MELTING GRAFT-WOUND SYNDROME

Progressive epithelial loss (melting) from a previously well-taken gra ft, healed burn wound, or healed donor site is a significant problem i n the treatment of patients with burn injuries. For many years, such e pithelial loss was attributed to the growth of Streptococcus spp; howe ver, we recently have encountered progressive epithelial melting witho ut significant colonization or infection with Streptococcus spp We ret rospectively reviewed 1035 cases admitted from January 1994 to July 19 96 and then collected data prospectively from 324 patients admitted to the University of Washington Burn Center from August 1996 to May 1997 . Melting gaft-wound syndrome developed in 29 patients. Swab wound cul tures from these patients mainly grew Staphylococcus aureus, and none grew Streptococcus spp. All patients were treated with systemic antibi otics and local wound care. Twenty-seven patients healed spontaneously , but two underwent debridement and re-autografting to close the wound s. The melting gt aft-wound is a significant clinical problem, and its incidence appears to be increasing. The pathophysiology, clinical cou rse, and treatment of the melting graft-wound syndrome are not well un derstood, and there is no description of it in the literature. This st udy describes the clinical features of the syndrome.