A comparative study of graft uptake in split skin grafting between the first postoperative dressing done on day 3 versus day 5





SSG, Early postoperative dressing, Graft uptake, Graft rejection


Background: Skin grafting offers a method of regaining skin continuity. The common causes of skin graft failure are hematoma, seroma, infection. These affect the graft uptake maximally in the initial postoperative period by impairing graft adherence and subsequent revascularization. Aim of study was to compare graft uptake, rejection, seroma and infection among first postoperative dressing on day 3 versus day 5.

Methods: A comparative, prospective study conducted at our institute from November 2015 to April 2021, with 100 patients who underwent SSG (split skin grafting) who were distributed into two groups. Group A underwent the first postoperative dressing on day 3 and group B on day 5. The second postoperative dressing was done 2 days following the first. The grafted site was then assessed on for the percentage of graft uptake, rejection, seroma, infection clinically and through culture and sensitivity.

Results: The mean graft uptake in group A was 88.48% whereas in group B was 82.62% in the first dressing and in the second dressing, group A was 88.14% whereas group B was 78.02%, with statistically significant data and thus showing less rejection and infection rate in group A. Seroma was present in 82% of cases in group A and 74% in group B on 1st postoperative dressing which reduced to 6% and 12% respectively with the 2nd dressing.

Conclusions: Thus, the first postoperative dressing done on Day 3 following skin grafting, significantly increased the final uptake of the graft, reduced seroma, infection and rejection rate.

Author Biographies

Gurushantappa Yalagachin, Department of General Surgery, KIMS, Hubli, India

Professor and Head of the Department
Department of General Surgery

Abhijit D. Hiregoudar, Department of General Surgery, KIMS, Hubli, India

Associate Professor 

Department of General Surgery

Sanjay B. Mashal, Department of General Surgery, KIMS, Hubli, India

Assistant Professor

Department of General Surgery

Ashika Bagur, Department of General Surgery, KIMS, Hubli, India

Department of General Surgery

Senior Resident

Naveena G. Shivaramu, Department of General Surgery, KIMS, Hubli, India

Junior Resident 

Department of General Surgery


Gibson T, Rudolph R, Ballantyne D. Physical properties of skin and skin grafts. McCartly Phys Propert. 1990;1(1):207-75.

Shenaq SM, Bienstock A, Kim JYS. Plastic and reconstructive surgery. Schwartz's principles of surgery. 8th ed. New York: McGraw-Hill Medical; 2005: 1792.

McGrath MH, Pomerantz J. Plastic surgery. Sabiston textbook of surgery. 19th ed. Philadelphia: Elsevier Saunders; 2012: 1917.

Evans J. Massive tissue loss: burns. Acute and chronic wounds: Current management concepts. 3rd ed. St Louis, MO: Mosby; 2007: 361-90.

Podiatry Today. Fact sheet: CE: A guide to current concepts in skin grafting. Available at: https://www.hmpgloballearningnetwork.com/site/podiatry/ce-a-guide-to-current-concepts-in-skin-grafting. Accessed on 1 October 2021.

Converse JM, McCarthy JG, Brauer RO, Ballantyne DL. Transplantation of skin: grafts and flaps. Reconstruc Plast Surg. 1977;1:152-239.

Cuschieri S. The STROBE guidelines. Saudi J Anaesthesia. 2019;13(1):31.

Arif T, Sami M. Calculating area of graft required for vitiliginous areas during split-thickness skin grafting: A simple, accurate, and cost-effective technique. J Cutan Aesthet Surg. 2017;10(3):160.

Bhattacharya S, Ravikrishnan J, Rao BS, Shenoy HD, Shetty SR, Menezes L. A comparative study of the efficacy of topical negative pressure moist dressings and conventional moist dressings in chronic wounds. Indian J Plast Surg. 2007;40(2):133-40.

Younes N, Albsoul A, Badran D, Obedi S. Wound bed preparation with 10 percent phenytoin ointment increases the take of split-thickness skin graft in large diabetic ulcers. Dermatol Online J. 2006;12(6).

Maher A. Establishing a consensus for the surgical management of chronic burn wounds: A randomised prospective comparative study. Egypt, J Plast Reconstr Surg. 2009;33(1):31-7.

Rituraj AS, Chatterjee S. Topical phenytoin: role in diabetic ulcer care. IJIMS. 2015;2(6):93-7.

Ünal S, Ersoz G, Demirkan F, Arslan E, Tütüncü N, Sari A. Analysis of skin-graft loss due to infection: infection-related graft loss. Ann Plast Surg. 2005;55(1):102-6.

Converse JM, McCarthy JG, Brauer RO, Ballantyne DL. Transplantation of skin: grafts and flaps. Reconstruct Plast Surg. 1977;1:152-239.

Ameer F, Singh AK, Kumar S. Evolution of instruments for harvest of the skin grafts. Indian J Plast Surg. 2013;46(1):28.

Gray H, Williams P, Dyson M. The integument. Gray's Anatomy. 37th ed. London: Churchill Livingstone; 1989: 70-95.

Snell RS. Snell’s Clinical Anatomy. New Delhi: Wolters Kluwer India Pvt Ltd; 2018.

Sinnatam C, Sinnatamby C, Last R. Last's anatomy. 10th ed. Edinburgh: Churchill Livingstone; 2000: 1-3.






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