number of dressings and living skin equivalent constructs that are marketed for burn wounds are also used to treat donor site wounds [9]. The healing of asplit skin graft donor site wound is influenced by various factors such as the anatomical site and the method of harvesting [8].Dressings developed for burn wounds require antibacterial activity so as to reduce the incidence of infection. But in the case ofdonor site wounds the risk of infectionis not the major cause of a slower rate of healing. It is the sensation of pain, which impairs and slows the healing of these donor sites.
The results of this survey have confirmed that pain is the greatest challenge when dealing with donor site wounds. However, there are fewclinical options availablethat have been developed to minimize pain. Instead the developmentof dressings with antibacterial and hemostatic properties appears to have taken priority.
The sensation of pain can affect all four phases of healing of acute and chronic wounds starting with hemostasis, inflammation, proliferative, and maturation or remodeling [8, 10- 13]. And the ability to control, reduce and even eliminate pain depends on the treatment protocol during each of these phases. It has been observed that the severity and duration of the inflammatory response determines the healing rate and the extent of scarring due to the release of cytokines [13] that will vary depending on the size, depth, location, age, etiology and other concomitant factors associated with the wound. It has been reported in cases of skin tears and chronic wounds that the use of moist dressings with, for example, hydrogels, that cover the wound completely and exclude all air, are able to reduce the level of pain to a significant extent [8, 10, 13]. The use of inherently porous woven, knitted and foam structures that contain significant amounts of air activate the nociceptors and live nerve endings and cause significant amounts of pain.
Another important and desirable property that was identified by the survey relates to the ease and pain free removal of a dressing. It has been reported that if wounds become dry and scabs are formed, then dressing removal is associated with pain and trauma unless saline is utilized to assist in the removal of the dressing. Interestingly there are a number of dressings that claim to reduce pain based on patients’ perceptions but there has been as yet no scientific measurement or assessment of pain.
Further clinical trials and observations are needed in order to develop a standard therapeutic procedure for the management of donor site wounds.