Patient-reported outcomes of palatal donor site healing using four different wound dressing modalities following free epithelialized mucosal grafts: A four-arm randomized controlled clinical trial

Abstract

Background: The aim of this study was to compare the effects of four different commonly used wound dressings in improving patient reported outcomes (PROMS) after free epithelialized mucosal grafts (FEGs) harvesting.

Methods: Following 72 FEGs harvesting from 72 patients, patients were assigned into four groups.

Control: collagen plug + sutures (CPS); test: collagen plug with cyano-acrylate (CPC), platelet rich fibrin (PRF) + sutures, or palatal stent only (PS). Patients were observed for 14 days, with evaluation of pain level utilizing the visual analog scale, number of analgesics consumed, need for additional analgesics, amount of swelling, amount of bleeding, activity tolerance, and willingness for retreatment.

Results: Compared to the control group all test groups indicated significant lower pain perception (P < 0.0001), lower analgesic consumption (P < 0.0001), and higher willingness for retreatment (P < 0.0001), while no statistically significant differences among test groups were observed. There were no statistically significant differences in amount of day-by-day swelling, bleeding, and activity tolerance among four groups. Compared to other groups, the PS had the lowest overall pain scores (over the 14-day period). Palatal thickness, graft length, graft width, and graft thickness did not appear to affect patient morbidity (P > 0.05).

Conclusions: All interventions significantly decreased pain perception compared to a hemostatic collagen sponge alone over the palatal donor site after FEG surgery. In the first few days after surgery, the use of a palatal stent seemed to be associated with less overall pain, pain pills consumed, and higher willingness of doing the same procedure again.

Keywords: pain; palate; sutures; tissue adhesives; wound healing.

FIGURE 1

(A) Intra‐surgical photo of graft harvesting. (B) Uniform graft width was always attempted while considering the thickness of the palatal tissue

FIGURE 2

Donor site management in the four groups. (A) PRF group: platelet‐rich fibrin membranes packed in the donor site and stabilized with sutures. (B) CPS group: Collagen sponge packed in the donor site and stabilized with resorbable sutures (control group). (C) PS group: Palatal stent delivered immediately after the surgery. No dressing was placed in the surgical site. (D) CPC group: Collagen sponge packed in the donor site and stabilized with cyanoacrylate. No sutures were used

FIGURE 3

Statistical comparison of day‐to‐day pain, swelling, bleeding, activity tolerance, and need for more pain killer scores among the four groups