Prevalence and risk factors of lower limb skin graft failure in Pakistani patients

Background: Lower limb skin grafting is a common reconstructive procedure, but graft failure remains a significant challenge. Multiple patient- and procedure-related factors can influence outcomes. Objective: To evaluate demographic, clinical, and surgical variables associated with lower limb skin graft success and failure. Methods: This observational study included 79 patients undergoing lower limb skin grafting for indications including cancer, trauma, ulcers, and elective reconstruction. Demographic characteristics, comorbidities, procedural details, and postoperative outcomes were recorded. Variables were compared between graft success and failure groups, and statistical significance was assessed. Results: The mean age was 28.5 ± 11.2 years, with 41 males and 38 females. Hypertension (n=75) and diabetes mellitus (n=62) were the most prevalent comorbidities. The most common indication for grafting was cancer (n=23), and split-thickness grafts were most frequently used (n=70). Graft failure occurred in 28 cases (35.4%). Significant predictors of graft failure included older age (median 73 vs. 62 years, p=0.02), female gender (p=0.005), and use of immunosuppressive medication (p=0.02). Other factors, such as BMI, comorbidities, and dressing type, were not statistically significant. Conclusion: Age, gender, and immunosuppressive therapy significantly impact lower limb skin graft survival. Preoperative optimization of at-risk patients and tailored perioperative management may improve graft outcomes.