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A 67-year-old man underwent full-thickness skin graft reconstruction of an ear defect following skin cancer excision. Similar to our case, the majority of reported graft contaminations are a result of falling on the floor.
The majority of available literature regarding graft decontamination focuses on bone and tendon grafts, with relatively few studies looking specifically at contaminated skin grafts. When deciding whether or not to salvage a contaminated graft, the surgeon must take into consideration the individual risk factors of the patient, blood supply to the graft, donor tissue type, and possible alternatives reconstructive options. Speak Up and Stay Alive book and radio programming is wholly owned by Millennium Star Publishing LLC. Unfortunately, there is no consensus on a management protocol for dropped grafts, but the preferred method among plastic surgeons appears to be decontamination and completion of grafting, with povidone-iodine solution being the most popular decontaminant.1 Other decontamination solutions reported in the literature include chlorhexidine gluconate, antibiotic mixtures, sodium hypochlorite, and hydrogen peroxide.
Results are largely inconsistent, but many studies recommend decontamination with either chlorhexidine gluconate1,3 or povidone-iodine.4,5 It is worth noting that povidone-iodine has been shown to be toxic to skin fibroblasts in vitro,6 decreasing its appeal for use on skin and soft tissue.

While there is a dearth of literature on the management of contaminated autologous skin grafts, survey data suggests that it can be salvaged without significant morbidity. Today Pat digs into to the current state of affairs as she shares her story and that of her guests.  How would things improve if healthcare providers could say I’m sorry? Following decontamination, it was subsequently used to complete the reconstruction, with full graft take and no evidence of infection after 4 months of follow-up. Recommendations include notifying the ancillary staff of graft usage, avoiding manipulation of the graft outside of the sterile field, placing the graft inside a covered container away from trafficked areas, and minimizing the number of tissue hand offs. In our patient, decontamination was performed with povidone-iodine followed by normal saline lavage.
A survey of sports medicine specialists investigating the preferred management of contaminated anterior cruciate ligament grafts. A comparison of five treatment protocols for contaminated bone grafts in reference to sterility and cell viability.

Surgical wound infection rates by wound class, operative procedure, and patient risk index.
Please note – All content on this website is for information only and is not intended to diagnose or treat any illness, disease, or to replace medical advice. In our case, we could have avoided contamination by simply preparing the graft immediately overlying the sterile field.

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