Journal of Clinical and Diagnostic Research (Jun 2018)
A Study to Analyse the Influence of Bacterial Bio-Burden on the Success Rate of Split Thickness Skin Grafting
Abstract
Introduction: Split Thickness Skin Grafting (STSG) is one of the main surgical procedures to repair soft tissue loss in patients with non-healing chronic wounds. Even when the prerequisites for successful grafting are met, graft may fail if the wound bed contains more than 105 bacteria/g of tissue. Hence in this present study quantitative bacteriological profile of granulating wound beds that were prepared for grafting was done preoperatively, to analyse the influence of bacterial bio-burden on the success rate of STSG. Aim: 1) To determine quantitative aerobic bacterial culture of granulating wounds that are prepared for grafting; 2) To assess the success rate of graft uptake postoperatively. Materials and Methods: This cross-sectional study was carried out in the Institute of Microbiology, Madras Medical College, Chennai, Tamilnadu, India. A total of 100 patients prepared for STSG surgery were included in this study from March 2016 to August 2016. Tissue sample from the recipient wound bed was collected before grafting and quantitative aerobic bacterial culture of the specimen was done. Results: Out of 100 patients, 32 patients had significant bacterial growth with bacterial counts ≥105 CFU/g of tissue in preoperative quantitative culture. On clinical evaluation the graft uptake was reduced when preoperative quantitative bacterial count is ≥ 105 CFU/g of tissue, which was statistically significant. The most commonly isolated pathogens in preoperative quantitative culture were Staphylococcus aureus (26.4%) and Pseudomonas aeruginosa (26.4%). The mean graft uptake was reduced by 24.5% and 31.2% if immediate preoperative culture showed Staphylococcus aureus and Pseudomonas aeruginosa respectively when compared to the no growth group, which was statistically significant. Conclusion: This study emphasises the importance of quantitative and qualitative bacteriological culture of pregrafted wound beds prior to skin grafting, thereby preventing graft failure.
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