Use of Bedside/Office Skin Graft Technique: Exploring Field Sterility and Local Anaesthesia in Resource-Poor Settings

Managing tissue loss is challenging for surgeons, especially in extensive areas where direct closure is difficult. Skin grafting can address these complex wounds, but costs often borne by patients in resource-poor settings pose a significant burden. Safe alternatives like field sterilisation and local anaesthesia enable effective bedside procedures, benefiting patients and the healthcare systems. This study shares our experience with skin grafting in such settings.

This is a retrospective study of 46 patients with soft tissue defects presenting to the Plastic surgery Division of the Jos University Teaching Hospital between February 2016 and September 2023. The patients' skin grafting was deemed feasible under local or regional anaesthesia, with an average size of 100 mm² with varying sizes ranging from 3 cm by 1 cm to 14 cm by 14 cm. They were counselled and consented to office/bedside skin grafting.

Forty-six patients were operated on during the period under review, with their ages ranging from 5 to 90 years with a mean 37.25 years and a median of 36 years. Most of the patients were men and 13% were women. Seventy percent of the wounds that needed resurfacing using split thickness skin graft were on the lower limbs, 25% were on the upper limbs, and 5% were on other areas, such as the penile shaft, chest, and scalp. The graft take averaged 90% but ranged from 70% to 100%. Three patients had complete graft loss. No patient developed a donor site infection.

Results from skin grafting out of a conventional theatre in selected patients using field sterility are comparable to procedures done in a formal operating theatre. This offers a safe, affordable alternative with the generation of less waste.