A comparative study of early-delayed skin grafting and late or non-grafting of deep partial thickness burns at the University Teaching Hospital

Abstract

Objectives: To demonstrate the benefits of performing a split skin graft within 15 days post burn and explore the
differences in duration of hospital stay, occurrence of infection and contracture formation in comparison to standard care currently provided at U.T.H (late or non split skin graft).

Design: This was a prospective, non-randomized, interventional study involving patients with deep partial thickness burn wounds at UTH. Study subjects were to either receive an early-delayed skin graft, or the standard treatment at the time based on the surgical firm to which they were admitted.

Results: Forty-three (55.1%) patients allocated to receive an early-delayed ssg while 35 (44.9%) were assigned to the late or non-ssg group. The proportion of males was 23 (29.5%) in the early-delayed group and 22 (28.2%) in the late or non ssg group while the proportion of females was 20 (25.6%) in the early-delayed group and 13 (16.7%) in the late or non ssg group. The participants' age range was 2 months to 84 years. Forty-nine (62.8%) were 5 years and below, eight (10.3%) were aged 6-10 years, ten (12.8%) were aged 11-20 years, and eleven (14.1%) were aged 21 and above years. The following were the main causes of burns, in their order of frequency, hot water (57%), flames (27%), hot food (i.e. cooking oil, porridge, beans [14%]), and chemicals (1%). In both groups the most common cause for burns was hot water, 19 (24%) in the earlydelayed skin graft group and 26 (33%) in the late or non ssg group. In forty seven (60%) patients burns were observed to affect multiple regions of the body. Mean total body surface area burn was 14%. Overall, 73 patients (93.6%) came from within Lusaka. It was also noted that 39(50%) were self referrals. Overall, 86% presented to the hospital within 24 hrs but  despite early presentation participants were reluctant to recieve an early skin graft due to lack of understanding of the procedure. Findings of this study found that at significance levels of 0.05 in the late or non SSG group hospital stay was significantly longer, (U = 305.500; p = 0.001) and infection higher (Chi Square = 4.510; p = 0.034).No significant difference was noted in contracture formation in the two groups (Chi square = 0.999; p = 0.258).

Conclusions: Early–delayed split skin graft was found to statistically significantly reduce length of stay and occurence of infection as opposed to late or non ssg.No statistically significant relation could be established for occurence of contractures due to loss in follow up of patient valuable information was lost. This study shows that  even if early delayed SSG were to be offered at UTH there is need to carry out awareness campaigns to change  peoples attitudes towards the surgical procedure (SSG). This is an approved treatment world-wide which has not  gained wide acceptance amongst patients presenting to U.T.H that participated in this study. Patient attitudes and perceptions need to be changed as SSG currently is not seen as a curative treatment but as added injury to an  already injured patient.This study showed that SSG is possible and the few patients who underwent early grafting  showed good outcomes, shorter hospital stay and lower infection rates. Reduction in contracture formation may  have been determined if follow up was achieved.