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

Abstract

A comparative study of early-delayed skin grafting and late or non-grafting of deep partial thickness burns at the University Teaching Hospital (UTH) was carried out over a period of 18 months. This was after an observation that at U.T.H there is no standard of care for timing of performing a skin graft post burn. The objective of the study was to demonstrate the benefits of performing a split skin graft within 15 days post burn and explore the differences in duration of hospital stay, infection and contracture formation in comparison to standard care provided at U.T.H. In total 78 patients with deep partial thickness burns were enrolled in the study. Among them, 43 (55.1%) subjects were assigned to receive an early-delayed skin graft (grafted within 15 days), and 35 (44.9%) to receive current standard treatment provided at U.T.H (late or no split skin grafting). Age distribution was 2 months to 84 years. It was noted that 49(62.8%) of patients were below the age of 5 years. Sex distribution was 57.7% male and 42.3% female. The patient’s assigned to early-delayed split skin graft 23 (29.5%) were male and 20 (25.6%) female. Those that were assigned to standard treatment offered at UTH were male 22 (28.2%) and female 13 (16.7%).In both groups the most common cause for burns was hot water (57%) with 24% in the group assigned to receive an early-delayed ssg and 33% in the late or non-ssg group. The time it took for patients to present to the hospital post burn was noted and it was found that 86% of patients presented to the hospital within 24 hours post burn. 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. x A common feature noted in the two groups was the reluctance to have the procedure performed. Patients, parents and guardians often declined to have skin grafting performed within 15 days with consent being obtained after 21 days when they were convinced the burn would not heal without the intervention. 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 the patients who underwent early-delayed split skin grafting showed good outcomes.