Are Routine Wound Swabs Indicated Before Split-Thickness Skin Grafting? - A Retrospective Observational Study

Abstract

Background: Bacterial contamination is traditionally considered an important determinant of skin graft survival. While quantitative tissue cultures have demonstrated a relationship between bacterial burden and graft take, routine wound swab cultures are commonly performed even in clinically clean wounds. The benefit of this practice remains unclear.

Methods: A retrospective observational study was conducted between January 2023 and December 2024 in a tertiary care centre. Adult patients aged 18–50 years with clinically clean wounds measuring ≥15 × 10 cm and presenting 15–28 days after trauma were included. Patients were divided into two groups: Group A underwent routine pre-operative wound swab culture followed by culture-specific antibiotics, while Group B underwent grafting without routine wound swabs. All wounds were surgically debrided prior to split-thickness skin grafting. Graft take was assessed on postoperative days 2, 5, and 8.

Results: A total of 271 patients were analysed (Group A: 133; Group B: 138). Nearly half of clinically clean wounds (48.9%) in Group A showed no bacterial growth. Mean graft take was comparable between Group A and Group B (72.4% vs 73.7%; p = 0.299). No statistically significant association was observed between routine wound swabbing and graft take.

Conclusion: Routine wound swab cultures do not improve graft take in clinically clean wounds. Meticulous surgical debridement remains the most important determinant of successful skin grafting.