British Journal of Plasric Surgery ( 1986) 39.
5 I &5 IX
{<“r1986 The Trustees of British Association of Plastic Surgeons
A new approach to the problems encountered with Opsite as a
donor site dressing: systemic ethamsylate
J. D. RICHMOND and A. B. SUTHERLAND
Lothian Plastic and Oral Surgery Service, Bangour General Hospital, West Lothian
Summary-A prospective clinical trial has shown that systemic ethamsylate’ reduces the problems
with exudation sometimes seen when OpsiteZ is used as a dressing for split skin graft donor sites.
Opsite has a number of properties which make it an
attractive donor site dressing (James and Watson,
1975). It can be rapidly applied, is comfortable and
permits rapid healing. One main disadvantage is
that exudate can collect beneath the Opsite where it
may either remain as a localised collection or track
and drain peripherally.
Several different approaches have been tried,
with varying degrees of success, to overcome this
problem. These have included the use of pressure
dressings, perforations in or drains beneath the
Opsite, and the aspiration of fluid collections
(James and Watson, 1975; Ramirez et al., 1984). In
addition the manufacturers have been testing a
more porous version of the material.
Ethamsylate, given systemically, is a haemostatic
agent reducing small vessel haemorrhage by
increasing platelet adhesiveness and decreasing
capillary fragility and bleeding time. When given
intravenously it is effective within 30 minutes, and
no major side effects have been reported (Deacock
and Birley, 1969).
A preliminary study looking at the effects of giv-
ing ethamsylate to patients with Opsite donor site
dressings found that the drug appeared most effec-
tive when continued for 72 hours post-operatively.
The study also demonstrated major technical prob-
lems in trying to quantify accurately the volume of
serosanguinous fluid which exudes from split skin
graft donor sites.
The following prospective study was undertaken
to determine if Ethamsylate could be used to re-
duce the problems associated with exudate collec-
tion when Opsite was used as a donor site dressing.
’ Ethamsylate (Dicynene) is manufactured by Delandale Labor-
atories Limited.
2 Opsite is a water vapour permeable polyurethane sheet manu-
factured by Smith and Nephew.
Materials and methods
Fifty adult patients having split skin grafting under
general anaesthetic, with donor sites of up to
250cm2, were included in this study. Allocation to
the control or experimental group was on the basis
of hospital record number. The only patients deli-
berately excluded were those with a history of drug
allergy, ischaemic heart disease, deep venous
thrombosis, pulmonary emboli or recent ingestion
of aspirin.
The experimental group received 1 gram of eth-
amsylate intravenously immediately after the
induction of general anaesthesia. Post-operatively
they received 500mg of ethamsylate orally at 6-
hourly intervals for 72 hours. The control group
received only one tablet of a placebo (lactose) at 6-
hourly intervals for 72 hours post-operatively.
Once the skin had been harvested the donor sites
were wrapped in moist saline packs until the re-
mainder of the surgical procedure had been com-
pleted. The skin around the donor site was then
dried and wiped with ether before a sheet of Opsite,
large enough to extend at least 5 cm beyond the raw
edge of the donor site, was applied. The area of the
donor site was then calculated and an external
dressing of gauze, gamgee and crepe was applied.
The external dressing was removed and the
donor sites inspected 48 to 72 hours post-opera-
tively. The findings at that time and at daily inter-
vals thereafter were recorded by the medical staff
on a printed checklist. Because of staffing con-
straints it proved impossible to perform this study
as a double blind trial, but we believe the criteria
used to determine patient management were suffi-
ciently objective to eliminate any unconscious bias
when the recording doctor was aware of which arm
of the trial the patient had been allocated.
No action was taken if the Opsite was adherent
with onlv a small volume of exudate tranDed
A NEW APPROACH TO THE PROBLEMS ENCOUNTERED WITH OPSITE AS A DONOR SITE DRESSING 517

beneath it. Collections of 5 to 15 ml were aspirated. Table 1 The composition of the control and experi-
If the volume of fluid aspirated exceeded 15 ml then mental groups
an external dressing was applied for a further 24
hours. In those cases in which the fluid had tracked Control group E.rperimental group
and drained peripherally the site of the leak was
Number 25 2s
patched with Opsite or, if large areas of the Opsite Sex ratio (M/F) 1I!‘14 12113
had become detached, the Opsite was replaced Mean cr,qr 45y(range I6 71 y) 42y(range 17 79~)
before an external dressing was applied for a
further day.
The data collected from both groups were tested
statistically by the fourfold table variant of the Chi
squared test.
Table 2 Donor sites, donor site area and time until
donor site healing
Results
There was a complete absence of donor site pain in Conrrol E.xperimentul
both groups. In those patients where it was neces- group group
sary to change the Opsite, this caused only minor Donor sile.r
discomfort. Thigh 15 13
Statistically the groups were well matched for Upper arm 8 10
age and sex (Table 1) donor site and area (Table 2) Buttock 7
and the indications for skin grafting (Table 3). Donor site areu
With few exceptions the grafts were described as Mean (cm’) 207 200
being of medium thickness. Range (cm2) 7c250 50-250

