Analysis of Skin-Graft Loss Due to Infection

Abstract

This prospective study was performed to analyze the causes of infection-related skin-graft loss in a general population of plastic and reconstructive surgery patients. One hundred thirty-two patients who received either full- or split-thickness skin grafts to reconstruct soft-tissue defects were included. The tissue defects were grouped according to the cause as follows: vascular ulcers (9.2%), burns (14.5%), traumatic tissue defects (36.6%), and flap donor-site defects (39.7%). In all cases, the preoperative evaluation indicated an adequate wound-bed preparation. However, graft loss secondary to infection was recorded in 31 patients (23.5%). The microbiological cultures revealed Pseudomonas aeruginosa in 58.1% of the cases (P<0.05), followed by Staphylococcus aureus, Enterobacter, enterococci, and Acinetobacter; 58.3% of grafts in vascular ulcers, 47.4% of grafts in burns, 16.7% of grafts in traumatic-tissue defects; and 13.5% of grafts in donor-site defects were lost due to infection. Vascular ulcers and burns were more commonly associated with graft losses due to infection than other tissue defects (P<0.001). No correlation was found between the etiological cause of the defects and the microorganisms cultured. However, Pseudomonas infections were more fulminant and caused an increased reoperation rate 4.2 times (P<0.05). Full-thickness grafts were more resistant to infection than split-thickness grafts (P<0.05). Graft loss due to infection was also more common in grafts applied to the lower extremities or when performed at multiple sites. In conclusion, 23.7% of skin grafts were lost due to infection in a group of general plastic surgery patients. Infection-related graft loss was more commonly encountered in vascular ulcers and burn wounds, and the most common cause was Pseudomonas aeruginosa.

An overview of factors maximizing successful split-thickness skin grafting in diabetic wounds

“…Skin grafts generally will not take on poorly vascularized wound beds, such as bare tendons, cortical bone without periosteum, heavily irradiated areas, or infected wounds. However, virtually any tissue type with a vascular granulating bed is acceptable for grafting (135). NPWT has been shown to provide many aspects of STSG success by promoting granulation tissue, lowering bacterial counts, and removing accumulated fluid, such as hematoma/seroma, both of which reduce the chronic inflammatory process that occurs in chronic wounds such as elevated MMPs.…”

Division of overall duration of stay into operative stay and postoperative stay improves the overall estimate as a measure of quality of outcome in burn care

“…There were wound-related issues in 41% of the patients with extended postoperative stays, and their median was 12 days. This outlines the validity of the concept of operative stay/ postoperative stay as it could detect longer periods of care that can be reduced by transferring the patient back to his home hospital, or supplying the care in outpatients if the patient’s general condition permits [9]. …”

“…The calculation of seven days is based on the assumption that a skin graft is usually the last operation done, and the dressing is changed five days later, followed by one further dressing to exclude infections and failure of the graft [9, 20]. We then considered that patients who stayed for more than seven days had by definition extended their postoperative stay, which was the total of days beyond seven days after the last intervention (Fig 1).…”

“…Many reasons for extended stay can be considered [2, 9–12]: first wound related, secondly need for advanced medical support and additional treatment for psychological or other medical causes, or accommodation preparation before discharge. The need for an outcome measure that is more reproducible than duration of total stay is evident.…”

Antimicrobial Effect of Skin for Allograft and Management in Burn Wound

“…Mayhall CG also reported the burn patients are exposed to a risk of infection especially by S. aureus (23.0%), P. aeruginosa (19.3%), E. coli (7.2%) and C. albicans (3.5%) [17]. So skin grafts wound frequently be lost due to infection in vascular ulcers and burn wounds [18]. The best skin grafts come from the patient's own unburned skin (donor sites) [19].…”