Skin grafting the contaminated wound bed: reassessing the role of the preoperative swab.
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. Method: Patients requiring meshed split-thickness skin grafting were prospectively included; the indication for grafting was es...
| Publicado en: | Journal of Wound Care Vol. 22; no. 2; pp. 85 - 90 |
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| Autores principales: | , , , , , |
| Formato: | pictorial research tables/charts Journal Article |
| Publicado: |
Mark Allen Holdings Limited
Feb2013
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=87543849&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 87543849 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09690700 H3U jtl: Journal of Wound Care issn: 09690700 maglogo: N pubinfo: dt: Feb2013 vid: 22 iid: 2 pid: 11383 pub: Mark Allen Holdings Limited artinfo: ui: 87543849 104289619 104289619 10.12968/jowc.2013.22.2.85 87543849 ppf: 85 ppct: 5 formats: fmt: @attributes: type: P tig: atl: Skin grafting the contaminated wound bed: reassessing the role of the preoperative swab. aug: au: Aerden, D. Bosmans, I. Vanmierlo, B. Spinnael, J. Keymeulen, B. Van Den Brande, P. affil: Department of Vascular Surgery, University Hospital Brussels, Belgium sug: subj: Skin Transplantation Methods Negative Pressure Wound Therapy Utilization Human Protocols DICOM Prospective Studies Observational Methods Descriptive Statistics Data Analysis Software T-Tests Male Female Child Adolescence Adult Middle Age Aged Aged, 80 and Over Child: 6-12 years Adolescent: 13-18 years Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Aged, 80 & over Male Female ab: 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. Method: 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). Conclusion: 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. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare. pubtype: Academic Journal doctype: pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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