Determinants of Donor Site Infections in Small Burn Grafts

Ja, Griswold; Bj, Grube; Lh, Engrav; Ja, Marvin; Dm, Heimbach

doi:10.1097/00004630-198911000-00014

Cited by 20 publications

(5 citation statements)

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“…This finding reflects previous work done in pediatric patients, which showed that routine antibiotic prophylaxis was unnecessary in the era of early excision and closure of burns, 12 – 14 and more recent work, which showed no effect of perioperative antibiotic prophylaxis on the incidence of bacteremia graft loss, or surgical site infection. 22 The unique practice patterns at our institution—where initial excision is randomized by surgeon call schedule and where some surgeons routinely request prophylactic antibiotics in small burn excisions and others do not—provide a natural comparison group for retrospective review.…”

Section: Discussionsupporting

confidence: 86%

“…Perioperative antibiotics are often used in cutaneous surgery for extensive burn injuries, during which the large surface area of the surgical site and altered physiology puts the patient at high risk of local and systemic infection. 11 , 12 , 15 However, no standardized data exist for prophylactic use of antibiotics in small burns, a scenario in which these risks are reduced. The potential reduction in infectious risk must be weighed against practicing antibiotic stewardship to preserve effective therapies for multidrug-resistant organisms, particularly in the susceptible burn population.…”

Section: Discussionmentioning

confidence: 99%

“…5,9,10 The current evidence regarding perioperative prophylactic antibiotic use is mixed. Several studies in patients with deep burns have demonstrated fewer donor site infections and fewer skin graft losses with antibiotic prophylaxis, 11,12 whereas other studies have reported no difference in graft take with or without perioperative antibiotics. 13,14 Bacteremia secondary to surgical excision is related to a TBSA greater than 45% and a burn injury older than 10 days, which suggests that antibiotic prophylaxis for small, acute burn excision and grafting may be unnecessary.…”

Section: Introductionmentioning

confidence: 99%

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Is Antibiotic Prophylaxis Necessary in Small (≤20% TBSA) Burn Excisions? A Retrospective Study

Puthumana

Khan

Tiongco

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: This study investigates the effect of prophylactic perioperative antibiotic use on patients with small burns [≤20% total body surface area (TBSA)] on rates of infection, graft loss, or readmission. Methods: A retrospective chart review was conducted on patients admitted to our institution's burn center between January 2020 and July 2021. Patients were included if they had a 20% or less TBSA burn with 1 or more operating room visit for burn excision and were excluded if a preoperative infection was present. Data were gathered regarding patient demographics, burn mechanism, burn characteristics, and outcome measures including infection, graft loss, and readmission. Statistical analysis was conducted by Mann-Whitney U and Fisher exact tests, and P values reported at two-sided significance of less than 0.05. Results: There were no significant differences in age, body mass index, TBSA, percent third-degree burn, or comorbidities between patients who received (n = 29) or did not receive (n = 47) prophylactic perioperative antibiotics. There was a nonsignificant trend toward higher length of stay in the prophylactic antibiotic group, possibly driven by a nonsignificant trend toward higher rates of flame injuries in this group. There was no difference in infection (P = 0.544), graft loss (P = 0.494), or 30-day readmission (P = 0.584) between the two groups. Conclusion:This study finds no significant difference in postoperative infection, graft loss, or 30-day readmission in two similar patient cohorts who received or did not receive prophylactic perioperative antibiotics for acute excision of small (≤20% TBSA) burns.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is Antibiotic Prophylaxis Necessary in Small (≤20% TBSA) Burn Excisions? A Retrospective Study

Puthumana

Khan

Tiongco

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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“…Alexander et al, in 1984, showed no differences in graft takes with or without antibiotics 35 . A few years later, Griswold et al reported less donor site infection and a tendency to reduce skin graft infection in those who received antibiotics, in a retrospective study 36 .…”

Section: Skin Graftingmentioning

confidence: 97%

Antibiotic Prophylaxis in Burn Patients: A Review of Current Trends and Recommendations for Treatment

