Should a graft site be treated with a moist or dry dressing?

Graft Site Dressing Management

For skin graft sites, use moist dressings rather than dry dressings—they promote faster healing, reduce pain, and result in better graft take. 1, 2, 3

Primary Recommendation

Moist wound healing dressings are superior to dry dressings for graft sites, based on consistent evidence showing:

• Faster epithelialization: Moist dressings significantly reduce healing time compared to dry dressings 4, 3
• Better pain control: Patients experience less discomfort with moist dressings, particularly in the first 3 postoperative days 5
• Improved graft survival: Moist environments maintain graft integrity and prevent desiccation 6, 3

The American Heart Association supports this approach, recommending occlusive dressings for clean, superficial wounds to promote healing 2. This principle extends to graft sites where maintaining a moist environment is critical for successful integration.

Specific Dressing Options by Clinical Context

For Standard Graft Sites:

• Hydrocolloid dressings: Provide excellent immobilization, compression, and moist environment; associated with shorter treatment duration (8.3 vs 13.6 days) and lower complication rates 7
• Foam dressings: Ideal for moderate to heavy exudate; reduce pain compared to petrolatum gauze 1, 5
• Advanced composite dressings: ORC/collagen/silver-ORC with absorptive silicone borders achieve epithelialization in 11 days versus 18 days with petrolatum gauze 4

For Donor Sites Specifically:

• Hydrophilic polyurethane foam: Produces less initial discomfort and trends toward more complete healing by day 14 compared to petrolatum gauze 5
• Moist wound-healing products: Clear advantage over non-moist products in reducing pain and increasing healing rates 3

Application Protocol

Initial dressing application 1, 2:

• Clean the graft site gently with running tap water or sterile saline
• Avoid antiseptic agents like povidone-iodine for wound irrigation
• Apply appropriate moist dressing based on exudate level

Dressing maintenance 8, 1:

• Keep dressing undisturbed for minimum 48 hours unless leakage occurs
• For most graft sites, changes can be reduced to once or twice weekly
• Remove and inspect if signs of infection develop (redness, swelling, foul-smelling drainage, increased pain, fever)

Important Contraindications

Avoid occlusive/moist dressings when 2, 9:

• Signs of infection are present—moist environment may promote bacterial growth in already infected wounds
• Wounds are contaminated with saliva or caused by animal/human bites
• Initial days after certain procedures requiring breathable dressings

The Exception: Dry Dressing Success

One high-quality study showed excellent results (98.54% graft take) using Xeroform (petrolatum-impregnated gauze) with dry coarse-mesh gauze left intact for 5 days 6. However, this approach requires:

• Minimal manipulation until day 5
• Acceptance of potentially more pain compared to moist alternatives
• More nursing time for frequent monitoring

This dry approach contradicts the broader evidence base favoring moist healing 3, and should be considered only when moist dressings are contraindicated or unavailable.

Key Clinical Pitfalls

• Don't apply pressure before needle removal in vascular access contexts—this can traumatize the graft 8
• Don't use advanced dressings on primarily closed surgical wounds solely to prevent infection—standard dressings are equally effective and more cost-efficient 8
• Don't fail to address underlying exudate causes—excessive moisture without proper absorption leads to maceration despite appropriate dressing selection 9
• Select dressings based on exudate control, comfort, and cost—not marketing claims 1