title: Skin grafting the contaminated wound bed: reassessing the role of the preoperative swab.
abstract: OBJECTIVE
  To investigate use of the preoperative wound swab to predict graft failure compared with establishing the indication for skin grafting on clinical grounds alone.
  
  
  METHODS
  Patients requiring meshed split-thickness skin grafting were prospectively included; the indication for grafting was established on clinical grounds exclusively. A preoperative swab of the wound bed was taken, but its result was concealed to prevent it influencing clinical decision-making. Negative pressure wound therapy (NPWT) was used for both wound bed preparation and graft fixation.After 2 months, graft area take percentage was measured using digital image processing software and the results validated against the result of the preoperative wound swab.
  
  
  RESULTS
  Eighty-seven wounds were included in the study. Mean graft area take percentage was 88%,with five grafts considered complete failures(< 25% take).A posteriori analysis of the wound cultures showed that 53% had been contaminated on grafting, but these did not fare any worse than near-sterile wounds. Qualitative analysis of cultures showed that wounds containing either Pseudomonas aeruginosa or Staphylococcus aureus did have inferior outcome (mean take percentage 78.9% vs 91.3%; p=0.038).Diabetes was also a deteriorating factor (mean take percentage 83.0% vs 90.7%; p=0.004).
  
  
  CONCLUSIONS
  Establishing the indication for skin grafting on clinical grounds exclusively does not yield grossly inferior results. In light of recent advances in skin grafting, including use of NPWT as adjuvant therapy, the requirement for routine preoperative wound swabs may be questioned.
authors.affiliation: Department of Vascular Surgery, University Hospital, Brussels, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Aerden
authors.forename: I
authors.initials: I
authors.lastname: Bosmans
authors.forename: B
authors.initials: B
authors.lastname: Vanmierlo
authors.forename: J
authors.initials: J
authors.lastname: Spinnael
authors.forename: B
authors.initials: B
authors.lastname: Keymeule
authors.forename: P
authors.initials: P
authors.lastname: Van den Brande
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058491:Bacterial Load; D002648:Child; D002985:Clinical Protocols; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D011300:Preoperative Care; D011446:Prospective Studies; D016038:Skin Transplantation; D014947:Wounds and Injuries / Q000382:microbiology* / Q000451:nursing / Q000601:surgery*