Dr Dylan Prunster1, Dr Rachael Baines1, Dr Tania McWilliams1, Professor Fiona Wood1
1Perth Children’s Hospital – Burn’s Unit, Perth, Australia
Calcium alginate dressings are a widely accepted standard dressing for split skin donor sites. This method provides good haemostasis, reliable healing, low infection rates and removal is tolerated well in children. We present a case of an unusual donor site reaction occurring after the use of this dressing.
A 4yr old female sustained 8% flame burns to bilateral arms, chest and back of mixed dermal thickness. On day 4 post-injury a tangential excision and split skin graft harvest from right buttock was performed. Adrenaline soaked packs were used on the donor site to achieve haemostasis prior to apply calcium alginate dressing and securing with Fixomull. At next dressing change an area of the donor site was noted to be mottled, white, with a firm, rough texture.
We believe this to be a case of dermal calcification within a donor site as a result of the calcium alginate dressing. This has previously been reported in a case series by Davey et al. 2000. It is postulated that excessive liberation of calcium from the dressing occurs locally resulting in the precipitation of calcium salts into the healing donor site. Alternatively an unusually florid inflammatory response may have been triggered causing dystrophic calcification.
Although the mechanism of this complication is not fully understood, all documented cases have successfully been treated on first debridement or spontaneous resolved with expectant treatment.
Davey, RB, Sparnon, AL & Byard, RW 2000, “Unusual donor site reactions to calcium alginate dressings,” Burns, vol. 26, no. 4, pp. 393–398.
Dr Dylan Prunster is a surgical service registrar working within the West Australian Health Department with a keen interest in Plastic and Reconstructive Surgery. He obtained his primary medical qualification from the University of Western Australia and subsequently undertook an internship and residency at Royal Perth Hospital.