Is the Preoperative Wound Culture Necessary Before Skin Grafting Minor Burns? A Pilot Study in a Low Resource Setting Burn Service.

Autor:	Holm S; Department of Head, Neck and Reconstructive Plastic Surgery, Örebro University Hospital, Örebro 70185, Sweden.; Department of Surgical Science, Örebro University, Örebro 70185, Sweden., Smith MTD; Department of Anaesthetics and Critical Care, Greys Hospital, Pietermaritzburg 3201, South Africa.; Department of Surgery, Pietermaritzburg Metropolitan, Pietermaritzburg 3201, South Africa., Huss F; Deparment of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala 75310, Sweden.; Department of Plastic and Maxillofacial Surgery, Burn Center, Uppsala University Hospital, Uppsala 75237, Sweden., Allorto N; Department of Surgery, Pietermaritzburg Metropolitan, Pietermaritzburg 3201, South Africa.; Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Berea 4001, South Africa.
Jazyk:	angličtina
Zdroj:	Journal of burn care & research : official publication of the American Burn Association [J Burn Care Res] 2024 Sep 06; Vol. 45 (5), pp. 1281-1286.
DOI:	10.1093/jbcr/irae048
Abstrakt:	The most common cited cause of split-thickness skin graft failure is infection and due to the association between bacterial findings in wound beds an attempt to decrease the bacterial burden before skin-grafting evolved. Thus, preoperative microbiology swabs of the wound bed became routine at some institutions prior to grafting. This is not standard practice in the Pietermaritzburg Burn Service. Emphasis is instead placed on a strict protocol of intraoperative wound bed preparation to promote adequate graft take. This pilot study aims to evaluate whether preoperative wound swabs are appropriate. We performed a prospective observational study to determine if positive wound cultures were associated with graft failure. All patients with a burn surface area of less than 10%, where delayed grafting (later than 28 days from the time of burn injury) was performed, from March to December 2021 were analyzed. Patient demographics, days from burn to graft, %TBSA burn, %TBSA grafted, whether sharp debridement prior to grafting in the same procedure was performed or not, use of topical gentamicin intraoperatively, graft outcome (% graft loss), need for regraft, and organism grown were recorded into an excel spreadsheet for analysis. The sample included 52 patients. Of these, 17 (31.5%) were female. The median %TBSA grafted was 8% (IQR 4%-13%) and similar in both groups. The median days from burn to grafting were 35 days. Thirty-nine patients (75%) had graft Take and 13 (25%) had graft Failure. In the failed group, the median % graft failure was 50% (30%-70%). Of the group with successful graft take, 90% were noted to have had a positive wound culture prior to grafting. A positive wound culture was not found to be a risk factor for graft failure (P = .993). Despite the positive wound cultures graft take was more than 90% in 75% of grafts performed and only 2/52 patients required supplementary grafting. We believe that this demonstrates that our local protocol is reasonable in this setting and that waiting for negative wound swabs prior to grafting should not be a reason to delay grafting. (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Databáze:	MEDLINE
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