Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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Prof. Somashekhar Nimbalkar
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Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Saraswati Dental College
Lucknow
On Sep 2018




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Calcutta National Medical College & Hospital , Kolkata




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Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : October | Volume : 16 | Issue : 10 | Page : PC11 - PC15 Full Version

Factors Affecting Graft Uptake of Large Wound Surface, Covered by Mesh Split Skin Grafting: A Longitudinal Study


Published: October 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/57636.17001
Rajneesh Rawat, Sunil M Lanjewar, Rohit Kumar Chauhan, Jyoti Baghel

1. Junior Resident, Department of General Surgery, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India. 2. Professor, Department of General Surgery, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India. 3. Junior Resident, Department of General Surgery, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India. 4. Senior Resident, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Nagpur, Maharashtra, India.

Correspondence Address :
Dr. Rajneesh Rawat,
Junior Resident, Department of General Surgery, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India.
E-mail: rajneeshrawat09@gmail.com

Abstract

Introduction: Skin grafting is one of the most indispensable techniques in surgery these days. In low resource settings, skin grafting using mesh, still forms the important technique of wound coverage.

Aim: To evaluate the factors affecting graft uptake of large wound surface covered by mesh split skin grafting on day 5, day 10 and day 21 of postoperative days.

Materials and Methods: This prospective longitudinal study was conducted at Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India, from June 2017 to December 2019, among patients with large wound surface. After baseline evaluation and wound preparation; patients were posted for mesh skin grafting. Postoperatively, the graft uptake percentage was assessed on the day 5, day 10 and day 21. Other parameters that were assessed were demographic details, mean stay of the patients during the preoperative and postoperative period, effect of various factors (age, gender, co-morbidities, addictions, site and aetiology of raw area, preoperative cultures) influencing graft uptake and postoperative complications. Statistical Package for Social Sciences (SPSS) version 20.0 was used for statistical analysis.

Results: A total of 117 patients were enrolled in the study, out of which, 97 (82.9%) of the patients were males. The most common raw area was seen in lower limbs and accounted for 98 patients and the most common cause of raw area was cellulitis (n=91). Out of 117 patients, 105 (89.7%) had successful graft uptake on postoperative day 5, 102 patients (87.2%) on day 10 and 100 patients (85.4%) on day 21. Whereas, 17 (14.5%) patients had failed uptake of graft on postoperative day 21. It was observed that age (p-value=0.04) and preoperative cultures (p-value=0.01) were statistically significant factors influencing graft uptake.

Conclusion: The present study concluded that mesh split skin grafting is a reliable and useful technique with successful graft uptake. Hence, it can be considered for the management of large raw areas.

Keywords

Graft uptake, Graft failure, Mesh skin grafting, raw area, Split skin grafting, Wound management

The first-ever documented use of skin grafting occurred more than 3000 years ago in India (1). From this modest beginning, skin grafting evolved into one of the basic clinical tools in surgery. Skin grafts have progressed from the outmoded autograft and allograft preparations, to newer biosynthetic and tissue-engineered living skin equivalents (2). In today’s modern era, it is no longer considered as an option of last resort, rather it has become a technique that is routinely used and sometimes preferentially used during soft tissue reconstruction.

The mesh graft principle was first employed in the early 1900’s, when a technique was described for use in humans, which utilised a die with blades notched at staggered intervals to cut short parallel “accordion” slits in grafts (3). In 1958, the first method for skin graft expansion was developed by Meek CP, in the form of small postage stamp-sized islands of graft spread over the recipient site (4). In 1964, Tanner introduced the mesh skin grafting technique (5).

Meshing a graft offers various advantages that play a vital role in wound management. Firstly, it provides a route for the escape of fluid that might otherwise accumulate between the graft and recipient bed. Secondly, it increases the flexibility of the grafts, allowing it to better conform to uneven recipient surfaces, ensuring that good contact between the graft and recipient bed is maintained. Thirdly, when grafts are placed on areas that might be difficult to immobilise, the mesh incisions provide a convenient site for placing “tacking” sutures between the graft and recipient bed (6).

