Tumescent Versus Non-Tumescent Technique in Split-Thickness Skin-Graft Harvesting: A Systematic Review and Meta-Analysis

Abstract

OBJECTIVE: Taking a split-thickness skin graft (STSG) is a common reconstructive procedure, but the donor site often causes patients significant pain and bleeding. The authors investigated whether the tumescent technique is a better, safer method for harvesting these grafts. DATA SOURCES: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 5 major databases were searched. STUDY SELECTION: Randomized controlled trials (RCTs) comparing tumescent versus standard non-tumescent STSG harvesting were selected for inclusion. DATA EXTRACTION: Data were analyzed using random-effects models. The Cochrane RoB 2 tool was used to assess bias, and the GRADE method was used to rate the certainty of the evidence. DATA SYNTHESIS: Nine RCTs (n = 429) were included. The tumescent technique reduced intraoperative blood loss [standard mean difference (SMD): -2.68, 95% CI: -3.41 to -1.94; P < .001] and postoperative analgesic needs (SMD: -1.75, P < .001), with a consistent direction of effect despite high heterogeneity (I2 = 96%). Donor sites healed 1.2 days faster (P < .01); hematoma/seroma risk dropped (RR: 0.28, P = .04). Graft take showed no difference (P = .07). GRADE: high for hematoma reduction; moderate for blood loss/analgesics; low for graft take. CONCLUSIONS: The tumescent technique is associated with clinically meaningful reductions in donor-site blood loss, hematoma formation, postoperative analgesic requirements, and time to epithelialization, without adversely affecting graft take. The consistency of the effect direction supports its role as a safe and effective donor-site strategy.