Graft Failures in Lower Limb Reconstruction for Non-Melanoma Skin Cancers (NMSCs)

Aims/ Objectives

To measure quality of service provided, to correlate between graft morbidity and age, sex of the patient, size of the lesion, site, type of skin cancer and underlying co-morbidities, to improve service, to raise awareness and educate on the failures of spilt-skin grafts on the lower limb, to compare outcomes from other studies

Standards and Methods

Local guidelines on the STSGs within the Trust exist and should be followed. No formal standards found in BAPRAS, NICE, ASPS. Retrospective data collection on password-protected Trust computers.

Results

The majority of the grafts fell into the uncomplicated (44%) and minor complications (43%) category (0 and 1 respectively), whereas only 6% of the total grafts failed. In the category 3, there are 5% females and 1% males. It is apparent that there is a pattern in which the majority of the failed grafts are located in the shin (67% in category 0, 72% in category 1, 69% in category 2 and 73% in category 3). This observation is in accordance with another study which supports that the distal the lesion, the greater the complication rates. This could also be attributed to the decreased blood supply in the peripheral system.  Failed grafts were noticed in patients >80 years old (91%), whereas cardiovascular conditions, including peripheral vascular disease, atrial fibrillation and hypertension were 82% in category 3.

Discussion – Actions for change

Documentation and categorisation of STSG morbidity according to the following: Category 0 Healed/ uncomplicated graft, Category 1 Minor, easily-treatable complications (inflammation, slough, seroma), Category 2 Partial graft loss, >3 weeks to heal (infection, haematoma). Category 3 Failed graft. Pre-operative assessment for co-morbidities.