How Is a Failed or Compromised Skin Graft Diagnosed?

There are numerous causes for graft failure. In meticulous graft surveillance, both the donor site (in autografts) and the graft site (receiver) are inspected serially. Such monitoring is required to diagnose any processes that may contribute to the failure of a graft:

Poor vascularity.

Examining for color change, reduced capillary refill, warmth, edema, and general appearance might help to diagnose vascular impairment.

Hematoma or seroma, i.e. blood or fluid collections, respectively.

Blood or transudate (exudate, in the case of an infection) can be aspirated with a needle for diagnostic purposes. The retrieved contents are analyzed for red blood cells, white blood cells, and microorganisms using a microscope (via a gram stain). Aspirate can also be cultured to determine the sensitivity of any positive bacterial growth. Aspiration also provides the therapeutic advantage of decreasing the distance between the graft and the wound bed.

Infection of the donor site.

Methicillin-resistant Staphylococcus aureus (MRSA), Streptococcus, and Pseudomonas are the most prevalent infecting pathogens.

If an infection is suspected, the diagnosis is made by obtaining cultures from the graft site, identifying any infectious organism, and testing its sensitivity to multiple antibiotics.

Shearing using mechanical means.

Movement is the most prevalent cause of graft failure, as it dissociates any new blood vessel growth (neovascularization) into the graft, depriving it of oxygen and nutrition. This complication involves fluid accumulation (hematoma or seroma) between the graft and the graft site bed, further separating the graft from the bed. I

Prevention of Failed or Compromised Skin Graft

To prevent graft failure or compromise, it is necessary to conduct meticulous surveillance to detect the following as early as possible:

• Poor vascularity
• Hematoma or seroma
• Infection
• Shearing by mechanical means

Proper wound bed preparation can prevent these issues before grafting. Intraoperative rigorous hemostasis and careful graft placement can lower the risk of problems during the grafting process. After the treatment, the affected area is immobilized and dressed appropriately to prevent shearing throughout the healing period.

Before the procedure, comorbidities that negatively impact neovascularization and healing must be treated in order to provide the graft the best chance to “take” (adhere properly) for the site to recover. This includes tight glycemic management for diabetics, the cessation of smoking, and the correction of any protein or vitamin deficits. Temporarily cease medications (steroids, immunosuppressants, and anticoagulants) that inhibit wound healing.

When performing full-thickness skin grafts, the wound should be debrided and evaluated for shearing or infection. Any fluid accumulation should be drained through the creation of small holes and aspiration, which has the added benefit of facilitating the diagnosis of infection through the retrieval of material for culture.