Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Apr 22:2:2059513116642089.
doi: 10.1177/2059513116642089. eCollection 2016 Jan-Dec.

An analysis of surgical and anaesthetic factors affecting skin graft viability in patients admitted to a Burns Intensive Care Unit

Catherine E Isitt  1 , Kayleigh A McCloskey  1 , Alvaro Caballo  2 , Pranev Sharma  1 , Andrew Williams  2 , Jorge Leon-Villapalos  2 , Marcela P Vizcaychipi  1   3
Affiliations

An analysis of surgical and anaesthetic factors affecting skin graft viability in patients admitted to a Burns Intensive Care Unit

Catherine E Isitt et al. Scars Burn Heal. .

Abstract

Objectives: Skin graft failure is a recognised complication in the treatment of major burns. Little research to date has analysed the impact of the complex physiological management of burns patients on the success of skin grafting. We analysed surgical and anaesthetic variables to identify factors contributing to graft failure.

Methods: Inclusion criteria were admission to our Burns Intensive Care Unit (BICU) between January 2009 and October 2013 with a major burn. After exclusion for death before hospital discharge or prior skin graft at a different hospital, 35 patients remained and were divided into those with successful autografts (n=16) and those with a failed autograft (n=19). For the purposes of this study, we defined poor autograft viability as requiring at least one additional skin graft to the same site. Logistic regression of variables was performed using SPSS (Version 22.0 IBMTM).

Results: Age, Sex, %Total Burn Surface Area or Belgian Outcome Burns Injury score did not significantly differ between groups. No differences were found in any surgical factor at logistic regression (graft site, harvest site, infection etc.). When all operations were analysed, the use of colloids was found to be significantly associated with graft failure (p=0.035, CI 95%) and this remained significant when only split thickness skin grafts (STSGs) and debridement operations were included (p=0.034, CI 95%). No differences were found in crystalloid use, intraoperative temperature, pre-operative haemoglobin and blood products or vasopressor use.

Conclusions: This analysis highlights an independent association between colloids and graft failure which has not been previously documented.

Keywords: Graft failure; anaesthetic management; burns; burns intensive care unit; colloids; skin graft.

PubMed Disclaimer

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The anaesthetics data were originally presented by CE Isitt and KA McCloskey at ISICEM conference in Brussels, Belgium in March 2015 and the surgical data were presented at the Nordic Burn meeting in Linkoping, Sweden in May 2014 by A Caballo.

Figures

Figure 1.
Figure 1.
CONSORT 2010 diagram showing patient selection.
See this image and copyright information in PMC

References

    1. Brusselaers N, Monstrey S, Vogelaers D, et al. Severe burn injury in Europe: a systematic review of the incidence, aetiology, morbidity and mortality. Critical Care 2010; 14(5):R188. - PMC - PubMed
    1. Harbin KR, Norris TE. Anaesthetic management of patients with major burn injury. AANA Journal 2012; 80(6): 430–439. - PubMed
    1. Weber DJ, van Duin D, DiBiase L, et al. Healthcare-associated infections among patients in a large burn intensive care unit: incidence and pathogens, 2008–2012. Infect Control Hosp Epidemiol 2014; 35(10): 1304–1306. - PMC - PubMed
    1. Orgill DP, Ogawa RO. Current methods of burn reconstruction. Plast Reconstr Surg 2013; 131(5): 827e–836e. - PubMed
    1. Herndon DN, Tompkins RG. Support of the metabolic response to burn injury. Lancet 2004; 363: 9424. - PubMed

LinkOut - more resources