495 Factors Affecting Optimal Outcome in Pediatric Skin Grafts

Abstract

The majority of skin grafts done at our pediatric burn center are sheet grafts performed exclusively by two surgeons with similar techniques. In spite of the excellent take and appearance of sheet grafts in the acute and subacute post operative period, a number of grafts developed hypertrophic scarring yielding suboptimal long term outcomes when mature. The aim of this study is to explore contributory factors that may potentially be modified to yield better long term outcomes in our sheet skin grafts and reduce the need for additional scar treatment interventions. Records for all patients who underwent split-thickness skin grafts at our institution between January of 2013 and July of 2018 were reviewed. Data including age, gender, race, Fitzpatrick score, mechanism of injury, burn anatomic location, joint involvement, time to skin graft, time to first pressure garment fitting, percentile weight change during graft healing and maturation, and compliance with garment wear was collected and analyzed. Grafts were scored from most recent medical photographs by a panel of clinicians and non clinicians as optimal or suboptimal. We identified 131 grafts to review. The median follow-up was 249 days (range 23-2455 days). Sixty nine grafts (53%) had a suboptimal long term outcome. Of all factors studied, only joint involvement was significantly associated with suboptimal outcome (p=0.0009). Compliance with pressure garment wear resulted in significantly more optimal outcomes overall (p=0.025). However, in the subgroup of patients that was highly compliant with pressure garments and had skin grafts involving joints, graft outcome was optimal in only 50%, indicating equivocal value of pressure in those areas. Skin grafts involving joints are more likely to have a suboptimal outcome requiring further scar treatment after maturation. This is an injury related factor that cannot be affected. However, patient compliance with pressure therapy yielded more optimal graft outcomes. We recommend pressure garment therapy following skin grafting in pediatric burn patients with an emphasis on outpatient compliance to reduce the risk of long term hypertrophic scarring. The applicability of this research study will eventually be utilizable and adapted to our institute practice, in order to produce the desired outcome over time.