Abstract:

Background: One of the most terrifying consequences of Split thickness skin grafting (STSG) is surgical site infection (SSI), which can result in the loss of the entire graft and put the patient at greater danger of systemic infections and the need for further surgery to replace the graft. Little information is available on the magnitude of SSI, bacteriological profile, antibiotic susceptibility patterns and factors associated with SSI following STSG surgeries at our setting which necessitated us to conduct this study.

Methods: This prospective longitudinal study was conducted in general surgical, orthopedic and plastic/reconstructive wards at BMC involving patients who underwent STSG surgeries between January and June 2023. Data were recorded using standard structured questionnaires. Wound/pus swabs were collected from patients with clinical evidence of SSI for bacteriological processing. Statistical data analysis was performed using STATA version 15.0.

Results: A total of 96 patients with median age [IQR] of 38.4[21.5 - 54.5] years were enrolled. Male sex accounted for 49 (51.0%). Traumatic skin loss, 33(34.4%) was the most common indication for skin graft surgery. About 30.2% (n=29) and 27.1% (n=26) developed clinical and laboratory confirmed SSI respectively. Gram-negative bacteria were predominantly isolated (92.3%; n=24). Male gender (p-value = 0.021), diabetes mellitus (p-value = 0.009), diabetes mellitus and hypertension (p-value =0.012), HIV infection (p-value = 0.028), wound size (pvalue < 0.001), pre-operative low hemoglobin (p-value < 0.001), pre-operative wound colonization (p-value = 0.008), rank of the surgeon (p-value = 0.04) and the duration of surgery (p-value < 0.001) were statistically associated with SSIs.

Conclusion: About one third of patients develop SSI after STSG surgeries at BMC. Evidencebased treatment approach using laboratory culture and sensitivity results is recommended in the management of SSI following STSG surgeries. Further studies are recommended to establish if colonization can be among the contraindication of skin grafting, junior doctor’s surgeries should be supervised by senior doctors especially for high risk patient, Also to individualize the antibiotic treatment based on C&S in the management of SSI following STSG surgeries.