Abstract
Pretibial lacerations are problematic and best managed by surgical debridement, then skin grafting. Traditional postoperative care involves bed rest to optimise graft survival. This meta-analysis assesses early mobilisation versus bed rest for skin graft healing of these wounds. Medline, Embase, Cochrane, Cinahl, and Google Scholar databases were searched. Analyses were performed on appropriate clinical trials. Four trials met with the inclusion criteria. No difference was demonstrated in split skin graft healing between patients mobilised early compared to patients admitted to hospital for postoperative bed rest at either 7 (OR 0.86 CI 0.29–2.56) or 14 days (OR 0.74 CI 0.31–1.79). There was a statistically significant delay in healing in patients treated with systemic corticosteroids (OR 8.20 CI 0.99–15.41). There was no difference in postoperative haematoma, bleeding, graft infection, or donor site healing between the comparison groups. In the available literature, there is no difference between early mobilisation and bed rest for the healing of skin grafts to pretibial wounds. Corticosteroids exert a negative effect on skin graft healing unlike early mobilisation, which does not cause increased haematoma, bleeding, infection, or delayed donor site healing. Modality of anaesthesia does not affect skin graft healing.
Highlights
Pretibial lacerations are a common injury in the elderly often leaving nonviable traumatic skin flaps [1,2,3]
There were four articles included in the meta-analyses entailing three randomised controlled trials and one prospective cohort study
There is no difference in the healing of split skin grafts to pretibial lacerations in patients managed with early mobilisation compared to patients managed with postoperative bed rest
Summary
Pretibial lacerations are a common injury in the elderly often leaving nonviable traumatic skin flaps [1,2,3]. Intrinsic factors negatively impacting on the healing of pretibial lacerations include anatomical constraints, age-related changes, and vascular insufficiency [4, 5]. That facilitate skin graft healing, give way to tendons distally, that provide a hostile environment for skin graft healing [6,7,8]. There is a paucity of subcutaneous tissue padding between the skin and the tibia, while the skin is fairly inelastic and with increasing age becomes thinner less resistant to trauma [9, 10]. Extrinsic factors affecting wound healing in pretibial lacerations may include diabetes mellitus, systemic corticosteroids, and malnutrition. The prevalence of systemic corticosteroid use in this population of patients is up to 40% [11]
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