Abstract:
Skin grafting is a key reconstructive technique following skin cancer excision. Many patients are on anticoagulation or antiplatelet therapy, raising concerns about skin graft failure due to bleeding and impaired wound healing. This study evaluated the failure rates of full-thickness (FTSG) and split-thickness skin grafts (SSG) in patients on anticoagulants/antiplatelets versus those not on anticoagulation and assessed the impact of various factors that may affect the graft outcomes. A retrospective review of 88 patients who underwent FTSG or SSG from July to September 2024 was conducted. Data on demographics, social history, co-morbidities, anticoagulant/antiplatelet use, graft type, donor site, cancer type, and outcomes were analysed.
The overall graft failure rate was 26.1%, with higher but non-significant rates in patients on anticoagulants (37.5% vs. 19.6%, p=0.114). FTSG had higher failure rates than SSG (35.7% vs. 17.4%, p=0.087). Graft failure varied significantly by cancer type, with squamous cell carcinoma (30.8%) showing higher rates than basal cell carcinoma (16.2%, p=0.048). The use of chloramphenicol 1% ointment significantly reduced failure rates (7.7% vs. 33.9%, p=0.022).
In conclusion, patients on anticoagulants have increased but non-significant risks of graft failure. FTSG and SCC are associated with higher failure rates, while chloramphenicol ointment significantly improves outcomes. Recommendations include optimising pre-operative assessment including maintaining perioperative anticoagulation for low-risk cases, enhance intra-operative factors such as ensuring haemostasis and using chloramphenicol ointment, and ensure follow up for graft check. A re-audit is planned to achieve a graft failure rate below 33%.
