Skin grafting the contaminated wound bed: reassessing the role of the preoperative swab

Objective:To investigate use of the preoperative wound swab to predict graft failure compared with establishing the indication for skin grafting on clinical grounds alone. Method:Patients requiring meshed split-thickness skin grafting were prospectively included; the indication for grafting was established on clinical grounds exclusively. A preoperative swab of the wound bed was taken, but its result was concealed to prevent it influencing clinical decision-making. Negative pressure wound therapy (NPWT) was used for both wound bed preparation and graft fixation. After 2 months, graft area take percentage was measured using digital image processing software and the results validated against the result of the preoperative wound swab. Results:Eighty-seven wounds were included in the study. Mean graft area take percentage was 88%, with five grafts considered complete failures (< 25% take). A posteriori analysis of the wound cultures showed that 53% had been contaminated on grafting, but these did not fare any...