Skin grafting is one of the most indispensable techniques in surgery these days. In low to middle-income countries like India, skin grafting using mesh, still forms the important technique of wound coverage. Currently, there is a paucity of research focused on skin graft using a mesh, that forms the mainstay in wound management in resourceconstrained countries (7),(8),(9). With this background, the present study was conducted with an aim to determine the percentage of graft uptake on various postoperative days i.e. day 5, day 10 and day 21 following mesh split skin grafting and the factors influencing the graft uptake.

Material and Methods

This prospective longitudinal study was conducted at Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India, from June 2017 to December 2019, among patients with large wound surface. The Institute’s Human Ethics Committee approved the study (IGGMC/ Pharm /IEC/206/2017). Informed consent was obtained from all the patients who participated in the study.

Inclusion and Exclusion criteria: The study included all patients >18 years of age with a large raw area, having more than 4% of body surface area involvement. Wallace rule of nines and Lund-Browder chart were used, for estimating the total body surface area affected (10). The study excluded patients with uncontrolled diabetes, raw areas due to burns, and not willing to participate in the study.

All the patients, with large raw areas fulfilling the study criteria during the study period formed the sample population. These cases were identified from Outpatient Department, admissions to the Surgery Wards and Emergency Wards. A total of 117 patients satisfying study criteria were enrolled in the study.

Primary outcome was, the percentage of graft uptake on various postoperative days (day 5, day 10 and day 21). Secondary outcome parameters included demographic details, mean stay of the patients in the hospital during the preoperative and postoperative period, effect of various factors (age, gender, co-morbidities, addictions, site, aetiology of raw area, and preoperative cultures) influencing graft uptake and postoperative complications.

A successful skin graft was defined as, graft uptake of around 80% or more over the recipient wound bed. A failed split skin graft was defined, if more than 20% exposure of the dermis or devitalised tissue occurs, and which required prolonged care. This baseline measurement of 20% was chosen based on research by Henderson NJ et al., (11).

Procedure

Detailed history and thorough clinical examination was done in all the cases including site, size of the raw area. For all the patients haematological, biochemical, microbiological and radiological investigations were carried out. Ultrasound AV doppler study was done, to rule out peripheral vascular disease and other pathology.

Wound preparation was done for all the patients by adequate wound debridement. Empirical antibiotics were started which was titrated according to their respective wound culture sensitivity. Following, three consecutive cultures as sterile, patients were planned for split skin grafting. The conventional dressing (regular) was done using betadine, hydrogen peroxide which was replaced with normal saline, once healthy granulation tissue appeared. When healthy granulation tissue appeared, the patient was prepared for skin grafting.

All surgeries were performed under spinal anaesthesia with prophylactic antibiotics. They were typically meshed before application in the ratio of 1:1.5 as shown in (Table/Fig 1). The grafts were fixed with sutures, staples. Bactigras total antiseptic gauze dressing was applied over the graft. Strict immobilisation of the affected raw area site was done using Plaster of Paris, till postoperative day 5. Postoperatively, on the day 5, the graft uptake percentage was assessed followed by day 10 and day 21.

Statistical Analysis

The data was analysed using Statistical Package for Social Sciences software version 20.0 (IBM SPSS Statistics for Windows, Armonk, NY, IBM Corp., USA) for Windows. Categorical variables were evaluated using the Chi-square test or Fisher’s-exact test. Continuous variables were evaluated using either a t-test or Mann-Whitney U test, based on whether data distribution was normal or non normal. A p-value<0.05 was considered statistically significant.

Results

A total of 117 patients were enrolled in the study. Out of 117 patients, 97 (82.9%) of the patients were males and 20 (17.1%) were females. The mean age of the study population was 48.4±15.2 years with a range of 19-81 years. Hypertension was the most common co-morbidity (17, 14.5%) followed by well-controlled diabetes (8, 6.8%) (Table/Fig 2).

