ORIGINAL ARTICLE Surgeon’s practices and beliefs in Australia and New Zealand regarding the donor site wound for paediatric skin grafts Craig A McBride , 1,2 Bhaveshkumar Patel , 1,2 Roy M Kimble 1,2 and Kellie A Stockton 3 1 Pegg Leditschke Children’s Burns Centre, 3 Department of Physiotherapy, Queensland Children’s Hospital and 2 Centre for Children’s Burns and Trauma Research, Queensland Children’s Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia Aim: Children’s burns care in Australasia is performed by paediatric surgeons and by plastic surgeons. The aim was to determine practices regarding the donor site wound (DSW), and to explore any differences by training scheme or nature of unit (paediatric vs. mixed). Methods: Online survey of Australasian burns surgeons. Results: Forty surgeons responded. 23/40 paediatric surgeons, 23/40 worked in a stand-alone children’s burns unit. All used powered derma- tomes. Alginates were the most common DSW dressing. Idealised dressings favour patient factors over cost. Plastic, and mixed-practice, sur- geons use a broader range of dermatome settings in children >1 year. Mixed practice surgeons use thicker settings. All surgeons see pain as a common DSW problem. Paediatric surgeons recognise itch as a problem. Conclusions: While there are differences related to training scheme and the mix of patients being treated, there is a broader commonality of practice. Key words: paediatric burn; skin transplantation; transplant donor site. What is already known on this topic 1 Surgeons from different training schemes carry out STSG in chil- dren in Australia and New Zealand. 2 Some children with burns are treated in stand-alone children’ burns centres, while others are treated in mixed adult and paedi- atric units. What this paper adds 1 There is a broad commonality of practice for the care of chil- dren’s burns, despite training scheme and place of work differences. 2 Paediatric surgeons, and surgeons working with children only, use a narrower range of dermatome settings when harvesting skin grafts. 3 Surgeons preference patient factors when deciding on donor site wound dressings. Paediatric burns care in New Zealand and Australia is variously carried out by plastic surgeons, by paediatric surgeons, or by both specialties collaboratively. Some units are stand-alone paediatric burns units, while others combine paediatric and adult care. Prac- tices within and among units may vary; based upon differences in the training of surgeons, the patient populations they treat, and the history of local practices developed over time. Increasingly, primary dressings for burns – particularly in chil- dren – have moved towards those containing silver as a preven- tive measure against infection. This has led to marked decreases in the proportion of children being treated who subsequently require split-thickness skin grafting (STSG). If a child does require a STSG a second, iatrogenic, wound is necessarily created – the donor site wound (DSW). Care of this wound has received less attention in the literature. In 2000 Patrick Lyall and Stewart Sinclair published the results of a survey of DSW practices. 1 This survey was directed at all Plastic and Reconstructive Surgeons in Australia and New Zealand and received 116 responses. The most common DSW dressing overall in that survey was calcium alginate. There were practice differences between centres, and between Australia and New Zealand – though satisfaction with choice of DSW dress- ing was relatively high in all centres. Surgeons took a patient- focused approach to dressings; favouring factors such as patient comfort, healing time and patient convenience above ease of nursing care and cost of dressings. This survey was sent to plastic surgeons only, and thus did not capture data from general or paediatric surgeons who also treat burns in some jurisdictions. Similar published surveys have an adult focus. 2,3 Paediatric-only data of this nature, both patient and surgeon-specific, are rarer. Correspondence: Associate Professor Craig A McBride, Surgical Team: Infants, Toddlers, Children (STITCh), Children’s Health Queensland Hospital and Health Service, Level 7d Directorate; Queens- land Children’s Hospital, 501 Stanley Street; South Brisbane, Qld. 4101, Australia. Fax: +61 7 3068 3469; email: cmcbride@paedsurgery.com Conflict of interest: None declared. Accepted for publication 13 July 2020. doi:10.1111/jpc.15117 Journal of Paediatrics and Child Health (2020) © 2020 Paediatrics and Child Health Division (The Royal Australasian College of Physicians) 1