DS27: Outcomes in wound healing after lower leg skin surgery

C. Smith and E. McGrath

Royal Devon and Exeter NHS Trust, Exeter, UK

Secondary intention wound healing (SIWH) is often used following lower leg skin surgery, but evidence regarding outcomes is lacking and comparisons with other options for wound closure, such as flap or graft repair, have not been made. We aimed to evaluate complications, patient satisfaction and time to healing associated with SIWH, skin graft and flap repair following lower leg skin surgery. A retrospective analysis was performed of consecutive patients who had an excision on the lower leg between April and November 2020 (n = 235). Those with wounds closed primarily (n = 195) were excluded. Anonymized data were collected using electronic patient records and telephone survey. Data were collected on informed consent, details of procedure and wound closure, size of specimen, histological diagnosis, details of aftercare including patient satisfaction, complications and time to healing. Forty patients underwent SIWH, flap or graft repair during the 8-month period, with a response rate of 95% (n = 38). Of these, 30 underwent SIWH, five had a skin graft and three a flap repair. The mean length of specimen was 23 mm, 24 mm and 39 mm for SIWH, flap and graft repair, respectively. The complication rate for both SIWH and flap repair patients was 33%; this was 40% for grafted patients. The majority of patients with SIWH (63%) were completely satisfied with their aftercare, but 80% took > 2 months to heal. Of the three patients who had flap repair, 66% were completely satisfied and healing time varied between 4 weeks and 4 months. Eighty per cent of patients who had a graft were completely satisfied with the aftercare procedure and all grafted wounds healed within 8 weeks. Overall, 68% of patients reported that options for wound closure were not discussed prior to the procedure. Most patients in this analysis were offered SIWH rather than flap or graft repair. Although the majority were satisfied with their outcome, they reported prolonged healing times, and many were not offered alternative wound closure. We now plan to improve our consent process to offer patients a range of repair options for their lower leg surgery. We suspect that – although this study was not powered to detect it – flaps and grafts are likely to lead to shorter healing times overall, with an associated reduction in burden on community nursing teams. This work adds to the body of evidence that lower leg surgery is associated with prolonged healing and a high complication rate. This needs to be included in the consent conversation.