Graft Failures in Lower Limb Reconstruction for Non-Melanoma Skin Cancers (NMSCs)

DATE PUBLISHED
October 26, 2018
SECTION
Articles

Abstract

Aims/ Objectives

To measure quality of service provided, to correlate between graft morbidity and age, sex of the patient, size of the lesion, site, type of skin cancer and underlying co-morbidities, to improve service, to raise awareness and educate on the failures of spilt-skin grafts on the lower limb, to compare outcomes from other studies

Standards and Methods

Local guidelines on the STSGs within the Trust exist and should be followed. No formal standards found in BAPRAS, NICE, ASPS. Retrospective data collection on password-protected Trust computers.

                 

Results

The majority of the grafts fell into the uncomplicated (44%) and minor complications (43%) category (0 and 1 respectively), whereas only 6% of the total grafts failed. In the category 3, there are 5% females and 1% males. It is apparent that there is a pattern in which the majority of the failed grafts are located in the shin (67% in category 0, 72% in category 1, 69% in category 2 and 73% in category 3). This observation is in accordance with another study which supports that the distal the lesion, the greater the complication rates. This could also be attributed to the decreased blood supply in the peripheral system.  Failed grafts were noticed in patients >80 years old (91%), whereas cardiovascular conditions, including peripheral vascular disease, atrial fibrillation and hypertension were 82% in category 3.

Discussion – Actions for change

Documentation and categorisation of STSG morbidity according to the following: Category 0 Healed/ uncomplicated graft, Category 1 Minor, easily-treatable complications (inflammation, slough, seroma), Category 2 Partial graft loss, >3 weeks to heal (infection, haematoma). Category 3 Failed graft. Pre-operative assessment for co-morbidities.

 

Keywords

NMSC, Non melanoma skin cancer, graft failure, lower limb reconstruction, graft failure in lower limb reconstruction

References

RJ. Donegan et al. An overview of factors maximizing successful split-thickness skin grafting in diabetic wounds. Diabetic Foot & Ankle 2014, 5: 24769

SRPS Volume 10, Number 1, Skin grafts, skin substitutes and principles of flaps

Teh BT. Why do skin grafts fail? Plast Reconstr Surg. 1979 Mar;63(3):323-32.

http://www.podiatrytoday.com/ce-a-guide-to-current-concepts-in-skin-grafting

Robert B. Weinstein. Orthoplastic foot and ankle reconstruction. Part I: Skin grafting. Chapter 36

Reddy S et al. Incidence and Risk Factors for Lower Limb Skin Graft Failure. Dermatology Research and Practice Volume 2014

Split Skin Graft - Countess of Chester Guideline

Fietz1 et al. The halo split skin graft in the management of non-melanoma skin cancer of the leg: a retrospective study. Research Dermatol Pract Concept 2013;3(4):11

J. Anderson et al. Split thickness skin grafts for the treatment of non-healing foot and leg ulcers in patients with diabetes: a retrospective review. Diabetic Foot & Ankle 2012

Author Details

Charles Malcolm Rees

Dr Konstantinos Gasteratos

Mr Atta .