Hypertrophic skin grafts in burned patients: a prospective analysis of variables

A prospective study of 70 consecutive burned patients, 26 pediatric patients and 44 adults, who had 173 separate anatomic sites grafted, was carried out to determine the incidence of hypertrophic skin grafts after thermal injury. The age, race, postburn day grafted, anatomic site grafted, and nature of the recipient graft bed was recorded. The patients were followed for a minimum of 1 year, at which time the skin grafts were classified as Excellent (E)--skin graft flat and not thickened; Good (G)--less than 5% of skin graft thickened or elevated; Fair (F)--greater than 5% of skin graft thickened or elevated; and Poor (P)--skin graft elevated greater than 2 mm or contracture present. Overall, 55% of the grafted sites were excellent, 18% were good, 13% were fair, and 14% were poor. Pediatric patients had a higher incidence of fair or poor results (50%) than adults (17%) (p less than 0.001), and blacks had poorer (39% F or P) results than whites (12% F or P) (p less than 0.001). The presence of dermal elements in the recipient graft bed was associated with less long-term skin graft scarring than when the grafts were placed on recipient beds without dermal elements (p less than 0.01). Skin grafts that were performed within 14 days of the injury had a lower incidence of F or P results (24%), than grafts performed after 14 days postburn (37%) (p less than 0.03). Based on the results of this prospective study, it is possible to identify and quantitate the relative risk of a burned patient developing a hypertrophic skin graft.