%0 Journal Article
%T Mobilisation versus Bed Rest after Skin Grafting Pretibial Lacerations: A Meta-Analysis
%A James Southwell-Keely
%A John Vandervord
%J Plastic Surgery International
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/207452
%X Pretibial lacerations are problematic and best managed by surgical debridement, then skin grafting. Traditional postoperative care involves bed rest to optimise graft survival. This meta-analysis assesses early mobilisation versus bed rest for skin graft healing of these wounds. Medline, Embase, Cochrane, Cinahl, and Google Scholar databases were searched. Analyses were performed on appropriate clinical trials. Four trials met with the inclusion criteria. No difference was demonstrated in split skin graft healing between patients mobilised early compared to patients admitted to hospital for postoperative bed rest at either 7 (OR 0.86 CI 0.29每2.56) or 14 days (OR 0.74 CI 0.31每1.79). There was a statistically significant delay in healing in patients treated with systemic corticosteroids (OR 8.20 CI 0.99每15.41). There was no difference in postoperative haematoma, bleeding, graft infection, or donor site healing between the comparison groups. In the available literature, there is no difference between early mobilisation and bed rest for the healing of skin grafts to pretibial wounds. Corticosteroids exert a negative effect on skin graft healing unlike early mobilisation, which does not cause increased haematoma, bleeding, infection, or delayed donor site healing. Modality of anaesthesia does not affect skin graft healing. 1. Introduction Pretibial lacerations are a common injury in the elderly often leaving nonviable traumatic skin flaps [1每3]. Intrinsic factors negatively impacting on the healing of pretibial lacerations include anatomical constraints, age-related changes, and vascular insufficiency [4, 5]. Proximal muscle bellies, that facilitate skin graft healing, give way to tendons distally, that provide a hostile environment for skin graft healing [6每8]. Anteriorly there is a paucity of subcutaneous tissue padding between the skin and the tibia, while the skin is fairly inelastic and with increasing age becomes thinner thus less resistant to trauma [9, 10]. Extrinsic factors affecting wound healing in pretibial lacerations may include diabetes mellitus, systemic corticosteroids, and malnutrition. The prevalence of systemic corticosteroid use in this population of patients is up to 40% [11]. Treatment options for pretibial lacerations include primary closure, defatting then resecuring the traumatic skin flap or debridement, and skin grafting. The former two options produce less predictable results [12每14]. Debridement and skin grafting involve the creation of a separate wound, but this donor site and the skin graft usually heal uneventfully.
%U http://www.hindawi.com/journals/psi/2012/207452/