Ramos¹

2018

J Infectiology

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As nosocomial infections in burn patients are prevalent and dangerous, systemic antibiotic prophylaxis has been considered, beside other interventions. However, this kind of therapy has been questioned due to controversy related to its effectiveness and complications, such as drug toxicity and development of multidrug-resistance. This review includes evidence reported during the period 1966-2016. The quality of evidence and strength of recommendation of these guidelines are based on the GRADE system. Early post-burn prophylaxis showed no effectiveness for toxic shock syndrome or burn wound infection prevention (Grade 1C) in non-severe burn patients but it could be useful for those who had severe burns and require mechanical ventilation (Grade 2B). Perioperative prophylaxis would neither have indications for wound cleaning nor for devitalized tissue debridement of most burn patients (Grade 2B), but there is not enough evidence to make a strong recommendation to those who have extensive burns. Finally, prophylaxis could be used to prevent skin graft infections in selected procedures (Grade 2B).

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“…Biobrane has proved to be more comfortable than fine mesh gauze as a donor-site dressing, but it has also been associ- ated with an increased number of donor-site infections. 1,[17][18][19][20] Duoderm is an occlusive dressing made up of an outer layer of polyurethane foam that is relatively impermeable to oxygen and water, and an inner layer of hydrocolloid polymer complex that is occlusive and hydrophilic. 1,[21][22][23] Duoderm has been shown to promote the rate of epithelialization and collagen syntheses and to decrease the pH of wound exudates, thereby potentially reducing bacterial counts.…”

Section: Donor-site Discomfortmentioning

confidence: 99%

An Alternative Method to Minimize Pain in the Split-Thickness Skin Graft Donor Site

Akan

Yıldırım

Misirlioğlu

et al. 2003

Plastic and Reconstructive Surgery

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In the art of plastic surgery, the reconstruction of tissue defects to obtain cosmetic and functional recovery is the major concern. Skin grafting is the most frequently used procedure for reconstructing defects of various size and anatomical localizations. On the other hand, donor-site problems associated with this invaluable procedure are inevitable. Various methods are used in the postoperative management of the partial-thickness donor site created during the harvest of a split-thickness skin graft. Each technique has the potential for complications of fluid loss, excessive pain, prolonged period of healing and immobilization, hypertrophic scarring, and undesirable pigmentation. Donor-site pain is probably the most disturbing complication in the early postoperative period. The aim of this article is to point out the significance of donor-site pain, which has not been emphasized thoroughly in the literature, and to introduce flap skin as a potential graft donor site for patients in whom reduction of donor-site morbidity is of primary concern. The principal goal of the technique described in this article is to eliminate donor-site pain by harvesting the graft from the flap that is insensate after the elevation. In 15 patients, the overlying skin of the flap that had been used for reconstructive purposes was used as the donor site (group I). In the remaining 23 patients, the posterolateral thigh was used as the donor site (group II). Donor-site discomfort was recorded during the first 8 days postoperatively using a visual analogue scale. To analyze the data, we used the Friedman test, Dunn's multiple comparison test, and Mann-Whitney U test. It was observed that the visual analogue scale of both of the groups showed a significant decrease within days (group I, p < 0.0001; group II, p < 0.0001). The mean pain scores were significantly lower in group I than in group II (p < 0.0001). When donor-site pain is of primary concern, this procedure provides uneventful and comfortable healing while avoiding postoperative pain in the donor site. For that reason, this technique might be used in appropriate cases to minimize donor-site pain.

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Determinants of Donor Site Infections in Small Burn Grafts

Cited by 20 publications

References 0 publications

Is Antibiotic Prophylaxis Necessary in Small (≤20% TBSA) Burn Excisions? A Retrospective Study

Is Antibiotic Prophylaxis Necessary in Small (≤20% TBSA) Burn Excisions? A Retrospective Study

Antibiotic Prophylaxis in Burn Patients: A Review of Current Trends and Recommendations for Treatment

An Alternative Method to Minimize Pain in the Split-Thickness Skin Graft Donor Site

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