Analysis of skin-graft loss due to infection: infection-related graft loss.
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.
Unal
Sakir
S
Department of Plastic Surgery, Mersin University School of Medicine, Mersin, Turkey.
Ersoz
Gülden
G
Demirkan
Ferit
F
Arslan
Emrah
E
Tütüncü
Necmettin
N
Sari
Alper
A
D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D006085:Graft Survival; D006801:Humans; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D016038:Skin Transplantation; D013530:Surgical Wound Infection / Q000209:etiology* / Q000382:microbiology