Impact of nonscraping of granulation tissue on outcomes after skin grafting

Abstract

Context: Chronic granulating burn wounds are covered with split-thickness skin grafts (SSG) after scraping of granulation tissue. But scraping is associated with increased blood and protein loss, and time required for hemostasis. We, therefore, conducted a study to determine if scraping can be avoided. Aims: Comparison of outcome of SSG and blood loss in burn wounds treated with and without scraping of granulation tissue. Settings and Design: Prospective clinical study. Materials and Methods: Over a year, 30 adult patients, with healthy granulating postburn wounds of size at least 100 cm2 and 4 to 10-week duration, were included. Wounds were divided into two halves, with one-half grafted after scraping (Group A) and other without scraping (Group B). Intraoperative blood loss was calculated. Dressings were done at postoperative days 3, 5, 7, and 10. Graft take, complete wound-healing time, and regrafting requirement were assessed. Statistical Analysis: Unpaired t test for quantitative variables. Results: Mean graft take (87.21 ± 9.48 Group A; 86.58 ± 11.18 Group B) was similar in both groups. Average intraoperative blood loss was significantly lesser (Group A 54.58 ± 6.5 mL/100 cm2; Group B 10.2 ± 1.5 mL/100 cm2), and duration of complete wound healing was increased without scraping (14.66 ± 2.79 days Group A; 15.73 ± 3.13 days Group B). There was no requirement of regrafting in both groups. Conclusion: Scraping of wound bed is avoidable in selected patients, although at expense of marginally faster healing. Leaving the healthy granulation tissue intact does not affect overall graft take and is associated with decreased blood loss.