SUCCESS OF SKIN-GRAFTING ON A CONTAMINATED RECIPIENT SURFACE

Over a three-year period, 90 burn patients having split thickness skin grafting were studied. The deep burn surface area ranged from 5 to 35 % of TBSA. All had a positive bacterial contamination of the burned ar ea greater than > 100,000 organism per gram. The conventional method o f burn management was used. All cases had preoperative baths and povid one iodine soaks. Postoperative topical antibiotics were applied to th e grafted site, selected by culture and sensitivity testing. There was an 80-95% take of the graft in 87 cases, 50% in two cases, and in one case there was complete graft loss. The latter was due to the presenc e of another species of contamination not specified by the culture and sensitivity at the time of surgery. Another five patients with a simi larly infected recipient surface were grafted without applying the abo ve protocol; this was considered as a ''control group''. Two out of fi ve cases showed a graft take of less than <20% and there was complete graft loss in the other three cases. This postulated that diligent cle ansing with antiseptic soaks is effective in reducing the bacterial co unt. Specific topical antibiotics inhibit the bacterial action on the granulation tissue surface, as they do in vitro until early vasculariz ation required for graft adhesion occurs. Using this simple protocol, good graft take could be achieved even in the presence of bacterial co ntamination; thus resulted in a shorter hospital stay.