Skin graft failure is predicted by waist-hip ratio: A marker for metabolic syndrome

Background: Obesity is recognized as a risk factor for wound healing problems in surgery, but the reason for this increased risk is unclear. It is now recognized that truncal obesity, as measured by either the waist circumference or the waist-hip ratio (WHR), is a strong risk factor for an array of metabolic problems termed 'metabolic syndrome'. It was suggested that increased WHR would be a sensitive marker of obesity-related wound healing impairment and therefore would predict skin graft failure. Method: Consecutive patients undergoing full-thickness skin graft of the head and neck region in a private practice setting were enrolled prospectively. The body mass index and WHR were recorded at the time of surgery and skin graft take was assessed at 1-2 weeks. Results: There was a strong correlation between increased WHR and graft failure; all four patients in the study having a WHR greater than 1 showed partial or total graft loss compared with only one patient having a 10% loss in the remainder (r = -0.76, P = 0.002). Conclusion: There is a strong correlation between truncal obesity as measured by the WHR and skin graft failure. WHR or waist circumference should be considered as a preoperative assessment tool in identifying patients at risk of surgical complications.