Prospective study of the effect of the recipient bed on skin graft survival after thermal injury.

There is little objective information available on the influence of the graft bed on skin graft survival after early excision of the burn wound. Yet surgeons are faced daily with the question of whether to graft onto fat after sequential excision of the burn eschar, or whether to excise deeper and graft onto muscle or fascia. To answer this question 71 consecutive patients were enrolled in a prospective study of the effect of the recipient graft bed on skin graft survival after thermal injury. These patients included 25 pediatric patients (mean TBSA, 19.1%) and 46 adult patients (mean TBSA, 25.1%). Overall mean +/- SD graft take was 94 +/- 11%. No difference between the per cent of graft take of grafts placed on fat (94 +/- 11%) versus fascia (85 +/- 19%) was found (p = 0.21). The results of this prospective study indicate that when the burn is too deep to graft onto dermis, there does not appear to be any advantage to routinely performing a fascial excision to avoid grafting onto a fat or mixed fat/dermal recipient graft bed, since the percentage of graft take and the incidence of regrafting are similar between these groups.