Purpose: The almost single disadvantage of polyurethane film dressings, an uncontrolled leakage, is probably as often described as its numerous advantages for split-thickness skin graft donor sites. The authors developed a multi-perforated polyurethane film dressing (MPD), which permits a controlled leakage into a secondary absorbent dressing. Following preliminary successfull clinical trial, this study was conducted to compare the MPD-system and Aquacel® (ConvaTec, Bristol-Myers Squibb Company, New York, NY), a hydrofiber wound dressing, which also seems to fulfill all criteria of an ideal STSG donor site dressing. Material & Methods: Prospective randomized double-blind clinical trial of 50 patients using a matched pairs design by equally dividing the donor site for application of Aquacel® and MPD. Both materials were covered with a secondary gauze dressing. The dressings were kept unchanged for 10 days. Primary objective was the reepithelization rate 10 days postoperative. Secondary objectives were pain, costs, infection rate, and scarring, assessed 60 days postoperatively with the Vancouver Scar Scale. Results: 86.4% of the MPD donor sites showed a complete reepithelialization compared to 54.5% of the Aquacel®-treated donor sites at the 10th day. MPD was significantly less painful until and by dressing removal. A significant increase of pain of the Aquacel®-treated donor site in the course of time was detected. Aquacel® was more expensive than MPD. There was no significant difference in respect of scar formation. Conclusion: MPD-treated donor site areas had a good rate of reepithelialisation and a low pain level. Both could result from a beneficial moist wound environment and low shear forces mainly produced by a liquid layer underneath the PU-film. The results of the Aquacel®-treated donor sites referring to rate of reepithelialization and painlevel could be partly explained by the ambivalent qualities that were observed throughout the trial. In some cases the Aquacel® was dried-out and caused high shear stress on the wound surface, in other cases the wound covering remained particularly wet without healing of the underlying wound, maybe due to maceration. The authors ascribe the absence of differences concerning scar formation to the lack of distinct wound healing problems. Overall MPD was superior to Aquacel® concerning epithelialization rate, pain and costs. Further attributes such as easiness of application, low labour input, high patient comfort and protection against secondary wound infection qualify the MPD as an ideal wound covering for STSG donor sites.