Ultra-Early Mobilization After Split-Thickness Skin Grafting in Burn Patients Is Not Associated with Graft Loss

Abstract Timing of mobilization following split-thickness skin grafting (STSG) in burn patients varies amongst burn centers, due to concerns for graft loss with earlier post-operative mobilization. Existing literature supports the feasibility of earlier mobilization after STSG but is limited in scope. This study aimed to explore the association between time to mobilization after STSG and graft loss, hypothesizing that ultra-early mobilization within 24 hours of STSG does not increase the risk of graft loss. Adult patients who underwent STSG for treatment of thermal burn injuries at an ABA-verified burn center from 2021-2024 were included. Each incident of STSG was categorized as ultra-early (≤24 hours) or late (>24 hours) mobilization. Mobilization cohorts were then compared by graft loss using an institutional grading scale, defined as graft loss >50% of the area grafted, requiring prolonged wound care, or requiring re-operation. Mobilization was defined as either passive or active movement. Of the 240 patients included, there were a total of 431 STSG. Of these, 69 patients were critically ill with a total of 193 STSG. Rates of graft loss were similar between groups (9% vs 9.2%; P =0.93). Neither ultra-early mobilization (OR, 0.59; 95% CI, 0.20-1.73; P = 0.33) or ambulation compared to in-bed exercises (OR, 1.41; 95% CI, 0.36-5.50; P = 0.62) increased the odds of graft loss. The findings suggest that ultra-early mobilization within 24 hours after STSG does not increase the risk of graft loss in burn patients, and out-of-bed ambulation does not increase the risk of graft loss compared to in-bed therapy.