Split-thickness skin graft outcomes and associated risk factors in patients with skin defects at Al-Gumhouri hospital, Sana'a, Yemen: a prospective observational study.

backgroundSplit-thickness skin grafting (STSG) is a fundamental reconstruction procedure used to manage various skin defects. Graft failure presents substantial clinical and economic challenges in resource-limited, conflict-affected settings. This study aimed to evaluate the outcomes of STSG and to identify associated risk factors in a tertiary hospital in Yemen.

methodsThis prospective observational study was conducted at the Al-Gumhouri Teaching Hospital, Sana'a, Yemen, between January 2023 and January 2024. Patients of all ages who underwent STSG for skin defects were eligible for inclusion. Clinical data, wound characteristics, and microbiological samples were collected before and after grafting. The primary outcome was graft failure (> 5% loss) 3 weeks postoperatively. Univariate and multivariate analyses were performed to identify risk factors.

resultsAmong 198 patients (71.7% male, mean age 23.2 ± 16.0 years), 32.3% experienced graft failure. Burns were the most common cause of defects (65.2%). Postoperative infection was documented in 41.4% of cases, with gram-negative bacteria (Klebsiella spp. and Pseudomonas aeruginosa) being the predominant post-grafting pathogens. Multivariate logistic regression identified positive post-grafting bacterial culture as the only independent risk factor for graft failure (adjusted odds ratio [aOR], 48.34; 95% CI 13.58-172.15; P < 0.001). Although preoperative hemoglobin ≤ 10 g/dL (P = 0.036) and body mass index (BMI) ≥ 26 kg/m² in adults (P = 0.022) were significantly associated with graft failure in the univariate analysis, these associations did not remain significant after adjustment for confounders.

conclusionsPostoperative infection, particularly gram-negative bacteria, was a predominant independent risk factor for STSG failure. Enhanced infection prevention strategies, particularly those targeting gram-negative organisms, are critical for improving graft outcomes in resource-limited environments. Pregrafting patient optimization, including anemia correction, which is feasible, may also contribute to better outcomes.