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  • Presentation

Novel Techniques in Skin Grafting and Intra-incisional Antibiotics

Description

Dr. Broadland discusses innovative techniques in skin grafting, specifically focusing on pinch grafts and the use of intralesional antibiotics. He emphasizes the challenges of grafting on lower extremities and highlights how pinch grafting can be beneficial compared to traditional methods of second intention healing. His research demonstrated that pinch grafts significantly reduced healing time, with a median time of 36 days compared to 56 days for second intention healing. Additionally, pinch grafts showed lower infection rates and improved patient tolerance. Dr. Broadland presents various case studies illustrating the effectiveness of pinch grafts in managing complex wounds and emphasizes the importance of proper post-operative care, including using compression bandages and avoiding excessive cleaning. He also introduces the concept of using intralesional antibiotics as a means to enhance local infection control, highlighting the shift from systemic to local antibiotic application. This method has shown to drastically lower infection rates while minimizing systemic side effects. Overall, Dr. Broadland advocates for incorporating these techniques into surgical practice to improve patient outcomes.

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Conclusions

  • Pinch grafting significantly reduces healing time compared to second intention wound healing, with a median healing time of 36 days versus 56 days.
  • Patients receiving pinch grafts have a higher likelihood of wound healing within a specified time frame, with 4.87 times more patients healed at 50 days compared to those with second intention healing.
  • Infection rates were lower in the pinch graft group, with no infections reported compared to two in the second intention group, indicating a trend towards improved outcomes with pinch grafts.
  • Pain levels postoperatively tended to be lower for patients in the pinch graft group, with 72% reporting pain scores of 1 or less, compared to 48% in the second intention group.
  • Patients in the pinch graft group reported fewer difficulties in caring for their wounds during follow-up periods, suggesting better tolerability of the procedure.
  • The use of intra-incisional antibiotics, such as Clindamycin, contributes to a reduction in surgical site infections compared to systemic antibiotics, highlighting a shift in practice towards local antibiotic application.
  • Local antibiotic application results in higher tissue concentrations and lower systemic exposure, reducing the risk of antibiotic resistance and preserving the intestinal microbiome.
  • Overall, pinch grafting and intra-incisional antibiotics represent effective techniques in managing complex wound closures and enhancing patient recovery.
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  • Niklinska EB, Hicks A, Wheless L, Hanlon A. Characteristics of Lower Extremity Infection Rates Following Mohs Micrographic Surgery. Dermatol Surg. 2021 Dec 1;47(12):1547-1550.
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  • Griego RD, Zitelli JA: Intra-Incisional Prophylactic Antibiotics for Dermatologic Surgery. Arch. Dermatol. 134:688-692,1998.
  • Huether MJ, Zitelli JA: Clindamycin for Intra-incisional Antibiotic Prophylaxis in Dermatologic Surgery. Arch Dermatol 2002; 138: 1145-1148.
  • Zitelli JA, et al. A retrospective case series evaluating the efficacy of preoperative, intra-incisional antibiotic prophylaxis in Mohs micrographic surgery: An effective method to reduce surgical-site infections and minimize systemic antibiotic use. JAAD 83(5) pp 1501-03, Nov 2020.