The Effect of Recipient Site Bacterial Profile on the Percentage Take of Split Thickness Skin Graft at Kenyatta National Hospital

Abstract

Background Split thickness skin graft (STSG) is a common procedure but graft failure often occurs due to multiple factors. These factors includes infection, hematoma, poor surgical technique, and seroma formation among others. Recipient site microbiology prolife reflect the organism that eventually infect the graft causing failure. Studies on graft failure due to infection have not been done in Kenyatta National Hospital (KNH). Objective The aim of the study was to assess the effect of the recipient site microbiological profile on the graft take for patients undergoing split thickness skin grafting in KNH. Methods This was a descriptive study among patients undergoing skin grafting in KNH. A total of 69 patients who underwent STSG were recruited in the study, the recipient site was assessed on day 5 and 10 and percentage graft take rate recorded. The wounds were biopsied at the time of the skin grafting and sent for microscopy culture and sensitivity. Outcomes variables that were assessed were percentage skin graft take, bacterial profile of the recipient site and the effect the bacterial profile had on the skin graft take. Data was entered into SPSS and analyzed for proportions, rates and bivariate analysis was done for association using Chi-square. Statistically significant was taken at p-value <0.05. Results The location of the wound was majorly in the lower limbs 45 (65%) with a wound size median value of 26.5% (IQR: 9 - 33) for percentage burn. The median percentage graft takes of the wound at day 5 and 10 was 60%. Majority 92% of the wounds biopsied cultured organisms, the majority were; Pseudomonas Aeroginosa 12 (17.39%). Pseudomonas aeroginosa affected graft survival with a percentage take of less than 20%.

Conclusion The median percentage take of skin graft wounds is 60% with majority of wounds grafted in KNH are post burn wounds. Graft take did occur in wounds that did culture organisms but presence of some specific organism were a negative predictor of graft take this include pseudomas aeroginosa, proteus spps and streprococcus pyogens.