Moriarty's sign - predictor of skin graft take.

Abstract

Resurfacing wound beds with split skin graft is the most common procedure in plastic surgery. Association of more pain in the donor site than in the recipient site has been used as apredictor of successful graft take by Stark in 1962 who termed it Moriartyssign. The aim of the study was: 1) to predict the successful take of skin graft by eliciting Moriartyssign; 2) to decide the day of first graft inspection based on Moriartyssign. The authors hereby present aprospective study in 100 patients who underwent wound resurfacing with split thickness skin graft at the Department of Plastic Surgery in atertiary care center between January 2014 and June 2015. The area with more pain, absence of pain or equivocal response at the graft donor site was recorded on the visual analog scale for 10 days. In this study, 80 patients had positive Moriartyssign, 12 patients had equivocal responses and 8 patients showed anegative sign. Patients with positive Moriartyssign underwent their first graft inspection on 10th postoperative day and showed 100% graft take. Twelve patients with equivocal response underwent first graft inspection on 5th day and had 70-80% graft take. In 8 patients, with negative Moriartyssign first graft inspection done on 3rd day, the graft take was < 50%. The study demonstrates that Moriartyssign is areliable clinical predictor of split thickness skin graft take and may be useful as aguide to determine the day of first graft inspection. It is an effective method even for junior members of the surgical and nursing team to monitor parameters in relation to this sign. It can be practiced in asmaller group of hospitals, too. Hence, the authors recommend to integrate this clinical assessment in routine practice.