The Effects of Hyperglycemia on Skin Graft Survival in the Burn Patient

Rate of Healing in Skin-Grafted Burn Wounds

“…Although diabetes mellitus has been shown by many authors to cause delayed wound healing and poor skin graft take, we did not find a statistically significant correlation between the presence of diabetes and time to complete wound healing. [1][2][3][4]7,12 This may have been due to the aggressive treatment of hyperglycemia in our inpatients. We acknowledge that this nonsignificant finding could be related to the small number of cases in the series and the low incidence rate.…”

“…Although there is abundant information in the literature regarding skin graft healing and factors that contribute to major skin graft loss, most authors measure these outcomes at arbitrary time points in the healing process of the skin-grafted wounds, such as postoperative day 7 or postoperative day 14. [2][3][4][5] Until now, there has been no prospective information about the time it takes for skin-grafted burn wounds to become 100 percent epithelialized. This study provides that information as well as a description of the role played by risk factors previously known to contribute to graft loss or decreased graft take in time to complete wound healing.…”

“…Contrary to these results, previous studies have reported infection as one of the most common causes of graft loss. 1,3,6,7 The development of new topical antimicrobial agents, such as 5% Sulfamylon solution (Bertek Pharmaceuticals) and Acticoat (Smith and Nephew, Memphis, Tenn.), appears to have changed this state of affairs. This does not mean that all skin-grafted wounds require antimicrobial dressings.…”

“…1,2 Studies that have reported the outcome of skingrafted wounds used an arbitrary endpoint of a few days to 2 weeks to measure the effects of variables such as graft type, infection, hematoma, shear, nutrition, and diabetic status on graft take. [2][3][4] Better information is needed to counsel our patients and improve our results.…”

Factors Affecting Success of Split-Thickness Skin Grafts in the Modern Burn Unit

“…Even in patients without diabetes mellitus, hyperglycemia and glucose intolerance may occur after burns and impact the success rate of STSGs. Mowlavi et al 23 noted that the incidence of graft take was decreased significantly in groups with hyperglycemia (60%) compared with groups with normoglycemia (84.6%). The proposed mechanism for the poor wound healing and increased rate of infection is the increased level of serum glucose from accelerated gluconeogenesis and perturbations in insulin metabolism.…”