The primary study outcome was the percentage change in wound score according to the Bates-Jensen wound assessment tool after 4 weeks of treatment with
A. tinctoria extract ointment (20%) or standard daily dressing (dressing with base ointment) at the split-thickness skin graft donor site. Secondary outcomes included the percentage change in wound surface area, the proportion of patients who achieved complete healing and the adverse effects of dressing with
A. tinctoria extract ointment. To the best of our knowledge, this is the first clinical study to evaluate the healing effect of
A. tinctoria on the split-thickness skin graft donor site. Our results suggest that a dressing providing a moist environment gives beneficial effects [
2,
15,
16]. Under optimal conditions, the skin graft donor site heals within 7 to 21 days [
16]. A proper wound dressing may reduce the time to complete re-epithelialization and to prevent conversion of the donor site to a full-thickness wound [
15,
17,
18]. The healing process occurs in three phases of inflammation, proliferation, and maturation [
19,
20]. It is established that the inflammatory phase has the greatest impact on the healing process [
21]. Alkannin, shikonin and their esters are the main ingredients in
A. tinctoria that have anti-inflammatory, antimicrobial and antioxidant properties and promote wound healing [
10,
12,
22]. Previous studies showed that alkannin/shikonin (A/S) had wound-healing effects on chronic ulcers, leprotic ulcers, burn injuries and anal fissures [
10,
12]. As mentioned earlier, no studies have reported the wound-healing activity of A/Son split-thickness skin graft donor sites. The anti-inflammatory activity of A/S accelerates wound healing. In our study, decreases in wound score were significantly higher in the
A. tinctoriagroup. More specifically, we found that the proportion of patients who achieved complete healing increased with use of the alkannin/shikonin (A/S)-based ointment. Other clinical studies showed that A/Shad healing effects in cases of chronic, severe or contaminated wounds. Furthermore, animal studies showed promotion of angiogenesis, collagen production and epithelialization in acute, non-contaminated wounds by the A/S-based ointment [
23,
24]. Previously, it was indicated that the
Aloe vera cream enhanced wound healing compared with dry gauze dressing; this may have been due to the moisture-retaining effect of
Aloe vera on the wounds, but in the present study, it appears as though the pharmacologic properties of A/S were responsible for the observed effects [
25]. These results indicate that wound-healing pharmaceutical preparations, such as A/S-based ointment, which modulates both inflammatory and proliferative phases of wound healing, maybe more efficient than standard dressing for donor site management after skin graft harvesting.