Prevention of Failed or Compromised Skin Graft
Preventing graft failure or compromise is by scrupulous surveillance to identify as early as possible the following:
- Poor vascularity
- Hematoma or seroma
- Mechanical shearing
Pre-graft, these complications can be prevented by proper wound bed preparation. During the grafting, complications can be reduced with intraoperative meticulous hemostasis and careful placement of the graft. After the procedure, immobilization is used with appropriate dressing to prevent shearing during the healing period.
Comorbidities that negatively impact neovascularization and healing should be addressed before the procedure to give the graft the best opportunity to “take” (proper adhesion) and the site to heal. This entails strict glycemic control for diabetics, smoking cessation, and correcting any protein or vitamin deficiencies. Medications that interfere with wound healing (steroids, immunosuppressants, and anticoagulants) should be discontinued temporarily.
In full-thickness skin grafts, the wound should be debrided where necessary and inspected for shearing or infection. Any fluid collections should be drained via creating small perforations and aspiration, which has the added benefit of diagnosing infection via retrieval of material to culture.
After about 2 weeks, the epithelium of a skin graft should be intact and scar prevention measures begin. Silicone covering and pressure therapy are applied to prevent hypertrophy (keloid). This protocol should be continued for 3 months.