Factors Associated With Early Skin Graft Success Following Initial Burn Excision: A Retrospective Cohort Study

Early split-thickness skin graft incorporation is essential for successful burn reconstruction, yet patient- and operative-level factors associated with graft success remain incompletely defined. This study evaluated factors associated with early graft take following initial burn excision and split-thickness skin grafting, with operative time and hospital length of stay examined as secondary outcomes. A retrospective cohort study was performed at a single American Burn Association–verified burn center including adult patients who underwent index burn excision and grafting between 2017 and 2022. Multivariable linear regression was used to evaluate factors associated with graft take, operative duration, and hospital length of stay. A secondary longitudinal mixed-effects analysis incorporating all operative procedures was performed to account for repeated operations. Among 165 patients included in the primary analysis, graft take following the index procedure was higher in patients treated with the rotary harvesting system than with a conventional dermatome (94.7% vs. 89.8%, P = .043), whereas operative duration and hospital length of stay were similar. After adjustment for clinically relevant covariates, harvesting technique was no longer independently associated with graft take following the index procedure. However, longitudinal mixed effects analysis of 269 operative procedures demonstrated that rotary harvesting remained independently associated with an adjusted 5.9% improvement in graft take (95% CI, 0.7–11.1%; P = .025) without increasing operative duration. Greater grafted surface area was the strongest predictor of longer operative time. Rotary skin harvesting was associated with improved graft incorporation throughout burn Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation reconstruction without increasing operative duration or hospitalization. Prospective multicenter studies are warranted to confirm these findings and further evaluate long term clinical outcomes.