The impact of delay to operation as a prediction for graft failure requiring unplanned second surgery

Dr Doran Kalmin1, Dr Edward Raby, A/Prof Dale Edgar, Winthrop Professor Fiona Wood

1State Adult Burns Unit, Fiona Stanley Hospital, Perth, Australia


Early excision of deep burns is considered the primary factor in reducing the incidence of invasive burn wound infections. The WA Model of Care for the State Adult Burns Unit at FSH aims to undertake one operation to treat the acute burn wound in its entirety. This study identifies the impact of time to first operation and uses this as a marker for incidence of failed surgical grafting requiring unplanned second surgery.

A retrospectively analysed prospective cohort study was conducted at FSH SABU between February 2015 to December 2019. Patients who underwent at least one skin grafting procedure were included. 1599 patients were included in the study, 91 of whom underwent repeat grafting procedures. Median time from injury to operation in patients not requiring repeat grafting was 5 days with an IQR of 4 days and mean TBSA of 3.8% compared with median of 3 days, IQR of 3 days with mean TBSA of 16.3% in patients requiring repeat grafting. The mean age of patients requiring repeat grafting is 4.3 years older compared with patients not requiring repeat grafting with 7.3% of patients with lower limb burns likely to require repeat grafting compared with 2.9% for other areas. In this cohort, graft failure requiring re-operation is not associated with delay to first operation however it is associated with positive swabs on admission, lower limb burns, increased age and higher TBSA. This study provides data that will allow early identification of higher risk patients to reduce their possibility of graft failure.


Doran is an unaccredited Plastics registrar in Perth having recently completed a Master of Surgery focusing on Burns

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