The use of intermediate skin substitutes between debridement and final autografting is routine for many practitioners. Materials such as xenografts and allografts have been promoted to help with wound coverage before autografting. However there is limited data for their use in relatively small burn wounds (<10% total body surface area, TBSA). In this study, we analyzed the outcomes of one hundred consecutive patients who underwent autografting for burns <10% TBSA at our ABA verified burn unit in the absence of intermediate skin substitute use.
We retrospectively analyzed one hundred patients who underwent split thickness skin graft autografting for burns 50% graft failure), and time to complete healing (no further wound care required).
Twelve patients (12%) had unpredictable graft beds and their procedure was staged. These patients underwent surgical debridement and were dressed in antimicrobial dressing for an average of 5 days before autografting. No patients had intermediate skin substitutes between procedures. Eighty-eight patients (88%) were debrided and grafted in a single stage. In the staged group, there was a 0% rate of graft failure compared to 9.1% rate of graft failure in the primarily grafted group (p=0.004). There was a similar length of stay and time to complete healing in the staged group and primarily grafted group (p=0.496 and p=0.571). There was a significantly shorter time from injury to first procedure between the staged group and the primarily grafted group (8.7 days and 13.5 days, p=0.014). In the eight instances of graft failure, infection or inadequate debridement was the cause. Seven of these eight cases required further surgical intervention.
Intermediate skin substitutes are an unnecessary step in grafting small burns. These add only complexity and cost to patient care. Many patients can be debrided and grafted in a single stage. Debridement alone with delayed grafting is a highly effective surgical method when the wound bed is not suitable for immediate grafting.

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