Effect of Bacterial Colonisation of Recipient Wound Bed in Leg Ulcers on Graft Uptake in Split Thickness Skin Grafting in a Tertiary Care Center-A Cross Sectional Study

Background: Chronic leg ulcers are associated with prolonged morbidity and impaired quality of life. Split-thickness skin grafting (STSG) is an effective surgical intervention for wound coverage; however, successful graft uptake depends on adequate wound bed preparation, microbial control, and systemic patient factors. Bacterial colonisation may impair graft adherence and neovascularisation, resulting in partial or complete graft failure. Aim: To evaluate the effect of bacterial colonisation of recipient wound beds on split-thickness skin graft uptake in patients with leg ulcers. Materials and Methods: This hospital-based cross-sectional observational study was conducted in the Department of General Surgery, Sri Venkateswara Ramnarain Ruia Government General Hospital, Tirupati, in collaboration with the Department of Microbiology. A total of 114 patients with leg ulcers undergoing STSG were included. Preoperative wound swabs were collected for microbiological assessment. Graft uptake was evaluated on postoperative days 5–7 and categorised as complete (?95%), partial (75–94%), or poor (<75%). Statistical analysis was performed using SPSS. Associations were assessed using the Chi-square test, and multinomial logistic regression was used to identify predictors of graft uptake. A p-value <0.05 was considered statistically significant. Results: Among 114 patients, 76 (66.7%) had positive wound cultures, while 38 (33.3%) were culture-negative. Staphylococcus aureus was the predominant isolate (17.5%), followed by Pseudomonas aeruginosa (14.0%). Complete graft uptake was observed in 68 (59.6%) patients, partial uptake in 30 (26.3%), and poor uptake in 16 (14.0%). Culture-positive wounds demonstrated significantly lower complete graft uptake (47.4%) than culture-negative wounds (84.2%) (?²=14.29, p=0.0008). Culture positivity independently increased the odds of partial uptake (OR=2.8, p=0.003) and poor uptake (OR=4.1, p=0.001). Pseudomonas aeruginosa colonisation, diabetes mellitus, prolonged ulcer duration, and larger ulcer size were also associated with adverse graft outcomes. Conclusion: Bacterial colonisation of the recipient wound bed significantly compromises STSG uptake in leg ulcers. Preoperative wound culture assessment, effective infection control, optimisation of systemic factors, and meticulous postoperative care are essential to improve graft survival and reduce graft failure. Keywords: Bacterial colonisation; Leg ulcers; Split-thickness skin grafting; Graft uptake; Wound infection