Incidence and patterns of split thickness skin graft failure at Kiruddu National Referral Hospital in Uganda

Abstract Introduction: Graft failure results in delayed wound healing, increased hospital stays, repeat surgery, further donor sites and increased scar formation. There is limited information specifically about difficulties at the graft site after split skin grafting in the lower limbs. The purpose of this study was to determine the incidence and patterns of split thickness skin graft failure at Kiruddu National Referral Hospital (KNRH) in Uganda. Methods This was a prospective longitudinal study in which patients who had split skin graft on the lower limbs were followed up till the 10th day to assess the graft failure rates. Graft failure was defined as any take less than 80% on the 10th post-operative day. Culture and sensitivity was done for the patients that had graft failure. Using SPSS version 26, the incidence and failure patterns were computed. Results We enrolled 160 study participants, majority of whom were female 84(52.5%) with a mean age of 32.5 years (SD = 19.4). In this study, 59 participants had graft failure representing an incidence ratio of 36.9% (369 graft failures per 1000 grafts done). All failures were partial. The main direct cause of failure was infection, seen in 51(86.4%) of all the failures. The commonest causative organism was Pseudomonas aeruginosa seen in 41.2% of the patients that had infection as the cause of failure. Other organisms included Staphylococcus hemolyticus 12(23.5%), Proteus mirabilis 10(19.6%) and Staphylococcus aureus 8(15.7%). Amikacin had the highest sensitivity against all the organisms isolated in this study. All organisms were resistant to ampicillin, cotrimoxazole and ceftriaxone. Conclusion The failure rate was high. More attention to reduce the risk of graft failure should be focused on minimizing graft infection since this was the main cause of failure. Amikacin should be considered for empiric treatment in patients that experience infection following grafting in KNRH before the culture results are available.