A randomised prospective study of split skin graft donor site dressings: AWBAT-D™ vs. Duoderm®.

OBJECTIVE: To assess patient comfort and wound-healing efficacy of a new, purpose-designed biosynthetic material (AWBAT-D™) in the healing of split-skin graft donor sites in comparison with our standard dressing, Duoderm(®). MATERIALS AND METHODS: We conducted a prospective randomised controlled trial of donor site dressings, comparing AWBAT-D™ with our standard dressing, Duoderm(®). Patients were randomly allocated to have their donor site dressed with one of these materials. Outcome measures included pain scores at rest and during dressing changes, time to re-epithelialisation, time to discharge, scarring and infection. Results were assessed for significance using the Mann-Whitney U-test (non-parametric data) and the Chi-Square test (parametric data). RESULTS: Fourteen patients were recruited with 8 donor sites in each group. The mean pain scores at rest and during dressing changes were not found to be significantly different between the two groups (P=0.99 and P=0.90 respectively). The median time to re-epithelialisation was shorter in the Duoderm(®) group at 11 days compared to 17 days in the AWBAT-D™ group (P=0.007). The median time to discharge was not significantly different (P=0.38). No infection or scarring has been observed. CONCLUSIONS: Based on these early results, AWBAT-D™ appears to have slower donor site healing and does not provide significant improvements in postoperative pain or discharge time compared to Duoderm(®). There is no evidence at this stage that our standard donor site dressing should be changed.

Diagnostic laparoscopy for suspected appendicitis: only useful in young women.

The clinical diagnosis of acute appendicitis is inaccurate and can be associated with a negative appendicectomy rate in excess of 40%. The latter has an attendant, albeit low, potential for increased morbidity and mortality, particularly related to infection. In this two year prospective audit of 282 patients presenting with the symptoms and signs of acute appendicitis, preliminary diagnostic laparoscopy (PDL) was performed on 145 patients with the remainder (137) proceeding directly to open appendicectomy. In the PDL group, appendicectomy was undertaken when there was clear clinical evidence of inflammation or when the appendix was not visualised. The negative appendicectomy rate was similar in both groups (21.6% vs. 21.2%) with a male predominance in the PDL group. Whereas women of childbearing age obtained most benefit from PDL with avoidance of unnecessary open operation, the results of our audit showed little benefit for men.