Analysis of Factors That Affect the Outcome of Skin Grafts

Ki-Chan An; Jang-Seok Choi; Jung-Han Kim; Dong-Min Kim

doi:10.4055/jkoa.2012.47.2.119

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An, Choi, Kim, and Kim: Analysis of Factors That Affect the Outcome of Skin Grafts

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2012; 47(2): 119-124.

Published online: 30 April 2012

DOI: https://doi.org/10.4055/jkoa.2012.47.2.119

Analysis of Factors That Affect the Outcome of Skin Grafts

Ki-Chan An, M.D., Jang-Seok Choi, M.D., Jung-Han Kim, M.D., Dong-Min Kim, M.D.

Department of Orthopedic Surgery, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea.

Correspondence to: Jung-Han Kim, M.D. Department of Orthopedic Surgery, Busan Paik Hospital, College of Medicine, Inje University, 633-165, Gaegeum-dong, Busanjin-gu, Busan 614-735, Korea. TEL: +82-51-890-6129, FAX: +82-51-892-6619, kimjunghan74@gmail.com

Received 8 April 2010 Revised 29 June 2010 Accepted 24 January 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study aimed to investigate factors that affect the successful outcome of skin grafts.

Materials and Methods

One-hundred and one patients undergoing split-thickness skin grafts were reviewed between March 2000 and March 2008. The mean age of the patients was 39 years (16 to 67 years). The numbers of male and female patients were 63 (62.4%) and 38 (37.6%), respectively. The average follow up period was 8 weeks (2 to 23 weeks). For the analysis, patients were classified by patient factors and wound factors affecting the outcome of skin grafts. The criteria for the successful outcome of skin grafts were as follows: over 80% of skin ingestion rate, no exposure of subcutaneous tissue, no distinct signs of infection, and no need for reoperation. Also, statistical analysis was used to identify the correlation between each factor regarding the outcome of each skin graft.

Results

The preoperative serum levels of c-reactive protein (CRP) and white blood cell (WBC) were significantly correlated with the success of skin grafts (p<0.05). The cut-off value of WBC and CRP were 10.500×10³/µl and 1.02 mg/dl, respectively. Each factor showed 27.6 and 9.5 times of association strength.

Conclusion

Among the various factors, the preoperative serum levels of CRP and WBC had significant correlations regarding the successful outcome of skin grafts. This result suggests that those levels can be objective indexes to predict the outcome of skin grafts.

Keywords: skin graft, correlation factors, correlation intensity

Figures and Tables

Figure 1

Receiver operating characteristic (ROC) curve for prediction of skin graft outcomes. (A) ROC curve for prediction of graft failure by the level of CRP. Area under the curve was 0.760 (95% confidence interval: 0.666-0.838, p<0.001). (B) ROC curve for prediction of graft failure by the level of WBC. Area under the curve was 0.780 (95% confidence interval: 0.682-0.859, p<0.001). CRP, c-reactive protein; WBC, white blood cell.

Figure 2

Etiology of skin defects and the ratio of graft loss due to infection. In more than half of cases, the skin defects were caused by traumatic events. DM, diabetes mellitus.

Table 1

Criteria for Defining a SSI

Specific criteria are used for identifying infected episiotomy and circumcision sites and burn wound. SSI, surgical site infection.

Table 2

Patient's Factors Associated with Skin Graft

CRP, c-reactive protein; ESR, erythrocyte sedimentation rate; DM, diabetes mellitus.

Table 3

Wound Factors Associated Skin Graft

CDC, Centers for Disease Control and Preventation.

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