Secondary Infections Post Split-Thickness Skin Graft: Uncommon
Secondary infections following split-thickness skin grafts (SSG) are uncommon when appropriate wound management techniques are employed, with modern studies reporting zero graft infections when optimal protocols are used.
Infection Risk Profile
The available evidence demonstrates that graft infections are rare with contemporary wound management:
In a series of 17 high-risk patients undergoing SSG with back-grafting technique, no patients experienced any graft infection, despite these patients having risk factors for delayed wound healing 1.
When antimicrobial-impregnated dressings combined with negative pressure wound therapy (NPWT) were used, no infections or graft failures were observed in patients with chronic or contaminated wounds, including those from trauma, burns, diabetic ulcers, and pre-existing infections 2.
In diabetic patients with foot and ankle wounds—a traditionally high-risk population—STSG bolstered with NPWT achieved healing in an average of 17 days without reported infectious complications 3.
Key Factors Preventing Infection
The low infection rates are attributable to several protective strategies:
Adequate wound bed preparation through debridement of necrotic tissue prior to grafting eliminates the bacterial burden that would otherwise lead to infection 4.
Proper immobilization and wound contact using techniques like NPWT prevents fluid accumulation (hematoma/seroma) that could serve as infection nidus 2.
Use of antimicrobial-impregnated dressings (containing 0.2% polyhexamethylene biguanide) provides additional infection prophylaxis, particularly valuable in contaminated or chronic wounds 2.
Clinical Context
While the graft site itself shows low infection risk, it's important to distinguish this from:
Donor site complications, which are more commonly related to delayed healing rather than infection, particularly in patients with comorbidities 1, 5.
Pre-existing wound contamination, where the infection preceded grafting (such as post-necrotizing fasciitis wounds), but the graft itself heals without secondary infection when proper technique is used 4.
Common Pitfall
Do not confuse graft failure from poor take (due to inadequate immobilization or hematoma formation) with infectious complications—the former is more common than true bacterial infection of the graft 2.