Biology of infections of split thickness skin grafts

The purpose of this study was to identify determinants of split thickness skin graft infection. The bacterial count of the experimental wounds was proportional to the incidence of infection in split thickness skin grafts. When the wound was heavily contaminated with 10⁷ organisms, infection developed under most grafts. Graft take frequently occurred in wounds subjected to a lower level of inoculum. The importance of bacterial counts as a determinant of potential skin graft infection was also suggested by a clinical study. We now routinely use quantitative bacterial counts to identify the granulating wounds that are ready for grafting. The type of organism played no significant role in the development of infection.The recipient site on which the graft was placed had an important bearing on infection of split thickness skin grafts. The incidence of skin graft infection was higher in fascial wounds than in dermal wounds contaminated with the same level of inoculum. Meshing of the split thickness skin graft offered no significant protection against infection. The infection rates of meshed and nonmeshed grafts did not differ significantly in experimental and clinical wounds.