In the control group 20 of the 25 patients had the Time until donor site healing
external dressing replaced at 48 hours and in the Mean (days) 13 13
Range (days) 8 30 l&40
majority this was due to the leakage of exudate
peripherally (Table 4); in 10 cases the external
dressing was replaced on more than one occasion.
In five cases enough of the Opsite had become
detached to merit it being changed: in two patients
this happened on three occasions and these Table 3 The indications for skin grafting
patients’ donor site dressings were converted to
Vaseline gauze, dry gauze, gamgee and crepe. Conlrol E.rperimental
In only 10 of the 25 patients in the experimental group group

group was it necessary to re-apply the external Traumatic skin loss 9 8

dressing, and in the majority this was due to the Tumour excision 8 I?
presence of a localised collection of exudate (Table Release burn contracture 4 I
4). Four patients required to have the external Other 4 3
dressing replaced on more than one occasion, but
no patient required a change of Opsite; four
patients had small collections treated by aspiration
only.
No donor site in either group became infected. Table 4 Action taken when the external dressing was
In both groups the time until donor site healing removed 48-72 hours post-operatively
was similar (Table 3). In two patients in each group
Control E.vperimentul
the time until donor site healing exceeded 3 weeks.
group ,ww
In two of these cases the healing donor site was
traumatised with the Opsite in situ, and in the No action required 5 11 (P<O.O5)
remaining two cases the donor site was damaged by Aspiration only 0 4(P<O.Ol)
premature removal of the Opsite. Aspiration and re-padding 6 x (P<O.l)
Opsite patching and re-padding 9 ?. (P<O.O5)
There was no difference in the percentage graft Change of Opsite and re-padding 5 0 (P<O.OS)
take between the two groups.
518
No thrombotic complications were encountered
in either group despite the fact that those with
thigh donor sites or lower leg grafts were generally
confined to bed for at least one week post-opera-
tively.
Discussion
Opsite, an occlusive polyurethane sheet which is
permeable to water vapour, theoretically provides
conditions almost ideally suited to epidermat re-
generation in split skin graft donor sites. Unfortu-
nately problems with haemoserous exudate
gathering beneath the Opsite have prevented its
adoption as the standard donor site dressing.
Ethamsylate is a synthetic non-hormonal agent
which reduces small vessel bleeding whilst showing
no evidence of thrombogenic effect. Although
patients with a history of thrombogenic disease
were deliberately excluded from this trial, it has
been used without ill effect in such patients (Bailey
and Taylor, 1984).
This controlled trial showed a statistically sig-
nificant reduction in the number of external dress-
ing changes, Opsite patchings and Opsite changes
in those given ethamsylate compared with the con-
trol group. Although it was impossible to quantify
the amount of exudate lost on to the external dress-
ings when leakage occurred, the results would im-
ply that less exudate was produced in the treated
group.
As far as we are aware this is the first report of
the use of an antihaemorrhagic agent to reduce the
amount of exudate originating from split skin graft
donor sites. The study was organised to measure
BRITISH JOURNAL OF PLASTIC SURGERY
the effect on donor site dressing maintenance,
rather than an attempt to measure the volume of
exudate produced.
Ethamsylate reduced but did not eliminate the
problems which stimulated this paper. This is a pre-
viously untried solution to the problems, and the
encouraging early result suggests that it is worthy
of further consideration.
Acknowledgements
We would like to thank the consultants who permitted their
patients to be included in this study, the junior staff who
recorded the findings, and Dr C. C. M. Howie for her help and
advice during the preliminary study.
References
Bailey, A. J. M. and Taylor, W. (1984). ABPI Dafa Sheet Com-
pendium 1984-85, Datapharm Publications Limited.
Deacock, A. R. de C. and Birley, D. M. (1969). The anti-hae-
morrhagic activity of ethamsylate (Dicynene). Brifish Journal
ofdnaesthesia, 41. 18.
James, J. H. and Watson, A. C. H. (1975). The use of Opsite, a
vapour permeable dressing, on skin graft donor sites. British
Journal of Plastic Surgery, 28, 107.
Ramirez, 0. M., Granick, M. S. and Futrell, J. W. (1984). Opti-
mal wound healing under Op-site dressing. Plusric and Recon-
structive Surgery, 73,474.
The Authors
J. D. Richmond, FRCS(Ed), formerly Plastic Surgery Registrar.
A. B. Sutherland, MD, FRCS(Ed), Consultant Plastic Surgeon.
Bangour General Hospital, West Lothian, EH52 6LR.
Requests for reprints to: J. D. Richmond, Home Office,
Rathcluan House. Cupar. Fife, Scotland.