The mean haemoglobin of the study population was reported to be 10.6±2.1 g/dL. As per World Health Organization (WHO), cut-off haemoglobin <12 g/dL in females, and <13 g/dL in males were taken as criteria for labelling anaemia (12). Around 37 (31.6%) were anaemic, out of which 35 (29.9%) required transfusion. Twelve patients required more than a unit of packed cells before posting for surgery. Hypoalbuminaemia (67, 57.3%) followed by hypoproteinaemia (57, 48.7%) was seen in the study population.

The most common raw area was seen, in lower limbs due to various aetiologies and accounted for 98 patients. Most common cause of the raw area was cellulitis, which accounted for a maximum of 91 patients. Pseudomonas aeruginosa (19, 16.3%) was the most common organism isolated, followed by Klebsiella pneumoniae (15, 12.8%) (Table/Fig 3). The majority of the patients received amoxicillin and clavulanic acid combination (80, 68.4%) as prophylactic antibiotics and later guided by culture sensitivity reports.

On postoperative day 5, the graft uptake was analysed in which 105 (89.7%) patients had successful graft uptake and 12 (10.3%) had graft failure. About 102 patients (87.2%) on day 10 had successful uptake of graft. It was observed that, 100 (85.4%) patients had successful graft uptake, while 17 (14.5%) had graft failure on postoperative day 21 (Table/Fig 4). (Table/Fig 5) shows graft uptake following mesh split skin grafting in lower limb raw area on postoperative day 5, 10, 21.

The mean duration of preoperative hospital stay was 15.5±9.4 days and postoperative stay was 8.2±5.6 days. Thus, the length of hospital stay in the postoperative period has come down to nearly 50% of the preoperative duration (Table/Fig 6).

Pain (n=67) was the most common complication experienced in postoperative period. Other complications reported, hyperpigmentation (17, 14.5%), graft contractures (7, 5.9%), decreased sensation (12, 10.3%) and lymphoedema (3, 2.6%) (Table/Fig 7). It was observed that age (p-value=0.04) and preoperative cultures (p-value=0.01) were statistically significant with graft uptake (Table/Fig 8).

Discussion

Split thickness skin grafting is an indispensable technique, employed by surgeons to resurface wounds that are predicted to heal poorly. Considering the utility and feasibility for developing countries, meshed grafts being easy to use, remain the most utilised tool for skin expansion. In the present study, the mean age of the study population was 48.4±15.2 years with a range of 19-81 years which was similar to a study done by Swaminathan SP et al., who reported mean age as 50.8 years (7). On the contrary, Cornwall JV et al., found in their study that 70% of the patients were over the age of 70 years (13). In the present study, the male to female ratio was 4.9:1 which was similar to Narwade P et al., (8). However, it was higher than concluded in the study by Gireboinwad S et al., (2:1), Turissini JD et al., (1.6:1) and Kim SW et al., (1.3:1) (9),(14),(15). This might be because most of the females were homemakers and with resultant restriction of outdoor activity, thereby less exposure for trauma.

In the present study, it was found that 96 (82%) of patients undergoing mesh split skin grafting for lower limb wounds being the most common site. This was higher, as compared with the study by Gireboinwad S et al., where lower limbs were the most common site of the raw area in both infective and traumatic aetiology (74.6%) (9).

The most common aetiology of the raw area reported in the present study was infection (82.1%) followed by traumatic causes (10.3%). Gireboinwad S et al., noticed infective cause in 38%, Narwade P et al., in 21.6% and Sundresh NJ et al., in 6.4% of the patients, which was much lower as compared to the current study (9),(8),(16). Traumatic cause noticed in present study was 10.3% which was much lower as compared to Swaminathan SP et al., (34.4%), and Sundresh NJ et al., (26%) (7),(16).

