Multicenter research of the dependence of skin graft engraftment and the concentration of blood hemoglobin, total serum protein and albumin

Abstract

The Objective was to evaluate the effects of the concentration of blood hemoglobin, total serum protein and albumin on skin graft engraftment frequency.Methods and Materials. The study included 186 patients with full-thickness skin burn more than 5 % of total body surface area who were treated in five different burn departments of the Russian Federation. Depending on the readiness of the wounds, all performed surgical treatments were divided into four groups: 1) simultaneous skin graft after tangential necretomy; 2) simultaneous skin graft after radical necretomy; 3) skin graft for granulation wounds; 4) skin graft for a long time existing pathologically (hyper)granulation. Venous blood was taken from all the patients 12 hours before and 12–24 hours after skin graft. The concentration of blood hemoglobin, total serum protein and albumin was determined in the obtained samples. The evaluation of skin graft engraftment frequency was carried out by a combined method on the 7th day after skin graft. The data obtained were processed using descriptive and nonparametric statistics.Results. The concentration of total serum protein (p=0.001) and albumin (p=0.000) had a significant impact on the skin grafting results. This relationship was most pronounced during skin grafting on granulating wounds and after radical necretomy. The data obtained were identical for meshed and non-meshed skin grafts. Decrease in hemoglobin concentration did not lead to a degradation of skin grafts (p=0.068) in any of the study groups. According to the results of the laboratory parameters ranking, it was found that maintaining the concentration of total serum protein more than 6 g/dL allows 1.3 times to improve the results of skin grafting, and albumin concentrations more than 3.5 g/dL – 1.4.Conclusion. During the study, we were unable to confirm the existence of a relationship between the concentration of blood hemoglobin and the results of skin graft engraftment by any of the statistical analysis methods in any of the study groups. Accordingly, the inability to transfuse erythrocytes to a patient with anemia below 9–8 g/dL cannot be considered as an absolute contraindication for early surgical treatment of burned patients. Apparently, the concentration of total serum protein and albumin has a much greater effect on the skin grafting results. Trigger values of total serum protein can be recognized as 6 g/dL (albumin – 3.5 g/dL), which provides good results of engraftment in at least 90 % of operated patients.

Keywords

• burns
• burn disease
• hemoglobin
• total protein
• albumi
• necrectomy
• skin graft