ABSTRACT
BACKGROUND: Skin grafts are a common method of closing skin defects. The literature comparing methods of graft application and subsequent outcomes is poor, but reports indicate a graft failure rate between 2 and 30%. The aim of this study was to audit our current skin graft practice. METHODS: Data were collected prospectively on all skin grafts performed by the general surgical department between 1st December 2005 and 1st December 2006. A standardized proforma on each patient included data on age, gender, graft indication, application method, comorbidities, length of stay, and graft outcomes including graft take at 1, 2 and 6 weeks post-operatively. RESULTS: There were 85 grafts performed on 74 patients, median age 72 years (9-102 years), with 10 (12%) acute admissions. Prophylactic antibiotics were given to 50% (38 of 74) of patients. Successful grafts (>80% take) were performed in 68 (80%) patients. The overall graft complication rate was 24.7% (22 of 85 grafts). Infection occurred in 13 of 17 graft failures. No patients underwent re-operation for graft failure. Patients who received prophylactic antibiotics had a reduced risk of graft failure (Fisher's exact test, P = 0.016). CONCLUSION: Skin grafts were performed successfully in the majority of patients. Graft complication and failure rates compare well with the world literature. The use of prophylactic antibiotics was the only predictor of successful graft take.
Subject(s)
General Surgery , Practice Patterns, Physicians'/statistics & numerical data , Rural Health Services/organization & administration , Skin Transplantation , Adolescent , Adult , Aged , Aged, 80 and over , Antibiotic Prophylaxis , Child , Comorbidity , Female , Humans , Male , Middle Aged , New Zealand , Outcome and Process Assessment, Health Care , Postoperative Complications , Prospective StudiesABSTRACT
STUDY DESIGN: A retrospective clinical observational study was conducted. OBJECTIVE: To assess the relation of spinal fracture type and its magnitude of distortion to subsequent long-term development of late spinal deformity in childhood onset spinal cord injury. SUMMARY OF BACKGROUND DATA: In this study, 76 adults who sustained spinal cord injury during childhood were examined clinically and radiographically alongside a retrospective review of case notes and radiographs. METHODS: The nature of the spinal injury and the progression of its displacement were defined from radiographs taken immediately after injury, then at 4 months and at 1 year. Eventual adult spinal deformity was defined from standardized erect long-plate radiographs. Scoliosis, kyphosis, and lordosis were measured using Cobb's method. RESULTS: There was no statistically significant difference in the severity of scoliosis, kyphosis, or lordosis between traumatic and nontraumatic injuries, nor between patients with and those without radiologically visible bony injury. Of the 14 patients with traumatic thoracic and lumbar injuries who had undergone no surgical intervention, 10 (71%) showed development of major scoliotic curves that did not include the fracture site. The patients with no angular displacement at the fracture site after 1 year went on to experience the development of more severe scoliosis (mean, 66 degrees) than those who had displaced fractures (mean, 38 degrees). In five, a low kyphotic curve and a compensatory lordosis above it developed. CONCLUSIONS: There is no evidence that the bony injury to the vertebral column itself in the child with spinal cord injury influences the development of late scoliosis or lordosis, but it may influence any eventual kyphosis.
