The Effects of Aloe Vera Cream on Split-thickness Skin Graft Donor Site Management: A Randomized, Blinded, Placebo-controlled Study
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Abstract: Purpose. Split-thickness skin graft donor site management is an important patient comfort issue. The present study examined the effects of aloe vera cream compared to placebo cream and gauze dressing on the rates of wound healing and infection at the donor site. Methods. Forty-five patients were enrolled in this randomized clinical trial and divided into three groups: control (without topical agent), placebo (base cream without aloe vera), and aloe vera cream groups. All patients underwent split-thickness skin grafting for various reasons, and the skin graft donor site wounds were covered with single-layer gauze without any topical agent, with aloe vera, or with placebo cream. The donor sites were assessed daily postoperatively until complete healing was achieved. Results. Mean time to complete re-epithelization was 17 ± 8.6, 9.7 ± 2.9, and 8.8 ± 2.8 days for control, aloe vera, and placebo groups, respectively. Mean wound healing time in the control group was significantly different from the aloe vera and placebo groups (P < 0.005). The healing rate was not statistically different between aloe vera and placebo groups. Conclusion. This study showed a significantly shorter wound care time for skin graft donor sites in patients who were treated with aloe vera and placebo creams. The moist maintenance effect of these creams may contribute to wound healing.
Skin grafting is a reconstructive procedure in plastic surgery designed to accelerate the healing of wounds, such as burns and trauma wounds. The donor sites created after harvesting a split-thickness skin graft present an additional wound to manage. The management of the donor site after removing the skin graft is an important patient comfort issue. A suitable wound dressing helps to achieve wound healing and to satisfy patients barring any complications, such as infection or pain. A suitable dressing should also facilitate physiological recovery.1,2 There are two dressing strategies for wound healing after skin grafting: dressing with high humidity at the wound harvesting surface (moist dressing) and non-moist dressing (dry dressing).2–4 Dressing material that adheres to the wound causes bleeding, and removing the dressing is often painful. A moist dressing has a greater effect on wound healing and pain relief than a dry dressing.5 Various types of dressing materials have been recognized based on ease of use, cost, optimal healing environment, and pain relief, eg, paraffin gauze dressing,6 hemicelluose dressing (Veloderm®, BTC srl, Torino, Italy),1 lipido-colloid wound dressing (Urgotul®, Laboratoires Urgo, Chenôve, France),7 polyurethane film,8 carboxymethyl cellulose dressing (Aquacel®, ConvaTec, Skillman, NJ),9 ionic-containing hydrofiber dressing,10 alginate (Kaltostat®, ConvaTec),3 and polyvinyl pyrrolidone-iodine liposome hydrogel.11 These dressing materials induce moisture on the wound surface by absorbing and maintaining water. In 2009, Voineskos et al4 conducted a comprehensive systematic review of skin graft donor site dressings. They concluded that the evidence supporting moist wound dressings is weak, and more methodologically sound, randomized, controlled trials are needed to determine the optimal dressing for split-thickness skin graft donor sites.