Journal Article

364 A Blinded Comparison of Lubricants to Facilitate Split Thickness Skin Graft Harvest in a Porcine Skin Model

A Beckett, S Kahn, R Brooks, A Lintner, M Roberts and S Patterson

in Journal of Burn Care & Research

Volume 39, issue suppl_1, pages S152-S152
Published in print April 2018 | ISSN: 1559-047X
Published online April 2018 | e-ISSN: 1559-0488 | DOI: http://dx.doi.org/10.1093/jbcr/iry006.286
364 A Blinded Comparison of Lubricants to Facilitate Split Thickness Skin Graft Harvest in a Porcine Skin Model

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Abstract

Introduction

Multiple different skin lubricants have been utilized to facilitate the harvest of split thickness skin grafts. Lubricants are generally selected according to provider and institutional preference, as no single “ideal” lubricant has been objectively established. Many providers use poloxamer 188, but there has been a recent national shortage, prompting a search for a suitable substitute. The purpose of this study is to test some commonly used lubricants in the search of a substitute to poloxamer 188 at our institution.

Methods

Four experienced skin graft harvesters (30 years of combined skin grafting experience) were selected to participate in the study. Using blocks of refrigerated “butcher shop” porcine skin and subcutaneous fat, five lubricating solutions were tested, including poloxamer 188, mineral oil, glycerin, normal saline and a novel lubricating solution (120 g sterile bacteriostatic water based surgical lubricant diluted to 200 cc total with sterile water), and also a dry control. The study was conducted in two rounds, in which each participant harvested four grafts of porcine skin using with a dermatome set at 0.014”, blindly testing the five solutions in random order during each round and assigning a score based on friction and ease of use of each lubricant (1–5 Likert Scale, 1=poor, 5=excellent), for a total of 20 data points per solution. Tests were also controlled based on number of passes per blade. Data was pooled and means were compared with ANOVA and a Tukey post-test.

Results

Mean scores for each of the solutions were as follows: dry control= 1.1 ± 0.1; glycerin= 2.62 ± 1.02, saline= 3.88 ± 0.81, mineral oil= 3.75 ± 1.00, novel water based lubricant solution= 4.63 ± 0.71, and poloxamer 188= 3.88 ± 0.81. All solutions were superior to dry control (p<0.01). Glycerin was noted to have statistically lower scores than all of the other solutions (p<0.01). The novel water based surgical lubricant solution had significantly higher mean scores than both glycerin (p<0.01) and mineral oil (p<0.05).

Conclusions

In a porcine skin model, the novel water based surgical lubricant solution subjectively had the best performance. It was statistically superior to glycerin and mineral oil. Glycerin had the worst performance with statistically lower scores than all other solutions. Saline performed surprisingly better than expected, but this may have been related to the inherently greasy nature of the butcher shop porcine skin, creating some limitations and decreasing the fidelity of the model. In a search for the “ideal” lubricant, other models should be further studied.

Applicability of Research to Practice

Skin lubricants to facilitate harvest have not been objectively evaluated. A shortage of the commonly used poloxamer 188 prompted us to investigate a reliable alternative.

Journal Article.  0 words. 

Subjects: Medicine and Health ; Acute Medicine ; Emergency Medicine ; Critical Care ; Surgery

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