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Lower limb at higher risk of surgical site failure

The lower limb is at higher risk of surgical site failure after lesion removal, especially in patients with split-skin grafting as mode of closure, and in patients aged older than 74 years, according to recently published study results.

Researchers in Australia conducted a prospective observational study of 73 patients (45 men; mean age, 73 years) between July 2010 and March 2012 who presented for postoperative management of lower limb split-skin graft (n=50) or primary closure (n=23). A percentage of surgical site failure from the total patient population as used to measure incidence. Binary logistic regression models determined predictors.

Lesions removed included 26 basal cell carcinomas, 31 squamous cell carcinomas and three melanomas.

Incidence of lower limb split-graft failure and primary closure dehiscence was 53.4%, or 39 of 73 surgical procedures. Thirty-three of 50 patients who received split-skin grafting (66%) experienced surgical site failure, compared with six of 23 patients who had primary closure (26.1%). Increasing age over 74 years (P = .04) and postoperative hematoma (P = .01) were predictors of lower-limb surgical site failure. Ten patients who developed surgical site infection experienced surgical site failure.

“This was the first study to investigate the incidence and predictors of lower limb split-skin graft failure and primary closure dehiscence in ambulatory dermatological surgery patients,” the researchers wrote. “Outcomes from this study demonstrated that dermatological surgeries of the lower limb are at high risk of surgical site failure, especially when split-skin graft is the surgical mode of closure.” – By Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.