A Comparative Study of Split-Thickness Skin Graft Fixation and Uptake Using Autologous Platelet-Rich Plasma Versus Conventional Methods

TL;DR

This study shows that using autologous platelet-rich plasma improves skin graft success and reduces complications compared to traditional methods.

Contribution

The study demonstrates PRP's effectiveness in enhancing skin graft fixation and uptake, offering a novel clinical adjunct.

Findings

PRP application resulted in 69.2% immediate postoperative adhesion compared to 0% in conventional methods.

Graft uptake was significantly higher in the PRP group at days 3, 5, and 7 postoperatively.

PRP reduced postoperative complications like edema and hematoma.

Abstract

Introduction: Split-thickness skin grafting is a cornerstone in reconstructive surgery for managing skin defects. However, graft failure remains a significant challenge. This study evaluated the effectiveness of autologous platelet-rich plasma (PRP) in enhancing split-thickness skin graft (STSG) fixation and uptake compared to conventional methods.

Methods: This prospective comparative study included 104 patients requiring STSGs, randomly allocated into two equal groups (n=52 (50%) each). The PRP group received autologous PRP application at the recipient site before graft placement, while the control group underwent conventional fixation with staples/sutures. Outcomes were assessed based on immediate postoperative adhesion, graft uptake percentage, and complications (edema and hematoma) at days 3, 5, and 7 postoperatively.

Results: The groups were comparable in terms of demographic characteristics and wound parameters. Immediate postoperative adhesion was observed in 36 (69.2%) patients in the PRP group versus none in the control group (p<0.001). The PRP group demonstrated significantly higher graft uptake on day 3 (96.07±5.7% versus 86.33±6.06%, p<0.001) and day 5 (92.7±8.4% versus 79.9±9.1%, p<0.001), with sustained difference on day 7 (90.8±10.5% versus 75.62±11.2%, p=0.07). The PRP group exhibited significantly less graft edema and hematoma throughout the follow-up period (p<0.001).

Conclusion: Autologous PRP significantly enhances STSG fixation and uptake, improves overall graft take rates, and reduces postoperative complications. The immediate adhesion effect provides enhanced graft stability without additional mechanical fixation, which is valuable in anatomically challenging areas. The improvement in graft take rate is clinically significant and can translate into reduced need for regrafting, shorter hospital stays, and improved outcomes. PRP's anti-inflammatory, pro-angiogenic, and hemostatic properties create an optimal environment for graft integration, supporting its incorporation as a valuable adjunct in split-thickness skin grafting procedures.

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