Comparative Outcomes of Delayed Exposed vs. Immediate Skin Graftingon Granulating Wounds

Résumé

Introduction: Skin grafting is a critical procedure in the management of large or deep wounds, particularly those that are granulating. The timing of grafting, whether immediate or delayed, has long been a subject of debate among clinicians. This study aims to compare the outcomes of immediate versus delayed skin grafting in patients with granulating wounds. Methods and materials: This prospective, comparative, and purposive study was carried out in the Department of Plastic Surgery, Shaheed Suhrawardy Medical College Hospital, Dhaka, from 1st July 2023 to 30 June 2024. A total number of 66 patients were included consecutively in this study. Patients were divided into 2 groups. Group I: Spit thickness skin grafting on granulating wound by Delayed exposed method, Group II: Spit thickness skin grafting on granulating wound by immediate method. Statistical analysis of the results was done by computer software devised as the Statistical Package for Social Sciences (SPSS). Data were analyzed using Student's t-test, and Chi-squared (x2) Test. A 'p' value <0.05 was considered as significant. Result: The results of this study indicate that immediate skin grafting (Group I) led to significantly better outcomes compared to delayed grafting (Group II). Group I had a lower graft infection rate (17.1% vs. 41.9%, p=0.026) and fewer cases of graft loss (11.5% vs. 35.5%, p=0.048). Operation times were significantly shorter in Group I (48.0±3.8 minutes vs. 92.5±4.6 minutes, p<0.001), and postoperative hospital stays were also reduced (9.6±0.9 days vs. 16.7±1.1 days, p<0.001). Additionally, only 2.9% of Group I required subsequent grafts compared to 19.4% in Group II (p=0.036). Conclusion: Immediate skin grafting leads to better clinical outcomes compared to delayed grafting in the management of granulating wounds. Immediate grafting significantly reduces graft infection rates, graft loss, operation time, and postoperative hospital stays, while minimizing the need for subsequent grafting.