Risk factors for graft failure

Risk factors for graft failure are similar to those for other surgical wounds; see Prevention of surgical wound complications. Address factors affecting wound healing for each patient. Specific risks for skin graft failure include:

• poor wound bed preparation—ideally, the graft should be placed on a clean bed of granulation tissue
• poor vascularity of the wound bed—referral to a vascular specialist may be required
• haematoma or seroma under the graft—can cause separation of graft from the recipient bed, leading to graft death
• excessive patient or graft-site mobilisation—can cause dressings to move or shear against the graft, limiting the ability of the dressing to compress the graft to the wound bed
• excessive compression (more than 30 mmHg)—can impair blood flow to the graft
• inadequate compression on a lower leg—can prevent graft adherence
• haemorrhage
• infection.