Hypertension was the most common co-morbidity in the present study, seen in 14.5% which was similar to Narwade P et al., in 13.33% and higher as compared to Sundresh NJ et al., in 2% (8),(16). Diabetes was seen in 6.8% of the patients in the present study which was similar to study by Sundresh NJ et al., i.e, 8% (16).

Various factors like anaemia, hypoproteinaemia is known to cause impaired wound healing. Around 37 (31.6%) patients were anaemic, out of which 35 (29.9%) required transfusion which was similar to Narwade P et al., where the prevalence of anaemia was reported as 35% (8). Hypoproteinaemia in the present series, found in 48.7% which was similar to James SM et al., (46.8%) (17). Pseudomonas aeruginosa (16.3%) was the most common organism isolated followed by Klebsiella pneumoniae (12.8%). It was similar to the study by Ünal S et al., where Pseudomonas was isolated as the most common pathogen (18).

Out of 117 patients, 105 (89.7%) patients had successful graft uptake on postoperative day 5 which was similar as compared to the study by Lari AR and Gang RK, (90%) and Kreis RW et al., (92%) (19),(20). However, this was slightly lower than the study by Zermani RG et al., (93%) and Reddy S et al., (94%) (21),(22). In the present study, mean graft uptake on postoperative day 10 was 87.2% which was similar to Munasinghe N et al., (87%), Lumenta DB et al., (85%) (23),(24). In the current study, graft uptake on postoperative day 21 was 89.4% which was similar to the study by Henderson NJ et al., (11).

Association of various factors influencing graft uptake: In the present study, age-wise graft acceptance of patients was analysed which was found statistically significant (p-value=0.04). This observation could be attributed to the fact that, aging produces intrinsic physiologic changes that result in delayed or impaired wound healing. Similar findings were reported by Gireboinwad S et al., where age was statistically significant with graft uptake (9). In the current study, there was no association between tobacco, smoking and alcoholism with graft acceptance (p-value=0.58), which was similar to the study done by Gireboinwad S et al., (9). However, the significant association could not be deduced due to inadequate evaluation about dose and duration of these substances consumed by patients. Co-morbidities such as diabetes mellitus and hypertension plays a pivotal role in the impairment of healing processes, that lead to graft failure; however, the present study did not show a significant association of co-morbidities with graft uptake, which was similar to the study done by Gireboinwad S et al., (9). This might be attributed to the fact that according to the inclusion criteria of the study, only well-controlled diabetics were included.

The study also found no significant association between the site of ulcer and percentage of graft acceptance (p-value=0.70), and was similar to the findings by Swaminathan SP et al., and Gireboinwad S et al., (7),(9). It was found that there was not much difference in the percentage of patients, who had graft accepted in traumatic, infective, controlled diabetics, postsurgical. This might be explained that they had included ischaemic, malignant and venous causes of raw areas also, which were excluded in our study.

A prospective design was the main strength of this study. This topic needs to be further explored among a larger sample. Authors recommend this as the standard for the management of large raw areas, especially in low resource settings where costs limit the usage of other advanced novel procedures.

Limitation(s)

Present study results were limited by the single-centre study design. Long-term follow-up was not done. Other important aspects which could have been assessed, included cost-effectiveness of the procedure, quality of life and patient satisfaction.

Conclusion

In resource constrained settings, people with wounds having large raw areas, due to the various aetiologies are common and are difficult to heal on its own. Certain modifiable factors can be done during surgical intervention to promote the wound healing. One such procedure is, application of meshed split skin graft over these raw areas. The present study concludes that mesh split skin grafting is a reliable and useful technique with successful graft uptake.

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DOI and Others

DOI: 10.7860/JCDR/2022/57636.17001

Date of Submission: May 08, 2022
Date of Peer Review: Jun 29, 2022
Date of Acceptance: Aug 05, 2022
Date of Publishing: Oct 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 16, 2022
• Manual Googling: Aug 03, 2022
• iThenticate Software: Aug 04, 2022 (11%)

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