Baseline risk factors for split-thickness skin graft failure: A retrospective cohort study

Split-thickness skin grafting is a common procedure for the treatment of complicated wounds. Predictors of skin graft failure are not fully understood. The study aimed to identify baseline predictors of skin graft failure and delayed healing.

Consecutive adult patients with wounds treated using split-thickness skin grafting between 2009 and 2019 were included in a retrospective single-center study. Failures referred to total graft loss or the need of a new operation.

In total, 1484 wounds in 1011 patients were analyzed. Graft failure occurred in 384 (25.9%) cases and reoperation was required in 297 (20.0%) cases. At 1 year, the wound was healed in 91.5% of the cases. Logistic regression analysis showed that peripheral arterial disease, diabetes, use of immunosuppressive medication, and wounds located in the foot significantly increased the risk of graft failure, while wounds located in the chest and those secondary to trauma, burn, or cancer excision had significantly lower graft failure risk. Cox proportional hazards analysis showed that wounds of the hand, forearm, and thigh as well as those secondary to trauma and burns were associated with higher rates of wound healing at 1 year. Wounds in feet, wound duration, lower limb edema, peripheral arterial disease, use of antipsychotic medication as well as wounds secondary to surgical complications, venous insufficiency, diabetes, and other comorbidities were associated with lower wound healing at 1 year.

The present study identified several risk factors associated with poor outcome after skin grafting. These findings highlight the importance of recognizing patient comorbidities and wound etiology in preoperative planning.