Skip to main content Skip to main navigation menu Skip to site footer

Evaluation of bacterial infection of split-thickness skin grafts at the Korle Bu Teaching Hospital


Background: Split skin grafts are frequently employed to provide biological cover for extensive wounds. The clinical outcome of skin grafts depends on a variety of factors of which infection is one of the most important. The intent of this study was to define the micro-organisms causing skin graft infections and failures at the National Reconstructive Plastic Surgery and Burns Centre (NRPSBC) at the Korle Bu Teaching Hospital (KBTH). 

Aim: The study assessed the extent to which bacterial infection of grafted wounds resulted in graft failure and subsequent re- grafting.

Materials and Methods: The study was a longitudinal study conducted on the wards of the NRPSBC at the KBTH on patients with wounds who received split skin grafts. Wound swabs of discharging grafted wounds were inoculated into a Stuarts’ transport medium to prevent desiccation and transported immediately to the microbiology laboratory for further processing.

Results: Fifteen (20.8%) of the grafts failed to take. The incidence of infected grafted wounds was 79.2% (57). Infected grafted wounds that resulted in graft failure were 14 out of 57 infected wounds (24.6%). Pseudomonas aeruginosa and Other Pseudomonas Species were identified as the bacteria frequently involved in graft failure at the NRPSBC.

Conclusion: In this study, we found a graft failure rate of 20.8%. This was influenced by the bacterial load present in the graft bed.



  1. Ratner D. Skin Grafting: From Here to There*. Dermatol Clin. 1998 Jan 1;16(1):75–90.
  2. Valencia IC, Falabella AF, Eaglstein WH. Skin grafting. Dermatol Clin. 2000;18(3):521–32.
  3. Mutalik S, Ginzburg A. Surgical management of stable vitiligo: a review with personal experience. Dermatol Surg. 2000;26(3):248–54.
  4. Moisidis E, Heath T, Boorer C, Ho K, Deva AK. A prospective, blinded, randomized, controlled clinical trial of topical negative pressure use in skin grafting. Plast Reconstr Surg. 2004;114(4):917–22.
  5. Hynes PJ, Earley MJ, Lawlor D. Split-thickness skin grafts and negative-pressure dressings in the treatment of axillary hidradenitis suppurativa. Br J Plast Surg. 2002;55(6):507–9.
  6. Llanos S, Danilla S, Barraza C, Armijo E, Pineros JL, Quintas M, et al. Effectiveness of negative pressure closure in the integration of split thickness skin grafts: a randomized, double-masked, controlled trial. Ann Surg. 2006;244(5):700–5.
  7. Penington AJ, Morrison WA. Skin graft failure is predicted by waist–hip ratio: A marker for metabolic syndrome. ANZ J Surg. 2007;77(3):118–20.
  8. Ünal S, Ersoz G, Demirkan F, Arslan E, Tütüncü N, Sari A. Analysis of skin-graft loss due to infection: infection-related graft loss. Ann Plast Surg. 2005;55(1):102–6.
  9. Thornton J, Gosman A. Selected readings in plastic surgery. 1st ed. Vol. 10. 2004.
  10. Henderson NJ, Fancourt M, Gilkison W, Kyle S, Mosquera D. Skin grafts: a rural general surgical perspective*. ANZ J Surg. 2009;79(5):362–6.
  11. Robson MC, Krizek TJ. Predicting skin graft survival. J Trauma Acute Care Surg. 1973;13(3):213–7.
  12. Teh BT. Why Do Skin Grafts Fail?. Plast Reconstr Surg. 1979;63(3):323–32.
  13. Zekri A, King W. Success of skin grafting on a contaminated recipient surface. Eur J Plast Surg. 1995;18(1):40–2.
  14. Kirkwood B, Stearne J. Essential Medical Statistic. 22nd ed. Wiley John and Sons Incorporate; 2002.
  15. Ferreira, T., Rasband, W. ImageJ User Guide. U. S. National Institutes of Health; 2012. Available at: (Accessed: 2nd April 2020).
  16. McGregor A, McGregor I. Free skin grafts, In; Fundamental Techniques of Plastic Surgery. 1st ed. Edinburgh: Churchill Livinstone; 2000. 35-59 p.
  17. Browse NL, Gray L, Jarrett PE, Morland M (1977) Blood and vein-wall fibrinolytic activity in health and vascular disease. Br Med J 1: 478–481.
  18. Gjodsbol K, Christensen JJ, Karlsmark T, Jorgensen B, Klein BM, et al. (2006) Multiple bacterial species reside in chronic wounds: a longitudinal study. Int Wound J 3: 225–231.
  19. Aerden D, Bosmans I, Vanmierlo B, Spinnael J, Keymeulen B, Van den Brande P. Skin grafting the contaminated wound bed: reassessing the role of the preoperative swab. J Wound Care [Internet]. 2013 [cited 2016 May 20];22(2).
  20. Jackson DM, Lowbury EJL, Topley E. Chemotherapy of Streptococcus pyogenes infection of burns. The Lancet. 1951;258(6686):705–11.
  21. Gilliland EL, Nathwani N, Dore CJ, Lewis JD. Bacterial colonisation of leg ulcers and its effect on the success rate of skin grafting. Ann R Coll Surg Engl. 1988 Mar;70(2):105–8.
  22. Schneider M, Vildozola CM, Brooks S. Quantitative assessment of bacterial invasion of chronic ulcers. Am J Surg 1983;145:260-2.
  23. Wayne PA. Clinical and Laboratory Standard Institute (CLSI): performance standards for antimicrobial susceptibility testing. Twenty Second Inf Suppl. 2012;32(3):1–278.
  24. Lawrence JC. The bacteriology of burns. J Hosp Infect 1985;6(Suppl B):3-17.
  25. Jones WJ, Edwards R, Finch R,Jeffcoate WJ. A microbiological study of diabetic foot lesions. Diabetic Medicine 1985;2:213-15.
  26. Steer, J.A., Papini, R.P., Wilson, A.P. et al. Quantitiative Microbiology in the management of burns patients. II. relationship between bacterial counts obtained by burn wound biopsy culture and surface alginate swab culture with clinical outcome following burn surgery and change of Dressing. Burns 1996; 22: 3, 177–181.)

How to Cite

Nsaful, K. O., Paintsil, A. B., Dakubo, J. C. B., Nsaful, J., Appiah-Labi, K., & Nartey, E. (2020). Evaluation of bacterial infection of split-thickness skin grafts at the Korle Bu Teaching Hospital. Bali Medical Journal, 9(1), 259–265.




Search Panel

Kwesi Okumanin Nsaful
Google Scholar
BMJ Journal

Albert B. Paintsil
Google Scholar
BMJ Journal

Jonathan C. B. Dakubo
Google Scholar
BMJ Journal

Josephine Nsaful
Google Scholar
BMJ Journal

Kwaku Appiah-Labi
Google Scholar
BMJ Journal

Edmund Nartey
Google Scholar
BMJ Journal